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

Assessment of Risk Factors in Patients with Myocardial Infarction and Coronary Artery Disease: A Needs Assessment Study

Sara Shah Abadi

Background and Aim: Cardiovascular diseases (CVDs) are a major cause of death worldwide. The objective of this study was to determine the most important behavioral (inadequate nutrition, low physical activity, smoking and alcohol consumption) and non-behavioral (stress, high blood sugar, dyslipidemia, hypertension and obesity) risk factors for CVD among CVD patients hospitalized in Kermanshah Heart Hospital. This was a needs assessment study aiming at designing interventions for reducing CVD risk factors.
Materials and Methods: In this cross-sectional study 402 CAD patients (60.4% males and 39.6% females) were selected by consecutive sampling from among those hospitalized in Imam Ali Hospital for the first time. Data were collected using the Iranian version of WHO Stepwise questionnaire and the patients’ files and analyzed using the SPSS-16 software.
Results: The mean (±SD) age of the patients was 54.2 (±8.8) years. About 73% of them had a poor diet and 46.5% had low physical activity; in addition, 36% of the men had consumed alcohol in the previous year and 26.1% were smokers. Non-behavioral risk factors were quite common too. The proportions of the patients suffering from diabetes, hypertension and overweight-plus-obesity and abdominal obesity were 49.3%, 48.0%, 54.7% and 61.0%, respectively. Finally, 43.3% of the patients had high stress, 31.0% were hypertriglyceridemic and in another 21% hypercholesterolemia was seen.
Conclusion: Based on the findings it can be concluded that, as compared to other risk factors, imbalanced nutrition was more prevalent common among the patients. Another major risk factor was obesity, particularly abdominal obesity. In addition, blood glucose disorders were more common than dyslipidemia.

Promotion of Normal Vaginal Delivery Among Primigravidae: An Application of Social Marketing in the Field of Health

Mohsen Shamsi

Background and Aim: In Iran the rate of Cesarean section is reported to be 48%, which is higher than the acceptable rate recommended by WHO (15%). This study was conducted to determine the effect of an intervention based on social marketing on the reduction of intention to choose Cesarean section by primigravidae in Boyer-Ahmad County, Iran in 2015.

Materials and Methods: In this field trial 39 primigravidae three to four months pregnant who had an intention to choose Cesarean section for delivery participated. A formative research (a quantitative survey and a qualitative study) was done to achieve the social marketing mix, and based on the results a tailored intervention was designed and pretested on the subjects. The final intervention was implemented for a period of one month and its effectiveness assessed after at least one month by a proportion test.

Results: The average age of the women was 25.82 years. The proportion of the women with a high school (or lower) and university education was 38.5% and 61.5%, respectively. One month after the intervention thirty of the pregnant women expressed willingness and intention to have a normal delivery, which was a statistically significant change (p=0.01).

Conclusion: An educational intervention based on the consumer-oriented social marketing theory can be effective in designing, implementing and evaluating a program aiming at reducing Cesarean section intention.

The Health Literacy of Pregnant Women in Bandar Abbas, Iran

Sakineh Dadipoor

Background and Aim: Health literacy implies the achievement, processing and perception of fundamental information and services required for making appropriate health-related decisions. Due to the high significance of health literacy during pregnancy and its direct effect on fetus, the present research was conducted to investigate the health literacy of pregnant women visiting medical centers in Bandar Abbas, Iran in 2015.
Materials and Methods: This was a cross-sectional descriptive-analytic study conducted on 250 pregnant women visiting the healthcare centers in Bandar Abbas, Iran selected by mixed sampling (both clustering and simple random). The data were collected using an adult health literacy questionnaire and analyzed using SPSS version 16, the statistical tests being independent-sample t-test, ANOVA, Tukey test and linear regression.
Results: The average age of the pregnant women was 31.61±7.45 years. The proportions of the women with an adequate, borderline and inadequate level of literacy were 52%, 20.8% and 27.2%, respectively. A statistically significant association was found between health literacy and education (p<0.001), age (p<0.001), occupation (p<0.001) and the quality of healthcare provision during pregnancy (p<0.001).
Conclusion: The results reveal that the mothers’ health literacy is inadequate or at borderline. Based on these results the following are recommended in an attempt to promote health literacy of pregnant women: 1. revising/simplifying teaching materials, including both oral and pictorial, in addition to written materials in the form of posters, pamphlets and brochures; 2. promoting communication skills of health workers/mothers.

Predicting Factors Affecting Medication Adherence and Physical Activity in Patients with Type-2 Diabetes Mellitus Based on the Theory of Planned Behavior

Hasan Eftekhar Ardebili

Background and Aim: Self-care has a vital role in the control and prevention of complications in patients with Type-2 diabetes mellitus (T2DM), two important behaviors in self-care being medication adherence and physical activity. Regular physical activity has been shown to improve glycemic control, reduce blood pressure, reduce lipids and improve cardiorespiratory fitness in individuals with T2DM. In addition, medication adherence is a key factor in controlling and decreasing the risk of related complications. This study aimed to determine and predict the most important factors affecting the levels of physical activity and medication adherence in patients with T2DM based on the theory of planned behavior.

Materials and Methods: This cross-sectional study, based on the planned behavior theory, was performed on 160 selected men and women with T2DM referring to urban health centers in Yasuj, Iran in 2016; the selection was done by random cluster sampling. Data on medication adherence and physical activity were collected using questionnaires and analyzed using SPSS version 20 software, the statistical tests being descriptive statistics, Pearson correlation coefficient and multiple linear regression; a p<0/05 was considered to indicate statistical significance.

Results: Altogether, 45% and 43% of the patients had a low and medium level of physical activity, respectively, only 12% having an acceptable level. The adherence to medication was much better ─ 76% had a good adherence. As regards the planned behavior theory constructs, perceived behavior control had a significant relationship with physical activity and medication adherence. Results of multiple linear regression also showed that perceived behavior control was a predictive variable for physical activity level and medication adherence in the patients.

Conclusion: Based on the findings, which indicate that the most important construct is perceived behavior control as regards medication adherence and level of physical activity, it is concluded that it is vital to strengthen the self-care component of health programs and support such programs.

Performance Assessment of Human Resource Management of the Social Security Organization Using the European Excellence Model (EFQM)

Saeid Ebrahimi

Background and Aim: Human resources in any organization are its main capital. They are the only unique asset that are not liable to depreciation over time, but they even create more added value. The Social Security Organization (SCO) as a social insurer organization needs urgent assessment of its human resource management. In this regard, it appears that such an essential assessment can be done using the European Foundation for Quality Management (EFQM) model.

Materials and Methods: This project was an applied descriptive study conducted at the Social Security General Department in Tehran, Iran. The data collection tool was a standard questionnaire for performance assessment based on the EFQM model, the reliability of which (0.989) was determined by using the Cronbach's alpha coefficient. A total of 388 questionnaires were distributed, of which 311 were completed and returned to the researcher; the response rate was 81%. Analysis of the data was done using the SPSS-16 software.

Results: The human resource managers in the SCO achieved a score of 495.72. The empowerment and results dimensions rated 261.34 and 198.38, respectively. In the empowerment dimension, policy and strategy criteria had the highest score (56.12) and process the lowest (51.28), while in the results dimension, community criteria had the highest (50.27) and the customers criteria the lowest (51.18) score.

Conclusion: Based on the findings it can be concluded that the European Foundation for Quality Management (EFQM) model is suitable for assessing both the performance, strengths and weaknesses of the Tehran Security General Department human resources and improving its performance. Certainly better implementation of programs and achieving excellence will be possible through sustainable collaboration.

The Bases of the Formation of Sexual Behavior in Women of Reproductive Age in Kashan City: A Survey

Effat Sadat Merghati Khoei

Background and Aim: Considering that the knowledge of, and attitude towards, sexuality is a key factor influencing sexual behavior, the main objective of this survey was to determine the bases of sexual knowledge and formation of attitude towards sexual script in women of reproductive age in Kashan City, Iran.

Materials and Methods: This was a cross-sectional study including 500 women of reproductive age referring to all health centers in Kashan Iran, selected by simple random sampling,. The data collection tool was the Sexual Knowledge and Attitude Scale (SKAS). The data were analyzed using descriptive statistics, correlation and regression model.

Results: The age range of the majority of the participants (51.9%) was 26-35 years, and the educational level of 39.9 % of them was high school education. The majority of them had a high level of sexual knowledge and attitude (51.4% and 62.9% respectively). The Pearson correlation test showed a significant positive correlation between knowledge and attitude of the women (p<0.05), and based on the multivariate regression analysis their knowledge score correlated with education and economic status and their sexual attitude scores with age and education.

Conclusion: The participating women were young and educated and their knowledge and attitude scores were high. However, they had erroneous attitudes and ideas, such as a feeling of shame and anxiety at intercourse, considering initiation in sexual relation responsibility of the man, and considering childbearing as the main purpose in sexual relations. It is essential to design and implement appropriate educational programs to help the women change their attitudes and ideas.

The Impact of an Educational Program Based on the Health Belief Model on Diabetic Foot Care in Type-2 Diabetic Patients

Davoud Shojaeizadeh

Background and Aim: Diabetes mellitus (DM) is one of the most common public health problems worldwide. Diabetic foot as a late complication of DM imposes high physical and emotional costs to the patients. The purpose of this study was to determine the effect of an educational program based on the Health Belief Model (HBM) on diabetic foot care in type-2 DM patients.
Materials and Methods: Ninety seven (female=57, male=40) type-2 diabetes patients, randomly divided into two groups ̶ and intervention (n = 47) and a control group (n = 50) ̶ participated in this study. Using questionnaires data were collected, initially and 3 months after the educational intervention, on demographic characteristics, awareness and the HBM constructs. The intervention group participated in 3 educational sessions during the3-month period. The data were analyzed by SPSS 20, the statistical test being Shapiro-Wilk, Chi-Square, Wilcoxon, McNemar tests and paired T-Test.
Results: There were no statistically significant differences before the intervention between the experimental and control groups with respect to the mean scores of knowledge and HBM’s components (perceived susceptibility, severity, benefits and barriers, as well as self-efficacy and self-care). The intervention improved the scores significantly in the experimental groups (p<0.05), while there were no significant changes in the control group scores (p>0.05).
Conclusion: This study shows that type-2 diabetic patients need to learn how to take care of their feet and that implementing educational programs based on the Health Belief Model can be effective in this regard.

The Risk Assessment of Pb and Cd Through Consuming Spices

Soheil Sobhan

Background and Aim: Spices are likely to contain toxic heavy metals. The objective of this study was to assess the non-carcinogenic risk of consuming curry powder, turmeric and cardamom, marketed both in bulk and in packaged form, in Hamedan, Iran, as regards lead and cadmium in 2015.
Materials and Methods: This descriptive study, conducted in Hamedan, Iran, included nine samples of packaged and nine samples of bulked spices, the heavy metal contents of which were measured in triplicates, after acid digestion, by atomic absorption. The data were analyzed by SPSS, the statistical tests being one-way ANOVA, Shapiro-Wilks test, oOne-Sample T-Test, Pearson's correlation coefficient and the independent T-test.
Results: The maximum mean concentrations of lead and cadmium (mg/kg) were 5.48±0.95 and 0.13±0.20, respectively. The mean concentration of lead in turmeric samples was higher than the respective WHO standard. On the other hand, the health index (HI) of lead in the turmeric sample (mean =3/25×10^-2, 1/5×10^-1) and that of cadmium (222×10^-3, 1/04×10^-2) were less than one, that is, below the risk threshold for children and adults, respectively.
Conclusion: The findings based on health index show that consumption of spices does not pose any risk for the consumers. However, considering that the mean concentration of lead in the turmeric samples exceed the respective standard, as well as the non-biodegradability and bioaccumulation of heavy metals, if consumption of spices is not controlled, health problems in the long term are not unlikely to occur in the consumers. Therefore, regular periodic monitoring of chemical pollutants content of spices, especially heavy metals, is recommended for protection of consumers’ health.