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

Epidemiologic Characteristics and Time Trend of Cutaneous Leishmaniasis Incidence in Cities under the Surveillance of Shiraz University of Medical Sciences

Narges Khanjani

Background and Aim: Considering the importance of cutaneous leishmaniasis in Iran, this study was conducted to present the epidemiological characteristics of patients with cutaneous leishmaniasis, the time trend and the mapping of the disease in the cities under the supervision of Shiraz University of Medical Sciences.

Materials and Methods: Data was collected from the Heath deputy of Shiraz University of Medical Sciences and Health Centers of cities from 2005 to 2014; and was analyzed using Excel and SPSS19 software. Chi square test and Poisson regression were used for analysis.

Results: The incidence of the disease increased from 109 cases per 100,000 in 2005 to 218 in 2008 and decreased to 110 in 2014. The 0-9 age group was the most vulnerable and housewives were the most involved occupational group. Most people had a wet wound. The hands were the most affected. The highest incidence of disease was in the autumn. Zoonotic Cutaneous Leishmaniasis (ZCL) was the dominant type. Cutaneous leishmaniasis was more in northern than southern regions of the province in the recent years.

Conclusion: In the last years of the study, unlike in the early years, the incidence of disease in the northern region of the province was more than the southern regions. This finding could be a warning signal that the disease could be relocating and spreading in areas where the disease was not endemic before.

Evaluation of Information-Motivation-Behavioral Skills Model in Predicting Health Promoting Lifestyle of High School Students

Hashem Mohammadian

Background and Aim: Considering the lack of attention to the health promotion of adolescents due to their perception of being healthy in most countries of the world, we aimed to evaluate the predictors of adolescent health promoting lifestyle through path analysis based on IMB model.

Materials and Methods: This is a descriptive-analytic study on 400 high school students in Andimeshk city in two urban and rural areas. The sample size was obtained using the Cochran formula.They were selected by classified random sampling. In this study, demographic data, information about IMB model structures and student adherence to healthy lifestyle were collected in four areas nutrition, physical activity, stress control and responsibility. Correlation between total structures was analyzed using SPSS-23 software. Lisrel 8.5 software. Meanwhile, the relationships between variables were analyzed using Path analysis to fit and approve model fit model using LISREL8.8 software.

Results: All structures of IMB model had a Significant relationship with adolescent healthy lifestyle. Self-efficacy structure had the most predictive power. In general, self-efficacy variables, 75%, motivation 66%, and 50% knowledge had a positive and significant effect on behavior. This model was able to explain 71% of the variance in adolescent lifestyle behavior. Also, in this model, the level of self-efficacy variance (behavioral skills), 52%,, And motivation variance was explained 57%. Motivation and knowledge indirectly influenced the lifestyle behavior (behavior) by 55% and 50%, respectively.

Conclusion: The findings of this study showed that the IMB model has a good application for explaining and predicting the healthy lifestyle of adolescents. Accordingly, it is recommended that health planners apply the IMB model in order to promote adolescent lifestyle in this population.

Exploring the Relationship Between Accreditation and Hospital Performance: Using Data Mining Approach

Seyed Shahabeddin Shahebrahimi

Background and Aim: Hospital accreditation is a systematic external evaluation of a hospital’s structures, processes and results (outputs/ outcome) by an independent professional accreditation body using pre-established optimum standards. This study aimed to examine the relationship between accreditation and hospital performance. In addition, the most important accreditation constructs affecting hospital performance were identified and ranked.
Materials and Methods: This descriptive, correlational and cross-sectional study was conducted using the data related to accreditation scores and nine performance indicators of 121 hospitals in 2014 and 123 hospitals in 2015 in Tehran province, Iran. Shannon entropy method was used for calculating the weights of the hospital indicators. Then, Feature Selection method in data mining was used to explore the relationship between accreditation scores and hospital indicators. Data were analyzed using IBM SPSS Modeler software. Analyses were carried out at the 0.05 significance level
Results: The mean of hospitals’ accreditation scores were 61.98% and 69.56% in 2014 and 2015 respectively. All performance indicators except the number of outpatients were increased in 2015 compared to 2014. There was no significant difference in the scores between 2014 and 2015 data. Hospitals’ accreditation scores were not associated with their performances. However, accreditation scores of leadership and management; accident and emergency; and procurement departments had the most effect on hospitals’ performance.
Conclusion: Accreditation was not correlated with hospital performance. Thus, improving accreditation system including standards, methods and surveyors and using quality management strategies in hospitals are necessary for improving hospital’ performance.

Generalized Structural Equation Modeling (GSEM) and its Application in Health Researches

Mehdi Yasseri

Background and Aims: Generalized Structural Equation Modeling (GSEM) is a family of statistical techniques utilized in the analysis of multivariate, categorical and ordinal data in order to measure latent variables and their connection with each other. The aim of this study is to consider the structure of data, and introducing GSEM to medical science researchers and presenting a practical example of in medical science researches.

Materials and Methods: An introduction to Structural Equation Modeling (SEM), along with its advantages and disadvantages was presented, and also GSEM and its all kind of forms was specified. An example to study hypertension risk factors in patients suffering from diabetes was carried out, which was a demonstration of using GSEM method for binary response variables. The data includes a random sample of 2716 people from Golestan province cohort studies.

Results: Age, body mass index, abdominal obesity, residence place, socioeconomic status, salt intake had direct effect on hypertension. Race, education, vitamin D and physical activity had direct and reverse effect on hypertension (p.value<0.05).

Discussion: Unlike SEM, the limitative hypothesis that our data should have a normal distribution do not needed in this model, also GSEM is powerful tool in the analysis of categorized data. Nevertheless this method cannot perform goodness of fit test, and adjustment and modification method of the model directly, and that they are some limitation in using this method.

Estimation of Survival in Women Diagnosed with Breast Cancer with Cure Survival in West-Azerbaijan and East-Azerbaijan Provinces

Mehdi Yaseri

Background and Aim: Breast cancer is one of the most prevalent cancers in women and is the second cause of mortality due to cancer in women, with lung cancer being the first.

Materials and Methods: In this study we followed all the cases for 5 years, patients from West-Azerbaijan and East-Azerbaijan Provinces that diagnosed with breast cancer in 2009 and 2010 that attended to health cares. Using multivariate cure cox model for the influence of variables in this study.

Results: In this study 171 cases which suffering from breast cancer had the mean age of 55.9 ± 12.9 and the range of 23 to 89 years, in time of cancer diagnosis. Mean of patients follow-up was 51.7± 23.4 months with range of 11 days to 78 months. Overalls 52 death occurred and patient survival rate of 5 years was estimated 60. 6 percent. Eventually the two variables which are economic status and emergency hospitalization were found the two factors of pre-warning in long term survival of patient suffering from breast cancer.

Conclusion: Due to the findings, it seems using cure model in patients suffering from breast cancer was better than classical survival models.

A Study on the Effect of Educational Intervention Based on Health Belief Model on Infection Control Among Dental Students of Shahid Beheshti University of Medical Sciences

Davoud Shojaeizadeh

Background and Aim: Observance of the principles of infection control in dentistry is the basis of preventing the transmission of dangerous diseases such as AIDS, hepatitis and preventing the spread of diseases in the community. In view of the importance of dentistry education in the field of observance of the principles of infection control, the aim of this study was to determine the effect of educational intervention on infection control among dental students of Shahid Beheshti University of Medical Sciences.
Materials and Methods: The present study is a pre and post interventional study that the number of samples is 75 dental students referred to Endodontics Department of Shahid Beheshti University of Medical Sciences for endodontic treatment and radiotherapy of teeth during treatment in the academic year of 95-96 that were selected by available sampling method and after determining the sample size, a researcher-made questionnaire was prepared based on the Health Belief Model and verified in terms of validity and reliability, and completed in two stages before and after training with a 3 month interval. Three training sessions were conducted in this study for 15-30 minutes during the course of one month as group training and question and answer. During these meetings, students were given useful materials about infection control in dentistry, pathogenic microorganisms, transmission methods, and infection control guidelines in dentistry radiology. The data gathering tool was a questionnaire based on Health Belief Model. after data collection, spss21 software was used to analyze them. Non-parametric Kolmogorov-Smirnov tests, paired t-test and non-parametric Wilcoxon test were used for statistical analysis of the 0/05 significance level before and after the knowledge and structures of the health belief model.
Results: The results of statistical analysis showed that 62.7% of the participants were female students and 89.3% of single students, and the participants in the study were from 8,9,11 terms. The results of this study showed that the mean and standard deviation of knowledge and performance scores of students toward infection control before training were 11.48 ± 2.23 and 5.48 ± 0. 93, respectively, and after the training were increased to 14.75±0.57 and 9.36 ± 0.91. This difference was statistically significant by doing paired t-test (p the comparison of the mean and standard deviation of the scores of other aspects of the health belief model regarding infection control among dentistry students also showed a significant increase.
Conclusion: According to the results, it can be concluded that education based on the health belief model has been effective in controlling infection in dentistry students.

The Effect of Theory – Based Educational Intervention on Mother's Skill About Sexual Care of Their Children

Zahra Jalili

Background and Aim: Nowadays, the need for informing children and teens in different ages, about sexual problems, is felt more than ever before. Sexual training and education; such as every other original training, must be done at the right place and time. On the other hand, this training should be based on a systematic program and educational models to achieve the desire results. The aim of this study is to determine the effect of educational intervention on the BAZNEF Model on mother's skill about sexual care of their children, Tehran 2017.
Materials and Methods: This study was a quasi-experimental intervention with control group. Ninety six mothers of children aged 5-6 were selected in Tehran pre-schools. They were randomly divided into two groups; intervention and control. Data were collected by a researcher made questionnaire based on BAZNEF Model whose the validity and reliability were confirmed. After pre-test, according to educational needs, educational content and program were based on BAZNEF Model and that were conducted in the intervention group. Data were analyzed by SPSS23, independent t, Mann-Whitney and Chi- squar statistic tests.
Results: The mean scores of attitude, subjective norms, behavioral intention and behavior showed no significant difference before the education in both intervention and control group. However, the result showed compelling difference in mean scores of attitude, subjective norms, behavioral intention and behavior after the education (p<0/001).Enabling factors showed no important variation among intervention and control groups before and after the experiment.
Conclusion: The finding of current study confirmed the educational intervention, based on BAZNEF Model, was effective on mother's attitude, subjective norms, behavioral intention and behavior about sexual care of their children.

Knowledge and Practice of People in Kermanshah Regarding Food Hygiene and Safety

Maryam Khashij

Background and Aim: Paying attention to the hygiene and safety of food will have a great success for people around the world. In recent decades, due to mass production and food processing, the globalization of food trade, industrialization, etc., the prevalence of diseases associated with contaminated water and food is increasing. Therefore, the study of knowledge and attitude of people in this field have been a necessity and this research was conducted to investigate the knowledge and practice of people of Kermanshah city, Iran in relation to food hygiene and safety.
Materials and Methods: This was a cross-sectional study. Data were collected through questionnaires. 252 inhabitants of Kermanshah were randomly allocated by cluster sampling. Data analysis was performed using SPSS version 17 by Spearman and X² test.
Results: Most of Kermanshah people were lack of proper knowledge and practice about food poisoning. Of these, 54% of people mistakenly thought that fully cooked foods also have microbes. In addition, 68.3% of the subjects did not have a proper health function regarding the consumption of fresh fruits and vegetables, so that they only cleaned it before consumption. Finally, the mean score of knowledge and practice was 11.62 ± 2.27 and 17.69 ± 1.59, respectively.
Conclusion: Considering the significant correlation between the level of knowledge and practice of the people living in Kermanshah about food safety, the necessity of conducting appropriate educational programs to increase the awareness and subsequently improve the performance of the related organs can upgrade status.