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

Two Decades of Experience of Using Clinical Practice Guidelines in Iran (2001-2021)

Alireza Olyaeemanesh

Background and Aim: Clinical Practice Guidelines (CPGs), are "recommendations intended to optimize patient care based on systematic reviews of available evidence and assessment of the benefits and harms of alternative care options". CPGs play an important role in improving the quality of care, reducing the diversity of treatment methods, reducing medical errors, managing health costs and increasing patient safety. This study was conducted with the aim of analyzing the decisions, consequences and policy trends of using CPGs in Iran during the period 2001-2021.
Materials and Methods: This study was a type of health policy analysis, carried out using analysis of the policy process approach. Data were collected through reviewing policy documents (n=79) and qualitative interviews (n=27). Analysis of policy documents was done using the content analysis method, the software used being Excel software, while for analysis of the interviews the framework analysis method was used, the software being the MAXQDA10 software.
Results: The policy of using CPGs in Iran started in 2001 and has improved over the past two decades. During the period 2016-2021 a total of 836 CPGs (knowledge products) were published, but according to the participants, many of these CPGs or knowledge products did not have the necessary quality and were not used by physicians. The findings of this study also showed that in Iran there is a suitable atmosphere for implementing CPGs and the policies of using them are sound policies; however, there is a huge gap between the development and implementation of CPGs.
Conclusion: Although the process of applying CPGs has improved in Iran, their implementation faces challenges and, thus, they have not been fully implemented. Therefore, there is a need to adopt new standard methods and approaches to improve the quality and reliability of CPGs. Certainly, the support of the government, Ministry of Health and Medical Education, the medical community, insurance organizations and other stakeholders, along with proper collaboration and appropriate policy formulations, are essential to achieve success.

The Effect of Economic Complexity Index on the Health Outcomes in Iran and Selected Developing Countries

Atefeh Delgarm

Background and Aim: Economic complexity indicates the availability of knowledge within a country. Increasing economic complexity indicates an increased capacity of producing a diverse set of complex products. The complexity of the economic structure of a country is the main factor affecting social choices and human abilities, including but not limited to, employment and learning opportunities, and the employment status of an individual is an important determinant of his/her health status. Therefore, the production of advanced products depends to a large extent on the quality of human capital and knowledge. On the other hand, knowledge and education are widely recognized as promoting factors of the health of the population.
Materials and Methods: This research investigated the effect of the economic complexity index (ECI) on the health outcomes in seventeen selected countries in the region using panel data in the period 2001-2019 by using the quantile regression and the OLS ordinary least squares methods.
Results: Based on the findings of this study, ECI, globalization, economic growth and trade openness variables will improve health. However, despite this, the institutional quality variables, politics and urban population have not improved health in the countries studied.
Conclusion: The results of this research are particularly relevant to developing economies that usually suffer from poor health and low levels of economic complexity.

Associations Between Food Preferences, Health Literacy and Body Mass Index Among Primary School Students in Malekan County, Iran

Roya Sadeghi

Background and Aim: Food preferences and health literacy ─ key determinants of food choices in childhood and adolescence ─ are determinants of chronic diseases in adulthood. This study aimed to determine associations between food preferences, health literacy and body mass index (BMI) among elementary school students in Malekan city, east Azarbayejan Province, Iran in 2021-2022.
Materials and Methods: This cross-sectional descriptive-analytical study included 582 male and female primary-schoolers in the fourth, fifth and sixth grades in both the public and private schools in Malekan County (Malekan, Lilan, and Mubarakshahr) selected by the two-stage randomized cluster method. A questionnaire including background questions and questions about health literacy and a researcher-made checklist of food preferences was used to collect data online using the Pros-Online Platform. The content validity ratio and index were used to determine validity and Cronbach's alpha index to check for the reliability of the questionnaire (CVI=0.98, CVR=0.91, Cronbach's alpha > 0.7). Data were analyzed using Mann-Whitney, t-test, one-way analysis of variance, Kruskal-Wallis and Chi-square tests at a significance level of 0.05 using SPSS 26.
Results: The average health literacy score of all the students was rather low (52.9±00.33), that of the female students (55.7±36.49) being slightly higher than that of the boys (49. 9±29.79). Further analysis of the data showed that there was a statistically significant relationship between the students' food preferences and health literacy variables (p<0.001). Furthermore, statistically significant relationships were observed between the students' BMI and their food preferences (p˂0.001) and health literacy (p˂0.001).
Conclusion: Considering the low level of health literacy of the adolescents and a positive relationship between health literacy, food preferences and BMI in adolescents, it can be concluded that increasing their health literacy will improve their healthy food choices. Therefore, it seems that interventions based on a theoretical framework aiming at increasing the students’ health literacy and improving their food preferences can be beneficial to them as a potential strategy for improving their healthy eating patterns resulting in preventing overweight and obesity.

The Relationships of Familial Emotional Atmosphere, Self-Control and Sleep Quality with Internet Addiction in Adolescents

Fatemeh Pooragha Roodbarde

Background and Aim: In recent decades, the use of the Internet as a suitable and affordable means of communication has become increasingly popular among people, especially young people. However, the excessive use of this technology has led to negative physical, behavioral and psychological consequences, causing concern in many families and even in authorities involved in the educational system. Therefore, the purpose of this study was to investigate the association of family emotional atmosphere, self-control and sleep quality with Internet addiction in teenagers.

Materials and Methods: This research was a cross-sectional and descriptive correlational study. The statistical population was all the 300 male students in the 4^th to 6^thgrades of two non-governmental high schools in Rasht city, Iran in the academic year of 1401-1401. A sample of 169 was selected based on the Morgan's Krejci table and using the available sampling method. The data collection tools were the Young's internet addiction, Pittsburgh sleep quality, Tanji self-control and Nodargah family emotional atmosphere questionnaires.

Results: The analysis of the data showed that there is a significant positive correlation between Internet addiction and family emotional atmosphere (r=0.597) and sleep quality (r=0.331), while a negative and significant correlation exists between self-control and Internet addiction (r=0.668). Furthermore, the regression test results showed that all the three variables, namely family emotional atmosphere, self-control and sleep quality, can predict the changes in the internet addiction variable, such that per one standard deviation change in the familial emotional atmosphere, self-control and sleep quality a change of 0.163, ̶ 0.382 and 0.375 deviation occurs in Internet addiction. Finally, simultaneous regression analysis showed that 51% of the students' internet addiction level can be explained by family emotional atmosphere, self-control and the students' sleep quality.
Conclusion: Based on the findings it is concluded that the variables family emotional atmosphere and sleep quality have a direct positive, while self-control has an inverse negative, relationship with Internet addiction. In addition, the family emotional atmosphere, high self-control and good sleep quality are effective in managing the use of the Internet by teenagers, which would mean that the proper awareness of parents and school counselors of the subject can help prevent internet addiction in teenagers.

The Relationship Between Domestic Violence Against Women and their Childbearing Intention: A Survey in Sadra City, Iran

Serajeddin Mahmoudiani

Background and Aim: Domestic violence against women as a social characteristic can affect women's reproductive behaviors. The present study investigated the relationship between domestic violence against women and their childbearing intention.
Materials and Methods: This study was a survey conducted using a questionnaire in 2022. The statistical population was married women aged 15-49 years living in Sadra city, Iran, out of whom a sample of 379 was selected by the multi-stage cluster technic. Domestic violence against women was measured using a form with 26 items with a Likert scale, the domestic violence score being obtained by the sum of scores of the items. The SPSS software version 20 was used to analyze the data, the statistical tests being descriptive statistics and two-dimensional logistic regression.
Results: The most common types of domestic violence against women were found to be, in descending order, psychological, physical, economic and sexual violence. The duration of marriage and education of women had a statistically significant effect on their childbearing intention. Increasing domestic violence against women was found to reduce their childbearing intention.
Conclusion: Reducing domestic violence can increase the women’s intention to have children. Therefore, reducing domestic violence against women should be on the policy agenda of the relevant decision makers.

Relationship Between Problem-Solving Skill and Successful Quitting of Substance Use Disorder and Psychoactive Drugs in Isfahan, Iran

Siroos Ahmadi

Background and Aim: Substance use disorder (SUD) is a disease in the treatment of which the biological and medical methods are emphasized, but social factors also play an effective role. This research has tried to investigate the relationship between problem-solving skill and successful quitting of SUD.

Materials and Methods: This was a causal-comparative research in which two groups, namely, drug addicts with successful quitting (n = 222) and those with unsuccessful quitting (n = 222) selected by multi-stage random sampling were compared. The research tool for measuring the problem solving skill was the Social Problem Solving Scale of D'Zurilla et al. (2002).

Results: The findings showed that the mean problem-solving skill score and its five components were significantly higher in the successful quitting group than in the unsuccessful group. Based on the logistic regression results, the problem-solving skill (B=0.271, Wald=110.490 Sig=0.000, EXP (B) =1.76, Cox & Snell=0.457) will increase the chance of successful quitting 1.76 times and can explain 0.457 of the changes in the dependent variable.

Conclusion: It can be concluded that psychosocial factors are also effective in the treatment of the substance use disorder. This means that paying more serious attention to these factors will help to alleviate one of the basic social and public health problems of the society.

Epidemiological Characteristics of Diabetes in Patients Referring to the Diabetes Clinic in Bu-Ali Hospital, Zahedan, Iran

Mostafa Peyvand

Background and Aim: Diabetes is a disease in which blood sugar level is high due to hormonal disturbances. Monitoring and evaluation certainly helps to prevent, manage and control this widespread disease. The aim of this study was to study the epidemiology of diabetes in the Diabetes Clinic in Bu-Ali Hospital, Zahedan in South East Iran.
Materials and Methods: This was a cross-sectional descriptive-analytical study conducted in 2020 including all the 1164 patients referring to the Diabetes Clinic in Bu-Ali Hospital. Data were collected using a standard check list and analyzed using the Stata-v14 software.
Results: Information on 1164 patients with diabetes was recorded and analyzed. Most (97.7%) of the patients had type-2 diabetes. The average fasting blood sugar in patients with type-1 and type-2 diabetesd was 236 and 201 mg/dL respectively, the corresponding A1C levels being abnormally high ─ 9.6% and 8.4%. Fasting blood sugar was associated with diabetic foot complications and nephropathy (p<0.05).
Conclusion: Based on the findings of this study the level of care of diabetic patients in terms of quantity and quality is not quite acceptable, not conforming to the respective national standards. This issue indicates the unfavorable performance of the Diabetes Center, which can be attributed to the poor conditions of the geographic region, insufficient equipment and specialized manpower and low health literacy of the people. Therefore, increasing the awareness of overweight and obese people, especially those with a family history of diabetes, about prevention can help to reduce the incidence of the disease or minimize its complications.

Economic Burden of Surgical Site Infections: A Case–Control Study

Farinaz Moghadasi

Background and Aim: Surgical site infection (SSI) is an infection that occurs within 30 days after surgery and involves the skin and subcutaneous tissue of the surgical incision. It is one of the most common nosocomial infections which, in addition to endangering lives of the patients, increases the heath care expenditures in the health system. The objective of this study was to estimate the cost of surgical site infections in hospitals.
Materials and Methods: This was a case-control study conducted in a teaching hospital in Kashan, Iran in 2017 to find information about direct hospitalization costs of surgical site infections. Detailed information about the hospiutalization costs of case and control patients was extracted using patient records and the hospital information system software.
Results: Out of all the patients 115 (1.04%) experienced an SSI. The median additional direct medical cost was US$ 2577 and US$ 1034 for the case and control in-patients, respectively (p <0.001). The cost of treating SSI was US$ 1543 per patient. The direct hospitalization costs were 2.5 times greater for patients with an SSI than for those without an SSI. Further analysis of the data showed that the cost of SSI was related to the patient's age, duration of surgery and length of hospital stay before infection.
Conclusion: Surgical site infection treatment costs imposes high costs on the patients, health insurance companies and the hospitals. Therefore, hospitals managers should design and implement interventions to reduce surgical site infections.