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

Evaluation of Performance of Rural Health Houses in Kerman City, Iran in Dealing with Covid-19

Haniye Sadat Sajadi

Background and Aim: Performance evaluation is a useful way to obtain information for decision-making and management of healthcare organizations. The purpose of this study was to assess the performance of health houses in rural areas in Kerman City, Iran during the outbreak of Covid-19.
Materials and Methods: This cross-sectional study was conducted in 2021-22 using descriptive and analytical methods. The research population included all the health houses in Kerman City (n=57), Iran. The tool for data collection was the Health House Performance Evaluation Checklist of the Ministry of Health and Medical Education developed to supervise the performance of health houses during the outbreak of Covid-19. Data analysis was done using SPSS 26 software, the statistical tests being descriptive statistics (mean and standard deviation) and analytical statistics including independent t-test, one-way analysis of variance and Pearson and Spearman correlations.
Results: The average performance score of the health houses (n =55) in managing Covid-19 was 96.37 out of 136. Installation of the village map on the wall of the health house (92.3%), screening and following up the positive-test individuals and informing the health care team to track and isolate individuals in close contact (84.6%) were found to have the highest, and injecting the third dose (78.8%) and the second dose (75%) of the Covid vaccine the lowest, scores. From among the characteristics investigated the variable of native Behvarzes (the personnel of health houses) had a statistically significant positive relationship with the performance score (p=0.01). In addition, the health houses with more than one Behvarz were found to perform better than those with only one Behvarz (p=0.05).
Conclusion: Assessing the performance of health care units at times of crisis, including communicable diseases epidemics, will make it possible to identify the bottlenecks that need improvement for better preparedness in the future. Based on the findings of this research, the expansion of the coverage of the covid-19 vaccination, updating the disease incidence, the performance of health care teams at home visits, and the progress of the operational plan were the variables that needed improvement most.

Comparison of the Adverse Pregnancy Outcomes Among Women with or without a History of Covid-19 in the Pregnancy and Postpartum Stages Covered by the Babol University of Medical Sciences, Babol, Iran: A Virtual Training Package

Roya Sadeghi

Background and Aim: Considering the quality of prenatal care services, indentification of the avoidable and inevitable maternal factors and proper promotion of the knowledge and skills of health care service providers is vital for providing suitable preventive and interventional services with the aim of ensuring a successful pregnancy and proper management in the health care system. This study was conducted to compare the adverse pregnancy outcomes among women with or without a history of Covid-19 in the pregnancy and postpartum stages covered by the Babol University of Medical Sciences, Babol, Iran.
Materials and Methods: This was a descriptive-analytical cross-sectional study including 4124 women, either pregnant or after a recent childbirth (with or without Covid-19) between 20.2.2020 and 29.3.2022, registered in the Sib electronic system (hereinafter Sib) of Babol University of Medical Sciences, Babol, Iran. Using a checklist developed and validated by an expert panel data were collected on the prevalence of maternal and neonatal outcomes in mothers with or without a history of Covid-19 and compared. The data collected were analyzed with SPSS 24 using descriptive tests such as chi-square and Fisher's exact test and STATA version 22, and the adverse outcomes with high frequencies following Covid-19 were determined.
Results: Analysis of the data showed the following to be the most common outcomes among mothers with a history of Covid-19: 1. obstetric complications and maternal disorders/diseases (hypertension, type-2 diabetes mellitus, at least one case of bleeding during pregnancy, premature/delayed birth and premature rupture of the amniotic sac, n= 457, 27.8%); 2. medical and surgical problems (unhealthy pregnancy weight gain and thromboembolic events, n=206, 12.5%). In addition, there was a statistically significant difference between the two groups of pregnant mothers with and without a Covid-19 infection as regards medical and surgical problems (P=0.001) and obstetric complications and maternal diseases (p=0.002). As regards the adverse neonatal outcomes in pregnant mothers with and without a history of Covid-19, there was a statistically significant difference between the two groups in terms of Apgar score at minutes 1 and 5 (p≥0.001) and exclusive breastfeeding (P=0.001) and the presence of Covid-19 symptoms in the baby (p<0.001).
Conclusion: Based on the findings of this study it seems that Covid-19 infection during pregnancy is associated with a higher risk of some of the undesirable maternal and neonatal outcomes. Therefore, it is essential to plan and implement programs for health education, creation of a sound attitude towards better management, enhancement of the skills and capabilities of the health-care providers and, finally, promotion of the knowledge of service recipients.

Concerns and Tolerance Strategies Among Parents with Children Suffering from Down Syndrome in Mashhad, Iran: A Phenomenological Study

Mahmoud Azadi

Background and Aim: Down syndrome is one of the chromosomal disorders known as the most common genetic disorder causing health and medical problems such as mental, respiratory and cardiovascular problems. Parents of children with Down syndrome experience many problems and challenges in life. The purpose of this research was to find the concerns and tolerance strategies of parents of children suffering from Down syndrome.
Materials and Methods: This study was carried out in 2022-23 with a Colaizzi`s phenomenological approach. The research population was the parents of children with Down syndrome in Mashhad, Iran under coverage of the Welfare Organization, the sample being selected by purposeful sampling; after conducting 13 interviews, the researcher reached theoretical data saturation.
Results: Analysis of data revealed 4 main themes and 12 sub-themes in the section of parents' concerns and 3 main themes and 6 sub-themes in the section of tolerance strategies among the parents of children with Down syndrome.
Conclusion: Based on the findings of this study it can be concluded that the parents of children with Down syndrome have many concerns about the family life, the future of their children and their treatment process, as well as social problems. In addition, the parents who use spiritual tolerance strategies can deal better with the problems arising from living with their child.

Promotion of the Public Health by Increasing Consumption Taxes on Harmful Commodities: A Dynamic Panel Data Approach

Elham Fatholahi

Background and Aim: Products such as tobacco are considered harmful to human life due to the fact that they contribute greatly to mortality around the world. Tobacco use kills more than eight million people worldwide annually. This has necessitated the imposition of taxes on such harmful products with the aim of reducing their demand and, thus, guaranteeing the increase in the health of the population in Iran.
Materials and Methods: Using the tobacco tax as a proxy for the tax on harmful products and the death rate as an indicator of the general health of the population, this study investigated the effect of the tax on harmful products on the health of the population in 30 provinces of Iran between 2007 and 2018. For this purpose, the dynamic panel generalized moment method (GMM) using Eviews 10 and stata17 software was used as an experimental estimation technique.
Results: Analysis of the data collected revealed that the tax on harmful products can help promote the health of the population, since the government can use the additional income thus generated to improve the health of the population. These findings support the World Health Organization's justification that taxes on harmful products, especially on tobacco, not only can reduce their consumption, but also can help to promote health outcomes. In addition, increasing the tax on cigarettes, which is considered the most important and key strategy by the World Health Organization, will lead to spending the resulting income on improving health and educational infrastructure, health centers, emergency services, etc.
Conclusion: In general, the more a government spends on health care, the more the health of the population and, consequently, the higher the life expectancy of the population. Regarding the effects of prices/and taxes on smoking or tobacco consumption on the mortality reduction in Iran, if the taxes imposed on harmful products are increased and the resulting additional funds are used and effectively administered to meet the recommendations of the World Health Organization, better desirable outcomes will result in the health of the population as compared to those observed in this study. In addition, the policymakers should start actions that will help promote economic growth, because this will increase the health of the population. Moreover, actions and efforts aiming to increase the population growth rate should be accompanied by significant investments in the health sector.

Explanation of the Probiotic Industry Development in Iran's Food Industry

Nusratullah Shadnoush

Background and Aim: Probiotics, or useful microorganisms tobtained from beneficial microorganisms, have attracted the attention of the world community, especially the health sector, in recent years. The reason is that probiotic products can help in treating diseases and strengthening the human body without any side effects, unlike drugs which may usually have many side effects. Considering the importance of these products, this study was conducted to find and explain the drivers of probiotic industry development in Iran's food industry.
Materials and Methods: Data were collected, using the thematic analysis method, on the views of the experts of the probiotic industry in Iran, including experts in nutritional and medical sciences and probiotic producers, concerning the most important driving forces in the development of probiotic industry businesses in Iran. Based on the data the effects of the variables obtained were investigated using the structural equation modeling method with a partial least squares approach.
Results: Analysis of the data showed that the development of probiotics industry was statistically significantly related directly both to macro-environment (coefficients T=3.13, p=0.033<0.05; 95% confidence level) and micro-environment (coefficients of T=2.13, p=0.001<0.05; 95% confidence level).
Conclusion: It can be concluded that the development of the probiotic industry in Iran is influenced by both the macro-environment and the micro-environment. What can provide the basis for the development of this industry in the macro-environment and the micro-environment sectors is the political forces such as governments and the private sector, respectively.

Comparison of the Effectiveness of Positive Thinking Skills Training and Behavioral Activation Therapy in Self-Care and Corona Stress in Patients with Diabetes

Hamzeh Akbari

Background and Aim: Self-care behaviors are the most common behavioral response in attempts to prevent corona stress in patients with diabetes. Therefore, this study aimed to compare the effectiveness of positive thinking skills training and behavioral activation therapy on self-care and corona stress in patients with diabetes mellitus.
Materials and Methods: This was a semi-experimental study using a pretest-posttest and follow-up design with experimental and control groups. The statistical population included all the diabetic patients referring to the Vanoshe Diabetes Clinic in Qaemshahr city, Iran in 2020-2021, from among whom 45 patients were selected by accessible sampling technic based on the inclusion and exclusion criteria and randomly divided into three 15-member groups, namely, positive thinking skills training, behavioral activation therapy and a control group. The first and second experimental groups received positive thinking skills training in six 60-minute virtual sessions and behavioral activation therapy training in eight 70-minute virtual sessions, respectively, and the control group was in the waiting list. Data were collected using the Corona Stress Scale "CSS-18" and the Summery of Diabetes Self-Care Activities "SDSCA" and analyzed using the repeated measures of variance analysis and the Bonferroni post hoc test with SPSS-22.
Results: The findings revealed that there was a significant difference between the two experimental groups and the control group. Both the positive thinking skills training and behavioral activation therapy interventions reduced corona stress (F= 15.73) and increased self-care (F= 16.17) in the patients, and the effects of the interventions in the follow-up phase were found to be continuing (p <0.05). In addition, the results of Bonferroni post hoc test showed that positive thinking skills raining was more effective than behavioral activation therapy on corona stress reduction (IJ= 9.02), while as regards self-care the behavioral activation therapy (IJ= 12.93) was more effective (p <0.05).
Conclusion: Based on the findings it can be concluded that positive thinking skills training and behavioral activation therapy interventions can be effective in improving self-care and corona stress reduction among diabetic patients. It is recommended that therapists and counselors use, in addition to other treatment methods, these therapies to improve the self-care and corona stress reduction in diabetic patients.

The Effectiveness of Emotional Regulation and Mindfulness Techniques Based on Dialectical Behavior Therapy in Improving Negative Emotions (Depression, Anxiety, Anger) in Borderline Personality Disorder

Aisan Farzi

Background and Aim: This study was conducted to investigate the effectiveness of mindfulness and emotion regulation based on dialectical behavior therapy on negative emotions (anxiety, anger and depression) among people with borderline personality disorder (BPD).
Materials and Methods: This was a single-case experiment study of the multiple-step baseline type conducted in eight one-hour sessions on three patients with a one-month follow-up. The statistical population was patients suffering from borderline personality disorder, from among whom three volunteers diagnosed by a psychiatrist were selected by the targeted available selection process and a structured clinical interview based on the research criteria. Data were collected using the second edition of the Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI) and Multidimensional Anger Inventory (MAI) questionnaires.
Results: Data analysis using special graphs and tables for the single-subject designs showed that the effect size in the variables of anxiety, depression and anger for the three subjects was, respectively, as follows: for the first subject 2.494, 2.260 and 2.484; for the second subject 3.087, 2.827 and 2.727; and for the third subject 4.854, 2.183 and 2.917.
Conclusion: This treatment method can bring about statistically significant changes in the symptoms of depression, anxiety and anger in patients with borderline personality disorder.

Association Between Organizational Socialization and Organizational Citizenship Behavior Among Tehran University of Medical Sciences Senate Staff Members, Tehran, Iran

Hossein Dargahi

Background and Aim: Organizational citizenship behavior (OCB) of employees in an organization as an optional and voluntary behavior may help to improve organizational productivity. It is important to know that encouraging employees to perform voluntary behaviors needs pre-employment education training in the format of organizational socialization. Therefore, this study was conducted to find the association between organizational socialization and OCB among Tehran University of Medical Sciences Senate staff members, Tehran, Iran
Materials and Methods: This research was a cross-sectional descriptive-analytical study conducted in 2021-2022. The research population was a group of 1419 staff members in the Tehran University of Medical Sciences Senate, Tehran, Iran, from among whom an available sample of 243 was selected according to Krejcie and Morgan Table based on a response rate of 86%. Data were collected using the Katz’s Organizational Socialization and the Organ & Konovsky’s OCB Questionnaires, the face and content validity of which had been determined by experts, and based on the Cronbach's alpha test the reliability of the questionnaires was found to be 0.83 and 0.81 for the organizational socialization and OCB questionnaires, respectively. Data analysis for descriptive and analytical statistics was done using the SPSS software.
Results: The means of the employees’ organizational socialization and OCB scores were 3.8 and 3.35 (relatively high), respectively. A statistically significant correlation was observed between the organizational socialization and OCB and their subthemes.
Conclusion: Explaining and encouraging voluntary behaviors of organizational citizenship among the employees through implementation of pre-employment and on-the-job training and empowerment courses may help to promote organizational productivity.