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

Frequency of Non-Polio Enteroviruses Among Acute Flaccid Paralysis Patients in Iran Before and During the COVID-19 Pandemic

Ahmad Nejati

Background and Aim: During the COVID-19 pandemic public health measures and protocols such as regular hand washing and wearing a face mask were recommended at the national level. The implementation of these health protocols reduced the prevalence of respiratory diseases, but no study has been conducted to investigate the impact of the implementation of these protocols on the spread of viruses that are transmitted through fecal-oral route. Considering that non-polio enteroviruses (NPEVs) are mainly transmitted through fecal-oral route, this study was conducted to determine the prevalence of non-polio enteroviruses in patients with acute flaccid paralysis (AFP) in Iran before and during the COVID-19 pandemic.
Materials and Methods: To detect non-polio enteroviruses stool samples of AFP cases received by Iran National Polio Laboratory in 2019 (before the COVID-19 pandemic) and 2021 (during the COVID-19 pandemic) were tested. To isolate NPEVs by cell culture, the WHO standard protocol was used, and the TaqMan One-Step Real Time PCR was used for molecular testing.
Results: In 2019, a sample of 21 out of 1070 patients and a sample of 12 out of 100 patients were found to be positive for non-polio enterovirus by cell culture and the molecular method, respectively; these ratios decreased to10 out of 678 and 3 out of 100 in 2021.
Conclusion: Based on the findings of this study, it can be concluded that the observance of personal hygiene and public health protocols during the COVID-19 epidemic have, in addition to the general reduction of respiratory transmission of viruses, also affected the faecal-oral transmission of viruses.

Cumulative Probability of Occurrence of Cardiac Complications in Type 2 Diabetes Mellitus Using Survival Analysis in Patients Referring to the Diabetes Clinic, Bu-Ali Hospital, Zahedan, Iran

Background and Aim Cardiovascular complications in diabetes mellitus are one of the most common complications of this disease. The aim of this study was to determine the cumulative probability of occurrence of cardiac complications in type 2 diabetes mellitus using survival analysis in patients referring to the Diabetes Clinic, Bu-Ali Hospital, Zahedan, Iran.
Materials and Methods: This was a descriptive and analytical historical cohort study using the survival analysis method in 2020 on 410 patients referring to the Diabetes Clinic, Bu-Ali Hospital, Zahedan, Iran. Data were collected and analyzed using the SPSS-v21 software, the statistical tests being descriptive tests, followed by the Kaplan-Meier method and the Cox proportional hazards model of survival.
Results: The results of this study showed that 122 individuals (29.7%) of the diabetic patients had cardiac complications. The median survival time (in months) of the occurrence of cardiac complications was found to be related to fasting and two-hour postprandial blood sugar levels (p<0.05). Further analysis of the data showed that two variables, namely fasting blood sugar and regular visits, remained in the final model of the multiple Cox regression.
Conclusion: The findings of this study showed that the cardiac complications of diabetes in the population studies are relatively high. Therefore, it is essential to plan and implement interventions aiming to change lifestyle and control regularly blood pressure, cholesterol and blood sugar in the patients in order to prevent the disease

Analysis of the Importance and Performance of Mental Health Programs in the Primary Health Care System in Iran

Reyhaneh Fayyaz

Background and Aim: The objective of this study was to gain a deep understanding of the importance (expected services) and performance (services provided) of mental health services to determine the priority indicators of mental health to help design higher quality and more effective community mental health interventions.
Materials and Methods: This was a mixed-method study including all the mental health executives and practitioners (n=998) in Iran. In the quantitative part, the Importance-Performance Analysis (IPA) model was used to determine the importance and performance of the current mental health programs in the primary health care (PHC) system, and in the qualitative part complementary explanations were analyzed using the thematic analysis method.
Results: The findings show that there were gaps between the expected services and the services provided in the mental health program. Thus, the following points should be taken into account to be able to improve the mental health services: 1. Strengthening the domestic violence prevention program as regards spouse misbehavior and misbehavior towards children; 2. Continuation of lifestyle skills and parenting programs, 3. Self-care in mental health and drug use programs; 4. psychiatric disorders diagnosis and care and a healthy adolescents program is desirable and necessary, but revising and modifying the suicide prevention program (as regards costs and treatment) are essential. 5. In addition, the psycho-social intervention programs in disasters, addiction harm reduction program, strengthening family foundation and the Competent Family Program are of low importance in formulating a strategy.
Conclusion: Corrective actions based on the prioritizations determined can be included in the working agenda of the managers of mental health care systems at the primary levels to improve the quality of mental health services.

Reasons for Referring Patients in Rural Areas of Zahedan City to the Second Level of the Health Care System

Mohammad Hassan Amiri Moghaddam

Background and Aim: The health system is trying to prevent unnecessary referrals to higher levels by providing tiered services and thus reduce the cost of health care. Therefore, this study was conducted in Zahedan City, Iran with the aim of finding the causes of referrals from level 1 to higher tiers in rural areas.
Materials and methods: This cross-sectional study was conducted on 458 rural patients referred to the second level in the rural areas of Zahedan City, Iran. Data were collected from the family health files available in the Sib system and analyzed using the SPSS-16 statistical software, the statistical tests being descriptive statistics (percentage, frequency) and Chi-square test.
Results: The highest (57.6%) and lowest (4.1%) proportions of referrals to the second level of service provision were found to have been in 2018 and 2016, respectively. From among the referred patients nearly 50% had been referred due to the need for a higher expertise, thus most referrals (67.2%) were to specialists. Further analysis of the data showed that only in 23.6% of the cases there was a feedback from the higher level to the first level.
Conclusion: The findings show that referrals from family physicians to higher levels in the health system requires higher medical expertise and patient insistence. In addition, feedback to the first level of service provision has not received proper attention. Establishing interactions between physicians and other health service levels, refresher training of physicians, emphasizing the importance of providing feedback and promoting the awareness of patients can reduce to a large extent inappropriate referrals.

Analysis of Publication Trends and Visualization of Scientific Structure in the Field of Traditional Medicine

Afshin Hamdipour

Background and Aim: Traditional medicine (TM) or complementary medicine is an old method based on culture, which has been developed in various forms of indigenous therapeutic methods in different societies. This research was conducted with the aim of analyzing the publication trend and visualizing the scientific structure of TM.
Materials and Methods: This study was carried out with a scientometric approach. The statistical population included 29,852 documents indexed in the TM field at the WoS database during the period of 2012 to 2020. The Excel and VOSviewer software were used for data analysis.
Results: The findings showed that the scientific outputs of TM during the period studied had had an upward trend with 343,700 citations. Two universities in South Korea, namely Kyung Hee University and Korea Institute of Oriental Medicine (KIOM), had had the largest number of publications in this field. Further analysis of the data revealed that the highest levels of cooperation occurred between China and the US (565 cooperations), followed by China and Australia (253 cooperations) and China and the UK (134 cooperations). Finally Iran was found globally to have ranked fourth as regards TM publications and to be the most highly specialized country (in terms of RSI) in this field. This would necessitate more attention to appropriate scientific policy-making on the part of the responsible officials.
Conclusion: The cumulative frequency of publications in the field of traditional medicine in 2030 will be twice that in 2020. This trend would require special attention in scientific policy-making.

The Status of the Referral System in the Family Physician Program in Isfahan Metropolitan Area: a Qualitative Study

Razieh Khalili Nezhad

Background and Aim: Primary levels of health services are designed to provide, maintain and promote the health of healthy young people, while the goal of higher levels is to screen and restore the health of the patients. One of the challenges is the personal culture of some of the health service providers and the recipients of these services. One of the recent reforms in the healthcare system has been the implementation the Health System Reform Plan based on the family physician and the referral system. This study investigated the status of the referral system in the family physician program in Isfahan metropolitan area in 2018.
Materials and Methods: This was a qualitative study with a contractual content analysis conducted on a sample of 28 individuals selected by purposeful snowball sampling continued until saturation. Interviews were held with male and female healthcare workers (n = 14), midwives (n = 10), and managers (n = 4). Data analysis was done using the SPSS.25 statistical software.
Results: This study succeeded to explain strategies to improve the quality of the referral system and the views of health service personnel and, finally, find the strengths, weaknesses and solutions for improving the referral system.
Conclusion: The findings show that the performance of the referral system in the city of Isfahan is in line with the goals. However, visiting referred patients, providing feedback and referral to the laboratory are not as effective as they should be. Therefore, planning is needed to remove obstacles and solve problems such as shortage of human resources, non-human resources and infrastructure, insufficient provision of medicines and job insecurity so that goals can be reached.

Analysis of Challenges Affecting the Job Efficiency of the Bank Melli Iran Personnel During the Covid-19 Pandemic

Background and Aim: As a crisis, the Covid-19 disease affected all aspects of people's lives, especially the occupational aspect. Bank employees were more under pressure due to the type of service they provided to the public. The aim of this study was to analyze the challenges affecting the job efficiency of some of the Bank Melli Iran personnel during the Covid-19 pandemic.
Materials and Methods: This was a qualitative research project with a phenomenological approach. The research population was the employees of Melli Bank branches in the 10th district of Mashhad City, Iran in 2021, from among whom a sample of 10 people was selected by purposeful sampling, the sampling process continuing until saturation. Data were collected through semi-structured interviews and analyzed using the inductive thematic analysis method.
Results: Data analysis showed 12 sub-themes, 3 main themes including challenges at the individual, interpersonal and organizational levels, and a core theme.
Conclusion: The findings of this study show that the Bank employees’ concept of the Corona pandemic can affect their work efficiency. These findings can be used for planning to solve the problems and challenges of this group of people after the Corona pandemic.

Medical Social Work Interventions in Discharge Planning: A Qualitative Study

Ahmad Kalateh Sadati

Background and Aim: Hospital social workers as a group of discharge planners perform effective interventions for the safe discharge of patients. The purpose of this research was to investigate the interventions of medical social workers in safe discharge of patients.
Materials and Methods: This was a qualitative study conducted in 2023 in Iran. Data were collected through semi-structured interviews with a sample of 16 social workers working in public hospitals selected by purposeful, accessible and snowball sampling and analyzed using the thematic analysis method.
Results: The findings of this research show that hospital social workers implement specialized interventions within a framework of six planning stages with the aim of safe patient discharge. The three main themes are: professional intelligence, supportive framework and sustainability of interventions; the main theme of the current research is safe discharge.
Conclusion: The findings of this research indicate that the interventions of social workers for the safe discharge of the patients include measures before, during and after the discharge of a patient, based on the principles, values, intelligence, professional skills and the social work process. Social workers in this field need the support of responsible officials in the health system.