مجله پایش
سال پانزدهم شماره 5 (پیاپی 69، مهر و آبان 1395)

Health inequality and inequity had been assessed in many studies within and between countries. Reducing this inequity can be achieved through the adjustment of social determinants of health and primary healthcare. These two paradigms, social determinants of health and primary healthcare, are the main concerns of policy making in health care system.
The aim of this study was to design a model for integrating social determinant of health into primary healthcare system. The implementation of this model can help to reduce health inequalities and promote health equity.
This study was conducted in two phases. First, the integration models were compared between selected countries. Then, based on the results obtained and the capabilities of Iranian primary healthcare system, we designed and proposed an integration model of social determinants of health in primary healthcare system for Islamic Republic of Iran.
Successful integration of social determinants of health in the health system requires policymaking and an appropriate mechanism that include policies, a comprehensive healthcare system, welfare system and the evaluation strategies and indicators.
We proposed a model of integration of social determinants of health compatible with the Iran’s primary healthcare system. This model contains three levels, national, meso, and micro level. Implementing this model is more likely to improve the health equity indicators.

Hospitals’ website has considerable potential to attract medical tourism. Therefore, these websites should be designed based on particular features. This study was conducted to determine the minimum data set needed for hospitals’ website to attract medical tourism.
This was a qualitative study. The population of this study was physicians and health information management experts. Snowball sampling was used as sampling methods. An electronic form was used to collect data. Data was analyzed by content analysis, descriptive methods and represented.
In all 30 physicians and experts participated in the study. The findings showed that experts indicated two main dimensions (structure and content) with 18 categories as minimum data set. In addition the analyses showed that hospitals should have website with unique URL with special attention to providing information on patient admission, information regarding services, waiting lists, and duration of convalesces.
Hospitals that wish to contribute to medical tourism; should redesign their websites based on minimum data sets presented in this study. Structural and contextual dimensions represented in this study also should be considered, if we want to be successful in medical tourisms.

The health workforce has a dynamically changing nature and the regular documentation of its distribution is a persistent policy concern. This study aimed to measure the distribution of general physicians in primary health care in Bushehr, Iran.
This was a descriptive study including all general physicians working in primary health care in Bushehr Province, Iran (2010-2013). We investigated the degree of inequality of distribution of general physicians by calculating the Gini Index and plotting Lorenz curve by DAD 4/6 & Robin Hood index by Excel software, both before and after adjusting for crud mortality and consultation rates.
The highest value of the degree of inequality was based on the number of consultations which was at the beginning and end of the study period 0.321 & 0.196 (with reduction equivalent to %39), based on crude mortality rate of 0.157 & 0.125 (with reduction equivalent to 20%) and at population level of 0.117 & 0.86 (with reduction equivalent to %26). The number of physicians available for distribution based on the number of consultation relative to the population was twice, approximately. The amount of redistribution of general physician increased from 15 people based on the population to 31 based on the number of consultations and from 10 to 20 in 2010 & 2013, respectively.
It seems that the distribution of general physicians was not proportional to the population & health needs between districts. Based on Gini & Robin Hood Indices, more efforts are needed to tackle health inequality.

The role of patients in the definition of service quality can be considered as key competitive criteria. As a result, service providers are trying to apply quality assessment tools that significantly emphasis on customer orientation. In this regard, we aimed to report on validity and reliability of the Persian version of SERVUSE questionnaire.
This cross-sectional study was conducted to verify the validity and reliability of SERVUSE questionnaire. A sample of 80 patients of the cardiac surgery in two teaching hospitals affiliated to Mashhad University of Medical Sciences were selected randomly and were evaluated in two stages. The first step before admission, the patient's expectations of quality of care and the second stage before discharge, their perception of quality of care were received.
The Cronbach’s alpha in both instances was satisfactory (0.74 and 0.91 respectively). To determine the validity, questionnaire was distributed to experts who had experience in the quality of care. After their comments the validity of the questionnaire were assessed by content validity. The results showed that the translated version of the questionnaire has relatively acceptable validity.
The Persian version of the SERVUSE questionnaire can be used for evaluating the quality of health care services in Iran.

This study was conducted to assess factors associated with injuries caused by accidents in the elderly referred to hospitals of Hamadan Province, Iran.
This was a retrospective study. Data for all elderly patients referred to hospital emergency in Hamadan province during 2009 to 2014 were collected. Data extracted from injury registry software. Descriptive statistics was used to explore the data.
A total of 11954 patients were registered during the study period. 64.48% were male. The mean age of men was 70.5 ± 8.8 and the mean age of women was 71.1 ± 8.7 (P the findings suggest elderly people are in danger of accidents. It seems that effective and regular training about injury prevention and providing a secure living environment for the elderly is necessary.

The purpose of this intervention was to evaluate a theory-driven instructional multimedia about exercise behavior and health-related physical fitness among women in Tehran, Iran.
This was a randomized controlled trial. In all a random sample of 130 women who were living in institutional houses in Tehran, Iran (2014) participated in the study. We designed ‘Women and Active Life’ self-taught multimedia based on the expanded theory of planned behavior (TPB) using the Flash and ActionScript3 software. This multimedia consisted of a menu with six principal actions (particularly educational sessions). The expected outcomes were analyzed at baseline, 3 and 6 months post-intervention.
Administering educational package was conducive in increasing and sustaining all outcome measures including the developed TPB constructs, cardiopulmonary fitness, muscular strength/endurance and flexibility in the experimental group at 3 and 6 months post-education, respectively (P0.05).
Utilizing new technologies such as interactive multimedia grounded on the expended TPB led to improved exercise behavior, aerobic/muscular fitness and body composition in women.

The present study aimed to assess quality of life in infertile women.
This was a cross-sectional study conducted on infertile females visiting infertility-treatment center in Shiraz in, Iran. A number of 162 infertile females were selected based on their availability. The personal data were collected using a socio-demographic questionnaire quality of life was measured by an exclusive questionnaire. Then, the quality of life was classified into 4 levels: very poor, poor, moderate and good.
The results obtained from the study showed that quality of life in infertile women was generally moderate. The highest mean quality of life was related to physical aspect of life (40.60 ± 9.08) and the lowest mean quality of life score was related to emotional aspect (11.0± 5.72). There were significant relationships between some personal and social characteristics such as education (P = 0.01), history of chronic disease (P = 0.008), cause of infertility (P = 0.006) and quality of life.
Infertile women's quality of life was relatively poor and affected by various personal and social factors. Therefore, identifying and modifying these factors is recommended to improve quality of life in this population.

Heart failure is a severe chronic disease and has a negative impact on the quality of life (QoL). The aim of this study was to assess quality of life and its related factors in patients with heart failure using an specfic measure..
A cross-sectional study of 210 patients with heart failure was conducted using convenience sampling methods. The Minnesota Living with Heart Failure (MLHF) and socioeconomic questionnaires were used to collect data. The data analysis was performed using descriptive statistical tests, Pearson correlation coefficient, independent t-test, and regression analysis.
The mean age of patients was 57.90±13.54. Higher and lower scores were observed for the treatment satisfaction with mean and standard deviation of 66.34±17.32, and angina stability with mean and standard deviation of 38.92±24.02. The results of multiple liner regression showed that there was significant difference between quality of life and NYHA class (β =0.13; p=0.04).
The finding indicated that quality of life was low in patients with Heart Failure. Higher NYHA class was independent predictors of poor QoL in patients hospitalized with heart failure. It seems necessary to put more focus on nursing care to enhance and improve quality of life for these patients.

To translate and validate a Persian version of the AAQ in Iran. The AAQ consists of 24 items which cover three theoretical domains: physical change, psychological growth, and psychosocial loss.
The existing AAQ (English version) was translated into Persian according to process of translation and adaptation of instruments of The World Health Organization protocol. Data were then collected from 200 older people. Reliability (internal consistency, test- retest reliability) face validity, content validity, known-groups comparison and criterion validity of the AAQ, with the SF-36, and the WHOQOL, were examined.
The mean age of participants was 67.66 ±6.28, and more than half (50.5%) were female. There was satisfactory internal consistency (Cronbach’s a 0.80–0.89) for the subscales. Test-retest reliability (ICC) of the questionnaire with interval time of two weeks was 0.97(p We tested and validated a Persian version of the AAQ with 24 items. It appears to be a promising tool, providing reliable and valid data helping for measuring Attitudes to Ageing among elders in different settings such as clinics, homes and research environments. It is recommended in the future studies that structural validity of the Persian version AAQ in larger sample factor analysis be examined.

Recent increases in pediatric abdominal obesity suggest that children and adolescents should be assessed anthropometrically as a step toward managing their long-term cardiovascular risk status. This study was conducted to investigate the relationship between waist-to-height ratio and blood pressure in adolescent girls in Kashan, Iran.
This was a cross-sectional study. A sample of 1046 girls aged 11-19 years participated in the study and their height, waist circumference, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. Waist-to-height ratio was calculated by dividing the waist to height. Abdominal obesity was defined WHtR > 0.5. Blood pressure in all girls who had high blood pressure in the first visit, again was measured in second visit and if their blood pressure was high in the second visit, again their blood pressure was measured in other visit (third time) and the average of the three blood pressure was considered as their established blood pressure. Hypertension and prehypertension was defined according to percentiles of age- sex and height presented by the fourth report on the diagnosis, evaluation and treatment of hypertension of children and adolescents. The findings were analyzed using descriptive and analytical statistics by of spss16 software.
The prevalence of prehypertension and hypertension were 6.8% and 7.3% respectively and 24.6 percent of participants had waist-to-height ratio greater than 0.5. ANOVA test showed positive relation between the mean of systolic-diastolic blood pressure and waist-to-height ratio (p The results of study showed that there was relationship between the mean of systolic and diastolic blood pressure and waist-to-height ratio among adolescents and abdominal obesity was associated with increasing risk of hypertension.