مجله دانشکده بهداشت و انستیتو تحقیقات بهداشتی
سال شانزدهم شماره 3 (پیاپی 63، پاییز 1397)

Population aging is one of the most important economic, social and health challenges of the twenty-first century. The increasing rate of aging in the population will increase the risk of households being confronted with catastrophic health expenditure (CHE). The purpose of this study was to determine the effect of aging on households' CHE in Iran. The data on household income-expenditure were obtained from the annual Iranian Statistical Center reports for the period 2007-2016. The statistical technique used for data analysis was the regression Logit technique, the software for the final data analysis being the Excel and STATA. The results showed that increased numbers of elderly people in a household would increase the probability of the household being confronted with CHE. Additionally, the following households were also more likely to be at risk of CHE: urban families; female-headed families; those not owning private homes; those with no income or with an unemployed head; and those in the lower income deciles. Moreover, no insurance coverage would decrease the likelihood of a household to be at risk of CHE. Considering the findings of this study and the aging of the Iranian population, it is essential that the government, in line with fair financing and reducing the economic burden of health expenditures on households with an elderly member, try, through special support packages for the elderly, to prevent confrontation of such families with catastrophic health expenditures.

All hospitals need to be monitored and continuously evaluated. Pabon Lasso graphical model assesses the efficiency of hospitals using a combination of their input data and performance indicators. The aim of this study was to determine the effects of Iran Health System Evolution Plan on Tehran University of Medical Sciences (TUMS) hospitals’ performance indicators using the Pabon Lasso model in 2016. This was a descriptive-analytical and cross-sectional study including 8 general and specialized hospitals. The hospital input data and performance indicators were collected by permission of TUMS Vice-chancellor’s Office for Therapeutic Services. Chi-square and the two-sample T2 tests were used for data analysis, and hospital performance was assessed using the Pabon Lasso Model. The results showed that the number of TUMS hospitals located in zones 3 and 4 had increased after implementation of the Iran Health System Evolution Plan, which indicates improved efficiency of these hospitals, as confirmed by the chi-square test. Based on the Pabon Lasso graphical model, it can be concluded that the performance indicators of the hospitals show improvements in performance after implementation of the Iran Health System Evolution Plan. The successful experience in the management of the hospitals in this study can act as a practical guide for managers of other hospitals throughout the country for better management.

Considering that meta-cognitive beliefs play a very important role in the prevention, preservation and continuity of addiction, this study aimed to determine the effectiveness of meta-cognitive group therapy (MCT) on the extent of addiction-proneness in male university students. This study was a quasi-experimental project with pretest-posttest, a control group and follow-up. The statistic population consisted of all the male Bachelor's students of the Mashhad Ferdowsi University, Iran in the academic year 2016-17. The sample was 30 students selected and assigned randomly to an experimental or control group. Data were collected using a meta-cognition questionnaire (MCQ-30) and the addiction potential scale (APS). Statistical tests included analysis of covariance and the dependent t-test. Covariance and post-test addictive potential scores showed that MCT could desirably affect the addiction-proneness of university male students (p<0.01). Based on the findings it can be concluded that metacognitive therapy can reduce the addiction proneness of male university student, the effect lasting for three months. Therefore, it is recommended that responsible authorities in the health sector use meta-cognitive therapy for addiction prevention and resumption.

The objective of this study was to design and examine the effectiveness of a parent-child relationship improvement program in reducing the externalized problems in children with Down's syndrome. A parent-child relationship improvement program was designed, followed by assessing its effectiveness in a random sample of pupils using a quasi-experimental research design with a pre-test, post-test and follow-up. The study population was all the pupils with Down’s syndrome in the schools for exceptional student in Tehran and their parents in the academic year 2016-2017. The parents and their children were divided into two experimental and control groups.
Thirty-six out of 56 mothers were screened based on a diagnostic interview and inclusion and exclusion criteria and completed the CBCL and parent-child relationship questionnaires in the pre-test, post-test, and follow-up stages. Data analysis was performed using the multivariate covariance analysis with repeated measurements. The results showed that the mean post-test scores were statistically significantly different between the control and experimental groups, the mean scores of the experimental group being lower than those of the control group, which indicates a positive effect of the family-centered intervention. Based on the findings, it is concluded that the parent-child relationship improvement program can reduce the subscales of conflict and dependence and increase the subscale of intimacy in the parent-child relationships. Moreover, it can also reduce behavioral problems in children with Down’s syndrome.

The Internet is a tool that responds to many human needs, but this technology can also have an impact on people's lives. This study aimed to examine the role of the Internet in family values. This descriptive-analytic cross-sectional study was conducted in 2015 in Tehran, Iran. The research population consisted of all the students of Tehran University of Medical Sciences, Tehran, the sample size being 384. Data were collected using a questionnaire, as well as The Young's standard questionnaire, and analyzed by the SPSS software version 22, the statistical test being one-way analysis of variance. The findings showed statistically significant positive associations (p<0.05) between the student's dependence on the Internet on the one hand and the following variables on the other: intimacy among users, family awareness and information, and the extent to which the students were using the Internet. However, no statistically significant relationship was found between Internet use and anonymity on the Internet. The constant use of the Internet and accepting it as the main reference and channel for obtaining information have caused negative effects on family life and the relationships and values within the family framework. Therefore, university students should try to make optimum, more proper use of the Internet. It is also recommended that responsible authorities adopt appropriate policies and implement cognitive-behavioral interventions aiming at changing the patterns of Internet use.

Stress during pregnancy can have a lasting effect on the mental health of women after childbirth. Statistics show that about 18% of pregnant women have major or partial depression during pregnancy, but many have not been screened or treated. Lack of treatment can have serious consequences for the mother and her child. The purpose of this study was to determine the mental health status and marital satisfaction of pregnant mothers in Kashan city, Iran in 2015. This was an analytical cross-sectional study. Using the convenience sampling method 202 pregnant women were selected from four urban health centers in Kashan, Iran and entered the study. Data were collected using a Diagnostic Interview, the General Health-28 Questionnaire and the Golombok Rust Inventory of Marital State. Descriptive statistics was used for data analysis, the statistical tests being one-way ANOVA, chi-square test, Pearson correlation test and logistic regression. The results showed that 26.7% of the pregnant women were suffering from psychiatric disorders, the most and least serious disorders being related to physical activity and depression, respectively. About 80% of the women expressed very good marital satisfaction. Further analysis of the data showed statistically significant associations between depression and age and anxiety, insomnia and duration of marriage, marital satisfaction and delivery type, and mental health and marital satisfaction. Furthermore, marital satisfaction had a negative association with education. (p<0.05). It seems that it is essential to develop and implement a therapeutic, psychiatric and health care model for women at risk of psychiatric disorders during pregnancy and after childbirth in the health service delivery system in Iran.

Developing appropriate programs for community problem solving and community development and prosperity will be possible only after realistic identification of the community’s problems. Community health assessment is a process by which researchers and community members understand the health care system and community concerns through data collection and analysis, determining strengths and weaknesses and defining the community’s resources and demands. Basmenj is a town located 10 kilometer from the metropolitan City of Tabriz, Iran and on the verge of adjoining this metropolis. This paper reports results of the community assessment of this town. This study was conducted in autumn 2017. The methodology used for community assessment was based on the eight-stage model of North Carolina. In the first seven stages the Basmenj community problems were identified and prioritized, followed, in the eighth stage, by developing an action plan for solving the problems in order of priority. Approximately 100 different problems were identified at the end of the first stage. Based on the Hanlon classification model, the top prioritized problems of the region were found to be, in that order, youth addiction, urban trashes, stray dogs, environmental pollution caused by Pars Color Company, narrowness of the main street, inner-city livestock farming, early marriage among girls, wastewater problems, youth unemployment, and high consumption and self-administration of anti-biotics.
From among these problems, the urban trashes problem was studied briefly. Factors playing a role in its causation were found to be as follows: lack of waste reduction and waste sorting programs, low citizens’ knowledge about trash gathering, absence of an appropriate urbane wastewater system, and, finally, lack of participation of citizens and the private sector in trash gathering and burying A wide range of social, cultural and economic problems was identified. The top priority was found to be focusing on problems related to urban trashes. However, it should be noted that solving all the community problems identified requires the co-operation and support of all the governmental organizations, as well as involvement of the community at large.

Ergonomics climate indicates employee perceptions of the extent to which the organization emphasizes and supports the design and modification of work, so that both performance and well-being of the personnel are improved. The purpose of this study was to determine the validity and reliability of the Persian version of the ergonomics climate assessment questionnaire in order to create a suitable tool for determining the overall values of an organization in connection with ergonomics and climate assessment. First, the ergonomics climate assessment questionnaire was obtained from the Colorado State University of America, where it had been developed. The back-translation method was used to confirm its language suitability and precision. The content validity of the questionnaire was assessed by 10 relevant experts, followed by a cross-sectional study using a sample of 50 employees of a power generation plant using Cronbach's alpha to determine its reliability. The content validity ratio (CVR), content validity index (CVI) and reliability of the questionnaire were found to be 0.90, 0.94 and 0.96 ( for the 59 items), respectively. These results indicating that the questionnaire is a valid and reliable tool. Considering the acceptable validity and reliability of the ergonomic climate assessment questionnaire, it can be used as a valid and reliable tool to assess and analyze the status of ergonomic climate in different industries and organizations in Iran.