مجله پیاورد سلامت
سال یازدهم شماره 3 (امرداد و شهریور 1396)

An assessment framework is necessary in order to achieve the goals of health system in any country. The current study was done with the aim of measuring the effects of the aspects of performances on realization of health system goals.
This study was a cross-sectional, descriptive-analytic which was carried out during the years 2014-2015. Four hundred and nineteen experts among all experts in the area of health by snowball and cluster sampling participated in the study. Collecting data was performed through the questionnaire of Health System Perfomance Assessment. The questionnaire’s validity was confirmed using content validity method and its reliability was confirmed using Cronbach's alpha coefficient. Data was analyzed by means of Pearson correlation coefficient test and Regression using SPSS 22 software.
The results of Pearson correlation coefficient test showed that the two component functions on equitable access to health services, the functions of protection against financial risks and actions on targets were equal to 0/827, 0/655 and 0/870. Respectively the results of the test showed 87% of the variance explained the aims of the functional components. Thus, we conclude that the functions of the financial risk for changes in standard deviation units and functions on equitable access to health services was as much as 0/655, and 0/827 predictable.
Since the aspects of performances influence the realization of health system goals, investigating the effects of performances on the health system goals can help policymakers and managers to improve the performance through identifying weaknesses and strengths, review of interventions and healthcare reform, and the management of the health system.

Nowadays, organizations significantly emphasize on different aspects and dimensions of knowledge and intellectual capitals. Knowledge and information are power and each individual equipped with them is powerful. Thus attention to knowledge and intellectual capitals for reaching to Psychological Empowerments in each organization is necessary and inevitable. The aim of this research was to study the impact of Intellectual Capital on Psychological Empowerments in experts of Iran’s Ministry of Youth and Sports.
This cross- sectional study was performed among 230 experts in Iran’s Ministry of Youth and Sports through convenient sampling. Data collection was conducted by the use of standard questionnaires of intellectual capital Bontis (1998) and psychological empowerment Spreitzer (1995) with Cronbach’s alpha coefficients of 0.71 and 0.86. Descriptive statistics and regression tests were used for data analysis by spss.
Results of study showed that mean intellectual capital and psychological empowerments was 3.49 and 3.81 respectively. Additionally, results showed that intellectual capital had the ability to predict the examinees’ psychological empowerments (R square= 0.12).
According to the results, it is necessary to use intellectual capitals in organizations for more psychological empowerment and also training sessions should be conduct

Iron deficiency anemia is one of the most common nutritional problems of women in reproductive age, which has a major impact on fetal growth, low birthweight and premature delivery. This study aimed to assess the prevalence of anemia and related factors in pregnant women having referred to health centers of Mazandaran province.
In this descriptive-analytical study, 866 pregnant women were selected through stratified cluster sampling method from 19 cities, affiliated to Mazandaran University of Medical Sciences. Data was collected by using the registration form and information obtained through maternal family documents and a questionnaire. SPSS software version 18 was used and the data were analysed by descriptive and analytical statistics such as mean comparison test, chi-square and logistic regression.
The prevalence of anemia in Mazandaran was 13.4% and it was higher among pregnant women in urban areas than those in rural areas. Logistic regression showed that mother’s age, number of pregnancies, prenatal care, unwanted pregnancy, consumption of red meat, using iron tablets, tea drinking, and mother’s education level had a significant effect on anemia.
Since iron deficiency anemia is a preventable problem and pregnant women are among the vulnerable groups, considering care programs before and during pregnancy, having appropriate dietary patterns, consumption of iron supplements, and having a program to prevent unwanted pregnancies may lead to reducing the risk of catching a disease.

Organizational agility is regarded an important factor for hospital effectiveness. Considering the necessity of hospital effectiveness, focus on organizational health can ensure the future success of an organization. This study mainly aims to determine the relationship between organizational agility and organizational health in hospitals affiliated to Shahid Beheshti University of Medical Sciences (SBMU).
This is an applied, descriptive-correlational research. The population of the study included all SBMU hospital employees. The 375 members of the sample were selected based on Morgan and Krejcie table. The sampling method was multistage. Data collection tool was the questionnaires of organizational agility and organizational health. The questionnaires were valid based on the expert’s judgment, and Cronbach's alpha reliability value of the questionnaires was 0.88. The data were analyzed by descriptive and inferential statistics (Pearson correlation, regression, and t-test), using SPSS software.
The correlation between organizational agility and organizational health was positive and significant (r=0.66, P Hospital managers need to work hard to promote organizational agility so that in addition to obtaining competitive advantage, they can improve organizational health by giving an appropriate and timely response to changes and taking advantage of the obtained opportunities.

Nowadays heart disease is very common and is a major cause of mortality. Proper and early diagnosis of this disease is very important. Diagnostic methods and treatments of the disease are so expensive and have many side effects. Therefore, researchers are looking for cheaper ways to diagnose it with high precision. This study aimed to identify a model for the treatment of heart disease.
In this descriptive cross-sectional study, the sampling method was census. The sample consisted of data from Khatam and Ali Ibn Abi Talib Hospitals in Zahedan. The data were developed as an Excel file, and Clementine12.0 software was used for data analysis. In the present study, C5.0, C & R Tree, CHAID, and QUEST algorithms and artificial neural network were carried out on the collected data.
The accuracy of 76.04 by C & R algorithm indicates the better performance of Decision Tree Algorithms than that of the Neural Network.
This study aimed to provide a model for the prediction of a suitable heart disease treatment to reduce treatment costs and provide better quality of services for physicians. Due to considerable implementation risks of invasive diagnostic procedures such as angiography and also obtaining successful experiences of data analysis in medicine, this study has presented a model based on data analysis techniques. The improvable point of this model is the provision of a decision support system to help physicians to increase the accuracy of diagnosis in the treatment of diseases.

The World Health Organization (WHO) has placed special emphasis on the protection of families against the costs of health services. Patients suffer not only from the burden of a disease, but also from the burden of their health costs. The aim of this study was to estimate out-of-pocket costs and to identify the factors that affect catastrophic expenditures among patients with cardiovascular diseases in Khuzestan Province.
In this descriptive-analytic study, 100 cardiovascular patients having referred to educational hospitals in Ahwaz, Khuzestan Province, were considered. Out-of-pocket costs were estimated and using Econometrics Logit model, factors affecting catastrophic expenditures among households were identified. All analyses were performed using SPSS and Stata.
The average out-of-pocket cost was 16,008,936 rials per patient during one year. Also, 55% of patients faced with catastrophic expenditures. Income level and family size had a significant negative impact; however, patients’ employment status had a positive but insignificant effect on catastrophic expenditures.
Hospital inpatient expenses and drug costs cover most of out-of-pocket expenditures and should be considered by policymakers. By increasing the income level and family size, families will encounter catastrophic expenditures less. The out-of-pocket costs among patients with cardiovascular diseases can be reduced by boosting the insurance coverage and government help.

Spiritual quotient is an essential factor of managers’ competencies for development of organizations. The managers need high spiritual quotient to impress the staffs’ organizational commitment. This research is aimed to determine the correlation between the managers’ spiritual quotient with the employees organizational commitment in Tehran University of Medical Sciences (TUMS).
This research was a descriptive-analytical, and cross-section study that induced in TUMS headquarters among 80 of the managers and 225 of the staffs at 2014-2015. The research tools were two questionnaires, including spiritual quotient and organizational commitment that used after the validity and reliability of these questionnaires was confirmed. The data was analyzed by SPSS software, average and standard deviation, for descriptive results, and used T-Test, One-Way Variance Analysis, and Pearson technique for analytical statistics.
Average of the managers’ spiritual quotient was desired. Although, the average of the staffs organizational commitment was moderate. There was a significant correlation between spiritual quotient of managers with organizational commitment of the staffs (p=0.034).
The managers should emphasize to develop their spiritual quotient in order to promote the organizational commitment of the staffs. Using organizational psychologist to develop this relationship is our suggestion.

Increasing healthcare organizations’ efficiency is a necessity due to the resource scarcity in health sector. The aim of this study was to evaluate hospitals’ efficiency in Iran.
This study was conducted using a systematic review and meta-analysis approach to find empirical research papers published on hospital efficiency in Iran between 1997 and 2016. Seven electronic databases and two search engines were searched using appropriate key words. Bibliography section of the retrieved papers and related journals were also searched for papers that were not yet indexed in the data bases. 1563 publications were identified. All retrieved papers were assessed using a checklist before analysis. Finally 91 empirical studies were reviewed.
Data Envelopment Analysis, Pabon Lasso and Stochastic Frontier Analysis methods were mostly used for measuring hospital efficiency respectively. The average efficiency of Iran hospitals varied between 0.584 and 0.998. Hospitals affiliated to Social security organisation were more efficient. In contrast, non teaching public hospitals and charity and private hospitals were less efficient. Number of hospital beds and manpower were the most used input variables and number of outpatients and inpatients patient and surgical procedures were the most used output variables in Data Envelopment Analysis. Stochastic Frontier Analysis method has more advantage in measuring hospital efficiency compared to Data Envelopment Analysis.
Iran hospitals suffer from inefficiency. Thus, managers should identify the reasons for hospitals’ ineffeiciency and apply measures for increasing their efficiency and reducing wastage of limited resources.

Gastric cancer is the second leading cause of cancer death in the world. Due to the prevalence of the disease and the high mortality rate of gastric cancer in Iran, the factors affecting the development of this disease should be taken into account. In this research, two data mining techniques such as Apriori and ID3 algorithm were used in order to investigate the effective factors in gastric cancer.
Data sets in this study were collected among 490 patients including 220 patients with gastric cancer and 270 healthy samples referred to Imam Reza hospital in Tabriz. The best rules related to this data set were extracted through Apriori algorithm and implementing it in MATLAB. ID3 algorithm was also used to investigate these factors.
The results showed that having a history of gastro esophageal reflux has the greatest impact on the incidence of this disease. Some rules extracted through Apriori algorithm can be a model to predict patient status and the incidence of the disease and investigate factors affecting the disease. The prediction accuracy achieved through ID3 algorithm is 85.56 which was a very good result in the prediction of gastric cancer.
Using data mining, especially in medical data, is very useful due to the large volume of data and unknown relationships between systemic, personal, and Behavioral Features of patients. The results of this study could help physicians to identify the contributing factors in incidence of the disease and predict the incidence of the disease.

Estimation of radon density in underground centers is very important. Considering the use of high-energy medical accelerators, radiotherapy departments are usually located in underground floors. The aim of this study was to evaluate staff exposure to radon gas in these centers in Tehran in 2015-2016.
This is a descriptive, cross-sectional survey. In radiotherapy centers of Tehran, 32 radon gas diffusion chamber detectors were installed for a period of 3 months. After collecting the detectors, radon gas concentrations were calculated. The annual effective dose of personnel was evaluated using staff’s working hours per week.
The minimum and maximum concentrations recorded in this study during one year were 22.14 and 398.52 Bq/m3, respectively, with an average of 87.01 ± 80.68 Bq/m3. Also, radiotherapy personnel’s annual effective dose was 0.34 ± 0.43 mSv per year with the minimum and maximum amounts of 0.02 and 2.35 mSv per year, respectively.
The results indicate that radon level in radiotherapy centers and also that the annual effective dose of personnel in these centers are permissible, and no special action is needed. However, if more attention is paid to certain factors such as air-conditioning, the amount of the gas can even be brought to less than this limit.

Due to the importance of infertility caused by oxidative stress induced by nicotine, this study was to evaluate the effect of alfalfa extract in contrast with the nicotine on ovarian tissues in rats.
Twenty-four adult female rats were randomly divided into 4 groups. Control group received no treatment; nicotine (0.2 mg/kg) was injected to T1 subcutaneously; and nicotine plus hydroalcoholic extract of alfalfa was prescribed to T2 and T3 orally for 25 days at 250 and 500 mg/kg, respectively. On the last day, the animals were weighed. After euthanizing the animals, their ovaries were removed and weighed. Right ovary was used for MDA measure and left ovary was fixed and stained to count the primary, secondary, graafian, and atretic follicles and corpus luteum (CL).
Body weight in T1 (219 gr) decreased by 10 percent, and the average compared with that of the control group, T2 and T3 was significant. The highest ovarian weight was observed in T3 group (146.66±8.94mg). In T3, the average of primary and graafian follicles and CL was higher than that of T1, but atretic follicle was lower than that of T1 group. The MDA concentration in the control group (0.35±0.01 µmol/ml) was less than that in the other groups, but the TCA in T3 (821.18±3.25 µmol/ml) was significantly more than that in T1 group (708.85±12.44).
The hydroalcoholic extract of alfalfa can reduce the oxidative stress caused by nicotine on ovarian tissue and probably improve fertility status.

Health and equal access to quality care regardless of age, gender, race and location is health system's goal in all countries. This study aimed to determine inequality in healthcare services distribution and development level of cities in Guilan province.
This descriptive, cross-sectional study assessed the distribution state of 13 healthcare indicators in all cities of Guilan (n=16) in year 2011 and 2013. In order to collect data, the database of Statistical Center of Iran (SCI) was used as reference. The taxonomy technique was employed to determine the degree of development of different cities. In addition, indicators were weighed by Shannon’s entropy. Finally, TOPSIS was used to rank the cities in term of access to health sector resources.
Taxonomy technique in 2 years showed that Rudbar, Rudsar and Lahidjan were of most developed cities and Talesh, Rezvanshahr and Amlash were the most under-developed cities respectively. After weighting indicators and according to Shannon entropy, the number of specialists and paramedics gained the most and the least weight, respectively.
Due to the inequality in distribution of health resources in Guilan province, attention to underdeveloped cities in this province should be a priority. To achieve equitable health resources in Guilan, it is recommended that the plannings be based on state of development of cities.