مجله تصویر سلامت
سال نهم شماره 2 (تابستان 1397)

In addition to strengthening the country's economic viability, Health tourism entails providing regional security and has a special place in the financial circulation of countries. The purpose of this study was to analyze the status of the health tourism system in Iran and identify the strategies to improve this industry.
Material and This qualitative research was done in three stages. In the first stage, by reviewing the literature and successful healthcare tourism reforms in successful countries were identified. In the second stage, the status analysis tool was used to analyze the status of health tourism system in Iran. In the third stage, according to the experiences of successful countries, the proposed strategies for improving the health tourism system of Iran were identified.
By analyzing data, strengths were identified such as the existence of specialized medical and specialist centers with low costs and the ability to treat infertility diseases and the most important weakness was identified as the lack of clarity of duties in the health tourism system of the country. The most important opportunities include: fundraising and job creation, enabling economic, social and cultural. The most important threat includes: the lack of awareness of tourists from other countries due to lack of adequate advertising of media and Internet. Based on these, institutional reforms were proposed at the levels of macro policies and strategic reform.
Iran can play a significant role in developing this industry in the region and in the world and earn income from health tourism because of potential capabilities.

The people educated in midwifery play a remarkable role in achieving the third millennium goals of World Health Organization. Employees’ educational needs should be responded for performance development. Educational need assessment is one of the accreditation requirements in human resources development. This research aimed to assess educational needs among midwives in obstetric and delivery wards at educational hospitals affiliated with Ahvaz University of Medical Sciences.
Material and This research was a descriptive-analytic and cross-sectional study. Study population included midwives working in obstetric wards in educational hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences. Study was conducted using census method. Data gathering instrument was a questionnaire in which respondent's demographic and educational need's in general, special and medication domains were collected. Instrument validity was confirmed by content analysis and Chronbach's α was calculated 0.89. Data were analyzed using mean, standard variation and non-parametric statistic tests in SPSS 21.
Educational needs in medication domain was estimated very high (4.03±1.22), and were calculated high in general (3.76±0.74) and special (0.9±3.7) domains. Managing side effects in medicines (4.11±0.87), CPR (4.31±1) and neonatal resuscitation (1.03±4.29) were the most needed education courses in medication, general and special domains, respectively
More attention should be paid to midwives’ educational needs in order to upgrade their knowledge and skills along with obstetric services improvement. Identifying midwive's occupational needs, based on valid and evident findings, is a prerequisite for education quality improvement.

The aim of the present study was to investigate the relationship among alexithymia, responsibility attitude, positive and negative affect, and suicidal ideation in people with obsessive tendencies.
Material and The study sample was comprised of 400 students from Tabriz University from whom 151 students with an obsession score higher than the cut-off point were selected randomly as people with obsession tendency. Toronto Alexithymia Scale (TAS-20), responsibility attitude scale (RAS), PANAS Positive and Negative Affect Schedule, Yale-Brown Obsessive-Compulsive Scale and Beck Scale for Suicidal Ideation (BSSI) were used to collect the data. The data were analyzed using Pearson product-moment correlation method and hierarchical regression.
The hierarchical regression results showed that controlling demographic variables, alexithymia variable as overall, difficulty identifying feelings subscale, difficulty describing feelings subscale and negative affect can predict suicide. Responsibility and positive affect variables and externally-oriented thinking in alexithymia could not predict the dependent variable.
Based on these findings, we can conclude that difficulty identifying feelings, difficulty describing feelings and negative affect are the main determinants for suicide in people with obsessive tendencies.

All individuals have specific rights within healthcare system and patient’s bill of rights is regarded as person’s knowledge in health context. Awareness about patient’s bill of rights by the patient and healthcare staff is considered as an important part of delivering high quality healthcare services.
Material and This cross-sectional study was conducted on the patients who referred to dental clinics and private offices in Tabriz in northwest of Iran. Study sample consisted of 500 participants. A total number of 600 health centers were identified in 10 regions. In each region, according to the number of health centers, 20% of health centers were selected randomly. Within clinics, five participants were chosen based on random. Data were analyzed using SPSS 23 and applying Pearson Chi-square test. Among 500 distributed questionnaires, most of the participants (31.9%) were in 25-34 years old range. In awareness and knowledge section, 94.8% of the participants believed that dentist must give enough information about the procedure before and after treatment. Regarding the right to have access to health record, only 40% believed that they have right to get access to their health record. Education level has a significant impact on the awareness level of patients toward patient’s bill of rights. Encouraging individuals to continue education in higher levels and delivering information about patient’s bill of rights through media will promote individuals’ health.

Diabetes mellitus has serious clinical, social and economic consequences. The increasing prevalence of diabetes around the world has led to many personal and social problems. The aim of this study was to determine the relationship between lifestyle and social factors in diabetic patients.
Material and This was a descriptive-analytical study. Patients with impaired fasting glucose test with diagnosis of diabetes referred to health centers in Tabriz city in 2014 were evaluated. Then, patients completed a checklist containing two parts. The first part includes demographic information, family medical history and the second part includes assessment of social support, mental health status and the socioeconomic factors of the patients. After completing the checklists, data were entered into SPSS v.16 statistical analysis program and then analyzed.
In this study, it was observed that there was a significant relationship between the incidence of diabetes with age increasing, smoking, reduced physical activity, diet, obesity, mental stress and mental health, but there was no significant relationship with gender, education level, blood pressure, history of diabetes in first-degree relatives and high blood cholestrol. The study found that diabetic patients had good support from family and friends.
The results of this study showed that factors such as old age, low physical activity, obesity, stress and lack of mental health were some of the factors involved in the incidence of diabetes.

Play is defined as any type of targeted physical or mental activity which is done individually or in group and develops children needs. This study aimed at effectiveness of play therapy on symptoms of emotional, behavioral and problem-solving skills in children in foster care centers.
Material and The study population included all 7-10 years old children (a total of 1284) residing in foster care centers in Tabriz in 2017. A sample of 30 was selected by convenience-random method and were divided in to experimental and control groups equally (15 in each group). The research tools included play therapy package, computer-based problem-solving test, and Children's Symptoms Questionnaire scale. Experimental group received 10 play therapy sessions according to Hansen, Meissler, and Ovens protocol but control group received no intervention. The scale of the problem and components hyperactivity, conduct, behavior, disease, generalized anxiety, phobia, obsessive-compulsive, post-traumatic stress and tick scale was Children's Symptoms Questionnaire scale. The experimental group received 8 sessions each individually.
Analysis of the data showed that play therapy promotes problem-solving, reduces hyperactivity, conduct, abnormal behavior, generalized anxiety, phobia and tics (P0.005).
It can be concluded that play therapy is an effective method for behavioral and emotional disorders and improves problem-solving performance.

Breast cancer is the second leading cause of death from cancer in women after lung cancer, and is the most common cancer in women after non-melanoma skin cancer. Given the importance of the issue, therefore the aim of this study was to evaluate the response to neoadjuvant chemotherapy in patients with locally advance breast cancer (LABC).
Material and This study was performed as a cross-sectional descriptive-analytic survey in Gazi hospital in Tabriz. In this survey, 77 patients with LABC were enrolled and data were collected from patients’ health records. All the patients were treated based on Anthracycline regimen and among them, 38 cases (49.4%) received Docetaxel and 39 cases (50.6%) were treated without Docetaxel. These descriptive data of patients were analyzed with Ordinal Logistic Regression and the therapeutic response of Docetaxel was evaluated in these patients.
Among patients in this study, 21 cases (27.3%) showed non therapeutic response, 43 cases (55.8%) had partial response, and in 13 cases (16.9%) complete response to treatment were achieved, in which three cases (23%) without Docetaxel regimen and 10 cases (77%) with Docetaxel regimen had complete response to treatment. Also, 14 cases (18.2%) of patients were HER-2 positive. Complete response to treatment was not observed in HER-2 positive patients and partial response was observed in 10 cases (71.4%).
In this study, the response to treatment was significantly higher in patients who received Docetaxol than in non-Docetaxel group (P=0.004). As well as there was a significant relation between response to treatment and positive or negative HER-2 receptor patients.

According to the World Health Organization’s report, tobacco use is the first preventable leading cause of deaths in the world.While the prevalence of tobacco use is declining in high-income countries, this prevalence is increasing in the low-income and middle-income countries. Daily, 205 thousand USD and 386 million USD annually spent on cigarette purchasing in Iran, and the health system of the country pays about 1 billion and one hundred and sixty million USD to cure the complications of cigarette smoking. The present study aimed at determination of effective programs and interventions applied in prevention and reduction of tobacco use in societies. Medical databases were searched, related studies retrieved and their content reviewed and classified. According to the results of this study, programs and interventions for prevention and reduction of tobacco use were categorized in six domains including: "studies at different levels of age and groups," "studies in the physical and community environment," "tax and price studies," "electronic cigarette smoking studies," "harm reduction studies," and "interventions facilitating solutions." The results of the study, suggests the followings as appropriate strategies that fit the culture and abilities of the Iranian health system: "culture, the establishment and application of rules", "interventions with a focus on specific groups", "education at all levels and interventions," "organizing training courses and emphasizing the role of the family in protecting adolescents" and “free drug therapy ".