فهرست مطالب
Journal of Health Scope
Volume:10 Issue: 1, Feb 2021
- تاریخ انتشار: 1400/01/10
- تعداد عناوین: 10
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Page 1Background
Cross-border health care, whether sanctioned by the governments (out-of-country care) or initiated by the patients (medical tourism), is on the rise globally. The medical tourism industry has shown great potential for improvement in Iran.
ObjectivesWe aimed to examine the representation of data elements on Iranian public and private medical tourism websites and evaluate their content maturity.
MethodsA descriptive cross-sectional design was used to gather and statistically analyze data from 12 medical tourism websites.
ResultsThe highest level of data representation was provided for medical tourism attractions and destinations, followed by the geographical location of hospitals and the establishment of tourist agencies. Very few websites featured data elements on admission forms. Fisher's exact test revealed no statistically significant difference in the representation of data elements between the providers of medical tourism websites (P > 0.05). Most privately owned medical tourism websites and only one in the public sector had a moderate-content status. No website was confirmed to be rich or poor regarding their maturity.
ConclusionsMore investment is required for the development of information and communication technology infrastructures in the Iranian medical tourism industry to attract foreign service-users, although many other factors such as political and economic forces may be involved.
Keywords: Iran, Website, Medical Tourism, Medical Tourist, Health Care, Cross Border, Data Element -
Page 2Background
Homeless people are prone to sexually transmitted and blood-borne infectious diseases such as hepatitis B, hepatitis C, and HIV due to their risky behaviors and low awareness of various diseases.
ObjectivesThus, the present research aimed to examine the epidemiologic patterns of HBV, HCV, HIV, and related factors among the homeless population of Zahedan in 2019.
MethodsA cross-sectional study was conducted on a total of 329 homeless people. Eligible people were selected using a convenience sampling method from homeless individuals residing in care centers affiliated with the Welfare Organization and the Health Deputy of Zahedan University of Medical Sciences. Data on the demographic and behavioral characteristics of the cases were collected through a structured questionnaire completed in face-to-face interviews. A 10 cc blood sample was taken from each of the cases for serological tests of hepatitis B, hepatitis C, and HIV. The test results and collected data were entered in SPSS16 software. Logistic regression analysis and chi-square tests were used to analyze the data.
ResultsThe majority of the cases (84%) were males, and 59% were in the age-group of 35 - 50 years. Of the subjects, 93% had a history of drug abuse, 74% reported a history of smoking, and 45% had tattoos. The prevalence of hepatitis C, hepatitis B, and HIV was 13%, 2.7%, and 0.3%, respectively (only one case of HIV was identified). In a multi-variate model, imprisonment history [OR = 2.32 (1.08 - 4.98)], history of sexual abuse [OR = 3.73 (1.36 - 10.26)], being widowed or divorced [OR = 2.83, (1.21 - 6.64)], and history of injection with shared needles and syringes [OR = 5.11 (1.97 - 13.28)] remained the predicting factors of hepatitis C.
ConclusionsBased on the obtained results of the study, homeless people are more prone to infections with HCV, HBV, and HIV due to their risky behaviors. Therefore, a need is highlighted for preventive interventions and developing the level of health literacy in this group regarding behaviors contributing to the aforementioned infections.
Keywords: HIV, HCV, HBV, Homeless People -
Page 3Background
Today, medical tourism is a growing phenomenon in the healthcare industry, especially among developing countries.
ObjectivesThe purpose of this study was to compare the Iranian medical tourism industry with selected countries.
MethodsThis comparative study was conducted in 2020. Data were gathered from databases, including PubMed, Web of Knowledge, Scopus, Magiran, SID, and websites of the World Tourism Association, the Ministry of Tourism, and the Ministry of Health of the selected countries from 2000 to 2020. A researcher-made checklist was used to collect data. Selected countries were compared in terms of the status of tourism and travel competitiveness, governance and policy-making status, the status of the medical tourism industry, and medical tourism infrastructure
ResultsThe main difference between the selected countries and Iran lies in the organizational structure of the main stakeholders of the tourism industry. In other countries, this industry is organized and supervised by specific coordination bodies. In terms of tourism and travel competitiveness, Singapore, with a global rank of 17, was better than other countries. Based on the status of the medical tourism industry, Costa Rica ranked 7th in the world, and Singapore, the UAE (Dubai), Turkey, UAE (Abu Dhabi), Jordan, and Iran ranked 15, 22, 27, 31 35, and 41, respectively. In Iran, all indicators of medical tourism infrastructure were lower than those of other countries except for competitive prices.
ConclusionsConsidering a low rank of Iran in all the studied components, the organizational integration structure of the medical tourism industry and increasing competitiveness can help the development of this industry in Iran.
Keywords: Medical, Developing, Countries, Comparative Study, Health Tourism, Tourism -
Page 4Background
Sedentary occupations frequently expose employees to prolonged periods with poor posture, which has been considered as the cause of musculoskeletal disorder.
ObjectivesThe study set out to identify the related factors of a taking healthy sitting posture in office workers.
MethodsThis qualitative study aimed to use the theoretical domains framework (TDF) to investigate perceived determinants to taking a proper sitting posture in office workers. Semi-structured interviews with 25 office workers according to purposive sampling was conducted with a convenience sample of university office workers in Iran. Recorded interviews were transcribed into MAXQDA version 10. Directed content analysis and framework analysis were used for drawing the 12 domains of the TDF.
ResultsExplored themes were mapped onto the TDF domains, including skills, knowledge, behavioral regulation, goals, environmental context and resources, social influences, beliefs about capability, intentions, emotion, beliefs about consequences, memory, and attention and reinforcement.
ConclusionsThis study is a theoretical starting point in making structured interventions to change improper sitting posture among office workers. Also, the identified factors provide organizational managers with a wide list of factors by which they can encourage their employees to use proper postures in the workplace, leading to a significant reduction in job absenteeism and insurance fees associated with health problems. In addition, this study enriches the literature by providing additional empirical evidence for the TDF theory.
Keywords: Sitting Posture, Theoretical Domain Framework, Office Worker -
Page 5Background
COVID-19 patients with preexisting comorbidities are at increased risk of exacerbated symptoms.
ObjectivesThe current study aimed to firstly assess the impact of predisposed comorbidities on the severity of COVID-19, and secondly investigating the associated clinical outcome of patients with COVID-19 infection in Bangladesh.
MethodsIn this single-center retrospective study, the medical data of 157 hospitalized COVID-19 patients, including their preexisting comorbidities, from April 30, 2020, to June 15, 2020, are analyzed. Patients’ clinical outcomes in moderate-to-critical COVID-19 infections need for Intensive Care Unit (ICU) and mechanical ventilation support, and mortality were evaluated, with emphasis on predisposed chronic diseases.
ResultsApproximately 40.1 and 7.6% of patients (n = 157) presented severe and critical COVID-19 symptoms, respectively (P = 0.001). The most common comorbidity was diabeties (24.8%), followed by hypertension (23.2). Patients with one or two comorbidities did not present critical symptoms. Most of the critical cases had at least five comorbidities compared to those with 3 or 4 comorbidities (33.3% versus 8.3%; P = 0.038). The highest incidence of critical COVID-19 (41.7%) was among those with 7 comorbidities. Compared to patients with 4 or fewer comorbidities, patients with 5 (n = 15), 6 (n = 4), and 7 (n = 7) comorbidities were more hospitalized at ICU (above 70%, P = 0.025) and had a higher need for intubation support (above 60%, P = 0.038), and presented higher 30-day mortality (6.7, 25, and 28.6%, respectively; P = 0.002), which can be attributed to the declined clinical outcome of patients with 5 or more comorbidities in moderate-to-critical COVID-19 infection.
ConclusionsThis study demonstrated a positive association between the severity of COVID-19 and the number of predisposed comorbidities, which leads to poor clinical outcomes.
Keywords: Intensive Care Unit, Intubation, Mortality, Comorbidities, Length of Hospital Stay, COVID-19 -
Page 6Background
World Health Organization estimated that 1 in 4 men and 1 in 5 women have hypertension (HTN). Considering the impact of high blood pressure (BP) identification to prevent its related complications.
ObjectivesThis study was performed to describe the first national BP screening program conducted in Babol, north of Iran.
MethodsIn this historical cohort carried out at Babol University of Medical Sciences, data related to the 2019 BP screening mass campaign in adult people ≥ 30 years were collected. BP less than 120/80 mm Hg was considered as normal, and mean BP ≥ 140/90 mm Hg or taking antihypertensive medication was defined as hypertension. When the systolic pressure was 120 - 139 or the diastolic pressure was 80 - 90 mm Hg, the person was classified as a prehypertensive case.
ResultsTotally, 220,241 adult people, with a mean age of 49.82 ± 14.26 years were screened, of whom 42,107 cases (19.1%; 95% CI: 18.95 - 19.28%) had hypertension, 112,406 cases (51.0%) had normal BP, and 65,728 cases (29.8%) were diagnosed as prehypertensive cases. After controlling for demographic covariates, the logistic regression models showed significantly higher odds of hypertension for married individuals (adjusted OR = 1.23; 95% CI: 1.19 - 1.27; P < 0.0001) and those living in urban regions (adjusted OR = 1.84; 95% CI: 1.79 - 1.88; P < 0.0001). The prevalence of hypertension showed no significant difference between men and women (P = 0.476).
ConclusionsAs nearly one in five adults had hypertension, and nearly 30% were diagnosed as prehypertensive individuals, a continuous BP screening program is recommended in this region. High BP was observed more in older and married cases and in people living in urban regions.
Keywords: Blood Pressure, Hypertension, Mass Screening, Noncommunicable Diseases -
Page 7Background
Clinical decision support (CDS) functionalities in Computerized Provider Order Entry system (CPOE) need to be identified by the institutional healthcare providers in developing countries. In this regard, CDS functionalities should be a priority for the execution in CPOE.
ObjectivesThus, our study was done to identify and prioritize the CDS functionalities in CPOE.
MethodsA Two-round Modified Delphi process was used. Firstly, a systematic search was conducted in electronic databases from the date of database inception to February 2019 for identifying CDS functionalities integrated into CPOE. Studies were retrieved from databases, including PubMed, Embase, ProQuest, Scopus, Web of Science, Cochrane, Science Direct, ACM digital library, and IEEE Xplore Digital Library. Secondly, the Modified Delphi method was carried out in 2019 to provide contextual priorities regarding CDS functionalities in CPOE in two iterative rounds. A total of 12 experts working in the three Intensive Care Units (ICUs) with more than three years of experience with homegrown CPOE in Shiraz Nemazee Teaching Hospital, including two clinical pharmacists, two health information management faculty member, four cases with critical care fellowship, and four critical care experts participated in the study. The ≥ 66.6% agreement was considered as the consensus level. SPSS software version 24 was used for statistical analysis.
ResultsTotally, 327 studies, which met eligibility criteria were found. A number of 60 potential CDS functionalities in CPOE were identified from eligible studies. Also, 13 out of 60 CDS functionalities reached high priority consensus after 2 iterative Delphi rounds, including drug-allergy checking (83.3%), basic dosing guidance (75%), single dosing checking (66.7%), duplicate therapy checking (66.7%), drug-pregnancy alerts (75%), time-based alerts (66.7%), alert for deep vein thrombosis prophylaxis (66.7%), alerts for duplicate medication order checking (66.7%), drug-drug interaction checking (75%), intelligent dosing guidance based on the patients’ characteristics (66.7%), renal-drug problems checking (83.3%), drug-disease interaction checking (66.7%), and displaying medication/test cost (75%).
ConclusionsOur study identified high-priority CDS functionalities to be considered in the CPOE system from the viewpoint of multidisciplinary experts, especially in Iran. Results of this study may be beneficial to plan, design, and implement CDS functionalities in CPOE in the ICU.
Keywords: Intensive Care Units, Decision Support Systems, Computerized Provider Order Entry, CPOE, Medical Order Entry Systems -
Page 8Background
Self-care is one of the important aspects of treatment in hemodialysis patients. This study was done to determine the effect of the family-centered empowerment model on the self-care of hemodialysis patients.
MethodsThis study was performed on 100 hemodialysis patients referring to the Zahedan hemodialysis department in 2018. For the intervention group, the family-centered empowerment model was executed in four stages, including understanding the threat, problem-solving, educational participation, and evaluation according to the steps of the model, and the control group received the usual care of the department. The data collection tools were the demographic information questionnaire and self-care questionnaire. Data were analyzed using SPSS V.22 by analysis of variance (ANOVA), independent t-test, repeated measures t-test, and Chi-square test.
ResultsBased on the independent t-test, the mean self-care score of patients in the intervention and control group was significantly different (P < 0.001). There was a significant difference in the "main caregiver relation" variable (P = 0.006). The results of the "time" and "intervention" effects of this test also showed that these two variables had a significant effect on mean self-care scores (P < 0.001). The results of ANOVA showed that self-care score changed in the two groups there was an increase in the self-care score in the intervention group compared with the control group (P < 0.001).
ConclusionsImplementing the family-centered empowerment model in hemodialysis patients by strengthening the ability of the patient and their families to care provides a platform for their promotion and maintenance of their self-care.
Keywords: Hemodialysis, Self-care, Family-Centered, Empowerment Model -
Page 9Background
Schizophrenia is one of the most serious psychiatric diseases that affects the patient’s family members in addition to the patient himself. This disease can lead to depression and anxiety in the family members of the patient and even affect their functioning.
ObjectivesThe present study was conducted to investigate the effect of a short-term family psychoeducation course on the depression and anxiety family functioning in caregivers
MethodsIn this before-after clinical trial, 163 first-degree family members of patients with schizophrenia were invited to participate in a short-term FPE course. A total of 65 of this group attended the first training session. Prior to the first session, the beck depression inventory (BDI), the beck anxiety inventory (BAI), and the family assessment device (FAD) were completed for the participants based on a family functioning model. Six months after the end of the FPE course, the 36 subjects who had completed the initial questionnaires and fully attended the sessions were invited to complete the questionnaires again. A total of 31 subjects completed the questionnaires again at this stage. The data were analyzed by SPSS-20 software using Mann–Whitney and Wilcoxon rank tests.
ResultsThe mean age of the participants in both stages of questionnaire completion was 48.64 ± 11.85 years. Among them, 16 (51.6%) were female, and 15 (48.4%) were male. Also, six (19.4%) subjects had an education above high school, and mothers were the most frequent participating family members with a frequency of 11 (35.5%). The anxiety and depression scores of these subjects were 10.8 ± 5.14 and 6.9 ± 2.45 at baseline, respectively. These scores decreased significantly after six months to 5.03 ± 2.48 and 4.40 ± 1.9, respectively. In addition, among family functioning, Role and Behavioral control was significantly improved (P-value < 0.05).
ConclusionsThe results of this study showed that depression and anxiety levels decreased in the family members of the examined patients six months after an FPE course. This effect can be further investigated through studies conducted with control groups. These findings suggest that the integration and institutionalization of FPE programs in the healthcare system are essential for improving the status of patient caregivers with severe psychiatric illnesses and their families.
Keywords: Schizophrenia, Caregivers, Family Education -
Page 10Background
Although the number of pedestrian traffic accidents is decreasing worldwide, more than one-third of traffic fatalities in Iran are related to pedestrians. High-risk behaviors of pedestrians increase their vulnerability to road traffic injuries.
ObjectivesThis study aimed to investigate gender differences in adopting safe pedestrian behaviors in Tabriz, Iran.
MethodsThis cross-sectional study was carried out among pedestrians aged 18 years and over (n = 508) living in the second municipal district of Tabriz, Iran. The stratified random sampling method was used to recruit a representative sample of adults from 23 July to 21 November 2019. A standardized, structured questionnaire was used for evaluating traffic behaviors in five domains (i.e., adhering to traffic rules, pedestrians’ traffic violations, positive pedestrian behaviors, pedestrians’ distraction, and pedestrians’ aggressive behaviors). The data was analyzed by SPSS version 22 using independent t-test, regression, chi-square, and ANOVA tests.
ResultsOverall, 58.5% of the participants were female. Women had significantly higher scores in three domains of pedestrian traffic behaviors (i.e., no traffic violations, not being distracted, and not having aggressive behavior) than men (P < 0.001). Additionally, married women and women with higher education levels earned significantly higher scores than others in total pedestrian traffic behaviors. There were significant differences between men and women regarding the use of a personal car and walking daily more than an hour (P < 0.05).
ConclusionsOur findings suggest gender differences in the five dimensions of pedestrian traffic behaviors in Iran. Gender-specific risk reduction strategies in the Iranian pedestrians’ safety intervention programs may promote safe traffic behaviors of pedestrians.
Keywords: Gender, Pedestrian, Traffic Accident, Safety Behavior