Drug Prescription Indicators in Outpatient Services in Social Security Organization Facilities in Iran.

OBJECTIVES: The aim of this study was to estimate drug prescription indicators in outpatient services provided at Iran Social Security Organization (SSO) healthcare facilities. METHODS: Data on all prescribed drugs for outpatient visits from 2017 to 2018 were extracted from the SSO database. The data were categorized into 4 main subgroups: patient characteristics, provider characteristics, service characteristics, and type of healthcare facility. Logistic regression models were used to detect risk factors for inappropriate drug prescriptions. SPSS and IBM Modeler software were utilized for data analysis. RESULTS: In 2017, approximately 150 981 752 drug items were issued to outpatients referred to SSO healthcare facilities in Iran. The average number of drug items per outpatient prescription was estimated at 3.33. The proportion of prescriptions that included an injection was 17.5%, and the rate of prescriptions that included an antibiotic was 37.5%. Factors such as patient sex and age, provider specialty, type of facility, and time of outpatient visit were associated with the risk of inappropriate prescriptions. CONCLUSIONS: In this study, all drug prescription criteria exceeded the recommended limits set by the World Health Organization. To improve the current prescription patterns throughout the country, it would be beneficial to provide providers with monthly and annual reports and to consider implementing some prescription policies for physicians.

A novel radiofrequency modulation therapy versus routine physiotherapy modalities in treatment of myofascial pelvic pain syndrome: a pilot randomized trial.

OBJECTIVE: The current study aimed to compare the effectiveness of novel radiofrequency modulation (RM) therapy with a tailored physiotherapy course for patients with chronic pelvic pain (CPP) of myofascial origin, also known as myofascial pelvic pain syndrome (MPPS). METHODS: We enrolled 46 patients with myofascial CPP to compare the effectiveness of a 10-session routine physiotherapy course versus a 6-session RM with an integrated device (HIGGS) in alleviating MPPS morbidity and pelvic floor muscle (PFM) rehabilitation. The primary outcome was reduction in pelvic pain after the final session and in the follow-up period 3 months after the final intervention session. RESULTS: The 6-session therapy in the RM group and the manual, biofeedback, and transcutaneous electrical nerve stimulation therapies in the physiotherapy group were similarly effective in reducing pain and improving PFM endurance after the final intervention session in each group, whereas perineometer readings and PFM strength were associated with greater improvements in the physiotherapy group. CONCLUSION: The results of this study demonstrated comparable effectiveness of RM in the management of MPPS and improvement of PFM function compared to routine physiotherapy programs with fewer sessions of therapy.

Association of health literacy and nutritional literacy with sun exposure in adults using structural equation modelling.

BACKGROUND: Inadequate health and nutritional literacy is a common problem among adults, associated with poor health outcomes. Therefore, this study aimed to investigate the relationship between health literacy and nutritional literacy to sun exposure behaviour. METHODS: We conducted a cross-sectional study on 261 adults (18-65 years) in Iran. Data was collected on knowledge, motivation, health literacy, nutritional literacy, and sun exposure behaviour using an interview-assisted questionnaire. Using the information-motivation-behavioural skills model and structural equation modeling, we tested whether health and nutritional literacy were associated with the relationships between knowledge of vitamin D, attitudes toward sun exposure, and sun exposure behaviour. Different models using structural equation modeling were performed to analyze the data. RESULTS: The finding showed that health literacy (ß = 0.29, p < 0.001) and nutritional literacy (ß = 0.14, p = 0.02) was directly associated with sunlight exposure. Indirect relationships also existed between knowledge and sunlight exposure through health literacy (ß = 0.33, p < 0.001) and nutritional literacy (ß = 0.22, p = 0.01). The model had good fit (x2/df = 1.422; RMSEA = 0.040; CFI = 0.851; NFI = 0.657). There was no significant relationship between health literacy and motivation (ß = 0.11, p = 0.16), nutritional literacy and motivation (ß = 0.06, p = 0.42) and motivation and sun exposure (ß = 0.01, p = 0.91). CONCLUSIONS: The findings showed that individuals with sufficient health literacy and nutritional literacy were more likely to have exposure to sunlight. Health and nutritional literacy should be considered when educating adults about vitamin D supplements and sunlight exposure.

The relationship between happiness and self-rated health: A population-based study of 19499 Iranian adults.

BACKGROUND: Health is one of the most important factors that affect happiness. This study aimed to assess the association between happiness and self-rated health among the Iranian adult population. METHODS: This cross-sectional study was conducted on a sample of adults aged 18-65 In Iran in 2020. Demographic information, the Oxford Happiness Questionnaire, and a single item on self-rated health were used to collect the data. The relationship between happiness with demographic variables and self-rated health was examined by performing logistic regression analyses. RESULTS: In all, 19499 were studied (9845 males and 9654 females). The mean age of participants was 36.38± 8.17 years. The mean happiness score was 4.1± 0.57 (out of 6) and this for self-rated health was 3.66±1.2 (out of 5). The results obtained from logistic regression analysis showed that very poor health status (OR: 5.114, 95% CI, P = 4.490-5.824, p <0.001), poor or very poor income status (OR: 1.553, 95% CI, P = 1.406-1.716, p <0.001), unemployment (OR: 1.704, 95% CI, P = 1.432-2.029, p <0.001), being aged 25-34 years (OR: 1.190, 95% CI, P = 1.088-1.302, p <0.001), and years of education (OR for 10-12 years of education: 1.271, 95% CI = 1.174-1.377, p< 0.001) were significant contributing factors to a lower happiness. CONCLUSION: The results showed that self-rated health was the most significant factor that affected happiness even after adjustment for socioeconomic variables, including age, income, employment, and education. Indeed, improving population health might be an effective measure to improve happiness among Iranians.

The Effect of Psychosexual Education on Promoting Sexual Function, Genital Self-Image, and Sexual Distress among Women with Rokitansky Syndrome: A Randomized Controlled Clinical Trial.

STUDY OBJECTIVE: To assess the effectiveness of psychosexual education on promoting sexual function and genital self-image and reducing sexual distress through e-learning among women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. DESIGN: Randomized controlled trial. SETTING: Imam Khomeini Hospital "Pelvic Floor Clinic" in Tehran. PARTICIPANTS: Thirty-eight 15- to 49-year-old women with MRKH syndrome who had undergone surgical or nonsurgical vaginal reconstruction techniques more than 6 months before the intervention were assigned to 2 parallel intervention and control groups of 19 each. INTERVENTIONS: Psychosexual education was delivered through e-learning for the intervention group over an 8-week period, with no limitations of time and space. Sexual function, genital self-image, and sexual distress were evaluated at baseline, and at 4 and 8 weeks after the intervention. MAIN OUTCOME MEASURES: The data collection tools included the Persian version of the Female Sexual Function Index, Female Genital Self-Image Scale, and the Revised Female Sexual Distress Scale. RESULTS: The between group mean differences of sexual function, genital self-image, and sexual distress after 4 weeks (-1.2 [95% CI, -2.1 to -0.1], P = .025; -1.9 [95% CI, -2.9 to -0.9], P < .001; 4.2 [95% CI, 2.0-6.4], P < .001, respectively), as well as after 8 weeks (-1.8 [95% CI, -3.1 to -0.5], P = .009; -3.0 [95% CI, -4.5 to -1.5], P < .001; 6.7, 95% CI, 3.9-9.6], P <0.001, respectively) after baseline were significant. CONCLUSION: Psychosexual education improved sexual function and genital self-image and reduced sexual distress in women with MRKH syndrome. Therefore, using this approach, we can raise individuals' sexual knowledge and skills and correct their sexual beliefs and attitudes.

The Relationship between Different Levels of Health Literacy and Smoking Prevention Among Medical Sciences Student.

BACKGROUND: Higher rates of Smoking among university students have been reported in various studies. On the other hand, health literacy (HL) can improve health behaviors. In fact, identifying factors affecting the adoption of smoking preventive behaviors such as HL can help prevent and reduce the prevalence of smoking among people. The aim of this study was to identify the relationship between different levels of HL and adoption of smoking preventive behaviors among university student in 2016. METHODS: This was a cross-sectional descriptive study. Three hundred and forty-seven dormitory students of Shahid Beheshti University of Medical Sciences in Iran were selected through single-stage cluster sampling for the study. Data were collected using a measure of HL (the HL inventory for adults-HELIA) and a designed questionnaire to assess the adoption of smoking preventive behaviors. The data were analyzed using SPSS software version. 16 and descriptive statistical and Logistic regression test. RESULTS: The mean (SD) of the score for adoption of smoking preventive behaviors and HL were 45.91 (12.99) and 70.52 (14.12) out of 100, respectively. The results showed that the adoption of smoking preventive behaviors had significant relationship with variables such as HL, gender, father's education and not smoking (P < 0.05). CONCLUSIONS: Less adoption of smoking preventive behaviors was seen in students with lower levels of HL, female students, students with illiterate fathers and smokers. Therefore, it seems essential to take these factors into consideration in designing preventive programs for smoking in target groups.

A mobile-based educational intervention on sexo-marital life in Iranian men with spinal cord injury: a randomized controlled trial.

STUDY DESIGN: A randomized controlled trial. OBJECTIVE: To assess the effectiveness of a mobile-based educational intervention on sexo-marital life in Iranian men with spinal cord injury (SCI). SETTING: Foundation of Martyrs and Veterans Affairs', "Spinal Cord Injury Association", and the "Protection Center of Spinal Cord Disables". METHODS: Participants were men with SCI aged at least 18 years old. The effectiveness of a mobile App was evaluated on 70 married men with SCI. Sexual adjustment, sexual satisfaction, marital adjustment, and marital satisfaction were assessed by valid and reliable questionnaires at baseline, 4 and 8 weeks after the intervention. RESULTS: The between-group mean difference (95% CI) of sexual adjustment (4.2, CI: 3.6-4.8) after 4 weeks as well as 8 weeks (8.6, CI: 7.6-9.5) after baseline was significant (P < 0.001). The between-group mean difference (95% CI) of sexual satisfaction (6.9, CI: 8-11.2) after 4 weeks as well as 8 weeks (16.4, CI: 14.1-18.7) after baseline was significant (P < 0.001). There were significant increases in all the domains of marital satisfaction's between-group mean differences after 4 weeks as well as 8 weeks after baseline (P < 0.001). Repeated measures ANOVA showed there was no statistically significant increase in marital adjustment's between-group mean difference (95% CI) after 4 weeks (-0.1, CI: -0.1- 0, P < 0.16) as well as 8 weeks (0.4, CI: -0.3-1.1, P < 0.25) after baseline. CONCLUSION: The application-based educational intervention showed the positive effect of education on sexo-marital life in men with SCI. We recommend the rehabilitation team's healthcare providers embrace this educational strategy for individuals with SCI.

Socio-economic risk factors of household food insecurity and their population attributable risk: A population-based study.

Background: Food insecurity as a major public health problem has associations with a wide range of adverse consequences on health and quality of life. The aim of this study is to determine the prevalence of food insecurity among Iranian households, its key socioeconomic risk factors and population attributable risk via a large-scale cross-sectional study in the capital of Iran. Methods: This cross-sectional study was performed among 30,809 households with complete questionnaires of food security, during 2011. The univariate test was used to investigate the association between economic status and covariates with household food insecurity. Multiple logistic regression model was used to assess the independent effect of economic status on household food insecurity. Results: Totally, 37.8% (95% CI: 37.25, 38.34%) of the households were food insecure. There were significant associations between economic status and household food insecurity after adjustment for other variables (p-value<0.001). The extent of household food insecurity that could be attributed to the economic status in the 1st and 2nd quintiles (poorest and poor households), compared with the 5th quintile (richest households), was estimated to be 48.43% and 60.12%, respectively. Conclusion: Food insecurity is relatively prevalent among households in Tehran. Economic status was identified as the most significant determinant of household food security, as 62.7% of poorest households were food insecure. Therefore, there is a crucial need to address food insecurity as a priority in food policies.

The role of perceived barrier in the postpartum women's health promoting lifestyle: A partial mediator between self-efficacy and health promoting lifestyle.

INTRODUCTION: In recent decades, the focuses of health studies were mostly in middle-aged women, and few studies have investigated the lifestyle of women after delivery. The aim of this study was to determine the effects of both self-efficacy and perceived barriers on Iranian women health-promoting lifestyle (HPL) in the first 1 year after childbirth. MATERIALS AND METHODS: Using a cross-sectional design, 310 women at first-year postpartum were surveyed in Zanjan (Iran) in 2016. The proportionate stratified random sampling method was carried out to select a participant. HPL has assessed with HPL profile II questionnaire. Self-efficacy was assessed using self-rated abilities for health practices scale. Perceived barriers were assessed by Barriers to Health-promoting Activities for Disabled Person scale. A meditational model was used to examine whether perceived barriers mediates between perceived self-efficacy and HPL. RESULTS: The participants mean age was 29.82 (5.1) years, 53.9% were primiparous, and most of them were homemakers (82.9%). The mean total score of HPL was 2.50 (0.29). The relationship between HPL and self-efficacy was mediated by perceived barriers partially. DISCUSSION: Self-efficacy, not only promotes women's HPL but also indirectly affect the women's lifestyle by reducing perceived barriers.

Readiness to change for interprofessional collaboration in healthcare: Development and validation of a theory-based instrument.

This paper presents a study that aimed to develop and validate a theory-based instrument for the assessment of readiness to change for interprofessional collaboration in healthcare (IPC-TTM). The instrument was developed in the Persian language and tested in the Iranian context. Healthcare professionals from medical and nursing professions participated in the assessment of validity and reliability of the instrument. We conducted this psychometric study in two phases: First, the questionnaire was developed based on the transtheoretical model (TTM) through literature review and expert panel. Then, in the validation phase, we held three modified Delphi rounds to assess the content and face validity of the questionnaire. We used confirmatory factor analysis (CFA) to evaluate the fit of the questionnaire as applied to modified TTM. Reliability of the final instrument was tested by assessing the test-retest reliability of instrument items with Kappa coefficient. We also calculated the intraclass correlation coefficient (ICC) and Cronbach's alpha to assess the test-retest reliability and internal consistency of the instrument sub-scales. The initial item pool consisted of 30 items and three sub-scales (Attitude, Intention, and Action). The content validity of the questionnaire was confirmed with 17 items. Based on the CFA results two additional items were deleted to increase the fit of the model. The final instrument was confirmed with 15 items and three sub-scales. Reliability assessment on the 15-item instrument showed an acceptable test-retest reliability of the instrument items. ICC values for the Attitude, Intention, and Action sub-scales of the instrument were calculated as 0.82, 0.73, and 0.71, respectively. Moreover, Cronbach's alpha for the Attitude, Intention, and Action sub-scales were 0.85, 0.73, and 0.77, respectively. This study offers a new theory-based instrument to measure readiness to change for interprofessional collaboration in healthcare in the Iranian context. The questionnaire can be used for 'needs assessment' in developing tailored educational interventions and self-assessments in interprofessional education studies.

Application of the short form of quality of life instrument version 2 in a large population of Tehran.

Background: Quality of life (QoL) is now considered as a key indicator in health studies. Therefore, this study was conducted to evaluate QoL in the general population of Tehran (capital of Iran) using SF-12v2 questionnaire and determine some factors associated with it. Methods: This was part of a large population-based cross sectional study conducted in Tehran, Iran, in 2011. Participants were selected from all districts of Tehran using multistage cluster random sampling method. Data were collected using the Iranian version of the SF12v2 questionnaire. Linear regression model was used to assess the independent effect of surveyed variables of the study population on their QoL. P< 0.05 was considered statistically significant. Results: Overall, 30 809 individuals over the age of 20 from 22 urban districts were included in this study and evaluated by SF-12v2 questionnaire. The mean age of the study population was 44.5±15.9, and most of them were female (19 967 (64.8%)). The total mean score of SF-12v2 was 60.4 and the lowest and highest mean scores were observed in GH (46.9±26.5) and MH subscales (64.1±24.7), respectively. It was also observed that District 3 of Tehran had the highest mean score (65.2±18.7) in the total QoL and District 12 had the lowest mean score (56.6±18.7), respectively. The results of multiple linear regression model showed that sex, age, education, household size, presence of chronic disease in family, having insurance, smoking, and marital status were significantly related to most subscales and two summary components of QoL. Conclusion: The results of this study showed that the surveyed population of Tehran had a relatively moderate QoL, but it changed from district to district. It was also observed that age and education of the study population were important variables in relation to QoL.

Different patterns of association between education and wealth with non-fatal myocardial infarction in Tehran, Iran: A population-based case-control study.

BACKGROUND: Myocardial Infarction (MI) is a main cause of death and disability worldwide, which involves a number of genetic, physiopathologic and socio-economic determinants. The aim of this study was to assess the patterns of association between education, wealth and some other risk factors with non-fatal MI in Tehran population. METHODS: Data derived from a second round of large cross-sectional study, Urban HEART-2, conducted in Tehran in 2011. Out of 118542 participants, all 249 self-reported incident cases of nonfatal MI were selected as the case group. A number of 996, matched on age and sex, were selected as controls. Principle component analysis (PCA) was used to calculate wealth index and logistic regression model to assess relations between the study variables. RESULTS: Mean (SD) age of participants was 60.25 (12.26) years. A total of 870 (69.9%) of the study subjects were men. Education, wealth status, family violence, hypertension and diabetes were observed as independent predictors of non-fatal MI. Overall, as the level of education increased, the odds of non-fatal MI decreased (p<0.001). We observed an almost J-shaped association between wealth status and non-fatal MI. No significant associations were found between marital status, BMI and current smoking with non-fatal MI (p<0.05). CONCLUSION: We found different patterns of association between education and wealth with nonfatal MI among Tehran adults. Lower risk of non-fatal MI is linked to high educated groups whereas economically moderate group has the lowest risk of non-fatal MI occurrence.

Response-oriented measuring inequalities in Tehran: second round of UrbanHealth Equity Assessment and Response Tool (Urban HEART-2), concepts and framework.

BACKGROUND: Current evidence consistently confirm inequalities in health status among socioeconomic none, gender,ethnicity, geographical area and other social determinants of health (SDH), which adversely influence health ofthe population. SDH refer to a wide range of factors not limited to social component, but also involve economic, cultural,educational, political or environmental problems. Measuring inequalities, improving daily living conditions, andtackling inequitable distribution of resources are highly recommended by international SDH commissioners in recentyears to 'close the gaps within a generation'. To measure inequalities in socio-economic determinants and core healthindicators in Tehran, the second round of Urban Health Equity Assessment and Response Tool (Urban HEART-2)was conducted in November 2011, within the main framework of WHO Centre for Health Development (Kobe Centre). METHOD: For 'assessment' part of the project, 65 indicators in six policy domains namely 'physical and infrastructure','human and social', 'economic', 'governance', 'health and nutrition', and also 'cultural' domain were targetedeither through a population based survey or using routine system. Survey was conducted in a multistage random sampling,disaggregated to 22 districts and 368 neighborhoods of Tehran, where data of almost 35000 households(118000 individuals) were collected. For 'response' part of the project, widespread community based development(CBD) projects were organized in all 368 neighborhoods, which are being undertaken throughout 2013. CONCLUSION: Following the first round of Urban HEART project in 2008, the second round was conducted to trackchanges over time, to institutionalize inequality assessment within the local government, to build up community participationin 'assessment' and 'response' parts of the project, and to implement appropriate and evidence-based actionsto reduce health inequalities within all neighborhoods of Tehran.