Outcomes of Health Care Reform Implementation in Slum Areas of Isfahan: a qualitative study

Background & Objectives: In slum areas, due to the economic, cultural and social reasons and how health services are delivered, the health status of people needs serious attention. Implementation of health reform plan in Iran led to increased attention to the health of slum area population. The present study was conducted to assess the outcomes of implementation of primary health care services reform in comprehensive health service centers at slum areas in Isfahan. Methods: This qualitative research with phenomenology approach was conducted in 2018. Study samples consisted of 21 experts of health deputy and health providers of comprehensive health services centers in Isfahan University of Medical Sciences selected using purposive and snowball sampling methods. Data gathering was done by semi-structure interview. Data analysis was done using content analysis and through the 10th version of MAXQD software. Results: The outcomes of health Reform Plan implementation in primary health care services provision, at Isfahan's slum area Health Services Centers were organized and classified in 6 main themes and 51 sub-themes. Main themes were promotion of health care availability, private sector participation, management, improvement of staff education and providing resources based on the needs and establishing electronic health records with 51 sub-themes. Conclusion: Feasibility of using public-private partnership models in building, operating, transferring, needs assessing, system evaluation and monitoring of the Comprehensive Health Service Center and compiling the required human resources chart can improve the outcomes of this plan. Key­words: Milestones, Health care reform, Primary health care, Private sector, Slum area Citation: Raeisi AR, Shaarbafchizadeh N, Aghdak P, Fouladi Z. Outcomes of Health Care Reform Implementation in Slum Areas of Isfahan: a qualitative study. Journal of Health Based Research 2019; 5(1): 81-100. [In Persian

Comparing the Effects of the Postural Restoration Exercises with and without Core Stability Exercises in Patients with Non-Specific Chronic Low Back Pain

Introduction: This study compares the effect of postural restoration (PR) exercises with and without core stability exercises on the pain, intensity, function, quality of life (QoL), and passive range of motion (PROM) at lumbo pelvic-femoral complex in patients with non-specific chronic low back pain. Materials and Methods: This was an interventional type of randomized clinical trial study. The participants were 45 female patients (48.1±6.11 years, 161.4±5.06 cm height, 65.08±6.9 kg weight, and 24.9±2.8 body mass index). They were randomly divided into three equal groups: Group 1=PR exercises and core exercises, group 2=PR exercises, and group 3=control group. Pain intensity, function, QoL, and PROM were measured with the visual analog scale, Oswestry disability index, short form-36 questionnaire, and goniometer. The analysis of covariance was used to compare the means in the study groups before and after the intervention. The intervention groups performed the exercises for six weeks. Results: The results showed a significant difference between the QoL, pain intensity, function, and PROM of left hip adduction in the group with PR exercises with and without core exercises and control (P=0.000). In the PR group with core exercises (P=0.001) and without core exercises (P=0.001), a significant increase was observed in the adduction of the left hip. There was no significant difference between the function (P=0.850), pain (P=0.120), QoL (P=0.328), and PROM (P=0.094) in the intervention groups. Conclusion: PR exercises with and without core stability are equally effective in reducing pain and improving function, QoL, and hip adduction range of motion in women with left anterior interior chain patterns

Changing Trend of Breast Cancer in Ardabil Province, Iran by Age Group, Grading, and Gender during 2003-2016

Background: Breast cancer (BC) is the most prevalent cancer in women and the second most common cancer in the world. Two million new cases were reported in 2018. The aim of this study was to investigate the changing trend of BC in the people of Ardabil during 2003-2016. Method: In this cross-sectional descriptive study, we analyzed BC incidence rates using population-based cancer registries stratified by city, age group, gender, and disease grading. We analyzed the collected data by statistical methods in SPSS version 21. Results: The mean age of patients was 48.4±13.1. Of all patients, 98.5% were female, and most were aged 40-60 (56%). The most of BC cases was registered in year 2011 with the most incidence rate about 10.41 per 100000 and the most of cases with 71.5% was registered in Ardabil city. The incidence rate of BC reached from 4.13 per 100000 in 2003 to 6.93 in 2016. The annual percentage change during the study years was 4.1%. Conclusion: Results showed that the incidence rate of BC during study years had an increasing trend in Ardabil’s people and reached from 4.13 per 100000 in year 2003 to 6.93 per 100000 in year 6.93 with Annual percentage change about 4.1%. The trend of BC incidence increased during 2003-2011 and then, decreased during 2011-2016

The healthy behaviours and COVID-19 mortality among Iranian women: A case–control study

Background: Women are among the susceptible groups to Coronavirus disease-19 (COVID-19) in Ardabil, north-west of Iran, despite the current global status. The underlying causes of high incidence and fatality rate of women in Ardabil are not fully understood. Hence, this study aimed to investigate the healthy behaviours in women of Ardabil and its relationship with COVID-19 mortality. Methods: We conducted a case–control study to compare the adherence to health protocols and behaviours with respect to COVID-19 between the infected (261 patients) and healthy (515 persons) women. Health protocols and behaviours such as using mask, gloves, disinfectants, history of travelling and contacting, and attending various gatherings and places during the COVID-19 pandemic along with demographic variables were defined as independent variables, and COVID-19 death rate was defined as the dependent variable. Multivariable logistic regression methods were used to explore the risk factors associated with COVID-19 mortality. Results: Chi-square and Fisher tests showed significant differences between infected and healthy women in terms of history of contact and traveling (p < 0.05), wearing mask (p < 0.001), going to work place (p < 0.001), and attend public gatherings (p = 0.038). Multivariable logistic regression disclosed that the age group over 80 years: 8.97 times (95% CI 2.27–29.85), women with underlying chronic diseases: 4.14 times (95% CI 1.61–10.64), and obese women: 3.01 times (95% CI 1.04–6.03) were more likely to die from COVID-19 than other women. Conclusion: Considering the high incidence and mortality rate in Ardabil women due to COVID-19 and the corresponding health behavioural factors, special emphasis should be given to the increase of women awareness on the importance of healthy behaviours, diet, and life-style

Investigating Middle-aged Health Literacy in Ardabil

Background and objective: Health Literacy is the capacity of individuals to obtain process and understand basic health information and services needed to make healthy decisions .Therefore, this study was designed to determine health literacy of Middle-aged in Ardabil. Methods: This Cross-Sectional study was conducted on 1049 adults aged 20-60 years attending referred Ardabil health centers in 2015. Data collecting tool was Iranian health literacy questionnaire. Data was analyzed by correlation tests, Chi-square, T-test and linear regression using SPSS (16). Results: Mean age participants were 39.59&plusmn;14.1 years. 56.4 percent (n=65) were females. Most participants had Diploma and postgraduate Diploma. Participants had a weak level to access information (76.3%), moderate level in perceive data (59.9%), moderate level in judgment (57.8) and level moderate in use of information (75.1%). Conclusion: Overall, there was moderate health literacy in Middle-aged. It seems necessary training programs be designed according to the needs of Middle-aged with low health literacy. Paper Type: Research Article

Effects of taping on knee joint position sense of female athletes across the menstrual cycle

Introduction: The rate of anterior cruciate ligament (ACL) tearing is more common in female athletes and one of thereasons is the effect of sex hormones. It was illustrated that knee joint position sense (JPS) isaltered across the menstrual cycle and its lowest level is at menses. Therefore, it’s important to find a method to reduce injury risk at menses. Thus, the purpose of this study was to evaluate the effect of taping as a stimulator of skin, on the knee JPS in healthy female athletes across the menstrual cycle with different levels of estrogen and progesterone. Materials and Methods: In this semi-experimental study, 16 healthy female athletes with regular menstrual cycle voluntarily participated. Knee JPS was measured at 3 menstrual cycle phases, before and after patellataping. JPS was evaluated by reproduction of the target angle (30° flexion) in standing position, from full extension. Serum estrogen and progesterone levels were collected in these 3 phases. Knee angles were measured by using a system comprised of skin markers, digital photography, and autoCAD software. Absolute error was considered as a dependent variable.Results: There was a significant difference between the knee JPS in 3 phases of measurement before taping (P=0.025), while no significant difference was found between knee JPS in 3 phases after taping (P=0.965). Conclusion: Findings of this study suggest that healthy female athletes have different levels of knee JPS across a menstrual cycle and its accuracy decreasesat menses. This differencecan be reduced by skin stimulatingmethods, such as taping. Therefore, kinesio taping would improve the knee JPSdeficiency at menses

The evaluation of the MMP-2/TIMP-1 ratio in peptic ulcer and its association with refractory helicobacter pylori infection

Abstract Background Helicobacter pylori (H. pylori) is one of the leading causes of peptic ulcers, and its treatment is a worldwide challenge. Matrix metalloproteinases and their inhibitors influence the development and healing of peptic ulcers. This study aimed to evaluate the ratios of matrix metalloproteinase-2 (MMP-2) to tissue inhibitor of metalloproteinase-1 (TIMP-1) in patients with peptic ulcers that are sensitive or resistant to H. pylori treatment and compare them with healthy individuals. Methods In this study, 95 patients were included and divided into two groups sensitive (41 patients) and resistant to treatment (54 patients). The results were compared with a control group of 20 participants with normal endoscopy and H. pylori-negative. After obtaining written informed consent, five ml of venous blood was taken to determine their serum MMP-2 and TIMP-1 levels using an enzyme-linked immunosorbent assay. Results In patients with H. pylori-induced peptic ulcers, the MMP-2/TIMP-1 ratio was significantly higher than the healthy controls (P < 0.05). MMP-2 level was associated with patients’ response to treatment (P < 0.05). The MMP-2/TIMP-1 ratio was higher in patients with simultaneous gastric and duodenal ulcers (P < 0.05). Conclusion It seems that peptic ulcer disease caused by infection with H. pylori increases the MMP-2/TIMP-1 ratio in patients with peptic ulcers. However, it might not be a good predictor of refractory H. pylori-induced peptic ulcer disease

Menstrual cycle and knee joint position sense in healthy female athletes

Purpose. The aim of this study was to investigate the effect of menstrual cycle on knee joint position sense (JPS) in healthy female athletes. Methods. Sixteen healthy female athletes participated in this study. Serum estrogen and progesterone levels were collected during the three phases of menstrual cycle. The knee JPS was also measured during the same phases using a system comprise of skin markers, digital photography, and AutoCAD software. Absolute angular errors were calculated as well as changes in hormone levels between the three phases. Results. Serum estrogen concentration was significantly higher during the mid-luteal (179.5 Pg/ml) and mid-follicular (125.6 Pg/ml) phases as compared with the early follicular (menses) (22.8 Pg/ml) phase (P = 0.0001). Also serum progesterone concentration was significantly higher during the mid-luteal phase (7.35 Ng/ml) as compared with the menses (0.58 Ng/ml) and mid-follicular (0.5 Ng/ml) phases (P = 0.0001). The greatest amount of mean (SD) value of absolute error was at menses (4. 2°), and the least amount of it was at mid-luteal (2. 5°) phase. Also, a significant difference was observed within three phases of menstrual cycle (P = 0.025). Conclusion. The result of this study suggests that healthy female athletes have different levels of knee JPS across a menstrual cycle. JPS accuracy decreases in menses, when circulating sex-hormones levels are low. Therefore, female athletes are at higher risk of injury at menses and improving their awareness regarding the knee injury risk factors can be a fundamental step toward preventing injuries

Epidemiological study of snakebites in Ardabil Province (Iran)

Introduction: Average annual incidence of snakebite worldwide is between 5.5 to 1.2 million, and at least 125,000 of them are fatal. In Iran, around 4,500-11,000 snakebites occur annually, and a small number of them are fatal. Snake bites can cause intoxity and immediate death in patients, and the aim of this study was to investigate the epidemiological study of snakebites in Ardabil Province. Methods: This study was a cross-sectional that has been done on 67 snakebite patients who were admitted to the Imam Khomeini Hospital of Ardabil during 2008-2013. Information included: age and sex of victims, region of incidence, site of bite, hospitalized duration and symptoms. Data analyzed by descriptive statistical methods using SPSS version 19. Results: There was significant difference between the two sexes (p=0.001). There was no significant difference between the mean age of male and female victims (p=0.68). Most of the victims were in the age group of 20-29 years (34.3%). All snakebites happened in rural areas. There was no significant relation between gender of victims and the residential location of victims (p=0.32). Most snakebites happened during 11 a.m. to 4 p.m. (32.8%). Most of the snakebites occurred in spring and summer seasons. Results showed that most of the bites in yearly months was seen in the summer season and the difference between seasons is significant. (p=0001). Most snakebites, with 38 cases (56.7%), were observed on lower limbs and among them right limbs with 20 cases (52.6%) had the greatest number. There was significant difference between organs of bites in victims because the most organs were in the right lower limb (p=0.002). Of all cases, 66 (98.5%) were injured by a species of viper snake. All patients, showed symptoms of pain, swelling, erythema and ecchymosis bite. Twenty-seven (40.3%) of all cases, suffered fainting. Nausea and vomiting were two other common symptoms. The antidote used in patients was 5.1±1.3 vials. The mean incidence rate of snakebite was an estimated 4.1 per 100000. Conclusions: Possible risk factors include male gender and young age. It was also found that the stings reach peak in the morning and noon. These reports are all in rural areas, and mostly occurred in the warm months. Snakebites in rural parts around Ardebil were

Perceived Attentional Function and Related Factors in Women Following Breast Cancer Surgery

Background: This study examined perceived cognitive function in patients with breast cancer and determined the main predictors of changes in cognitive function following treatment. Methods: The analytical cross-sectional study was performed in this study. 96 women receiving adjuvant treatment after surgery and who had already received adjuvant treatment were included in the study. The convenience sample was selected from the list of patients in Cancer Registry Center, private clinics and the Oncology Ward of Imam Khomeini Hospital in Ardabil, Iran. We used the Attentional Function Index to measure perceived cognitive function. SPSS version 16.0 was used to analyze the data. We used the t-test and analysis of variance to compare the differences in the Attentional Function Index scores to demographic and medical characteristics. Results: The mean Attentional Function Index score was 59.53±1.69. There was a statistically significant difference between the scores in terms of current non-surgical treatment (P<0.000). Regarding the time elapsed after disease diagnosis, the difference between the Attentional Function Index scores was statistically significant (P<0.00). Conclusion: Chemotherapy and hormone therapy can act as risk factors for cognitive impairment in patients with breast cancer