1 1680-7626 Iranian Institute for Health Sciences Research, ACECR 30 Designing media diplomacy for international awareness for health tourism Amir Rastegar b Bagher Sarokhani c Shahnaz Hashemi d Shahnaz Hashemi e b Islamic Azad University, Science and Research Branch, Tehran, Iran c Islamic Azad University, Science and Research Branch, Tehran, Iran d Islamic Azad University, Central Branch of Tehran, Iran e University of Police, Tehran, Iran 1 8 2018 17 4 349 360 10 06 2018 Objective (s): Health tourism has a high strategic importance for the economy of the country due to its high capacity to create foreign currency earning and job creation through attracting tourists and exporting healthcare and helping the country to engage constructive interaction with the countries of the region and the world and promoting internal convergence. Health tourism in Iran, despite the high quality of healthcare services and low prices, has not yet reached its proper position in the global market and it is taking its first steps due to lack of proper information-dissemination and advertising among other factors. In order to reach health tourism goals, a study was conducted to take advantage of the capacity of media diplomacy at international level. Methods: 25 in-depth and semi-structured interviews were conducted from 25 participants. In this study, grounded theory of Corbin and Strauss (version 2008) was used to collect and analyze data. Data analysis was carried out in four stages including: data analyzing for concept, data analysis for context, process analysis, data and integrating categories, which resulted in the following findings. Results: Overall about 940 first-level codes (open code) were extracted without their overlap calculation. Then, these codes were compared based on existing similarities and differences and 26 sub-subcategories (including concepts and contexts) were obtained. Consequently 11 sub-categories were produced and then four main categories for concept and one main category for context were created. Finally, one core variable was emerged. The core variable was ‘integrated management in media diplomacy in public relations centers of organizations responsible for health tourism’. Conclusion: Media diplomacy in public relations centers of the organizations responsible for health tourism is in fact a channel for announcing the position of the organization at international level, sending information and convincing a foreign audience to support the organization positions. With having media diplomacy, tourism organizations can have a share in the global market.
31 Self-care in health system: Prevention and management dimensions Farzaneh Maftoon Mojgan sharifan Fatemeh Naghizadeh Moghari 1 8 2018 17 4 361 370 31 07 2018 Objective (s): Self-care is the conscious, acquired, and purposeful activities that people take to preserve their lives and provide, maintain and enhance their own health and their families. In self-care, people use their knowledge, skills, and power as a source to take care of their health responsibly. Every human being inherently has the power and ability to take care of himself, and this is the gem that God has given to him. Self-care is not a substitute for professional and organizational care, but a complement to it and one of the determinants of using it. From this perspective, self-care is more about interacting with a health care system, and as a result of self-care, we will have a more efficient health care system. Regarding the main dimensions of self-care, various sources have addressed this issue with different approaches.Some researchers have classified self-care into health SC and medical SC. In another approach, four types of activities include regulatory self-care, preventive self-care; reactive self-care and restorative self-care are the main types of self-care. This study includes the main aspects of self-care in prevention levels and outlines the dimensions of self-care management in the health service delivery system. Methods: In this qualitative study, after a literature review, the research group developed the draft of the main dimensions of self-care, based on levels of prevention, and self-care management. Then findings shared with an expert panel. The expert panel included experts on epidemiology and public health, health education, health management, family health and clinical experts. The panel finalized the different levels of prevention and management dimensions of self-care in health delivery system. Results: The main dimensions of self-care were determined as follows: for first level of prevention, the main dimensions of self-care were: health maintenance and promotion, Lifestyle modification, Disease prevention; for the second level of prevention (secondary prevention), the main areas of self-care included the following three areas: early diagnosis, treatment and control of latent diseases; patient compatibility with the diagnosis of a disease (coping); compliance with the onset of timely treatment; for the third level of prevention (tertiary prevention), the following five dimensions were identified: diagnosis of diseases, treatment and control, patient compatibility with illness or disability, evaluation of symptoms and proper drug use, Palliative and rehabilitation care. Regarding implementation of self-care in health delivery system, at least three aspects should be considered: preparation of the system, preparation of patients, and payment mechanisms. Conclusion: According to the findings of this study, self-care is an integral part of all areas of care, and therefore health plans should be designed with a self-care reinforcement approach. Structured and evidence-based implementation of a comprehensive self-care support system is the first priority. The establishment of a health care provider that promotes and facilitates self-care behaviors should be the focus of future executive and management studies. 32 Self-care behaviors and its related factors in patients with heart failure Zahra Farghadani i Zahra Taheri-Kharameh j Alireza Airi-Mehra k Ali Montazeri l i Students Research committee, Qom University of Medical Sciences, Iran j School of Paramedical Sciences, Qom University of Medical Sciences, Iran k Students Research committee, Hamadan University of Medical Sciences, Hamadan, Iran l Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran 1 8 2018 17 4 371 379 26 06 2018 Objective (s): Self-care could prevent frequent admission and promote health in patients with heart failure. The purpose of this study was to evaluate the self-care and its related factors in patients with heart failure. Methods: In this cross-sectional study, 100 patients with heart failure who were referred to teaching hospitals in Qom, Iran  were selected through convenience sampling. The data were collected using a demographic questionnaire and the Self-care of Heart Failure Index (SCHFI) and the European Heart Failure Self-care Behaviour Scale (EHFSCBS). Data were analyzed using descriptive statistics, and multiple regression analysis. Results: The mean age of patients was 55.13 ± 13.76 years and 59% were men. More than half of the patients had moderate self-care status. The highest and lowest self-care scores were related to self-confidence in self-care with mean and standard deviation of 58.82 ± 17.47 and self-care management with mean and standard deviation of 53.94 ± 15.41. The results of regression analysis showed that there was a significant relationship between the variables studied, duration of illness and discharge fraction with self-care (P <0.05). Conclusion: The findings showed that self-care status of patients with heart failure was moderate. The focus and attention in nursing care and medical care, in order to improve and promote the self-care status, especially management of self-care in these patients, seems necessary. Further studies on the barriers and facilitators of self-care behaviors are recommended. 33 Respecting offspring of embryo donation’ rights based on ethical principles Azar Yahyaei m Noora Kariman n Mehrzad Kiani o Hamid Reza Daneshparvar p Soodeh Shahsavari m School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran n School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran o School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran p Forensic Medicine Organization, Tehran, Iran School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran 1 8 2018 17 4 381 398 06 06 2018 Objective (s): Embryo donation is one of new technologies, which in recent decades has been used for the treatment of infertile couples. However, its usage, like other new biotechnology methods raised some ethical concerns. Since compatibility of such improvements with ethical standards in order to protect individuals against the misuse of new technologies should be guaranteed, the present study was designed to determine the ethics of embryo donation. Methods: This was a descriptive study of quality of services provided in 11 embryo donation infertility centers from Oct 2013 to July 2014 by interviewing 100 couples seeking embryo donation in the Tehran Central Forensic Center. The embryo donation instructions of these centers were collected. The research instrument was two questionnaires that assess ethics of embryo donation processes in infertility centers. The findings were analyzed using descriptive statistics. Results: In more than 50% of cases, brief information on different aspects of embryo donation process had been given to applicants and in 80% of cases; the necessity of legal or jurisprudence expert advices had not been provided. In 56% of cases, applicants’ mental health was not determined and in 64% of cases, the applicants’- embryo compatibility issues had not been studied. In 76% of cases, the embryo donation process had been described strictly confidential and in 28%, there was a conflict of interests between doctor and patient in infertility centers selection. There were no restrictions or priority in service provided and in most cases the donated embryo health was not guaranteed. There were no constitutional arrangement to guarantee child interests such as heritage, incest and etc. Conclusion: The findings indicated that ethics of offspring of embryo donation such as autonomy, justice, beneficence and efficiency rarely were discussed with donors. 34 Evaluation of the Incidence of Neurodevelopmental Disorders in Children Aged 1 to 3 Years with Congenital Hypothyroidism Treated with Levothyroxine Ramin Mozafari kermani Ahmad Ahmadi Jila Sedighi Mahmoud Tavoussi Aliasghar Haeri Mehrizi Rahele Rostami Fatemeh Naiimi Health Metrics Research Center, Institute for Health Sciences Research, ACECR, Tehran, Iran Fellowship of Pediatric Endocrine.Baghiatollah Hospital, Tehran, Iran Health Metrics Research Center, Institute for Health Sciences Research, ACECR, Tehran, Iran4. Mahmoud Tavoussi Health Metrics Research Center, Institute for Health Sciences Research, ACECR, Tehran, Iran Nursing student at the Faculty of nursing, Aja University of Medical Sciences 1 8 2018 17 4 399 407 17 06 2018 Objective (s): To assess the incidence of neurodevelopmental disorders in children aged 1 to 3 years with congenital hypothyroidism treated with Levothyroxine. Methods: In a historical cohort study, 122 neonates with congenital hypothyroidism under treatment with levothyroxine and 122 healthy children aged between one and three years were evaluated by the ASQ questionnaire for their neurodevelopmental status. Sampling was done non-randomly. In the exposure group, questionnaires were asked by telephone or they were invited to the clinic for an assessment period after contact with them. In the healthy children group (control group), children who were referred to the clinic for periodic examinations were selected. Results: Overall 17.2% of children with congenital hypothyroidism and 12.3% of health children failed to obtain tershold score for developmental test giving a relative risk of 1.4, but the risk was was not significant. Conclusion: The study showed that children with congenital hypothyroidism would develop normally if diagnosis and initiation of treatment starts at age under one month. The prescribed dose of 10 micrograms per kilogram of baby weight at the start of treatment and adjusting the dosage of the drug correlate with the age and weight of the child and continuing until the age of three, will lead to normal development in children. 35 Happiness among young adults in Iran: a nationwide cross sectional study Ali Montazeri Mahmoud Tavousi Aliasghar Haeri Ramin Mozaffari Fatemeh Naghizadeh Moghari Mahdi Anbari Akram Hashemi 1 8 2018 17 4 409 420 18 07 2018 Objective (s): To assess happiness and its correlates among young adults in Iran. Methods: This was a national cross sectional study among a representative sample of young adults in Iran, in 2017. Happiness was measured using the Oxford Happiness Questionnaire. Logistic regression analysis was performed in order to examine association between happiness and independent variables. Results: In all 14292 young adults were studied. The mean (SD) happiness score for the study sample was 4.09 (0.57) which was suggestive of ‘rather happy; pretty happy’ condition. Proportional to mean score 51.1% (n = 7306) of the respondents were ‘happy’ and the remaining 48.9% (n = 6986) were ‘unhappy’. In multivariate logistic regression analysis no significant association was observed between happiness, age, gender, and education. However, the association between happiness and income [OR for poor/very poor= 1.69, 95% CI: 1.51-1.90] and employment status [OR for unemployed = 1.88, 95% CI: 1.53-2.32] was evident. Conclusion: The findings suggest that overall young adults in Iran feel ‘rather happy’. To improve happiness at individual level equal distribution of opportunities and wealth seems essential. 36 Sexual quality of life in pregnant women: A cross sectional study Nezal AJ Fatemi Samii Rad Mehri Kalhor kobra hasanpour Mahmood Alipour Ali Montazeri School of Nursing and Midwifery, Qazvin University of Medical sciences, Qazvin, Iran Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran Kowsar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran School of Nursing and Midwifery, Qazvin University of Medical sciences, Qazvin, Iran School of Nursing and Midwifery, Qazvin University of Medical sciences, Qazvin, Iran Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran 1 8 2018 17 4 421 429 23 07 2018 objective (s): Sexual dysfunctions are the most common problem in women during reproductive life and pregnancy is associated with physiological changes in sexual function.. This study aimed to evaluate the sexual quality of life of women during pregnancy. Methods: This cross-sectional study conducted on a sample of pregnant women referred to a teaching hospital affiliated to Qazvin University of Medical Sciences from October 2012 to July 2014. The data from these participants were obtained by a questionnaire consisting of three parts: demographic, history of obstetric information and sexual quality of life for women (SQOL-F). Women were followed-up during the 9-month in three trimester quarter. Data were analyzed by statistical tests (chi-square, t-test, and analysis of variance). Results: A total of 300 women participated in the study with an average age of 2 .29 ± 4.13 years. The results showed that as pregnancy progressed, sexual quality of life decreased significantly (P=0.03). Conclusion: The results showed that the sexual quality of life in pregnancy in the first, second and third trimesters varied and as pregnancy progressed sexual quality of life declined. Since sexual quality of life is an important issue in couple’s relationships, consultation for better adaptation to the physical and psychological changes during pregnancy seems essential. 37 Pre-marital counseling based on Islamic-Iranian culture Raziyeh Ekhtiari Amiri Kiiumars Farahbakhsh Atousa Kalantari Hormozi Hossein Salimi Bejestani 1 8 2018 17 4 431 442 28 07 2018 bjective (s): Marriage is the most important and most excellent social coustom. The aim of this paper was to compile and develop a model for pre-marital counseling proportionate to the cultural ground and social values In Iran. Methods: The study was consisted of two stages. In stage I a sample of experts in pre-marriage counseling were interviewed. Interviews continued until data saturation. Then, thematic analysis was performed to explore the data. In stage II Islamic resources were reviewed to formulate a pre-marriage counseling pattern. Results: Stage I: In all 25 experts were interviewed and several themes including personal and family assessment emerged. Stage II: from the Islamic viewpoint faith was found to be the most important issue in marital relationship. was developed using the two parts’ findings. Conclusion: A desirable pre-marriage counseling model should focus on similarities in all aspects between couples. Perhaps using such criteria could help both counselor and couples to establish an stable family. 38 Prevention strategis of unplanned pregnancies among adolescents: A systematic review Neda Nik khesa Roghayieh Nourizadeh Saeed Dastgiri Esmat Mehrabi 1 8 2018 17 4 443 453 11 08 2018 Objective (s): Unwanted pregnancies and sexual health problems, and consequently illicit abortions and sexually transmitted diseases, may also occur among adolescents. Therefore, in the present study, we investigated various interventions that were used in studies to prevent unwanted pregnancy among adolescents through a systematic review. Methods: An extensive literature search was conducted using the Google Scholar, Cochran Library, SID, Magiran, Web of Science, Scopus, Pubmed, e-learning databases on clinical trials conducted during 1990 and 2018. To evaluate the quality of the studies, the Cochran tools for RCT were used. Finally, 15 studies were selected for systematic review. Results: Overall, based on findings from the review of related articles, interventions to reduce unplanned pregnancies in adolescents were categorized as follows: (i) interventions focusing on contraceptive methods, (ii) interventions focusing on the impact of preventive training including health education, individual and group counseling and parent education, (iii) multiple interventions that included a combination of interventions focusing on promoting contraceptive methods and preventive training. Conclusion: Evidence provided by this  ystematic reiew supports the use of educational and preventive interventions focusing on multiple interventions to reduce adolescent pregnancies, but there is a need for a proper framework, infrastructure, and resources for the success of these interventions. 39 Relationship between consanguineous marriage and spontaneous abortion and stillbirth Mehri Shams Ghahfarokhi 1 8 2018 17 4 455 462 15 08 2018 Objective (s): spontaneous abortion and stillbirth has always been a devastating experience for the mother and of concern in clinical practice. Since consanguineous marriage is common in Iran, high rates of congenital malformations and genetic diseases result in high abortion and stillbirth. The aim of this paper was to assess relationship between consanguineous marriage and abortion in Isfahan, Iran. Methods: A cross sectional study using a designed questionnaire was conducted. The study population was all married women aged 15 to 50 years. As such a member of households living in Isfahan were identified and interviewed. The sampling method was a multi-stage cluster sampling based on the list of population and household census in 2011 in Isfahan, Iran. Accordingly, the minimum number of samples of 587 households was estimated. However, we interviewed 608 women. The statistical method used in this research is t-test and logistic regression, which is done using STATA software. Results: The spontaneous abortion and stillbirth rates in consanguineous marriages were higher than non-consanguineous marriages. Of the 484 non-consanguineous marriages, 50 women (10.33%) and of the 124 consanguineous marriages, 22 women (17.74%) had spontaneous abortion and stillbirth. Consanguineous marriage with an spontaneous abortion and stillbirth had a significant positive correlation (P =0.023), and the odd ratio indicated that women who had a non-consanguineous marriage had 94.3% less spontaneous abortion and stillbirth. Also there was a significant positive correlation between age and spontaneous abortion and stillbirth (P <0.001), and one-year increase in age, increased spontaneous abortion and stillbirth by 18.7%. The relationship between the number of children with spontaneous abortion and stillbirth was negative and significant (P <0.001). The increase in the number of children decreased the spontaneous abortion and stillbirth by 76.7%. The relationship between education and spontaneous abortion and stillbirth was negative, but it was not significant. Conclusion: The findings suggest that consanguineous marriage seems associated with spontaneous abortion and stillbirth. Also, the study results indicated that non-genetic factors such as age and number of children also could have a significant impact on spontaneous abortion and stillbirth.