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Introduction: Patient hospitalization rate (P.H.R) is an important issue in health decision making because its increasing can imposes abundant expenditure on each patient or therapeutic or health systems like assurance companies. Moreover, it can increase the danger of nosocomial infections. So, description, examinating and modelling of P.H.R. can be as a guideline for above subjects and as an introduction would lead one to study the issue with insight.
Materials and Methods: For determining of P.H.R., Iwo samples of size 1428 and 816 of patients were chosen systematic randomly from Vali-Asr and Ta'min-Ejtemai hospitals, respectively during the year of 2002. Hospitalization rate, age, sex, location of birth place and residence place of patients recorded. Mixed distributions modelling and Poisson regression models as well as ordinary regression methods were applied to analyze and modelling the data.
Results: Means of P.H.R of patients at Vali-Asr hospital was 4.1±5.4 days. Two component Poisson was a relatively appropriate model was a very relevant model for analyzing of their P.H.R. By using mixed Poisson regression method a significant relationship among patient's age, marriage status and location of life with P.H.R was obtained. Findings in Ta'min-Ejtemai showed that the mean of P.H.R was 4.7±3.2 days. One component Poisson model was appropriate model for data distribution. A significant relationship among age, sex, location of life with P.H.R in this hospital was seen.
Conclusion: Our findings showed that P.H.R in Vali-Asr hospital follows two component Poisson model. For Vali-Asr data, the normal model was not appropriate even with changing the statistics variables, but for P.H.R data of Ta'min-Ejtemai, changing the logarithmic variable could transform data into approximate of normal model. Finally, comparison between mixed distribution Poisson model and acquired regression with simple linear regression in Val-Asr hospital presented different results, but in Ta'min-Ejtemai hospital had similar results.

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Introduction: End stage renal disease (ESRD) is a major health problem and each year the number of patients is increasing. If the disease becomes irreversible, patients must always be hemodialyzed. Since mortality rate will increase due to inadequate dialysis, determining the efficacy of hemodialysis and improving its quality is very important. The main goal of this research is investigating the efficiency of hemodialysis. Materials and Methods: This is a cross-sectional analytical study which was conducted on 103 people who were under dialysis treatment in the Vali-e-Asr hospital of Arak in year 2003. Weight, blood pressure (before and after dialyze), time of dialysis, BUN and Cr before dialysis and 5 minutes after turning of the pump and before the second dialysis were measured. Data was analyzed by T test and Pearson correlation. Results: The mean of KT/V was 0.58 ± 0.1 normal protein catabolic rate (nPCR), 0.36 ± 0.11 g/kg per day and time average concentration of urea (TAC), 43.3 ± 14 mg/d which had a significant difference with standard measures (p<0.05). KT/V was 0.49 ± 0.18 and 0.47 ± 0.10 for men and women respectively which was significantly different (p<0.03). There was a positive and linear relationship between education level and TAC, KT/V and number of dialysis per week. Conclusion: Regarding the low efficiency of hemodialysis in 80% of patients and lower levels of hemodialysis efficacy indicators in comparison to standard measures, periodic assessment and also investigating the reasons of low efficacy of hemodialysis is recommended.

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Introduction: World health organization has proclaimed the prevalence of smoking among 15 years old European region students, more than 24 percent. The cigarette smoking indicator in our country among over 15 years old individuals is 11.9 percent and in the province under survey is 15.6 percent. This research has been performed in order to study the effect of health education program based on health belief model (H.B.M) on preventive actions of smoking in middle school students. Materials and Methods: This is a quasi-experimental study, done on 248 students of grade one in middle schools of Boukan city (119 boys and 129 girls) that were randomly divided into experimental and control groups. Data collection tool was a questionnaire including 77 questions based on health belief model (perceived susceptibility, perceived severity, perceived benefits and perceived barriers to smoking, and cues to action) and preventive actions of smoking. After data collection in the first stage, action was taken with regard to educational intervention and then in the second stage (after the intervention), data was collected again. Data was analyzed using T test. Results: Results showed that the mean score of all parts of health belief model in experimental group(except for perceived barriers) after educational intervention compared to before intervention was increased significantly and also the mean score of all parts of HBM after intervention was significantly increased in experimental group compared to control group. Conclusion: The results of this survey show that by increasing the score of health belief model parts including, perceived susceptibility, perceived severity and perceived benefits, adopting preventive actions of smoking also increases. Therefore, the results of this survey confirm the efficiency of health belief model in adopting preventive actions of smoking.

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Introduction: Nowadays drug abuse is an important problem in the world. Existing data show that using drugs especially pseudo-amphetamine compounds have increased and it seems necessary to determine the knowledge of high risk groups especially youths in this field. The aim of this study is to survey knowledge and attitude of students in Arak University of medical sciences based on Health Belief Model. Materials and Methods: This is a cross-sectional analythical study which was carried out on 100 students of medical, nursing- midway and pre-medical schools in 2006.This survey was done by completing a questionnaire including 53 questions base on health belief model. Data was analyzed using Chi square and Mann-Whitney U tests. Results: The mean age of samples was 22/3(±3/18) years which 67 persons were female. The highest obtained score was related to perceived sensivity and had a meaningful relationship with action (p<0.05). Based on student's opinion of cues to action, TV was the most important resoure in education about Ecstasy. Conclusion:Beased on findings and regarding the meaningful relationship of percieved susceptibility (the danger of using Ecstasy) with action, it is better to provide educational program to prepare youngsters minds about perceived sensivity.

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Background: Hospitals need performance evaluation systems for development and competition in order to evaluate the effectiveness and efficiency of their plans, processes and human resources. The objective of this research is to design an evaluation system at hospitals through the use of the Balanced Scorecard. Methods and Materials: In this comparative study, the selected countries consisted of Australia, USA, Canada and New Zealand, and 34 public hospitals of Iran which were applying strategic planning. Performance evaluations were examined in terms of 6 aspects including mission, vision, strategies, perspectives, objectives and measures .A pattern was designed for performance evaluation of public hospitals in Iran and was validated using experts’ survey of DELFI method. Results: All countries had mission and vision as important aspects of their performance evaluation model while health effectiveness promotion was the most important strategy. High quality health services, resource development, innovation and guaranty in continuous services were other strategies. Perspectives of Balanced Scorecard included customer, internal processes, learning and development of staff and financial affairs. All of the countries had objectives and measures for each of the perspectives. Iranian hospitals had mission, vision, strategies and objectives but for them perspectives had not been defined and measures were not congruent with strategies and objectives. In the model, 4 perspectives were determined to describe hospital strategies and to use competition benefits as well. Conclusion: Applying measures of 4 perspectives including "Patients and Community", "Internal process and Productivity", "Growth and innovation" and "financial aspects" to doevaluation of Iranian public hospitals collates their performance, improves productivity of their resources and enhances patients and community satisfaction.

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Background: The most important determinant factor in elder’s quality of life is healthy. Since health can be declined by aging, in health promotion consider an effective model of care can be vey important. We surveyed the effect of Orem Self Care Model on quality of life (QOL) of elderly in Masjed Solaiman. Methods and Materials: This is a pre and post quasi-experimental study was carried out on 349 elderly clients which were selected from 11 health care centers in Masjed Solaiman in 2007-2008. Orem Self Care program was performed during a 3 months in days that the clients came to health care centers. Data were gathered by a short form questionnaire (SF36) before and after the intervention and was analyzed by descriptive statistics and paired t-test. Results: Results showed a significant increase in mean scores of different dominations of QOL including health, physical performance, physical role- performance, emotional role- performance, social performance, body pain, power and energy, general health perception, and overall mean of QOL. Paired t-test showed a significant difference (p<0.001) between all of dominations of the quality of life. Conclusion: Performing Orem Self Care educational program had a positive influence on improving QOL of elderly.

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Abstract Background: Side effects of drugs were increased with intractable consumption and this fact is more important in women during pregnancy and lactation period. The aim of this study has been determined the effect of education based on Health Belief Model on self-medication in mothers referring to health centers of Arak. Materials and Methods: In this clinical trial study, 300 mothers referring to health centers of Arak were participated. Data were collected with a questionnaire based on Health Belief Model and a performance checklist about drugs intractable consumption. Before educational intervention, questionnaires and checklists for both groups were completed and then intervention was done during 1 month in 4 sessions, 60 minutes. Data again were collected and then analyzed 3 month after intervention in both groups. Results: Before educational intervention, the rate of knowledge, perceived susceptibility, severity, and benefit of self medication were in the mediate level and the mother's performance about drug intractable consumption were more than mediate. After educational intervention, between two groups had significant difference in all variables and mothers performance in self-medication was reduced (p<0.05). Conclusion: By increasing in mean score of Health Belief Model parts, including: knowledge, perceived susceptibility, severity, and benefit, performance in field of self-medication was reduced. Recommended, training based on this model carried out in other health centers for reducing drugs intractable consumption.

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Abstract Background: Over 2 billion world people suffer from iron deficiency. Teenager girls are one of vulnerable groups in this area. Health education with various methods is a suitable tool for motivating and modifying incorrect function. The purpose of this research was determining the effect of health education program base on PRECEDE Model for controlling iron- deficiency anemia. Materials and Methods: This quasi-experimental and two-phase study was done on 72 students placed into case and control groups in 2007-8. Intervention was done in three sections with 45 minutes and 3 months after educational intervention was followed. Questionnaire base on PRECEDE Model parts and blood lab exams (Hb, Hct, Feritin) were data gathering tool. Data were analyzed by pair T- test, independent T- test, Mann- Whitney and Chi- square tests. Results: The mean score of knowledge (p<0.001) and attitude (p<0.001) (Predisposing factors), Using educational resources, taking place educational class and participating in educational programs (Enabling factors), encourage family and teachers (Reinforcing factors) and iron deficiency anemia preventive behaviors had a significant increase in the case group after the educational intervention. Conclusion: Above results indicate positive effect of educational intervention program base on PRECEDE Model and main components (Predisposing, Enabling, Reinforcing factors) in improving of iron deficiency anemia preventive behaviors in the study population.

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Background: All members of society should have equal access to necessary health care. The main goal of this research is to determine the status of health care access in eight selected countries and to suggest a new model for Iran. Materials and Methods: This study was done comparatively on eight countries. In order to define a framework for categorizing the countries Jordan scales was employed. In this method, based on the kind of insurance system, countries are divided into 4 groups, from each 2 countries were selected. Data obtained from each country were placed in comparative tables. For presenting the final model, Delphi technique was utilized in two stages. Results: To increase equity in their health care systems, all the countries in this study utilized such strategies as insurance coverage for all, defined health care packages, appropriate human resources, family physicians, referral system and high level of GNP in health sector. Also, low direct payment by patients, expansion of insurance coverage and the existence of out of pocket pay limit in pharmaceutical and medical services were also very helpful. These policies have been made in a way that the level of individuals' income did not affect the access to such services. Conclusion: Equitable access to health care services in Iran necessitates the establishment of national health insurance system aiming at omission of parallel insurance, provision of medical care coverage for all the basic medical services especially health care coverage for the elderly and patients with chronic psychological problems.

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Background: The purpose of this study was to identify the effect of health education according to health belief model (HBM) on the adoption of preventive behaviors of infection with giardia lamblia by primary school students in Arak. Materials and Methods: In a randomized quasi-experimental case study, 1200 students were randomly divided into two equal groups of test (instruction) and control (non-instruction). The sample size for giardiosis identification tests included 300 students, who had been equally and randomly selected from the control and test groups. Health education was according to HBM and its impact on the students' lifestyle-related patterns of behavior was considered. Results: Paring nails in the test group, significantly increased after education while it decreased significantly in the control group. The number of students who carried a glass for drinking slightly increased, but it remarkably decreased in the control group. The number of students who applied soap after using the restrooms remarkably increased in both the test and control groups. The relationship between not paring nails and infection with giardia lamblia was statistically significant. Additionally, after education, the ratio of reduction of infection with giardia lamblia in the test group to its increase in the control group was statistically significant. Conclusion: Preventive behaviors significantly improved and appeared influential in the reduction of infection with giardia lamblia. Thus, using a HBM in prevention of parasitic infections along with instructing the parents are suggested for prevention of parasitic infections.

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Background: Self-medication is one of the existing problems in the treatment cycle of patients that with aging and increased drug use, its side effects increase. The purpose of this study was to assess the factors influencing self-medication among elderly urban centers in Zarandieh based on Health Belief Model Materials and Methods: This descriptive cross-sectional study was conducted on 180 elderly individuals (95 females and 85 males) over 60 in Zarandieh. Data collection tools were a questionnaire designed based on HBM model (perceived susceptibility/ severity, and perceived benefits/barriers) and self-medication checklist. Results: The prevalence of self- medication in the elderly was 31% (33% women and 29% men). The most common reasons for self-medication were previous experience of the disease and its recognition (61%), availability of drugs (60.5%), and good result of their previous treatment (56.7%). There was a significant difference in awareness, sensitivity, severity, perceived benefits and barriers among people with or without self-medication history (P< 001). Conclusion: Noticing the side effects of drugs and the high prevalence of self-medication among elderly, designing educational programs for changing the awareness and beliefs of elderly regarding self-medication is recommended.

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Background: Brucellosis is a major zoonotic disease with worldwide distribution. The prevalence of this disease has decreased in developed countries however, in developing countries, it is still prevalent. The aim of study was to determine the effect of a health belief model (HBM) based educational program on the empowerment of rural women in Zarandieh in prevention of brucellosis. Materials and Methods: In a quasi-experimental study with a pre-test/post-test design, 141 rural women were randomly selected and assigned to experimental and control groups. The educational program was implemented for the experimental group. Data were gathered by a researcher-made questionnaire and analyzed by SPSS software version 16. Results: Demographic variables of the two groups were similar before education. In addition, there were no significant differences between the experimental and control groups with regard to mean knowledge, HBM constructs, and performance however, the post-test revealed significant differences in terms of the mean of variables between the two groups (P<0.001). Conclusion: The HBM based educational program is effective in women’s empowerment and also promoting women’s beliefs and performance regarding brucellosis therefore, the findings of this study may be used as a framework in designing zoonotic diseases prevention programs

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Background: Gastric cancer is a common and lethal disease throughout the world. This study was designed and carried out to determine the five-year survival rate of gastric cancer patients who had undergone surgical treatment at Taleghani Hospital of Tehran, and to assess its associated factors. Materials and Methods: In this historical-cohort study, information obtained from a total of 213 gastric cancer patients who underwent surgery at Taleghani Hospital of Tehran between 2003 and 2008 was included. In the analyses, Kaplan-Meier method, log-rank test, Cox proportional hazards model, and Lin-Ying additive hazards model were used. Results: The five-year survival rate and the median life expectancy in the studied patients were 14.6% and 29.6 months, respectively. Two covariates showed significant impacts on the gastric cancer patients’ data in both models: age at diagnosis and tumor size. We found that pathologic stage was significant under the Lin-Ying model (P=0.043) however, it was not significant under the Cox model (P=0.069). Other clinicopathological characteristics were not statistically significant (P>0.05). Conclusion: Since Cox and Lin-Ying models consider different aspects of the association between risk factors and the study outcome, it seems desirable to use both of them as complementary models but not as alternative models to obtain a more comprehensive understanding of data. This study showed that the early detection of patients in younger ages and in primary stages is important to decrease the risk of death in patients with gastric cancer and to increase the survival rate.

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Background: Considering the lack of a standardized and validated questionnaire on oral health care for pregnant women based on a specific behavioral pattern, the aim ofthis study was development and psychometric assessment of an oral health instrument based on Health Belief Model in pregnant women. Materials and Methods: This cross-sectional study was carried out on 340 pregnant women in Arak city. After reviewing the related literature, the instrument was designed and its content validity ratio, content validity index, face validity, and exploratory factor analysis were measured. For measuring the reliability of the scales, three methods, including test-retest, internal consistency, and agreement, were used. Data analysis was done using SPSS software. Results: The reliability of the 61 items was evaluated with impact score of 1.5 and the content validity index of 0.79 and based on exploratory factor analysis were classified into seven categories. The overall reliability measured through Cronbach alpha was 0.84. The reliability of the questionnaire was 0.88, perceived susceptibility was 0.73, severity was 0.70, perceived benefits was 0.75, perceived barriers was 0.71, the cues to action was 0.72, and self-efficacy was 0.76. Kappa coefficients were determined with a high performance for checklists. Conclusion: This study provided good evidence of the strength factor structure and reliability of Health Belief Model structures about oral health behaviors in the vulnerable group of pregnant women, according to the study of psychometrics process.

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Background: There are various factors effective in the appearance of metastasis that have been surveyed and recognized in different studies. However, the appearance of metastasis by determination of these factors cannot be predicted. One of the models used for the analysis of recurrent data and consideration of heterogeneity between patients is frailty model. Materials and Methods: In this survival study, 133 women with breast cancer were treated in Fayazbakhsh Hospital, Tehran, during 2005-2007. All patients were followed until April 2011. Frailty model was employed for the analysis of data and gamma frailty distribution was assumed with the average one and Ө variance. All statistical methods were run in R software. Results: Disease-free survival rates for 3 and 5 years were 0.78 and 0.72, respectively. During the follow-up period, the risk of metastasis was estimated to be 43%. Two factors were identified as the prognostic factors in the appearance of metastasis: tumor malignancy grade and the number of positive lymph nodes. Frailty variance was 4.27 (P=0.001). Conclusion: The significant variance of frailty component in the model indicates that patients who have identical explanatory variables face different levels of risk experiencing metastasis. Also, specific characteristics of the patients are important in the incidence of metastasis.

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Background: Gastric cancer is the second leading cause of mortality due to cancer worldwide and it is the most common type of cancer in Iran. The aim of this study was to assess the effects of prognostic factors on the survival of patients with gastric cancer using the penalized spline in Cox model and compare it with Cox proportional hazards model. Materials and Methods: In this retrospective study, information obtained from a total of 216 gastric cancer patients who underwent surgery at Taleghani Hospital of Tehran between 2003 and 2008 years was included. Cox proportional hazards model and penalized spline in Cox model were used. R software was used for data analysis. The efficacy of these models was compared according to Akaike information criterion. Results: The five-year survival rate was 30% and the mean follow-up time was 16.60±15.28 months. Survival mean and median were 46 and 30 months, respectively. The analysis of Cox proportional hazards and penalized spline models resulted in age at diagnosis and tumor size as prognostic factors for survival time (P<0.05). Also, Akaike information criterion and survival curve for patients with a tumor size over 35 mm and age at diagnosis over 45 years were equal in both models. Conclusion: Cox proportional hazards and penalized spline models generated similar results thus, it is more appropriate to use Cox proportional hazards model because of its ease of interpretation and capability of modeling both continuous and discrete covariates. This study also showed if gastric cancer is diagnosed early, the relative risk of death will reduce.

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Background: It can be used different models such as nonparametric, semi-parametric and parametric to estimation of survival. Depending on the nature of the data, some methods may be more appropriate. Using of appropriate model result more accuracy estimation of survival and it's affected. so the aim of this study estimation of survival and determination of its related risk factor. Materials and Methods: In this study, 169 patients with colorectal cancer who had treated in Hamadan MRI Center from March 2005 to Jun 2013 were evaluated. Survival time of patients is considered from diagnosis time to death or end of study. The effect of Demographic and clinical risk factors on survival is assessed by parametric model. follow up of patient Data were analyzed using Spss16 and R statistical software.

Results: The median survival was 4.3±40 months. Univariate analysis showed that the effect of staging of tumor, tumor grade, histology type of tumor, metastasis and relapse on survival were significant but in multivariate model histology type of tumor and metastasis were significant.

Conclusion: using of appropriate statistical model for detection of affected risk factor on patient with colorectal cancer can be prevented progression of disease and increased of survival of them.

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Background: Planning of educational programs to inform the people about the prevention of diseases such as cancers is necessary. This study was conducted to determine the effect of educational interference based on HBM on practices of women about gastric cancer.

Materials and Methods: In this semi-experimental study, 88 women participated from Arak. The subject were randomly divided in two groups, experimental group and control group (each group includes 44 women). Inclusion criteria were absence of cancer, Iranian nationality, age over 18 years, living in the city. Data collected with a questionnaire based on HBM and performance checklist about colorectal cancer prevention was used in order to evaluate the effectiveness of the educational program. Intervention was done in 1 month consist of 3 session each session 45 minutes. Three months later data were recollected and analyzed.

Results: In this study, the mean age in case and control group was 38.3±9.6 and 36.3±11.1 years respectively, with no significant differences (p=0.381). Average scores of knowledge and practice in experimental was 72.8±13.06 and 30.81±6.2 respectively group before the intervention, which was 88.05±12.2 and 65.3±8.9 respectively after the intervention (p<0.05). Moreover before of intervention susceptibility, severity and percieved benefit about practice of mothers was moderate but after intervention the entire items between experimental and control groups was significantly different (p<0.05).

Conclusion: Finding of this research confirms the effect of Health Belief Model on prevention from gastrointestinal cancer in women of Arak.

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Background: Colorectal cancer is the most common gastrointestinal cancer. Investigating the factors that predict survival time for these patients is important.The purpose of this study was comparison of parametric models by estimating the prediction error and also identifying the effective factors on predicted survival time of patients with colorectal cancer.

Materials and Methods: This cohort study was conducted with 600 patients who were suffered from colorectal cancer in Taleghani Hospital of Tehran between 2001 to 2005 and they were followed up for at least 5 years. For identifying the effective factors on survival time, of the patients we analyzed the data by some parametric models such as Weibull, Exponential and Log logistic and compared these models with the estimation of prediction error by apparent loss method.

Results: Among 600 patients there was 344 men (57.3%) and 256 wemon (47.7%). Of total, 151 patients were died that 62.3% of them were men. Univariate analysis showed that the effect of BMI, sex, staging of tumor, tumor site were significant but in multivariate model staging of tumor and BMI were significant. By the estimation of prediction error, the best model was Log logistic.

Conclusion: With respect to the importance of survival time prediction, we found that we can use the prediction error to compare the parametric models. In addition, because of effectiveness of tumor stages and BMI in the patients’ survival time, survival time could be increased by an on-time diagnosis and an appropriate controled diet.

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Background: Accidents and injuries one of the main causes of death and disability in the world and the most significant causes in children referred to hospital. So, this study aimed to assess the health belief model constructs and function of the mothers referred to health centers in the city of Khorramabad in the preventive behaviors of accidents and injuries in children.

Materials and Methods: This cross sectional and analytical study was done on 261 mothers with children aged less than 5 years are referred to health centers in the city of Khorramabad in 2014. Data was collected with a questionnaire based on the Health Belief Model. The data collected were analyzed by software SPSS-20.

Results: In this study the mean and standard deviation of age of mothers was 28.98±5.37 years and the mean score of function and self-efficacy were 59.1±14.74 and 69.1±11.07 respectively. Moreover, the mean scores of the other health belief model constructs such as perceived sensitivity, severity, benefits and barriers was higher than average. There was significant negative correlation between self-efficacy and perceived barriers (r=-0.256, p<0.01), and also between the perceived barriers and function (r=-0.391, p<0.01).

Conclusion: According to the score of the function of mothers and the other constructs of health belief model, training programs based on the model directly and indirectly in the form of multimedia training package recommended to promote preventive behaviors of accidents occur in children.