partnership model to improve population health screening for noncommunicable conditions and their common risk factors, Qazvin, Islamic Republic of Iran

Early findings and management of health conditions are among the key functions of health care systems. We developed a partnership framework to establish an extended primary health care-based selective screening service for the entire population of a small town as a key project of Qazvin Health Plan, Qazvin, Islamic Republic of Iran. Eight scientific associations and a diverse technical taskforce extensively reviewed evidence to adapt the grade A and B preventive recommendations of the American Preventive Service Taskforce. A list of 15 priority health conditions was identified and screening protocols were developed accordingly. Then strategies for working with private sector providers for better health care were applied to form our partnership model through which we ensured provision of screening services in 3 areas: service provision, quality and costs. Six private medical offices and a laboratory cooperated with the public health centre of the town to screen eligible residents. Preliminary analysis of the results suggests that the framework has successfully engaged private care providers

future balance between training and demand for radiologists in Iran

The present study aimed to evaluate the balance between training and demand for radiologists in the Iranian health care system between 2008 and 2027. A total number of 250 clusters were randomly selected from urban and rural areas of Iran, of which 168 were selected from urban areas and 82 were selected from rural areas. In order to collect basic medical data and to determine the number of radiology visits in the last two weeks, questionnaires were prepared and sent out to the subjects' houses. Information on the number of radiologists as well as statistics on the Iran's population were provided by the Medical Council of the Islamic Republic of Iran [IRI] and the Statistics Center of IRI, respectively. Radiologists were visited 245 times during a two-week time period, which resulted in an average referral to radiologists of 0.125 for each individual. Our results indicated a slight shortage of radiologists in 2008, which is expected to disappear till 2023. Afterwards, the training of radiologists is expected to slightly surpass the demands. Results from the present study suggested that an overall balance between training and demand for radiologists in Iran is likely to happen in near future

Ways to improve the current performance of the boards of trustees of medical universities in Iran

Establishment of boards of trustees for all universities was legalized in 1988. It is crucial to assess the performance of the boards and to adjust them to the mandates raised by new visions of the country. Subjects were members of boards of trustees and officers in charge of board's affairs at medical universities. Furthermore, a sample of 860 resolutions adopted by the boards was selected to assess the state of their enforcement. About 70% of the resolutions addressed have been enforced. There is a consensus on focusing on policy-making and high supervision on the objectives of the institutes rather than other areas. Furthermore, ways suggested improving the performance of the boards. Despite the rather high enforcement rate of the resolution in the past ten years, several interventions are suggested to improve the current performance of the boards of trustees and to meet new directions

Health in the 5[th] 5-years development plan of Iran: main challenges, general policies and strategies

Access to the right to the highest attainable level of health is a constitutional right that obliges governments and other players to take step to increase all individuals' chances of obtaining good health. At the least, health and education are two crucial requirements for this as well. Iran's vision 2025 is going to lead the country to a developed state with the highest rank of economic, scientific and technological status in the region. Enjoying health, welfare, food security, social security, equal opportunities, etc, are also considered as part of characteristics of Iranian society in 2025. Although health system of Iran has many achievements in providing health services specially for the poor following the Islamic Revolution of 1979, but the evidences gathered to develop the 5[th] 5-years economical, social and cultural plan [5[th] 5YDP:2011-2015], listed a variety of main challenges in stewardship, financing, resources generation and service provision functions of the existing health system. Thus, to overcome the main challenges, about 11% of general policies of 5[th] 5YDP are directly address health related issues with emphasizing on healthy human and comprehensive health approach with considering: Integration of policy making, planning, evaluation, supervision and public financing; Developing both quantity and quality of health insurance system and reducing out-of-pocket expenditures for health services to 30% by the end of the 5[th] plan. The strategies of 5[th] 5YDP adopted by the parliament as an Act will change the health system fundamentally through tuning the main drivers; so, its implementation needs brave leaders, capable managers, motivated technical staff and social mobilization

Health observatories in Iran

The Islamic Republic of Iran, in her 20 year vision by the year 2025, is a developed country with the first economic, scientific and technological status in the region, with revolutionary and Islamic identity, inspiring Islamic world, as well as effective and constructive interaction in international relations. Enjoying health, welfare, food security, social security, equal opportunities, fair income distribution, strong family structure; to be away from poverty, corruption, and discrimination; and benefiting desirable living environment are also considered out of characteristics of Iranian society in that year. Strategic leadership towards perceived vision in each setting requires restrictive, complete and timely information. According to constitution of National Institute for Health Researches, law of the Fifth Development Plan of the country and characteristics of health policy making, necessity of designing a Health Observatory System [HOS] was felt. Some Principles for designing such system were formulated by taking following steps: reviewing experience in other countries, having local history of the HOS in mind, superior documents, analysis of current production and management of health information, taking the possibilities to run a HOS into account. Based on these principles, the protocol of HOS was outlined in 3 different stages of opinion poll of informed experts responsible for production on management of information, by using questionnaires and Focus Group Discussions. The protocol includes executive regulations, the list of health indicators, vocabulary and a calendar for periodic studies of the community health situation

[National and sub national mortality effects of metabolic risk factors and smoking in Iran: a comparative risk assessment]

Mortality from cardiovascular and other chronic diseases has increased in Iran. Our aim was to estimate the effects of smoking and high systolic blood pressure [SBP], fasting plasma glucose [FPG], total cholesterol [TC], and body mass index [BMI] on mortality and life expectancy, nationally and sub-nationally using representative data and comparable methods. We used data from the Non-Communicable Disease Surveillance Survey to estimate means and standard deviations for the metabolic risk factors, nationally and by region. Lung cancer mortality was used to measure cumulative exposure to smoking. We used data from the death registration system to estimate age-, sex-, and disease-specific numbers of deaths in 2005, adjusted for incompleteness using demographic methods. We used systematic reviews and meta-analyses of epidemiologic studies to obtain the effect of risk factors on disease specific mortality. We estimated deaths and life expectancy loss attributable to risk factors using the comparative risk assessment framework. In 2005, high SBP was responsible for 41,000 [95% uncertainty interval: 38,000, 44,000] deaths in men and 39,000 [36,000, 42,000] deaths in women in Iran. High FPG, BMI, and TC were responsible for about one-third to one-half of deaths attributable to SBP in men and/or women. Smoking was responsible for 9,000 deaths among men and 2,000 among women. If SBP were reduced to optimal levels, life expectancy at birth would increase by 3.2 years [2.6, 3.9] and 4.1 years [3.2, 4.9] in men and women, respectively; the life expectancy gains ranged from 1.1 to 1.8 years for TC, BMI, and FPG. SBP was also responsible for the largest number of deaths in every region, with age-standardized attributable mortality ranging from 257 to 333 deaths per 100,000 adults in different regions. Management of blood pressure through diet, lifestyle, and pharmacological interventions should be a priority in Iran. Interventions for other metabolic risk factors and smoking can also improve population health

[Prevalence of tobacco use and its association with perception of health among secondary and high school students in Damavand and Pakdasht districts]

Tobacco use mainly begins since adolescence. According to susceptibility of adolescents to high risk behavior such as tobacco use, this study designed to evaluate prevalence and some determinants of tobacco use among secondary and high school students in Pakdasht and Damavand cities. We carried out an analytic cross-sectional study among secondary and high school students by using an anonymous self-administered questionnaire. The questionnaire was completed by 2618 eligible students aged 13 and 15 years. History and current use of tobacco and also their feeling about their health in a spectrum from excellent to bad were evaluated. 26.1% of boys and 21.1% of girls had history of tobacco use [p=0.003]. Mean age [ +/- standard deviation] at which smoking started was 12.3 +/- 2.69 and 12.7 +/- 2.01 for boys and girls, respectively. 13.3% of secondary school and 13.7% of high school students were tobacco users at the time of study. Mean daily consumption of tobacco was 3.4 and 2.2 percent among secondary and high school students, respectively. No-users of tobacco had the better feeling of health than tobacco users [p=0.0005]. This study showed higher prevalence of tobacco use among secondary school than high school students. According to beginning of tobacco use before high school in majority of students, early prevention programs should be performed in secondary school students

[Waist circumference cut off in relation to hypertension in Iran]

Cardiovascular disease is the most important reason for mortality in many countries, and because of its increasing prevalence, it is vital to recognize the related risk factors. Hypertension is a major risk factor for CVD. Waist circumference [WC] cut point is a simple way to recognize hypertension. WC cut off points vary for different races, making it necessary to determine WC cut off points in Iranians. This study was conducted to determine the waist circumference cut off in related to hypertension in Iran. We enrolled 83772 individuals, 41775 men and 41997 women, aged eighteen years and older from cities and villages throughout the country. The cut off point for waist circumference was determined and exams for blood glucose and COL, TG was done. Cut off points for waist circumference were determined for hypertension using the ROC curve analysis, yielding 89 cm for men and 93 cm for women. These results showed that the cut off point for WC in Iran is higher than other Asians and is more similar to whites; the present study shows that waist is ciruimference a strong determinant in relation to hypertension

study on association between watching television and videos with violent behaviors in male secondary and high school students of Pakdasht district

Research shows that watching scenes of violence can increase incidence of high violent behavior in youth. Expansion of television networks and higher accessibility to video films in Iran was a motivation for studying the association between behavior of television and video watching and some violent behaviors is adolescents. This cross-sectional study investigated the pattern of television and video film watching in weekdays and weekend separately in middle and high school boy students in Pakdasht district. After cluster sampling, 604 eligible students answered to a standard questionnaire about the number of hours they spend to watch television and video films and their practice regarding some violent behaviors in the past 12 months. High school students spent more times in weekdays and weekend to watch television and video. We found a positive and significant correlation between watching TV and video films and target violent behaviors. Meanwhile, students that reported to carry some kind of weapon such as knife and chain, had significantly more violence behavior than the other peers [p<0/01]. Parents and school authorities should be more sensitive to what adolescent students watch. Cultural authorities should consider the negative effects of these products on committing violent behavior among children and adolescents. Also health educational programs for increasing the information of students about the concepts of violence in television and video films is the suggestion of this research

Association between computer use and feeling of students about their school and school exercises

Spread of computer use and various ability of it can affect the life style of people, especially students. The present study was conducted to determine the patterns of computer use among students and their feeling about school and exercises. An analytic cross-sectional study was carried out on 1872 primary, middle and high school students by cluster sampling method in Damavand city. The number of hours that spend for computer in weekdays and weekends and feeling about school and exercises were answered by students in a standard questionnaire. Computer use by boys were significantly more than girls [P=0.0005]. In weekdays, with increasing the educational stage, computer use was increased [p=0.03]. Bad feeling about school and exercises was associated with more computer use in our subjects [p<0.01]. Pediatricians should carry out health education on the number of hours students should spend in front of the computer

[Prevalence of hypertension in Iranian urban and rural populations aged over 20 years in 2004]

Several studies have shown differences in HTN prevalence between urban and rural populations. The aim of this study was to compare the prevalence of HTN and the status of HTN awareness, treatment and control between Iranian urban and rural populations aged over 20 years. As a part of a nation-wide survey in 2004 on risk factors of non-communicable diseases, a cross-sectional study was performed on 75.132 adults aged over 20 years. In all participants, blood pressure was measured for twice in a standard method, followed by a collection of data on patients' awareness, treatment and control of HTN. The data were compared between urban and rural populations. The crude prevalences of HTN were 30.5% [CI 95%: 30.496- 30.50], 29.2% [CI 95%: 29.19-29.21], and age-adjusted prevalences were 26.09% [CI 95%: 26.086-26.094] and 26.03% [CI 95%: 26.015-26.025] for urban and rural populations, respectively. Rural residents were significantly less aware of HTN, its treatment and control than urban people. Considering the similarity of age-adjusted HTN prevalence between Iranian rural and urban communities, there is the same burden on our health system. With respect to the lower degree of HTN awareness and control in rural residents, and the integral role of rural health system in diminishing the mentioned difference, further developments are recommended for system

Hypertension and pre-hypertension: prevalence, awareness and management among Iranian adults older than 20 years

Hypertension [HTN] is an important worldwide challenge. The 7th report of the Joint National Committee [JNC7] provided the last classification of blood pressure levels and introduced the new category of prehypertension. The aim of this study was to estimate the national prevalence of HTN and prehypertension according to the JNC7 guideline and to determine the status of HTN awareness, treatment and control in Iranian adults aged older than 20 years. This cross-sectional study was a part of a nationwide survey on the risk factors for non-communicable diseases, which was conducted in 2004. In 75112 over 20 year old adults, two blood pressure measurements were obtained by a standard method and blood pressure levels were classified according to the JNC7 criteria. Data on patients' awareness, management and treatment of HTN were also collected. The age-adjusted prevalence of HTN and prehypertension was 25.3% and 49.7% in men, and 26% and 38% in women, respectively. Only 35% of hypertensive subjects were aware of their disease, and effective control was observed in 21.4% of them. Considering the high prevalence of HTN and prehypertension and the low awareness and effective control of HTN, our country is facing a serious health problem