Socioeconomic inequality and child maltreatment in Iranian schoolchildren

Socioeconomic inequality and child maltreatment have not been studied using the concentration index as an indicator of inequality. The study aimed to assess the association of child maltreatment with socioeconomic status among schoolchildren in Qazvin province, Islamic Republic of Iran. In this cross-sectional study a questionnaire based on the ISPCAN Child Maltreatment Screening Tool–Children's Version and the Juvenile Victimization Questionnaire was filled by 1028 children aged 9–14 years, selected through multistage stratified random sampling. The concentration indices for economic inequality were –0.086 for any type of child maltreatment and –0.155, –0.098 and –0.139 for the physical, psychological and neglect subtypes of maltreatment respectively. The number of children and the economic status of the family also showed a significant association with child maltreatment in all 3 subtypes. Appropriate planning for effective interventions for at-risk children of lower socioeconomic status should be considered by the relevant decision-makers

Seroprevalence of poliovirus antibodies among 7-month-old infants after 4 doses of oral polio vaccine in Sistan-va-Baluchestan, Islamic Republic of Iran

Despite high coverage rates of polio vaccine in the Islamic Republic of Iran, the seroconversion rates of infants may be inadequate. This study measured seroprevalence of antibodies against poliovirus serotypes 1 to 3 [PV1, PV2 and PV3] in 7-month-old infants who had received at least 4 doses of trivalent oral polio vaccine. A serosurvey was conducted in 2010 in rural areas of Chabahar, Sistan-va-Baluchestan province. Using cluster sampling, 72 eligible infants were tested for antibody against the 3 poliovirus serotypes according to WHO guidelines. Antibody titres >/= 1:10 were considered positive. The seropositive rates for antibody against PV1, PV2 and PV3 were 84.7%, 95.8% and 70.8% respectively. Only 63.9% of participants were seropositive for antibodies against all 3 poliovirus serotypes. Except for PV2, the seroprevalence of antibody against the other 2 poliovirus serotypes, especially PV3, was unsatisfactory

[Factors affecting the development of evidence-based health policy papers at the Ministry of Health Care and Medical Education]

Introduction: successful reduction in the gap between applied knowledge and pure knowledge, depends on the identification of factors affecting it .The objective of the study was to identify the barriers and facilitators to the development of evidence-based papers from the perspective of their producers at the Ministry of Health Care and Medical Education headquarter office

Methods: qualitative approach and framework analysis were used in this study. Semi-structured interviews were conducted with a purposive sample of producers of evidence-based policy papers. MAXQDA10 Software was used to applying the codes and managing the data

Results: three themes of behavioral beliefs, normative beliefs and control beliefs and 18 subthemes were identified. Behavioral beliefs included: knowledge and innovation, quality of policy papers, use of resources, contextualization and time-consuming; normative beliefs consisted of policymakers, policy authorities, policy administrators, and co-workers; and control beliefs involved: access to evidence, recruitment policy, management and policy stability, performance management, empowerment, policy making process, physical environment, and competing factors

Conclusion: most of the barriers were related to control beliefs. This finding corresponds to 85/15 rule in TQM [Total Quality Management]. This theory-based study identified the factors influencing the development of evidence-based policy papers in terms of all the components of theory of planned behavior, but the factors identified in the exploratory studies were related to one component of the theory. This finding advocates the theoretical approach to identify affecting factors on a behavior

Risk of polio reintroduction to border regions of Islamic Republic of Iran: seroprevalence study of children with at least 5 doses of oral polio vaccine

Movements of populations from countries where polio has not been eradicated is a concern in the Islamic Republic of Iran. A cross-sectional, community-based study was implemented in 2010 in 2 districts in Sistan-va-Baluchestan Province near the south-east border. The aim was to determine the seroprevalence of antibodies in children aged 20 [+/

Factors influencing women's willingness to volunteer in the healthcare system: evidence from the Islamic Republic of Iran

This case-control study evaluated the factors influencing volunteering in the Islamic Republic of Iran's Women's Health Volunteer [WHV] programme/which is implemented in 150 centres in Khorasan-e-Razavi Province. We recruited 145 cases [volunteers] and 146 controls [non-volunteers] from the centres. Data were collected by questionnaire. Sociodemographic variables included were: length of residence in neighbourhood, number of siblings, husband's age and education and job, family size, quality of life, self-rated health status, neighbourhood intimacy, child under 2 years, house ownership, wealth index. Social network variables included were: ego network size, type of acquaintance, intimacy with others, relationship communication, relationship duration, emotional support, advisory support, monetary support, physical support, time support. There were significant associations [P < 0.05] between women's propensity to volunteer and family size, presence of a child under 2 years in the family, neighbourhood Intimacy, social network composition, and emotional and advisory support

Iran health system reform plan methodology

The Ministry of Health and Medical Education of Iran, along with the country movement towards achievements of Iran's Vision 2025 put compilation of the health system reform plan on its agenda. In this article, we are trying to show the method we used for developing this plan and how this method considered the general condition of the country along with maintaining the standards of scientific and technical programs. All steps of this planning are described in the paper and finally we discuss the techniques and the appropriateness of the method compare with the experience of the other countries

Health system vision of Iran in 2025

Vast changes in disease features and risk factors and influence of demographic, economical, and social trends on health system, makes formulating a long term evolutionary plan, unavoidable. In this regard, to determine health system vision in a long term horizon is a primary stage. After narrative and purposeful review of documentaries, major themes of vision statement were determined and its context was organized in a work group consist of selected managers and experts of health system. Final content of the statement was prepared after several sessions of group discussions and receiving ideas of policy makers and experts of health system. Vision statement in evolutionary plan of health system is considered to be: "a progressive community in the course of human prosperity which has attained to a developed level of health standards in the light of the most efficient and equitable health system in visionary region[1] and with the regarding to health in all policies, accountability and innovation". An explanatory context was compiled either to create a complete image of the vision. Social values and leaders' strategic goals, and also main orientations are generally mentioned in vision statement. In this statement prosperity and justice are considered as major values and ideals in society of Iran; development and excellence in the region as leaders' strategic goals; and also considering efficiency and equality, health in all policies, and accountability and innovation as main orientations of health system

Future of health care delivery in Iran, opportunities and threats

The aim of this study was to determine the impact of important social and technological trends on health care delivery, in the context of developing "Iran's Health System Reform Plan by 2025". A detailed review of the national and international literature was done to identify the main trends affecting health system. To collect the experts' opinions about important trends and their impact on health care delivery, Focus Group Discussions [FGDs] and semi-structured in-depth interviews techniques were used. The study was based on the STEEP model. Final results were approved in an expert's panel session. The important social and technological trends, affecting health system in Iran in the next 15 years are demographic transition, epidemiologic transition, increasing bio-environmental pollution, increasing slums, increasing private sector partnership in health care delivery, moving toward knowledge-based society, development of information and communication technology, increasing use of high technologies in health system, and development of traditional and alternative medicine. The opportunities and threats resulting from the above mentioned trends were also assessed in this study. Increasing healthcare cost due tosome trends like demographic and epidemiologic transition and uncontrolled increase in using new technologies in health care is one of the most important threats that the health system will be facing. The opportunities that advancement in technology and moving toward knowledge-based society create are important and should not be ignored

[High-risk behaviors of HIV positive individuals referred to behavioral counseling centers of universities of medical sciences in Tehran]

Development of effective antiretroviral therapies [ART] has reduced mortality and increased life expectancy among individuals with HIV infection. Antiretroviral therapy regiments have improved symptoms and quality of life among these patients, whose sexual and reproductive needs, have, therefore, increased as well. In 2010, 20.8% of HIV-infected Iranians acquired the disease through sexual relations. The objective of this study was to define high-risk sexual behaviors among individuals infected with HIV referred to the Triangular Clinics of Universities of Medical Sciences in Tehran. This cross-sectional interview-based survey included 400 HIV-positive individuals selected by consequential sampling. The majority [60%] of the subjects was males, and 44.2% of men and 51.3% of women with HIV were in the age group 34-25 years. On the whole, 15.6% of the women and 49.6% of the men had high-risk sexual behaviors after diagnosis of HIV infection. Further analysis of the data showed that 62.5% of HIV-positive individuals were not aware of the risks of unsafe sexual relationship [using no condom] for HIV-positive transmission.. Based on the logistic regression module, it was found that factors strongly associated with high-risk sexual behavior were being male, being single, under high school diploma/graduate degree, alcohol intake and use of hormonal and permanent methods of family planning [p<0.05]. The findings of this study confirm previous reports showing common high-risk sexual behaviour after diagnosis in HIV-positive populations. Providing suitable health services and advice on fertility and sexual health will result in no- or low-risk sexual life for couples

Evidence-based health care, past deeds at a glance, challenges and the future prospects in Iran

Along with the global fervor over evidence based medicine [EBM], certain measures have been taken in Iran too. Many educational workshops and national and international seminars have been held. Multiple educational packages have been prepared and even included in the educational curriculum. In recent years, policies have been directed toward encouraging clinical guidelines, health technology assessment reports and policy briefs. Also, recently, the 'National Strategic Program in Evidence-Based Health Care in the Islamic Republic of Iran' has been defined by the Ministry of Health and Medical Education. In spite of all these efforts, studies that follow the uptake of evidence based contents at the bedside show that EBM is not used in practice and at the bedside. The overall effect of the efforts mentioned is the knowledge promotion of the participants of the educational programs and or increasing their abilities in articles' critical appraisal; nothing has been added in the practice arena. It seems that, in Iran, EBM's current and future needs are to focus on its implementation, what is in other words called 'knowledge translation' or the application of scientific evidence

Community capacity assessment in preventing substance abuse: a participatory approach

Community-based participatory research [CBPR] increasingly is being used to address health issues. Few evidence exist to indicate how builds the capacity of communities to function as health promoter and what resources are required to promote successful efforts. This article presents the result of a capacity assessment for preventing drug abuse through CBPR, which working with rather than in communities, to strengthen a community's problem-solving capacity. For exploring the perception of stakeholders, a dynamic model of the dimensions of community and partnership capacity served as the theoretical framework. In this descriptive research, stakeholder analysis helps us to identify appropriate of stakeholders [Key stakeholders]. Data were collected using a topic guide concerned with capacity for preventing drug abuse. Interviews were audiotape and transcribed. Data were analyzed thematically. CBPR has been undertaken to involve local people in making decisions about the kind of change they want in their community and the allocation of resources to reduce substance abuse. We identified key stakeholders and examining their interests, resources and constraints of different stakeholders. The current study has shown the benefits of community-based participatory approach in assessing capacity. Through CBPR process people who affected by Drug issue engaged in analysis of their own situation and helps identity innovative solutions for their complex problem. This participatory approach to a capacity assessment resulted in a synergistic effort that provided a more accurate picture of community issues and concerns

Lessons learnt from malaria epidemics in the Islamic Republic of Iran

The Islamic Republic of Iran is in the pre-elimination phase of malaria control, but malaria epidemics are still a concern in the south of the country. This retrospective study presents the epidemiological characteristics and predisposing factors of 60 of the malaria epidemics reported in Sistan va Baluchestan province during 2005-09. A zero-truncated negative binomial model was used to investigate the relation between predictor variables and the total number of malaria cases. Malaria epidemics occurred mainly in the southern part of the province, mostly between July and October, peaking in August. Most malaria epidemics were small-scale [8.3% were < 100 cases] and short [51.7% lasted < 1 month]. Plasmodium falciparum was present in 46.7% of the epidemics. An increase in the rainfall rate as well as population movements were the most significant predisposing factors. The results may help inform an epidemic investigation and reporting system as the country approaches the malaria elimination phase

Assessing health system responsiveness: a household survey in 17[th] district of Tehran

Responsiveness is an indicator by WHO to evaluate the performance of health systems on non-medical expectations of consumers. This study measures the health system responsiveness and the factors affecting responsiveness in Iran health system. World Health Survey [WHS] questionnaire was used to collect data on a two-stage cluster sampling in 17[th] District of Tehran in 2003. Of a sample of 773, 677 and 299 individuals who respectively had outpatient or inpatient services utilization responded to the responsiveness module of WHS questionnaire. More than 90% of respondents believed that responsiveness issues were very important. Performance of outpatient services was better than hospital services in terms of responsiveness. [Prompt attention] and [quality of basic amenities] received low score for outpatient services. Service user variables had no significant effect on responsiveness, while type of centers was significantly related to responsiveness. Principal component analysis found three factors for both outpatient and inpatient services that explained 62% and 61% of total variances respectfully. Iran health system should pay more attention to responding non-medical expectations of service users. It sounds that health system interventions are main determinant of responsiveness score compared to demographic or user variables. Training health staff, allocating more resources and reengineering some processes may play a role in improving responsiveness. Responsiveness domains seems to be tailored based on each society's cultural factors

[Using the social marketing model to reduce risky driving behaviors among taxi drivers in Tehran]

In social marketing, the common techniques of commercial marketing are used to increase the chances of acceptability of an idea or action by the target group. In this study, we determined the impact of an intervention based on social marketing to reduce risky driving behaviors among taxi drivers in Tehran. This was a quasi-experimental study, consisting of a quantitative and a qualitative part, on taxi-drivers in 2 regions [an intervention and a control groups] in the City of Tehran. Based on a formative research approach, the components of social marketing, namely, the product [reminder message for concentrating on avoidance of two target behaviors, tailgating and not driving between lines], price, place and promotion were determined. An 8-week educational program was implemented, the components being installation of stickers before the driver's eyes, distributing a pamphlet, and transferring messages through taxi route supervisors as opinion leaders. After six weeks, risky driving behaviors were assessed by checklists and compared. The intervention resulted in statistically significant reductions in the two target behaviors in the intervention group as compared with the control group. Furthermore, logistic regression showed that the odds ratio for avoiding both behaviors increased significantly in the intervention group. Determining specific target groups, designing interventions based on actual needs and wants of the target group, and focusing on the factors influencing the behavior market are the basic elements of social marketing. Due consideration of these elements when designing behavioral interventions would lead to reductions in risky driving behaviors

[ cross sectional study on the results of participatory needs assessment in zone 17 of Tehran: three years after intervention]

Introduction: The aim of this study was to assess the effects of a previously conducted needs assessment on West Abouzar neighborhood changes after three years

Methods: This was a cross sectional study in two qualitative and quantitative parts. In the qualitative phase, we conducted semi-structured interviews to determine the types of interventions and selection criteria, and their effects on the approaches of the local headquarters. Based on the qualitative results, a questionnaire was designed in order to use in the quantitative part of the study. A total of 352 individuals selected through random cluster sampling were recruited to the study. Data were gathered by local trained individuals and were analyzed using appropriate methods

Results: The results revealed that for all identified problems, except for drug abuse and unemployment, at least one intervention was performed. Majority of interventions were constructive, while in social issues limited interventions were conducted. It was shown that 29.5% of the interventions were good in quality, 47% were moderate and 23.5% were weak. More than half of the participants [51%] stated that interventions were effective regarding their quality of life; however, they expected more influential interventions. A total of 21.1% of respondents believed that the interventions were relatively effective; 11.1% reported that the interventions were very effective; and 17% stated that the interventions had no effect on their lives

Conclusion: Participatory needs assessment and conducting interventions based on the local needs are effective approaches to resolve health-related problems

[Target audiences' awareness and perspectives about the guideline on "dissemination of health research results and innovations"]

Introduction: Media act as the most significant tool in dissemination of health news. The Health Ministry's guideline on public dissemination of results can be considered the first controlling policy in disseminating health news in the country. This study examines the level of awareness and perspectives of health journalists, researchers and health research managers on the aforementioned guideline

Methods: The study was conducted through both qualitative and quantitative methods. In the qualitative section, opinions of 23 individuals including researchers, health journalists and research centers' authorities were gathered through six in-depth interviews and four focus group discussions. The content of the interviews were analyzed through thematic analysis with Open code software. In the qualitative section, as a quick complementary study, the guideline's publicizing was reviewed by questioning the medical universities' public relations officers [41 universities] and researchers [24 individuals] whose research results had been disseminated in mass media in the past one month

Results: In the qualitative section, the guideline was examined for three domains of publicizing, content, and executive assurance. Most interviewees were unaware of the guideline. Concerning the content, not being comprehensive, and incompleteness of the guideline's items, lack of clarity of the items, absence of specification of target audiences, and lack of executive assurance were mentioned. In the quantitative section, 28 [71.8%] medical universities' public relations officers and 21 [87.5%] researchers were unaware of the guideline

Conclusion: The importance of public dissemination of health research and innovation findings grows accordingly with the increased production of science in the country. Implementing research governance and existence of compulsory guidelines seems necessary in this respect. The current guideline's content is defective, and this matter impedes its executive assurance. Therefore, we suggest revising it with the help of relevant stakeholders and experts [lawmakers, journalists, politicians, scientists, etc]

[Performing content validation process in development of questionnaires]

Content validity is the first type of validity that has to be ensured during the design of a tool. Its prerequisite for other validities and its close relationship with the tool reliability place it in a vital position in the questionnaire design. However, since it has not been paid enough attention in national publications therefore in this paper we will explain the different steps in preparing an appropriate content for questionnaires and also their assessment. The steps of the content validation process for designing valid and reliable questionnaires have been explained in this paper: development [domain identification, items generation and instrument construction], Judgment - quantification [determining the inter rater agreement among experts, determining the clarity and relevancy of each of the questions along with the clarity, relevancy and comprehensiveness of the tool as a whole] have been explained. The benefits of performing the content validation in questionnaire development are not increasing the possibility of accessing desirable content validity indexes [relevancy, clarity, and comprehensiveness] only, but also improving the Reliability indexes of tool and decreasing need for resources [financial and temporal] are the other benefits of this approach. Although subjective nature of experts' responses is the problematic issue in this process but the more quantitative steps of the content validation has reduced considerable part of previous worries about this process. These issues explain why content validation has become a suitable process for questionnaire

[Psychiatric symptoms in patients with dementia: prevalence and their relationship with caregiver burden]

Although it is important to study the association between caregiver burden and individual with dementia, a little has been paid attention to this issue in Iranian population therefore the aim of study was to investigate the frequency of psychiatric symptoms and patients with dementia and caregiver burden associated with individual with dementia. In this study 84 patients who had referred to Iran Alzheimer's Association, along with their caregivers were included in our study. Iranian Version of Caregiver Burden and NPI questionnaires were employed. Factors affecting factors on burden was analyzed by multivariate linear regression. Our findings showed that there was at least one psychiatric disorder in all patients. Among all psychiatric symptoms delusion and elation had the highest and lowest rates with 39.3 and 2.4 percentages, respectively. Linear regression indicated that "indifference" and "irritability" symptoms were the effective psychiatric symptoms on the amount of burden placed on the caregivers. The symptom frequency of irritability and other symptoms showed a statistically significant positive correlation with caregiver's NPI-D score. These findings suggest that improvement of treatments for delusions, irritability among dementia patients may reduce caregiver burden

Serum zinc levels in children and adolescents with type-1 diabetes mellitus

There have been very few studies, with contradictory results, on the zinc status of children and adolescents with type-1 diabetes mellitus. The objective of this cross-sectional study was to determine zinc status based on the serum zinc concentration in type-1 diabetic children and adolescents and compare it with that of healthy controls. Thirty children and adolescents with type-1 diabetes mellitus, aged 6 to 18 years, and 30 age- and sex-matched healthy controls participated in the study. Serum zinc, fasting blood sugar, hemoglobin A[1c] and serum albumin were measured by flame atomic absorption spectrophotometry, enzymatic colorimetry, ion-exchange chromatography and colorimetry using bromocresol green methods, respectively. No statistically significant difference was found in the mean serum zinc concentration between diabetic patients and healthy controls [111.0 +/- 3.1 and 107.1 +/- 3.8 mg/dl respectively, P= 0.4]. No correlations were found between the serum zinc levels and fasting blood sugar, hemoglobin A[1c], or the duration of the disease in the patients. The zinc levels of diabetic children and adolescents are not noticeably different compared to those of healthy controls and are independent of glycemic control and the duration of the disease

Evidence-based approach to HIV/AIDS policy and research prioritization in the Islamic Republic of Iran

In formulating the second national strategic plan for prevention of HIV/AIDS in the Islamic Republic of Iran a more evidence-based approach was needed. This paper reports on a systematic review of the local evidence about the determinants of HIV/AIDS transmission in 3 categories: poor knowledge and negative attitudes about HIV transmission; injection drug use; and sexual promiscuity. Of 93 reports reviewed, 53 met the inclusion criteria. Information about the prevalence and magnitude of effect for the 3 risk determinants at the national and regional level was scarce. Heterogeneity between studies, even in the same sub-population, was significant. An improved research base and better sharing of information are needed within countries of the Eastern Mediterranean Region