Self-reported versus proxy reported quality of life for breast cancer patients in the Islamic Republic of Iran

Since quality of life [QoL] is subjective, self-reported QoL is the main source of assessment; however, in some situations the patient cannot evaluate his/her own status. In this cross-sectional study, 148 patients with breast cancer referred to the Cancer Institute of the Islamic Republic of Iran and their caregivers were selected through the consecutive sampling method. Five oncologists from this centre also evaluated the QoL of these patients. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was completed by these 3 groups and the results compared. The patient-caregiver intra-class correlation coefficient [ICC] for all 15 QLQ.C30 domains was moderate to good [ICC = 0.41-0.76]. Agreements between QoL scores of patients and those of oncologists were moderate to good, except in the 4 domains. In the patient-caregiver comparison there was 55% exact agreement, and for the patient-physician comparison agreement was 45%. The findings can be used in the patients' decision-making process and care planning when patients with breast cancer are unable to self-report the QoL

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

Social capital of Iranian patients living with acquired immune deficiency syndrome and associated factors

This study investigated the social capital of Iranian patients living with acquired immune deficiency syndrome [AIDS] and the associated factors. In a cross-sectional study the Integrated Social Capital Questionnaire was filled by a sequential sample of 300 patients visiting a referral counselling centre in Tehran. The patients' social capital scores were around 50% in the trust, social cohesion, collective action and cooperation and political empowerment domains. The groups and networks membership domain scored the lowest [27.1%]. In regression analysis, employment status was significantly associated with groups and networks membership; age, marital status and financial status were associated with collective action and cooperation; period of disease awareness and marital status affected social cohesion and inclusion; and having risky behaviour affected empowerment and political action. Efforts are needed to enhance the social capital of those patients living with AIDS who are younger, unemployed, divorced/widowed, with risky behaviours and shorter disease awareness

Predictors of transition in smoking stages in Iranian adolescents: latent transition analysis

This study determined the prevalence of smoking stages in adolescents, the probability of transition across stages and the personal and environmental predictors of transition. A school-based study was conducted in 2010-11 using a random sample of 5197 students [mean age 15.7 years] in Tabriz city. The students were evaluated twice, 12-months apart. The latent transition analysis model revealed 9 interpretable statuses for the measurement of smoking stages. Prevalence data showed that at the first and second assessments 75.1% and 66.8% of students respectively were in the committer stage, while 4.8% and 7.1% respectively were daily smokers. Over 12 months, 10.1% of the never smokers became experimenters and 1.7% became regular smokers, while 17.0% of experimenters became regular smokers. The analysis also showed factors associated with transitions in cigarette smoking stages. Although the prevalence of smoking was low in our adolescents, the rate of becoming a smoker over 1 year was high

Determining appropriate strategies for improving women's health promoting behaviours: using the nominal group technique

Women's health constitutes a major aspect of development in societies and is considered a health-related priority. The aim of the present study was to determine appropriate strategies for improving health promoting behaviours in women of reproductive age in the Islamic Republic of Iran. Using the nominal group technique, a panel discussion was held in October 2011 with 12 health specialists who were selected through purposive sampling. In the first round, panel members generated 81 strategies; after eliminating irrelevant items and merging items with similar concepts, 44 strategies remained. After group discussion and voting, the following 4 items had the highest scores: improving physical activity, with a social support approach; empowering women; promoting and improving men's role in women's health; and promoting social support. The strategies presented in this study may be utilized by policy-makers, managers and health care providers to improve women's health promoting behaviours, and thus contribute to their wellbeing

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

Lifetime and current waterpipe use among adolescents in Tehran, Islamic Republic of Iran

Waterpipe use among Iranian adolescents has become a matter for concern. A descriptive, crosssectional community-based survey was performed in 2010 to determine the prevalence of waterpipe use and associated factors among Iranian adolescents in Tehran, Islamic Republic of Iran. After multi-stage, random cluster sampling 1201 adolescents aged 15–18 years old responded to a questionnaire based on the Youth Risk Behavior Surveillance. The prevalence of current waterpipe smoking [at least once in the previous 30 days] was 28.0%, significantly higher among males [34.8%] than females [21.4%]. A total of 45.1% of adolescents reported lifetime use [ever use] of waterpipes and 34.2% had ever shared a waterpipe. In multivariate logistic regression analysis the significant correlates of current waterpipe use for both males and females were having smokers among friends and family members, while for males, older age and educational failure were also risk factors.

Substance abuse in high school students in association with socio-demographic variables in Northwest of Iran

Substance abuse in adolescents and its often tragic consequences, including addiction, is one of the preventable major public health problems. The aims of this paper were to estimate the prevalence of substance abuse and to evaluate its some associated factors in adolescents of Tabriz City [northwest of Iran]. A self-administered questionnaire was completed in 4903 randomly selected students with mean age of 15.7 years old. The aim of the questionnaire was obtaining information on substance abuse, socio-economical information, cigarette smoking behavior, general risk taking behavior, self-esteem, attitude towards smoking and self-injury as well as demographical characteristics. Prevalence of substance abuse was 1.4% [95% CI: 1.1-1.7] which was different statistically significant between boys [2.4%] and girls [0.6%] [P<0.001]. Older age [OR=1.43], not living with parents [OR=2.34], having general risk taking behavior [OR=2.26], higher smoking stage [OR=2.39], lower self-esteem [OR=1.09] and positive attitude toward smoking [OR=1.08] were factors associated with student's ever use of substance. The result has shown low prevalence of substance abuse in Iranian adolescents. Our findings showed some associated factors such as lower self-esteem with adolescent's substance abuse

Quality of life in the group of patients with chronic eye disease

To assess vision related quality of life and determinants in patients afflicted with chronic eye disease. In this analytical cross-sectional study, consecutive sampling was performed at Noor Eye Hospital between 2008 and 2009. A valid and standard 39-item visual functioning questionnaire [National Eye Institute visual functioning questionnaire, NEI-VFQ 39] was completed. The questionnaire consists of 11 domains related to vision and one domain about general health. The total score range from zero [0] to 100, where a higher score reflects better vision related quality of life. The independent t-test, pearson correlation coefficient as well as simple and multiple linear regression models were employed for statistical analysis. The mean overall score in patient and control groups were 54.5 [95% confidence interval [Cl] 57.3 -71.8] and 96.0 [95% CI: 88.2-103.9], respectively. Patients with cataracts had the highest score [64.6; 95%CI: 57.3 - 71.8] and those with visual acuity of 20/70 or worse showed lowest scores [41.9; 95%CI: 30.7 - 53.1]. Age [P=0.006] and education level [0.001] were associated with quality of life score. Based on our study findings, it could be concluded that low vision patients with a visual acuity of 20/70 or worse hardly received half of the total scores. Diabetic retinopathy, age related macular degeneration, glaucoma, and cataract stand in ascending rank order. The relatively lower scores as compared to results from other countries warrant further research into the causes of such differences

Psychometric properties of the Persian version of the youth risk behavior survey questionnaire

Adolescents may get involved in high-risk behaviors. Surveys are the primary, and sometimes the sole source of data collection for many high-risk health behaviours. We examined the reliability and validity of the psychometric properties of the self-administered Persian version of the 2009 Youth Risk Behavior Surveillance System [YRBSS] questionnaire. In a methodological study in summer 2010, 100 Iranian adolescents aged 15-18 years were recruited through convenience sampling. The face and content validity were used for the questionnaire validity. In order to evaluate the questionnaire's reliability, the Intraclass Correlation Coefficient [ICC] and Cronbach's alpha were calculated for domains and 89 items. Among 89 items, the ICC values were below 0.4 [weak reliability] for 2 items [2.25%], 0.4-0.6 [moderate reliability] for 10 items [11.24%], 0.6-0.8 [good reliability] for 32 items [35.96%] and 0.8-1 [excellent reliability] for 45 items [50.56%]. The prevalence of most high-risk behaviors was constant in the first and second survey. The value of Cronbach's alpha was 0.73 for intentional and unintentional injuries, 0.77 for tobacco use, 0.86 for alcohol and other drug use, and 0.79 for unsafe sexual behaviors. No domain had a mean ICC of below 0.6. Furthermore, 97.75% of the items had moderate to excellent reliability. Thus, the Persian YRBSS questionnaire had an acceptable reliability. Over the 2-week period, sexual behaviors were reported with less consistency compared to other behaviors. In any case, researchers must be aware of the limitation of the data collected through this questionnaire, particularly in comparison to the domain of sexual behaviors. Overall, 97.75% of the items had moderate to excellent reliability. Thus, the Persian YRBSS questionnaire had an acceptable reliability

[Internal evaluation of the department of epidemiology and biostatistics / of the school of public health, Tehran University of Medical Sciences]

Experience at the national and international levels shows that internal evaluation, especially at the level of academic departments, can play a critical role in warranting having a university with high standards. The objectives of the present research project were to determine [a]. the quality of the structural elements of the Epidemiology and Biostatistics Department [EBD] School of Public Health, Tehran University of Medical Sciences, and [b]. The strengths, weaknesses, opportunities and threats, on the basis of which action could be taken to improve the quality of activities in the Department. The study was conducted with the collaboration of the head and faculty members, all of the students [residents, Ph.D. and M.S. students], and the graduates, of the EBD. Nine variables were studied, namely, 1]. Aims and objectives; 2]. Organizational and management structure; 3]. Faculty members; 4]. Students; 5]. Teaching and learning process; 6]. Courses and curricula; 7]. Graduates; 8]. Research and educational facilities and equipment; and 9]. Research activities of the faculty members. First the initial weight of the 9 variables were determined by opinion poll carried out among all the faculty members of EBD. Then unrelated data were identified through proper tests and omitted and the final weights extracted. The tools used to collect the data included interview, observation, and 7 self-prepared questionnaires and 2 check lists. The mean score for the 9 factors studied was 59.8%, the range being between 37.0% [for objectives and mission] and 72.0% [for graduates]. The graduate domain is one of the key areas in internal evaluation of the Department of Epidemiology and Biostatistics. On the other hand, the lower score for objective and aims domain implicates the need for future intervention in this domain

[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

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

Socioeconomic status and obesity relationship in non-menopause women aged 15-49 years in Tehran, Iran

To investigate the association between socio-economic status and obesity in non-menopause women aged 15-49 years in Tehran, Iran. This study was based on Iran National Health Survey conducted in 1999. Obesity is defined as a Body Mass Index over >/= 30. Constructed area [per-person], educational level and job are considered as factors indicating the socioeconomic status. The results have been adjusted for age and mental health using univariate and multiple logistic regression. A total number of 2859 non-menopause women aged 15-49 yr from urban areas of Tehran have been studied. The prevalence of obesity and overweight were 16.4%and 28.4% respectively. Women aged 30-49 yr had greater risk of obesity [adjusted OR=2.53, 95% CI: 1.99-3.20]. Comparing with students, homemakers and employees were at higher risk of obesity [adjusted OR=4.33, 95% CI: 2.47-7.76, adjusted OR= 2.82, 95%CI: 1.41-5.63 respectively]. Those with >=12 years of education had lower risk of obesity compared to illiterate women [adjusted OR=.57, 95% CI: 0.38-0.86]. The role of social factors is dominant over economic factor on obesity. This fact should be considered as one of the most important research priorities in future researches

Effect of Ministry of Health and Medical Education structure on application of medical research

Integration of health services and medical education the brief manifest of Iran's Ministry of Health and Medical Education [MOHME]- has been studied mainly from the perspective of health service and medical education quality so far. The objective of present study however, is to examine the impact of integrated structure of MOHME on domestic research utilization. Macro-level policy makers in charge of designing the national research and innovation system are expected to benefit from the results of this study. The study was conducted inform of Grounded Theory and through interview's with a wide range of persons ranging from policy makers to healthcare providers in medical and non-medical groups. Integration' has not fully evolved yet. Beyond the structural changes that have been created at the higher levels of MOHME and medical universities, a set of processes should have been defined for attainment of the desired goals. Neither the created structural changes have covered the level of educational and research groups, nor the set of needed processes has been defined. The issue of inadequate research utilization is not limited to health sector, but is also present in other pillars of the national research and innovation system. From the perspective of health research, the national research and innovation system should be defined at the macro level before making any decisions about changing the current structures. The reason is that the main problems of the research system in Iran are not confined to medical sciences or the 'integration', but more general and drastic issues are existent. Any putative structural changes in the 'integration 'and medical sciences should be viewed only as secondary to these main issues

need to revise assessment criteria of academic board members:assessment of research based knowledge transfer in Tehran university of medical sciences

In the past two decades, scientific publications in Iran has considerably increased in the context of medical science and the number of articles published in ISI journals has doubled from 1997 to 2001. Along with this quantitative development, it is interesting to know whether the researches done have led to a change in service provision and an improvement in the health of the society eventually. The aim of the present study was to examine the behavior of researchers in Tehran University of Medical Sciences about knowledge transfer activities. The other question was which factors could affect the researchers' behavior of knowledge transfer. The samples of study were all Tehran University of Medical Sciences' research projects that had received grants from inside and outside the university in 1383, had registered their contracts, had been finished by the time this study was done [the second half of 1385] and their reports had been sent. of 315 research projects that possessed the inclusion criteria, 301 projects were examined and their respective checklists were completed. The researcher's questionnaire was sent to the principal investigators of the projects and eventually 208 questionnaires were collected. Researchers stated that their passive activities of knowledge transfer to be more in the field of publishing articles. The mean score for researchers' performance in this field was 27% of the total score. The mean score of the researchers' performance in [active] activities was 6% of the total score attainable. The review of 301 research proposals showed that the total cost of the projects under study was a little less than 12 trillion rials, whereas in only 20 projects [6.6%], part of the cost had been provided by organizations outside the university. Among these, only 7 cases [2.3%] had considered costs for research-based knowledge transfer. In spite of the present expectations of knowledge transfer in the world, many academicians still use the methods of research based knowledge dissemination and not implementation. So, if it is necessary to 'connect knowledge to practice', it is also necessary to introduce considerable changes in organizational procedures and encouragement policies [e.g. employment and promotion of academic members]. The organizations themselves need to show commitment to knowledge transfer too. This means that apart from creating the necessary motivation in researchers, methods of implementation such as securing the necessary funds as part of the expenses of research projects and also training of researchers should also be considered

[Knowledge translation: a model for research utilization]

The present study was aimed to design a knowledge transfer model that would provide a conceptual framework for linking the different components of a knowledge translation cycle. Such a theoretical model will enable us to organize and evaluate the current situation and design further studies on the transfer of research generated knowledge. This research, performed in 2006-7 in Tehran University of Medical Sciences, utilized two district methodologies: the first part was a narrative review with the goal of identifying the existing knowledge transfer models; the second part included focus group discussions to find out the views and opinions of researchers and decision-makers concerning the factors that promote or hinder knowledge translation within the health system. The two studies have provided the input for designing a "Knowledge Translation Cycle" with five domains: Knowledge Creation, Knowledge Transfer, Research Utilization, Question Transfer, and the context of University. Within each domain, the model includes two components [with the exception of the university context]. This model offers a theoretical basis for identifying the basic requirements and the linking mechanisms for the translation of knowledge

[Self-assessment in research organization [Application of the knowledge translation model]]

The main purpose of the study was the development of a self-assessment tool for research organizations to enable them to assess knowledge translation in their own settings. The development of this self-assessment tool is done based on a narrative review and subsequent focus group discussions, to design a knowledge translation model that would provide a conceptual framework for linking the different components of a knowledge translation cycle, which reported previously. Repeatability of the self-assessment domains was assessed in the 21 participants using intraclass correlation coefficient [ICC]. Each participant filled the form twice within a two-week interval. The internal consistency for each domain was estimated in the 45 study subjects using Cronbach's alpha. This self-assessment tool is an instrument that allows stakeholders in a research organization to review their own knowledge translation activities. This tool consists of 50 statements in four domains; 1- The research question, 2- Knowledge production, 3- Knowledge transfer and 4- Promoting the use of evidence. The respective ICCs and Cronbach's alpha for the four domains were 0.94 and 0.79 for the research question, 0.87 and 0.70 for knowledge production, 0.90 and 0.86 for knowledge transfer, 0.48 and 0.27 for promoting the use of evidence. This self-assessment tool is a way of listing the wide range of variables that affect knowledge translation at organizational level. Although the tool is intended for use by a group of people and not by individuals, it is not a survey instrument and its results should not be interpreted quantitatively. Therefore, this self-assessment tool can be useful for assessing the knowledge translation activities of each research organization, thereby identifying its shortcomings and seeking ways to improve them

[A Study on noise- induced hearing loss in Agriculture and industry factory - Iran]

Noise-induced hearing loss is a prevalent work-related morbidity in the country. We determined the strength of association between hearing loss and occupational noise exposure as the first step in prevention programs. A historical cohort study involving 100 exposed and 31 non-exposed subjects was conducted. Noise exposure was estimated using sound level meter BSEN 60651, Type 2. Past noise exposure was estimated using the existing data on the place and type of work. Audiometry was used to assess hearing loss in each subject in 3- year intervals on an occupational cohort from 1993-2004. Noise-induced hearing loss was found in 49% [49 subjects] of the exposed group and 9.7% [3 subjects] of non-exposed group [p<.0001]. Nobody used any form of hearing protection routinely in either group. Relative risk for noise-induced hearing loss was 5.1[CI95%: 1.7- 15.1].Time at risk was estimated 24.9 years [22.7-27.1] in exposed and 22.2 years [20.7-23.7] in unexposed group by survival analysis. More legislation, hearing conservation programs, and surveillance and biological monitoring of work sites and workers are required to prevent occupational hearing loss. Planning strategies for noise assessment and control can help improve the work environment. Gross occupational exposure to noise has been demonstrated to cause hearing loss and the authors believe that occupational hearing loss in the country is a widespread problem