[Identification of community needs and prioritization of problemsbased on community assessment in Azerbaijan Borough, Tehran, Iran]

Community assessment is a process by which a clear picture of the community assets, strengths, resources, and needs is obtained with active participation of the community itself, followed by prioritization of the community needs and formulating strategies and programs to solve the problems. This study was conducted to identify and prioritize problems and needs of the Azerbaijan Borough in Tehran city, Iran, with active participation of the people. This study was conducted to determine the attitudes and beliefs of the community members about their community needs and problems. The study was based on a model designed in North Carolina, US. In this model, the assessment process is performed in eight steps. In the first seven steps problems are identified and prioritized, and in step 8 a plan of action is developed to deal with the problem selected. A total of 40 problems were identified and divided into several groups. The most important problems were as follows: social problems; environmental health problems; educational and cultural problems, civil rights and urban services; distribution and use of drugs; lack of family counseling centers; shortage of parks and playgrounds for neighborhood children; lack of supervision by municipal contractors on urban cleaning; and lack of mental health services specially for the elderly. Several types of problems, including health, as well as non-health-social, cultural and economic-problems were identified. Community assessment provides an appropriate opportunity for active participation of community members and makes available sufficient information for sound decision-making. Thus, community assessment can be regarded as a suitable technique for identifying and prioritizing community needs

Direct estimation of life expectancy in the Islamic Republic of Iran in 2003

We estimated the life expectancy for 2003 for 23 provinces in the Islamic Republic of Iran using population and mortality data from the Ministry of Health and Medical Education. The underreporting of deaths above 4 years was corrected using the Brass Growth Balance method. We assumed that the distributions of population, deaths, and hence life expectancy in the 23 provinces were equal to those for all 28 provinces of the country. Thus we estimated life expectancy at birth to be 71.56 years for the total population [95% uncertainty interval [UI]: 71.52-71.62]; 70.09 [95% UI: 70.02-70.16] years for males, and 73.17 [95% UI: 73.10-73.24] years for females. Our estimates were higher than the model-based estimates of the Statistical Centre of Iran, United Nations agencies and the World Bank, due to differences in the estimation methods used

Health state valuation in Iran: an exercise on cardiovascular diseases using visual analogue scale method

Disability Weights [DWs] are main components for computing summary measure of population health [SMPH] and economic studies. They are specific for each community, but there are no previous studies in Iran. In this study, we investigated the feasibility of health state valuation [HSV] in Iranian population. Twelve cardiologists in 3 sessions of expert panels, defined 25 states, related to cardiovascular diseases [3 major and 22 specific diseases]. From January to March 2008, 80 persons in 4 groups including: physicians, patients, patients' families and general publics [each group 20], were interviewed and valuated the states, using visual analogue scale [VAS] method. SPSS[Registered] 15 for window[Registered] [SPSS Corporation, Chicago, Illinois] was used for statistical analysis. Data showed that the defined health states had various severities. All the 4 groups ranked the "3 major-diseases" and "very-mild" and "very-severe" states, similarly. Non-physicians were not able to differentiate among "valvular-diseases" and "pacemakers" properly. The reliability of responses was acceptable. VAS is an appropriate and reliable method for HSV in Iranian population. Non-physicians' opinions can be consider in major cardiac diseases. Valuation of more specific situations must perform by physicians

Effectiveness of adolescents' immunization against hepatitis B on burden of the disease in Iran

Hepatitis B is a common problem in many countries. Due to high efficacy, safety and low cost of vaccine, mass immunization has become a favorite strategy to improve population health. In this study, we tried to estimate marginal effectiveness of adolescents' immunization program in Iran. Epidemiologic data about of hepatitis B in Iran was gathered through literature review, expert opinion, existing resources of data and synthesis by modeling of other data. In a state transition model, different stages of disease were simulated in 15 to 100 year old individuals. Comparing the results of burden of hepatitis B with and without immunization revealed an estimate of avoidable burden of disease with intervention. Monte Carlo simulation and sensitivity analyses were done for uncertainty analysis of results. Immunization of around one million 15-year, old males and females prevents 2071 of male and 581 of female premature deaths due to acute hepatitis B, cirrhosis and hepatocellular carcinoma annually. Moreover, it prevents loss of about 52 and 36 percent of YLL [years of life lost] due to hepatitis B complications in males and females respectively. On average, it avoids loss of Disability Adjusted Life Years [DALY] of 0.012 and 0.006 years, according to present value of life. Monte Carlo simulation of populations showed that effectiveness of the intervention is quite significant and about half of males and one third of females with disability, equal to at least one year of full health, will be free. With sensitivity analyses, results were standing in acceptable limit of values in both bivariate and probabilistic calculations. Our study showed that effectiveness of adolescents' immunization against hepatitis B is quite significant. Calculation using basic estimates of cost of intervention program implies that this intervention is possibly very cost effective. For final judgment, results should be combined with cost effectiveness analysis, and compared to other interventions

[Knowledge, Attitude and Practice Regarding the mass Anti-Measles and Rubella Immunization Campaign [2004] in the Population Covered by Tehran University of Medical Sciences]

The campaign to eliminate measles and rubella [MR] is one of the most important current health projects in Iran. One of the basic requirements of this program is the creation of an efficient system for collecting data on MR morbidity and mortality, people's knowledge, attitude and practice [KAP] regarding MR prevention, and people's participation in the eradication drive. The present study was done to assess people's knowledge, attitude and practice in relation to the current anti-MR campaign. This cross- sectional study was carried out four months after the mass [anti-MR campaign [performed in May 2004]. The target population included at the people aged 20-25y who lived in areas covered by Tehran University of Medical Sciences and Health Services. The calculated sample size was 384, using a 2-stage sampling procedure. We used X2 tests, odds ratios and confidence intervals to detect relationships between various categorical variables. We also performed Cronbach's alpha test to assess questionnaire reliability, and principal component analysis to ensure construct validity. Data were collected on 390 individuals. The percentages of people with an acceptable level of knowledge, attitude and practice were 63.3%, 53.6% and 93.1% respectively. After controlling for confounders in a logistic regression model, it became apparent that knowledge concerning the mass immunization campaign was related to the individual's own education and that of his/her mother. Attitude was found to be affected by factors such as education, marital status and the family's main income level. The practice component, on the other hand, was not significantly related to any of the variables included in this study. The positive achievements of this program should be used in planning any future immunization campaigns. Particular attention should be paid to factors that affect overall coverage. These include human resources, equipment, vaccines and other materials, service quality, the cold chain, information provided to the public, and people's as well as providers' knowledge of the immunization program, the target diseases [s] and the vaccines

[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