National health guidelines in I.R of Iran, an innovative approach for developing countries

Guidelines have produced and used in complex environment of health care system with its ethical, economical, legal and other aspects; that should be taken into account in any country. Modifying the format and content of guidelines might facilitate their usage and lead to improved quality of care and cost containment. We have produced this tool for explained above purpose. A coordinating national team has settled at the office of minster of health and medical education, supported by a guideline review committee. An innovative and appropriate approach for adapting national health guidelines has consisted of eight steps, have defined For preparing the draft of each guideline a technical team which, including main author, her/his co-workers have nominated. The authors of each topic have systematically searched databases of the proposed Twenty-two International Sites, and then have selected at least five sources of them that were more relevant. The final recommendations have proposed by agreement of technical team and Guideline Review Committee. In less than 5 months, more than 500 authors in whole country have selected to prepare guidelines and, approximately 150 guidelines have provided in three volumes of the published and distributed book. Each guideline had a national ID number, constant forever; all topics should be reviewed every 3-5 years. National health guideline[s] would be essential means for policy making in health system and increased the cost containment and quality of care. Ministry of Health and Medical Education should provide and distribute the guidelines based on its accountability to legal responsibility

[Quality gap in premarital education and consultation program in the health centers of Shahid Beheshti medical university]

Attendance in pre-marital education and counseling program may be the couple's first encounter with the health care system. Their perception and satisfaction of this program would play critical role in further use of health services. The purpose of this study was to identify the quality gap of pre-marital education and counseling program from viewpoint of couples referring to premarital counseling centers of Shahid Beheshti University of Medical Sciences in 2010. In a descriptive cross-sectional study, a total of 1200 couples attending in premarital counseling centers were selected with non random sampling method and studied using SERVQUAL questionnaire. Data were analyzed with Wilcoxon, independent t-test, analysis of variance, and Turkey tests using SPSS version 18. The mean age of couples was 25.5 +/- 4.8 years, 65.8% of subjects were women and 34.2% were men. 56.5% of the couples had high school diploma or higher. There was negative service quality gap [-0.1] between expected and received services. The most service quality gap was in assurance dimension [-0.23] and the least was in empathy dimension [-0.04]. There was no significant difference between gap score mean, gender, and history of participation in premarital counseling classes, but there was significant difference in gap score between different education levels [p<0.001]. Regarding to negative gap between received and expected service; health care system should consider the couples' expectation to improve the quality of premarital education and counseling program

[ reproductive health status of women with experience of violence in harm reduction centers in Tehran, 2010]

Due to complications and consequences of violence against women and limited information about reproductive health issues in women with experience of violence, this survey was carried out to assess reproductive health status of these women in harm reduction centers in Tehran in 2010. This descriptive cross-sectional study was conducted on 69 out of 75 vulnerable women who were clients of harm reduction centers, and experienced at least one type of violence [emotional, physical, and sexual]. Data collection tools were questionnaires and data collection method was structured interview. The questionnaire had five dimensions, demographics, reproductive health, sexual performance, sexual behavior, and violence. Data was analyzed with SPSS 18; descriptive and analytic statistics were applied. Mean age of participants was 34.3[9.6] years and 37.7% of them were divorced. Mean age at first marriage was 16.7 [2.5] years and mean age at first sexual relationship was 16.1 [4.8] years. Illiteracy observed among 17.4% of participants. Among these women, 69.3% reported all three types of violence; furthermore, 85.3%, 86.7%, and 76% reported physical, emotional and sexual violence, respectively. 62.9% had unwanted pregnancy and 51.6% had an abortion. Contraception was completely ignored in 46.5% of participants. Among eligible women, 52.2% never participated in cervical cancer screening examination, 82.4% of them had sexual dysfunction, 39.1% of them had anal sex and 34.8% had oral sex. Despite of access to reproductive health services, many of these women had poor reproductive health conditions. Greater support and proper interventions can lead to better results for these women