RESUMO
Community assessment is one of the core competencies for public health professionals; mainly because it gives them a better understanding of the strengths and drawbacks of their jurisdictions. We planned to recognize an appropriate model that provides a conceptual framework for the Iranian community. This study was conducted in Tehran, during 2009-2010 and consisted of two parts: a review of the literature and qualitative interview with selected experts as well as focus group discussion with health field staff. These steps were done to develop a conceptual framework: planning for a steering committee, forming a working committee, re-viewing community assessment models and projects, preparing the proposed model draft, in-depth interview and focused group discussions with national experts, finalizing the draft, and preparing the final model. Three different models published and applied routinely in different contexts. The 2008 North Carolina Community Assessment model was used as a reference. Ten national and 18 international projects were compared to the reference and one and six projects were completely compatible with this model, respectively. Our final proposed model takes communities through eight steps to complete a collaborative community assessment: form a community assessment team, solicit community participation and gain inter-sectoral collaboration, establish a working committee, empower the community, collect and analyze community's primary and secondary statistics, solicit community input to select health priorities, evaluate the community assessment and develop the community assessment document, an develop the community action plans
RESUMO
Multiple Sclerosis [MS] is a disease with high disabling disorders and considerable social and economic impacts. This study was conducted to analyze the spatial distribution of MS disease in Tehran, Iran during 2001-2012. The existing information in the MS patients' medical files who had registered in Iranian MS Society [IMSS], located in Tehran office, was used for analysis. The relationship between diseases incidences in 22 zones of Tehran based on estimated socio-economic status [SES] of each zone was evaluated. High and low clustering approach was used in order to investigate the disease's distribution pattern meanwhile, Getis Ord's Gi test and Hot Spot analysis approach has been used to detect high risk zones of the disease. A total of 6027 MS patients were registered between 2001- 2012 which 4580 [%75.99] were women. During the study period, zone number 6 figured as the most high risk zone for the disease [P<0.1]. A heterogeneous distribution was shown for the disease. Cumulative incidence of the disease in northern zones [101.73 per 100,000 inhabitants] was two times more of Southern zones [53.79 per 100,000 inhabitants]. There seems to be a direct linear relationship between estimated incidence rate of the disease in each zones with the level of SES [P<0.001]. Heterogeneous geographical distribution of MS and its higher estimated incidence for northern zones in Tehran may be because of higher SES and other factors in mentioned zones. It is recommended to consider the surveillance with long-term and cost-effective interventional strategies along with disease in high risk zones
RESUMO
INTRODUCTION: Breast cancer is the most common cancer among Iranian women. This study aimed to determine risk factors for breast cancer in the north of Iran. METHOD: A matched case-control study was conducted in Mazandaran province of Iran in 2004 of 250 biopsy proven cases of breast cancer and 500 neighbor controls that were matched by age within a 3 year period. Statistical analysis was carried out using conditional logistic regression with the backward elimination method and crude and adjusted odds ratios with related 95% CIs were estimated with Stata 8.0 software RESULTS: Multivariate analysis showed that higher education (OR=4.70, 95%CI: 1.71-12.88), late menopause (OR=4.18, 95%CI: 2.54-6.88), history of induced abortion (OR=1.62, 95%CI: 1.13-2.31), positive first-degree family history of breast cancer (OR=3.14, 95%CI: 1.37-7.20), and BMI (OR=1.02, 95%CI: 1.01-1.03) were risk factors for breast cancer. Furthermore, having more episodes of full term pregnancy (OR=0.87, 95%CI: 0.80-0.95), longer duration of breast feeding (OR=0.993, 95%CI: 0.989-0.997) and parity more than 2 were shown to be protective factors. CONCLUSIONS: Our study revealed the role of some modifiable determinants of breast cancer that can be focused by public health intervention in the northern community of Iran. Accordingly, the women who have one or more of the following risk factors should take the special attention to risk of breast cancer: obesity, being menopause, positive family history of breast cancer and history of induced abortion. The protective effect of longer duration of breast feeding should be encouraged too.