Exploring Reproductive Health Education Needs in Infertile Women in Iran: A Qualitative Study / 예방의학회지

Objectives@#An inadequate understanding of infertility can affect individuals’ self-efficacy and ability to perform self-care; thus, reproductive health education is an important part of infertility treatment. The present qualitative study aimed to explore the experiences and educational needs of infertile women with regard to reproductive health. @*Methods@#In this qualitative study, we utilized a content analysis approach. Purposive sampling was performed to ensure maximum diversity. In total, 23 individual interviews were conducted with 20 Iranian women with infertility and 3 key informants between July 2018 and February 2019 in northern Iran. Data were collected through in-depth, semi-structured interviews. Data analysis was performed using a conventional content analysis approach. @*Results@#Reproductive health education needs were identified by analyzing interview data from 4 main categories: familiarity with the fertility process and preparation for pregnancy, recognition of infertility and expectations around seeking treatment, recognition of preventive actions associated with reproductive health, and correction of false beliefs. Recognizing the causes of infertility and understanding the different approaches to infertility treatment are among the most important educational needs of infertile women. The potential for neglect of health-related issues due to concerns about fertility and the maternal experience necessitates education about preventive measures for cervical cancer, breast cancer, and sexually transmitted infections. Correcting misconceptions, including those related to contraceptives and traditional medicine, can also help promote reproductive health. @*Conclusions@#In infertile women, the educational needs associated with reproductive health are multifaceted. Satisfying these needs can help achieve optimal treatment results and promote reproductive health.

Vitamin D status and its relation to inflammatory markers in patients with mild to moderate ulcerative colitis

Background: Inflammatory bowel disease [IBD], Crohn's disease [CD], and ulcerative colitis [UC] are autoimmune inflammatory diseases of the alimentary tract, which seems to be caused by the interaction of environmental and genetic factors as well as diet and nutritional factors such as vitamin D. The aim of this study was to assess the vitamin D status and its associations with erythrocyte sedimentation rate [ESR], and high-sensitivity C-reactive protein [hs-CRP] as inflammatory markers in patients with UC

Methods: In this analytical cross-sectional study 90 patients with mild to moderate UC who were resident of Tehran were assessed. 25[OH]D, parathyroid hormone [PTH], ESR and hs-CRP were measured. Dietary intake was assessed by 3-day 24h diet recall. Statistical analyses were performed using STATA [Version 12]

Results: The average serum 25-OH-vitamin D3 was 33.1+/-8.3 ng/mL and 38.9 % of the patients were vitamin D deficient or insufficient [37.3 % of men and 41% of women]. No significant correlation between serum 25[OH]D and hs-CRP, ESR, body mass index [BMI], and disease duration was found. There were no significant differences in serum 25[OH]D between men and women. Mean daily dietary vitamin D and calcium intakes were 189.5 Iu [95% CI: 176.0-203.1] and 569.5 mg [95% CI: 538.8-600.2] respectively

Conclusion: In this cross-sectional study 38.9% of the patients with mild to moderate UC were vitamin D deficient or insufficient and vitamin D level was not correlated to ESR and/or hs-CRP. More studies are needed to investigate the effect of vitamin D in the pathogenesis of UC or as a part of its treatment

Quality of life in Iranian elderly population using the SF-36 questionnaire: systematic review and meta-analysis

Background: Ageing is a major known risk factor that is a threat to human health. To date, many studies have investigated quality of life [QOL] among the elderly population in the Islamic Republic of Iran. However, their results were inconsistent.

Aims: We designed this systematic review and meta-analysis to estimate the overall mean score of QOL based on the Short Form 36 Health Survey Questionnaire [SF-36] among the Iranian elderly population.

Methods: We searched international databases [Medline, Scopus and Science Direct] and national databases [Science In-formation Database, MagIran, IranMedex and Irandoc] up to February 2015. We included all cross-sectional studies that evaluated QOL among the Iranian elderly population using SF-36.

Results: Of 2150 studies identified, 15 were included in the meta-analysis. The mean scores for QOL in the 8 scales were: 47.58, 51.75, 55.42, 55.78, 59.55, 51.54, 47.85 and 51.31 for physical-role, physical function, mental health, bodily pain, social functioning, emotional-role, general health, and vitality, respectively.

Conclusions: Our results indicated that health-related QOL decreased with increasing age. QOL was worse in women than in men, especially in physical-role and general health scales. Elderly people who lived in a nursing home had lower QOL than those who lived in their own home. So, health policy-makers should design comprehensive programmes to improve health-related QOL for the Iranian elderly population

Barriers to pap smear test for the second time in women referring to health care centers in the South of Tehran: a qualitative approach

Background: Cervical cancer is a preventable disease with a regular screening program. Many studies have reported a large number of barriers that women had for the first time, but this study decided to find other barriers for the second time pap smear

Methods: In this qualitative research, data were gathered through in-depth interviews and expressed through conventional content analysis in the form of constant comparison. The participants were 15 women with family profile at 30 health care centers who lived in the south of Tehran and had done Pap smear for one time but didn't do it for the second time

Results: Three main themes emerged from the analysis of the interviews: negative experiences of the first Pap test were as follows: results of the first time test, readiness for performing the test, getting the test itself, and the site of the first Pap test. Personal barriers to getting the second Pap test were: inattention to time, physical barriers to the second Pap test, and inhibitory beliefs. Perceived social barriers to getting the second Pap test with two sub-themes included social supports and abstract norms

Conclusion: This study provided other barriers about Pap smear including lack of the spouse's support, the role of health care providers and physicians in screening program for early diagnosis in women

A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran / 예방의학회지

OBJECTIVES: General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. METHODS: A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran’s health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. RESULTS: Iran’s medical education is faced with several challenges that were categorized in four main themes including student selection, medical students’ perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. CONCLUSIONS: Challenges that were found could have negative effects on retention. Modification in student’s perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas.

Years of life lost because of premature death due to intentional and unintentional accidents in Ghazvin province from 2004 till 2008

Background: Accidents are the second cause of death in Iran and one of the significant challenges in public health. They can affect people in all ages. In this study, we try to calculate years of life lost due to intentional and unintentional injuries, which is considered as one of the main indicators for prioritizing public health problems

Methods: This study is a practical cross sectional survey research HSR [health system research] that uses secondary analysis on the death data of Ghazvin province. The calculations also take into account the WHO standards in age group, sex and years of life lost [YLL] due to death

Results: This study showed that the unintentional accidents were the leading cause of death based on YLL from 2004 until 2008 in Ghazvin province. The number of deaths due to intentional and unintentional accidents was 3796 deaths as of which 2954 [77.8%] was male and 842 [22.2%] female. In general three quarter of the YLL due to early death relates to accidents for males and less than a quarter relates to accidents for females. Between 2004 until 2008, the maximum number of years of life lost [YLL] in both sexes is for the age group of 15 to 49

Conclusion: Considering the high level of years of life lost [YLL] due to accident in this province, especially in men, more appropriate interventions for the more risk prone age groups and male in general need to be taken into account

Research's practice and barriers of knowledge translation in Iran

Knowledge Translation is a process that includes synthesis, dissemination, exchange and application of knowledge to improve the health, services and products In this study we have attempted to examine the knowledge translation practice and its perceived barriers on the universalities and research institutes [research sector] in Iran. Both qualitative and quantitative approaches were used. In the quantitative section, a questionnaire had prepared for this study was completed by 88 authors country wide from randomly selected papers. In the qualitative section 13 in-depth interviews and 6 focus group discussions were held with managers and policy makers, clinical and health service providers, and researchers. Twenty four percent of the authors had no interaction whatsoever with the target audience. Lack of expectation toward creating change in the target audience, researchers' incentives, low level of trust among researchers and decision makers, absence of a predefined mechanism for delivery of research results and inappropriate research priorities were among the most important barriers identified in the qualitative section. Translation of research findings into some concrete outputs which can affect health of people is not in mandate of researchers and subsequently they are not prepared for this as well. Based on the barriers identified, it seems that the following interventions are necessary: cooperation among policy makers at macro and meso [organizational] level and the research sector; establishing networks for researchers and decision makers in choosing the research topic, priority setting, and building trust among researchers and policy makers

Application of capture-recapture for fine-tuning uncertainties about national maternal mortality estimates

Maternal mortality ratio [MMR] is one of the main indicators of the millennium development goals and its accurate estimation is very important for the countries concerned. The objective of this study is to evaluate the applicability of capture-recapture [CRC] as an analytical method to estimate MMR in countries. We used the CRC method to estimate MMR in Iran for 2004 and 2005, using two data sources: The maternal mortality surveillance system and the National Death Registry [NDR]. Because the data registry contains errors, we defined three levels of matching criteria to enable matching of cases between the two systems. Increasing the matching level makes the matching criteria less conservative. Because NDR data were missing or incomplete for some provinces, we calculated estimates for two conditions: With and without missing/incomplete data. According to the CRC method, MMR in 2004 and 2005 were 33 and 25 in the best-case scenarios respectively and 86 and 59 in the worst-case scenarios respectively. These estimates are closer to the ones reported by United Nations Agencies published in 2010, 38 and Hogan's study, 30 in 100,000 live births in 2005. The MMR estimation by CRC method is slightly different from the international studies. CRC can be considered as a cost-effective method, in comparison with cross-sectional studies or improvement of vital registration systems, which are both costly and difficult. However, to achieve accurate estimates of MMR with CRC method and decrease the uncertainty we need to have valid databases and the absence of such capacities will limit the applicability of this method in developing countries with poor quality health databases

association of the transitions in smoking stages with prevalence of cigarette smoking in the classes and schools: a longitudinal study

Adolescent tobacco use remains a major public health priority to reduce the prevalence of tobacco use in community. The aim of this study was determining the association of the transitions in smoking stages with prevalence of cigarette smoking in the classes and schools in adolescents of Tabriz City [northwest of Iran]. Fifty-six high schools were randomly selected, and 4903 students completed a self-administered questionnaire on cigarette smoking twice with a 12-months interval in 2010 and 2011. Transition from experimenter to regular smoker stage was associated with the prevalence of cigarette smoking in the school. The results have shown the association of student's smoking uptake with the prevalence of cigarette smoking in the school. This highlights the importance of enforcing smoke free policies in schools

Quality of life of medical students in Tehran University of medical sciences

This study aims to investigate the quality of life [QOL] of Tehran University of Medical Sciences' [TUMS] medical students at different educational levels and specify the most important factors related to this quality. A sample of 242 medical students was selected randomly, given their number in three educational levels [basic sciences, physiopathology-stager and intern]. The QOL was measured by WHOQOL-BREF. The students obtained average high score in two psychological and environmental health domains, and low score in physical health and social relationship domains. As the educational level of students increased their quality of life decreased at all four domains. At social relationship domain, the female students had overall better situation as compared to males [p=0.009]. The female and male students had opposite condition at the level of basic sciences and internship, in a way that the female students earned higher marks at basic sciences level and the males at internship level [P= 0.008]. The condition of female students in terms of environmental, physical and psychological health became static while their education rose. However, only environmental health of the male students reduced as their education level increased [P= 0.05]. The students were of undesirable conditions in two domains of social relationship and physical health. Internship is a specific level in both groups which has a negative impact on the dimensions of quality of life and naturally needs more care for the students. Married status improved the students' QOL and could moderate the undesired effects of internship

Epidemiologic evaluation of child abuse and neglect in school-aged children of Qazvin province, Iran

This study was carried out to detect the prevalence of child abuse in three domains of physical, psychological and neglect among elementary school aged children of Qazvin Province, Iran. In this descriptive-analytic and cross-sectional study, 1028 elementary school aged children of Qazvin Province selected through multistage cluster sampling were assessed for child abuse in all domains, except for sexual abuse through a researcher-made questionnaire. The questionnaire was standardized for validity and reliability. Gathered data was statistically analyzed and P-value less than 0.05 was considered significant. Out of 1028 studied children, including 540 [52.5%] boys and 488 [47.5%] girls 679 [66.05%] cases declared at least one type of child abuse. The number of positive cases for each domain of emotional, physical and neglect was 618 [60.1%], 360 [35%] and 394 [38.3%] respectively. No significance was seen regarding the gender and/or regions of living in any of the domains and total prevalence. Regarding the results of this study which showed a prevalence rate of 66% for child abuse; and since there are strong association between child maltreatment and its impacts in juvenile and adulthood periods in the forms of offending, mental health concerns such as suicide and homicide, substance abuse, school failure, employment difficulties, teenage pregnancy, adult attachment difficulties, family violence, intergenerational violence and so on, appropriate education to the parents, and the punishment laws for child abuse is recommended

Disease surveillance and private sector in the metropolitans: a troublesome collaboration

An effective response to health problems is completely dependent upon the capacities of the health system in providing timely and valid information to take action. This study was designed to identify various reasons from various perspectives for underreporting disease by physicians in the private sector in big cities in developing countries setting. In this qualitative study, we used focus group discussions [16 manager], and in-depth semi-structured interviews [7 private physician, 2 experienced policy maker and a researcher]. We used the thematic approach for data analysis. Results were amplified by a comprehensive literature review. Themes were classified in 6 categories: Infrastructure and legal issues, the priority of disease reporting, workflow processes, motivation and attitude, human resources and knowledge and awareness. As the main reasons of under reporting, most physicians pointed out complicacy in reporting process and inadequate attention by the public sector. Managers emphasized instituting legal incentives and penalties. Experts focused on physicians' knowledge and expressed a need for continuing medical education programs. Independent interventions will have little chance of success and sustainability. Different intervention programs should consider legal issues, attitude and knowledge of physicians in the private sector, and building a simple reporting process for physicians. Intervention programs in which the reporting process offers incentives for all stakeholders can help improving and sustaining the disease reporting system

Barrier and facilitators of HIV related risky sexual behavior

This study was conducted to identify the determinants of protective behavior in relation to HIV transmission. Since the risk of transmission is higher among those who have extramarital intercourse, the study sample constituted of such people. We started this study in 2010 and finished it in 2011. Participants were divided into low-risk and high-risk groups. High-risk people included sex workers and those who presented at drop- in centers. interviewers were 18 men and women in low-risk group and 12 men and women in the high-risk group. Data were collected through in-depth interviews and were analyzed using the thematic framework method. In both groups, protective behavior was influenced by willingness to protect, intention or decision to protect, and personal, social, and environmental barriers and facilitators. In terms of willingness, behavior was influenced to preserve sexual pleasure by avoiding condoms. In terms of barriers and facilitators, trust in partner, misperceptions, condom inaccessibility, unplanned sex, fear of contracting the disease, partner's wish, ethical commitments were mentioned by both groups, stigma of condom possession by the low-risk group, and partner's force was mentioned by the high-risk group. Educational programs need to focus on changing the concept that "condoms reduce sexual pleasure". In addition, interventional programs to strengthen factors such as self-efficacy, ethical commitments, faithfulness, and correct beliefs such as undue trust in partner, misconception of being safe, unplanned sex, and the stigma of possessing condoms can be very effective in changing high-risk sexual behavior

Personal and family factors affecting life time cigarette smoking among adolescents in Tehran [Iran]: a community based study

The prevalence of smoking among adolescents varies in different parts of the world. The current study aims to survey the socio-demographic and family characteristics related to adolescent lifetime cigarette smoking among 1201 Iranian adolescents aged 15- 18 years old. This study is a population-based cross-sectional survey conducted using the multistage random cluster sampling method in Tehran, Iran in the summer of 2010. The prevalence of lifetime cigarette use amongst boys [30.2%] was about 1.5 times that of girls [22.2%], [p=0.002]. Older age, low parental control, very little parental supervision in the adolescent's selection of friends, and having a friend or family member who smokes were associated with lifetime cigarette use among male adolescents. Moreover, the use of verbal punishment by the parents was a protective factor for female lifetime cigarette use. Smoking has become one of the great health threats among Iranian adolescents. As a result, health promotion programs should be gender based whilst educational and interventional programs for preventing tobacco use should begin before adolescence

Knowledge of medical students of Tehran university of medical sciences regarding plagiarism

The core concept of plagiarism is defined as the use of other people's ideas or words without proper acknowledgement. Herein, we used a questionnaire to assess the knowledge of students of Tehran University of Medical Sciences [TUMS] regarding plagiarism and copyright infringement. The questionnaire comprised 8 questions. The first six questions of the questionnaire were translations of exercises of a book about academic writing and were concerning plagiarism in preparing articles. Questions number 7 and 8 [which were concerning plagiarism in preparing Microsoft PowerPoint slideshows and copyright infringement, respectively] were developed by the authors of the present study. The validity of the questionnaire was approved by five experts in the field of epidemiology and biostatistics. A pilot study consisting of a test and retest was carried to assess the reliability of the questionnaire. The sampling method was stratified random sampling, and the questionnaire was handed out to 74 interns of TUMS during July and August 2011. 14.9% of the students correctly answered the first six questions. 44.6% of the students were adequately familiar with proper referencing in Microsoft PowerPoint slideshows. 16.2% of the students understood what constitutes copyright infringement. The number of correctly answered questions by the students was directly proportionate to the number of their published articles. Knowledge of students of TUMS regarding plagiarism and copyright infringement is quite poor. Courses with specific focus on plagiarism and copyright infringement might help in this regard

Barriers of clinical practice guidelines development and implementation in developing countries: a case study in Iran

Knowledge products such as clinical practice guidelines [CPG] are vitally required for evidence-based medicine [EBM]. Although the EBM, to some extent, has been attended during recent years, no result has achieved thus far. The current qualitative study is to identify the barriers to establishing development system and implementation of CPGs in Iran. Twelve semi-structured, in-depth interviews were conducted with a purposive sample of health policy and decision makers, the experts of development and or adaptation of CPGs, and the experts of EBM education and development. In addition, 11 policy-makers, decision-makers, and managers of the health system participated in a focus group discussion. The analysis of the study data was undertaken by thematic framework approach. Six themes emerged in order of their frequency include practice environment, evidence-based health care system, individual professional, politician and political context, innovation [CPG] and patients. Most of the indications in the treatment environment focused on such sub-themes as regulations and rules, economical factors, organizational context, and social context. While the barriers related to the conditions of treatment environment, service provider and the features of innovation and patients had been identified before in other studies, very little attention has been paid to the evidence-based health care system and politician and political context. The lack of an evidence-based healthcare system and a political macro support are mentioned as the key barriers in Iran as a developing country. The establishment of a system of development and implementation of CPGs as the evidence-based practice tools will not be possible, unless the barriers are removed

Only one third of Tehran's physicians are familiar with 'evidence-based clinical guidelines'

Clinical guidelines have increasingly been used as tools for applying new knowledge and research findings. Although, efforts have been made to produce clinical guidelines in Iran, it is not clear whether they have been used by physicians and what factors are associated with them? Four hundred and forty three practicing physicians in Tehran were selected from private clinics through weighted random sampling. The data collection tool was a questionnaire on familiarity and attitude toward clinical guidelines. The descriptive and analytical findings were analyzed with t-tests, Chi2, logistic and linear multivariate regression by SPSS, version 16. 31.8% of physicians were familiar with clinical guidelines. Based on the logistic regression model physicians' familiarity with clinical guidelines was positively and significantly associated with 'working experience in a health service delivery point' OR = 2.13 [95% CI, 1.17-3.90], 'familiarity with therapeutic protocols' OR = 2.09 [95% CI, 1.22-3.57] and 'holding a specialty degree' OR = 2.51 [95% CI, 1.24-5.07]. The mean overall attitude scores in the 'usefulness', 'reliability', and 'problems and barriers' domains were, respectively, 78.9 [SD = 16.5], 78.9 [SD = 19.7] and 50.4 [SD = 15.9] out of a total of 100 scores in each domain. No significant association was observed between attitude domains and other independent variables using multivariate linear regression. Little familiarity with clinical guidelines may represent weakness in of production and distribution of domestic evidence. Although, physicians considered guidelines as useful and reliable tools, but problems such as difficult access to guidelines and lack of facilities to apply them were stated as well

What motivates talented medical students to study simulta-neously at master of public health [MPH]?

Nearly three decades ago, the Master of Public Health [MPH] academic degree was introduced to Tehran University of Medical Sciences' School of Public Health, Tehran, Iran. A new program for simultaneous education of medical, pharmaceutical and dental students was initiated in 2006. Talented students had the opportunity to study MPH simultaneously. There were some concerns about this kind of admission; as to whether these students who were not familiar with the health system had the appropriate attitude and background for this field of education. And with the present rate of brain drain, is this just a step towards their immigration without the fulfillment of public health? This qualitative study was conducted in 2012 where 26 students took part in focused group discussions and individual interviews. The students were questioned about their motivation and the program's impact on their future career. The participants' statements were analyzed using thematic analysis. The primary motivations of students who entered this program were: learning health knowledge related issues, gaining a perspective beyond clinical practice, obtaining a degree to strengthen their academic r‚sum‚, immigration, learning academic research methods and preparing for the management of health systems in the future. Apparently, there was no considerable difference between the motivation of students and the program planners. The students' main motivation for studying MPH was a combination of various interests in research and health sciences issues. Therefore, considering the potential of this group of students, effective academic investment on MPH can have positive impact

algorithm of smoking stages assessment in adolescents: a validation study using the latent class analysis model

Not withstanding the importance of smoking stages evaluation in adolescents, there is not an appropriate instrument for its measurement. This study aims to introduce an appropriate instrument for measurement of smoking stages in adolescents and to examine its validity using latent class analysis [LCA] model. We designed an algorithm to measure the smoking stages. The relevancy and clarity of the algorithm was examined by experts and lay experts. We assessed the reliability of our algorithm using test retest method. Moreover, using the LCA, we studied the validity of the stages measured by the designed algorithm in 4903 students [ages 14-19], who were randomly selected from grade 10 high school students in Tabriz [North West of Iran]. The algorithm content validity indicates high relevancy and clarity percentages. Intra-class correlation of 0.929 was found in the assessment of the reliability of smoking stages [9 stages] in 154 students within a two week interval. The LCA model revealed nine interpretable classes [G[2] = 0.051, df = 1, P = 0.821] for the measurement of smoking stages. Examination of the smoking cessation stages in a sample of 218 students in the cessation stage demonstrated that the results for five classes could be interpreted [G[2] = 0.001, df = 1, P = 0.975]. The results suggested that this algorithm is clear, valid, and reliable.