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
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.
Iran; notification; public health practice; reporting
The most fundamental way to decrease the burden of noncommunicable diseases (NCDs) is to identify and control their related risk factors. The goal of this study is to determine socioeconomic inequalities in risk factors for NCDs using concentration index based on Non-Communicable Disease Surveillance Survey (NCDSS) data in Kurdistan province, Islamic Republic of Iran in 2005 and 2009.
The required data for this study are taken from two NCDSSs in Kurdistan province in 2005 and 2009. A total of 2,494 persons in 2005 and 997 persons in 2009 were assessed. Concentration index was used to determine socioeconomic inequality. To assess the relationship between the prevalence of each risk factor and socioeconomic status (SES), logistic regression was used and odds ratio (OR) was calculated for each group, compared with the poorest group.
The concentration index for hypertension was -0.095 (-0.158, -0.032) in 2005 and -0.080 (-0.156, -0.003) in 2009. The concentration index for insufficient consumption of fruits and vegetables was -0.117 (-0.153, -0.082) in 2005 and -0.100 (-0.153, -0.082) in 2009. The concentration index for the consumption of unhealthy fat and oil was -0.034 (-0.049, -0.019) in 2005 and -0.108 (-0.165, -0.051) in 2009. The concentration index for insufficient consumption of fish was -0.070 (-0.096, -0.044) in 2005. The concentration index for physical inactivity was 0.008 (-0.057, 0.075) in 2005 and 0.139 (0.063, 0.215) in 2009. In all the cases, the OR of the richest group to the poorest group was significant.
Hypertension, insufficient consumption of fruits and vegetables, consumption of unhealthy fat and oil, and insufficient consumption of fish are more prevalent among poor groups. There was no significant socioeconomic inequality in the distribution of smoking, excess weight, and hypercholesterolemia. Physical inactivity was more prevalent among the rich groups of society in 2009. The reduction of socioeconomic inequalities must become a main goal in health-care policies.
Concentration index; inequality; Iran; non communicable diseases; socioeconomic status
The study aimed to assess medical students' attitudes toward mental illness following a 4-week psychiatry clerkship. All fifth-year medical students from three academic centers in Tehran were asked to participate in the study. They completed the questionnaire on the last day of their 4-week psychiatry clerkship. A self-administered questionnaire was used to examine participants' Attitudes Toward Mental Illness (ATMI). One hundred and sixty eight students completed the questionnaires (88.9% response rate). In general, the students had favorable attitudes toward mental illness at the end of their clerkship, with mean (± SD) ATMI total score of 78.6 (± 8.1) (neutral score, 66.0). The students showed the most favorable opinion (95.2%) about Category 5 (stereotypic attitude toward people with mental illness) whilst they revealed the least favorable opinion (64.3%) regarding Category 1 (social relations with people affected by mental illness). In addition, the students thought that movies were on the top of influential media on shaping the attitudes toward mental illness. Overall, most of Iranian medical students had generally favorable attitudes toward people with mental illness at the end of their clerkship. Therefore, it may be expected next generation of medical doctors show more favorable attitude toward mental illness.
Attitude; health personnel; medical students; mental disorders; public opinion; population.
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 résumé, 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.
Curriculum; Graduate; Administration; Public health; Education; 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.
Barriers; clinical practice guideline; development; health care system; implementation; qualitative study
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.
Attitude; clinical guidelines; evidence-based medicine; physician
Preparing long term reformatory plan for the health system, like other macro plans, requires guiding principles which is according to the values, and as a bridge, connect the ideals and values to the goals. This study was designed with the purpose of explaining the values and principles of health system, and as a pre-requisite to compilation of Iran’s health system reform plan at 2025.
The document of values and principles of health system reform plan for 2025 was developed by reviewing the literature and receiving the opinions of senior experts of health system, and was criticized in focus group discussion sessions of experts and decision makers.
The values of Iran are: dignity of human, the right to maximum attainable level of health, comprehensive health, equity and social cohesion. The principles of this health system include: institutionalizing the ethical values, responsiveness and accountability, equitable access (utilization), prevention and health promotion, community participation, inter-sectoral collaboration, integrated stewardship, benefit from innovation and desired technology, human resources promotion and excellence and harmony.
Based on the perception of cultural and religious teachings in Iran, protecting of human dignity and human prosperity are the ultimate social goal. In this sense, health and healthy humans, in its holistic concept (physical, mental, social health and spiritual) are the center and development in any form should lead to the human prosperity in a way that each of the individuals could enjoy the maximum attainable level of health in its holistic meaning and in a faire manner.
Health system; Value; Principle; Iran
The aim of study is to assess the importance and challenges of Malaria elimination (ME) in Iran's health system.
Opinion of experts from Ministry of Health and Medical Education and the chancellors of medical universities affected by malaria were gathered using Focus Group Discussions and in-depth interviews. We asked them about the importance and main challenges of ME in Iran.
Main factors on importance of ME were: it's a struggle to reach to equity in the poorest regions of county, prevention of emerging disease in susceptible regions, lowering the cost of control and its effects on the region's socioeconomic condition. Main challenges were Iran's long border with malaria-endemic countries Pakistan and Afghanistan and illegal immigrants, underdevelopment in rural areas, system's insensitivity and diagnosis problem due to reduction of cases.
Quantitative and holistic researches are needed for assessing the consequences of ME.
Malaria; Prevention and control; Iran; Impact
We aimed to evaluate the timeliness of reporting of malaria surveillance system and understanding the existing problems.
The timeliness of malaria surveillance system of Iran was evaluated in four provinces of Iran including Sistan & Baluchistan, Hormozgan, Kerman (as provinces with local malaria transmission) and Khuzestan (without local malaria transmission). In this descriptive-analytic cross-sectional study two levels of Primary Health Care service providers including first level (Health Houses) and second level (Urban or Rural Health care units) were evaluated with regard to reporting of malaria surveillance system.
Forms number 1 (87% reported within one day) and number 2 (reporting median: 2 days) are reported from first level to second level, and forms number 4 (median: 4 days), number 3 (median: 6 days), number 7 (median: 9 days), number 5 (median: 11 days) and number 6 (median: 19 days) are reported from second level to the third level respectively in a shorter time. Independent variables such as distance, local malaria transmission level, and case finding type, are the factors affecting the reporting delay.
Reporting in the first level compared to the second level is done with lower delay. In the areas where there is a deadline set for reporting, reporting is done more timely. Whatever number of malaria cases is decreased, sensitivity and subsequently timeliness reduced. It is recommended that the studies of timeliness be done with sensitivity and usefulness analysis of surveillance system.
Timeliness; Malaria; Surveillance system; Iran
Timely notification is of great importance in health emergencies. So identifying the most important sources of information used by people in emergencies seems necessary. The objective of this study was to assess peoples’ level of awareness concerning the symptoms, routes of transmission, prevention, and treatment of H1N1 at the time of the pandemic and also to identify their most important source of information.
Two telephone surveys were performed at the beginning of levels five and six of the pandemic at a four-month interval on two populations. Using a questionnaire, random phone numbers were called and 662 and 701 individuals from Tehran were surveyed at the two phases, respectively.
Peoples’ level of awareness concerning the disease, symptoms, its routes of transmission, prevention, and treatment of H1N1 had increased in the second phase of the study. At the same time, people were less afraid of the disease in the second phase. The most important sources of information used were TV, newspapers, and radio, respectively.
Mass media including TV and newspapers were recognized as the most important sources of information used by the people in emergencies. It seems that designing educational programs and synchronizing the media's policies with health authorities can help fight future health emergencies and prevent delays in notifying people.
Epidemics; emergency; health promotion; mass media; swine flu
According to World Health Organization (WHO) estimation, more than half of all pharmaceutical products are inappropriately prescribed, distributed, and sold and more than half of all patients use the medicines prescribed for them incorrectly. As more than 40% of therapeutic costs are pharmaceutical costs, this implies a significant waste of health resources in the world.
To find effective factors in irrational prescription of corticosteroids in Iran and design suitable interventions to decrease prescription rates of corticosteroids.
Materials and Methods
A qualitative study was performed in 2009 on fifteen general practitioners in two groups identified by high and low corticosteroid prescription rates. Data analysis was performed by thematic analysis and the study's validity was based on training interviewers, use of interview guide, avoidance of imposing opinions, coding by two independent persons and use of all opinions obtained in the analysis.
The effective factors in irrational prescription of corticosteroids can be divided into four categories: lack of knowledge, patient-physician relationship in terms of monetary cost, poor availability of proper alternative medicines and weak supervision of regulatory bodies. As the same results were found in both groups regarding the role of regulatory organizations and availability of alternative medicines, it seems that interventions in knowledge and the patient-physician relationship which were different in the two groups can be more effective for reduction of prescription in high rate prescribers although intervention in regulatory supervision and medicine availability could have a moderate effect in both groups. In addition the common feature in all the above categories was the gap between knowledge and actual practice which is significant on three regulatory levels, supervisors, physicians and patients, and should be noted for intervention design.
The interventions applied in other countries can also be effective in decreasing irrational prescription of corticosteroids in Iran. These interventions include: standard clinical guidelines, essential medicines list, practical workshops, purposeful training based on problem-solving, training of all parties including pharmacists and patients, improved regulatory mechanisms, availability of assured quality medicines, availability of suitable alternatives to painkillers and realistic rational prescription policy.
Inappropriate Prescriptions; Corticosteroids; Qualitative Research
Little experience exists on valid and reliable tools for assessment of the determinants of underweight and overweight in children and adolescents living in the Middle-East and North Africa (MENA). This study aimed to develop a valid and wideranging questionnaire for assessment of these parameters in a nationwide sample of Iranian children and adolescents.
This national study was conducted in 31 provinces in Iran. The first phase consisted of focus group discussion with 275 children and adolescents and their parents. After a qualitative content analysis, the initial items were extracted. In the next step, the face validity was assessed by expert panelists using the quantitative method of the Impact Score. To assess the content validity, the content validity rate (CVR) and the content validity index (CVI) were determined. The internal consistency was examined by Cronbach alpha, and its test-retest reliability was determined. The socio-demographic variables, perinatal factors, lifestyle factors, family history, knowledge and attitude were assessed. Dietary intakes were assessed by a validated 168-item semi-quantitative food frequency questionnaire. A validated questionnaire for quality of life was filled in anonymously.
A team of expert researchers conducted the data analysis of 576 interviews by using qualitative content analysis method. The analysis process began by determining the semantic units about the concepts studied. The initial questionnaire was developed in four domains by including Likert scale questions. In the face validity step, all questions of the primary questionnaire obtained a score of more than 1.5. In the phase of CVR assessment, 6 questions obtained a score of less than 0.62, and were omitted. The rest of questions were assessed for CVI, and got a score of more than 0.75. Cronbach's alpha coefficient of the whole questionnaire was 0.97, and the Pearson correlation coefficient of the test-retest phase was 0.94.
The developed questionnaire is a valid and reliable tool for assessment of the determinants of weight disorders in a nationally representative sample of children and adolescents in the MENA.
Children and adolescents; overweight; questionnaire validity; underweight
The World Health Organization (WHO) is in the process of establishing a new global database on the growth of school children and adolescents. Limited national data exist from Asian children, notably those living in the Middle East and North Africa (MENA). This study aimed to generate the growth chart of a nationally representative sample of Iranian children aged 10–19 years, and to explore how well these anthropometric data match with international growth references.
In this nationwide study, the anthropometric data were recorded from Iranian students, aged 10–19 years, who were selected by multistage random cluster sampling from urban and rural areas. Prior to the analysis, outliers were excluded from the features height-for-age and body mass index (BMI)-for-age using the NCHS/WHO cut-offs. The Box-Cox power exponential (BCPE) method was used to calculate height-for-age and BMI-for-age Z-scores for our study participants. Then, children with overweight, obesity, thinness, and severe thinness were identified using the BMI-for-age z-scores. Moreover, stunted children were detected using the height-for-age z-scores. The growth curve of the Iranian children was then generated from the z-scores, smoothed by cubic S-plines.
The study population comprised 5430 school students consisting of 2312 (44%) participants aged 10–14 years , and 3118 (58%) with 15–19 years of age. Eight percent of the participants had low BMI (thinness: 6% and severe thinness: 2%), 20% had high BMI (overweight: 14% and obesity: 6%), and 7% were stunted. The prevalence rates of low and high BMI were greater in boys than in girls (P < 0.001). The mean BMI-for-age, and the average height-for-age of Iranian children aged 10–19 years were lower than the WHO 2007 and United states Centers for Disease Control and Prevention 2000 (USCDC2000) references.
The current growth curves generated from a national dataset may be included for establishing WHO global database on children’s growth. Similar to most low-and middle income populations, Iranian children aged 10–19 years are facing a double burden of weight disorders, notably under- and over- nutrition, which should be considered in public health policy-making.
Growth; Iran; Reference curve; Weight disorder
Regular physical activity (PA) is an underlying factor since childhood and adolescence for having a healthy and active future for life. The aim of this stud y was to review the evidence on increasing the youth PA to develop the national program at country level. At first, the databases were searched using the sensitive keywords, and systematic reviews of the relevant databases were extracted. The studies were evaluated in terms of relevance and methodological quality for effective interventions that were detected. These cases were also identified in the effective interventions: disadvantages, benefits, costs, methods, and limitations of early studies, which were based on systematic review of the studies. Three interventions were identified as physical education curriculum reform, the creation of extra-curricular activities, as well as approaches to environmental and social support. Evidences showed that the relative impact of these interventions were not high. Thus, a combination of all three options of integrated approach is recommended for reducing the sedentary lifestyle of youths.
Behavioral change; evidence informed; life style; policy
Increasing diabetes incidence demands investigation of risk factors, prioritization and designing modification interventions. We calculated the potential modifiable incidence of diabetes due to reduction in risk factors.
We used counterfactual analysis model to estimate avoidable burden of incident diabetes related to each risk factor. The potential impact fraction (PIF) index calculated utilizing the data of current prevalence, magnitude of impact and counterfactual status of risk factors. We considered the levels of evidence while giving higher priority to domestic data.
The estimated PIF regarding minimum feasible risk for the impaired fasting glucose (IFG), impaired glucose tolerance (IGT), combined IFG/IGT, low HDL, high triglyceride, high total cholesterol, hypertension, general obesity, central obesity and physical inactivity were 0.13, 0.10, 0.18, 0.01, 0.12, 0.03, 0.13, 0.03, 0.02 and 0.10, respectively.
While the combined risk factors of IFG and IGT should be noticed as the most important potential factor in prevention of diabetes and reducing its incidence burden, among the other risk factors, modification of hypertension, high triglyceride, and physical inactivity could have more impact.
Diabetes mellitus; Potential impact fraction; Prevention
Mass media play an important role in keeping people up-to-date with the latest health news. This study aims at investigating the quality of health news disseminated in the print media, its course of production and factors affecting its quality.
In the quantitative section of the study, 410 health-related news items, published during a six-month span in the Iranian public press, underwent content analysis. In the qualitative section, focus group discussions were held with journalists, editors-in-chief and news gatekeepers.
The quantitative phase showed that 18% of the news articles were not fit for dissemination in public. The qualitative phase illustrated that multiple factors at various levels affect the quality of news, namely poor knowledge, inadequate motivations and context-related barriers.
The quality of health news reporting is not desirable. Educational interventions need to be carried out to raise awareness among researchers and journalists. Also, certain steps should be taken to increase motivations and strengthen infrastructures, including designing guidelines and monitoring news.
“Caregiver Burden” is actually an expression addressing the adverse consequences of the care provided to the patients’ with dementia. Review of the previous studies reveals a higher rate of depression and anxiety among the caregivers as compared to the general population. This study has been designed to evaluate the caregiver burden and then the factors influencing it among caregivers of patients with dementia in Iran.
In this cross-sectional study, 153 patients and their caregivers registered in the Memory Clinic in Roozbeh Hospital and Iranian Alzheimer Association (IAA) were included. Data collection scales were Iranian Version of Caregiver Burden, Global Deterioration scale and Barthel index. Multiple linear regression model was applied to determine the factors influencing the caregiver burden.
Out of the 153 patients, 90 were male. The mean age calculated for the patients and the caregivers was 77.1 and 53, respectively. The mean of caregiver burden was 55.2. Three variables, gender (P<0.01), education of the patient (P<0.005 for illiterate patients), and the patient's dependence on the caregiver for his/her daily tasks (P<0.000)) were correlated with a high level of burden on the caregiver. The recommended model explains 0.664% of the variance of the outcome variable.
Presence of either moderate or higher levels of burden (58-116) in more than 50% of the caregivers of these patients’ highlights the need for more attention from health policy makers in Iran. Promoting the level of caregivers’ quality of life along with enabling the patients in performing their daily tasks in order to reduce the imposed burden on caregivers’ is recommended.
Dementia; caregivers; burden; family caregivers; elderly people; caregiver burden; Iran
In Iran, admission to medical school is based solely on the results of the highly competitive, nationwide Konkoor examination. This paper examines the predictive validity of Konkoor scores, alone and in combination with high school grade point averages (hsGPAs), for the academic performance of public medical school students in Iran.
This study followed the cohort of 2003 matriculants at public medical schools in Iran from entrance through internship. The predictor variables were Konkoor total and subsection scores and hsGPAs. The outcome variables were (1) Comprehensive Basic Sciences Exam (CBSE) scores; (2) Comprehensive Pre-Internship Exam (CPIE) scores; and (3) medical school grade point averages (msGPAs) for the courses taken before internship. Pearson correlation and regression analyses were used to assess the relationships between the selection criteria and academic performance.
There were 2126 matriculants (1374 women and 752 men) in 2003. Among the outcome variables, the CBSE had the strongest association with the Konkoor total score (r = 0.473), followed by msGPA (r = 0.339) and the CPIE (r = 0.326). While adding hsGPAs to the Konkoor total score almost doubled the power to predict msGPAs (R2 = 0.225), it did not have a substantial effect on CBSE or CPIE prediction.
The Konkoor alone, and even in combination with hsGPA, is a relatively poor predictor of medical students’ academic performance, and its predictive validity declines over the academic years of medical school. Care should be taken to develop comprehensive admissions criteria, covering both cognitive and non-cognitive factors, to identify the best applicants to become "good doctors" in the future. The findings of this study can be helpful for policy makers in the medical education field.
Community-based participatory research (CBPR) has been applied by health researchers and practitioners to address health disparities and community empowerment for health promotion. Despite the growing popularity of CBPR projects, there has been little effort to synthesize the literature to evaluate CBPR projects. The present review attempts to identify appropriate elements that may contribute to the successful or unsuccessful interventions.
A systematic review was undertaken using evidence identified through searching electronic databases, web sites, and reference list checks. Predefined inclusion and exclusion criteria were assessed by reviewers. Levels of evidence, accounting for methodologic quality, were assessed for 3 types of CBPR approaches, including interventional, observational, and qualitative research design as well as CBPR elements through separate abstraction forms. Each included study was appraised with 2 quality grades, one for the elements of CBPR and one for research design.
Of 14,222 identified articles, 403 included in the abstract review. Of these, 70 CBPR studies, that 56 intervention studies had different designs, and finally 8 studies met the inclusion criteria. The findings show that collaboration among community partners, researchers, and organizations led to community-level action to improve the health and wellbeing and to minimize health disparities. It enhanced the capacity of the community in terms of research and leadership skills. The result provided examples of effective CBPR that took place in a variety of communities. However, little has been written about the organizational capacities required to make these efforts successful.
Some evidences were found for potentially effective strategies to increase the participant's levels of CBPR activities. Interventions that included community involvement have the potential to make important differences to levels of activities and should be promoted.
Community-based participatory research; effectiveness; researches; systematic review
A school-based surveillance system entitled the childhood and adolescence surveillance and prevention of Adult Noncommunicable disease (CASPIAN) Study is implemented at national level in Iran. This paper presents the methods and primary findings of the third survey of this surveillance system.
This national survey was performed in 2009–2010 in 27 provinces of Iran among 5570 students and one of their parents. In addition to physical examination, fasting serum was obtained. Body mass index was categorized based on the World Health Organization growth charts.
Data of 5528 students (2726 girls, 69.37% urban, mean age 14.7 ± 2.4 years) were complete and are reported. Overall, 17.3% (17.3% of girls and 17.5% of boys) were underweight, and 17.7% (15.5% of girls and 19.9% of boys) were overweight or obese. Abdominal obesity was documented in 16.3% of students (17.8% of girls and 15% of boys). 57.6% of families consumed breads, the staple food for Iranians, prepared with white flour. Most families (43.8% in urban areas and 58.6% in rural areas) used solid hydrogenated fats. 22.7% of students did not add salt to the table food. 14.2% of students reported to have a regular daily physical activity for at least 30 min a day. Overall, 10.4% of students (11.7% in urban areas and 7.3% in rural areas) reported that they used tobacco products, often waterpipe. 32.8% of students experienced at least three times of bullying in the previous 3 months. During the year prior to the survey, 14.46% of students had an injury needing the interference by school health providers.
This survey is confirmatory evidence on the importance of establishing surveillance systems for risk behaviors to implement action-oriented interventions.
Chronic diseases; prevention; risk behaviors; risk factors; school health; surveillance
This study aims to identify the differences between Injecting Drug Users (IDUs) and non-IDUs, with regard to some potential factors. This could be useful to design effective interventions for harm reduction, which is one of the priority areas in reducing the burden of addiction.
Sixty cases and 60 controls participated in this pair-matched case-control study, which was conducted in Tehran. The cases were IDUs who were asked to introduce two friends; one IDU and the other non-IDU as the paired control. In addition to demographic variables, onset age of cigarette smoking, dropping out of school, imprisonment, history of being sexually abused for money, and family history of using illegal drugs were obtained from the cases and controls via an interview. Pair Odds Ratio (OR) was estimated through McNemar and conditional multivariable logistic regression analysis.
Eighty-three % of the IDUs and 92% the controls were male. The mean for onset age of cigarette smoking was 16 in the cases and 20 in the controls, which was significantly different between cases and controls (P<0.001).
In the multivariate analysis, dropping out from school was significantly different between cases and controls (OR=4.22 95% CI: 2.23 – 14.0). Imprisonment was more frequent in IDUs compared to non-IDUs (OR=3.70 95% CI: 1.09 – 11.08). The cases had more sexual relationship for earning money compared to the controls (OR=3.14 95% CI: 1.24 – 13.70). Onset age of cigarette smoking was significantly (P<0.001) sooner in the IDUs compared to the non-IDUs (15.9 and 20.1 years, respectively). IDUs reported 5.5 times more that non-IDUs of having an addict in their family (P value=0.04).
The finding of this study can be useful in identifying the persons who are at risk of IDU. Therefore, people who involve with risk factors recognized in this study should be triggered for harm reduction prevention strategies.
Addiction; case control; injection drug use; snowball sampling
Residence characteristics can affect health of residents. This paper reports the development of an instrument assessing these aspects of neighborhoods.
Materials and Methods:
Literature search and focus group discussions with residents were carried out and relevant items were extracted. Five experts reviewed and commented on the items. An observation instrument with 54 items was composed and completed by two independent observers in 20 randomly selected locations. Due to lack of acceptable reliability in some items, the checklist was revised. The new 22-items checklist in four categories (general characteristics, public green area characteristics, access to services and undesirable features) was completed by two independent trained observers in 28 randomly selected locations.
The items in the final checklist had kappa statistics ranging from 0.63 to 1, with an exception of the item assessing “presence of beggars, homeless or working/street children”, with kappa as low as 0.27 due to variability of their presence in different times. Average Kappa statistics was 0.78 for general characteristics, 0.79 for public green area characteristics, 0.84 for access to services, and 0.54 for undesirable features.
Neighborhood and health observation instrument seems to have good reliability in city of Tehran. It can probably be used in other large cities of Iran and similar cities elsewhere.
Health; Iran; reliability; residence characteristics; validity
The purpose of this study is to determine association between personal, family, neighborhood, and social network characteristics and perceived intimacy in the neighborhood by the women.
In this cross-sectional study, we applied a two-stage sampling method to choose a representative sample of 150 married women and housewives, aged 15 to 49 years, who had education between six and twelve years and lived in the urban areas of the Khorasan-e-Razavi province of Iran. Association between personal, family, neighborhood, and social network variables, with the perceived neighborhood intimacy, was assessed through univariate and multiple linear regression.
Based on the multiple model, there were significant associations between neighborhood intimacy as perceived by the women and their education level (Standardized Beta=–0.190, P=0.019), length of residence (Standardized Beta=0.175, P=0.029), self-rated health status (Standardized Beta=0.177, P=0.029), and their individual social network size (Standardized Beta=0.211, P=0.030).
The potential predictors including length of residence, self-rated health, and size of the respondents’ personal social networks had a direct association with the women's perceived neighborhood intimacy, while the education level of the respondents had an inverse association with the neighborhood intimacy, as another potential predictor. Neighborhood intimacy could express the social health condition of the community members.
Iran; neighborhood; urban population; women's health