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1.  Application of Capture-Recapture for Fine-tuning Uncertainties About National Maternal Mortality Estimates 
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
PMCID: PMC4050684  PMID: 24932395
Capture-recapture; epidemiologic methods; Iran; maternal mortality
2.  Breast cancer-preventive behaviors: exploring Iranian women’s experiences 
BMC Women's Health  2014;14:41.
Background
Breast cancer-preventive behaviors are critical for community and women’s health. Although many studies have addressed women’s knowledge and attitudes toward breast cancer, little information is available about their experiences of breast cancer preventive behaviors. This study aimed to explore the experiences of Iranian women regarding preventive behaviors.
Methods
This was a qualitative study. A sample of Iranian women aged 30 years and over was selected purposefully. Data collected through focus group and semi-structured audiotaped interviews and were analyzed by conventional content analysis.
Results
The following five main themes emerged from the analysis: attitude toward breast cancer and preventive behaviors, stress management, healthy lifestyle, perceived social support and individual/environmental barriers. The findings showed that women were highly motivated to preventive behaviors of breast cancer but faced considerable challenges.
Conclusions
The findings indicated that increased awareness, positive attitudes, stronger motivational factors, and fewer barriers toward preventive behaviors are most important parameters that might encourage women to practice breast cancer-preventive behaviors.
doi:10.1186/1472-6874-14-41
PMCID: PMC3973958  PMID: 24606758
Preventive behaviors; Breast cancer; Iranian women; Qualitative study
3.  Pictorial Health Warning Labels on Cigarette Packages: An Investigation on Opinions of Male Smokers 
Background:
Health warning labels on cigarette packages are among the most straightforward and important tools to communicate with smokers and various studies have illustrated their efficacy.
Objectives:
The current study aimed to investigate the opinions of male smokers in Mashhad city about the efficacy of health warning labels printed on cigarette packages on the smoking status of smokers.
Patients and Methods:
This cross-sectional descriptive study was conducted in 2013 using a questionnaire. The research population included the male smokers of Mashhad. The participants were selected from the customers referring to the newsstands for cigarettes. The obtained data were analyzed employing SPSS software Version 16, and the statistical tests including Kruskal-Wallis, Spearman, and correlation coefficient of Pearson, Chi Square, Mann-Whitney, and Bonferroni correction were used in this regard.
Results:
In this research, there were 500 participants with the average age of 25 years. The initiation age of smoking was eight years while the maximum age was reported as 45 years. Results of this research about the effect of these labels on decreasing cigarette consumption rate showed that almost half of the participants believed that these labels were ineffective for them (52.2%) and other smokers (53.8%).Furthermore, significant relationship was found between the age and opinion of the smokers about the influence of these labels on reducing their cigarette consumption (P < 0.001).
Conclusions:
To promote the effect of printed images on cigarette packages, it is recommended to consider the suitability of labels in the targeted culture. In addition, to be more effective consultation sites to quit smoking should be introduced under the images.
doi:10.5812/ircmj.14879
PMCID: PMC4005439  PMID: 24829777
Smoking; Tobacco Products; Iran
4.  Commercialization of biopharmaceutical knowledge in Iran; challenges and solutions 
Background
The objective of this study was to investigate the application of the university research findings or commercialization of the biopharmaceutical knowledge in Iran and determine the challenges and propose some solutions.
Results
A qualitative study including 19 in-depth interviews with experts was performed in 2011 and early 2012. National Innovation System (NIS) model was employed as the study design. Thematic method was applied for the analysis. The results demonstrate that policy making, regulations and management development are considered as fundamental reasons for current commercialization practice pattern. It is suggested to establish foundation for higher level documents that would involve relating bodies and provide them operational guidelines for the implementation of commercialization incentives.
Conclusions
Policy, regulations and management as the most influential issue should be considered for successful commercialization. The present study, for the first time, attempts to disclose the importance of evidence input for measures in order to facilitate the commercialization process by the authorities in Iran. Overall, the NIS model should be considered and utilized as one of the effective solutions for commercialization.
doi:10.1186/2008-2231-22-29
PMCID: PMC3974067  PMID: 24568555
Knowledge translation; Biopharmaceutical research; Facilitators and barriers
5.  Gender-based sexual roles: A mixed methods study in Iranian families 
Background:
Gender role attitudes toward sexual matters may define suitable and appropriate roles for men and women during a sexual relationship. This study aimed to explore and assess gender-based sexual roles in Iranian families.
Materials and Methods:
This was an exploratory mixed methods study in which perceptions and experiences of 21 adult Iranian participants about gender-based sexual roles have been explored in three provinces of Iran in 2010-2011, to generate items for developing a culture-oriented instrument to assess gender role attitudes. The developed and validated instrument, then, was applied to 390 individuals of general population of Tehran, Iran in 2012.
Results:
In content analysis of the qualitative phase data, four categories emerged as the main gender-based sexual roles: Decision making, relationships, care, and supervision and control. After passing the stages of item reduction, seven items remained for the instrument. In the quantitative phase, results showed that most of the participants (78.9%) believed in shared sexual roles for both genders. Consideration of a sexual role as “entirely masculine” or “preferably masculine” was the second prevalent attitude in 71.43% of gender-based sexual roles, whereas “entirely” or “preferably feminine role” was the second next most dominant attitude (14.28%).
Conclusions:
The results of the present study have revealed some new gender-based sexual roles within Iranian families; which may be applicable to show the capacity for achieving some domains of reproductive rights in Iran.
PMCID: PMC3917182  PMID: 24554957
Attitude; gender role; Iran; sexuality
6.  Clarifying the Role of Schools in Tendency or Lack of Tendency Toward Smoking among Teenage Boys (11-14) in Mashhad, Iran 
Background:
Recent studies show that the prevalence of tobacco use among teens and students is increasing, and the initiation age of tobacco use has decreased.
Objectives:
The current research aimed to signify the role of schools in the process in which student teenage boys became smokers in 2012 in Mashhad.
Materials and Methods:
The current study was part of a qualitative research conducted by content analysis method and purposive sampling, performing 35 in-depth interviews, and 2 focused group discussions. The participants in this research included teenagers, teachers, students` parents , psychologists, and experts in the field of fighting against tobacco use, those who either had the experience of exposure to cigarettes at school, or were well-informed persons about tobacco use.After performing each interview, the interview was transcribed, and analyzed before the next interview. The data were under continuous consideration and comparative analysis in order to achieve data saturation.
Results:
After analysis and codification of data, four concept categories were achieved to clarify the role of schools in student smoking: 1) School purity or impurity to high-risk behaviors; 2) Directive or nondirective schools for controlling tobacco; 3) Preventive or predisposing schools for smoking behavior, and 4) Perceived positive outcomes from smoking at school. Each main category was divided into three subordinate themes.
Conclusions:
With regard to decrease of cigarette use initiation age and the great influence of schools on teenagers’ behavior, it is recommended to perform special screening programs based on the achieved themes in this research to reduce tobacco use. It is also suggested that school staff pay more attention to students’ communication networks and pressures that are imposed on a student for smoking cigarettes during the school time.
doi:10.5812/ircmj.12848
PMCID: PMC3964423  PMID: 24719706
Smoking; Adolescent; Tobacco; Schools
7.  Distribution of Breast Density in Iranian Women and its Association with Breast Cancer Risk Factors 
Background:
Breast cancer is one of the most common cancers and the first-leading cause of cancer deaths among women in the world. Indeed, breast cancer is ranked as the first malignancy among Iranian women. Breast density, defined as the percentage of fibro glandular breast tissue in mammographic images, is one of the known risk factors for breast cancer. According to American college of radiology-Breast Imaging Reporting and Data System (ACR-BIRADS), mammographic density is divided into four categories. Studies have shown that increased breast density is associated with significant increase in breast cancer risk. Therefore, it is assumed that breast density should be associated with other breast cancer risk factors.
Objectives:
The aim of this study was to assess the epidemiologic distribution of breast density of the patients in a referral center in Iran, and to evaluate the association of high breast density and breast cancer risk factors and other factors that may possibly affect the mammographic density according to previous studies.
Patients and Methods:
In an analytical cross-sectional study, 728 of those who had referred to Imam Khomeini Imaging Center either for diagnostic or screening purposes, participated in the study, after filling out the informed consent form, the survey questionnaire based survey assessing breast cancer risk factors affecting the breast density and related demographic features, was conducted. SPSS 11.5 software and chi-square, t-test and logistic regression tests were used to analyze the data.
Results:
Most of patients (75%) in categories 2 and 3 of mammographic density had a breast density of 51.9%, however, this amount was less (49.2%) in screening mammograms, while in diagnosing group it was more (51.6%). The Findings showed an increase in age, body mass index (BMI), duration of breast feeding, and also to be menopause e, unemployed and married, younger than 29 years old at first delivery, having children up to 8 and smoking are associated with less breast density. Diagnostic mammograms and symptomatic patients showed denser breasts. But density had no association with oral contraceptives pill (OCP) consumption or hormone replacement therapy or calcium and/or vitamin D consumption, age at menarche and menopause, menstruation cycle phase and family history of breast cancer. Age at the first delivery, menopausal status and parity were independently associated with breast density.
Conclusions:
Density distribution and risk factors prevalence is different among symptomatic patients and the diagnostic mammograms of the screened persons, hence such information should be considered in the patient managements. In order to consider the effect of marriage and parity on decreasing the breast density, basic consultations should be performed. Smokers and obese women may falsely show low breast density while they may be in high-risk group. In this study no specific phase of menstrual cycle is suggested for mammographic examinations.
doi:10.5812/ircmj.16615
PMCID: PMC3955513  PMID: 24693398
Breast Neoplasms; Mammography; Mass Screening
8.  An Algorithm of Smoking Stages Assessment in Adolescents: A Validation Study Using the Latent Class Analysis Model 
Background:
Notwithstanding 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.
Methods:
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).
Results:
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 (G2 = 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 (G2 = 0.001, df = 1, P = 0.975).
Conclusions:
The results suggested that this algorithm is clear, valid, and reliable.
PMCID: PMC3883256  PMID: 24404366
Adolescence; latent class analysis; reliability; smoking stages; validity
9.  The perspectives of iranian physicians and patients towards patient decision aids: a qualitative study 
BMC Research Notes  2013;6:379.
Background
Patient preference is one of the main components of clinical decision making, therefore leading to the development of patient decision aids. The goal of this study was to describe physicians’ and patients’ viewpoints on the barriers and limitations of using patient decision aids in Iran, their proposed solutions, and, the benefits of using these tools.
Methods
This qualitative study was conducted in 2011 in Iran by holding in-depth interviews with 14 physicians and 8 arthritis patient. Interviewees were selected through purposeful and maximum variation sampling. As an example, a patient decision aid on the treatment of knee arthritis was developed upon literature reviews and gathering expert opinion, and was presented at the time of interview. Thematic analysis was conducted to analyze the data by using the OpenCode software.
Results
The results were summarized into three categories and ten codes. The extracted categories were the perceived benefits of using the tools, as well as the patient-related and physician-related barriers in using decision aids. The following barriers in using patient decision aids were identified in this study: lack of patients and physicians’ trainings in shared decision making, lack of specialist per capita, low treatment tariffs and lack of an exact evaluation system for patient participation in decision making.
Conclusions
No doubt these barriers demand the health authorities’ special attention. Hence, despite patients and physicians’ inclination toward using patient decision aids, these problems have hindered the practical usage of these tools in Iran - as a developing country.
doi:10.1186/1756-0500-6-379
PMCID: PMC3849268  PMID: 24066792
Patient decision aid tool; Qualitative study; Iran
10.  A social network analysis on clinical education of diabetic foot 
Introduction
Identification of Educational Influentials (EIs) in clinical settings helps considerably to knowledge transfer among health and medical practice providers. The aim of this study was identifying EIs in diabetic foot ulcers (DFU) by medical students (clerks, interns and residents) and providing their relational pattern in this subject.
Methods
Subjects were medical students at clerk, intern and resident levels in a local educational hospital. A standard questionnaire with four domains (knowledge, communication, participation and professional ethics) was used for identifying EIs. Students introduced those people with these characteristics who referred them for DFU. Respective communication networks were drawn as intra-group (such as resident-resident) and inter-group (such as intern-resident) networks and quantitative criteria of density, in-degree and out-degree centrality and reciprocity were measured.
Results
The network density of clerks-residents (0.024) and interns-residents (0.038) were higher than clerks-attends (0.015) and interns-attends (0.05); indicating that there were more consulting interactions in former networks than the latter. Degree centrality in residents-related networks (clerks-residents = 2.3; interns-residents = 2.6) were higher than attends-related ones (clerks-attends = 1.1; interns-attends = 1.7), while they were not statistically significant. However, In-degree centralization, which indicating a degree of variance of the whole network of ingoing relationships, in attends-related networks was greater than resident-related networks.
Conclusion
Resident were consulted with almost as same as attends on DFU. It showed that residents were playing a remarkable role in knowledge transfer and they can be considered as EIs in this clinical setting. It seemed that the availability was the main reason for this key role.
doi:10.1186/2251-6581-12-44
PMCID: PMC3879216  PMID: 24330538
11.  Disease Surveillance and Private Sector in the Metropolitans: A Troublesome Collaboration 
Background:
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.
Methods:
In this qualitative study, we used focus group discussions (16 manager), and in-depth semi-structured interviews
Results:
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.
Conclusions:
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.
PMCID: PMC3793485  PMID: 24130945
Iran; notification; public health practice; reporting
12.  Collaboration in research and the influential factors in Golestan University of Medical Sciences research projects (2005-2007): an academic sample from Iran 
Background
Number of Iranian articles published in ISI journals has increased significantly in recent years.Despite the quantitative progress, studies performed in Iran represent low collaboration in research; therefore,we decided to evaluate collaboration in Golestan University of Medical Sciences (GOUMS) research projects.
Methods
In this cross-sectional study, all GOUMS research projects that had got grants from the universitybetween 2005-2007 were studied. Among 107 research projects included in our study, 102 projects were evaluatedand checklists were completed. The researcher's questionnaire was sent to the principle investigators (n=46) of the projects and eventually 40 questionnaires were collected.
Results
The review of 102 research proposals shows that 10 projects (9.8%) have been performed in collaborationwith other organizations. Scientific outputs in these projects have been more than projects which wereconfined to the university (98% compare to 68%; p= 0.04). The total cost of the projects under study was a littlemore than 300,000 US$. In just 12 projects (11.8%) a part of the cost had been provided by organizations outsidethe university. About 50% of researchers declared that they had chosen their research topic based on their"personal interest". Only 1 project was performed by the demand of nongovernmental organizations and 12 researchersreported no collaboration in their activities.
Conclusion
This study shows that collaboration in GOUMS research projects is low. Moreover, collaborationswith governmental and nongovernmental organizations are trivial. The scientific outputs in collaborativeresearch projects are much more than other projects.
PMCID: PMC3917486  PMID: 24791118
Research; Collaboration; Knowledge transfer
14.  Correlates of physical activity in adolescence: a study from a developing country 
Global Health Action  2013;6:10.3402/gha.v6i0.20327.
Background
Physical activity is important for adolescent health. The current study aimed to explore factors that predict physical activity among adolescents.
Methods
This was a cross-sectional study of physical activity among a sample of adolescents in Tabriz, Iran. Information on physical activity was collected using a modified version of the Adolescent Physical Activity and Recall Questionnaire (APARQ). In addition, a self-administrated questionnaire was used to collect data on demographic characteristics, perceived family support, and self-efficacy. Both univariate and multivariate logistic regression analyses were performed to examine the association between physical activity and independent variables including gender and psychosocial predictors.
Results
In all, 402 students were studied. The mean age of adolescents was 12.93 (SD=0.49) years; 51.5% were female. The mean time of moderate and vigorous physical activity for all adolescents was 44.64 (SD=23.24) Metabolic Equivalent (MET) min per day. This figure for female adolescents was 38.77 (SD=19.94) MET min per day and for males it was 50.87 (SD=24.88) (P<0.001). The results obtained from multiple logistic regression analysis indicated that female gender (OR=2.59, 95% CI=1.46–4.57, P=0.001) and poor family support (OR=1.10, 95% CI=1.03–1.20, P=0.038) were the most significant contributing factors to low level physical activity in adolescents. Other variables studied did not show any significant results.
Conclusion
The findings from the current study indicated that female adolescents were at risk of lower level of physical activity. In addition, it was found that the lack of family support represented an increased risk for low-level physical activity. It seems that family support should be an integrated part of any health education/promotion programs for improving physical activity among young adolescents in general and for female adolescents in particular.
doi:10.3402/gha.v6i0.20327
PMCID: PMC3651954  PMID: 23663416
adolescent health; physical activity; family support; Asia; Iran
15.  Personal and Family Factors Affecting Life time Cigarette Smoking Among Adolescents in Tehran (Iran): A Community Based Study 
Oman Medical Journal  2013;28(3):184-190.
Objectives
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.
Methods
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.
Results
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.
Conclusions
As a result, health promotion programs should be gender based whilst educational and interventional programs for preventing tobacco use should begin before adolescence.
doi:10.5001/omj.2013.51
PMCID: PMC3680644  PMID: 23772284
Adolescent; Smoking; Cigarette; Family behavior; Tehran; Iran
16.  Internal conflicts of Iranian first-time mothers in adaptation to maternal role 
Background:
Studies indicate that becoming a mother is accompanied by prominent physical, social, and psychological changes which can affect not only mother's psychological healthiness, but also all other aspects of her personal and family life.
The purpose of this research was to explore the struggles experienced by Iranian first-time mothers in adapting to their maternal role between 0 and 1 year after giving birth.
Materials and Methods:
A qualitative design was used in this study. Twenty-one first-time mothers with diverse ethnic backgrounds were recruited in their home or healthcare centers in Tehran and Ahwaz. Data collected through in-depth interviews were analyzed by qualitative content analysis.
Results:
The analysis produced four themes: “Unpreparedness,” “lack of control,” “incomplete maternal feelings,” and “unstable relations.” The main theme, “internal conflict,” integrates all other categories and encapsulates the major changes to which women are subjected, as well as the factors distressing this experience.
Conclusion:
Discrepancies between subjective expectations and postnatal experiences take an influential role in causing postpartum conflict and strain. The more accurate information mothers and families have about this transitory stage, the better they can get prepared to deal with it. This specifies the pivotal role of midwives, midwifery educators, and healthcare policy makers in incorporating these concepts into training programs and protocols of healthcare and support services in due time, form, and content that is in accordance with mothers’ mental and psychological needs.
PMCID: PMC3748542  PMID: 23983759
Conflict; Iran; mother; role adaptation
17.  Epidemiologic Evaluation of Child Abuse and Neglect in School-Aged Children of Qazvin Province, Iran 
Iranian Journal of Pediatrics  2013;23(2):159-164.
Objective
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.
Methods
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.
Findings
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.
Conclusion
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.
PMCID: PMC3663306  PMID: 23724176
Child Abuse; Child Maltreatment; Emotional Disturbances; Child Neglect; Violence; Iran
18.  What Motivates Talented Medical Students to Study Simultaneously at Master of Public Health (MPH)? 
Iranian Journal of Public Health  2013;42(4):402-409.
Background
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?
Methods:
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.
Results:
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.
Conclusion:
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.
PMCID: PMC3684727  PMID: 23785680
Curriculum; Graduate; Administration; Public health; Education; Iran
19.  Barriers of Clinical Practice Guidelines Development and Implementation in Developing Countries: A Case Study in Iran 
Background:
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.
Methods:
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.
Result:
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
Conclusion:
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.
PMCID: PMC3634174  PMID: 23626892
Barriers; clinical practice guideline; development; health care system; implementation; qualitative study
20.  Only One Third of Tehran's Physicians are Familiar with ‘Evidence-Based Clinical Guidelines’ 
Background:
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?.
Methods:
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.
Results:
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.
Conclusions:
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.
PMCID: PMC3634175  PMID: 23626893
Attitude; clinical guidelines; evidence-based medicine; physician
21.  Alcohol and Drug Use Prevalence and Factors Associated With the Experience of Alcohol Use in Iranian Adolescents 
Background
Alcohol and other drugs use is a problem among adolescents leading to numerous physical, social, and educational damages.
Objective
For determining the prevalence of alcohol and other substance use as well as the factors associated with the experience of alcohol use in adolescents.
Patients and Methods
This is a population-based and cross-sectional study, which was conducted in August 2010 on adolescents aged 15–18 years in Tehran. Data were collected by a Youth Risk Behavior Surveillance System (YRBSS) in 1,201 adolescents. The multistage cluster sampling method was used. Questions belonging to the domain of alcohol and other substance use were analyzed.
Results
In general, 15.1% of adolescents had experienced alcohol, which is significantly higher in boys (21.9%) compared to girls (8.4%) (P = 0.000). 3.1% of adolescents had experience using opium and marijuana. 5.6% had used ecstasy. The results of multivariate logistic regression indicated that low parental control rather than medium control [AOR: 0.09], lifetime cigarette use [AOR: 10.41], having a tobacco user friend [AOR: 4.36], and having an alcohol user friend [AOR: 5.84] are factors that are significantly related to the experience of alcohol use in female adolescents. In addition, studying in private schools rather than public schools [AOR: 3.46], lifetime cigarette use [AOR: 3.41], lifetime water pipe use [AOR: 4.43], experience of sexual activity [AOR: 8.52], having an alcohol user friend [AOR: 12.60], and having a water pipe user in family [AOR: 2.98] are factors that are significantly related to the experience of alcohol use in male adolescents.
Conclusions
We recommend interventional plans based gender aimed at improving adolescent health with regard substance abuse.
doi:10.5812/ircmj.4022
PMCID: PMC3745749  PMID: 23984000
Alcohol Drinking; Prevalence; Adolescent; Iran
22.  Intention to Start Smoking and its Related Factors in Never Smoked Adolescents in Tabriz, 2010 
Background:
Intention to smoking is a strong predictor of future smoking behavior. The aim of this study is identifying the personal, environmental, and psychological factors relating to intention to smoking in adolescents of Tabriz city (Northwest of Iran).
Methods:
Four thousand nine hundred and three (4903) students were randomly selected and completed a self-administered questionnaire about cigarette smoking, intention to smoking, and the related risk factors through multi-stage sampling. The association of independent variables with intention to smoking was evaluated using the multi-variable logistic regression model.
Results:
The mean age of student was 15.7 ± 0.73 years, and 42.9% of the samples were male. The results showed that 95.0% of students were in committer stage (students who had never smoked and were sure never start smoking). Having general risk-taking behavior (OR = 2.90; 95% confidence interval [CI]: 1.21-6.97), smoker in the family (OR = 2.60; 95% CI: 1.20-5.61), and positive attitude towards cigarette smoking (OR = 1.30; 95% CI: 1.18-1.43) had statistically significant association with intention to start smoking in future.
Conclusion:
Majority of non-smokers have firm decision to not start smoking in the future. Having general risk-taking behavior, smoker in the family, and positive attitude towards smoking are associated with intention to smoking in adolescents.
PMCID: PMC3530307  PMID: 23272288
Adolescents; attitude to smoking; intention to smoking; risk-taking behavior; smoking stages
23.  Reasons for Physicians’ Tendency to Irrational Prescription of Corticosteroids 
Background
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.
Objectives
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.
Results
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.
Conclusions
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.
doi:10.5812/ircmj.2284
PMCID: PMC3560541  PMID: 23396638
Inappropriate Prescriptions; Corticosteroids; Qualitative Research
24.  Environmental Air Pollution and Acute Cerebrovascular Complications: An Ecologic Study in Tehran, Iran 
Background:
In this study, we aimed to assess the association between air pollution and cerebrovascular complications in Tehran, one of the most air-polluted cities in the world, among different subgroups of patients with stroke in 2004.
Methods:
In this ecologic study, we calculated the daily average levels of different air pollutants including CO, NOX, SO2, O3, and PM10 and also humidity and temperature on the day of stroke and 48 hours prior to stroke in 1 491 patients admitted with the diagnosis of stroke in eight referral hospitals in different areas of Tehran. Then, we evaluated the association between the rate of stroke admissions and the level of the selected pollutants, humidity, and temperature on the day of stroke and 48 hours prior to stroke among different subgroups of patients.
Results:
There was no significant association between the same-day level of the pollutants and the rate of stroke admissions, but an association was seen for their level 48 hours before stroke. These associations differed among different subgroups of age, sex, history of underlying diseases, and type of stroke. Same-day temperature had a reverse association in patients with hemorrhagic stroke and in patients without a history of heart disease or previous stroke. A direct significant association was seen for humidity level 48 hours before stroke in patients with a history of heart disease.
Conclusions:
It is inferred that air pollution has a direct association with the incidence of stroke and these association differs among different subgroups of patients. The results of this study are not time-dependant and can be generalized to different times and regions. Moreover, these results may be useful for environmental health policy makers.
PMCID: PMC3483001  PMID: 23112900
Air pollution; cerebrovascular complications; CO; humidity; NOx; O3; PM10; SO2; temperature; Tehran
25.  Social support for women of reproductive age and its predictors: a population-based study 
BMC Women's Health  2012;12:30.
Background
Social support is an exchange of resources between at least two individuals perceived by the provider or recipient to be intended to promote the health of the recipient. Social support is a major determinant of health. The objective of this study was to determine the perceived social support and its associated sociodemographic factors among women of reproductive age.
Methods
This was a population-based cross-sectional study with multistage random cluster sampling of 1359 women of reproductive age. Data were collected using questionnaires on sociodemographic factors and perceived social support (PRQ85-Part 2). The relationship between the dependent variable (perceived social support) and the independent variables (sociodemographic characteristics) was analyzed using the multivariable linear regression model.
Results
The mean score of social support was 134.3 ± 17.9. Women scored highest in the “worth” dimension and lowest in the “social integration” dimension. Multivariable linear regression analysis indicated that the variables of education, spouse’s occupation, Sufficiency of income for expenses and primary support source were significantly related to the perceived social support.
Conclusion
Sociodemographic factors affect social support and could be considered in planning interventions to improve social support for Iranian women.
doi:10.1186/1472-6874-12-30
PMCID: PMC3675417  PMID: 22988834

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