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1.  People’s trust in health news disseminated by mass media in Tehran 
Background: People are increasingly interested in health news. As a mass media, the ‘Islamic Republic of Iran Broadcasting’ (IRIB) has the highest number of target audiences. In Iran, some people follow health news via health programs on satellites and other means of communication. However, all of these programs do not live up to the standards of scientific evidence. In this study, we examined Tehran people’s trust in health news disseminated by the IRIB and other mass media outlets.
Methods: A cross-sectional study was conducted in Tehran. Through multistage sampling, 510 households proportional to size were randomly selected from five regions of Tehran including northern, eastern, western, southern and central regions. One person from each household completed the questionnaire through interviews. The questionnaire included questions on people’s level of trust in health news delivered by the IRIB, satellite programs, the internet and magazines. It also included demographic questions. The validity and reliability of the questionnaire was evaluated.
Results: Among the interviewees, 50.6% was female. The highest level of trust by the participants was observed in the IRIB (65.2%), and the lowest trust was observed in satellite news (43.4%); p< 0.001. The interviewees believed that the IRIB news broadcasters had more mastery over the subject than the ones in satellite channels (p< 0.001). The IRIB’s coverage of important and relevant health topics was also significantly perceived to be better than that of satellite news (p< 0.001). According to 83.5% of interviewees, the quality of health news had improved in the past 10 years. Fifty nine point eight percent of participants believed the quality and accuracy of the IRIB health news was monitored.
Conclusion: People’s higher level of trust in domestic news as compared to foreign sources and the better status of domestic sources in other areas such as precision in reporting, coverage of more important news, its delivery in lay language, the news broadcasters’ proficiency, and other cases - from the participants’ point of view - can highlight the significance of designing interventions for changing health behavior among domestic health news producers. Therefore, the results of this study can prove useful to health news policy makers in the IRIB.
PMCID: PMC4313454
Iran; News; Health
2.  Prevalence and associated factors of self-reported hypertension among Tehran adults in 2011: a population-based study (Urban HEART-2) 
Background: Hypertension is an important public-health challenge worldwide. The prevalence of hypertension greatly varies across countries. The aim of this study was to estimate the prevalence of self-reported hypertension and to determine related factors in a large random sample of Tehran population in 2011.
Methods: In this cross sectional study, 69173 individuals aged 25–64 years were selected using multistage cluster random sampling method. All participants were interviewed by trained personnel using standard questionnaires. Weighted prevalence and incidence rates were calculated and principle component analysis (PCA) was used to construct wealth index. Chi-square and odds ratio were used to assess associations in univariate analysis. Logistic Regression model was used in multivariate analysis.
Results: The prevalence of self-reported hypertension was 5.27% in total, 3.83% in men and 6.64% in women (p< 0.001). The annual incidence rate of self-reported hypertension was 6.87 per 1000; 5.26 in men and 8.43 in women (p< 0.001), obviously varied across various districts. In multivariate analysis, age, sex (woman), marital status (single), obesity and smoking were positively associated with prevalence of self-reported hypertension. Education level was negatively associated to hypertension. On the other hand, wealth status was not associated to self-reported hypertension.
Conclusion: Our study findings highlighted low awareness rates of hypertension among Tehran adults especially in men and younger people. Hence, we recommend public health strategies to improve health education programs. Moreover, programs to develop the surveillance system and screening programs to early detection of undiagnosed cases are urgently needed particularly in high risk population subgroups.
PMCID: PMC4301203  PMID: 25664306
Hypertension; Self-reporting; Prevalence; Tehran
3.  Designing university students’ health surveillance system in Iran from stakeholders’ opinion 
The university student health surveillance system can play a key role in the health promotion of the educated class of the society. This can be done through collecting information related to health and using it for screening and prevention of disease. Hence, this article will be based on the necessity of existence of such system.
Materials and Methods:
We used interview and focus group discussion in this qualitative study. The participants were the health system authors, experts, student service administrators, and also students. Content analysis was done after data saturation by the research team.
Based on thematic analysis, 249 codes were obtained, and about 20 themes or main expressions were extracted by separating purported sentences and combining them, and omitting overlaps. These themes were summarized into 13 subcategories and finally 4 main categories. The four categories included necessity of surveillance, stewardship, components of health surveillance system, and administrative consideration.
From the participants’ point of view, it seems necessary to have a health surveillance system for students; this system must be in accordance with the health system of the country. The Ministry of Health is the best option for stewardship of the system; however, it needs universities’ support. Need assessment, performing a pilot study, and considering a program for quality control can guarantee for success in this program.
PMCID: PMC4223971  PMID: 25400682
Iran; stakeholders; students’ health; surveillance system
4.  Perceived risk of exposure to indoor residential radon and its relationship to willingness to test among health care providers in Tehran 
Radon exposure is the second cause of lung cancer after exposure to tobacco smoke and the first cause in nonsmokers. The purpose of this study was to assess perceived risk of exposure to indoor residential radon among health care providers in urban and rural health centers affiliated to Tehran University of Medical Sciences.
In 2012–2013, a survey was carried out on 462 health care providers to assess their awareness and risk perception about exposure to indoor residential radon. Only subjects who had previously heard about radon were asked to answer knowledge-based and risk perception questions and report source of knowledge, willingness to test and willingness to pay for radon test kits.
About 67% of responders had heard about radon before this study and of these, 83.5 % recognized it as being hazardous and 34.5 % identified lung cancer as the main health outcome of exposure to radon. Overall, 33% of 310 subjects had knowledgeable awareness. Seventy percent of responders who had previously heard about radon, had high perceived risk and they were more willing to test their houses and more willing to pay for radon test kits.
Having knowledge about radon and perceiving it as a risk had a significant association with willing to take relevant health related behaviors. Furthermore, risk perception contributes to willing to spend more money when health is a concern. Education of health care providers seems to be a pre-requisite to public campaigns on radon awareness and testing.
PMCID: PMC4243733  PMID: 25426296
Radon; Perceived risk; Risk; Willingness to test; Willingness to pay
5.  Urban traffic-related determinants of health questionnaire (UTDHQ): an instrument developed for health impact assessments 
Background: Traffic and transport is a substantial part of a range of economic, social and environmental factors distinguished to have impact on human health. This paper is a report on a preliminary section of a Health Impact Assessment (HIA) on urban traffic and transport initiatives, being conducted in Sanandaj, Iran. In this preliminary study, the psychometric properties of Urban Traffic related Determinants of Health Questionnaire (UTDHQ) were investigated.
Methods: Multistage cluster sampling was employed to recruit 476 key informants in Sanandaj from April to June 2013 to participate in the study. The development of UTDHQ began with a comprehensive review of the literature. Then face, content and construct validity as well as reliability were determined.
Results: Exploratory Factor Analysis showed optimal reduced solution including 40 items and 8 factors. Three of the factors identified were Physical Environment, Social Environment, Public Services Delivery and Accessibility. UTDHQ demonstrated an appropriate validity, reliability, functionality and simplicity.
Conclusion: Despite the need for further studies on UTDHQ, this study showed that it can be a practical and useful tool for conducting HIAs in order to inform decision makers and stakeholders about the health influences of their decisions and measures.
PMCID: PMC4301240  PMID: 25664285
Urban traffic; Health Impact Assessment; Social Determinants of Health; Factor Analysis; Questionnaire; Psychometric Properties
6.  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.
PMCID: PMC4050684  PMID: 24932395
Capture-recapture; epidemiologic methods; Iran; maternal mortality
7.  Breast cancer-preventive behaviors: exploring Iranian women’s experiences 
BMC Women's Health  2014;14:41.
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.
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.
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.
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.
PMCID: PMC3973958  PMID: 24606758
Preventive behaviors; Breast cancer; Iranian women; Qualitative study
8.  Pictorial Health Warning Labels on Cigarette Packages: An Investigation on Opinions of Male Smokers 
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.
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.
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).
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.
PMCID: PMC4005439  PMID: 24829777
Smoking; Tobacco Products; Iran
9.  Psychometric properties of the Persian version of Social Capital Questionnaire in Iran 
Background: The aim of this study was to investigate the psychometric properties of Social Capital Questionnaire ( SCQ) developed by Onyx and Bullen (2000) among a sample of medical science students in Tehran University of Medical Sciences, Iran and to compare the factor analysis with findings from two previous studies in Australia and the United States.
Methods: Multistage cluster sampling was employed to recruit 293 medical science students (Male: 95/Female: 198) from 7 faculties in Tehran University of Medical Sciences. After translating SCQ into Persian applying back-translation technique and three-stage consensus panel, the questionnaires administered to the respondents and they were asked to complete them. Statistical Analysis was performed using SPSS version 16.0 for Windows.
Results: Exploratory Factor Analysis (EFA) was conducted to evaluate factor structure of the Persian SCQ (PSCQ),which showed a moderate replicability, validity, and reliability (Cronbach alpha= .79) to those found in previous studies. Twelve factors extracted with eight values greater than 1 which altogether accounted for 76.23% of the total variance. Applying Cattell's scree test, it was indicated that between seven and eight factor sextracted. The correlations between factors were detected in the low (at the lowest 0.002) to modest (at the highest 0.614) range.
Conclusion: The differences found in the factor analysis between the studies may be ascribed to the various types of populations studied. Despite the difference in populations studied, our findings support the meaningful nessof P-SCQ as an instrument that is worthy of further attention for use in social health researches, although more studies are recommended to help researchers in comparing its variety in dimensions of different communities.
PMCID: PMC4153523  PMID: 25250262
Social Capital; Factor Analysis; Construct Validity; Iran
10.  Iranian mothers’ perception of the psychological birth trauma: A qualitative study 
Iranian Journal of Psychiatry  2014;9(1):31-36.
Childbirth is one of the most vulnerable moments and the most important and memorable events in the lives of women that despite of bringing happiness, it can be associated with psychological trauma and endanger the mother and neonate health. Mothers’ perception of the psychological birth trauma is a highly subjective process that depends on the cultural, social and biological conditions of mothers that is not achievable except with examination of their views. This study aimed to understand psychological birth trauma from the perceptions of Iranian mothers.
A qualitative research design using in-depth interviews of 23 Iranian mothers was conducted from Tehran and Isfahan health centers. The interviews were transcribed and analyzed using conventional content analysis.
Two themes were extracted from the data: impact of psychological birth trauma and trends of psychological birth trauma. Several categories and sub-categories also emerged from the data. Feelings of fear, anxiety, helplessness and sense of impending death (collapse) were reported by the mothers.
By considering the unforgettable experience of mothers from the psychological birth trauma, a plan for supportive care before, during and after birth is critical.
PMCID: PMC4277605  PMID: 25561946
Mothers’ perspectives; Psychological birth trauma; Content analysis
11.  Commercialization of biopharmaceutical knowledge in Iran; challenges and solutions 
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.
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.
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.
PMCID: PMC3974067  PMID: 24568555
Knowledge translation; Biopharmaceutical research; Facilitators and barriers
12.  Gender-based sexual roles: A mixed methods study in Iranian families 
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.
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%).
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
13.  Clarifying the Role of Schools in Tendency or Lack of Tendency Toward Smoking among Teenage Boys (11-14) in Mashhad, Iran 
Recent studies show that the prevalence of tobacco use among teens and students is increasing, and the initiation age of tobacco use has decreased.
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.
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.
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.
PMCID: PMC3964423  PMID: 24719706
Smoking; Adolescent; Tobacco; Schools
14.  Distribution of Breast Density in Iranian Women and its Association with Breast Cancer Risk Factors 
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.
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.
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.
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.
PMCID: PMC3955513  PMID: 24693398
Breast Neoplasms; Mammography; Mass Screening
15.  An Algorithm of Smoking Stages Assessment in Adolescents: A Validation Study Using the Latent Class Analysis Model 
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.
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 (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).
The results suggested that this algorithm is clear, valid, and reliable.
PMCID: PMC3883256  PMID: 24404366
Adolescence; latent class analysis; reliability; smoking stages; validity
16.  The perspectives of iranian physicians and patients towards patient decision aids: a qualitative study 
BMC Research Notes  2013;6:379.
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.
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.
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.
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.
PMCID: PMC3849268  PMID: 24066792
Patient decision aid tool; Qualitative study; Iran
17.  A social network analysis on clinical education of diabetic foot 
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.
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.
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.
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.
PMCID: PMC3879216  PMID: 24330538
18.  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
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.
PMCID: PMC3793485  PMID: 24130945
Iran; notification; public health practice; reporting
19.  Collaboration in research and the influential factors in Golestan University of Medical Sciences research projects (2005-2007): an academic sample from Iran 
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.
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.
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.
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
21.  Correlates of physical activity in adolescence: a study from a developing country 
Global Health Action  2013;6:10.3402/gha.v6i0.20327.
Physical activity is important for adolescent health. The current study aimed to explore factors that predict physical activity among adolescents.
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.
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.
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.
PMCID: PMC3651954  PMID: 23663416
adolescent health; physical activity; family support; Asia; Iran
22.  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.
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.
PMCID: PMC3680644  PMID: 23772284
Adolescent; Smoking; Cigarette; Family behavior; Tehran; Iran
23.  Internal conflicts of Iranian first-time mothers in adaptation to maternal role 
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.
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.
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
24.  Epidemiologic Evaluation of Child Abuse and Neglect in School-Aged Children of Qazvin Province, Iran 
Iranian Journal of Pediatrics  2013;23(2):159-164.
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.
PMCID: PMC3663306  PMID: 23724176
Child Abuse; Child Maltreatment; Emotional Disturbances; Child Neglect; Violence; Iran
25.  What Motivates Talented Medical Students to Study Simultaneously at Master of Public Health (MPH)? 
Iranian Journal of Public Health  2013;42(4):402-409.
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.
PMCID: PMC3684727  PMID: 23785680
Curriculum; Graduate; Administration; Public health; Education; Iran

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