Payesh
Year:2004 | Volume:3 | Issue:3|Papers Count:11

Objective(s): To develop a practical guide for health professionals who want to design appropriate interventions in health programs by means of organized research? Specific objectives included finding the most practical and accurate methods for decomposition of outcomes, measuring the impact of each determinant in applied settings, and prioritizing research for achieving this goal.Methods: In this paper all causal models were reviewed (i.e. graphical, structural, sufficient-component cause and counterfactual models), and judged as to whether they can provide an appropriate conceptual framework to prioritize research and interventions. Results: The Attributable Fraction is the classic epidemiologic measure for causal attribution of a risk factor. Since Attributable Fraction depends on measuring zero levels, which is neither feasible nor desirable, "Generalized Impact Fraction" was substituted for this purpose. The appropriate conceptual framework in practical settings could be Counterfactual Analysis for comparative risk assessment. Conclusion: As it is not possible to perform every theoretical approach, choosing the most practical methods is essential in selecting epidemiologic methods for health programs. It seems that despite its limitations, Counterfactual Analysis and subsequent "General Impact Fraction" estimation could be most practical and accurate way in this situation. Further development of the method can be accompanied by selection of a sequence of different interventions based on "Average Attributable Fraction", provided the required data are available.  

Objective(s): To examine the relationship between schoolbag weight and students' body weight in primary school students in Hamadan. Methods: 558 students (270 girls, 288 boys) in primary schools of Hamadan were selected by random sampling. Their bodies and bags were weighed. Results: 12 percent of children carry bags weighting more than 10% of their body weight, while 88% carry lighter. In comparison with other countries such as Australia, Italy, Canada and even the US, where children carry bags weighting up to 30-50% of their body weight, primary students in Hamadan carry rather lower weight. Conclusion: The school health care professionals should devise programs for educating students about how to select the bag and how to load and carry it.  

Objective(s): To determine health needs of a population living in the Tehran's 17th municipal district and identify appropriate strategies to deal with them. Methods: This research included 2 phases: the first phase was a qualitative study with 2 stages, focus group discussion, in-depth interview with key informants of the 17th district and expert panel methods with specialists. The second phase was a cross sectional study carried out with a closed questionnaire based on the results of phase 1. Results: The results of the first phase indicted that the presence of railway tracks in the 17th district was the most important problem affecting people's health status. Comparing the opinions of community leaders and health professionals with those of local residents, and study of cause-effect chain, it was obvious that with the transfer of Tehran-Tabriz railway, the major problems of this area will decrease. On the basis of this we arranged a meeting and invited officials from the municipality and railway organization to convey problems. Conclusion: The findings indicated that it is possible to disseminate community-based investigations to improve public's health.

Objective(s): To design and pilot "data registry protocol for injured patients" in Rasoul Akram Hospital (RAH). Methods: As part of the implementation of the "Trauma Care System Project", an interventional and case study was carried out in RAH in Tehran, Iran. After preparation of "essential data set", designing of "data registry protocol", six indices were devised for monitoring of coverage and quality of the registration. The trends for change in these indices were determined by assessment of 2003 injured clients who were registered during July 2003 to May 2004. Results: The coverage index showed an upward trend (slope=0.03, P<0.001). The average "percent of data field defects" as the main indicator of quality showed a significant decreasing trend (slope= -0.02, P<0.001). Conclusion: This research illustrates that "data registration" with the current staff in RAH is feasible. It seems that the "data registration" could be integrated into the routine duties of nurses. 

Objective(s): To determine requirements for implementation of a total quality management system at Rasoul Akram Hospital. Methods: This cross-sectional study was conducted in 2003. All the supervisors (n=52) in different departments were included in the study. A 75-item questionnaire was used to gather data regarding leadership commitment, total quality management structure, consumer orientation, employee participation, communication, manpower involvement, organizational culture and teamwork. Data analysis was carried out using descriptive statistical procedures. Results: 67% and 59% of the respondents confirmed leadership commitment and total quality management structure respectively. Consumer orientation, employee participation, communication, manpower development, organizational culture, and teamwork (as viewed by supervisors) were implemented at levels of 63%, 56%, 61%, 58% and 53%, 56% levels respectively. Conclusion: It seems that the hospital needs to improve with regard to all these requirements, particularly organizational culture, teamwork, employee participation, manpower development, and total quality management structure.

Objective(s): To determine prevalence rates and risk factors for some common chronic diseases and senile changes leading to disability in pensioners of Imam Khomeini Relief Committee in Tehran between September 2002 and September 2003. Methods: This was a cross-sectional study. Data on demographic characteristics and senile features were collected by interviews. Data on history of chronic diseases were collected from individual computerized data cards. Results: There were 193 male (30%) and 452 female (70%). 80% of our elderly subjects had at least one chronic disease. The most common chronic condition was osteoarthritis (79.2%). 79.22% of population was taking drugs on a long-term basis. Only 2 persons didn't show any changes associated with disability. The presence of chronic diseases in the elderly was significantly related to age and marital status (p< 0.001). Conclusion: chronic diseases and senile changes associated with disability were very common among the study population. Younger age and marital status are significant preventive factors for chronic diseases. Our results need to be confirmed by other nationwide studies.

Objective(s): To investigate the characteristics of an appropriate need assessment model and also to determine the most applicable need assessment models according to the viewpoints of health directors and experts in Isfahan University of Medical Sciences and Health Services. Methods: In this descriptive-qualitative research 40 health directors and their assistants and 40 staff experts of health and Therapeutic Network in Isfahan were studied .The data were collected through a questionnaire whose validity was confirmed by content validity and its reliability by test-retest. Then the data were analyzed by SPSS software using frequency distribution and ch2 test. Results: The proper patterns for need assessment of the staff organization needs have the following characteristic: They define need as the distance between the existing and the desired situations, consider appointment, employees and goals as need assessment sources, use questionnaire and direct observation as need assessment tools, recognize need in district level and job, consider the participation rate of employees as the criterion for determination of the model, apply need assessment timing in several steps, gather people representatives at special places as the most suitable location, use Delphi methods as the most suitable executive method, apply compositional patterns and purpose axis patterns as the most applicable models. Conclusion: Educational need assessment is the first and most steps in educational planning in medical education and health system. Determining the needs based on precise patterns and techniques can increase the effectiveness and quality of planning in this system.

Objective(s): To estimate a frequency of HBsAg prevalence by a simple sampling method on 120 pregnant women attending health centers in Ahwaz city between March and December 1998. Methods: The data were collected through a questionnaire and interviews (as a supplementary tool) accompanied with laboratories results. Results: The results showed that 2 out of 120 specimens were HBsAg positive with no evidence of HBe Ag. Conclusion: The high prevalence of chronic Hepatitis B carriers, support a generalized screening of all pregnant women for HBsAg.