Payesh
Year:2013 | Volume:12 | Issue:4|Papers Count:12

In Clinical Medicine and Public Health, Primary, Secondary and Tertiary Preventive services mainly focus on preventing of diseases. But Quaternary Prevention (P4) is related to preventing of unnecessary diagnostic, therapeutic and preventative services. P4 was coined by Marc Jamoulle, a Belgian family physician, in 1986. Unfortunately P4 is not well known in Iran. In this review the history, definition and goals of P4 is presented. As some of the unnecessary clinical medicine and public health services are prevalent in Iran, the importance of educating P4 in Iranian universities of medical sciences and health care services is discussed.

Objective (s): The aim of this project was to offer a culturally adapted model for implementing a health programs.Methods: First evidence collected from the literature. Then expert opinions were thought. Then data were synthesized to adapt a culturally tailored model for implementing a health program.Results: The analysis indicated that health service delivery systems should be evidence-based. On the other hand health care quality requires appropriate implementation method. Prioritizing, feasibility and the different outcomes must be defined in implementing plan. Also for wide spread of a new program, considering health policies, stakeholders roles, and existing resources should be considered.Conclusion: The findings suggest a six-step model for implementation of a health programs.

Objective (s): To assess mental health and its relationship with social capital in older people.Methods: This was a cross-sectional study of older people aged over 60 living in Tehran, district 9. The sample was selected by multistage random sampling. To assess mental health and social capital the General Health Questionnaire (GHQ-28) and the Urban HEART Questionnaire were used, respectively.Results: In all 320 older adults were studied. There was relationship between mental health and individual trust, social cohesion, and social support while mental health and social trust and collective relations did not show significant association.Conclusion: The findings suggest that there is a mutual relationship between mental health and social capital.

Objective (s): Dental caries is one of the most common infectious diseases and is high in developing countries such as Iran. Since women with pregnancy are considered to a high-risk group for dental caries, this study aimed to investigate about oral health among this population.Methods: This was a cross-sectional study. A sample of 340 women with pregnancy was selected with random sampling method from health centers in Arak, Iran. Data were collected by a checklist including information on DMFT.Results: The mean age of pregnant women was 28.2±3.7 years and the mean DMFT was 5.4±2.83. There were no significant association between insurance coverage and DMFT (P=0.411). The results obtained from multiple logistic regression analysis indicated that age, income and brushing behavior were predictors of oral health status among pregnant women.Conclusion: The present study indicated that in general oral health was poor in pregnant of women. It seems social and behavioral issues play important role in oral health among this population.

Objective (s): To investigate about the effect of sexual health education on sexual function during pregnancy.Methods: This was a randomized educational control trial of 60 pregnant women with gestational age<33 weeks (30 women in intervention group and 30 women in control group) who were referred to health centers of Hamadan during 2011-2012. The data were collected by a questionnaire at baseline and one month follow-up in two groups.Results: There were no significant differences between two groups before intervention. After sexual education, there were significant differences in sexual desire (P=0.003), sexual arousal (P=0.003), orgasm (P=0.007), number of sexual intercourse (P<0.001), and dysparunia (P<0.001) between two groups. Also, willcoxon test showed significant differences in all components of sexual function at baseline and one moth assessment in intervention in group.Conclusion: Sexual health education improves sexual function during pregnancy. Indeed health care systems should provide education for pregnant women.

Objective (s): Continuation rate is one of the most important factors in the success of any contraceptive methods. Although oral contraceptive pill (OCP) is the most reliable method for preventing pregnancy, a number of women do not contnue to use the pills. This study reports on improving continuation by appliying the theory of Planned Behavior.Methods: This was a case-control study of women aged 15-49 years old using low dose (LD) pills attending family planning centres in Ahwaz, Iran in year 2012. To improve continuation of OCP an educational program based on the Theory of Planned Behavior was developed. Cases received the usual care plus the program while the control only received the usual care. Data were collected via face-to-face interviews at baseline (before the intervention) and at three and six months follow-up. This paper reports on three months data. Logistic regression analysis was performed to assess the effect of the educational program on continuation.Results: The results revealed that the educational program did not have a statistically significant effect to increase continuation of OCP (OR =2.09, 95% CI=0.77-5.68, P =0.15). However, women who did not receive the educational program 2 times were more likely to discontinue the pills compared to women who received the intervention.Conclusion: The findings indicated that educational intervention based on Theory of Planned Behavior might improve continuation of OCP. To asretain such conclusion the effect of the educational program on continuation reamins to be assessed at six months follow-up.

Objective (s): Exposure to air pollution has been associated with higher adverse pregnancy outcomes. This study aimed to investigate the stages of behavior change towards air pollution among pregnant women using the stage of change theory.Methods: In this cross sectional study a sample of pregnant women who referred to three health centers located in different geographic regions of Tehran were randomly selected and assessed. The inclusion criteria were age between 18 and 35 years, having the history of pregnancies without adverse outcomes, not suffering from chronic disease during the present pregnancy and being satisfied to taking part in the study. Data were collected by a standard questionnaire based on stage of change theory.Results: In all 200 eligible pregnant women with mean age of 26.9±4.8 participated in the study. The analysis of data showed that most women (51%) were at pre-action stages. Only 16% of pregnant women were identified at action stage.Conclusion: The findings suggest that a relatively high proportion of pregnant women are at pre-action stages of behavior changes towards exposure to air pollution. The need for further investigation and perhaps necessary action is recommended.

Objective (s): To develop a measure for assessing oncology nurses’ attitudes toward providing spiritual care.Methods: This was a two-part study (qualitative and quantitative) that carried out in 12 hospitals affiliated to Shahid Beheshti and Tehran Universities of Medical Sciences. In all 154 nurses (24 nurses in qualitative phase and 130 nurses in quantitative phase) took part in the study. Data were collected through semi- structured and focus group interviews with oncology nurses. Interviews were analyzed with qualitative content analysis approach. Then items derived from content analysis mixed with items derived from literature and item pool was assessed for content, face, construct, and criterion validity. Internal consistency and stability was performed to assess reliability.Results: In all 286 items were identified and after indicating the content validty index and the content validity ratio, the number of items was reduced to 68 (CVI 0.75% and CVR 0.45%). To determine construct validity, we used factor analysis that was identified 3 principal components consisting of knowledge, emotion and performance that explained 45% of variance observed. Taylor spiritual care perspective was used to assess criterion validity. The correlation coefficient between two questionnaires was acceptable (r = 0.548). The Cronbach’s alpha coefficient was used to determine internal consistency and test- retest for stability of the scale and both showed satisfactory results (a= 0.903 and r= 0.734) respectively.Conclusion: Oncology nurses attitude towrd providing spiritual care is a valid and reliable measure.

Objective (s): In recent years there are special attention to the issue of children's education and learning spaces. Unfortunately, in Iran most schools and kindergartens are established without proper design or in non-educational buildings. The purpose of this research was to assees the relationship between some design principles and children's behaviour.Methods: This was a semi-experimental study with pre-and post-test design among a random sample of pre-school children aged between 5 to 7 years. Childeren were assigned into the experimental and control groups (15 children each). The experimental group was located in a specially designed place while the controls were lockated in a usual place.Results: The results showed that natural and appropriate lightening in the space, creation visual and aural communication with the outdoor kindergarten spaces and also connection with green and open space and targeted playing in the open space decreased behavioural disorders in the experimental group.Conclusion: The findings indicated that the physical qualities of the educational environments have a major impact on children's behavior.

Objective (s): This study aimed to determine the prevalence of overweight and obesity among students in Marand, IranMethods: In this cross-sectional study 10679 students (elementary, pre-high school and high school students) were selected randomly. Then their weight, and height, was measured and body mass index (BMI) percentage calculated. BMI was used to assess students' weight status. Descriptive statistics were used to explore the data.Results: The majority of the students (81.8%) had normal weight. More than 6% (6.25%) and 3.5% of students were overweight and obese respectively. The prevalence of overweight and obesity was more common among male students compared to females (P<0.001). Also, the prevalence of overweight and obesity among pre-high school students was significantly higher than elementary and high school students (P<0.001).Conclusion: The findings showed a relatively low level of overweight and obesity among students in Marand. However, it seems that students would possibly benefit from a nutrition and health promotion program to reduce the tendency of overweight and obesity, especially among male students.

Objective (s): Effective methods for preventing tobacco use are crucial for adolescents. One behavioral change theory that has been successfully used for designing smoking prevention programs is the theory of planned behavior (TPB). The aim of this study was to examine the ability of the theory of planned behavior (TPB) in preventing tobacco use among adolscents.Methods: In this quasi-experimental study, a total of 280 male junior high school students aged between 14 to 19 years (140 cases and 140 controls) were selected randomly from 4 schools of Zarandieh, Iran. The cases participated in educational classes for one month. Data was collected using a questionnaire based on the TPB on tobacco use. Two groups completed the questionnaire before and six months after intervention.Results: Our findings indicated that mean scores of the TPB constructs (knowledge, attitude, subjective norms, perceived behavior control, intention) were significantly increased in the experimental group compared to the controls. Also, tobacco use decreased significantly among the experimental group after intervention (before intervention 25% vs. after intervention 10.5% in the experimental group, P<0.001).Conclusion: The results support the implementation of educational programs based on the TPB in preventing smoking behavior among adolescents.