Payesh
Year:2005 | Volume:4 | Issue:2|Papers Count:9

Several years have passed since the establishment of population research centers all over the country. During the course of their activities, these centers have had numerous practical achievements. Still, the theoretical background of these activities needs further discussion. Moreover, the conceptual framework that centers in each of the medical universities have chosen for their activities is not explicitly defined and is not clearly communicated to other centers. The Population Research Center in Tehran University of Medical Sciences, like other centers, has understood the necessity of a common conceptual framework to direct the activities of the Center and to strengthen its position. The Population Center in Tehran University has chosen "Planned Approach To Community Health" (PATCH) as the framework to direct its activities in order to achieve its goals and objectives in Tehran's 17th municipal district. The Center tries to convey its practical experience and achievements to other population centers. The Planned Approach to Community Health is composed of 5 practical steps: 1) Community Mobilization 2) Needs Assessment 3) Priority Setting 4) Development of a Comprehensive Interventional Plan and 5) Evaluation. In this article, the components and practical steps of Planned Approach to Community Health are explained in detail and an actual example of the implementation of the whole process is presented in the form of a project carried out by Tehran University of Medical Sciences. This project is entitled "Evaluation of an educational intervention accompanied by community participation to promote hygienic distribution of food in zone 17- covered by the Population Research Center". The aforementioned project is one of the many programs designed and carried out according to PATCH.

Objective(s): To improve the performance of the trauma management system, we examined the pattern of injury "hot spots" in Tehran. Methods: All hospitals in Tehran admitting trauma victims were included in this study. In randomly selected days throughout the year (41 days), trained interviewers collected data on trauma cases round the clock. If the patient was hospitalized, further information about the cause of trauma and its mechanism was recorded. Results: In all, 4198 patients were admitted to the hospitals and interviewed. The mean age of the patients was 29.8±18 years. 78 percent of our patients were male. The major mechanism of injury was traffic accident followed by falls, penetrating injuries, and alcohol intoxication. The highest number of cases came from the 4th, 20th and 12th municipal districts (Bazaar, Pa-Menar, Khaniabad). If we considered only road traffic accidents (as the major cause of trauma), the 4th, 20th and 12th regions were the most frequent sites of occurrence. Conclusion: More comprehensive studies have to be performed on the causes of injuries in the "hot spots" to elucidate what preventive strategies would effectively reduce the incidence of trauma in these areas.

Objective(s): The Ministry of Health and Medical Education in Iran launched a nation-wide campaign against Measles and Rubella (MR) in December 2003. The target population in southern Tehran covered by Tehran University of Medical included 590000 people. Based on official reports, the campaign's coverage level in this area was 109%. The unexpectedly high coverage level was the principal motivation for this study. Methods: 400 households were selected by cluster sampling. In each eligible household one of the family members in the target age group was selected at random. Chi-square and Fisher's exact tests were used for data analysis. Results: 98% (95% CI: 96 - 100) of the 5 to 25 year-old people under study were vaccinated. 3 people (0.8%) in the vaccinated group were not from the target group for the vaccination program. 38 people (9.7%) from the vaccinated group presented with mild side effects. Just one case of anaphylactic shock was reported in the study subjects. Non-compliance in the mass vaccination campaign was due to pregnancy (3 people), being too busy (3 people), sickness (1 person) and fear of vaccination (1 person). 45% of population had been covered by mobile vaccination teams. 98% had obtained vaccination cards. Conclusion: Compared to similar programs worldwide, figures from our mass vaccination program within this short period of time demonstrate the success of the executive managers in providing high levels of coverage. Evaluation of immune response and cost effectiveness analysis of the campaign are necessary for more comprehensive evaluation.

Objective(s): To assess one-month drug compliance and some of the factors that influences it in a sample of diabetic patients. Methods: This was a cross-sectional study carried out from April to September 2004. In this study, 256 diabetic patients in Shariati and Imarn Khomeini hospitals were assessed in terms of one-month drug compliance and their knowledge about diabetes, their attitude regarding drug usage, family support, drug accessibility and other factors that probably influence compliance. Results: 221 patients (86.3%) had drug compliance levels of ≥90% during the month preceding the study. The associations between drug compliance and age, knowledge, patients attitude about controlling of diabetes and drug effectiveness were significant (P<0.001, P=0.017, P=0.04 and P=0.009 respectively). However, there was no significant association between drug compliance and drug accessibility, family support, education, and co morbidity and disease duration. Conclusion: Higher compliance in those aged above 45 years is probably due to greater risk perception. Age, knowledge and attitude influence drug compliance and therefore patients under 45 years of age, should be regarded as target group for interventions to increase drug compliance.

Objective(s): To investigate health-related quality of life among an elderly population in Tehran, Iran and to study its relationship to co-morbidity and demographic variables. Methods: Using a stratified multi-stage cluster sampling method, a sample of people aged 60 years old and over was studied. Health-related quality of life was assessed using the Iranian version of The Short Form Health Survey Questionnaire (SF-36). Data on co-morbidity were collected for both short-term and chronic diseases. The latter included hypertension, diabetes, cardiovascular diseases, arthritis, cancers, neurological disorders, respiratory diseases and low back pain. Results In all, 396 individuals were interviewed. The mean age was 67.9 (SD=± 9.6)years, most were married (80 %) and the mean duration of their formal education was 5.3 years. The results showed significant gender differences in all quality of life dimensions and for both short-term and long-standing diseases (P values ranging from 0.008 to <0.001). Also, it was found that demographic variables including age, employment status, marital status and educational level were significantly associated with most quality of life dimensions. Conclusion: The findings indicate that health-related quality of life in elderly people is highly dependent on both co-morbidity and demographic variables. Indeed, establishing effective geriatric health services for this vulnerable age group is essential.

Objective(s): To determine the knowledge of pregnant women about factors predisposing to high-risk states. Methods: 407 pregnant women were studied in Imam Khomeini hospital in 1998. We used a questionnaire (with scores for each item ranging from 0 to 4) to evaluate the knowledge of the respondents. Results: 50.4% of the subjects were 20-29 years old, 35.6% were primigravidas and 75.5% were receiving prenatal care. 326 women (80.1%) knew about high-risk ages for pregnancy (<16 and >35 years). More than 90% had a high level of knowledge about some special diseases before and during pregnancy and also about addictions during pregnancy (tobacco, narcotics and other drugs) as predisposing factors for high-risk pregnancy. The frequency of high-level knowledge of the warning signs in the current pregnancy was 7.4%. The same figure for warning signs in the past pregnancies was 17.7%. A total of 309 women (75.9%) had a high level of knowledge. Moderate and low levels of knowledge were recorded in 90 (22.1%) and 8 subjects (2%), respectively. There was a significant relation between knowledge and education, parity and the use of prenatal care services (P=0.0001). Conclusion: The findings indicated that the pregnant women had fairly good knowledge about high-risk pregnancies and the use of prenatal care significantly contributed to present condition. Thus, there is need to encourage women to use such services move frequently.

Objective(s): Determining to what extent postpartum breast-feeding education can increase the duration of breast-feeding over a period of four months after delivery. Methods: This randomized trial was performed to assess the effectiveness of a breast-feeding education program in lengthening the duration of exclusive breast-feeding. This was a brief package aimed at empowering participants through a process of education and skill building. All patients (n=120) had normal babies through vaginal delivery and were randomly allocated into two groups, matched for demographic and obstetric characteristics. The intervention group (n=60) but not the control group received the breast-feeding course. Of all 120 subjects, 110 (53 in the intervention group and 57 in the control group) completed the study. Breastfeeding duration was assessed after four months of follow-up and data were analyzed using the SPSS software package with t- test and X2. Results: The breast-feeding program was effective in increasing the duration of exclusive breast-feeding so that the rate of exclusive breast-feeding at the end of 4thmonth was %64.2 in the intervention group and %29.8 in the other group (P.V<0.0001). Mothers in the intervention group breast-fed their babies for longer periods compared to those in the control group. These differences were statistically significant. Conclusion: This study suggests that education on breast-feeding might be an effective way to promote the initiation and duration of breast-feeding.

Objective(s): To assess the effectiveness of using visualesthetic elements in health education to prevent HIV exposure. Methods: In the first phase of the study, we administered two questionnaires to students in Shiraz, International Imam Khomeini and Soureh Universities. The first questionnaire (containing 16 items) assessed AIDS knowledge and the second contained questions accompanied by 3 pictures with real, abstract and symbolic designs. The second questionnaire was used as a tool to determine the impact of different graphic designs on subjects perception of the health message. Dimensions covered by this assessment were "better comprehension", "greater effect" and "more rapid communication". The second phase of the study involved a reassessment of knowledge using the same 16-item questionnaire as in phase 1. Results: Before-after tests in all three universities showed a significant effect of the visual message in promoting knowledge of AIDS and its transmission mechanisms (P<0.01). Real pictures produced higher scores on all the three dimension covered by the assessment process. Conclusion: The nature of the message may be a more important factor than the reception process. The scarcity of resources for AIDS prevention in Iran highlights the importance of individual-level education for effective AIDS control.