Iranian Journal of Public Health
Year:2012 | Volume:41 | Issue:4|Papers Count:14

Background: Ethics is a discipline, which primarily deals with what is moral and immoral behavior. Public Health Ethics is translation of ethical theories and concepts into practice to address complex multidimensional public health problems. The primary purpose of this paper was to conduct a narrative literature review-addressing role of ethics in developing curriculum in programs and schools of public health, ethics-related instruction in schools and programs of public health and the role of ethics in developing a competent public health workforce.Methods: An open search of various health databases including Google scholar and Ebscohost yielded 15 articles related to use of ethics in public health practice or public health training and the salient features were reported.Results: Results indicated a variable amount of ethics’ related training in schools and programs of public health along with public health practitioner training across the nation. Bioethics, medical ethics and public health ethics were found to be subspecialties’ needing separate ethical frameworks to guide decision making.Conclusions: Ethics based curricular and non-curricular training for emerging public health professionals from schools and programs of public health in the United States is extremely essential. In the current age of public health challenges faced in the United States and globally, to have an ethically untrained public health force is arguably, immoral and unethical and jeopardizes population health. There is an urgent need to develop innovative ethic based curriculums in academia as well as finding effective means to translate these curricular competencies into public health practice.

Background: To examine the effects of soy [in the form of textured soy protein (TSP) and soy-nut] on body composition in elderly women with metabolic syndrome (MetS).Methods: A 12-week randomized clinical trial was conducted on 75 women between 60-70 years of age with MetS in rural health clinics around Babol, Iran in 2009. The participants were randomly assigned to one of the three groups of soy-nut (35g/d), TSP (35g/d) and control. Body fat, lean mass and anthropometric indicators were measured before and after intervention, too.Results: Participants were classified as overweight and showing android fat distribution. After 12 weeks of intervention, both soy-nut and TSP groups showed an increase of non-significant in lean mass (0.9 and 0.7 kg), hip circumference (0.45 and 0.28 cm), triceps skinfold (TSF) thickness (0.87 and 0.67mm) and reduction in BMI (-0.15 and -0.33), waist circumference (-0.83 and -1.2) and body fat (-1.5% and -1.7%). Significant increase in the mean change of TSF and lean mass was observed in the users of soy-nut compared to the control group (P<0.01, P<0.05).Conclusion: 12-week intervention of soy had a mild favorable effect on body composition in elderly women with MetS.

Background: In Kazakhstan, as in many other countries, a transformation of the traditional stereotypes of reproductive behavior, and change the types of family relationships is occurred. It is caused by social status changes, by the transformation of women’s valuable orientations and social-role attitudes. The objective of this study was to identify the indicators of reproductive units and the motives for having children in the family.Methods: Designed questionnaires were used to study the regulation of fertility in young families, and women's views about the ideal, desired, and expected number of children per family. The survey covered 1017 respondents aged less than 39 years.Results: Expected number of children in the family depends on living conditions. The average expected number of children per family increases with improvement of living conditions and with increases in income. Statistically significant differences in the average expected number of children in families with a satisfactory and good income compared to poor income (P<0.001). Revealed the predominance of the expected, desired and ideal number of children among women of Asian ethnic group and on the desired and ideal number of children the differences were statistically significant (P<0.05). By mathematical formula that based on a poll can be calculated probability of birth of each child in the family.Conclusion: Reproductive attitudes of Astana women depend on age, educational level, income, professional employment, marital status, and ethnicity. The findings confirm the hypothesis that family plans are largely exposed to specific conditions of life.

Background: Metabolic syndrome (MS) is the syndrome closely related to cardiovascular disease (CVD) risk factors. Few prospective studies have compared the impact of dynamic changes of MS on the development of cardiovascular diseases (CVD).Methods: Overall, 3461 subjects were recruited from a cohort study on Prevention of Multiple Metabolic disorders and MS in Jiangsu of China (PMMJS) with a follow up of 3.8 years. The associations between the dynamic changes (Difference, the value at first follow-up subtract the value at baseline) of MS, component numbers, components and relative risk (RR) of CVD were analyzed by using Cox regression model.Results: The total incidence standardized rate of CVD was 2.58%, and the incidence standardized rates of CVD in MS-/follow-up MS-, baseline MS-/follow-up MS+, baseline MS+/follow-up MS- and baseline MS+/follow-up groups were 2.05%, 5.01%, 1.65% and 4.39% separately. After adjustment confounding factors Difference in FPG, BP and TG have significantly effects on the incidence of CVD.Conclusion: Difference of MS component numbers had the prediction ability of CVD, but MS groups based on baseline and first follow-up MS and/or non-MS had not. In Chinese, the dynamic change of MS component numbers was a useful predict factor for CVD.

Background: Obesity is an important and life-threatening disease, associated with different chronic conditions such as cardiovascular disease, diabetes, and dyslipidemia. We sought to address the paucity of information on the trends of anthropometric indices such as weight, waist circumference, and body mass index in the adult population of Iran.Methods: We drew upon data from the First Non-communicable Disease Survey in Iran in 2005. In total, 79, 611 participants between 20 and 64 years old were selected via the random multistage cluster sampling. The Lambda Median Scale method was applied to construct normal curves for anthropometric indices.Results: The mean of waist circumference in both genders increased with age and in all the age groups except those between 20 and 24 years old was higher in the women. The mean of body mass index was higher in all the age brackets in the women, but the means of weight and height were higher in the men. The association of theses indices with diabetes, hypertension, and dyslipidemia was stronger in men.Conclusion: The ranges of waist circumference and body mass index in Iranian population are different from those of other countries. The higher body mass index and waist circumference in females and the direct association between obesity and chronic diseases, is advisable that the effects of this phenomenon be fully investigated and due heed be paid to the importance of lifestyle modification.

Background: To compare mental health and well- being in different levels of the perceived discrimination among Iranian people living in Tehran.Method: Using multi- stage sampling, 1255 subjects with the average age of 45 years and 9 months (including 672 women and 583 men) were selected and they completed all items of the general health questionnaire (GHQ), the social well- being inventory (SWI), personal well- being inventory (PWI), and a question to assess the perceived discrimination.Results: Data analysis by Kruskal- Wallis test revealed that there were significant differences between physical symptoms (X2=5.93, P<0.05) and depression (X2=15.70, P<0.05), the subscales of mental health in different levels of the perceived discrimination. Furthermore, comparing personal well- being scores and its subscales in different levels of the perceived discrimination showed significant differences in personal hygiene (X2=7.20, P<0.05), and security in future (X2=7.60, P<0.05). Emotional well- being (X2=12.25, P<0.05), self-rule (X2=7.45, P<0.05), personal growth (X2=19.87, P<0.05), and psychological well- being (X2=9.09, P<0.05) were significantly different in different levels of the perceived discrimination, too. Moreover, comparing social well- being in different levels of the perceived discrimination indicated significant differences between social acceptance (X2=14.91, P<0.05), and social participation (X2=10.91, P<0.05).Conclusion: Therefore, people are more active in society, increases the possibility of encountering with discrimination and consequently the perception of that.

Background: More than 36 % of the total population of Iran consists of young people aged 15 to 25 yr. Recent studies show that this age group has the highest rate of serious health problems. Youth participatory studies on youth health priority have shown that mental health is one of the most important priorities in youth health. Aim to assessing the mental health needs of youth we conducted a peer group based multidisciplinary study.Methods: To conduct a multi disciplinary approach through involving youth for finding their mental health needs and their suggestion for solving them, we designed a qualitative approach based on grounded theory. To data collection, we used a semi-structured guide questionnaire. Sixteen focus group discussions were conducted by trained peers with youth aged 15-25 years.Result: According to FGDs results, most of youth health needs concern with their interpersonal communications skills particularly with their parents’; they had some problems with their parental expectations meet; life skills; self-expression and problem solving process. They were extremely interested in participatory approach in which they involved in assessment and determination of their health problems also in designing health programs.Conclusion: Success of program shows empowering the community through capacity building and notice to peer group-based interventions to critical enhancing in various aspects of youth health is the most effective method to needs assessment and community mobilization for better health.

Background: This study was to determine common methods to treat addiction used by patients checked into Outpatient Treatment and Rehabilitation Clinics in Tehran.Methods: The study was conducted in Social Security affiliated outpatient clinics including three governmental and several private centers in 22 districts of Tehran. Demographic data, personal information, social characteristics and information regarding prevention, treatment, and follow-up records of 1, 372 patients were obtained and analyzed.Results: A majority of cases referring to the treatment centers were male (95.2%). Patients were 14 to 75 yr (mean 35.48±10.57 yr); 61.7% were married and lived in rented homes in the city; 938/1372 (68.4%) had at least one previous attempt failure when seeking re-treatment. A majority of them (77.8%) had a history of 1 to 4 quit attempts; a number 63.1% had an abstinence period of 1 week to 6 months.Conclusion: The majority of our understudy subjects had a history of previous attempts to treat their addiction with a maximum abstinence period of 6 months.

Background: There is a great amount of literature concerning the effect of racial segregation on health outcomes but few papers have discussed the effect of segregation on the basis of social, demographic and economic characteristics on health. We estimated the independent effect of segregation of determinants of socioeconomic status on infant mortality in Iranian population.Methods: For measuring segregation, we used generalized dissimilarity index for two group and multi group nominal variables and ordinal information theory index for ordinal variables. Sample data was obtained from Iranian latest national census and multilevel modeling with individual variables at level one and segregation indices measured at province level for socioeconomic status variables at level two were used to assess the effect of segregation on infant mortality.Results: Among individual factors, mother activity was a risk factor for infant mortality. Segregated provinces in regard to size of the house, ownership of a house and motorcycle, number of literate individual in the family and use of natural gas for cooking and heating had higher infant mortality. Segregation indices measured for education level, migration history, activity, marital status and existence of bathroom were negatively associated with infant mortality.Conclusion: Segregation of different contextual characteristics of neighborhood had different effects on health outcomes. Studying segregation of social, economic, and demographic factors, especially in communities, which are racially homogenous, might reveal new insights into dissimilarities in health.

Background: If you want to start a long journey towards patient safety, you should create a good culture of patient safety among employees alongside structural interventions. The first step in doing so is the assessment of current culture in the organization using different tools. One of the most commonly used instruments of measuring patient safety culture is Hospital Survey of Patient Safety culture (HSOPS). The aim of this study was to assess the validity and reliability of Farsi version of this questionnaire for the first time in Iran’s hospitals.Methods: We purposefully selected four hospitals out of seven general Tehran University of Medical Sciences affiliated hospitals. Then a 420 sample of staff of these hospitals were taken randomly. Staff was asked to complete the questionnaire. Confirmative factor analysis, correlation coefficient, Cronbach’s alpha were employed in statistical analyses.Results: Factor loadings for almost all questions were acceptable. Factors jointly explained 77.8% of the variance in the responses. The Cronbach’s alpha coefficient was between 0.57 and 0.8. The study revealed that over 70% of employees were working at their hospitals more than 40 hours a week and also more than half of the employees were not reporting errors.Conclusion: Farsi version of HSOPS with 12 dimensions and 42 questions is a valid and reliable questionnaire to measure patient safety culture for the first time in Iran hospitals. This tool will be helpful in tracking improvements and in heightening awareness on patient safety culture in Iran.

Background: Water filtration units have been faced problems in water turbidity removal related to their media, which is determined by qualitative indices. Moreover, Current qualitative indices such as turbidity and escaping particle number could not precisely determine the efficiency of the media in water filtration, so defining new indices is essential. In this study, the efficiency of Anthracite-Silica and LECA-Silica media in turbidity removal were compared in different operating condition by using modified qualitative indices.Methods: The pilot consisted of a filter column (one meter depth) which consisted of a layer of LECA (450 mm depth) and a layer of Silica sand (350 mm depth. Turbidities of 10, 20, and 30 NTU, coagulant concentrations of 4, 8, and 12 ppm and filtration rates of 10, 15, and 20 m/h were considered as variables.Results: The LECA-Silica media is suitable media for water filtration. Averages of turbidity removal efficiencies in different condition for the LECA-Silica media were 85.8±5.37 percent in stable phase and 69.75±3.37 percent in whole operation phase, while the efficiency of total system were 98.31±0.63 and 94.49±2.97 percent, respectively.Conclusion: The LECA layer efficiency in turbidity removal was independent from filtration rates and due to its low head loss; LECA can be used as a proper medium for treatment plants. Results also showed that the particle index (PI) was a suitable index as a substitute for turbidity and EPN indices.

Background: To describe the epidemiological features of pediatric visceral leishmaniasis in southern Iran.Methods: This retrospective study was carried out using local hospital records of VL patients from 2001 through 2009. Data such as age, gender, place of residence, clinical signs and symptoms, treatment, history of recurrence were recorded. The collected data were statistically analyzed using SPSS software.Results: A total of 260 cases of VL have been recorded during 2001 to 2009 in south of Iran, based on hospital records. Mean age of patients was 3.5 years with the highest prevalence in 2 years old patients. The diseases have been more common in males (60%). The main clinical signs and symptoms of the patients were fever (96.2%), hepatosplenomegaly (68.8%) and abdominal protrusion (71.9%). Most of cases were from Kazeroun County (17.5%) in Fars Province followed by Borazjan in Boushehr Province. Bone marrow aspirations have been performed in 178 of cases and Leishmania amastigotes were detected in only 50 (28.1%) cases. Glucantime has been the first drug treatment while 19.3% of cases have been treated with amphotericin B. Mortality rate was 6.2% and children under 1 year old have been the main victim of the disease. Relapse has been noted in 7.3% of patients.Conclusion: VL is still endemic in South of Iran, especially in Fars Province with a noticeable mortality rate.Moreover, cases of the diseases are reporting from neighboring provinces and this might be due to the spreading of the diseases to the adjacent provinces.

Background: Activity Based Costing (ABC) is one of the new methods began appearing as a costing methodology in the 1990’s. It calculates cost price by determining the usage of resources. In this study, ABC method was used for calculating cost price of remedial services in hospitals.Methods: To apply ABC method, Shahid Faghihi Hospital was selected. First, hospital units were divided into three main departments: administrative, diagnostic, and hospitalized. Second, activity centers were defined by the activity analysis method. Third, costs of administrative activity centers were allocated into diagnostic and operational departments based on the cost driver. Finally, with regard to the usage of cost objectives from services of activity centers, the cost price of medical services was calculated.Results: The cost price from ABC method significantly differs from tariff method. In addition, high amount of indirect costs in the hospital indicates that capacities of resources are not used properly.Conclusion: Cost price of remedial services with tariff method is not properly calculated when compared with ABC method. ABC calculates cost price by applying suitable mechanisms but tariff method is based on the fixed price. In addition, ABC represents useful information about the amount and combination of cost price services.

Background: Non- Tuberculous Mycobacteria are environmental opportunistic pathogens that can be found in various terrestrial and aquatic habitats. There are an epidemiological links between species isolated in tap water and those isolated from patients. hsp65 gene has more variability in its sequences, compared to the some more conserved genes in NTM, for identification of mycobacteria to species level. In this study, the prevalence of NTM in Isfahan City water samples was determined using culture, biochemical tests and PCR-RFLP analyses of hsp65 gene.Methods: Eighty-five water samples were collected and cultured. The mycobacterial isolates were identified by conventional biochemical tests. A 441 bp fragment of hsp65 genes was amplified and digested by two restriction enzymes, BstEII and HaeII. Digested products were analyzed using polyacrilamid gel electrophoresis (PAGE).Results: 25.9% of the water samples contained different species of NTM. Dominant isolates were M. fortuitum (26.7%), M. chelonae like organism (13.3%) and M. mucogenicum (13.3%). Nineteen isolates of Mycobacteria were differentiated usinghsp65 genes PCR-RFLP. Three isolates could not be identified at the species level because their RFLP patterns were different from other known PCR-RFLP profiles. There were differenthsp65 gene PCRRFLP profiles produced by digestion with BstEII and HaeIII.Conclusion: This study showed that PCR-RFLP of hsp65 gene in mycobacteria is more reliable method for identification of NTM at the specie level than conventional phenotypic methods (P<0.05). In comparing of RFLP patterns of this study to other investigation, some minor differences were negligible.