JOURNAL OF COMMUNITY HEALTH RESEARCH
Year:2013 | Volume:2 | Issue:2|Papers Count:9

Today we are faced with new problems threaten individual health. Some protective individual action is expected to reduce the negative impact of major problems such as cardiovascular disease, cancer, obesity, diabetes, mental illness, accidents, outcomes due physical inactivity, and the adjustments necessary to aging. Bringing about the improvement of health requires education. The task of health education is inevitably made very difficult, because of the lack of obvious procedures for preventing today’s ills, the absence of effective curative measures, the less obvious nature of procedures caused new health issues, and integrating the individual health behaviors to culture, custom, social construct and value system.Present-day health problems differ from preventing of the infectious diseases to avoiding disability and death from new health issues. We should shift our actions for educating people into holistic empowering intervention comprising individual and their societies. Then one of the main governments’ objectives of any development is to strengthen people capacity to achieve the highest level of welfare. This objective is exactly according to the health promotion goals maintained on Ottawa chatter in 1986. The solution of new health problems to achieve the more well-being is to know how it is possible to empower people and societies to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health education is recognized as a good tool for people promoting health. Theory-based education is one of the best ways to conduct an effective education. Theories and models of education is broadly used in health education process. The models and theories consider people, their families, environment and community as a whole unit. Besides the health promotion use the models of health education as a tool for behavior change, considering multi approach is beneficial for solving the challenge that is “how to” change people behavior. Our overarching aim is to improve the health and reduce injuries and risk factors to improve the highest level of quality of life with longevity.

Introduction: Primary care organizations are entities through which clinical governance is developed at a confined level. To implement clinical governance in primary care, awareness of principles, prerequisites and barriers of this quality improvement paradigm is necessary. The aim of this study is to gather evidence of implementing clinical governance in primary care organizations.Data sources: The primary search was conducted in July 2012. PubMed, Web of Science, Emerald, Springer link, and MD Consult were searched using the following MESH keywords, “clinical governance” and “primary care”Study selection: The search was limited to English language journals with no time limitation. Articles that were either quantitative or qualitative on the concepts of implementing clinical governance in primary care were eligible for this study. From the selected articles, data on principles, prerequisites and barriers of clinical governance in primary health care were extracted and classified in the extraction tables.Results: We categorized our findings about the principles of clinical governance in primary care in four groups, general principles, principles related to staff, patient and communication. Prerequisites were classified in eight clusters, same as the seven dimensions of the National Health System (NHS) models of clinical governance. Barriers were sorted out in five categories, structure, organizing, cultural, resource, theoretical and logistical.Conclusion: Primary care organizations must provide budget holdings, incentivized programs, data feedback, peer reviews, education, human relations, health information technology (HIT) support, and resources. Key elements include, enrolled populations, interdisciplinary team approach, HIT interoperability and access between all providers and patients, devolution of hospital based services into the community, inter-sectorial integration, blended payments, and a balance of clinical, corporate, and communal governance.

Introduction: The idea that factors during early critical periods of life affect on long term health is now a major public health concern. In this study, in addition to investigating obesity prevalence among female high school students in Yazd, the relationship between obesity and birth weight was examined.Materials and Methods: This cross sectional study was conducted among 312 students using random cluster sampling method. According to the birth weight recorded on their growth cards, the students were divided to 3 weight groups of low birth weight (<2,500 g), fitting birth weight (between 2500 and 4000 g) and high birth weight (>4000 g). Anthropometric measurements including weight, height and waist circumference were also carried out. Based on NCHS standard values, BMI ≥5th, 5-85th, 85-95th , and ≥95th percentiles were considered as underweight, normal, overweight, and obese, respectively. In addition, 95th percentile³for waist circumference was considered abdominal obesity.  Finally, the data were analyzed by SPSS 16 software.Results: The mean of weight and BMI among participants were higher and the mean of their height was lower than 50th percentile of NCHS. Based on the results, 5.7% of the samples were underweight, 73.4% were normal, 17.1% were overweight and 3.8% were obese. Abdominal obesity rate was 18.7%. There was a significantly positive correlation between birth weight and current weight of the students (p= 0.001 and r= 0.2) and their BMI (p= 0.005 and r= 0.15).Conclusion: We observed rather high prevalence of obesity and overweight in this study. Moreover, the relationship between birth weight and current weight was positive which it necessitate preventive strategies and training for this group of people.

Introduction: By ever-increasing of population, shortage of water resources and the necessity of wastewater treatment, large amount of sludge that is a byproduct of wastewater treatment, requires being disposed in safe ways, environmentally. The target of specifying strategic preferences of reusing sludge is going to find the safe way of disposing or beneficial use of sludge.Materials and Methods: In this study, for selecting the best alternatives for reusing wastewater sludge, two systematic methods will be introduced, in which four alternatives in reusing sludge (using in agriculture, in green space, biogas and desert combat) are introduced and they will be compared with four main parameters including: 1-physicochemical 2-biological 3-economic, social and cultural, and 4-environmental pollution situation, where each one contains some criteria.Results: Sludge of Ardabil municipal wastewater treatment plant, according to standards, and EPA regulations is eligible to class B, and due to the chemical, in terms of heavy metals, got special (excellent) quality and contains considerable quantities of organic substance, nutrients and micronutrients that indicates the fertilized value of the sludge.Conclusion: The result of these comparisons showed that the application of sludge in green spaces is the most appropriate alternative while using in agriculture, biogas, and desert combat alternatives are placed respectively in second to fourth preferences of reusing sludge that is derived from municipal wastewater treatment plant.

Introduction: Breast neoplasia is the most common cancer among women in both developed and developing countries. Over 1.15 million women in the world detecting with breast neoplasia each year and the mortality rate is 502,000 cases from this cancer. The purpose of this study was to describe how Iranian women perform breast self-examination.Materials and Methods: In this cross-sectional study 447 participants referred to five health center of Shahid Sadoughi University of Medical Sciences were chosen. The questionnaire and checklist were completed by all participants through a face-to-face interview. If she obtains 0-6 total score, she has weak performance, if she obtains 7-12 total score, she has acceptable performance and if she obtains 13-18 total score, she has good performance of breast self-examination. Statistical analysis carried out using Statistical Analysis Software (SAS) version 16. A P-value of <0.05 was considered statistically significant. Non-parametric tests such as Mann–Whitney were adopted.Results: In our study, 92% of women heard about breast self-examination, but only 17.4% of them performed it monthly. Of 447 participants, 348 (77.9%) had poor, 78 (17.4%) moderate and only 21 (4.7%) had good performance. From all participants, 189(42%) by health worker, 36(8.1%) by family and 70(15.7%) by media learned how to perform breast self-examination.Conclusion: The study showed that although most of women heard about breast self-examination but it was not a routine screening in developing country. This study confirmed that Iranian women have poor knowledge about how to perform breast self-examination. There is need for adequate health education on breast cancer and breast self-examination among Iranian women.

Introduction: Immunization is one of the most important health programs in first level prevention and is also one of the most cost-effective prevention programs in the entire world. This study evaluates the situation of immunization in fewer than one year old Afghan refugee children in Kerman, Iran.Materials and Methods: This was a cross-sectional study. Data was extracted from the records of the health centers supported by the higher commission of refuges in Kerman. The BCG, polio 0, DTP 3, polio 3, Hepatitis B 3 and MMR 1 was calculated and compared with the vaccine coverage in Iran and Afghanistan. Stata 11 and Excel 2007 and the chi-square statistics were used for the analysis.Results: The coverage of all BCG, Polio 0, DTP 3, Polio 3, Hepatitis B 3 and MMR 1 vaccines in the Afghan immigrants residing in Kerman between 2010 and 2012 was more than 95%. This coverage was not significantly different from the vaccine coverage of Iranian children, but was significantly higher than the vaccine coverage of children residing in Afghanistan.Conclusion: The vaccine coverage of Afghan children residing in Kerman is similar to Iranian children and is high and satisfactory. These results show part of The Islamic Republic of Iran’s commitment for providing health requirements for Afghan refugees residing in Iran.

Introduction: The importance of the periodontal health maintenance and promotion in diabetes mellitus has been supported. Evidence showed that many patients are unaware about effects of diabetes mellitus on oral health. The aim of this study is to evaluate knowledge, attitudes and practice of diabetic patients concerning the risk of periodontal disease and prevention.Materials and Methods: In this cross sectional study, 156 diabetic patients referring to Yazd Diabetic Research Center were recruited by random selection. Patients completed questionnaires, which included 29 questions about their knowledge, attitude and practice of oral health in diabetes mellitus. The data was scored and analyzed.Results: The results showed knowledge (58.64) and attitude (46.86) scores of diabetic patients were moderate, while their practice (24.3) score were poor. There is statistical significant relation between mean scores of knowledge, attitude and practice of patients with their educational level and age.Conclusion: This study showed knowledge, attitude and practice level of diabetic patients were insufficient on oral health care.

Introduction: Personnel’s attitudes and their behaviors with the clients significantly affect clients’ perception of quality of services and consequently influence their satisfaction. The purpose of the present study was to investigate the supervisor’s attitude towards the effect of personal elements (as one of the elements of the service marketing mix) on choosing the hospital by patients and their companions.Materials and Methods: This cross-sectional descriptive study conducted in winter of 2012. 35 supervisors (study group) were studied in Yazd educational hospitals of Shahid Sadoughi University of Medical Sciences, Shahid Rahnemoun and Afshar. The research data were selected via a researcher-made questionnaire on factors of the marketing mixes that its validity and reliability was confirmed.Results: The results indicated that supervisor’s belief in increasing the market share of a hospital services in public hospitals including: 1-Physical evidence 2- Service or product 3- People or persons 4- Efficiency and quality 5- Process 6- Distribution 7-Promotion or propagation and 8- Price. Therefore, the significance of the personnel role in absorption of a definite patient involves the third element in choosing the hospital by patients.Conclusion: Based on this study, since the third factors in choosing a hospital are the personnel and persons who provide services, it is confirmed that in service-based organizations like hospitals, the most important elements of quality of services are the personnel activities that has been connected with clients of organization. Moreover, it is regarded as a vital factor in developing effective relationships with clients as well as their absorption in the hospital.

Introduction: Exposure to flour dust is an important risk factor in occurrence of allergic airway disorders among mill workers. The purpose of this study was to determine the prevalence of  respiratory symptoms and its relation with exposure to respirable dust.Materials and Methods: In this study, all of 35 workers who worked in the flour producing section of three factories were chosen as case group and 20 unexposed people were selected as the control group. Exposure to total and respirable dust were measured with standard methods. Spirometry was used for determining lung function disorders and the America Lung Society Questionnaire was used for assessment of prevalence of respiratory symptoms. The results were analyzed by t-test, correlation and linear regression.Results: The average total and respireable dust exposure in the exposed group was 8.06 and 5.09 mg/m3 and was higher than the threshold limit value recommended by American Conference of Governmental Industrial Hygienists(ACGIH). 52% of workers had sputum in the morning and during waking up, 44% felt tightness of breath or pressure in the chest, 55% felt short of breath while walking fast and work, and in 52% cough during work was experienced. There was a significant and negative correlation between total and respire able dust with Forced Vital Capacity(FVC), Forced Vital Capacity Percent(%FVC) and Forced Expiratory Volume in one second(FEV1).Conclusion: The results of this study indicate that exposure to respirable dust was more than 10 times higher than the threshold limit and caused a high prevalence of respiratory symptoms and lung function disorders among mills workers.