JOURNAL OF SCHOOL OF PUBLIC HEALTH AND INSTITUTE OF PUBLIC HEALTH RESEARCH
Year:2016 | Volume:14 | Issue:2 |Papers Count:10

Background and Aim: The main purpose of this study was to investigate the interrelationships between health capital and education in Iran during the period 1980-2013.Materials and Methods: The econometric vector error correction model was used to obtain patterns, using the Eviews 9 software for data analysis.Results: The data showed that the coefficient related to the effect of education index on the health index and that related to the effect of health index on the education index were both negative. In other words, improvements in education had led to improvements in health capital and vice-versa.Conclusion: It can be concluded that improvements in education can reduce child mortality and, consequently, improve health capital. Also, improvements in health capital can lead to improvements in education index. Therefore, it is empirically proven that these two indices are interrelated in Iran. This means that investment in both sectors can accelerate simultaneously improvements in both health capital and education indices. In Article 24 in chapter three of the Fifth National Economic, Social and Cultural Development Plan achieving a human development index (HDI) close to that in countries with high HDIs and coordination with regard to growth of education, occupation and health indices have received particular emphasis. So, considering the emphasis put on the health system in the Fifth Plan, the policy recommendation is that economic policy-makers should pay special attention to allocating financial resources to the health and education sectors in Iran.

Background and Aim: The most important healthcare reform in Iran during the last decade has been implementation of the family physician and referral system in rural areas and small towns with a population of less than 20000. The program was expanded (as a pilot project), with small modifications, to rural areas of 2 provinces, namely, Fars and Mazandaran. This study was initiated to assess the achievements, challenges and weak points of the pilot project before deciding to expand it to other provinces.Materials and Methods: This qualitative study was conducted in winter 2013. Data were collected using document desk reviews, semi-structured interviews with key informants, and focus-group discussions. Relevant family health policy makers, managers and service providers in the two provinces were invited to the meetings. The data were analyzed and categorized based on the content analysis method.Results: The data showed that the family physician program is faced with several challenges regarding objectives; stewardship; service providing; and human, financial and information resources. It is to be noted, however, that the program has had achievements such as increased access to services, increased coordination among insurance organizations and medical universities, and organizing and managing health files.Conclusion: The program should not be expanded to other provinces before redesigning in order to assure that it is more complete and comprehensive and create commitment and adequate guarantee among stakeholders. It is essential that all the stakeholders agree on general and specific objectives of a 5-year program and prepare an operational plan for each specific objective.

Background and Aim: Thalassemia major (ThM) is one of the most common autosomal recessive genetic disorders in the world. Its prevention and control is a priority in the disease prevention programs in the Iranian health system. The ThM screening program (screening at the time of marriage) has been an important step in its prevention in Iran. This study aimed to evaluate this program.Materials and Methods: This was a descriptive-analytical study in Babosar District consisting of two phases. The first phase was a retrospective descriptive study aiming at finding the background causes of the diseases in subjects under 18 years old (born after March 1997). In phase 2, then, in an interventional analytical study, screening was repeated along with laboratory tests before, or at the beginning of, pregnancy (n=5500).Results: Phase 1 (cross-sectional descriptive): There were 25 cases of ThM under 18 years old, parents of 15 of whom (60%) had married before 1997 and 4 (16%) had children suffering from ThM (S2). The parents of the remaining 10 (40%) had married after 1997 (S1).Phase 2: Considering the findings of Phase1, an interventional program called thalassemia screening was started in September 2006 including 9750 pregnant or prepregnanct mothers. The program led to identifying 20 new beta-thalassemia-carrier couples, including 10 couples married before 1997 and 10 married after 1997 (without official marriage registration, laboratory errors and hemoglobinopathies). All the 20 couples were quickly referred to the Genetic Center, which resulted in prevention of the birth of 4 ThM neonates.Conclusion: The 9-year intervention (2006-2015) resulted in timely action, preventing birth of 4 thalassemia major babies. Considering incidence of the disease during the previous 9 years (1997-2006), it can be concluded that the before-after randomized clinical trial is an effective way to reduce thalassemia major incidence.

Background and Aim: A New Health Reform Plan consisting of seven programs was initiated in Iran in mid-May 2015 aiming to reduce the out-of-pocket payments, improve the public’s health, and promote the public health indicators. This study was conducted to determine the effect of the Plan on the performance indicators of Hamedan university hospitals.Materials and Methods: In this longitudinal descriptive-analytical study, based on the interrupted time series design, data related to hospital performance indicators were collected from all (15) Hamedan University hospitals for a period of 15 months (7 months before, and 7 months after, the implementation of the Plan, with a one-month interval in between). The SPSS software was used for data analysis.Results: The data indicated changes in all the performance indicators after the implementation of the Plan. The largest changes were in the number of emergency and selective surgeries and the smallest in the ratio of active to total beds. Further analysis of the data showed that, as compared to the same months in the previous year, only a small number of these changes (number of emergency surgical operations and the ratio of active to total beds) were statistically significant.Conclusion: Based on the findings it can be concluded that changes have occurred in all the selected indicators as a result of implementation of the New Reform Plan, indicating that the Plan has affected favorably performance of the hospitals. However, the effects observed should be judged cautiously, considering the possible negative consequences such as induced demand and hospital workload increase in the long run.

Background and Aim: Nowadays selecting an appropriate technology for storing and disposal of health care wastes is a difficult task. For example, selecting an optimum technology for storing and disposal of hospital wastes is a complex multi-criteria decision-making process, which requires consideration of qualitative and quantitative factors and criteria. This paper presents a new decision-making model for selecting a better method in the management of health care wastes in the City of Tehran.Materials and Methods: So far selection of technologies for health care wastes storing has been based on inaccurate information or uncertain data, and linguistic variables have been used by decision-makers (experts) to assess the ranks, criteria and options described. In this study a combinational multi-criteria decision-making model has been used which includes the fuzzy analytic network process technique and the fuzzy MULTIMOORA method. This model uses the fuzzy analytic network process to get the related with criteria and sub-criteria of better health care wastes storage technology and uses MULTI MOORA method for evaluation of five available technologies based on the above-mentioned criteria.Results: Analysis of the data showed that the "environmental" and "technical" criteria were the most important criteria for selection of the best technology, while for storing health care wastes "hydroclave" is the most appropriate technology in the City of Tehran.Conclusion: The proposed framework for assessing health care wastes technologies for storing hospital wastes is effective, and the hydroclave technology is to be considered as the best solution and the most suitable option from the environmental, public health and technical perspectives in the City of Tehran.

Background and Aim: Over 200 million pregnancies occur worldwide annually; one third are unwanted and half end up in abortion. This study aimed to determine the prevalence of unwanted pregnancies and induced abortions during women’s childbearing age over a period of 30 years (divided into 5-year intervals) in Tehran, Iran.Materials and Methods: This cross-sectional study was conducted in 2014 on 518 married women 15 to 55 years old living in Tehran with a history of at least one pregnancy. A questionnaire containing two sets of questions on individual and demographic characteristics and women’s abortion history was used to collect the data for a period of 30 years (divided into 5-year intervals). The data collected were analyzed using SPSS 16 (the significance level was a p-value of<0.05).Results: Of the 966 pregnancies among the 518 women studied, 665 (68.4%) were planned and 307 (31.6%) unwanted. There were 249 abortions, 108 (43.4%) of which were miscarriages, 41 cases (16.5%) for medical reasons, and 100 cases (40.2%) induced (deliberate). The proportion of induced abortions in unwanted pregnancies increased from 0.0% in 1981-1986 to 41.7% in 2011-2014.Conclusion: Based on the findings it can be concluded that due to changes in family planning program effectiveness and accessibility of contraception methods in Iran unwanted pregnancies and the subsequent abortions have become more common.

Background and Aim: Much emphasis is being put on participation of the community and parents in early child development (ECD). This article discusses the lessons learnt from the MAZDAK project, which attempts to involve the community in the Monitoring and Promoting Children’s Development Program.Materials and Methods This was a 9-month community-based participatory research (CBPR) project of the Health System Research (HSR) type. The target population were the families residing in western Eivanak, including 300 children. All the phases of the project were conducted with participation of groups of 10 local volunteer women (in Persian singular Rezakar, plural Rezakaran), each group covering 30 children. At the end of the period challenges and limitations of the community participation were discussed in 2 focus-group discussions (FGDs) and a telephone survey with the participation of 50 of the parents.Results: Community participation could be seen at three levels: 1. Integrating and linking the existing services and programs in community organizations; 2. Creating an interface organization of people in order to facilitate involvement of community members (Rezakaran); 3. Involving the parents themselves in the process of monitoring and promoting child development. Barriers to more active participation of parents were as follows: mothers’ occupation; number of children; father’s or other family members’ disagreement of the; holidays and bad weather; large numbers of individuals under coverage of each Rezakar which made her deeper understanding and communication with the mothers difficult; irregular follow-ups; age and educational differences between the Rezakaran and those under their coverage; frequent changing of Rezakaran.Conclusion: Building trust, engaging and empowering people and governmental and nongovernmental organizations is the greatest challenge in such a program. Experience shows that it is possible to increase the chance of success by selecting people’s favorite programs and priorities, using simple and friendly tools (ASQ Album), use of technologies to facilitate communication, selection of volunteers with due consideration of social conditions and, finally, increasing the motivation of volunteers for sustainability of activities.

Background and Aim: Physical activity is a low-cost and uncomplicated way for the prevention of osteoporosis. The aim of the present study was to determine the interactive effects of constructs of perceived benefit, barriers, susceptibility and severity on perceived exercise behavior self-efficacy for prevention of osteoporosis based on the Health Belief Model in female-employees of Kermanshah City.Materials and Methods: This analytic-descriptive study was conducted on 595 female-employees in the governmental and private organizations in 2014. Inclusion criteria included women between the age of 30 years and start of menopause and having no history of osteoporosis. Data were collected using a two-part questionnaire including questions on demographic variables and questions related to the Health Belief Model and analyzed using the SPSS and Lisrel software.Results: Analysis of the data showed that perceived severity and perceived barriers had direct and indirect effects on self-efficacy for exercise behavior. Self-efficacy had the highest correlation with perceived benefits (r=0.319). Further analysis of the data revealed a significant inverse correlation between perceived barriers and perceived severity and a significant positive correlation between perceived benefits and perceived severity.Conclusion: The results of this study show female-employees do not have a high perceived susceptibility or severity to osteoporosis. A high perception of barriers and a low self-efficacy perception indicate the need for implementing appropriate intervention programs and increasing preventive behaviors.