JOURNAL OF SCHOOL OF PUBLIC HEALTH AND INSTITUTE OF PUBLIC HEALTH RESEARCH
Year:2010 | Volume:8 | Issue:3|Papers Count:8

Background and Aim: Inequality in the distribution of hospital recourses is a great obstacle in planning and provision of health care. This inequality in mainly observed in the government hospitals in a country. The objective of the present study was to determine the distribution of specialized physicians and active beds in the Iranian government hospitals between 2001 and 2006Materials and Methods: The method used in the study was retrospective, descriptive- analytical. The data were analyzed (Lorenz Curve and Gini index estimation), using the Excel Software.Results: Based on the Gini coefficient, the distribution of specialized physicians during the 5-year period (2001-2006) was 0.0876, 0.0874, 0.0909, 0.0329, 0.0951, and 0.0520, respectively. The corresponding figures for active beds were 0.024, 0.0171, 0.0208, 0.0251, 0.0212, and 0.084.Conclusion: The findings of the study indicate that, in spite of differences in the proportions of specialized physicians and active beds among the provinces with regard to their populations, the distributions in the government hospitals have been equitable. The results of this study can provide useful insights for the country's Health Ministry policy-makers.

Background and Aim: Today cardiovascular diseases are the main cause of disability and mortality in many countries. This study was performed to determine the effect of health education based on the Health Belief Model on the knowledge, attitude and practice of housewives in Isfahan, Iran regarding improving their nutritional behavior for preventing heart disease.Materials and Methods: This was a quasi-experimental intervention, including 68 Isfahani housewives randomly divided into an experimental (n=34) and a control (n=34) group. Data were collected using a standard health belief model (HBM) and a food-frequency (FFQ) questionnaire. The experimental group attended, after a pre-test, 6 weekly education sessions. The HBM questionnaire was completed 3 times (before and immediately, and 2 months, after education), while the FFQ questionnaire was completed twice (before and 2 months after education) by the housewives. The data were analyzed using SPSS16 software, the statistical tests being t-test, and repeated measure ANOVA.Results: The two groups were not significantly different with regard to demographic variables. Similarly, before the intervention they were statistically similar with respect to the scores of the HBM components (P>0.05). After the intervention, significant differences appeared between the experimental and the control groups with regard to all the components (knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived efficacy, and performance; in all cases, P<0.001)Conclusion: Based on the findings, it can be concluded that the intervention had a positive impact on the feeding pattern of the women and was effective in increasing or improving their knowledge, attitude and practice.

Background and Aim: Length of stay (LOS) in a hospital is one of the best hospital indicators that can be used for various purposes. In this survey, we studied the hospital LOS and its associated factors in Tehran University of Medical Sciences Women's Hospital (a teaching hospital) in Tehran using the Cox proportional hazards semi parametric model and compared the results with the results obtained using the multiple linear regression.Materials and Methods: This was a descriptive-analytical study in which we reviewed 3421 files of inpatients hospitalized in, and those discharged from, the oncology, surgery and obstetrics units in 2008. The required data were collected using a data collection sheet and inpatient interviews. A P<0.05 was considered statistically significant.Results: The median of patients' LOS in the hospital was 50.8 hours, that in the obstetrics, surgical and oncology units being 48.5, 54.4 and 94.2 hours, respectively. Of all the patients, 2632 (76.9%) had been discharged with a recovery status and the rest (23.1%) with a no-recovery status. Results of the Cox proportional hazards model showed that the following variables had increased LOS: a distance longer than 200 km between a patent's residence and the hospital, hospitalization in the surgery and oncology units, admission on a Thursday, admission by an internist, hospitalization for neoplastic, endocrine, nutritional, or genitourinary system diseases (P<0.005), as well as a high number of diagnostic laboratory tests, radiographies or sonographies (P<0.001). Patients admitted and hospitalized as an emergency case had a shorter LOS (P<0.001) than others. On the other hand, based on the multiple linear regression model results, some occupations (being a worker, a farmer, a stockbreeder, or a retired spouse) admission on a Thursday, (The first day of the weekend in Iran), suffering from a neoplastic disease, and a high number of diagnostic tests or radiographies or sonographies increased, and admission by a resident decreased, patients' LOS (P<0.05).Conclusion: Considering having censored data, the Cox proportional hazards model is a more suitable model than the multiple linear regression models for identifying factors influencing patients' LOS in a hospital. From among the LOS Cox model's associated factors as identified in this study, policy-makers and managers can only change admission days and the number of diagnostic tests. That is to say, they should try to prevent admission on a Thursday (unless emergency cases) and also perform the required primary diagnostic tests before admitting a patient into the hospital, which would lead to a more effective utilization of hospital beds and other resources.

Background and Aim: Rabies, a viral and zoonotic disease, causes acute and fetal encephalitis in humans and other mammals and is a cause of death in developing countries. It is usually transmitted by animal bite, but other routes of transmission are mucus membranes, breathing, placenta, contaminated instruments, and organ implanting. This study shows the mapping of geographical distribution of animal bite cases, rabies, and death due rabies in 3 Caspian Sea littoral provinces, namely, Golestan, Mazandaran, and Gilan.Materials and Methods: Data on human and animal rabies cases and animal bites were collected from the Reference Rabies Center of the Pasteur Institute in Tehran and the Rabies Diagnosis Section of the Amol Research Center during 2002-2007.The data was analyzed by the SPSS (11.5) software and mapping was done by Arc GIS 9.2.Results: During the 6-year period, of the 670,743 animal bite cases reported in Iran 63890 (9.5%) had occurred in Golestan, 25,767 (3.8%) in Mazandaran, and 22,874 (3.4%) in Gilan. The distribution of animal bite cases in the 3 provinces was as follows: Agh ghala, Bandar Torkaman, Azad shahr and Kolaleh in Golestan; Galugah, Behshahr, Ramsar and Neka in Mazandaran; and Shaft, Masal, Siahkal and Fuman in Gilan. The data also showed that of the total 2,312 animal rabies cases, in Iran, 9.22% had been reported from Golestan, 4% from Mazandaran, and 2.6% from Gilan. Furthermore, animal rabies cases had occurred mostly in Gonbadekavoos, Bandar Torkaman, Gorgan and Kolaleh in the Golestan Province; Behshahr, Neka and Chalus in the Mazandaran Province; and Masal, Fuman and Rezvanshahr in the Gilan Province. The most important disease vector (91.3%) for both human and animal rabies was the dog. A total of 41 human deaths due to rabies had been reported during the period, 2 being from Mazandaran.Conclusion: The results show that a more effective disease control and surveillance system is essential and can help improve planning for service provision in the health care centers.

Background and Aim: Non-communicable diseases (NCD), also referred to as chronic or lifestyle-related diseases, are a serious health problem in most countries today. The World Health Organization (WHO) has discussed this issue and presented solutions for it in its annual meetings. This paper reviews and reports on the action taken by the Medical University of Isfahan (MUI) through its Non-communicable Disease Control Program based on the WHO "Prevention and control of non-communicable diseases: implementation of the global strategy", which is a comprehensive program for controlling non-communicable diseases.Materials and Methods: In this descriptive-analytical study, the activities of 21 Non-communicable Disease Units in Isfahan Province affiliated to MUI in its Non-communicable Disease Surveillance System aiming at combating non-communicable diseases were assessed using a self-assessment technique and the relevant documents reviewed. All the NCD officers (n=30) were enrolled in the study. A validated researcher-designed questionnaire containing items related to six areas based on the WHO "Prevention and control of non communicable diseases: implementation of the global strategy", the reliability of which had been confirmed, was used. The data were analyzed using the SPSS software, the statistical tests being the t-test.Results: The general self-assessment score of MUI in the activities related to non-communicable disease surveillance and control program was 1.44 0.59 (out of 4). From among the six strategies studied, the "increasing public awareness about non-communicable diseases" strategy and the "improving collaboration and participation in prevention and control of non-communicable diseases" strategy achieved the highest and the lowest score, respectively. Documentation was weak (less than 50%), and there was no significant difference between the scores of actions documented and those not documented (P=0.1).Conclusion: Isfahan Medical University is one of the leading universities in Iran. It has taken important valuable measures in the area of non-communicable disease control and surveillance programs. However, our findings show that there are several weaknesses in these programs. Not paying sufficient attention to documentation, for example, is a serious weakness, since documentation plays an important role in the performance and excellence of an organization, guaranteeing its success.

Background and Aim: Pressure ulcer is a common problem and a large drain on hospital resources, especially in wards such as ICU where patients stay for a long time. The aim of this study was to explore the likely factors contributing to pressure ulcers in the ICU units of Tehran University of Medical Sciences teaching hospitals, Tehran, Iran.Materials and Methods: This project was conducted in all the seven ICUs of four teaching hospitals affiliated to Tehran University of Medical Sciences. In the first phase the researcher performed a direct observation of all the 90 patients who were admitted to the ICU units to check the presence of any pressure ulcer. In the second phase, 310 patients discharged from the same ICU units between March 2007 and February 2008 was randomly selected and their medical records reviewed. A structured questionnaire was used to collect the data.Results: Pressure ulcer occurred more frequently in the elderly; women; patients who were less active and had less mobility, hospitalized for a long time, or those with fever, diabetes, high blood pressure, paralysis, or respiratory diseases. In addition, pressure ulcer was seen more frequently in the patients hospitalized in the general ICUs, as well as in those with infections and different types of tumors.Conclusion: Using a standard risk assessment tool and paying attention to the main risk factors of pressure ulcer can be a useful method for identifying the high-risk patients before admission in order to prevent them from developing such ulcers.

Background and Aim: Lead is a toxic metal used in different industries and occupational and environmental exposure to it is quite likely to occur. Because of its high potential toxicity, serious damages to those exposed to it are common. Since the ceramic industry, in which lead is used, is considered a domestic industry in Iran, in this study occupational exposure of glaze workers to lead was assessed in a ceramic industry.Materials and Methods: A total of 55 glaze workers (39 tillers and 16 potters) were selected as the case group. Association of lead concentration with several variables, including work shift, work type, ventilation system, and the number of extra work hours during the previous month, was determined. A sampling pump (SKC Co.) and ester cellulose filters with a pore size of 0.8 mm, 37 mm in diameter, were used for sampling. The flow-rate was adjusted at 2 l/min based on the NIOSH 7300 method. After sampling, filters were transferred to the laboratory and digested in a mixture of nitric acid and per chlorate solution (4:1) and analyzed by ICP-AES. To minimize probable errors and pollution during sampling and sample handling, samples were also taken from employees in the administration department to serve as control. Spiro metric tests were performed on both the case and the control groups.Results: The lead concentrations were higher than the threshold limit value (TLV) (0.17 mg/m). Independent t-test showed that there was a significant relation between concentration of the lead present in the breathing zone air and 2 independent variables, including shifts work (morning and afternoon) and the ventilation system among tillers. Also, based on the one-way ANOVA, there was a significant relation between concentration of the lead present in the breathing zone and the number of extra working hours over the shift.Conclusion: The mean lead concentration in the breathing zone was higher than the respective TLV. Considering the hazardous nature of lead, protective measures- personal, occupational and environmental- should be taken. Moreover, clinical examination of job applicants at the time of employment, as well as periodic examinations and Spiro metric tests on the workers, are also strongly recommended.

Background and Aim: Pressure ulcer is a common problem and a large drain on hospital resources, especially in wards such as ICU where patients stay for a long time. The aim of this study was to explore the likely factors contributing to pressure ulcers in the ICU units of Tehran University of Medical Sciences teaching hospitals, Tehran, Iran.Materials and Methods: This project was conducted in all the seven ICUs of four teaching hospitals affiliated to Tehran University of Medical Sciences. In the first phase the researcher performed a direct observation of all the 90 patients who were admitted to the ICU units to check the presence of any pressure ulcer. In the second phase, 310 patients discharged from the same ICU units between March 2007 and February 2008 was randomly selected and their medical records reviewed. A structured questionnaire was used to collect the data.Results: Pressure ulcer occurred more frequently in the elderly; women; patients who were less active and had less mobility, hospitalized for a long time, or those with fever, diabetes, high blood pressure, paralysis, or respiratory diseases. In addition, pressure ulcer was seen more frequently in the patients hospitalized in the general ICUs, as well as in those with infections and different types of tumors.Conclusion: Using a standard risk assessment tool and paying attention to the main risk factors of pressure ulcer can be a useful method for identifying the high-risk patients before admission in order to prevent them from developing such ulcers.