Iranian Journal of

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Background & Objectives: Iron is a major essential micronutrient during pregnancy and has an important role in intrauterine fetal growth and safe delivery. This survey was designed to study the status of anemia, iron deficiency and iron deficiency anemia in pregnant Iranian women. The results can help health policy-makers with the design and implementation of targeted strategies to overcome these problems.
Methods: This cross-sectional study involved 4368 women at gestational ages ranging from 6 to 9 months. Subjects were drawn through cluster sampling from 11 different regions of the country. Hemoglobin (Hb), hematocrit (Hct), mean corpuscular volume (MCV) and serum ferritin levels were measured and the prevalence of anemia, iron deficiency and iron deficiency anemia (IDA) was determined both nationwide and separately in each region.
Results: Overall, 21.5% of the women suffered from anemia 42.7% were iron deficient and the prevalence of IDA was found to be 10.4%. The prevalence of anemia s was significantly greater in rural areas than in urban settings (22.2- 27.8% compared to 17.1 -21.6%, 95%CI). The highest prevalence of anemia and low Hct was seen in the women of region 5 (including Sistan and Baluchistan, South Kerman and South Khorasan with rates of 44.2% and 40.5% respectively). Region 6 (covering Isfahan, Yazd, Kohkilooyeh-Boyerahmad and North Kerman) had the lowest prevalence of anemia and low Hct (9% and 10.8% respectively). Use of iron supplements (even irregular) had a positive effect in reducing anemia. It affected Hct levels only when taken regularly.
Conclusions: Anemia is still a major health issue for pregnant Iranian women. Although supplementation should be continued, there is a need for more comprehensive interventions addressing all target groups, especially women of child-bearing age.

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Background & Objectives: Men (husbands) play a very important role in family planning programs, especially in developing countries. The objective of this study was to determine the prevalence of different methods of contraception in women of reproductive age in Iranshahr in 2004-2005 and the extent of their husbands' participation in family planning.
Methods: This was a cross-sectional study focused on women who were married but not pregnant at the time of the research. We used multi-stage cluster sampling and a pre-tested questionnaire to record the method of contraception and to see if the husband was actually participating in family planning. We used the SPSS (13th version) software to calculated measures of location and dispersion.
Results: The total sample of 700 married women in the (10-49y) age group included 400 subjects in rural areas and 300 in cities. Of these, 696 agreed to take part in the research. Overall, 65.5% of these women were using at least one form of contraception the remaining 34.5% did not use any contraceptive methods. The percentage of unwanted pregnancies was estimated at 16%. The mean number of pregnancies was 7, with a median of 4.5. Sixty-three percent of the subjects reported good cooperation by their husbands. Logistic regression analysis showed that the probability of using contraception was significantly related to the husband's cooperation.
Conclusions: Our results underline the importance of men's support and cooperation in the success of family planning efforts.

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Background & Objective: Malnutrition is one of the main nutritional problems among children under 5 years especially in developing countries. The effects of malnutrition in this range of age group includes disorder of mental and physical growth and development, increase in the morbidity and mortality, decrease of the learning capacity. A detailed epidemiological picture of the prevalent malnutrition status among children under 5 years in different regions of Iran enables health policy makers to identify priorities, establish political commitment and design appropriate interventional programs to prevent and control malnutrition and improve nutritional status of children. To determine the prevalence rate of malnutrition among children under 5 years.
Methods: Demographic data, weight and height of 34200 Iranian children between 0-72 months old in 28 provinces of the country in 2005 year based on a cluster sampling were gathered. The subjects' weight and height were measured by trained staff. Prevalence of underweight, stunting, and wasting indicators was determined by measuring the weight and height of subjects in urban and rural areas. EPI6 statistical software, version b6/04, was used for all statistical analyses.
Results: 4.7% of the children aged less than five years suffered from stunting (95% CI: 4.5- 4.9%) The prevalence of this type of malnutrition among urban children is significantly less than rural children (95% CI: 3.1- 3.5% and 6.5-7.1% respectively). Meanwhile the prevalence of underweight was 5.2% in the country (95% CI: 5.1-5.4% while the prevalence of this type of malnutrition was significantly less among urban children than those in rural ones. Moreover, the prevalence of wasting was 3.7% (95%CI: 3.5-3.9%) and there was a significant difference in this regard between the urban and rural children. Thus this indicator was significantly higher among urban children than those in rural areas (95%CI: 3.8-4.3% and 3.0-3.5% respectively).
Conclusion: The results of the study show that the prevalence of protein-energy malnutrition was low among Iranian children under five years old. In comparison with previous studies, it is felt that there has been a prudent decrease in all malnutrition in all levels. However, there were significant differences in the prevalence of malnutrition in different provinces, which has resulted in the differences in their developmental stages as well. It appears that subjective strategies are required to improve the nutritional and health status among children under five in all provinces.

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Background & Objectives: Triglyceride/HDL-cholesterol ratio (TG/HDL-C) has been shown as an indicator for metabolic syndrome (MetS). This study aimed to detect the role of this ratio to predict coronary heart disease (CHD) outcome in an Iranian men population with high prevalence of MetS.
Methods: 1824 men ≥ 40 years old, free of clinical cardiovascular disease at baseline, were included in the study from February 1999 to August 2001. Serum level of total cholesterol (TC), HDL-C, TG, and risk factors of CHD including age, systolic blood pressure, diastolic blood pressure, body mass index, diabetes, smoking and family history of cardiovascular diseases were measured at initial phase of study.
Results: During a median follow up of 6.5 years until March 2007, a total of 163 new CHD events occurred. According to a Cox proportional hazard modeling, after adjustment for TC and other risk factors, men in the top quartile of TG/HDL-C relative to first quartile had a significant hazard ratio (HR) of 1.85 (95% CI, 1.07-3.17). Combined HR for TC and TG/HDL-C (men in the top quartiles of both TC and TG/HDL-C relative to first quartiles) after adjustment for other risk factors was 6.13 (95% CI, 2.37-15.86).
Conclusions: The evaluation of both TG/HDL-C ratio and TC should be considered for CHD risk prediction in Iranian male population.

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Background & Objectives: Medical Tourism has been recently paid more attention. Individual practitioners and medical organizations must be able to provide accurate information about this rapidly evolving trend. Since there has been little known about this issue, we decided to assess the knowledge about and attitude towards medical tourism in Rafsanjan, Iran.
Methods: A questionnaire including XXX questions were completed by Rafsanjan Medical University staff. All information was analyzed by SPSS software.
Results: Only 8.3% of individuals sated that they studied some articles about Medical Tourism, and only 14.7% of them had deal with these kinds of patients. The majority of participants (80.7%) hadn’t had any idea about the quality of medical expenses by Medical Tourists. Mainly (68.7%) believed that development of Medical Tourism in Iran would not have any bad social consequences and 62% believed that its development in Iran could improve the knowledge of Iranian doctors. The majority (67.3%) agreed to arrange for inviting tourism to Iran in order to use of Medical Tourists and 54.3 of them believed that development of Medical Tourism could improve treatment of Iranian patients.
Conclusions: The knowledge of participants seems is very low therefore appropriate educational programs should be tailored by responsible organizations in Iran. However medical staff’s attitude towards medical Tourism seems is very positive which indicates having necessary potential for any activity in this regard in future.

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Background & Objectives: Although the population of elderly is increasing in Iran, few studies carried out on this group. The aim of this study was to identify life expectancy and contributory risk factors for the Tehranian elderly of ages above 60 years.
Methods: Individuals above 60 years old whom were recruited in the primary phase of the Tehran Lipid and Glucose Study (TLGS) during 1998-2001 were followed up for 12 years and their vital status were registered (1998-2011). Age and sex mortality rates for age groups (60-69, 70-79, 80+) were calculated and by using Cox proportional hazard model the mean of survival time and hazard rates with respect to risk factors were estimated.
Results: Life expectancy for females and males after crossing 60 years of age reaches to 81 and 80 years, respectively without any statistically significant differences between these two groups. Cox model showed that diabetes, BMI>33Kg/m2 and non ischmecic heart disease reduced survival time in women significantly. While diabetes, smoking, hypertension, ischemic heart disease, history of MI, stroke or sudden death of father, brother or son, lack of physical activity and antihypertensive medications are among the hazardous risk factors for men.
 Conclusion: Among the variables studied, only three (ABC) of them were found as risk factors of women's life, while for men seven risk factors were identified. It seems that more studies are needed to determine the risk factors for women.

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Background and Objectives: One of the decentralized models that has been formed based on universal health coverage is the model of health complexes in Tabriz. This study was conducted to evaluate the model.
 
Methods: This case study was conducted in 2017. Beside observation, 28 individuals, including informed experts in the field of establishment of health complexes in Tabriz University of Medical Sciences, were purposefully selected and semi-structured interviews were also conducted. To analyze the interviews and the results of observations, the framework analysis was used based on the components of the Primary Care Evaluation Tool (PCET) model.
 
Results: The strengths of the health complex model are decentralized planning, strengthening the private sector participation, have more appropriate methods for assessing the performance of the health team, creating a sense of delivering effective services in providers, using electronic information registration system, using the prospective payment method, strengthening the referral system, enhancing service continuity, and facilitating financial and geographical access, especially in marginalized areas. However, there are some problems such as lack of some facilities and equipment, lack of some workforces and high workload, financial instability, and lack of insurance organizations cooperation with the plan.
 
Conclusion: The health complex model has improved organizational, financial, and geographic access to health services. It seems that if the resources are more stable and by cooperation of basic insurances, the results of this project will be better.
 

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Background and Objectives: Universal health coverage will have a problem in achieving it’s goals if it doesn’t consider the quality. This study aimed to Background and Objectives: Universal health coverage cannot achieve it’s goals if it doesn’t consider the quality. This study wants to assess the quality of health services in Iran, identify existing challenges and provide solutions.
 
Methods: This study was a mixed qualitative and review study. In the first stage, the national main indicators of the quality of services were reviewed. Then, the orientation of the available upstream documents on the quality of services was explained. The most important challenges, trends, and recommendations of health quality improvement were extracted via interviews.
 
Results: Proper observation of the Iran health care quality requires appropriate framework and indicators. Upstream documents strongly emphasized on the government's responsibility to play a key role as stewardship and that the health system should provide the necessary structural, procedural, and consequential requirements besides determining appropriate model. Quality management programs had obstacles in some aspects like the performance of managers and human resources, structural/communicational requirements, education, payment system, culture, use of quality management indicators and models, financial, information, and equipment resources, laws and regulations, and supervision.
 
Conclusion: Improving the quality of health services in Iran requires strategies in organizing, resource generation, payment, laws and regulations, and behavior of policy makers and planners. Quality tools should be used without haste and should pay attention changes in the nature of diseases, expectations of stakeholders, and increased global attention to this issue in designing related plans.

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Background and Objectives: Before any development in scientific health activities, we have to observe its scope and compare it with health sector. Accordingly, the aim of this study was to determine the quality and quantity of the health-prioritized disciplines mentioned in the comprehensive health plan of Iran.
Methods: This scientometric cross-sectional study was done during 2010-2017. The study population was 26 prioritized areas in three categories of survival, excellence, and infrastructure according to comprehensive health plan of Iran in 2010. The data collection tool was the SCImago database. The number of documents, citation indicators, and h-index were analyzed by Excel.
Results: The findings of the research showed that the highest h-index of Iran in the excellence, survival, and infrastructure category was in Nano (90), infectious diseases (67), and systematic ecology (56), respectively. Moreover, the highest ranked citations in three categories of survival, infrastructure, and excellence were related to traditional medicine, family medicine, and dentistry with a global rank of 8, 9 and 15, respectively. In categories of excellence, survival and infrastructure; public health, bioinformatics, and infectious diseases had the highest number of products with 7045, 5371 and 5135 articles.
Conclusion: There has been a marked improvement in the quality and quantity of all the subject categories over time. The general domains of excellence, survival, and infrastructure categories had the highest mean H-index, and the highest average growth rate of scientific productions was related to excellence, infrastructure and survival categories, respectively.

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Background and Objectives: Plagiarism is the most prevalent type of scientific misconduct, and various rules and strategies have been proposed to combat it in different countries. A review of other countries' experiences in this area contributes to good policymaking. The present study was conducted to introduce preventive interventions of plagiarism in the leading countries.
Methods: The present study was a qualitative review study of applied practices. In this study, preventive interventions of scientific plagiarism in the 27 European ::::::::union:::::::: countries were studied due to the appropriate coherence and structural similarity at national, organizational, and individual levels. The national-level interventions were analyzed using the content analysis method in mentioned countries.
Results: The results of analyzing the national-level interventions were categorized into eight main themes, including reaching a national agreement on examples of scientific plagiarism and misconduct; policy development; monitoring and supervision; financial support development; development of databanks and software; compiling educational programs for faculty members and students; dissemination and use of successful experiences; and eventually establishment of laws related to scientific misconduct, plagiarism, and punishments activities.
Conclusion: Using preventive interventions at a national level proves the commitment and determination of policymakers to control and prevent plagiarism. Proper use of preventive interventions at a national level strengthens the controlling and preventive infrastructures of this issue at the organizational level, and enhances moral commitment and professional skills among the country's researchers.