Journal of School of Public Health and Institute of Public Health Research

Educational needs for mental health promotion in engaged youth

Shahnaz Rimaz

Background and Aim: Educational programs for couples' mental health promotion in marital life are a necessity. The first step in planning an educational program understands the needs of the target group. This paper reports the mental health educational needs in youth planning to marry.

Materials and Methods: In a descriptive-analytical cross sectional study, 450 individuals taking part in pre-marriage education courses in Tehran were selected by randomized stratified sampling. The data was collected using a questionnaire that measured the educational needs in the area of mental health by the 5-point Likert-type scale. Data analysis was done using the SPSS-15 software, the statistical tests being the independent T-test, one-way analysis of variance (ANOVA), and the chi-square test.

Results: On the whole, the subjects' felt need for mental health education was more than moderate (3 on the Likert scale) women expressed a higher need than men (p=0.001). The main concern of the participants - both men and women - was How to keep romance alive in married life. The extent of need expressed for mental education was not statistically different in different socio-demographic groups of women, while worker men expressed a higher need than self-employed men (P=0.018).

Conclusion: Based on the findings of this study, young people planning to marry have a felt need for education in the area of mental health. It is recommended to design and implement educational programs to promote their knowledge in this area with due consideration of priorities stated by them.

Musculoskeletal Disorders Risk Assessment in Patient Transfers among Hospital Nurses Using MAPO Technique

Alireza Choobineh

Background and aims: Work-related musculoskeletal disorders (WMSDs) are a serious problem among the nursing staff. Manual patient-handling tasks, such as lifting, transferring, and repositioning patients, are the major causes of WMSDs among nursing staff. The objective of the present study was risk assessment of musculoskeletal disorders during patient transfers by the movement-and-assistance-of-hospital patient (MAPO) technique among hospital nursing staff of Shiraz University of Medical Sciences (SUMS), Shiraz, Iran.

Materials and Methods: This cross-sectional study included 400 randomly selected nurses from 75 wards in 11 hospitals in Shiraz. Data were collected using demographic and Nordic Musculoskeletal Disorders Questionnaires and the MAPO index checklist. Statistical analysis was performed using SPSS version 16.

Results: The means of age and job tenure of the subjects were 30.76±6.44 and 6.92±5.75 years, respectively. The 12-month prevalence of musculoskeletal disorders was 88.2%. The results of assessment by the MAPO index revealed that more than 83% of the subjects were at risk, 20.5% of them exposed to high risk. Further analysis of the data indicated that the musculoskeletal disorders occurrence was significantly associated with the MAPO index score (p<0.05).

Conclusion: Work-related musculoskeletal disorders were found to be associated with the MAPO index. Therefore, MAPO is an appropriate tool for musculoskeletal disorders risk identification and assessment due to patient handling in the nursing personnel. In any attempt to improve the working conditions, patient transfer aids, environmental factors, and proper training should be taken into consideration.

The effect of education by community health volunteers on choice of delivery kind in pregnant women based on the Behavioral Intention Model (BIM

Hamed Rezakhani Moghaddam

Background and aim: Delivery or parturition is the peak of a woman’s pregnancy period, accompanied with birth of one or more babies. Unfortunately, Cesarean section, despite its probable undesirable health and economic consequences, has become more and more common. Considering that the goal of health education is behavior change in people, the objective of this study was to investigate the role of health volunteers in educating mothers consulting the health care centers in Ardabil in the area of choice of delivery method based on the Behavioral Intention Model (BIM).
Materials and Methods: In this experimental study, 140 primaparous mothers in Ardabil city in the seventh month of pregnancy were selected by systematic random sampling and divided into a case and a control group, and a written pretest was given to both groups. Education based on the BIM was imparted to the case group. One month after delivery, both groups were post-tested. The data on awareness, attitude, results evaluation and practice were analyzed using the Wilcoxon, Mann Whitney-U and Chi-square tests.
Results: The findings revealed statistical differences between the case and control groups after intervention with regard to awareness, evaluation of results and attitude (p<0.001). However, behavioral intention did not change (p=0.106).
Conclusion: Although health volunteers' participation results in an increase in knowledge and promotes attitude and evaluation of behavioral results in pregnant women, it does not change their behavioral intention. It is suggested to conduct similar studies for comparative purposes involving other trainers, such as physicians and nurses in other cities, using other educational models and methods.

Survey of climatic condition of Malaria disease outbreak in Iran using GIS

Mansour Halimi

Background and aim: Malaria as a mosquito-borne disease is largely dependent on climatic conditions. Temperature, rainfall and relative humidity are considered as climatic factors affecting the geographical distribution of this disease. These climatic factors have definite roles not only in the growth and proliferation of the mosquito Anopheles but also in the parasite Plasmodium activity. The purpose of this study was to find in which regions of Iran climatic conditions favour spread of malaria.

Material and Methods: Data on 3 climatic factors, including the mean monthly temperature, rainfall and mixed ratio of humidity, obtained from 31 synoptic meteorological stations during the 30-year period 1975-2005 were used. By running the informative filters through map algebra tools in the Geographical Information System (GIS), the synoptic meteorological stations were classified into 4 groups in terms of climatic conditions favouring activity and proliferation of the mosquito Anopheles and the parasite Plasmodium. Then the regions were interpolated in terms of climate risk of malaria incidence using the tension Spiline interpolation method.

Results: The maps of climatic potential malaria risk indicated that the southern provinces including Hormozgan, Bushehr and Khuzestan, southern parts of Sistan-Balouchistan province, such as Chabahar and Nikshahr, as well as Northern provinces of the country, including Mazandaran and Gilan, have the highest climatic potential for risk of malaria spread. On the other hand, provinces in the North Western region, including West and East Azarbaijan, Ardebil, Kurdistan and Zanjan, have the lowest climatic potential risk of malaria spread. Further analysis of the data showed that a large segment of the population is living in regions with medium- to high-risk zones.

Conclusion: The findings of this study can be used when designing malaria control programs to identify different regions in terms of climate-based malaria risk. The presented risk map of malaria in this study is completely based on climatic factors. The disconformity between these presented climate-based maps and the observed high-risk map is due to such factors as socioeconomic and lifestyle changes, as well as border problems (foreign subjects entering the country).

Case - control study of factors influencing on drug abuse relapse in addicts referred to two recovery centers in Tehran

Maryam Dastoorpour

Background and objectives: Relapse after treatment is a common problem among drug addicts in addiction control and prevention programs. About 80% of the addicts relapse into drug abuse within 6 months after treatment. The purpose of this study was to determine factors associated with drug abuse relapse in patients consulting two selected addiction treatment centers in Tehran.

Material and Methods: In this case-control study, 160 relapsed patients were compared with 160 abstentious patients. A researcher-developed questionnaire was used to collect data. Chi-square test, odds ratio (OR) and logistic regression were performed for data analysis.

Results: The findings showed that factors increasing rate of relapse were smoking after relapse (OR=7.14, CI=3.855-13.244), substance-related cues (OR=6.76, CI= 3.915-11.678), interaction with addict peers (OR=6.38, CI=3.921-10398), malaise (OR=3.93, CI=2.446-6.305), and family conflict (OR=2.04, CI=1.227-3.385). Opium- and dross-addicts were found to be less likely to have a relapse than crack- or pot- users (OR= 0.208, CI-0.128- 0.336).

Conclusion: The findings of this study reveal that relapse into drug abuse is significantly associated with personal, social, psychological and medical variables. It is recommended to

integrate family counseling and therapeutic approaches, constant monitoring, and health care in treatment plans in order to reduce the adverse effects of factors such as family conflicts, peer pressure and drug-related cues in patients' likelihood of relapse.

high-risk behaviors of HIV positive individuals referred to Behavioral Counselling Centers of Universities of Medical Sciences in Tehran

Saharnaz Nedjat

Introduction: Development of effective antiretroviral therapies (ART) has reduced mortality and increased life expectancy among individuals with HIV infection. Antiretroviral therapy regiments have improved symptoms and quality of life among these patients, whose sexual and reproductive needs, have, therefore, increased as well. In 2010, 20.8% of HIV-infected Iranians acquired the disease through sexual relations. The objective of this study was to define high-risk sexual behaviors among individuals infected with HIV referred to the Triangular Clinics of Universities of Medical Sciences in Tehran.

Materials and Methods: This cross-sectional interview-based survey included 400 HIV-positive individuals selected by consequential sampling.

Results: The majority (60%) of the subjects was males, and 44.2% of men and 51.3% of women with HIV were in the age group 34-25 years. On the whole, 15.6% of the women and 49.6% of the men had high-risk sexual behaviors after diagnosis of HIV infection. Further analysis of the data showed that 62.5% of HIV-positive individuals were not aware of the risks of unsafe sexual relationship (using no condom) for HIV-positive transmission.. Based on the logistic regression module, it was found that factors strongly associated with high-risk sexual behavior were being male, being single, under high school diploma/graduate degree, alcohol intake and use of hormonal and permanent methods of family planning (p<0.05).

Conclusion: The findings of this study confirm previous reports showing common high-risk sexual behaviour after diagnosis in HIV-positive populations. Providing suitable health services and advice on fertility and sexual health will result in no- or low-risk sexual life for couples.

Factors affecting time to pregnancy, Kermanshah, Iran, 2011

Kourosh Holakouie Naieni

Background and Aim: The time needed to achieve a wanted pregnancy is referred to as time to pregnancy (TTP). Due to differences in lifestyles and geographical locations in different countries, factors affecting TTP may be different in various countries. This study was conducted in 2011 to determine factors affecting time to TTP in Kermanshah, Iran.
Materials and methods: In this case-control study 174 women with TTP>12 months (cases) and 587 women with TTP<=12 months (controls) were selected. The tool for collecting data was a questionnaire. The SPSS-16 software was used for data analysis, a p-value <0.05 being considered as statistically significant.
]Results: Multivariate analysis showed that factors decreasing TPP statistically significantly were women's education level (≥high school diploma OR=0.854, CI 95%=0.741-0.984), frequency of intercourse in a week (OR=0.728, CI95%=0.631-0.839), blood group A compared to O (OR=0.639, CI95%=0.405-1.01), and non-exposure to smoking (OR=0.606, CI95%=0.380-0.965). On the other hand, factors increasing TPP were a woman's irregular menstrual cycle (OR=3.701, CI95%=2.127-6.441), lack of physical activity (OR=1.920, CI95%=1.263-2.918) and a body mass index (BMI) higher than 25 (OR=2.221, CI 95%=1.489-3.312).
Conclusion: According to the results of this study, a high BMI and lack of exercise increase, while factors such as frequency of intercourse decrease the length of TTP. Couples seeking medical intervention for pregnancy often disregard factors associated with TTP. It is recommended that care-providers support these couples, promote their awareness, and give them suitable advice.

Technical Efficiency Measurement of Social Security Hospitals

Hamid Sepehrdust

Background and Aim: Hospitals as one of the major institutions providing health care services within the health sector utilize a high percentage of the sector's key resources to respond to the needs of consumers. The aim of the present study was to identify factors affecting technical, scale and management efficiency of the Social Security Organization (SSO) hospitals during the period 2007-2009 and find ways to improve the efficiency of inefficient hospitals.
Materials and Methods: A total of 65 SSO hospitals active during the period 2007-2009 were included in the study. Data envelopment analysis was used assuming constant return to scale of production (CRS). To distinguish between management and scale efficiency of hospital units, the study used input-oriented model (BCC) assuming variable return to scale (VRS).
Results: The findings showed that small hospitals with less than, and large hospitals with more than, 100 active beds have 11% and 8.8% surplus inputs, respectively, the surplus inputs being medical and nursing staff, other personnel, as well as active beds for hospital services. In addition, the impact factors of medical staff, nursing staff, other personnel, and active beds were 24%, 9.8%, 11.7% and 16.8% for small hospitals' efficiency and 25.7%, 18%, 21.7% and 30.7% for large hospitals' efficiency, respectively..
Conclusion: Considering the average scale and management scores derived for efficiency measurement, it is recommended that the Social Security Organization hospitals reduce their surplus costs and increase their output products and services to achieve the optimum level of efficiency.