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

Factor analysis of social capital questionnaire used in Urban HEART study in Tehran

Mohsen Asadilari

Background and Aim: Social capital composed of networks, norms and values, which facilitates cooperation within and between groups to achieve mutual benefits and common goals. Social capital increases the benefits of investing in physical and human capital. In a society that favors more social capital, collaboration is easier. This study investigates the validity and reliability of a social capital tool, which had been administered through a large population-based survey using factor analysis.
Materials and Methods: Data were obtained from Urban Health Equity Assessment and Response Tool (Urban HEART-1) survey in Tehran. Factor analysis is a method of discovering structural position of variables to reduce them into a limited number of components which are more fundamental. The reliability of the questionnaire and main components of the tool were investigated through factor analysis.
Results: According to factor analysis, three main components of social capital including, individual trust, cohesion/ social support and social trust/associative relations, were recognized. These three components explained 66.14% of total variance of the social capital tool. Also, overall Cronbach's alpha coefficient was 0.88 which indicates high reliability of the questionnaire.
Conclusion: Social capital tool, which was administered in Urban HEART project, covers the main components of social capital framework with high reliability and validity, which is suitable to be used in other population-based surveys.

Satisfaction of physicians and midwives participating in the rural family physician and insurance scheme with the plan in Isfahan province, 2010

Maryam Kheirmand

Background and Aim: Job satisfaction is one of the most important factors in maintenance of a professional person and the job success, increasing the personal efficiency and the quality of services. On the other hand, it is a tool in the hands of managers in order to maintain the staff in their jobs. The aim of this descriptive study was to investigate the satisfaction of physicians and midwives participating in the family physician scheme with the plan.
Materials and Methods: The study population was made up of 221 physicians and 144 midwifes. The tool was an author made questionnaire certified by experts as a standard, valid and reliable scale via content validity measurements through a pilot study.
Results: The average satisfaction of physicians and midwives was 44.34% while the highest satisfaction was 65% with the location of services and the lowest was 30.6% with the financial issues. In relation to the financial affairs, physicians were more dissatisfied than midwives, so satisfactions were increased by the increase in the amount of salaries.
Conclusion: Over 4 years of implementation of family physician plan, the physicians and midwives satisfaction was shown to be still low. It is necessary to consider re-programming in the scheme in order to increase the amount of payments and create more motivational factors for physicians as well as to reduce working hours for midwives and establish appropriate levels of payments for them.

3 years performances of the Provincial Health and Food Security Councils in I.R.Iran: the way forward

Behzad Damari

Background and Aim: Improvement of national and provincial health indices requires intersectoral collaboration and community participation So, National High Health and Food Security Council and Provincial Health and Food Security Councils (PHFSC) have been implemented since 2006. The main responsibilities of PHFSCs are, assessment of province health situation and effects of executive organizations on it's improvement, to define and approve the province health strategic plan, developing of AIDS and HIV prevention and control plan and resolving intersectoral issues of health. The goal of this study is first 3 years performance assessment of the PHFSCs.
Materials and Methods: This is a descriptive evaluation study which included all the PHFSCs. The outcome assessment indicators were determined by content analysis of "the approved tasks" and also "the essential aspects for promoting of PHFSCs" by focus group discussions. Situational analysis was provided by two researcher made questionnaires one for co Assessment of the contents of content analysis of PHFSCs all meetings minutes (from establishment year to the end of 2008) and another for gathering viewpoints of Secretaries of PHFSCs.
Results: Data analysis shows that the meeting's agendas of the PHFSCs have less followed the prioritized major health issues of provinces and national burden of diseases most issues were in the domain of communicable disease control and non-communicable diseases risk factors control included scarcely. Only in two Universities of Medical Sciences (UMSc) province comprehensive health plan were proposed. None of the UMSc approved a secretariat for PHFSC in its organizational top chart. PHFSCs secretaries believed that, the main obstacles of the PHFSCs' successes, are weak financial resources, and lack of decisions executive enforcements.
Conclusion: PHFSCs performances are moderate and moderate to low due to lack of comprehensive strategic plan and no implementation model for intersectoral decisions, other organizations believe on the effectiveness of the PHFSCs less and the main burden of disease of the provinces not mostly included in the agenda of PHFSCs. Following proposals are highly recommended for PHFSCs promotion: training and empowerment of UMSc and organizations for developing comprehensive health plan in the province and defining the responsibilities of each organizations for, determining policy priorities of common health issues of the provinces by High Health and Food Security Council and publicizing them by the Ministry of Health and the other relevant ministries and approving the structure and working system of the PHFSC secretariat in UMS by the Board of Trustees of UMS.

The effect of tomato juice on serum concentrations of IL-6, IL-8, CRP and TNF-α of over-weight or obese girl students of Tehran University of Medical Science

Ahmad Saedisomeolia

Background and Aim: Tomatoes are the richest source of lycopene, a potent antioxidant. Tomato products improve antioxidant defenses and reduce the risk of inflammatory diseases, at least partly due to the presence of lycopene. Lycopene, as an anti-inflammatory agent, prevents the production of inflammatory cytokines. Obesity is a chronic inflammatory condition in which the increased level of body fat leads to an increase in circulating inflammatory mediators. We hypothesized that the consumption of a lycopene-rich food would reduce inflammation in people with overweight or obesity.
Materials and Methods: One hundred and six overweight or obese female students of Tehran University of Medical Sciences were enrolled and randomly allocated to an intervention group (n=53) or a control group (n=53), consuming 330 ml/day of tomato juice or water respectively, for 20 days. At baseline and day 20, serum concentrations of interleukin-6, interleukin-8, tumor necrosis factor-α and high sensitivity C-reactive protein were analyzed by ELISA and compared between groups.
Results: Serum concentrations of interleukin-8 and tumor necrosis factor-α decreased significantly in the intervention group compared to the control group and compared to the baseline. Subgroup analysis indicated that this effect was confined to subjects who were overweight. Among obese subjects, serum interleukin-6 concentration was decreased in the intervention group compared to the control group, with no observed differences in interleukin-8 and tumor necrosis factor-α.
Conclusion: Tomato juice reduces inflammation in overweight and obese females. Thus, increasing tomato intake may provide a useful approach for reducing the risk of inflammatory diseases such as cardiovascular disease and diabetes, associated with obesity.

Effect of educational intervention based on Health Belief Model on knowledge and attitude about pap smear test among female secondary school teachers in district 11 of Tehran

Fereshteh Majlesi

Background and Aim: Cervical cancer is the second most common cancer in women with incidence of more than 500000 cases per year. It is preventable because of its long pre-cancerous period, suitable screening programs and effective treatments. Since the social and cultural barriers alongside the lack of knowledge are deterrents to participation in screening programs, the current study was performed to assess the effect of educational intervention through the Health Belief Model on knowledge and attitude of teachers about pap smear, considering their role in making people aware. Materials and Methods: This was a controlled before-after interventional study conducted on 72 individuals selected through simple sampling, assigned to two groups. Data collection tool was a questionnaire used and compared before training and one month after that. Training methods (intervention) included lectures with questions and answers. Data were analyzed with SPSS, version 11.5. Results: 47.2% of intervention and 45.8% of control group were 40 to 50 years old and majority of them (47.2% and 50% respectively) had undergraduate educational level and 86.1% were married. Respectively, 67.2% and 74.2% have experience of being examined via Pap smear, while the knowledge of women in both groups was moderate about the disease. Study results revealed significant differences in knowledge, attitude and Health Belief Model constructs within intervention group (before and after training) as well as between groups (p<0.05). Conclusion: Using Pap smear test among the participants was lower compared with healthy people aims targeted by 2010. Therefore, necessity of education and knowledge promotions are obvious.

Evaluation of submicron particle filtration efficiency of domestic and imported surgical masks

Ali Faghihi-Zarandi

Background and Aim: Bioaerosols are one of the most important agents that cause post operating infections in hospitals. Surgical masks are recommended for prevention of bioaerosols transmition in operating rooms. This study aimed at evaluation of submicron particle filtration efficiency of domestic and imported surgical masks.
Materials and Methods: In this cross sectional study, 5 types of surgical masks that have the most utilization in operating rooms of country’s hospitals including domestic and imported surgical masks were tested. To evaluate all samples, the submicron particle filtration measurements were carried out based on ISIRI 6138 and American DOP standards. Filtration efficiency calculations and pressure drop measurements were performed and the results were analyzed using statistical tests.
Results: Results showed that particle filtration efficiency of domestic and imported masks were 56.130% (±10.7) and 31.906% (±7.062) respectively. Also, filtration efficiency in domestic masks were more than imported masks (P> 0.001). Among all samples, Arman mask had the most filtration efficiency (66.5475 % ±6.14951), where the least (27.8275 % ±4.44152) filtration efficiency (P> 0.001) belongs to Blosom. The maximum mean of pressure drop in Arman mask (35 ±2. 58 Pa) and the least mean of pressure drop in Zist filter mask (11 ±1.82 Pa) were observed. According to the effect of filtration efficiency and pressure drop on general quality of mask, the quality factor of masks were also evaluated. Results showed that Zist filter mask had the most quality factor (0.068) while Blosom had the least quality factor (0.016).
Conclusion: This research showed that domestic surgical masks have a better quality toward imported surgical masks but can not obtained quality confirmed by standards, yet. To reduce respective infections and prevalence of diseases, it is recommended using filters with suitable physical characteristics and also carrying out test of surgical masks before supplying.

The effect of education based on health belief model on promotion of physical puberty health among teen girls in welfare boarding centers in Tehran

Davoud Shojaeezadeh

Background and Aim: Puberty as a stage of life is an important developmental process. Teen girls have numerous health care needs and their specific issues should be considered. This study mainly aimed to determine the impact of education based on health belief model on promotion of physical puberty health among female teenagers who were residents in welfare boarding centers in Tehran city.
Materials and Methods: It was a quasi-experimental intervention study, conducted in welfare boarding centers of Tehran city among inhabitant girls with 12 to 19 years old. All eligible persons were selected (n=61). Data collection tool was a questionnaire including demographic information, health belief components, physical function during menstruation, completed before and one month after training by interview. Educational intervention was implemented in 3 months. Data was analyzed by Wilcoxon statistical test using SPSS16 software.
Results: After educational intervention, perceived severity (p<0.001), perceived susceptibility (p<0/001), perceived barriers (p<0.001), perceived benefits (p<0.001), and physical function during menstruation were significantly different.
Conclusion: Educational intervention improved girls' perceptions and performance. Thus, health belief model should be used for puberty health education planning in female adolescents.

National and sub national mortality effects of metabolic risk factors and smoking in Iran: a comparative risk assessment

Majid Ezzati

Background and Aim: Mortality from cardiovascular and other chronic diseases has increased in Iran. Our aim was to estimate the effects of smoking and high systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC), and body mass index (BMI) on mortality and life expectancy, nationally and sub-nationally using representative data and comparable methods.

Materials and Methods: We used data from the Non-Communicable Disease Surveillance Survey to estimate means and standard deviations for the metabolic risk factors, nationally and by region. Lung cancer mortality was used to measure cumulative exposure to smoking. We used data from the death registration system to estimate age-, sex-, and disease-specific numbers of deaths in 2005, adjusted for incompleteness using demographic methods. We used systematic reviews and meta-analyses of epidemiologic studies to obtain the effect of risk factors on disease specific mortality. We estimated deaths and life expectancy loss attributable to risk factors using the comparative risk assessment framework.

Results: In 2005, high SBP was responsible for 41,000 (95% uncertainty interval: 38,000, 44,000) deaths in men and 39,000 (36,000, 42,000) deaths in women in Iran. High FPG, BMI, and TC were responsible for about one-third to one-half of deaths attributable to SBP in men and/or women. Smoking was responsible for 9,000 deaths among men and 2,000 among women. If SBP were reduced to optimal levels, life expectancy at birth would increase by 3.2 years (2.6, 3.9) and 4.1 years (3.2, 4.9) in men and women, respectively the life expectancy gains ranged from 1.1 to 1.8 years for TC, BMI, and FPG. SBP was also responsible for the largest number of deaths in every region, with age-standardized attributable mortality ranging from 257 to 333 deaths per 100,000 adults in different regions.

Conclusion: Management of blood pressure through diet, lifestyle, and pharmacological interventions should be a priority in Iran. Interventions for other metabolic risk factors and smoking can also improve population health.