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

Iranian women's understandings of menopause and cultural scenarios

Effat Merghati khoii

Background and Aim: Women perceive menopause differently. Beside biological changes, women experience menopause based on the cultural scenarios. The qualitative research presented here is about how Iranian women perceive menopause within cultural scenarios.

Materials and Methods : Data was collected during 4 focus group sessions and 6 individual in-depth interviews of women aged 40 years and older. Informants were selected from the Tehran University of Medical Sciences. The sessions were facilitated by using a semi-structured inventory focus group. Content analysis was adopted using combined free and analytical coding to reduce data, to extract meanings, to categorize domains and to obtain themes .

Results: We categorized our findings into four main domains: gender role, the changes in socialization, social interactions and supporting resources. Descriptions of the later domain are going to be reported in subsequent manuscript.

Conclusion: The women's understandings of menopause are shaped based on the specific cultural scenarios. Menopause recognized as a factor which changes women’s life line. Meanings as 'Loosing femininity' and 'changes in women's roles in the community' describe women's gender role, social interactions and changes in the socialization throughout the menopause years. The women’s misconceptions, accumulated myths, and ignorance about femininity were evidenced based on narratives. The majority of women raised ‘role change’ as an important determinant in social interactions. Gender role changes as well as women's socialization patterns have forced women to accept loosing femininity as a reality. Developing comprehensive and culturally sensitive health services to address women's needs in the climacteric years is suggested .

Community Based Participatory Research, a model for health promotion

Mitra Safari

Background and Aim: Current traditional research methods for solving social problems were challenged due to limited participation of community . The health companion project was carried out with the aim of determining effective model of community participation for solving health problems in Boyerahmad and Dena township. .

Materials and Methods : This study is a community based participatory research performed in Kohgiloyeh and Boyerahmad province 2005-2009.The study population was the entire rural and urban households of Boyerahmad and Dena county.The strategic committee of project including academic researchers, managers of health and health related sectors was formed and this committee selected six regions for research activities. In each region local directing group "health companion " was established with participation of stakeholders: academic researchers, local leaders, health providers and public representatives to guide all aspects of project. The members of the group empowered and enabled by attending training workshops for need assessment, priority setting, research methodology that through these activities the health problem priorities of the regions were recognized, the research area determined and intervention programs were designed and implemented according to these research area.

Results: The most important achievement of this project is the methods of activities to reaching goals. Implementation of six participatory interventional proposal for solving health problems and needs are the other achievement. The frequency and means of health problems and their risk factors significantly reduced after the completion of intervention program in each region.

Conclusion: Establishing and activities of health companion groups followed model of Planned Approach to Community Health (PATCH) that help community to form health promotion team, collecting and organizing of data, choosing health priorities, developing a comprehensive intervention plan and evaluation .

Evaluation of Harm reduction Programs in prisons from the attitude and viewpoint of Iranian prison staff

Ghobad Moradi

Background and Aim: probably after pestilence, HIV/AIDS is most important and severe health threat for public health. Prisons could facilitate the spread of HIV/AIDS and Hepatitis and transmit it to societies. The main strategy to control HIV/AIDS and hepatitis among Injecting Drug Users is Harm Reduction Programs. These programs are conducted in Iran Prisons. The goal of this study is to evaluate Harm reduction Programs including Methadone Maintenance Therapy (MMT) and Needle exchange from the viewpoint of prison staff in Iran including principals, managers, physicians and counselors.

Materials and Methods : It was a cross sectional study in which 370 prison staff working in prisons all around the country were evaluated to assess their viewpoint and insight about Harm reduction Programs including Methadone Maintenance therapy and Needle exchange.

Results: A percentage of 95.23 of prison managers and experts had a positive view toward Methadone Maintenance therapy. 70.25 percent had a positive insight toward needle exchange program. The employment type and work experience was significantly (p<0.05) related to the viewpoint of managers and experts towards Methadone Maintenance therapy program. Age was the only factor that had a significant relationship (p<0.05) with Needle exchange program.

Conclusion: MMT has lots of supporters in prisons. The positive insights of managers and experts towards methadone maintenance therapy program demonstrate the high level of staff’s approval for conducting this program it could be interpreted as a sign of success of program in the country. However there is not a comprehensive approval and collaboration with needle exchange program in prisons. Nevertheless, it is alarming that 42.5% of staff believe that conducting methadone maintenance therapy may increase and intensify addiction in prisons.

What should we do for improving Iranian social health?Situational analysis, national strategies and role of ministry of health and medical education

Behzad Damari

Background and Aim: Definition of World Health Organization 1948 for Health includes social domain which two other domains of health, physical and mental, have counter effects on it. Quantity and quality of an individual relation to community in order to improve population welfare is a definition for social health. Social capital and security improvement and reduction of impoverishment and inequity is the impact of this relation and it's opposite side is increasing social problems. In this article, by reviewing social health situation of Iranian community and analysis of it's determinants, improvement strategies have been provided and role of Ministry of Health and Medical Education(MOHME) proposed.

Materials and Methods : This is a descriptive and analytic study A conceptual framework were described based on a nationally committed definition of social health and used for description and analysis. Secondary data of reviewing existing research and documents were utilized for situational analysis Focus group discussion of steering/stakeholder committee members and review of the best evidences and international experiences made analysis and proposed interventions.

Results: The evidences show that average increasing rate of social problems during recent years is 15% annually. Albeit, it is not possible to draw the increasing or decreasing trend of social health indices precisely since past 2 decades due to the lake of surveillance system. Several social problem reduction and social health improvement interventions are running by organization but, inadequate sensitivity of responsible persons, not to evaluate the current interventions, inadequate utilization and coverage of population from primary level preventive services, inappropriate selection of essential interventions, allocation of most available resources to tertiary level of prevention(after harm services), weakness of activity implementation system and intersectoral collaboration for executing interventions, disintegration of social health related financial resources and inadequate sensitivity and competencies of people in combating to social problems and risks are obstacle to effective interventions in improving social health indices. Economical, political, international and technological big changes should be added to these reasons.

Conclusion: Social health progress will not be achieved without intersecotral collaboration Improvement of existing situation is not under duties and responsibilities of MOHME, so proposed direction including vision, strategic objectives and interventions, for social health should be implemented partially by MOHME Remaining parts required advocacy to be done by other sectors. It is essential that the proposed program be approved in health policy council of MOHME for implementation of this direction and achieving to it's objectives and then be approved by health and food security high council and social council of country after that the intersectoral collaboration agreements of social health improvement should be supervised deeply.

Services Quality Analysis Using Importance-Performance Analysis (IPA) Tool in Selected General Hospitals in Tehran: 2011

Soudabeh Vatankhah

Background and Aim: Quality measurement and management has changed to be one of the most important topics in health care today. This study aims to analyze service quality through Importance-performance Analysis tool in selected hospitals.

Materials and Methods : This is an Analytical-descriptive study. Research community was all admitted patients to four hospitals during a specific period, the sample of the study consists of 284 inpatient person selected by stratified random sampling method. The main instrument was a questionnaire consists of two parts "importance" and "performance" with the same items in 8 dimensions. Assigning the scores for each of those service items in a two-dimensional diagram with four cell, each gives special guideline for hospitals. SPSS 17.0 for windows was employed for the scale measurement.

Results: The results of the study indicate that the most important dimensions in patients attribute with 3.55 mean were for "accountability" and the best performance in patients point of view was for "responsiveness" and "reliability". The key dissatisfier with least importance and performance score was for "service organization" with the mean of 3.11.

In analyzing service quality, reliability, empathy, assurance and accountability dimensions were located in Cell I, service process was located in Cell II, service organization was located in Cell III and finally tangibles and responsiveness dimensions were located in Cell IV.

Conclusion: Application of IPA to these data showed that developing service process management system in order to improve process of service delivering is important directions for hospitals to work on.

Investigating health team view points about cost-effective alternatives in elderly caring

Marzieh Javadi

Background and Aim: Global growth in the elderly population for both health care providers and families and also the community is an important challenge . Elders are the largest and fast factor for increasing hospital admissions in Society . Increasing costs of aging is the most concern to elders and their families. This study aimed to investigate the health team s approach about cost–effective alternatives for aging health services.

This study is a qualitative research which was done through content analysis.

18 people consisting of five faculty members , 6doctors , 3 nurses and 4health public health expert were participated. Samples were selected based on purposive sampling . Data were collected through interviews .

Results: Four core themes derived from this study which included: 1- Emphasis on training for aging care ( including training doctors, nurses , health professionals , public health experts, elder sand their family caregivers). 2- Emphasis on proper implementation of primary health care for the elderly. 3- Emphasis on home care for elderly.4-attntion to mental health of elderly.

Conclusion: It seems effectiveness of tree alternatives emphasis to training, home care and mental health for elderly are obvious and evident, so implementing and applying these suggestions would be helpful.

But the second alternative emphasis on proper implementation of primary health care for the elderly must be performed based on a comprehensive needs assessment in elders population. Finally it is stressed that calculating and comparing actual costs of each alternative in elders caring must be measured through quantitative researches.

Determinants of fruit and vegetable consumption among People in the Age Range of 18-70 Years in Arak, Iran

Kourosh Holakoei naeini

Background and Aim: High fruit and vegetable intake has been introduced as one of the key factors of healthy diet to prevent chronic disease. This study attempts to explore the fruit and vegetable intake in Arak city and its relationship with demography and socio-economic factors.

Materials and Methods : In this cross sectional study, 660 people in 18 -70 age range were selected with a two-stage cluster sampling and were interviewed for demography and socio – economic questionnaires and a 56- items semi-quantitative food frequency questionnaire to assess fruit and vegetable intake. After univariate analysis, the association of the significant variables with fruit and vegetable intake was also evaluated with multiple linear regression.

Results: In this study, over 60 percent of subjects consumed less than the minimum recommended amount of fruit and vegetable (5 servings or 400 gr a day).The total consumption of fruit and vegetable indicated an inverse significant relationship with age (p =0.04 and β = - 0.02), and a direct significant relationship with economic status (p <0.001and β =0.10). The father's educational level (p =0.005 and β =0.38 for diploma level and p =0.03 and β =0.36 for academic education) and physical activity level (p =0.001 and β =0.03 per hour) were factors associated with fruit consumption. The gender was only associated with vegetable consumption so that women had higher consumption in this study (p =0.03 and β=0.23).

Conclusion: The findings of this study indicate low fruit and vegetable consumption in the population under study. In this study, age, physical activity, and socioeconomic status and fathers’ education were the factors that were significantly associated with fruit and vegetable consumption.

Entomological research and its specific course in Iran from 1935 to 2008

Hossein Ladoni

Background and Aim: Malaria remains an important vector-borne disease globally and is a threat for human life. Forty percent of the world’s populations who are living in low-income countries are at risk of malaria. The disease exists in Iran and caused economic and social damages. As result of malaria control program that has been done during the past years, the disease is eliminated from the most parts of the country, so that it is only reporting from a small part in these years.

Materials and Methods : During this study, all available papers, books and thesises were reviewed and articles from Iranmedex, DIS and PubMed databanks were also used. Furthermore the related reports from different sources were noted.

The extensive studies have important information about malaria vectors. In this study the data about malaria vectors and related training courses are listed. During this study the related papers, Books and thesises which have been reviewed.

Although efforts, surveillance system, diagnostic and treatment facilities, as well as knowledge and attitude of peoples regarding to health behavior are improved nowadays, there are significant improvements about decreasing the malaria cases. Risk of the disease exists because of population exchange and asymptomatic cases. The malaria can be studied with both public health and economical aspects. This paper represents entomological studies of malaria during 1935 by the end of 2008.

Conclusion: our study revealed that, based on recent malaria national program, the authorities should make an emphasis on vector control monitoring, resistance management, malaria evaluation and because of weak supervision on all malaria operation at stage of elimination of malaria, accurate and careful suppersional require to reach the objective and goal of elimination.