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

Improving Approaches of Intersectoral Collaboration for Health by Health and Food Security High Council in I.R.Iran

Abbas Vosoogh Moghaddam

Background and Aim: Intersectoral Collaboration and Community Participation are two main strategies for sustaining equity in health. Based on the 4th 5years country development plan, Health and Food Security High Council(HC) as a strategy for developing intersectoral collaboration. Reviewing members' opinions of HC may show the clear way of improving intersectoral collaboration for health promotion of the population to senior officials of Ministry of Health and Medical Education. Materials and Methods: This was a descriptive and qualitative study. Information were gathered by structured interview to HC members and content analysis of the documents and gray materials related to initiation and performance of the HC since it's opening. Content analysis and adding up the interviews were done by hand after defining the main domains. Results: Most of HC members believed that the HC effectiveness is very low or low. For the 1st step, defining health priorities and then responsibilities and expectations of each organization were proposed. Organizations necessity to introduce a sustained representative, creating taskforces for deep working on the issues, regular meeting in secretariat, concurrent information sharing to the members, strengthening similar structure in provinces and giving more authority to them and connecting the council to the scientific committees of health elites are main improvement approaches. Conclusion: There is gap between the performance of the HC and the law makers' expectations. Implementing secretariat of HC including expertise and special working system of intersectoral collaboration will mostly cover the weakness. Defining periodical roles and expectations of organizations and capacity building of health collaborators of the ministries and organizations, and incentivizing organization which have effective contribution, will strengthen and continue the collaboration more.

The Relationship between Quality of Life and Social Capital amongst people living with HIV/AIDS attending the Imam Khomeini Hospital Consultation Center for clients with risky behaviors in Tehran– 2011

Shahnaz Rimaz

Background and Aim: Quality of life amongst people living with HIV/AIDS is affected by their experiences such as social isolation, stigmatization and discrimination. Physical, mental and social problems are common throughout their lives. Therefore, studying the quality of life of HIV-infected individuals are shortcomings in various cultural contexts. The purpose of this study was to assess the quality of life of people living with HIV/AIDS in Iran. Materials and Methods: A cross-sectional study design was used. We used convenience sampling to recruit 300 HIV-infected adults attending the Imam Khomeini Hospital consultation center for clients with risky behaviors in Tehran. To collect the data we employed the World Health Organization Quality of life for HIV Brief version (WHOQOL-HIV BREF). T-test, one-way ANOVA, Pearson’s coefficient and multiple regression were used for analysis. Results: The mean ±SD age of the respondents was 34.3±7.5 years. The majority of them were males (55%) and asymptomatic (51.7%). Among the domains of quality of life, Level of independence had the highest score (13.4±3.1), and environment (12.5±2.8) and psychological (12.5±3.1) domains had the lowest. Younger's, women and employed subjects reported better quality of life for different domains of quality of life (p<0.05). Conclusion: Psychological and environment domains in quality of life were found to be adversely affected by HIV. Accurate and culturally sensitive interventions are suggested to address the patients' psychological and environmental needs.

Design of the child abuse Questionnaire in Iran

Ali Aflatooni

Background and Aim: Child abuse is a social problem that affects the lives of children. The purpose of this study was to design a valid and reliable Persian questionnaire to measure the status of child abuse. Materials and Methods: Content validity was measured with search of relevant electronic databanks, preparation of the first draft of the questionnaire and determinant of its relevancy and clarity. Reliability was measured with Cronbach’s alpha, and repeatability was measured with intra cluster correlation through test-retest with two weeks interval. Results: The mean of clarity and relevancy of the tool were 80.36% and 92.5%, respectively, and rang of these two measure were 90.14 - 97.2, also. The average of intra cluster correlation (ICC) and Cronbach’s alpha were 0.95 and 0.92, respectively. Conclusion: The new tool has acceptable validity and reliability and is suitable for child abuse studies in Iran.

The relationship between Food Groups and Multiple Sclerosis disease: a case control study in tehranian adult

Bahram Rashidkhani

Background and Aim: There is some evidence that nutrition probably plays a role in the etiology of multiple sclerosis (MS). The present case-control study was conducted in the City of Tehran, Iran with the purpose of finding any possible relations between food groups and MS.

Materials and Methods: In this case-control hospital-based study conducted in 2011 in the City of Tehran, data were collected on several variables including socio-economic status, life style, and food intakes of 70 MS patients and 140 controls matched for age and gender, through interviews and questionnaires. All the statistical tests were done using the SPSS software version 16. Logistic regression was used to calculate the odds ratio (OR).

Results: After adjusting for confounding variables, it was seen that subjects in the upper tertile of intakes of the fruit group, tomatoes, other vegetables, and liquid oils, were significantly less likely to be suffering from MS disease, the odds ratio being 68% (OR: 0.32 95% CI: 0.13-0.79), 82% (OR: 0.18 95% CI: 0.05-0.65), 61% (OR: 0.39 95% CI: 0.93-0.16), and 94% (OR: 0.06 95% CI: 0.08-0.58), respectively. On the other hand, subjects shown to be significantly less at risk of the disease were those in the upper tertile of the intakes of non-liquid oil [ 1.58 times (OR: 2.58 95% CI: 1.05-6.33) ] and soft drinks [1.87 times (OR: 2.87 95% CI: 1.17-7.02)] (p for trend < 0.05).

Conclusion: The findings of this study support the probable role of nutrition in preventing multiple sclerosis.

Analysis of retention time among a sample of opioid dependents participating in the Methadone Maintenance Treatment Program in Iran

Tahereh Pashaeie

Background and Aim: The objective of this study was to determine factors associated with time to relapse and, thus, retention time, of a cohort of opioid-dependents under methadone maintenance treatment, using survival models, in the Iranian National Center for Addiction Studies (INCAS).

Materials and Methods: A total of 198 opioid-dependent clients participating in the Methadone Maintenance Treatment Program, implemented by INCAS between April 2007 and March 2011, were included in the study. A Cox proportional hazard (PH) model was applied to determine predictors of relapse time among the patients.

Results: The data showed that 86 clients relapsed into drug use during the treatment program. The proportional hazard assumption was satisfied according to the goodness of fit test showing that Cox proportional hazard model was appropriate. Estimates of the PH model indicated that an increase of 1mg in the methadone dosage could lead to a decrease of 0.15 in hazard ratio and an increase in the length of treatment (p<0.001). Predictors for raising the probability of drug relapse included suffering from mental disorders (compared to mentally healthy: hazard ratio = 2.29, p<0.001), being a poly-substance user (compared to mono-substance users: hazard ratio = 4.80, p<0.001), and having retention experience in the past (compared to those with no previous therapy: hazard ratio = 1.90, p<0.001). Other variables entered in the model, including social and demographic variables, had no statistically significant effect on hazard ratio.

Conclusions: Although higher methadone dosages are associated with a longer time to relapse, we recommend highly to pay special attention to providing more therapeutic and consultive services to mental health patients, poly-substance users, and individuals with a past therapy record.

Comparison of Grip and Pinch Strengths of Adults among Five Cities of IRAN

Mostafa Mohammadian

Background and Aim: Measuring the hand's grip strength and comparing it with its normative data is a valid method for detecting intensity of the numerous damages of hand. In addition, co mparing grip strength of people in different regions can reveal hidden facts resulting from genetic and environmental factors . Therefore , the present study was carried out with the aim of comparing grip strengths and three types of pinch (tip, key and palmar) strengths of healthy people living in five Iranian cities and determining normative data of grip strengths of citizens of these cities.

Materials and Methods: This was an applied cross-sectional study. The study population included 1008 healthy adults (526 males and 482 females) from the Fars (Persian) ethnic populations in five cities of Iran ( Mashhad, Isfahan, Shiraz , Kerman and Yazd ). The American Society of Hand Therapists (ASHT) recommendations were followed to establish normative data of grip and pinch strengths . Jamar dynamometer and Seahan pinch gauge were used to measure grip and pinch strengths. In addition, the effect of body mass index (BMI) and other anthropometric variables (hand length, height and weight) on grip strengths was assesed.

Results: In the present study, no significant differences were found between grip and pinch strengths of adults in the five cities. From among the parameters studied , height and hand length had the most influence on the grip strengths .

Conclusion: The findings of this study show that populations of any particlular ethnic group have similar grip strength despite living in different geographical areas. The normative data of grip strength obtained in this study are important for ergonomists helping them to optimize work programs and designing tools, as well as for therapists helping them to reach the goals of treatment, assessing the body response to medical treatment, and detecting good function of the upper extremities .

Assessing Lifestyle of high school students in Bandar Abbas, Iran

Teymour Agha molaei

Background and Aim: In recent years great emphasis has been put on the importance of a healthy lifestyle. This study aimed to assess the lifestyle of high school and pre-university students in Bandar-Abbas, Iran.

Materials and Methods: Using a multistage sampling method a total of 410 high school and pre-university students in Bandar-Abbas, Iran were selected. To assess the lifestyle of the students the Adolescent Health Promotion Scale was used. This 40-item scale assesses six health-promoting behaviors, including those related to nutrition, social support, personal responsibility, health valuation, physical activity, and stress management.

Results: The mean age of the students (49.8% males and 50.2% females) was

16.5 (SD=1.34) years. The data showed the mean score of the total scale to be 64.89 out of 100. The mean scores (out of 100) of the subscales of nutrition, social support, personal responsibility, health valuation, physical activity and stress management were 71.06, 63.00, 63.12, 82.11, 41.49, and 68.58, respectively.

Conclusions: The findings of this study reveal that the health-promoting behaviors of high school students living in Bandar-Abbas are not, on the whole, desirable. The regular physical activity subscale had the least score, which shows that a sedentary lifestyle is a common, serious problem among thestudents.

The study of the effect of e-education on physical activity and body mass index of female employees

Davood Shojaeezadeh

Background and Aim: Physical inactivity is one of the 10 leading causes of mortality and disability. This study aimed to investigate the effect of e-learning on physical activity and body mass index (BMI) of female-employees.

Materials and Methods: In this semi-experimental interventional study, 120 female-employees of Tehran University of Medical Sciences were selected randomly and assigned to a case or control group. Data were collected using a demographic and an international physical activity questionnaire. Pre-test and post-test questionnaires were completed by the case and control subjects prior to, and 2 months after the final phase of, the intervention. The intervention included virtual education through short message service (SMS), email messages or messages via intanet, and educational films for a period of 16 weeks. SPSS-17 was used to analyze the data, the statistical tests being Chi-square, independent and paired-t, and Fisher's exact tests.

Results: The mean age of the participants was 41 and 39 years in the case and control group, respectively. Most of them held a bachelor's degree and were married with 1 or 2 children. After the intervention, the mean score of physical activity in the intervention group increased significantly as compared with the control value (p<0.001). However, the intervention did not produce any change in the mean BMI of the case in comparison with the control group (p=0.119), although it brought about a statistically significant reduction in the initial BMI (p<0.001).

Conclusion: Web-based education, SMS and multi-media messages can increase physical activity in female-employees and might prevent illnesses caused by physical inativity.