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

Quality of Life and Related Factors among multiple sclerosis patients

Maryam Dastoorpour

Background and Aim: MS is a chronic and destructive inflammatory disease with a not contradiction continuing of life but can influenced the quality of life of patients. The purpose of this study is to determine the quality of life in MS and its related factors. Materials and Methods: This cross-sectional study was performed on 172 patients admitted to the MS Society of Iran (Tehran) and convenience samplings were obtained for 10 months. Tools for data collection were MSQOL-54 and MS patients were also interviewed. Data using descriptive and Analytical tests such as multiple regression were analyzed. Results: The mean age of patients was 34/8 ± 9/6 years. Analysis of 14 sub-domains of quality of life questionnaire showed that the highest average score in the domain of quality of life was social functioning (71/7 ± 21) and the least was role limitations due to physical problems (44/2 ± 39/4). Results of multivariate regression models shown that between age has an significant inverse relationship to domain of physical combined and only variable significant on the combined domain of psychological – psychiatric, Area residential Variable was (p.value 0/001). Conclusions: The study shows that demographic variables medical and economic factors influence the quality of life of patients with multiple sclerosis. Identify the factors related to the quality of life of these patients can be helpful in predicting quality of life. The variables influence on the quality of life for MS patients must be targeted in designing effective intervention programs to improve their quality of life.

Provincial Health Policy Secretariate: Coordinating and Brokering Structure for Comprehensive Health

Abbas Vosoogh moghaddam

Background and Aim: Since health is a multidimensional issue and several factors affected on it, forming a structure which can manage these factors at provincial level is difficult but possible. Analysis of Stewardship function of Iranian Health system showed that an effective platform for operationalizing the national policies has not been provided in provinces yet So, study the current situation of policy making and planning process and designing a model for provinces was necessary. Materials and Methods: This is a descriptive and analytic study which used system designation mathod. Information were gathered by reviewing scientific literatures of policy making systems, critical review of documents related the policy making and planning structures in universities of medical sciences(UMS) in the country and written survey of the chancellors. Synthesized information presented to steering committee, that had been selected after stakeholder analysis, and the principles and requirement of designation were agreed by them. Based on the principles, Components of the proposed system as "Provincial Health Policy Secretarite(PHPS)" including mission and goals, system process, procedures and standards, management style and financial, human and information resources prepared and finalized by running several focus group discussion sessions, presenting selected health experts and steering committee. Results: Scattering of policy and decision making centers in UMSs, weakness of monitoring and evaluation of provincial health policies and programs, weakness of coordination of education, research and health services policies, weakness of evidence based policy making system in 3 levels of UMS, board of trustees and health and food security technical taskforce of the province, weakness of presence of key stakeholders in preparing policies in UMS are the most important improving opportunities of provincial health policy and planning system. Considering existing gaps, PHPS could operationalize brokering, supervising and surveillance roles of the chancellor (Vice Minister of Health at Province) and ensure the attainment of the three streams: following the standards of academic and community engagement, evidence based policies and plans and monitoring progress of provincial health indices improvement policies and plans among executive organizations. Conclusion: Several units effective on policy and planning in province should be coordinated. PHPS not only prevent the parallel structure but can improve the other structures functions as well. Formal implementation of PHPS in top chart of UMSs and training experts of the unit will help integrated policy and planning and facilitate to achieve the best health indices in the province and the country.

Assessmnent of Potency of Oral Polio Vaccine Maintained Outside the Cold Chain in Cell Culture System

Shohreh Shah mahmoodi sadeghi

Background and Aim: Expanded program on immunization is one of the strategic universally accepted methods for control of childhood diseases including poliomyelitis. Oral Polio Vaccine (OPV) which consists of live attenuated poliovirus is considered as appropriate and most convenient tool for nation-wide vaccination. Polio virus is sensitive to heat, so OPV should be kept frozen and transferred to vaccination centers under cold chain conditions. Thermo-stability of vaccine during transportation is very important. Potency test is used to evaluate the quality and stability of vaccine. This is the first documentated study on evaluation of OPV potency kept out of cold chain conditions in Iran. Materials and Methods: To study the effects of time and temperature on potency of polio vaccine, vaccine vials were exposed to 24°C (room temperature) and 37°C (average temperature in tropical regions) for one to seven days. Vaccine potency evaluation was performed according to World Health Organization protocol. Results: It can be inferred from comparison of the results of this study with the international standards that OPV is stable at 37◦C for only one day, but if it is exposed to room temperature for 4-5 days, serotypes 1 and 2 remain unaltered but serotype 3 will lose its potency to a great extent. Conclusions: Although Polio viruses are relatively resistant to environmental conditions, their sensitivity to heat is the reason to transport the vaccine, which contains live attenuated virus, under cold chain conditions. This will prevent the titer of the vaccine virus to decrease. Vaccine stored at temperature below 4°C is preferred, otherwise the vaccine kept at room temperature (24°C) is useable for 4-5 days, and at 37◦C the vaccine is potent only for one day.

The application of joint model for longitudinal and survival data in peritoneal dialysis patients

Mahmood Mahmoodi

Background and Aim: In many medical studies along with longitudinal data, which are repeatedly measured during a certain time period, survival data are also recorded. In these situations, using models such as, mixed effects models or GEE method for longitudinal data and Cox model for survival data, are not appropriate because some necessary assumptions are not met. Instead, the joint models have been introduced, to consider: 1- measurement error in time-dependent covariates 2-monotone and non-ignorable missing data which occurs after an event and 3- relation between longitudinal and survival outcomes, simultaneously. At this paper, joint model Puts longitudinal response (i.e. creatinine) as a time dependent variable, along with other covariates in survival sub model, to investigate dialysis patients survival. Materials and Methods: This research contained information about 417 patients affected to chronic renal failure, under treatment of continuous ambulatory peritoneal dialysis (CAPD) method. Patients were referred to three medical centers in Tehran (Shariati, Modares and Shafa) between 1997 to 2009.In this study longitudinal data and time dependent covariate were used Therefore, different variables for each person at certain time have been measured. In first some information was gathered from patient’s file, and then effective factors on survival of patients have been determined by using joint model. Results were compared with naive analysis (extended Cox model). For data analyzing, R software and significant level of 0.05 have been used. Results: with using joint model sex, age, diabetes, diastolic blood pressure, haemoglobin, urea, LdL, and creatinine covariates were significant. In extended Cox model, only age and Diastolic blood pressure covariates were considered as effective factors on hazard of death in patients. Conclusion: Joint model assess the effective factors on both endpoints simultaneously. Also it considers missing data that appeared due to an event, and covariates which were measured with error. Therefore in these cases, using joint models that led to better results and more knowledge about dieses, are necessary.

Explaining process of dental caries from women’s viewpoint: study with grounded theory approach

Arezoo Falahi

Background and Aim: women’s barriers and beliefs are important in the care of teeth and oral health in family and it influence on family’s goals, values and health behavior. Depend on the role of women in shaping health behaviors in family and explain their experiences in the field of oral and dental diseases, the aim of this study was to apply grounded theory approach to develop a process about dental caries in women. Materials and Methods: A grounded theory design was used for data gathering and analysis. 23 participants including 18 women, 3 dentists and 2 spouses were chosen through purposive and theoretical sampling methods. Face to face and semi-structured interviews and two focus groups were held to gather data. Interviews were recorded, taped and analyzed via the grounded theory method developed by Strauss and Corbin. In order to support the validity and rigor of the data, different criteria such as acceptability, confirmability and transferability were utilized. Results: During the data analysis, the core category of “Promoting acknowledge for preservation of teeth” and five main themes of “destructive factors of teeth”, “maintaining dental”, “social and environmental factors”, “Effective believes in dental health”and“Trying to rebuild teeth” were developed. Conclusion: To prevent of oral and dental disease, promoting women’s awareness is not only individual factor but also family, dentist, social and religious believers and policies and executive systems are important. The findings of this study can be effective in designing educational appropriate models in women’s oral and dental health and also may be useful for developing educational context in dentists and policymakers.

The prevalence of HTLV-1 infection in blood donation volunteers in Mashhad

Gharib Karimi

Background and Aim: Human T-Cell Lymphotropic Virus (Type I) is the cause of two major diseases : Adult T cell Leukemia-Lymphoma and Tropical Spastic Paraparasia and Myelopathy associated with HTLV-I. Disease transmission is possible during unsafe sexual contact, blood transfusion and vertical transmission method. Blood safety and minimizing the risk of transfusion transmitted infections are the main goals of blood transfusion organization. Mashhad is located in an endemic area and it is essential to investigate about the virus epidemiology. Materials and Methods: In this descriptive study from 1388 to 1389. all the blood donation volunteers, who were eligible for blood donation but had HTLV serum positive results in both screening and confirmatory tests with Elisa and Western Blot method, respectively, were considered as HTLV infected individuals. The infected group was compared with a group of healthy blood donors as a witness group. The data were analyzed by SPSS-17 software. Results: Out of all 432 infected donors, 353(% 81.7) were male and 79 (% 18.3) were female. The prevalence rate in two years of study was %0.26 and %0.25 Respectively . There was a significant relation between age, sex, marital status, education levels and history of blood donation with HTLV-1 seropositivity. Conclusions: Because of the improvements in donor screening and laboratory methods , the prevalence of HTLV-1 infection among blood donors has currently decreased. According to the low rate of infection among younger blood donors, regular blood donors and donors with higher educational levels ,it should be considered to select donors from these groups.

Perceived support from organization, supervisor and coworkers as the predictors of health outcomes in workers

Mohammad reza Khodabakhsh

Background and Aim: Occupational injuries are of the most important factors of fatal and disabling of thousand individuals in workplace. Therefore, cognizing the influencing factors on occupational injuries is very important. The purpose of this study was to determine the predicted power of health outcomes in workers by perceived support from organization, supervisor and coworkers. Materials and Methods: The current research is the kind of correlation studies. Sample consisting of 189 employees in Isfahan Steel Company in 2012 was selected according to the stratified random sampling method and responded questionnaires about demography characteristics perceived support from organization, supervisor and coworkers incident reporting rate and its dimensions (physical symptoms, psychological symptoms and accident). Data was analyzed using of Pearson correlation coefficient and MANOVA. Results: The results showed that perceived organizational support significantly predicted almost 9%, 8% and 14% of variables variances of incident reporting rate and its two dimensions that is physical symptoms and psychological symptoms (p<0.01).Also, perceived supervisor support significantly predicted almost 11% of psychological symptoms variance and perceived supervisor support significantly predicted almost 5% of physical symptoms variance (p<0.05). It wasn’t significantly observed relationship between the dimension of accident and perceived support from organization, supervisor and coworker (p>0.05). Conclusion: The research results maintained the importance of psycho-social variables in predicting health outcomes in workers.

Gender variations in health-related quality of life among elementary school children

Gholamabbas Moosavi

Background and Aim: This study aimed gender variations about adolescents' health-related quality of life. Materials and Methods: A cross-sectional study was performed on four hundred students selected by a Stratified random sampling. Two-way analysis of variance was used for the analysis of total health-related quality of life scores among boys and girls in terms of demographic factors. Data analysis was conducted with software SPSS 18 and LISREL8.8 programs. Results: There were important differences in health-related quality of life total score between boys and girls in relevance rank of birth, level of education and BMI. Although, these differences weren't statistically significant (p>0.05), Girls’ reports were higher compared to boys except for the emotional functioning subscale. Conclusions: Teachers and parents should make great efforts for meet the requirements and difficulties of emotional and behavioral in adolescent girls. It is Necessary to execute coping mechanisms by the training consultants to minimize stress and anxiety for the mother to be.