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

Challenges and directions of public health development in Iran from the viewpoint of provincial health deputies and health center

Behzad Damari

Background and Aim : Equitable improvement of the national health situation in Iran requires a sufficient and logical balance between preventive and curative needs. Considering the profound changes that have occurred in disease patterns and the population over the last three decades, it is essential to review the ongoing preventive services with due consideration of the current and future needs of the population in an attempt to provide more effective and appropriate services. The provincial health deputies (PHDs, vice-chancellors of the universities of medical sciences), who are responsible for establishing and adjusting new preventive health services, are confronted with many challenges in this matter. A thorough knowledge of these challenges will help greatly in developing strategies aiming at improving the national preventive health services.

Materials and Methods : The participants in this study were the PHDs throughout the country. Data were collected through interviews and focus-group discussions. The main question was "What are the challenges and procedures in the area of preventive health services in the Iranian universities of medical sciences in the stewardship/supervision, resources and services domains?".

Results : Results of the study reveal that PHDs have various challenges that have increased over time because of their persistency and the additional burden of the family physician program and referral system, and the effects are quite apparent in both the staff domain and in the universities where the family physician program is being executed. Although the challenges in all the three domains of stewardship, resources and service provision are not equally distributed, service and resource provision domains suffer most. However, solutions to the problem proposed by the participants emphasize on improvement of stewardship in the domain of public health. The universities consider the Ministry of Health and Medical Education to be the main culprit for these problems.

Conclusion : The existing challenges will prevent establishment of legal articles of the 5^th ational Development Plan in the health sector. In order to promote the health situation in Iran on an equitable basis (achievement of better health indices), at least ten actions to be taken in the universities of medical sciences at the national level are required: activation of the High Council of Health and Food Security and encouraging social accountability of all the governmental, private, and nongovernmental sectors developing a ten-year plan for preventive health and intersectoral collaboration specifying general and specific annual expectations from preventive health departments of medical universities in the form of memoranda of understanding (MoUs) and creating health oriented competition among provinces and cities adopting a model for provision of health services in cities and suburban areas in coordination with the family health program and the referral system evaluating and integrating the existing preventive health programs elimination of overlapping units in the organizational chart at the central level increasing funds for the national preventive health services programs and not letting use of these funds for other programs measuring general satisfaction of the preventive health managers and employees and maintaining and promoting human resources of the health sector expansion of preventive health services coverage down to the district level and, finally, better management of the facilities, equipment and standards of health centers.

Exercise and sexual dysfunction among postmenopausal women in Iran

Masoumeh Simbar

Background an d Aim : Several factors can affect the sexual function of women. The aim of this study was to determine the correlation between exercise and sexual function in post-menopausal women.

Materials and Methods : This was a community-based, descriptive-analytical study including 405 post-menopausal women 40-65 years old selected by multi-stage stratified random sampling . The data were obtained through interviews using the Female Sexual Function Index (FSFI) and a researcher-made questionnaire. The data were analyzed using descriptive and analytical tests such as multiple linear regression and logistic regression models .

Results : On the whole, 61% of the subjects had sexual dysfunction. The most common type of exercise was “walking” (79.8%). For the women who exercised, the mean score in the domain of pain was significantly lower (worse) (p=0.013). The total FSFI, lubrication and pain domains scores were significantly lower in the women who did exercises other than walking as compared to those who did not exercise or practiced only walking. The weekly exercise frequency had positive correlations with lubrication (r=0.18, p=0.014) and orgasm (r=0.146, p=0.045) domain scores. However, multiple regression analysis to determine predictors of total score of FSFI and the domains scores did not give any statistically significant results. Finally, the logistic regression test showed that one additional exercise session per week would result in reduction of chances of sexual dysfunction by 80.2%.

Conclusion : Based on the findings, it may be concluded that exercise can be a w ay to compensate for sexual problems and dissatisfactions caused by reduced sex and sexuality in post-menopausal women. Exercising more frequently during the week could have positive effects on the sexual function of post-menopausal women.

Quality of life and its association with overweight and obesity in high school girls

Ahmadreza Dorosti motlagh

Background an d Aim : Overweight and obesity are one of the most serious health and social problems in the world today. The fact that obesity is highly prevalent among adolescents is particularly alarming, considering that the disease has many undesirable physical and mental consequences. This study examined the relationship between overweight and obesity and the quality of life.

Materials and Methods : A total of 400 high school girl-students, selected by the two-stage cluster sampling, completed the demographic and sf-36 quality of life questionnaires. Their weights and heights were measured using the Seca scale (precision 100 g) and non-elastic tape (precision 0.5 cm) by the researcher, respectively.

Results : The prevalence of overweight and obesity in the sample was 21.8%. The mean scores of general health, physical health, physical limitations, and social functioning were significantly lower among overweight and obese, as compared to normal, subjects. Dissatisfaction with physical fitness, not living with both parents, poor economic conditions and skipping breakfast were factors associated with a lower quality of life.

Conclusion : Considering the high prevalence of overweight and obesity among high school girls and their significant correlations with the physical dimensions of quality of life, attention to obesity as a major health and social problem on the part of health planners and policy-makers is of utmost importance.

Stigma and Gender Identity Disorder Impacts and Outcomes

Fardin Alikhah

Background an d Aim : Most people have behaviors appropriate for their biological sex . However, there are also people who have behaviors of the opposite sex . The latter group is known as transsexual, which means that they have a sense of intense conflict between gender and sex. As a result of social changes in Iran in recent decades, the presence and appearance of these people in public life and the media environment has increased. The emphasis in this paper is on the fact that identification of a person/group as a deviant may pave the way for gravitation of that person/group to deviant behaviors.

Materials and Methods : This was a qualitative study. The sampling method was cumulative and the d ata were collected by interviewing, participatory observation, and in-depth interviews and analyzed thematically .

Results : The findings show that transsexuals suffer a mental adversity when hide their true identity and are exposed to stigma when reveal their desired identity. The stigmatization is in such a way that a transsexual gradually accepts stigma and gravitates to deviant position and roles.

Conclusion : The main impacts of a successful stigma would be the continuation and expansion of deviant behaviors among transsexuals. Promoting public awareness can help in decreasing and preventing individual and social harms resulting from an unreasonable attitude towards this phenomenon by the people.

Trend of exposure to carbon monoxide in Tehran taxi drivers during one year

Jamaleddin Shahtaheri

Background and Aim: Motor vehicles are an absolute necessity used extensively in all countries of the world. They are a major cause of air pollution with highly undesirable consequences. Thus, exposure to traffic pollution is a growing public health concern. Several studies indicate that people in the cabin of a vehicle inhale air with high concentrations of pollutants such as nitrogen oxides(NOx), particulate matter (PM), volatile compounds (VOCs) and carbon monoxide (CO).

Materials and Methods: Eexposure of drivers inside motor vehicles to CO was assessed during one year in Tehran, Iran. For this purpose, the concentration of CO was measured in the breathing zone of 72 male taxi drivers using a portable real-time instrument equipped with electrochemical sensors. In addition, records of fixed air pollution monitoring stations in Tehran were examined and the CO concentration in those records were compared with those measured in the taxis.

Results: The mean in-vehicle CO concentration was 19.91 ± 4.37ppm, while records of fixed air pollution monitoring stations showed the concentration of this pollutant in the air to be 3.69 ± 1.03ppm.

Conclusion: It can be concluded that factors such as traffic density, weather conditions and vehicles lifespan affect the extent of exposure of taxi drivers to carbon monoxide.

Application of an ion imprinted polymer for development of cadmium biological monitoring in an automobile industry

Seyed Jamaleddin Shahtaheri

Background and Aim: Exposure to heavy metals always causes serious health problems in people working in the industry. Heavy metals may interfere with enzyme functioning or accumulate in specific body organs, leading to various health problems. Cadmium is a toxic heavy metal widely used in various industries and, therefore, workers in metal industries are at risk of exposure to it.

Materials and Methods: A solid-phase sorbent was synthesized and factors influencing its sorption and elution steps were optimized (R>95%). The validated sorbent (chemically, physically and as regards reproducibility) was used to determine the cadmium content of the worker`s urines.

Results: Optimized conditions for sorption and elution step were found to be as follows: pH= 7 sorption and elution time (both)= 5 min elution volume= 6 mL, and elution concentration= 2 mol L^-1. The great selectivity and the nano-particle size of the sorbent resulted in its highly precise performance (0.6ppb) and high validity and accuracy (CV<3%).

Conclusion: Using the nano-magnetic sorbent technique and some such laboratory methods as flame atomic absorption spectroscopy, one can easily measure trace amounts of heavy metals in urine. This technique is relatively less expensive and rapid since, when using it, one can omit the filtration and centrifugation steps.

Association between air pollution and hospital admissions of respiratory disease patients in Tabriz, Iran using the neural network model

Mohammad Shakerkhatibi

Background and Aim: A ssociations between air pollution and morbidity have been reported in several studies. Due to limited publications in the literature for Iran, this study aimed to determine the association between air pollution and hospital admissions of respiratory disease patients in Tabriz, Iran.

Materials and Methods: The methodology used in this study was case -crossover and the artificial neural network model. The variables of the model included air quality, hospital admission and air pollutants. Daily hospital admission data were collected from five hospitals in Tabriz, Iran based on the International Classification of Diseases (ICD-10) , air quality data including NO₂, SO₂, CO, PM₁₀ and O₃ from the six fixed online air quality monitoring stations, and the daily mean temperature and relative humidity data for the same period from the East Azerbaijan Meteorological Bureau.

Results : P articulate matter with a median aerometric diameter <10 μm (PM₁₀) was found to be the most important pollutant affecting respiratory hospital admissions. The ANNs data showed that the most important causes of hospital admissions were for COPD NO₂, NO and CO, for respiratory infections PM_10,and for asthma PM₁₀, O₃ and CO. The highest associations were observed between hospital admissions due to COPD and asthma in females and those due to respiratory infections in males. The elderly (individuals over 65 years old) were at the highest risk.

Conclusion: The results show a significant relation between air pollutants and respiratory hospital admissions in Tabriz, Iran. The importance and necessity of enforcement of existing regulations and enacting laws to prevent and control the adverse health effects of air pollution are confirmed.

The effects of endurance training and high intensity interval training on orexin-A and anthropometric parameters in obese adolescent boys

Mohammad reza asad

Background and Aim: Considering the uncertainties about associations between orexin-A and obesity, the present study was conducted to determine the effects of 8 weeks of endurance training and high intensity interval training ( HIIT) on plasma levels of orexin-A and some anthropometric parameters in obese adolescent boys.

Materials and methods: In this semi-experimental project 35 healthy, inactive and obese boys (mean age 15.5±0.69 years, mean body mass index (BMI) = 28.72±2.20, equal to or higher than the 95^th percentile) were randomly divided into three groups of equal numbers, namely, control, endurance training, and HIIT. The endurance training and the HIIT group participated in eight weeks of endurance training (25-40 minutes running per day, with an intensity 65-85% Heart Rate Reserve) and eight weeks of HIIT (30 seconds running with an intensity 90-95% Heart Rate reserve, 4-7 repetitions a day and two minutes of a rest interval with 50-55% Heart Rate reserve), three days per week, respectively. Plasma levels of orexin A, anthropometric measurements (waist-to-hip ratio, body fat percentage and body mass index) and VO2 max were determined before and 48 hours after the last session of the training. Data were analyzed and are reported as mean ± SD using repeated measure ANOVA (p < 0.05).

Results : Despite a decreasing trend in the plasma orexin-A level in the control and HIIT groups and its rising trend in the endurance training group, no statistically significant differences were observed between the control and experimental groups (P>0.05). However, HIIT and endurance training caused significant reductions in the anthropometric parameters such as body fat percentage (8.7%, 9.7%), body mass index (1.6%, 1.9%) and waist to hip ratio (2.7%, 2.9%), accompanied by a significant increase in the VO2 max (6.7%, 10.9%) (p<0.05).

Conclusion: Endurance training is more effective than HIIT as regards improvement in body composition of obese adolescent boys, although the changes may not be in line with changes occurring in plasma orexin-A levels. It is recommended that more studies be conducted in this area, controlling sleep, nutrition and changes due to puberty, and with longer durations of exercise.