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

Health System Governance in Iran: A Delphi Study

Parisa Rahimitabar

Background and Aim: Good governance results in better health outcomes for the society thorugh improving health system performance. The governance of Iran health stsyem faces some challenges. Hence, this study aimed to propose and verify a model for strengthening Iranian health system governance.
Materials and Methods: This descriptive study was conducted in 2016 using the Delphi method. A health governance model with six dimentions including sturucture, communication, regulation, policy making and planning, stewardship and evaluation and accreditation has been proposed. Then, the proposed model verified using 25 Iranian healthcare experts’ opinions in two rounds.
Results: Developing an integrated health system model comprising health system enablers and results, downsizing and reducing the number of directorates in ministry of health,determining basic principles for regulation, enhancing communication with other external organizations affecting people health, using more evidence in policy making and planning, developing a strategic plan and national health policy, enhancing leadership, management and stewardship; and developing comprehensive systemic standards for evaluation and accreditation of healthcare organizations are recommended to enhance the effectiveness and efficiency of Iran health system governance.
Conclusion: Iran health system governance faces numerous challenges. Using successful countries’ experience and internal health care experts’ opinions help to reduce the current challenges and achieve health system goals.

Utilization of Inpatient Services by Older People in Iran and its Determinants

Maria Mohammadi

Background and Aim: Iran is experiencing a very fast population ageing, ranking 3^rd globally in terms of pace of population ageing. The increase in the elderly population has been accompanied by an increase in demand for health services. A knowledge and understanding of the utilization of health services by the elderly are essential for resource allocation and health planning. This study aimed to investigate the utilization of in-patient services by the Iranian elderly and explore its determinants.
Materials and Methods: This study was a secondary analysis of the data of a cross-sectional National Study on the Utilization of Health Services in Iran, including 22470 households across the country. The study population was people aged 60 years and over, the sample size being 8205 individuals selected by stratified random sampling from provinces, towns and villages. A questionnaire was used to collect information on the need of the individuals to hospitalized services during the last one year and receiving the required services and analyzed using multilevel logistic regression to identify the factors related to the utilization of inpatient health services.
Results: Of the 8205 participants, 1411 (17%) reported that they needed in-patient services at least once during the previous year, about 93% of whom referred to a hospital, of whom about 1288 (97%) finally had finally received the required services. The factors related to inpatient service utilization were age (p=0.03) and having insurance status (p<0.001), such that the older individuals and those with no insurance, although they had higher inpatient service needs, received less services. The most important cause of dissatisfaction in the towns was related to the behavior of nurses and non-physician personnel and in villages long waiting time for receiving a service. Finally, the most important causes being not willing to be hospitalized were the high service cost and no health insurance coverage.
Conclusion: The older people and those with no insurance should be priority groups in health service utilization policy-making and planning, so that they can access and receive better services. The causes of low inpatient service utilization and dissatisfaction should be taken into consideration seriously by health service providers and managers.

The Frequency of Salmonella Serotypes in Pasteurized and Unpasteurized Creams Offered in Local Markets and Their Antibiotic Resistance Patterns

Mo0hammad Mehdi Soltan Dallal

Background and Aim: Salmonella species is one of the important pathogens causing food poisoning and gastroenteritis. The aim of the present study was to assess the quality of traditional creams as regards bacterial contamination.
Materials and Methods: This was a cross-sectional study including a total of 250 traditional cream and 50 pasteurized cream samples collected in the south of Tehran retail shops. The samples were diluted in a phosphate-buffered saline, transferred to a rappaport-vassiliadis salmonella (rvs) enrichment broth according to the CDC procedures and incubated at 37° C in Hektoen enteric agar and bismuth sulfite agar media for 24 hours. Antimicrobial susceptibility testing was done using the Clinical and Laboratory Standards Institute (CLSI) procedures. On the following day the suspected colonies were examined for phenotype and finally confirmed by the API 20 E test.
Results: Of the 250 unpasteurized cream samples 15 (6%) were contaminated with Salmonella. Of the 7 serotypes identified, the most frequent Salmonella serotype was the infantis serotype with 7 cases (33.3%). Furthermore, Coliform bacteria such as Escherichia coli, Enterobacter, Klebsiella and Citrobacter were also isolated. The highest antibiotic resistance was to nalidixic acid (93.3%), tetracycline (73.3%) and trimethoprim (66.7%). None of the pasteurized cream samples was contaminated with Salmonella.
Conclusion: The results confirm the need for more effective control and monitoring of the traditionally prepared cream marketed in the city by the Food Control Authority. In addition, educating the public about the consumption of pasteurized cream can play a good role in reducing foodborne illnesses.

Assessment of Phytoremediation Potential of Alyssum Maritimum in Remediation of Lead-Contaminated Soils

Eisa Solgi

Background and Aim: Phytoremediation is a promising method for improving soils that can easily absorb heavy metals, resulting in decontamination of the soil. The objective of this study was to assess the phytoremediation potential of Alyssum maritimum in the remediation of lead-contaminated soil.
Materials and Methods: A randomized complete block design was used with five levels of lead (Pb) concentration (as lead nitrate) and Alyssum maritimum with six treatments in the research greenhouse of Malayer University, Malayer, Iran. After growth and flowering of the plant, lead concentration in its different organs was measured by atomic absorption spectrometry. The bioaccumulation factor (BCF) and the translocation factor (TF) were used to determine the potential of plant species selected for removing heavy metals from the soil in the environment.
Results: Analysis of the data showed that the highest accumulation of lead nitrate was in the leaf. It could be expected, then, that an increase in the concentration of Pb in the soil would result in the accumulation of Pb in the organs of Alyssum maritimum. Generally the degree of Pb accumulation in various plant organs followed the pattern: leaf > root > stem pattern. The BCF and TF indices of Alyssum maritimum species were greater than 1, which would indicate a high potential for transfer and accumulation of lead in the above-ground parts of the plant.
Conclusion: The selected plant species has, based on defined criteria for a heavy metal hyperaccumulator plant and its bioaccumulation factor and translocation factor values, a high potential for remediation of lead-contaminated soil and can be included in the group of hyperaccumulator plants.

Factors Influencing Domestic Violence Victims: A Case Study of Referrals to Herat Social Agencies in Herat, Afghanistan

Seyyed Mehdi Seyyed Zadehsani

Background and Aim: A person is more likely to become a violence victim in his/her family than outside the family. The purpose of this study was to investigate domestic violence, especially violence against women, in families in Herat Province, Afghanistan.

Materials and Methods: A total of 130 female victims referring to support centers in Herat, Afganistan were selected using the accessible sampling method. A researcher-developed questionnaire was used to collect data.

Results: No woman older than 40 years referred to the centers, and the age of 65.4% of those referring was below 30 years. The proportions of the women suffering from psychological, physical-plus-sexual and economic violence were 42%, 29% and 26%, respectively. In addition, 65.4% of them had been married for at most 5 years and only 10% had been married for over 10 years. Further analysis of the data showed that about 60% of the clients were illiterate and only 13.8% had a bachelor's degree; 72.3% of the victims were housewives and only about 21% had freelance or office jobs; more than 70.2% of the victims were at the lowest income level, and about 76.6% had married with their own accord. As regards the victims' spouses, 88.5% were under 40 years of age, 57.7% were illiterate and 29.2% were high school graduates. In terms of occupation, they were typically non-employed and had private jobs (13.8% workers, 22.3% farmers and 40.8% freelance). Furthermore, 95.4% had been married for the first time and 97.7% had one spouse. Finally, 83% of them (83.8%) were not addicts.

Conclusion: The most frequent complaints were related to psychological violence. Clients were typically under 40 years of age with a marriage history of less than 5 years. A typical victim in this study was a young illiterate woman who was financially weak; had a young, self-employed, low-educated spouse who had been married for the first time; had no other spouse; and was not a drug addict.

The Role of City of Darab Elementry School Teachers' Assessment of School Environment Health in Predicting Their Mental Health and Happiness

Amin Bagherikerachi

Background and Aim: This study investigated the role of teachers' assessment of school environment health in predicting their mental health and happiness.
Materials and Methods: This was a descriptive-correlational study. The statistical population was a group of 254 primary school teachers in the city of Darab, Iran, from whom a sample of 160 was selected by stratified sampling. Happiness and mental health were measured using the Oxford and Gildberg questionnaires, respectively, and teacher’s assessment of environmental health was determined using a researcher-made questionnaire, all the questionnaires being valid and reliable.
Results: On the whole, 57.23 %, 37.73% and 5.00% of the teachers judged the school environment health to be desirable, moderate and undesirable, respectively. As regards the teachers’ assessment of the school environmental heath, there were statistically significant differences between male and female teachers, local and nonlocal teachers, their field of study (primary education and other fields), schools for boys and for girls, their previous knowledge of health, type of employment (life tenure versus others), and whether they were teaching in health promoting or ordinary schools (p<0.05). The teachers assessment of school environmental health was significantly correlated with happiness and mental health (p<0.0001); their assessment of environmental health could predict 19.8% of happiness changes and 10.2% of mental health changes.
Conclusion: Judgment of the school environment health by teachers as unfavorable would affect their happiness and mental health.

Health Literacy Skills Effective in Predicting Adoption of Osteoporosis Preventive Behaviors in High School Female Students

Leila Dehghankar

Background and aim: Health literacy can be one of the most important effective factors in the adoption of preventive behaviors of osteoporosis by raising awareness and understanding the benefits of diagnostic and preventive behaviors. The objective of this study was to determine the health literacy skills effective in predicting adoption of osteoporosis preventive behaviors in high school female students.
Materials and methods: This was a descriptive cross-sectional study including 375 high school girls in Qazvin, Iran, selected by multi-stage sampling. Data were collected using the standard Health Literacy Measure for Adolescents (HELMA) and the Preventive Behavior of Osteoporosis Measurement questionnaires. The data were analyzed using the statistical software SPSS-23, the tests being descriptive statistics, Spearman correlation coefficient and multiple regression analysis.
Results: Two of the eight components of health literacy, namely, understanding and communication, and two, namely usage of health information and calculation, were found to receive the highest and the lowest mean scores, respectively. The total scores of health literacy and the adoption of preventive behaviors of osteoporosis were 70.84±12.58 (out 100) and 22.43±5.60 (out of 36), respectively. Multiple regression analysis showed that the components of health literacy could predict 38.4% of the changes in the adoption of preventive behaviors of osteoporosis (R²= 0.384). The only other predictor of adoption of behavior was the usage of health information (P=0.001، β=0.044).
Conclusion: Based on the findings of this study, it is recommended to pay special attention, when developing educational programs for the prevention of osteoporosis in adolescents, to health literacy as a whole, especially the usage of health information component.

The Relationship Between Patient Care Tolerance and Coping with Stressful Situations Among Nurses

Mir Masoud Fatemi