Journal of School of Public Health and

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A community-based rubella serological survey of 795 individuals selected by cluster sampling technique from rural areas of Ourmia ,the center of West Azerbaijan province located in the northwestern Iran , was carried out from December 2001 to March 2002. The aims of the study were to characterize rubella epidemiology in a representative non- immunized community in northwest Iran and also to determine national vaccination strategy against rubella. The survey comprised a seroprevalence study, with stratification by age (0-45 years) and sex. Sera from 392 female and 378 male were tested for rubella IgG antibody using enzyme linked immunosorbent assay (ELISA) technique. "Rubella seropositivity" was defined as serum rubella IgG antibody level > or =13 IU/ml. Of the 770 cases, 58.1% were seropositive. Due to mathernal derived antibodies, 100% of the newborns was seropositive. This figure decreased with time until it became zero by 9 months of age. Then from the age of 4y, it began to rise until it peaked at 93.4% in the age group of 15-19 years. Then the seropositivity decreased to 85.7% in the age group of >35 years. Of women in the reproductive age groups (15-45 years), 89.6% were seropositive. No statistically significant difference in seroprevalence was found between the two sexes. This small preliminary study indicates that like many other countries, rubella is endemic in Iran and eliminating rubella and congenital rubella syndrome in the country will require international efforts, including vaccination of preschool- and school-age children and all susceptible young adults.

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As adoptin and maintenance of healthy eating behaviours is an important factor for Ischemic Heart Disease (IHD) prevention , this research was conducted to determin dietetic risk factors in relation to IHD. This is a case – control study conducted in fall 2003 in Tehran Heart Center and Tehran Shahid Rajaii hospital. 100 subjects with IHD, as cases and 100 controls with no cardiovascular disease in their medical history, participated in the study.Nutritional data was collected by Food Frequencey Quastionnaire. Some important risk factors including hypertention, hyperlipidemia,diabetes, Body Mass Index (BMI) and physical activity were evaluated. There was a positive association between IHD and consumption of fats and a negative association between IHD and consumption of fruits and vegetables.The most important factors were low intake of fish and high intake of fried foods that increased the risk of disease 13.96 and 54.65 times, respectively. Also 73% of patients had high risk diet while only 17% of controls had high risk diet. High risk diet increased the risk of cardiovascular diseases approximately 20 times. The main dietetic risk factors in this study were : low intake of fish, fruits and vegetables and lower consumption of oiles while hydrogenated fats with undesirable trans-fatty acid content, were the main source of dietary fat, in case group. Therefore community-based educational programmes are nesseary to promote healty nutrition.

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Background and Aim: As the population of the world increases, it is essential that food production keep pace. It will be necessary not only to produce more food, but also to maintain this food so that it is safe and wholesome for human consumption. The purpose of this study was to investigate the rate of Coliform, Staphylococcus aureus, Mould, Yeast and other aerobic and mesophilic bacteria as contaminats of milk and milk products in Yazd province.
Material and Methods: In this study a total of 198 different samples including Milk (24.2%), Yoghurt (21.2%), Cream (12.1%), Cheese (18.2%), Ice cream (12.1%) and dairy powders (12.1%) were investigated by culture method and biochemical tests. Then obtained data were analyzed by SPSS and χ2 programs.
Results: On the basis of our findings, of the total samples, 136 cases (68.7%) were desirable, 48 cases (24.2%) acceptable and 14 cases (7.1%) undesrable. Microbial contaminants of undesrable samples were coliform (7.1%), Staphylococcus aureus (6.1%) and yeast (6.1%). Meanwhile, the results of χ2 Statistical analysis test, showed significant different between contamination rate and kind of Milk products (df = 5, χ2 = 17.75, P<0.005(.
Conclustion: It seems that despite the efforts, which have been done for prevention of food contamination in Yazd province, it is still considered as a threat for people Health.

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Background and Aim:  One of the biggest problems faced by parents of handicapped children is the child's health care. This study investigates patterns of heath care utilization and the related factors in children with mental impairment.

Material and Methods: This cross-sectional study involved 110 children (≤14 year old) with developmental disabilities in Tehran. Parents were selected by systematic random sampling for face-to-face interview.  Statistical analysis was based on negative binomial regression.

Results: Over 99% of the surveyed children received ambulatory care and 15 % had been hospitalized over the preceding year 0.9% had never used health services. These children had utilized health services 207+18 times in a year. Among these services 38+3 were not subsidized by the State. Factors affecting service utilization were parent information (p<0.033) and referral to the proper service delivery points (p<0.029).

Conclusion: Appropriate interventions are required to address the above-mentioned factors and improve service utilization.

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Background and Aim: Improvement of national and provincial health indices requires intersectoral collaboration and community participation So, National High Health and Food Security Council and Provincial Health and Food Security Councils (PHFSC) have been implemented since 2006. The main responsibilities of PHFSCs are, assessment of province health situation and effects of executive organizations on it's improvement, to define and approve the province health strategic plan, developing of AIDS and HIV prevention and control plan and resolving intersectoral issues of health. The goal of this study is first 3 years performance assessment of the PHFSCs.
Materials and Methods: This is a descriptive evaluation study which included all the PHFSCs. The outcome assessment indicators were determined by content analysis of "the approved tasks" and also "the essential aspects for promoting of PHFSCs" by focus group discussions. Situational analysis was provided by two researcher made questionnaires one for co Assessment of the contents of content analysis of PHFSCs all meetings minutes (from establishment year to the end of 2008) and another for gathering viewpoints of Secretaries of PHFSCs.
Results: Data analysis shows that the meeting's agendas of the PHFSCs have less followed the prioritized major health issues of provinces and national burden of diseases most issues were in the domain of ​​communicable disease control and non-communicable diseases risk factors control included scarcely. Only in two Universities of Medical Sciences (UMSc) province comprehensive health plan were proposed. None of the UMSc approved a secretariat for PHFSC in its organizational top chart. PHFSCs secretaries believed that, the main obstacles of the PHFSCs' successes, are weak financial resources, and lack of decisions executive enforcements.
Conclusion: PHFSCs performances are moderate and moderate to low due to lack of comprehensive strategic plan and no implementation model for intersectoral decisions, other organizations believe on the effectiveness of the PHFSCs less and the main burden of disease of the provinces not mostly included in the agenda of PHFSCs. Following proposals are highly recommended for PHFSCs promotion: training and empowerment of UMSc and organizations for developing comprehensive health plan in the province and defining the responsibilities of each organizations for, determining policy priorities of common health issues of the provinces by High Health and Food Security Council and publicizing them by the Ministry of Health and the other relevant ministries and approving the structure and working system of the PHFSC secretariat in UMS by the Board of Trustees of UMS.

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  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 .

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Background and Aim: The Pars Energy-Economic Special Zone, as the energy capital of Iran, needs a healthy productive workforce. In order to be able to promote equitable health indicators of the Zone, it is essential to first obtain information about the situation of the health system in the region.

Material and Methods: This was a cross-sectional qualitative study. Data were collected using an essential public health services (EPHS) performance assessment questionnaire and a researcher-developed questionnaire for strengths, weaknesses, opportunities and threats (SWOT) analysis of the Zone health system. In the next phase, stakeholder analysis was done:  the major stakeholders were invited and asked, after explaining the methodology to them, to complete, individually, the EPHS performance assessment and the SWOT analysis questionnaires, followed by grouping and summarizing the results. Finally, content analysis of results of the group discussions was done and the main domainsا extracted.

Results: The EPHS overall average score was 37.8 (out of 100, the standard score). The greatest weakness was allocated to information functioning. Delivering public health services by the district health networks was the most important strength. Further analysis of the data showed that the far external environment in all the subdomains was the major threat to the public health in the zone.

Conclusion: Based on the findings, it can be said that the organizational status of the Zone is in a weak and threat position. One of the root causes is poor functioning of the public health system. It is essential that the Ministry of Petroleum and the Ministry of Health and Medical Education find effective ways for integrated leadership of the public health services in the Zone.                 

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Background and Aim: One of the main functions of municipalities, as a social institution, is providing, maintaining and improving health of citizens. Scattered attempts have been made with the objective of expanding equitable health service networks in cities, particularly suburban areas. The present study aimed at designing an integrated system for urban health managent center.

Material and Methods: This was a descriptive-analytical study. Based on the viewpoints of experts and relevant stakeholders, global evidence, national experience, and existing legislations, a conceptual framework for designing an urban health management center was developed and requirements for its implementation were determined. On the basis of the conceptual framework, regulations for designing model for a regional urban health management center (RUHMC) was prepared.

Results: The proposed model has 5 important characteristics which would provide an excellent opportunity as a response to the existing challenges of the health network in cities through active participation of the municipality, as a social institution, and other organizations:

                    1. Facilitating intersectoral collaboration, as against individual movements of the

 governmental health sector;   

2.   Defining and providing social health services and influencing the social determinants of health components;

3.   Providing active, rather than passive, services;

4.   Decentralization by forming a board of trustees and/or coordination council;

5.   Direct community participation in all phases, from decision-making (membership in the coordination council) to service provision.

Conclusion: Pilot implementation and evaluation of the proposed RUHMC model is recommended before expanding it to other parts of the city. In addition, it is essential that, before expanding the model to the other cities, the final regulations be examined and ratified by the High Council of Health and Food Security.

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Background and Aim: Considering the key role of the Ministry of Health and Medical Education (MOHME) in the implementation and follow-up of the health system reform, its organizational culture can play an important role in the success of this transformation. The aim of this study was to determine the dimensions and orientations of the current organizational culture of the MOHME headquarters.

Materials and Methods: This was a cross-sectional descriptive and explorative study. The study population was the central staff of MOHME. Data were collected using a questionnaire and analyzed by SPSS version 11.5. Descriptive statistical methods (mean, standard deviation, coefficient of variation and interval) were used to describe quantitatively the cultural dimensions, followed by a qualitative analysis as well.

Results: Analysis of the data showed the following: 1. Organizational cultural dimensions existing at a high level include self-supervision and identity; 2. Organizational cultural dimensions existing at a moderate level include authority and freedom in operations, clear goals and expectations, communication, coordination and coherence; and 3. Organizational cultural dimensions existing at a low level include innovation, learning, fair reward system, acceptance of change, management support and criticism.

Conclusion:  Considering the key role of the MOHME headquarters staff in designing and implementing health promotion programs, bringing about changes in the organizational culture should be a top priority of the ministerial high authorities.

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Background and Aim: For achievement of equity in the population health the implementation of health in all policies is essential. The most crucial intervention in this approach is inter-sectoral collaboration.
 Materials and Methods: This was a qualitative study based on the national policy framework. Data were collected using literature review, in-depth interviews and focus group discussions with the stakeholders. The results were categorized into three sections, namely, situational analysis and factors affecting it, developing goals and objectives, and requirements and interventions.
 Results: Currently inter-sectoral collaboration in the Iranian health system potentially allows to have health in all policies policy in terms of explicit legislative support, national macro-policies/upstream documents and organizational structure. It will require proper planning as regards designing and institutionalizing appropriate mechanisms for collaboration, as well as cultural and skills capacity building, for stakeholders within and outside the health sector.
Conclusion: The findings of this study can be used in annual operational planning of the High Council of Health and Food Security secretariat.