Journal of School of Public Health and

  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.

  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.

  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.

  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.

  Background and Aim : The National Malaria Control Program was developed, in 2011, into the National Malaria Surveillance Program. It is one of the most comprehensive surveillance systems in Iran. The aim of this study was to evaluate the impact of malaria elimination program on data quality and accuracy in the national malaria surveillance system.

  Materials and Methods : This was a cross-sectional study conducted in four malaria-prone provinces in Iran to determine and assess the completeness and accuracy of the information collected in the malaria surveillance system. The purpose was to compare data reporting forms 3 and 4 (reporting positive cases from selected district health centers) between two time points, namely, 2009-2010 (before starting the program) and 2010-2012 (after starting the program).

  Results: The total number of reporting forms included in the study was 1927, nearly 54% from the initial time point and the rest from the final time point. The highest and lowest proportions were 94.78% and 17.30% from Iranshahr and Hormozgan University health centers, respectively. On the whole, the degree of completeness of the forms was 84% (83.7% and 85% before and after starting the program, respectively). Based on the Chi-square test, the differences were not statistically significant.

  Conclusion: Only a minor change occurred in the degree of completeness of the forms between the two time points: a 4% increase in form 4 and a 3% decrease in form 3. It can be concluded, then, that the elimination program h ad no significant effect on the completeness and accuracy of the reporting forms.

  Background and Aim : Milk and dairy products provide more than 50% of the calcium requirement in the daily diet of Iranians. In order to promote adolescents’ health and prevent the devastating effects of osteoporosis in adulthood, appropriate action should be taken to increase milk consumption among adolescents. The objective of this study was to increase milk and dairy products consumption among eighth-grade girl-pupils in Kamyaran City, Iran through designing and implementing an educational program based on the theory of planned behavior (TPB).

  Materials and Methods : This was a quasi-experimental study conducted in 2014, including a total of 168 eighth-grade girl-pupils from two (out of six) schools, one as the intervention and the other as the control group, selected randomly by cluster sampling. The intervention group received education in 4 sessions, the educational tools being a pamphlet and a poster. Data were collected on the TPB constructs, food intake (by 24-hour dietary recall), and frequency of milk and dairy product intakes during the previous 3 days. All the participants completed the questionnaires at the beginning and 3 months after the intervention. The data were analyzed using the SPSS-18 software, the statistical tests being chi-square, independent-t and paired t-tests.

  Results : The intervention brought about statistically significant increases in the mean scores of behavior intention, attitude, subjective norms, and perceived behavioral control (p<0/001). In addition, an increase was observed in the frequency of milk and dairy product intake, which was 0.36 units per day initially (p<0/001).

  Conclusion : Considering the effectiveness and low cost of this intervention, expanding this program can potentially lead to a rise in milk and dairy products consumption among the pupils.

  Background and Aim: Nutritional knowledge acquired by young girls as would-be mothers will play an important role in children’s and family health protection and promotion in the future. The purpose of this study was to determine the effects of an educational program based on the BASNEF model on the nutritional behavior among guidance school first-grade female-students.

  Materials and Method: This was an interventional study carried out in the form of a clinical trial including 160 female-pupils divided into two groups ─ a case and a control group ─ randomly selected by two-stage sampling, namely, classification and cluster sampling. The data gathering tool was a questionnaire. Education about healthy nutrition was imparted to the case group in 4 60-minute sessions in the form of lectures, group discussions, and question-answer in addition, pamphlets were distributed among the subjects. Data were collected and analyzed using the SPSS-18 software, the statistical tests being Chi-square, fisher , independent and paired t-tests.

  Results: The data showed that the mean scores of knowledge and BASNEF model components as regards nutritional behavior increased after the intervention in the case, they being higher significantly in the case group as compared to the controls. The most important subjective norms after the intervention were the pupils’ parents .

  Conclusions : The findings indicate that a 3-month educational intervention based on the BASNEF model can bring about desirable changes in some of the undesirable nutritional behaviors in guidance school pupils, and that designing and implementing interventions of this kind, with the support of health and school authorities, is quite feasible.

  Background and Aim: Xylanases are widely used in various food industries, including livestock and poultry feed industries, the pulp and paper industry, as well as the pharmaceutical industry. Several strains of microorganisms are capable of producing this enzyme by different mechanisms, Bacilliaceae being one of its important sources at the commercial scale. The culture medium for xylan is expensive and, therefore, it is not economical to use in producing xylanase by Bacillus subtilis S7e. The purpose of this study was to explore the possibility of using industrial-agricultural wastes as a source of carbon and nitrogen in submerged fermentation, for producing xylanase in amounts higher than that which can be produced by xylan culture (10048 U/).

  Materials and methods: The indigenous strain of Bacillus subtilis S7e was cultured in the xylan medium, followed by incubation at 30°, 37° and 40° C. Then the nitrogen sources (rapeseed meal, soybean meal, tomato seeds, tea seeds, peptone, Vinas alcohol, casein, and ammonium sulfate) and carbon sources (molasses, wheat bran, rice bran, rice industry waste, gluten waste, malt waste, whey powder, and bagasse) were substituted for the meat and yeast extracts and the xylan culture medium, respectively.

  Results : The maximum enzyme activity was observed at 30° C after 48 hours of incubation (6183U/l). Rapeseed meal with an enzyme activity of 10048U/l and molasses with an enzyme activity of 3759U/l were found to be the best nitrogen and carbon sources for Bacillus subtilis S7e , respectively.

  Conclusion: Based on the findings of this study, f rom an economic point of view, agricultural-industrial wastes (rapeseed meal and molasses) are an excellent substitute for the more expensive culture media currently in use for producing the enzyme xylanase.

  Background and Aim : Asymptomatic malaria is a great challenge in the control, elimination and eradication programs of the disease in the endemic areas. The infected individuals with asymptomatic malaria are not cured and are, consequently, a potential source for contamination of the mosquito vectors and spread of the disease in the area. Therefore, detection of asymptomatic infected people is very important as regards combating the disease. This study was conducted to determine the presence and prevalence of asymptomatic malaria in Jask district, Hormozgan Province, Iran during 2012-13, in the hope that the results will help in designing strategies to eliminate the disease in the area.

  Materials and Methods: A total of 200 persons under coverage of health centers in Jask district were selected randomly and enrolled in the study. From each subject a 5-ml blood sample was taken in 3 occasions (total number of samples = 600), slides p repared and examined using microscopic and molecular (PCR) methods, as well as rapid diagnostic (RDT) tests.

  Results: None of the 600 slides prepared microscopically showed any positive malaria case. Neither did any of those prepared by RDTs or Nested-PCR.

  Conclusion : The findings of this study indicate that implementation of the malaria control program has been successful in the area therefore the malaria elimination program should continue.

Background and Aim: Overcoming barriers of living with type-2 diabetes mellitus is a challenge in line with empowering patients for a well-managed life. This study was conducted to determine the effect of an educational intervention based on the BASNEF model on the living barriers among type-2 diabetes patients and factors affecting it.

Materials and Methods: This study, conducted in 2014, was a quasi-experimental intervention including a total of  90 type-2 diabetes patients under coverage of South of Tehran Health Centers, randomly divided, after a pre-test, into 2 groups ─ an experimental and a control (comparison) group. Based on the information obtained through the pre-test, a one-month education was imparted at the experimental group in 6 sessions the control group received no education. The educational contents included, based on the BASNEF model constructs, diabetes as a disease and its cardiovascular complications, healthy nutrition, physical activity, methods of self-monitoring blood glucose control, and ways of communication with the health personnel and physicians.

Results: The findings showed significant differences between the mean scores of constructs of the BASNEF model (beliefs, attitudes, subjective norm, enabling factors) and constructs of barriers of living with diabetes (diagnosis, treatment, self-monitoring, communication with health professionals) in both the experimental and control groups before and after the intervention (p<0.0001).

Conclusion: The findings of this study show the necessity of educating type-2 diabetes patients aiming at reducing barriers to living with the disease. The BASNEF model is one of the applicable theories that can be used to this end.

Background and Aim: Malfunction in the energy homeostasis central system resulting from melanocortin receptor 4 (MC4R) mutations is considered to be an important factor in development of obesity. Although physical activity can weaken the effect of obesity-related genes, very few investigations have been carried out in relation to the MC4R gene. This study was conducted to investigate the association between physical activity and body mass index (BMI) in different MC4R genotypes (rs17782313).

Materials and Methods: A sample of 400 individuals was randomly selected from among subjects participating in the Iranian Multicenter Osteoporosis Study (IMOS). Their weights and heights were measured and their dietary intakes and physical activity data assessed using validated questionnaires. In addition, the different MC4R genotypes (rs17782313) were determined in the subjects by the PCR-RFLP method. Finally, using the adjusted multiple linear regression model, the probable effect of physical activity on BMI in different MC4R polymorphisms (rs17782313) was determined.

Results: Only in individuals with the CT genotype was a statistically significant association (p<0.05) observed between body mass index and physical activity (hr/d and METs-hr/wk).

Conclusions: Physical activity, particularly in heterozygous MC4R polymorphism individuals (rs17782313), can play an effective role in reducing body mass index.

Background and Aim: Considering the ongoing national malaria elimination program in Iran, establishing a bank of human Plasmodium genes and proteins can be very useful for research purposes. This study was conducted to collect some of the native isolates of human Plasmodia from endemic areas in the country.

Materials and Methods: A 2ml vein-punctured blood sample was prepared from each confirmed malaria case. The samples were dispensed in EDTA pre-dosed tubes and cryopreserved for further tests. Moreover, relevant Geimsa-stained thick and thin blood smears were kept in a safe place. Tests for genetic indicators of MSP-1 was performed for each of the P. vivax samples with the RFLP-PCR techniques. In addition, an in vivo drug sensitivity test was performed for each P. falciparum case. Collecting and cryopreserving samples will continue.

Results: A total of 131 samples, including 109, 19 and 3 P. vivax, P. falciparum and mixed samples, respectively, were preserved with relevant data such as species, parasitaemia and nationality of the donor. MSP-1 gene classification resulted in three different haplotypes including Hap.1, Hap.2 and Hap.3 with frequencies of 20.6%, 41.2% and 38.2%, respectively. The In vivo drug sensitivity tests on P. facilparum isolates showed that all of the isolates were sensitive to the current drug of choice, namely, a combination of artesunate and fansidar.

Conclusion: This study resulted in the preservation of considerable amounts of P. vivax and P. falciparum samples for further relevant studies and research purposes.

Background and Aim: Prenatal and neonatal care provides an opportunity for counseling, resulting in reduction of pregnancy-related and neonatal complications. It is expected that such care would result in promoting the health status of these vulnerable groups and improving the relevant indicators.

Materials and Methods: This was a cross-sectional survey including 668 mothers and 2-month-old children. Data were collected using questionnaires and structured interviews.

Results: On the whole, 35.9%, 21.0% and 5.1% of the mothers reported, at least, one pregnancy, one complication, and one neonatal complication, respectively. Results of the logistic regression model showed that the odds ratio of reporting at least one of the pregnancy complications increased by more than double in women who had a medical history or a high-risk pregnancy, increase decreased by 63% in those who had continuous care during pregnancy, decreased by 40% in those who had received thorough prenatal care, and increased by 0.05% for every unit increase in age. The odds ratio of reporting at least one postpartum complication increased by 70% per unit of in the density of health workers. Moreover, the odds ratio of reporting at least one neonatal complication decreased by 48% in women who had received full neonatal care and by 50% per every unit of increase in the density of health workers.

Conclusion: The findings of this study show the important role of behvarzes (community health workers) in detecting postpartum and neonatal complications, as well as the importance of antenatal care and quality of antenatal care as regards detecting at-risk women and neonates and prevention of pregnancy and antenatal complications.

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.                 

Background and Aim: Diabetes mellitus is one of the most common medical problems in pregnant women. Nutrition plays an important role in the prevention and control of this disease. Some studies have found a relationship between gestational diabetes mellitus (GDM) and food insecurity. The objective of this study was to investigate the association between food insecurity and GDM.

Material and Methods: : This case-control study included 274 pregnant women (137 GDM cases and 137 healthy controls) selected by convenience sampling. Data on the subjects’ food insecurity, demographic features and physical activity (MET) were collected by interviewing and their heights and weights measured. For the analysis of the data, the Chi-square test, independent sample t-test and multivariate and univariate logistic regression tests were used, the statistical software being SPSS 16.0.

Results: On the whole, 18.2% and 21.9% of the women in the case and control groups suffered from food insecurity, respectively. There were statistically significant differences between the case and control groups with regard to a previous history of pregnancy, a family history of diabetes in the first and second degree relatives, and a history of giving birth to a baby weighing over 4 kgs.

Further analysis of the data showed a family history of diabetes mellitus and a low socio-economic status to be independent risk factors for GDB.

Conclusion: No statistically significant difference was observed between food insecurity of the women and gestational diabetes mellitus in this study. Despite this finding, considering that there are associations between food insecurity and other types of diabetes mellitus, we recommend further studies on this subject to be able to either accept or reject the hypothesis on the association between food insecurity and gestational diabetes mellitus.

Background and Aim: Malaria is still one of the major health problems in comparison with any other parasitic disease in Iran with considerable economic and mortality consequences. Sistan-and-Baluchestan, Hormozgan and Kerman are the most affected provinces in the country approximately 96% of the cases are reported from these three provinces. The aim of this study was to determine the frequency, distribution and rate of parasitaemia of human Plasmodium (P.) species in patients infected with malaria parasites in Kerman province.

Materials and Methods: A total of 92,798 peripheral blood smears were collected from suspected malaria patients during the period 2009-10. Thin and thick blood smears were prepared according to the World Health Organization (WHO) standard procedure. Percentage of parasitaemia was determined based on the number of parasites in the positive slides. The Chi-square test was used for data analysis.

Results: A total of 571 samples were found to contain human Plasmodium species, including 523, 44, and 4 cases of P. vivax, P. falciparum and mixed infection, respectively. The results also showed that, as compared with the previous year, the total number of P. vivax cases

decreased in 2010 by 33.96%. The highest level of parasitaemia was observed in one of the patients infected with P. falciparum, with 77240 parasites/µl of blood, and the lowest in a patient infected with P. vivax, with 48 parasites/µl of blood. There were no differences between the positive and negative cases as regards parameters such as nationality, habitat or gender (Chi-square, p<0.05).  Furthermore, based on the Mann-Whitney test, there was no significant difference between the mean counts of P. falciparum and P. vivax (p-value = 0.464).

Conclusion: Considering that Iran is in the elimination stage of malaria, patient finding and rapid, timely diagnosis of the disease are very important, particularly cases coming from Pakistan and Afghanistan, helping sustainability of the elimination program.

Background and Aim: Exercise is one of the major factors influencing health. Modern media such as   the Internet can play an important role in shaping an individual’s attitude towards physical exercise and behavior. This study aimed to identify priority of factors influencing use of the Internet to expand physical exercise in a university environment.

Materials and Methods: A 23-item questionnaire (Cronbach’s alpha = 0.98) was designed to test the effect of virtual environment on expanding physical exercise among the university staff, faculty and students (Likert scale; 1, fully disagree to 5, fully agree). A sample of 500 individuals were selected by cluster-sampling and completed the questionnaire.

Results: The data showed that, based on the Friedman test, priority factors were not similar among the different categories of university audiences (p<0/001). While among the students and the staff the communication network factor ranked first, with an average rank of 3.56 and 3.46, respectively, among the faculty members it was information that ranked first, with an average rank of 3.64. Further analysis of the data showed a statistically significant difference among the three groups of university audiences – students, faculty and staff – as regards the total score of cyberspace application in university sport (F= 9.776, p < 0.05). There was no difference between the two genders. (t=0.78, p<0.5).

Conclusion: The findings show that the Internet can be quite effective in expanding university sport. It can provide an appropriate tool or substrate for expanding physical exercise/sport due to its popularity among university audiences. Hence, it is essential that university sport managers and planners use this cyberspace substrate to expand university sport by adopting appropriate relevant strategies.

Background and Aim: Aspergillus arasiticus species can contaminate agricultural products both on the farm and in storage in tropical regions. In recent years much research has been conducted on extracts of, and chemical compounds derived from, plants to be used potentially to reduce growth of toxin-producing microorganisms. Not much information is available in this area, so this study was conducted to determine the antifungal effect of Pistacia Atlantica subsp. Kurdica on the growth of Aspergillus parasiticus.

Materials and Methods: According to the microdilution method, based on the latest version of the Clinical Laboratory and Standards Institute (CLSI) Document M27-A3, modified M38-A2 protocol, minimum inhibitory concentration (MIC) at different concentrations of Pistacia Atlantica subsp. Kurdica against the standard parasiticus species (ATCC15517) was determined.

Results: Pistacia Atlantica subsp. Kurdica could inhibit growth of Aspergillus parasiticus; the minimum concentration with an inhibitory effect on the growth of the fungus was 125mg/ml.

Conclusion: The Pistacia Atlantica subsp. Kurdica can potentially have a pronounced growth-inhibiting effect on A. Parasiticus. It is recommended to conduct more studies in this area to getinformation on expression of genes involved in the phenomenon.

Background and Aim: Nowadays, in health promotion and disease prevention great emphasis is put on participatory community-based approaches. These approaches are considered as the main strategy of health promotion by using multiple interventions. Community assessment is a participatory research approach in which problems prioritization and resource distribution are done using information collected in a region aiming at promoting health of the community.

Materials and Methods: In this applied research community assessment was made in the Chahestaniha region in the City of BandarAbbas with the objective of identifying and prioritizing the main problems. The assessment consisted of eight phases, namely, the formation of a community assessment team, Primary and secondary data collection, data analysis and interpretation, combining district-level health statistics with community assessment data, reporting to the community, prioritizing health problems, and prepared a community assessment document.  In the eighth phase, after considering all risk factors that cause high prevalence of Children head lice, the action plan was designed and implemented to solve the problems.

Results: The Chahestaniha community assessment led to identifying 52 problems. The priority problems were classified. High prevalence of lice on children’s head was chosen as the top major problem to be solved, an action plan for solving it was developed and implemented.

Conclusion: The full cycle of community assessment methodology can be applied, with only some small changes, in most communities with different sizes, cultures, traditions and social habits. The method can obtain participation of the people in conducting the study and implementing interventions.

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.