Journal of School of Public Health and

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Background and Aim: Domestic violence against women is a major health problem, as well as a violation of human rights. It adversely affects the physical, mental, and social well being of women, families and communities. This phenomenon exists in all countries around the world. Although its prevalence, strength, types, effects, and risk factors are different, it is not limited to any geographical zone or distinct social class. This article presents the views of Tehrani couples and experts on underlying factors causing domestic violence against women in Iran and action to be taken for prevention.
Materials and Methods: This qualitative study was carried out through eight FGD meetings, in 2 days, with the participation of 50 couples. The couples were divided into 8 groups based on sex, education, and history of violence. Results of the FDGs were categorized and analyzed. Data were discussed in group meetings of 50 experts in different fields, such as health, medicine, law, education, and Islamic studies, from academic, policy making, governmental executive, and women's affairs organizations, divided into three groups of community general education and information dissemination, health system, and judiciary system. Results were discussed and finalized in a general meeting.
Results: The couples and experts identified underlying factors in 4 categories socio-cultural, economic, legal, and medical. Actions to be taken for prevention and control were believed to be educational, legal, and supporting services.
Conclusion: On the basis of the findings of this study, it was suggested that strategies/actions/services to solve the problem and reduce harm should include providing appropriate information and education for couples and the community emphasizing the health system responsibility empowering physicians and other health personnel to help women who are victims or susceptible to domestic violence legal transparency and reforms meeting legal needs law reinforcement and implementation providing safe shelters for victims and establishment of a national center for research and planning on violence.

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Background and Aim: The prevalence of congenital hypothyroidism (CH), one of the main causes of preventable mental handicap in neonates, is much higher in Iran than the global average.
The objective of this study was to identify risk factors for congenital hypothyroidism (CH) by using the screening program in Fars Province, Iran, during the period 2003-2006.

Methods and Materials: A case-control study was carried out, the samples being 126 cases and 401 controls. The neonates were those born between 2003 and 2006, under coverage of the National Congenital Hypothyroidism Program. The data were analyzed using the univariate and multivariate analysis tests.

Results: An increased risk for CH was detected in infants with consanguine parents, by a multivariate analysis test (odds ratio (OR) = 2.9, 95% confidence interval (CI):1.8-4.8). The test also confirmed previously reported statistically significant associations with additional birth defects OR = 2.2 (1-4.6), birth defects in first-degree relatives OR = 4.7 (1.6-4.8), female gender OR = 1.9 (1.1-3), and twin births. Although not significant, an increased risk for CH was observed among infants with gestational age<30 weeks (preterm delivery) (OR = 1.7(0.9-1.3)).

Conclusion: This study identified risk factors contributing to the etiology of CH. In particular, our results suggest a multifactorial origin of CH, in which both genetic and environmental factors play a role.

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Background and Aim: Anemia is an important public health problem in Iran. The most prevalent type (50%) is iron-deficiency anemia. Flour fortification with iron and folic acid is one of the main strategies usually adopted to combat anemia. Two pilot projects were conducted in 2 Iranian provinces: the first one in Bushehr in 2001 and the second one in Golestan in 2007. The present study was conducted in January 2009 to evaluate the process and determine the effectiveness of the flour fortification pilot project in the 2 provinces.

Materials and Methods: To evaluate the effectiveness of the project, blood hemoglobin and ferritin levels were measured in a sample population of child-bearing women aged 15-49 years in Bushehr Province (n=600) and Golestan Province (n=625), selected by multi-stage sampling before and after the intervention. For process evaluation, the iron content in samples of flour and bread made from the flour were measured in a descriptive study.

Results: We found similar trends in the indicators of anemia/iron deficiency among the women in Bushehr and Golestan provinces. The flour fortification project appears to have had beneficial effects on the serum ferritin levels (low levels indicate iron deficiency) in both provinces. The prevalence of iron deficiency decreased from 22.2% to 15.7% (p<0.002) and from 26.7% to 14.6% (p<0.001), in Bushehr and Golestan, respectively. However, the prevalence of anemia was significantly higher after intervention in Golestan (p<0.001). Further analysis of the data also revealed that the intervention did not have any statistically significant effect on the prevalence of iron-deficiency anemia in either province. The coverages of fortified flour and bread were 90% and 98.7% in Bushehr and 94.1% and 95% in Golestan, respectively.

Conclusion: The flour fortification pilot project in Iran resulted in reducing prevalence of iron deficiency and improving body iron reserves in women, but it had no effect on anemia prevalence. It can be concluded that in circumstances where iron deficiency is not a major cause of anemia, interventions such as flour fortification with iron alone will not produce any significant effect.

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Background and Aim: Despite the fact that the proportion of youth population is very high in Iran, there is no well designed, comprehensive reproductive health program for the youth. This prompted the health planners to evaluate all the existing centers that deliver reproductive health services to the youth in the country in order to identify the weaknesses and strengths of the services and the centers.

Materials and Methods: A descriptive analytic study was conducted from March 2006 to March 2007, in coordination with the Vice-chancellor for Health of Universities of Medical Sciences, through Offices for Health of the Youth and Schools (OHYS). Five health centers, namely, Tehran, Semnan, Bam, Chabahar, and Fassa Health Centers (the only centers delivering reproductive health services to the youth) were included in the study. They were assessed for structure and physical facilities, job satisfaction of the personnel, satisfaction of the youth consulting them, and the services (including consultative services) delivered. The data were gathered through questionnaires using a checklist and analyzed by the SPSS-13 software.

Results: The health center personnel thought that the quality of services delivered at the centers was low. They also believed that the physical facilities, including equipment in the clinical examination room, furniture, cleanliness of the premises, and entertainment facilities, were not of an acceptable standard. About 64% of the personnel of the health centers personnel expressed job satisfaction. On the other hand, 39% of the young people consulting the centers expressed full, and 54% relative, satisfaction with the services they were receiving the remaining 7% were not content at all. The highest rate of satisfaction was with the psychologist, physician, and midwife, so that 95% of the clients recommended the centers to other young people seeking reproductive health services. Finally, the clients said that in most of the centers paramedical personnel, including nutrition officers (50%) and midwives with a Master's degree (17.5%), were insufficient.

Conclusion: It is suggested that a comprehensive service package be developed to be used in all the health centers, rather than each center deliver services based on the existing facilities and individual preferences. Such a package should be based on the national reproductive health programs (according to the medical education curricula). Intersectoral collaboration (particularly from the Ministry of Education and cultural organizations) is also very essential.

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Background and Aim: Priority setting is one of the most important issues in health research systems. No national health system can afford to finance all research projects proposed by researchers, especially in developing countries. Therefore, we decided to set the main national health research priorities in Iran using the Essential National Health Research (ENHR) method.

Materials and Methods: All of the Iranian universities of medical sciences and other stakeholders collaborated in this study. The methodology for research priority setting was based on needs assessment and ENHR. 

Results: The total number of research priorities gathered from universities of medical sciences was 6723. The proportions of topics related to basic science, applied and development subjects were 17%, 78% and 5%, respectively. Further analysis of the data showed that almost half (46.3%) of the research priorities were descriptive, 36.0% analytical, and 17.6% interventional. The research priorities were divided into 9 main areas, namely, communicable diseases, noncommunicable diseases, health system research, pharmaceutical sciences and industrial pharmacy, basic science, traditional and herbal medicine, nutrition, environmental health, and dentistry.

Conclusion: Up to now the common procedure for research priority setting has been, with a top-to-bottom approach, managed by a limited number of researchers and experts, while in the method presented in this paper a bottom-to-top approach is used, which is more effective.

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Background and Aim: Visceral leishmaniasis is a systemic parasitic disease with a high fatality rate in under-5-year-old children. The disease is endemic in some parts of Iran, particularly in the north-west region. In 2001 a visceral leishmaniasis (VL) surveillance system was established for children aged ≤ 12 years in the primary health system in Meshkin-Shahr District, Ardebil Province, situated in the north-west of Islamic Republic of Iran.

Materials and Methods: All cases with clinical signs and symptoms of VL and confirmed positive by the direct agglutination test (DAT) were referred for physical examination and treatment.

Results: The mean annual incidence of VL decreased significantly from 1.88 per 1000 children before (1985-2000), to 0.77 per 1000 child population after (2001-07), the intervention. In the control area with no surveillance, it increased from 0.11 to 0.23 per 1000.

Conclusion: Early detection of VL using serological tests and timely treatment of cases can decrease the mortality and morbidity rates of VL in endemic areas.

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Background and Aim: Iran National Polio Laboratory (NPL) is a member of the World Health Organization (WHO) Polio Laboratories Network. NPL receives stool specimens from acute flaccid paralysis (AFP) cases from all the provinces throughout Iran for poliovirus detection and identification. Furthermore, the NPL also detects non-polio enteroviruses (NPEVs) in these specimens.  Recently, NPEVs have come to be believed to be one of the most important causes of AFP following wild poliovirus.  This paper reports the prevalence of different types of NPEVs isolated from the specimens of AFP cases between 1995 and 2000.

Materials and Methods: Stool collection, virus detection and serotype identification were performed according to the WHO standard procedures.

Results: A total of 2180 stool specimens from AFP cases were received at the National Polio Laboratory. Coxsackie B viruse and echoviruses 6, 11, 7 and 13 had the highest frequency, identified in 23.7%, 14.4%, 12.7%, 11% and 10.2% of the NPEVs isolated from AFP cases, respectively. Four cases of echovirus 20 were identified, in 2 cases the patiets having died and in one the patient having been afflicted with residual paralysis. There have been no reports of death or residual paralysis (paralysis continuing after 60 days) due to echoviruse 20.

Conclusion:  Considering the upward trend of AFP cases in Iran, even after wild poliovirus eradication, studies are needed to determine the frequency and type identification of NPEVs and the relationship between NPEVs and residual paralysis in the post-eradication era (2000 onwards).

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Background and Aim: Mortality from cardiovascular and other chronic diseases has increased in Iran. Our aim was to estimate the effects of smoking and high systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC), and body mass index (BMI) on mortality and life expectancy, nationally and sub-nationally using representative data and comparable methods.

Materials and Methods: We used data from the Non-Communicable Disease Surveillance Survey to estimate means and standard deviations for the metabolic risk factors, nationally and by region. Lung cancer mortality was used to measure cumulative exposure to smoking. We used data from the death registration system to estimate age-, sex-, and disease-specific numbers of deaths in 2005, adjusted for incompleteness using demographic methods. We used systematic reviews and meta-analyses of epidemiologic studies to obtain the effect of risk factors on disease specific mortality. We estimated deaths and life expectancy loss attributable to risk factors using the comparative risk assessment framework.

Results: In 2005, high SBP was responsible for 41,000 (95% uncertainty interval: 38,000, 44,000) deaths in men and 39,000 (36,000, 42,000) deaths in women in Iran. High FPG, BMI, and TC were responsible for about one-third to one-half of deaths attributable to SBP in men and/or women. Smoking was responsible for 9,000 deaths among men and 2,000 among women. If SBP were reduced to optimal levels, life expectancy at birth would increase by 3.2 years (2.6, 3.9) and 4.1 years (3.2, 4.9) in men and women, respectively the life expectancy gains ranged from 1.1 to 1.8 years for TC, BMI, and FPG. SBP was also responsible for the largest number of deaths in every region, with age-standardized attributable mortality ranging from 257 to 333 deaths per 100,000 adults in different regions.

Conclusion: Management of blood pressure through diet, lifestyle, and pharmacological interventions should be a priority in Iran. Interventions for other metabolic risk factors and smoking can also improve population health.

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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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Introduction: Development of effective antiretroviral therapies (ART) has reduced mortality and increased life expectancy among individuals with HIV infection. Antiretroviral therapy regiments have improved symptoms and quality of life among these patients, whose sexual and reproductive needs, have, therefore, increased as well. In 2010, 20.8% of HIV-infected Iranians acquired the disease through sexual relations. The objective of this study was to define high-risk sexual behaviors among individuals infected with HIV referred to the Triangular Clinics of Universities of Medical Sciences in Tehran.

Materials and Methods: This cross-sectional interview-based survey included 400 HIV-positive individuals selected by consequential sampling.

Results: The majority (60%) of the subjects was males, and 44.2% of men and 51.3% of women with HIV were in the age group 34-25 years. On the whole, 15.6% of the women and 49.6% of the men had high-risk sexual behaviors after diagnosis of HIV infection. Further analysis of the data showed that 62.5%  of HIV-positive individuals were not aware of the risks of unsafe sexual relationship (using no condom) for HIV-positive transmission.. Based on the logistic regression module, it was found that factors strongly associated with high-risk sexual behavior were being male, being single, under high school diploma/graduate degree, alcohol intake and use of hormonal and permanent methods of family planning  (p<0.05).

Conclusion: The findings of this study confirm previous reports showing common high-risk sexual behaviour after diagnosis in HIV-positive populations. Providing suitable health services and advice on fertility and sexual health will result in no- or low-risk sexual life for couples.

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 Background and Aim: Definition of World Health Organization 1948 for Health includes social domain which two other domains of health, physical and mental, have counter effects on it. Quantity and quality of an individual relation to community in order to improve population welfare is a definition for social health. Social capital and security improvement and reduction of impoverishment and inequity is the impact of this relation and it's opposite side is increasing social problems. In this article, by reviewing social health situation of Iranian community and analysis of it's determinants, improvement strategies have been provided and role of Ministry of Health and Medical Education(MOHME) proposed.

 Materials and Methods : This is a descriptive and analytic study A conceptual framework were described based on a nationally committed definition of social health and used for description and analysis. Secondary data of reviewing existing research and documents were utilized for situational analysis Focus group discussion of steering/stakeholder committee members and review of the best evidences and international experiences made analysis and proposed interventions.

  Results: The evidences show that average increasing rate of social problems during recent years is 15% annually. Albeit, it is not possible to draw the increasing or decreasing trend of social health indices precisely since past 2 decades due to the lake of surveillance system. Several social problem reduction and social health improvement interventions are running by organization but, inadequate sensitivity of responsible persons, not to evaluate the current interventions, inadequate utilization and coverage of population from primary level preventive services, inappropriate selection of essential interventions, allocation of most available resources to tertiary level of prevention(after harm services), weakness of activity implementation system and intersectoral collaboration for executing interventions, disintegration of social health related financial resources and inadequate sensitivity and competencies of people in combating to social problems and risks are obstacle to effective interventions in improving social health indices. Economical, political, international and technological big changes should be added to these reasons.

  Conclusion: Social health progress will not be achieved without intersecotral collaboration Improvement of existing situation is not under duties and responsibilities of MOHME, so proposed direction including vision, strategic objectives and interventions, for social health should be implemented partially by MOHME Remaining parts required advocacy to be done by other sectors. It is essential that the proposed program be approved in health policy council of MOHME for implementation of this direction and achieving to it's objectives and then be approved by health and food security high council and social council of country after that the intersectoral collaboration agreements of social health improvement should be supervised deeply.

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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 A im : sexual health in children is difficult subject, does not deal with it formal method. Importance of Sex education of children is accepted in the world. The aim of this paper is describing the concept of sexual health from the viewpoint of children's famil y and identification norms of child sex education and determining sex education priorities of the parent's viewpoint.

  Materials and Methods: This is qualitative study. Samples were selected by targeted method of student's parents of five regional educated o f Tehran. Data were collected by focus group interview and discussion and were analyses by subject and content analysis.

 
Results: The findings were classified in three main areas: 1) Family management 2) the role of school 3) framework of the religion an d traditions.

 

  C ONCLUSION onclusion : Most participants believed sexual health behavior in children is not health indicators. They implemented their family policies in management of Sexual behavior o f their children. In Family control was meant: restriction of sexual behavior in child as a norm. Culture of silence and connivance in management of children's behavior has become norm, because child's sexual behavior is inconsistent with traditional values of family. In identifying priorities of sexual education of children, progression interaction between home and school was known as the most deficits. They are acting their internal values in educational system of children because their conflict of values, norms and tastes difference has not been challenge. It is important and priority of parents to being prepared for the management of their children's sexual behavior .

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Background and Aim: Intersectoral Collaboration and Community Participation are two main strategies for sustaining equity in health. Based on the 4th 5years country development plan, Health and Food Security High Council(HC) as a strategy for developing intersectoral collaboration. Reviewing members' opinions of HC may show the clear way of improving intersectoral collaboration for health promotion of the population to senior officials of Ministry of Health and Medical Education. Materials and Methods: This was a descriptive and qualitative study. Information were gathered by structured interview to HC members and content analysis of the documents and gray materials related to initiation and performance of the HC since it's opening. Content analysis and adding up the interviews were done by hand after defining the main domains. Results: Most of HC members believed that the HC effectiveness is very low or low. For the 1st step, defining health priorities and then responsibilities and expectations of each organization were proposed. Organizations necessity to introduce a sustained representative, creating taskforces for deep working on the issues, regular meeting in secretariat, concurrent information sharing to the members, strengthening similar structure in provinces and giving more authority to them and connecting the council to the scientific committees of health elites are main improvement approaches. Conclusion: There is gap between the performance of the HC and the law makers' expectations. Implementing secretariat of HC including expertise and special working system of intersectoral collaboration will mostly cover the weakness. Defining periodical roles and expectations of organizations and capacity building of health collaborators of the ministries and organizations, and incentivizing organization which have effective contribution, will strengthen and continue the collaboration more.

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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.

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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.

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  Background and Aim: Water and food born diseases are one of the important causes of morbidity and mortality in through the world. The objective of this study was to investigate factors affecting the persistence of diarrheal cases after the explosive epidemic phase of diarrheal disease in Yazd province.

  Materials and Methods: We designed a match case control study that was performed on base of incidence cases of diarrhea since 24 Aug, 2013 to 03 Sept, 2013.Characteristics of cases and control were obtained by interviewers using a pre-determined questionnaire. Logistic regression was used at 0.05 significant level.

  Results: Totally 69 incidences cases of diarrhea were compared with 138 controls. Incidence rate of diarrhea in Yazd province was 13.79 per thousand. The adjusted odds ratio estimate for presence a patient stricken with gastroenteritis in the household was 3.63 [95% CI: 1.43, 9.20]. The adjusted odds ratio for low education, history of the trip, history of contact with patient and eating outside the home were 1.75, 1.55, 1.93 and 1.37 respectively, that increase odds of disease but their effects was not statistically significant.

  Conclusion: In this study the most important risk factor for diarrhea was history of contact with the person with the disease in the household. This result may indicate the lack of personal hygiene by patients and their relatives and thus transmission of disease to others peoples. Therefore the role of health education and informing about transmission and preventive ways is very important in prevention and control of outbreaks of diarrhea diseases.

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  Background and Aim: The aim of the present study was to investigate the views of policy makers and key persons about national AIDS control politics.

  Materials and Methods : This qualitative study used purposive sampling. To collect data, the perspectives of six experts about AIDS were inspected. Framework analysis was used to analyze the data.

  Results: The results of this study showed that beside the strengths there are also significant weaknesses in making the policies, administering the existing policies, executing the programs in organizations, and planning new policies to control AIDS hence these problems and weaknesses must be identified to achieve the main goals of AIDS control program.

  Conclusion: AIDS is not only a health problem but a social, economical and cultural problem, which requires more attention from authorities and related organizations for developing and implementing policies in accordance with international guidelines. To achieve Millennium development goals (MDGs) in the context of AIDS it is essential for policy makers and key figures to consider more effective activities and measures in their agenda.

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  Background and Aim: Addiction behaviors have been established among high risk behaviors among different age groups in Iran. This study aimed to investigate the effects of a designed educational program on high risk behaviors of a sample of addicts in Qom, Iran.

  Materials and Methods: Totally, 128 men with addiction history in self help groups referred to health centers in Qom were studied. The instruments used to collect data were a self administered demographic questionnaire and the designed scale high risk behavior based on Health Belief Model (HBM).

  Results: The mean age of participants was 32.4 years. There were no significant difference between two groups at baseline in terms of all demographic data and all HBM constructs. The mean scores of HBM constructs, improved significantly in comparison with baseline. (p < 0.05).

  Conclusions: This study indicated that designed educational program could improve all HBM constructs after intervention. Additionally, behavior intention might be changed after intervention significantly.

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  Background an Aim: Community-based health promotion program encompasses actions aiming at enabling individuals, organizations and communities for enhancing behaviors and creating a healthier environment. Considerable experiences regarding community health promotion and community-based health promotion exists in Iran, but they have not been documented adequately.

  Materials and Methods: This paper reports some of the findings of a situation assessment project of community-based health promotion programs in Iran, including typology of community-based health promotion programs and critical analysis of challenges and threats, discussing potential opportunities to improve community-based health interventions. All the available reports, official documents, information and published papers related to community-based health promotion programs implemented in Iran were examined.

  Results: The majority of health-related interventions excluding three national programs, namely, the volunteers, community health workers (Behvarzes) and polio eradication programs, were categorized in three large groups ─ community-based initiatives, community-based participatory research, and community-based addiction prevention. Many of these programs were not community-based in the true sense of the word.

  Conclusion: The findings indicate that in Iran, unlike many other countries, the majority of the interventions are initiated and implemented at the national level with good organizational support. Although implementation of such programs is generally considered feasible in Iran, it seems that the available opportunities have not been adequately exploited for their implementation.