Journal of School of Public Health and

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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: Internet has become an effective medium to transfer new scientific and research findings, knowledge and information in educational processes across the world. It also facilitates essential communication among millions of people globally and offers users plenty of entertainment for their leisure time. However, excessive computer use interferes with daily life and carries a risk of addiction. Therefore, the concept of internet addiction is now considered a social problem. This study was conducted to determine the association between internet addiction and general health among dormitory students of Tehran University of Medical Sciences in 2010.

Materials and Methods: This cross-sectional study, conducted in 2010, included 125 female- and 110 male-students from dormitories of Tehran University of Medical Sciences, selected by stratified random sampling. The instruments for data collection were two standard questionnaires - YANG Internet Addiction and Goldberg's General Health (GHQ). Data were analyzed by SPSS-19, the statistical tests being Kolmogorov-Smirnov, Mann-Whitney U, Chi-square, correlation coefficient, and multivariate regression.

Results: The results showed that, based on the YANG classification, 34% of the students were addicted to the internet. In comparison with ordinary users, the general health of the internet-addicted users was at a higher risk (p<0.001). The two groups were also different with regard to anxiety and depression (p<0.001), but not with regard to physical function or social function.                     

Conclusion: Internet addiction among dormitory students is a cause for concern. Well-designed programs focusing on education, counseling and behavioral intervention are needed to reduce internet addiction amongst vulnerable students.

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Background and Aim: Malaria threatens more than half of the world's population in about 100 countries. During the period 1921-1951 malaria was one of the most important public health issues in Iran, no other disease causing as much financial loss and mortality as malaria did. The objective of this study was to investigate malaria epidemiology in Iran during the period 1940- 2006 (65 years), in the hope that the infotmation and experience will be used in the future.

Materials and Methods: This study included a review of the available literature on the suject, as well as a study of health systems, existing records, and analysis of data and information on malaria in Iran. Data were colected from three main sources: national or international electronic sources (26 sources) non-electronic sources, including theses, journal articles, and various documents and reports, as well as data obtained from the national malaria surveillance system (a total of 180) and interviews with five informed and expert individuals. In addition, national documents prepared by the Center for Disease Control, Ministry of Health and Medical Education, during the previuos 6 months were made available to, and used by, the research team.

Results: The findings show that, despite several annual fluctuations, the trend of incidence of the disease during the 65-year period, from 1940 to 2006, was a downward trend. The incidence declined from 250-333 per 1000 people in the early 1940's to 0.22 per 1000 people in 2006.

Conclusion: The changes in incidence of malaria show that elimination of malaria is a possible and feasible goal. The experiences achieved in controlling this disease can be utilized for controlling other diseases as well.

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Background and Aim: Social capital composed of networks, norms and values, which facilitates cooperation within and between groups to achieve mutual benefits and common goals. Social capital increases the benefits of investing in physical and human capital. In a society that favors more social capital, collaboration is easier. This study investigates the validity and reliability of a social capital tool, which had been administered through a large population-based survey using factor analysis.
Materials and Methods: Data were obtained from Urban Health Equity Assessment and Response Tool (Urban HEART-1) survey in Tehran. Factor analysis is a method of discovering structural position of variables to reduce them into a limited number of components which are more fundamental. The reliability of the questionnaire and main components of the tool were investigated through factor analysis.
Results: According to factor analysis, three main components of social capital including, individual trust, cohesion/ social support and social trust/associative relations, were recognized. These three components explained 66.14% of total variance of the social capital tool. Also, overall Cronbach's alpha coefficient was 0.88 which indicates high reliability of the questionnaire.
Conclusion: Social capital tool, which was administered in Urban HEART project, covers the main components of social capital framework with high reliability and validity, which is suitable to be used in other population-based surveys.

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Background and Aim: Job satisfaction is one of the most important factors in maintenance of a professional person and the job success, increasing the personal efficiency and the quality of services. On the other hand, it is a tool in the hands of managers in order to maintain the staff in their jobs. The aim of this descriptive study was to investigate the satisfaction of physicians and midwives participating in the family physician scheme with the plan.
Materials and Methods: The study population was made up of 221 physicians and 144 midwifes. The tool was an author made questionnaire certified by experts as a standard, valid and reliable scale via content validity measurements through a pilot study.
Results: The average satisfaction of physicians and midwives was 44.34% while the highest satisfaction was 65% with the location of services and the lowest was 30.6% with the financial issues. In relation to the financial affairs, physicians were more dissatisfied than midwives, so satisfactions were increased by the increase in the amount of salaries.
Conclusion: Over 4 years of implementation of family physician plan, the physicians and midwives satisfaction was shown to be still low. It is necessary to consider re-programming in the scheme in order to increase the amount of payments and create more motivational factors for physicians as well as to reduce working hours for midwives and establish appropriate levels of payments for them.

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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: Tomatoes are the richest source of lycopene, a potent antioxidant. Tomato products improve antioxidant defenses and reduce the risk of inflammatory diseases, at least partly due to the presence of lycopene. Lycopene, as an anti-inflammatory agent, prevents the production of inflammatory cytokines. Obesity is a chronic inflammatory condition in which the increased level of body fat leads to an increase in circulating inflammatory mediators. We hypothesized that the consumption of a lycopene-rich food would reduce inflammation in people with overweight or obesity.
Materials and Methods: One hundred and six overweight or obese female students of Tehran University of Medical Sciences were enrolled and randomly allocated to an intervention group (n=53) or a control group (n=53), consuming 330 ml/day of tomato juice or water respectively, for 20 days. At baseline and day 20, serum concentrations of interleukin-6, interleukin-8, tumor necrosis factor-α and high sensitivity C-reactive protein were analyzed by ELISA and compared between groups.
Results: Serum concentrations of interleukin-8 and tumor necrosis factor-α decreased significantly in the intervention group compared to the control group and compared to the baseline. Subgroup analysis indicated that this effect was confined to subjects who were overweight. Among obese subjects, serum interleukin-6 concentration was decreased in the intervention group compared to the control group, with no observed differences in interleukin-8 and tumor necrosis factor-α.
Conclusion: Tomato juice reduces inflammation in overweight and obese females. Thus, increasing tomato intake may provide a useful approach for reducing the risk of inflammatory diseases such as cardiovascular disease and diabetes, associated with obesity.

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Background and Aim: Cervical cancer is the second most common cancer in women with incidence of more than 500000 cases per year. It is preventable because of its long pre-cancerous period, suitable screening programs and effective treatments. Since the social and cultural barriers alongside the lack of knowledge are deterrents to participation in screening programs, the current study was performed to assess the effect of educational intervention through the Health Belief Model on knowledge and attitude of teachers about pap smear, considering their role in making people aware. Materials and Methods: This was a controlled before-after interventional study conducted on 72 individuals selected through simple sampling, assigned to two groups. Data collection tool was a questionnaire used and compared before training and one month after that. Training methods (intervention) included lectures with questions and answers. Data were analyzed with SPSS, version 11.5. Results: 47.2% of intervention and 45.8% of control group were 40 to 50 years old and majority of them (47.2% and 50% respectively) had undergraduate educational level and 86.1% were married. Respectively, 67.2% and 74.2% have experience of being examined via Pap smear, while the knowledge of women in both groups was moderate about the disease. Study results revealed significant differences in knowledge, attitude and Health Belief Model constructs within intervention group (before and after training) as well as between groups (p<0.05). Conclusion: Using Pap smear test among the participants was lower compared with healthy people aims targeted by 2010. Therefore, necessity of education and knowledge promotions are obvious.

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Background and Aim: Bioaerosols are one of the most important agents that cause post operating infections in hospitals. Surgical masks are recommended for prevention of bioaerosols transmition in operating rooms. This study aimed at evaluation of submicron particle filtration efficiency of domestic and imported surgical masks.
Materials and Methods: In this cross sectional study, 5 types of surgical masks that have the most utilization in operating rooms of country’s hospitals including domestic and imported surgical masks were tested. To evaluate all samples, the submicron particle filtration measurements were carried out based on ISIRI 6138 and American DOP standards. Filtration efficiency calculations and pressure drop measurements were performed and the results were analyzed using statistical tests.
Results: Results showed that particle filtration efficiency of domestic and imported masks were 56.130% (±10.7) and 31.906% (±7.062) respectively. Also, filtration efficiency in domestic masks were more than imported masks (P> 0.001). Among all samples, Arman mask had the most filtration efficiency (66.5475 % ±6.14951), where the least (27.8275 % ±4.44152) filtration efficiency (P> 0.001) belongs to Blosom. The maximum mean of pressure drop in Arman mask (35 ±2. 58 Pa) and the least mean of pressure drop in Zist filter mask (11 ±1.82 Pa) were observed. According to the effect of filtration efficiency and pressure drop on general quality of mask, the quality factor of masks were also evaluated. Results showed that Zist filter mask had the most quality factor (0.068) while Blosom had the least quality factor (0.016).
Conclusion: This research showed that domestic surgical masks have a better quality toward imported surgical masks but can not obtained quality confirmed by standards, yet. To reduce respective infections and prevalence of diseases, it is recommended using filters with suitable physical characteristics and also carrying out test of surgical masks before supplying.

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Background and Aim: Puberty as a stage of life is an important developmental process. Teen girls have numerous health care needs and their specific issues should be considered. This study mainly aimed to determine the impact of education based on health belief model on promotion of physical puberty health among female teenagers who were residents in welfare boarding centers in Tehran city.
Materials and Methods: It was a quasi-experimental intervention study, conducted in welfare boarding centers of Tehran city among inhabitant girls with 12 to 19 years old. All eligible persons were selected (n=61). Data collection tool was a questionnaire including demographic information, health belief components, physical function during menstruation, completed before and one month after training by interview. Educational intervention was implemented in 3 months. Data was analyzed by Wilcoxon statistical test using SPSS16 software.
Results: After educational intervention, perceived severity (p<0.001), perceived susceptibility (p<0/001), perceived barriers (p<0.001), perceived benefits (p<0.001), and physical function during menstruation were significantly different.
Conclusion: Educational intervention improved girls' perceptions and performance. Thus, health belief model should be used for puberty health education planning in female adolescents.

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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: Educational programs for couples' mental health promotion in marital life are a necessity.  The first step in planning an educational program understands the needs of the target group. This paper reports the mental health educational needs in youth planning to marry.

Materials and Methods: In a descriptive-analytical cross sectional study, 450 individuals taking part in pre-marriage education courses in Tehran were selected by randomized stratified sampling. The data was collected using a questionnaire that measured the educational needs in the area of mental health by the 5-point Likert-type scale. Data analysis was done using the SPSS-15 software, the statistical tests being the independent T-test, one-way analysis of variance (ANOVA), and the chi-square test.

Results: On the whole, the subjects' felt need for mental health education was more than moderate (3 on the Likert scale) women expressed a higher need than men (p=0.001). The main concern of the participants - both men and women - was How to keep romance alive in married life. The extent of need expressed for mental education was not statistically different in different socio-demographic groups of women, while worker men expressed a higher need than self-employed men (P=0.018).                                                                        

Conclusion: Based on the findings of this study, young people planning to marry have a felt need for education in the area of mental health. It is recommended to design and implement educational programs to promote their knowledge in this area with due consideration of priorities stated by them.

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Background and aims: Work-related musculoskeletal disorders (WMSDs) are a serious problem among the nursing staff. Manual patient-handling tasks, such as lifting, transferring, and repositioning patients, are the major causes of WMSDs among nursing staff. The objective of the present study was risk assessment of musculoskeletal disorders during patient transfers by the movement-and-assistance-of-hospital patient (MAPO) technique among hospital nursing staff of Shiraz University of Medical Sciences (SUMS), Shiraz, Iran.

Materials and Methods: This cross-sectional study included 400 randomly selected nurses from 75 wards in 11 hospitals in Shiraz. Data were collected using demographic and Nordic Musculoskeletal Disorders Questionnaires and the MAPO index checklist. Statistical analysis was performed using SPSS version 16.

Results: The means of age and job tenure of the subjects were 30.76±6.44 and 6.92±5.75 years, respectively. The 12-month prevalence of musculoskeletal disorders was 88.2%. The results of assessment by the MAPO index revealed that more than 83% of the subjects were at risk, 20.5% of them exposed to high risk. Further analysis of the data indicated that the musculoskeletal disorders occurrence was significantly associated with the MAPO index score (p<0.05).

Conclusion: Work-related musculoskeletal disorders were found to be associated with the MAPO index. Therefore, MAPO is an appropriate tool for musculoskeletal disorders risk identification and assessment due to patient handling in the nursing personnel. In any attempt to improve the working conditions, patient transfer aids, environmental factors, and proper training should be taken into consideration.

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Background and aim: Delivery or parturition is the peak of a woman’s pregnancy period, accompanied with birth of one or more babies. Unfortunately, Cesarean section, despite its probable undesirable health and economic consequences, has become more and more common. Considering that the goal of health education is behavior change in people, the objective of this study was to investigate the role of health volunteers in educating mothers consulting the health care centers in Ardabil in the area of choice of delivery method based on the Behavioral Intention Model (BIM).
Materials and Methods: In this experimental study, 140 primaparous mothers in Ardabil city in the seventh month of pregnancy were selected by systematic random sampling and divided into a case and a control group, and a written pretest was given to both groups. Education based on the BIM was imparted to the case group. One month after delivery, both groups were post-tested. The data on awareness, attitude, results evaluation and practice were analyzed using the Wilcoxon, Mann Whitney-U and Chi-square tests.
Results: The findings revealed statistical differences between the case and control groups after intervention with regard to awareness, evaluation of results and attitude (p<0.001). However, behavioral intention did not change (p=0.106).
Conclusion: Although health volunteers' participation results in an increase in knowledge and promotes attitude and evaluation of behavioral results in pregnant women, it does not change their behavioral intention. It is suggested to conduct similar studies for comparative purposes involving other trainers, such as physicians and nurses in other cities, using other educational models and methods.

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Background and aim:  Malaria as a mosquito-borne disease is largely dependent on climatic conditions. Temperature, rainfall and relative humidity are considered as climatic factors affecting the geographical distribution of this disease. These climatic factors have definite roles not only in the growth and proliferation of the mosquito Anopheles but also in the parasite Plasmodium activity. The purpose of this study was to find in which regions of Iran climatic conditions favour spread of malaria.

Material and Methods: Data on 3 climatic factors, including the mean monthly temperature, rainfall and mixed ratio of humidity, obtained from 31 synoptic meteorological stations during the 30-year period 1975-2005 were used. By running the informative filters through map algebra tools in the Geographical Information System (GIS), the synoptic meteorological stations were classified into 4 groups in terms of climatic conditions favouring activity and proliferation of the mosquito Anopheles and the parasite Plasmodium. Then the regions were interpolated in terms of climate risk of malaria incidence using the tension Spiline interpolation method.

Results: The maps of climatic potential malaria risk indicated that the southern provinces including Hormozgan, Bushehr and Khuzestan, southern parts of Sistan-Balouchistan province, such as Chabahar and Nikshahr, as well as Northern provinces of the country, including Mazandaran and Gilan, have the highest climatic potential for risk of malaria spread. On the other hand, provinces in the North Western region, including West and East Azarbaijan, Ardebil, Kurdistan and Zanjan, have the lowest climatic potential risk of malaria spread. Further analysis of the data showed that a large segment of the population is living in regions with medium- to high-risk zones.

Conclusion: The findings of this study can be used when designing malaria control programs to identify different regions in terms of climate-based malaria risk. The presented risk map of malaria in this study is completely based on climatic factors. The disconformity between these presented climate-based maps and the observed high-risk map is due to such factors as socioeconomic and lifestyle changes, as well as border problems (foreign subjects entering the country).

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Background and objectives: Relapse after treatment is a common problem among drug addicts in addiction control and prevention programs. About 80% of the addicts relapse into drug abuse within 6 months after treatment. The purpose of this study was to determine factors associated with drug abuse relapse in patients consulting two selected addiction treatment centers in Tehran. 

Material and Methods: In this case-control study, 160 relapsed patients were compared with 160 abstentious patients. A researcher-developed questionnaire was used to collect data. Chi-square test, odds ratio (OR) and logistic regression were performed for data analysis.

Results: The findings showed that factors increasing rate of relapse were smoking after relapse (OR=7.14, CI=3.855-13.244), substance-related cues (OR=6.76, CI= 3.915-11.678), interaction with addict peers (OR=6.38, CI=3.921-10398), malaise (OR=3.93, CI=2.446-6.305), and family conflict (OR=2.04, CI=1.227-3.385). Opium- and dross-addicts were found to be less likely to have a relapse than crack- or pot- users (OR= 0.208, CI-0.128- 0.336). 

Conclusion: The findings of this study reveal that relapse into drug abuse is significantly associated with personal, social, psychological and medical variables. It is recommended to 

integrate family counseling and therapeutic approaches, constant monitoring, and health care in treatment plans in order to reduce the adverse effects of factors such as family conflicts, peer pressure and drug-related cues in patients' likelihood of relapse.   

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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: The time needed to achieve a wanted pregnancy is referred to as time to pregnancy (TTP). Due to differences in lifestyles and geographical locations in different countries, factors affecting TTP may be different in various countries. This study was conducted in 2011 to determine factors affecting time to TTP in Kermanshah, Iran.
Materials and methods: In this case-control study 174 women with TTP>12 months (cases) and 587 women with TTP<=12 months (controls) were selected. The tool for collecting data was a questionnaire. The SPSS-16 software was used for data analysis, a p-value <0.05 being considered as statistically significant.
]Results: Multivariate analysis showed that factors decreasing TPP statistically significantly were women's education level (≥high school diploma OR=0.854, CI 95%=0.741-0.984), frequency of intercourse in a week (OR=0.728, CI95%=0.631-0.839), blood group A compared to O (OR=0.639, CI95%=0.405-1.01), and non-exposure to smoking (OR=0.606, CI95%=0.380-0.965). On the other hand, factors increasing TPP were a woman's irregular menstrual cycle (OR=3.701, CI95%=2.127-6.441), lack of physical activity (OR=1.920, CI95%=1.263-2.918) and a body mass index (BMI) higher than 25 (OR=2.221, CI 95%=1.489-3.312).
Conclusion: According to the results of this study, a high BMI and lack of exercise increase, while factors such as frequency of intercourse decrease the length of TTP. Couples seeking medical intervention for pregnancy often disregard factors associated with TTP. It is recommended that care-providers support these couples, promote their awareness, and give them suitable advice.

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Background and Aim: Hospitals as one of the major institutions providing health care services within the health sector utilize a high percentage of the sector's key resources to respond to the needs of consumers. The aim of the present study was to identify factors affecting technical, scale and management efficiency of the Social Security Organization (SSO) hospitals during the period 2007-2009 and find ways to improve the efficiency of inefficient hospitals.
Materials and Methods: A total of 65 SSO hospitals active during the period 2007-2009 were included in the study. Data envelopment analysis was used assuming constant return to scale of production (CRS). To distinguish between management and scale efficiency of hospital units, the study used input-oriented model (BCC) assuming variable return to scale (VRS).
Results: The findings showed that small hospitals with less than, and large hospitals with more than, 100 active beds have 11% and 8.8% surplus inputs, respectively, the surplus inputs being medical and nursing staff, other personnel, as well as active beds for hospital services. In addition, the impact factors of medical staff, nursing staff, other personnel, and active beds were 24%, 9.8%, 11.7% and 16.8% for small hospitals' efficiency and 25.7%, 18%, 21.7% and 30.7% for large hospitals' efficiency, respectively..
Conclusion: Considering the average scale and management scores derived for efficiency measurement, it is recommended that the Social Security Organization hospitals reduce their surplus costs and increase their output products and services to achieve the optimum level of efficiency.

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Background and Aim: The most important single determinant of the quality of life of the elderly is health. Studies have shown that health declines with age. Because of high vulnerablity of the elderly due to many problems, they need particular attention and self-care programs for their health promotion. The objective of this study was to assess the quality of life of elderly clients under coverage of the Southern Tehran Health Center and determine the effects of a self-care program on it.

Materials and Methods: This was a controlled interventional study conducted in 2010-2011. A total of 132 elderly clients (52 in the intervention, and 80 in the control, group) were selected by randomised cluster sampling from 5 Health Care Centers in Southern Tehran. A 3-month educational program was prepared with contents based on books published by the Ministry of Health and Medical Education and implemented. The quality of life was assessed in both groups at the beginning and 2 months after the intervention using a short questionnaire (sf36). Data were collected through a structured interview (demographic characterstics) and analyzed using descriptive and analytical statistical tests.

Results: The mean quality-of-life score of the experimental group increased after education the mean score of physical domain of the quality of life increased from 52.75 in 66.11 and that of the emotional domain from 53.61 to 70.85. The scores of different domains of quality of life of the control subjects did not change significantly.

Conclusion: The findings show that a self-care educational program can have a positive affect on quality of life of the elderly.