Journal of School of Public Health and

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Natural disasters cause millions of death and disability and major financial losses world wide every year. The major concern of our health system has already been to reduce physical mortality and morbidity. While such events may be a considerable source of stress for the survivors and cause serious and long-lasting psychiatric complications. The purpose of this study was to assess the function of rescuers in mental health service delivery to survivors of Bam earthquake in four steps Rescuing, Emergency services, Transportation of the injured survivors and Treatment in the first 2 weeks after the earthquake. For reaching the purpose 4 groups of the survivors were selected: first group was the healthy survivors (>15 years) living in Bam after the earthquake, the second group was healthy survivors (<15 years) living in Bam after the earthquake, the third group was the injured survivors admitted in Kerman and Tehran hospitals and the last group was the Relatives who accompanied the injured survivors. 2 weeks after the earthquake a questionnaire including questions about, demographic data, function of rescuers in rescuing and emergency services steps, informing the survivors of their relatives condition and Condoling with the survivors and mental health services delivery was filled for each of the cases. In all groups, more than 85% of the cases who needed help and rescued from the load of the earthquake were rescued by their relatives and rescuers of the Red Crescent Society or other governmental organization just had a little portion (5%)in this field. Only 25%of the cases who needed help and rescuing from the load of the earthquake were rescued in the first hour after the earthquake. Only 40% of the cases were sympathized by their rescuers. About 65% of the cases had enough information about their relatives. 40% of the cases were prevented from crying by rescuers. Only 30% of the cases said that they knew addict individuals who were hot given alternative materials. 30/% of the children had played during 2 weeks after earthquake and 42/% of them had facilities for playing. Regarding to all studied groups rescue activities, primary care services and transfers have been performed by relatives and domestic people , therefore general training and organizing CBO (community Based organization) for providing services in disasters especially in regions which are at high risk of earthquake will be useful for reducing the injuries. According to this research rescuers are in serious need of training in mental health services and that major areas of education need are: using counseling techniques, providing the necessary information for the survivors and stress management techniques.

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Background and Aim: By definition, the ratio of output to input in any firm is called efficiency. In general, there are two main approaches for measuring efficiency ─ parametric and non-parametric. The objective of this study was to assess the efficiency of Health Services Workshops in Iran in 2006.

Methods and Materials: The efficiency of Health Services Workshops in Iran in 2006 was assessed using the non-parametric method, based on linear programming. More specifically, the Data Envelopment Analysis (D.E.A) was used. The most important feature of the Data Envelopment Analysis (D.E.A) is its applicability for the firms that operate under a multiple input-and-output framework. Assessment of efficiency was based on 2 assumptions, namely, fixed and variable efficiency.

Results: The data show that, based on fixed efficiency, the efficiency in the Bushehr, Fars, Kerman, Mazandaran and Yazd provinces is the highest, the average being 80%, which means that the idle capacity is 20% . Based on the variable efficiency. assumption, in Ilam, Chahar Mahal-and-Bakhtiari, Semnan, and Kohgiluyeh Boyerahmad provinces the efficiency is 85% (idle capacity = 20%).

Conclusion: On the whole, the Chaharmahal-Bakhtiyari province is the most efficient in holding Health Services Workshops in Iran. Therefore, other provinces should follow this province as an example when planning to increase their efficiency.

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Background and Aim: Pressure ulcer is a common problem and a large drain on hospital resources, especially in wards such as ICU where patients stay for a long time. The aim of this study was to explore the likely factors contributing to pressure ulcers in the ICU units of Tehran University of Medical Sciences teaching hospitals, Tehran, Iran.

Materials and Methods: This project was conducted in all the seven ICUs of four teaching hospitals affiliated to Tehran University of Medical Sciences. In the first phase the researcher performed a direct observation of all the 90 patients who were admitted to the ICU units to check the presence of any pressure ulcer. In the second phase, 310 patients discharged from the same ICU units between March 2007 and February 2008 was randomly selected and their medical records reviewed. A structured questionnaire was used to collect the data.

Results: Pressure ulcer occurred more frequently in the elderly women patients who were less active and had less mobility, hospitalized for a long time, or those with fever, diabetes, high blood pressure, paralysis, or respiratory diseases. In addition, pressure ulcer was seen more frequently in the patients hospitalized in the general ICUs, as well as in those with infections and different types of tumors.

Conclusion: Using a standard risk assessment tool and paying attention to the main risk factors of pressure ulcer can be a useful method for identifying the high-risk patients before admission in order to prevent them from developing such ulcers.

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

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

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

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

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Background and Aim: The health system is trying to prevent unnecessary referrals to higher levels by providing tiered services and thus reduce the cost of health care. Therefore, this study was conducted in Zahedan City, Iran with the aim of finding the causes of referrals from level 1 to higher tiers in rural areas.
Materials and methods: This cross-sectional study was conducted on 458 rural patients referred to the second level in the rural areas of Zahedan City, Iran. Data were collected from the family health files available in the Sib system and analyzed using the SPSS-16 statistical software, the statistical tests being descriptive statistics (percentage, frequency) and Chi-square test.
Results: The highest (57.6%) and lowest (4.1%) proportions of referrals to the second level of service provision were found to have been in 2018 and 2016, respectively. From among the referred patients nearly 50% had been referred due to the need for a higher expertise, thus most referrals (67.2%) were to specialists. Further analysis of the data showed that only in 23.6% of the cases there was a feedback from the higher level to the first level.
Conclusion: The findings show that referrals from family physicians to higher levels in the health system requires higher medical expertise and patient insistence. In addition, feedback to the first level of service provision has not received proper attention. Establishing interactions between physicians and other health service levels, refresher training of physicians, emphasizing the importance of providing feedback and promoting the awareness of patients can reduce to a large extent inappropriate referrals.