Journal of School of Public Health and

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.

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.