Publications by authors named "Hossein Malekafzali"

42 Publications

The design and psychometric evaluation of the Adolescents' Resilience in Disaster Tool (ARDT-Q37): A mixed method study.

Heliyon 2019 Jul 17;5(7):e02019. Epub 2019 Jul 17.

Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran.

Adolescent resilience after a disaster has been shown to be a protective factor against loss, trauma, and psychological distress. Its importance for successful disaster recovery is widely accepted by disaster risk management professionals, yet very few tools are available to assess adolescent resilience during an emergency or after a natural disaster has occurred. The aim of this study was to develop and evaluate the psychometric properties of a questionnaire designed to measure adolescents' resilience before, during or after a natural disaster. This mixed method study was carried out in three phases involving item generation, systematic review (phase one), qualitative analysis (phase two) and the reduction of items (phase three). The psychometric evaluation of the Adolescents' Resilience in Disaster Tool (ARDT) was conducted using the data from 599 high school students North of Iran (Golestan Province). The initial item pool included 80 items that were reduced to 37 after assessment of validity (face, content and structure) and reliability. Exploratory Factor Analysis found five factors that affect adolescents' resilience which included helping, trusting in God and hopefulness, adaptability, self-confidence and social support. The internal consistency was desirable (α = .86 and ICC = .91; 95% CI: .849 to .948). The psychometric support for the 37-item version of the ARDT in this study indicates strong support for the ARDT-Q37 as a rapid assessment tool to evaluate resilience in adolescents aged 12-18 years old. Identifying the status of adolescents' resilience and determining their level of need for intervention during and after a natural disaster is critical for long- and short-term outcomes. Implications for policy makers and professionals involved in the preparedness, response and recovery from natural disasters are discussed.
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http://dx.doi.org/10.1016/j.heliyon.2019.e02019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639693PMC
July 2019

Social Determinants of Health and Home Safety for Under-five Children in a Neighbor's Tehran, Iran.

Int J Prev Med 2018 24;9:109. Epub 2018 Dec 24.

Social Determinants of Health Research Center, Islamic Azad University, Tehran Medical Branch, Tehran, Iran.

Background: Social determinants of health (SDH) provide a platform in improving health society such as safety. Safety is essential for children because it is directly related to the health and development. The objective of this study was to evaluate the current home safety in the capital city of Iran for children below five years by community-based initiative and its association with common SDH variables.

Methods: This is a cross-sectional study, considering community- and family-based initiative. According this five domains checklist which was including physical, kitchen, bath, toys, and first-aid kit, 200 family home safety were evaluated. Moreover, the relation between children safety and social determinants of health was assessed. Furthermore, the research team designed an attractive record card for each child that was distributed among families by community volunteers.

Results: The result was extracted into two age groups: less and more than 6 months. We designed an attractive card for each child and distributed among families by volunteers. It showed that children of age above 6 months had higher home safety score. We found a positive association between mother's education and total safety score.

Conclusions: This study was a part of MAZDAK project which means friendly environment for children in Persian word. It showed that an effective way for promoting children safety in the community would be community engagement and family cooperation. As the family education can help reduce children injuries, MAZDAK as a model can been run in the other places to check the effects of SDH on home safety for children. This was an experience of improving community knowledge and behavior about home safety by the parents themselves to improve their children safety environment, and it is going to continue the efficacy of Intervention.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_60_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326020PMC
December 2018

Domains and Indicators of Resilient Children in Natural Disasters: A Systematic Literature Review.

Int J Prev Med 2018 26;9:54. Epub 2018 Jun 26.

Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Resilience has received increased attention among both practitioners and scholars in recent years. Child resilience has received notable attention in disaster risk reduction (DRR) during the creation of the Sendai Framework 2015-2030 to improve child protection in the event of disasters. As resilience is a subjective concept with a variety of definitions, this study evaluates its different factors and determinates in the existing research to clarify the path for the near future and objective research. A systematic literature review was conducted by searching and selecting the peer-reviewed papers published in four main international electronic databases including PubMed, SCOPUS, WEB OF SCIENCE, and PsycINFO to answer the research question: "What are the criteria, factors or indicators for child resilience in the context of a natural disaster?" The process was based on PRISMA guidelines. In total, 28 papers out of 1838 were selected and evaluated using thematic analysis. The results are shown in two separate tables: one descriptive and the other analytical. Two main themes and five subthemes for criteria for child resilience in a disaster have been found. The factors found cover the following areas: mental health, spiritual health, physical, social behavior, and ecological, and as well as environmental. The majority of the included studies mentioned the scattered criteria about children resilience without any organized category. Although this concept is multifactorial, additional research is needed to develop this study and also observe other kinds of disasters such as human-made disasters.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_1_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036786PMC
June 2018

Effect of the estrus cycle stage on the establishment of murine endometriosis lesions.

Int J Reprod Biomed 2018 May;16(5):305-314

Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.

Background: Establishment of a standardized animal endometriosis model is necessary for evaluation of new drug effects and for explaining different ethological aspects of this disease. For this purpose, we need a model which has more similarity to human endometriosis.

Objective: Our objective was to establish an autologous endometriosis mouse model based on endogenous estrogen level and analyze the influence of estrus cycle on the maintenance of endometriotic lesions.

Materials And Methods: In this experimental study, endometriotic lesions were induced in 52 female NMRI mice by suturing uterine tissue samples to the abdominal wall. The transplantation was either performed at proestrus/estrus or at metestrus/diestrus cycles. Urine-soaked beddings from males and also male vasectomized mice were transferred to the cages to synchronize and maintenance of estrus cycle in female mice. The mice were sacrificed after different transplantation periods (2, 4, 6 or 8 wk). The lesions size, macroscopic growth, model success rate, histological and immune-histochemical analyses were assessed at the end.

Results: From a total of 200 tissue samples sutured into the peritoneal cavity, 83 endometriotic lesions were confirmed by histopathology (41.5%). Model success rate for proestrus/estrus mice was 60.7% vs. 79.2% for metestrus/diestrus mice. The endometriotic lesions had similar growth in both groups. Number of caspase-3, Ki67-positive cells and CD31-positive micro vessels were also similar in endometriotic lesions of two groups.

Conclusion: If we maintain the endogenous estrogen levels in mice, we can induce endometriosis mouse model in both proestrus/estrus and metestrus/diestrus cycle without any significant difference.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6046203PMC
May 2018

Characteristics and components of children's and adolescents' resilience in disasters in Iran: a qualitative study.

Int J Qual Stud Health Well-being 2018 ;13(sup1):1479584

i Pediatric Nephrology, Valiasr Hospital, Imam Complex , Tehran University of Medical Science , Tehran , Iran.

Children and adolescents are vulnerable in times of disaster and they will suffer more severely if neglected. The concept of resilience differs between cultures, and identifying the components of resilience is essential for decision making and interventions in disasters such as risk management. This study aimed to identify the components of children's resilience in disasters in Iran. This qualitative study took a content-analysis approach. Data were collected through semi-structured interviews with 23 people and three group meetings. Conventional content analysis was used for data analysis. MAXQDA 10 software was used for classification. The resilience components derived from the data were categorized into two main categories, internal and external, and eight subcategories covering psychological, emotional, cognitive, mental, spiritual, physical, social, and behavioral factors. The results also showed that the nature of resilience is both intrinsic and extrinsic. Recognizing the dimensions of children's resilience in disasters can lead to a new perspective for authorities and planners in disaster and emergency situations. The results of this study could be used by planners and policymakers to develop interventions to enhance children's and adolescents' resilience at the time of disasters, which is also underlined and highlighted by international documents.
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http://dx.doi.org/10.1080/17482631.2018.1479584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032014PMC
January 2019

Involving Mothers in Child Development Assessment in a Community-based Participatory Study Using Ages and Stages Questionnaires.

Int J Prev Med 2017 5;8:102. Epub 2017 Dec 5.

Social Determinants of Health Research Center, Islamic Azad University, Tehran Medical Branch, Tehran, Iran.

Background: Child-friendly environment project (MAZDAK) is a community-based project for monitoring the development of children in Iran that was implemented as a pilot study in one of the neighborhoods of Tehran (Eyvanak-e Gharb). This study attempted to engage mothers in monitoring of their children's development and assesses the status of children's development by a community-based participatory approach using the ages and stages questionnaires (ASQ).

Methods: This study was a community-based participatory research. Two hundred households residing in Eyvanak-e Gharb with children under 5-year-old were selected as a convenient sample and completed the ASQ. Descriptive measures were used to describe the overall status of children, in each domain. Furthermore, we compared the current sample with other populations, using independent -test.

Results: This study engaged mothers, trained volunteers from the community, and some local institutions in screening and monitoring children development and addressing any poor developmental growth. The mean scores of the different domains (communication, gross motor, fine motor, problem solving, and social-personal) in sampled children in MAZDAK project were higher than corresponding mean scores of the children in a project conducted in Tehran in 2006.

Conclusions: Involving mothers and community in monitoring children development based on ASQ was an effective strategy to monitor and foster children development.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_268_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738788PMC
December 2017

Human spiruridiasis due to Physaloptera spp. (Nematoda: Physalopteridae) in a grave of the Shahr-e Sukhteh archeological site of the Bronze Age (2800-2500 BC) in Iran.

Parasite 2017 2;24:18. Epub 2017 Jun 2.

School of Public Health, Tehran University of Medical Sciences, District 6, Pour Sina St, P.O. Box 6446, Tehran 14155, Islamic Republic of Iran.

Evidence of rare human helminthiasis in paleoparasitological records is scarce. we report here the finding of Physaloptera spp. eggs in a soil sample collected in the pelvic and sacrum bones area of a skeleton excavated from a grave of Shahr-e Sukhteh archeological site dating back to the Bronze Age. The site is located in southeastern Iran and has attracted the attention of numerous archeological teams owing to its vast expanse and diverse archeological findings since 1997. The spirurid nematodes Physaloptera spp. are rarely the cause of human helminthiasis nowadays, but this infection might not have been so rare in ancient populations such as those in the Shahr-e Sukhteh. Out of 320 skeletons analyzed in this study, only one parasitized individual was detected. This surprising result led us to suspect the role of nematophagous fungi and other taphonomic processes in possible false-negative results. This is the first paleoparasitological study on human remains in this archeological site and the first record of ancient human physalopterosis in the Middle East.
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http://dx.doi.org/10.1051/parasite/2017019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467177PMC
April 2018

Dietary and Socio-Demographic Determinants of Serum Persistent Organic Pollutants (POPs) Levels in Pregnant Women in Tehran.

J Family Reprod Health 2016 Sep;10(3):129-138

Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran.

To determine the levels of Polychlorinated biphenyls (PCBs) and Polybrominateddiphenyl ethers (PBDEs) as persistent organic pollutants (POPs) in serum of primiparous women at the third trimester of pregnancy and identify the main determinants of POPs levels such as socio-demographic, lifestyle, and diet in Tehran. One- hundred eighty five serum samples from two simultaneous case-control studies were collected from September 2013 until August 2015.Ten most abundant PCB congeners (International Union of Pure and Applied Chemistry (IUPAC) congeners 28, 52, 74, 99, 101, 118, 138, 153, 180 and 187) as well as eight PBDE congeners (IUPAC congeners 28, 47, 99, 100, 153, 154, 183 and 209)were analyzed by Gas Chromatography Mass Spectrometry (GC/MS). Multiple linear regression analysis was conducted to explain the relationship between total PCBs and total BPDEs and most detected congeners and some determinants, separately. The mean (SD) age of the participating women was 27.82 ± 5.24 years. The geometric mean (SD) of total PCBs was 2.42 ± 2.26 and total PBDEs was 1.28 ± 1.41 ng/g lipid. Only the PCB 138, PCB 153 and PBDE 153 were detected in 100% of samples. We observed a significant relationship between the time of being indoors and total PBDEs (P = 0.03). Passive smoking was significantly associated with PCB 153 (P = 0.049). The results of the linear regression analysis showed the negative and weak association (P-value < 0.05) between diet (egg and fat and oil consumption) and POPs in this population. It seems the most common route of exposure to PBDEs in our population is indoor pollutants. Meanwhile inhalation of smoke from environment is a route of exposure to PCB 153. Further study is needed to evaluate the effects of socio-demographics and especially dietary intake on POPs level.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241357PMC
September 2016

Association of serum concentrations of persistent organic pollutants (POPs) and risk of pre-eclampsia: a case-control study.

J Environ Health Sci Eng 2016 24;14:17. Epub 2016 Nov 24.

Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, 8th Floor, No. 1547, North Kargar Ave., Enghelab Square, Tehran, I.R. Iran.

Background: There is increasing evidence that persistent organic pollutants (POPs) may contribute to pre-eclampsia. The objective of this study was to evaluate the association between Polychlorinated Biphenyls (PCBs) and Polybrominated Diphenyl Ethers (PBDEs) as POPs with pre-eclampsia.

Methods: This case-control study was performed in the three general university hospitals of Tehran University of Medical Sciences. Serum samples were collected from cases ( = 45) who had diagnosed with preeclampsia and from control samples ( = 70) with normal pregnancy and attended the same hospital for a routine prenatal visit at the third trimester of pregnancy. Pollutants levels were analyzed by Gas Chromatography Mass Spectrometry (GC/MS).

Results: Mean participant age was 27.3 ± 5.39 with median 27. As the main independent variable, total POPs manifested with adjusted OR equal to 1.54 (95 % CI: 1.26-1.87, -value <0.0001), which was significantly associated with pre-eclampsia. The adjusted OR proved a statistically significant association between total PCBs 1.77 (95 % CI: 1.34-2.32) and total PBDEs (OR = 2.19; 95 % CI: 1.39-3.45, -value = 0.001) with pre-eclampsia considering confounding variables (maternal age, pre-pregnancy body mass index (BMI), gestational age, weight gain during pregnancy and total lipids in maternal serum). Finally, pre-pregnancy BMI and weight gain during pregnancy had a positive association with pre-eclampsia and gestational age yielded a negative association with pre-eclampsia in all analysis.

Conclusion: Our data indicate the association between total POPs, total PBDEs, and total PCBs with pre-eclampsia, even after controlling for the effects of a number of potentially confounding factors. Further investigation about route of exposure and the trend of POPs especially in pregnant women is needed.
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http://dx.doi.org/10.1186/s40201-016-0256-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121940PMC
November 2016

Association between serum concentrations of persistent organic pollutants and gestational diabetes mellitus in primiparous women.

Environ Res 2016 Nov 16;151:706-712. Epub 2016 Sep 16.

Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: There is growing evidence that persistent organic pollutants (POPs) may play an important role in increasing the risk of gestational diabetes mellitus (GDM).

Objectives: The aim of this study was to examine the association between polychlorinated biphenyls (PCBs, 10 congeners) and polybrominated diphenyl ethers (PBDEs, 8 congeners) and GDM in primiparous women with no family history of diabetes in first-degree relatives during the third trimester of pregnancy.

Methods: This case-control study was performed among the three university hospitals of Tehran University of Medical Sciences. Serum samples were collected from cases (n=70) that were diagnosed with GDM and from controls (n=70) with a normal pregnancy that attended the same hospital for a routine prenatal visit. Pollutant levels were analyzed by Gas Chromatography Mass Spectrometry (GC/MS).

Results: Logistic regression analyses manifested the positive association between total POPs (sum of total PCBs and PBDEs) (Odds ratio (OR)=1.61, 95% CI: 1.31-1.97, p-value <0.0001) and total PCBs (OR=1.75, 95% CI: 1.35-2.27, p-value<0.0001) and GDM considering confounding variables (age, gestational age, pre-pregnancy body mass index (BMI), and total maternal serum lipid). In addition, we found a positive association between total PBDEs and GDM (OR =2.21; 95% CI: 1.48-3.30, p-value <0.0001). Finally, we found a positive association between Ln PCB 187, 118 and Ln PBDE 99, 28 with GDM. Meanwhile a negative association between Ln PCB 28 and GDM was established.

Conclusion: Our data suggest that exposure to certain POPs (PCBs and PBDEs) could be a potential modifying risk factor for GDM.
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http://dx.doi.org/10.1016/j.envres.2016.09.002DOI Listing
November 2016

Is the status of diabetes socioeconomic inequality changing in Kurdistan province, west of Iran? A comparison of two surveys.

Med J Islam Repub Iran 2016 24;30:375. Epub 2016 May 24.

PhD, Professor of Epidemiology, Iranian Epidemiological Association, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: About 80% of deaths in 350 million cases of diabetes in the world occur in low and middle income countries. The aim of this study was to determine the status of diabetes socioeconomic inequality and the share of determinants of inequalities in Kurdistan Province, West of Iran, using two surveys in 2005 and 2009.

Methods: Data were collected from non-communicable disease surveillance surveys in Kurdistan in 2005 and 2009. In this study, the socioeconomic status (SES) of the participants was determined based on the residential area and assets using principal component analysis statistical method. We used concentration index and logistic regression to determine inequality. Decomposition analysis was used to determine the share of each determinant of inequality.

Results: The prevalence of diabetes expressed by individuals changed from 0.9% (95% CI: 0.6-1.3) in 2005 to 3.1% (95% CI: 2-4) in 2009. Diabetes Concentration Index changed from -0.163 (95% CI: -0.301- -0.024) in 2005 to 0.273 (95% CI: 0.101-0.445) in 2009. The results of decomposition analysis revealed that in 2009, 67% of the inequality was due to low socioeconomic status and 16% to area of residence; i.e., living in rural areas.

Conclusion: The prevalence of diabetes significantly increased, and the diabetes inequality shifted from the poor people to groups with better SES. Increased prevalence of diabetes among the high SES individuals may be due to their better responses to diabetes control and awareness programs or due to the type of services they were provided during these years.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972065PMC
August 2016

Association between electromagnetic field exposure and abortion in pregnant women living in Tehran.

Int J Reprod Biomed 2016 May;14(5):347-54

Department of S exual H ealth P romotion, Iranian National Center for Addiction Studies (INCAS), Risk Behavior Reduction Institute, Tehran , Iran .

Background: Health-related quality of life is affected by electromagnetic field exposure in each person everyday life. However, this is extremely controversial issue.

Objective: Investigation of the associations between electromagnetic field exposure and miscarriage among women of Tehran.

Materials And Methods: In this longitudinal study, 462 pregnant women with gestational age <12 wks from seven main regions of Tehran city in Iran with similar social and cultural status were participated. Women were interviewed face-to face to collect data. Reproductive information was collected using medical file recorded in those hospitals the subjects had delivery. The measuring device measured electromagnetic waves, Narda safety test solutions with valid calibration date at the entrance door of their houses.

Results: A significant likelihood of miscarriage in women who exposed to significant level of electromagnetic wave. However, this association was not confirmed by Wald test.

Conclusion: This study may not provide strong or consistent evidence that electromagnetic field exposure is associated or cause miscarriage. This issue may be due to small sample size in this study.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910032PMC
May 2016

Developing a household survey tool for health equity: A practical guide in Islamic Republic of Iran.

Med J Islam Repub Iran 2015 5;29:305. Epub 2015 Dec 5.

BS, Office of Health Technology Assessment, Health Standards and Tariffs, Tehran, Iran.

Background: An obvious gradient in health outcomes has been implicated in many evidences relating to social and economic factors. Proper data are requested to convince policy-makers calling for intersectoral action for health. Recently, I.R. of Iran has come up with 52 health equity indicators to monitor health equity through the country. Conducting regular surveys on 14 out of 52 national health equity indicators is needed to provide a basis for the health inequality analysis through the country. We aimed to introduce a survey tool and its related protocols on health equity indicators.

Methods: This study was conducted through addressing the literature and expertise of health and demographic surveys at the national and international levels. Also, we conducted technical and consultative committee meetings, a final consensus workshop and a pilot study to finalize the survey tool.

Results: We defined the study design, sampling method, reliable questionnaires and instructions, data collection and supervision procedure. We also defined the data analysis protocol on health equity indicators, generated from non-routine data.

Conclusion: A valid and reliable tool, which could be employed at the national and sub-national levels, was designed to measure health equity in Iran. Policy-makers can use this survey tool to generate useful information and evidence to design appropriate required intervention and reduce health inequality across the country.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764270PMC
February 2016

A youth-led reproductive health program in a university setting.

Med J Islam Repub Iran 2015 5;29:210. Epub 2015 May 5.

PhD, Research Expert, Development of Research & Technology Center, Deputy of Research & Technology, Ministry of Health and Medical Education, Tehran, Iran, and Non Communicable Disease Research Center, Endocrine & Metabolism Research Institute, Tehran University of Medical Science, Tehran, Iran.

Background: Reproductive health problems affect youths in all countries. There is an urgent need to enhance youths reproductive health services to provide a healthy life for this group. In this regard, the present study aimed to evaluate the Reproductive Health Peer Education Program based on the opinion of university students.

Methods: This interventional study was conducted in Qazvin University of Medical Sciences through the peer education method. The participants of this study were 24 peer educators who received training in a 40 hour peer educator training course. The peer education program was implemented in the university. In order to evaluate this community- based intervention, 329 students were selected through the stratified sampling method and their opinion was assessed. Descriptive statistical methods were used by SPSS software for data analysis.

Results: The results of the study revealed that peer education was accepted by 64.7% (n= 213) of the students, according to their opinion. The educational priorities of the students were as follows: pre-marriage counseling (78%, n= 166); STI/AIDS (17%, n= 36); and contraception (5%, n= 11). The peer education program was recognized as the most required reproductive health service in the university by 55.3% (n= 118) of the students. They believed that the most important duties of the peer educators were: education (33.5%, n= 71); counseling (30.4%, n= 65); referring to a counseling center (21.6%, n= 46) and referring to a therapeutic center (14.5%, n= 31). Also, the students stated that confidentiality (53%, n= 113), suitable communication (26%, n= 55) and sufficient knowledge (21%, n= 45) were desired characteristics for the peer educators.

Conclusion: According to the students' opinion, peer education could provide suitable reproductive health services and could also be beneficial for reproductive health promotion and might reinforce positive behaviors in youths. Reproductive health peer- counseling is a sensitive process, and it is best to be conducted under the supervision of specialists.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476226PMC
July 2015

Estimating the Annual Incidence of Abortions in Iran Applying a Network Scale-up Approach.

Iran Red Crescent Med J 2014 Oct 5;16(10):e15765. Epub 2014 Oct 5.

Regional Knowledge Sciences, Tehran Hub for HIV/AIDS Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran.

Background: Abortions are of major public health concern in developing countries. In settings in which abortion is highly prohibited, the direct interview is not a reliable method to estimate the abortion rate. The indirect estimation methods to measure the rate of abortion might overcome this dilemma; They are practical methods to estimate the size of the hidden group who do not agree to participate in a direct interview.

Objectives: The aim of this study was to explore the practicality of an indirect method for estimating the abortion rate , Known as Network Scale-up, and to provide an estimate about the episode of abortion with and without medical indications (AWMI+ and AWMI-) in Iran.

Materials And Methods: This cross-sectional study was conducted in 31 provinces of Iran in 2012. A random sample between 200 and 1000 was selected in each province by the multistage sampling method that 75% of the data were collected from the capital and 25% from one main city. We selected samples from urban people more than 18 years old (12960) and we asked them about the number of abortion in women they knew who had experienced the medical and non-medical abortions in the past year. A range for the transparency factor was estimated based on the expert opinion.

Results: The range of the transparency factors for AWMI+ and AWOMI- were 0.43-0.75 and 0.2-0.34, respectively. Regarding the AWMI+, our minimum and maximum estimations (per 1000 pregnancies) were 70.54 and 116.9, respectively. The corresponding figures for AWMI- were 93.18, and 148.7.

Conclusions: The frequency rates for AWMI+ and AWMI- were relatively high. Therefore, the system has to address to this hidden problem using the appropriate preventive policies.
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http://dx.doi.org/10.5812/ircmj.15765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270634PMC
October 2014

Pasteur Institute of Iran--an evaluation model.

Iran Biomed J 2014 07;18(3):189-95

Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Pasteur Institute of Iran was established in 1919 with the aim to produce vaccines and prevent communicable diseases in Iran. Over time, their activities extended into areas of research, education and services. Naturally, such a vast development begs establishment of a comprehensive management and monitoring system. With this outlook, the present study was carried out with the aim to design a performance assessment model for Pasteur Institute of Iran that, in addition to determining evaluation indicators, it could prepare the necessary grounds for providing a unified assessment model for the global network of the Pasteur Institutes.

Method: This study was designed and performed in 4 stages: first; design of indicators and determining their scores. Second; editing indicators according to the outcome of discussions and debates held with members of Research Council of Pasteur Institute of Iran. Third; implementation of a pilot model based on the Institute's activities in 2011. Fourth; providing the pilot model feedback to the stakeholders and finalizing the model according to an opinion survey.

Results: Based on the results obtained, the developed indicators for Pasteur Institute of Iran evaluation were designed in 10 axes and 18 sub-axes, which included 101 major and 58 minor indicators. The axes included governance and leadership, resources and facilities, capacity building, knowledge production and collaborations, reference services, economic value of products and services, participation in industrial exhibitions, status of the institute, satisfaction and institute's role in health promotion.

Conclusion: The indicators presented in this article have been prepared based on the balance in the Institute's four missions, to provide the basis for assessment of the Institute's activities in consecutive years, and possibility of comparison with other institutes worldwide.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048484PMC
http://dx.doi.org/10.6091/ibj.12472.2014DOI Listing
July 2014

Project monitoring and evaluation: an enhancing method for health research system management.

Int J Prev Med 2014 Apr;5(4):505-10

Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran ; Non Communicable Disease Research Center, Endocrine and Metabolism Research Institute, Tehran University of Medical Science, Tehran, Iran.

Background: Planning, organizing, staffing, leading and monitoring are the basic functional component of management. In present article, we aim to define the project monitoring and evaluation in health research system (HRS) considering its success and challenges based on our national experience.

Methods: IN THIS STUDY BASED ON THE INFORMATION OF ANNUAL MEDICAL SCIENCE UNIVERSITIES EVALUATION DURING THE LAST DECADE THE HRS INDICATORS HAVE BEEN SCORED IN THREE AXES BASED ON HRS FUNCTIONS: Stewardship, capacity building and knowledge production. In this article, we will focus on the results of HRS evaluation from 2002 to 2010, also on its success and challenges.

Results: In an overall view, the main results are the experiences of the designing and implantation of such process after pre-project preparation, all parts followed under the whole supervision of the aims of the HRS evaluation. Project management light the way of practical application of knowledge, skills, tools and techniques for better HRS evaluation and management.

Conclusions: We concluded that; although monitoring and evaluation as an essential part of HRS Management light the improvement ahead way but we still need to advantage of the new project management advances.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018601PMC
April 2014

Development and evaluation of a nutritional health program for adolescents.

Iran J Nurs Midwifery Res 2013 Sep;18(5):425-7

Research Expert, Deputy of Research and Technology, Ministry of Health and Medical Education, and Non Comunicable Disease Research center, Endocrine and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Unhealthy nutritional behaviors are a threat to adolescents. In this regard, we compared different training methods through a participatory interventional study.

Materials And Methods: Through proportional random selection, 1823 female students were selected from 15 middle schools of Tehran. Following 2 years of intervention, nutritional habits of three different interventional groups were assessed.

Results: Eating breakfast was significantly higher in the trained groups, and the use of weight loss diets was lower in them than in the control group. Also, satisfactory consumption of various kinds of nutrients in the trained groups was more than in the control group.

Conclusion: Participatory health training, especially through parents, leads to adolescence nutritional health promotion.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877468PMC
September 2013

Peer Education: Participatory Qualitative Educational Needs Assessment.

Iran J Public Health 2013 Dec;42(12):1422-9

1. Deputy of Research & Technology, Ministry of Health & Medical Education , Iran ; 2. Non Communicable Disease Research Center, Endocrinology & Metabolism Population Sciences Institute, Endocrine and Metabolism Research Institute, Tehran University of Medical Sciences , Tehran, Iran.

Background: In the area of youth health, peers education is an approach to health promotion. Assess the training needs of peers educators clarifies the components, values, and quality of training protocols. Aim to that we conducted a participatory educational needs assessment of youth peer educators.

Methods: Involving youth and key informants in direct collaboration with research team, a qualitative approach was planned based on grounded theory. For data collection a semi-structured guide questioning was designed. Sixteen focus group discussions and 8 in depth interview were held.

Results: The majority of participants emphasized on the importance of mental health, life skills, AIDS prevention, contraception methods, and healthy nutrition as the main training topics. They were extremely interested into the comprehensive educational material among their participatory role in peer programs.

Conclusion: The training programs should be well defined based on the knowledge, skills and behavior of peers. During the implementation, training programs should be followed to meet the ongoing educational needs of service providers.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441939PMC
December 2013

Governance in community based health programmes in I.R of Iran.

J Pak Med Assoc 2013 Feb;63(2):211-5

Undersecretary for Research and Technology, Ministry of Health and Medical, Tehran, Iran.

Objective: To assess the nature of community-based health programme experience in Iran, and use the results in order to advocate more friendly policies in community, academy and funding organisations.

Methods: The qualitative study was done in 2010-11 at various locations in Iran using semi structural in-depth interviews with the principals and managers of programmes, and focus group discussions with volunteers and service users of 13 Community Based Health Programmes which were active for at least five years. A total of 21 in-depth interviews and 20 focus group discussions were conducted. Data analysis was based on deductive-inductive content analysis approach considering the pre-determined structure in accordance with the study questions. The participants' views were analysed within the main category of governance, including the three sub-categories of leadership, monitoring and evaluation, and resource mobilisation.

Results: According to the participants, governmental programmes have centralised decision-making and management processes and local volunteers have no role in selecting managers at different levels of a programme. Such programmes are funded by the governmental core resources. In non-government organisations, resources available for such purposes mainly come through charitable individuals, service delivery fees and profitable economical activities, financial participation of volunteers and by using other organisations' facilities. In most programmes, there were no systematic process for monitoring and evaluation.

Conclusion: Community-based Health programmes in Iran need to be revised in line with the positive input.There is a need to have community-based units within the Ministry of Health and Medical Education and other relevant organisations.
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February 2013

How does the impact of a community trial on cardio-metabolic risk factors differ in terms of gender and living area? Findings from the Isfahan healthy heart program.

J Res Med Sci 2012 Aug;17(8):732-40

Cardiovascular Research Center, Isfahan Cardiovascular Research Institute,Isfahan University of Medical Sciences, Isfahan, Iran.

Objective: To assess the impact of gender and living area on cardiovascular risk factors in the context of a comprehensive lifestyle intervention program.

Design: Data from independent sample surveys before (2000--2001) and after (2007) a community trial, entitled the Isfahan Healthy Heart Program (IHHP) were used to compare differences in the intervention area (IA) and reference area (RA) by gender and living area.

Setting: The interventions targeted the population living in Isfahan and Najaf-Abad counties as IA and Arak as RA.

Participants: Overall, 12 514 individuals who were more than 19 years of age were studied at baseline, and 9570 were studied in postintervention phase.

Interventions: Multiple activities were conducted in connection with each of the four main strategies of healthy nutrition, increasing physical activity, tobacco control, and coping with stress.

Main Outcomes: Comparing serum lipids levels, blood pressure, blood glucose and obesity indices changes between IA and RA based on sex and living areas during the study.

Results: In IA, while the prevalence of hypertension declined in urban and rural females (P < 0.05). In IA, the prevalence of hypercholesterolemia and hypertriglyceridemia decreased in both females and males of urban and rural areas except for hypercholesterolemia in rural males (P < 0.01). In RA, the significant changes include both decrease in the hypercholesterolemia among rural males (P < 0.001) and hypertriglyceridemia in urban females (P < 0.01), while hypertriglyceridemia was significantly increased in rural females (P < 0.01).

Conclusions: This comprehensive community trial was effective in controlling many risk factors in both sexes in urban and rural areas. These findings also reflect the transitional status of rural population in adopting urban lifestyle behaviors.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687879PMC
August 2012

Needs assessment in health research projects: a new approach to project management in iran.

Iran J Public Health 2013 1;42(2):158-63. Epub 2013 Feb 1.

Deputy of Research & Technology, Ministry of Health & Medical Education, Iran ; Non Communicable Disease Research Center, Endocrine and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: The science and technology health plan has defined the outline of health research to the national vision of Iran by 2025. The aim of this study was to focus on the process of needs assessment of health research projects also health research priority setting in Iran.

Methods: THE PROJECT MANAGEMENT LIFE CYCLE HAS FOUR PHASES: Initiation, Planning, Execution and Closure. Based on abovementioned points we conducted the study.

Results: Focusing on the needs assessment led to systematic implementation of needs assessment of health project in all of the medical sciences universities. Parallel with this achieved strategies health research priority setting was followed through specific process from empowerment to implementation.

Conclusion: We should adopt with more systematic progressive methods of health project managements for both our national convenience as well as our international health research programs.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595647PMC
March 2013

Rapid detection of human and canine visceral leishmaniasis: assessment of a latex agglutination test based on the A2 antigen from amastigote forms of Leishmania infantum.

Exp Parasitol 2013 Mar 28;133(3):307-13. Epub 2012 Dec 28.

Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

The diagnosis of visceral leishmaniasis (VL) in humans and animal reservoir hosts is difficult, particularly in rural areas where the disease is endemic and laboratory facilities are limited. This study aimed to develop a latex agglutination test (LAT) for the rapid detection of anti-Leishmania antibodies against the A2 antigen derived from the amastigote form as well as those against crude antigens derived from the promastigote form of an Iranian strain of Leishmania (Leishmania) infantum. The A2 antigen (42-100 kDa) was prepared from the amastigote form of L. infantum, purified with electroelution and compared with the crude antigen from the promastigote form of L. infantum. Both antigens showed appropriate intensity reactions, were selected using dot blotting of positive and negative pooled sera and used to sensitize 0.9-μm latex beads. The tests were carried out on sera from 43 symptomatic, human patients with VL confirmed by parasitological examination and direct agglutination test (DAT), 30 healthy controls and 32 patients with other infections but without VL. Canine sera were collected from 63 domestic dogs with VL confirmed using parasitological examinations and DAT and 31 healthy dogs from areas non-endemic for VL. Compared with the controls, human sera from DAT-confirmed patients yielded a sensitivity of 88.4% (95% CI, 82.1-94.5%) and specificity of 93.5% (95% CI, 87.0-99.7%) on A2-LAT (amastigote) when 1:3200 was used as the cut-off titre. A good degree of agreement was found between A2-LAT and DAT (0.914). LAT required 3-5 min to complete, versus the 12-18 h needed for DAT. Compared with the controls, A2-LAT of canine sera from DAT-confirmed cases yielded a sensitivity of 95.2% (95% CI, 95.0-95.4%) and specificity of 100% (95% CI 100%) when 1:320 was used as the cut-off titre. A good degree of agreement was found between A2-LAT and DAT (0.968). Similarly, the sensitivity and specificity of Pro.-LAT (promastigote) was calculated to be 88.4% and 91.9%, respectively for human sera and 96.8% and 90.3%, respectively for canine sera. No statistically significant differences were observed between A2-LAT and Pro.-LAT for the detection of human and canine L. infantum infections. In conclusion, A2-LAT and Pro.-LAT could be used in parallel to screen for L. infantum infections in humans and dogs in areas endemic for VL in Iran.
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http://dx.doi.org/10.1016/j.exppara.2012.12.002DOI Listing
March 2013

Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: the Isfahan Healthy Heart Program.

Arch Iran Med 2013 Jan;16(1):4-11

Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: This study evaluated the outcome of a comprehensive, community-based healthy lifestyle program on cardiometabolic risk factors. The Isfahan Healthy Heart Program (IHHP) was a comprehensive action-oriented, multi-component intervention with a quasi-experimental design and reference area.  

Methods: IHHP targeted the population-at-large (n = 2,180,000) in three districts in central Iran. Data from independent sample surveys before (2000 - 2001) and after (2007) this program were used to compare differences in the intervention area  and reference area over time after controlling for age, education level and income. The samples in 2000 - 2001 and 2007 included 6175 and 4719 participants in intervention area, and 6339 and 4853 in reference area, respectively. Multiple interventional activities were performed based on the four main strategies of healthy nutrition, increased physical activity, tobacco control and coping with stress. 

Results: The prevalence of abdominal obesity, hypertension, hypercholesterolemia, hypertriglyceridemia and high LDL-C decreased significantly in the intervention area versus the reference area in both sexes. However the reduction in overweight and obesity was significant only in females (P < 0.05 for all). There were no significant changes in the prevalence of diabetes mellitus.  In the intervention area, the prevalence of hypercholesterolemia decreased from 23.5% to 12.5% among females without any changes in females in the reference area (p < 0.0001). In males, hypercholesterolemia decreased significantly in both intervention area (18.5% to 9.6%) and reference area (14.4% to 9.8%; p = 0.005). Mean triglyceride levels had a significant decrease in the intervention area and a non-significant decrease in the reference area (p < 0.0001). 

Conclusions: A comprehensive healthy lifestyle program comprising preventive and promotional activities that considers both population and high risk approaches can be effective in controlling cardiometabolic risk factors in a middle-income country.
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http://dx.doi.org/013161/AIM.004DOI Listing
January 2013

Is Community-based Participatory Research (CBPR) Useful? A Systematic Review on Papers in a Decade.

Int J Prev Med 2012 Jun;3(6):386-93

Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran.

Background: Community-based participatory research (CBPR) has been applied by health researchers and practitioners to address health disparities and community empowerment for health promotion. Despite the growing popularity of CBPR projects, there has been little effort to synthesize the literature to evaluate CBPR projects. The present review attempts to identify appropriate elements that may contribute to the successful or unsuccessful interventions.

Methods: A systematic review was undertaken using evidence identified through searching electronic databases, web sites, and reference list checks. Predefined inclusion and exclusion criteria were assessed by reviewers. Levels of evidence, accounting for methodologic quality, were assessed for 3 types of CBPR approaches, including interventional, observational, and qualitative research design as well as CBPR elements through separate abstraction forms. Each included study was appraised with 2 quality grades, one for the elements of CBPR and one for research design.

Results: Of 14,222 identified articles, 403 included in the abstract review. Of these, 70 CBPR studies, that 56 intervention studies had different designs, and finally 8 studies met the inclusion criteria. The findings show that collaboration among community partners, researchers, and organizations led to community-level action to improve the health and wellbeing and to minimize health disparities. It enhanced the capacity of the community in terms of research and leadership skills. The result provided examples of effective CBPR that took place in a variety of communities. However, little has been written about the organizational capacities required to make these efforts successful.

Conclusion: Some evidences were found for potentially effective strategies to increase the participant's levels of CBPR activities. Interventions that included community involvement have the potential to make important differences to levels of activities and should be promoted.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3389435PMC
June 2012

Health research system evaluation in I.R. of Iran.

Arch Iran Med 2012 Jul;15(7):394-9

Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran.

Background: Several systems have been proposed to rank academic institutions worldwide. We aimed to introduce a new method of Health Research System (HRS) evaluation in Iran.

Methods: In this cross-sectional study, a specific questionnaire has been used to assess stewardship, capacity building, and knowledge production through annual evaluations of HRS in Iran. This article has explored the results of the 5-year evaluation (2003 - 2008) and aims to introduce this method to other developing countries.

Results: According to our study, in the stewardship axes, all medical science universities designed strategic plans by 2008 and 70% of the approved projects were based on priorities. In the domain of capacity building, the trend in the number of arranged workshops and held congresses is ascending. In the domain of knowledge production, the number of Iranian biomedical research articles increased from 2996 in 2003 to 8816 in 2008.The proportion of ISI Web of Science/Pub Med indexed articles per academic members also increased from 0.09 to 0.33.

Conclusion: We conclude that HRS evaluation in Iran has supported knowledge production and has strengthened evidence-based policy making. The adapted ranking system for evaluation of medical research activities is an effective strategy for HRS promotion.
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http://dx.doi.org/012157/AIM.004DOI Listing
July 2012

Neighborhood intimacy as perceived by women living in urban areas and its association with personal and social network characteristics.

Int J Prev Med 2012 May;3(5):318-25

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: The purpose of this study is to determine association between personal, family, neighborhood, and social network characteristics and perceived intimacy in the neighborhood by the women.

Methods: In this cross-sectional study, we applied a two-stage sampling method to choose a representative sample of 150 married women and housewives, aged 15 to 49 years, who had education between six and twelve years and lived in the urban areas of the Khorasan-e-Razavi province of Iran. Association between personal, family, neighborhood, and social network variables, with the perceived neighborhood intimacy, was assessed through univariate and multiple linear regression.

Results: Based on the multiple model, there were significant associations between neighborhood intimacy as perceived by the women and their education level (Standardized Beta=-0.190, P=0.019), length of residence (Standardized Beta=0.175, P=0.029), self-rated health status (Standardized Beta=0.177, P=0.029), and their individual social network size (Standardized Beta=0.211, P=0.030).

Conclusion: The potential predictors including length of residence, self-rated health, and size of the respondents' personal social networks had a direct association with the women's perceived neighborhood intimacy, while the education level of the respondents had an inverse association with the neighborhood intimacy, as another potential predictor. Neighborhood intimacy could express the social health condition of the community members.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372074PMC
May 2012

Preparation and evaluation of a glycerol-preserved direct agglutination antigen for long-term preservation: a comparative study of the detection of anti-Leishmania infantum antibodies in human and dog.

Asian Pac J Trop Med 2012 Feb;5(2):117-20

Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Objective: To prepare and evaluate a glycerol-preserved antigen from an Iranian strain of Leishmania infantum (L. infantum) for use in glycerol-preserved direct agglutination tests (GP-DAT) as an alternative to freeze dried direct agglutination tests (FD-DAT) that use freeze-dried antigen.

Methods: Glycerol-preserved DAT antigen was prepared and stored at different temperatures. We tested antigen stored at 4 °C, 22-37 °C and 50 °C over a period of 365 days. Seven hundred twenty-nine serum samples were collected from different geographical zones of Iran from 2007-2009, and 80 of these samples were pooled to produce sera. Each pooled serum contained 10 sera. All positive and negative pooled sera were separately tested for anti-L. infantum antibodies with GP-DAT, FD-DAT and formaldehyde-fixed direct agglutination test (FF-DAT) antigens; tests were performed on both human and dog sera over a period of 12 months.

Results: There was strong agreement between the results obtained using GP-DAT and FD-DAT antigens stored at 22-37 °C for 12 months for both human (100%) and dog (100%) pooled sera. The direct agglutination test results were highly reproducible (weighted kappa: GP=0.833, FD=0.979 and FF=0.917).

Conclusions: Because GP-DAT antigen is highly stable over a range of temperatures and is easy to transport in the field, this type of antigen may be particularly useful in areas with endemic visceral leishmaniasis.
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http://dx.doi.org/10.1016/S1995-7645(12)60008-XDOI Listing
February 2012

A peer-based study on adolescence nutritional health: a lesson learned from Iran.

J Pak Med Assoc 2011 Jun;61(6):549-54

Research & Technology, Ministry of Health & Education, Tehran, Iran.

Objective: To study the adolescence opinions' among nutritional habits and beliefs.

Methods: To conduct a multi disciplinary approach through involving adolescence/youth for finding their mental needs and their suggestion for solving them, we designed a qualitative approach based on grounded theory. For data collection a semi-structured guide questioner designed and 16 focus group discussions were conducted by trained peers with youth aged 10-19 years.

Results: According to FGDs results, although majority of participants agreed on the important role of nutrition in health and the effect of nutritional habits on different aspect of health, they used modern and publicized fast foods. On the other hand, most of female and male participants said that different factors influenced the girls and boys diet selection i. e. girls' paid more attention to diet selection and taste and health of foods, whereas boys were careless and gluttony caused more food to be consumed.

Conclusion: Adolescents' information (both genders) regarding nutritional problems resulting from improper food habits were not satisfactory. Peer-based health programmes through target groups for capacity building and participation of stakeholders will fulfill the objectives.
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June 2011

Training of general practitioners about smoking cessation counseling.

J Pak Med Assoc 2011 May;61(5):449-52

Research & Technology, Ministry of Health & Education, Iran.

Objectives: To study general practitioners' knowledge regarding smoking and their formal educational training on quitting smoking and associated readiness for providing associated services.

Methods: This cross sectional study was carried out using an anonymous WHO based questionnaire. According to sample size estimated based on general practitioners' population ratio, review literatures and response rate probability; it was given to the 5140 general practitioners selected by random quota sampling method from a total of 25,600 practitioners all over the country at the time of the study.

Results: There were 3804 (74%) males with 16% being smokers and 4.6% having a history of smoking. Thirty percent of the subjects felt that they were ready for smoking cessation counseling, but only 9% had received formal training for it during medical school or post graduate training, while more than 80% perceived such training as necessary. Smoking cessation intervention during physician visits was associated with increased patient satisfaction especially among those who smoked.

Conclusion: Formal training for smoking cessation among the study subject was inadequate. They were of the opinion that more courses should be included in medical school as better trained doctors could make good counselors.
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May 2011