Banning Advertising Unhealthy Products and Services in Iran: A One-Decade Experience.

During the past decade, Iran's health system has attempted to prohibit advertising of unhealthy products and hazardous services. Considerable success has been achieved in the fields of public places and print media advertisements. Conversely, efforts were not effective enough in the fields of TV and radio advertisements. Over the last three years, the Iranian Ministry of Health and Medical Education has published a list of unhealthy products and services on an annual basis. The list has been developed using a criteria-based mechanism, and compared to the previous list that was developed based on the consensus of the main stakeholders. This approach resulted in a significantly shorter list that consisted of three groups: 1) a number of unhealthy food products, 2) some cosmetic products and services, and 3) all tobacco products. We suggest that future strategies should focus on close monitoring of effective implementation; improving inter-sectoral collaboration; making industries more socially accountable; and increasing public demand for protecting children against exposure to hazardous advertisements.

Composite social health index: Development and assessment in provinces of Iran.

Background: Overall human health has been considered as physical, mental, and social health. The aim of the present study was to develop and measure Social Health Index in Iran by regions. Policymakers can implement evidence-based interventions by gaining knowledge about social health status. Methods: To develop Social Health Index, social health indicators were collected by literature review and indicators whose information existed in provincial level. The final list of indicators was derived based on expert opinions. Then, data were normalized by comparative standardization. Using additive model, the total score of social health was calculated and provinces were ranked. Results: Based on the composite index, including 39 indicators, a healthy society is properly characterized by lack of drug use, child labor, divorce, unemployed academics, child abuse, and smoking. The highest and lowest social health belonged to Yazd and Sistan and Baluchistan provinces, respectively. Conclusion: This study showed the provinces' social health as an important tool for evidence-based policymaking. To monitor social health status, similar studies should be conducted every 3 to 5 years.

Prioritizing barriers to implement clinical governance in teaching hospitals of Iran: A mixed method study.

Background: Clinical governance, as a program to improve the quality of health care, was introduced in all hospitals in Iran in 2009. However, implementation assessments revealed that the program was not adopted in many hospitals. This study aimed to determine and prioritize barriers to clinical governance program implementation in hospitals of Shahid Beheshti University of Medical Sciences. Methods: This qualitative study was performed in the first part of this exploratory mixed methods study. A purposive sample of 25 individuals who were involved in the implementation of the program was selected. They participated in semi-structured interviews and the data were analyzed using content analysis. In the second part (quantitative), a questionnaire was prepared based on the first phase of the study, and 74 stakeholders completed the questionnaire, which included all extracted obstacles to the establishment of clinical governance. They rated these obstacles with a 5-point Likert scale. Results: A total of 9 themes were discovered in the qualitative part of the study. These themes were prioritized as follow: (1) weak organizational leadership, (2) insufficient human resources, (3) inappropriate organizational culture, (4) inadequate financial resources, (5) insufficient knowledge of personnel and management, (6) inappropriate monitoring and evaluation, (7) lack of coordination (8) deficiencies in policies and procedures, and (9) incomplete registration system and inadequate documentation. Conclusion: The results of this study showed that significant barriers exist in implementation of the clinical governance program in hospitals. These problems have to be addressed in order for the implementation procedure to be successful.

Measuring positive health of Iranians; Finding from Iran social health survey (ISHS).

Background: Positive health as a "health asset" goes beyond risk factors for diseases and produces longer and healthier life, as well as, better prognosis when illness strikes, against traditional medicine focusing on treating people in negative health to a state that is neutral or free from disease. The aim of present study was to conduct a national survey estimating positive health indicators of Iranians Methods: This survey was performed on September 2014 in all provinces of Iran with 10500 samples. The psychometrics of employed scale was examined in separate study. To estimate positive health indicators, each question included a series of declarative statements and each respondents answer to questions based on a five-point Likert type scale. Results: From a total of 10500 respondents, 10244 fulfilled questionnaire (Response rate= 97.5%). About 49% of participants were male. In a scale from 1 to 5, mean of score of life satisfaction, happiness, quality of life, and self-perceived health were 3.45, 3.28, 3.56 and 3.66, respectively. The highest level of positive health indicators was achieved in provinces of Guilan and West Azerbaijan. Conclusion: The result of the study shows majority of Iranian people assess their perception of health, quality of life, life satisfaction and happiness as 'moderate' or 'good' (between 66 to 82% of respondents. It would seem that measured positive health indicators in comparison with the rates of past national studies, have been decreased between 3.5 to 4% that should be noticed in social health policy making.

Smoking Pattern and Associated Sociodemographic Factors: Findings from a Nationwide STEPS Survey in Iran.

BACKGROUND: Smoking is a modifiable risk factor for noncommunicable diseases with a wide range of harmful health outcomes. Identification of sociodemographic characteristics of smokers can be a guideline to development of effective intervention proportional to target population. This study aimed to determine smoking pattern and its associated sociodemographic factors in Iran. METHODS: This cross-sectional study was conducted based on data from the sixth round of nationwide STEPwise approach to Surveillance (STEPS) survey in the 31 provinces of Iran. A total of 10,834 participants aged ≥15 years were selected through a multistage cluster sampling method. Collecting data was performed via three-step questionnaire (ecological, behavioral risk factors, and physical and biochemical measurements). Data analysis was performed via Epi Info and then SPSS version 21 softwares using descriptive methods and analytical tests. RESULTS: Of all participants, 9.6% were current cigarette smokers, which was significantly more frequent among men than women (21.5% vs. 1.1%, respectively, P < 0.001). Smoking was significantly associated with being self-employed and having under diploma education level (P < 0.05). Of all current cigarette smokers, 8.7% were daily smokers. The mean ± standard deviation of systolic blood pressure and history of cardiovascular symptoms in current smokers were higher than nonsmokers (P = 0.005 and P < 0.001, respectively). Coughing for >4 weeks, frequent wheezing, and shortness of breath were significantly more frequent in current smokers than nonsmokers (P < 0.001, P < 0.001, and P = 0.02, respectively). CONCLUSIONS: Our results draw a picture of sociodemographic distribution of smoking pattern to determine the specific characteristics of the target population affecting cigarette smoking and identified specific demographic strategies for preventive and control action plan.

Protocol Design for Large-Scale Cross-Sectional Studies of Surveillance of Risk Factors of Non-Communicable Diseases in Iran: STEPs 2016.

INTRODUCTION: The rise in non-communicable diseases (NCDs) has gained increasing attention. There is a great need for reliable data to address such problems. Here, we describe the development of a comprehensive set of executive and scientific protocols and instructions of STEPs 2016. METHODS/DESIGN: This is a large-scale cross-sectional study of Surveillance of Risk Factors of NCDs in Iran. Through systematic proportional to size cluster random sampling, 31,050 participants enrolled in three sequential processes, of completing questionnaires; physical measurements, and lab assessment. RESULTS: Out of 429 districts, samples were taken from urban and rural areas of 389 districts. After applying sampling weight to the samples, comparing the distribution of population and samples, compared classification was determined in accordance with the age and sex groups. Out of 31,050 expected participants, 30,541 participant completed questionnaires (52.31% female). For physical measurements and lab assessment, the cases included 30,042 (52.38% female) and 19,778 (54.04% female), respectively. DISCUSSION: There is an urgent need to focus on reviewing trend analyses of NCDs.To the best of our knowledge, the present study is the first comprehensive experience on systematic electronic national survey. The results could be also used for future complementary studies.

Development of a scale for measuring social health of Iranians living in three big cities.

BACKGROUND: Social health is considered as a significant dimension of health and, hence, its assessment is vital in health planning. Within this context, this study aimed to develop a valid and reliable scale for measuring individual's social health in Iran. To do so, an exploratory sequential mixed method was used. METHODS: To establish the item pool and primary scale, 30 interviews with experts and other stakeholders, and a primary review of relevant literature and similar questionnaires were conducted. Then, a survey with 800 respondents from three cities in Iran was undertaken to assess the validity and reliability of the scale. RESULTS: In the qualitative stage of this study, after careful consideration, forty questions were remained for the next step. Considering the correlation of the score of each question with the total score of the questionnaire, seven questions were omitted. For this questionnaire with 33 remaining questions, Cronbach's alpha for internal consistency was estimated to be 0.86. The reliability coefficient for 100 samples (taken after 7 to 10 days from the first round of sampling) was 0.91. Considering the factor analysis, three factors were recognized. These factors were named as "family", "community" and "friends and relatives". Cronbach's Alpha for internal consistency of community, friends and relatives, and family factors were estimated to be 0.91, 0.77 and 0.78 respectively. The corresponding value of the reliability indicator, intraclass correlation coefficient (ICC), for community, friends and relatives, and family were calculated 0.69, 0.80 and 0.67 respectively. CONCLUSION: We developed a measurable scale for social health at an individual level in the Iranian community with an acceptable level of validity and reliability. The new developed scale is able to provide an opportunity to measure Iranians' social health at an individual level. Such an indicator of individual health can be used in evaluating the performance of social health policies and providing a platform for evidence-based policy-making in the social health context.

Prevalence of Ecstasy use and predisposing factors among Iranian female high school students.

OBJECTIVES: To determine prevalence of ecstasy use and its predisposing factors among Iranian high school female students in Tehran, capital of Iran. METHODS: In this cross-sectional study, 2350 female students of 36 high schools from Tehran, were selected by multi-stage cluster sampling to determine prevalence of ecstasy use and its predisposing factors. SPSS- version 13 was employed to conduct analysis through chi-square, fisher's exact test and logistic regression methods. RESULTS: The prevalence of ecstasy use was 2.3% (95% CI: 1.7-2.9%). Party was the most prevalent place of first use (65%) and access was easy for most users (63%). In multivariate analysis, smoking (P-V = 0.005), alcohol use (P-V = 003), use of other substances (P-V < 0.001), being in relationship with boys (P-V = 0.015), families without one or two parents (P-V = 0.020), night spending at friends home without parents' permission (P-V = 0.001) were associated with ecstasy use. CONCLUSION: Due to relation of ecstasy use with other substances, designed programmes should be comprehensive, with different strategies and collaboration of several sectors. The main strategies are to improve students' health literacy, family support, to limit supply and access, and to legislate appropriate regulatory laws.

Setting research priorities to reduce burden of cancer in Iran: an institutional experience.

OBJECTIVE: The aim of this study was to draw a set of priority areas of cancer research in order to utilize these priorities as broader policy for decision-making on a comprehensive cancer control program at the national level in Iran. MATERIALS AND METHODS: A steering committee consisting of scientists from the three major areas of clinical, basic research and public health sciences recommended a qualitative study of ranking an exhaustive outlines of cancer science topics by cancer scientists throughout country. Scientists were identified through Medline search and contacting cancer research centers all over the country. An exhausting outline of cancer science topics was modified and posed to Iranian cancer scientists. Doing research on each outlined topic was judged based on its state of being necessary, appropriate, practical or yielding in the Iranian societal context. An electronic system of communication was developed and all scientists were asked to rank each topic based in order of 1 to 5. As the areas of expertise of scientists were diverse, the participants had the option to rank the outlined topics that they think suitable to their areas. RESULTS: Out of 135 identified scientists, 108 participated of whom 56 were clinicians (M.D's with university appointment), 35 basic scientists and 17 epidemiologists and public health scientists. As the top first five areas of research priorities, the overall assessment indicated as research topics: 1) cancer surveillance and registration as the first priority; followed by 2) exogenous factors in the origin and cause of cancer; 3) surveillance--patient care and survivorship issues; 4) issues of end-of-life care; and 5) cost analyses and health care delivery of cancer services. CONCLUSION: The study concluded that research on infrastructure of cancer control programs, cancer registration, service delivery and patient quality of life bears higher priority in Iran.

Comparison of drain clamp after bilateral total knee arthroplasty.

Suction drains provide an easy and feasible method for controlling hemorrhage after total knee arthroplasty. However, there has been no compromise regarding the optimum clamping time for these drains. We conducted a randomized clinical trial in 50 patients to compare 12-hour drain clamping and continuous drainage after total knee arthroplasty in terms of wound complications, blood loss, and articular arc of motion. To eliminate any other factor except duration of clamping, we chose to compare only knees belonging to a single patient and to restrict the study to those knees undergoing surgery due to osteoarthritis. From a total of 100 knees (50 patients) studied, the 12-hour-clamping method resulted in a significantly smaller amount of postoperative blood loss (p < 0.001). The passive ranges of motion and wound complications were not significantly different between the two groups.

Does health-related quality of life predict injury event?

BACKGROUND: Unintentional injury is a leading threat to children's health. Some human factors have been determined as predictor of unintentional injury. Association between Health-Related Quality of Life (HRQOL) as a human factor and unintentional injuries is unclear. The objective of study is to examine the association between HRQOL and unintentional injuries among primary school children. METHODS: This study was a cross-sectional conducted in Ahwaz, a city in Iran. Overall, 3375 children aged 6-10 years were randomly selected from primary school. HRQOL was measured by 56 items taken from seven domains of Netherlands Organization for Applied Scientific Research Academic Medical Center (TNO AZL) child quality of life (TACQOL) parent form. Parents were interviewed to collect information about incidence, cause and a brief description of injury within the past 12 months prior to the study. RESULTS: The response rate was 3375 of 3792 (89%). There was a significant trend for increasing occurrence of injury with decreasing of HRQOL score (p was less than 0.001). Adjusted OR for injury was significantly higher in very low (2.38, 95% CI: 1.45-3.86), low (2.18, 95% CI: 1.34-3.56), and medium (1.73, 95%CI: 1.06-2.83) HRQOL groups compared to reference group (very high HRQOL). The median of total HRQOL (P less than 0.001) and all its domains (P=0.017) (except autonomous functioning) was lower in injured group compared to uninjured one. CONCLUSIONS: This study found an association between HRQOL and unintentional injury among primary school children. This is a preliminary finding and further investigations with a well-defined analytical design are needed.

Association between health-related quality of life and children's unintentional injuries.

OBJECTIVE: To examine the association between health-related quality of life (HRQOL) and unintentional injuries among children. METHODS: Overall, 3375 children aged 6-10 years were randomly selected from primary schools in Iran. HRQOL was measured by 56 items taken from seven domains of TNO AZL child quality of life (TACQOL) parent form. Parents were interviewed to collect information about incidence, cause and a brief description of injury within the past 12 months prior to the study. RESULTS: The response rate was 3375 of 3792 (89%). There was a significant trend for increasing occurrence of injury with decreasing of HRQOL (P<0.001). Adjusted OR for injury was significantly higher in very low (2.38, 95% CI: 1.45-3.86), low (2.18, 95% CI: 1.34-3.56), medium (1.73, 95%CI: 1.06-2.83) HRQOL groups compared to reference group (very high HRQOL). The median of total HRQOL (P<0.001) and all its domains (P=0.017) (except autonomous functioning) was less in injured group compared to the uninjured one. CONCLUSION: This study found an association between HRQOL and unintentional injury among primary schoolchildren. This is a preliminary finding and so further investigations with a well-defined analytical design needs to be done.