Trend of knowledge production of research centers in the field of medical sciences in iran.

Establishment of medical research centers at universities and health-related organizations and annually evaluation of their research activities was one of the strategic policies which followed by governmental organization in last decade in order to strengthening the connections between health research system and health system. The aim of this study is to scrutinize the role of medical research centers in medical science production in Iran. This study is a cross sectional which has been performed based on existing reports on national scientometrics and evaluation results of research performance of medical research centers between years 2001 to 2010. During last decade number of medical research centers increased from 53 in 2001 to 359 in 2010. Simultaneous scientific output of medical research centers has been increased especially articles indexed in ISI (web of science). Proper policy implementation in the field of health research system during last decades led to improving capacity building and growth knowledge production of medical science in recent years in Iran. The process embedding research into the health systems requires planning up until research products improves health outcomes and health equity in country.

The analysis of health research system evaluation in medical sciences universities.

BACKGROUND: Based on Iran by 2025 defined vision, we must to receive the first grade of science position in south western Asian region. Thus we need to have a comprehensive evaluation program. METHODS: A comprehensive WHO Health Research System Analysis (HRSA)- based evaluation system was developed to evaluate the HRS in Iran. This article has explored the results of the five-year evaluation (2003-2008) and aims to introduce this method to other developing countries. Here we explore the results of research performance evaluation from 2002 to 2010 and by comparing the results with previous available information, we reveal the probable role of this method in research promotion and proposed approach to facilitate and expedite achieving the prospects for goals of health research based on the visions of Iran by 2025. RESULTS: All of the indicators of stewardship and capacity building axes are received to their predefined levels. Moreover all of the medical science university research policies are based on their strategic plannings which are extracted from national visions of Iran by 2025. Most of the predefined goals in knowledge production domain had a significant grow trend but for more growth for commitments they should be closely follow. CONCLUSION: We developed an HRS-based comprehensive evaluation program to our national vision as well as our regional and international research competition.

Factors influencing women's willingness to volunteer in the healthcare system: evidence from the Islamic Republic of Iran.

This case-control study evaluated the factors influencing volunteering in the Islamic Republic of Iran's Women's Health Volunteer (WHV) programme, which is implemented in 150 centres in Khorasan-e-Razavi Province. We recruited 145 cases (volunteers) and 146 controls (non-volunteers) from the centres. Data were collected by questionnaire. Sociodemographic variables included were: length of residence in neighbourhood, number of siblings, husband's age and education and job, family size, quality of life, self-rated health status, neighbourhood intimacy, child under 2 years, house ownership, wealth index. Social network variables included were: ego network size, type of acquaintance, intimacy with others, relationship communication, relationship duration, emotional support, advisory support, monetary support, physical support, time support. There were significant associations (P<0.05) between women's propensity to volunteer and family size, presence of a child under 2 years in the family, neighbourhood intimacy, social network composition, and emotional and advisory support.

Factors influencing women's willingness to volunteer in the healthcare system: evidence from the Islamic Republic of Iran

This case-control study evaluated the factors influencing volunteering in the Islamic Republic of Iran's Women's Health Volunteer [WHV] programme/which is implemented in 150 centres in Khorasan-e-Razavi Province. We recruited 145 cases [volunteers] and 146 controls [non-volunteers] from the centres. Data were collected by questionnaire. Sociodemographic variables included were: length of residence in neighbourhood, number of siblings, husband's age and education and job, family size, quality of life, self-rated health status, neighbourhood intimacy, child under 2 years, house ownership, wealth index. Social network variables included were: ego network size, type of acquaintance, intimacy with others, relationship communication, relationship duration, emotional support, advisory support, monetary support, physical support, time support. There were significant associations [P < 0.05] between women's propensity to volunteer and family size, presence of a child under 2 years in the family, neighbourhood Intimacy, social network composition, and emotional and advisory support

Health research evaluation and its role on knowledge production.

BACKGROUND: Knowledge production and evaluation are two important functions of health research system (HRS). In this article, we aimed to reveal the correlation between evaluation of health research organizations and health knowledge production promotion. METHODS: A comprehensive evaluation system was developed to evaluate the academic performance of national medical science universities on an annual basis. It assess following domains; stewardship, capacity building and knowledge production. Measurable indicators for each domain were assigned, a 'research profile' for each department was provided. In this study, we compared the results of annually national Health Research System evaluation findings during 2005-2008. RESULTS: The number of scientific articles has been increased from 4672 to 8816 during 2005 to 2008. It is mentionable that, the number of articles which has been published in indexed data bases has risen too. This fact could be related to directed policy for more international publication of scientific articles from Iran. The proportion of total articles to the number of academic members was 1.14 in 2008, comparing to 0.84 in 2005. It means that this proportion have increased about twice (0.7 Vs 0.45) during mentioned time. Moreover, other scientific products such as authored books based on domestic researches and cited articles in textbooks have increased according to special attention to knowledge production by policy makers. CONCLUSION: We conclude that Health System Research evaluation could be used as a mean for implementing policies and promoting knowledge production.

Malaria Status in Economic Cooperation Countries; Achievement and Gaps toward United Nations Millennium Development Goals.

BACKGROUND: Evaluating the malaria status of the Economic Cooperation Organization (ECO) member countries relation to goal 6 of 3rd Millennium Development Goals (MDGs) which includes have halted by 2015 and begun to reverse the incidence of malaria. METHODS: By 2009, we reviewed the MDGs reports, extracted the data from surveillance system, published, and unpublished data. The main stakeholders, from both governmental and international organizations in the country have been visited and interviewed by the research team as part of the data validation process. RESULTS: The malaria incidence is very heterogeneous among ECO countries, which differ less than 200 cases in total country in Kazakhstan, Kyrgyzstan, Turkey, Turkmenistan, Uzbekistan, and Azerbaijan to 82,564 cases (2,428/100,000) in Afghanistan and 59,284 cases (881/100,000) in Pakistan and about 18/100,000 in Iran in 2008. Malaria has been a major public health problem in Pakistan and Afghanistan and will continue to pose serious threat to millions of people due to poor environmental and socioeconomic conditions conducive to the spread of disease. The main malaria endemic areas of Iran are in southeastern part of the country; consist of less developed provinces that are bordered in the east by Afghanistan and Pakistan. There are little valid information about proportion of population in malaria-risk areas using effective malaria prevention and treatment measures indicators. CONCLUSION: All ECO countries could achieve MDGs malaria indicators by 2015 except Pakistan and Afghanistan, unless preparing urgent intervention programs to fulfill the goals.

An Experience of Peer Education Model among Medical Science University Students in Iran.

BACKGROUND: The purpose of this study was to evaluate the effectiveness of peer education among university students for reproductive health promotion based on researchers' experiences. METHODS: This interventional study was conducted in Qazvin University of Medical Science during 2002 to 2004 through stakeholders' partnership and selection of 24 volunteer students according to their knowledge, interest, communication skills. Capacity building was performed through holding an interactive reproductive health coarse contained marital health, illegal abortion, family planning, STI/AIDS, communication and counseling skills. Trained peer educators have introduced to other student and present education and counseling formally and informally. A post interventional study was conducted after 9 months in order to find its effectiveness. RESULTS: In our experience Stakeholders' partnership in community interventional programs led to the best expected availability of better health through ownership and adopting policies. In present study, the proper determined criteria for selection of peer educators and clear understood expectations of the peer educators' role were very important in health promotional program. Although peer education was acceptable program for university students, more support and supervising for peer groups are needed. The students believed that the power point of peer education and counseling related to same age groups sympathy, confident, well behaved, cheerful, and kind-hearted and peer educators awareness. CONCLUSION: Universities are appropriate real world for experience a friendly youth program and then disseminate it to other young communities. There seems peer education is effective strategy for reproductive health promotion and reinforce positive behaviors in youth.

An Explanatory Model of Depression among Female Patients in Fars, Kurds, Turks Ethnic Groups of Iran.

BACKGROUND: Depressive disorder is globally estimated to be as many as one in five visits to primary health care. Approximately more than 50% of depressed women in primary care are not diagnosed. As a part of a major investigation into perceptions of women's depression, this study explored how female patients and their relatives conceptualize patients' conditions in three ethnic groups in Iran (Fars, Kurds and Turks). METHODS: Qualitative methods were used for data collection. Depressed women and their relatives were purposively selected from the public psychiatric clinics affiliated to university of medical sciences in the three study cities. Twenty-five depressed women and 14 relatives were interviewed in three ethnic groups. RESULTS: One theme "illness meaning", including three categories: perceived symptoms, label of the illness, and effects of the illness was found through the content analysis. The participants perceived symptoms of illness as somatic and psychological depending on the participant's assumed reason for the onset of the illness. There were most similarities in term used for of the illness in the three ethnic groups. Most of the study participants described the illness in terms of nerve problems/illness, and depression "afsordehgi". The most important effects that depressed women had experienced because of their illness were marital conflict or a guilt feeling originating from their inability to support family. CONCLUSION: These findings suggest the need to recognize and choose appropriate diagnostic approach for depressed women in the context of Iran.

The Effectiveness of Educational Intervention in the Health Promotion in Elderly people.

BACKGROUND: More than 8% of Iran's populations are elderly. The greatest challenge in this generation is improvement of health and quality of life. So we decided to perform an interventional study with the aim of promoting the health of the elderly. METHODS: This study was a community interventional in Ekbatan Complex. Subjects were elderly. At first, need assessment was done with the participation of 200 elderly by questionnaire. Based on the need assessment, we designed the educational interventions in different fields such as nutrition, mental health, and exercise and then, we compared the results. RESULTS: 0ne hundred elderly participated as interventional group. There were 86% women and 24% of men. Almost 59% were in the 60-69 age group. More than » of the subjects were university graduates. Pre and post interventional groups were matched in age, education and gender. Regarding nutrition, second priority food in women aged 60-69 was rice and after the intervention, it was changed to vegetables (P= 0.05) but in other age groups and in the men's groups no difference were noted. Aerobic exercises in women has increased after the intervention (P= 0.01). With regards to mental health, life satisfaction among women under study has increased from 68% to 90% after the intervention (P= 0.01). Feeling happy most of the time has increased from 53% to 83% in women aged 60-69 (P= 0.01) and in men from 64% to 83% (P= 0.05) respectively. CONCLUSION: Policymakers should design long-term educational programs to promote the elderly lifestyles.

Integrated visceral leishmaniasis surveillance system in primary care for children in Meshkin-Shahr district, north-western Islamic Republic of Iran.

In 2001 a visceral leishmaniasis (VL) surveillance system was set up for children aged < or = 12 years in the primary health system in Meshkin-Shahr district of Ardebil province, north-western Islamic Republic of Iran. All cases with clinical signs and symptoms of VL and positive by the direct agglutination test were referred for physical examination and treatment. The mean annual incidence of VL decreased significantly from 1.88 before (1985-2000) to 0.77 per 1000 child population after the intervention (2001-07). In a control area with no surveillance, it increased from 0.11 to 0.23 per 1000. Early detection of VL using practical serological tests and timely treatment of cases could decrease the mortality and morbidity rates of VL in endemic areas.

Integrated visceral leishmaniasis surveillance system in primary care for children in Meshkin-Shahr district, north-western Islamic Republic of Iran

In 2001 a visceral leishmaniasis (VL) surveillance system was set up for children aged ≤ 12 years inthe primary health system in Meshkin-Shahr district of Ardebil province, north-western Islamic Republic ofIran. All cases with clinical signs and symptoms of VL and positive by the direct agglutination test were referredfor physical examination and treatment. The mean annual incidence of VL decreased significantly from 1.88before (1985–2000) to 0.77 per 1000 child population after the intervention (2001–07). In a control area with nosurveillance, it increased from 0.11 to 0.23 per 1000. Early detection of VL using practical serological tests andtimely treatment of cases could decrease the mortality and morbidity rates of VL in endemic areas

En 2001, un système de surveillance de la leishmaniose viscérale a été mis en place pour les enfants âgésde 0 à 12 ans dans le système de santé primaire du district de Meshkin-Shahr, province d’Ardebil, nord-ouest dela République islamique d’Iran. Tous les cas présentant des signes cliniques et des symptômes de leishmanioseviscérale ainsi qu’une réaction positive au test d’agglutination directe étaient orientés en vue d’un examen physiqueet d’un traitement. L’incidence annuelle moyenne de la leishmaniose viscérale a nettement diminué, passant de1,88 avant l’intervention (1985-2000) à 0,77 pour 1 000 enfants après l’intervention (2001-2006). Elle a augmentédans une zone témoin sans surveillance, passant de 0,11 à 0,23 pour 1 000 enfants. Un dépistage précoce dela leishmaniose viscérale à l’aide de tests sérologiques pratiques et une prise en charge rapide des cas permettraientde réduire les taux de mortalité et de morbidité de la leishmaniose viscérale dans les zones endémiques

Coronary heart disease and associated risk factors in Qazvin: a population-based study.

In a cross-sectional study in Qazvin, Islamic Republic of Iran, 846 residents (425 men and 421 women) aged > or = 25 years were assessed for coronary heart disease and its associated risk factors comparing ischaemic and non-ischaemic groups. The age-adjusted prevalence of possible myocardial infarction, ischaemic ECG changes and angina pectoris were 4.2%, 36.8% and 2.2% respectively. There was no difference in the mean systolic and diastolic blood pressure and body mass index between ischaemic and non-ischaemic groups. There was a significant association between possible myocardial infarction and hypertension, type 2 diabetes, and smoking in women. There was also a significant association between ischaemic ECG changes and waist-hip ratio in women and between ischaemic ECG changes and hypertension in men.

Coronary heart disease and associated risk factors in Qazvin: a population-based study

In a cross-sectional study in Qazvin, Islamic Republic of Iran, 846 residents [425 men and 421 women] aged >/= 25 years were assessed for coronary heart disease and its associated risk factors comparing ischaemic and non-ischaemic groups. The age-adjusted prevalence of possible myocardial infarction, ischaemic ECG changes and angina pectoris were 4.2%, 36.8% and 2.2% respectively. There was no difference in the mean systolic and diastolic blood pressure and body mass index between ischaemic and non-ischaemic groups. There was a significant association between possible myocardial infarction and hypertension, type 2 diabetes, and smoking in women. There was also a significant association between ischaemic ECG changes and waist'hip ratio in women and between ischaemic ECG changes and hypertension in men

Sustainable control of iodinedeficiency in Iran: beneficial results of the implementation of the mandatory law on salt iodization.

Iodine deficiency disorders (IDD) were prevalent in the Islamic Republic (IR) of IRAN before 1989, when the national salt iodization program with 40 mg l/k of salt was initiated. Despite a comprehensive IDD control program, less than 50% of the households in rural areas consumed iodized salt by 1994. A law for the mandatory production of iodized salt for households was passed in 1994. The purpose of this study was to evaluate goiter status and urinary iodine excretion 2 yr after this law was implemented. In each of 26 provinces, 30 groups of 40 schoolchildren, total 36,178, were examined for goiter and classified according to World Health Organization (WHO) classification. Urinary iodine excretion was measured in 2,917 children by digestion method. Goiter was endemic in all provinces, but the majority were small (grade 1) goiter. Median urinary iodine was 20.5 microg/dl 85.1% had urinary iodine > or =10 microg/dl. Median urinary iodine was above 13 microg/dl in all 26 provinces. In all provinces the percentage of schoolchildren with urinary iodine <5 microg/dl was less than 16%. In nine provinces the median urinary iodine was between 13 to 20 microg/dl; urinary iodine of their schoolchildren was <5 microg/dl in 10.8% and <2 microg/dl in 6-9%. No significant difference was observed between boys and girls or children of rural and urban regions in urinary iodine excretion. We conclude that 7 yr after the beginning of salt iodization and 2 yr following mandatory iodized salt consumption, urinary iodine excretion is adequate in schoolchildren; considering the data of the percent of households consuming iodized salt and programmatic setting of the IDD program, The IR of Iran has reached a sustainable control program for iodine deficiency.

Sociodemographic attributes of Iranian wives who reported unwanted pregnancies.

In a 1989 Family Planning Study in Iran, 40 percent of the married women of reproductive age reported that their last or current pregnancies were unwanted and unintended. This finding is consistent with the results obtained from a number of studies undertaken in the countries of North Africa and the Middle East. Although the phenomenon of unwanted pregnancy is a significant topic in the population studies, it has received very little attention. This paper shows the differences between two groups: group A, those married women who reported that their last or current pregnancies were wanted, and group B, those married women who reported that their last or current pregnancies were unwanted. The findings of this study clearly show significant differences between these two groups in regard to some key sociodemographic attributes: wife/husband's education, actual and desired fertility, wife's current age, past and present practice of contraceptive methods, and extent of satisfaction with family planning services are among the attributes differentiating these two groups. Our examination of these variables suggests that group B had higher parity, fertility, less desire for more children, less use of contraceptive techniques, and less satisfaction with the efficiency of the contraceptive techniques than group A. The relationship between education and wanted/unwanted pregnancies is mixed. The urban women who wanted pregnancies and were 25 years old or older were more educated than those who did not want pregnancies. On the contrary, the rural women whose pregnancies were not wanted were more educated than those who wanted pregnancies regardless of age, parity, and locality differences. Furthermore, the urban/rural women with different levels of parities who did not want to be pregnant were more educated than the urban/rural women who wanted pregnancies. Finally, the standardized regression coefficients, obtained in logistic regression, reveal that among urban women the desire for more children and parity are the first and second most significant independent variables differentiating between group A and group B. Among rural women, living children and the desire for more children were the first and second most important variables differentiating between group A and group B.

Community-based nutritional intervention for reducing malnutrition among children under 5 years of age in the Islamic Republic of Iran.

A project was conducted in a rural area in September 1994 with the aim of decreasing the incidence of protein-energy malnutrition among children under 5 years, by nutritional intervention through the primary health care system. An initial situation analysis revealed the region's resources and causes of malnutrition. Practical instruction on feeding methods, deworming, environmental sanitation, the promotion of home-grown vegetables and reinforcement of the growth monitoring programme were chosen as the routes for intervention. All indices were reassessed in the region after 1 year. Results showed that nutritional awareness had grown among mothers, and that the incidence of malnutrition had dropped from 6.5% to 1.8%, as measured against the weight-for-height index.

Community-based nutritional intervention for reducing malnutrition among children under 5 years of age in the Islamic Republic of Iran

A project was conducted in a rural area in September 1994 with the aim of decreasing the incidence of protein-energy malnutrition among children under 5 years, by nutritional intervention through the primary health care system. An initial situation analysis revealed the region's resources and causes of malnutrition. Practical instruction on feeding methods, deworming, environmental sanitation, the promotion of home-grown vegetables and reinforcement of the growth monitoring programme were chosen as the routes for intervention. All indices were reassessed in the region after 1 year. Results showed that nutritional awareness had grown among mothers, and that the incidence of malnutrition had dropped from 6.5% to 1.8%, as measured against the weight-for-height index

Secular trends in cardiovascular mortality in Iran, with special reference to Isfahan.

OBJECTIVE: There has been a general decline in mortality from cardiovascular diseases (CVDs) in most of the developed countries since the beginning of the 1970s. Still, in recent years developing countries have seen an increasing frequency in CVD mortality. However, mortality rate studies in these populations are scarce. Here we report all-cause and CVD mortality rates for men and women aged 25-74 years over a 16-year period in 24 cities in Iran with special reference to the city of Isfahan. METHODS AND RESULTS: The study was based on national death records using the ninth international classification of diseases and age standardization was performed using the total population of Iran in 1985 as a standard. Due to limitations in available data, mortality rates for the specific categories of CVD for the whole country could not be provided. The in-hospital death rates following myocardial infarction in coronary care units (CCUs) and cardiology departments in Isfahan hospitals were also assessed. The completed medical records from hospitals or the relatives of decedents were reviewed by physicians certified in internal medicine, cardiology and neurology to assess the reliability of death certificate data regarding CVD by determining the sensitivity and specificity of the death certificates against the standard of the reviewers. The official circulatory diseases proportional mortality ratio continues to rise since 1981 with a steep increase since 1987, constituting 26.6% and 47.3% of all deaths in 1981 and 1995, respectively. Age-adjusted all-cause and CVD mortality data were decreasing since 1981 and increasing since 1990. During those years age-adjusted CVD, stroke and other CVD mortality rates were decreasing in Isfahan with a slight increase in ischaemic heart disease (IHD) death rates in both sexes. Mortality rates based on sex showed a 38% and 24.8% decline in all-cause and CVD mortality in men between 1981 to 1995, and a 35% and 34.9% decline for female mortality rates for the same period, respectively. The in-hospital death rate following myocardial infarction in Isfahan was increasing between 1993 and 1995 with a slight decrease thereafter. The results of death certification assessment showed a specificity of 0.89 and a sensitivity of 0.43 with the positive and negative predictive values of 0.82 and 0.57, respectively. CONCLUSION: These data indicate that circulatory diseases remain a serious public health threat in Iran. It suggests the ongoing need for more regular, systematic and innovative surveillance data to improve the capability of measuring, explaining and predicting the disease trend on which the national public health policy depends.

A survey on breast feeding in the Islamic Republic of Iran.

PIP: Breastfeeding was studied among 10,240 urban and 10,794 rural mothers whose children ranged in age from 18-23 months. The sample size for rural and urban areas was equal but in each province, cluster sampling was used proportional to the population of each district. Results of the study show that between 17-28% of urban mothers in the provinces have deprived their children of the minimum period of breastfeeding (4 months). The results also show that between 51-68% of mothers have breastfed their children for at least 1 year. The % of mothers who have breastfed their children for at least 1.5 years was in the 36-50% range. On the other hand, 11-22% of mother residing in rural areas have never breastfed their children: if they have, the period was for less than 4 months. The % of mothers who have breastfed their children for at least 1 year is in the 61-79% range. The % for those mothers who breastfed their children for 1.5 years is between 47-66%. The overall conclusion is that: rural mothers are more willing to breastfeed their children than urban mothers; that in all urban and some rural areas, illiterate mothers have a higher % of breastfeeding; and that is some rural areas, literate mothers breastfed their sons more than their daughters.^ieng