Health Promotion Perspectives
Volume:3 Issue: 1, Jun 2013

In order to build a framework to address policy gaps and needs, community’s risk factors were identified and the extent to which current policies were in place to address the risk factors were compared. Face-to-face interviews, using the US Centers for Disease Con trol and Prevention’s CHANGEtool were conducted in a rural Northeast Missouri county possessing exceptionally high chronic disease rates to as sess the factor(s) had the greatest influence on the rates in each sector of the community. The Health Care Agency sector possessed the most factors cate-gorized as environmental and policy assets, and the Community-at-Large and Business/Worksite sectors seemed to possess the least environmental and policy factors categorized as assets. Because organizational policies can strongly influence community health practices and behaviors, collaborative leadership from the Health Care Agency sector, comprehensive worksite health promotion programs in the Business/Worksite and Community In stitu-tions/Organizations sectors, and tobacco-free school policies are recom-mended. Multiple community sectors must work together to change not only behaviors but also environments in this county.

In order to develop appropriate obesity control and treat ment strategies, the key point is to understand the barriers perceived by overweight or obese people in trying to follow weight-loss programs. This study examined perceived barriers to weight-loss programs among over weight or obese women. In this descriptive-analytical study, 204 overweight or obese women aged 31. 97± 10. 62 yr, were selected randomly from the nutritional counseling centers in 2008 in Tabriz, Iran. The mean BMI was 33. 83 ±5. 75 kg/ m2. A structured questionnaire including questions on barriers to weight-loss diet and physical activity was filled out for each participant by face-to-face interview. Height and weight measured objectively and demo graphic details were obtained. Data analysis carried out using mul tiple re gression and factor analysis. The most important perceived barriers to weight-loss diets were ''situational barriers'', stress, depression, and food craving. High educational level was independent determinant of situational barriers (β=0. 329, P=0. 048). Employee women had a higher mean score on stress and de pres sion than students and housewives. Lack of time and exercising lonely were the most important items of «External barriers» and Lack of motiva tion was the most important item of «internal barriers» to physical activity. Employ ment and being student were highly associated with external bar riers (β=1. 018, P<0. 001 and β=0. 541, P= 0. 002). Moreover, older women who had low educational level, perceived more internal barriers. Weight reducing strategies should take into account the spe cific perceived barriers to weight-loss diets faced by overweight or obese women, particularly situational barriers, stress and depression and food craving; and lack of time and lack of motivation as barriers to physical ac tivity.

Improving adherence to care standards is one way to im prove quality of delivered care. This study aimed to determine the degree of provid-ers'' adherence to maternity care standards from the perspective of pregnant women. This cross-sectional study was conducted on 185 pregnant women in their ninth month of pregnancy who received maternity care from health centres in Tabriz, Iran. Participants were selected randomly from 40 health centres. Data collection used a researcher-developed ques tionnaire based on Iranian Ministry of Health (MOH) standards for mater nity care. Question-naire validity was reviewed and confirmed by 10 experts. About 69% of pregnant mothers during their 9-month pregnancy received at least six items of standard maternity care. Almost two-thirds of participants received recommended maternity care at or above minimal stan-dards for some aspect, such as the number of care during pregnancy, referral to health centre physician, and weight and blood pressure measure ment. Some other services such as measuring uterus height, review for oedema and varicosities, referral to a dentist, listening for fetal heart sound and vaginal examination, were reported at very low adherence to the Ministry of Health guidelines A notable proportion of pregnant mothers reported receiving suboptimal care indicating significant room for improving the quality of maternity care based on Iranian MOH standards and guidelines. The results indicate potential benefits from interventions to improve health care provid-ers training and the awareness of pregnant women about the standards for good maternity care.

The present study aimed to examine pathways to imprison ment for women in Pakis tan. It was hypothesized that early life victimiza tion in women, problematic family relationship and eco-nomical depriva tion would be significantly associated with criminal activities of women prisoners. To identify the pathways to prison, structured interview was de vised by the researchers. Sample comprised of 114 women pris-oners en listed from KotLakhpat jail, Lahore, Pakistan. Poverty, revenge, anger and lack of empowerment were signifi cantly associated with crimi nal activities of women offender. The umbrella of rehabilitation should also cover social and legal matters of women of fenders along with tackling their psy-chological issues.

Musculoskeletal health in schoolchildren is a global health problem. The objective of the current study was to assess ergonomic be havior and musculoskeletal health in urban poor schoolchildren in Pune, India. Sixty-five (29 male students) slum dwelling schoolchildren were assessed for their ergonomics using a validated and reliable tool. Average age was 13 years. Out of 65 students, 36 reported pres ence of musculoskeletal pain. In addition, 78.5% had bad ergonomics when lifting books. Sitting posture was poor in 67.7%, while 50.8% dem onstrated bad posture while using a computer. As far as the female stu dents were con-cerned, it was seen that out of 36 students, 55.6% com plained of presence of pain. Out of the 20 students who reported pain, 70% had a score lower than 7.5 on ergonomic score assessment (indicative of bad ergonomics). When the male students were considered, out of 29 students, 65.5% reported presence of pain. Out of the 19 students who reported pain, close to 79% demonstrated bad ergonomics. There is presence of musculoskeletal aches and pains in this underprivileged section of the society, including demonstration of bad er-gonomics and postures while performing activities in school. Thus, mus-culoskeletal health problems exist in urban slum schoolchildren. It is im-portant to identify health problems at an early stage in both boys and girls. Children are the future of the nation and hence, identification of health issues early in life and preventing them from becoming chronic is of ut most importance.

Regular and daily physical activity during childhood and at school is one of the important part of requirements of normal growth, development and well-being. To achieve physical activity promotion among school child aged population recess as outside of class time efforts is scheduled and allows students to engage in physical and social activities. The purpose of the present study was to assess recess activities as well as status of physical activities among a sample of Iranian students at the pri mary schools. This cross-sectional study was performed in four randomly se-lected schools from a list of 26 elementary schools in March, 2012 in the city of Shahindej, located in North-west of Iran. Participants were 439 (10–12 years) elementary schools’. Physical activity level by self-reporting, mental health using the parent-completed Child Health Questionnaire, and happiness was assessed using a Persian translated version of the Subjective Happiness Scale. Hierarchical logistic regression analysis was applied in two steps using the enter method to analyze data in the SPSS version 17. Backward logistic regression analysis showed that gender of the parent who answered the study questions, father’s education, educational grade of children, BMI, physical function, physical health, health status of the children and family function were significantly related to the children’s physical activity level. Promoting parents’ awareness and schools’ staff about im-portance of physical activities especially in recess times must be an impor tant part of school and community mental health promotion programs.

Type 2 diabetes mellitus, as a noncommunicable disease, is the main public health challenge in the 21st century. The prevalence of di abetes mellitus adjusted for the world population in Iran was 8% until the year 2010. Lipid levels are considered as important parameters to be eva luated, as high serum lipid levels are often reported as a complication in patients with diabetes mellitus. It is claimed that functional foods may im prove complications of diabetes mellitus, so this study was designed to evaluate the effects of high performance inulin on glycemic status and lipid profile of women with type 2 diabetes. The study was a randomized controlled clinical trial. Forty-nine type 2 diabetic females (fiber intake <.,30g/d, 25<.,BMI<.,35 kg/m2) were divided into two groups. Patients in the intervention group (n=24) re ceived 10g/d inulin and patients in the control group (n=25) received 10g/d maltodextrin for 8 weeks. Glycemic status and lipid profile indices were measured pre and post intervention. Data were analyzed using SPSS software (verision11.5). Paired, unpaired t-test and ANCOVA were used to compare quantitative variables. Supplementation with inulin caused a significant reduction in FBS (8.50%), HbA1c (10.40%), total cholesterol (12.90%), triglyceride (23.60 %), LDL-c (35.30 %), LDL-c/HDL-c ratio (16.25%) and TC/HDL-c ratio (25.20%) and increased HDL-c (19.90%). The changes for the control group parameters were not significant at the end of study. Inulin may help to control diabetes and its complications via improving glycemic and lipid parameters.

Food fortification is the addition of one or more essential nutrients to a food whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency of one or more nutrients in the population or specific population groups. The present cross-sectional study was conducted to obtain comprehensive in formation towards consumption of Targeted Fortified Products (TFP) among rural and urban mothers of children < 3 years in Jaipur, India. In this cross-sectional study conducted in 2012, three hundred rural and urban mothers were selected from Primary Health Centre, Ach rol Village and Uniara Hospital in Jaipur, Rajasthan. The data were col lected using a self-administered questionnaire. The current nutritional sta tus of children was determined by anthropometric measurements. A total of 53.33% rural and 65.33% urban mothers had know ledge (P=0.046), amongst which 52.67% rural and 66.00% urban mothers (P= 0.026) consumed TFP directed towards mothers. In addition, 56% rural and 94.67% urban mothers had knowledge (P=0.000) about TFP directed towards children, amongst which 19.33% rural and 50.67% urban mothers (P=0.000) fed their children with TFP. There was significantly less awareness regarding consump tion of TFP directed towards both pregnant women and children among rural when compared to urban population. Attitudes seemed to be go verned by the traditional beliefs and family influences of region rather than the knowledge obtained. There is a need of intensive coordinated efforts to create awareness among mothers to enhance the maternal and child diets through TFP.

The prevalence of obesity is increasing throughout the world. Obesity assessed by body mass index (BMI) has shown to be associated with gestational complications while the relationship using waist circumference (WC) is not clear yet. The present study was aimed to determine the relationship between WC and adverse pregnancy complications. In this prospective cohort study, 1140 nulliparous pregnant women at 1st trimester of pregnancy referred to health care centers in Ta-briz, Iran were enrolled in 2009-2010. Anthropometric indexes including (weight, height and WC) were measured using standardized measures and methods. BMI was classified into normal, overweight and obesity based on WHO classification. Abdominal obesity was defined as WC ≥ 88 cm. Pregnancy complication including gestational diabetes, hypertension and preeclamsia. Data were analyzed using SPSS, version 16. Mean of BMI and WC were 24.32±4.08 kg/m2, 81.84±9.25cm at 1st trimester of pregnancy, respectively. Prevalence of overweight (BMI=25-29.9 kg/m2) and obesity (BMI>29.9 kg/m2) was 27.6%, 8.8%, respectively. Abdominal obesity based on WC was 34.8%. Significant correlations were found between BMI and WC (r=0.73, P =0.0001). Women with BMI>29.9 kg/m2 and WC>88 cm were more likely to suffer from gestational pregnancy and hypertension, as well as preeclampsia and preterm delivery. Early maternal WC similar to BMI is related with pregnancy complications.

The present study compared people with depressive symp toms and people without depressive symptoms with reference to their coping styles, level of aggression and interpersonal conflicts. A purposive sample of 128 people (64 depressed and 64 normal controls) was selected from four different teaching hospitals of Lahore. Both the groups were matched on four demographic levels i.e. age, gender, educa-tion and monthly income. Symptom Checklist-R was used to screen out de-pressed and non-depressed people. The Brief COPE, the Aggres sion Ques-tionnaire and the Bergen Social Relationship Scale were used to assess coping styles, aggression and interpersonal conflicts respectively. The Independent t-test was used to compare the groups. Binary logistic Regression was also car-ried out to predict the role of research variables in causing depression. The results showed that level of aggression and interpersonal con-flict was significantly more in people with depressive symptoms as compared to control group. On the other hand control group was using more adaptive coping styles than people with depressive symptoms but no difference was found in the use of maladaptive coping styles. The present findings revealed that coping styles, aggression and interpersonal conflicts play important role in depression. Therefore, these dimensions must be considered while dealing with the depressive patients. Implications for preventive work are also discussed in the light of previous researches.

The aim of this study was to compare the levels of job satis-faction and its predictors among primary health care and treatment sectors'' staff in East Azerbaijan Province, Iran. This comparative study was conducted in East Azerbaijan Province, Iran in 2011. A questionnaire survey was performed on 420 staff from health care and treatment sectors using multi-stage proportional cluster sampling method. Job satisfaction was measured in five aspects namely: structural and managerial; individual; social; work it-self; environ mental and welfare job satisfaction factors. The job satisfaction measure ment score was normalized to fall into a range of zero to 100. Statistical analyses were performed using Friedman and independent sample t-tests. Overall satisfaction in health and treatment sectors was moderate with a mean score above 50. Hospital General Practitioners reported sig nifi-cantly higher job satisfaction score (mean ± SD=57.34 ± 17.02) com pared to health care center General Practitioners (mean ± SD= 31.74±14.99). The highest satisfaction scores belonged to individual factors both in health care sector staff (64.83±18.50) and treatment sector staff (63.55±17.44). The lowest job satisfaction was observed with environmental and welfare factors (38.47±19.86 and 36.83±19.86, respectively). The job satisfaction significantly differs between primary health care and treatment sectors. Based on the results, environmental and welfare factors may be targeted to improve the job satisfaction in public health care system.

Globally, tobacco use is a major public health concern given its huge morbidity and mortality burden that is inequitably high in law- and middle-income countries. The World Health Or ganization has suggested banning the advertisement, promotion and sponsorship of to bacco. However, governments in some countries, including India, are ei ther directly engaged in tobacco industry oper ations or have a mandate to promote tobacco industry development. This paper analyses a short-term advocacy campaign that chal-lenged the state-tobacco industry ties to draw lessons for effective public health advocacy. This paper uses a case study method to analyze advocacy efforts in India to thwart the state-tobacco industry partnership: the Indian gov-ernment’s sponsorship and support to a global tobacco industry event. The paper explores multiple strategies employed in the five-month advo cacy campaign (May to October 2010) to chal lenge this state-industry tie. In doing so, we describe the challenges faced and the lessons learnt for effective advo-cacy. Government withdrew participation and financial sponsor ship from the tobacco industry event. Use of multiple strategies in cluding en gaging all concerned government agencies from the be ginning, strategic use of media, presence and mobilization of civil society, and use of legal tools to gain information and judicial action, were complementary in bringing desired outcomes. Use of multiple and complementary advocacy strate gies could lead to positive outcomes in a short-time campaign. The Framework Con-vention on Tobacco Control could form an impor tant advocacy tool, espe-cially in countries that have ratified it, to advocate for im provements in na-tional tobacco control regulations.

Environmental Health Indicators (EHIs) are the most im-portant criteria for evaluation of effi ciency and effectiveness of the activi ties of the health sector. The operations and situation of the health sys tem can be analyzed through surveying the indicators and comparing them during different times. The present study aimed to study the EHIs of Ta briz, using the common environmental health processes and national EHIs of the Ministry of Health. The required information for determination of EHIs was col lected from different sources, including mainly the Environmental Health De-partment of the Health Center of East Azerbaijan Province, Iran and other organizations. We found some important desirable and undesirable EHIs in Ta briz, including high percentage of households with access to safe and reliable drinking water, high safety in microbiological and chemical quality of drink-ing water, acceptable level of BOD5 and COD in the effluent of wastewater treatment plants (WTP), lack of complete municipal wastewa ter collection and treatment, relatively poor sanitation and health of food markets and public places, undesirable collection, transportation and dis posal of munici-pal solid waste, low EHIs of some school classrooms, un acceptable disposal of medical waste in some hospitals, and finally high level of noise pollution in the city. Considering the poor condition of some EHIs of Tabriz, im-plementing proper actions for pro motion of the indicators especially devel-opment of municipal wastewater collection, improvement of solid waste management, environmental health of some schools and mosques, and fi nally the noise pollution level of the city is recommended.

In Pakistan, the issue of institutionalized elderly is a neg lected area and little is known about their subjective conditions. The present study was conducted in 2012 which examined the relationship between religiosity and subjective well being amongst institutionalized el derly people. Data was collected from 100 adults above the age of 60 years in Lahore, Pakistan, through purposive sampling strategy. Religiosity was measured through Religiosity Index, while Trait Well Being Inventory was used to assess subjective well being. Pearson product moment correlation coefficient and regression analysis were used for the analysis of the data, which revealed that reli giosity has a significant positive relationship with life satisfaction. How ever, no as-sociation was found between religiosity and mood level. More over, regres-sion analysis indicated that religiosity positively predicted life satisfaction among elderly. The current research would create awareness and urge the poli-cy makers to look into this social issue and provide better long term care to the residents of old homes.

The aim of this study was to apply a new method for se lecting a few genes, out of thousands, as plausible markers of a disease. Hierarchical clustering technique was used along with Support Vector Machine (SVM) and Naïve Bayes (NB) classifiers to select marker-genes of three types of breast cancer. In this method, at each step, one sub ject is left out and the algorithm iteratively selects some clusters of genes from the remainder of subjects and selects a representative gene from each cluster. Then, classifiers are constructed based on these genes and the accu racy of each classifier to predict the class of left-out subject is recorded. The classifier with higher precision is considered superior. Combining classification techniques with clustering method re-sulted in fewer genes with high degree of statistical precision. Although all classifiers selected a few genes from pre-determined highly ranked genes, the precision did not decrease. SVM precision was 100% with 22 genes instead of 50 genes while the NB resulted in higher precision of 97.95% in this case. When 20 highly ranked genes selected to be fed to the algorithm, same precision was obtained using 6 and 5 genes with SVM and NB clas sifiers respectively. Using hybrid method could be effective in choosing fewer number of plausible marker genes so that the classification precision of these markers is increased. In addition, this method enables detecting new plausible markers that their association to disease under study is not bio logically proved.