نشریه سلامت اجتماعی
سال یکم شماره 1 (پاییز 1393)

A defined population is needed to determine the potential needs of society، calculate the correct indicators in the suitable time & health care activities and to do the population based study. It is also needed to provide the required education for training، to perform the educational program and intervention in promoting healthy lifestyles. In addition، a defined population is required for screening and treatment، implementing the referral system and to determine the optimal service. The aim of this study is to introduce the structure and start-up methodology of the research network of a defined population، affiliated by the social determinants of health research center of Shahid Beheshti University of Medical Sciences. The project started by choosing 10 health centers of 10 different areas in 2012. Two new centers have been added during years 2013 and 2014. Now the number of the covered population، by the network، has reached to 40000 people. The covered population is chosen based on the characters representing the total population of Tehran city.

Health volunteers are the women who do charity work to prevent، protect and promote the health status of the covered neighbors and hereby cooperate with the health centers. The aim of this study was to compare the health volunteer''s performance in the covered health centers by Shahid Beheshti University of Medical Sciences. This descriptive- analytical study was performed by the participation of 2060 Health volunteers، who were cooperating with 90 covered health centers by Shahid Beheshti University of Medical Sciences. These include Shomal، Shargh، Shemiranat، Pakdasht، Damavand and Firoozkooh. We used census sampling method. Demographic data was gathered through interviews with the health volunteers and their performance evaluated by the supervisor of the volunteers; through the evaluation forms and these data gathered together. The mean (SD) of the health volunteers performance was 30. 9 (16. 4) in all centers. They were 35. 1 (22) in Shargh، 34 (14. 5) in Shomal، 32 (11. 3) in Firoozkooh، 28. 3 (14) in Shemiranat، 7. 9 (9. 2) in Damavand and 23. 6 (8. 5) in Pakdasht respectively. The mean (SD) of the efficacy of health volunteers was 8. 6 (9. 9) in all centers. They were 11. 7 (5. 6) in Firoozkooh، 10. 7 (15. 7) in Shargh، 9. 4 (6. 8) in Shomal، 7. 9 (4. 9) in Damavand، 7. 9 (6. 1) in Shemiranat and 4. 6 (4. 3) in Pakdasht respectively. Older and married volunteers with more experience performed better. There was no significant relationship between the efficacy of health volunteers with their literacy level، employment status and absorber of them. The health volunteers of Shomal، Shargh and Firoozkooh had the best performances respectively. The performances of those in Shemiranat، Damavand and Pakdasht were less than the overall health centers’ mean score. The efficacy score of Firoozkooh، Shomal and Shargh health centers were above the overall health centers’ mean score respectively. Considering all factors، it seems that the efficacy of the health volunteers of Shomal and Pakdasht were the most and least suitable respectively.

The lack of a proper sewage collection & disposal system، the water and sewerage project، in the city of Rasht، became a priority by Guilan province Urban Water and Sewerage Company with the government partnership and World Bank financial support. The objective of this research was to complete the first phase of a two-phase study، to determine the impact of using an urban sewerage system on acute diarrhea in children under five years old، in Rasht city in the Guilan province. The study is a concurrent control before and after field trial which is carried out in two phases: before (phase I) and after (phase II). Sampling for phase I was performed in the middle month of each season، November and February 2009 and May and August 2010. The incidence of acute Diarrhea was measured with the participation of 1560 mothers of children under 5 years old. This was done in two groups: the intervention group (inside the sewerage system project perimeters) and the control group (outside the project perimeters). Data was collected by local female general practitioners and medical students by door-to-door interviews with mothers. Data was analyzed using the SPSS 11. 5 software package. The Pearson Chi-Square was used to compare qualitative variables between groups، whilst the t-test and One-Way ANOVA was used to compare quantitative variables. The average annual incidence of acute diarrhea in children under five years old was 10. 4% (9. 4% in the intervention group and 11. 4% in the control group). The seasonal pattern of acute diarrhea incidence was 10. 5% (9. 3% in the intervention group and 11. 7% in the control group) in May، 12. 5% (11. 5% in the intervention group and 13. 4% in the control group) in August، 9. 3% (8. 1% in the intervention group and 10. 5% in the control group) in November، and 9. 1% (8. 5% in the intervention group and 9. 8% in the control group) in February respectively. The study showed the incidence of acute diarrhea in children under five years old in Rasht city is moderate and it follows a seasonal pattern. The highest rate was seen in summer and the lowest rate in winter. It is expected to decrease with the initiation of the sewerage system program.

It is obvious that، because of the lack of resources، we should devote our limited resources to priorities in order to reach an acceptable level of health. The objective of this study was to research priority setting for Pediatric Surgery Research Center; with the participation of all stakeholders. This is a Health System Research (HSR) project in order to apply governance and leadership issues with the participation of 41 people including faculty members in Pediatric Surgery Research Center، Shahid Beheshti Medical University and the other pediatric specialists and health system stakeholders as well as the people associated with health system inside & outside the university. This was performed in 2010 using the Council on Health Research for Development) COHRED (model with little change. Based on the model، at first the stakeholders were identified and the field situation of Pediatric Surgery was analyzed. Then، research areas and titles were specified and research priorities were set out by giving scores according to the criteria. The seven obtained research areas in priority order are included pediatric trauma، pediatric cancers، pediatric urology diseases، undescended testicles in children، developmental genetics & congenital defects، emergency in children and application of laparoscopic surgery in children. Because each of the research areas is composed of multiple subareas، we managed to finally specify 43 research subareas as research priorities. These subareas included epidemiology، risk factors، prevention، screening، diagnosis and treatment. They also included follow-up، complications، knowledge & attitudes of parents، quality of life، economy aspects and data bank for further research. In this project، research priorities were set out for Pediatric Surgery Research Center of Shahid Beheshti University of Medical Sciences، with the participation of all the stakeholders based on the recommended model of WHO (COHRED). It seems that the reliability of the priorities is in moderate level، but there is certain validity in obtaining the best content in terms of the study conditions.

There are different methods to assess dietary intake in the community. Accurate and appropriate methods، rather than costly and time-consuming ones، are good alternatives to assess dietary intake. The aim of this study was to analyze the validity of telephone and face-to-face interviews، in determination of bread-consumption pattern. A randomized and stratified multi-stage sampling method was used to select 2312 participating households within the Tehran metropolitan area. The study (research) was carried out in two individual and household levels، using 24 hours recall and purchase frequency questionnaire. The same 24 hour recall and purchase frequency questionnaires were used at both individual and household level. At household and individual level، the correlation coefficients between the two methods were 0. 64 and 0. 60، respectively (p<0. 001). Mean difference of intake of bread between the methods at individual level was 16-21 g/day and at household level was 3-4 g/person/day، statistically not significant. Our findings suggest that a telephone survey can provide a reliable estimation of actual bread intake at both individual and household level. This method is important considering its cost and needed time.

Quality is a major concern in the services offered by the health sector. The first basic step، in formulating any quality-improvement program، is recognizing consumers’ perceptions and expectations of the services'' quality. The aim of this study is to determine the gaps in the health services and provide solutions to increase clients'' satisfaction in the clinics of Shomal Health Center of Tehran. This cross-sectional and descriptive study was done in 2013. The sample size was 325، proportionately selected from the recipients of primary health care in each clinic. Data was collected by a questionnaire، based on the five dimensions of service quality gap SERVQUAL instrument; which includes 22 questions. The collected data was statistically analyzed using SPSS software. There was a significant difference between the client''s perception and expectation in each of the five dimensions of service quality. The smallest gap was in the communion (0. 68) and the largest gap in the concrete (0/88) service. The client''s education was significantly associated with the quality gap. None of the service dimensions were beyond the expectations of the respondents. Therefore، there is an ample room for improving the service processes.

Nutrition is one of the effective factors in the protection of health and the prevention of disease. Therefore، determination of the relationship between nutrition choices and health of people is emphasized. The aim of this study is to determine the effectiveness of education and nutrition consultation on changing the unhealthy nutritional habits، and improving healthy nutrition behavior among the clients of Sardar-Jangal health center in 2012. This interventional study was performed with the participation clients of Sardar Jangal health center in 2012. The sample size was 1500 and the sampling method was census. Data was gathered through a questionnaire and interview. The questionnaire included information regarding age، sex، education، employment and nutritional status. The scores between 9-11، 5-8 and less than 5، respectively، were considered as favorable، relatively favorable and unfavorable nutritional status. The participants with relatively favorable and unfavorable status were referred to nutrition education and consultation classes. At the end of the consultation classes، their nutritional status were assessed again. The data was analyzed through SPSS 21، using T-Test. In the study، 1500 clients of Sardar Jangal health center participated. The sample included 383 (25. 6%) male and 1117 (74. 4%) female. The mean age of male and female was 38. 3±21. 1 and 36. 9±17. 4 respectively. Before participating in the nutrition education and consultation classes، the nutrition status of 343 (30. 7%) of females was favorable whilst for 775 (69. 3%)، the nutritional status was unfavorable. Among 114 (29. 8%) of males it was favorable and amongst 268 (70. 2%) it was unfavorable. Between the mentioned clients، the nutrition status of 144 (20. 1%) females and 28 (12. 7%) males improved after nutritional consultation (P < 0. 001). The results showed nutritional education and consultation are effective in improving the nutritional behavior and modifying the incorrect nutritional behavior.

Background and Objetive: Renal Cell Carcinoma (RCC) accounts for approximately 90% of kidney cancer cases and its incidence rates have increased over recent years. Many studies have shown that high Body Mass Index (BMI) is positively associated with RCC. However the role of diet in etiology of RCC is controversial. The aim of this study was to identify the association of BMI and food intake with RCC.

Forty four patients with pathological confirmation of RCC and 84 controls matched with cases by sex، age (5-year age group) and smoking status، were recruited in this case-control study. General characteristics (including socioeconomic and health status، self-reported weight and height)، physical activity and food frequency questionnaires were completed. The food items were classified into 29 groups. Statistical analyzing was done with SPSS-21.

No association was found between BMI and RCC. The mean daily intake of egg differed significantly in two groups (30. 7، 21. 6 gram per day in cases and controls، respectively). When we analyzed the association of food groups with RCC، there was also a significant positive association between egg consumption and RCC (OR= 1. 093، 95% CI=1. 004-1. 190). The mean daily intake of other food items، including cheese، cream، potato and sugar، was significantly higher. Whilst the mean daily intake of tomato، lentil and split peas was lower in cases than controls.

Our data shows that there is no significant association between BMI and RCC. A higher intake of egg، cheese، cream، milk، potato and sugar and lower intake of tomato، lentil، and split peas may increase the risk of RCC.