مجله تحقیقات نظام سلامت حکیم
سال پانزدهم شماره 2 (پیاپی 57، تابستان 1391)

This article reviews how geospatial analysis capabilities، remote sensing techniques، as well as geographical information system approaches could be applicable in individuals'' and environment’s health observation. The investigation of spatial factors related to individuals'' health has been the most important aspect of efforts to identify and control environmental factors. Spatial analysis and geographical information could benefit researches in a variety of ways in this field. This article considers the carried out studies worldwide on integration of remote sensing، GIS with health and diseases related notions، i. e. medical geography. GIS، as a central core of location-based disasters، can play a significant role in discovering the influence of location on inception، existence، and distribution of diseases and infections. This article aims to introduce geospatial techniques and space-based information to researchers who study and monitor health systems، e. g.، epidemiologists، demographers and geographers. Thanks to the information technology advancements، GI Systems ease and facilitate temporal، geospatial analysis through data mining، data visualization، and crowd sourcing. More importantly، geospatial techniques provide more precise and valuable information at lower prices and time. Involving location and time into some studies on health system will certainly inspire new visions and creativities to explore influential variables on diseases inception and dissemination، which is very beneficial in controlling and isolating diseases، patients، and environmental impacts.

Assessment of a decade experience about patients cost sharing in the Social Security Organization and availability of general practitioners visits can provide useful insight for health policymakers. In the present study، demands for general practitioners’ visits were estimated using panel data (1998-2009). The study population included 30 million individuals covered by the Social Security Organization who have visits with the general practitioners during 1998-2009. The estimated results of the model indicated that the effect of «proportion of out of pocket specialist''s visit to out of pocket general practitioner''s visit» and the out of pocket paid for drug was reverse and the effects of access was straight in the use of general practitioners’ services. The per capita household expenditures adjusted on family size had no significant effect on the index. The out of pocket changes are important. Regarding different provinces، the organization should consider the availability and price for each service based on the sensitivity of the service and the ability to substitute it with other services and other providers available in the setting. By balancing patients cost sharing، the utilization of health services would be based on real needs of patients.

Operational models should be used to improve quality in organizations. The purpose of this study was to develop a model to use the total quality management (TQM) in the Center for Management Medical Emergencies and Accidents of Iran. This operational model was developed using Iran''s EMS profile، lessons learned from studying the quality system of EMS in 11 countries، and experiences of implementing the TQM in other organizations. The developed model was validated through expert surveys using a 20-items questionnaire. The validation of the model was approved (mean=4. 38 (0. 15) out of 5 scores). According to the model، the EMS in Iran should have a semi-centralized structure in the three national، regional، and organizational levels. Separation of supervision and accreditation body from executive management is the pillar of the model. The important parts of the model are as follows: constituting a unit to coordinate EMS and emergency departments services، creating single dispatch unit between police، EMS، fire station، and red crescent population، establishing two-tiered service، and developing new units including quality groups and quality council in three levels، allocating a quality coordinator unit، developing supervision body، data bank of trauma and heart disease، statistics and public relation units، customer relationship management unit and deputy for education and research. Implementing the model and its requisites can increase success in total quality management، create a basis for self-evaluation، enhance patients'' satisfaction، improve job satisfaction، promote empowerment of people، create a basis for accreditation and evidence-based approaches، and enhance the role of private sector in service delivery.

Unintentional injuries are multi-causal and highly reported among children and adolescents. This study aimed to determine risky behaviors leading to unintentional injuries among high school students in Tehran in 2009. From 237300 high school students (185151 in public and 52149 in private schools)، 727 students were selected using multistage randomized sampling. From 20 educational districts، eight districts were selected and were divided to three north، centre، and south areas. Data were gathered using the standard questionnaire of the CDC which had been validated in Iran. Participants were healthy students aged 12-18 years. Risky behaviors related to falling، burning، poisoning، and road traffic injuries were studied. The students aged 16. 8±1. 2 years. Overall، 44% of male students and 38% of female students were exposed to risky behaviors. Driving without having driving-license was more common among male students studying in public schools (p<0. 001). Motorcycling was more common among students studying in the high schools located in the south of Tehran (p<0. 001). Male students had more substance abuse، driving without driving-license، and motorcycling without using helmets (p<0. 001). Because of high prevalence of risky behaviors related to unintentional injuries، mainly among boys and those who live in more deprived areas، decision-makers should have population-based programs to decline risky behaviors.

Nurses are of the most important staff in health systems. Nurses'' job satisfaction is an important issue in the nursing management. Low job satisfaction can result in decreasing quality of care، early job leaving، and increasing absenteeism. Nursing staff shortage is a global problem. The aim of the present systematic review was to investigate factors affecting nurses'' job satisfaction. In this study، we conducted searches to find available articles through related databases (OVID، ScienceDirect، Interscience، and SID). The keywords for search were «nurses»، and «job satisfaction» in English and Persian languages. The articles containing factors affecting nurses'' job satisfaction were selected. At last، 61 articles، two article references، and one thesis were selected. Data were described using diagram and text. Several factors affect nurses'' job satisfaction including autonomy، job stress، collaboration between physicians and nurses، interpersonal communications among nurses، quality of patient care processes، organizational factors، and income and salary. Focusing on factors that affect nurses'' job satisfaction can help to minimize nurses'' job dissatisfaction.

Domestic violence against pregnant women is an important health problem. Pregnant women who experience domestic violence are at risk of pregnancy complications. The aim of this study was to determine the effect of domestic violence on pregnancy outcomes in pregnant women referring to Karaj medical centers. This descriptive analytical study was conducted on 335 pregnant women during six months (2007-2008). Participants were recruited using convenience sampling method. Pregnant women with adverse pregnancy outcomes (n=168) were considered as cases and pregnant women with desirable pregnancy outcomes (n=167) were considered as controls. Data were collected through interviews with the participants using demographic data form، the domestic violence against pregnant women questionnaire، and adverse outcomes in pregnancy questionnaire. Data were analyzed in the SPSS using t-test، Chi-square and logistic regression. The prevalence of domestic violence in the case group was 30. 1%، including verbal-psychological (25. 1%)، sexual (22. 7%)، and physical (8. 4%) violences. The prevalence was 21. 8% in the control group، including verbal-psychological (14. 9%)، sexual (14. 6%)، and physical (3. 3%) violences. There were statistically significant differences between the total domestic violence rate (p=0. 002)، verbal-psychological (p > 0. 001)، sexual (p=0. 002)، and physical (p=0. 003) violences in the two groups. There was a significant relationship between verbal-psychological violence with low birth weight (OR= 3. 3; 95% CI: 1. 328-8. 593)، sexual violence with premature rupture of membranes (OR= 2. 67; 95% CI: 1-7. 09)، and physical violence with abortion after 12 week gestation (OR= 3. 56; 95% CI: 1. 15-11. 03). Regarding the results of this study، it seems that domestic violence against pregnant women increases adverse pregnancy outcomes. Therefore، screening and prevention programs focusing domestic violence in pregnancy may help to improve desirable pregnancy outcomes.

One of the most important pollutants that can be monitored in the atmosphere through remote sensing technology is particulate matter’s concentration (PM10). This study aimed to assess the MODIS sensor’s ability in monitoring of the PM10 in urban areas and producing daily maps of this pollutant. The MODIS Level 1B-1KM، MODIS Level 1B-250M images، as well as pollutants data collected from pollution surveying stations at different parts of Tehran were used in this study. The model was based on the concept of linear spectral unmixing of only two endmembers; surface reflectance without pollution and PM10 reflectance in the air. These two reflectances are extracted from MODIS images itself. In this respect، the surface reflectance was extracted from an image of a clear day and reflectance of aerosols was calculated from an image of highly polluted day when the surface was completely masked by the pollutants. Findings showed that there was an acceptable correlation between model prediction and insitu measurements. This correlation was found to be about 70% with a RMSE of about 132. 22 μg/m3 between model predicted and insitu measured for Tehran. Comparing RMSE with those of ground measurement of PM10، the relative error was high for low PM10 concentrations (about 200 μgr/m3); consequently model was exaggerated. This relative error was low for the higher values of the PM10. Existance of acceptable correlation between model prediction and insitu measurements were indicative of the ability of satellite images in monitoring of the air pollution due to particulate matter particularly over urban areas.