مجله تحقیقات نظام سلامت حکیم
سال پانزدهم شماره 3 (پیاپی 58، پاییز 1391)

Nowadays، the development of participatory approaches with emphasis on community empowerment is recognized as an important tool in health promotion. The present study was conducted to assess the strengths، weaknesses، challenges and lessons learned from participatory community-based programs in the Islamic Republic of Iran. In this qualitative study، thirteen community-based participatory programs related to health have been assessed in leadership، community participation/other stakeholders and capacity building themes. In this study، the main strength of leadership was volunteers` motivation in service delivery and community resource mobilization. The weak points were lack of community participation in decision-making process in national level، lack of regular monitoring and evaluation programs، and lack of appropriate policymakers` supports. In participation axes، the partnership of women was as the strength and lack of male participation and weakness of team working were as the challenges of the programs. Moreover، the participatory process of community empowerment was important as well as the other strengths in many programs and lack of appropriate update was the weak point. Capacity building of community، NGOs and policymakers are important in cooperation mechanisms، partnership، team working and resource mobilization fields in development of participatory community-based programs.

Dust storms which changes climate have harmful effects on health and economy. Dust can increase rate of meningitis، asthma، and virus-caused diseases. It also damages DNA of skin and lung cells. The purpose of this study was to depict the situation of the dust storms entering Iran.

Data on dust phenomenon during past 50 years (1961-2007) were obtained from the Iran Meteorological Organization. Data on the concentration of suspended particles and dust during 2001-2009 were obtained from the Environmental Protection Agency، Iran. To validate the data gathering instruments، the High Volume Air Sampler model PM10 and the Envirocheck model 1. 07 were set up in the National Institute of Health Research، Ahvaz station. Data were gathered in six days and in dusty days of the first six months of 2010. Data obtained from the two organizations were compared with each other using the Excel and SPSS-16.

The year 2009 was the dustiest year with an average of 42. 8 dusty days in the last three years. The dustiest days with 107 and 102 dusty days were seen in Kermanshah in 2008 and Khuzestan in 2009، respectively. The highest concentration of dust was recorded in Bushehr in 2009 with a concentration of 9900 µg/m3. The average concentration of all floating particles in Khuzestan equaled 7576 µg/m3 during the three years. The longest dusty hours happening in Khuzestan lasted for 144 hours. The average hours for each dust event were 32 hours in this province.

Concentration of dust particles in dusty days have significantly increased in all provinces. The mean and standard deviation of particle concentration in Ahvaz is 16. 5±11 times more than the standard concentration rates in the country. Considering the severity of these phenomena and its harmful effects on health of dwellers in the region، policy-makers should take necessary measurements.

Acceptance of medical students in the Comprehensive pre-internship Exam (CPIE) is a prerequisite for entering to the internship course. Identifying and controlling risk factors of success in the CPIE is necessary. This study aimed to determine effective factors on the results of the CPIE in the medical Alumni of Kashan University of Medical Sciences during an 18-year period. In this cross-sectional study، medical alumni of the last 18 years whose CPIE results had been recorded in their university files (n=533) were selected. Data were gathered using a questionnaire including the result of the CPIE، and educational and demographic data. The frequency of failure in the CPIE was calculated. The Chi-squared test، Fisher''s exact test، independent t-test، multivariate stepwise linear regression، logistic regression، and crude and adjusted odds Ratio were used to analyze the status of the probable risk factors. The frequency of failure in the CPIE was 9. 2%. Temporary transfer to other universities، delay in passing basic sciences course، and low average score for basic sciences exam were the most important risk factors of the failure in the CPIE. The multivariate linear regression analysis showed that high school average score (B=-1. 04، SE=0. 467)، comprehensive basic sciences exam score (B=0. 52، SE=0. 075)، duration of basic sciences course (B=-7. 40، SE=1. 56)، and externship course average score (B=5. 03، SE=1. 1) explained more than 64. 5% of variance of the CPIE score; and in this regard، the highest value was for the comprehensive basic sciences exam score (R2=0. 513). T he risk factors of failure in the CPIE should be controlled; so، the students at risk should be identified and supported.

Needs of patients is one of the most important issues that should be considered in decision making of managers in hospitals. This study aimed to determine preferences of patients referring to the outpatient clinic of Firoozgar hospital. In this study، 150 patients referring to the outpatient clinic were selected using convenience sampling method in 2011. We used the choice based conjoint analysis to conduct the study and analyze the data. The mean age of the participants was 31. 76 (±0. 738). Most of the participants (70%) were female; and 30% were male. Doctors'' consultation with patients was the most important issue from the participants point of view (relative importance=37. 1%). The second important issue was the formation of medical records (relative importance=21. 6%). The least important issue was the way of setting appointments (relative importance=10. 2%). Patients needs and views should be noticed in all stages of planning، implementation and evaluation of patient-oriented interventions. Meeting the needs of patients may lead to enhance the quality of services provided and patients'' satisfaction. Several research tools and methods are provided to capture patients'' views and preferences in health care services. The choice based conjoint analysis is recommended to apply in studies that assess participants'' views.

Distribution of professional human resources in health sector is an important issue. This study aimed to propose an appropriate need-based model in order to apply in distribution of professional human resources. In this descriptive study، using four selected criteria in the field of professional human resources distribution، four levels of need to professional human resources in each region were determined. Using the benchmarking of four tax systems، appropriate payment methods for each level were proposed. The best method of payment for the first level، in which most professional human resources are needed، was progressive method. For the second، third، and fourth levels that have respectively lower scores، proportion، per capita، and regressive methods were recommended. Creating a purposive economic incentive for need-based distribution of professional human resources in the health sector is a main challenge. Our proposed model in this study could partly solve the problem. Further studies on this model، creating legal requirements، and using appropriate information systems are recommended to take more advantages of this model.

Accreditation is an important field in health services evaluation that helps health care organizations to gain acceptable situation in performance indicators. The purpose of this system is making a framework for continuous quality improvement to meet health system goals. This study aimed to design an evidence-based national accreditation model for specialized clinics of hospitals.

This descriptive study was conducted from 2009 to 2011. Following a systematic literature review in the SID، Ovid Medline، and PubMed databases using relevant key words، several accreditation models and related standards were extracted. All relevant standards were used to develop a Delphi questionnaire to gain experts opinions. Experts assessed and scored all standards based on two aspects of ‘Importance’ and ‘performance’.

In the systematic review phase، the JCAHO (USA) and CCHSA (Canada) accreditation models were chosen as the best models to benchmark. The Lebanon and Egypt accreditation models were also chosen as the best local (EMRO region) models. Related standards in the selected models were determined and used in our Delphi questionnaire with further standards obtained from the health services management text books. Two rounds Delphi study was done with high response rate. About 68 standards were accepted and 5 standards were rejected. Finally، the designed model was completed by merging similar standards، developing and debriefing essential elements of each standard.

The final designed model had 38 standards with ‘content statement’ and ‘objective measurable components’. This model could be a comprehensive accreditation model in number، range and diversion of the standards. There is no doubt that application of this model might led to significant improvement in health centers performance and clients’ satisfaction.

Injuries are leading causes of death and disability in children، worldwide. Few studies have focused on injuries in children in Iran. This study aimed to assess the prevalence of non-fatal home injuries and its related factors among children attending health centers in Ahvaz، 2011. In this cross-sectional pilot study، 400 children seeking for routine child care in 12 health centers of Ahvaz were selected for study. Data were collected using a questionnaire which was completed by trained individuals. We used the «WHO guideline for external injury» for classifying and coding the data. Data were analyzed in the SPSS-16 using the Chi-square test and Regression Logistic. This was a section of a larger study to assess the prevalence and related factors of home injury in children attending health centers in the Khuzestan province. The overall prevalence of injury among under five years children was 40% (n=156). Four common causes of injury were falls (30. 1%)، swallowing (22%)، burns (16. 8%) and poisoning (11. 4%). Logistic Regression test showed a significant association between injury with type of house (OR=2. 52; 95% CI 1. 34-4. 76)، and age of children (OR=0. 031; 95% CI 0. 01-0. 81; P<0. 05). Results of this pilot study showed that the prevalence of injuries was in an alarming level in children attending health centers of Ahvaz. Surveillance system of home injury should be considered as a part of mother and child health program.

The role of religious beliefs in treatment and coping with diseases، especially life-threatening diseases such as cancer، is an important issue. The aim of this study was to assess the relationship between religious beliefs with the quality of life in patients with cancer. This descriptive analytical study was conducted on 189 patients with different types of cancer hospitalized in the Kosar hospital، Qazvin. Data were collected using the quality of life questionnaire (derived from the European organization for research and treatment of cancer)، Karnofsky performance status، and the Duke University''s religion index. The data were analyzed using the descriptive statistical tests and multiple regressions in the SPSS-20. One hundred and seven patients were male. Most of the patients suffered from gastrointestinal cancers (stomach cancer: 36. 5% and esophagus cancer: 28. 5%). The mean score for the patients'' performance was 89. 87±15. 61. The mean score for the total quality of life among the patients was 5180±28. 30 (males: 53. 17±28. 92; females: 50. 93±28. 26). The highest score in the performance domain belonged to the patients'' physical performance and the lowest score belonged to the total quality of life. In the signs and syndromes domain، the severe problem was for the economic impacts. The mean score for the religion index was 21. 08±4. 69 (males: 20. 81±4. 77; females: 21. 38±3. 76). The multiple regression analysis revealed that the in presence of demographic characteristics and patients'' performance score، religious beliefs significantly predicted quality of life. The regression model explained about 58% of variance in quality of life. T he results indicated that the religious beliefs could be related to the quality of life among patients with cancer. Reinforcing religious beliefs among patients with cancer may improve their quality of life.

Time and cost analysis of health care programs help managers to plan more precise strategies through appropriate allocation of resources resulting in high productivity. The present study aimed to analyze the cost and time of health care programs at the first level health care services in Shahroud University for Medical Sciences in 2009. In this cross-sectional study، all urban and rural health care centers of the university (n=26) were selected. In the level one health care centers، 43 programs were identified. Data were analyzed using cost analysis program in the Excel. The results were displayed in frequency distribution tables and diagrams. The number of programs in subcategories were as follow: disease prevention: 17 (39. 55%) programs; family health: six (13. 95%) programs; environmental health: six (13. 95%) programs; mouth and teeth health: two (4. 56%) programs; outpatient treatment: four (9. 30%) programs; professional health: four (9. 30%) programs; and school health: four 4 (9. 30%) programs. Among all the programs، the most spent time (45. 51%) was for the programs of the outpatient treatment category. With 16. 82% of the total budget allocated to outpatient treatment programs، this category ranked the first among the 43 categories. The most services were also provided in the outpatient treatment programs (n= 997730)، followed by family health category (n= 224350). Collaboration of private sector is recommended to reduce the cost in high-cost programs such as outpatient treatment and laboratory programs to improve efficiency of the programs.

Social capital results in collective work and is related to the sustainable development. The sustainable development generates capital for future generations as the same amount or more than the current generation''s capital. In this cross-sectional study، 224 female staff working at two hospitals were randomly selected. Data were collected using a questionnaire designed by Manafi (2008). The validity and reliability of the questionnaire was confirmed (Cronbach''s alpha=85. 0). Data were analyzed using the Pearson correlation test and t-test. The within group dimension of the social capital had the highest score (45. 32 ± 4. 33). The lowest score belonged to the social capital outside the group (5. 66 ± 1. 72). Regarding the anomie، gender anomie had the highest score (19. 10 ± 3. 24)، and the economic anomie had the lowest score (13. 18 ± 2. 61). There was a negative relationship between the social capital with anomie (p ≤ 0. 01; r= -0. 021). It seems that increasing social capital can reduce the employees'' anomie. Enhancing the social capital in organizations is critical. Decision makers should provide environments with mutual trust، and informal groups.