Journal of Community Health Research
Volume:2 Issue: 2, Jul-Sep 2013

Primary care organizations are the entities through which clinical governance is developed at local level. To implement clinical governance in primary care, awareness about principles, prerequisites and barriers of this quality improvement paradigm is necessary. The aim of this study is to pool evidence about implementing clinical governance in primary care organizations. Data sources: The literature search was conducted in July 2012. PubMed, Web of Science, Emerald, Springerlink, and MD Consult were searched using the following MESH keywords; “clinical governance” and “primary care” Study selection: The search was limited to English language journals with no time limitation. Articles that were either quantitative or qualitative on concepts of implementing clinical governance in primary care were eligible for this study. Data extraction: From selected articles, data on principles, prerequisites and barriers of clinical governance in primary health care were extracted and classified in the extraction tables. We classified our findings about principles of clinical governance in primary care in four groups; general principles, principles related to staff, patient and communication. Prerequisites were categorized in eight clusters; same as the seven dimensions of National Health System (NHS) models of clinical governance. Barriers were sorted out in five categories as structure and organizing, cultural, resource, theoretical and logistical. Primary care organizations must provide budget holding, incentivized programs, data feedback, peer review, education, human relations, health information technology (HIT) support, and resources. Key elements include; enrolled populations, an interdisciplinary team approach, HIT interoperability and access between all providers as well as patients, devolution of hospital based services into the community, inter-sectorial integration, blended payments, and a balance of clinical, corporate, and community governance.

The idea that factors during early critical periods of life affect on long term health is now a major public health concern. In this study, in addition to investigating obesity prevalence among female high school students in Yazd, the relationship between obesity and birth weight was examined. This cross sectional study was conducted on 312 female high school students. Random cluster sampling method was done among 6 high schools from two education districts in Yazd. According to the birth weight recorded on their growth cards, the students were divided to 3 weight groups of low birth weight (<2,500 g), appropriate birth weight (between 2500 and 4000 g) and high birth weight (>4000 g). Anthropometric measurements including weight, height and waist circumference were alsocarried out. In terms of the percentiles proposed by NCHS, BMI was considered as light weight (5th percentile≤), normal (5-85th percentile), overweight (85-95th percentile) and obese (95th percentile≥). In addition, 95th percentile≥for waist circumference was considered abdominal obesity. Finally, the data were analyzed by SPSS 16 software. The samples'' mean weight and BMI were higher than 50th percentile of NCHS and their mean height was lower than 50th percentile of NCHS. Based on the results, 5.7% of the samples were underweight, 73.4% were normal, 17.1% were overweight and 3.8% were obese. Abdominal obesity rate was measured as 18.7%. There was a significantly positive correlation between birth and current weight of students (p= 0.001 and r= 0.2) and their BMI (p= 0.005 and r= 0.15). Relatively high prevalence of obesity and overweight in this study and its positive relationship with birth weight necessitate preventive strategies and training during and even before pregnancy by relevant authorities for women at gestational age and other related groups.

By ever-increasing of population, shortage of water resources and the necessity of wastewater treatment, huge volumes of sludge that is a byproduct of wastewater treatment, requires to be disposed in environmentally secure ways. The target of specifying strategic preferences of reuse of sludge has been to find the correct way of disposal or beneficial use of sludge. In this study, to select the best alternative for reuse of wastewater sludge two systematic methods are introduced, which four alternatives for reuse of sludge (use in agriculture, use in green space, biogas, desert combat) are introduced and they are compared by four main parameters including: 1- physicochemical 2-biological 3 - economic, social and cultural, and 4 - environmental pollution situation, that each contains some criteria. In this study, first each of the related parameters and criteria are compared by the expert groups of and through questionnaire. Then these weights are entered into Expert Choice software for the analyze of AHP model and paired comparisons and weightings have been done on the related parameters and criteria. Ultimately, the output of the software is entered into TOPSIS software for the analyze of TOPSIS model until the best alternative is selected. sludge of Ardabil municipal wastewater treatment plant, according to standards and EPA regulations is eligible to class B, and due to the chemical in terms of heavy metals have special (excellent) quality and contains considerable quantities of organic substance, nutrients and micronutrients which indicates the fertilizer value of the sludge. The result of this comparison has shown that the application of sludge in green spaces is the most appropriate alternative and then use in agriculture, biogas alternative, and desert combat alternative are, respectively, placed in the second to fourth preference for the reuse of sludge derived from municipal wastewater treatment plant.

Breast neoplasia is the most common cancer among women in both in the developed and the developing country. Over 1.15 million women worldwide are detected with breast neoplasia each year and the mortality rate is 502,000 cases from this cancer. This study designs to describe how Iranian women perform breast self-examination. In this cross, sectional study 447 participants who referred to five-health center of Shahid Sadoughi University of Medical Sciences were chosen. The questionnaire and checklist were completed from all participants through a face-to-face interview. If she obtains 0-6 total score, she has weak Performance, if she obtains 7-12 total score, she has acceptable Performance and if she obtains 13-18 total score, she has good Performance of breast self-examination. Statistical analysis was carried out using Statistical Analysis Software (SAS) version 16. A P-value of <0.05 was considered statistically significant. Non-parametric tests such as Mann–Whitney were adopted. In our study 92% of women heard about breast self-examination, but only 17.4% of them perform it monthly. From all 348 (77.9%) had poor, 78 (17.4%) moderate and only 21 (4.7%) had good performance. From all participants 189(42%) by health worker 36(8.1%) by family and 70(15.7%) by media learn how to perform breast self-examination. Study showed although most of women heard about Breast Self Examination but it was not a routine screening in developing country. This study confirmed that Iranian women have poor knowledge about how to perform breast self-examination. There is need for adequate health education on breast cancer and breast self-examination among Iranian women.

Immunization is one of the most important health programs in first level prevention and is also one of the most cost-effective prevention programs in the entire world. This study evaluates the situation of immunization in fewer than one year old Afghan refugee children in Kerman, Iran. This was a cross-sectional study. Data was extracted from the records of the health centers supported by the higher commission of refuges in Kerman. The BCG, polio 0, DTP 3, polio 3, Hepatitis B 3 and MMR 1 was calculated and compared with the vaccine coverage in Iran and Afghanistan. Stata 11 and Excel 2007 and the chi-square statistics were used for the analysis. The coverage of all BCG, Polio 0, DTP 3, Polio 3, Hepatitis B 3 and MMR 1 vaccines in the Afghan immigrants residing in Kerman between 2010 and 2012 was more than 95%. This coverage was not significantly different from the vaccine coverage of Iranian children, but was significantly higher than the vaccine coverage of children residing in Afghanistan. The vaccine coverage of Afghan children residing in Kerman is similar to Iranian children and is high and satisfactory. These results show part of The Islamic Republic of Iran’s commitment for providing health requirements for Afghan refugees residing in Iran.

The importance of the periodontal health maintenance and promotion in diabetes mellitus has been supported. Evidence showed that many patients are unaware about effects of diabetes mellitus on oral health. The aim of this study is to evaluate knowledge, attitudes and practice of diabetic patients concerning the risk of periodontal disease and prevention. In this cross sectional study, 156 diabetic patients referring to Yazd Diabetic Research Center were recruited by random selection. Patients completed questionnaires, which included 29 questions about their knowledge, attitude and practice of oral health in diabetes mellitus. The data was scored and analyzed. The results showed knowledge (58.64) and attitude (46.86) scores of diabetic patients were moderate, while their practice (24.3) score were poor. There is statistical significant relation between mean scores of knowledge, attitude and practice of patients with their educational level and age. This study showed knowledge, attitude and practice level of diabetic patients were insufficient on oral health care.

Quality of services extremely depends on how personnel have contact and interaction with the clients. Moreover, the personnel’s attitudes and their behaviors with the clients significantly affect clients’ perception of quality of services and consequently influence their satisfaction as well as their absorption to the services of an institution. This study intends to investigate the supervisor’s attitude towards the effect of persons or the personal element (as one of the elements of the service marketing mix) on choosing the hospital by the patients and their companions. This cross-sectional descriptive study conducted in the winter of 2012. The study participant involved 35 supervisors in Yazd educational hospitals of Shahid Sadoughi University of Medical Sciences; Shahid Rahnemoun and Afshar. The research data were gleaned via a researcher-made questionnaire on factors of the marketing mix which its validity and reliability were confirmed. Data analysis was performed using SPSS software. Results revealed that supervisor’s belief in the increasing of market share of a hospital services in public hospitals are consist of: 1-Physical evidence 2- Service or product 3- People or persons 4- Efficiency and quality 5- Process 6- Distribution 7-Promotion or propagation and 8- Price. Therefore, the significance of the personnel role in absorption of a definite patient involves the third element in choosing the hospital by the patients. Based on this study, since the third factor in clients’ (patients, etc.) choices of hospital are the personnel and persons who provide services, it is confirmed that in service-based organizations like hospitals, the most important elements of quality of services in retaining and absorbing new clients and surviving the organization are the personnel activities who has been connected with organization clients. Moreover, it is regarded as a vital factor in developing effective relationships with the clients as well as their absorption in the hospital.

Exposure to flour dust is an important risk factor in occurrence of allergic airway disorders among mill workers. The purpose of this study was to determine the prevalence of respiratory symptoms and its relation with exposure to respirable dust. In this study, all of 35 workers who worked in the flour producing section of three factories were chosen as case group and 20 unexposed people were selected as the control group. Exposure to total and respirable dust were measured with standard methods. Spirometry was used for determining lung function disorders and the America Lung Society Questionnaire was used for assessment of prevalence of respiratory symptoms. The results were analyzed by t-test, correlation and linear regression. The average total and respirable dust exposure in the exposed group was 8.06 and 5.09 mg/m3 and was higher than the threshold limit value recommended by American Conference of Governmental Industrial Hygienists(ACGIH). 52% of workers had sputum in the morning and during waking up, 44% felt tightness of breath or pressure in the chest, 55% felt short of breath while walking fast and work; and in 52% cough during work was experienced. There was a significant and negative correlation between total and respirable dust with Forced Vital Capacity(FVC), Forced Vital Capacity Percent(%FVC) and Forced Expiratory Volume in one second(FEV1). The results of this study indicate that exposure to respirable dust was more than 10 times higher than the threshold limit and caused a high prevalence of respiratory symptoms and lung function disorders among mills workers.