Iran's Program Research Articles

The cost effectiveness of rotavirus vaccination in Iran

ABSTRACTRotavirus is the most common cause of severe diarrhea leading to hospitalization or disease-specific death among young children. Effective vaccines have recently been approved and successful vaccination program implemented. The aim of this study was to evaluate the cost effectiveness of mass rotavirus vaccination program in Iran. We developed a Markov model that reflects key features of rotavirus natural history. Parameters of the model were assessed by field study or developed through literature search and published data. We applied the model to the 2009 Iranian birth cohort and evaluated the cost-effectiveness of including the rotavirus vaccine (Rotarix®) into Iranian expanded immunization program (EPI). With an estimated hospitalization rate of 0.05 and outpatient rate of 0.23 cases per person-year, vaccinating cohort of 1231735 infants in Iran with 2 doses of (Rotarix®), would prevent 32092 hospitalizations, 158750 outpatient visits, and 1591 deaths during 5 y of follow-up. Under base-case assumption of $10 cost per course of vaccine, the vaccination would incur an extra cost of $1,019,192 from health care perspective and would avert 54680 DALYs. From societal perspective, there would be $15,192,568 saving for the society with the same averted DALYs. The incremental cost effectiveness ratio showed a cost of $19 US dollars per averted DALY from health care perspective and a saving of $278 US dollars for each averted DALY from societal perspective. Introducing rotavirus vaccine into EPI program would be highly cost-effective public health intervention in Iran.

Microfinance in Iran: a Case Study of the Rural Microfinance Support Project

Microfinance programs in Iran began to be implemented at the end of the 1990s thanks to both the local government and international organizations’ efforts to eradicate poverty. Today microfinance is a growing sector in the country and has been officially recognized by the Iranian government, which included its development as one of the main points of the last Five Year Development Plan. A number of efficient microfinance programs are active in Iran among which the Rural Microfinance Support Project, promoted by the Iranian Agricultural Bank and ifad, stands out. The following study is an attempt to identify the impact of this program on women empowerment and poverty reduction through a research conducted on a sample of one hundred women clients of the program in the province of Šabestar, East Azerbaijan.

An Evaluation of the Undergraduate TEFL Program in Iran: A MultiCase Study

An Evaluation of the Undergraduate TEFL Program in Iran: A MultiCase Study

The Evaluation of Reproductive Health PhD Program in Iran: A CIPP Model Approach

This study aimed to evaluate the status of reproductive health PhD program based on the CIPP model in domains of context, input, process and product in five nursing and midwifery schools in Iran in which the program has been established. Data were collected through the five researcher-made questionnaires which distinctively constructed for five groups of participants - heads of departments, faculty members, directors of libraries, graduates and students- and a checklist for equipment evaluation. The results of the study indicate that the status of Reproductive Health PhD program was fairly appropriate. Continuous evaluation and improvement of the inappropriate and fairly appropriate indicators is essential to enhance the quality of the program.

Drug use treatment and harm reduction programs in Iran: A unique model of health in the most populated Persian Gulf country.

Because of the proximity of Persian Iran to Afghanistan, the main opium producer in the world, drug use especially opium use has a long history in Iran. Opium and its residues are the traditional drugs while heroin, heroin Kerack, norgesic, temgesic, and methamphetamine use and injection have emerged more recently. In recent decades, heroin smoking and injection have presented challenges to the Persian health policy makers to accept and develop the internationally-approved programs of drug use treatment and harm reduction. The current paper summarizes the overall picture of main drugs used and the history of establishing the nationwide movement of drug use treatment and harm reduction programs after the 1979 revolution until the end of 2014. The paper concludes that Persian Iran has a well-developed healthcare system in the provision of drug use treatment and harm reduction programs in the south-west of Asia especially the Persian Gulf region. These therapeutic and harm reduction-related programs are required to be strengthened by opium supply reduction and eradicating drug production in Afghanistan. The provision of prevention programs, drug education via mass-media, employment and inexpensive leisure activities are required in Iran. In addition, conducting household surveys of the prevalence of drug use and evaluating the clinical effectiveness and treatment outcomes of the provided drug treatment and harm reduction programs are required. National and regional collaborations are rigorously suggested to manage supply reduction along the borders and implement demand reduction inside the borders.

Oral Academic Discourse Socialization of In-Service Teachers in a TEFL Program

Oral academic discourse socialization refers to a process through which students learn about the conventions and practices of their disciplinary fields while doing academic spoken practices. In this study, it refers to the interactions of the participant teachers with their peers and instructors as well as their engagement with academic texts. This paper reports on academic discourse socialization of several EFL teachers in a TEFL graduate program in Iran through oral discourse practices including small-group discussions and debates after microteachings over the first year of the program. It explores how the student teachers are initiated further into the values and practices of their EFL discourse community through collegial interactions with their peers. The active participation of the participant teachers in discourse socialization practices facilitated learning in a collaborative learning community. The participants shared their personal practical experiences, scaffolded their peers and engaged with assigned academic texts. Designing professional training programs that are likely to contribute to collegial interaction can be of great importance in teacher education programs.

Methadone maintenance treatment program in prisons from the perspective of medical and non-medical prison staff: a qualitative study in Iran

As one of the most important components of harm reduction strategy for high-risk groups, following the HIV epidemics, Methadone Maintenance Treatment (MMT) has been initiated in prisoners since 2003. In this paper, we aimed to assess the advantages and shortcomings of the MMT program from the perspective of people who were involved with the delivery of prison healthcare in Iran. On the basis of grounded theory and through conducting 14 Focus Group Discussions (FGDs), 7 FGDs among physicians, consultants, experts, and 7 FGDs among directors and managers of prisons (n= 140) have been performed. The respondents were asked about positive and negative elements of the MMT program in Iranian prisons. This study included a total of 48 themes, of which 22 themes were related to advantages and the other 26 were about shortcomings of MMT programs in the prisons. According to participants' views "reduction of illegal drug use and high-risk injection", "reduction of potentially high-risk behaviors" and "making positive attitudes" were the main advantages of MMT in prisons, while issues such as "inaccurate implementation", "lack of skilled manpower" and "poor care after release from prison" were among the main shortcomings of MMT program. MMT program in Iran's prisons has achieved remarkable success in the field of harm reduction, but to obtain much more significant results, its shortcomings and weaknesses must be also taken into account by policy-makers.

Adult Immunization Among Health Care Personnel and Target Groups in Iran

Background: Immunization is an essential issue in primary health care, which has a tremendous impact on infection prevention. Objectives: This study aimed to determine the immunization status of health care personnel (HCP) and adult patients admitted at teaching hospitals. Patients and Methods: A total of 1506 HCP and patients were enrolled according to 13 target groups. The immunization profile was evaluated based on adjusted recommendations of Advisory Committee on Immunization Practices (ACIP) according to the available vaccines in Iran. Results: The rate of immunization was more than 50% only in hepatitis B vaccination among HCP (64.5%) and tetanus-diphtheria (Td) booster dose among HCP and pregnant women (54.6% and 72.9%, respectively). The other vaccines according to the target groups had no acceptable rate, especially with respect to influenza and pneumococcal vaccinations among patients with underlying chronic diseases. Conclusions: The low rate of immunization warrants implementation of novel protocols in adults as well as implying on educational programs in Iran.

Challenges of Providing Cervical Cancer Prevention Programs In Iran: A Qualitative Study

Cervical cancer has become a major public health problem worldwide. Iran, like other developing countries, is facing a number of challenges in managing the disease. This qualitative study documents challenges encountered in cervical cancer preventing programs in Iran. In-depth interviews were conducted with 28 participants including eleven patients with cervical cancer, three gynecologic oncologists, five specialists in Obstetrics and Gynecology, five midwives, three health care managers and one epidemiologist in Mashhad Iran, between May and December of 2012. The sample was selected purposively until data saturation was achieved. Data credibility verified via allocated sufficient time for data collection, using member checking and peer debriefing. Data analysis was carried out using conventional content analysis approach with ATLAS. ti software. Findings from data analysis demonstrated 2 major themes and 6 categories about challenges of providing cervical cancer prevention programs including: individual and social challenges (cognitive/behavioral challenges and socio/cultural challenges) and health system challenges (stewardship, financing, competency of health care providers and access to services). Each category included some subcategories. Managing the cervical cancer prevention programs need to include the consideration of individuals, health care providers and health system challenges. Addressing the low level of knowledge, negative attitudes, socio cultural challenges, Poor intersectional collaboration and coordination and intra-sectional management, financing and competency of health care providers are essential steps toward significantly reducing the burdens of cervical cancer.

Modification of nursing education for upgrading nurses' participation: a thematic analysis.

Background:The product of the educational nursing programs in Iran is training nurses who less have professional apprehension and commitment for participating in professional decisions. Whereas nurses especially those in high academic levels are expected to more involve in professional issues.Objective:The aim of this study was to explore Iranian nurse leaders’ experiences of making educational nursing policy with emphasizes on enhancement of nurses’ participation in professional decisions.Methods:We used a qualitative design with thematic analysis approach for data gathering and data analysis. Using purposive sampling we selected 17 experienced nurses in education and making educational nursing policies. Data gathered by open deep semi-structured face to face interviews. We followed six steps of Braun and Clarke for data analysis.Results:In order to enhance nurses’ participation in professional decisions they need to be well educated and trained to participate in community and meet community needs. The three main themes that evolved from analysis included opportunities available for training undergraduate students, challenges for PhD nurses and general deficiencies in nursing education. The second theme includes three sub-themes; namely, the PhD curriculum, PhD nurses’ attitudes and PhD nurses’ performance.Conclusions:We need for revising and directing nursing education toward service learning, community based need programs such as diabetes and driving accidents and also totally application of present educational opportunities. The specialization of nursing and the establishment of specialized nursing associations, the emphasis on teaching the science of care and reinforcing the sense of appreciation of pioneers of nursing in Iran are among the directions offered in the present study

Mortality Attributable to Excess Body Mass Index in Iran: Implementation of the Comparative Risk Assessment Methodology.

Background:The prevalence of obesity continues to rise worldwide with alarming rates in most of the world countries. Our aim was to compare the mortality of fatal disease attributable to excess body mass index (BMI) in Iran in 2005 and 2011.Methods:Using standards implementation comparative risk assessment methodology, we estimated mortality attributable to excess BMI in Iranian adults of 25–65 years old, at the national and sub-national levels for 9 attributable outcomes including; ischemic heart diseases (IHDs), stroke, hypertensive heart diseases, diabetes mellitus (DM), colon cancer, cancer of the body of the uterus, breast cancer, kidney cancer, and pancreatic cancer.Results:In 2011, in adults of 25–65 years old, at the national level, excess BMI was responsible for 39.5% of total deaths that were attributed to 9 BMI paired outcomes. From them, 55.0% were males. The highest mortality was attributed to IHD (55.7%) which was followed by stroke (19.3%), and DM (12.0%). Based on the population attributed fractions estimations of 2011, except for colon cancer, the remaining 6 common outcomes were higher for women than men.Conclusions:Despite the priority of the problem, there is currently no comprehensive program to prevention or control obesity in Iran. The present results show a growing need to comprehensive implications for national and sub-national health policies and interventional programs in Iran.

Determinants of Farmers' Participation in Horticulture-based Extension Programs in Iran: Application of the Theory of Planned Behavior

This paper aims to discover the determinants of farmers’ participation in horticulture-based Education programs in the Western Azerbaijan province, Iran. Using the Theory of Planned Behavior (TPB), the study also tries to make a comparison between participants and non-participants, who have achieved in this program. A sample of 231 farmers (137 participants and 94 non-participants) was selected based on a stratified random sampling method. Data gathering instrument was a questionnaire that its validity was approved by a group of experts and its reliability was confirmed by calculating Cronbach's alpha (α=0.71). The results showed that, there were significant differences between participants and non-participants in agricultural education programs in terms of all the TPB contexts. Additionally, the results of the regression analysis showed that attitude to how thinking and decision and subjective norms were the best determinants of farmers’ participation.

Preserving self-concept in the burn survivors: a qualitative study.

Background:Burn injury is a devastating experience affecting all aspects of a person's essence, including his/her identity and perception. These patients require complex cognitive efforts to redefine their identity to deal with difficult condition after burn injury and preserve self-concept. The experience of life after burn injury is generally a solitary one, closely related to the patients’ cultural and religious context. Therefore, this study was conducted aiming at investigating burn patients’ experiences regarding how to preserve self-concept in life after burn injury in Iran.Materials and Methods:This qualitative study was carried out using qualitative content analysis and in-depth unstructured interviews with 17 surviving burn subjects.Results:During the qualitative content analysis process, the concept of “locating” as the essence of the participants’ experience was extracted as follows: (A) self-exploration (exploring the changes in one's life), (B) others’ exploration (exploring the changes in the life of family members and the relationship between self and others), (C) position evaluation (self-position analysis), and (D) self-concept preservation.Conclusion:The present study has developed new understandings of mental experiences of burn patients’ self-concept by describing the concept of “self-locating”. It helps us in classifying and understanding the concepts described in comprehensive theories developed in this area. They do this by focusing on what burn patients experience for choosing self-preservation strategies and having a meaningful life. The finding can be used as a conceptual framework for palliative care program in Iran.

Barriers to Condom use Among “Socially Damaged Women”: A Qualitative Study in Iran

One of the most effective strategies to prevent transmission of sexually transmitted infections (STIs) is use of condom, but obstacles to its use in high-risk groups have not yet been fully understood. The main objective of our study is to evaluate barriers to condom use among Socially damaged (SDW). A qualitative method was utilized. Two focus group discussions (FGDs) and eighteen semi-structured in-depth interviews were conducted with SDW, 15-45 years old, at shelters and harm-reduction drop-in-centers in Tehran, Iran. Data was analyzed using the content analysis approach. All women in the study were sexually active and most of them were divorced. They all had primary school education at a minimum, and a limited knowledge of HIV and STIs, yet the rate of condom use in these high-risk groups are low. The most common obstacles to consistent condom use among SDW included misperception, low perceived sensitivity and self-efficacy partner objections. Hence, preventions strategies based on increasing knowledge about STIs and condom use, self-efficacy, perceived sensitivity must be designed and improvised to induce condom use. These data will be useful in designing and improving STIs prevention outreach programs in Iran.

Adenoma detection rates in an opportunistic screening colonoscopy program in Iran, a country with rising colorectal cancer incidence.

BackgroundData on the quality of colonoscopies in populations with rising colorectal cancer (CRC) incidence is scarce. We aimed to calculate the adenoma detection rates (ADR), and assess the quality of colonoscopies in an opportunistic screening colonoscopy program in Iran.MethodsAll the colonoscopy and pathology reports of asymptomatic adults over age 50 who underwent screening colonoscopy between June 2007 and March 2013 were reviewed. The colonoscopy quality indicators including ADR were calculated, and patient factors associated with the adenoma detection were determined.ResultsA total of 713 asymptomatic adults aged 50 years and older who underwent their first-time screening colonoscopy were included in this study. ADR and advanced-ADR were 33.00% (95% CI: 29.52-36.54) and 13.18% (95% CI: 10.79-15.90), respectively. We observed a significantly higher rate of cecal intubation in patients with fair or better bowel preparation compared to those with poor prep, 90.00% vs. 70.45%, respectively (P < 0.001). Bowel preparation (adjusted OR: 2.49, 95% CI: 1.75-3.55), older age (≥60) (adjusted OR: 1.70, 95% CI: 1.22-2.36), and male gender (adjusted OR: 1.39, 95% CI: 1.01-1.92) were associated with the adenoma detection.ConclusionsOur ADR in both genders meets and exceeds the recommended colonoscopy quality benchmarks. The polyp and adenoma detection rates in the current study are comparable to those reported from Western countries where the incidence of CRC is traditionally high. These data are in line with the epidemiologic transition of CRC in Iran.

Efficacy of wheat genotypes and Stb resistance genes against Iranian isolates of Zymoseptoria tritici

Septoria tritici blotch (STB), caused by Zymoseptoria tritici has been considered one of the important diseases of wheat in Europe and elsewhere including Iran. The most economical strategy to control the disease is the use of genetic resistance. To this aim, this study was conducted to identify new sources of resistance to STB and to investigate the effectiveness of known Stb genes against six Iranian isolates of Z. tritici. Genetic variability analysis using random amplified polymorphic DNA (RAPD) markers revealed high polymorphic banding patterns indicating that a high genetic variability existed among the isolates. Inoculation assays identified 116 isolate-specific resistances among all interactions (n = 420). Of 52 genotypes, 26 wheat genotypes showed no isolate-specific responses and were susceptible to all isolates, which may explain increasing epidemics of Z. tritici occurring in major wheat-growing regions in Iran. Five genotypes were highly resistant to all isolates. Effectiveness determination of Stb genes revealed that Iranian isolates have a broad virulence spectrum against most of the known Stb genes. Among all Stb genes, Stb15 and Stb16/Stb17 in cultivars Arina, Riband and M3 were the most effective resistance genes and conferred resistance to all isolates tested. Hence, these genes should be effective in breeding programs in Iran to control the disease.

Family physician program in Iran: considerations for adapting the policy in urban settings.

Nationwide implementation of Family Physician (FP) program started in 2005 and targeted almost 25,000,000 citizens residing in rural areas and cities with less than 20,000 populations in Iran. Despite its blatant initiation that resulted in some modest achievements, the future of FP looks unclear in Iran. Thus far, no longitudinal evaluation of the implementation and impact of FP program has been conducted. However, meager evidence highlights the facilitating role of an existing and strong Primary Health Care (PHC) network in the implementation of FP in rural areas in Iran. A longstanding challenge, however, as emphasized by most stakeholders, remains to be the expansion of FP program into urban settings, where the PHC is undeveloped and fragile as well as the powerful private sector is resistant. Using an adapted conceptual framework of institutions, ideas, and interests, this policy perspective aims to shed light on main difficulties of FP implementation in urban areas of Iran. We analyze FP policy in the context of ongoing interactions and conflicts among institutions (the structures and rules that shape policies), interests (the groups and individuals influencing policy), and ideas (discourses around policies). Our argument will, we envisage, help plan for more appropriate implementation of FP in cities in Iran, and hopefully beyond.

Predictors of treatment retention in a major methadone maintenance treatment program in iran: a survival analysis.

To identify correlates related to retention time of a cohort study of the opioid-dependent patients participating in the Methadone Maintenance Treatment (MMT) program offered by a major addiction treatment clinic in Tehran, Iran between April 2007 and March 2011. Several parametric Survival models assuming Weibull, Log-normal and Log-logistic distributions were compared to search for association between covariates and risk of relapse and dropping out of treatment among 198 patient participants. According to Akaike Information Criterion (AIC), Log-normal model had the best fitting. Estimates of this model indicated that increase in average methadone dosage was associated with longer retention time. Correlates associated with shorter retention time were suffering from mental disorders, using stimulant drugs, being poly-substance dependents and having prior treatments. Findings of this study provide support for giving more attention to patients who are poly-substance or stimulant-drug dependents, have non-substance psychiatric comorbidity and the ones with addiction treatment history. Independent of patient characteristics, retention improved as the dose of methadone increased.

Tissue and organ donation and transplantation in Iran.

Tissue and organ transplantation is one of the most promising treatments for some incurable diseases. Nowadays, transplantation is the common therapy in many countries. Unfortunately, availability of donated tissues and organs is limited. There are several factors which may affect donation rate for instance; social factors, culture, religion, and family decision. Accordingly, religious beliefs have a crucial role in tissue and organ donation and transplantation. Islam as a code of life has a comprehensive road map to lead mankind. Spiritual view of human life is considered to be much more valuable in Islam. Therefore, saving a human life is one of the most important Islamic teachings. In Iran as a Muslim country, tissue and organ transplantation program was established based on religious scholars' permission which has an essential role towards considerable development of the program in Iran.

Exploring English as a foreign language (EFL) teacher trainers’ perspectives on challenges to promoting computer literacy of EFL teachers

Computer literacy is a significant component of language teachers’ computer-assisted language learning (call) knowledge. Despite its importance, limited research has been undertaken to analyze factors which might influence language teachers’ computer literacy levels. This qualitative study explored the perspectives of 39 Iranian efl teacher trainers on possible challenges to EFL teachers’ computer literacy development. The findings suggest that the teacher trainers considered the role of computer literacy as important in efl teachers’ professions. The teacher trainers reported a couple of challenges to EFL teachers’ development of computer literacy as well as measures to eliminate the effects of these challenges. In addition, the trainers did not have sufficient computer knowledge to prepare efl teachers for teaching in call courses. The findings further indicated that the participants perceived that EFL teachers need to be trained for developing their computer literacy. However, the trainers did not have consensus on including computer literacy training for teachers in mainstream teacher training programs. Finally, computer skills related to using the Internet and language teaching software tools were regarded as necessary for EFL teachers to acquire. The study would have implications for the improvement of mainstream teacher training programs in Iran and other countries.