Provincial Health Center Research Articles

Performance Assessment of a Communicable Disease Surveillance System in Response to the Twin Earthquakes of East Azerbaijan.

Following the twin earthquakes on August 11, 2012, in the East Azerbaijan province of Iran, the provincial health center set up a surveillance system to monitor communicable diseases. This study aimed to assess the performance of this surveillance system. In this quantitative-qualitative study, performance of the communicable diseases surveillance system was assessed by using the updated guidelines of the Centers for Disease Control and Prevention (CDC). Qualitative data were collected through interviews with the surveillance system participants, and quantitative data were obtained from the surveillance system. The surveillance system was useful, simple, representative, timely, and flexible. The data quality, acceptability, and stability of the surveillance system were 65.6%, 10.63%, and 100%, respectively. The sensitivity and positive predictive value were not calculated owing to the absence of a gold standard. The surveillance system satisfactorily met the goals expected for its setup. The data obtained led to the control of communicable diseases in the affected areas. Required interventions based on the incidence of communicable disease were designed and implemented. The results also reassured health authorities and the public. However, data quality and acceptability should be taken into consideration and reviewed for implementation in future disasters.

Completed suicide and associated risk factors: a six-year population based survey.

The investigations on suicide conducted within low- and middle-income countries are limited. This study evaluated the trend of suicide and its associated risk factors in the west of Iran. This six-year population-based survey was conducted in Kermanshah Province, in 2012. The data on suicide was extracted from the suicide database of the Provincial Health Center, which was collected for six successive years. Multivariate logistic regression analysis was performed and odds ratio (OR) as well as its 95% confidence intervals (CI) was reported. During the study period, 13,810 attempted suicides occurred of which 1,564 (11.33%) were completed. The incidence rate of suicide has increased in recent years. Based on logistic regression analysis, OR estimate of completed suicide increased 1.46 (95% CI: 1.36, 1.56) fold for every 10-year increase in age. Moreover, OR estimate of completed suicide was 2.53 (95% CI: 1.94, 3.31) in men compared to women. Compared to married people, the OR estimate of completed suicide was 1.41 (95% CI: 1.15, 1.72) in single people, 1.92 (95% CI: 1.15, 3.23) in widowed people, and 1.97 (1.32, 2.95) in divorced people. The lower the educational level, the higher the risk of completed suicide. Compared to school/college students, the risk of completed suicide was higher among housewives, employed people or employees, and retirees. A majority of the suicides (90.05%) occurred at home. Taking medications was the most common way (69.13%) of a suicide attempt. We indicated that associated factors with completed suicide vary in Iran compared to other developed and developing countries and that factors associated with attempted suicide are different from that of completed suicide.

Types, Risk Factors, Clinical symptoms and Diagnostic Tests of Acute Adult Meningitis in Northern Iran During 2006-2012.

Acute bacterial meningitis is a medical emergency condition that requires prompt diagnosis and treatment and otherwise associated with serious morbidity and mortality. The aim of this study was to assess types, risk factors, clinical symptoms and diagnostic tests of meningitis in hospitalized patients of Mazandaran University of medical sciences hospitals during 2006-2012. This is a retrospective descriptive study. Following approval of the ethics committee of Mazandaran University of Medical Sciences, records of adult patients diagnosed with acute meningitis from 2006 to 2012 were extracted from Mazandaran Provincial Health Center and patients attending hospitals affiliated to Mazandaran University of Medical Sciences. Data were analyzed with SPSS-16 using descriptive statistics (frequency, mean, standard deviation, and median). In this study, of the 137 patients with meningitis, 73 (53.9%) were viral, 61 (46%) bacterial, 1 (0.7%) fungal, and 2 (1.4%) unknown. The majority of risk factors in patients were head trauma, upper respiratory infection, and drug addiction. The most common clinical signs were headache, fever, nausea and vomiting, and stiff neck. In this study, the incidence of meningitis was much lower than any other country. It could be due to geographic variation or incomplete recording of patient's data. It is recommended to perform a longitudinal study during the coming years on patients with meningitis.

Trend Analysis of Gastrointestinal Cancer Incidences in Guilan Province: Comparing Rates over 15 Years

Cancers of gastric and esophagus are the most frequent gastrointestinal (GI) tract cancers in Iran. This study aimed to analyze time trends of GI tract cancers in Guilan province by gender and age to provide solid scientific evidence for cancer prevention and control. The data were obtained from the Guilan Cancer Registry System and Guilan Provincial Health Center, over the 15 year period between 1997 and 2011. Crude incidence and age standardized (AS)incidence rates were calculated and annual percent change was estimated by Joinpoint software for long term trend analysis. During the study period, 8,332 cases of GI malignances with a male to female ratio of 1:1.73 were registered in Guilan province. The AS rates for esophageal, gastric, colon and rectal cancers were 5.97, 14.5, 7.59 and 3.58 per 105 respectively. While the trend was declining and relatively constant for esophageal and gastric cancer, respectively, the incidence trend for colon and rectal cancers was of increase over the period of the study. The results indicated that the incidence of GI cancers was relatively low in Guilan province compared to neighboring provinces. An effective cancer control program including prevention measures, early detection and effective treatment needs to be implemented to reduce cancer morbidity and mortality.

Public Policies to Improve Transplant Accessibility in Argentina

Introduction: Besides the constant increase of waiting lists for transplants (WL) and the shortage of organ donors, the Argentine republic shows difficulties in accessibility within vulnerable populations due to socio-economic and georeferencial reasons, like the poor development of transplant teams in remote regions and the different ways of funding. For example the population density varies from 0.9 to 14; 34% of the population depends on the Public Health System, with ranges that vary from 17 to 54% in the different provinces. Out of the 53 Units of Renal Transplantation, 54% are in 2 provinces from a total of 24. To face this problem of Public Health, the Health Ministry designed comprehensive policies. And through the National Organ Procurement and Transplantation Institute (INCUCAI), in 2009, it began the Transplantation Solidarity Fund with the approval of provincial health centers for the creation and/or strengthening of the transplantation activity in public establishments, with the aim of assisting patients with no health care coverage. Objectives: To strengthen the net of Establishments of the State Public sector in order to ensure an improvement in patient access to the WL and to transplantation, with special emphasis on Kidney Transplantation. And to increase organ and tissue availability for transplantation as well. Material and methods: Law 24193 (art. 49 and 51) created the Transplantation Solidarity Fund; Resolutions 198/08, 280/08 and Resolution 356/10 (Art.1) gave INCUCAI the authority to implement the financial assistance to carry out those actions aimed at facilitating access to the WL, at transplanting patients with no formal health coverage and at developing and strengthening cells and/or tissue banks, and pre-transplantation and transplantation evaluation centers. Data were taken from the National Transplantation System (SINTRA). Results: In 2010 and 2011 u$s 1.950.000 were transferred to the provinces in order to set up: 1 Pediatric Bone Marrow Transplant Unit of National and Regional reference, 1 Renal Transplant Unit and 1 Provincial HLA Laboratory of Regional Regency, 4 Multi-tissue Banks of National and Regional reference, equipment to improve provincial management units with REPS and various provincial and regional hospital equipment. The increase in the last 2 years (2010/2011) was of: 20.8% of Real Donors (RD), 33% of transplants in general, out of which 18% was in kidney implants and 33% in liver implants. Conclusions: The management outcome of the State investment in integral actions resulted in concrete benefits in the Donation-Transplantation universe, improving sustained patient incorporation to the WL, creating or strengthening Transplantation public centers with the consequent increase in transplants in our country, and a positive impact in transplant accessibility of patients with no health coverage.

Epidemiological aspects of cutaneous leishmaniasis in Ilam province, west of Iran (2000–2007)

ObjectiveTo investigate the epidemiology of cutaneous leishmaniasis in Ilam province between 2000 and 2007. MethodsThe data of this descriptive cross-sectional study included the existing data regarding the prevalence of cutaneous leishmaniasis in different seasons, years and districts which were reported to Ilam Provincial Health center between 2000 and 2007. ResultsThe analysis of the collected data revealed that Ilam province was one of the endemic foci of zoonotic cutaneous leishmaniasis caused by Leishmania major. The study also showed the rate of cutaneous leishmaniasis incidence with the general rate of 1.2 per one thousand populations. It was also evident that the highest rate of incidence of cutaneous leishmaniasis was in fall and winter, which is one of the most important characteristics of zoonotic cutaneous leishmaniasis. Ulcers were present in 5 161 Patients. Of these, 28.9% were female and 71.1% were male. 3 447 cases (66.8%) had ulcers on hand and foot, 1 213 cases (23.5%) on face and 501 cases (9.7%) on trunk. A total of 1 907 patients (36.9%) had only one ulcer. But 3 254 cases (63.1%) had more than one ulcer. The highest incidence was found among patients with two age groups of 20–29 years old (46.8%) and 10–19 years old (17.3%). ConclusionsWith respect to the increased prevalence of cutaneous leishmaniasis in Ilam province, health care observers should pay further attention on preventing the disease spread.

A study of family health problems in Iran from the stakeholders' perspective.

Background:Family health is one of the World Health Organization's (WHO) programs concerning individuals’ and families’ health and development. If properly implemented, family health may ensure the health of human beings and support their self-fulfillment; and may pave the way for bringing up a healthier and better generation by achieving two important and specific quantitative and qualitative results. This study aims at establishing the existing problems in the medical education system with respect to family health, which may be managed by the family health professional if a Masters’ course educational program is developed.Materials and Methods:In this cross-sectional, descriptive study, five Type-1 and four Type-2 and Type-3 universities were randomly selected. Then, the faculty members of health services/public health departments, health managers, health and treatment networks managers, personnel of provincial health centers in family health units, and also public health B. S. students were surveyed on the existing problems in the national health system which can be solved by family health professional. A questionnaire containing one open-ended and several demographic questions was sent by mail for some and personally handed over to some others. Since the data were of a qualitative nature, first the categories were specified through content analysis and then the opinions of each category of individuals were differentiated based on the relevant categories.Results:Results obtained from the comments of the study population led to specification of problems in health system, which could be solved by the family health senior expert. Such problems were categorized into six groups as: Planning and implementation, research, education, management, service-providing, and cultural problems.Conclusion:Given the problems in our nation concerning various family health issues, the field of family health in the levels of associate and bachelor degrees cannot respond to all public requirements, and health personnel in these levels do not possess various professional, planning, research, and educational skills required to analyze family health problems. Therefore, it is suggested that a Masters’ course educational program be developed.

A COMPARISON OF MELANCHOLIC AND NONMELANCHOLIC RECURRENT MAJOR DEPRESSION IN HAN CHINESE WOMEN

BackgroundAlthough the diagnosis of melancholia has had a long history, the validity of the current DSM-IV definition remains contentious. We report here the first detailed comparison of melancholic and nonmelancholic major depression (MD) in a Chinese population examining in particular whether these two forms of MD differ quantitatively or qualitatively.MethodsDSM-IV criteria for melancholia were applied to 1,970 Han Chinese women with recurrent MD recruited from 53 provincial mental health centers and psychiatric departments of general medical hospitals in 41 cities. Statistical analyses, utilizing Student's t-tests and Pearson's χ2, were calculated using SPSS 13.0.ResultsMelancholic patients with MD were distinguished from nonmelancholic by being older, having a later age at onset, more episodes of illness and meeting more A criteria. They also had higher levels of neuroticism and rates of lifetime generalized anxiety disorder, panic disorder, and social and agoraphobia. They had significantly lower rates of childhood sexual abuse but did not differ on other stressful life events or rates of MD in their families.DiscussionConsistent with most prior findings in European and US populations, we find that melancholia is a more clinically severe syndrome than nonmelancholic depression with higher rates of comorbidity. The evidence that it is a more “biological” or qualitatively distinct syndrome, however, is mixed.

Needs assessment of health education in health‐networks of the Isfahan province of Iran, 2005–2006

An essential element of a successful educational system is evidence concerning the core educational needs of the system. This descriptive study used the consent-based technique of needs assessment to determine health educational needs and priorities within such education in 21 district health networks of the Isfahan province of Iran. This study was conducted in the Isfahan province from March 2005 to December 2006 among health experts of the Isfahan provincial health center and the following three groups in district health networks: health experts at headquarters; health workers delivering health services; and people in the community covered by these networks. Health education needs and priorities of the Isfahan provincial health authority at the district health networks were determined. While the first priority of headquarter experts and field workers was mental health and family planning, respectively, the first priority of people in the community in most districts was nutrition. The findings showed that in most districts there are differences in viewpoints between health workers, health experts and service users regarding health educational needs and priorities within the needs.

Nizal Sarrafzadegan: leading cardiovascular research in Iran

Nizal Sarrafzadegan: leading cardiovascular research in Iran

Achieving health for all: a proposal from the African Region of WHO

The Director of WHOs Regional Office for Africa presents a health development framework based on the primary health care (PHC) concept. the government should review national health policies national health strategies and national heath services to resolve basic issues. Then it should define the framework for health development by breaking down the goal into operational target-oriented subgoals for individuals families and communities by creating health districts as operational units and by organizing support for community health. Once this framework has been decided the government should use it to restructure the national health systems. At the district level health and development committees helped by community health workers and district health teams would be responsible for community health education and activities. The provincial health offices would oversee district activities select and adapt technologies and provide technical support to communities. A board would manage the provincial hospitals (public private and voluntary). These hospitals would work together to organize secondary medical care programs. A public health office wold link them with the provincial health centers. Other sectors would also be involved e.g. departments of education and water. The national health ministry would set national policies plans and strategies. A suprasectoral health council would coordinate cooperation between universities and other sectors and external agencies. National capacity building would involve establishing management cycles of health development using national specialists as health advisors and placing health as a priority in development. To implement this framework however the government needs to surmount considerable structural economic and social obstacles by at least decentralizing and integrating health and related programs at the local level fostering a national dialogue and promoting social mobilization.

Health programming for the Peace Corps in Afghanistan: family planning.

In October 1970 a request was submitted by the government and the Afghan Family Guidance Association AFGA for assistance in the operation of the provincial clinics. In order to explore the prospects for Peace Corps participation in the family planning program the author visited the provincial hospitals and health centers and discussed prevailing health problems with Afghan colleagues. After 2 weeks of visitation the author question and very seriously the justification for the projected involvement in a family planning program for 2 reasons: first infant mortality is extremely high; and second the average alfghan family was not seen to be emotionally culturally or educationally prepared to get involved in the practice of birth control. There are many health economic and social problems surrounding the Afghans whose main struggle is for existence and survival. Based on these projections the recommendation for Peace Corps participation was modified to include attention to maternal and child health as well within the family planning program. Peace Corps nurse-volunteers are being trained in midwivery and family planning. The success of the program will depend largely on the availability of supplies from USAID and AFGA and on the success of the knowledge attitude and Practice of Family planning study currently underway which will include estimations of various demographic and health indicators essential for health programming.