Developing national framework of monitoring and evaluation of non-communicable diseases control and prevention: an experience from Iran

Background: Islamic Republic of Iran, as a country has undergone dramatic and rapid demographical and economic transition leading to increase mortality and morbidity of Non-Communicable Diseases (NCDs). Furthermore, the prevalence of risk factors of NCDs is at alarming range for the population. In response to this challenge, a number of different high level policies have been developed dealing with NCDs, directly or indirectly. However, the fragmentation of policies makes monitoring of NCDs control difficult. Therefore, the aim of the present study was to develop a comprehensive framework for monitoring and evaluating of NCDs control and prevention.  Methods: A qualitative approach with content analysis method was conducted. Components of NCDs monitoring and evaluation framework were extracted and adaptation of components based on requirements of Iran’s health system was made.    Results: Based on the proposed framework, the three main components of NCDs surveillance are as follows; 1) monitoring outcomes (morbidity and mortality); 2) monitoring risk factors; and 3) assessing health care system response, which includes national capacity to prevent NCDs.  Conclusion: The developed framework is a political tool to strengthen activities to control and prevention of NCD and making more effective inter-sectorial collaboration

Prevalence of metabolic syndrome and its determinants among Iranian adults : evidence of IraPEN survey on a bi-ethnic population

Metabolic syndrome (MetS) is a growing public health concern worldwide. It has been demonstrated that individuals with MetS are at an increased risk of cardiovascular events and diabetes. We aimed to investigate the prevalence of MetS and its components among Turkic and Kurds ethnic groups in a bi-ethnic (Turk and Kurd) population. This cross-sectional study is part of the national health transformation plan created in response to the emerging epidemic of non-communicable diseases (Iran's Package of Essential Non-communicable Disease study), launched in 2014 in Naqadeh, Iran. In total, 3506 participants aged 30-70 years were randomly included in the study from urban and rural regions. Cardio-metabolic risk factors related to MetS diagnosis and other related sociodemographic factors were assessed for men and women in both the Turk and the Kurd population. Multivariate logistic regressions were applied to identify MetS-associated factors among both the Turk and the Kurd population. The mean (SD) age of the participants was 49.6 (12.3) years. Of the participants, 56.2% (n = 1969) were women, and 43.8% (n = 1537) were men. Three-fifths of the participants were Turk (60.3%, n = 1751). The overall prevalence of MetS was 37.05%, with a higher prevalence in women (49.8% versus 24.3% in men). The prevalence of MetS and its components among Turk people (41.6%) were significantly higher than that among Kurd people (33.9%) (p < 0.0001). In addition, the prevalence of MetS was higher among women, urban, and older people for both ethnicities. Strong associations were found between MetS prevalence and being older, being female, being overweight, being obese, having a higher waist-to-hip ratio, and having a history of diabetes and cardiovascular disease (CVD) in the family for both Turks and Kurds. The raised waist circumference (WC) is the most prevalent MetS component for Turk men and women. Meanwhile, the most prevalent MetS component for Kurd participants is low high-density lipoprotein for women and a raised WC for men. Significant differences were found between Kurdish men and women for all components, except for a raised WC and a raised fasting blood glucose (p < 0.05). Because the Iranian population features multiple ethnicities, the recognition of the prevalence of MetS components is a major step in establishing intervention strategies for modifying cardio-metabolic risk factors based on the population ethnicities and their sociodemographic, cultural, and lifestyle factors. We recommend future studies for planning an efficient and sustainable health education and promotion program to halt MetS prevalence

Job Satisfaction Differences between Primary Health Care and Treatment Sectors: An Experience from Iran

Background: The aim of this study was to compare the levels of job satis¬faction and its predictors among primary health care and treatment sectors' staff in East Azerbaijan Province, Iran.Methods: This comparative study was conducted in East Azerbaijan Province, Iran in 2011. A questionnaire survey was performed on 420 staff from health care and treatment sectors using multi-stage proportional cluster sampling method. Job satisfaction was measured in five aspects namely: structural and managerial; individual; social; work-itself; environ¬mental and welfare job satisfaction factors. The job satisfaction measure¬ment score was normalized to fall into a range of zero to 100. Statistical analyses were performed using Friedman and independent sample t-tests.Results: Overall satisfaction in health and treatment sectors was moderate with a mean score above 50. Hospital General Practitioners reported sig¬nifi¬cantly higher job satisfaction score (mean ± SD=57.34 ± 17.02) com¬pared to health care center General Practitioners (mean ± SD= 31.74±14.99). The highest satisfaction scores belonged to individual factors both in health care sector staff (64.83±18.50) and treatment sector staff (63.55±17.44). The lowest job satisfaction was observed with environmental and welfare factors (38.47±19.86 and 36.83±19.86, respectively).Conclusion: The job satisfaction significantly differs between primary health care and treatment sectors. Based on the results, environmental and welfare factors may be targeted to improve the job satisfaction in public health care system

Protocol Design for Large–Scale Cross–Sectional Studies of Surveillance of Risk Factors of Non–Communicable Diseases in Iran: STEPs 2016

INTRODUCTION: The rise in non-communicable diseases (NCDs) has gained increasing attention. There is a great need for reliable data to address such problems. Here, we describe the development of a comprehensive set of executive and scientific protocols and instructions of STEPs 2016. METHODS/DESIGN: This is a large-scale cross-sectional study of Surveillance of Risk Factors of NCDs in Iran. Through systematic proportional to size cluster random sampling, 31,050 participants enrolled in three sequential processes, of completing questionnaires; physical measurements, and lab assessment. RESULTS: Out of 429 districts, samples were taken from urban and rural areas of 389 districts. After applying sampling weight to the samples, comparing the distribution of population and samples, compared classification was determined in accordance with the age and sex groups. Out of 31,050 expected participants, 30,541 participant completed questionnaires (52.31% female). For physical measurements and lab assessment, the cases included 30,042 (52.38% female) and 19,778 (54.04% female), respectively. DISCUSSION: There is an urgent need to focus on reviewing trend analyses of NCDs.To the best of our knowledge, the present study is the first comprehensive experience on systematic electronic national survey. The results could be also used for future complementary studies

Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method: A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Home-based supportive and health care services based on functional ability in older adults in Iran

BACKGROUND: Home-based care is affordable due to population aging, increased chronic disease, and higher hospitalization costs. The objective was to evaluate home-based supportive and health care services provided to older adults and identify possible associations between activities of daily living (ADLs), instrumental ADL (IADLs) classifications, sociodemographic variables, clinical characteristics, and perceived social support among older adults. MATERIALS AND METHODS: In this cross-sectional study, 700 people aged 60 years and older were selected by stratified cluster sampling. Areas of Tabriz City were selected as clusters, and 55 comprehensive urban health centers were selected as stratifies. Chi-square, Pearson’s and Spearman’s tests, and multiple linear regression were used for statistical analyses. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 24.0, SPSS Inc., Chicago, USA). The study instrument included demographic characteristics of older adults and caregivers, health services provided at home, and two valid questionnaires, including the KATZ index of independence in (instrumental) activities of daily living and a multidimensional scale of perceived social support. Scores on scales and demographic variables were collected during telephone interviews. The study lasted from April 25, 2022, to October 30, 2022. RESULTS: A high level of perceived social support was 56.6%. The study found that 51.3% of participants had family caregivers. Most participants had ADL independence (85.4%), while 22.9% and 24.3% were dependent and needed assistance with IADL, respectively. Women had a lower ADL score and a higher IADL score than men (P < 0.05). The obtained results of multiple regression analysis revealed a negative and significant association between unemployment, illiteracy, increasing age, five and more medications, and ADL and IADL dependency (P < 0.05). CONCLUSION: Empowering older adults to reduce dependency, and designing a formal home-based care system is recommended

Factors Influencing the Job Satisfaction of Health System Employees in Tabriz, Iran

Background: Employees can be counseled on how they feel about their job. If any particular dimension of their job is causing them dissatisfaction, they can be assisted to appropriately change it. In this study, we investigated the factors affecting job satisfaction from the perspective of employees working in the health system and thereby a quantitative measure of job satisfaction.Methods: Using eight focus group discussions (n=70), factors affecting job satisfaction of the employees were discussed. The factors identified from literature review were categorized in four groups: structural and managerial, social, work in it-self, environmental and welfare factors.Results: The findings confirmed the significance of structural and managerial, social, work in it-self, environmental and welfare factors in the level of job satisfaction. In addition, a new factor related to individual characteristics such as employee personal characteristics and development was identified.Conclusion: In order to improve the quality and productivity of work, besides, structural and managerial, social, work in it-self, environmental and welfare factors, policy makers should be taken into account individual characteristics of the employee as a factor affecting job satisfaction

Challenges in Developing Health Promoting Schools’ Project: Application of Global Traits in Local Realm

Background: Despite the importance of student health and school hygiene as an aspect of the infrastructure of community health, few feasibility studies have been conducted on school health programs in developing countries. This study examined possible barriers to and challenges of such programs from the executive perspective in East Azerbaijan Province in Iran. Methods: This qualitative study used the content analysis approach to recognize barriers to and challenges of health promoting school program from the executive perspective. Fourteen experts were selected in the areas of children and adolescents and school health, physical education and school headmasters. Data were collected using semi-structured interviews and analyzed using the content analysis method. Results: Five themes were extracted as major barriers and challenges: 1. Intraand inter-sectorial collaboration; 2. Policy and rule formulation; 3. Infrastructure and capacity; 4. Human resources; 5. Community involvement. Conclusion: The localized version of the current health promoting school program had major faults. If this program is considered to be a healthcare system priority, it should be revised to set effective policies for implementation and to sustain school health programs based on the capacities and objectives of each country

Post-treatment Clinical Outcomes of Cutaneous Leishmaniosis in the Bam Area, South Eastern Iran: Analysis of over 9,000 Cases

Background: Knowledge about risk or protective factors for post-treatment outcomes in Cutaneous Lishmaniosis are rare, especially in endemic areas such as Iran. The present study aimed to evaluate the association between the outcome of infection, clinical manifestation, and treatment with adverse post-treatment outcomes in Cutaneous Lishmaniosis patients. Methods: This was a cross sectional study based on recently collected data of 9077 Cutaneous Lishmaniosis patients (4585 female and 4492 male) from March 2003 to March 2011 in the Bam area, Iran. Multivariable multinomial logistic regression was applied to assess the effect of outcome of infection, clinical manifestation and treatment on relapse, treatment after interruption, treatment failure and clinical resistance. Results: Head lesions were strongest risk factor for relapse (Odds Ratio, OR=4.21; CI 95%: 3.56-4.98), treatment after interruption (2.00; 1.70-2.35), treatment failure (6.61; 5.17-8.45) and clinical resistance (2.62; 2.00-3.44). Family occurrence (yes vs. no), intra lesion therapy method, treatment duration (>3 v. ≤ 3 week) and source of detection by Surveillance (active vs. passive), were the most protective factors for relapse (OR=0.58; CI 95%: 0.46-0.74), treatment after interruption (0.36; 0.31-0.42) treatment failure (0.24; 0.20-0.29) and clinical resistance (0.24; 0.09-0.67). Conclusion: Head lesions and treatment variables (e.g. therapy method and duration) could predict the occurrence of adverse post-term outcomes of Cutaneous Lishmaniosis. Further longitudinal studies have to clarify cause and effect relationships