Entanglement Of The Rights Of The Child, Well-Being And Justice: A Conceptual Framework For Child Protection And Well-Being

Background: Human Rights (HRs) framework supports improving human health status and the reduction of health inequalities through action on Social Determinants of Health (SDH). Given the shortcoming of HRs to protect the children, the question is, how can we ensure child protection and well-being rather than just child health?Methods: In this conceptual analysis study, first, we explain the fundamental rights of the child and the steering role of them in moving towards health equity through action on SDH; second, meanwhile argue the shortcoming of rights-based protection, provide a list of the core capabilities and corresponding rights of the child; and third, we represent a conceptual framework for child protection and well-being using both HRs norms and moral entitlements based on recent ethical theories of justice, with a preventive approach.Results: According to the framework, HRs instruments should lead to the protection of the child and the development of core capabilities through addressing social determinants and providing equal opportunities, of which the ability to live a healthy life is just one. In addition, actualizing these capabilities depends on the context. Since achieving well-being rather than just the health, in addition to acquiring the core capabilities as states of beings, implies their function as doings, that requires considering the socioecological context to provide means necessary to meet the essential dimensions of well-being at the level of adequacy.Conclusion: Implementing the suggested framework requires that each country create a national action framework and determine the role and duties of the responsible organizations

Knowledge and Attitude of Midwives and Obstetricians Towards Therapeutic Abortion Law and its Ethical Pitfalls

Background: Despite the implementation of a safe motherhood program in many countries, unsafe abortion continues to be a matter of reproductive health. Thus, urgent efforts to make abortion legal and safe have been recommended in developing countries. The present study was done to determine the knowledge of midwives and obstetricians about the therapeutic abortion law as well as their attitude about the ethical pitfalls.Methods: In this descriptive knowledge and attitude study, a researcher-made questionnaire was used to gather data, after estimating the appropriate Cronbach’s Alpha coefficient. A total of 162 midwives and obstetricians working in public and private medical centers affiliated to Shahid Beheshti University of Medical Sciences in 2018 were included in the study by convenience sampling method.Results: According to the results, 9.3% of participants had a low level, 72.8% had a moderate level, and only 17.9% had a good level of knowledge. The total mean score of knowledge was 7.17±1.7. The mean score of knowledge in the group of obstetricians (7.60±1.74) was significantly higher than midwives (6.94±1.54), (t=2.29, p=0.024). There was a significant correlation between participants’ age and their knowledge (r=0.912, p=0.001). Also, 47.53% of the participants believed that the therapeutic abortion law has some pitfalls. The most frequent attitude was about the restriction of the therapeutic law up to 19 weeks for fetal indications.Conclusion: The level of participants’ knowledge was low to moderate. The findings indicated the need for training the professional standards related to prenatal genetic screening and therapeutic abortion

Knowledge, attitude and practice of the elder residents of Tehran city about healthy lifestyle

Background and Aim: In the third millennium, aging are appeared as a global reality more than before.Developments in controlling of the contagious diseases, nutrition and healthy environment resulted in increasing life expectancy. So the twentieth century challenge for surviving has been replaced by living stay with better quality and healthy aging. Present study was carried out in order to determining the knowledge, attitude and practice of the urban elders about healthy lifestyle in 2008.Materials and Methods: In this descriptive analytic research, 450 elder people of Tehran residents with more than 60 years old were studied. The sampling method was random clustering and structured questionnaire was used for data collection. Interviewers completed questionnaires after referring to their homes. SPSS V.18 software was used for data analyses.Results: 54.6 percent of elders were men. Mean scores in each of the three fields for men was more than women. Our findings show significant relation between age, sex, income and marital status of subjects with their knowledge, attitude and practice. So with increasing age their knowledge, attitude and practice were decreased respectively. Knowledge, attitude and practice of elders about healthy lifestyle was related to membership in public and national organizations, significantly (p=0.01).Conclusion: Our findings indicate on need to comprehensive programming for health education about healthy life style, respecting social determinants of health and encourage elder residents of urban regions to membership in public organizations.Key words: Elderly, Healthy Lifestyle, Knowledge, Attitude , Practic

Ethical considerations from the viewpoint of headquarters experts on HIV/AIDS prevention and control strategic program

Background: The HIV control and prevention program is one of the Public Health programs that confronts with many ethical challenges. This study aimed to explore ethical considerations from the viewpoint of headquarters experts on HIV and AIDS prevention and control strategic plan. Methods: In this qualitative study with content analysis design, focus group discussion method was utilized. After purposeful introduction of the experts and previous coordination about subject and time, two discussion sessions were held with the participation of six ministry and university headquarters experts of HIV control program. After frequent reviews of the data and using deductive content analysis, main themes and subthemes were categorized. In order to transformability of the findings to similar situations, the data were checked by three external reviewers. Results: The participants agreed that HIV/AIDS control requires focusing on prevention, treatment, and support services, and considering the general population and all vulnerable groups. In this study, five main themes were emerged: informing and empowering to make autonomous decisions, observing confidentiality, prohibiting stigma and discrimination, and being accountable. Conclusions: The viewpoint of participants indicates on the more need to pay attention the mentioned ethical considerations when compiling and finalizing the program. Moreover, in addition to instructing moral norms in PH programs with a special look to HIV/AIDS and how to apply them in the formulation and implementation of program, systematic evaluation of the program by an ethical framework is recommended to ensure the achievement to the goals of program

Analysis of Iranian youth health policy: Necessity of action-oriented interventions

Background: Protecting the youth and adolescents' health is considered to be an indicator of health equity. The current study was conducted to analyze health status of the Iranian youth and adolescents, identify service gaps, and design action-oriented interventions. Methods: In this study with multimethods design conducted in 2014, first to identify and analyze the current situation, related articles and national and international documents were searched and reviewed. Then, stakeholders' analysis, interviews, group discussion, and analysis of the youth and adolescent health management system were done, and the policy document was drew up in three sections of recognition, orientation, and suggested interventions. Results: The most important focus areas of the youth and adolescents' health were identified to be their behavior and lifestyle, less advantaging of primary health care in cities, and high rates of educational dropouts. Considering a responsive national structure to develop and implement a comprehensive and integrated program for educating healthy lifestyles and reducing risky behaviors and focusing on accident prevention as a first priority at the level of impact and planning on risk factors of noncommunicable and communicable diseases related to sexually transmitted infections and AIDS at the outcome-level indicators is a necessity through intersectoral collaboration and community participation strategies. Conclusions: Achieving premiere indicators of the Iranian youth health requires political commitment and support of the state, more than ever. To cooperation and utilize the capacity of other sectors to implement the Ministry of Health and Medical Education programs, establishment of the youth health commission is recommended with participation of the main partners

تحولات اجتماعی نظام سلامت ایران در طی دوران انقلاب اسلامی

Background and Aim: Study of Social developments of health system in Iran society, ever since the Islamic Revolution, could be the first step in analyzing people's reactions to the disease, treatment, hypochondriasis and process-oriented medicine and medicalization. Therefore, in this study, meanwhile description of each period, firstly, we explore the medical situation and then address patients’ reactions and public tendency to health and selection of the therapist and treatment approach. Materials and Methods: In this social science research, library method was used to study and analyze texts. In addition, targeted search in the internal databases of Noormags, Irandoc, SID, as well as the google. Scholar was done. Findings: According to the conditions of the treatment system and political development of the country, country's health-care process can be divided into four distinct periods: the lack of medical upscale, Luxury-oriented medicine, public health development and realization of divided identity of traditional medicine Ethical Considerations: Honesty and fidelity were observed in reporting and citing the texts. Conclusion: Although the patriarchal tendencies of the health system in the Eleventh Government have diminished and the officials of the Ministry of Health and Medical Education have tried to Ministry of Health and Medical Education has tried to provide accountability, but it seems, this flow is being realized in the other way. The analysis of the general tendencies and reactions to these four periods can play a significant role in reforming the structure of the health system and health equity.   Cite this article as: Mahlooji K, Haghi Aghghaleh SH, Abdoli M, Akrami F. Social Developments of Iran’s Health System during Islamic Revolution. Medical History Journal 2020; 12(44): e9.زمینه و هدف: مطالعه روند تحولات اجتماعی نظام سلامت در جامعه ایران، از دوران انقلاب اسلامی تاکنون، می‌تواند گامی آغازین در تحلیل واکنش‌های مردم به امر بیماری, درمان، خود بیمارانگاری و فرایند پزشکی‌زدگی محسوب گردد. به همین دلیل در این مطالعه ضمن تشریح هر دوره، ابتدا به وضعیت پزشکی در آن دوره اشاره نموده و در مرحله بعد واکنش بیماران را به پزشکی و گرایش عمومی به سلامت و انتخاب درمانگر و رویکرد درمانی مورد تحلیل قرار می‌دهیم. مواد و روش‌ها: در این پژوهش علوم اجتماعی، از روش کتابخانه‌ای برای مطالعه و تحلیل متون بهره گرفته شد. برای این کار علاوه بر جستجوی دستی اسناد و متون، از جستجوی اینترنتی هدفمند در پایگاه‌های داخلی SID، Irandoc، Noormags و نیز موتور جستجوی Google Scholar استفاده شد. یافته‌ها: با توجه به شرایط حاکم بر نظام بهداشت و درمان کشور می‌توان فرایند مراقبتی سلامت کشور را به چهار دوره مشخص: 1ـ کمبود؛ 2ـ پزشکی مجلل؛ 3ـ توسعه بهداشت عمومی؛ 4ـ دوره تحقق هویت طب سنتی تقسیم‌بندی نمود. این فرایند در کشور ایران یک واقعه جامعه‌شناسی منحصر به فرد تلقی می‌شود. ملاحظات اخلاقی: صداقت و امانتداری در گزارش و استناد به متون رعایت گردید. نتیجه‌گیری: هرچند گرایشات پدرسالارانه نظام سلامت در دولت یازدهم کاهش یافته و مسؤولین وزارت بهداشت، درمان و آموزش پزشکی سعی نموده‌اند تا چهره پاسخگویی از خود ارائه نمایند، اما به نظر می‌رسد جریان سلامت کشور در مسیری دیگری در حال تحقق است. تحلیل گرایش‌ها و واکنش‌های عموم به این چهار دوره می‌تواند در اصلاح ساختار نظام سلامت و عدالت در سلامت نقش چشم‌گیری داشته باشد

Clinical outcomes of high-risk infant follow-up program in a tertiary care centre

Background: High-risk infant follow-up (HRIF) program is necessary for early detection, timely intervention, and promotion of health outcomes in vulnerable infants, ethically. The present study was carried out to assess the clinical outcomes of the HRIF Program in Alzahra hospital as a tertiary care centre, in Iran. Materials and Methods: In this cohort study, 5840 neonates were born at Alzahra hospital, from June 1, 2011 to 30th February 2012. Among those who were admitted to neonatal intensive care unit (NICU), 253 infants were recruited by census according to HRIs criteria. After doing necessary measurements and family education, information was recorded in HRI health certificate and then entered in the access database for analysis. Results: From 253 eligible HRIs registered, 241 (95%) infants attended the follow-up clinic after discharge. A total of180 cases were recalled for further visits, 110 of which attended the clinic. Anthropometric indices had an increasing trend in the first 6 months of life. There was no significant relation between ages and stages questionnaire (ASQ) results and infant birth weight, height, and head circumference. The ratios of intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) were 8.7% and 3.1%, respectively. The incidence of congenital hypothyroidism was 2:341 in HRIs. Conclusions: Although some outcomes, such as ROP, improved in our study compared to similar studies, the findings indicate an impairment of the current follow-up processes and highlight the necessity to modify the current HRIF program. Ethically, we insist on integrating HRIF program in child health services to promote early childhood development

Assessing Family-Centered Care in Iranian NICUs from Perspective of Neonatal Individual Developmental Care

Background: Preterm deliveries and premature babies are among challenges for families and communities. A family-centered care model is a model that helps families become less challenged by preterm birth and learn how to care for their premature infants. The aim of this study was to evaluate the implementation of family-centered care in the Iranian neonatal intensive care units (NICUs).Methods: This national cross-sectional study was conducted on a total of 23 NICUs of 9 universities of medical sciences, where students were trained in the neonatology fellowship course, in seven provinces of Iran. Family-centered developmental care was assessed in six different domains, including the philosophy of nursery, family communication, family support, family resources, admission and discharge planning, and decision-making. In addition, a total of 29 items were asked. The data were analyzed using Stata software (version 13) using descriptive statistical tests.Results: The mean scores in all domains were weak, and the total score for all domains was 34.18 (95% CI: 33.75-34.60) out of 100. The mean scores were 30 in the philosophy of nursery, 43.47 in family communication, 26.71 in family support, 35 in family resources, 45 in admission and discharge planning, and 25 in decision-making. The lowest score was reported for decision-making, and the highest score was reported for admission and discharge planning.Conclusion: Since family-centered developmental care in Iran is not favorable, the obtained findings suggest the development of a suitable plan to upgrade family-centered developmental care as well as comprehensive NICU care, including developmental care, with regard to other domains

Assessment of Physical Environment of Iran’s Neonatal Tertiary Care Centers from the Perspective of the Neonatal Individualized Developmental Care

Background: Globally,it is estimated that approximately 13 million neonates are born prematurely each year. The development of the central nervous system in premature neonates continues outside of the uterus and in the environment of neonatal intensive care unit (NICU). This study aimed to evaluate the physical environment of hospital and nursery in Iran’s tertiary care centers. Methods: This cross-sectional study was conducted on a total of 23 NICUs of nine Universities of Medical Sciences, where students are trained in the neonatal fellowship course, from seven provinces of Iran, 20th July to 21th September 2015. Data analysis was performed using SPSS software, version 16, and descriptive statistics. Results: In this study, four dimensions of physical environment of hospitals and NICUs including the accessibility of NICU, the physical environment of NICU, infants’ bed space, and the sensory elements of bed spaces were evaluated. The obtained scores for each item was 41.17, 39.95, 38.83, and 39.28 out of 100, respectively. The highest mean score was 71.30 that was related to NICU temperature and ventilation considerations. The lowest mean score was 20, which was related to controlling over the movements around the infants’ beds. The total mean score of the physical environment of hospital and NICU was 39.77. Conclusion: According to the results, it is recommended to take appropriate action to develop physical space and infrastructures for neonatal care regarding developmental care along with other dimensions