Trend of geographical disparities in child and maternal mortality indicators in Northwest Iran

  Background: The present study was conducted to assess the trend of geographical disparities in child and maternal mortality rates in 20 districts of East Azerbaijan, in the Northwest of Iran, between 1999 and 2013.  Methods: Data on to health indicators between 1999 and 2013, extracted from population registry panels (ZIJ), was made available for the study by the East Azerbaijan Health Center. Disparities were measured by calculating the Index of Disparities (IDisp) and the trend was assessed using the general linear model test.  Results: All the four indicators revealed decreasing trends between 1999 and 2013 (P<0.001), while there were no significant differences among the districts studied (P>0.05). The ranges of the IDisp between 1999 and 2013 were 19-32% for Neonatal Mortality Rate (NMR), 16-22% for Infantile Morality Rate (IMR), 14-20% for Under 5 Mortality Rate (U5MR), and 120-143% for Maternal Mortality Rate (MMR), which revealed an increasing trend for all the indices. The trend of health indicators before and after implementation of the family physician program showed no significant difference for MMR (P= 0.228), while significant declining trends were observed for NMR, IMR, and U5MR (P<0.001).  Conclusion: The results showed that despite the downtrend in NMR, IMR, U5MR, and MMR indicators, there are still geographical disparities in these indicators among districts of the East Azerbaijan province, in the Northwest of Iran.Keywords: Geography; Infant mortality; Maternal mortality; Registry 

A Qualitative Study on the Experiences of Specialists on Patient-Oriented Decision Making in a Developing Country

Introduction: Patient centered decision making is one of the main aspects of evidence –based medicine, in addition to being morally important. The aim of this study was to extract the experiences of clinicians on patient-centered decision making. Method: A qualitative study based on descriptive phenomenology method was done. Purposive sampling was used to select the clinicians from among faculty members of medical school. Focus Group Discussion (FGD) was used to gather the data .The discussion continued till the saturation of data was achieved. Content analysis was used for data analysis. Results: The participants of FGD were 6 clinicians from various specialties. 218 codes were extracted from the data and they were categorized in 4 themes and 16 subthemes. The main themes were: good relationship with patients, respect to the opinions and beliefs of the patients, taking into account the needs, preferences and experiences of the patients, comfort and safety of outpatient and inpatient setting for patient, shared decision making. Conclusion: Patient centeredness based on the experiences of clinicians in an educational hospital is similar to other studies but in developing countries like Iran clinicians have contextual and cultural barriers to apply it

Compatibility of the Curricula of Public Medicine Internship and Apprenticeship Programs with General Practitioners’ Roles and Responsibilities

Background and Objectives: The aim of the present study is to investigate the compatibility of public medicine internship and apprenticeship curricula with roles and responsibilities of general practitioners (GPs) from their personal perspectives at health centers, affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. Methods: This cross sectional analytical survey was performed on 80 GPs in East Azerbaijan province, Iran in 2014 via simple random sampling. The data collection tool included a researcher-made questionnaire, based on the curricula of community medicine internship and apprenticeship programs and a focus group discussion about GPs’ responsibilities. The content validity and reliability of the questionnaire were confirmed by professionals and experts of public health education. For data analysis, descriptive statistics (mean, standard deviation, frequency, and percentage) and one-sample t test were performed, using SPSS. Results: On average, more than 83% of GPs in this study believed that subjects presented in public medicine internship and apprenticeship programs should remain in the curricula. More than 60% of GPs demanded the integration of subjects, including professional ethics and approaches towards preventive medicine and disease risk factors, in the internship program. In addition, more than 50% of GPs asked for the integration of accurate drug prescription and test administration in the internship program. Generally, the respondents reported amoderate to high level of compatibility between the educational content of internship (mean, 3.3 ± 0.74; minimum, 1.1; maximum, 5) and apprenticeship (mean, 3.13 ± 0.77; minimum, 1; maximum, 4.92) programs. Conclusions: According to the results, GPs reported a medium to high level of compatibility between the curricula of internship and apprenticeship programs, as stated by GPs. They also asked for the integration of certain subjects in their curricula. Therefore, it is essential to coordinate the educational syllabus with the actual medical education needs of students in order to improve GPs’ efficiency and promote a community-based approach in medical education. Keywords: Coordination, Curricula, Internship, Apprenticeship, Responsibility, General Practitioner

The Effect of Teaching Practical Physical Modalities on the Ordering Skills of Physical Medicine and Rehabilitation Residents

Introduction: Physical modalities are performed by physiotherapists based on physiatrists’ orders, so the residents pay less attention to the need and importance of learning the practical modalities. The aim of this study was to determine the effect of teaching the practical aspects of modalities to residents of Physical Medicine and Rehabilitation in order to improve their skills and attitudes toward ordering and doing physical modalities. Methods: In an interventional, before after study, all residents of physical medicine and rehabilitation, took the medical history of the patients willingly participatedand performed physical examinationand ordered physical modalities. They were also assessed by performing the modalities on the patient. Following the primary assessment, an experienced physiotherapist taught the residents how to do physical modalities. After the practical education, residents were assessed by ordering the modalities and performing them on simulated patients. Their satisfaction of the educational program was evaluated after the intervention. Results: The mean scores of using modalities before and after the education were 23.08± 5.50 and 52±10.18 respectively (p=0.0001). The mean scores of ordering the modalities before and after the education were 1 and 1.66 (p=0.038). The mean score of satisfaction was 91.66±8.74 out of 100. Conclusion: Since physical medicine and rehabilitation residents and specialists who order physical modalities for patients do not perform it on their own patients, teaching the practical physical modalities can improve their skills. The satisfaction rate of residents with the course was very high

The role of history of blood pressure and diabetes in the prevalence of stroke in Azar cohort

Introduction: The prevalence of diabetes and hypertension has been growing steadily in the last decade. These are important risk factors for stroke and the contribution of each risk factor may change due to geographical location. We conducted the present study with the aim of determining the relationship between blood pressure and diabetes history and stroke in the population covered by the Azar Cohort. Methods: In this case control study which was a subset of Azerbaijan province study (Azar Cohort), 357 patients were divided into patients with and without a history of stroke. The two variables of hypertension and diabetes history, in these two groups were compared. Data were collected and compared with inferential statistical tests. Results: The results showed that blood pressure could increase the risk of stroke by 3.68 times (95% CI: 2.32-5.86). The history of diabetes mellitus in people with and without stroke was not statistically significant (OR=1.54; 95% CI: 0.87-2.72). Conclusion: The results of this study showed that high blood pressure is a predictor of stroke but diabetes cannot be effective in stroke in the cohort population of Azerbaijan

Effect of intra-organizational factors on research

      Along with other areas in our country, the research in medical sciences is a necessity for the maintenance and improvement of community health. The objectives of this study were to determine the intra-organizational factors of conducting research in Tabriz University of Medical Sciences. The matrix of the study included entire academic members and research staff of the university where 121 of them were selected randomly for a descriptive cross sectional study. A questionnaire was designed to collect data using Likert Spectrum. The major difficulty was the lack of sufficient free time. Significant differences were seen in respect with the access to facilities and conducting research, assessing expected benefits of conducting research, level of research awareness among academic members with and without research project. Differences in respect with motivation force, collaboration, job satisfaction and expected benefits from conducting research were shown to be not significant. As stated by academic members, their problems involved with conducting research projects provides lesser role of intra-organizational factors compared to that of personal factors. In other words, the most major problems in not doing research are the lack of sufficient time and proper skills in research method and innovation in looking for problems to be solved.

Prioritizing social determinants of health in East Azerbaijan: a qualitative research

Background: In order to improve health-centered decision making and planning to reduce inequalities in health, it is important to identify, classify, and prioritize social determinants of health. This study aimed to identify and rank three major social determinants of health in East Azerbaijan. Methods: This research was conducted using a qualitative approach in grounded theory. Through purposeful sampling, 40 key informants from East Azerbaijan, North West of Iran, were selected and in-depth interviews were performed. The collected data was analyzed with a three-step coding method including open, axial, and selective coding using Corbin and Strauss’s systemic approach. Also, Interpretive Structural Modeling and “Matrice d'Impacts Croisés Multiplication Appliquée à un Classement” (MICMAC) analysis were used to identify and rank social determinants of health in East Azerbaijan. Results: Of the 40 participants, 27 (68%) were male and 13 (32%) were female. The mean age was 39.28± 12.46 years. 63% had a doctoral degree. According to the result of MICMAC analysis, social harm, social capital, and good governance were identified as three major social determinants of health in East Azerbaijan province. Conclusion: Social determinants of health have a significant and crucial role in human welfare and by identifying and prioritizing social determinants of health at a local level and/or national level, the first step can be taken toward social welfare

Social Determinants and Reproductive Factors of the Menopausal Symptoms among Women in Tabriz-Iran

  Background: Menopause is a natural event in which different degrees of psychosomatic changes occur. The social, demographic and behavioral factors in different nations have a significant effect on symptoms of menopause. The aim of this study was to determine the relationship between the personal, demographic, social and reproductive factors with symptoms of menopause and the frequency of the mental and physical symptoms of menopause among women in Tabriz, Northwest of Iran.   Methods: A cross-sectional study was conducted in the clinics and health centers of Tabriz, East Azerbaijan and Iran. A total of 300 women aged 40-60 years filled a questionnaire on the socio demographic variables, reproductive history and symptoms checklist.  Results: Among the symptoms, muscle and joint pain (68.7%), and increased facial hair (20.5%) were the most and the least common ones respectively. According to participants, as age increases, the symptoms worsen (p=0.003).The frequency of the symptoms of the employed women was less than those of retired ones and housewives (p=0.001). The physical and mental symptoms had negative relation with educational status (p<0.05). An increase in the number of the children, the history of the oral contraceptive use and dysmenorrhea had positive relation with the frequency of the symptoms.  Conclusion: The quality of life of the women during menopause worsens with an increase in age and number of children, whereas it improves with higher educational levels and employment

Illicit methylphenidate use among Iranian medical students: prevalence and knowledge

Afshin Habibzadeh1 Mahasti Alizadeh2 Ayoub Malek3 Leili Maghbooli1 Mohammadali M Shoja4 Kamyar Ghabili41Students' Research Committee, 2Department of Community Medicine, 3Department of Psychiatry, 4Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Methylphenidate, a medication prescribed for individuals suffering from attention-deficit/hyperactivity disorder, is increasingly being misused by students.Objective: The aims of this study were to evaluate the frequency of methylphenidate use among a group of Iranian medical students and to assess their knowledge of methylphenidate.Methods: Anonymous, self-administered questionnaires were completed by all medical students entering the university between 2000 and 2007.Results: Methylphenidate users’ mean knowledge score was higher than that of nonusers (15.83 ± 3.14 vs 13.66 ± 3.10, P = 0.008). Age, gender, and school year were positively correlated with knowledge score (P < 0.05). Data analysis demonstrated that 27 participants (8.7%) had taken methylphenidate at least once in their lifetime. The respondents believed that the most common motive for methylphenidate use among youths was that it aided concentration and therefore ability to study.Conclusion: This study indicates a relatively low level of knowledge about methylphenidate among Iranian medical students. More educational programs regarding the use of methylphenidate are required and should be focused on the student suppliers, clinicians, pharmacists, and medical students.Keywords: methylphenidate, medical student, prevalence, Ira

The effects of interprofessional education on teamwork, communication skills and quality of health care in advanced and developing countries: A systematic review and meta-analysis study

Background: Inter-professional education is a new approach in education in which professionals in various fields of health systems learn from each other based on educational events in a real environment, actively and interactively. This systematic review and metaanalysis aims to investigate inter-professional education in advanced and developing countries. Methods: Persian and English keywords were used to search these databases: ISI Web of Science, Scopus, ProQuest, PubMed/Medline, Embase, Google Scholar, ERIC, Magiran, Irandoc, and Barakat with an English language restriction and for the years 2000 to 2019, using these terms: Embase, Meshand and free. Two evaluators assessed the extracted articles using the Critical Appraisal Skills Program (CASP) checklist. CMA 3.1 software was used for the analysis with a fixed-effects model. Results: A total of 1425 articles formed the basis of this study. In all, nine articles were extracted that examined the effect of inter-professional education from the viewpoints of professors and students (three for professors and six for students). Heterogeneity among the nine studies was not significant. Teamwork scores, communication skills, and healing of the participants in the study increased by 0.339, 0.283, and 0.275 points after the intervention, respectively. Conclusion: Inter-professional education is one method of educational integration. Students become aware of how their role overlaps with other medical professions as well as the limitations of their role in treating patients. However, inter-professional education implementation requires infrastructure, such as training professors and preparing them and students to accept inter-professional education