فهرست مطالب فریبا بخشیان

The aim of the study is to assess knowledge and behavior of participants about dietary fats pattern. Also، our goal was to design a nutrition education program about dietary fat intakes which is relatively brief and low cost in terms of time and material. In this experimental study we recruited three groups of household women under the cover of health centers of Tabriz city as Random-cluster sampling method. Group A (n= 90) participated for 3 sessionsand group B (n= 86) for 5 sessions education intervention about dietary fat pattern. Also group C (n= 90) were allocated as control group. We randomly selected some partners (n= 65) of intervention groups (group A and B)، as reinforces factors، the other control group. For evaluation، a knowledge and behavior questionnaire was administrated to all groups. Furthermore، the effectiveness of education was compared among two intervention groups with different attendance classes. For mean scores knowledge، no significant difference existed between groups. Mean score of behavior were less than 50% in all groups [group A: 49. 3±16. 5، group B: 44. 3±17. 7، group C: 43. 57±13. 5 and group M: 50. 51±18. 66]. Mean scores of knowledge and behavior showed a significant difference in the intervention groups (post-test versus pre-test) [group A: 79. 4±23. 6 and group B 83. 22±21. 5، p<0. 001]. Different impacts of class attendances have not significant effectiveness for knowledge and behavior to compare two intervention groups (groups A and B)، but significant compared control group (group C) (p=0. 0001). Women had low knowledge about optimal dietary fat pattern and behavior levels were poor. Short time education program was effective for household women.

Family physician team is responsible for all of primary health care services including family planning. This study was evaluated the impact of Family physician program (FPP) on family health indices in cities of East- Azerbaijan.

In this study the whole population of 3 small cities (n=36000) were selected and the six -year (2000 to 2006) coverage of family planning of the couples were investigated based on available statistics. On the qualitative side، the files of 600 couples were selected through stratified and cluster sampling procedures and their documents were investigated.

After FPP، the number of physicians and midwives were doubled in urban health centers. Coverage of family planning services increased from 39. 7% to 66. 2%، use of condom method increased by 10% and OCP، IUD decreed by 6%. However the number of births was nearly unchanged in 7 years. The periodic examination of women and Pap smear increased significantly (P<0. 05).

FPP has achieved partial success in providing family healthcare services including periodic examination of women and Pap smear sampling. Therefore، revision of the Job description and performance assessment of family physician teams is recommended.

In the middle age (500–1500), while European countries were struggling with frightening epidemics such as plague, smallpox, tuberculoses, leprosy, and their medical treatments were based on superstitions and fanaticism, scientists such as Avicenna and Rhazes laid the foundation of the golden period in medicine.In the late periods of golden centuries, during the Mogul invasion of Iran, Rashidaddin Fazlollah Hamadani devoted a great deal of effort to preserve the knowledge by foundation of the knowledge city of Rabé Rashidi andDaralshafa (Medical and Health Service College) in Tabriz. Rashidaddin established a successful health management system which was accordance with the current modern health management systems. The objective of this review is to present a clear perspective of a successful Iranian Islamic model of health delivery system 700 years ago.The review was conducted in the form of descriptive bases of original documents with a systemic approach.Findings show a successful management experience in health system in terms of stewardship, resource allocation, provision of health services and financing which appears to be in accordance with the World Health Organization (WHO) declaration in 2000.Promotion of team working, employment of fulltime and part-time physicians, implementation of a fair and functional economic structure, health economic, sustainable financial mechanisms, public insurance, home care provision, and isolation of communicable diseases in hospitals can be considered as examples of a successful Iranian Islamic health management system.It can be concluded that as Iranian health management system is faced with many different challenges, gleaning lessons from successful national historical experiences can play a key role in the establishment of a competent system based on our Islamic and national values and in accordance with modern scientific achievements.

Implementation of family physician program has increased the attendance of physicians and midwives in rural areas. The effectiveness of these interventions needs to be evaluated. The aim of study was to assess the quantity and quality of prenatal care and Family Physician Program outcomes. In this cross-sectional study, 751 rural pregnant women (12% of study population) of rural Tabriz from 2003 to 2008 were selected using stratified random sampling procedures. Data were extracted from mothers’ health files records and collected with valid check list from 1994 to 2001. Data were analyzed and compared with before and after the program implementation. The results showed that the number of visits by physician and midwife, BMI, Iron supplementation, initiation of first prenatal care and the number of sonography examinations as indicators of prenatal care increased significantly after the family physician program implementation but there were non-significant increase in folic acid and multivitamin supplement therapy and postnatal period care while there was no difference between maternal weight gain, the infants’ height-weight mean score in periods before and after implementing family physician program. The results indicated that the attendance of physician or midwife has improved some of the prenatal care in both quantitative and qualitative aspects but there was no strong evidence on its effectiveness in caring outcomes. As a result, further studies are necessary to determine outcomes of the plan.

Implementation of Family physician program in Iran provided appropriate capacity to improve community participation and intersectoral collaboration to public health in recent years. The aim of this study was to determine the family physician impact on community participation and intersectoral collaboration in health care centers in Tabriz University of Medical Sciences. This cross-sectional descriptive study was conducted in three health centers of three districts in the East Azerbaijan province. Data were extracted from records of two periods of time; before and after implementing family physician program. Data were analyzed using SPSS 16 software. The results showed that the trend of community initiatives and actions in public health field are growing slowly. After implementation of family physician program, the number of agreements for operational and completed collaborations in intersectoral collaboration is increased. In spite of doubling the number of physicians after implementation of family physician program, the trend of community initiatives and intersectoral collaboration in the field of environmental health are slow. As a result, revising the physicians’ roles and performance evaluation checklists in these fields are essential.

Providing and promoting children's health is a major task of family physicians in Iran’s health care system. This study was carried out to determine the impact of family physician program on health indicators of children in the rural area of Tabriz city. This cross-sectional descriptive study was conducted on children born in rural region of Tabriz city from 2003 to 2008. A total number of 751 samples were selected (12% of total population) using stratified sampling. Data were collected using a valid checklist that was constructed and performed by the researcher in the last research. The data were extracted from family health file records (child care forms) for two periods of time: before and after implementing family physician plan. Data were analyzed by SPSS 16 software. The results showed that there was a significant difference in children's health indicators including the number of cares for child, micronutrient supplementation, child's age in the first time health care, the number of referrals and hospitalization case before and after implementing family physician plan. Meanwhile, the continuity of breastfeeding, anthropometric index of height and weight were not significantly different in the improvement of indicators after the implementation of family physician program. (p<0.05) The presence of doctors and midwives in health team had a significant effect on some components of child care. However, there was no reliable evidence to prove its impact on child health indicators. Therefore, revision of the family physician responsibilities, reform of the family health information system and further studies to determine the exact impact of the plan is recommended.

Family physician as the leader of health team is responsible for monitoring water quality, food and cosmetic preparation settings. This study was carried out to determine the effect of family physician program on the performance of health centers in the mentioned processes in urban areas of East Azerbaijan, Iran. In this cross-sectional descriptive study, three health centers of the East Azerbaijan province were selected as samples and data were extracted from environmental health records files for water and sampling was used for food and cosmetic distributors for two periods of time: before and after implementing family physician plan. Data were analyzed using SPSS 16 software. The results showed that monitoring of chlorine in drinking water was doubled and microbial sampling of water was increased one and a half time. Furthermore, the monitoring processes of health regulations in food and cosmetic preparation settings after implementing family physician program were improved. In spite of improvements in drinking water monitoring process after family physician program implementation, it is necessary to revise the family physician responsibilities and performance evaluation checklists in this section.

One of the most important objectives of millennium development goals of World Health Organization is promotion of mothers’ health. Pregnancy is one of the most critical and important periods in woman's life. The main objective of this study was to survey the effectiveness of health services for mothers in Iran health system in dimensions of change in health status of women during pregnancy period, performance of health care personnel in delivering of services, documentation of activities and health networks in logistic and management sections. This was a descriptive cross sectional study in which data related to 1500 mothers, who had documented evidence of prenatal care in health houses of Iran Health network during 2 pregnancies, were collected. Based on data gathered from their medical records, quality of prenatal care was compared between 2 pregnancies. Results show improvements in quantity of services, performance of health personnel and health network in supportive functions. But documents in medical records are not complete, especially in controlling blood presser and laboratory testes, for example, regarding anemia. Monitoring and assessment of health services in health networks must be revised based on outcome in order to increase productivity. Health care services for mothers should be planned and conducted by members of health care team (doctors, midwives, Behvars and Mother).

Ignorance in infection control precautions and great number of women's seeking health services necessitate conducting of effective educational interventions in order to improving performance of outpatient units in prevention of transmission of infectious agents. This study compared two educational methods, including seminar with printed materials and printed materials only. In this interventional study, gynecologists and midwives of both public and private sections were studied. Data were gathered by questionnaire, checklist and microbiologic studies. After primary data gathering, methods of seminar with printed materials and printed materials only were performed in 81 and 67 subjects, respectively. After three months, results were compared with primary data. Regular controlling of dry heat or autoclave by medical engineers, using disposable speculum, proper disinfectant solution and reducing the number of positive microbial samples were highly influenced by printed materials method. While, in meeting standard time and temperate limit of sterilization and using proper disinfectant solution, the first method had better influence. In the most items, printed materials had higher result compared with participate in seminar and receiving printed materials. performance indicator increased from 65% to 78% in first method and 80% in second method (p<0.001). Our findings are compatible with recent studies published in Iran and other countries. It showed the less effect of traditional presentations alone and high effects of audit and feedback on professional practice and health care outcomes. Therefore policy making on effective medical education and audit and feedback for infection prevention is recommended.

In order to achieve the objectives of MDGs especially reduction of child mortality, the effectiveness of services must be increased. The main objective of the present study is surveying the effectiveness of child health services in Iran Health System. This cross sectional study was performed based on existing data. We compared data of 1500 children with their sibling. The weight and height of second children were increased as compared to first children. Performance of health care personnel was also improved in growth chart drawing, promoting breast feeding, and on time complementary feeding. Health network performance showed promotion, however, monitoring and assessing guidelines must be changed.

Abstract Iran's health system is encountered with a variety of challenges and problems due to the issues of quality, relevancy, and effectiveness. The main reason of inefficacy in health system is unnecessary centralization. In the latest decade, health sector decentralization polices have been implemented on a broad scale throughout world especially in developing countries. Decentralization is transfer of decision making authority from central ministry of health (MOH) to preferable units or alternate institutions to Improve productivity. The main objectives of this research were to review in decentralization at provision of services and presenting a model for Iran. In this comparative research, mechanisms of decentralization in England, Turkey, Zambia, Ghana, Mexico, Thailand, France, Chile, Sweden, and Philippines were reviewed in order to prepare an appropriate model for Iranian health system. The valid mechanisms in function of delivering services proposed in a model for Iran. The developed model in the form of a questionnaire using Delphi techniques was distributed among informant and experts such as health management professors, heads of medical universities; and authorities of MOH and vice chancellors. Analysis of 35 collected questionnaire indicated that all participated subject agreed with appropriate this new developed model. Also the model was statically confirmed the significant of results (P<0/05). Constituents of the model are: Decentralizing in provision of services to provincial level and delegating of social services for aged people, disabilities and un- attended children to ministry of welfare and social security or municipalities.

Health system of Iran has been challenged in the so many ways such as equity, relevance, and efficacy in a changing environment rapidly. To answer to this increasing challenge, and to decrease the costs, and increase the outputs, minifying units of health system network in Tabriz Metropolitan have been designed as an experience. Present research have been designed and implemented to find the answers and evidences documented witnesses of metropolitan cities in case of unifying or multiple administrations for provincial health centers and meanwhile separated administration of health centers headquarter unified. This is an applied study. The community, and the sample of research are health centers headquarters before and after the minifying units.(based on personnel, costs, performances qualities and quantities, and employee's job satisfactions). Even though the number of personnel have been reduced from 248 to 148 after minifying, and the cost flow have been changed from 67/47 % (2002) to 69/93% (2003) qualities and quantities of health performances(the most important tasks of health centers) not only do not decreased, but in some cases have been improved. The personnel 's job satisfactions have not changed either before of after the minifying. Therefore the minifying procedures may be used as an improvement strategy in metropolitan cities and universities units.