مجله تحقیقات نظام سلامت حکیم
سال دوازدهم شماره 4 (پیاپی 47، زمستان 1388)

In near future, most of the elderly people will be living in developing countries such as Iran. Maintaining autonomy and independence is the main goal in elderly care. This study was conducted to understand the concept of autonomy from the viewpoint of elderly people. A qualitative research based on van Manens phenomenological methodology was developed. Semi-structured interviews were used for 10 old people who were selected by purposeful sampling. Research activities of van Manens methodology were used for analysis of verbatim transcripts. Four themes emerged by which the phenomenon of autonomy could be illustrated. These themes were: being a self director, not being a burden, financial independence and living in one’s own house. Being a self director included sub-themes of independence, decision making, freewill and authority. Not being a burden included sub-themes of self-care, independent performance and being useful for the family and community. Financial independence included sub-themes of experience of inflation, financial security, fear of financial dependency, and relation between financial ability and health status. Living in one’s own house included sub-themes of having separate life from offspring, hate of living in nursing homes, feeling of dignity by having separate life from offspring, and family’s effort for the older people to live in their own house. The attention paid to these themes by older people showed that autonomy is both multidimensional and context-dependent in older people of Iran. The findings will help health professionals to develop an effective caring system for older people.

The aim of this study is to map acute flaccid paralysis in the provinces of Iran, using mixture distributions. In this study, information about the new cases of acute flaccid paralysis which were provided by Management Center of Ministry of Health and Medical Education in 1385 (2006) were analyzed. Poisson Mixture distribution was used to find out the number of at risk groups. Number of components and parameters of each component were found by nonparametric maximum likelihood method using the C.A.MAN software. Bayes’ theorem and programs which are written in the R2.8.0 software were used to assign each province to a parameter. Finally the results were shown on the map using ArcGis9.2. The results show that the incidence of acute flaccid paralysis can be classified into four categories, each having their own specific risk and probability. This study showed that Mixture models can be used to accurately map acute flaccid paralysis in Iran.

In spite of prominent growth in scientific publications in Iran in the past two decades, studies performed in Iran shows that we have a big gap between knowledge production and knowledge transfer. Thus, the present study was performed to evaluate the rate of knowledge transfer in Golestan University of Medical Sciences.

The samples were all Research projects of Golestan University of Medical Sciences during 2005- 2007 which had been finished by the time of this study (the second half of 2009) and their reports had been present. Data gathering form consisted of checklists of projects and a questionnaire for the researchers.

Review of 102 research proposals showed that the total cost of the projects was a little more than 3 billion Iranian Rials. Among these projects, only 6 cases (5.8%) had considered costs for research-based knowledge transfer. Clinical sciences’ and health system research’s researchers stated their passive activities of knowledge transfer to be more in the field of publishing articles, but in the basic sciences it was more in the field of presentations in congresses or seminars. The mean score of the researcher's performance in 'active' activities was 9% of the total score attainable.

Results of this study show that costs considered for knowledge transfer activity was low, which means that researcher in this field need motivation and education in the field of knowledge transfer.

Nowadays length of stay (LOS) is an important measure that is widely used in hospitals to assess use of hospital services and efficiency and performance of hospital activities. The aim of this study is to analyze factors affecting LOS in public hospitals in Lorestan province, Iran. The type of this study is descriptive-analytical and cross-sectional which was done in 2006. Subjects are inpatient’s medical records (662 cases) which were selected by randomized sampling. T-test, One-way ANOVA and multifactor regression were used for the analysis. Average length of stay in public hospitals of Lorestan province in 2006 was 3.03) SD= 4.34) days. Factors such as gender, age, marital status, residence, job, referral type, type of insurance, type of disease, and discharge status have effect on average length of stay. By increasing of age, average LOS is increased. The average LOS in men is longer than women. With analysis of average LOS indicator in hospitals, we can achieve the aim of better allocation of resources and hospital beds and optimizing productivity of the existing beds. According to the findings of this study, it is recommended to take measures to reduce the hospitalization of elderly patients through development of home care and nursing homes. Establishing referral system and family physician system in the cities will help in faster diagnosis, reduction in treatment duration and unnecessary hospital stays.

We studied the factors that affect quality of informed consent process among patients undergoing surgery in the teaching hospitals in Kashan province, Iran. In a cross sectional study, we surveyed 300 randomly selected patients in teaching hospitals of Kashan, Iran in 2008 and interviewed them before surgery, using a questionnaire. Patients were asked about disclosure of information, voluntary decisions, consent form understandability, and physician-patient relationship. We used descriptive and analytical approaches to analyze our data. Consent-givers evaluated the information disclosure, comprehensibility, voluntariness and interaction as “average”, “poor”, “poor” and “excellent”, respectively. Information disclosure was worse in the general hospital and general operations (p<0.001). Those who had received information brochures reported higher levels of comprehensibility for the forms. 266 patients (88.7%) stated that the physician or surgeon must explain the severe complications including risk of mortality (P < 0.0001) however, 56.7% had not been informed about the complications. In addition, learning the information was associated with lower level of anxiety (P<0.05). The present i nformed consent process seems not to be of high-quality. Patients like to receive more information even about severe complications or risk of mortality. Therefore, appropriate approaches to enhance patients’ awareness, especially in general hospitals, seems to be necessary. Providing alternative information, including brochures, have positive impacts on giving voluntary informed consent, comprehensibility of the consent form and the physician-patient relationship. Finally, conveying appropriate information will not lead to anxiety among patients.

Control of cancer as the third cause of death is a health priority in Iran. In the last decade, different cancer registries launched to estimate the incidence of cancer in Iran. In this study, we evaluated quality of the results of cancer registries. First we used data from national pathology based cancer registration program and compared Age-Standardized Incidence Rates (ASRs) of all cancer types from 2004 to 2006 for the entire country and stratified them by provinces. Subsequently, we compared ASRs of eight common cancers in Tehran, Ardabil, Isfahan, Lorestan, Kerman, Golestan, and Semnan provinces. ASRs of all cancers in the national pathology based cancer registry for the entire country increased from 2004 to 2006, although the increasing trend was not observed for all provinces. ASR was considerably higher in the population-based cancer registries compared with the pathology-based ones. The completeness of pathology based cancer registry was 53 to 63 percent in men and 61 to 70 percent in women. The coverage was even lower in the cancers with high case-fatality rates including stomach (44% in male and 48% in female) and lung (19% in male) cancers. National cancer registration does not provide consistent and reliable results. ASRs in the pathology-based cancer registries are underestimated. In order to use the cancer registry data for policy making and research, national cancer registration program in Iran needs a major revision.

Previous evaluations revealed that cancer registration in Iran is not functioning appropriately and a reform is needed. We evaluated cancer registries in 18 countries and suggested a new cancer registration system for Iran.

We compared information from Iranian cancer registry with the same information from selected countries with a population size more than 10 million that their cancer registration data were published by International Agency for Research on Cancer (IARC). Moreover, we studied trends in the number of registration centers, from establishment of their first center up to 1997. Finally we suggested a new program for establishment of a national cancer registration system in Iran.

On average, geographical coverage of cancer registries was 24.6% in these countries. They all had population-based cancer registration system. Overall, every ten years, 3 cancer registry centers were added in all the mentioned countries together.

Instead of pathology-based cancer registry, we should promote establishment of population-based cancer registries in Iran. Given limited resources available, coverage of 25-30 percent of the country by cancer registry would be sufficient to produce national cancer incidence data. We suggest promoting population-based cancer registry in Fars, Tehran, Golestan and Ardabil provinces and try our best to provide qualified data from these regions before extending the registration activities to other regions.

Due to an increase in the number of laborers in the South Pars Gas Field in Assaluyeh, Iran, the possibility of an increase in the social pathologies is evident. The objective of this study was to assess the situation of drug use and addiction among the laborers. The study population consisted of key informants, the laborers and staff of gas and petrochemical complexes, native people, drug users and dealers. Totally, 12 sessions of focus group discussions, 60 in-depth interviews and 377 urine tests for opioids were carried out in year 2007. Opium followed by alcohol, hashish, heroin and heroin-crack was reported to be the most common drugs of use in the laborers. The prevalence of current opioid use in the laborers is estimated to be 15% - 25%. The main factors related to drug addiction in laborers consisted of drug addiction upon employment, exhausting work condition and climate, high population density in the dormitories with limited monitoring facilities, low attention of the contractor to drug use and limited availability of prevention and treatment facilities. However, since 2006, the speed of construction has been slowed down with a reduction in the size of temporary work force. Consequently, there has been an improvement in drug abuse situation. In order to control the drug use in the area, it is necessary to have clear policies, and implement a multi-strategic plan. The budget is affordable using a very small portion of the returned profits.