International Journal of Preventive Medicine
Volume:1 Issue: 1, Winter 2010

Health statistics leave little doubt that the current health system in Iran, which is mainly based on primary health care (PHC), is a functioning one, and that health in Iran has improved far beyond where it was 40 years ago. However, this system has its limitations too. While PHC is very effective in reducing morbidity and mortality from infectious diseases and other acute conditions, it is far less effective in addressing chronic and multi-factorial conditions which are now emerging in Iran.In this article, we review some of the salient features of the current health system in Iran, its strengths and limitations, and then introduce community-based participatory research (CBPR) as a method that could potentially fill some of the gaps in the system. We will discuss the definition and steps needed to implement CBPR, provide someimportant references, and discuss how this approach may not only improve the health system but it could also lead to improvement in other fields in the society too.

Writing papers can be used as a means to convey a message. Knowledge transfer is also about conveying the right message to the right target audience. The aim of this study was to determine the proportion of articles that had mentioned a clear message and the target audience in the abstract and the article as awhole, and also to examine their association with different determinant factors. Articles published from 2001 to 2006 that were based on clinical and health system research conducted on Iranian populations and on maternal care, diabetes and tuberculosis were searched systematically in domestic and international databases.Eventually checklists (Additional file 1) were completed for 795 articles. Overall, 98.5% of articles had a clear message, whereas 12.5% had addressed the direct target audience. Presence of a clear message in formatted abstracts were seen 3.6 times more (CI95%: 1.5-8.7) than in articles without formatted abstracts (p = 0.005). Addressing of the direct target audience was seen twice as much inhealth system research articles as compared to clinical studies, odds ratio was 2.3 (CI95%: 1.47-3.48, p<0.001). Creating a format for journal abstracts seems to bean effective intervention for presenting the message in articles.

The aim of this study was to assess the prevalence of cardiovascular risk factors in adults and their children from the 3 major groups of migrants participating in the PEP Family Heart Study 11 and to compare the cardio-metabolic risk profiles between migrants and German participants. In this community-based cross-sectional study, anthropometricdata, blood pressure and lipid profiles of migrants (480 children, 363 adults) from Turkey (TUR), Eastern Europe (EEU) and German immigrants from the former Soviet Union (GFSU) were compared with age- and gender adjusted German (GER) residents (3253 children, 2491 adults). The profile of risk factors differed considerably regarding specificity and frequency. The prevalence of ≥3 risk factors was as follows: in GFSU men 62%, women 36%, boys 19% and girls 17%; in TUR men 57%, women 30%, 15% boys and 6% girls; in GER men 48%, women 19%, boys 4% and girls 6%; for EEU men 38%, women25% and 0% in children. No risk factor was present in GFSU men 13%, women 25%, boys 38% and girls 42%; TUR men 13%, women 28%, boys 27% and girls 22 %; GER men16%, women 45%, boys 46% and girls 41%; EEU men 17%, women 42 %, boys 29% and girls 27%. About 50% of the adults from Turkey and Eastern Europe were current smokers and one third of women and half of men from these two countries were overweight. The implementation of primary care measures for the prevention of cardiovascular disease in migrants is necessary, and it should consider the ethnic differences and the heterogeneous risk profiles.

Primordial prevention of chronic disease is of clinical and public health importance. Considering the fetal onset of atherosclerosis, we aimed to determine the cord blood level of lipoproteins and apolipoproteins as well as their correlation with birth weight and gestational age. This cross-sectional study comprised 100 healthy Indian newborns. Ten ml. of cord blood was collected from placental end of umbilical vein. Serum was separated by centrifugation and analyzed on the same day for lipid profile including total cholesterol (TC), triglycerides(TG), high density lipoprotein- cholesterol (HDL-C), very low density lipoprotein-cholesterol (VLDL) and low density lipoproteincholesterol (LDL-C), apolipoproteins A-I and B (ApoA-I, ApoB). Atherogenic index (AI) was calculated as the ratio of ApoB to ApoA-I. Cord blood of female newborns had higher TC, HDL-C, LDL-C, Apo A-I, Apo B and AI as compared to male newborns, whereas TG and VLDL-C were higher in male than in female newborns. Significant positive correlation was observed between cordblood Apo A-I and HDL-C (r= 0.45, p<0.01), and between cord blood Apo-B and LDL-C (r= 0.44, p<0.01). Non-significant inverse correlation was observed between Apo A-I and ApoB with gestational age. There was a significant inverse correlation between TG and gestational age (r= –0.197, p <0.05). Positive non-significant correlation was observedbetween AI and birth weight (r=0.046, p>0.05). These findings are another confirmatory evidence for the association of prenatal factors with cord blood lipid profile, and can serve as starting point for studying lipid transport system changes during early life.

Because of the importance of adaptive behaviors in social and domestic lives, this study aimed at a comparison of various domains of adaptive behaviors, between mentally retarded and normal individuals. A number of 246 normal and 74 mentally retarded individuals (7-18 years of age, mean: 12±3.5 years), participated this study in Tehran, Iran. Their adaptive behaviors scores, were obtained using "Adaptive Behavioral Scale, Residential & Community" (ABS-RC: 2), consisting of 18 domains of behavior. The scale was first translated into Persian by the professionals and then retranslated into English byanother translator, to ensure content non-distortion. The following domains were significantly lower in mentally retarded than in normal individuals: independent functioning, economic activity, language development, number & time, prevocational/ vocational activity, self direction, responsibility, socialization, disturbing interpersonal behavior, domestic activity, social engagement, conformity and trustworthiness. No significant difference was documentedin the physical development, stereotype & hyperactive behaviors, sexual behavior as well as self abuse behavior domains, between the two groups. As mentally deficient subjects did worse than normal ones in terms of many adaptive behavioral domains, it implies that the adaptive behavioral issues in such people might need a great deal of attention and intervention. For these retarded people to function better in their social and residential environment, it would be necessary todevelop their adaptive behaviors. This study may shed light on the importance of attention to the adaptive behavioral domains of mentally retarded people and also indicates the necessity of preventive measures, even for normal individuals.

To determine the best anthropometric index in relation to cardiovascular disease risk factors among children and adolescents. This cross-sectional school-based study was conducted among a random sample of 3179 students, aged 6 to 18 years, in three large cities in Brazil. The prevalence of overweight and obesity was 10% and 5%,respectively. In relation to the students in the lower quartile (Q1) of the distribution of subscapular skinfold, the students in the upper quartile (Q4) presented a 2.0 times higher risk (odds ratio) of having elevated total cholesterol levels. Overweight and obese students had a 3.3 times higher risk of having elevated systolic blood pressure, and a 1.9 times higher risk of elevated diastolic blood pressure than other students.The less active students presented a 1.58 times higher risk of having waist-to-height ratio (WHtR) above the upper tertile (Q3). WHtR mean values was 0.46 (SE 0.00) presented the largest area under the curve (AUC) [0.613 (CI995%:0.578-0.647)] for high total cholesterol levels, [0.546 (CI995%: 0.515-0.578)] for low HDL-C levels, and [0.614(CI95%: 0.577-0.651)] for high LDL-C levels, while body mass index presented the largest AUC [0.669 (CI95%: 0.64-0.699)] for increased diastolic blood pressure followed by the waist circumference for increased systolic blood pressure [0.761 (CI95%: 0.735-0.787)]. WHtR is considered as a simple and accurate anthropometricparameter that identifies youth with cardiovascular risk factors. In this study, WHtR above 0.44 was indicative of risk factors in children and adolescents. These findings can be applied in future preventive strategies against CVDs, and screening programs.

Adherence to prescribed medications is a key dimension of healthcare quality. Poor medication adherence might be a significant barrier to achievement of positive clinical outcomes. This study aimed to compare the adherence to oral hypoglycemic agents in patients with type 2 diabetes by using two methods of completing diary checklist and collecting drug shells. This randomized clinical trial was conducted in Isfahan Diabetes Institute. A number of 100 type 2-diabetic patients were selected through systematic sampling method and then were randomly allocated to two groups of equal number. Each group was invited to attend our 12-week educational program. We asked one group to complete diary checklist about how they took their drugs during the studyperiod. The other group was asked to collect the shells of oral hypoglycemic agents after taking in a pocket. Medication adherence ratio was calculated for both groups. Overall, 87 patients completed the study, of which 30 cases (34.5%) were in the check list group and 57 (65.5%) in the reference group. In the check list group, the adherence ratio was good in 96.7% and moderate in 3.3%, with no case of poor adherence. In the reference group, the corresponding figures were 55.2%, %6.9 and 37.9%, respectively (p<0.05 between groups). Although the adherence ratio was greater than 80% in both groups, it was significantly higher in the check list group. Therefore, we suggest that by increasing adherence to prescribed medications, diary checklist can be an effective method of secondary prevention of chronic diseases, as diabetes mellitus.

This study aimed to compare cardiovascular disease (CVD) risk factors, lifestyle habits and pharmacological treatment in two groups of elder adults with 20 years difference in their mean age. This study comprised 590 women including two groups with mean age of 42.4±5.5 vs. 66.5±4.0 years, and 486 men of two groups with mean age of 44.1±5.6 vs. 63.9±7.0 years. Data on physical examination, fasting blood analyses, 7-day dietary records, physical activity, smoking and actual medication use were recorded. Compared with younger individuals, seniors had a moreadverse risk factor profile in terms of abdominal obesity, overweight, hyperglycemia, hypertension, dyslipoproteinemia without differences in HDL-C. But this is not reflected by lifestyle behavior. Less than 2% of the elderly and 17% of the younger adultswere current smoker. Furthermore, the pattern of physical activity was different in terms of more continuous sports in seniors contrasting with extremes between no sports and more than twice a week in the younger group. Seniors consumed significantly lesscarbohydrates including more monosaccharide and less polysaccharides, more alcohol and water. The intake of fat and protein was higher in elder women than in all other groups. One third of seniors took antihypertensive medications and 12% used lipidmodifying drugs. Different levels of prevention against CVDs andtheir risk factors shall be considered for various age groups of population. The findings of this study emphasize on the necessity of preventive measures against smoking and physical inactivity in younger adults and dietary habits in seniors.