مجله تحقیقات نظام سلامت حکیم
سال سیزدهم شماره 4 (پیاپی 51، زمستان 1389)

Complexity of Health System along with importance of evidence based policy making implies the health policy system to be based on reasonable characteristics and measures. The goal of the current study was to respond to the question of where and how to make wise policies for health. This is a qualitative study based on in-depth structured interviews and purposeful sampling. The interviewees were 12 persons including: 2 ex-health ministers, 2 parliamentarians (members of Commission for Health), 2 ex-deputy health ministers and 6 national health experts. Data were collected, stratified and analyzed in 3 main themes, namely "policymaking problems", "functions of the health policy making system" and the "requirements for policy support unit", to shape the conceptual frame work. Regarding the content analysis of the interviews, characteristics of a reasonable health policy making system were summarized in having seven principles, namely: “stakeholder's participation”, “social accountability”, “securing of implementation”, “meritocracy”, “sustainability in positions”, “being evidence based” and “ability for coordination and collaboration”. The interviewees have proposed several customized solutions to cope with each of the seven principles as well. All seven items mentioned by the interviewees are quite consistent with the health policy making cycle. In spite of all controversies on the location of the health policy support unit within the health sector, one can conclude that taking all the aforementioned principles into full consideration while designing and implementing the policy making system for health would assist the health system to attain the country’s 20-year vision in the health sector.

Aflatoxin M1 (AFM1) in one of the most common mycotoxins that can often be found in dairy products and has some serious complications. The aim of this study is to assess AFM1 contamination of pasteurized cheese produced by two dairy factories in Tehran.

In this cross-sectional study, 100 samples of pasteurized cheese produced by two factories were gathered in both winter and summer seasons and examined by ELISA technique for AFM1 contamination. Data were analyzed by SPSS using T-test and Man-withiney statistical tests.

AFM1 was found in 62% of examined samples. The average contamination level was 53.39 (±51.90) ng/kg. AFM1 contamination of six samples (9.3% of positive cases) exceeded Iran’s standard level (200 ng/kg). Mean contamination of AFM1 in summer cheese samples was significantly lower than winter samples (p< 0.03).

The finding of this study showed that produced cheese in Iran have high contamination of AFM1 which can threaten public health. Better control of animal feeding and dairy factories can reduce AFM1 contamination in dairy products.

Usability of information systems means the ability of these systems to be used effectively, satisfactorily and efficiently for specific objectives by specific users. This study aims to evaluate the usability of hospital information systems (HIS) according to the criteria of isometric 9241, Part 10. In this cross-sectional study, hospitals which have HIS were identified and the standard questionnaire of isometric 9241, Part 10, was used to assess their HIS. This questionnaire assesses these seven principles: suitability for the tasks, self- descriptiveness, controllability, conformity with user expectations, error tolerance, suitability for individualization, and suitability for learning. The SPSS software was used to analyze data; descriptive tests (mean, percentage and frequency) were used to review the specified criteria. T he mean score of suitability for the task was 3.04, while the mean scores for self- descriptiveness, controllability, error tolerance, and suitability for learning were 2.86, 3.09, 2.95, and 2.97, respectively. The highest score was for conformity with user expectations (3.14) and the lowest was for suitability for individualization (2.57). Developers of HIS in Iran should pay more attention to some abilities such as the ability of forms, screens and menus to be changed according to user’s preferences; compatibility of HIS with user’s level of knowledge and skill; adjustability of the amount of information displayed on screen according to user’s needs; compatibility of the names of commands, objects, and actions with user’s vocabulary; adjustability of input devices according to user’s needs; and adjustability of the software's response times according to user’s speed.

Home safety plays an important role in community health, especially when it comes to children and elderly. This study aimed to determine the role of residential area in home safety. In this cross-sectional study, 459 houses in the central area and outskirt of Mashhad were chosen based on cluster sampling. Home safety was assessed using the safety questionnaire of the national plan for prevention of domestic accidents. The questionnaire assesses five parts which are kitchen, bedrooms, bathroom, balcony and roof, and the staircase. The overall home safety score and scores of its five sections were calculated according to the questionnaire guide. Demographic factors including gender, marital status, occupation, number of household and educational level were also recorded. The two groups of houses had different safety scores in rooms and bathroom sections, in addition their external safety scores (balconies, courtyards, rooftops and parking) was different (p<0.001). Among the demographic factors, gender and education of the head of the household played an important role, i.e. the female gender and education level of less than high school diploma were associated with decreased home safety in both central and outskirt regions; the decrease was more significant in the outskirts. Safety of houses is affected by the region. Therefore, monitoring constructions especially in outskirts is essential. Strengthening foundations that support women headed households and increasing the level of public information can play an important role in promoting home safety.

Men pay less attention to their health status and have worse life styles compared to women. The current study investigates the perceptional barriers for health among men. This is a qualitative study which was conducted using focus group discussion (FGD). 110 men in different age groups were selected. All FGDs were audio recorded and transcribed verbatim. Data were analyzed manually using constant comparative analysis and open, axial, and selective coding. Conformability and credibility of the data were validated. The present study demonstrated that economical concerns, family issues, lack of social security, environmental problems and not having appropriate general management strategies are the main health barriers that prevent men from thinking of health as a priority. Content analysis showed that the major concern of men was financial, mostly due to unemployment. A small number of men who considered health as an important issue, did so to avoid being a burden rather than thinking of health per se. This study showed the barriers that prevent men from thinking of health as a main priority. These findings can assist health policy makers in designing appropriate strategies for prevention of diseases.

The most important graduate schools of Iran are located in the earthquake prone city of Tehran and any damage to these centers will hinder the sustainable development of Iran’s higher education. This study aimed to assess the preparedness of School of Public Health (SPH) at the Tehran University of Medical Sciences for future probable earthquakes.

This cross-sectional study was conducted in 2009 and has assessed the SPH preparedness for an earthquake in terms of organizational, individual, structural and non-structural readiness. Using a 30-items checklist, organizational readiness was assessed through documents review and interview with key informants. Individual readiness was assessed using a systematic sampling of 204 faculty members, staff and students. Vulnerability index was calculated for non-structural elements (Basic-installments, equipments and architectural elements). Rapid visual screening was applied for structural vulnerability and the loss rate (LR) was calculated.

The organizational readiness score was 20 (out of 100) and the mean of individual readiness was 36.0 (SD: 12.0, range: 7.8-76.3). Non-structural vulnerability for the Basic-installments, equipments and architectural elements were 65.55, 55.80 and 53.48, respectively. The LR of the Green building was between 0.5 and 0.75 that means need to retrofitting; The Nafisi and Administration buildings’ LR were >0.75 that means necessity of reconstruction.

The study revealed that SPH readiness for an earthquake should be enhanced in terms of organizational, individual, non-structural and structural elements. The authors hope that this study draws the attention of higher education authorities to the importance of readiness assessment and countermeasures for the earthquake.

Successful implementation of total quality management (TQM) needs committed leadership, customer-based approaches, process management, efficient communication, knowledge management, staff sharing and continuous improvement culture. European Foundation for Quality Management is the appropriate framework for introducing or assessing TQM in organizations. The aim of this study was to assess five enabler criteria including leadership, strategy, people, resources-partnerships and processes in Center for Management of Medical Emergencies and Accidents using European Foundation for Quality Management (EFQM) as framework.

399 road and urban emergency medicine services (EMS) stations and all official units in Ilam, Bushehr, Mazandaran, Ardebil, West Azerbaijan, Yazd, Tehran, Sistan – Baluchestan, Khorasan-razavi and Isfahan centers along with their managers (328) and personnel (1576) were selected. The research was conducted in 14 months by a 189-item rating scale to evaluate organization, and two questionnaires to determine leadership style and status of organization empowering.

Overall, t he mean enabler criteria score was 168.4±34.6 out of 500; therefore, the selected divisions were labeled as drifter organizations which were in early stage of quality improvement road. In comparison, the Tehran, Isfahan and Khorasan- razavi centers with higher score were labeled as improver organizations. The leadership criterion obtained the minimum score (26.6±9.4) and people criterion obtained the maximum score (35.1±5.6).

To provide the capability for TQM implementation, it is essential to enhance the knowledge and attitude of managers and personnel about quality and its requirements. In addition, EFQM is a proper framework for evaluation and monitoring of EMS performance and determining areas and plans for improvement.

Each year, the government provides considerable financial contribution in health expenditure of the insured employees in the informal sector. Nevertheless, there are still a great number of households in the active employed and unemployed group that are excluded from universal health insurance. This research assessed policies for developing health insurance for active workers in the informal sector, and the self-employed health insurance plan. This was a descriptive– analytic study. Using the primary record data from the Iranian Statistical Center, Health Insurance Services Organization, and Social Security Organization, the secondary data were created and analyzed using situation analysis. In 1996-2007, the government’s share for compensating the shortages of funds for health insurance of the employed and unemployed workers in informal sector has reduced significantly. Also, the average growth rate of per capita health expenditure of the insured people in informal sector has been less than the average for the insured people in both formal and informal sectors. In the plan of health insurance for the population in informal sector, it is also expected that more than half of the health expenses to be financed by the service users. If the government does not intervene in organizing insurance plan for the informal sector and does not provide financial support, developing of health insurance in this sector is not feasible. The results of the current plan for the self-employed shows that the required incentives and demand for social health insurance is not present in the non-obligatory state, especially for the unemployed active workers.