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Background and purpose : Health care workers (HCW,s) are at increased risk of hepatitis viruses infection .Seroprevalence rates of hepatitis B and C viruses ( HBV,HCV) are higher among HCWs .Universal precautions to prevent the transmission of infections during medical cares along with vaccination are recommended or even mandatory in most countries. The purpose of this study was to determine the seroprevalence of anti-HAV , anti–HCV ,and anti-HBs antibodies,and HBV vaccination status in a general teaching hospital HCWs in Sari-Iran .
Materials and methods : Between June to October 2003, questionnaire was used, data extracted from medical records, and serology by ELISA method for anti-HAV, anti-HBs anti-HCV, and-HBs-Ag in those HCWs with negative anti-HBs. HBV vaccination status were recorded . Seroprovalence rates of HBs-Ag and anti-HCV antibody were compared with those detected in blood donors during the same period.
Results : Totally 263 HCWs and 17 kitchen staff were participated in the study. Anti –HAV, anti-HBs , anti-HCV ,and HBs-Ag were detected in 90.36% ,87.5% ,0.37% and 0.74% of the subjects respectively. HBs-Ag and anti-HCV were detected in 4.8% and 0.83% of blood donors, respectively. 61.9 % of HCWs completed their HBV vaccine series and 72.7% of non-vaccinated HCWs developed anti-HBs antibody.
Conclusion : These data showed that the prevalence of HBs-Ag and anti-HCV in HCWs was lower than general population. HAV infection was hyperendemic. HBV infection was higher among non-vaccinated personnel, and more than 1/3 of HCWs did not complete their vaccination, so, mandatory HBV vaccination, is recommended.

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Background and purpose: From the second half of 2005, family medicine as reform in primary health care sector was introduced for all rural as well as towns with less than 20000 population in order to improve the performance of this system particularly curative care. In this reform both the method of employment and the payment mechanism that could potentially change the performance of family medicine team were changed. In this paper change in the performance of health centers in ambulatory care before and after the implementation of reform in two cities (Mazandran province) is compared. Materials and methods: This investigation includes two case studied in two cities. Data of 30 rural health centers in Sri and 12 in Joybar were gathered. The collected data were based on existing data of Iran’s primary health network information system. A check list was used for data collection. These data were related to one year before the implementation of scheme and three years after the date that the scheme was started. Results: A substantial increase in the number of patients visited by physician had happened that is about 6 times higher than their performance in the same centres before the reform. A change of about two times increase in the provided services of lab and injection and wound dressing unit had also happened. Conclusion: In this study, health care providers of health centres under the same conditions of primary health care delivery behaved differently so that their performance improved about 6 times compared to prior the reform. The changes, with fewer slopes, were seen on other curative care including lab and injection and wound dressing services.

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Background and purpose: Services of triangle centers in terms of training are counseling, prevention, and treatment in the three areas of sexually transmitted diseases, HIV / AIDS and drugs abuse. Healthcare providers of these centers have little respect for women’s reproductive health needs (including safe motherhood). The health care centers do not provide enough sexual services including sexually transmitted diseases, HIV/AIDS and drug abuse to patients. The aim of this study was to determine and compare the most common SRH needs of individuals of this two types of centers. Material and Methods: In this cross-sectional study, for determining the sexual and reproductive health needs of the women in two groups, a standardized questionnaire of SRH needs assessment was used. The frequency of sexual and reproductive health needs of 600 women referred to health centers (group I: 514 women) and triangular center (Group II: 86 women) were evaluated Results: The most common SRH needs of women was cesarean section (need to safe delivery) in both two types of centers in the domain of safe motherhood, the use of traditional methods of contraception (need to spacing in childbearing) in the domain of family planning in the clients of the both two types of centers, being multi-partner of participants’ husband (need to general and sexual health) in health care centers and being multi-partner of participants in triangle center in the domain of sexual history and practices (that the prevalence in two types of centers was very low, turbid and cheese form vaginal discharge (need to general and sexual health) in both types of centers in the domain of sexually transmitted infection, poor knowledge about routes of HIV transmission (need to knowledge about HIV/AIDS) in the domain of HIV/AIDS, and husband's sexual coercion (need to general, mental and sexual health) in the domain of violence. Among these needs, cesarean section (domain of safe motherhood) was more common than the others. Conclusion: Considering that the most common SRH needs was related to safe motherhood domain (high rate of cesarean section), so, in order to save sources and solve some problems including stigma, it is recommended that these two types of centers be integrated.

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Background and purpose: The need for continuous measures of preventive behaviors, health researchers is highlighted. Means of achieving that goal requires the use of adequate reliability and validity in the scientific literature. Material and methods: This cross-sectional study was done in 2013 on a two-stage random sampling method, 135 persons were Tehran Health Center East. Through the qualitative and quantitative study of face validity, content validity index calculation and judging the quality via a 14-member panel of experts and validity by performing exploratory factor analysis-with the agreement reliability (coefficient alpha) and test-retest method of estimating was approved. Results: A total of 50 males, first three items need to be corrected with the number 45 on the calculation of the index scores of items (with quantity greater than 1.5) with CVI greater than 0.07 and CVR higher than 0.08 down found. As demonstrated, good homogeneity of subdirectories than the average correlation between questions 0.35 (P<0.001). By calculating Cranach's alpha reliability of the tool, 0.83 was verified and the results show test-retest stability of the questionnaire and its subdivisions. Conclusion: The evidence of the strength of the factor structure and the reliability of an instrument can be developed to provide a tool for research, teaching and practice of health workers are of interest. The psychometric quality of the instrument was satisfactory. The course restrictions of the methodology should be considered in the development of more questionnaires.

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Background and purpose: Health care system is organized at three levels in order to increase efficacy and effectiveness and create justice and also people availability. Considering the three levels of primary health care, access of people to specialized services through referral system is possible. With regard to the importance of referral system in family physician program, this study was performed to evaluate the function of referral system and network system in Northern provinces of Iran. Material and methods: This analytic study was performed in autumn and winter of 2012. Twenty five percent of health centers (139 centers from 552) which implement the family physician program and rural insurance coverage by medical universities of Golestan, Mazandaran, Babol and Guilan were randomly selected. In each center, 7-8 patients who were referred to level 2 by their family physician and received necessary services were evaluated. They were at their homes at inquiry time. Results: From 963 patients who received the level 2 services, 687 cases (71%) were females and 276 (29%) were males. Three hundred and twenty cases (33%) had referral form from health house. Only 299 (31%) persons referred to the centers because of diagnosis of family physician and in 161 (17%) of cases, the family physician had a role to choose a specialist of level 2. For 155 (16.1%) of cases, the specialists wrote the results of their evaluation in feedback form. Only 149 (15.5%) of patients returned to their family physicians. Six hundred ninety-seven (79.6%) of patients did not return to their family physician because of lack of knowledge. Conclusion: The results of this study showed that many principles for referral system from level 1 to higher levels and vice versa are not considered that require education, reformation and intervention in this field.

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Abstract Background and purpose: One of the main factors in establishing health equity is delivering equal spatial access to public medical cares to all members in a society. The aim of this study was to evaluate equity in health by assessing people's access to health care centers using Geographic Information System (GIS) in Kermanshah (west of Iran). Material and methods: In this descriptive-analytical study information about medical and health centers and statistical blocks of Kermanshah in 2011 were collected. Data were analyzed using functional radius of 700 meters for each health care center, block area, number of households, and population with and without access to such centers in Arc/GIS software. Results: Data showed that 63.70% of Kermanshah blocks were not covered by health care centers and 132871 households did not have access to these centers. However, from 109440 households with access, 35009 households had access to 2 or 3 centers. Also, 475128 people did not have access to health care centers. Conclusion: The spatial distribution of health centers in city of Kermanshah shows an imbalanced distribution of health care centers. This study revealed a high concentration of health care services in some parts especially in the central part of the city. Meanwhile, western and south-western areas in Kermanshah were not provided with any health care centers. Therefore, applying efficient methods such as GIS could be of great benefit for efficient planning and dealing with such problems.

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Background and purpose: Medical wastes are amongst the main problems of solid waste management and have some serious health risks. Their management is of great importance since they could threaten human health. The aim of this study was to determine the quality, quantity and the method of medical waste disposal in Gachsaran. Materials and methods: A cross-sectional study was conducted in healthcare settings in Gachsaran including 20 doctor’s offices, seven clinics, five health stations, four outpatient clinics, three laboratories, nine health centers, and 51 health houses. Census sampling was performed in which three samples were chosen during three months from each healthcare setting. The mean of three samples was considered as the final weight. Excel and SPSS software and descriptive statistics were applied to analyze the data. Results: The mean amounts of total waste, infectious waste, and non-infectious waste generated in Ghachsaran health settings were 625, 201, and 424 kg per day, respectively. Total amount of referrals was 2031 and the amount of waste produced per capita was 307.7g. Doctor’s offices and health houses generated the highest and lowest amount of infectious wastes (70 and 4.5 kg, respectively). Conclusion: Infectious wastes are produced at a high rate in healthcare settings. Moreover, there are different types of healthcare settings that generate many wastes, therefore, it is necessary to perform continues monitoring, on their management, particularly on collection and disposal process. These measures could maintain and enhance the health of exposed people and other people in the society.

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Background and purpose: Satisfaction is an important indicator in measuring the quality of services. Improving the quality of services provided in subspecialized clinics requires an appropriate understanding of the situation and the problems that different sectors are faced with. This study aimed to determine the patients’ satisfaction level from services provided in Sari Tooba Clinic and associated factors using Hotelling's T2.

Materials and methods: This analytical cross-sectional study was performed in 603 patients attending Sari Tooba clinic in 2015. The research instrument was a researcher-made questionnaire. The reliability and validity of the questionnaire was determined. Data analysis was conducted in SPSS V.20. 

Results: The overall levels of satisfaction were found to be poor (20%), moderate (27%), and good (52%). No significant relationship was found between patients’ satisfaction levels and place of residence, insurance, marital status, and age. Among five investigated dimensions, the patients were only satisfied with physicians and demonstrated significantly poor levels of satisfaction in other dimensions.

Conclusion: The services provided to patients in Sari Tooba clinic was found to be relatively satisfactory, however, in the pharmacy (waiting time) and amenities (quiet area) high levels of dissatisfaction were observed. Therefore, more measurements should be taken to make a more relaxed environment. Also, increasing the number of staff in pharmacy could shorten the waiting time, thus increasing patients’ satisfaction.

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Background and purpose: High rate of mothers and infants’ death and preterm birth are amongst major public health problems worldwide. The aim of this study was to identify, evaluate and rank the factors responsible for low birth weight using data mining techniques and also investigating the impact of predictor variables and developing a decision support system which could help physicians to make better treatment decisions at the birth of low weight infants.

Materials and methods: Relevant information was collected from Imam Ali Hospital affiliated with Zahedan University of Medical Sciences in 2013 including smoking, the age of mothers, etc. Different data mining algorithms were applied for modeling. Data analysis was performed in Clementine software.

Results: The variables that were very influential in predicting the low weight of infants at birth were mother’s weight (100%), mother’s age (98%), the number of doctor visits in the first trimester of pregnancy (45.86%), and previous preterm delivery (43.11%). Other variables poorly influenced the prediction.

Conclusion: The findings revealed some relationships between the low weight of infants at birth and mother’s weight, mother’s age, number of doctor visits in the first trimester of pregnancy, previous preterm delivery, high blood pressure, race, uterine irritability, and smoking. The accuracy of prediction improved via data mining techniques compared to logistic regression. Classification tree could determine the low weight of infants at birth well and random forest technique had an important role in making the diagnosis.

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Background and purpose: Reducing maternal mortality by 75% between 1990 and 2015 was the fifth goal of the Millennium Development Goals Declaration in 2000 (MDG 5) and all countries were committed to achieve this goal. This study aimed to assess Iran’s success in achieving this target.

Materials and methods: Data was obtained from national data sources and international reports or estimations including World Report from United Nations on maternal mortality trends, the World Bank database, World Health Organization and UNICEF reports, Maternal Mortality Surveillance System, Demographic and Health Surveys 2000 and 2010, and yearbooks of National Organization for Civil Registration and Statistical Center of Iran. Data was analyzed using Excel software to produce descriptive statistics.

Results: Findings showed that Islamic Republic of Iran with an average annual reduction of 6.4% between 1990 and 2015 and a total reduction of 80% in maternal mortality during the past 25 years is one of the nine countries that have fully achieved the fifth Millennium Development Goal.

Conclusion: Coordinated efforts of Iran for reducing maternal mortality during the last 25 years could be an inspiration for other countries to reduce preventable maternal mortality.

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Background and purpose: Appropriate health services including sexual health are regarded as human rights especially for women. The aim of this study was to determine the extent and causes of lack of sexual health services in women attending health centers, and providing a suitable strategy for their elimination.
Materials and methods: This study was conducted using a sequential explanatory mixed method in 2014. The first phase of the study was done in 514 women who referred to Sari health centers applying a cross-sectional design. Women who did not receive even one of the sexual health services entered the qualitative phase of the study, which was done by conventional qualitative content analysis. Then, the two phases were combined. Nominal group technique was used to prioritize the strategies about sexual health services.
Results: The quantitative phase showed that 20% of females and 50% of male partners did not seek treatments for genital ulcers or abnormal secretions. None of the males with multiple spouses have used condoms at their last sexual intercourses. According to the qualitative phase, two reasons were found for not receiving sexual health services: the lack of women's attendance to health centers and non-accountability of health centers to women's sexual health needs.
Conclusion: The current health system in Iran does not respond to women’s sexual health needs. Therefore, in Iran, sexual health services are suggested to be integrated with the health system alongside empowering women about their health needs and increasing men's awareness in providing women's sexual needs.
 

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Background and purpose: AIDS, can cause psychological and social problems in patients and affects their quality of life. Therefore, infected people need more care. This study was conducted to investigate the effect of different care methods in quality of life of HIV+ patients.
Materials and methods: HIV-positive patients in Mazandaran were divided into two groups of intervention (n=34) and control (n=17). Patients in intervention group received medical and social care for one year. Quality of life was assessed in both groups before and after the intervention using WHOQOL-Brief and a researcher-made questionnaire.
Results: The study population included 49 patients including 56.67% males and 43.33% females. Before the intervention there was no significant difference in quality of life between the two groups. But after the intervention, satisfaction from personal relationships decreased significantly while social-occupational worries and concerns about the disease showed significant increase in intervention group. Compared to the control group, after one year, satisfaction from current treatment (P=0.02), concerns about the disease (P=0.0009), and quality of social life (P=0.02), showed significant increases in the intervention group. 
Conclusion: The participants in this study had low levels of quality of life and physical and mental health care could be of great benefit in improving quality of life of HIV+ patients. In designing care protocols for these patients, all aspects of life should be considered.
 
 

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Background and purpose: The primary health care program for the suburbs is being implemented in Iran after the Health Transformation Plan where services are delivered with the priority of outsourcing and purchasing services from non-governmental sectors. In this program, different payment methods have been used. This study aimed at addressing the challenges associated with payments made to urban primary health care providers in Iran.
Materials and methods: This qualitative study was conducted using a framework analysis approach through semi-structured interviews with 30 experts and service providers. Data were analyzed using MAXQDA.10 and Gale framework analysis method.
Results: The study showed that lack of proper financing of the program is one of the most important challenges of the payment system. Other challenges included insufficient and late payments to providers, impossibility of recording all activities and inability to exchange data between electronic information registration systems (both horizontally and vertically), improper contracting method, incompatibility of service package volume with the amount of payment, the impossibility of applying the monitoring result on the amount of payment due to paying the minimum amount of labor law payment, and inflexibility of payment instructions.
Conclusion: The payment system for urban primary care providers does not have a suitable structure in various dimensions, including financing, payment, contracting method, data registration system, and monitoring and evaluation system. If these problems continue to exist, providers would leave the service system and the quantity and quality of services are reduced.       
 

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Background and purpose: The deleterious effects of chronic stress on dimensions health have already been stablished. Hair cortisol concentration is a promising new tool for the assessment of long-term stress. This study was conducted for determining the relationship between perceived stress and hair cortisol in women health care workers.
Materials and methods: This cross sectional study was conducted in 2018, among 188 women health care workers in Babol/Iran. Data collection was done using a demographic and perceives stress questionnaire. Hair cortisol was extracted according to exiting protocol. Data analysis was done with SPSS21 software at a significance level of P<0.05.
Results: 69.3% of participants had high level of stress. The mean amount of extracted HCC was 1.74 (1.63) pg/mg. There was significant difference between means the HCC of groups with low stress level 1.457(1.163) and high stress levels 1/928(1.829). (P= 0.04).
Conclusion: There was significant relationship between of the HCC and perceived stress. HCC was increased in participants with high perceived stress level.
 

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Background and purpose: A part of the expenses of every household in all societies of the world is health expenditures, which can sometimes be disastrous for families. This study was conducted to investigate the change in the share of health expenditure from the total Household costs in Mazandaran province and the possible impact of health system reforms on it in Iran during the recent two decades, especially the Health Transformation Plan.
Materials and methods: This is a retrospective descriptive-analytical study, based on quantitative and secondary data. The data required for this study was taken from the Statistics Center including household income and expenditure for a period of 18 years from 2001 to 2018. Descriptive statistics indicators and trend charts were used to describe the quantitative data, and to analyze household health expenditures, the t-test was applied in SPSS software.
Results: The results of the study showed that on average, the share of health expenditures in the total household expenses was 12.04% for urban households and 11.36% for rural households that is more than the stated and expected limit of 10%. The trend of changes in the percentage of health expenditures from the total household expenses at the time of the research compared to the base year has been variable and in some years it has decreased and in some years it has increased.
Conclusion: The health system reforms have not ultimately led to the reduction of household health expenditure to less than the expected level and its increasing trend in Mazandaran province.This means the risk of catastrophc health expenditure among households still exist. Even with the implementation of subsequent plans, the achievement of the previous plan has been neutralized. Considering the importance of financial issues in universal health coverage and also the limited resources of the health sector, more detailed policies and plans should be designed and implemented to target vulnerable groups so that families' financial hardship is prevented as well as the possibility of universal coverage is increased to the maximum.