Background and purpose: The COVID-19 pandemic may have influenced the average years of life lost (YLL). This study aimed to analyze trends in mortality and YLL before and after the onset of COVID-19 in northern Iran. Materials and methods: This cross-sectional study was conducted using data from all recorded deaths in Mazandaran Province. The Cochran–Armitage trend test and the Mann–Whitney test were applied for data analysis, with a significance level set at P < 0.01. All analyses were performed using softwares of Stata version 14, Excel 2013, and SPSS version 23. Results: The crude death rates during the study period were 424, 419, 432, 474, 575, 603, and 496 per 100,000 population, while the corresponding average YLL were 19.7, 19.3, 18.6, 18.1, 17.2, 17.8, and 17.8, respectively, indicating a decrease in YLL during the peak of the COVID-19 pandemic in this province. The findings also indicated greater vulnerability among the elderly, a decline in deaths due to external causes and traffic accidents, a higher incidence of male deaths, and a greater number of deaths occurring in urban areas. Conclusion: Although COVID-19 increased all mortality indicators studied, the average number of years of life lost due to premature death decreased and its trend changed during the COVID-19 period in this province. The lower number of years of life lost due to premature death in urban population could be due to greater access to healthcare services. It is recommended that, given the availability of a nationwide system for registering and classifying causes of death, this information capacity be used to monitor relevant events and changes in health indicators in order to continuously monitor and take supportive and compensatory measures in crises such as the coronavirus

Background and purpose: Since 2013, Iran's health system reform has been implemented at the national level with goals such as increasing people's access to health services, reducing direct payments to patients, and improving the quality of services. As this initiative has been associated with significant changes in the financing of hospitals, this study aims to investigate the changes in income and expenses of public hospitals in Mazandaran province, as two important indicators of key hospital financial performance, before and after the implementation of the reform. Materials and methods: This is a retrospective study that was conducted in 2018. Since this study deals with the impact of the intervention carried out by the public sector by comparing the changes before and after the implementation of the intervention, it is therefore considered a type of quasi-experimental study. The statistical population includes all government hospitals in Mazandaran province. The sampling method was census and covered all 24 public hospitals of Mazandaran province. The time frame of the study covers from 2009 to 2016, that is, 4 years before and 4 years after the implementation of the reform. Secondary data that is routinely recorded in the information system of the country's hospital system has been used in this study. To collect the data, a researcher-made checklist was used based on the objectives of the study and the availability of data in the routine information recording system of hospitals, which mainly included the variables of staff cost, non-staff cost, cash income, insurance income, and working year. After collecting the data from the comprehensive and centralized Electronic Information System (HIS), which contains all the financial and functional information of all hospitals in the province, the data were extracted and analyzed using SPSS software and appropriate statistical methods. Results: In general, after the implementation of the reform, the average costs in the studied hospitals increased from 249,613 to 771,552 million Tomans (2.61 times) and the average incomes increased from 152,738 to 534,804 million Tomans (3.50 times). Therefore, both the average cost and the average income in the 4-year periods before and after the implementation of the initiative have generally increased, but the growth rate of costs and incomes in the period before the implementation of the reform was lower than the period after its implementation, although, in the same period, the gap between expenses and incomes has been widening. In the period after the implementation of reform, due to the rapid increase in income at the beginning of the implementation, the gap between cost and income has decreased relatively, but gradually the rate of income growth has decreased compared to the rate of cost growth, and as a result, the gap between the cost and income of the hospitals studied in the end of the study period has experienced an unprecedented gap. It has also been found that during the years of the study, the staff cost has continued to rise with more or less trends, while the non-staff cost has started to decrease sharply and unprecedentedly since 1995. Conclusion: Although the implementation of the reform has increased the financial turnover of government hospitals, due to the increase in the average cost compared to the increase in their average income, the implementation of this plan has increased the financial pressure on the hospitals and widened the income deficit compared to their cost. Therefore, the gap between cost and income and the rising trend of this gap in government hospitals can be a challenge for funding hospitals and guaranteeing the relative access of people to these services now and in the future.

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.

Background and purpose: Inpatient costs constitute a major part of health systems expenditure. The aim of this study was to investigate the changes in the level and trends of average inpatient cost in Behshahr Imam Khomeini Hospital during implementation of the Family Physician Plan (FPP) and Health Transformation Plan (HTP). Materials and methods: In this longitudinal study based on Interrupted Time Series (ITS), the data included monthly average inpatient cost in Behshahr Imam Khomeini Hospital during seven years (2011-2018). Data analysis was conducted in segmented regression model in R 3.6.1. Results: The growth rate of the number of inpatient cases was negative for two consecutive years after implementation of the FPP. The highest growth rate of average inpatient cost was 83% that occurred in 2014 (the first year after implementation of HTP). The change in the level of average inpatient cost at the beginning of the HTP was significant (P<0.001) compared to before that which increased by 3,896,826 Rials. Conclusion: Over the past decade, change in the average cost of hospitalization has experienced a heterogeneous trend influenced by the FPP and the HTP. Further studies are recommended to investigate the impacts of different components and packages of these reforms on health spending.

Background Health transformation plan (HTP) implemented in Iran since 2014 to improve accessibility and financial protection of patients. This study aimed to assess the impact of HTP on health spending in Iran. Methods This was a quasi-experimental design using Interrupted Time Series. All registered impatient records in Iran health insurance organization (IHIO) for the population of Mazandaran province (1,628,919 population in 2011), north of Iran from March 2010 to February 2019 were included. Data for three depended variables: hospitalization rate, average inpatient cost and inpatient expenditure per capita was extracted in 96 monthly observations. Segmented regression analysis was done in R version 3.6.1. Results Hospitalization rate in 2010 was 6.6 in 1000 people and its level change was 0/799 immediately after HTP (P < 001). Post-reform level and trend changes for monthly average inpatient cost of registered admissions in IHIO were also significant (P < 001). IHIO inpatient expenditure per capita for 1,628,919 population in Mazandaran province was 24,436 Rials in 2011 and increased significantly immediately following HTP as 34,459 Rials (P < 001). Conclusions Three important components of health spending including hospitalization rate, average inpatient cost and inpatient expenditure per capita were increased dramatically after HTP. Cost containment strategies and strengthening the preventive care initiatives is required to control the escalating trends of inpatient expenditure in Iran.

Background Low and middle income countries has recently implemented various reforms toward Universal Health Coverage (UHC). This study aims to assess the impact of Family Physician Plan (FPP) and Health Transformation Plan (HTP) on hospitalization rate in Iran. Methods We conducted an Interrupted Time Series (ITS) design. The data was monthly hospitalization of Mazandaran province over a period of 7 years. Segmented regression analysis was applied in R version 3.6.1. Results A decreasing trend by − 0.056 for every month was found after implementation of Family Physician Plan, but this was not significant. Significant level change was appeared at the beginning of Health Transformation Plan and average of hospitalization rate increased by 1.04 ( P < 0.001). Also hospitalization trend increased significantly nearly 0.09 every month in period after Health Transformation Plan ( P < 0.001). Conclusions Family physician created a decreasing trend for hospitalization in urban area of Mazandaran province in Iran. HTP with lower user fee in governmental public hospitals and clinics as well as fee-for-service mechanisms, stimulated both level and trend changes in hospital admissions. Some integrated health policy is required to optimize the implementation of diverse simultaneous reforms in low and middle-income countries.

Introduction: Quality information is essential for evidence-based decision-making and improving the performance of the healthcare system. Hence, health information management system should be continuously monitored. The aim of this study was to assess the quality of routine information on the care of patients with diabetes mellitus in rural health centers of Sari County, Iran. Methods: This cross-sectional study was conducted in 2018. The statistical population included routine statistical reports of the patients with diabetes mellitus in all rural health centers of Sari County. The sample size was 30 rural health centers selected using census sampling method. Data were collected using a validated Performance of Routine Information Systems Management (PRISM) tool, which had four dimensions including timeliness, accuracy, completeness, and data processing. The gathered data were reported using descriptive statistics. Results: 81.50 percent of data was timely. The accuracy of the data was between 39.99 and 53.33 percent, and the overall compliance was 16.67 percent. 94.90 percent of the quarterly reports of the patients with diabetes mellitus was complete. 86.66 percent of the units calculated the indicators for their own units, summarized the reports, and compared the performance of the service-provider units. However, the comparative indicators of the related activity were neglected. Conclusion: According to the results of this study, the accuracy of data in rural health centers is not optimal. Logically, the existing weaknesses prevent the attainment of data collection purpose, which in turn makes its citation and use unattainable.

Background and purpose: There is a return to rationality and ethics in the approach of current world. After several eras, humanity comes to consider rationality and ethics in addressing its physical and moral needs. From this point of view, ethics could be considered as a center of evolution in the future. This approach mainly influences those practices that are in the lead in serving people. Therefore, in this study, the aim was to investigate stakeholders’ points of view about Phenomenological ethics and professional behavior of auxiliary health workers at first level of health services delivery. Materials and methods: This qualitative study was conducted through semi-structural interview in 2017. The study population included 9 principals of staff technical unit, 5 physicians in charge of rural comprehensive health centers, and 12 auxiliary health workers of affiliated health houses who were selected purposefully. After conducting the interviews, the data was transferred to paper and analyzed using content analysis with emphasis on core and non-core factors that influence behavior and professional ethics of auxiliary health workers from inter-organization stakeholders’ viewpoints. Findings: The results of this study included two general domains of the main elements (ethical and behavioral), and a total of 12 sub-areas of each of the two main elements, including 3 sub-domains that comprised the moral criterion: (secrecy, censorship, good behavior), as well as three behavioral criteria (accountability, expressive power, motivation), and ultimately 107 basic categories from 3 perspectives, which were all selected by institutional stakeholders: technical units, physicians of comprehensive health centers, as well as healthcare providers.Conclusion: The expressed experiences have shown that the issues surrounding the ethics and behavior of auxiliary health workers who are providing health services at the front line of health system, is inevitable in order to intervene in improving and promoting the quality of morality and behavior of this group of health professionals.

Background and purpose: Studies on the function of referral system in Iran had not covered all aspects and structures of the referral system. This could be due to lack of an appropriate tool that could investigate referral system in Iran. The current study was done to translate and investigate the validation of Referral Systems Assessment and Monitoring (RSAM) Toolkit based on family physician in Iran. Materials and methods: The English version of RSAM was translated into Farsi. Content validity was assessed by calculating content validity ratio (CVR) and content validity index (CVI). For this purpose we used 20 informed individuals familiar with family physician program and referral system. Then, the tool was used in 52 family physician units in Mazandaran province and its reliability was investigated. Data were analyzed in SPSS V24 and LISREL 8.8. Results: The coefficients of CVR and CVI were 70% and 90%, respectively, which were higher than the acceptable values. The Chrocbach’s alpha coefficient for reliability of multiple choice items was 0.89 (good) and the Kudar-Ricahrson coefficient for two-choice items was 0.83. (acceptable). Conclusion: The RSAM tool for Family Physician Program in Iran has the necessary scientific features and could be efficient in investigating this form of referral system.

Introduction: Inaccurate data and unqualified data can be misleading, and cause false decisions. Therefore, the quality of data can guarantee its usefulness. The aim of this study was to assess the quality of routine data related to diabetes caretakers of Health Houses (HHs) in Sari City, Iran. Methods: This was a descriptive study carried out in 2018. The Statistical population of this study included monthly reports of all HHs in Sari. A sample of 72 HHs was selected randomly. Performance of Routine Information System Management (PRISM) tools at health facility level were used for data collection through interview and observation. The gathered data were analyzed using descriptive statistics. Results: Data accuracy rate was between 90.96 and 18.05 percent. Moreover, according to patients interviewed, recorded information of 52 percent of them was not based on reality. Conclusion: The routine data related to diabetes caretakers, which is one of the main requirements of continuous monitoring of the performance of service units and making appropriate decisions, were not accurate.

Background and purpose: Reliable information about utilization of medical services is key for making appropriate decisions of all healthcare systems. Nonetheless, most policy decisions and planning in the rural areas of developing countries are made with the lack of such crucial information. In this article we attempt to reveal the pattern of curative care utilization of rural population in Amol, a county in Northern Province of Mazandaran. Methods: In this study 355 patients living in rural area who in the last three month utilized curative care from different providers were interviewed in their doorsteps. All interviewees were heads of family or people age above 15. SPSS software was used for analyzing the data. Results: About a quarter of patients (24.5%) have referred to their local family physicians. It is noticeable that the proportion of people who referred to GP out of family physicians scheme exceeds the proportion of patients referred to GPs who are working as family physicians in the FMRI scheme. Among the studied variables, only basic insurance, severity of disease, and type of care utilized had significant association with referred or not referred of individuals to their own family physicians.Conclusion:Family medicine and rural insurance in Iran has increased the overall service utilization of population in rural areas but not in the scale that the government has spent its limited healthcare resources. This raises the concern of inappropriate resource allocation for inappropriate people and inappropriate services.

Introduction: Qualitative information is necessary for planning, decision-making, and performance management. Scales for assessing the Performance of Routine Information Systems Management (PRISM) have international applications as tools for data quality assessment. So, the aim of this study was to survey the validity and reliability of these scales in the context of Iran. Methods: This was a descriptive study. In order to determine the validity and reliability of these scales, first, they were translated to Persian. Then, an expert panel with 20 members was used to determine the validity of the scales. In order to determine the reliability, the tools were used in 50 primary health care centers in Mazandaran Province, and the Kuder-Richardson and Cronbach’s alpha reliability coefficients were used as well. Results: The expert panel confirmed the content validity of the scales. These experts, while maintaining the original structure and dimensions of the tools, modified them by making some changes including eliminating, adding, and/or modifying some items. The reliability coefficients of these scales for Kuder-Richardson and Cronbach’s alpha were estimated to be 0.72 and 0.77, respectively. Conclusion: Translated PRISM scales are appropriate instruments for assessing the performance of health information systems, as well as quality assessment of routine health system data in Iran.

Background and purpose: Although, economically, referral systems make utilization of health facilities at different levels sound, in many countries caretakers often bypass primary care facilities that are regularly costlier for caretakers and health care systems. The main objective of the current study was to assess the utilization of hospital services with more emphasis on economic point of view. Materials and methods: The present study was a facility-based cross-sectional study. A researcher developed questionnaire was used to collect the data. The samples were randomly selected and interviewed on their consent. SPSS Software was also used to analyze the collected data through Chi-2, correlation, and t-test. Results: Just 29.4 percent of the attendees to the hospital were carrying out a referral slip from their family medicine. Five variables including type of care, type of attending, appointment arrangement, satisfaction with family medicine, and vising family medicine were statistically analyzed and found significantly related to carrying referral slip. Conclusion: Because of dysfunction of referral system, Iran’s health care system was found to be far from achieving economic advantages of a referral based DHS. It is actually an inappropriate use of limited health resources in a country like Iran that seriously suffers from shortage of financial and health system resources. This is likely due to deficiencies in the components of its referral system, therefore, a full revision of current reforms and appropriate remedies for deficiencies in the components of referral system was found to be in top priority in Iran.

Back to table of contents Previous article Next article Perspectives in Global Mental HealthFull AccessTreatment of Postpartum Mood Disorder in IranMehran Zarghami, M.D., Samad Rouhani, Ph.D., Fatemeh Abdollahi, Ph.D.Mehran ZarghamiSearch for more papers by this author, M.D., Samad RouhaniSearch for more papers by this author, Ph.D., Fatemeh AbdollahiSearch for more papers by this author, Ph.D.Published Online:1 Dec 2016https://doi.org/10.1176/appi.ajp.2016.16040479AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The patient, a housewife, is now 54 years old. Her father refused to educate her beyond elementary school and compelled her to marry the son of his friend. She worked in her husband’s fields in addition to her household and maternal roles. She referred to her life’s course as “her chance.”After her first delivery at age 24, she was confused, perplexed, and disoriented. She reported feeling like she was in a daze and like her thinking was arrested. She said she was being held in a terrible hole, detained by a fearful creature—a jinnee. She wondered if it was “worth living like this” and attempted self-poisoning with an herbicide. After detoxification in an emergency clinic, the patient’s family asked a traditional healer to help them remove the jinnee from her body by prayer. Gradually, her symptoms subsided, and after several weeks she was symptom free. Afterwards, she experienced some minor episodes that remitted after she attended her traditional healer.She first saw a psychiatrist at age 30, for hypersexuality and hostility to her family. She said that her brother had abused her sexually and that her husband was in an extramarital affair. She showed psychomotor agitation and pressured speech. She was treated with lithium carbonate, haloperidol, and chlorpromazine, and her symptoms resolved within 2 weeks. She had 11 similar episodes thereafter, often after discontinuing medication. Two of these episodes were postpartum. Among her 13 siblings, two of her brothers and a sister have had similar episodes. During the patient’s recent episodes, she has been threatening to kill herself and her husband. She refused lithium maintenance treatment because she feared it would make her obese and cause her husband to leave her.DiscussionIn Iran’s health care system, there is no program specifically for the screening of postpartum mood disorders (PPMD). Lack of structured, widespread family education and psychotherapy programs focusing on PPMD, together with denial, helplessness, and cultural barriers, are factors that contribute to the misery of mothers trying to seek help. PPMD treatment can include pharmacotherapy and psychological and social support (1). A focus on ritual practices such as prayer and almsgiving for depression is influenced by Islam. A variety of postpartum rites, such as prescribed confinement periods (which normally range from 30 to 40 days), balanced diet, and practical and emotional support from family members and a traditional birth attendant, are practiced in Iranian communities. Although none of these customs were originally intended to relieve PPMD, they potentially provide social and emotional support for new mothers who are at risk of PPMD.Complementary/alternative/traditional therapies are also used for care and treatment of PPMD. Some medicinal plants (such as saffron, rose, geranium, and Asperugo procumbens) and foods (such as fish, garlic, milk, oregano, mint, and spinach) are considered to have antidepressant effects and are prescribed by traditional doctors (2–5).One of the rare traditional rites for treatment of depressed mothers in the southern part of Iran is called Zar, in which lay women go to practice mindfulness meditation. The pregnant or postpartum woman is accompanied by a traditional midwife and stays on a campus near the sea for 3 to 14 days. The traditional midwife massages the woman with an ointment that contains 21 kinds of herbal medicines. On the last day, the patient asks the traditional healer, who has a stick in her hands, to help raise the jinnee or “Al” (a fearful creature who is the persecutor of the parturient woman) from her body.From the Psychiatry and Behavioral Sciences Research Center, Addiction Institute, and the Departments of Psychiatry and of Public Health, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.Address correspondence to Dr. Abdollahi ([email protected]).The authors report no financial relationships with commercial interests.References1 Henshaw CA: What do women think about treatments for postnatal depression? Clin Eff Nurs 2004; 8:170–175Crossref, Google Scholar2 Moosavi SM, Ahmadi M, Amini M, et al.: The effects of 40 and 80 mg hydro-alcoholic extract of Crocus sativus in the treatment of mild to moderate depression. J Mazandaran Univ Med Sci 2014; 24:48–53 (Persian)Google Scholar3 Farzin D, Zarghami M, Khalaj L: Evaluation of antidepressant activities of rose oil and geranium oil in the mouse forced swim test. J Babol Univ Med Sci. 2005; 7 (Persian)Google Scholar4 Hoseini A: Comparing the antidepressant effects of Asperugo procumbens L and fluoxetine: a randomized double-blind clinical trial [dissertation]. Sari, Iran, Mazandaran University of Medical Sciences, 2010Google Scholar5 Tavakkoli-Kakhki M, Motavasselian M, Mosaddegh M, et al.: Food-based strategies for depression management from Iranian traditional medicine resources. Iran Red Crescent Med J 2014; 16:e14151Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byReassessing the Mental Health Treatment Gap: What Happens if We Include the Impact of Traditional Healing on Mental Illness?7 September 2020 | Community Mental Health Journal, Vol. 57, No. 4 Volume 173Issue 12 December 01, 2016Pages 1177-1178 Metrics KeywordsMood Disorders-PostpartumMood Disorders-BipolarPDF download History Received 26 April 2016 Revised 19 June 2016 Accepted 18 July 2016 Published online 1 December 2016 Published in print 1 December 2016

Background and purpose: Family physician program was implemented in Iran since 2005. The referral system is considered to be highly important in this program. But failure in appropriate implementation of referral system is a core problem of rural family medicine program in Iran. This study investigated the viewpoints of family physicians regarding referral system in 2012. Materials and methods: This qualitative research was conducted using a conventional content analysis. Purposive sampling was done and continued until data saturation. Semi-structure interviews were carried out with 26 respondents who had at least one year experience as family physician. Results: Main problems were categorized as four main themes including: the role of service providers at higher levels, the role of patients, and role of executive authorities. These themes were associated with sub-themes including lack of feedback, reverse referral, patients' lack of knowledge about the program, lack of patients' trust in family physicians, patients who insist on receiving higher level services, and inappropriate implementation of instructions. Conclusion: Failure in referral system in family physician program is believed to be associated either with ministry of health as the main policy-maker or the Iran Health Insurance Organization. Therefore, the policies should be reviewed or the implementation of the program should be done with more strict supervision.

Background and purpose: Water is the most important limiting factor of sustainable development. Poor quality of water sources and lack of appropriate management in some regions are the main reasons of water crises in the country. This study was conducted to assess water sources quality and the trend of their change in rural area of Sabzevar County in a five year period. Materials and Methods: In total 43 sources of water in villages or complexes with more than 700 population were selected randomly and their Physico-Chemical and microbiological variables were studied. For microbiological characteristics 801 samples from those 43 sources were taken and examined in a five year period. Results: The results showed that the average microbial contamination of all 801 samples from 43 sources during a five year period was 12.3 with a variance of 13.3. Total Dissolved Solids (TDS) index was 349.02 ppm with variance of 193.704 ppm. In three sources, the TDS index had statistically significantly difference with the maximum level of 500 ppm. The maximum limit of EC of water from wells in a three years period has increased from 2526 in year 1 to 3213 in year three of study. Among 43 sources of rural drinking water, just one source, with average 4.7± 3.9 ppm had statistically significantly difference with the upper limit maximum of 1.5 mg per litter. Conclusion: Having positive result of E-coli in some of water sources and high level of some Physico-Chemical indexes and the increasing trend of declining quality of water sources in a five year period of study, therefore creating a GIS based data bank of water quality for continues monitoring of change in water quality, improvement and filtration of some sources, and replacement with a sources of better quality are essential.

OBJECTIVE:Violence during pregnancy has been associated with adverse pregnancy outcomes. This study aimed to explore the link between psychological violence (PSV) and pregnancy outcomes in terms of maternal and birth for the first time in women attending Mazandaran University of Medical Sciences (MUMS) primary health centers (PHCs) in Iran.METHODS:Prospective cohort of 1461 pregnant women exposed and non-exposed to PSV was followed until the pregnancy outcome. Modified Intimate Partner Violence, demographic and pregnancy outcomes questionnaires were administered face-to-face. Logistic regression analysis was down to estimate independent effects of the PSV on pregnancy outcomes.RESULTS:More than half of the women (69.9%) reported PSV during pregnancy. The differences between the two groups in reference with pregnancy complication did not reach statistical significance. Premature rapture of membrane was the only outcome that was independently associated with PSV.CONCLUSION:PSV in pregnancy was frequent in our study. Although the lack of adverse pregnancy outcome following PSV was observed in this study, intervention is required to prevent the effect of violence on women and child health.

Background and purpose: Equity in access to health care has become a desirable policy objective. Therefore, accessibility to health care should be provided based on health needs rather than socio- demographic variables. This will lead to a better utilization of health care and improvement of equity in health. The aim of this paper is to examine the effects of family socio-economic status as an indication of individual’s socio-economic status on the utilization of their health care. Materials and Methods: This was a cross-sectional study conducted in Ghaemshahr County, Iran in early 2013. In this household survey, 807 individuals were randomly approached at their home. A self-designed questionnaire was applied. The parent or every individual above 18 years were asked to fill the questionnaire for themselves and other member of their family. Using SPSS software analyses were performed with employing correlation coefficient, Chi-square and t-test. Results: About 47.9% and 52.1% of respondents were living at urban and rural area respectively. Respondents were from a quite different socio-economic and demographic background. Utilization of health care had only significant association with the location of respondents. Underutilization of health care has proportionately more evident in a rural area compared with the urban area. Conclusion: Accessibility to and utilization of health care was lower in a rural area. There is a concern of inequity in health at rural area and is going to be expanded. Appropriate policy and intervention are required to improve the situation.

Background and purpose: In the second half of 2005, reform of Primary Health Care through Implementing Family Medicine was introduced for all small towns and rural places with populations less than 20,000. This was done to improve curative healthcare services. 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, the change in the performance of health centers in ambulatory care before and after the implementation of reform was compared in two cities (Mazandran province). Materials and methods: This investigation included two case studies in two cities. The data was collected from 30 rural health centers in Sari and 12 in Jouybar. The collected data was based on the existing data of Iran’s primary health network information system. A check list was used for data collection. The data from one year before implementation of scheme and three years after that was analysed. Results: A substantial increase in the number of patients visited by a physician took place that was 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, injection and wound dressing unit also occurred. Conclusion: In this study, the performance of health care providers in health centres under the same conditions of primary health care delivery changed dramatically. In fact, their performance improved about 6 times compared to that of the before reform. These changes, with fewer slopes, were seen on other curative care including the lab, injection and wound dressing services.

Where many studies have investigated the trend of change in the methods of family planning, but study about the change of couple's participation in the family planning programs is limited. A subject that attempts to be covered in this article. This is an exploratory-explanatory study. Using a self made checklist, the relevant data were extracted from the contents of family folders existing in the health centres of the district under study. Data were analysed using descriptive statistics and K-squared test. The results of this study revealed that in the beginning of study period contraceptive pills were the most common methods of family planning among the females while in the end of study period there was a shift towards IUD. Also the results of this study have shown that the use of male condom was statistically significantly increased in the end of the decade in contrast to its beginning, but still females undertake the main role in the family planning programs. In addition to the use of more risky methods of family planning methods by females in contrast with methods used by males, females participate in the family planning programs several times more than the males do. The trend of change is towards the increased role of males in the family planning programs that could be an indicator of improvement in gender equity as well as improvement in the quality of family planning programs. More interventions are required to bust this trend. (Rouhani S, Abdollahi F, Almasi S. Family planning and gender equity in health, a trend of change during a decade in Iran. Life Sci J 2013;10(4s):387-391) (ISSN:1097-8135). http://www.lifesciencesite.com . 58