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Background and Objective: Due to the increase of incidence of extrapulmonary tuberculosis in Iran, This study was conducted to determine the epidemiological pattern of extrapulmonary tuberculosis in the Mazandaran province, northern Iran. Methods: This descriptive-analytic study was carried out on medical record of 3313 tuberculosis patients in Mazandaran province, northern Iran during 2001-11. Age, gender, affected year, area and affected organ were gathered for each patient. Results: 843 (25.4%) of subjects were diagnosed with extrapulmonary tuberculosis. The incidence of extrapulmonary tuberculosis increased by 4% for every unit increase in incidence year (P

Introduction: Satisfaction has been a concept of high importance in today's health care services and is considered as one of the criteria in evaluating the quality of services. The present study has been conducted to evaluate the satisfaction level of patients with rural insurance in terms of the first and second levels of health services presentation in northern provinces of Iran. Materials and Methods: This cross-sectional study was conducted in the second half of the year (2012); 139 centers (25%) implementing rural insurance and family physician program were selected through systematic random sampling as the research samples and 6 out of 8 patients with insurance, who received required services after being referred to the second level by FPs, were evaluated. Data-collecting instrument was a researcher-made questionnaire, and the validity and reliability were confirmed. Data were analyzed by SPSS17 statistical software at the significance level of p<0.05. Results: From the 955 patients who received services after referral to the first and second levels, 752 patients (78.7%) were female. The mean age of patients was 40.2±15.6 years and the mean referral of patients during the 9 months of (2012) was found to b e 8±8.4 to home health and 6.4±6.6 to healthcare centers. Out of the 5 scores for level of patients satisfaction, 4.5±0.5, 4±0.7 and 4±0.8 were allocated to home health, healthcare centers, and second level hospitals and specialists, respectively. There was an inverse relationship between the overall satisfaction and education level and a direct relationship between satisfaction and age, number of referral to home health and healthcare centers (P<0.05). A significant difference was observed in the mean level of patients' satisfaction with second level hospitals and clinics in northern provinces of Iran (P<0.05). However, no significant difference was found in the patients' satisfaction level between home health and healthcare centers (P>0.05). Conclusion: The results showed a high level of satisfaction in patients with rural insurance. While maintaining and improving the existing condition, it is proposed that satisfaction levels of patients with other health insurances be compared and evaluated. [ABSTRACT FROM AUTHOR]

Introduction: The quality of healthcare services can be determined by patient satisfaction as it affects the performance, sustainability, and durability of health services. This study aims to determine patients' satisfaction with healthcare service providers and its determinants in the urban family physician program in Fars and Mazandaran provinces, Iran., Methods: A cross-sectional study was conducted on the populations covered by the urban family physician program in Fars and Mazandaran provinces in 2016. In total, 864 households were selected in each province using random cluster sampling. Socio-demographic variables and underlying factors were gathered. Patient satisfaction levels were evaluated using a validated questionnaire., Results: Of the 1,480 participants with a mean age of 46.9 ± 14.2 years, 53.3% lived in Fars province and 74.2% were female. Furthermore, 67.9% of the patients were satisfied with their healthcare service providers. A higher satisfaction level was observed among the patients who resided in Fars province, lived in cities with <100,000 residents, walked <10 minutes to the family physician's office, had a family physician they previously knew, accepted the family physician, had a positive attitude towards the importance of having a family physician and a referral system, and had adequate knowledge of the family physician program., Conclusion: The results indicated that two-thirds of the patients were satisfied with healthcare service providers. Several socio-demographic variables were associated with the patients' satisfaction levels. Improving the family physician program by providing adequate medical equipment and monitoring physicians' performance could increase patient satisfaction and improve the sustainability of the program., (© Academy of Family Physicians of Malaysia.)

Background: Unwanted pregnancy is a type of unplanned pregnancy that can endanger health of mother and child. This study aimed to determine the prevalence of unwanted pregnancy and its associated factors and consequences in Iran., Methods: This cross-sectional study was conducted in regions with low, moderate and high risk of maternal death. Two provinces were randomly selected in each region and 24 public health centers in each province during 2007-2012. Thereafter, 15-20 mothers, received at least one session of pregnancy care, were selected from each healthcare center. Data were gathered from both health records and interview with the mothers., Results: Of 2714 participants, 86.4% and 13.6% had respectively wanted and unwanted pregnancies. The underlying factors of unwanted pregnancy were determined as low distance with previous and next pregnancy, economic problems and have enough children. Moreover, there were significant relationships between unwanted pregnancy and place of residence, mother's age and education, father's education, pre-pregnancy care and number of previous pregnancies and children. There were also significant association between unwanted pregnancy and pregnancy care, anemia, exposure to risk factors and disease, intake of folic acid and iron, domestic violence, bitter memories and men's participation., Conclusion: Although the prevalence of unwanted pregnancy has had a significant decrease in Iran, these mothers still require a higher level of educational, counseling and supportive services due to their low access to pregnancy care services and high exposure to associated risk factors., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright© Iranian Public Health Association & Tehran University of Medical Sciences.)

Purpose: Colorectal cancer (CRC) is the second leading cause of cancer deaths. This screening aimed to determine the positivity of the fecal occult blood test (FOBT) and the results of colonoscopy among a medium-risk population in the northern regions of Iran., Methods: This cross-sectional study was conducted in 2016 on 924 eligible samples from people over the age of 50. After completing the questionnaire, participants were referred to a laboratory for three immunochemical fecal occult blood tests (IFOBTs). If the result of at least one test was found to be positive, they were submitted to the state hospital for colonoscopy. Results were recorded according to the number of people with CRC, polyps, and other diseases., Results: Among a total number of 897 (97.1%) cases, at least two acceptable samples were sent to the laboratory and in 229 (25.5%) cases, at least one case was IFOBT-positive. Finally, 118 (64.1%) cases were referred to the hospital for colonoscopy; among these, 5 colonoscopies were incomplete, while 113 had complete colonoscopies with 42 healthy subjects, 3 cases of cancer, 28 cases of polyps, and other diseases identified in the remaining patients., Conclusions: Based on the results, the prevalence of positive IFOBT, polyps, and cancer was high. The results of this study will play an important role in establishing a CRC screening program in the country. With reference to the status of the general population, the target group in the country should be reviewed and not limited to the first-degree relatives of patients.

Background and Objective: A successful family physician program needs ongoing and full cooperation between people and the organizations in charge. Ensuring the satisfaction of family physicians through improvement of the underlying factors could motivate them to provide high-quality services. This study aimed to determine the family physicians' satisfaction level with the factors affecting the dynamism of the urban family physicians program in the Fars and Mazandaran provinces of Iran., Method: This cross-sectional study was carried out in urban areas in the Fars and Mazandaran provinces in 2016. The sample consisted of 143 and 96 family physicians, respectively, in Fars and Mazandaran provinces and was selected using the stratified random sampling method. Data were collected using a questionnaire and included both sociodemographic variables and factors assessing the family physicians' satisfaction levels. Each factor was scored based on a Likert scale from 0 to 5 points, and any satisfaction level higher than 3 out of 5 was equated with being satisfied., Results: The overall satisfaction levels among family physicians in Fars and Mazandaran provinces were 2.77±0.53 and 3.37±0.56, respectively, revealing a statistically significant difference between provinces (p<0.001). Moreover, the mean satisfaction scores for the performances of healthcare centers, insurance companies, specialists, healthcare workers, and the population covered were 2.78±0.1, 2.54±0.9, 2.52±0.8, 4.24±0.07, and 2.96±0.8, respectively. The family physicians' levels of satisfaction were significantly correlated with population size (p=0.02, r= -0.106), and willingness to stay in an urban family physician program (p<0.001, r= +0.398)., Conclusion: This study revealed that family physicians exhibited a low level of satisfaction with the urban family physician program. Given the direct association between family physicians' satisfaction levels and retention in the program, it is expected that family physicians will no longer stay in the program, and it is likely to have subsequent executive problems., (© Academy of Family Physicians of Malaysia.)

Background: Anemia is a common nutritional disorder that is more prevalent in pregnant women than other population groups. This study aimed to assess the frequency of anemia and its association with health care determinants among Iranian pregnant women from provinces with different Maternal Mortality Rate (MMR)., Methods: This cross-sectional survey was carried out on 2737 pregnant women referred to public health centers in Iran, 2015. The participants were randomly selected by multistage sampling from six provinces with low, moderate or high MMR. The level of hemoglobin lower than 11 g/dl were defined as anemia in first and third trimester of pregnancy., Results: The rate of anemia in first and third trimester were respectively 8.2 and 26.7%. The most determinants of anemia among women in both first and third trimester of pregnancy were geographical classes with high MMR, no care before pregnancy, and type of house. Moreover, lower number of previous pregnancies (OR, 0.48; 95% CI, 0.27 to 0.85) and adequate care during pregnancy (OR, 0.66; 95% CI, 0.47 to 0.92) were protected women from anemia and high number of children (OR, 2.07; 95% CI, 1.13 to 3.80) enhanced risk of anemia in first trimester of pregnancy. Moreover, higher body mass index had lower odds of anemia in third trimester., Conclusion: The rate of anemia is differed in various parts of Iran, and this disorder gets worse in third trimester of pregnancy than first. Strengthening health care programs may be a useful strategies to prevent and control anemia., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.