Journal of community health research

71-87

Authors: JaafarSadeq Tabrizi, Raana Gholamzadeh Nikjoo

Abstract Introduction: Primary care organizations are entities through which clinical governance is developed at a confined level. To implement clinical governance in primary care, awareness of principles, prerequisites and barriers of this quality improvement paradigm is necessary. The aim of this study is to gather evidence of implementing clinical governance in primary care organizations. Data sources: The primary search was conducted in July 2012. PubMed, Web of Science, Emerald, Springer link, and MD Consult were searched using the following MESH keywords; “clinical governance” and “primary care”. Study selection: The search was limited to English language journals with no time limitation. Articles that were either quantitative or qualitative on the concepts of implementing clinical governance in primary care were eligible for this study. From the selected articles, data on principles, prerequisites and barriers of clinical governance in primary health care were extracted and classified in the extraction tables. Results: We categorized our findings about the principles of clinical governance in primary care in four groups; general principles, principles related to staff, patient and communication. Prerequisites were classified in eight clusters; same as the seven dimensions of the National Health System (NHS) models of clinical governance. Barriers were sorted out in five categories; structure, organizing, cultural, resource, theoretical and logistical. Conclusion: Primary care organizations must provide budget holdings, incentivized programs, data feedback, peer reviews, education, human relations, health information technology (HIT) support, and resources. Key elements include; enrolled populations, interdisciplinary team approach, HIT interoperability and access between all providers and patients, devolution of hospital based services into the community, inter-sectorial integration, blended payments, and a balance of clinical, corporate, and communal governance. Keywords: Clinical Governance, Primary Health Care, Organization and Administration; Review Literature as Topic

96-106

Authors: Bizhan Maghsoudlou Kamali , Mohammad Taghi Ghaneian , Taleb Abdollahi

Abstract Introduction: By ever-increasing of population, shortage of water resources and the necessity of wastewater treatment, large amount of sludge that is a byproduct of wastewater treatment, requires being disposed in safe ways, environmentally. The target of specifying strategic preferences of reusing sludge is going to find the safe way of disposing or beneficial use of sludge. Materials and Methods: In this study, for selecting the best alternatives for reusing wastewater sludge, two systematic methods will be introduced, in which four alternatives in reusing sludge (using in agriculture, in green space, biogas and desert combat) are introduced and they will be compared with four main parameters including: 1-physicochemical 2-biological 3-economic, social and cultural, and 4-environmental pollution situation, where each one contains some criteria. Results: Sludge of Ardabil municipal wastewater treatment plant, according to standards, and EPA regulations is eligible to class B, and due to the chemical, in terms of heavy metals, got special (excellent) quality and contains considerable quantities of organic substance, nutrients and micronutrients that indicates the fertilized value of the sludge. Conclusion: The result of these comparisons showed that the application of sludge in green spaces is the most appropriate alternative while using in agriculture, biogas, and desert combat alternatives are placed respectively in second to fourth preferences of reusing sludge that is derived from municipal wastewater treatment plant. Keywords: Waste water; Sewage; Population; Water Pollutants; Drinking Water; Water Purification

117-123

Authors: Azizallah Dehghan , Narges Khanjani , Roohollah Zahmatkesh

Abstract Introduction: Immunization is one of the most important health programs in first level prevention and is also one of the most cost-effective prevention programs in the entire world. This study evaluates the situation of immunization in fewer than one year old Afghan refugee children in Kerman, Iran. Materials and Methods: This was a cross-sectional study. Data was extracted from the records of the health centers supported by the higher commission of refuges in Kerman. The BCG, polio 0, DTP 3, polio 3, Hepatitis B 3 and MMR 1 was calculated and compared with the vaccine coverage in Iran and Afghanistan. Stata 11 and Excel 2007 and the chi-square statistics were used for the analysis. Results: The coverage of all BCG, Polio 0, DTP 3, Polio 3, Hepatitis B 3 and MMR 1 vaccines in the Afghan immigrants residing in Kerman between 2010 and 2012 was more than 95%. This coverage was not significantly different from the vaccine coverage of Iranian children, but was significantly higher than the vaccine coverage of children residing in Afghanistan. Conclusion: The vaccine coverage of Afghan children residing in Kerman is similar to Iranian children and is high and satisfactory. These results show part of The Islamic Republic of Iran’s commitment for providing health requirements for Afghan refugees residing in Iran. Keywords: Immunization; Child; Health Centers; Primary Prevention

131-137

Authors: Mohammad ZareZadeh , Mohammad Reza VafaeiNasab , Nadjme Hajian

Abstract Introduction: Personnel’s attitudes and their behaviors with the clients significantly affect clients’ perception of quality of services and consequently influence their satisfaction. The purpose of the present study was to investigate the supervisor’s attitude towards the effect of personal elements (as one of the elements of the service marketing mix) on choosing the hospital by patients and their companions. Materials and Methods: This cross-sectional descriptive study conducted in winter of 2012. 35 supervisors (study group) were studied in Yazd educational hospitals of Shahid Sadoughi University of Medical Sciences; Shahid Rahnemoun and Afshar. The research data were selected via a researcher-made questionnaire on factors of the marketing mixes that its validity and reliability was confirmed. Results: The results indicated that supervisor’s belief in increasing the market share of a hospital services in public hospitals including: 1-Physical evidence 2- Service or product 3- People or persons 4- Efficiency and quality 5- Process 6- Distribution 7-Promotion or propagation and 8- Price. Therefore, the significance of the personnel role in absorption of a definite patient involves the third element in choosing the hospital by patients. Conclusion: Based on this study, since the third factors in choosing a hospital are the personnel and persons who provide services, it is confirmed that in service-based organizations like hospitals, the most important elements of quality of services are the personnel activities that has been connected with clients of organization. Moreover, it is regarded as a vital factor in developing effective relationships with clients as well as their absorption in the hospital. Keywords: Hospitals; Marketing; Personnel, Hospital; Hospitals, Public; Patients