BackgroundHealth literacy refers to personal competencies for the access to, understanding of, appraisal of and application of health information in order to make sound decisions in everyday life. The aim of this study was to develop and evaluate the psychometric properties of an instrument for the measurement of health literacy among adolescents (the Health Literacy Measure for Adolescents-HELMA).MethodsThis study was made up of two phases, qualitative and quantitative, which were carried out in 2012–2014 in Tehran, Iran. In the qualitative part of the study, in-depth interviews with 67 adolescents aged 15–18 were carried out in 4 high schools to generate the initial item pool for the survey. The content validity of the items was then assessed by an expert panel review (n = 13) and face validity was assessed by interviewing adolescents (n = 16). In the quantitative part of the study, in order to describe the psychometric properties of the scale, validity, reliability (internal consistency and test-retest) and factor analysis were assessed.ResultsAn item pool made up of 104 items was generated at the qualitative stage. After content validity was considered, this decreased to 47 items. In the quantitative stage, 582 adolescents aged 15–18 participated in the study with a mean age of 16.2 years. 51.2% of participants were females. In principal component factor analysis, 8 factors were loaded, which accounted for 53.37% of the variance observed. Reliability has been approved by α = 0.93 and the test-retest of the scale at two-week intervals indicated an appropriate stability for the scale (ICC = 0.93). The final questionnaire was approved with 44 items split into eight sections. The sections were titled: gain access to, reading, understanding, appraise, use, communication, self-efficacy and numeracy.ConclusionThe Health Literacy Measure for Adolescents (HELMA) is a valid and reliable tool for the measurement of the health literacy of adolescents aged 15–18 and can be used to evaluate different levels of functional, interactive, and critical health literacy in adolescents.

Background: Oral health of women during pregnancy is an important issue. Not only it can compromise pregnancy outcomes, but also it may affect their newborn's overall health. The aim of this study was to assess the oral health status and associated factors in pregnant women. Methods: A cross-sectional study was conducted amongst 407 pregnant women in the second and third trimester of pregnancy in Varamin, Iran. Oral health status was examined, and demographic, socioeconomic status and dental care behavior data were collected. Oral health indices included periodontal pocket, bleeding on probing (BOP) and decayed, missed, filled teeth (DMFT). Regression analysis of DMFT was used to study the association between demographic, dental care behaviors indicators and outcome variables using the count ratios (CR) and 95% confidence intervals (CI). Results: The mean (SD, Standard Deviation) age of participants was 27.35 (5.57). Daily brushing, flossing habit were observed in 64.1, and 20.6% of mothers, respectively. Mean (SD) of DMFT, D, M, F were 10.34(5.10), 6.94(4.40), 2.22 (2.68) and 1.19(2.23), respectively. Women older than 35 years had significantly more DMFT [CR = 1.35 (95% CI 1.13; 1.60)], less D [CR = 0.75 (95% CI 0.59; 0.94)], and more M [CR = 3.63 (95% CI 2.57; 5.14)] compared to women under 25 years after controlling for education and dental care behaviors. Women with academic education had significantly less decayed teeth [CR = 0.63 (95% CI 0.48; 0.84)], compared to women with under 12 years of education. Conclusions: Oral health status of pregnant women was not satisfactory, having an average of seven decayed teeth in their mouth.

Background: Health literacy is the ability to access to, understand, evaluate and use of essential health information to make basic health decisions. This study aimed to develop and psychometrically evaluate an instrument for measuring health literacy among adults (the Health Literacy Instrument for Adults-HELIA). Methods: In addition to a literature review, a panel of specialists from different disciplines was formed to generate an item pool. Then, a framework was defined to develop the initial questionnaire based on a definition of health literacy and the most important global public health issues. The initial questionnaire contained 66 items. Next, 15 experts in public health were approached to assess content validity. Consequently, 19 items were removed and a provisional version of the questionnaire with 47 items was provided. Finally, a random sample of adults completed the questionnaire and psychometric properties of the instrument were assessed. Results: Overall, 323 adults aged 18 to 65 years old completed the questionnaire. When the exploratory factor analysis was performed, 33 items were loaded, which indicated a 5-factor solution for the questionnaire that jointly explained 52.9% of the variance observed. The factors were as follows: access to information (6 items), reading (4 items), understanding (7 items), appraisal (4 items), and decision making/behavioral intention (12 items). Confirmatory factory analysis also indicated a good fit to the data for the five-latent structure (χ2/df = 1.60, SRMR = 0.049; RMSEA = 0.043; CFI = 0.98; NFI = 0.95; NNFI = 0.98 and GFI = 0.87). Additional analysis for internal consistency showed satisfactory results with Cronbach's alpha coefficients ranging from 0.72 to 0.89. Intraclass correlation coefficient (test-retest analysis) also showed acceptable stability for the questionnaire (ICC = 0.84). The mean score for health literacy as measured by the HELIA was 76.3 (SD = 15.1) out of 100 for the study sample. Conclusion: The findings suggest that the Health Literacy Instrument for Adults (HELIA) is a valid and reliable instrument for measuring health literacy. It is a short and easy-to-use instrument that could be applied in different settings.

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Background: It is important to be able to predict cancer incidence and mortality rates for planning and managing the risk factors. Objectives: The present study investigated the changes in the incidence and mortality rates of five most common cancers in Iran. Methods:The cancer incidence and mortality data were obtained from the national cancer and mortality registries. Five most common cancers in both men and women were selected. Changes in the incidence and mortality rates of the selected cancers in both sexes were estimated by age group, annual percent change (APC), and average APC (AAPC) and then graphically displayed. Results:The most common cancers (except skin cancer) were breast, colorectal, stomach, esophageal, and thyroid cancers in women and stomach, prostate, bladder, colorectal, and esophageal cancers in men, respectively. The AAPCs of all cancer incidence rates had increased by 11.9% in men and 11.6% in women from 2002 to 2010. Also, the mortality rates had enhanced by 0.4% and 0.1% per year in men and women from 2006 to 2011, respectively. The greatest APC was reported in prostate cancer. The rate had increased by 41.9% from 2002 to 2004, by 13.4% from 2004 to 2008, and slowly augmented by 3.9% from 2008 to 2010. In women, the greatest APC was observed in colorectal cancer; the rate had enhanced by 13.4% per year from 2002 to 2010. The greatest increase for age-standardized mortality and incidence in 2011 was attributed to gastric cancer (12.5% and 17.1% per 100,000 men, respectively). In women, the highest age-standardized mortality rate was related to gastric cancer at 6.9% per 100,000 women. The incidence and mortality patterns of colorectal and esophageal cancers in men and women were similar, although they were slightly higher in men than women. Conclusions: Overall, cancer incidence rates had increased in both sexes. Many factors were responsible, such as changes in lifestyle, environmental factors, increased life expectancy, improvements in the registration systems, and declining mortality rates due to early detection and treatment. The results of this study provided useful information for the prediction of changes in the incidence and mortality of cancer and subsequent design of cancer control programs in Iran.

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Background Dental caries is a costly and very common disease, especially in pregnant women. Reasons such as not paying attention to oral health, poor diet and also lack of adequate education in this regard cause this to happen. Performing well-designed educational interventions using primary health system’s forces, can improve oral health of pregnant women and help control this disease. We conducted this study to evaluate the effectiveness of some oral health interventions on pregnant women dental caries. Methods A field trial study was done in comprehensive Health Centers in Varamin, Tehran, Iran to assess 439 mothers’ dental health status from pregnancy up to 2 years after delivery in intervention (n = 239) and control groups (n = 200). Mothers in intervention groups received oral health-related education consisted of nutritional and behavioral messages via either of four methods: A: comprehensive method including all following methods together (n = 74), B: group discussion by dentists (n = 59), C: face to face education by primary health care providers (n = 53), and D: social network applications (n = 53); while those in control group only received routine maternal and oral health care. We used a questionnaire to collect mothers’ demographic, socioeconomic and dental care behavior data and also performed oral examinations to assess their DMFT at baseline and 24 months after delivery to evaluate the effectiveness of these educational oral health interventions. Results From 454 mothers participated the examination session, 18 pregnant women discontinued during the follow-ups and 439 were remained with mean age of 27.47. In the intervention group, the frequency of daily brushing among women increased from 64% at baseline to 85.6% at the last follow-up and the mean D significantly decreased nearly 1unit at same period (P < 0.05). Most and least dental caries changes were in comprehensive intervention group and social network intervention group compared to other intervention groups, respectively. Conclusions Performing educational interventions during and after pregnancy using various message delivery methods and messengers (oral health professionals and trained PHCPs), could improve oral health status and behaviors of pregnant and lactating mothers in a feasible and applicable manner.

Background: The importance of using modern electronic and virtual education in medical sciences, which can be used without any time limit, is increasingly increasing. Objectives: The current study aimed to provide a framework for distance education based on the Electronic Learning Management System for the staff of the Deputy for Public Health. Methods: This study had three phases. First, the level of preparedness of the staff of the health department (trainers and learners) was assessed through a descriptive-survey using a questionnaire. In the second phase, the analysis of the educational programs that were implemented during the last year was carried out. Finally, in the third phase, to manage the e-learning process based on the selected Instructional design model, considering the newness, a structure was proposed, guaranteeing quality while taking into consideration the deputy’s current facilities and staff. Results: According to the results, 84.4% of the trainers and 87.4% of the learners were agreed with E-learning. 72.2% of trainers noted that their educational programs could be held electronically, and 84.4% of trainers and 64.4% of learners believed that moving toward E-learning is necessary. 82.6% of the goals of the curriculum were cognitive, and 92.4% were theoretical. The design of the structure of E-learning was carried out in the areas of planning, content creation, course implementation, evaluation, and electronic loading. Besides, the tasks of each area were tailored to the Instructional Design Model of Gagne and were based on the capabilities of the Deputy for Public Health. Conclusions: The present study showed that trainers and learners are ready to conduct E-learning and that educational programs also can be held electronically, and a structure that incorporates the quality and proper management of this department is designed based on the potential and personnel resources of the department.