Payesh
Year:2008 | Volume:7 | Issue:2|Papers Count:11

Objective: Self poisoning is one of the most common forms of suicide- especially in adolescents- and constitutes a major reason for hospitalization and referral to emergency wards. The high frequency of repeated attempts together with the shortage of reliable epidemiologic data makes it difficult to plan effective preventive measures. The present article is the first section of a two-part paper on the epidemiology of self-poisoning in Iran Methods: This was a cross-sectional study conducted in Tehran, Mashad, Tabriz, Isfahan, Shiraz and Kermanshah (5 major provinces of Iran). Data were collected using a structured questionnaire and were analyzed in a descriptive fashion. Results: In all, 723 cases were studied. There were 550 cases (%71) of self poisoning with suicidal intent. The mean age of those who had attempted suicide was (25.42 ± 10.26) years; sixty percent (n=330) were female and the remaining 40% (n=220) were male. Eighty percent of attempted suicides involved the use of drugs; other suicide modalities included poisons, psychotropic substances and other chemicals. Thirty-one percent of the cases reported previous suicidal gestures. The mean number of past suicidal attempts was 2.08 (SD = 2.28).Conclusion: The findings show that the frequency of attempted suicide is relatively high. To deal with the current situation, issues of mental heath have to be addressed more attentively and hospital emergency wards must be provided with adequate equipment and trained manpower (psychologists, psychiatrists, toxicologists, etc).

Objective: Self poisoning is one of the most common forms of suicides and a frequent cause of hospitalization in Accidents and Emergency Departments, especially in the younger age groups.This research was prompted by the current lack of reliable and adequate information on the epidemiology of suicide, and its main objective was to provide a basis for effective interventions in the future. The present article is the second section of a two-part paper on the epidemiology of self-poisoning in Iran.Methods: This was a cross-sectional study conducted in Tehran, Mashad, Tabriz, Isfahan, Shiraz and Kermanshah (5 major Provinces of Iran). This article deals with results from data analysis and comparisons between cases of suicide and accidental self-poisoning.Results: In all, 723 cases were studied. Among those who had committed suicide, the frequency of severe physical illness was greater in women compared to men (P<0.002). The mean age of the subjects who expressed regret after the suicidal gesture was significantly lower than those who did not (P<0.003). Moreover, subjects who had a real intention to kill themselves were significantly older than those who did not have such an intention (P<0.01). Results from logistic regression analysis showed that higher age, male gender, and residing in Tehran were associated with a higher probability of deliberate self-poisoning (P<0.001 for all the three variables). In addition, having a definite plan for suicide and previous history of a suicidal attempt were significantly related to having real intention to die (Odds ratios 2.52 and 1.87, respectively) Conclusion:  Most hospitalizations in poisoning wards (>74%) involve suicidal self-poisoning. Measures must be taken at all three levels of prevention with special attention to the epidemiology of the problem in different regions.

Objective: This prospective study was conducted to evaluate the characteristics and outcomes of trauma patients attending the emergency department of a university hospital in Ahvaz- Iran (2000). Methods: We identified all trauma admissions due to blunt and penetrating injuries. Data were collected from emergency departments and intensive care log books at Golestan hospital by on-site data collectors. Results: The total number of patients included in the study was 1141; of these, 952 (83.4%) were males. The mean age of the study sample was 26.7 +/- 17 years (range, 1- 84 years). Injuries were predominantly of the blunt type (91.8%), with only a small percentage of penetrating injuries (8.2%). The most common cause of injury was traffic accidents (59%). There were a total of 96 deaths (8.4%), and only a small number had an ISS of ≤ 15. Reflecting the overall mechanisms of injury, most deaths were caused by traffic accidents (71 patients-74%) and falls (16 patients- 16.7%). Conclusion: The high frequency of traffic (especially pedestrian) accidents suggests that considerable effort is required for preventing these injuries.

Objective(s): The Service quality gap is the gap between customer expectations and the perceived quality of the service delivered. The basic step in eliminating this gap is recognizing customers’ perceptions and expectations of service quality and determining the quality gap. The aim of this study was to determine  the quality gap in primary healthcare services in the health centers of Bandar Abbas. Methods: This was a cross-sectional study and the target population consisted of women attending the health care centers of Bandar Abbas. We selected a total of 400 women according to the order of theire attendance. The SERVQUAL measurement instrument was used to determine the gap in service quality. The instrument comprises five dimensions: tangibles, reliability, responsiveness, assurance and empathy. Data were analyzed by the SPSS software. Results: There were quality gaps in all the five dimensions of service quality. The smallest gap (-0.76) was in the assurance and the greatest gap was observed for the empathy (-0.98). There were significant differences between the mean of service quality gap in all dimensions (P<0.0001). Conclusion: The negative gap in service quality indicates that client expectations are higher than their perceptions. Thus, there is a need for improvement across all the five dimensions.

Objective(s): To provide a new, appropriate model for organizational structure of the medical records departments (MRDs) and information functions in hospitals in Iran. Methods: This was a Two-Phase study: the first phase was a situational analysis of the current organizational structure model of MRDs in Iranian hospitals. In the second phase, through a comparative study of three developed countries, the US, England and Australia, a suggested model was developed and its validity was evaluated using the Delphi technique by means of a valid and reliable questionnaire. Results: The first phase showed that the current organizational structure of Iranian MRDs is not appropriate for the efficient management of health care information. In addition, there were no appropriate structures to provide comprehensive information management services. The findings of the Delphi technique showed that most of the experts believed that the restructuring MRDs was necessary and that the majority were agreed the model purposed and considered it to be appropriate and applicable for Iranian hospitals. Conclusion: The restructuring MRDs in Iranian hospitals are necessary and the approved model can improve the health information management processes in Iranian hospitals. Indeed, the implementation of the model is strongly recommended.

Objective(s): Patient satisfaction is an important indicator of quality of care and service delivery. The objective of this study was to examine patients’ satisfaction with the emergency departments in hospitals affiliated to Tehran University of Medical Sciences. Methods: A study was carried out in the emergency departments of five major teaching hospitals (affiliated to Tehran University of Medical Sciences) in Tehran, Iran by trained researchers using a valid and reliable questionnaire. The study included patients who had spent at least 10 hours in the emergency department, who were able to answer the questions without the need for an interpreter, did not have significant cognitive problems, and were well enough to answer the questions. The study questionnaire comprised five sections namely: nursing care, physician care, behavioral concerns, physical comfort and hoteling, and waiting time. The questionnaire was administered in secure and confidential conditions inside the emergency department and in the absence of the hospitals’ medical and non-medical staff. Data were analyzed descriptively using SPSS 13. Results: In all 153 patients were eternal into the study. After dichotomizing the state of satisfaction in each of the five dimensions, the highest dissatisfaction rates were observed in the following domains: nurses’ explanation to patients (73.2%), giving information (54.2%), investigating complaints (40.6%), patient welfare facilities (54.3%), and being kept waiting to receive laboratory services (26.2%) respectively. Only 44% of the patients rated their general satisfaction with the hospital as good or very good. Conclusion: The findings indicate the need for measures to improve services for patients visiting the emergency department and to ensure quality of service.

Objective(s): To define the main criteria for application of simulation in healthcare systems, especially in outpatient settings. Methods: This was a systematic review of the literature. The search involved the use of 3 keywords, namely simulation models, health care systems and outpatient services. Results: The articles were categorized into 3 main groups: - Changes in patients arrival patterns, - Changes in resource allocation methods, - Changes in service delivery processes. The findings are presented in the light of the above headings. Conclusion: Literature show that simulation can be an effective decision-making tool and it can be employed usefully to improve the performance of the health system. It should be kept in mind, however, that a proper information system must be in place to facilitate access to information and to encourage participation by simulation experts and stakeholders such as clients, service providers, and decision makers.

Objective(s): The purpose of this study was to determine the types of waste produced by the research laboratories of the Department of Environmental Engineering at Tehran University of Medical Sciences and to assess the environmental impact of these waste products. Methods: In order to determine the environmental impact, parameters such as wastewater quantity and quality, solid waste production, noise, particulate matter (PM1, PM10, PM25), heat, light as well as the probability of occurrence and significance of impact were monitored in 2006. Results: These parameters were selected for monitoring and analysis of various laboratory types such as chemical, microbiologic and pilot laboratories and those dealing with air pollution. We first classified the environmental effects as those of very high, high, moderate, and low significance. It then emerged that overall, chemical and sewage laboratories were posing a greater environmental danger because they produced three waste materials that have very significant environmental effects. Conclusion: We suggest that the chemical laboratory should be monitored constantly due to its higher rate of hazardous waste production and safety precautions should be put in place to protect staff and students.

Objective(s): Female high school students are among most vulnerable population groups with regard to AIDS because of their age and their high-risk behaviors. This study aimed to assess AIDS literacy among female high school students from two different socio-economic backgrounds in Tehran, Iran. Methods: A cross-sectional study was conducted to investigate about AIDS knowledge and attitudes among female students in Tehran, Iran. Two available high schools were identified and after obtaining consent from authorities, a brief questionnaire was administered to all students. Results: In all, 581 students participated in the study. The mean age of the respondents was 15.3 (SD=0.94) years (ranging from 14 to 17y). Data analysis showed that the subjects had a fairly good knowledge of AIDS. The percentage of correct answers ranged from 33.4% to 96.4%. Also, the majority of the respondents strongly agreed or agreed with statements that “AIDS is a public health problem and people should be informed about the disease” (95.9%) or “people with AIDS should receive support from family, community and the government” (89.0%). Most students indicated that the mass media (including television and newspapers) were their main sources of information on HIV and AIDS (52.2%). Thirty-seven percent said that they need more information on AIDS prevention followed by need for more general information about AIDS (22%) and information about AIDS transmission modes (17.0%). Overall, those from affluent backgrounds showed a better understanding of the topic and there were significant differences in knowledge levels between the two high schools. Conclusion: The findings indicate that in general female students have a fairly good knowledge about AIDS and have positive attitudes towards people with AIDS. However, since female high school students are at greater risk, in order to enhance AIDS literacy among this population, implementation of further health education programs is recommended.