Payesh
Year:2002 | Volume:1 | Issue:2|Papers Count:10

Objectives: The aim of the study was to evaluate the factors associated with the selection of IUD as a reversible, safe and effective method in comparison with other contraceptive methods by married women in Pakdasht city. Material & methods: A multicenter clinic-based case-control study was conducted in January 2001. In a direct interview 60 current IUD users (cases) and 83 women using other contraceptive methods (controls), answered to 23 questions. Data obtained from 143 women was computerized and analysis was performed with SPSS and STATA programs. Results: Cases were younger than controls (P<0.01) and it was found that literacy (Odds ratio=2.44, 95%CI=1.44-5.71), history of I.U.D. training (Odds ratio=3.1, 95%CI=1.5 1-6.35), husband agreement(Odds ratio=19.88, 95%CI=4.52-87.8) and fewer number of: pregnancy (Odds ratio =2.79, 95%CI=1.26-6.15), children (Odds ratio=2, 95%CI=1.03-4.0I) and sons (Odds ratio =3.46, 95%CI= 1.54- 7.78) were positively associated with selection of IUD, besides the history of side effects from this method decreased using of this instrument (Odds ratio=0.17, 95%CI=0.4-0.73) . Conclusion: In each country there are unpredictable factors affecting contraceptive consumption behavior. This factors includes cultural condition, religious, epidemiology of diseases, reproductive health, availability of family planning services and economic issues. Therefore, research and investigation about this factor in different regions of each country for decision makers in health system is inevitable.  

Hearing disability in children should be detected early, in order to avoid developmental disorders in language, speech, psychological and social behavior. Objective: To determine Risk factors for sensorineural hearing loss in children. Material & methods: The association of selected risk factors with sensorineural hearing loss was assessed in a case- control study of 396 children aged under 6 years from 1374 to 1376 in Tehran. 200 cases with diagnosed sensorineural hearing loss who were attending to deaf educational centers were compared with 195 controls who were chosen among the nurseries. The questionnaire was used to obtain information about maternal and child risk factors. Results: Multiple Logistic Regression Analysis showed the following factors to be independently associated with increased risk of sensorineural hearing loss in children: positive family history of hearing loss (Odds ratio=11.9, 95%C 1=5.3- 27.2), parental consanguinity (Odds ratio=4.1 ,95% CI=2.2 -7.4), seizure (Odds ratio=6.8 , 95% CI=2.2 20.8), hyperbilirubinemia needing exchange transfusion ( Odds ratio=3.3 , 95% CI=1.05 - 10.7), head trauma (Odds ratio=3 , 95% CI=1.001- 9.1), ototoxic drugs(Odds ratio=3.1, 95% CI=1.4 - 6.8), maternal (prenatal) trauma( Odds ratio=15.9 , 95% CI=1.5 -164.4), maternal (prenatal) rash (Odds ratio= 13.8, 95% CI=1.4 - 136.3) and delivery complication (Odds ratio=1.9, 95% CI=1.003 - 4). Conclusion: We believe that a dramatic increase in the early detection of hearing impairment in early infancy is achievable. Initially, this would best be accomplished by adopting a policy of screening high risk infants. Pediatricians, in particular, must consider earlier referral of high-risk patients.    

In our country, different classes provide dental care services based on oral health status of people and public sectors plans and policies. Manpower estimation of dental care providers needs knowledge about the role of these classes in supplying dental services. Material & methods: This cross-sectional study conducted on about 24000 urban residents through urban population of the country showed relative frequency of providing dental cares by different classes to people's refers. Results: General practitioners with 75.79% were dental care providers who played the most important role in delivery of services in 1377. These results may be due to people's accessibility to different provider classes. Conclusion: Changes in educational programs of dental schools based on community needs leads to efficient and enough dental professionals. Such programs could make a change in people's referral patterns toward the suitable direction. In this condition every person refers to the most convenient dental care provider.    

Objectives: To determine delivery time, types of services and occupation percentage by each service among dentists in Tehran. Material & methods: A cross - sectional study was conducted among the general dentists who work in private clinics in Tehran. 100 dentists were chosen randomly. They filled out a self-administered questionnaire. In order to determine the time spent on each service by the dentists, the median of data was calculated as the central indices. Results & Conclusion: The list of dental treatments was determined by median time for delivering each of them. The useful working time was 90000 minutes for each dentist during a year. The results of this study can be used in planning of dental workforce.  

Objectives: The ministry of health and Jahad daneshgahi conducted a research on integration of breast cancer screening in to the health network as a pilot study in the 1996.The location of this pilot study was Shahrehord, Mobarakeh and Lanjan districts. The objective was to assess the compliance of health network to run this new program. Material& methods: Screening tests were clinical examination and breast self-examination (BSE). Target group was 30 years and older women who were screened for 2 rounds of screening (one-year interval). Target group was examined by Behvarz/ health worker in health network and the suspicious cases of breast lump were referred to general physician. Likewise, the suspicions cases in clinical examination performed by general physician were referred to surgeon. Health workers recommended BSE and general physicians used Fine Needle Aspiration, too. Surgeons used biopsy for definite diagnosis. In 1999, after two rounds of screening (two years), an assessment program was conducted on this pilot study. It is important to note that effectiveness of screening program is assessed by the estimation of mortality rate reduction in about 5-10 years with comparing study (screening) and control (non- screening) groups. Results: Evaluation criteria are: feasibility and effectiveness. 1. Indicators of Feasibility: . Acceptability Acceptability In this assessment is equal to response rate or coverage. The coverage for screening was 66% in the first round and 53% in the second. . Cost-effectiveness Data for this indicator was not available, therefore it was not measured. Proportion of diagnosed cases Percentage of total malignant cases to total biopsies was 7%. - First round: Pick up rate was 28 In 100000 women. Percentage of malignant cases to total biopsies was 15%. - Second round: Pick-up rate was 10 to in 100000women. Percentage of malignant cases to total biopsies was 2%. . Proportion of positive tests who followed, diagnosed and treated Information of treated cases who were diagnosed by surgeons was not available. First round: 92% of positive tests in Behvarz/ Health worker examination were client of general physician (8% Attrition Rate) and 25% of positive tests in general physician examination were client of surgeon (75% Attrition Rate). Percentage of malignant cases to positive tests in Behvarz/ health worker examination was % 0.1. Second Year: 77% of positive tests in Behvarz/ Health worker examination were client of general physician (23% Attrition Rate) and 45% of positive tests in general physician examination were client of surgeon (55% Attrition Rate). Percentage of malignant cases to positive tests of Behvarz/ Health worker examination was % 0.1. 2. Indicators of Effectiveness: . Specific mortality reduction rate in diagnosed cases through screening This indicator was not estimated because there is not cancer registration system in our country. . Reduction of breast cancer staging by screening Stages in first round were 11% (I), 33% (II),33 (III) and 23% (IV). Data of stages in second round was not available. Comparing stages in screening group and control group was impossible because of missing cancer registration system. . Percentage of cases diagnosis by screening Estimation of this indicator was impossible because of missing cancer registration system. Conclusion: As show the results, coverage rate of screening program was low and declining and covered age groups were not appropriate. Attrition rates were high and there was not any appropriate follow-up plan. Attrition cases may be malignant or false positive and they have used and expense in other services in the health system, and their follow-up data was missing, too. Data of effectiveness indicators were not available because there is not any cancer registration system. Implementation of a useful mass population screening program needs to assess  effectiveness of screening because of high cost of program, false positive and false negative cases follow-up. Therefore, the first step for any control program of cancer in this country is implementation of cancer registration system.    

Cesarean Section Prevalence (CSP) is normally affected by medical indications. However, it seems CSPis also affected by patient / consumer's demand. Objectives: A cross-sectional study has been conducted to determine the prevalence and influential factors affecting CSP. Material & methods: CSP has been studied in eight hospitals (two private and six public) during December 1998 to March 1999 in Tehran (Iran). Results :The findings show that CSP were 26.8% and 25.5% in primi-and multi- para woman, respectively. Highest ratios were observed among private hospitals (87.4% and 78.5%). The corresponding ratios for public hospitals were between 14.6-39.2%. Conclusion: The CSP was significantly associated with socio-economic condition, educational and occupational status of the mother (P<0.000). 

Objectives: To study demand and utilization of medical services in elderly and their causes. Material & methods: This investigation is a cross sectional study held in Tehran. Sampling was randomized and 424 multistage elderlies have been selected and their data was gathered by questionnaire. The data included demographic information, medical complaint and the utilization of medical service by elderly. Results: 424 elders aged sixty and more have been studied. These 424 cases were detected among 1416 families with a total number of 5649 members. Thus, the elder made up 7.5 percent of the family members. The result revealed that in 2001, every 100 elders had 283 demands for medical care and 235 cases have received related medical services. Other 48 cases received no services. Also the results revealed: -Significant difference in demand between elders and others (P.value=0.000, Odds ratio=3.28, 95% CI= 2.65 4.06) - Significant difference in demand between different groups among elderlies (P=0.0001). - Significant difference in demand between elder women and men. Conclusion: In this study, every 100 elders had 283 demands for medical care per year. 235 of them had received related services. Cardiovascular, Musculoskeletal and neuro- psychological diseases were the most common disease groups. These results necessitate planning of preventive, treatment and rehabilitation services. Also other results of this study revealed that: - Elder women are at higher risk than men. - Those older than 70 are at higher risk than the other elderlies. Using demand rate, the health sector can calculate work load and estimate the number of health providers required for elderlies.