Hakim Journal
Year:2003 | Volume:6 | Issue:2|Papers Count:16

The involvement of families in the care of chronic and serious mental patients is one of the principles of every mental health program. In this regard, assessment of the burden and needs of these families to different care services is of special importance.Twelve hundred of main caregivers of the patients (schizophrenia, bipolar mood disorder, major depressive disorder) from 6 psychiatric centers in Tehran were enrolled to the study. The instruments were FBIS (family burden interview schedule), MRSS (Morningside rehabilitation status scale), and "the caregivers needs to care and therapeutic services" questionnaire. Chi square, regression and pearson correlation coefficient were used for data analysis.The results showed that short-term hospitalization, rehabilitation and follow up services are rated among the primary needs of the caregivers while institutionalization of the patients was the last. The burden of the caregivers of schizophrenic patients was higher than the two others (p<0.05). Disruption of family leisure and using up another person’s holiday, disruptive family interaction and suffering from patient’s illness (as a subjective burden) were the most prevalent causes of the burden in the family. The negative and positive symptoms were correlated with the severity of the burden and needs of caregivers (p<0/05).Family is an important and reliable source to care of chronic and serious mental patients. In programming the national mental health policies, priority must be given to the needs of caregivers and to development of rehabilitation, education and short-term hospitalization services.

Dissertation writing is a suitable opportunity for students to become familiar with performance of research processes during study years. This study was conducted to compare the quality of medical students’ dissertations of 1991-92 academic years, with that of 1998-99 in 14 medical schools of Iran.Eight hundred and seventeen dissertations (1991-92=410, 1998-99=407), were chosen randomly from 4240 dissertations. The original copies of dissertations were evaluated and scored using a questionnaire. Data were analyzed by using Mann-Whitney, Kruskal-Wallis, t test and Chi-square tests.The study showed that, the median score of medical students' dissertation in 1991-92, increased from 105 to 288 in 1998-99 academic year (P<0.001).Although the quality of medical students’ dissertations has been improved considerably in this period, it is a long way to reach optimal status. It seems we have to implement new strategies so that students involved in researches, have an environment full of creativity and competition to improve the quality of researches. This needs a fundamental reform in long- term planning for medical education in Iran.

Costs of cardiovascular therapeutic care compromises a great economic burden, both for the patient and the health and insurance systems due to the future loss of capabilities and performance defects of the patients. For a proper managing decision to be made, detailed information would be necessary.In a retrospective descriptive-analytical study, 2304 cardiovascular cases of the Isfahan University hospitals during a 6-year period were studied. A stratified sampling model was adopted for case selection and a sample size of 384 patients were randomly selected among the total patients in each year. The costs of the different modalities and admission rates were calculated according to each patient group during the 6 years period. The mean admission cost of one MI patient was 101955±21492 Rs and this charge for a chronic ischemic heart disease was 97654±18712 Rs, for hypertension 162824±42196 Rs, congenital heart disease 197451±113341 Rs, a patient with arrhythmia 108411±27502 Rs and for a congestive heart falilure patient the mean cost was 98015±16305 Rs. Pace maker implantation, CABG and valve replacement were the three most costly interventions. The increasing trend of economic burden suggests a sum of 400,000,000,000 Rials to be devoted to cardiac patients in the year 2004 in the country. Prevention could be an effective method for cost containment and increasing cost-effectiveness of the health care for these patients.

Oxygen is used as an acceptable therapeutic option. One way of oxygen-therapy is application of humidifier, but unfortunately contamination of humidifiers may infect patients. Survey of microbial contamination of oxygen humidifier reservoirs in selected hospitals of Tehran was the purpose of this study.One hundred and thirty samples of water in humidifiers from three general hospitals in Tehran were collected. Prevalence of microbial contamination and its severity was assessed by colony count. These samples were from internal medicine, ICU and CCU wards. All samples were inoculated on Brain-Heart Infusion agar and colony counts were performed. The pure colonies were subcultured and isolated strains were determined by microbiological methods.Results showed that the rate of contamination was 90%. Mixed microbial contamination was evident in 56.5% of the samples. The contamination rate was varied from 63.6% to 100% in different wards. Colony counts were changed in the range of 100 to more than 105 CFU/ml. There were more than 105 CFU/ml in 23.2% of samples. The most common isolated strains were Staphylococcus saprophyticus, Proteus spp, Acinetobacter spp, E.coli, S.aureus, Diphteroid spp, Fungi, and Pseudomonas aeruginosa.According to the high incidence of contamination in humidifiers, especial attention is needed to prevent transmission of infection by these instruments.

A cross-sectional study from July through November 2000 was made in the south of Tehran to determine bacterial contamination in ice-creams produced by traditional ways and handmade fruit juices including carrot juice and coconut milk. Samples were taken from every other unit (confectioneries and workshops). The EPI-info software was used for analysis of the data. The results showed that 75% of ice-creams produced in confectioneries and 94.7% produced in workshops, as well as 94.6% of carrot juice and 87.7% of coconut milk samples were contaminated. The study revealed that 84% of shopkeepers did not observe personal hygiene, 97.7% of them did not use hygienic instruments, 87.2% never paid any attention to hygienic measures when constructing their shops, and 56.4% never took hygienic percautions when preparing food stuffs.According to this study and the previous study we suggest that appropriate technology for food preservation and industrial modification for food products such as ice-cream and fruit juice should be taken into consideration. In this way we can prevent the production of non-industrial food stuffs, ice-cream, coconut milk and carrot juice. On the other hand training of the personnel involved in food preparation about some subjects such as personal hygiene, healthy precedures in the buildings, healthy food preparation and healthy procedures about worktools should be taken into consideration and be studied throughly. Activities of the shops and groceries that don’t meet healthy procedures should be prevented.

Because of the world wide spread of infectious mycobacteria, awareness of quantity of community contact with this microorganism is a necessity. Serologic assays are one of the major tools for determining the history of contact and contamination of people with mycobacteria.We used an enzyme-linked immunoabsorbent assay (ELISA) test to assess serum antibodies IgG and IgM against antigen 60 (anti-A60). These tests were applied to 542 healthy blood donors reffering to Kermanshah Blood Bank.Out of 542 healthy individuals, 280 cases (51.7%) were negative for anti-A60 IgG, 112 cases (20.7%) were suspicious and 150 cases (27.7%) were found positive. Out of 542 healthy individuals, 399 cases (73.6%) were negative for anti-A60 IgM, 58 cases (10.7%) were suspicious and 85 cases (15.7%) were found positive. There was no meaningful correlation between area of living, history of BCG vaccination, level of education, job, financial status, sex and mean rank of serum concentrations of IgG and IgM (P>0.05). There was a meaningful correlation between ages of blood donors and their IgM serum (and not IgG) level (P<0.001). The least seropositive cases (21.18%) were found in the first age group (17-24 years old). In the second age group (25-34 years old), the seropositive cases were greather than the other two groups. Among seropositive cases, 45 persons (52.94%) were in the second group. The least seronegative cases were found in the third age group (88 cases). These individuals (166 cases) covered 84.7% of population of the third group and 41.6% of seronegative cases. Additionally, the first group included the least suspicious cases (12 cases) and seropositives (18 cases). In general, the most members of each group were seronegatives. Determining the correlation between age and serum IgM, we evaluated the correlation between age and other variations. Among the variations, there was a meaningful relation between age and job; mainly, members of the first age group were soldiers (49 cases-25%), students (45 cases-23%) and unemployed persons (24 cases-12.2 %(.We suppose that considerable presence of anti-A60 IgG and IgM antibodies are because of endemicity of mycobacteria in the area. At this situation, a considerable number of people, suffer from inapparent infections and are in a "persistent state". By the way, A number of positive results can be considered as a false positive results (because of community of A60 among mycobacteria and cross-reaction of A60 among mycobacteria). So we recommend changing the serumic dilution and cut-off point of the test before doing the same study in our country. We suggest that the higher number of seronegaitves in the first group age may be due to their contact circumstances with mycobacteria and quality of their humoral immunity function.

Hemophiliacs are at a greater risk of contracting all kinds of hepatitis especially hepatitis C because of persistent consumption of blood products. Nowadays, an effective vaccine to prevent hepatitis C is not yet available and post transfusion transmission of this virus has remained as a problem. In this study we tried to survey the prevalence of HCV and its risk factors among a group of hemophilic patients in Iran.In a cross sectional study, we evaluated nearly all of hemophilic patients who referred to Iran Hemophilia Society from 20 march 2000 to 20 march 2001. The seroprevalence of antibodies to hepatitis C (anti-HCV Ab) was studied with anti HCV enzyme linked immunosorbant assay (ELISA), and confirmed with recombinant immunoblot assay (RIBA). HBs Ag, HBs Ab and HIV antibody in the samples were detected as mentioned above. The study was performed on 176 hemophiliacs. Out of them, 106 patients (60.2%) were anti-HCV Ab positive. There is no significant relation between seropositivity for anti-HCV Ab and sex, age, marital status, type or the severity of bleeding disorder, type or number or duration of the product consumed and family history of hepatitis in our patients. Also, there is no significant relation between anti-HCV seropositivity and HBs Ag seropositivity in patients, but seroprevalence of anti-HCV Ab was significantly higher in HBs Ab positive patients compared with HBs Ab negatives (P=0.038). Four patients were HIV Ab positive, and all of them were positive for anti-HCV Ab, too.A high seroprevalence for anti-HCV Ab was detected in patients with hemophilia in our study. Whereas a number of effective strategies, including donor screening and especially viral inactivation procedures for concentrates and recently use of recombinant factor therapy, have been implemented in the world in order to prevent the transmission of viral infections due to blood or blood product transfusion. Surely the use of such strategies can reduce the prevalence of viral disease like viral hepatitis and AIDS in our hemophiliacs.

Everyday, 7000 youth (10-24years old) are infected by HIV according to a WHO report. Educational interventions, such as school- based programs are one of the best defenses against the spread of AIDS. Hence, to assess students knowledge of HIV/AIDS and to evaluate the effectiveness of education, the present study was designed and implemented.This is a quasi-experimental study which was conducted in public high schools of the third educational region of Tehran metropolitan in 2002.Using random stratified sampling method a total of 246 students were selected and findings were analyzed using SPSSFW.The results implied that in case group, before the intervention, 50.6% had very good HIV/AIDS knowledge comparing to 93.3% after the intervention. Paired t-test showed that knowledge scores of case group were significantly different before and after the intervention (p=0.000) while there was seen no statistically significant differences in the knowledge scores of control group from pre-test through post-test (p=0.151).It is recommended to implement high school HIV/AIDS educational programs in order to assist to these students, who are one of the high - risk groups for HIV/AIDS and are in a modifiable stage in terms of beliefs, attitude, and behaviors; because, knowledge is one of the prerequisites of beliefs, attitude and behavioral change.

Since the age to start smoking has decreased in societies and smoking prevalence has increased, studies must be carried out in order to evaluate the knowledge, attitude and practice (KAP) of youngsters about smoking to perform proper programming. The present cross-sectional study was formed on 19-25 year old youngsters of the Isfahan and Najaf-abad cities. Subjects studied were 1315 persons (49% male and 51% female) selected using a randomized multistage sampling method. A questionnaire was completed by trained health care workers. The questionnaire included demographic information and questions about KAP (knowledge, attitude and practice) in the field of smoking. Data were statistically analyzed using Chi-square, Logistic regression and independent t-test.The mean score for knowledge and 8.34±1.97 and for attitude 15.39±2.43. Regarding knowledge, there was no significant difference between men and women but regarding attitude, the difference was significant (P<0.0001) and at high school level of education and higher the difference in both fields was meaningful (P<0.0001). But no difference was seen between rural or urban societies. In respect of practice, 11.8% of youngsters smoked (22.5% men, 6.0% women) and the most prevalent product was cigarette (88.9%) with an average 10 per day. The age for starting smoking among young men was 17.3 ±1.6 and in young women 20 ±2.9. Sex, smoker parents and education level had a reasonable relation with youngsters’ smoking habit, respectively.Considering the results of the present study, knowledge and attitude of youngsters about smoking was good unlike the practice that wasn’t acceptable in men.In respect to smoking hazard, widespread training programs should be designed even in primary school in order to prevent smoking and also to stop smoking once it begins.

The effects of oral contraceptive treatment, on pregnancy rate were studied through a randomized clinical trial on 20-35 years old infertile women undergoing IVF/ICSI with Long protocol in Valie-Asre Hospital, Reproductive-health Research Center. One hundred and twenty eligible patients randomly assigned into two groups after getting informed consent. The patients in control group were treated with GnRh agonist initiated in the 21th day of menstrual cycle. Then they received HMG from the 3rd day of next cycle, based on sufficient criteria of pituitary suppression. The case group was given OCP (LD) 1 daily which started on 5th through 21th day of menstrual cycle. The GnRh agonist was begun on 21th day and treatment were continued the same as the control group. Two groups were similar regarding age, type and duration of infertility.No significant difference was seen between the control and case groups regarding to the mean of HMG ampoules. The mean days of receiving GnRh agonist in the cases was significantly lower than controls (20.1± 3.9 days versus 22.2±4.3 days, P=0.006). The frequency rate of ovarian cysts and hyperstimulation syndrome was similar in both groups. The pregnancy rate per cycle was 18.3% in the intervention cases and 16.7% in controls without any significant differences. There were no significant differences in abortion and full term pregnancy rates between these two groups.

The main purpose of this study was to determine the effects of Ocimum basilicum (OB) expenditure on blood lipids levels in NIDDM patients.In this clinical crossover trial, 16 patients with NIDDM, who were referred to the Research Center for Diabetes in Yazd, were studied for ten weeks. None of these patients were using hypoglycemic drugs.An estimation of the amount of energy, carbohydrate (CHO), protein(Pro), fat, and fiber intakes was done using 3- days food record questionnaire and data analyzed by Food Processor II software. Also, before and after each period, the levels of serum cholesterol, triglyceride, LDL and HDL were measured after 8 hours fasting. The patients during two different periods of 4 weeks, with an interval of 14 days between each period, were consuming either their own regular dietes or OB (in the form of dry powder, 20 gram daily) with their own regular diets.Results indicated that, the mean values of CHO and fiber consumed during the second regimen were significantly more than the first regimen (242.9±47.1 vs. 204.8±48.4, P<0.01 and 20.9±5.6 vs. 9.6±8.5, P<0.001). The mean fasting total serum cholesterol level at the end of the period using OB with regular diet decreased significantly when compared with the basic values and also with the regular diets (181.1±18.4 vs. 199.5±26.9, P<0.001 and 181.1±18.4 vs. 196.2±32.7, P<0.05). The mean fasting total serum triglyceride and HDL level at the end of period using OB with regular diet did not change significantly when compared with the basic values and also with the regular diets.The mean fasting serum LDL level at the end of the period using OB with regular diet decreased significantly compared with the basic values and also with the regular diets (102.9±18.6 vs. 120.1±24.1, P<0.001 and 102.9±18.6 vs. 117.5±24.5, P<0.05).These findings indicate that using Ocimum basilicum with one’s regular diet has medical benefits in metabolic control of NIDDM patients.

A major cause of early failure of prosthetic joints, particularly total knee prostheses, has been reported to be wear of the articulating surfaces and release of wear debris in patient’s body, which is mostly related to the joint contact stresses. In previous studies, the variation of the contact area has been always analyzed in knee extension and semi-flexion positions. We studied the contact area of femoral and tibial components of commercial total knee prosthesis across the whole range of knee flexion, including deep flexion, using casting technique. The femoral component was fixed rigidly on a horizontal shaft beneath of a compression testing machine, being able to rotate with the shaft and provide a full range of knee flexion angles. The tibial component was mounted, with enough laxity for abduction –adduction rotation, on the end of a vertical rod at the moving cross head of the testing machine. At each flexion angle, the surfaces of the femoral and tibial components were covered with silicon rubber solution, then a compressive load of 2000 N was applied to the joint for 5 minutes and removed following the setting of the silicon. The silicon casts were then photographed to obtain the contact areas of the tibio-femoral joint at different flexion angles.The contact area appeared to be almost consistent between 0 to 90 degrees knee flexion with a mean of 173 mm2. The maximum and minimum contact areas were found to be 247 mm2 and 72 mm2, occurring at 120 degrees and 140 degrees of knee flexion, respectively. The mean contact stresses were obtained across the range of knee flexion, using the measured contact areas and appropriate force data from the literature. The contact stress had a maximum of 7 MPa at early knee flexion and 21 MPa at semi-flexion, but increased to more than 68 MPa at 140 degrees knee flexion. These results approve the clinical suggestion that the physiological activities which include deep knee flexion are critical for knee arthroplasty patients.  

Application of electromagnetic fields like continuous shortwave diathermy (SWD) has been used in physical therapy departments.In this study, three groups of pregnant Sprague Dawley rats were exposed to an incident power density of 10 w/cm for 210 minutes at 27/12 MHz during different periods of gestation. First group of pregnant rats (Experiment 1) from day 0 through day 6 of gestation, second group of pregnant rats (Experiment 2) from day 7 through day 13 of gestation and third group of pregnant rats (Experiment 3) from day 14 through day 20 of gestation were exposed to SWD. Three maching control groups (Sham) were irradiated for 210 minutes at 0 power density. Additional control groups of pregnant rats received no treatment. For evaluation of bone formation and skeletal malformations of rat embryos, morphometric study was performed on the tibia of of the embroys.Findings indicated a reduction in the formation of bone tissue and a reduced development of the tibia in the treated embryos. Morphometric study confirmed a significant reduction in total volume of tibia together with changes in its volumetric composition resulting from reduction in bone formation, cartilage formation and cartilage resorption in treated groups specially in Experiment 2.Reduction of observed bone formation appeared to be caused by SWD induced hyperthermia in the treated groups specially in Experiment 2. However, it seems possible to describe some effects of specific action (non- thermal effects) of SWD occurring independently of the rise in temperature.In conclusion, continuous shortwave diathermy (SWD) can act as a teratogene in pre- and post-implantation periods to reduce osteogenesis in embryos.