Hakim Journal
Year:2007 | Volume:10 | Issue:2|Papers Count:14

In Iran, the proposal for the admission of bachelor students into medicine has been presented before. Ultimately, in 2003, it was resolved in the “Higher Council of Programming” (HCP) that this admission should be exemplarily performed. As this proposal is still under consideration and its positive and negative aspects have not yet been completely examined, we decided to carry out a comprehensive assessment to define the main motivation for such a change in admission requirements and the best procedure for its implementation.Methods: To achieve the main objective of the assessment, a policy analysis framework was prepared. The first part of this study was a review of literature concerning admission of medical students. The second part of the study was composed of in-depth interviews with policy makers, focus group discussions with graduates, experts of medical education and medicine and science students.Results: All of the study subjects (except one person) pointed to the positive influence of this proposal on strengthening basic sciences in the course of medicine. Five policy makers (out of 7) insisted that a change in the educational content and the curriculum is mandatory to strengthen basic sciences and relevant research. The experts agreed with this proposal and considered it as an effective step for informed choice of medicine as a major and for improvement in the current position of the basic sciences. Almost every medical student agreed that, at present, the candidate’s personal preference and information is not decisive in choosing a medical career. In order to strengthen basic sciences, most of the science students believed more attention is necessary and more budgets must be allocated for research in these fields.Conclusion: On the whole, the advantages of this proposal can be divided into three groups: strengthening basic sciences, a more informed choice of medicine as a major, and finally the possibility of admitting more mature candidates. Although the main motivation of the universities requiring a bachelor’s degree as admission criteria is for the students to make an informed choice, strengthening the basic sciences seems a more important goal for the country.

A rapid progress has been made in all branches of science and technology over the past two decades. This study evaluates the scientific output of Iran in this period.Methods: The data used in this article have been extracted from ISI-Thomsonâ database using Rose-net information network on the Internet. Science production in Iran has been reviewed from 1970 to 2002 and compared with 15 other countries.Results: Science output in Iran had a rising trend from 1970 to 1980; however, it declined and then remained steady as the Iraqi war was imposed on Iran, until it gained a sharp rising trend again some years after the war. A comparison of Iran with other 15 countries until the year 2000 shows that these 16 countries in total have 69.2% of the science output of the world in ISI. The United States, Britain and Germany stand atop the list with 33.2, 7.8 and 7 percent, respectively, and Iran with 0.12% stands on thirteenth place among these 16 countries. China, India, and South Korea maintain a considerable difference and a relatively higher position in terms of scientific output as compared with Turkey, Egypt, Saudi Arabia, Iran, Pakistan, Kuwait and Iraq. Iran is ahead of Pakistan, Kuwait and Iraq, which produce a cumulative 0.16% of the science among these 16 countries. Comparing the ratio of science output to GNP, Iran stands on thirteenth place among 16 countries in the year 2000.Conclusion: Iran has had a considerable growth in presenting articles after the Iraq-Iran war, which marks the period of stability and development.

More than 1/6 of the total population worldwide smoke, and it is estimated that cigarette smoking will be the most common preventable cause of death in 2020. Anti-smoking advice from general practitioners is very effective, and recent evidence-based guidelines urge general practitioners to advise all patients against smoking at every opportunity. This study aimed to identify general practitioners’ knowledge regarding smoking, as well as their readiness to give counseling to their patients to stop smoking.Methods: This survey was carried out using a WHO-based questionnaire. According to sample size estimations, it was given to the 5140 general practitioners selected by quota sampling from all 25600 general physicians registered in the country at the time of the study.Results: Seventy-four percent of the studied doctors were male and 16% smoked, while another 4.6% had a past history of smoking. Thirty percent of subjects felt that they were ready to give counseling to patients on how to stop smoking, but only 9% had received any formal training regarding smoking cessation approaches in medical school or during post-graduate programs, while 80% perceived such training as necessary. Smoking cessation intervention during visits was associated with increased patient satisfaction with their care among those who smoked.Conclusion: Improvement of knowledge and attitude of doctors regarding smoking cessation could have an important impact on reduction of smoking in community and improvement of public health; so, providing appropriate training in medical schools or postgraduate programs is a priority.

Protozoan parasites of the genus Leishmania are the causative agents of leishmaniasis. Clinical manifestations of leishmaniasis in humans range from mild cutaneous lesions to fatal visceral involvement. This study was done to evaluate the therapeutic effects of seven herbal drugs, namely Eucalyptus globulus, Myrtus communis, Ferula gumosa, Artemisia herbaalba, Artemisia dracunculus, Allium sativum and Urtica dioica, on cutaneous leishmaniasis, caused by L. major.Methods: Leishmania major (MRHO/IR/76/ER) amastigotes taken from active lesions were subcutaneously injected into the lab mice (promastigotes isolated from the RPMI medium could also be used). The animals were randomly divided into three groups:1) test group, which were treated by the use of the aforementioned herbs administered locally, twice a day, 2) control 1 which received no treatment and 3) control 2 or placebo group receiving ethanol 96o which was the solvent of the essence or extracts.After the formation of lesions, which took 1 to 3 months following leishmania inoculation, the specimens were prepared, the number of amastigotes was counted and the diameters of the lesions were measured.The treatment was continued for a month. At the end of the treatment period the lesions were sampled and their diameters were measured.Results: The results showed that among the studied herbs, the essences of Eucalyptus globulus and Artemisia dracunculus reduced the diameter of lesions or caused small lesions to disappear completely.There was also a remarkable reduction in the number of parasites, leading to their complete omission in some cases. In the placebo and control groups no change was noticed in the size of the lesions or the number of parasites.Conclusion: The essences of Eucalyptus globulus and Artemisia dracunculus are effective drugs for healing cutaneous leishmania lesions. In order to find the effective substance in these essences, further investigations are recommended.

Musculoskeletal disorders are major causes of work-related disability for many occupational groups. Rapid Upper Limb Assessment (RULA) is a method developed for use in ergonomic investigations of workplaces where work-related upper limb disorders are reported. RULA is a screening tool that assesses biomechanical and postural loading on the whole body with particular attention to the neck, trunk and upper limbs. This study was performed to assess ergonomic postures of car industry assembling unit workers in Tehran in 2004, using RULA.Methods: A sample consisting of 196 workers with 37 postures were selected from assembling units (trim, mechanical and seat installation lines). Ergonomic postures were assessed using RULA.Results: The highest percent of inappropriate postures were in score seven and action level four, in all three lines. No differences were found between the three lines in scores and actions levels.Conclusion: The results indicated that inappropriate postures may be major causes of work- related disability. It is concluded that working conditions and postures need to be improved and changes are required immediately.

Introduction: Physical activity and strength training have the ability to improve muscle mass and bone density, while reducing the risk of osteoporosis. Physical activity level in Iranian women is generally low and it seems necessary to use a behavioral model, such as TTM to plan more effective interventions to promote physical activity.Methods: This randomized controlled study evaluated the effectiveness of a 12-week TTM-based exercise education program, including a progressive resistive exercise prescription and a complementary walking program, on improving physical activity, muscle strength and balance in 116 women aged 40-65.Results: The results implied that before intervention there were no differences between control (n=55) and experimental (n=61) groups. After intervention, the training group had a positive significant progress in stages (c2=76.17, p£.001). Significant improvements in physical activity, muscle strength (58%), dynamic balance (8.53%) and static balance (66.18%) were noted in the training group but not in control group (p£.001).Conclusion: These results support the applicability of TTM for physical activity intervention and indicate that this training program is very effective in improving balance and muscle strength in women.

The aim of this study was to investigate the neurotoxic effects of prenatal morphine exposure on the development of cerebellar cortical layers (CCL) in the mouse embryo.Methods: Female pregnant mice were orally administered 0.1 mg/ml morphine solution on the 17th day of gestation. Pregnant mice were killed afterwards and their fetuses were taken out and were evaluated for growth and cerebellar development. Quantitative computer-assisted morphometric study was done on cortical layers of cerebellum in the mouse embryos.Results: Morphine exposure caused a significant reduction in fetal weight and crown-rump length in the morphine group. Morphometric examination revealed that the thickness of CCL, especially that of the external granular layer (EGL), was decreased in the morphine-exposed emberyos. In addition, neuronal counting showed that cell proliferation in the EGL and internal granular layer (IGL) was suppressed after morphine administration and that the migration of neurons from the neuroepithelial layer to the cortex was decelerated.Conclusion: Morphine is a mitosis inhibitor and causes migratory disturbances of neurons at various stages of neuronal differentiation during cerebellar cortical development.

Strategic policy making in all health care systems should be based on information relating to health utilization behaviors and the factors determining this behavior such as sociodemographic factors, economic and political systems conditions, disease pattern and the care provided in health services.Methods: In a cross sectional study, using a multistage cluster random sampling, 2968 rural households in Guilan in which the household head or senior person was above 15 years old were interviewed using a structured questionnaire. The questionnaire consisted of demographic variables, disease history, and health utilization during the past month. Data analysis was done with SPSS 10 software and c2 tests were used.Results: In this study, 12086 people (family size: 4.7) were interviewed. In total, 1670 persons (138/1000, CI 95%: 135-141 /1000) reported of at least one medical problem in the previous month.Thirty (1.8%) had not sought any medical care and 41 (2.5%) had used self-treatments. The main sources of medical care were private clinics (49.3%), government-run outpatient clinics (38.8%), general hospitals (6.4%), and training hospitals (0.3%). Age group, sex and education affected the utilization of health services.Conclusion: It seems that underutilization of health centers, especially government-run centers, is multifactorial and future studies are recommended focusing on factors affecting health care utilization, causes of low frequency of attending public services and unit costs of these centers.

The prevalence of psychological disorders in different countries shows that these disorders are a substantial part of the global disease burden in many developing countries. According to the WHO estimates, 500 millions people around the world suffer from some kind of psychological disorder and almost half of them have minor disorders like depression and anxiety.Methods: This was a cross-sectional study on employees of fire department in Tehran, Iran. Twentyeight item version of general health questionnaire (GHQ) was applied as a measure of current mental health. Surveys carried out in Iran using this questionnaire indicate that the validity and reliability of this measure are 0.68-0.84 and 0.93-0.94, respectively. In this study, we used traditional ranking with a cut point of 6.Results: Mean age was 34.38 (SD: 9.6), 83.9% of employees were high school graduates, 85.4% of them were official employees, 49.3% had 1-3 family members, 47% were exclusively firefighters and 90% had hand-on jobs. The prevalence of suspected psychological disorders, according to the traditional ranking and cut point of 6, was 15.2% (SE: 0.35). There was a positive, statistically significant relation between the rate of suspected psychological disorders and age, duration of working in current job and the level of education.Conclusion: The results of this study, in accordance with other studies, underscore that the study of mental health provides valuable information for managers, organizations and service providing centers for educational planning, treatment and prevention of psychological disorders.

Risk ratio is usually the parameter of interest in epidemiologic and medical studies. Poisson regression model is an approach used to directly estimate risk ratio. When Poisson regression is applied to binomial data, the error for the estimated risk ratio will be overestimated. In other words, Poisson regression is likely to compute a confidence interval that is conservative. In this paper we aim at devising a modified Poisson regression method to rectify this problem.Methods: To illustrate modified Poisson regression, a simple 2-by-2 contingency table was used. Simple computation was performed to estimate variance. We compared ordinary and modified Poisson regression models by actual data from a study on predictors of coronary artery disease.Results: Application of ordinary and modified Poisson regression methods resulted in an estimated relative risk of 1.68 for hypercholesterolemia. The confidence intervals provided by these two methods were 1.005-2.82 and 1.05-2.68, respectively. The confidence interval provided by the modified Poisson regression was 10 percent narrower than that obtained by the ordinary method.Conclusion: Applying modified Poisson regression to cohort studies with binary data, compared with ordinary Poisson regression, reduces variance and increases precision of the estimated risk ratio. This method might result in different findings from ordinary Poisson regression for borderline statistical significance.

Excessive physical and psychological demands on nurses may lead to high rates of musculoskeletal disorders (MSDs). This study was conducted a) to determine the prevalence of MSDs among hospital nurses of Shiraz University of Medical Sciences (SUMS) and b) to examine the relationship between perceived demands and reported MSDs in different body regions of hospital nurses.Methods: In a cross-sectional survey, data were collected anonymously from 641 randomly selected registered nurses with at least one year of job tenure in nursing from 12 hospitals of SUMS. Nordic Musculoskeletal Disorders Questionnaire (NMQ) and Job Content Questionnaire (JCQ) were used as data collection tools.Results: The large majority of the participants (84.4%) had experienced some form of the symptoms of musculoskeletal problems during the last 12 months. Lower back symptoms were found to be the most prevalent problem among the nurses studied with a past year prevalence of 54.9%. Perceived physical demands were significantly associated with musculoskeletal symptoms in different body regions (OR ranging from 1.5 to 2.7). No association was found between perceived psychological demands and reported symptoms.Conclusion: Based on the findings, it can be concluded that any interventional program for preventing musculoskeletal problems among nurses should focus on reducing physical demands.