Hakim Journal
Year:2007 | Volume:10 | Issue:3|Papers Count:11

Introduction: Besides calculation of mortality indicators and prevalence and severity of diseases, measurement of health and assessment of health interventions currently take into account also other human values such as the quality of life; therefore, information about the quality of life in the general population of Tehran can be considered as baseline information to which can be referred in assessment of interventions. The aim of the present study was to assess the quality of life in the general population of Tehran. In this study, the World Health Organization Quality of Life-BRIEF (WHOQOL-BREF) questionnaire was used, whose range of scores in each of its four domains, namely physical health, psychological health, social relationships, and environment, is from 4 to 20, and higher scores indicate better quality of life. This questionnaire is composed of a total of 26 questions.Methods: In this cross-sectional study, 1164 people from the general population of 22 zones of Tehran Municipality filled the WHOQOL-BREF through a multi-stage stratified sampling scheme, and the results were compared with similar information gathered from completion of the same questionnaire in 23 other countries of the world.Results: Mean (standard deviation) of domain scores of the aforementioned questionnaire in the population under study were 14.3 (SD=2.6) for physical health, 13.4 (SD=2.6) for psychological health, 13.9 (SD=2.6) for social relationships, and 12.3 (SD=2.4) for environment. Mean scores of all domains were significantly higher for the participants in the WHO study as a whole than those for participants in this study. In analysis of different age bands, scores of the environment and the psychological health for Tehran's population were significantly lower than those for other parts of the world as a whole and in the same age band. Scores of the psychological health, social relationships, and environment in the group of patients participated in the population studied by WHO were either similar to or higher than the healthy people living in Tehran.Conclusion: Since a representative sample of Tehran's population participated in this study, the results provide useful information on this population's quality of life in different domains. Overall, the differences between scores achieved by Tehran's population and those obtained in other countries for different domains signify the importance of effective interventions in these domains, and warrant consideration.

Introduction: Substance abuse and smoking have crossed many social, economic, and geographical borders today, and are among major health problems that endanger a multitude of population groups including the pregnant mothers because of their untoward maternal and fetal outcomes. This study was conducted to determine the relation between substance abuse and smoking by couples during pregnancy as well as antenatal unsafe drug use by mothers and untoward maternal and fetal outcomes.Methods: A descriptive and analytic cross-sectional study was conducted on 4317 women who had the criteria for admission to postpartum wards of educational hospitals affiliated to Tehran, Iran, and Shahid Beheshti Universities of Medical Sciences in Tehran, and whose pregnancy was anyhow terminated during winter 2003. A questionnaire developed by the researchers was used for interviews and the questions were in four domains of demographic characteristics; obstetric history; smoking, drugs, and narcotic substance use during the recent pregnancy; and untoward maternal and fetal outcomes during the same time. Logistic regression model was used to determine the relation of narcotic substance use, smoking, and drugs, as well as other independent variables with the untoward fetal and maternal outcomes.Results: The mean age of these 4317 women was 25.8 ± 5.4 years, and the mean age of their husbands was 30.7 ± 6.1 years. From the women who participated in this study, 60 of them (1.4%) used narcotic substances, 79 (1.8%) smoke cigarettes, and 616 (14.3%) used unsafe drugs. From husbands of these women, 186 men (4.3%) used narcotic substances and 1486 (34.4%) smoke cigarettes. Unsafe drug use during pregnancy increased the odds of untoward maternal outcome (OR= 1.69, 95% CI: 1.31-2.17) and fetal untoward outcome (OR= 2.58, 95% CI: 2.07-3.22), both significant at the level of p< 0.001. Cigarette smoking by mothers also increased odds of untoward fetal outcome (OR=2.71, 95% CI: 1.52-4.48, p<0.001).Conclusion: Unsafe drug use and cigarette smoking by mothers during pregnancy increases the odds of untoward maternal and fetal outcomes. Therefore, preventive educational programs during pregnancy should focus on reduction and elimination of using such drugs and cigarettes.

Introduction: Agents of measles, rubella, and parvovirus B19 are among the etiologies of skin exanthematous diseases. Due to similarity in appearance of their skin rashes, clinical differential diagnosis is difficult.Methods: The method of choice for diagnosis of active infection with all these three agents is detection of specific immunoglobulin M (IgM) against them by ELISA method. In this descriptive cross-sectional study, 424 sera samples taken from suspected measles cases in different cities of Khuzestan province were analyzed.Results: 8 In the meanwhile, among the measles-positive patients, 104 cases (24.5%) had been previously vaccinated against measles, 55 cases (12.9%) of which had been vaccinated twice, and 49 (11.5%) had been vaccinated three times.Conclusion: Taking into consideration the relatively high frequency of measles among these patients, it seems that the vaccination program against measles has not been much successful in the Khuzestan province. Furthermore, since the majority of measles patients were young adults, it is proposed to revise the time interval between the two doses of the measles vaccine, and inject the first dose in 9-12 months of age and the second dose in pre-school age (4-6 years).

Introduction: The purpose of this research was to determine the most important factors that people in city of Yazd place on in their choice of a physician when they become sick.Methods: A total of 493 males and females of various age and educational groups were assessed through cluster sampling from 25 zones of Yazd city. Data collection was performed using the Hill and Garner's 19-factor checklist with two statements added by the research team. This questionnaire assesses the degree of importance in patients' choice of the physician by three parts of (A) personal characteristics of the physician, (B) physician- patient communication factors, and (C) the quality of medical service, each part of which comprised of seven statements. Statistical methods used were descriptive statistics and Kruskal- Wallis and Mann- Whitney nonparametric tests.Results: Based on the findings, the first seven factors were: knowledgeability and proficiency (personal characteristic of physicians), spending enough time for examination (communicative factor), being particularly attentive to the patient's problem (communicative factor), using competent assistants (service factor), avoiding dealing with other matters during the visit (communicative factor), easing the patient with an initial brief greeting (communicative factor), and avoiding attendance of other patients during the visit (service factor). These seven factors had mean scores of importance above the determined cut-off point (3.5), and while resending in the upper third of the distribution, were expressed as the most important factors in physician choice. All the personal characteristics of the physicians were rated as the least important factors, except knowledge and competency. Moreover, although no significant difference was found between males' and females' opinions, the differences among the age and educational groups in the two parts of communicative and service quality factors were significant (p<0.05).Conclusion: Physicians’ knowledge is of the most important factors that patients place on in choosing doctors. Specific attention to scientific competence, communicative skills, and factors related with the quality of medical services, contribute to more successful performance of the physicians and more satisfaction of the patients.

Introduction: Since only correct and effective Cardiopulmonary Resuscitation (CPR) can inrease the survival probability of patients with cardiopulmonary arrest, assessment and control of CPR performance is of great importance. The aim of this study was to determine the CPR skills of interns in the Shahid Beheshti University of Medical Sciences hospitals.Methods: Forty interns participated in the study and an assessment form with nine indices was used.Procedures of CPR were performed on a resuscitation manikin.Results: None of the participants was completely competent in performing CPR. CPR competency results for three of them were good, for five of them was intermediate, and for 21 was poor. Eleven participants were completely incompetent in performing CPR procedures according to our scoring method. Comparing the results of those who had previously participated in CPR workshop with results of others demonstrated average scores of 26.16 and 12.55 for the two groups respectively.Conclusion: This study underscores the necessity of obligatory CPR workshops for all medical students and re-assessment of their CPR skills. Moreover, establishment of new strategies for CPR education seem inevitable.

Introduction: Comparison of the status of universities with each other is a tool for assessment of the current situation in every part of the educational system and can be used as a planning model in universities. The aim of this study was to design the measurement criteria and to compare the structure, efficiency, and performance of medical schools in Iran, to determine the differences in their educational services, and to identify their relative strengths and weaknesses. Provision of educational services in this study is referred to as all the factors influencing the education of students from enrollment to graduation.Methods: A collection composed of 63 criteria and indicators was designed and categorized in form of a tree diagram. Weights of these indicators were then determined with consensual methods. A representative was introduced by each school for filling the data collection questionnaire. The collected information was complemented and verified through visits to the schools. Afterwards, the score of each school was calculated under each criterion. For final analysis, a computer software package specifically designed for this purpose was used.Results: Tehran Medical School ranked first, with a score of 67.84 out of 100; Shahid Beheshti Medical School was the second with a score of 65.62 out of 100; and Shiraz Medical School gained the third rank with a score of 58.24 out of 100.Conclusion: This study identified the strengths and weaknesses of educational service provision in medical schools of Iran and was disposed to program planners and authorities as a practical model for qualitative and quantitative improvement.

Introduction: Infection with hepatitis B virus (HBV) may result in either resolution of infection or chronic HBV carrier status. Since age at infection influences its chronicity or resolution, the purpose of this study was to assess the prevalence of HBV markers in individuals exposed to this virus.Methods: All the chronic HBV carriers or acute hepatitis B patients who had attended the department of infectious diseases of Babol University of Medical Sciences from April 1993 to September 2005 were identified. Viral markers were assessed in all family members of these cases. The prevalence of HBV markers was compared for sex and age groups.Results: During the study, 1160 males with a mean age of 31±13 years and 876 females with a mean age of 20±12 years were assessed. In males, the prevalences of (HB.S.Ag, anti-HBe), HBeAg, (anti-HB.S., anti-HBc), and isolated anti-HBc were 72.3%, 8.1%, 16.6%, and 3% respectively. In females, prevalences of these markers were 67.7%, 8.9%, 18.5%, and 5%, respectively. There was no significant difference in prevalence of HBV markers between sexes except for anti-HBc (p=0.014). Altogether, persistent infection had ensued in 1603 cases (78.7%) and 172 cases (8.4%) were HBeAg positive.Persistent HBV infection was seen in 73.1% and 70.7% of cases less than 10 and more than 50 year old respectively.Conclusion: This study showed that HBV infection mostly occurs vertically or in early childhood period.

Introduction: Ureaplasma urealyticum genital infection is a sexually transmitted that is involved in non-gonococcal urethritis, prostatitis, epididymitis, and infertility. The organism is seen in infertile couples more commonly than in healthy couples. U. urealyticum infection not only jeopardizes fertility but also poses infertility treatment and the resultant pregnancies at risk. Diagnosis of U. urealyticum infections by conventional bacterial methods is very difficult. The aim of this study was to compare culture with Polymerase Chain Reaction (PCR) for detection of U. urealyticum in semen of infertile and healthy men.Methods: From each of the two groups of infertile and healthy men who referred to infertility treatment center of Rouyan Institute in Tehran, 100 semen specimens were obtained. Regular spermogram was done. Bacterial DNA was extracted with Cadieux method and analyzed with PCR protocol, using species-specific primers for U. urealyticum (urease gene). Bacterial culture was done with broth-agar method.Results: U. urealyticum was detected by PCR in 12 semen specimens (12%) from infertile patients and in three specimens (3%) from healthy men. Result of culture was positive in five specimens (5%) from infertile patients and in one specimen (1%) from healthy men. The volume of seminal fluid, number of sperm cells, and percent of sperm cells with normal morphology were significantly decreased in infertile men. These three parameters were lower in infertile men with PCR positive than in infertile men men with PCR negative results.Conclusion: Since U. urealyticum has a potential causative role in several sexually transmitted diseases, reproductive failure, and neonatal morbidity and mortality, its detection with PCR is important and necessary in infertile couples. PCR is a sensitive method, and it is more rapid than culture for the detection of U. urealyticum in the clinical specimens (<24 hour hours versus 2-4 days).

Introduction: The Persian Gulf War of 1991 started with invasion of Kuwait by Iraq and its military occupation. Authorized by the United Nations, 34 countries of the world attacked the Iraqi troops in Kuwait in January 1991 and forced them to retire. Iraqi forces set fire to Kuwaiti oil fields as they retreated out and more than 600 oil wells were torched. Besides other consequences, this war caused a widespread bio-environmental pollution due to oil spill into the Persian Gulf and pollution of air and water by the chemicals and particulate matter from oil fire. This pollution affected the countries in the vicinage. It seemed that the provinces of Iran which were in the vicinity of the battlefields, as well as those provinces that where in the route of oil fire smoke movement were affected by direct and indirect impacts of this event. Assessment of mortality rates and pattern due to bio-environmental pollution from this war in population of southern Zagross provinces and their comparison with northern Zagross are presented in this article.Methods: This study was performed in spring of 2003 in Bushehr province, southern districts of Khuzestan province, southern districts of Fars province, western districts of Hormozgan province, and Gachsaran district of Kohgiluyeh- Boyerahmad province, which had been in the route of smoke movement according to the available maps (as the case area), and Semnan and Markazi provinces (as the control areas). The estimated sample consisted of 6000 households with residence history of 13 years or more in the studied areas, and was selected through cluster sampling. Current status of all members and the mortality history in the previous 15 years was studied in each household.Results: Eventually, 3246 households in the case area and 3110 households in the control areas were assessed. Number of individuals older than 9 year in these families was 14171 in the case area and 11329 in the control areas. Respectively, 48.5% and 47.5% of individuals in the case and control area samples were male. Mortality rate in children in case area have been higher than control area. Mortality rate in children younger than one in case and control area was 175.9 and 124.4 (per 10000) respectively.Conclusion: Household mortality history assessment revealed that the mortality trend of the 1-9 year old children in the case area from 1990 to 2002 was significantly increasing as compared against the control areas. The 60-79 year age group had consistently higher mortality rates in the case area in comparison with the control areas.

Introduction: Ageing is a process of gradual and spontaneous change, resulting in maturation through childhood, puberty, young adulthood, and then middle age. Not all of the changes that occur with age are deleterious and some of them like increased experience and circumspection are among the positive points of the old age. Iran's population of 60 year old and more has been 7.8% in Demographic and Health Survey in year 2000 and it is estimated to be more than 10% by year 2021. The aim of this study was to assess the health status of elderly workers of Tehran Municipality public services and green space.Methods: In this cross sectional study, health records of these workers were assessed from 2002 to 2005 and their data were analyzed. Altogether, records of 31272 individuals were assessed in this fouryear study. Using the old age definition of 60 year and more, there was a total 6532 elders among these workers. All the analyses were performed for this age group and in comparison with the less than 60- year-old group.Results: Mean age was 67.2 years (SD: 5.3). Smoking was reported by 26.7% of them. The most common complaints about the harmful factors of work environment were disturbing warmth and coldness (83.8%), work-related dust (69.5%), microbial contamination (50.5%), disturbing smell (44%), and risk of accidents and injuries (34%). The most common reported physical signs and symptoms were high blood pressure (30.2%), vision disturbances (27.8%), hearing disturbances (16.8%), cardiovascular disease (15.8%), and joint and extremities pain (15.7%).Conclusion: In comparison of clinical problems' oB.S.erved patterns in this group, some of them like high blood pressure and visual disturbances were similar with national patterns and other problems' pattern were different. In addition, the high proportion of illiteracy in the elderly population in this study necessitates providing facilities for their education at first and using the face-to-face education methods in the meanwhile for improving their health status.