HAKIM RESEARCH JOURNAL
Year:2009 | Volume:12 | Issue:1|Papers Count:10

Title: The meaning, causative factors, consequences, and future of the integration form the perspectives of the supports and opponents of it Introduction: In Islamic Republic of Iran the medical education and healthcare systems have been integrated for more than twenty two years. We carried out this study to reveal the meaning, causative factors, consequences and future of the integration from the perspectives of the supporters and opponents of it. Methods: Using purposive sampling method we selected four persons from each group of the supporters and opponents. An in-depth interview was performed with each of the participants. The interviews were tape recorded, and then transcribed. The transcriptions were read, coded, and summarized.Results: Almost all of the participants inadequately defined the concept of the integration. The supporters and opponents of the integration had contrasting views on the consequences and future of the integration.The supports believe that the bad “management of the change” was the root cause of the challenges that the integrated system is facing now, but the opponents see the problem in the very nature of the integration.Conclusion: There is still a very wide gap between the perspectives of the supporters and opponents of the integration this country.Lessons Learned: The findings of this study have several significant implications. Leaders of the ministry of health and medical education should bring the subject of integration into the daily discussions and devise suitable systems for monitoring the performance of the integrated system.

Introduction: In this study, validity, completeness, and timeliness of coding in Iran, Tehran, and Shahid Beheshti medical universities were compared.Methods: This is a descriptive-comparative study conducted in the first half of 2007. Research population included medical records of discharged patients of all medical universities located in Tehran, namely Iran (10 hospitals), Tehran (9 hospitals) and Shahid Beheshti (10 hospitals) in the first half of 2006. Data were collected by filling a checklist to determine the rate of validity, completeness, and timeliness of coding. Data analysis was done using descriptive statistics of SPSS and Excel.Results: The validity of clinical coding in Iran, Tehran and Shahid Beheshti medical sciences universities or main diagnosis were 82.2%, 79.46%, 85.05%, for other diagnosis were 80.04%, 75.04%, 89.06%, for main procedure were 85.32%, 80.67%, 85.43%, and for other procedure were 51.86%, 84.80%, 91.3% respectively. The rate of completeness of coding in the above universities for main diagnosis were 93.06%, 96.91%, 97.96%, for other diagnosis were 88.08%, 90.76%, 95.02%, for main procedure were 96.7%, 94%, 98.93% and for other procedures were 93.85%, 97.35%, 95.65% respectively. Among the 33 mentioned hospitals, only 2 of the hospitals of Shahid Beheshti University complied with timeliness of coding. Conclusion: Although completeness of coding has improved in Iran, its validity has not been improved and has some problems. In addition, the timeliness of coding of the majority of hospitals was considerably different from the World Health Organization standards. Thus, essential attempts are necessary for improving coding quality in these scopes.

Introduction: The treatment methods can be determined by paraclinic results. To control the quality of laboratories, laboratory specimens are tested in different countries. In Iran, there are more than 4000 clinical laborites belonged to governmental or non-governmental organizations and they need quality Control. The aim of this study was to determine the quality of laboratory specimens of Chol, HDL, LDL and Tg in four different hospitals in comparison with the reference laboratory.Methods: In this experimental study, 20 patients were selected randomly. From each patient 30cc blood were taken and each sample was equally divided into five parts. The specimens were immediately sent blindly to four different clinical laboratories as well as the reference laboratory. Data was analyzed by Excel and SPSS.Results: The result of each test varied in the clinical laboratories. The results of the laboratory labeled as “d” was different from the others. However, the laboratory labeled as “c” had no significant difference with the others. The highest percentage of Coefficient of Variation (CV) in the tests belonged to LDL with 7.55; and the lowest percentage of CV in the tests belonged to Chol (4.55).Conclusion: It seems that differences in the results may be related to different materials and machines which are used in the laboratories. It can be concluded that automation of laboratory test can be effective in reducing the test errors. In addition, the expert personnel can reduce the errors of test. Training laboratory personnel and calibration of machine is also recommended.

Introduction: After the birth of an infant, profound changes occur in the mothers’ lives. Although all women experience similar physiological changes in the postpartum period, certain factors make these experiences unique. This critical period has long-lasting effects on mothers and their families; appropriate and cost-effective care is an important challenge in this time. Thus, this study has tried to understand mothers' experiences, to provide a desired postpartum care.Methods: This study is a phenomenological qualitative research. After a purposive sampling of 15 postpartum women in hospitals or health centers in Isfahan, an in-depth interview by use of open–ended semi-structured questions was conducted. Colaizzi method was utilized for data analysis.Results: The four concepts extracted from this research are: effective interrelationship, professional care, education and finally, current conditions and available facilities.Conclusion: According to the results of this research, the type of care and support which mothers receive is very important. Therefore, to be able to help the mother and her family to play their influential role with minimum stress, paying attention to various effective factors along with changing the care's strategy from routine care to mother’s desirable care is important in this critical period.

Introduction: Malaria is one the most important health problems in tropical and semi- tropical countries. Each year 300-500 million people are infected and 2-3 million -mostly children and pregnant women- die from it. Currently malaria is the most important parasitic disease in Iran with limited local transmission in southeast, Iran. Methods: This descriptive survey investigates the epidemiologic situation of malaria in six years based on information extracted from the monthly malaria reports to CDC and Malaria Control Department by medical universities of the country.Results: The disease was mainly found in three southeastern provinces. In 2002, 68% of positive cases belonged to these provinces whereas in 2007 it increased to 95%. In 2002, 41% of the infected people were in Sistan and Baluchistan province which increased to 60% in 2007. A 6.5% reduction in malaria positive cases from 2002 to 2007 has been recorded and even with the unsuitable geographical conditions of the southeastern provinces neighboring Afghanistan and Pakistan, the percentage of P.falicparm has had a considerable downward trend from 15% in 2002 to 8.5% in 2007. This great reduction is mainly due to the influence of health system activities in controlling this disease and the improvements in diagnosis and treatment.Conclusion: It seems that with the help of political support and the effective work of employees of the various sections of health Department, malaria will be eliminated in Iran. Of course we can not ignore the negative effect of malaria infection in Pakistan until the malaria control program improves there.

Introduction: One of the most important issues in tobacco control is to organize smoking cessation programs. It is necessary to find nicotine dependency in smokers to be able to choose the proper treatment method; this is found by Fagerstorm Test. For easier assessment of cigarette dependency, this study was designed for the first time in Iran.Methods: This cross-sectional study was carried out during 2006-2008 in smoking cessation clinic of Tobacco Prevention and Control Research Center affiliated to Shahid Beheshti University of Medical Sciences. All the entrants of a four-session per week program of smoking cessation, have been assessed by Firestorm Test by a physician. Those who quit smoking were followed after 6 and 12 months.Results: 822 participants (72% male) with mean age of 42.5±13 years (range: 18-86) were studied. 71% of them were married. The mean score of Fagerstrom Test for 754 persons was 5.8±2.6 (range: 0-10, frequency of 0: 4%, frequency of 10: 6%), with median of 5 and mode of 8 (106 persons, 14.05%). The scores of 218 persons (29%) were below 4 (low dependency), 38% were between 5-7 (medium dependency) and 33% were between 8-10 (high dependency). Pierson Coefficient between total score and the first question (first time smoking in the morning) was 0.82. Besides, evaluation of Kronbach α in first question omission had maximum effect (-0.10) on the test result.Conclusion: Smoking during the first 5 minutes in the morning had the most important effect on finding high nicotine dependency.

Introduction: This study investigated the effect of mandatory seat belt use legislations on reducing traffic injuries and the intensity of road traffic injuries (RTIs).Methods: Data on RTIs from one year before untill two years after the implementation of mandatory seat belt use legislations were obtained from the police department. After data cleaning and stratification, RTIs and mortalities of the first and second year after the implementation of mandatory seat belt use legislations were compared with those in the year prior to the intervention.Results: The results showed that traffic mortalities consisted 13% of all RTIs in the year prior to the implementation, while it decreased to 9.7 % (95% CI: 9.6-9.9) and 11.4 % (95% CI: 11.3 -11.6) in the first and second years after the implementation, respectively. The trend of mortality reduction was not consistent in the two years, as we observed a slight increase in the proportion of mortalities in the second year after the implementation of mandatory seat belt use legislations, though it did not reach the level of the year before the implementation of this law.Conclusion: Our findings suggested that the mandatory seat belt use was efficient in reducing the intensity of RTIs and it was also efficient in reducing the crude number of RTIs. However, in the second year after the implantation, the efficiency of this intervention reduced.