Hakim Journal
Year:2008 | Volume:10 | Issue:4|Papers Count:15

Introduction: Despite the valuable information contained in the Vital Horoscope in regard with monitoring and evaluation of Iranian health system performance, few in-depth analyses of this information are available. We carried out this study to assess the time trend as well as the inequality pattern of health indicators in rural population of Iran applying the information derived from the Vital Horoscope in an in-depth analysis.Methods: Values of nine main health indicators were extracted from the official annual reports of Deputy for Health from 1993 to 2005. We predicted their values for 2006 and 2007 using linear regression and fractional polynomial regression models, and then analyzed the time trends of indicators’ changes. In addition, indicators were standardized with z score method, geographical map of indicators’ distributions were developed for two time bands of 1996-2000 and 2001-2005, and pattern of inequality was analyzed.Results: Under-5 Mortality Rate (U5MR), Infant Mortality Rate (IMR), and Neonatal Mortality Rate (NMR) have had a decreasing trend during the recent 13 years. However, NMR reduction gradient (b=-0.26) was less than that for U5MR (b=-1.60) and IMR (b=-1.16). Percentage of deliveries attended by unskilled persons has decreased by 3.5 times and Maternal Mortality Rate (MMR) has reduced from 47 to 32 deaths per 100,000 live births. Inequality pattern of the former indicator has tended to more homogeneity among the provinces in the latter time band. Proportion of newborns with birth weight less than 2500 grams has increased from 2.9% to 4.6% and has been the only indicator whose average national values has had undesirable increase. Total Fertility Rate (TFR) and family planning coverage have had an appropriate improvement during 1990’s but had a relative plateau thereafter and will have no significant changes by 2007 according to the prediction. Inequality pattern of fertility indicators has had a very negligible change among the provinces, but TFR has somehow tended to more homogeneity among the provinces.Conclusion: Our findings indicate an acceptable improvement in many of the health indicators in rural areas of Iran during the recent 1-2 decades. On the other hand, despite the inequality decrease in some of the indicators in recent years, still inequality remains as the chronic and main problem of rural health system in Iran.

Introduction: Free radicals especially reactive oxygen species can produce some disorders by damaging biomolecules like Deoxyribonucleic Acid (DNA), proteins, and membrane lipids. Lipid peroxidation in Low-Density Lipoprotein (LDL) particles and membranes of hepatocytes are involved in atherosclerosis and liver disease respectively. Non-enzymatic glycosylation of proteins is involved in complications of diabetes. Antioxidant-oxidant system imbalance can result in emergence of free radicals’ destructive effects in long term. We studied the antioxidant effects of a food spice, namely Piper nigrum, on the above-mentioned reactions.Methods: Total extracts of the black pepper were obtained and identified. Hepatocytes of rat were exposed to tert-butyl hydroeroxide (TBH) (1.5 mm) and amount of malondialdehyde (MDA) resulting from lipid peroxidation was measured in presence and absence of the plant extract. Alanine Aspartate Aminotransferase (AST) released from membrane lipid peroxidation was also measured. Glycosylation changes of hemoglobin and LDL oxidation were measured in the presence and absence of the extract and percent of oxidation inhibition was compared with that in control subjects.Results: The results showed that Piper nigrum decreased MDA formation by 17.78% and AST release from hepatocytes by 33.3% at a concentration of 10 µg/ml, and decreased hemoglobin glycosylation by 17.35% and at a concentration of 0.25 mg/ml. The antioxidant effect was very remarkable at the concentration of 1 mg/ml.Conclusion: This study showed that Piper nigrum has a very strong antioxidant effect at applied doses and it can be probably used as an antioxidant and food supplement in diabetic and liver disease patients, and in persons susceptible to atherosclerosis.

Introduction: Infertility phenomenon and especially its psychosocial aspects are very important and recognition of interaction between infertility and these aspects will have a great impact on quality of life improvement. In this study, we determined the prevalence and severity of depression and the effectiveness of psychiatric interventions on the rate of depression in infertile couples referred to Vali-Asr Reproductive Health Research Center of Imam Khomeini Hospital in Tehran.Methods: This research was carried out in two stages. In the first stage, 638 infertile patients were assessed in a cross-sectional study, and in the second stage, 140 volunteer couples were assigned to two groups of intervention (70 couples) and control (70 couples).The intervention group was treated with fluoxetine based on severity of disease, and cognitive-behavioral therapy and supportive psychotherapy for a period of six months. The Beck Depression Inventory (BDI), Stress scales (Holmes-Rahe) and a demographic-social questionnaire was used for data collection. Data were analyzed with t-test, paired t-test, chi-square, and logistic regression.Results: Depressive disorder was detected in 48% of women and 23.8% of men. Prevalence in women was twice that in men. Depression was more frequent in those with primary education, housewife women, 19-25 year olds, middle children of families, subjects with stress (especially severe stress), persons using emotional coping mechanism, and persons who believed ‘marriage is generation’. These relationships were statistically significant (p<0.0001).The results showed that mean of Beck's score diminished from 18.7 (SD = 9.7) in intervention group to 10.7 (SD = 5.8) in control group, that shows the considerable effect of psychiatric interventions (pharmacotheapy and psychotherapy) in reduction of depression symptoms (p<0.0001). Highest degree of this effectiveness was observed in women, 19-25 year olds, housewife women, persons with primary education, low economic levels, and in those with attitude of ‘chance’ to marriage. These relationship were statistically significant (p<0.0001).Conclusion: High prevalence of depression in infertile couples and effectiveness of psychiatric interventions, whose effect was significant in this study, demands serious attention to psychiatric treatment of this group of patients. This will undoubtedly lead to their better mental health and improvement of quality of life.

Introduction: Prediction of drug requirements in the earthquake-beaten areas is necessary for crisis management and program planning. Therefore, this study was performed to assess the real need for different drug groups and the most frequently used prescribed drugs for the outpatients in the first 6 months after the Bam earthquake of 2003.Methods: In this descriptive cross sectional study, data were collected by random selection of 3,000 prescriptions of outpatients who were visited by general practitioners of Emergency Medical Assistance Teams in 12 health care centers during the first 6 months after the Bam earthquake. Data included patients’ sex, number of drugs per prescription, drug categories, drugs’ names (generic or brand), and administration routes. The first 25 drugs with highest use frequency were recorded. Assessment of drug use pattern was done with World Health Organization’s criteria for this purpose.Results: Males constituted 47.4% and females constituted 52.6% of the patients. Mean number of drugs per prescription was 3.5. Oral administration was the most frequent route (81.7%) followed by injections (10.9%). Respiratory drugs (14.2%) were the most frequently used drug group, followed by analgesics and Non-Steroid Anti-Inflammatory Drugs (NSAIDs) (11.3%), antimicrobials (11.2%), digestive system drugs (9.6%) and central nervous system drugs (7%). Penicillins (6.8%), common cold preparations (8%), and systemic antacids (ranitidine and omeprazole) were the most frequently used drugs.Conclusion: Respiratory drugs, analgesics, antimicrobials, digestive system drugs and central nervous system drugs were the most frequently used and needed drugs during the first 6 months after the Bam earthquake. These results can be used as a template for prediction of drug needs after the natural disasters.

Introduction: Healthy women make the society healthy both somatically and psychologically. This study was planned to assess the general health status of female athletes of national teams to recognize the strengths and weaknesses of these national capitals. This will be effective in planning for improvement of health and professional performance of these athletes.Methods: A descriptive cross-sectional study on 156 female athletes of national teams was performed in 2001 with a census method. Specialist physicians recorded information according to history, physical examination, and paraclinic. T-test, chi-square, and correlation coefficients were used in analysis.Results: Mean age was 20.47 (19.53-21.41) years. In orthopedic assessment 96.1%, cardiovascular 74.4%, dental 29.4%, eye 69.2%, and Ear-Nose-Throat (ENT) 66% had no problem in either history or physical examination.Conclusion: Orthopedic status was completely desirable, cardiovascular and ENT were intermediate, visual was nearly and dental status was completely undesirable. Informing and sensitizing managers about the health status of female athletes of national teams can be an effective step in planning for disease prevention, screening, and treatment of athletes. Definitely, their health promotion is directly correlated with their success.

Introduction: Premature newborns are among the high risk newborns. One of the complications of premature newborns is poor weight gain due to late-onset metabolic acidosis, which affects 5-10% of these newborns. These infants are usually healthy and without underlying diseases. This study was performed to determine the effects of oral sodium bicarbonate in low birth weight premature newborns in correction of acidosis and hence, increase in their weight gain and length.Methods: This study was prospective and interventional and assessed 40 healthy newborns with gestational age less than 37 weeks and weight less than 2 kilograms at birth, who where born in hospital affiliated with Shiraz University of Medical Sciences and had late onset metabolic acidosis from second week of birth. Oral sodium bicarbonate (1 meq/Kg every 8 hours) was administered to the case group for 3 weeks or until acidosis was corrected. Increments in weight and length were compared between the two groups. T-test was used for statistical investigation.Results: The average weight gain per day was 15.23 ± 4.96 grams in case group and 8.46 ± 4.8 grams in control group, which was statistically significant (p<0.05). No significant difference was found for increase in length of the newborns (p>0.05).Conclusion: Oral sodium bicarbonate is effective in acceleration of weight gain in premature newborns with late onset metabolic acidosis and can lead to earlier discharge of these newborns and reduction of hospitalization costs.

Introduction: Hospital standards are one of the most valuable conceptual elements in the organization, since they have an important role in depicting the expected performance and evaluation of hospital activities. Previous studies’ results reveal that hospital standards set by Iran’s Ministry of Health (MOH) are not efficient enough in depicting the weaknesses and shortages of healthcare centers, and hence, they need further studies. Therefore, we compared the hospital standards of MOH with those set by the Joint Commission International.Methods: The present research is a descriptive - comparative study performed in spring and summer of 2006. Research environment consisted of the Joint Commission International hospital accreditation standards (216 statements) and hospital standards of MOH (724 questions consisting of handbook ‘A’ with 227 and handbook ‘B’ with 497 questions). Eventually, 335 questions from MOH standards were compared with 216 statements of the Joint Commission International’s standards. Data collection methods were use of the available information on the Net, e-mails (Joint Commission International’s standards), and the relevant references (MOH’s standards). Data were collected using six checklists based on Joint Commission International’s standards and were analyzed with comparative tables and descriptive statistical methods.Results: Final collation of MOH’s standards and Joint Commission International’s standards (335 questions versus 216 statements respectively) showed that the former covered 79 statements (36.6%) of the Joint Commission completely, covered 39 statements (18.0%) partially, and did not cover the remaining 98 statements (45.4%) at all. In other words, correspondence of MOH’s standards with those of the Joint Commission was 36.6% complete, 18.0% partial, and 45.4% without any correspondence.Conclusion: Despite of the greater quantitative aspect of the MOH’s standards for hospitals in comparison with the Joint Commission’s standards, MOH’s standards could not cover almost fifty percent (45.4 %) of the latter. In other words, 98 out of 216 statements of the Joint Commission have not had any equivalent in MOH’s standards for hospitals. This shows the fact that in compilation of hospital standards, MOH has not focused on many of the important items related to patient care process, such as continuity of care, patient and family rights, informed consent, assessment of patients, and education of patients and their families.

Introduction: Blood and blood components preparation, storage, transportation, and transfusion have a specific process each. Therefore, all of these stages have to be continuously supervised. This supervisory aspect will be appropriate when the responsible persons have the minimum necessary knowledge of the transfusion medicine.Methods: In a cross-sectional study, 222 persons from different educational levels (including resident physicians of different specialties, interns, stagers, and nurses) of Imam Reza teaching hospital in Mashhad were randomly selected. A questionnaire containing eight questions was used to assess their knowledge about different aspects of transfusion medicine including storage, transportation, and possible transfusion reactions separately and in comparison with each other.Results: Among the four groups assessed, the highest score (14.6) was for nurses, difference of which with other groups’ scores was statistically significant. After nurses, residents physicians attained the highest score (12.2). Among this group, residents of pediatric, internal medicine, and pathology had higher scores. Among different aspects of transfusion medicine, lowest knowledge of these groups was about settings of blood and blood components storage.Conclusion: This study reveals a low level of knowledge about transfusion medicine among the various medical groups of the assessed hospital. Therefore, it is proposed to include a special educational credit on transfusion medicine in curriculum of residents and medical students. Moreover, a special committee should repeatedly review the various educational aspects and contents of transfusion medicine in the curricula of different educational levels, and update them according to accepted standards.

Introduction: Rapid population growth has been recognized as the most fundamental impediment in economic and cultural development of the world’s countries today. This underscores the importance of attention to reproduction control and family planning, and vasectomy is known as a simple and effective family planning method. We studied the vasectomies performed in Noorsaadat Center from 1997 to 2002.Methods: A descriptive study was performed on 4397 men who underwent vasectomy in Noorsaadat Center. Medical records of all of these persons were studied and intended data were transformed to data collection forms.Results: From the total respondents, 77.9% were illiterate or had low levels of education and 2 1 .6% had high levels or university education; 28.6% were self-employed, 26.8% were public sector employees, 15.9% were blue-collar workers, and 28.7% had other occupations. For 52.8% of the clients, the last child was male and for 46.6% the last child was female. The previous contraceptive method was natural method in 47.4%, condom in 17.4%, 3.1% did not use any method, and the rest used other methods.Conclusion: Rapid population growth, youthfulness of Iran’s population, impressionability of social, economic, cultural, and heaths indicators from population growth, and vulnerability of women from multiple pregnancies, especially the unwanted ones, necessitates serious partnership of men in family planning. Vasectomy can be a sample of this active partnership. This study has descriptively assessed the vasectomies performed from 1997 to 2002 to discover the motivation for vasectomy and identify the modes of getting to know the method, and different promoting ways for encouraging vasectomy, so that more effective steps are taken for promotion and spread of this method.

Introduction: Healthy life expectancy (HALE) for every country is estimable in global and national level studies, in which the used data, methodologies, and hence the estimates’ values are not necessarily completely identical. Therefore, the current study was performed to estimate healthy life expectancy for Iran’s population, with use of the national-level studies’ data and methodologies for the first time.Methods: For estimation of life expectancy for 23 out of 28 provinces of Iran (in 2003), registered deaths for 23 provinces were used. For population of 23 provinces, information from Ministry of Health was used and its distribution was taken similar to the results of Demographic and Health Survey of year 1379 (2000), and taken also equal to results of graduation of population from year 1375 (1996) census. Life expectancy was estimated with direct method. Years Lived with Disability (YLD) was calculated from prevalence of diseases and their disability weights, and used in Sullivan’s method for estimation of HALE.Results: HALE at birth was 62.13 years for total population (95% Confidence Interval [CI]: 61.02-63.16), 61.55 years for males (95% CI: 60.61-62.50), and 62.79 years for females (95% CI: 61.84-63.71).Conclusion: National estimate of healthy life expectancy is 4.5 years higher than similar model-based estimate by World Health Organization. The reason is difference in direct and indirect estimation methods for specific mortality rates and hence the life expectancy, and difference in burden of disability estimation methods used in national and global burden of disease studies.