HAKIM RESEARCH JOURNAL
Year:2005 | Volume:7 | Issue:4|Papers Count:8

Introduction: Clustering is a statistical technique that can be applied in multivariate data, lead to identifying homogeneous and similar groups of individuals, objects, ..., and all 'subjects', based on common characteristics that have recorded or measured related to these subjects. Different clustering methods include: hierarchical, non-hierarchical and fuzzy. Fuzzy clustering method have useful characteristics in related to extract of more information and solve of problems that occurs in two other methods, hence, this technique recently has been more expanded. In this paper with use of fuzzy clustering technique, provinces of country are clustered or in fact homogeneous provinces of country are identified based on health and demographic indices. Methods: Four groups of indices used for clustering were: 1) household health service, 2) family planning, 3) fertility women and 4) health and community children. These indices were extracted from DHS(Demographic and Health Survey) design done by the Ministry of Health, Treatment and Medical Education in 2000. Based on each of these indices, similar provinces were identified. Results: Classification showed that standing in a certain cluster based on one indices group cannot necessarily determine being in the same cluster based on other indices groups. The reason for this, might be due to deference in demographic, social, cultural and economical status of the population under study. Conclusion: Results of this research are useful in running and rendering of health services proportional to situation of homogeneous groups of provinces by health officials.

Introduction: Hydatid disease is an important medical problem in tropical countries and waste many economic resources. Methods: A retrospective chart review conducted at three educational hospitals in Mashhad City (between September 1980 and August 2000 in Imamreza and Ghaem hospitals and between September 1983 and September 2002 in Omid hospital) revealed that 1759 patients with infection due to Echinococcus granulosus diagnosed by tissue biopsy. Results: Among these patients, 1005 cases were female (%57.2) and 754 patients were male (%42.9). The most common age decade was 20-29 years. In our report, the most common sites of hydatid disease (HD) were lung 788(%44.8) and liver 693 persons (%39.4). Liver involvement in women and lung infection in men were more common. Liver involvement was more common in older age than lung. Unusual sites of the disease included spleen (%1.8,), kidney (%1.95) bones (1%), heart (1 case), brain (0.2%), peritoneum (2%) and skin (%0.2). Single organ involvement was seen in the majority of patients and 42 cases had multiple involvement, including liver and lung, liver and spleen and etc. Conclusion: Because of high prevalence and different organ involvement in hydatid disease, it is necessary to concerning hydatid disease in any cystic lesion of body. In hydatid lesions of lung, screening of liver involvement is suitable.

Introduction: Helicobacter pylori (HP) is the most common etiologic cause of gastric and duodenal ulcers. HP eradication, may cure peptic ulcer diseases. Optimal regimen should have, an eradication rate superior to 90%, simplicity, short duration, safety and low cost. This study compares the optimal duration (14 days versus 10 days) of furazolidone, amoxicillin, omeprazole, bismuth regimen. Methods: The patients of this study enrolled from gastroenterologic clinic of Imam Khomeini hospital in Tehran and an ambulatory gastroenterologic clinic of Rasht. Patients with endoscopically proven gastric or duodenal ulcer were biopsied and HP infection was diagnosed with giemsa staining and positive rapid urease test. After taking written informed consent, patients were randomly and single-blinded assigned to I4-day and IO-day groups. Treatment regimen for both of them was furazolidone 200 mg/BD, amoxicillin 1 gr/BD, bismuth subcirate 240 mg/BD and omeprazole 20 mg/BD. Drug compliance was determined by pills count. Endoscopy and biopsy were performed 6 to 5 weeks after treatment and HP infection was evaluated Data were analyzed by SPSS/9 soft- ware. Student t- test and Chi-square  (χ2 ) were used and P value less than 0.05 was considered significant. Results: 54 patients enrolled in 14-day group and 53 in 10-day group. Two patients of 14-day group were excluded because of drug intolerance. Four patients (two of both groups) did not return for follow up. There were no significant differences between mean age, sex ratio, smokers and clean based ulcers in both groups. Ulcer healing rate was 96.2% in 14-day group and 88.7% in 10-day group after treatment, Hpylori eradication rate was 72.2% in 14-day group versus 67.9% in 10-day group, side effects were seen 62% in 14-day group and 49% in 10-day group that all these differences were not significant. Infection was eradicated in 61.5% and 38.9% of smokers in I4-day and 10-day group, respectively that showed no significant difference. Conclusion: According to this study, there was no significant difference between HP eradication rate of 10-day and I4-day regimen. It is recommended that large comparative trials should be designed to define optimal duration by the aim of superior to 90% eradication.

Introduction: Job satisfaction is one of the indices reflecting the effectiveness of management and leadership in each organization. With the application of participative leadership to increase feeling of job satisfaction among the nursing staff, managers can eventually enhance staff efficacy, productivity and commitment to organization, which in turn, will lead to the promotion of better services to patients. The aim of this study was to identify the leadership styles used by managers, to determine the extent of job satisfaction among employees and to suggest effective leadership styles to managers. Method: The study was based on a descriptive-co relational design. Data was collected using questionnaire. The sample comprised 400 managers and nurses employed at different treatment facilities affiliated to the Tabriz University of Medical Sciences. Results: Findings revealed that 54% of managers utilized authoritarian leadership and 72% of the staff reported job dissatisfaction. Furthermore, there was a significant relationship between mean leadership and job satisfaction score (r=0.65, P<0.001). Conclusions: In the organizations where managers involve personnel in making decision regarding affairs relevant to them or created a consultative environment for them, job satisfaction among staff is high. Therefore, managers of nurses are advised to involve their staff in goal setting and decision making and create a consultative environment so that the staff may experience greater job satisfaction and organizational commitment and ultimately, provide better quality services leading to greater patient satisfaction.

Introduction: Health care delivery system and payment type, have a lot of effects on patient referral and for reasons of high therapeutic costs and resource limitations in health care delivery systems and necessity to investigate the ways of improvement efficacy and effectiveness, this study was conducted on three health care delivery systems. Methods: In this descriptive study, 1036 patient covered by Imam Khomeini Committee welfare, rural health insurance and open referral received cares in public and private sectors, randomly selected. For gathering the data relevance to study specific objectives and self- referral investigation in three health care delivery structures, interview and questionnaire were used. Also patients opinions about self- referral factors were asked. For data analysis descriptive and analytical statistics were used. Results: The study showed that in Imam Khomeini Committee welfare (closed loop referral system) 6.8 % patients were self- referred, in rural health insurance (semi-closed loop referral system) 29.7%patients were self- referred and in open referral system 75.5 % patients were self- referred. Also in this study 50% patients believe that specialist skills and 42% waste of time are the factors cause self- referral. Conclusion: This study indicates needs for review and revise and renew health care delivery systems in Iran.

Introduction: Lactobacilli are the most frequent normal microflora in human's gastrointestinal tract and found in feces. The aim of this study was to isolate lactobacilli from feces of children aged between 6 to 24 months who were breast-fed, formula-fed or both and determine their inhibitory effect on enteric pathogens (E. coli, Salmonella, Shigella). Methods: Samples from 100 infant feces were collected and cultured on MRS medium. Lactobacilli were isolated and identified by standard methods (morphology, microscopic shape, fermentation of  carbohydrates and biochemical tests). The growth of isolated bacteria at different temperature, pH and the inhibitory effect by spot on the lawn, blank disk and well diffusion on enteric pathogens (E. coli, Salmonella, Shigella), resistance to common antibiotics and bile were examined. Results: The isolated bacteria were L. fermentum, L. plantarum, L. rhamnosus, L. gasseri, L. reuteri, L. crispatus, and L. acidophilus. About 67% of lactobacilli were isolated from breast-fed children, 18.75% from formula-fed children and 13. 75% from breast and formula-fed children at the same time. Conclusion: Our results show that the number of lactobacilli in the feces of breast- fed children is predominant. It may be substances in breast milk that help better growth of lactobacilli and by producing more inhibitory substances can change the entric pH that inhibit the growth and prevent the incidence of disease such as diarrhea. Hence, breast feeding is recommended. On the other hand, the inhibitory effect of substances from isolated lactobacilli from infant feces with breast - fed children was stable at low pH, high temperature, different concentration of bile salts, so, they might be considered as probiotic bacteria.

Introduction: From clinical point of view, study on the effects of sex steroid hormones on insulin secretion and sensitivity is important in related disorders treatment. Therefore, the main purpose of the present study was to clarify the effects of sex steroid hormones on insulin sensitivity in rats. According the roles of pancreatic B-cells ATP-sensitive K+ (KATP) channels in insulin secretion, the effects of the hormones on pancreatic KATP channels were also studied. Methods: Diazoxide (30mg/kg/day) or verapamil (100mg/kg/day) was used as pancreatic B-cell opener or blocker, respectively. Testosterone (50mg/kg/day as replacement dose in bi-orchidectomized rats and 10 mg/kg/day in intact male animals) and progesterone (20 mg/kg/day) and estradiol (200µg/kg/day) infemale rats, were also used. Male rats were divided into control, uni- and bi-orchidectomized, testosterone receiving bi-orchidectomized, diazoxide or verapamil and also "testosterone+diazoxide or verapamil" receiving animals. Female rats were divided into control, uni- and bi-ovariectomized, progesterone or estradiol receiving bi-ovariectomized, and progesterone, estradiol, diazoxide or verapamil receiving and also "Progesterone + diazoxide or verapamil" receiving animals. The period of 4 weeks was considered for each experiment. After 4 weeks, serum glucose and insulin were measured and insulin sensitivity (glucose/insulin ratio) was compared statistically between the groups. Results: In male rats, bi-orchidectomy, and diazoxide or "diazoxide + testosterone" treatment caused an increase but uni-orchidectomy, and testosterone, verapamil or "verapamil + testosterone" treatment resulted in decreasing of insulin sensitivity. In female rats, uni- and bi-orchidectomy, and progesterone, diazoxide or "progesterone + diazoxide or verapamil" treatment lead to an increase but estradiol or verapamil treatment resulted in decreasing of insulin sensitivity. Conclusion: Testosterone and estradiol were insulin sensitivity reducer but ovariectomy, bi-orchidectomy and progesterone were insulin sensitivity enhancer in rats. The results indicated that presumably testosterone was not contributed in closing or opening of pancreatic B-cells KATP channels but progesterone influenced insulin sensitivity by its inhibitory acting on pancreatic KATPchannels.