Hakim Journal
Year:2000 | Volume:3 | Issue:1|Papers Count:15

This paper is the result of a retrospective survey of maternal history in Iranian women aged 15-49 years. The aim of this study was to estimate fertility trend of Iranian women during 3 decades, from 1967 up to 1996. In this survey, the basic date of concern is the date of each live born child for a sample of women in reproductive period, and whether the live born is alive at present or not? The model suggested by Brass was used to determine fertility level and to analyse it's trend. Systematic and cluster sampling were applied. The proportion of sampling was 1/1000, and each cluster consisted 14 households, which led to a sample of 21824 women aged 15-49 years.The results of the study show that except in women aged 15-19 years whose fertility is affected by age at first marriage, the most of fertility levels in other age groups belong to the periods of 1977-1981 and 1982-1986. At first, this fact can be the consequence of ignoring Family Planning Policies and giving advantages to crowded families, and secondly, promoting marriage among youngs after Islamic Revolution of Iran (1979).In 1987-1991, and specially in 1992-1996, fertility levels decreased to less than half which could be the result of developing of Family Planning programs through providing facilities, increasing the level of women's education and increasing of age at first marriage. Women aged 45-49 years have had approximately 6.376 live birth but according to fertility behaviors of the periods:1992-1996, Total Fertility Rate(TFR) was 2.882 children, which reveals the effects of population control policies during recent 10 years.

In order to determine fauna and species combination of sand-flies, an investigation was earned out in North-west provinces of Iran (Ardabil, East Azarbaijan and West Azarbaijan) during 1993-1995.More than 10000 specimens of sand-flies were collected by using sticky, Light, Funnel traps and an aspirator. These sand-flies consist of 27 species, 18 from the genus of phlebotomus: Ph. alexandri (1.77%), Ph. anderejevi (0.05%), Ph. balcanicus (1.94%), Ph. brevs (0.14%), Ph. caucasicus (5.89%), Ph. halpensis (0.63%), Ph. jacusieli (18.19%), Ph. Kandelakii (10.43%), Ph. keshishiani (0.04%), Ph. major (0.73%), Ph. mongolensis (2.3%), Ph. papatasi (24%), Ph. perfiliewi (2.31%), Ph. sergenti (9.47%), Ph. smimovii (0.08%), Ph. tobbi (0.43%), Ph. ansarii (3.6%), Ph. longidactus (0.02%), and 9 of Sergentomyia: S.africana (0.01%), S.dentata (B.Yi). S.lwdgsoni (0.06%), S. paleslinesnsis (0.2%), S.pawloskyi (0.79%), S. sintoni (1%), S.squramipleuris (0.02%), S.theodori (1.34%) and S.tiberiads (0.02%).Sand -flies were active about six and three month in temperate and cold areas respectively.

A total of 2767 Specimens were collected from the suspected cases of Measles in IRAN during the period time from the fall season of 1995 to summer of 1996.Hemagglutination inhibition (HI) assay was utilized when both acute and convalescent serum samples were available while a Capture IgM EIA was used if a single serum sample was available.39% of the specimens tested were found to be positive for Measles. The majority of cases (22.67%) were found in the 15-19 years old age group, while the least number of cases (2.15%) was found in the less than one year old age group. Seasonal pattern of disease occurrence, indicates Measles to be most prevalent in the spring (55.29%), and least prevalent in fall (3.63%).61% of positive cases were found in patients who had never been vaccinated against Measles, and 30% of cases were found among patients with unknown history of vaccination and only 9% of positive cases were found in patients who have been vaccinated against Measles. Measles was developed in 16% and 40% of patients who were fully vaccinated (received two doses of vaccine) and patients who were never vaccinated respectively. The difference among the two groups is significant (P<0.0001).The highest rate of confirmed cases of measles within the population (per 100,000 of population) of various provinces in the country was observed in Semnan province (7.83 in 100000) and the lowest rate was observed in kermanshah (0.17 in 100000). The overall rate of confirmed cases of measles in the country was 1.79 per 100000 populations.

The main aim of this research is to study the cost values of medical services and the rate of financial partnership of the insured people within payment of medical services expenditure at the national level. The sway sample consists 4518 insured people of different funds of the Medical Service Il1SuranceOrganization (MSIO) in 19 provinces of the country who were admitted to be as in-patient in one of the non-contracted hospitals (mostly private) in 1997.The research has been conducted using a prospective design regarding both descriptive and analytic aspects.The results show that the average cost of hospitalization of insured inpatients in the non-contracted hospitals according to private and government tariffs with the average duration of stay of 3.87 days have been 1958940 and 744180 rials respectively.The insured people have paid more than 65% percent of the total expenses of the non-contracted hospitals without consideration of informal expenses. This caused the dissatisfaction of feeling more than 77% of them because of unreal tariffs. The self administered ones are insured immediately and their chance of hospitalization is about 90% in their first year of membership. Governmental employees and other groups are hospitalized once in a while every13 years. Considering the mean cost of hospitalization of the self - employed and governmental employees in the private sector, if they want to use private sectors, they have to pay about 4.7 and 3.5 times greater than formal per capita per month respectively. In non-contracted hospitals the rate of cesarian to normal delivery is 1.7 and it's cost for health insurance is significant. On the basis of results of this research, health insurance economy is not designed according to the realities of social economy so that it is so fragile and vulnerable. Hence actualization of tariffs and insurance per capita, estimating of the model of medical services, determination of the financial needs of medical insurance, the ability of payment of insured people, should be considered in the accounts of medical insurance economic. With this consideration we can keep confidence between the insured people, medical service providers and insurance organizations.

Cyclospora cayetanensis as a protozoa known within coccidia sub-classes which is distributed throughout the world. In recent years human cyclosporiasis has been detected and reported. The clinical symptoms of cyclosporiasis in human are similar to cryptosporidiasis and isosporiasis. Cyclospora has been recognized as a cause of human prolonged watery diarrhea in both immunocompromised and healthy persons.The first case of human cyclosporiasisin Iran was reported in 1996 by Rezaeian et.al in an AIDS patient. In this paper another case of cyclospora is being reported in a 10- years - old boy with diarrhea from Tehran.This case has been diagnosed by direct examination, staining and culture of stool in dichromat potassium medium. Knowing this organism and using some technique such as culture and specific staining are basically required for identification of many other cases.

This paper presents the result of one and half years of activity (starting in March. 1998 and ending in October 1999) at the Center of Study and Research on Medical Ethics, in Ministry of Health and Medical Education, Iran. This activity was financed as a research proposal. The main aim of the research was to emphasize on human dignity. The project was included 46 group discussions considering islamic rules and cultural aspects of our society. The ethical codes of medical research published internationally, including the Nuremberg the Helsinki Codes and the Belmont Report were investigated. The result of these discussions was a series of developed codes which were proposed to the scholars and interested bodies in medicine, figh and law, during two workshops in order to seek for their expetrize and views. The ultimare result was refined as 28 codes based on the applications: informed consent, fair selections of subjects and assessment of risk and benefit.

A great deal of epidemiological information is concluded from spatial data.Geographical aspect of tropical diseases such as malaria, whereby patients, its vector's temporal, and spatial distribution are affected by height, temperature, rainfall and land use; goes back to many years ago, ranging from simple epidemiological maps to analyzing satellite images. Geographic information system (GIS) provides the best technology to produce such information. In Iran, it has been used in many sectors for several times, but it has not yet been applied effectively in the health sector.For the first time, geographic information system, has been applied to control and manage malaria in Kahnuj, which led to redefining data processing of surveillance system of this disease and providing maps and other outputs for geographic points and areas.

Brain abscess is one of the most Serious Complications of cyanotic congenital heart disease. In these patients early Clinical diagnosis is possible through a high index of suspicion in these Patients. Any delay in early clinical diagnosis could result in irremediable outcomes. A 3-Year-study of 620 cyanotic Congenital heart disease Cases were seen at Shahid Rajaie Heart Hospital and Hazrat Ali Asghar Children's Hospital in the Period 1995 - 1998 revealed 7 cases of brain abscess. There was no significant sex predilection. Age distribution was from 3 months to 17 years, whereas 5 cases were 4 to 12 years old.Triad of apathetic state, relative bradycardia and history of vomiting in our patients are considered as early or relatively early evidence of brain abscess.Regular follow up of patients with cyanotic congenital heart disease is recommended at 3 months intervals up to 12 years of age to ensure against neurological risks.

Although Bacillus Calmette - Guérin (BCG) vaccine has been used widely around the world, still controversies exist about its effectiveness. Environmental factors would explain some of these differences. For this reason, it has been suggested to conduct independent studies in different countries to evaluate their own vaccination program effectiveness. To determine whether BCG vaccination program is effective (to protect) pulmonary tuberculosis in adult residents of Tehran province.In a matched case control study 110 patients below 65 years of age were compared with 220 hospital controls. For each case two controls were selected and matched on the basis of age (± 4 years) and sex. The Odds ratio of contracting pulmonary tuberculosis in vaccinated versus unvaccinated groups was estimated by Mantel Haenzel and conditional logistic regression.Crude and adjusted odds ratio of BCG vaccination on protection of pulmonary tuberculosis were 0.84 (95% CI: 0.53 - 1.34) and 1.37 (95% CI: 0.71 - 2.66), respectively none of which were statistically significant. This study shows that vaccination program is not effective to prevent transmission of tuberculosis. We strongly recommend further studies to be conducted on the younger age groups and non pulmonary tuberculosis.

In order to compare central venous pressure (CVP) and peripheral venous pressure (PVP), 31 patients undergoing elective neurosurgicalor open heart surgery were studied. After induction of balanced anesthesia and controlled ventilation and cardiovascular stabilization, in order to measure central venous pressure, central vein cannulation was done, then a No: 16 gauge catheter (Angiocath, 5 cm Length) was inserted through the basilic vein in the antecubital region. Simultaneous measurement of the central and peripheral venous pressures was made every 3 minutes. It was found that correlation between pressures at the end of expiration was 0.92 (p<0.01) and the correlation in measurements at the end of inspiration was 0.91 (p<0.01).Pearson's correlation coefficient between pressures that were recorded from the right hand and CVP were 0.98 (p<0.01) and those were measured from the left hand and CVP were 0.90 (p<0.0l). Furthermore, pressures were recorded from right hand statistically more correlated with CVP than left hand (p< 0.01).In order to construct a relation between CVP and PVP in each case, first we checked the effect of time on CVP and PVP which led to no time effect, so mean CVP and PVP was considered in the correlation and simple linear regression.The estimated correlation coefficient was r=0.95 (p<0.01) and the estimated regression line was PVP= 3.0 + 0.9 CVP (p<0.01).