مجله تحقیقات نظام سلامت حکیم
سال دهم شماره 3 (پیاپی 38، پاییز 1386)

Besides calculation of mortality indicators and prevalence and severity of diseases, measurement ofand 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. 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. 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. 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.

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. 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. 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). 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.

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. 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. 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. 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).

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. 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 patient's 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. 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 male's and female's opinions, the differences among the age and educational groups in the two parts of communicative and service quality factors were significant (p<0.05). 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.

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.

Forty interns participated in the study and an assessment form with nine indices was used. Procedures of CPR were performed on a resuscitation manikin.

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.

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.