مجله تحقیقات نظام سلامت حکیم
سال یازدهم شماره 1 (پیاپی 40، بهار 1387)

Hepatitis is the most prevalent disease of liver, which is caused by different viruses, drugs, and other etiologic agents. Hepatitis C virus infection is one of the most important blood- borne viral hepatitis infections. Taking into consideration its considerable prevalence among injective drug users, assessment of the HCV infection status among prisoners is of special importance. This cross-sectional study was carried out in prisons of 10 cities or provinces of Iran to determine the prevalence of contamination with HCV. Results of 8630 blood sample tests from prisoners who had been in prison for at least three months were studied and prevalence of contamination with HCV and its determinants like age and injective drug abuse were investigated. Frequency of contamination with HCV varied from 7.8% to 67.9% in prisons. Overall prevalence of contamination with HCV was 37.85% (95% CI: 36.8%-38.9%) in the studied prisons. There was an increase in percent of HCV disease with increase in age in almost all groups, and rate of contamination was significantly higher in age group of more than 30 years. There was also a significant relation between injective drug use and increase in prevalence of contamination with HCV. Altogether, the results show that the prevalence of HCV is increasing among the Iranian prisoners. Since the high-risk behavior groups like the injective drug users are aggregated in prisons and standard precautions are not practiced, regular case finding, preventive measures, and facilitation of access of this high-risk population to treatment are recommended.

Ectopic pregnancy (EP) is one of the common complications in obstetrics and its appropriate diagnosis and treatment is remarkably important for maintaining the fertility ability and reducing the prevalence of repetitive EP. The present study was performed to determine the fertility outcome following surgical management of ectopic pregnancy. One hundred patients with ectopic pregnancy who had been managed with surgical methods were assessed in a retrospective descriptive-analytic study. All the patients had undergone laparatomy. The consequences of the subsequent fertility in these patients were assessed as well as other variables such as age, parity, history of infertility, use of contraceptive methods, hemoperitoneum, cigarette smoking, presence of intra-abdominal adhesions, and history of pervious ectopic pregnancy. Seventy four percent (74 patients) had subsequent intrauterine pregnancy after the surgery. These patients had 88 pregnancies (14 patients had two pregnancies during the study period). Eighteen percent of patients had become infertile and 8% had a repetitive EP after the surgery. There was a considerable relation between the previous history of EP (occurring before the surgical management) and the subsequent pregnancy outcome.

Pyrazinamide (PZA) is one of the four front- line antituberculosis agents, which is very effective in eradicating the organism from the body by killing the active and non-active types of Mycobacterium tuberculosis in the acidic pH within macrophages, as well as in shortening the treatment course. Unlike the other antituberculosis agents, PZA is active in acidic pH, while the favorable pH for growth of the organism is 6. 8. This fact makes the susbptibility testing of the organism to PZA very difficult. With an appropriate and stable buffering system, pH of the 7H10 agar base medium was adjusted to be equal with 6. Moreover, the growth-inhibiting agents were omitted from the composition of the 7H10 agar base medium and it was highly enriched with special animal serum supplements, so that the organism could grow at a pH of 6 like the same way it would grow at the pH of 6. 8. Using the Henderson-Hassle Bausch's equation, which determines the enzyme-substrate activity at different pH levels, individual critical concentrations of PZA were determined and added to the medium, and the results were traced using the proportional method. Standard PZA-susceptible and PZA-resistant strains were used as controls along with the specific strains under investigation. As additional control groups, the specific strains under study and the standard PZA-susceptible and PZA-resistant strains were also cultivated in PZA-free mediums. In addition to PZA-susceptibility testing, susceptibility of the specific strains under study to the other front-line antituberculosis agents was also assessed (rifampin, isoniazid, etambotul, and streptomycin). Approximately 6 ٪ of the clinically isolated strains were identified as PZA-resistant and about 1 ٪ of the strains were resistant only to PZA. Since the low pH of the cultivation medium was continuously controlled in order not to interfere with growth of the organism, and the Henderson-Hassle Bausch's equation is very accurate in determination of the enzyme-substrate activity, our study results are reliable. An additional advantage of this method is feasibility of actual susceptibility or resistance determination based on different concentrations of the drug. It is also feasible to directly determine the susceptibility or resistance to PZA simultaneously with the primary sample culture.

Using the disease severity scoring system can guide the physician in objective assessment of disease outcome and estimation of treatment success. We studied the APACHE II disease severity scoring system. Using this system, the patients can be prioritized for receiving appropriate care and also more clarity is provided for the physician in describing the final disease outcome for the patient's relatives. In the current study, we aimed to determine the relation between the APACHE II score of the patients in surgical Intensive Care Unit (ICU) of Hazrat-Rasul hospital with patient's mortality rate. In this study, 300 patient records were assessed and the APACHE II scores calculated. There was no exclusion criteria based on age, sex or history of any disease. The study was cross-sectional and retrospective. Patient's survival was recorded. Statistical analysis was performed with SPSS software version 11.5. Clinical measures were calculated as mean ± standard deviation (SD) or percentage. In the survivors, the average (±SD) APACHE II score was 11.75±6.9, and in non-survivors it was 22.06±7.9, and the difference between them was statistically significant. Therefore, the rise in APACHE II score was related with increase in mortality. The mortality rate in patients with scores less than 15 was 8%, in those with scores of 16-19 was 39%, in scores of 20-30 was 59%, and in patients with scores higher than 30 was 100%. The APACHE II scoring system has been successful in predicting the mortality rate of the patients in this ICU. Comparison of our findings with the previous studie's results showed that in patients with scores less than 15, the observed mortality rate was comparable with the standard range mentioned in the textbooks, but in patients with scores higher than 15, the observed mortality was significantly higher than the standard limit. This difference was about 20% for patients with scores of 16-19, about 39% in those with scores of 20-30, and about 25% for patients with scores more than 30.

With increasing development of technology and use of different types of fuels, environmental pollutants are increasing more and more in volume. Air pollution is an important issue with regard to its role in affecting human population health and especially the children. Studies in other countries have shown that the exhaust particles resulting from gasoline and diesel motors contain large amounts of mutagens and carcinogens including Polycyclic Aromatic Hydrocarbons (PAHs). There are different methods for mutagenesis assessment of PAHs and other organic substances available in air pollutants among which the "AMES" method is the easiest, fastest, and the most cost-effective one. This method has been introduced by Dr. Bruce N. Ames in 1967. The Ames method uses different strains of Salmonella typhimurium bacteria, which are genetically manipulated so that they can not grow in media without histidin. These bacterial strains are cultivated in histidin-free media and the substance, whose mutagenicity is under investigation, is also added to the medium. If the substance is mutagen, the bacteria will transform to mutant strains and will be able to synthesize histidin and therefore will begin to grow. Investigations with the Ames method have shown that 83% of substances which are identified as mutagen with this method are carcinogen. We applied this method in the current study. Seventy six ambient air samples were collected on fiberglass filters using a "High Volume Sampler Set" during the spring, summer, and fall. The organic substances of the samples were extracted by dichloromethane and Soxhlet. The bacterial Strains (TA98 & TA100) were provided by the courtesy of Dr. Ames from the United States upon our contact with him and genotypes of the bacteria were confirmed using the pertinent assay methods. The extracted samples were assessed with the Ames method at three different concentrations of 0.8, 1.6, and 3.2 mg of dry material per 100 µl solvent. One-way analysis of variance and Post Hoc tests were used for statistical analysis. The results indicated the presence of mutagenic substances in Tehran's air pollutants. Findings from TA98 and TA100 strains demonstrated that the mutagenicity ratios of the organic substances had significant differences with the critical value of two, for concentrations of 1.6 and 3.2 mg/100 µl. The mutagenicity ratios calculated for samples collected in spring, summer, and autumn did not have any significant difference with each other at the three tested concentrations. Also the mean colony counts did not demonstrate any significant difference in the mentioned seasons and at the three concentrations, but the colony counts were lower than the colony counts of the negative control group at the three concentrations (P value = 0.001). Comparison of our results with those form studies in other countries shows that the mutagenesis rates of Tehran's air pollutants are more than the similar rates in other countries in some cases. This is alarming for the authorities in order to do more efforts for decreasing the air pollution, especially in Tehran.

The present research on hospital wastes sets out a comprehensive framework for improving waste management practices in hospitals of Tehran University Medical Sciences. This descriptive cross-sectional study was performed in year 2006. Data were collected using a checklist and a questionnaire whose validity and reliability were verified. The medical wastes generated in these hospitals were extremely heterogeneous in composition: paper and cardboard, plastic, syringes, glass, metals, food wastes, infectious wastes, etc. Forty two percent of the wastes were collected in containers and plastic bags. In 75% of the studied hospitals, the stay-time in storage sites was about 12-24 hours. All of the medical wastes of the hospitals were collected by covered-trucks and transported out of the hospital. In 46% of the hospitals, transfer of medical wastes to temporary stations was done manually. The hazardous wastes produced in the hospital wards amounted to about 42% of the total wastes. According to the results obtained in this study, in order to reduce these kinds of pollution in the hospitals, action should be taken to deal with pollutants at their source of generation, which should be focused within the hospitals. The staff members involved in waste collection and transport should practice all the personal protection measures. Of course, medical waste management cannot succeed without cooperation and participation of all groups of medical staff.

Client satisfaction with services is an important factor and one of the main elements in continuous service quality assurance and improvement. The goal of the present study was to determine and compare the client satisfaction and its components in governmental and private addiction treatment centers in Kordestan province. In a cross-sectional descriptive-analytic study, 377 subjects were selected with a stratified random method from clients of all addiction treatment centers in Kordestan province (five private and two governmental centers) who had an active treatment record. Our data collection tool was a researcher-developed questionnaire. The second part of the questionnaire contained the main satisfaction assessment questions, which were five-level Likert type. Chi square, Mann-Whitney U, Kolmogorov-Smirnov, Kruskal-Wallis, and Spearman's correlation coefficient were used for statistical analysis. The most important results were that satisfaction with the physical environment, accessibility, personnel's communication skills, medical services, and psychological consultation services were significantly higher in private centers than those in governmental centers while satisfaction with social-work services, cost of services, and the”general satisfaction” of clients were significantly higher in governmental centers. The “overall satisfaction” which was the sum of different components of satisfaction, except the general satisfaction, did not show any significant difference between the private and governmental centers. It seems that the importance and weight of the different components of satisfaction vary in the opinion of clients. Those services that are more supportive in nature, have a more positive influence on satisfaction of patients and weigh more than other components. In fact this explains the difference between the results of”overall satisfaction” and” general satisfaction”.

The goal of the present study was to assess the performance of the breast-feeding promotion project in Kohkiloyeh and Boyerahmad province. Performance of delivery wards in hospitals affiliated with the University of Medical Sciences and with the National Oil Company of Kohkiloyeh and Boyerahmad province was assessed in terms of practicing the ten steps recommended by World Health Organization and United Nations Children's Fund. Ten percent of the mothers who had delivered a child within one month before the time of study conduct (n = 43) and 30% of the delivery ward's personnel (n=137) were selected to participate in the study. Data was collected via observation, interviews, and review of the documentations. The performance of hospitals was calculated based on the percentage of the total expected score, and a score of 90% or above was considered as the acceptable level of performance. The mean percentage (and standard deviation) of performance scores were 77.42 (and 33.19) for the Oil Company's hospital, 69.64 (and 27.68) for Imam Sajjad hospital, 67.5 (and 32.1) for Imam Khomeini hospital, and 62.97 (and 37.99) for Shahid Rajaei hospital (in decreasing order). These findings show that the hospitals were in a relatively weak position in regard with implementation of the project. Performance of the baby-friendly hospitals in promotion of breast-feeding behavior of mothers is weak.