مجله سازمان نظام پزشکی جمهوری اسلامی ایران
سال سی‌ام شماره 4 (پیاپی 120، زمستان 1391)

Pregnancy has many physiologic and psychologic changcs in some cases various psychosomatic issues lead to high risk pregnancy. The said study has been done with a view to determine mind’s health in pregnant mothers with high and low risk pregnancy who used to refer to the health & treatment centers of Shahid Beheshti Medical Sciences University in 2010. 392 pregnant women studied in 2 groups of high and low study pregnancy. The 3 parts questionnaire distributed between pregnant women: first personal specifications, second the questionnaire (the form for evaluation of high risk pregnancy) and third, measurement of mental health GHQ1. Then data was analyzed using descriptive and deductive tests. Of 196 pregnant mother in high-risk group with mean age of 288±5.28, %56.6 and in Low risk people with mean age of 25.36±4.58, %46.4 didn’t enjoy an acceptable mental health. (T.Test with p ≤ 0.005). mean of mental Health score of pregnant women in high-risk group is 22.37 with SD of ±11.04 and in Low-risk group is 25.73 with SD of 12±31. The result showed that high risk pregnancy may affect mental health of the mothers. It is recommended that measurement of mental health should be taken into consideration among the care program of programming period.

Despite advances in public health, tuberculosis remains a major health problem and Several studies is stressed on the impact of demographic and epidemiological factors especially in people susceptible to the infection, therefore, identification of efficient factors in the increase of disease incidence can be useful to limit tuberculosis. The aim of this study was to investigate the environmental and underlying factors which are involved in tuberculosis.

This study is a retrospective descriptive one. Information of the medical records of patients admitted to Baqhyatallah hospital in Tehran during one year (1387 - 1388), was evaluated. We selected cases that were referred to the laboratory for diagnosis of tuberculosis. This information includes personal information, demographic findings, symptoms of diseases and the type of tuberculosis.

Of the 255 patients, 149 (4/58%) were males and 106 cases (6/41%) cases were females, respectively, in the aged range of 1 to 97 years. More than half of the patients, 164 patients (3/64%), were above 51 years of age. Of the 255 admitted patients, 30 patients suffered from tuberculosis based on laboratory results. Twenty-one (70%) were and 9 (30%) were females, respectively. All 30 patients suffered from pulmonary tuberculosis. Furthermore, only 1 (3/3%) suffered from pulmonary and extra pulmonary tuberculosis (colon), spontaneously. Most TB patients live in the city (3/93%) and were Iranian (3/93%). Among tuberculosis patients, 4 patients suffered from (3/13%) lung cancer, 1 (3/3%) from Sarcoidosis, 11 (7/36%) from pneumonia, 1 (3/3%) from hydatid cyst, 1 (3/3%) from asthma, 8% (7/26%) from COPD, 5 patients (7/16%) from previous exposure to chemical fumes and 4 (3/13%) patients had bronchiectasis.

Regarding to annual increasing of tuberculosis in the middle east especially neighbouring countries such as Afghanistan and Pakistan, death toll to this disease and losses and physical damage resulted from this disease, Understanding the factors that causes tuberculosis can be helpful to better management and limitation of disease.

Functional constipation, a common gastrointestinal problem especially in young women, often caused by paradoxical contraction or failed relaxation of the puborectalis and external anal sphincter muscles during defecation. Usual treatments consist of medications, surgery and injection of botulinum toxin have some complications and limitations. Therefore, the present study is aimed to investigate the effects of a proposed physiotherapy protocol, which is based on patients’ education and pelvic floor muscle training on functional constipation. A quasi-experimental study was conducted on ten women aged 29-50 years (29.7±7.7). After clinical and manometric assessments, the proposed protocol including patients’ education, general body relaxation exercises and pelvic floor muscle training have been presented for 18 sessions. The above assessments repeated on last session. The Spss/win11.5 and Wilcoxon was used for analysis. We found a significant increase in resting and squeeze pressures at upper and lower anal canals and rectum push pressure. upper and lower anal canal push pressures decreased significantly (p<0.05). In addition, there was a significant decrease in frequency of incomplete evacuation, hard defecation, obstruction feeling at anal canal and digital evacuation (p=0.006). According to the present study, the proposed physiotherapy protocol, could significantly affect on some signs and symptoms in women with functional constipation.

Nasal fracture is one of the most common cases referred to the ENT clinics. This study aimed to determine the value of conventional radiography in the diagnosis of patients with nasal injuries. In this study, all patients with nasal injury referred to the Emergency Department of Imam Khomeini, Ahvaz, Iran, were reviewed. After Radiography was done, cases were investigated. Of the 174 patients that had clinical diagnos is of nasal fracture, just 74% (141 cases) had positive findings in Radiology. For fractures and 19% (33 patients) had no findings for nasal fracture in X-ray. 26% (48 patients) had significant ecchymosis and 72% (126 cases) had no periorbital ecchymosis. Radiolography in nasal fracture is benefit less than clinical examination. But, it is recommended to confirm the diagnosis of clinically suspected cases and for legal issues.

AIDS has been considered as a main concern for public health in different societies. To carry out effective clinical managements, dental students must be aware of the importance, transmission and prevention of HIV/AIDS. The aim of this study aimed to address the level of knowledge among the final year dental students studying at Tehran Dental Schools about the AIDS and related factors in the academic year 2010-2011. In this descriptive cross-sectional study, 121 final-year dental students were selected from Tehran, Shahid Beheshti, Shahed and Islamic Azad Dental Schools. The participants were assessed through a questionnaire including 18 HIV/AIDS-related questions. The correct answers received 1 score. The knowledge level was calculated according to as the total number of correctly answered questions. The effect of age, gender, university, sources of knowledge and the participants’ self-assessments of their knowledge was studied by means of linear regression analysis. Of the total score of 18 points, the students received the mean score of 7.2 (standard deviation of 2.97) which hasbeen lower than the half of the maximum scores. Age(P=0.63), gender (P=0.74), course of study (p=0.38), continued educational programs (p=0.64), media (p=0.1), books and journals (p=0.93) did not show significant effect on the knowledge scores towards AIDS. The level of knowledge of the final-year dental students studying at Tehran universities regarding HIV/AIDS was generally inadequate. Increases in the quality and quantity of educational programs as well as some improvements in the dental education curriculum are necessary.

TB is a major problem worldwide and it is estimated one third of the world population are already infected and each year 9 million people develop full blown tuberculosis of these 3 million die of the disease, annually. Delay in diagnosis and treatment are major problems that play a significant role in all aspect of the disease from patient treatment to transmission in the community. The aim of this study was to investigate clinical symptoms and to find out are related to the delay in diagnosis and treatment of pulmonary tuberculosis in Kurdistan province. All new cases of smear positive TB occurring in Kurdistan province during the year of 2009 was included in thisstudy. Data on the different variables were abstracted from the patients’ file and entered into the computer. For each patient demographic data, clinical data including symptoms and the time of onset of symptoms as well as the time receiving different services were collected. Descriptive and analytical analyses were done using SPSS software. Analysis were done using ANOVA and t test. In all analytical analysis, a p-value of less than 0. 05 was considered as criteria for statistical significance. The mean ± standard deviation of patient, treatment, diagnosis, and total delay were 45. 6 ± 36. 5, 16. 8 ± 22. 2, 1. 7 ± 0. 9, and 64. 2 ± 46. 2, respectively. There was positive correlation between patient and diagnosis delay with total delay. Most clinical symptoms were cough، dyspnea, loss of appetite, loss of weight, sweetness, fatigu, fever, and hemoptesia and chest pain. As the number of clinical symptoms increased the total delay decreased. Our findings indicate that there is a delay in all aspect of TB in the studied population. These delays need to be addressed both at the service giver level as well as patient level. There are urgent needs of proper intervention to reduce all delays in the studied population.

Endemicity of Human T-cell lymphotropic virus type 1 (HTLV-1) infection in the northeast of Iran as well as noticeable prevalence of the infection in other parts of the country has been reported. In this review, findings of Iranian published studies which reports seroprevalence of HTLV-1 infection in general population, blood donors and patients with repeats blood transfusions, were discussed. The studies have shown a high prevalence of HTLV-1 infection in general population of some cities in Razavi Khorasan province such as Mashhad, Neyshabour, Sabzevar and Torbat-e- Heydarie. Prevalence of the infection has declined from 1.97% in 2004 to 0.42% in 2006; however, it was as high as 2.12% in general population in 2009. Prevalence of HTLV-1 infection is also noticeable in general population in Golestan (0.29%) and in blood donors in some provinces such as Charmahal-Bakhtiari (0.62%), West Azarbayejan (0.34%), Hormozgan (0.18%), and Karaj (0.11%). Furthermore, high rates of the infection (1% to 7%) have been reported among thalassemic, hemophilic and hemodialysis patients from various provinces including Charmahal-Bakhtiari, Tehran, Golestan, Fars, Hormozgan, Bushehr, Sistan & Baloochestsn, South Khorassan, and West Azarbayejan. Prevalence of HTLV-1 infection is high among general populations and blood donors from Razavi Khorassan and some other provinces as well as amongst patients with repeated blood transfusions in several regions of Iran. These findings support the necessity of selective screening for HTLV-1 to reduce the spread of infection.

Due to strong spiritual and humanity atmosphere of medical profession, from more than two decades, the Iranian Medical Community has been wishful to approving a logical and evidence based system to general practitioners (GPs) remuneration. GPs remuneration Method has meaningful effects on health expenditures. The aim of this study was to benchmark methods of GPs remuneration in the world.

using keywords including: remuneration, payment, pay, general practitioner, medical doctor, general physicians, consultation, family physician, gatekeeping, private sector, health expenditure, sessional, pay for performance, income, salary, capitation, fee-for-service, wage, compensation and name of the selected countries, and also visit the websites of health and economics of each countries, the existing documents were extracted and reviewed. Then we combined the extracted information each other.

we reviewed 261 documents on methods of GPs remuneration from 36 countries around the world. Dominant methods of physician remuneration were fixed salary, fee-for-service, capitation and pay per performance or a combination of these methods. A fixed salary is common as a part of doctors’ fee in most of selected countries. Payment method has a serious impact on physician performance. Purchasing power is used for comparison of the income level of doctors inter and intra- countries.

It seems today, using a combination of all methods mentioned above in a managed way is the implicit agreement. Combined remuneration methods combine the incentives of all its components. The hybrid approaches allow serious flexibility in different regional circumstances.