مجله سازمان نظام پزشکی جمهوری اسلامی ایران
سال سی و یکم شماره 2 (پیاپی 122، تابستان 1392)

Long term development plans are tools to draw future outlooks. This paper seeks to examine the health sector within the context of the laws adopted for the development plans after the victory of Islamic Revolution. In this study, a qualitative method was performed using the coordinated methods and analytical technique. In this method, five development plans, adopted in the Islamic Republic of Iran has been studied. All five development plans ratified and adopted after the victory of the Islamic Revolution on health sector were bold with existing related laws and rules. In the first and second development plans, laws on expansion of the health care network and population control exist. In the third development plan, the law deals with the handling over the responsibility of the health care service. In the fourth and fifth plans, the law insists on the reduction of payments out of the pockets of the patients while enhancing efficiency. A glance at the related-health care materials in five development plans show that the program was initially adopted to deal with the physical development of the health care centers in public sectors. At the beginning of third development plan, the facilities over of the health care services was taken into consideration while regarding the distributive equity. In the fourth and fifth plans the concepts, such as health care equity or justice were introduced and the outlook from physical development was shifted to justice and financial equity in health care service.

Telemedicine plays an important role in providing medical services over long distances, particularly in developing countries. For better management and planning, periodic assessment of this system seems necessary. This study was aimed to evaluate the first phase of teleconsultation project so as to use the findings for addressing the current practical problems and improving the system for future projects. After installing the equipment in Imam Khomeini Hospital of Firuzkuh and Zaeem Hospital of Pakdasht as the remote sites, teleconsultation project was started and patients at these hospitals requiring specialist opinion were enrolled in the study and consultation via teleconference by specialists at Masih Daneshvari Hospital as the central site was performed for them. A total of 22 patients (13 male) with mean age of 54.13 years (14 in Imam Khomeini Hospital) entered the study. Pulmonary medicine was the most frequently requested consultation 36.4%), followed by cardiology (27.3%). Teleconsultation was resulted in recovery and discharge of 8 patients, yet 4 patients required emergency referral to a more equipped hospital. This study demonstrated that inadequate knowledge and unacceptability of telemedicine among physicians and medical staff and unavailability of necessary instrumentation in remote centers, and also lack of all the required specialties in central site, were setbacks in the uptake of teleconsultation system. Therefore, future projects should be conducted with enough funding and using the experience of this study to improve the quality and quantity of the consultations in order to perform a more meticulous assessment.

Parkinson’s disease (PD) is a progressive neurodegenerative disease that results in damage to the basal ganglia. (PD) patients suffer from a wide range of motor and cognitive symptoms. Also there is a group of language and grammatical disorders such as failure to understand complex sentences, shortening sentences and removing prepositions and phrases in patient with PD. This study investigates the formation of past tense of regular and irregular verbs and comprehension of passive sentences by Persian-speaking PD patients and compares their behavior with normal speakers.

Twenty patients with PD and 30 healthy subjects, between 60 to 80 participate in this study. All participants were Persianspeaking male and monolingual. We used Mini-Mental State Examiniation (MMSE), Unified Parkinson’s Disease Rating Scale (UPDRS) and Modified Hoehn and Yahr scale for assessing cognitive state in both groups and staging of PD in patients group. Formation of past tense-regular and irregular verbs in both groups were compared by declarative-procedural model.

Our result showed unlike healthy group there is a significant difference between formation of regular and irregular verbs in patients with PD (P=0/023). Also there is a significant difference between both groups in formation of regular verbs (P=0/002). On the basis of the result, we concluded that there is a functional separation between processing of regular and irregular verbs in patient with PD that is not observed in healthy subjects.

Successful breast feeding, especially using breast crawl in the first 5 minutes after birth, is one of the important factors for newborn’s health. Breast crawl is the way that can reduce newborns death rate; however it is not widely used in Iran. In this Analytic cross-sectional study, stratified sampling was applied to recruit 150 midwives from 16 hospitals who are responsible for delivery or newborns immediately after birth. Data collection was conducted using nineteen focus group discussion consisted of 6-12 participants. Discussions were held in hospitals’ calm environment for about 1:45’ - 2 hours. Also, a questionnaire was used as an instrument for collecting demographic information. Instructional leaflets, composed of five questions were distributed among the participants. The instruments’ validity was assessed through CVI and CVR methods. Content analysis, descriptive statistics and Chi-Square test were conducted in SPSS-18 to analyze the data. The findings of the research reveal that 98% of the midwives have used skin-to-skin contact from at least two to four minutes. Moreover, 58.9% and 57.4% of the obstetricians have considered the contact as breast crawl in educational and non-educational hospitals, respectively; 58.9% and 53.2% of them have used skin-to-skin contact whenever possible; 28.6% and 23.4% have placed the newborns on their mother’s abdomen to perform breast crawl; 44.6% and 33.3% applied such contact immediately after birth; and 67.9% and 85.1% are satisfied with their workplace environment, respectively. The results show that midwives are familiar with skin to skin contact and its benefits for both mother and newborn. However, they do not employ this method immediately after birth. There is an urgent need for more qualitative and quantitative studies to investigate the inhibitory factors.

Shoulder Overuse injuries can cause pain, limitation of shoulder motions and reducing soft tissue flexibility which affect upper extremity functions. Stretching and strengthening exercises, as an effective way, are recommended to improve pain, flexibility and mobility in shoulder Overuse syndrome. The purpose of this study was to evaluate the effect of scapular stabilization exercises to improve pain, flexibility and mobility in patients with shoulder Overuse syndrome. A randomized clinical trial was designed in which 69 patients with shoulder Overuse syndrome were attended; they were randomly assigned into two groups of exercise therapy (ET; n=33) and physiotherapy (PT; n=35). All participants received 18 sessions of exercise therapy or conventional physiotherapy in the Sports Medicine Assessment Clinic; Hazrat Rasoul Akram Educational Hospital. Pain, shoulder’s range of abduction and external rotation and pectoralis minor length were evaluated. All measurements were done before and after intervention. Our findings indicate an increase in abduction (P=0.024) and external rotation (P=0.001) range and shoulder flexibility of the involved shoulder in both groups but significant difference was observed in exercise therapy group (Anthropometric Measurement P<0/0001, Measurement with Right Angle P=0.002). Pain reduction was shown in both groups and there was no significant differencebetween them. (P=0.576) Findings this study showed in pain reduction, increased of abduction and external rotation range and also improvement in flexibility of shoulder after 6-weeks involved of exercise therapy.

Meniere’s disease (MD) is a disorder of the inner ear characterized by episodic attacks of vertigo with hearing loss, tinnitus, and aural fullness. Vertigo is a common feature in MD patients, but the pathophysiology is still largely unknown. Videonystagmography (VNG) is a sensitive tool for oculomotor system and differential diagnosis and treatment monitoring of vestibular system disturbances. The aim of the present study was to explore the VNG findings in patients with severe MD. In a cross-sectional design, we examined 75 (45 males and 30females) 22-47 years-old patients with severe MD who were referred to ENT clinics of Imam Khomeini and Apadana Hospitals, Ahwaz. Balance function was assessed using VNG test-battery comprising of oculomotor (optokinetics, smooth pursuit, saccade and gaze), caloric and positional tests. The results of gaze,optokinetic and smooth pursuit and saccadic eye movement (accuracy, latency and velocity) were within normal limits. Positional evaluation in eye-covered condition was abnormal in 14MD patients. Directional preponderance and unilateral weakness indexes were abnormal in 13.33 % and 88.10 % of patients, respectively. Fixation index was also normal in all patients. Our findings revealed thatVNG isa suitabletool for vestibular function assessment in Meniere’s patients and among its subcomponents, caloric irrigation constitute the most sensitive test.

Tuberculosis is considered a major cause of morbidity and mortality worldwide. According to the WHO report 9.4 million individuals were suffering from active TB in 2009(1). Diagnostic methods for active pulmonary TB include: clinical suspicion, tuberculin skin test, acid fast bacilli stain, cultures for maycobacterium, and in recent years NNA (nucleid acid amplification). An ideal test for pulmonary active tuberculosis should be easily performed with rapid results, it should have high sensitivity and specificity, low cost,technically easy to operate and reproducible results in a variety of settings, have the possibility of drug-susceptibility testing and could distinguish Mycobacterium tuberculosis from other mycobacteria... Direct smear sputum microscopy is the primary method for diagnosing pulmonary tuberculosis but it lacks enough sensitivity and only about 44% of all new cases are detected by this method (2). Culture technique is still seen as the gold standard for active TB. Although, the sensitivity and specificity of culture is high, this method is slow and time consuming and needs special laboratory equipments (3,4,5). It not only provides the detection of various mycobacterial species but also the examination of drug sensitivity. It also provides the examination of genotype for epidemiological purposes if needed. Nucleic acid amplification tests (NAATs) can be performed in one day, But NAAT are not (fully) standardized and the diagnostic accuracy is highly heterogeneous, and need experienced personnel and expensive equipments.