Journal of School of Public Health and Institute of Public Health Research

A QUALITATIVE STUDY OF RISKY SEXUAL BEHAVIOR IN INJECTING DRUG USERS IN TEHRAN

A Rahimi Movaghar

There are about 200,000 injecting drug users (IDUs) in Iran. HIV/AIDS is closely associated with IDU in Iran. The objective of this study was to explore unhealthy sex behavior and the interventions for its control in IDUs.
A qualitative method was employed. Six districts in Tehran with a population of 400,000 were selected. These districts differed in socioeconomic characteristics, urban structure, IDU prevalence and crime rates. A total of 81 key informants from different sectors and 154 IDUs were selected by purposeful, opportunistic and snowball sampling, and interviewed individually or in groups. Ethnographic observations were done to study life situation in the subjects.
In one district no cases of IDU were found. In others, sexual promiscuity in IDUs was reported to be common. IDUs report sexual relationship to be more common with sex wrkers. In most of these areas, access to commercial sex is believed to be easy. Sex workers, themselves are commonly drug users, half of them are actually IDUs. Safe sex (e.g., use of condoms) is not a common habit. Homosexual relationship seems to be uncommon in IDUs and there were no reports of condom use in this type of contact. According to IDUs, dealing with this problem would require financial support and drug distribution for preventing sex work, and settlement and organization of sex workers as a prelude to effective sex education and promotion of condoms.
Expansion of injecting drug use and its relationship with blood-borne infections in recent years necessitates rapid interventions for controlling injection drug use and the associated risks. As unhealthy sex behavior seems to be common in IDUs, sex education, free condom distribution in drug abuse treatment centers and other health facilities (with the use of outreach methods) is highly recommended.

EPIDEMILOGICAL CHARACTERISTICS OF KALA-AZAR IN HOSPITALIZED PATIENTS IN ARDEBIL PROVINCE

M Mohebali

This study is a retrospective review of the epidemiology of kala-azar, using cases reported to health facilities in Ardebil province over a period of 5 years: from the beginning of 1997 until the end of 2001.
The total number of cases was 602, but as the assessment was only possible in hospitalized patients, the questionnaires were completed for 293 cases with detailed records in 5 hospitals (3 in Ardebil and two in Meshkin-shahr and Germi). Another 76 cases were also excluded (due to incomplete records) and in the end 217 questionnaires were analyzed by the Epi-info 2002 package.
Compared to the total number of cases (1051) reported in a similar study over the years 1985-90, the reduction in total number of cases (602) may be due to reduced incidence rate in Meshkin-Shahr and/or underreporting. Although the total number is down, the number of new cases in Germi and Bilehsavar districts has increased. In our study the overall male to female ratio was 1.4 to 1 this ratio was 1.5 to 1 in hospitalized patients. 74% (160) of cases were under 2 years of age and 93% (201) under 5. Only 1.8% (4) of patients were over the age of 10 years. Though the majority of the patients were seen in Ardabil city, most had been referred from Germi district. 87.5% were village dwellers, mostly referred on cold months of the year the number of referrals was lowest during summer. The most frequently used diagnostic test (especially in recent years) was DAT, positive in 77% of tested cases (titers/1600). We also performed BMA on 30 patients, of which 87% (26) were positive. 58%) of the subjects had been diagnosed in about a month after the disease onset and 93% within 4 months. The most common clinical features were anemia, fever, anorexia, splenomegaly (all present in >90% of cases) other manifestations were malnutrition, cough, hepatomegaly, diarrhea, vomiting, Iymphadenopathy, hemorrhage, jaundice, edema and ascitis. In 6 cases (3%) the chief complaint was febrile convulsion. The most common laboratory findings were anemia (mean Hb - 8.96 mg/dl), elevated ESR (highest level being 140mm/l hour), thrombocytopenia and neutropenia. Liver enzymes were elevated in one third of the patients. 96% of the cases treated with Glucantime the remaining 4% were relapse cases or treatment failures and had been given Amphotricin-B. 95.8% (211 cases) had been discharged in good general condition 3% (6) had died. The exact causes of death were not mentioned in hospital records.
According to these findings, Kala-azar is a major health problem in Ardebil province, especially within the rural population and specifically in Germi and Bilehsavar districts. It requires more intense control and more medical facilities alongside education programs for health workers and general population.

ASSESSMENT OF THE STAGE OF CHANGE IN PHYSICAL ACTIVITY AMONG HIGH SCHOOL GIRLS

R Dastjerdi

We performed a cross sectional study with the aim of assessing levels of habitual physical activity and associated factors (barriers and motivators), finding the stage of change among high school girls, and exploring relationships between physical activity and the following set of factors: age, parent education, type of school attended, knowledge, and attitude. 457 girls in the 1SI to 3rd grade of high school with a mean age of 15.6 (%95.3 cases were 14th to below 17Ih years old) in Tehran&aposs second region of educational office district were selected via proportional-to-size and cluster sampling methods. These girls attended 4 different types of facilities (public and private high schools / public and private vocational schools). The data were gathered through self-administered questionnaires. Our results indicated that %58.6 of students were in pre-contemplation and contemplation stages, while 24.7% were in action and maintenance stages of change.
The mean level of physical activity at work (in school) was 2.22, which was significantly lower than 2.75- the minimum acceptable level of physical activity at work (p<0.00 ). The mean level of sport activity was 2.73, significantly (p<0.001) higher than 2.33 (minimum acceptable level of sport activity). The mean level of physical activity at leisure time was 2.50, which had no significant difference with the minimum acceptable level of 2.50. (Note: all max. acceptable level is 5).
The most important barriers identified were: time constraints, lack of companions, lack of suitably located facilities and a general state of lassitude.
The most important motivators were individual interest, desire to lose weight, company of friends, and support of parents. The level of exercise did not show a significant relationship with age, probably because of the limited range of age categories enrolled in this study. Levels of physical activity at work and sport activity (p=0.004 for ph.act.work and p=0.012 for sport) showed a significant positive relationship with the mother&aposs level of education. No significant relationships were found between any type of physical activity and the father&aposs education. The level of sport activity in private high schools was significantly (p=0.005) higher than in public high schools. On the other hand no significant differences were observed between levels of physical activity in private or public high schools compared to private or public vocational schools. Only sport activity had a significant positive relationship with higher knowledge (p=0.005) and attitude (pO.OOl).
The majority of our population (%58.6) was in pre-cont. and cont. level of stage of change. Therefore more emphasis should be placed on improving health education. We must also teach our teenagers to organize their leisure time so they can do some simple and inexpensive physical activities like brisk walking between home and school or while shopping.

EFFECT OF HEPATITIS B VACCINATION ON HBsAg STATUS IN BLOOD DONORS

M Yahya pour

The purpose of this study was to evaluate the influence of hepatitis B vaccination on the results of surface antigen tests in blood donors. In this research, eighteen non-immunized volunteers (ten male, eight female) aged 21 to 58 years received 20 ug of the recombinant B vaccine (Heberbiovac-HB) intramuscularly. Blood samples were drawn from all volunteers before the first vaccine dose (day 0) and on days 1,2,3 and 7 after vaccination. HBSAg assessment was done by six different kits (Behring, organon, Diasorin, Equipar, Trinity, Radim ). In this study, seven (39 %) of the eighteen volunteers showed a positive HBSAg reaction, confirmed by the duplicate samples. The most positive reactions were obtained by trinity kit on day 5 and 7. We conclude that individuals recently vaccinated against hepatitis B may have positive tests for HBSAg and it is recommended that such persons defer all blood donations for at least 7 days.

THE ROLE OF GERMAN COCKROACH IN HOSPITAL INFECTIONS

H Ladonni

Hospitals are habitually thought of as places where people "recover from disease". But failure to control agents of disease in these institutions can create or worsen disease and infection such nosocomial infections constitute a major threat to all hospitalized patients. The German cockroach (Blattella germanica) can be an effective transmitter of nosocomial infections by virtue of its ubiquitous presence and its behavioral characteristics. This research is focused on nosocomial organisms in Imam Khomeini and Shariati hospitals (belonging to Tehran University of Medical Sciences) and may be a first step in devising effective infection control strategies.
After recording data on the collection site, the collected cockroaches were transferred to a laboratory, where bacteria and fungi were isolated from the body surface and the digestive tube. The specimens were also subjected to insecticide sensitivity tests by the mortality and knock-down test methods.
Cultures of the external body surface yielded a total of 77 fungal colonies (filamentous fungi, Actinomycetes, yeasts and yeast-like organisms), while those of the digestive tract produced 83 colonies. Notable among these isolates were the highly virulent Aspergillus fumigatus and Aspergillus flavus species.
Bacterial studies showed that 100% of the roaches carried rich bacterial floras, most commonly including Klebsiella, Pseudomonas, Proteus, Citrobacter, Enterobacter and Serratia species. Many of these bacteria demonstrated antibiotic resistance, suggesting that the contaminants belonged to the hospital milieu. These results establish cockroaches as effective mechanical transmitters of multi-drug resistant bacteria.
Mortality tests revealed a high degree of resistance to permethrin, tolerance to Aicon, and sensitivity to other insecticides. Knock-down tests showed high permethrin resistance, tolerance to Aicon and deltamethrin, and sensitivity to Sulfac.

THE BEHAVIOR OF WOMEN CONFRONTED WITH UNWANTED PREGNANCIES

F Zamani Alaviche

The goal of this study is to evaluate women&aposs behaviors while their family planning programs fail or facing unwanted pregnancy. This is a cross-sectional study. The population is all 15-49 years pregnant women (788 people) in the villages (62 villages) of Najaf Abad City having active health center. Data were gathered through interview and their profiles. They were recorded in questionnaires.T test and X2 were used to analyze data.
The results showed that high-risk behaviors happen %44/3 more when family planning program fails. 105 (%31/72) of women having unwanted pregnancy did unsuccessful activities in order to end their pregnancy. The activities are different. %35 was physical such as: hitting, lifting heavy objects or using unhealthy vulva objects, %28/6 used injection, %9/5 eat chemical and plant medicine. And the other used two or three ones together. Women showed good behaviors in %91 of wanted pregnancy and %45 of unwanted pregnancy. There is significant relationship (p=0/001) between dealing with pregnancy and it&aposs being wanted and unwanted. There is also significant relationship (p=0/Q01) between women&aposs education and their behaviors toward pregnancy. According to the research findings more than one third of women did high-risk activities when a family planning program fails or facing unwanted pregnancy. These certainly influence their own and their family mental and physical health. So role of the prevention, counseling techniques and women&aposs support must be considered more than before. Society should be become aware of the unwanted pregnancy symptoms.

TOTAL PLASMA HOMOCYSTEINE CONCENTRATION IN 35-65 YEARS OLD ISCHEMIC HEART DISEASE PATIENTS IN ACILINIC IN TEHRAN

A jazayery

On the basis of recent retrospective and prospective studies, it is now widely accepted that increased total plasma homocysteine is a strong, independent risk factor for cardiovascular disease. Some studies have detected hyperhomocystememia in more than one - third of patients with coronary vascular disease. With an increase in total homcysteine (tHcy) concentration of 5 janol/L, the relative risk of cardiovascular disease has been estimated to increase by 60% for men and 80% for women. In a cross-sectional study we investigated tHcy concentration in 35-65 year-old ischemic heart patients (n=348, 157 men and 191 women) in a clinic in Tehran.
Fasting total homocysteine level was measured by high-performance liquid chromatography (HPLC) and using the internal method. The data were analyzed statistically using one-way analysis of variance (ANOVA) and the independent t-test. The results showed that while 18.96% of the patients had a normal tHcy level (<8 /imol/lit), in 27.52%, 50.52%, and 2.8 % of them the level was almost high (8-<12 /imol/L), high (12-<25 /imol/L), and abnormally (>25 /imol/L), resapectively. The mean tHcy concentration in men was significantly higher than in women ( P= 0.02). More extensive studies should be conducted to assess the tHcy status in the Iranian population at large.

EVALUATION OF SERVICES QUALITY BASED ON THE PATIENTS' EXPECTATIONS AND PERCEPTIONS IN ZANJANHOSPITALS

A Mohammadi

Measuring of service quality is the basic prerequisite for improving quality. Patients&apos expectations and perceptions of service quality play an important role in the choice of hospital, loyalty to organization and behavioral intention. A first step towards improvement would be to determine areas of quality that are most defective. Studies show that consumers are in close contact with service providers, and they are involved in the service process. Therefore, this group can measure services quality better than any other group. This study was conducted to measure service quality based on patients&apos expectations and perceptions in Zanjan hospitals.
The cross-sectional design was used in this research. For data collection, SERVQUAL questionnaire was employed. To ensure the reliability of the questionnaire, the internal consistency reliability test (Cronbach alpha) was performed.
Findings: Cronbach alpha for service quality was .94. Results show that the assurance (knowledge, experience and ability to maintain patients&apos confidence and trust) was rated as the most important dimension. (SQ mean = -1.3). There were differences between patients&apos expectations and perceptions in all the dimensions.
the assurance dimension constitutes the most serious problem facing hospitals. It is recommended that physicians thoroughly explain the disease condition to patients, and that patients should be treated with dignity and respect.