Journal of School of Public Health and

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Background and Aim: Staphylococcus aureus is one of the most important human pathogens. A major clinical concern is the high rate of antibiotic resistance among Staphylococcus aureus strains. Methicillin-resistant S. aureus (MRSA) strains are a major cause of community- and hospital-acquired infections. Therefore, genetic investigation of S. aureus strains isolated from patients with staphylococcal infection is crucial not only for tracking of infections but also for nosocomial infection control.
Materials and Methods: In this study, 103 Staphylococcus aureus isolates were collected from Tehran University of Medical Sciences hospitals. Antibiotic susceptibility patterns of the isolates were determined using a panel of 13 antibiotics by the disk-diffusion method. The isolates were investigated for hvr by the PCR method.
Results: According to the antibiotic susceptibility testing, 21 antibiotype profiles were detected. Sixty-four out of the 103 isolates were resistant to methicillin. PCR results showed 10 different patterns of hvr.
Conclusion: The results of this study showed high rates of antibiotic resistance and variations of hvr among the Staphylococcus aureus isolates. The high degree of hvr variation can be a good tool to use for molecular typing of this bacterial strain. Further investigation of antibiotic susceptibility patterns and genetic features of this bacterium is highly recommended for controlling community- and hospital- acquired infections.

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Background and Aim: Job enrichment is a method that has been used to increase employee satisfaction and work motivation. The Hackman and Oldham job characteristics model (1976) has served as the foundation for many job enrichment efforts. In particular, a considerable amount of research has been devoted to the study of the job characteristics-job satisfaction relations. Te purpose of this study was to statistically determine the relation between job characteristics and job satisfaction among employees of hospitals affiliated to Tehran University of Medical Sciences (TUMS) in 2007.
Materials and Methods: This study was a cross-sectional one, including 6 TUMS-affiliated hospitals-Emam, Shariati, Baharlo, Ziaeian, Madaen and Azadi. The sample size was 400, consisting of 200 administrative employees (50%), 151 nurses (38%) and 49 physicians (12%). The random sampling and stratified proportional sampling methods were used to select the hospitals and interviewees, respectively. Two questionnaires were developed and used to identify job characteristics and job satisfaction: 1) job diagnostics surveys (JDS) and 2) Hertzberg's job satisfaction questionnaire. The reliability of the questionnaires was ascertained by test-retest using the Pearson correlation coefficient (r = 0.88). Linear-by-linear association and ordinal logistics regression analysis were used for analyzing the data gathered.
Results:The relations between the Motivational Potential Score (MPS) and job characteristics (except for feedback) with job satisfaction were statistically significant (p<0.05). Task identity was the most effective determinant of job satisfaction.
Conclusion: It appears that all the job characteristics (except feedback) are important determinants of job satisfaction of the hospital employees. Although the work environment is in need of restructuring, it is important to note, from a positive perspective, that the job characteristics discussed in this study are readily amenable to change job satisfaction at the organizational level.

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Background and Aim: Methyl tertiary butyl ether (MTBE) is an oxygenated additive chemical added to gasoline, which is as a substitute for tetra ethyl lead, to reduce discharge of pollutants from automobile exhausts. This organic chemical is present in water samples collected from areas where gasoline wastes are abundant. The objective of this study was to investigate the possibility of MTBE removal from drinking water at the point of use (POU) by using an Iranian granulated active carbon (GAC) bed.
Materials and Methods: Adsorption of MTBE from drinking water at POU was studied by using an Iranian GAC bed. The water samples treated by this filter adsorber were prepared synthetically at two concentrations (50 ppb and 100 ppb). In addition, the effects of residual chlorine at concentrations of 0.2 and 0.5 mg/L and of chloroform at a concentration of 100 ppb on removal of MTBE were determined.
Results: It was found that this filter adsorber could treat 375 liters of water containing 50 ppb MTBE, 100 ppb chloroform and 0.2 ppm residual chorine. If the residual chlorine content was increased to 0.5 ppb, the volume of water treated would be 335 liters. The filter could t eat 195 liters of water containing 100 ppb MTBE, 100 ppb chloroform and 0.2 ppm residual chlorine to acceptable levels for drinking, provided the amount of MTBE is below the respective standard.
Conclusion: Both residual chlorine and chloroform reduced the MTBE adsorption capacity on GAC due to occupation of adsorption sites. In addition, to the tendency of GAC to adsorb chloroform and chlorine was greater than that of MTBE.

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Background and Aim: Body mass index (BMI) is a generally accepted indicator of body weight and obesity. A BMI>30 indicates obesity, which is regarded as a risk factor for many diseases, because their pathogeneses are associated with increasing numbers of free radicals derived from oxygen. The present study was a clinical trial carried out in order to study the effects of weight loss on enzymatic antioxidants and its association with dietary intakes of copper, zinc, iron, selenium and, magnesium in obese women.
Materials and Methods: Thirty obese women, 19-50 years old, of whom informed consent was obtained, were included in the study. Information was collected on their general characteristics, and anthropometric measurements were made. A diet with a 500- to 1000-calorie deficit was recommended to the subjects, on the basis of micronutrient intakes estimated through a 24-hour dietary recall questionnaire 3 days before and after the intervention. The aim was to bring about a weight loss of 10%. A 10-ml blood sample was taken from each subject, before and after intervention, for enzymatic measurement of enzymatic antioxidants in the red blood cells.
Results: Weight loss caused a significant increase (p<0.01) in the mean glutathione reductase (GR) and catalase (CAT) no statistically significant change occurred in the mean values of superoxide dismutase (SOD) or glutathione peroxidase (GPX). The only association between the enzymes and trace elements (Cu, Zn, Fe, Mg, Se) was a negative linear correlation between daily zinc intake and GPX before intervention (r=0.395, p<0.05)
Conclusion: A 10% reduction in body weight might be an effective step toward increasing levels of enzymatic antioxidants which would minimize injuries caused by free radicals and reduce oxidative stress in obese women. Attention should be paid to the dietary intakes of micronutrients essential for the activities of these enzymes.

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Background and Aim: Laboratory fume-hoods are the first-level protection for the laboratory staff against hazardous chemical pollutants. Considering the large numbers of personnel, especially in petrochemical industry laboratories, this project was carried out in order to assess the performance of laboratory hoods based on tracer gas (SF6).

Materials and Methods: In this project 22 hoods in the laboratories of a petrochemical industry were studied. Operation of the hoods was assessed based on quantitative (with SF6 as tracer gas) and qualitative (face velocity measurement, using thermal anemometer) tests, according to ASHRAE 110 stndard.

Results: In comparison with the minimum acceptable face velocity (80 fpm), the mean values of face velocities of only 9.09% of the hoods passed the test (P=0.001) and were at an acceptable level. As regards the tracer gas test, the results were even worse: only 4.5% of the hoods passed the acceptability test (p=0.001). In addition, non of the hoods having an acceptable face velocity passed the tracer gas test. Similarly, no hood with an accepatable tracer gas performance had an acceptable face velocity.

Conclusion: Since there is no consistency between face velocity and tracer gas tests, performance of laboratory hoods can necessarily be assessed on the basis of the tracer gas quantitative test. The face velocity test is a supplementary test, which, if used alone wil give false results.

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Background and Aim: Application of modern technologies and changes in industries and work practices, particularly in assembly lines, have resulted in increased work-related musculoskeletal disorders (MSDs). This has led to reduced occupational competence in both industrialized and developed countries. This study was conducted to determine the prevalence of MSDs in the upper limbs, postural loading on the upper limbs (using the LUBA technoque), and ergonomic risk factors among assembly workers of an Iranian Telecommunications Manufacturing Company (ITMC) in Shiraz, Iran.

Materials and Methods: In this cross-sectional survey data were collected, using the Nordic Musculoskeletal Disorders Questionnaire (NMQ) and LUBA Checklist, on 193 randomly selected registered assembly workers from 8 units of the assembly line of ITMC, Shiraz, Iran. The statistical tests used were as follws: 1.The qui-square test, to determine factors causing MSDs 2. One-way analysis of variance and Kruskal-Wallis to determine postural loading index 3. Logistic multiple regression analysis, to determine risk factors.

Results: Lower-back symptoms were found to be the most prevalent problem (67.9%.) among the workers. The findings also showed that the upper limb disorders were significantly associated with age, sex, job, daily working time, work evironment conditions, and twisting (P<0.01). Based on LUBA, a large majority of the workers (89.64%) had experienced high postural loading (PLI = 5). In addition, significant associations were found between postural loading and symptoms of upper limbs and units of work (P <0.05).

Conclusion: Based on these findings, MSDs are prevelent among Telecommunication Manufacturing Company in Shiraz, Iran. The most important factors likely to cause MSDs are postural loading on the limbs and unfavourable working conditions. Interventional programs aimig at preventing musculoskeletal problems among assembly line workers should focus on reducing postural loading.

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Background and Aims: The ready-to-eat foods, before and after preparation, usually kept in a refrigerator before consumption for a relatively long time, increase the risk of food poisoning. The aim of this study was to determine the effect of refrigeration in the fast-food shops on the microbial contamination of fast foods.

Materials and Methods: A total of 100 samples, including 46 cooked beef livers and 54 cooked sausages were collected from fast-food shops in the south of Tehran and analyzed according to the procedures of the Office of Food Control Laboratories (OFCL). The samples were tested randomly for the microbial contamination on the first, third, fifth and seventh days of storage in the refrigerator.

Results: Results of microbial analysis showed that 35 cooked sausage samples (64.8%) and 34 cooked liver samples (73.9%) on the first day, 44 cooked sausage samples (81.5%) and 42 cooked liver samples (91.3%) after the third day, 47 cooked sausage samples (87.1%) and 44 cooked liver samples (95.6%) after the fifth day, and 50 cooked sausage samples (92.3%) after the seventh day were unfit for consumption Frying of the food items before consumption would decrease, though to a small extent, microbial contamination (P<0.05). Increased total micrbial counts of the food items, exceeding the respective standards, is the most important inhibitory factor for their consumption.

Conclusion: The results of this study showed that keeping cooked foods for a long time in the refrigerator causes increased microbial contamination over time.

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Background and Aim: Hospital disaster-management planning and preparedness are essential, considering earthquake threats in Iran. The objective of this study was to assess preparedness of hospitals affiliated to Iran University of Medical Science (IUMS) in Tehran against earthquakes in 2007 (1386 Iranian year).

Materials and Methods: This was a cross-sectional, descriptive-analytical study, involving 21 governmental and private hospitals affiliated to IUMS selected by random sampling. Data were gathered using checklists, questionnaires, interviews, and observation. The SPSS software was used for analysis of the data, and the Fisher exact test was employed for statistical analysis.

Results: The data showed that, on the whole, 28.6 %, 61.9 %, and 9.5 % of the hospitals were at a weak, moderate, and good preparedness level, respectively. The hospitals preparedness level with regard to equipment safety and hazardous materials planning increases with their degree of specialization, the association being statistically significant (p = 0.038). The findings also show that there is a significant relationship between the hospital preparedness level (as regards planning for building dangers reduction) and crisis management training courses (p = 0.034).

Conclusion: Training courses are very effective for creating hospital preparedness against earthquakes.

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Background and Aim: One of the most prevalent occupational diseases and conditions is musculo-skeletal disorders (MSDs) that impose expensive medical-recompense expenses, organic damages, and work-time wasting. The aim of this study was to detect spine curvatures (cervical, back/ low back, lumbar) and prevalence of musculo-skeletal disorders in assembly workers of Bahman automobile company, Tehran, Iran.

Materials and Methods: In this cross-sectional, descriptive-analytical study 160 assembly workers of Bahman Automobile Manufacturing Company (vans, cars), Tehran, Iran were included. In the descriptive part data were collected on the demographic characteristics of the subjects. In the analytical section associations among the dependent variables, as well as between the dependent and independent variables, were determined. The Nordick Questionnaire, a scale, and a flexible ruler were used for data collection. The SPSS software was used for data analysis.

Results: Although the mean age of the participants was low (30.89 yrs), the prevalence of MSDs was high (69.4% 1.58). The most prevalenct of the MSDs was in the lumbar part (n=83 %51.9) and the least in the hip and femoral region (n=9: %5.6). Significant associations (p < 0.05) were found between MSDs prevalence and independent factors (age, years of working, marital status). However, cervical, back, lumbar curvatures and the Delmax index were not statistically related with MSDs.

Conclusion: This study shows that associations exist between muscleo-skeletal disorders and age, years of working, height, and marital status. The findings also reveal that there is no relation between MSDs and the vertebral curvatures (cervical, back, lumbar), except the neck curvature in the car (not van) assembly workers. It may be concluded that genetics and environmental conditions can adversely affect the musculo-skeletal health. We cannot control the genetic factors. However, one can provide more favorable environmental conditions. For example, employing younger workers may help decrease the musculo-skeletal disorders.

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Background and Aim: The normal plasma fatty acid (FA) composition changes in hypertriglyceridemic obese and overweight indiuviduals. The objective of this study was to determine the plasma fatty acid composition in hypertriglyceridemic obese or overweight subjects with different FABP2 genotypes.

Methods and Materials: Forty-six hypertriglyceridemic subjects (33 men and 13 women, 25-60 years old) referred to the Endocrinology and Metabolism Research Center (EMRC), Shariaty Hospital in Thehran, between Mehr and Esfand 1386 (September 2007-March 2008), were genotyped for FABP2 polymorphism by PCR-RFLP. In addition, their blood lipid profile was determind enzymetically, photometrically and immunoturbidometrically, and their plasma fatty acid composition by gas-choromatography. Also, body weights and heights were measured and body mass index calculated.

Results: Positive associations were observed between Thr54 polymorphism in FABP2 protein and plasma lipid fractions (SFA, PUFA, ω-6-, ω-3- and total fatty acids (P<0.001 )). No significant differences were observed between PPARα polymorphism and plasma fatty acid composition, except for ω-3 fatty acids,

Conclusion: In obese or overweight hypertriglyceridemic subjects the plasma fatty acid compositions are different. The levels of some fatty acids are higher, while those of some others are lower, in different FABP2 genotypes. On the whole, higher levels of SFA, PUFA, ω-6, ω-3, and total fatty acids were more pronounced in Thr54- than in Ala54-carrieres.

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Background and Aim: Leishmaniasis is a parasitic disease transmitted by sand-flies. Seventeen out of the 30 Iranian provinces are contaminated. Although many therapeutic modalities have been suggested, no definite treatment for this widespread infection is available. Many drugs currently used for cutaneous leishmaniasis have their side effects and create complications-drug resistance, etc. This has prompted researchers to get interested in drugs of a natural origin. The aim of this study was to investigate and compare the efficacies of an extract of propolis and systemic glucantime against cutaneous leishmaniasis in Balb/c mice.

Materials and Methods: Groups of inbred, female Balb/c mice, aged 4-6 weeks, were inoculated with 1.6 × 10 6 viable stationary-phase promastigotes in the base of tail. The mice were provided by Iran Pasteur Institute, Tehran and were randomized into three groups of 9 mice each. Groups 1 to 3 were treated with pure 70% ethanol, systemic glucantime, or the propolis hydroalcoholic extract for a 6-week period the 4th group served as control. The statistical tests including student t-test were used for data analysis.

Results: Overall, 27 mice were studied. We did not observe any statistically significant difference among the groups with regard to the size of the ulcer at the beginning (P>0.01). At the end f the period, there was a significant difference with regard to reduction of ulcer size between the propolis extract and glucantime groups in favor of the propolis extract (P= 0.001). Further analysis of the data showed that the largest reduction in the ulcer size was caused by the propolis extract, as compared with the control, glucantime and alcohol groups.

Conclusion: Our results suggest that the propolis extract is more effective in the treatment of cutaneous leishmaniasis in mice. We suggest that the efficacy of this extract alone or in combination with drugs be assessed against human cutaneous leishmaniasis, using randomized clinical trials.

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Background and Aim: The role of fresh water snails as the intermediary host in transmitting parasitic infestations in man and animals is well known. In Iran, urinary schistosomisasis is known to be endemic in the Khuzestan Province, south-west of the country. Considering the Egyptian experience concerning the negative effects of Aswan Dam construction on expanding the prevalence of human bilharziasis, the possible role of huge agro-industrial sugar-cane projects on eliminating schistosomiasis in the only known endemic province of Khuzestan in Iran came to our attention. The main objective of this study was to identify the species of fresh water snails in a vast area under cultivation of sugar cane in Khuzestan province, S.W. Iran.

Methods and Materials: Thirty locations (points) under cultivation of sugar-cane in the area were selected for snail collection. In the selected localities there existed drains, canals, ditches, and water stands. Preliminary identification of snails was performed at the time of collection. A more complete taxonomical study was made after the samples were transferred to the laboratory of Dezful Health Research station.

Results: The total number of snails collected was 3825 snails, and seven different species were identified: Physa sp . (29%), Gyraulus sp. (19%), Melanoides sp. (16%), Bellamya sp. (14%), Melanopsis sp. (12%), L. gedrosiana, (7%)L. truncatula(2%). No Bulinus truncatus was seen .

Conclusion: Most of these snails are capable of getting involved in the life cycle of some zoonotic helminth parasites, e.g., Fasciolid and Heterophyd. These findings are encouraging. However, in order to avoid any possible undesirable effects on the public's health, constant monitoring, as well as annual malacological surveys, is essential.

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Background and Aim: Unwanted pregnancy is a widespread problem globally and in Iran, which can lead to low birth weight (LBW)-one of the most important causes of mortality in newborns. This study was conducted to assess the risk factors among women with unwanted pregnancies leading to delivery of LBW infants. Other LBW risk factors were also studied.

Methods and Materials: This was a prospective cohort study performed during March 2004 to April 2005 in the health centers of Shemiran, north of Tehran, Iran. A sample of 180 mothers, 15-49 years old, with an unwanted pregnancy (case group) and 430 mothers, in the same age group, with a wanted pregnancy (control group) were compared. To determine the effect of unwanted pregnancy three major type of variables (background, maternal, and neonatal variables) were selected, and the mothers were followed up for 11-12 months (from the first referral for prenatal care to about 2 months after delivery). Statistical univariate analyses were performed using the t- and χ2 tests. Also, multiple logistic regression was employed to identify the risk factors associated with LBW. SPSS 11.5 for windows was used for data analysis.

Results: The unwanted pregnancy prevalence was 11.7%. The mean of Apgar score was 8.6 in the case group and 8.9 in the control group, the difference being statistically significant (p<0.001).Mean birth `1234t5weight of neonate in the case group was about 2.984kg vs. 3.14kg in the control group, and the difference was statistically significant (p<0.001) . Univariate analysis showed that LBW was related to unwanted pregnancy (p<0.001), gestational age (p<0.001), mother's age (p<0.001), mother's marriage age (p<0.001), birth order (p<0.001), number of past pregnancies (p<0.001), family size (p<0.001), number of abortions (p<0.001), attempt to abort (p<0.001), high blood pressure (p<0.001), and diabetes (p<0.001). Finally, multivariable analysis revealed that LBW was only associated with unwanted pregnancy, high blood pressure, and diabetes in mothers, with adjusted odd ratios of 2.22, 2.81 and 3.55, respectively (p<0.05).

Conclusion: Prevention of unwanted pregnancies, increased gestational age, and appropriate management of mothers' chronic diseases can reduce the risk of LBW.

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Background and Aim: Environmental health impact assessment of industrial estates will help greatly in better planning for sustainable development and reducing disease risk in a community. The objective of this study was to assess the positive and negative effects of establishing an industrial estate in Jovein, Sabzevar, Iran in 2006-7 and suggest managerial strategies to reduce undesirable environmental health impacts.

Methods and Materials: A modified Leopold Matrix and Scaling checklist method was used. The existing environmental situation was investigated and then environmental impact assessment alternatives were determined, bearing in mind the amounts and kinds of predicted pollutants in the construction and operational phases . The assessment was made considering the immediate, direct, and indirect impacts in the short and long terms. It was attempted to use a wide range of values of different factors (-5, +5) in order to estimate the impact of all activities on the environmental status.

Results: The results of the study are presented with two alternatives, i.e., "No" (conducting the project with no concern for environmental issues), and "Yes" (performance of the project with application of methods to reduce the environmental harmful impacts), when establishing the industrial estate, in the construction and operation phases. The impact assessment with the "No" alternative scored -791, meaning that execution of the project had to be rejected. However, after reducing the harmful impacts the score rose to +252, indicating that the project would be accepted.

Conclusion: The method of reducing harmful environmental impacts along with environmental management programs introduced are accepted in this study. It is recommended that the Ministry of Health and Medical Education and The Iranian Environmental Protection Agency collaborate closely in the area of environmental health impact assessment of industries and industrial estates.

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Background and Aim: Determination of the age of vector mosquitoes is of particular importance in epidemiological studies of diseases transmitted by them, such as viral and parasitic diseases. The objective of this study was to determine the daily age of Anopheles stephensi based on changes in pteridine concentration in female mosquito cuticles by liquid chromatography (HPLC).

Methods and Materials: Females of Anopheles stephensi were raised in an insectary (28° C, 70% relative humidity). At 1, 5, 10, 15, 25, 30 days post-emergence they were divided into groups of 10 mosquitoes each. The mosquitoes in each age group were further divided into 3 subgroups of 10 each for chromatographic (HPLC, emotion = 355 nm and excitation= 465 nm) pteridine extraction. The chromatograms obtained were compared with the respective standards to determine the types of pteridines.

Results: Four types of pteridines were detected in the cuticle of Anopheles stephensi, including isoxanthopteridine, pteridine-6-carboxylic acid, biopteridine, and xanthopteridine. They were all present in all the cuticle of the mosquitoes however, no biopteridine in the head or xanthopteridine in the thorax were found. Generally, as the age of the mosquitoes increased, pteridine concentrations kept declining, such that after 30 days the total concentration reached 10% of the original.

Conclusion:The findings indicate that there is a negative correlation between the concentration of pteridines in the cuticle and daily age of female mosquitoes. The method described can be used as a standard method to determine the daily age of Anopheles, as well as of other mosquito species, since it is fast and precise and needs small samples. Its major limitation is non-availability of HPLC in many parts of the country, although it is possible to freeze dead mosquitoes and transfer them to centers where HPLC is available.

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Background and Aim: Organizational centralization, an important concept/system in management, relates to hierarchy of authority and degree of participation in decision-making. In this study we aimed to determine the extent of organizational centralization in hospitals affiliated with Tehran University of Medical Sciences (TUMS), Tehran, Iran and identify factors affecting the organizational centralization at the level of executive managers.

Methods and Materials: All the managers and head nurses of 13 TUMS hospitals (26 subjects) were included in this cross-sectional study in 2005. Data, collected using questionnaires, were analyzed using the following tests: t-test, ANOVA, Pearson and Spearman, the software being the SPSS. The extent of organizational centralization was categorized into centralized, semi-centralized, and uncentralized.

Results: Five of the 5 variables studied were statistically significantly associated with organizational centralization. They were gender (p=0.001), organizational position (p=0.005), attending management courses (p=0.001), and financial burden of decisions (p=0/03) in the hospital managers group, and possibility of controlling the decision (p=0.014) in the head-nurses group.

Conclusion: The average organizational centralization in the hospitals was 75.38% it was 76.3% and 73.38% for hospital managers and head-nurses, respectively. On the whole, the management system of TUMS hospitals is a semi-centralized system.

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Background and Aim: Adolescence is the transition period between childhood and adulthood, a period in life that begins at puberty. It is one of the fastest growth periods in a person's life. During this time, physical changes affect the body's nutritional needs, while changes in one's lifestyle may affect eating habits and food choices. Nutritional health during adolescence is important for supporting the growing body and for preventing future health problems. In Iran, the prevalence of anemia, obesity, and other chronic nutritional diseases has increased in recent years due to undesirable eating habits. This survey was conducted to determine consumption of the four major food groups (vegetables, fruits, milk products, and meat) among a group of high school students in Zanjan Province, Iran.

Methods and Materials: A descriptive, cross-sectional study was carried out on 1500 students, selected by random cluster sampling, in Zanjan high schools, Iran in 2005. The daily intakes of the 4 food groups during the previous week were determined using a food frequency questionnaire. The potential determinants of the pattern of food consumption were also determined.

Results: The proportions of the students not having consumed fruits, vegetables, and meat during the weak were 16%, 6.8%, and 10%, respectively. More than 95% of the students said that they had consumed milk/milk products at least once a day. Only 8.7% consumed fruits and 27% consumed vegetables 3 times or more daily.

Conclusion: The consumption of the 4 food groups of large proportions of Zanjan Province adolescents is below the current recommendations. Health and nutrition educational programs would be a valuable tool to correct erroneous food habits of the adolescents leading to improvements in their nutritional status.

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Background and Aim: Thalassemia is one of the most common worldwide single-gene diseases. On the molecular level, it is a heterogeneous disease. So far, beside large deletions, more than fifty point mutations have been identified for this disease around the world. Four to ten percent of Iranians are carriers of thalassemia-affected genes. In this study we determined the relationship between the value of MCV/MCH and the type and severity of mutations in alpha thalassemia carriers.

Methods and Materials: The major abnormality in alpha thalassemia carriers is decreased values of MCV and MCH. A total of 104 adult alpha thalassemia heterozygotes, 20-40 years old, including 33 persons from Khoozestan Province and 71 from Khorasan Province, were included in the study. Two hundred and eight chromosomes were isolated from peripheral blood leukocytes using standard procedures. DNA samples were amplified by Gap-PCR.

Results: Only one ° mutation (MED) was found in 2.9% of the population. The carriers of this mutation had virtually identical ranges of MCV and MCH. In contrast, + mutations were associated with significant differences in mean MCV and MCH values. The various mean MCV/MCH ratios of ° carriers were statistically significantly lower than those of + heterozygote. The results indicated that the degree of reduction in MCV and MCH is directly related to the severity of the mutations. Deviations, in cases, were associated with lower numbers of the carriers.

Conclusion: Only one ° mutation (MED) was found in 2.9% of the population. The carriers of this mutation had virtually identical ranges of MCV and MCH. In contrast, + mutations were associated with significant differences in mean MCV and MCH values. The various mean MCV/MCH ratios of ° carriers were statistically significantly lower than those of + heterozygote. The results indicated that the degree of reduction in MCV and MCH is directly related to the severity of the mutations. Deviations, in cases, were associated with lower numbers of the carriers.

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Background and Aim: Factors determining the health care-seeking behaviors of an individual are social, cultural, and economic (treatment costs). Utilization of a health care system by a person will, on the whole, depend mainly on the socio-economic and demographic factors, cultural beliefs and practices, gender discrimination and women's status, the economic and political systems, environment, patterns of illness, and the health care system itself. The main objective of the present study was to examine current patterns of health care-seeking behavior in residents of Tehran, Iran in 2007.

Methods and Materials: In a cross-sectional study a two-stage cluster sampling method was used to select neighborhoods at the first stage and households at the second. The sample included a total of 1882 individuals over 18 years old in the households. The data were collected using a questionnaire. For analysis of the data the exact fisher test, X2, and multivariate logistic regression were used the software used was SPAA.3

Results: About 22/9% (431 persons) of the participants reported 1-2 illnesses during the previous month. Multivariate logistic regression indicated that age, sex, perceived severity of the illness, educational level, and marital status were all statistically associated with an attempt to seeking care, whether self-treatment or consulting a health center. The effects of different variables on decisions related to seeking care from a health care center versus self-care were also examined. The data showed that age, sex, perceived severity of the illness, income, educational level, household size, and method of payment were statistically the most significant variables affecting seeking care from a health center.

Conclusion: Based on these findings, it may be concluded that increasing social awareness about side effects of medicines, potential dangers of self-treatment, continuous education and training of physicians and pharmacists, improving health insurance systems and universal insurance coverage will be appropriate strategies for better utilization of health care services by the people.