Tehran University Medical Journal

---

The healthy city is one that is designed to achieve optimal echological, social, and physical specifications for residents of the community that are developing constantly, and that a comprehensive different intrasector cooperation, resources and existing utilities are developed so that an environment of mutual cooperation and assistance for every individual civilian are provided. An environment to maximize their potential ability. One of the specific goals of healthy city, is the development of public knowledge, and cooperative involvement in social health and hygienic programs. The project of healthy city is carried in the Koyee Sizdah Aban, Rey city for the first time. This article has compared the studies carried in the Koyee Sizdah Aban and the other one that in carried in the district of Dowlat Abad, in regard to above-mentioned points. In this study the rate of knowledge, attitude, and the practice of four hundred of 15-49 years old women within the limits of healthy city, was compared with other four hundred women residing in the district of Dowlat Abad in regard to hygienic programs. According to the result of this study the mean percent of knowledge in the healthy cities women were significant in relation to other group. The rate of attitude toward the hygienic problems in the health city and the district of Dowlat Abad did not show a significant differences. The rate of practice of the women of healthy city with 95% of confidence was more than the women of Dowlat Abad. This study clarified that literacy of women and their spouse have positive effect on their knowledge and practice in regard to hygienic problems, but there is not meaningful relation between profession and age of women in regard to the knowledge and practice.

---

Background: The idea of integration of medical education into health care system with the goal of comprehensive self sufficiency and complete response to public health needs were initiated in 1985. There were many prose and cones in this procedure which raised many controversies. The dilemma about strengths and weaknesses increased in 2002 during which Iran parliament tried to change the situation. In this study we tried to conclude and exit the dilemma.

Materials and Methods: We studied the attitude of key academic person regarding the integration. In a cross-sectional study using a pretested questionnaire, we assessed the attitude of 556 academic staffs and managers from eight randomly selected medical universities.

Results: Most of respondents agreed the positive out come of integration like establishment of disease surveillance and improving in health indicators, but they believed that the quality of medical education has decreased. Most of respondents suppose that dissociation of medical education may cause a lot of problems.

Conclusion: There are a lot of controversies regarding the strengths and weaknesses of integration. External factors were causes of decreasing the quality of education so it is important to decide about the future by considering external factors.

---

Background: Heroin is one of the opiates which is used, as the most addictive drugs, in Iran. Considering the damaging effects of these drugs on the health of opiate addicts, investigation on the effects of heroin used in Iran, on male genital indicators including daily sperm production and its development, which has an essential role in fertility, seems to be necessary.

Materials and Methods: A total of 70 Bulb/c mature male mice, were divided into 5 groups of control, [intact (n=10), sham I (n=10) sham II (n=10)] and experimental groups [I (n=20), II (n=20], and 50 days after addiction to heroin (50 mg/kg) via intra peritoneal injection (IP), 6 mice from each groups were selected and after euthenizing, the testes and epididymes were removed. The rate of daily sperm production (DSP), epididymic sperm preservation (ESP) and the rate of sperm motility were measured accurately.

Results: In the study of the effect of heroin on daily sperm production and sperm preservation between the control and experimental groups, no significant differences were observed. The effect of heroin on sperm motility between control and experimental groups, the difference were significant (P<0/05).

Conclusions: In this survey, it was indicated that, the heroin used in Iran, causes a decrease in healthy sperms of mice their motility, and consequently can affect on genital indicators.

---

Background: The aim of this study is to describe the mental health and social profile of adolescent thalassemic patients through self-report and GHQ-12 test.

Materials and Methods: With convenience sampling, 156 consecutive adolescent thalassemic patients, recruited during a 20month period, filled in a semi-structured self-administered questionnaire in addition to a GHQ-12 questionnaire.

Results: 100 cases (64.1%) denied having health problems. 71 patients (45.5%) described their health status as not bad and 39 cases (25%) as good. The average GHQ-score was 6.12 (0.95 CI- 5.69-6.56). Nine cases (5.8%) scored low (0-1) and 21 cases (13.5%) scored borderline (2-3), while the score of 124 patients (79.5%) was favorable (4-12). There was a significant difference between mean scores in different age groups (p= 0.036) and 78 percent of those with low scores were in their late adolescent period (18-21 yrs). 15 patients (9.6%) had quit school due to their health problems. Mean GHQ score for quitters was significantly lower than those going on with their studies (p= 0.017).

Conclusion: These adolescent thalassemic patients seemed to have coped properly with their disease. Possibility of denial should also be considered. Further studies for detection of high-risk groups for psychosocial derangements can help us in applying appropriate and timely preventive and supportive measures.

---

Background: It was believed that Inhabitant of Islamshahr avoid referring to their health centers and health posts to receive bargain medical services. In search for the rate and causes of such neglect, this study was formed.

Materials and Methods: In a cross-sectional study from all urban centers and health posts under the supervision of Islamshahr health network, 712 files were selected randomly.

Results: Investigating the selected files it revealed that 25% were complete, 51% were defective and 24% were blank. In other words, only 25% of the files were complete and 75% of the files showed lack of full participation in primary care services. In the process of evaluation of each separate service unit, more defective files were found in family planning and oral health programs. But in the prenatal care and growth observation units, the number of complete files was a little higher than the number of defective ones. This is probably justifiable de to free vaccination of children and pregnant women, which causes the customer to refer to the mentioned units. In search for the causes of this lack of participation, 533 defective files were selected and those families were interviewed through some questionnaires.

Conclusion: In family planning and growth observation and prenatal care, the interviewees believed that there was no need for them to seek such services. This in turn shows their lack of knowledge about the necessity of these cares. In case of oral health, lack of such unite in the health center was mentioned as the reason. More details are discussed in the article.

---

---

Background: Medical education is inherently stressful and demanding to deal with various stressors, which may cause impaired judgment, reduced concentration, lack of self-steam, increased anxiety and depression.

Materials and Methods: A cross sectional study was conducted on 250 medical students from 6 month period to graduation in medical college of Tehran university of Medical sciences in order to assess their anxiety and practice of health behaviors and also the relation between the two variables and some other related factors..

Results: The results of study show that of 6.6% medical students suffer from severe state and 4.9% from trait anxiety. The finding of this study shows that 83.3% of girls and 84.6% of boys have practicing risky health behaviors. No statistical relationships found between, anxiety and practicing health behaviors. The relation between anxiety and health satisfaction was Statistically significant mental and physical (P<0.001).

Conclusion: The information found in this research, can help medical education institute to capitalize an opportunities to help their students in preventing risky behaviors, and different stress management techniques should be taught at medical schools.

---

Background: The common cold is the most prevalent sickness and an important cause of absence from job. Furthermore, it often disturbs travel, including the practice of hajj, causing the use of many inappropriate drugs by these travelers. The health belief model is a psychological model that attempts to explain and predict health behaviors. The purpose of this study was to determine the effects of zinc and health belief model based educational intervention on the behavior of hajj travelers with regard to viral upper respiratory tract infections (URTI).

Methods: This double-blinded randomized controlled trial was performed among hajj travelers in 2005. Preventive measures were randomly allocated to four groups: 1- education + zinc sulfate. 2- education + placebo. 3- zinc sulfate only 4- placebo only. Data regarding incidence and duration of URTIs, background disorders, vaccination and health behaviors for cold were gathered by questionnaire by physicians and finally analyzed by SPSS 11.5 software using chi-square, t-test and independent samples t-test.

Results: A total of 646 travelers were studied. The incidence of common cold in groups receiving zinc were significantly less than that for those receiving the placebo. (P=0.05). However, incidence was statistically the same for those who received education versus those who did not. Use of handkerchief was the most prevalent behavior and use of mask was the least prevalent behavior. Mean duration of symptoms was less in those receiving zinc and education (3.7 days) comparing to those who received placebo and education (5.6 days). 

Conclusions: This study showed that zinc consumption can decrease the incidence and duration of the common cold. Health belief model based education could promote some preventive behaviors although most people do not take advantage of them. We recommend the use of zinc by those attending hajj.

---

Background: Burnout is one of the most important factors in reduced productivity in organizations and involves physical and mental signs, especially in the human service professions. The role of nurses in the healthcare system is vital and motivation to ensure health security is extremely important. We carried out this research to examine the relationship between burnout and mental health in the nursing staff of educational hospitals of Tehran University of Medical Sciences.
Methods: A descriptive cross-sectional survey was conducted among 200 nurses selected via probable multistage sampling. We used three instruments in this study: 1) demographic questionnaire 2) General Health Questionnaire-28 (GHQ-28) and 3) Maslach Burnout Inventory (MBI).
Results: On the whole, using the MBI subscale, we found low levels of emotional exhaustion and depersonalization and high levels of reduced sense of personal accomplishment, both in frequency and intensity. The prevalence of symptomatic samples in the GHQ-28 was 43%, and two variables, burnout and poor mental health, were related (p<0.001). Burnout was to be related to gender, age and years of work. The correlation between poor mental health and years of work as well as hours of work in a week were significant.
Conclusions: Our results suggest that there is a strong correlation between poor mental health and burnout. Furthermore, the prevalence of symptomatic samples detected in our study using the GHQ-28 was much higher than that reported in studies of the general population. The high prevalence of symptomatic samples and high prevalence of burnout in the dimension of self accomplishment, especially in younger nurses, combined with the strong correlation between poor mental health and burnout all show that care should be taken to improve the stressful conditions that nurses face.

---

Background: Health care workers (HCWs) are at substantial risk of acquiring bloodborne pathogen infections through contact with blood and other potentially infectious materials. The main objectives of this study were to determine the epidemiological characteristics of occupational exposure to blood/body fluids, related risk factors of such exposure, and hepatitis B vaccination status among HCWs.
Methods: This cross-sectional study was conducted from December 2004 to June 2005 at three university hospitals in Tehran, Iran. Using a structured interview, we questioned HCWs who had the potential for high-risk exposure during the year preceding the study.

Results: With a total number of 467 exposures (52.9%) and an annual rate of 0.5 exposures per HCW, 391 (43%) of the 900 HCWs had at least one occupational exposure to blood and other infected fluids during the previous year. The highest rate of occupational exposure was found among nurses (26%) and the housekeeping staff (20%). These exposures most commonly occurred in the medical and emergency wards (23% and 21%, respectively). The rate of exposure in HCWs with less than five years of experience was 54%. Percutaneous injury was reported in 280 participants (59%). The history of hepatitis B vaccination was positive in 85.93% of the exposed HCWs. Sixty-one percent had used gloves at the time of exposure. Hand washing was reported in 91.4% and consultation with an infectious disease specialist in 29.4%. There were 72 exposures to HIV, HBV and HCV exposure to HBV was the most common. In 237 of the enrolled cases, the source was unknown. Job type, years of experience and hospital ward were the risk factors for exposure.
Conclusion: Education, protective barriers and vaccination are important in the prevention of viral transmission among HCWs.

---

Background: Mental health needs to increase in disasters and this study assesses the basic and mental health needs and delivered services during the first month after Bam (Iran) earthquake disaster in year 2004.
Methods: Thirty Five mental health professionals and experts were involved in mental health care and interventions for survivors in Tehran general hospitals and in the Bam, were participated in a focus group qualitative study, and finding analyzed after coding from tape recorder.
Results: The primary and immediate needs of survivors were: water, food, shelter, security, finding family members, treating and helping injured ones, respect and good relationship by others, and information and news about disaster and others. Second and long time needs and services were the previous needs and services and also immediate starting the daily routine activities, opening schools and workplaces, participating in community services and resettlement or housing. Lack of previous program and inadequate services are discussed in the paper.
Conclusion: It is the first time in Iran survivors get immediate mental health intervention in disaster, but based on finding and the survivors needs, and the problems reported in services were delivered, the study proposes a new mental health intervention program in natural disaster for Iran.

---

Background: Immediately after Comprehensive Medical Basic Sciences Examination (CMBSE), the secretariat of the Medical Basic Sciences Education Council (MBSEC) proceeds to rank medical universities according to the students’ scores both in individual academic subjects such as biochemistry, English and in all subjects put together. This study believes that the method used in ranking the universities according to the students’ English scores is not a proper method and thus doesn’t provide accurate results.
Methods: Seven of the major and smaller universities were selected. The language scores of all the students admitted to the medical schools of these universities during 3 academic years of 1378 to 1381 (2426 students in all) in both CMBSE and National university Entrance Examination (NUEE) were obtained. The language scores of each students in NUEE and CMBSE were matched.
Results: A significant correlation (max. R=69%, P<0.004 to min. R=27%, P<0.045) was observed between these two grades in all universities studied. Moreover despite the secretariat’s decision to calculate the scores and rank the universities in two separate groups of major and small universities, in some CMBSEs certain smaller universities were ranked in the group of major ones and in some others vice versa.
Conclusions: This has impaired the university ranking in the subject of English language. This study proposes two different ranking methods, that eliminate the present drawback in university ranking according to their student’s English scores.

---

Background: The basal levels of androgens in women decline gradually with age. These changes may reduce muscle strength and bone density leading to fatigue and psychological problems. Thus, the aim of this study was to compare the effects of resistance and endurance exercises on androgens, cortisol and lactate concentrations in elderly women.

Methods: In this study, 10 elderly women with a mean age of 54.3±3.74 years and a BMI of 24.88±2.07 kg/m2 completed an endurance exercise session (ES), a resistance exercise session (RS), and a control session (CS) in a randomized, cross-balanced design. The RS consisted of three sets of 10 repetitions of eight exercises with 80% 1RM (one repetition maximum) over of 45 minutes and the ES consisted of cycling at 60%-70% of maximum oxygen consumption for 45 minutes. During the CS, subjects performed no exercise. Before and immediately after exercises, and after 15 minutes of recovery, and also during CS blood samples were obtained an analyzed for serum testosterone, dehydroepiandrosterone sulfate, cortisol and lactate.

Results: There was a significant increase in testosterone levels following resistance and endurance exercise sessions (P<0.05). Dehydroepiandrosterone sulfate demonstrated a significant increase after resistance exercise (P<0.05). While differences in cortisol levels were not significant within groups, but they were significant (P<0.05) between groups.

Conclusion: A session of resistance exercise in elderly women can increase concentrations of androgens that are essential for their health and well-being.

---

Background: Sexual health is one component of reproductive health that has great impact on the health of individual and society. Sexual health has expressed as a strategy to achieve the millennium development goals. To date, many Iranian studies have addressed the issue of reproductive and sexual health but no study has addressed the definition of sexual health and described its components. Therefore, this study aimed to explore the definition of sexual health and provide a description of its components. Methods: This qualitative study was conducted from June 2009 to November 2013 in Tehran, Iran. Participants were Iranian sexual health experts selected by targeted sampling. Data was collected through semi-structured interviews. All interviews were audio-taped and transcribed verbatim with participants’ permission and then coded by researcher. Development of codes and themes was inductive and arose from the interviews. Data collection was stopped when data saturation was reached. Data was analyzed through conventional content analysis. Results: The theme of individual and family health was extracted from data. From this theme and its categories, the definition of sexual health and its components was extracted including knowledge and information (training needs), physical and mental health, economic needs, social and cultural values and religious values. Based on the results, the sexual health of adults is satisfying from sexual needs by establishing a healthy and socially defined relationship with someone of the opposite sex. Conclusion: According to this study, sexual health has a special definition in each age group and also has different requirements. To start a healthy sexual relationship, at first a correct relationship between a woman and a man must shape. A relationship that is based on customary, religious and social values. Sexual health is a system that consists of abstract components and without proper formation of each of these components we will not be able to access sexual health completely. It seems one of the most important components of sexual health is the knowledge and information about sexual issues. However, further studies are needed to confirm this result.

---

Background: Patient-centered care improves the quality of life and health care, and reduces the costs of care. The advent of new technologies such as health social networks, and personal health records (PHR), have significant impact on the patient-centered care. The aim of this article is to analyze and provide a set of features and requirements needed by the users of health social network serving as a PHR (Personal Health Record) system. The combination of capabilities offered by PHRs and social networks providing better delivery of patient-centered care. Methods: In this paper, after a brief study of capabilities and features of existing health social networks and based on a comparative study, a set of requirements which are necessary to create a comprehensive health social network as a PHR system are proposed. Identification of such a systems stakeholders and users e.g. healthcare professionals, patients, and healthcare organizations is important for categorizing the requirements. Also, classifying relatively vast range of existing systems is needed to have a better analyze and design. Results: The proposed health social network can be used by different user groups in healthcare e.g. healthcare professionals, patients, and healthcare organizations. According to the each user group’s requirements, it provides separate facilities for them. The users of this integrated health social network can optionally share some of their information with other users in their group or with users in the other groups and interact with them. Studies show that the proposal requirements and capabilities for health social network not only cover the capabilities of similar systems but also satisfactory provide the requirements of a PHR system to deliver the patient-centered care. Conclusion: The proposed set of requirements are qualitatively compared with the other similar systems. Using the proposed health social network that provides PHR capabilities for its users will have an irrefutable impact on quality and efficiency of patient-centered care, and play an important role in improving the health of society.

---

HIV/AIDS is among the leading causes of morbidity and mortality in world. There are more than 35 million people living with HIV/AIDS in the world. Although the annual incidence of HIV infection is decreasing globally, HIV prevalence is rising due to development of more effective treatment and higher survival. Iran suffers from concentrated HIV epidemics among injecting and non-injecting drug users. There are more than 27 thousand registered cases of HIV infection and it is estimated that there are above seventy eight thousand cases in the country. Regarding the burden of disease, it is projected that HIV/AIDS will have the highest growth during the next 10 years. The outcome of this epidemics will be determined by human behavior. HIV, psychiatric disorders and substance use disorders are closely correlated and are accompanied by similar risk factors. They also share common consequences such as stigma and discrimination. Correlation of psychiatric disorders, as one of the most influential determinants of our behavior, and HIV/AIDS infection is reviewed in this narrative article. Psychiatric disorders are associated with greater risk of HIV acquisition. Substance use disorders, both injecting and non-injecting, as well as severe mental illnesses put the individual at higher risk of acquiring HIV infection. Impaired judgment, diminished inhibition and control over behaviors, lack of insight and poor self-care have been proposed as the underlying mechanisms. On the other hand, HIV infection may put the individual at greater risk of developing a mental illness. Coping with a chronic and life-threatening illness, fear of stigma and discrimination, CNS invasion of the virus as well as the adverse neuropsychiatric side effects of anti-retroviral medications may all contribute to establishment of a psychiatric disorder. Although there exists a bi-directional correlation between mental health problems and HIV/AIDS infection, this reciprocity goes beyond. Psychiatric disorders can affect the patient’s adherence, access to treatment and care and can worsen the course and clinical outcome of the infection. The clinical importance, underlying mechanism and other implications of this correlation are reviewed in this article.

---

Viruses are important causes of acute and chronic diseases in humans. Newer viruses are still being discovered. Apart from frequently causing infections in the general community, many types of viruses are significant nosocomial pathogens that with emerging viruses has become a real issue in medical field. There are specific treatments, vaccine and physical barrier to fight some of these infections. Health care-associated viral infections are an important source of patient’s morbidity and mortality. The method of sterilization or disinfection depends on the intended use of the medical devices (comprising critical, semicritical and noncritical items) and failure to perform proper sterilization or disinfection of these items may leads to introduction of viruses, resulting in infection. Disinfection is an essential way in reducing or disruption of transmission of viruses by environmental surfaces, instruments and hands which achieves by chemical disinfectants and antiseptics, respectively. This review discusses about chemical agents with virocids properties (e.g. alcohols, chlorine compounds, formaldehyde, phenolic compounds, glutaraldehyde, ortho-phthaldehyde, hydrogen peroxide, peracetic acid, iodophor, ammonium compounds quaternary, bigunides and so on.), mechanisms of action and their applications in health care-associated viral infection control. As well as, we described an overview for hierarchy of viruses in challenge with disinfantans, effective agents on viral inactivation, i.e.targect viruses, viral stability or survival duration time in enviromental surfaces and hands. We explained disinfection of surfaces, challenges in emerging viral pathogens inactivation, viral resistance to chemical disinfectants and antiseptics. Because, there are laboratory studies and clinical evidences for some viruses which viral resistance to biocide or failure to perform proper disinfection can lead to infection outbreaks. Also, we described virucidal properties of antiseptics and introduced selected antiseptics with extensive virucidal action, because hands play an important role in the spread of many viral diseases, and regular proper hands hygiene is essential to decontaminate hands and can interrupt the spread of viruses. Here, we compared the currently available laboratory methods, standard methods from many countries and kinds of viruses in these methods for evaluation of virocide activity. Finally, it’s good to know: any disinfectant is not virocide unless it confirms by laboratory methods.

---

Background: The use of pesticides is essential to pests control in horticultural crops for the production of an adequate food supply for an increasing world population and for the control of insect-borne diseases. Therefore, pesticide residues in environment and food have a negative impact on the health of living organisms especially human. In this regard, the present study was carried out for assessment and comparing of propineb residues in Iranian tea and imported consumed tea.

Methods: In this experimental study, according to the Cochran's sample size formula, 12 samples from 4 brand of imported tea and 6 samples from 2 brand of Iranian tea were collected from market basket of Hamadan City in 2015. After preparation and processing the samples in the laboratory, propineb residues in samples determined using a spectrophotometric method to a wavelength range of 400 nm in 5 replications. Recovery tests were carried out using pesticide-free samples. Also, all statistical analyses were performed using the SPSS statistical package version 19 (Chicago, IL, USA).

Results: The mean concentration of propineb residues in Iranian tea samples were 1.60±0.27 µg/kg and in imported tea samples were 0.78±0.63 µg/kg, respectively and lower than the maximum residue limit (MRL) provided by the European Commission (100 ppb). The results of the comparison of the mean concentration of pesticide residues between Iranian and imported tea samples revealed no statistically significant differences between all the samples together (P=0.17).

Conclusion: The results showed that the residues of propineb were found in all analyzed tea specimens. But according to the mean concentrations of propineb residues in tea samples marketed in Hamedan City were lower than MRL, therefore, no adverse health effects have been established from controlled consuming of tea. Also, concerning increased use of agricultural inputs especially kind of pesticides for pest management by farmers, regular periodic monitoring of chemical pollutants content in Iranian and imported tea are recommended for food safety.

---

Background: Air pollution, especially the phenomenon of dust and particulate matter can cause mortality of many civilians, and causes various diseases including cardiovascular and respiratory diseases. One of the major pollutants in the air is particulate matter that concentration has increased over recent years. So, present study with aim of Quantification Health Endpoints Attributed to particulate matter in Tehran, Capital of Iran during the past decade (2005-2014) by AirQ software, version 2.2.3 (WHO European Centre for Environment and Health) was performed.

Methods: This study is a descriptive-analytic investigation. The process of performance this study lasted 12 months. Subject of this the study and research was in Environmental Health Engineering Department of Iran University of Medical Sciences. Exact data of every hour pollutants were taken from Department of environmental (DOE) Islamic Republic Iran and Air Quality Control Company of Tehran. Then validated according to the World Health Organization (WHO) guidelines and Statistical parameters for quantifying health effects were calculated in excel software. Finally, assessment of cases total mortality, cardiovascular mortality, respiratory mortality and cardiovascular disease and respiratory disease, with AirQ software was performed.

Results: The results of this study showed that the number of total mortality, cardiovascular mortality and respiratory mortality caused by exposure to Particulate matter smaller than 10 microns (PM10) in the past decade is 11776, 12121 and 33066 cases respectively. Also the total number of hospital admission due to cardiovascular disease and respiratory disease in the past decade is 20990 and 54352 cases in 2005-2014 years. Conclusion: According to the results of this study, during the last decade the level of air pollution and Concentration of pollutants in Tehran Increased. Effects and health consequences due to exposure to Particulate matter smaller than 10 microns (PM10) in Tehran Metropolis Is very severe and increased mortality and cardiovascular and respiratory diseases among the citizens of Tehran.

---

Results: The cases studied, 421 people died in Tajrish Hospital and 356 in Modarres Hospital. The highest number of deaths in both hospitals were in the internal wards (336 cases) and surgery (168 people). 45.6% of death certificates have been issued by a forensic expert. 64.8% cases correctly inserted ICD-10 code. Conclusion: Training of physicians for the importance of death certificate and how it should be completed is very important. This research showed that in the cases which the death certificates were completed by the hospital forensic medicine specialists were more useful and accurate.