Research in Medicine

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  Couvade syndrome is a phenomenon that an expectant father waiting for childbirth experiences during his wife's pregnancy or postpartum periods in the form of somatic or psychological complaints. In rare cases, this syndrome may lead to the psychotic dimensions. In the present report, we have introduced a patient who had severe depression with psychotic feature, fallowing his wife's being hospitalized for childbirth. The content of his delusions was related to the childbirth and his wife's pregnancy. As regards to the occurrence of a psychotic depression syndrome, our diagnosis was psychotic couvades syndrome. Its very  rare occurrence was the reason of presentation. Being admitted in the hospital, the patient was given haloperidol and amitiptyline. Then he was discharged after a successful recovery. Although this syndrome is very rare, more attention should be paid to the family mental health with much more emphasis on every member of family during the mother's pregnancy or postpartum periods.

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Background: With regard to the relation of exposure to electromagnetic field and disorders in some biological systems and also with respect to the increasing development of these fields, the present study was conducted on 101 employees in high voltage centers in Tehran in 2001 to determine the role of occupation in extremely low frequency (ELF) electromagnetic fields on mental health. Materials and methods: 101 individuals who were employed in electromagnetic fields at 50Hz frequency as a result of 230 KV current (case group) and 101 matched controls, (personnel of the administrative section), with no history of working in high voltage centers, entered this historical cohort study. Mental health status was examined using three choice GHQ-28 test utilizing cut off point of 17. Individuals who had received score of >17 were considered "probably unhealthy". Results: All 202 examined individuals were male and aged over 18 years. Of these, 17% in the control and 32.7% in the case group were revealed to be "probably unhealthy", (P<0.01). The relative risk of working in these fields raised the incidence of mental unhealthiness by 1.9 times (2.1-3.1 in community, p<0.05). Conclusion: Working in electromagnetic fields at extremely low frequency increases the incidence of mental unhealthiness. In spite of suitable validity and reliability of GHQ-28 test, according to many domestic and foreign studies, researches including clinical interview are recommended. With regard to their high risk job and the importance of mental health for good performance, paying further attention to their mental health, screening and timely treatment of patients is suggested.

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Background: Expenses of health facilities have a great impact on their quality. The present study was conducted to determine the expenses of each health facility in rural and urban health care centers in Zanjan province in 2001. Materials and methods: For this descriptive study, 26 minor health care centers in small villages, 6 rural and 5 urban health care centers were selected through randomized sampling. Expenses were determined according to the type of facility, the exact center, and also type of expense. Thus, expenses of usable materials and equipment, specific equipment, drugs, building repairs, vehicles, personnel, and other equipment were all determined in accordance to the population. Results: Expenses of minor health care centers in small villages, rural and urban health care centers were 49, 330, and 44 million Rials, respectively. Personnel expenses were by far the most common type of expenses that comprised 25.7, 21.5, and 31.3% of the aforementioned centers' expenses, respectively. Conclusion: Unfortunately, government has not allocated enough budgets for these health care centers. Meanwhile, paying further attention to the managing aspects of such centers could be helpful to control their expenses. Similar studies are highly recommended in other centers.

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Background : War is a stressful event that can lead to disastrous situations in human life. Those who are directly involved in this event and influenced by the resulting trauma are the first victims of the war. However the consequences involve the families and the society on the whole. The families of the wounded, disabled, martyred, or imprisoned soldiers are the forgotten victims of wars. The present study was conducted to determine the prevalence of depression and mental disorders in a group of war veterans and their spouses in the Qom province.

Materials and methods : The study population included 160 males and 90 females, (90 couples). They were asked to complete two valid questionnaires of Beck and GHQ as well as a questionnaire dealing with their demographic data. Sample selection was random from the official file in the Foundation for the Disabled in the Qom province.

Results : 75% of the patients included in the study were unemployed. Beck questionnaire revealed that 96.3% of the ex-soldiers and 88.9% of their spouses were suffering from mild to severe depression. GHQ questionnaire revealed that in 94.5% of veterans and 86.7% of their spouses symptoms suggestive of a mental disorder were present.

Conclusion : Anxiety-depression disorders, adjustment disorders and inter-personal relation disorders are common among the ex-servicemen and their spouses. War veterans and their families are in need of better support from different organizations that provide social and health services.

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Background: For conservation and continuous of educational, occupational and social performance, the well-being is the goal of mental health and providing information and statistical data in relation to mental  disorders are the original requirements for mental health policies. The present study was conducted to determine the prevalence of mental disorders in interns of Shahid Beheshti university of medical sciences  during a 6-month period.

 Materials and methods: For this descriptive study, 2 separate questionnaires, one dealing with demographic and the other GHQ-28 were completed. Results were compared in two groups of healthy and suspicious  subjects according to the sex, marital status, living places before entering university, present living places,  hopefulness to career, economic status, presence of underlying disease, abuse of substances (alcohol, opium, and canabis), and tendency to marriage.

 Results: Result showed that at the cut off point of 22 for men and 21 for women, 52.1% of the interns were suspicious to have any kind of mental disorders. Mental disorders were more frequently reported among females, married interns, interns living in rental house, non interested interns to medicine, disappointed  interns to their career, low economic status subjects, interns with underlying disease, and substance abusers.  Of these, female sex, lack of interest, disappointing, low economic status, and underlying disease have shown sign in cant association with menta! disorders. 

Conclusion: Mental disorders are quite common among these interns. Our data can be used as a statistical  source to plan for mental health policies.

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Background : Following previous reports of impaired physical and intellectual growth, hearing deficit, hypothyroidism, and hyperendemic goiter in Kiga, and the administration of iodized oil injection, this study was conducted to evaluate if the effect of the injection could be sustained by iodized salt supplementation.

Materials and methods : In 1989, one ml of iodized oil solution containing 480 mg of iodine was injected in 198 schoolchildren aged 8 to 14 years in Kiga. Four years later, in 1993 iodized salt consumption was begun and has been continued. Serum thyroid hormones, RT₃U and TSH were measured before and 3, 4 and 6 years after intervention (1989, 1992, 1993 and 1995). Assessment of urinary iodine was performed at the same intervals mentioned above by Foss method.

Results : Prior to the injection, 94% of the subjects had grade 2 goiters 4 years after injection 30% and two years after iodized salt consumption 56% were agoiterous (p<0.001). Urinary iodine was 11.4±19.8 before and increased to 93±66 and 92±34μg/L, 3 and 4 years after intervention. Two years after iodized salt consumption it was 161±34μg/L (p<0.001). Mean serum Increased T4 level was observed following the iodized oil injection and continued after iodized salt consumption. Serum TSH was 20.3±22.8, 2.1±1.9, 2.5±1.6 and 2.9±1.7 mU/L before and 3, 4 and 6 years after the beginning of study, respectively. All children were euthyroid at 3, 4 and 6 years of study.

Conclusion : Findings show benefits of iodized oil administration in decreasing goiter size and in reversing abnormal thyroid function. These effects are sustained by iodized salt consumption in schoolchildren previously hypothyroid due to iodine deficiency.

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 Background : when occurred during adolescence, adolescents in district 13 in Tehran as a part of Tehran Lipid and Glucose Study (TLGS) .

 Materials and methods : randomly selected. A demographic questionnaire as well as General Health Questionnaire (GHQ-28) which had already been validated for the Iranian population, were gathered by face-to-face interview. We have considered score of 6 as cut off point. Freedman, chi squared and Mann Whitney tests were used, when appropriate .

 Results : suspected to have some kinds of mental disorders . The mean (±SD) score of GHQ was 6.9±5.1 with the median of 6. The means of each of the subscales of the questionnaire were 0.9±1.4 for somatic system 1.3±1.7 for anxiety and sleep disorders, 3.7±2.0 for social dysfunction and 1.0±1.7 for depression. The median of these subscales were 0, 1, 4, 0, respectively . Compared with other subscales, subjects with social dysfunction had lower mental health statues (p<0.001) . Females were affected more frequently than males 65% vs. 35%, (p 0.001<. )

 Conclusion : frequency of females being higher . With respect to the importance of mental health in adolescence, investigating the risk factors of mental disorders, especially the social dysfunction scale , in future studies is recommended .

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Background : Noise-induced hearing loss is among the most common cause of occupational-related hearing loss. Nowadays, noise-induced hearing loss is a disastrous event of industrial world that may influence all races, ethnics and age groups.

 Methods : This cross sectional study was performed on 100 workers exposed to noisy environment (greater 85db) in Azmayesh factory. Having excluded all confounding variables, sixty 25-64 year-old workers were included and a thorough physical examination and desired laboratory tests were instituted. PTA was achieved 48 hours after occupational resting for both ears.

 Results : Noise with the frequency of 4000Hz could impair hearing function since only 48.3% of workers had normal hearing parameters. This impairment may be more significant as the duration of exposure increased. Meanwhile, 72.2% of workers who have been exposed less than 10 years to noisy environment had normal hearing function, while after 20 years of exposure this figure was as low as 33.3%. Age was inversely correlated with hearing function. As 60% of 25-34, 76.5% of 35-44, 37.5% of 45-54, and 42.9% of 55-64 year-old workers had normal hearing function.

Conclusion : Hearing loss is a frequent complication of noisy environment. All industrial factories are strongly recommended to observe protective facilities if their workers are exposed to noisy environment of greater than 85db. Periodic hearing assessment is also suggested for susceptible workers.

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Background: Organic solvents are widely used in different industries and occupations. They have a central role in production and use of paints. This study was carried out to evaluate the hepatic damage due to solvent exposure. Materials and methods: In this cross-sectional study 62 painters were selected as cases with at least one year exposure to solvents and 54 employees as controls with no exposure. Demographic and clinical information collected via questionnaire and physical examination and the results of liver function tests, (ALT, AST, ALP), were compared in the two groups. Results: The mean levels of ALT, AST, and ALP were not significantly different between cases and controls however the mean levels of ALT and AST in individuals with high exposure were significantly more elevated than in persons with low exposures, (subgroups of cases). Conclusion: We concluded that routine hepatic enzyme tests are not suitable for early detection of hepatic damage in workers exposed to solvents and the use of more sensitive tests should be considered.

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Background: Advances in knowledge and experience of human beings are rapidly changing and put organization’s role and performance in a big challenge. Nowadays, a successful organization steps in new approaches by means of knowledge forces and respecting human resource development. The present study was achieved to design a human resource development model for the health sector of Iran. Materials and methods: For this descriptive study, a thorough literature review was performed. Desired countries were selected according to their health and economic indices. They have approach, missions, program and specific allocates for their human resource development. Our designed model was introduced to the experts and the final model was developed based on the experts’ comments. Results: Results revealed that in health sector of Iran, especially Ministry of Health, human resource development should be set as priority and supported by the head of the organization. Meanwhile, designing the infrastructure and suitable mechanisms, appropriate approach, providing facilities, human and financial resources, and appropriate attitude may result in health service improvement. Conclusion: In the developed model human resources, financial resources and physical facilities had the most powerful effect. The model was approved by experts, therefore, such models should be applied in associated organizations and revised according to environmental and infrastructure conditions. KEYWORDS: Human resource development, Model, Health.

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Background: Pesticides are an extremely diverse group of substances with a wide potential for a variety of toxic effects. They are biocidal agents used to control a wide variety of organisms that pose a threat to health or compete for food or other materials. Selective toxicity for the target pest is the principle of pesticide use, but because organisms are similar at the cellular or subcellular level, adverse human health effects may occur. Worldwide estimates suggest the problem of toxicity and death is much greater in developing countries than in developed countries. Material and method: For this cross sectional study, 1279 farmers were selected in 5 provinces through a cluster sampling. Initial data were gathered by a questionnaire and acute and chronic side effects of pesticides were recorded. Results: Totally, 50% of farmers were illiterate, while the mean duration of their work experience was 22 years (18-26 years). In different regions, different pesticides were used, for instance, in Rafsanjan and Savejbolagh most of pesticides were organophosphates (95%). Meanwhile, 68% of farmers did not use any personal protective equipment. Only 5% of farmers noticed the manufacturers’ instructions and 27% burned the vessels. Conclusion: Educational package consisting of pesticides and their uses, the techniques of management and control of short and long term effects of pesticide poisoning, the methods of properly and effective use of personal protective equipment, and the necessary acts after use of vessel, should be distributed among farmers.

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Background: Prior investigators have proposed the association between religious orientation and mental health, since recently investigators have trended towards religious effects on mental health. The purpose of the present study was to determine the relationship between the religious orientation and mental health. Materials and methods: For this cross sectional study, 140 university students were randomly selected and assessed by Alport Religious Orientation Scale and General Health Questionnaire (GHQ). Results: Results revealed a significant correlation between the religious orientation and mental health. Intrinsic religious orientation was associated with mental health (p<0.004). As extrinsic religious orientation score increases mental health scores decreases and depression occurs more frequently. Conclusions: Internalizing the religion behavior and values may play basic roles in mental health status. Intrinsic religious orientation should be considered in psychotherapy and psychoeducational interventions.

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Background: Occupational stress is defined as inconsistency between occupational demands and individuals abilities, capabilities, and wishes. Occupational stress leads to different physical, mental, and behavioral outcomes and complications. Police officers, due to the nature and characteristics of their job, confront various stressors. This study has been designed in order to identify the frequency of occupational stress in police officers working in Tehran. Materials and methods: In a cross-sectional study, we identified the frequency of job stress in 250 police officers in Tehran. For measuring the degree of stress, we used police officer stressor factors index and Pickle Scaling of life events questionnaire as well as General Health Questionnaire (GHQ) for measuring the mental health status. Results: There was a significant correlation between mental health and occupational stress and life events. Additionally occupational stress and life events are predictive variables for mental health. There was no difference between white-collar personnel and blue-collars (disciplinary or administrative personnel) regarding the mental health and personality type, however, administrative personnel experience higher degree of occupational stress. Meanwhile, shift workers and married personnel experience higher degree of occupational stress versus day workers and single personnel, respectively. Conclusion: Psychological test, i.e., personality type questionnaire, should be applied within pre-employment exams in order to reduce stress in police officers. Periodical examination and psychological consultations are also helpful.

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Introduction: The relationship between coping styles and mental health was investigated in a sample of Multiple Sclerosis (MS) patients. A correlational analysis was performed to assess the kind of association that exists between stress-coping styles, including problem-focused, positive emotion-focused, and negative emotion-focused coping styles, and mental health, (psychological well-being and psychological distress). Materials and methods: One hundred and twenty patients, (41 men, 79 women), from Iranian MS Society were included in this study. All participants were asked to complete Tehran Coping Styles Scale (TCSS) and Mental Health Inventory (MHI). Analysis of the data involved both descriptive and inferential statistics including means, standard deviations, multivariate analysis of variance, Pearson's correlation coefficients and regression analysis. Results: The results revealed that positive emotion-focused coping style was positively associated with psychological well-being and negatively associated with psychological distress.Conclusion: It can be concluded that psychological well-being and psychological distress of MS patients are influenced by emotion-focused coping styles.

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Background and Aim: Injections are one of the most common health care procedures. Each year some 16 thousand million injections are administered in developing and transitional countries. Due to unsafe injection practices 26 million years of life are lost each year. Objective: To define the knowledge of health care providers about safe injection practice in children according to WHO standards. Materials and Methods: We prepared a cross sectional study and included health care personnel in two university affiliated medical centers. Data about the knowledge of safe injection practices, as recommended by the World Health Organization, was collected using a previously designed questionnaire. Statistical analysis was performed by using SPSS 13.0. Results: 150 personnel answered the questions. Percentage of incorrect answers were as follows: use of gloves 92%, need to disinfect single dose vials 80%, disinfecting site of muscular injections 86.7%, safe needle disposal 70.7%, recapping the needle 56%, and the optimal site for intramuscular injections in young children 12.7%. 72.7% were not familiar with auto-disable syringes. There was no significant difference in the belief that injection is better than oral medication between doctors and nurses (p>0.05). Almost 80% of doctors and more than 50% of nurses believed that parents preferred injection prescriptions for their children. Conclusion: Our findings revealed a serious lack of knowledge about safe injection practices among health care providers albeit doctors or nurses. We recommend that instructions about safe injection practices should be included in the medical and nursing curriculum. Moreover, improving communication skills between health care providers and their patients would prevent the misuse of all drugs including injections.

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Background and Aim: Health management for special patients is a serious challenge for policy makers. Because of chronic nature of these diseases the community has to cope with huge expenses, and a considerable part of health funds is allocated for the continuing care of these patients. Therefore, designing appropriate policies for organizing, financing and providing optimal health-care is of special importance. In this study, our main objective was to design a model for special patients' health management in Iran by studying the management strategies of similar patients from selected countries. Materials And Methods: We scrutinized studies done in England, Australia, United state, and Canada and used these as suitable references from which we selected applicable strategies and submitted these for approval to relevant experts to sketch out a service management model for health care management of special patients. The final model was developed by the use of 3-stage Delphi technique. Results: In almost all of our references we found that: • Health and welfare ministries along with the private sector provide decentralized health care to special patients. • Health care programs for special patients encompass free services for regular check ups, vaccinations, life style training, acute illness care, health advisors, health aids and equipment, and laboratory services. • Policies are made by a committee named as "committee of health of special patients" having its base at the supreme council of health. • Finances are provided mainly by governmental funds and, subsequently by societies and NGO's with some participation of the special patients themselves (as premium and franchise). Conclusion: Our model for management of special patients includes formation of "committee of health of special patients" in the supreme council of health, establishment of office of health of special patients in the Ministry of Health and Medical Education, and provision of decentralized provincial services. Finances should be provided through taxes, charity aids and supports from international organizations. Nongovernmental and charity aids may be increased to decrease the financial burden on governments. Keywords: Health Management Model Special Patients. *Corresponding Author: Dr. Ghodsi Yazdian Department of Health Services Administration, Faculty of Management and Economics, Islamic Azad University, Science & Research Institute, Hesarak St., Ashrafi Esfahani Blvd., Tehran, Iran. Email: gh_yazdian@yahoo.com