Cytogenetic abnormalities in 222 infertile men with azoospermia and oligospermia in Iran: Report and review.

Background: Infertility affects approximately 10%-15% of couples in reproductive age. In half of the couples, causes are male-related, associated with impaired spermatogenesis. There is a complex correlation between genetics and infertility. Several factors affect on gametogenesis, from which factors that lead to chromosomal abnormalities are one of the best known. The aim of this study was to determine type and rate of chromosomal abnormalities in infertile azoospermic and oligospermic males in Iranian population. Materials and Methods: The records of a total of 222 participants were evaluated retrospectively. Results: As a whole we observed 13.96% chromosomal abnormality, from which 12.15% showed numerical and 1.8% showed structural abnormalities. Conclusion: Comparison of our results with the review of the literature shows a higher incidence (4- fold) of gonosomal, in particular, numerical gonosomal, chromosomal anomalies. Cytogenetic analysis is strongly suggested for infertile men, particularly in those who suffer from azoospermia.

[Case - control study of factors influencing on drug abuse relapse in addicts referred to two recovery centers in Tehran]

Relapse after treatment is a common problem among drug addicts in addiction control and prevention programs. About 80% of the addicts relapse into drug abuse within 6 months after treatment. The purpose of this study was to determine factors associated with drug abuse relapse in patients consulting two selected addiction treatment centers in Tehran. In this case-control study, 160 relapsed patients were compared with 160 abstentious patients. A researcher-developed questionnaire was used to collect data. Chi-square test, odds ratio [OR] and logistic regression were performed for data analysis. The findings showed that factors increasing rate of relapse were smoking after relapse [OR=7.14, CI=3.855-13.244], substance-related cues [OR=6.76, CI= 3.915-11.678], interaction with addict peers [OR=6.38, CI=3.921-10398], malaise [OR=3.93, CI=2.446-6.305], and family conflict [OR=2.04, CI=1.227-3.385]. Opium- and dross-addicts were found to be less likely to have a relapse than crack- or pot- users [OR= 0.208, CI-0.128- 0.336]. The findings of this study reveal that relapse into drug abuse is significantly associated with personal, social, psychological and medical variables. It is recommended to integrate family counseling and therapeutic approaches, constant monitoring, and health care in treatment plans in order to reduce the adverse effects of factors such as family conflicts, peer pressure and drug-related cues in patients' likelihood of relapse

[Evaluating the hospitalization costs for elderly patients in teaching hospitals of Kashan university of medical sciences during 2009-10]

Considering that hospital costs of the growing elderly population account for a significant share of the health care costs, this study aimed to investigate the elderly hospitalization cost in teaching hospitals of Kashan university of medical sciences. In this cross-sectional study, 2067 patients [age >/= 60] admitted to teaching hospitals of Kashan university of medical sciences during a one-year period [Sep. 2009-Sep. 2010] were randomly selected using stratified random sampling. Data related to hospitalization charges of cases were obtained from medical records and analyzed. The mean hospitalization charge was 5533529 Rials. The highest cost share was for "bed-day" [26.4%]. The highest average hospitalization cost for different diseases were for digestive, neoplastic and respiratory system, respectively. However, diseases of the eye and circulatory system accounted for the largest share of total hospital costs. Regarding the ward, the highest charges were paid for the elderly patients in ICU and CCU, but internal wards had the largest share of total hospital costs. In addition, a significant relation was seen between the cost for each elderly hospitalized and the ward/disease condition [P<0.001], and the comorbidities [P=0.001]. To reduce the hospital costs, careful attention should be paid to disease services with the highest costs. Moreover, the preventive measures as well as alternative low-cost services [e.g. home care] and developing long-term care should be provided

[Medical and non-medical direct costs of cancers in patients hospitalized in Imam Khomeini cancer institution - 2010]

With more than 12 million new cases of cancers and nearly 7.6 million deaths all around the world in 2007, cancer currently is the third leading cause of death in the world. This study was conducted to determine medical and non-medical direct costs of cancer patients' hospitalized in the cancer institute affiliated with Imam Khomeini hospital. This was a cross-sectional study. All patients over 18 years old with kind of head, neck, and stomach cancers that undertaken of oncology treatments in the cancer institute which affiliated " Imam Khomeini Hospital". Initially eligible patients invited to participate in this study. The data was collected through structured interviews with patients and or their carers. The data, then, was analyzed by SPSS software. The average medical and non-medical direct out-of-pocket costs during primary treatment were 2,609,000 and 245,000 Tomans per patient, respectively. Furthermore, the direct average of medical costs for patients who lived in Tehran and other cities were 3,313,000 and 1,870,000 Tomans; while the direct average of non-medical costs for patients who lived in Tehran and other cities were 136,000 and 360,000 Tomans, respectively. The new policies for costs coverage related to cancer patients', particularly the medical insurance organizations, financial supports from finance intuits like as banks or charity organizations, appropriate distribution of cancer's centers or providing accommodation to cancer patients who are referred from the remote sites in other cities, and also achieving the equities in health sectors could be reduced the financial costs of cancer patients and might be helped them to manage of cancers efficiently and effectively

[ cross sectional study on the results of participatory needs assessment in zone 17 of Tehran: three years after intervention]

Introduction: The aim of this study was to assess the effects of a previously conducted needs assessment on West Abouzar neighborhood changes after three years

Methods: This was a cross sectional study in two qualitative and quantitative parts. In the qualitative phase, we conducted semi-structured interviews to determine the types of interventions and selection criteria, and their effects on the approaches of the local headquarters. Based on the qualitative results, a questionnaire was designed in order to use in the quantitative part of the study. A total of 352 individuals selected through random cluster sampling were recruited to the study. Data were gathered by local trained individuals and were analyzed using appropriate methods

Results: The results revealed that for all identified problems, except for drug abuse and unemployment, at least one intervention was performed. Majority of interventions were constructive, while in social issues limited interventions were conducted. It was shown that 29.5% of the interventions were good in quality, 47% were moderate and 23.5% were weak. More than half of the participants [51%] stated that interventions were effective regarding their quality of life; however, they expected more influential interventions. A total of 21.1% of respondents believed that the interventions were relatively effective; 11.1% reported that the interventions were very effective; and 17% stated that the interventions had no effect on their lives

Conclusion: Participatory needs assessment and conducting interventions based on the local needs are effective approaches to resolve health-related problems

Determining nursing manpower needed in a sample hospital

Hospital is the most expensive part of a health system. Manpower is the mainly valuable factor in productivity and service delivery. Since personnel costs make up more than 60% of hospital costs, increasing productivity and efficiency of human resources are significant. The most important ways to increase utilization of this valuable resource is to standardize the quantity and composition of the human distribution. This study determined the standardizing of nurses resources in a sample hospital. The descriptive and cross-sectional study applied in 2008. Data of study collected by questionnaires and library studies by using descriptive statistics were analyzed. Sample of study is the private general hospital with 85 active beds, including gynecology, surgery, men and children, women, surgery, neonatal intensive care wards. Data collection tools were tables containing the number and composition of nurses and hospital performance indicators. After gathering data, it compared with the standards and recommendations were conducted. Using standard of job hours of nursing care required for each group of patients and protocols of Ministry of Health and Medical Education. The numbers of nursing staff in the hospital were 96 people, including 38 nurses, 16 assistance nurses and 42 aid nurses. The optimum numbers based on average annual bed occupancy in different sectors were: 94 nurses, including 60 nurses, 34 assistance nurses and aid nurses. A sample hospital uses healthcare workers as an aid nurses to assist in a wide range of patients' care. With regard to development of medical sciences and become more specialized nursing care industry and major changes in techniques and equipments, to move on from traditional invasive surgical procedures to non-invasive medical practices and the incidence of further complex cases, it will be effected to replace them with educated nurses to care of patients

Barriers and facilitating factors for cervical cancer screening: a qualitative study from Iran

This study aimed to explore the experiences of Iranian women regarding the barriers to and facilitating factors for cervical cancer screening. Eight focus groups [N= 86 participants] were conducted with women referred to a health center in Karaj, Iran from January to March, 2007. Purposeful sampling was used. Married women aged 18 years old and over, not suffering from Obstetrics/ Gynecological disease during last two years and being willing to participate in the study were included. Framework analysis was used to extract the themes from the data. In general, the participants stated that they were not knowledgeable regarding cervical cancer. Moreover, most of the participants had negative beliefs regarding cancer prevention, including lack of free time to do the test, cost of the test, no symptoms cue. The perceived facilitating factors verified by the participants were cues to action, health care motivator, and perceived threat. The findings of this study revealed that there are various psychosocial barriers to cervical cancer screening among Iranian women. High accessibility and availably of the test as well as health care providers' encouragements may improve the rate of cervical cancer screening

[Barriers and motivating factors related to cervical cancer screening]

Although cervical cancer has high prevalence, few qualitative studies have been carried out to reflect the perceptions of women on the influential factors that affect cervical cancer screening in Iran. The aim of this study was to explore a culturally-based experience of Karaji women regarding the barriers to and motivating factors for Pap smear screening test among Karadj women in 2007. In this content analysis, eight focus groups were conducted using semi-structured guide questions [n=86]. Findings revealed that factors such as medical advice, advice from friends and family, knowledge about symptoms and pap smear screening method, free and accessible services, and perceived threats would influence the women to undergo a Pap test. Major barriers were lack of knowledge about cervical cancer and its causative factors, inappropriate beliefs, fear from cancer diagnosis, and pain related to the procedure. Regarding the influencing factors on the rate of Pap smear screening test, it seems that designing appropriate educational programs in order to promote knowledge and correct health beliefs using mass media and local communications will result in referring more women to undergo Pap smear screening test

Prevalence of extended spectrum beta-lactamase-producing enterobac-teriaceae by phenotypic and genotypic methods in intensive care units in Tehran, Iran

The occurrence of Extended Spectrum beta-Lactamase [ESBL]-producing Entrobacteriaceae has been steadily increased in recent years, resulting in limitation of therapeutic options. The purpose of this study was to determine prevalence of ESBL-producing Entrobacteriaceae isolated from Intensive Care Units [ICUs] and to investigate their phenotypic and genotypic characteristics. A total of one hundred fifty isolates were collected from urine and urinary catheter, sputum, blood, wound and other clinical samples from patient admitted in ICUs. All isolates were identified by biochemical tests and then were screened for ESBL production by Disk Agar Diffusion [DAD] according to the Clinical and Laboratory Standards Institute [CLSI] guideline. The species that met screening criteria were further tested for the effects of clavulanic acid by confirmatory method. ESBL-positive species were tested for bla[TEM] and bla[SHV] genes by PCR assay. Of total of 150 bacterial isolates, 133 [89.3%] isolates were positive in the resistance to all tested cephalosporin indicators; and 89 [59.3%] isolates were confirmed as ESBL producer. Klebsiella pneumoniae, Escherichia coli and Entrobacter spp. were the most ESBL-producing species. All isolates were sensitive to imipenem. The bla[TEM] [55.5%] was the most common gene detected in ESBL phenotypic-positive isolates using PCR method. The present study shows high prevalence of ESBL-producing Entrobacteriaceae from ICU patients. The increased rate of these species is mainly due to the inadequate and unnecessary antimicrobial therapy. Rational administration of beta-lactams and appropriate infection control policies may reduce prevalence of ESBL-producing bacteria in ICUs

[Qualitative assessment of dimensions and degree of autonomy granting to university hospitals]

The aim of this study was to determine the key organizational dimensions that influence the autonomy of university hospitals and the level of granted autonomy in each dimension. Six hospitals were randomly selected from those affiliated with three medical universities of Tehran, Iran and Shahid Beheshti. In this qualitative study, we interviewed 27 hospital managers [response rate of 82%]. The semi-structured interview guide was developed based on the results of four initial in-depth interviews and the organizational reform model of the World Bank. We used the framework method for the analysis of qualitative data. Nine themes were identified as the key factors influencing hospital autonomy: decision right in strategic management, decision right in human resources management, decision right in financial management, decision right in physical resources management, product market exposure, procurement market exposure, financial residual claim, governance arrangements and accountability mechanisms, and social functions of the hospitals. Limited decision rights in strategic, human resources, and physical resources management were granted to hospitals. Hospitals were not the financial residual claimant, but were exposed to competitive product market. Autonomy was limited regarding the procurement market. Governance systems were hierarchical and accountability mechanisms were supervisor-supervisee oriented. Some of the social functions of the hospitals were defined, but the expenses of these functions were not totally reimbursed by the government and the insurance industry. The autonomy granted to the hospitals is unbalanced and paradoxical. More decision rights should be granted for management of strategic, human resources and physical resources as well as hospitals entry to the procurement market. Hospitals need to be the financial residual claimant. The hierarchical administrative systems should be transformed to cooperative ones. Instead of supervisor-supervisee oriented control measures, Ministry of Health and Medical Education needs more regulatory mechanisms for controlling hospitals' performance and social functions

[Conflict management strategies of Lorestan province hospital manager]

Conflict management is regarded as a basic organizational leadership skill in the 21st century. Hospitals as the important centers of the health system need effective methods and appropriate strategies for organizational conflict resolution in order to reach their cardinal objective of communities' health. The present research aims to determine the conflict management strategies used by managers of hospitals affiliated with Lorestan University of Medical Sciences [LUMS]. This study is descriptive-analytic. The study population consists of 177 managers from 13 hospitals affiliated with LUMS. Data was collected through interviews using questionnaire containing demographic questions and Stephen Robin's conflict management questionnaire and was analyzed with SPSS software. Average age of managers was 3 6.47 +/- 6.9 years, their mean years of service were 12.5 +/- 8.2, and their mean years of managerial experience were 5.8 +/- 5.6. Females constituted 53.1% and males constituted 46.9% of the subjects. Identified strategies of conflict management were non-intervention [49.7%], control [44.6%], and solution orientation [5.7%]. Conflict management strategy and sex of managers had significant association [p = 0.36]. Correlation coefficient showed significant association between conflict management strategy and age of managers [p = 0.01]. According to our research results, styles of conflict management are different among managers and many factors influence organizational conflict management. Therefore, determination of conflict management styles is very important in every organization, especially in complex environment of hospitals

Antimicrobial susceptibility testing of Escherichia coli strains isolated from urinary tract infections to fluoroquinolones and detection of gyrA mutations in resistant strains

Widespread uses of fluoroquinolones have resulted in increasing incidences of resistance against these agents all over the world. The aim of this study was to assess, susceptibility of Escherichia coli strains from patients with Urinary Tract Infection against common fluoroquinolones and detection of mutations in the gyrA gene. Antimicrobial susceptibility testing of 164 E.coli isolates from patients with UTI, was evaluated by disk agar diffusion [DAD] and MIC methods. Polymerase chain reaction of E.coli strains were performed by amplification of Quinolone Resistance Determining Region [QRDR] of gyrA gene. PCR products were tested by Conformational Sensitive Gel Electrophoresis [CSGE] and those with hetrodublexes were selected and examined by DNA sequencing. According to disc agar diffusion, 49.3% were resistant to nalidixic acid, 41.4% to norfloxacin, 44.5% to ofloxacin and 40.2% to ciprofloxacin. By Minimal Inhibitory Concentration [MIC] testing a high-level of resistance [42.1%] to ciprofloxacin was observed. Mutations in codons 83 and 87 in all 81 isolates were positive by CSGE method

[Relation between [leadership styles] and [hospital performance indicators]

Hospitals are social foundations which appear to maintain and promote healthy life and today they are known as inevitable necessity for health sector development. Since manpower is recognized as the most important resource in organization, the leadership our direction of manpower is considered to be one of the most essential duties of hospital managers. To assess the leadership styles of hospital managers and chiefs and also their further effects on hospital operational indicators. This was a cross-sectional study carried out in Qom province [Iran] during 2004. A total of eight hospitals [3 charity hospitals and 5 public hospitals] were investigated. The target population included all hospital managers and leads [8 managers, 8 leads]. Data were collected using two types of questionnaires and analyzed by SPSS software. Consultative style was found among 75% of leads and the rest was benevolent- authoritative style. Among managers, 75% of leadership style was consultative followed by benevolent-authoritative style [12.5%] and exploitative-authoritative style [12.5%]. On the average, managers and leads leadership style was mainly consultative. Data were indicative of a better status of hospitals' indicators in Qom province compared to other parts of the country. Findings reveal that Iranian hospital managers and leads are reluctant to practice participatory management methods and do not intend to involve staff actively in decision making processes about hospital affiars. They do, however believe that despotic way of dealing with hospitals and health care facilitis affiars, is more approprite than the participatory method

[Stucture, process and preformance of the emergency unit of teaching hospital of Tehran university of medical sciences]

Nowadays, community health and different methods for health service delivery are among the most important public health issues in many countries. Most developing nations are trying to establish a health care system capable of meeting their basic needs.Hospitals are the most important service delivery points, and they need skilled manpower and adequate equipment for efficient performance of their medical care and educational functions. Today, the health of the mankind is facing greater hazards and challenges than at any other time in history, and within this context, hospitals are supposed to provide service of the highest standards and with minimum delay. Emergency wards are the sections where these principles apply more than anywhere else. These are rightly regarded as the "heart" of any hospital and a quick, efficient workflow in the emergency room can literally save lives. This was a cross-sectional [descriptive/analytic] performed in 2005 to assess the structure, process and performance in the emergency wards of 12 teaching hospitals affiliated to Tehran University of Medical Sciences. 33.3% of the ward chiefs were women the rest were men; they were all more than 30 years of age. The average rate for implementing proper managerial standards was 90.6%. The "manpower index" was 69.1%, and the "facilities and equipment" index was 44/5%. The "directions index" and "activities index" were 66.97% and 93.5%, respectively. The findings show that there is a positive and significant relationship between standards of management at the emergency department and the facilities and equipment index. Also, there are positive correlations between the emergency department's "manpower and rules" index instructions, activities, and years of service in hospitals

[Managers' knowledge on patient rights in Tehran hospitals]

Currently, increased knowledge of patients over their rights has been accompanied with greater demands and expectations and thus, it is of prime necessity to all members of medical care including hospital managers, to be fully aware of such rights. To comparatively determine the managers' knowledge on patients rights in Tehran public and private hospitals. This was a cross-sectional study carried out in 2004. All managers of public and private hospitals in Tehran were included [n=70]. Data were collected using a 36-question questionnaire and further analyzed by SPSS. Fisher and chi2 tests were used for statistical analysis. Among the public hospitals managers, 34.5% were found with good level of knowledge on patient' rights, 48.5% with medium and 17% with poor knowledge. In the same way, 23% of private hospitals managers were shown to have good level of knowledge, 54% with medium and 23% with poor knowledge on patient rights. There was no meaningful difference between the levels of knowledge among two groups. Based on data found in our study, lack of good knowledge on patient rights was obvious among the managers of both public and private hospitals. Since the knowledge is considered as a solid base for appropriate functionality, it could be predicted that the performance of hospitals managers on patient rights to be in parallel with the extent of their knowledge. Thus, a comprehensive series of training courses on "patient's bill of rights" for health care members including hospital managers is suggested

Selection an appropriate leadership style to direct hospitl manpower

This research has tried to find most proper leadership styles based on a approved model to direct hospital manpower appropriately. The main objective of this research was the comparison between manager's existing leadership styles and suggested styles to them in order to direct existing styles toward suggested ones. In this cross- sectional study all Qom province hospital managers participated. From the hospital the staff, 385 persons were selected by randomized stratifying sampling. Data were collected by two types of validated questionnaires, one for the staff and another for managers, and analyzed by SPSS software. The finding showed that among four types of leadership styles, 75% of manager's leadership style was 'consultative' and rest were 'exploitative- authoritative' or 'benevolent- authoritative', but in the view of about 78% of the staff, manager's leadership style was 'benevolent- authoritative' and only 0.8% of them believed that manager's style was participative .In general, based on the staff point of view, managers behaved less participative. On the other hand, Tannenbaum and Schmidt leadership style continuum model proved that the best leadership style for all the hospital managers was the 'consultative' one. It can be concluded that there was 25% gap between existing leadership styles and suggested ones and it should be tried to close this gap as far as posible

Quality gap of primary health care services at Kashan District Health Centers, Iran

This study aims to identify quality gap by assessing users' perceptions and expectations of primary health care quality at Kashan district health centers in Iran. This cross sectional study was carried out during the first three months of 2002. A total of 324 regular female users of primary health care services at Kashan district health centers have been approached. Random sampling of the households covered by each health center was undertaken. The survey instrument was designed around the validated SERVQUAL instrument. Service quality gap was measured by computing the difference between the rating respondents assign to expectations and perceptions statements. Internal consistency of different items of expectations and perceptions were 0.80 and 0.85, respectively using Cronbach's alpha coefficient. The Wilcoxon signed rank test to compare the distributions of the expectations and perceptions. Results show that there were mean differences between clients' expectations and perceptions in all dimensions of service. The largest and smallest mean quality gaps were in the responsiveness and tangibility dimensions, respectively. There were significant differences between clients' expectations and perceptions. The clients' choices clearly show that responsiveness, reliability and assurance are the three most critical dimensions of health care services, respectively. Negative quality gap in all dimensions indicate that there is room for service quality improvement in all five dimensions. These findings suggest that primary health care managers should be looking carefully at each of the dimensions where customers perceive that they are receiving a different service than expected and consider the extent to which they should work on influencing expectations or perceptions, or both

[Detection of helicobacter pylori-specific genes in the oral yeast]

Until today human stomach is the only recognized habitat of H. pylori. However, recruitment of DNA-based methods has made possible the detection of H. pylori in water and oral cavity, thus suggesting faecal-oral and oral-oral routes for transmission of H. pylori, respectively. In this study yeast has been proposed as a common vector for transmission of H. pylori. Thus designed primers were recruited to target 16S rDNA and cagA genes in the oral yeasts by PCR. Eighteen yeasts were examined microscopically for the presence of bacterial-like bodies. DNAs were extracted from oral yeasts using phenol-chloroform method. Amplification conditions were optimized as 33 cycles and annealing temperatures of 63°C for 16S rDNA and 51°C and 52°C for cagA gene which was targetted in two steps. DNAs of H. pylori and saccharomyces cerevisiae were used as controls. PCR products of two genes from one yeast and from H. pylori were cloned in pCAP and subsequently subcloned in pSK+ and sequenced. Bacterial-like bodies were observed in all oral yeasts. The amplified products of 16S rDNA from all oral yeasts were homologous in size with those of H. pylori. 15/18 [83%] yeasts contained cagA gene, homologous to H. pylori. CagA was not amplified from three yeasts and S. cerevisiae. Analysis of sequenced products of 16S rDNA and cagA from one oral yeast showed 98% homology with those of H. pylori. The presence of H. pylori inside the yeast was indicated by light microscopy and PCR. It appears that yeasts which are abundant in nature and thrive the mucosal surfaces of human might serve as reservoirs and vehicles of H. pylori

[Survey on quality gap in primary health care in Kashan health centers]

Background: the first basic step in formulating any quality improvement program is recognizing consumers' perceptions and expectations of service quality and determining the quality gap, then adopting guidelines to eliminate the gap

Objective: to assess the service quality gap in Kashan district health centers, based on consumers' perceptions and expectations

Methods: a sample of 300 females' health care consumers completed the research questionnaire. The SERVQUAL instrument administrated to assess the quality of services provided by health centers. To analyze data, descriptive and analytic statistic and correlation coefficient were applied

Findings: results indicated that there was an overall service quality gap between respondents' perceptions and expectations. The smallest gap was in tangibility dimension and the largest in responsiveness. Age and literacy respectively had direct and indirect significant correlation to quality gap

Conclusion: there was a quality gap in services. Thus, improvements are required across all the five dimensions, namely tangibility, reliability, responsiveness, assurance and empathy