Quality gap in primary health care services in Isfahan: women's perspective.

BACKGROUND: Quality gap is the gap between client's understanding and expectations. The first step in removing this gap is to recognize client's understanding and expectations of the services. This study aimed to determine women's viewpoint of quality gap in primary health care centers of Isfahan. MATERIALS AND METHODS: This cross-sectional study was conducted on women who came to primary health care centers in Isfahan city. Sample size was 1280 people. Service Quality was used to collect data including tangible dimensions, confidence, responsiveness, assurance and sympathy in providing services. Data were analyzed by t test and chi square test. RESULTS: The results showed that women had controversy over all 5 dimensions. The least mean quality gap was seen in assurance (-11.08) and the highest mean quality gap was seen in tangible dimension (-14.41). The difference between women's viewpoint in all 5 dimensions was significant. (P < 0.05). CONCLUSION: Negative difference means clients' expectations are much higher than their understanding of the current situation, so there is a large space to improve services and satisfy clients.

The evaluation of craniofacial dimensions in female Arak newborns (central Iran)in comparison with other Iranian racial subgroups

Although anthropometric dimensions evaluate the health of newborns, there is not enough information in this field in Iran. This study was undertaken on female newborns from Arak to determine the range of their head and face dimensions in comparison with other subgroups of the Iranian population. The means and SD of cephalic and prosopic indices were 81.5 ± 4 and 94.9 ± 8.1 respectively. The dominant type of cephalic index was mesocephalic and the rarest one was dolichocephalic. The dominant and rare types of faces were hypereuryprosopic and hyperleptoprosopic. The means of head length did not show statistically significance in the Arak, Turkmen and Fars populations, while head breadth was higher for the Arak individuals in comparison with Fars (P<0.01) and Turkmen (P<0.002). Although the mean of head circumference for the Arak was higher, there was no statistical significance in comparison with the Kurd, Turkmen and Fars racial subgroups. Morphological classification of the head showed that there were no statistical significant differences between Arak and Fars. The percent of the brachyocephalic type for Arak and Fars subgroup was statistically higher than that for Turkmen (P<0.02), while the dolichocephalic type was lower for Arak and Fars (P<0.02) Morphological classification of the face showed that there were no statistical significant differences between Arak and Fars. The most marked differences were observed in the face shapes of the Arak and Fars in comparison with Turkmen. The types of head and face of the female Arak newborns differ somewhat from those observed in populations from other parts of Iran. However, the cephalometric evaluation indicates that the craniofacial features of Arak newborns are more similar to the Fars racial subgroup living in Iran. In sum, it can be said that across the racial differences, socio-ecological factors such as colder climates and nutrition may influence craniofacial parameters (AU)

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Cortical bone perfusion in plated fractured sheep tibiae.

The limited contact dynamic compression plate and partial contact plate were designed to decrease contact with cortical bone in an attempt to decrease cortical ischemia, remodeling, and eventual porosis under the plate after use of standard dynamic compression plates. This study quantified cortical bone blood flow beneath the plate with these three different designs in a sheep tibia fracture model. In 18 skeletally immature sheep, the right tibia was fractured and then was internally fixed with an interfragmentary screw and a dynamic compression plate, limited contact dynamic compression plate, or partial contact plate. At 12 weeks, cortical bone perfusion was assessed with laser Doppler flowmetry in nine areas beneath the plate. The baseline (before fracture) cortical bone cell flux averaged 100 +/- 60 mV. After fracture, this decreased to 60 +/- 48 mV (p < 0.0003); immediately after plating, the perfusion averaged 29 +/- 25 mV (p < 0.01). Cortical bone perfusion then increased to 106 +/- 52, 165 +/- 71, and 163 +/- 71 mV at 2, 6, and 12 weeks after fracture (p < 0.001 for all when compared with values after plating). No significant differences in cortical perfusion were seen between the types of plate. Cortical porosity under the plate was assessed with digital density analysis of microradiographs of this region. No significant difference was seen between the types of plate in this analysis or in biomechanical and disulphine blue perfusion analysis. Thus, no significant advantage was seen for the new plate designs used in this model. This lack of advantage may be a result of the immature animals used in the study, the protocol for blood flow measurement, the invasive periosteal stripping employed to create the fracture, or all three. However, as advantages with the new plate designs have been seen in other studies, this area warrants further investigation.

Systemic immune response to peripheral nerve transplants across major histocompatibility class-I and class-II barriers.

The use of peripheral nerve transplantation in limb reconstruction has been limited by tissue rejection. In order to identify the major histocompatibility antigens involved in tissue rejection, mutant strains of inbred mice, differing from the parent strain (C57BL/6) by either major histocompatibility complex Class I (B6.C-H2bml mice) or Class II (B6.C-H2bml2 mice), were used in models of nerve transplantation. One, 2, and 3 weeks after nerve or skin transplantation, the immune response in the recipient animal was monitored with use of lymphocyte-dependent cytotoxicity and complement-dependent cytotoxicity assays. Skin transplants were used for comparison as the gold standard of a nonvascularized graft with an easily observable success or failure. There was no significant cellular immune response by the lymphocyte-mediated cytotoxicity assay when nerve or skin transplants involved an isolated Class-I or Class-II mismatch, but there was a significant response 2 weeks after transplantations across a combined Class-I and Class-II barrier for nerve (p < 0.04) or skin (p < 0.03). An antibody response to the grafts occurred for both skin and nerve transplants but only when a combined barrier was involved. This preliminary study, using a mouse model, suggests that nerve transplantation-may be performed without systemic evidence of rejection with only a partial cross match of the major histocompatibility complexes, thus decreasing the complexity of tissue typing necessary for tissue banking.

Physiology of peripheral nerve graft incorporation.

The degree of cell survival and the rate and extent of cellular migration was studied in fresh- and freeze-killed nerve grafts using an animal model with isogeneic nerve grafts performed between inbred rats. Nerve isografts 1.4 cm in length were used to bridge a 1.0 cm gap created in recipient animals. Vital fluorescent staining was used to monitor cell viability and to track cell migration between the nerve graft and the recipient host's nerve endings. The fresh nerve grafts maintained their fluorescent label, indicating that these grafts maintained their viability. The freeze-killed grafts had significantly lower cell survival, as determined by percent area of fluorescence, both 14 and 25 days after nerve grafting. The freeze-killed grafts also demonstrated a lower percentage of incorporation of labeled host cells from the proximal host nerve ending. Since the fresh nerve grafts maintained their viability, even though they were performed as nonvascularized grafts, free vascularized nerve grafts may not be necessary if a good vascular bed is present.

Cell viability and migration in nerve isografts and allografts.

Even though autogenous nerve grafts are used frequently, there is little information concerning cell survival rates and migration patterns, following peripheral nerve grafting. Labeling techniques with a vital fluorescent stain (PKH-26, Zynaxis Cell Science, Malvern, PA) allow cell migrations from both the nerve graft and host nerve to be tracked for up to 45 days from the time of nerve transplantation. With this labeling technique, two phases of nerve graft incorporation were identified, early and late, in an animal model using inbred Lewis and Brown-Norway rats. In genetically identical Lewis rats, isografts were performed as a means of modeling the autografts used clinically. At approximately 3 days after isogeneic transplantation, with the proximal host nerve end labeled, there was an early migration of host cells from the proximal nerve end into the epineural tissue of the nerve graft. At 25 days, a late phase was evident, with fluorescent labeling of host cells into the perineural and endoneural tissues. When the nerve grafts were labeled, the label persisted for up to 45 days, indicating viability of the graft. Cells migrated from the labeled nerve graft into the distal host nerve segment. Cellular migration from peripheral nerve tissue, following allograft transplantation, was initially similar to the isograft studies. But after 25 days, with the proximal host nerve end labeled, a significant decrease in the labeled host cells migrating into the graft was noted (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of immune response to nerve and skin allografts.

Research in limb reconstruction using peripheral nerve tissue has been hampered by tissue rejection. Not all tissues express major histocompatibility class I and class II antigens to the same extent. Allogenic and isogenic peripheral nerve grafts and split-thickness skin grafts were performed using C57BL/6 and Balb/c mice, which are inbred strains that differ at both major histocompatibility (MHC) class I and class II antigens. The cellular and humoral immune responses of the nerve transplants were compared with studies of skin transplants. Skin allografts represent a "gold standard": they are clearly rejected, with a tissue failure that is easily observed and closely correlated with cellular and humoral projection responses. A significant cellular immune response was noted following both the nerve (p < .04) and skin (p < .03) allografts. The peak response occurred by day 14 following the transplantation. The humoral response with rising antibody titers followed a similar pattern, with peak response at 14 and 21 days post-transplantation. Isogenic transplants did not produce a cellular or humoral immune responses. There was no significant difference between the immune responses produced by the skin transplants, compared to the nerve transplants. Because of the difficulty in producing accurate models of animal function following nerve transplantation, quantitative studies of host immune response to transplantation have not correlated well with the recipient's final functional result. A comparison of the immune responses between clearly rejected skin allografts and nerve allografts suggests that the immune response resulting from nerve allografts could decrease the functional performance of the nerve grafts.(ABSTRACT TRUNCATED AT 250 WORDS)

A method for measuring tension in small ligaments: an application to the ligaments of the wrist carpus.

A new technique has been devised for measuring the in situ tension in small ligaments. It is based on measuring the tension in an axially loaded flexible cable with pinned endpoints by deflecting the cable laterally and measuring its lateral load and deformation. Studies were performed in which nylon line and bone ligament bone preparations were placed in a materials tester and loaded in axial tension. Axial load as measured by lateral load and deformation was found to agree with the known load to within 8 percent. The method was sensitive to error in determination of ligament length, nonperpendicularity of the laterally applied load to the long axis of the ligament, and when used in situ, impingement of the ligament on a third bone causing bending. A device, consisting of an LVDT mounted to a rigid frame with its core rod connected to a load cell, was developed. The position of the core rod was controlled by a manual screw drive, and a hook on the other end of the core rod was used to deflect the ligament laterally. This device was applied to the study of tensions in five ligaments of the palmar wrist carpus, in seven cadaver specimens. Results showed that the radioscaphocapitate (RSC) and radiolunate (RL) ligaments had significantly greater tensions than the lunotriquetral (LT), the triquetrocapitate (TC), and scaphocapitate (SC) ligaments. For the four positions of the hand tested, neutral, 14 deg radial and 14 deg ulnar deviation, and 28 deg of extension, ligament tensions were found to be unaffected by position.(ABSTRACT TRUNCATED AT 250 WORDS)