ObjectivesProviding high service quality is one of the main functions of health systems. Measuring service quality is the basic prerequisite for improving quality. The aim of this study was to evaluate the quality of service in teaching hospitals using importance–performance analysis matrix.MethodsA descriptive–analytic study was conducted through a cross-sectional method in six academic hospitals of Qazvin, Iran, in 2012. A total of 360 patients contributed to the study. The sampling technique was stratified random sampling. Required data were collected based on a standard questionnaire (SERVQUAL). Data analysis was done through SPSS version 18 statistical software and importance–performance analysis matrix.ResultsThe results showed a significant gap between importance and performance in all five dimensions of service quality (p < 0.05). In reviewing the gap, “reliability” (2.36) and “assurance” (2.24) dimensions had the highest quality gap and “responsiveness” had the lowest gap (1.97). Also, according to findings, reliability and assurance were in Quadrant (I), empathy was in Quadrant (II), and tangibles and responsiveness were in Quadrant (IV) of the importance–performance matrix.ConclusionThe negative gap in all dimensions of quality shows that quality improvement is necessary in all dimensions. Using quality and diagnosis measurement instruments such as importance–performance analysis will help hospital managers with planning of service quality improvement and achieving long-term goals.

Background:Marital separation and divorce can be the most unpleasant event in the adult’s life, and families will be hurt by divorce event. The prevalence of divorce has been increased in last decades. Therefore, this study was conducted to identify the divorce cause among the divorce seeking men and women in Qazvin, Iran.Method:This cross-sectional study was conducted among 572 (400 women and 172 men) subjects who requested for divorce and were referred to divorce and marriage office of Qazvin province during 3 month in 2009. Data were collected by self – administered questionnaire, interviewing subjects and using Likert scale. Data were analyzed by Chi- Square test and Mann-Whitney (SPSS version 16).Results:The participants of the study included 400 women (26.5±7.4 years) and 172 men. In view points of women the primary wrong mate selection was main cause of divorce (59.8%), but the men believed that the families and relatives interference was the main reason for separation (43.7%). Among the respondents, mean score of “dependency to their families” and “unmet emotional needs” were 3.44±1.6 and 3.86±1.4 respectively. In addition mean score of infertility among men and women were 1.37±1.0 and 1.29±0.9 respectively.Conclusion:Wrong mate selection, unmet emotional needs, families’ interference, and “dependency to families” are more important factors than traditional factors which are sexual or physical factors.

Introduction: The aim of this study was to evaluate some virulence factors in Candida albicans isolates from patients with onychomycosis and determine the correlation between these factors and the antifungal resistance profile. Methods: Seventy species of C. albicans were confirmed using polymerase chain reaction amplification of the HWP1 gene. According to the Clinical & Laboratory Standards Institute guidelines, the susceptibility profile of four antifungal agents was investigated, and the production of aspartyl protease, phospholipase, haemolysin, and biofilm was determined. The correlation between these profiles was also investigated. Results: The isolates indicated different levels of resistance and production of virulence factors. Significant correlations were observed between the minimum inhibitory concentration (MIC) of fluconazole/itraconazole and biofilm production, between phospholipase production and fluconazole/ itraconazole MIC, and between fluconazole MIC and hemolytic activity in C. albicans isolates. The results also showed significant correlations between phospholipase activity and biofilm production. Conclusions: Our findings will contribute to a better understanding of the pathogenesis of C. albicans and characterize the relationship between virulence factors and antifungal resistance, which may suggest new therapeutic strategies considering the possible involvement of the virulence mechanism in the effectiveness of treatment.

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Background: Disk herniation (DH) is one of the most common disk lesions, inducing low back pain (LBP). Various therapeutic options have been proposed for treatment of disk herniation (DH). Intradiscal injection of ozone has been suggested for treatment of DH. Objectives: To determine the effect of intradiscal ozone injection on pain score and disability in patients with LBP from disk prolapsed. Patients and Methods:Patients with LBP diagnosed with DH were enrolled in this clinical trial study. After prep and drape the area and under the fluoroscopy guide (c-arm), intradiscal injection of ozone/oxygen mixture (4 mL, 40 µg/mL) was performed. Pain score and functional ability of the patients according to Oswestry Disability Index (ODI) were measured prior to the injection (baseline) and then at 2 and 4 weeks and then at 3 and 6 months after the injection. Results: Thirty patients (17 females, 13 males) with the mean age of 58.6 y (range, 42-73 y) enrolled in the study. The mean ± standard deviation (SD) of pain score before intervention was 8.1 ± 0.8. After two weeks, it was reduced to 3.2 ± 0.6 (P < 0.001) and finally dropped to 2.0 ± 0.6 sixth months after intervention (P = 0.0001). Functional status of ODI was 28.5 ± 2.1 before intervention and showed significant reduction after two weeks (with the mean of 12.3), and it was almost sustained till sixth months after intervention, with the mean of 11.4 (P = 0.001). Conclusions: Altogether, ozone had significant positive effects on patients with disk herniation unresponsive to other conservative and minimally invasive treatments.

Objective:Health care workers especially medical students are at risk of being exposed to blood-borne pathogens. Therefore, the aim of this study was to determine the knowledge, attitude and practice of medical students towards standard isolation precautions (SIP).Methods:A standardized questionnaire was completed by 148 medical students from April to July of year 2009 to seek their knowledge, attitude and practice towards standard isolation precautions in a clinical setting at Qazvin University of Medical Sciences, Iran.Results:The mean score of knowledge, attitude and practice towards standard isolation precautions were 6.8±2.1 (maximum 10), 16.6±4.2 (maximum 20), and 18.05 ± 4.5 (maximum 30) respectively. Significant differences were observed between practice of female and male (P < 0.008) and also knowledge of year 6 and year 7 students (P <0.021).Conclusion:Education on infection control based on standard isolation precaution must be stressed and barriers of appropriate practice must be removed.

Context:According to some studies, the tendency of mothers to breastfeed has declined in recent years. Due to numerous benefits of breastfeeding which had been reported, this problem may put children's health and overall health of society at risk. In this study, we reviewed previous studies, emphasizing importance and necessity and enumerating benefits of breast-feeding. Evidence Acquisition: Databases including Science Direct, Biomed, Medline, Cochrane Library, EMBASE, SID, and magazines related to the topic were searched using keywords. Articles that examined various aspects of breastfeeding were analyzed as well. Results: The most perfect food for babies during the first two years of their lives is breast milk. It has so many health benefits for both mother and baby. Breastfeeding was studied from various aspects. There was significant correlation between the examined factors in vast majority of papers. However, some factors that researchers considered important did not give definitive results; therefore more extensive research is needed in this area. Conclusions: Breast milk is the most perfect food for babies during the first two years and no replacement is recommended during this time. Breastfeeding has so many health benefits for both mother and baby during the breastfeeding period as well as in the future. Keywords: Breastfeeding; Nutrition; PediatricsImplication for health policy/practice/research/medical education: Decreased tendency of mothers to breastfeed in recent years may put children's health and overall society health at risk. In this study, we reviewed previous studies to emphasize importance, necessity and enumerate benefits of breast-feeding.

Background: Intestinal parasitic infections (IPIs) are among the most important etiologies of gastrointestinal disorders in developing countries. The present study was performed to determine the prevalence of IPIs in rural inhabitants of Fouman, northern Iran. Methods: Overall, 31 villages were randomly selected during 2015-2016. Stool samples were collected from 1500 inhabitants aged 2-87. The samples were examined by direct wet smear, formalin ethyl-acetate concentration and agar plate culture. Trichrome staining and modified acid-fast staining were used as confirmatory tests for intestinal amoeba and flagellates and cryptosporidium spp., respectively. Data were analyzed with Chi-Square and Fisher exact tests using SPSS. Results: 8.06% of participants were positive for at least one intestinal parasite. The prevalence of mixed parasitic infections was 0.87%. The most prevalent IPIs were caused by Trichostrongylus spp. (3.13%), followed by Strongyloides stercoralis (1.5%), Giardia lamblia (1.3%), and Entamoeba coli (1.0%), Blastocystis hominis (0.86%), E. histolytica/dispar (0.53%), Endolimax nana (0.26%), Iodamoeba butschlii (0.13%), Trichuris trichiura (0.07%), Enterobius vermicularis (0.07%), Hook worm (0.07%) and E. hartmani (0.07%). Statistically, the prevalence of IPIs showed significant differences regarding the age groups, education status, occupation (P<0.001), and the habit of eating raw vegetables (P<0.007), whereas, the differences were insignificant with regard to sex (P=0.924) and water supply (P=0.088). Conclusion: The prevalence of IPIs, especially soil-transmitted helminthes (STHs) has sharply decreased in northern Iran. Excluding Trichostrongylus spp. and S. stercoralis, other intestinal parasites only produce a marginal and unnoticeable health problem in this area, today.