Introduction:Additional to improving health and ensuring equitable financing that are two predominant goals of health system, another important goal of health systems is responsiveness to people’s non-medical expectations. In this study we try to assess the health system’s responsiveness in academic and non-academic hospitals.Methods:This is a cross sectional study done in summer 2014 in Mashhad-Iran, we surveyed a total number of 403 inpatients by multi-stage sampling. A questionnaire of responsiveness and a check list included demographic variables and characteristics of hospitalization were completed by trained interviewers. Scales from 0 to 10 was applied for each questionnaire at the end of assessment of questions.Result:403 participants Took part in this survey from 10 hospitals (6 academic and 4 non-academic hospitals). 124(30.8%) were from non-academic and 279(69.2%) from academic hospitals 140(34.7%) of patients were male and 263(65.3%) were female. mean age of participants was 36.77±1.52 years. The mean total score of responsiveness was 7.12±1.31 in academic hospitals and 6.99±1.38 in non-academic hospitals, considered as good performance. There was no significant difference between total scores of these two groups (p=0.38). Health care responsiveness score was higher in private (8.35±0.95) than other kinds of hospitals and charity hospitals had the lowest score (5.98±0.51).Conclusion:Responsiveness of health care system at hospitals is an important parameter for measuring patients’ perception of quality of health care. Although responsiveness rate of our hospitals are good but some components such as: choice health care providers, respect to autonomy of individuals, clear communication and confidentiality received lower responsiveness scores, therefore they require more attention and these domains can be the more significant choices that should be considered while designing improvement programs.

IntroductionExperts consider social accountability as a new paradigm in medical education and a cultural change that is necessary to be studied and understood more deeply. One of the problems of medical education is the inadequacy of medicine graduates to meet the social accountability. Therefore, the aim of this study was to examine the general medicine curriculum for social accountability.MethodsThis cross-sectional study was conducted on three groups of experts, faculty members, and general physicians working in health centers in Mashhad in 2014. According to the needs assessment and definition of need as a requirement or preference, the research was conducted in three stages using the Delphi method, in which the opinions of experts, lecturers, and practitioners were collected and classified based on the CARE model in four areas, i.e., clinical activities, advocacy, research, and educational categories, and, ultimately, the percentage of agreement was determined.ResultsAs indicated by the results of the need analysis, in order to reach social accountability of medical students of Mashhad University of Medical Sciences, the curriculum should cover four major areas, i.e., clinical activities, advocacy, research, and training. We found 38 items for social accountability that are required in the general medical curriculum, including clinical activities (12 items), advocacy (10 items), and scope of research (8 items). The educational area was comprised of 8 items. In this study, from 30 participants, only 19 people participated in the three-step Delphi, and there was a 70% response rate in the first stage and second stage, but 90.47% in the third stage.ConclusionThere is a growing interest around the world for social accountability in medical schools and other health-related schools. It is expected that the results will be of interest to planners and policy-makers in this field so that we will observe a promotion in the culture of social accountability in Mashhad University of Medical Sciences.

Context:Cutaneous leishmaniasis (CL) is an endemic parasitic skin disease in many parts of Iran including Khorasan province. Both clinical forms of the disease, anthroponotic cutaneous leishmaniasis (ACL) and zoonotic cutaneous leishmaniasis (ZCL) are present in this province. However, leishmaniasis molecular map is determined in four cities of Khorasan, but several foci still are remained unknown.Aim:The aim was to identify the species of Leishmania causing CL in Khaf, a District in Khorasan-e-Razavi province.Materials and Methods:Slide smears obtained from skin lesions of 120 patients suspected to leishmaniasis. Direct microscopy and polymerase chain reaction (PCR) performed using specific kinetoplast DNA primers. Data were analyzed with the use of SPSS.Results:Among 120 persons with skin ulcers suspected to CL, the results of direct smear of 54 (45%) samples were positive. PCR band were observed in 66 (55%) of examined samples in which 46 bands identified for Leishmania tropica and 20 for Leishmania major.Conclusion:Both ACL and ZCL are present in Khaf. L. tropica is the dominant causative species for ACL. Further study is recommended to discover probable reservoir and vector for L. major in Khaf.

Background:Driver-related behaviors are substantial causes for motor vehicle accidents. It has been estimated that about 95% of all accidents are due to driver-related dangerous behaviors and approximately 60% of accidents are directly caused by driving behaviors. The aim of this study was to assess driving behaviors and its possible related factors among drivers in Mashhad city, Iran.Method:In a cross-sectional design, a total number of 514 drivers in Mashhad, Iran Surveyed. Manchester driver behavior questionnaire with 50 questions evaluated dangerous driving behaviors in 4 categories “aggressive violations”, “ordinary violations”, “errors” and “lapses”.Results:In this study, the median age of drivers was 31. Besides, 58.2% of men mentioned having a history of driving accident. Our study indicated smoking and alcohol drinking as risk factors of having more accidents. Hookah abuse is a predictor of aggressive violations and errors.Conclusion:This is the first study to assess the relation of personal car and its market value with the likelihood of having accidents. Due to major influences of driving fines, cigarette smoking, alcohol consumption and addiction on violations and errors, we recommend pivotal measures to be taken by road safety practitioners regarding driving surveillance.

BackgroundCutaneous Leishmaniasis (CL) which is prevalent in all continents and is classified by the WHO as one of the neglected tropical diseases, existed in the past also, and discovered ancient works confirm this issue. The lack of adaptation of diseases between Persian Medicine (PM) and Modern medicine, led to no usage of effective therapeutic experiences of prior physicians.ObjectiveThe purpose of this study is finding skin lesions adapted to CL in PM for usage of same disease treatment in the next clinical trials, and the use of approved therapies in CL.MethodsIn a narrative review, without time limitation, documentary study was conducted for different names and clinical aspects of CL in printed and electronic resources of modern medicine such as: Rook’s Textbook of Dermatology, Harper’s Textbook of Pediatric Dermatology, PubMed, and Embase. Then, found names were searched in printed and electronic resources of PM such as: Al-Qanun fi al-tibb, Al-Tasrif leman ajeza an-e-Taliff, JamiTib 1.5 published by Noorsoft.org. Then, skin lesions which were similar to CL with these aspects were searched: clinical manifestation and forms, chronicity, curability, mosquito bite, were studied in references of PM. Finally, matching, syllogism and logical inference were performed and conclusion was made.ResultsForty-five names for CL were found in the searched resources. However, only Balkhieh, Kheyroonieh and Baghdadi button were names found in PM resources. Also, from 61 studied skin lesions in PM resources, only 6 cases had similarities to CL.ConclusionIn spite of the existence of CL’s similarity with Balkhieh, Kheyroonieh and the Baghdadi button, there are serious differentiations. Zat-ol-asl rashes and reddish solb rashes, kinds of stranger rashes, probably adapted with CL.

No abstract

BackgroundChemotherapy induced nausea and vomiting (CINV) is a side effect, and has negative effect on quality of life and continuation of chemotherapy. Despite new regimen and drugs, the problems still remain and standard guidelines, effective treatment and supportive care for refractory CINV are still not yet established. Persian medicine, the old Iranian medical school, offer Persumac (prepared from Rhus Coriaria and Bunium Persicum Boiss).ObjectiveThe specific objectives were to assess the effect of Persumac on the number and severity of nausea and vomiting in refractory CINV in acute and delayed phase.MethodsThis randomized, double blind, crossover clinical trial study was carried out on 93 patients with breast cancer and refractory CINV, who received outpatient high emetogenic chemotherapy in Imam Reza hospital, Mashhad, Iran from October 2015 to May 2016. The study has three stages: in stage I patients received a questionaire and completed it after chemotherapy. In stage II they were randomly divided into intervention group with Persumac and control group with placebo (lactose were used). In stage III, wash out and crossover was conducted. Both groups in all stages received standard antiemetic therapy for CINV. The following were set as the inclusion criteria of the study: female, Age ≥18 years, clinical diagnosis of breast cancer, history of refractory CINV, normal blood tests and at least three courses of chemotherapy remaining. Exclusion criteria of this study were: Total or upper abdominal radiation therapy along with chemotherapy, drugs/therapy for nausea and vomiting not prescribed in this study, hypersensitivity to Sumac or Bunium Persicum, use of sumac and Bunium Persicum in seven days prior to the intervention, clinical diagnosis of digestion disorders, non-chemotherapy induced nausea and vomiting, milk allergy, loss of two consecutive or three intermittent doses of Persumac or placebo. Outcomes were gathered by Persian questionnaire. Number and severity of nausea and vomiting was measured with a self-reporting tool; visual analog scale.ResultsDemographic data and other characters in both groups have no significant diffrence. Eighty of 93 eligible patients in stage I completed the study and in stage II, eleven declined participation for stage III (crossover). P value of carry over, period and treatment effects demonstrated that they had not affected the results before and after crossover. The mean severity of nausea in acute phase was in stage I: 4.83 ± 1.40, stage II: 4.54 ± 2.0 and stage III: 4.15 ± 0.92 in sequence AB (first Persumac and then placebo in crossover), and in sequence BA (first placebo and then Persumac in crossover) was respectively 4.83 ± 1.40, 4.54 ± 2.0, 4.15 ± 0.92 with p value of carry over effect: 0.03 and period effect: 0.22. Except for severity of nausea in acute phase, the mean number and severity of nausea and vomiting scores significantly decreased in acute and delayed phase of CINV.ConclusionPersumac may control the refractory CINV. The implicable and clinical importan...

Rubber industries workers are at risk of hepatic dysfunction from exposure to rubber dust and a mixture of different hydrocarbons. This study aimed to evaluate the relation between chemical hazards in workplace and serum hepatic transaminases in rubber industry workers in Iran. This historical cohort study was conducted in a rubber-manufacturing industry in Mashhad. It consisted of 91 workers with chemical substances exposure and 85 workers not exposed to chemicals. Hepatic transaminases including alanine transaminase (ALT) and aspartate transaminase (AST) were compared between these two groups. Required data were collected through questionnaire, liver enzymes evaluation, and environmental monitoring of chemical substances. The data were analyzed with SPSS 11.5. A total of 176 workers enrolled in this study included 113 (64.2%) male and 73 (35.8%) female. The mean of age and employment duration in exposed group were 29.22 ± 3.99 and 5.41 ± 2.77 and in non-exposed group were 30.33 ± 4.11 and 5.29 ± 2.77 respectively. The mean of ALT in exposed and non-exposed groups was 31.3 ± 8.04 and 23.8 ± 10.42 (p = 0.01) and the mean of AST was 29.6 ± 9.7 and 27.3 ± 8.2 (p = 0.1) respectively. A significant difference was shown between mean of ALT at the date of employment and at the time of the study in exposed group. According to our findings evaluation of serum transaminases is a useful screening method which might be beneficial in early detection of hepatocellular injuries in rubber industry workers.