اکرم هاشمی

The research activities of developing countries have increased over the last two decades. The expansion and decentralization of ethics committees necessitates appropriate performance evaluation. In 2023, a cross-sectional study was carried out on the Iranian research ethics Committees using the checklist called "Research Ethics Committee Self-Assessment Tool". The checklist was translated into Persian and revised based on the opinions of research ethics experts and the approved “regulation of establishment, grading, and description of duties for research ethics committees”. The electronic checklist was sent to the senior members of 269 research ethics committees. After gathering the data, it was analyzed using SPSS software. The response rate was 83%. The average overall score was 152.11 ± 25.173, or 69.14% of the maximum. The two sections (including continuing review (monitoring) and committee resources received less than 50% of the average score. The 138 research ethics committee scores were excellent and 85 committees were in the good range. The findings revealed that average scores are influenced by activity years, the number of monthly meetings, the presence of an approved annual budget, an approved quality improvement program, and having specific administrative staff. Completing the self-evaluation tool can raise the National Committee authorities' awareness about the adherence of the research ethics committees to the imperative standards. It can also lead to each committee's awareness of its strengths and challenges. Revision of national regulations governing the establishment, grading, and description of committee duties and then future self-evaluation can facilitate upgrading and improving the performance of ethics committees.

From the beginning of the COVID-19 pandemic, researchers aspired to produce an effective vaccine with appropriate efficacy and low side effects to mitigate the pandemic. It seems that vaccination is the only mean to save the world from this pandemic. In this article, we will review the ethical challenges of mass vaccination (focusing on the vaccine distribution and uptake), referring to the main principles of bioethics. Safe and standard manufacturing and passing scientific and ethical stages, as well as evaluation of efficacy and safety monitoring, are the main considerations in the production of vaccines. Justice requires that vulnerable and high-risk individuals be vaccinated sooner. Public vaccination must therefore be ethically prioritized. Individuals may for some reason resist vaccination. For example due to, the confusion caused by mass media information, public’s distrust of the medical profession, the proposed relationship between vaccination and development of certain diseases, and finally low death rate due to covid 19 in some groups, especially young and healthy individuals. However, as the disease is highly contagious and if it spreads, the death rate and hospitalization due to the disease rises sharply, and the consequences of the disease mainly affect vulnerable people, in moral decision-making, the benefits and harms of the vaccine for each person should be considered against the benefits for and harms to the society. In addition, to respect the individuals’ autonomy, cultural modalities and persuasive programs shall be considered. This article is aimed to address the ethical issues of the COVID-19 vaccine rollout while proposing practical solutions to handle them.

Although clinical research and clinical practice are closely related, distinguishing the boundaries between them is an important issue debated by contemporary bioethicists. Some commentators have criticized drawing a sharp line between research and practice (1, 3 & 4), but most experts and policy makers in the field of biomedical ethics, believe that the distinction between the two in clinical settings leads to increased scientific credibility of research and greater protection of patientschr('39') rights and safety (2, 18). They argue that blurring the boundaries between clinical practice and clinical research is an ethical mistake (6, 7). Despite significant efforts that have been undertaken in recent years to implement and enforce research ethics in Iran, the need to training in the field of basic concepts of research ethics and ethical justifications for the codes and guidelines of research ethics exists yet.  The purpose of this study is to address this gap in the literature. The first part of this paper deals with a brief history of research ethics that gave rise to the formation of boundaries debates and led to the publication of the Belmont Report. Then, a set of relevant definitions and criteria required to conceptually and practically distinguish between research and clinical practice are presented. Finally, the ethical dimensions of this distinction are reviewed as an argument in favor of the moral requirement to maintain the boundaries between clinical research and clinical practice for the various parties involved in clinical research.

Relevant publications were selected through a MEDLINE search. The key phrases used were clinical research or clinical practice plus distinction, boundaries or distinguishing. The main textbooks of research ethics and medical ethics, both electronic and paper types, were included in the search. International and national research ethics documents and guidelines were obtained via the organizational websites. 

This study has yielded several results with possible implications for the different parties involved in clinical research. First, through a close look at the nature of unethical human research studies that took place in the 1970s and prompted the U.S. policymakers to rethink research ethics governance and gave rise to creation of the Belmont Report (5, 8), it can be concluded that the mere issuing of research ethics guidelines in the absence of ethical oversight of research leads to a failure in protection of human subjects in clinical research. Recognizing and maintaining a sharp boundary between research and practice is the basic requirement of a thorough research oversight and providing precise definitions for the terms, clinical research and clinical practice, is the prerequisite to distinguish this boundary (14). Secondly, Activities that are designed initially with the aim of producing or contributing to the production of “generalizable knowledge” and have the form of a research methodology that have been described in an research proposal and have been scientifically (14, 15), methodology and ethically validated can be labeled as research. These research activities are deemed clinical research If they involve a human participant (7, 13). Such interventions that are intended to increase the well-being of a patient without undergoing a peer-review, although considered to generate “new knowledge”, are still considered as clinical practice because the knowledge gained is not generalizable, even though new (7). Thirdly, the issue of research-practice distinction can be discussed from various ethical aspects. On the practical level there are several issues involving both the physician/researcher and the patient/research participant. The roles and responsibilities of the physician and that of the researcher cannot be a single set of roles and responsibilities, as these two roles each have their own moral implications and duties, which may be in conflict at times (17, 18). Clinicians are committed to make clinical decisions according to the best interests of the patients, while researchers commit themselves to the research protocol (2, 6, and 7). Adopting distinct approaches to clinical research and clinical practice will also help physicians better distinguish their dual role of physician and researcher and manage potential conflicts of interest. Blurred boundaries between research and practice also leads to therapeutic misconception for Patients /research participants. Therapeutic misconception is a situation in which patients do not recognize that they are participating in a clinical research although being disclosed by the clinician/researcher (19). The therapeutic misconception may also occur to the minds of the clinicians, and the result is their reluctance to disclose to the patients that they are participating in a clinical research, when feeling far from regulatory agencies.  As research interventions are often unapproved, they pose an increased risk to research participants, as well as additional burden and cost. So, failure to understand the research process seriously infringes the patients’ rights to safety, quality care, and autonomy (10). How research and practice are distinguished also affects the actions taken on the policy level. It is of great importance that research ethics committees and policy making bodies make distinction between research and practice in clinical settings. Historically the most important trigger to acknowledge the issue of separate clinical research and clinical practice was the need to clearly define which activities should undergo oversight in the clinical realm where the professional norms does not require oversight on the practice of licensed clinicians (6). The general rule originally stated in the Belmont report is that whenever there is a research component in an activity, that activity should be monitored for the protection of human subjects (14). National Research ethics guidelines play an important role in shaping the attitudes of different parties involved in clinical research, toward their roles and responsibilities in research. As research ethics scholars have argued, using the notion of “therapeutic research” in the early versions of the declaration of Helsinki by the World Medical Association led to a "misunderstanding" in clinical research ethics and the violation of patientschr('39') rights (1). Although “therapeutic research” was a common concept in the classical research community, but also was reinforced by policy-making institutions; this conceptual error according to Howard Brady, an expert in the field of medical ethics, had prevented a correct and ethical understanding of "research with human subject" for years (11). A review of national biomedical research ethics guidelines issued by the “National Committee for Ethics in Biomedical Research” at the Iranian Ministry of Health and Medical Education, reveals a lack of basic definitions and clarifications. In some instances, like in the “General ethics guidelines for medical research including human subjects,” some provided definitions increase the ambiguity; however, some criteria for distinguishing between research and practice can implicitly be derived from the text. Codes number 10, 11, 26, and 28, which explain the researcherchr('39')s ethical responsibilities toward the participants - a responsibility that is not defined for clinicians- implicitly set out the criteria for research-practice distinction (16).

The issue of boundaries between research and practice in clinical settings is ethical in nature.  Although considerable efforts have been made to develop national biomedical research ethics guidelines in Iran, a comprehensive approach to providing the definitions of basic concepts and the underlying theoretical framework in the field of biomedical research ethics still seems lacking.

 The faculty members' attitude toward professionalism has a significant impact on conveying professional values to learners. The aim of this study was to assess the professional attitudes of the clinical faculty members of medical school in TUMS.

 In this cross- sectional study, 134 clinical faculty members of Tehran University of Medical Sciences using stratified sampling from different clinical departments were participated in 2017. The research tool was a 21- item questionnaire designed to assess the physicians’ attitude about professionalism which was developed and validated by experts. The data were analyzed Using Kruskal Wallis and Pearson correlation coefficient through SPSS .

 The average score of the participants' professional attitude was 69.96 out of 100 with standard deviation of 9.5. The highest  average of the positive attitude was  94.05 out of 100 for the issues of receiving commission for referral to the colleague and receiving consultation from the colleague and the lowest average of attitude was 28.57 out of 100 for the Team working collaboration of the physician and nurse, the patient's duty  to participate in medical education in the academic hospital, spending enough time for listening to the patient's concerns and the doctor’s right to choose his/ her patient. Professional attitude score was significantly higher in the psychiatric group in comparison with urology (p=0.046), surgery (p=0.002), Gynaecology (p<0.001) orthopedic (p=0.003) and internal medicine (p<0.001).

 According to the findings, professional attitude of faculty members is far from ideal. Their highest positive attitudes were about excellence, honesty, integrity and respect while their highest negative attitudes were regarding altruism and duty. It is suggested that re-trining programs focused on medical professionalism, continuously in transferring attitudes, with more emphasis on the principle of altruism and responsibility for the empowerment of clinical faculty members in medical schools should be considered.

  Considering the increasing trend of tobacco usage among adolescents, effective interventions are necessary for smoking prevention in this group. We, therefore, decided to investigate the status of preventive interventions on tobacco usage among Iranian adolescents, especially the theory/model-based interventions.
Meanwhile, the authors surveyed among other related studies, and categorized them in terms of effect/no effect. A literature review was performed. We selected studies to include in our analyses via a search of Scientific Information Database-SID and google scholar (as a supporter motor researcher) on November of 2017, using the keywords “Tobacco, Smoking, Hookahs” in the title and abstract of all published articles. After removing repetitive and unrelated cases, the full text of a series of articles on the prevention of tobacco in adolescents
was reviewed and the results were presented in terms of the phrases and tables. Out of 1078 extracted articles, 14 papers were finally evaluated. The interventions were divided into two
main categories. Totally, in 9 studies, health education models and theories were the basis for intervention, and other
approaches had been used in the remaining five studies. In spite of the influence of both types of interventions, model/theoretic interventions have been used
more than other interventions in smoking prevention, which could be due to the more favorable and clearer effects of these interventions in changing the various behaviors of the health sector.

To assess happiness and its correlates among young adults in Iran.
This was a national cross sectional study among a representative sample of young adults in Iran, in 2017. Happiness was measured using the Oxford Happiness Questionnaire. Logistic regression analysis was performed in order to examine association between happiness and independent variables.
In all 14292 young adults were studied. The mean (SD) happiness score for the study sample was 4.09 (0.57) which was suggestive of ‘rather happy; pretty happy’ condition. Proportional to mean score 51.1% (n = 7306) of the respondents were ‘happy’ and the remaining 48.9% (n = 6986) were ‘unhappy’. In multivariate logistic regression analysis no significant association was observed between happiness, age, gender, and education. However, the association between happiness and income [OR for poor/very poor= 1.69, 95% CI: 1.51-1.90] and employment status [OR for unemployed = 1.88, 95% CI: 1.53-2.32] was evident.
The findings suggest that overall young adults in Iran feel ‘rather happy’. To improve happiness at individual level equal distribution of opportunities and wealth seems essential.

The business model proposed for creative tourism is analyzed in the framework of sustainable communication-cultural tourism. Although creative tourism is generally understood as a form of social cultural tourism, tourism is a universal communication language that is different from the mainstream of cultural tourism. In addition, this paper examines how the business model can be used in sustainable development for small towns and villages and to be used to maximize their potential historical and cultural potential. The article also describes and teaches how this creative tourism can bring sustainable and socially sustainable development for the small and large communities in the country.

Surveying the attitude of interns and emergency medical assistants of Hazrat Rasool hospital in Iran about its educational environment.
The research had cross-sectional descriptive method. The statistical population included all interns as well as all emergency medical assistants of Hazrat-e-Rasool Hospital in the 2017 first semester of whom 37 samples were selected by census. In this study, the Persian version of the DREEM questionnaire was used. Descriptive statistical methods such as frequency, percentage, mean graph and standard deviation and analytical statistics such as t-test and Chi-square were used to analyze the data.
The results of study showed that the overall score of the educational environment in the group of assistants was 138.52 and in interns was 99±1.28, which had a significant difference between the two groups (p= 0.001). According to McAleer and Rough's Practical Guide, the average between 101 and 150 indicates that positive points were more than negative.
Decision makers and educational planners need more effort to improve the status quo.

During recent years fertility rate is decreasing in Iran. This study aimed to assess fertility desire, its correlates and reasons for fertility desire or fertility disinterest among Iranians.
This was a population-based study. A sample of married individuals living in all 32 provinces in Iran were asked whether they intend to have a child at present. Participants were interviewed via a structured questionnaire including items on socio-demographic and reproductive information. Participants also were asked to indicate reasons for desire or disinterest for fertility. Participants were free to name several reasons as they wish. Descriptive analysis was used to explore the data. Logistic regression analysis was performed to assess the association between fertility desire and independent variables.
In all 20935 individuals (10388 male and 10547 female) were interviewed. The mean age of participants was 36.28 (SD= 8.23) years. Overall 31.8% of the respondents indicated that they wish to have a child while the remaining 68.2 said that they did not. The most important reason for fertility desire was interest in having children (93.5%), followed by wish to experience parenthood (92.2%). The most important reason for disinterest was worry about the future of a new child (76.1%) followed by economic limitations (71.0%).
The results obtained from logistic regression analysis showed that infertility disinterest was significantly associated with older age [OR= 1.10, 95% CI(1.09-1.11 )], younger age at marriage [OR= 0.93, 95% CI(0.92-0.94)], female gender [OR= 1.44, 95% CI(1.24-1.67)], having more children at present [OR= 1.88, 95% CI(1.79-1.98)], lower number of abortion and stillbirth [OR= 0.86, 95% CI(0.82-0.92)] and living in urban areas [OR= 1.36, 95% CI(1.26-1.47)].
The findings suggest that willingness to experience parenthood and economic hardship are the most common reasons for fertility desire or fertility disinterest. The findings might help policy makers to implement appropriate interventions if they wish to improve population growth rate for the country.

The important element in evaluation of the operation of residents is their attitude and behavior. The best way for evaluation of attitude and behavior is questioning people in their work environment who are constantly in relation with residents. Therefore, this evaluation form helps to educate seniors to recognize problematic residents from the good ones. 360 degree or multi reference evaluations is a evaluation where, an index of personal, behavioral and operative expected scales is predicated and all related people with person in organization, including superior, colleagues, subordinates and costumers are asked to evaluate the person based on a specified scales. Usage range includes evaluation of behavioral habits and individual and group interactions. The goal of the study is to reflect strengths and weaknesses of residents, with the arising conception and their overviews.
Evaluation was held with existed standard questionnaire for all assistants in Hazrat Rasoul hospital. Ten questionnaires were considered for each resident (3 of them were filled by professors, 2 by residents and from the remaining 5 questionnaires, 2 of them by patients and 3 by nurses). All this information was summed up in the final form and after calculation average grade was given for each group. The average grade for each resident was calculated and the result was announced to him/her in private meeting.
Overall 326 residents were evaluated and from them 149 cases (7.45%) were men and 177 cases (3.54%) were women. Average age was between 29.5±70.32 years. 151 cases (3.46%) were married and the rest were single. From educated perspective 110 cases (7.33%) were studying in first year, 84 case (8.25%) in second year, 68 case (9.20%) third year and 64 case (6.19%) in forth year. Answers, after scoring, were added to SPSS software version 17 and with descriptive statistics and related test like T-TEST and ANOVAs, etc. were analyzed.
In evaluating the average score of residents in different years we concluded that average of all scores from professors, nurses, patients and residents and total score of residents from third year onward is higher from the rest of the residents and the lowest grade in all cases was for first year residents. In terms of grade, third year residents had highest grade and first year assistants had lowest grade. Overall the best grade was for orthopedics unit and weakest grade was for internal unit.

To find out reasons for fertility desire or fertility disinterest among people living in Tehran, Iran.
This was a population-based study. A sample of married individuals living in all 22 districts in Tehran recruited and was asked to indicate reasons for desire or disinterest for fertility. Data were collected via a single open question. Participants were free to name several reasons as they wish. Descriptive analysis was used to explore the data.
In all 1200 individuals (600 male and 600 female) were interviewed. The mean age of participants was 33.6 (SD = 7.31) years. The most important reason for fertility desire was wish to experience parenthood (90.7%) followed by having inadequate number of children (72.4%) and interest in having a crowded family (64.1%). The most important reason for disinterest for fertility was worrying about the future of the new child (83.2%) followed by economic problems (77.5%), and having adequate number of children (74.5%).
The findings might help health policy makers to implement appropriate interventions if they wish to improve population growth rate for the country.

To assess mental health in Iranian adults.
This was a national cross-sectional study carried out in 2015, in Iran. A sample of Iranian adults aged 18 to 65 years was entered into the study. The 12-item General Health questionnaire (GHQ-12) was used to assess mental health. In addition to descriptive analysis, logistic regression was performed to examine the association between mental health and demographic variables.
In all 19949 individuals were studied. The mean age of participants was 34.9 (SD = 11.8). Using the cut-off point score for the GHQ-12 (3/4) the findings indicated that 29.8% of the study sample reported mental health problem. Logistic regression analysis showed that older age (OR = 0.992, P The findings indicated that a considerable proportion of the study sample did not perceive their mental health status satisfactory. Perhaps reducing political tensions and creating more peaceful environment by mass media might help to improve mental health among Iranian adults.

To perform confirmatory factor analysis for the HELIA to insure its validity further.
This was a reanalysis of the data measuring health literacy among Iranian adults. For the purpose of the current study the data for 1856 Iranian adults aged 18 to 65 years living in 31 provinces were examined using the confirmatory factor analysis. The fit indexes were calculated for both each province individually and for the whole country.
Reliability was found to be satisfactory for the instrument throughout the country exceeding the 0.7 thresholds. The fit indexes for the country were as follows: RMSEA = 0.058, NFI = 0.96, NNFI = 0.97, CFI = 0.97, IFI = 0.97, RFI = 0.96, and SRMR = 0.051
The findings confirmed that HELIA is a reliable and valid instrument for measuring health literacy among Iranian adults throughout the country.

Objective (s): A population-base study was conducted to measure health literacy among Iranian adult aged 18-65. The Health Literacy for Iranian Adults (HELIA) was used to assess health literacy. The questionnaire contained 33 items on access to health information, reading, understanding, appraisal, and behavioral intention. Each item was rated on a 5- point scale giving a total score ranging from 0 (the worse) to 100 (the best). In all 20571 individuals entered into the study. The mean age of participant was 34.92 (SD = 11.80) and 51% were female. The mean year education of participants was 11.96 (SD = 3.79). Overall the mean score for health literacy was 68.32 (SD = 15.16) and that 44% of participants had limited health literacy. Further analysis of the data indicated that health literacy significantly was associated with age and education. In general the findings suggest that health literacy among Iranian adults was relatively acceptable. However, about half of participants had limited health literacy and this was more evident among vulnerable groups. Indeed planning and implementing educational interventions are recommended to improve health literacy among Iranian adults.

Objective (s): During recent years fertility rate is decreasing in Iran. This study aimed to assess fertility desire and its correlates in Tehran, Iran. This was population-based study. A sample of married individuals living in all 22 districts in Tehran recruited and were asked whether they intend to have a child at present. Participants were interviewed via a structured questionnaire including items on socio-demographic and reproductive information. Logistic regression analysis was performed to assess the association between fertility desire and independent variables. In all 1200 individuals (600 male and 600 female) were interviewed. The mean age of participants was 33.6 (SD = 7.31) years. Overall 36.8% of respondents indicated that they wish to have a child while the remaining 68.2 said that they did not. The results obtained from logistic regression analysis showed that infertility disinterest was associated with marriage duration (OR = 0.91, P = 0.0001, male gender (OR = 1.45, P = 0.02), number of children at present (OR = 2.9, P = 0.0001), poor income (OR = 2.77, P = 0.0001). Other independent variables also showed association in the expected direction, but the associations were not significant. These preliminary findings could shed some light on the topic. It seems there is need to conduct a national survey to have a better insight on fertility desire among Iranians.

Objective (s): Health literacy is a relatively new emerging concept in public health. It is also a new area for research with links to communication. It has been suggested that poor health literacy poses a major barrier to public’s health and might represent a major cost to health care system. The aim of this study was to review instruments that measure health literacy. A review was undertaken of all the full publications in the English language biomedical journals between 1993 and 2012. The search included the combination of keywords ‘health literacy’, and ‘tool’, or ‘instrument’, or ‘scale’, or ‘questionnaire’, or ‘measure’, that appeared in the titles/abstracts of the publications. In addition, a manual search was performed to include additional papers of potential interest. In all 1788 citations were identified. After screening, 1265 duplicate citations were excluded. The remaining 523 citations were further examined and 438 citations were found irrelevant. Finally the full texts of 85 papers were assessed. Of these 42 papers were found to be relevant and were included in this systematic review. We identified 23 instruments that were used to measure health literacy. These all were introduced. Lack of comprehensive instrument to measure health literacy was evident. Thus, developing a new instrument seems necessary. A new tool should be simple, short, and inclusive.

Objective (s): It has been suggested that globalisation could affect public’s health in different ways. The aim of this study was to examine the relationship between globalisation and mental health. A review was undertaken of all the full publications in the English language and Persian biomedical journals up to 2012. The search was limited to globalisation and included the combination of keywords ‘mental health’, ‘mental disorders’ ‘psychological health’, ‘psychological disorders’, ‘anxiety’ and ‘depression’ that appeared in the titles and abstracts of the publications. A manual search was also performed to include additional papers of potential interest. In all 244 citations were identified. After through examination and excluding duplicates, 22 citations on the relationship between globalisation and mental health were found to be relevant and were further examined. The findings are summarized under different headings and presented in different tables. With few exceptions, the findings showed that mental health or some aspects of mental health were affected due to globalisation. Depression, anxiety, identity problems, and suicide, individually or in combination, were the most important negative consequences of globalisation. Overall this review provides evidence for a negative relationship between globalisation and mental health. Further studies in this emerging issue are recommended.

Objective (s): Health literacy is a relatively new emerging concept in public health. It is also a new area for research with links to communication. It has been suggested that health literacy incorporates all of the major psychological, social, and environmental constructs that influence individual health choices. It has been suggested that poor health literacy poses a major barrier to public’s health and might represent a major cost to health care system. The aim of this study was to examine what is health literacy. A review was undertaken of all the full publications in the English and Persian language biomedical journals between 1993 and 2012. The search was restricted to ‘health literacy’ that appeared in the titles/abstracts of the publications. In addition, a manual search was performed to include additional papers of potential interest. In all 1788 citations were identified. After screening, 1265 duplicate citations were excluded. The remaining 523 citations were further examined and 438 citations were found irrelevant. Finally the full texts of 85 papers were assessed. Of these 42 papers were found to be relevant and were included in this review. The findings indicated that variations exist in defining health literacy and each definition contained some aspects of health literacy. We identified that a comprehensive definition of health literacy might include the following constructs: ability to read, ability and skills to access, understand, and appraise health information, make decisions, and practice in order to maintain or improve health. An agreed definition of health literacy is needed. An authoritative body might propose such a definition.

Objective (s): Depression is a common mental disorder. In Iran it counts third for the disease burden. A systematic review of the literature was carried out to collect data on the existing evidence on the topic in Iran. The search strategy included a combination of key words ‘depression’ and ‘Iran’. The intention was to review all full publications that have been appeared in Persian and English language biomedical journals during the last ten years (2000-2010). A total of 56 papers (44 papers in Persian and 12 papers in English) were intensified and reviewed. Overall the prevalence of depression reported to vary from 6% to 73% in different populations. Females reported higher depression compared to males (about twice). Depression in rural areas was higher than urban areas. Widowed reported higher depression. There were a considerable number of papers on female depression and infertility (16 out of 56 papers). The findings from this rapid systematic review suggest that in general the prevalence of depression in Iran especially among some populations is high. It seems that the future attempt should be focused on risk factors، prevention strategies and perhaps timely treatment of patients.

The present study has set the following To determine the relationship between social family role stress scores and social support scores among women clerks, doctors, and university teachers in Tehran. To determine the differences between the clerks and doctors, clerks and university teachers, and doctors and university teachers in the relationship scores of social family role stress and social support. Social family role stress scores were significantly positively correlated with social support scores among clerks, doctors, and university teachers, indicating that the more social support they received from the family and husbands for the work, the higher the social and family role stress they experienced. There was also a significant difference between the clerks and doctors in the relationship scores of social family role stress and social support. This difference may be attributed due to the higher mean score of doctors than the clerks. Significant differences were not found between the clerks and university teachers and doctors and teachers in the relationship scores of SFRS and SOS. A close scrutiny of results suggests that there is no significant difference in the correlation coefficients among clerks and university teachers. Among from 400 participants only 300 were selected for final analysis.

The purpose of this study was to investigate two different techniques for testing reading comprehension questions. Differences are measured by two different types of questions including inferential and referential questions. To answer the referential questions, the reader is required to move beyond the level of sentence comprehension and understand the relationship among the sentences. While, Inferential questions arc designed to check the student's ability to make logical conclusions, or inferences from the information provided in the text.400 senior students participated in the study. TOEFL (1991) was used as the main instrument in the study. 314 undergraduate English as a Foreign Language(EFL)students whose scores were between one standard deviation (SD) below and above the mean were selected for the final analyses .The reading comprehension items were classified into Referential (R) and Inferential (I) questions and their related subcategories based on Barrett's Taxonomy ( 1968) by IO MA teachers majonng 111 TEfL. Several statistical procedures (correlation coefficent, post-hoc cheffe's tests and factor analyses) were used to analyze the data. The results indicated that there was no significant difference between the means of referential and inferential reading comprehension questions and student's performance and they have the same underlying construct, but there was a significant difference between the mean scores of subjects in structure/vocabulary and referential/inferential questions. The finding will have some implications for curriculum developers, course material developers , language teachers and learners .In this research, different views towards teaching and testing reading comprehension, techniques and factors have been meticulously studied. Then based on these features, some suggestions have been made for an effective reading comprehension classroom. This study suggests language tester to provide a better device to test subskills in reading comprehension.