فهرست مطالب mph)

Introduction & Objective:

Cervical spondylotic myelopathy is a progressive degenerative disease as the most common cause of myelopathic symptoms in elderly patients, and yet many controversies exist regarding the optimal surgical approachs. In lordotic patients with ventral or ventrodorsal compression less than 3 levels, both anterior and posterior approaches can be selected. The purpose of this study was to compare anterior versus posterior surgical approaches in patients with cervical spondylotic myelopathy indicating both approaches based on Benzel criteria for choosing the optimal surgical approach.

Materials & Methods:

This non-randomized clinical trial was performed among patients referred to the neurosurgery clinic of our hospital between 2019 and 2021. Patients enrolled in the study were evaluated for SF-36 (Ware, 1992), mJOA (Benzel, 1991) and Nurick (Nurjck, 1972) scores preoperatively. Then, according to the surgeon's diagnosis, the patients were divided into two groups. It should be noted that all surgeries were performed by one surgical team and after discharge, they underwent 4.5 and 9 months follow-up to re-determine all three scores and the obtained information was analyzed by repeated measures analysis of variance.

In this study, 120 patients with a mean (± standard deviation) age of 61.10 (± 2.41) years, of whom 63 were men (52.5%) and 57 were women (47.5%), were studied. In this study, 60 patients underwent anterior surgery and 60 patients underwent posterior surgery. There was no significant difference between the two groups in terms of age (P = 0.053), gender (P = 0.361), duration of symptomatology (P = 0.075), degree of lordosis (P = 0.052), and anterior- posterior diameters of canal
(P = 0.284). The mean of SF-36 was significantly better in the anterior group than the posterior group at 4.5 (P = 0.001) and 9 months follow-ups (P = 0.001). The mean mJOA was significantly better in the anterior group than in the posterior group at 4.5 (P = 0.002) and 9 months (P = 0.001) follow-ups. The mean score of Nurick before surgery and follow-up of 4.5 months (P = 0.745) and 9 months (P = 0.909) was not significantly different between the two groups.

The results of this study showed that both anterior and posterior approaches improve the condition of patients in follow-up, but in patients with anterior approach, postoperative satisfaction ranking was better.

Insulin resistance has an important role in pathophysiology of polycystic ovarian syndrome (PCOS). Yet there are certain controversies regarding the presence of insulin resistance in non-obese patients.

The aim was to compare the insulin resistance and various endocrine and metabolic abnormalities in obese and non-obese PCOS women.

In this cross-sectional study which was performed from 2007-2010, 115 PCOS patients, aged 16-45 years were enrolled. Seventy patients were obese (BMI ≥25) and 45 patients were non-obese (BMI

There was no significant difference in presence of insulin resistance (HOMA-IR >2.3) between two groups (p=0.357). Waist circumference (p

Our study showed that metabolic abnormalities are more prevalent in obese PCOS women, but adrenal axis activity that is reflected in higher levels of DHEAS was more commonly pronounced in our non-obese PCOS patients.

Spinal cord injury (SCI) causes infertility in male patients through erectile dysfunction, ejaculatory dysfunction, semen and hormone abnormalities. Oxidative stress (OS) is involved in poor semen quality and subsequent infertility in males with SCI. The aim of this study is to examine the effects of SCI on the level of testosterone hormone.
In this experimental study, we evaluated the effects of exogenous testosterone on the activity of the antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx) as well as the levels of malondialdehyde (MDA) and protein carbonylation (PCO), as markers of OS, in 10 groups of SCI mice. Total antioxidant capacity (TAC) was determined using the 2,29-azinobis-(3-ethylbenzothiazoline6-sulfonic acid) (ABTS) radical cation assay.
Exogenous testosterone administration in mice with SCI significantly reduced SOD and GPx enzyme activities and MDA level. There was no significant decrease in PCO content. In addition, TAC remarkably increased in the sham and SCI groups not treated with testosterone but remained unchanged in all other experimental groups. Exogenous testosterone also reduced serum testosterone levels in all groups except the positive control group.
Our cumulative data indicated that SCI could cause sterility by disturbing the plasmatic testosterone balance. The normal level of endogenous testosterone was not completely restored by exogenous testosterone administration.

Eٍndotracheal suctioning is a method to remove secretions from the airway in patients who can not perform this voluntarily and have an artificial airway. Suctioning is frequently used in the ICUs and can result in many complications if not performed properly. The aim of this study was to compare the effects of hyperoxygenation on arterial blood gases before and after endotracheal suctioning. In this study, 36 patients admitted to the intensive care ward of Bahonar and Afzalipour hospitals that have inclusion criteria were chosen. The subjects were studied in acrossover design. The data collection form was used to record. This form has 2 parts: 1) demographic characteristics and 2) table to record the results of arterial blood sampling and continuous monitoring parameters in patients. Patients were randomly assigned to suctioning with lung hyperoxygenation and combination of hyperoxygenation and hyperinflation before and after suctioning. Arterial blood gases and physiological parameters were recorded pre-intervention and immediately and 30 minutes after intervention. Data were analyzed with SPSS software. Suctioning with both methods can increase PaO2 and O2 saturation immediately and 30 minutes after the suction. However, an increase with combined method is more sensitive. Hyperoxygenation can increase mean of paCO2 immediately and 30 minutes after thesuction but combination of hyper oxygenation and hyperinflation can decrease it. Hyperoxygenation can decrease pH immediately and 30 minutes after the suction but combination of hyper oxygenation and hyperinflation can increase it. Suctioning with both methods can decrease HCO3 however decreasing with hyperoxygenation is moresensitive. Physiological parameters determined immediately and 30 minutes after using a combination of suction with hyperoxygenation and hyperinflation were significantly higher than those with the hyperoxygenation suction method. This study showed that the effect of lung hyper oxygenation and combination of hyper oxygenation and hyperinflation on some of the arterial blood gas and physiological parameters beforeand after endo tracheal suctioning is variable. Among the most important is the influence an oxygen and blood pH. So suctioning can be done suctioned out with either of these two methods, depending on the specific clinical situation of the patients.

self-regulation is an important construct in motivation through which the students regulate their learning meta-cognition. Self-regulation is one of the most important predictive factors of academic achievement. Therefore evaluating academic self-regulation in learners is critical. The aim of this study was to develop validity and to determine the factors structure a self-regulation scale.

We validated the 34-items of Hong and O’Neil self-regulation scale. The scale consisted of four factors: effort, self-checking, self-efficacy, and planning. The score was translated, back translated and checked by several experts. 336 medical students were chosen through multiple steps random sampling and completed the questionnaire. We analyzed the data using SPSS and LISREL software using exploratory and confirmatory factor analysis methods.

Principle component analysis revealed that self-regulation scale consists of four factors. The scale accounted for %55 of variance. Confirmatory factor analysis showed that all of the factors confirmed with data.

This scale is a valid and reliable instrument in assessing Iranian students’, especially medical students’, self-regulation.

Cutaneous tuberculosis (TB) is a relatively uncommon form of extra pulmonary TB. Even in countries where TB still commonly occurs، cutaneous TB is rare. In our country accurate statistics of the forms of cutaneous tuberculosis are not available. The aim of this study was to assess the frequency of cutaneous tuberculosis during the years 1997 to 2012 in Gorgan، Iran. In this retrospective cross-sectional study، patients affected with cutaneous tuberculosis referred to 5 Azar Hospital in Gorgan from April 1997 to September 2012 were studied. Data collected from the medical records of patients were statistically described and analyzed. In this study، 30 cases of cutaneous TB were found that 18 (60%) of them were women. The disease was most commonly observed in age group of 21 to 40 years. Lupus vulgaris (18، 60%)، papulonecrotic tuberculid (6، 20%) and scrofuloderma (3، 10%) were the most common types of cutaneous tuberculosis in these patients. Lupus vulgaris is the most frequent form of cutaneous tuberculosis in Gorgan.

Treatment delay in the management of ST-elevation myocardial infarction conversely correlates with prognosis and survival of the patients. This study aimed to investigate factors associated with delay in the thrombolytic therapy of these patients in Tehran. Between 2007 and 2010, the interval between the self-reported time of the onset of symptoms and initiation of the thrombolytic agent in 513 patients with a diagnosis of acute ST-elevation myocardial infarction was recorded. Medical history and socio-demographic characteristics of the patients treated within two hours after the onset of symptoms and patients treated after two hours from the onset of symptoms were compared, and the odds ratios were calculated using logistic regression. The mean age of the patients was 61.2 (SD = 11.1) years, and 76% of the patients were male. The median time between the onset of symptoms and treatment was 158 (SD = 30.4) minutes. Mean for decision time was 61 (SD = 19), which was responsible for 83% of the entire treatment delay. The mean transportation time was 34 (SD = 12) minutes, and the median door-to-needle time was 44 minutes. Odds ratio for history of diabetes mellitus was 1.90 (95% CI: 1.26-2.87), for hypertension was 1.55 (95% CI: 1.08-2.23), and for prior coronary heart disease was 1.47 (95% CI: 1.17-1.84). The most important factor associated with delay in treatment was decision time. Improving emergency medical services dispatch time, obtaining pre-hospital electrocardiograms for early diagnosis, and pre-hospital initiation of thrombolytic therapy may reduce the delay time.

Endometriosis is the presence of endometrial glands and stroma in sites other than the uterine cavity, which is associated with infertility. The objective of this study was to evaluate the effect of laparoscopic surgical treatment on clinical pregnancy in infertile women with minimal or mild endometriosis. This clinical trial study was performed in infertile women who were referred to the gynecological clinic between April 2008 and March 2009. After confirmation of minimal or mild endometriosis by diagnostic laparoscopy, patients were randomly assigned into two groups using consecutively numbered, opaque sealed envelops. The first group consisted of women who only underwent diagnostic laparoscopy (no treatment) before randomization. The second group of patients underwent operative laparoscopies. T-test and chi-square test were used when appropriate. A p-value less than 0.05 was considered statistically significant. Analysis with 38 patients in each group showed characteristics such as age, body mass index (BMI), and duration of infertility were statistically similar in both groups. At 9 months follow-up, 9 (24%) women who had operative laparoscopies became pregnant compared with 7 (18%) women in the diagnostic laparoscopy group. The pregnancy rate showed no statistically significant difference between both groups (p=0.49). No complications were reported in either group. The present study suggested that laparoscopic surgical treatment was not superior to diagnostic laparoscopy in pregnancy occurrence in infertile women with minimal and mild endometriosis. (IRCT Number: IRCT201012311952N2).

Family Physicians project aims to promote healthy families and reduce treatment costs began in rural area and operating in most of rural area of country. The goal of this plan is to organize health insurance for well defined population in rural area. In this descriptive-analytical study 80 family physicians working in rural health centers in Yazd province were questioned about training needs. The most important educational needs of family physicians are environmental hazards in the workplace and identify and manage patients with mental and physical disabilities. Also 54.3% of physicians reported that the gap between theory training in student period and expectation from them in family physicians project is high or very high. The gap between theory and practical training in the GP training is high with the expectation from family physicians and this needs to revised the curriculum of GP training which approved by the ministry of health.

Narcotics are the most common drugs that have been used after cardiac surgery. Everyone knows that their side effects including respiratory depression, hemodynamic instability, and nausea, vomiting and itching are dose dependent. Magnesium is both N Methyl D Aspartate (NMDA) – receptor and calcium receptor antagonist and can modify important mechanisms of nociception. The purpose of this study was to investigate the effect of magnesium sulfate on pain score and reducing narcotic requirement in coronary artery bypass surgery patients. In a randomized, double blinded, placebo-controlled trial One hundred and eighty five patients (105 male and 80 female) undergoing elective coronary artery bypass graft surgery were studied. Mean age were 58+_11 (from 24 to79 years).We enrolled them in two groups randomly. Group1 received magnesium sulfate as an IV infusion 80 mg/kg during one hour after induction and the second group received the same volume of normal saline as placebo. During the postoperative period, Morphine requirement and pain score (visual analogue scale: scaled as 0 to 10, 0=no pain and 10= worst possible pain) in 6, 12, 18, and 24 hours were recorded and documented. There were no significant differences between two groups with respect to baseline data. In MG group, only 30 patients (32%) needed to receive Morphine Sulfate, but in placebo group, 75 patients (83%) needs some doses of Morphine Sulfate (p value < 0.001); The odds ratio showed that MG could strongly prevent the needs for receiving opioid analgesics for controlling of the pain. Intra operative use of magnesium sulfate can reduce receiving opioids after (CABG) operations

Ôbjective: Postpartum depression (PPD) is a common health problem which affects women in the postpartum period. This is a brief note on its associated factors in women from different cultures. Â literature review was performed in MËDLÏNË and Pubmed from 1991 to 2008 and Magiran from 1991 to 2009. Âdditional articles and book chapters were referenced from these sources. The prevalence of postpartum depression has been reported to be from 0.5% to 60% globally, and from 3.5% to 63.3% in Âsian countries, in which Malaysia and Pakistan had respectively the lowest and highest rates. Ône of the factors contributing to PPD in Âsian societies can be that women may not have the empowerment to reject traditional rituals that are imposed on them by their caregivers. Ünsatisfactory pre-existing relationships between the mothers and their caregivers resulting in mothers experiencing difficulties during their confinement period may be another factor. Thirdly, some features of these traditional rituals may be the cause of tension, stress and emotional distress. Ëmotional conflicts caused by insistence on practice of traditional rituals during the postpartum period may lead to mental breakdown.Çonclusion: Health care professionals should be aware that the phenomenon in Âsian cultures is as prevalent as Ëuropean cultures. Moreover, further research needs to be conducted on the global prevalence of the experiences of childbearing women with depressive symptoms.

Ôbjective: There is evidence to show an increase in use of stimulant substances among university students. This study is a qualitative assessment of the existing situation and the underlying reasons for stimulant use among the students of Tehran Üniversity of Medical Sciences in 2006.

Three qualitative methods have been used: focus group discussions with 7 groups (60 individuals) consisting of male and female students in the dormitories and in the university environment, in-depth interview with 20 drug user students, and interview with 20 key informants including counselors, managers and guards of dormitories, staff of the office for Çulture and Welfare Âffairs of students and members of student's organizations. Purposeful or opportunistic method was used for sampling.

Ëcstasy and methylphenidate (Ritalin) were mentioned as the stimulants used by the students. The main declared reasons for ecstasy use were desire to have fun and excitement, desire to modernity, participation in parties, curiosity and living without family. The high expense of ecstasy pills and the training provided by media were mentioned as the main protective factors. Most respondents believed that use of methylphenidate was more prevalent than ecstasy use. Ïn contrary to the drugs used for fun and enjoyment, methylphenidate is used for increasing learning abilities and academic achievement. Ôther pointed- out factors were ease of use and being stigma-free. Çonclusion Ïncreasing risk perception via training, social alternatives to risky activities and parental training for continuing care and advice in the college period are recommended.

Background Narcotics are the most common drugs used after cardiac surgery and their side effects, including respiratory depression, hemodynamic instability, nausea and vomiting, and itching are dose dependent. Magnesium is both an N Methyl D Aspartate (NMDA)–receptor and a calcium-receptor antagonist and can modify the important mechanisms of nociception. The purpose of this study was to investigate the effect of magnesium sulfate on the pain score and reducing narcotic requirement in coronary artery bypass grafting surgery (CABG) patients. Methods This randomized, double blinded, placebo-controlled trial recruited 185 patients (105 male and 80 female) undergoing elective CABG. Mean age was 58±11 years (range= 24 to 79 years). The patients were divided into two groups randomly: Group 1 received magnesium sulfate as an IV infusion (80 mg/kg) during a one-hour period post induction and Group 2 received the same volume of normal saline as a placebo. During the postoperative period, the patients’ morphine requirement and pain score (visual analogue scale= scaled as 0 to 10, 0=no pain and 10= worst possible pain) at 6th, 12th, 18th, and 24th hours were recorded and documented. Results There were no significant differences between the two groups with respect to the baseline data. In the magnesium sulfate group, only 30 (32%) patients needed morphine sulfate, whereas 75 (83%) patients in the placebo group required some doses of morphine sulfate (p value < 0.001). The odds ratio showed that magnesium sulfate could strongly prevent the need for opioid analgesics for pain control. Conclusions The intraoperative use of magnesium sulfate can reduce the need for opioids post CABG

Bakground:Malnutrition, especially in the developing countries, is a common disease ofchildren. Some causes of malnutrition are inappropriate supplementary feeding, parentallow nutrition-related knowledge, and childhood diseases especially digestive and respiratorydisorders. Various interventions have been made in different countries based on theirpresent conditions and facilities. The goal of the present study was to investigate the effect of interventions conducted by nutrition consulting center based on pivotal role of pediatrician at health center over growth status in children suffering from malnutrition. In this intervening quasi -experimental study, 189 children between 6-48 months affected by malnutrition were identified and included in the investigation using random sampling method. After verifiying diagnosis by pediatrist, required interventions were made and growth indices were determined before and after the intervention. Who’s Anthro software and graphs were used to evaluate growth indices. Results indicated that 17.8 and 9.1% of boys and girls were respectively suffering from acute thinness; however, after intervention these findings reduced to 4.4 and 5.1% respectively. Moreover, 14.4 and 6.1% of the boys and girls who suffered from acute low– weight showed meaningful lower problem the intervention. The interventions could not deal with shortness of stature in the society. Through setting up intervening centers pivoted by pediatricians at the center of the provinces aimed at recognizing and treating children suffering from malnutrition as well as activating referral systems, we may take a step forward into a better situation therein improving the status of children suffering from low weight and malnutrition.

Ïn the last two decades, the importance of developing strategies that reduce the burden of new onset psychosis on affected persons, their families, and the community has been recognized. This article reviews the literature on First-episode psychosis (FËP) in Ïran. Ïn the last decade, several studies on FËP have been published in Tehran concerning Duration of untreated psychosis (DÜP), pathways to care, diagnostic stability, outcome predictors, treatment, aftercare services, psychosocial interventions, and Neurological soft signs (NSSs). However, the samples in most studies were small, and most participants were recruited from inpatient wards. Therefore, caution must be exercised when generalizing the results to patients with FËP in the community, particularly in other parts of the country. We conclude that it is necessary to conduct follow-up research with sufficiently large samples from the community to support the previously published longitudinal studies on FËP, as well as to help to inform the development of specialized FËP and early intervention services.

ObjectiveAssessment of risk predictors for adverse neurodevelopmental outcome at 1 year of age in term and near-term infants.Material & MethodsThis case-control study was a representative sample of infants from different health-care centers of north and east of Tehran. The association between risk factors and delayed motor development (developmental quotient below 70 indicating a significant delay) was analyzed using correlating risk factors; including the perinatal and neonatal data to the developmental status. The case group consisted of 143 infants whose DQ score was less than 70 and the control group consisted of 140 infants who had a DQ score of more than 70. ResultsNeonatal seizures, Apgar score less than 3 after 5 minutes of birth (OR = 2.87 [95% CI; 1.68, 4.92]), low birth weight (OR = 5.86 [95% CI; 3.07, 11.18]), preterm delivery (OR =6.17 [95% CI; 3.04, 12.52]), Premature rupture of membranes (PROM)>24 hours (OR = 6.18[95% CI; 2.07, 18.51]) and hyperbilirubinemia leading to phototherapy or exchange transfusion (OR =3.75 [95% CI; 2.12, 6.65]) were associated with an increased risk for neuromotor delay on developmental examination at 1 year.ConclusionThis study identified distinct risk factors for an adverse outcome in infants. In this environment, perinatal risk predictors are most important.

Introduction & Chronic subdural hematoma (CSDH) is a common disease and consists of bleeding in the intracranial space. Trauma is the most common cause of CSDH. The present study is designed to determine factors associated with the outcomes of patients suffering from CSDH after surgery by Burr hole- drainage method. Through a prospective cross sectional study, all 59 patients with CSDH, who had been hospitalized in the Neurosurgery Department of Besat Hospital, in Sanandaj, Iran between 2008-2009, were recruited. A check list was prepared and data was gathered by interview and referring to patients’ hospital records. Patients were divided into four groups according to Odom and Finney outcome scale and then were further divided into two groups for easier analysis. T test, Chi square, Fisher exact test, and Logistic Regression via SPSS version 17 was used for analyses. Of 59 patients recruited, 51 (86.4%) were male. The mean age (± standard deviations) of patient's was 62.0±19.9 years. No statistical correlation was found between the time interval of the previous trauma to surgery, preoperative hospitalization, hematoma bloody content, drain anatomic site, recurrence signs in CT scan, recurrence treatment and patient’s outcomes (P>0.05). However, patient's age (elderly), sex (female), anticoagulatory drugs consumption, duration in which drain was kept within the hematoma cavity, presence of postoperative medical and surgical complications, GCS at hospitalization and at discharge and one month after discharge,risk factors and underlying medical conditions had significant relationships with the patient's outcomes (P

Post dural puncture headache (PDPH) is a relatively common complication in spinal anesthesia. Several regimens had explained for treatment of this problem. The aim of this study was to determine the effect of intravenous single dose of Aminophylline (1.5mg/kg/body weight) on the incidence of PDPH in cesarean section under spinal anesthesia.

In a double blind randomized trial study, 120 patients undergone spinal anesthesia for the elective cesarean section in Motahhari hospital of Marvdasht in Fars province in south of Iran during 2008. After umbilical cord clamping 1.5mg/kg/body weight of Aminophylline injected slowly and intravenously in 60 patients. In placebo group (n=60) normal saline injected intravenously. At the 1st, 4th, 24th and 48th hour after surgery, PDPH in patients were evaluated.

The incidence of PDPH was significantly lower in cases compared with controls during the first 24 hours post operation (5% vs. 31.7%, P<0.001). Incidence of PDPH in case and control groups after 48 hours was 5% and 23.3% respectively (P<0.004).

This study revealed that the intravenous single dose of Aminophylline (1.5mg/kg/body weight) significantly reduced PDPH after spinal anesthesia in cesarean section

Helicobacter pylori (H.pylori) with positive Cytotoxin associated Gene A (CagA) have higher potential for pathogenesis. Cytotoxin associated Gene A (CagA) accelerate the pathogenecity of bacteria due to cytotoxin production stimulation. The aim of this study was to determine the prevalence of the anti-CagA antibody among H. pylori infected persons in Golestan province-North of Iran.

This descriptive study was carried out on 676 H. pylori positive subjects in Golestan province, northern Iran during 2008. Anti CagA antibody were determined in H.pylori positive subjects. Data analyzed by SPSS-16 software and chi-square test.

Prevalence of anti CagA in Helicobacter pylori infected cases was 57.7% (390 cases: 179 males and 211 females) (95% CI: 53.9-61.4). According to age the highest and lowest cases of anti CagA antibody were seen in, 15-24 (63.4%) and under 5 years old (26.3%). The level of anti CagA antibody in Sistanian ethnicity group (67.2%) was more than other ethnic group. Anti CagA antibody in Rural area was more than urban regions. Sero prevalence of anti CagA antibody was highest in Minudasht twon (78%), located in East of province in comparison with Bandar Gaz (44%) in west of province.

This study showed the prevalence of CagA positive Helicobacter pylori strains in this region is similar to other regions of Iran, Asia and Europe and higher than African population.

According to the instructions by Iranian ministry of health and medical education، Continuous medical education (CME) is essential to maintain good knowledge level among health professionals to able to provide promising health services. But in practice it encounters challenges. Soon after set up of regulations for health professionals to attend CME courses، according to large size of country، restriction of healthcare human resource in far areas and busy diary of them، non-attendance courses was defined and advertised. These courses were of two main categories: web-based training or computer based training. In current short review author have focused on what have done over electronic CME programs and various aspects is discussed. These programs were conducted with various pedagogies in different centers while no evidence was established prior to commence. In current manuscript electronic education technologies are described and usability of them including advantages and disadvantages are debated.

Physical inactivity causes around 2 million deaths in the world each year. It is estimated to cause about 10-16% of cases each of breast cancer, colon cancers, and diabetes, and about 22% of ischaemic heart disease. This study is carried out based on determination of the effect of educational intervention through the theory of planned behavior on the physical activities of Kerman Health Center’s staff. This is a before and after quasi experimental research. This study was performed on 149 persons of Kerman province and city health Center’s staff in two groups of intervention and control. Through a questionnaire provided by the researcher, the elements of this theory were measured before and after intervention. The educational intervention was used in intervention group based on intervention according to this theory for 6 weeks and for control group just lecture was used. Then two groups were evaluated. Both groups don’t have any significant difference before intervention based on demographic characteristics. Before intervention there was no meaningful difference between the averages of the grades of the theory’s different elements in two groups (p>0.05). After intervention there was a meaningful increase in the average of awareness and behavioral intention of intervention group’s grades and there was a meaningful increase in the average of behavioral intention of control group’s grades (p<0.05). In mean difference of grades constructs of theory didn’t have revealed any significant difference between groups of intervention and control before and after intervention. The results showed that the 6 week implementation of theory of planned behavior base and lecture base has shown no significant effect on the physical activities of Kerman health Center’s staff.

Iran has gone through sharp demographic changes in the past three decades. Presently, in Iran, there is a lack of health promotional activities targeting the elderly which can lead to a decrease in their quality of life and an increase in their disability rates. Those most vulnerable amongst the elderly are females, who have low education and low socioeconomic status. For them and others, few social services, accessible housing options and long-term care facilities exist. Data was gathered using population projections over an 80-year period (1975 – 2055), facilitated by spectrum software prepared by the USAID/Health Policy Initiative with data source derived from projections of the United Nations, World Population Prospects. Projections derived were on the expected population, the median age of the population, population pyramids, total fertility rates, life expectancy, and dependency ratio. Projections showed that by the middle of this century approximately one fifth of the population will be over 60, with the median age of the population almost doubling from what it is today and the dependency ratio increasing steadily. Currently, the resources are not sufficient to address the special needs of an elderly population and are at risk for becoming even more strained over the 80 year span. Iran must begin to prepare itself for the impact that a massive ageing population will have in the ensuing years. Recommendations suggest developing policies supportive of accessible and affordable housing and care facilities, establishing community health programs that aid the elderly in continuing to live at home, and strengthening the availability of pension plans.

Stress urinary incontinence is a major confounding factor which impairs health quality in women. Some procedures cannot resolve it's impact on life quality. This study aims to assess a less common and newly method; use of transobturator tension- free vaginal tapes (TOT) in regard to short- term and long-term morbidity and impact on patient's quality of life (QOL). Fifty four patients diagnosed with urinary stress incontinence, underwent a transobturator tension free vaginal tape procedure with or whitout prolapse surgery