Iranian Red Crescent Medical Journal最新文献

Background: Many experts believe that the "health houses" of Iran have had major effects in increasing health status of Iranian rural community. One of the factors, which was critical to this success is the employment of young women and men from rural communities who serve as multipurpose health workers. They participate in a two-year task-oriented training course.

Objectives: The purpose of this article was to describe the model of training behvarzes as the community health workers who deliver health services to the health houses of Iran. This description included the specific method of recruiting these CHWs, strategies and methods of their training which is different from general academic education.

Materials and methods: A descriptive study design was utilized for this analysis in six areas. These areas have been selected according to the expert opinions and experiences of the Center for Health Networks Management.

Results: The results showed the specific method of student selection and clear objectives and standards of training related to the health needs of the community. Recruitment of native human resources, the relationship between training and performance are the characteristics, which have been made this system more efficient and responsive to the health system needs.

Conclusions: Development of the job and task analysis to ensure providing the right training needs, applying more evidences through different studies for reforms, more decentralized equipped system with decision-making tools have been proposed for development.

Background: Menorrhagia is a common health problem in women, particularly those with bleeding disorders. Little is known about the course of menorrhagia or other bleeding symptoms in women with the most common congenital bleeding disorder, von Willebrand disease (vWD).

Objectives: The aim of this study was to estimate the prevalence of vWD in women with diagnosed menorrhagia.

Materials and methods: In this cross-sectional study, a total of 460 consecutive patients, presenting menorrhagia, were analyzed. The initial screening and confirmation tests for the diagnosis of vWD included determination of prothrombin time (PT), partial thromboplastin time (PTT), bleeding time (BT), fibrinogen, factor VIII, vWF antigen, and vWF activity. A questionnaire was filled for every patient. The data were then analyzed using the SPSS software.

Results: Mean age of our patients was 32.5 ± 10.6 years. The level of von Willebrand factor in 22.5% and von Willebrand activity in 19.6% of patients was abnormal. The prevalence of vWD among patients with menorrhagia was 24%.

Conclusions: The high prevalence of vWD among our patients was the same as other previous reports, suggesting low awareness about this disease and under diagnosis of mild cases.

Introduction: Chronic renal dysfunction is a progressive and irreversible process in kidney function, which often resulted in chronic kidney disease (CKD) or chronic renal failure (CRF). Range of CKD is varying from proteinuria and renal failure to CRF.

Case presentation: A 78-year-old man presented with stage 4 CKD for 7 years; the glomerular filtration rate (GFR) and creatinine levels remained constant despite no change in his weight.

Conclusions: Although our patient had CKD stage 4, but his condition has not deteriorated and remained constant and stable for several years only by control of blood pressure and usual treatment which prescribed for patients at this stage.

Background: A healthy lifestyle is a valuable source to reduce the prevalence of health problems, and promoteehealth.

Objectives: The current study aimed to evaluate the lifestyle and obesity status of Hamadan public employees and their status based on the trans-theoretical model (TTM).

Patients and methods: This analytical cross-sectional study was performed in 2014 on 1200 public employees in Hamadan city, Iran selected through proportional stratified random sampling. Data collection was performed using a three-section questionnaire including demographic characteristics, The FANTASTIC lifestyle questionnaire, and the five-part algorithm. Data were analyzed by SPSS-20 using linear regression, Chi-square, Fisher exact test, and ANOVA.

Results: The mean age of the employees was 38.12 ± 8.04 years. Most of the employees (61.7%) had favorable lifestyle. About half of the employees were at the preparation stage of TTM. Most of the employees were in a poor condition regarding the physical activity and healthy eating habits. In most of the evaluated items, females got higher scores than males. The associations between lifestyle and age, gender, work experience, income satisfaction, and marital status were significant. Moreover, the associations between obesity and work experience, marital status, number of offspring, and gender were significant (P < 0. 05). Significant predicting variables of obesity were age and work experience; they explained 31.2% variance of obesity (adjusted R(2) = 0.312, R(2) change = 0.01).

Conclusions: Planning health education interventions for employees through effective approaches seems necessary.

Background: About 79% of the pregnant women experience sleep disorders and 70% of pregnant women experience some symptoms of the depression. Physiologic, hormonal, and physical changes of pregnancy can predispose mothers to depression these disorders before, during, and after childbirth and might be aggravated by neglecting health behavior. Health behavior education might be useful for the management of depression in pregnant women.

Objectives: This study aimed to evaluate the effect of sleep health behavioral education on the improvement of depression in pregnant women with sleep disorders.

Patients and methods: This study was a randomized clinical trial, performed on 96 pregnant women with sleep disorder diagnosed according to the Pittsburgh Sleep Quality Index. Tools for data collection included demographic questionnaire and Beck's Depression Inventory (BDI). Easy and accessible sampling was done. Participants were randomly (simple) allocated to intervention and control groups. In intervention group, sleep health behavior education was presented during a four-hour session held in weeks 22, 23, 24, and 25; then the patients were followed up to fill out the BDIQ in follow-up session at weeks 29 and 33 of pregnancy. The control group received no intervention and only received routine prenatal care. The results were assessed by Chi-square tests, independent-samples t-test, and Fischer's exact-test by SPSS 16.

Results: A statistically significant change was reported in the severity of depression in pregnant women with sleep disorders in the intervention group in comparison to the control group at weeks 29 (P < 0.000) and 33 (P < 0.00).

Conclusions: Sleep health behavioral education improves depression in pregnant women who are experiencing insomnia. Findings from this study add support to the reported effectiveness of sleep health behavioral education in the prenatal care and clinical management of insomnia in pregnancy.

Background: Obesity is rapidly increasing worldwide with negative effects on women's health, psychosocial factors and quality of life. Female sexual dysfunction (FSD) is a major public health problem that is worrying for many women physically, emotionally and socially.

Objectives: The purpose of this study was to investigate the association of body weight with FSD and sexual satisfaction, in Ilam, western Iran, in 2010 to 2011.

Patients and methods: This was a case-control study on 120 women aged 18-50 years [64 with FSD (case), 64 without FSD (control)] married, from Ilam-IR, who were interviewed as per the Iranian version of Female Sexual Function Index (FSFI). Body mass index (BMI) and waist-to-hip ratio (WHR) were recorded by researchers. The subjects were randomly selected from primary health centers.

Results: FSFI score was significantly lower in overweight women (P < 0.05). FSFI strongly correlated with body mass index (BMI) (r = -0.68, P < 0.001) and waist-to-hip ratio (r = -0.29, P < 0.05) in women with FSD. Of sexual function parameters, there was a strong and inverse correlation between BMI and arousal (r = -0.71, P < 0.001), lubrication (r = -0.61, P < 0.001), orgasm (r = -0.52, P < 0.001) and satisfaction (r = -0.54, P < 0.001), while pain (r = -0.12, P > 0.05) and desire (r = -0.17, P > 0.05) did not correlate with BMI. There was an association between BMI and extreme satisfaction (r = -0.28, P < 0.05). Extreme physical pleasure (r = -0.19, P > 0.05) and extreme emotional satisfaction (r = -0.16, P > 0.05) were not correlated with BMI.

Conclusions: Overweight and obesity negative affect sexuality in women with sexual dysfunction. A systematic evaluation of sexual function to disclose a cause and effect relationship between obesity and FSD is suggested.

Background: Despite the paramount importance of the patient's satisfaction, there are limited data on mothers' satisfaction with the nursing care provided to their children in Iranian clinical settings.

Objectives: This study aimed to evaluate mothers' satisfaction with two systems of providing care to their hospitalized children.

Patients and methods: This research was a two-group quasi-experimental study. Primarily, the basics of the case method and the functional care delivery systems were educated to the practicing nurses of the study setting. Each system was implemented independently. After the implementation of each system, 200 mothers whose children were hospitalized in the pediatric care ward of Shahid Beheshti Hospital, Kashan, Iran, were invited to respond to the 28 -item Pediatric Family Satisfaction Questionnaire. Study data were analyzed by SPSS v. 16.0.

Results: Results were indicative of mothers' satisfaction with medical care delivered by case method as 13.2 ± 5.2 and by functional method as 13.17 ± 5.56. Also, no significant difference was seen between two groups (P = 0.4). Mothers' satisfaction with nursing care delivered by case method was 17.7 ± 4.43 and by functional method was 13.33 ± 5.69 and there was a significant difference between two groups (P = 0.004). Mothers' satisfaction with accommodations by case method was 16.78 ± 4.07 and by functional method was 17.9 ± 6.67 with a significant difference between two groups (P = 0.06).

Conclusions: Improving the quality of care is associated with higher patient's satisfaction. Accordingly, developing and implementing programs for improving nurses' communication and clinical skills can improve both care quality and patient outcomes.

Background: Working outside daylight hours (7 am to 7 pm) is called shift work. Shift work is a common practice in many industries and factories such as steel industries, petroleum industries, power plants, and in some services such as medicine and nursing and police forces, in which professionals provide services during day and night.

Objectives: Considering the contradictory reports of different studies, we decided to evaluate the effect of shift work on cholesterol and triglyceride (TG) levels through a historical cohort on steel industry workers.

Patients and methods: This retrospective cohort study was performed on all the staff of Isfahan's Mobarakeh Steel Company between years 2002 and 2011. There were 5773 participants in this study. Data were collected from the medical records of the staff using the census method. For analysis of data, generalized estimating equation (GEE) regression was used.

Results: The results showed a significant difference in cholesterol levels between shift workers and day workers on the first observation (P < 0.001), yet no such difference was observed for TG (P = 0.853). Moreover, the results showed that the variables of age, work experience and BMI were not similar between shift workers and day workers. Therefore, to remove the effect of such variables, we used GEE regression. Despite the borderline difference of cholesterol between regular shift workers and day workers, this correlation was not statistically significant (P = 0.051). The results for TG also showed no correlation with shift work.

Conclusions: According to the findings of this study, there is no relationship between shift work and changes in serum TG and cholesterol. The lack of relationship can be due to shift plans for shift workers, nutrition, or the "Healthy Heart project" at Isfahan Mobarakeh Steel Company.

Background: Ischemic heart disease (IHD) is the most common cause of cardiovascular diseases and divided into two main categories as acute coronary syndrome (ACS) and chronic stable angina (CSA). These two groups have stenosis and atherosclerosis in the coronary artery, but are more severe in patients with ACS.

Objectives: We aimed to find the association between coroner and internal carotid artery, also comparing prospectively stenosis level, plaque morphology and intima-media thickness of internal carotid between patients with acute coronary syndrome (ACS) and chronic stable angina.

Patients and methods: In this study, 60 patients were enrolled as ACS group chosen from those admitted in CCU or referred to clinic. Forty-five patients of CSA group were chosen from those referred to clinic. All 105 patients underwent color Doppler sonography, and stenosis, plaque morphology and intima media thickness (IMT) were measured.

Results: In 60 patients with ACS, 49 (81.7%) had no stenosis in ultrasonography and 11 (18.3%) had some degrees of stenosis; also 28 (46.7%) and 16 (26.7%) of patients had plaque and IMT, respectively. In the rest 45 patients of CSA group, just 4 (8.9%), 17 (37.8%) and 8 (17.8%) patients had stenosis, plaque and IMT, respectively. Therefore, there was no statistically significant difference between the two groups regarding stenosis (P = 0.171), plaque morphology (P = 0.362) and IMT (P = 0.283) (Power = 90%).

Conclusions: According to the results, there were no significant and meaningful differences comparing ACS and CSA groups of patients by ECDS using three indicators of stenosis, plaque morphology and IMT as indicators of atherosclerosis. Results also display that patients with ACS had more stenosis, more plaque and thicker intima-media, but these differences were not statistically significant (P < 0.05).

Background: Heart size is an important and effective parameter in chest X-ray (CXR) interpretation. Studies indicate that, especially in middle-aged men, increased cardiothoracic ratio (CTR) is associated with ischemic heart disease (IHD) and increased rate of morbidity and mortality. The CXR is the most common imaging examination of the heart.

Objectives: A good quality posterior-anterior (PA) chest radiograph is an important indicator of the cardiac size. Nowadays, CXR has given its place to more advanced approaches such as two-dimensional echocardiography. However, CXR is still more accessible and feasible for most of the physicians. This study was designed to compare the findings of CXR and echocardiography in determination of the heart size.

Patients and methods: This cross-sectional study was carried out from 2006 to 2007. A total of 197 patients entered the study. The cases had been undergone PA CXR and 2-D echocardiography maximum within two days.

Results: Of participants, 24.9% had cardiomegaly according to the findings of CXR and 50.8% based on echocardiography. There was a statistically significant difference between the mean size of Right Ventricular End Diastolic Diameter in the patients with cardiothoracic ratio < 50% and ≥ 50% (P = 0.002) as well as Left Ventricular End Diastolic Diameter (P = 0.023). Also, a statistically significant difference was seen between echocardiography and CXR findings with regard to determination of the heart size (P = 0.003). Nonetheless, it is noteworthy that sensitivity and specificity of CXR findings in the diagnosis of cardiomegaly were 34%, and 84.5%, respectively.

Conclusions: CTR is the most common method of describing the heart size. Increased CTR in CXR is associated with poor prognosis, which is suggestive of importance and necessity of early diagnosis. Although CXR may not have the same diagnostic accuracy as echocardiography, its easy accessibility and high specificity in diagnosis of cardiomegaly is very helpful, which can play an important and a cost-benefit role, particularly in screening the enlarged heart size. Moreover, according to the statistics released by Medical Council of Iran, most of Iranian physicians are general practitioners and a few of them are cardiologist.