مجله پایش
سال یازدهم شماره 5 (پیاپی 45، مهر و آبان 1391)

Maternal mortality surveillance system has been functioning from 2000 in Iran. This system is implemented to reduce pregnancy-related deaths through illuminating the path that took the deceased mother to her death, identify preventable factors and devising and implementing intervention to resolve the problem and prevent similar death. To know executive personnel’s attitude about this system and identify how can be improved by interview with experts. This study had two sections. at the first one(quantitative) a questionnaire developed which included phrases about 3 steps of maternal mortality surveillance system. Reliability and validity of the tools were tested. Then 104 head quarters and staffs completed it and data in Spss software were analyzed. In the second section (qualitative) we interviewed with 6 experts and health manager who had previous study in safe motherhood subject. all 3 steps of system are moderately good in their opinion. Mean score in implementation of intervention (59 from 100) was lower than designing intervention (63 from 100) and information collection (67 from 100).The information collected is often insufficient to identify demographic data. Poor cooperation from the obstetrician due to lack of time, leads that death cases haven’t been reviewed perfectly. Obstetrician isnt charge for maternal health in the provinces. Interventions should be done in high level of treatment team but because it is very difficult, it is focused on lower level of team such as health workers. Therefore interventions are not effective and they can’t prevent avoidable factors. current forms and questions using in maternal mortality surveillance system in general is suitable. Some suggestions for improvement are these: - Demographic and socioeconomic information (father’s name, ID number, literature and socioeconomic level of deceased woman and her husband) should be added in the forms as check mark or optional questions to evaluate relation of social factors and maternal deaths.- In educational and treatment deputies a job vacancy as in charge of maternal mortality be added- Considering these items in faculty members promotion are recommended: (attending in questionnaire team and active attendance in mortality committee)- Considering the implementation of intervention in hospital annual evaluation score.- Using the national clinical guidelines by the providers to prevent mismanagements or faults.

Objectiv (s): The growth in the Iranian population and changes in its ratio in the year 1400 A.H. and also the increase in the frequency of cardiovascular diseases depict the need for scheduling and assessing the requirements for training more cardiologists in the future. By library search, we found reliable estimations of the Iranian population in the year 1400 and the available proportion of cardiologists in different countries in year 2000 by searching available databases. The average proportions of cardiologists in 31 countries were 45 per million people. However, in Iran it was 16-20 cardiologists per million people in 2010. It’s estimated that the population of Iran will rise to 86 million people by 2021. Therefore, if we consider the proportion of 45 cardiologists per million people as the referee, we already need 3870 cardiologists at that time. Increasing the proportion of cardiologists seems necessary in Iran. But it seems that increasing the annual health care system budget per capita and making a balance between the training specialized health workers and the real need of the society is also of great importance. An independent study and decision making by the health care authorities are necessary to achieve such a big goal.

Objective (s): To measure the relationship between organizational commitment of "Marand Health and Treatment Network" and their performance in Iran, 2010. The research has been a cross-sectional one of correlation type, which has been carried out in "Marand Health and Treatment Network".the data gathering device consisted of two questionnaires: a) organizational commitment Questionnaire in three dimensions consisting of emotional Commitment, normative commitment and continuance commitment on the base of seven ranking "Likert" scale(strongly against up to strongly for) b)work performance questionnaire in two dimensions consisting of operation factors and behavior factors on the base of five ranking "likert" scale(unacceptable up to excellent).Utilizing relevant books and essays the work was corrected and proved by professors. Related to the organizational commitment the following results were obtained: From emotional, continuance and normative commitment points of view the averages were 4.98, 4.43 and 4.95 respectively. The total average was 4.79 (out of 4).From work performance point of view the averages of operation factors and behavior factors were 3.24 and 3.22 respectively. The total average was 3.23(out of 3).In general, organizational commitment and work performance of the staff were satisfactory and more than the average. There was no meaningful relationship between emotional commitment and work performance (P>0.05).A meaningful relationship was seen between continuance commitment and staff operation factors (P<0.05 and r =0.157), however, there were no continuance commitment and work performance as well as a meaningful relationship between normative commitment and work performance (P>0.05).Finally the relationship between organizational commitment and work performance was direct and obtained at the rate of r =0.158.Coclusion: Regarding the increase in work performance of the staff that has high organizational commitment, we can have active health and treatment services by reinforcing effective factors on organizational commitment (especially effective factors on continuance commitment).

Objective (s): To determine the pattern of incidence and survival rates of cancers in elderly adult in the period of five years to obligate the screening and therapeutic aged care services to old people. This is a historical cohort study based on the data analysis years (2001 to 2005) and cancer registries reporting survival rates for these cancers in people aged 60 years and older. Collecting data was through observation and data gathering Cancer Research Center, Shaheed Beheshti University of Medical Sciences. The inclusion criteria were cancer patients 60+ years registered through the annual reports of cancer cases and survival patients followed. To compare the survival and separation of sex Kaplan Meier coax method was used. The death and death of the relative risks of various cancers were calculated by regression model. Based on data 33.5% of women surveyed aged 60 years and older and 66.5% were elderly men. The mean age was 71.2 years. Mean survival in this study was 88.2 years. The highest incidence of skin cancer was 5 years old. The geographical distribution of incidence was bladder cancer among elderly in Kermanshah province. Yazd province was the highest prevalence of common cancers in elderly. The average of five-year survival in Lorestan province was the highest and the Ardabil province had the lowest. The relationships between sex and death from cancers were (0.84 to 0.95), and the relationships between the relative risks of death from cancers (1.03 to 1.09) which were significant. The risks of cancer death among nine provinces were varied comparision to Tehran metropolitan. In oderwords survival rate of cancers in the nine provinces significantly were less than Tehran province.

As part of a study on health perception among Iranian people, the importance of health was assessed. This was a population-based study. A random sample of individuals aged between 18 and 65 years were entered into the study. Respondents were asked to rate a 5-point scale indicating how value health in their life. The data were analyzed descriptively. In addition logistic regression analysis was performed to assess the association between independent variables and the importance of health. In all 27,883 individuals took part in the study. The mean age of respondents was 32.7 (SD=11.8) years. The results indicated that 70 percent of the respondents valued the health very or very much important. For there analysis of the data showd that males and females valued the health similarly but age and education had significant contribution to people's perceptions. The findings of this study intoduce a noteworthy outlook of health importance among Iraninas and could be useful in characterizing public cognitions of health and provide essential basis for program development and health related interventions.

To applicate of regression based path analysis for introduction of the best model of self-monitoring of blood pressure determinants, using BASNEF Model constructs.

This descriptive analytical study carried out on 150 hypertensive patients referred to a private clinic, which entered in the study with a convenience sampling. The data were collected by interview, using a survey questionnaire which was adapted by the researchers. Before starting the interview, validity and reliability of the scales approved by an experts panel and cronbach alpha. The Statistical Package for the Social Sciences (SPSS) was used for the purpose of data entry, manipulation and analysis.

intention and enabling factors had a direct effect on self-monitoring behaviors which enabling factors had the most powerful effect. Subjective norms had indirect effects on self-monitoring behaviors through intention and enabling factors. Attitude had lowest effect on self-monitoring behaviors.

Regarding good power of BASNEF model in predicting that behavior, interventional programs aimed at promoting self monitoring among hypertensive patients with an emphasis on providing enabling factors, and reinforcemet of intention and subjective norms may be effective on hypertention control.

To determine of personal preference of delivery attendants regarding mode of delivery for themselves and their proposed type of delivery to pregnant women and relationship between their personal preference with their proposed type of delivery to pregnant women. The present research is a descriptive– analytical study that was done in 1388. After admissibility and permanency of the tools, a questionnaire which consisted of some individual – social characterisitics, pregnancy history, childbirth and some questions about the purposes of research was given to under research samples (153person of midwives and 90 person of obstetricians) completed questionnaire by their personal tendency and data were analyzed for independant groups by using the spss (vertion 13.o) and methods of descriptive statistics. Chi-square test and T-test. The results of this research showed that cesarean was preferential childbirth in 62.2 percent of obstetricians and 57.6 percent of midwives for themselves and suggested childbirth 33.7 percent of obstetricians and 17.6 percent of midwives suggested cesarian delivery to first gravid women. Also, there was a significant statistical relationship between type of preferential childbirth for themselves and their suggested childbirth to pregnant women. The type of suggested childbirth to pregnant woman by delivery attendents is influenced of preferential childbirth type for themselves. With attention to this group role on the field of consultation during pregnancy, Delivery attendents childbirth type has essential role on the field of the selection of child birth type of pregnant woman.

To evaluate the effect of abdominal hysterectomy on Body Image Scale (BIS) on women in educational hospital in Tehran. Analytical prospective study of the body image scale by 73 married women 35 to 55 years old based on entering criteria participating randomly in evaluate abdominal hysterectomy trial. The scale was completed pre-operatively, then 2 and 3 month post-operatively. Data was evaluated by Repeated Measures and Pair-wise comparisons in SPSS software. Significant differences in bis scores were found between women in before and 2and 3 month after abdominal hysterectomy. Demographic and reproductive characteristic were not associated with BIS. Abdominal hysterectomy was effective on women Body image in short period of time.

To study the knowledge, attitude and practice in breast feeding mothers in the field of physical activities and related factors on exercises. Tow hundred breast feeding mothers referring health and treatment centers of Tehran have been random selected from five centers through the questionnaire and their knowledge, attitude and related factors on exercise were studied. Regarding practice, Global physical activity questionnaire from World Health organization was used evaluating the three fields of work, exercise, leisure time, going from one place to another, level of physical activity. Data were analyzed using SPSS Statistical software after being collected. According to the data from this research, 74.5% of mothers were highly aware while 80.5% had positive attitude toward exercising during lactation. In term of physical exercise only 14% were performing some type of sport activity. Regarding physical activity, 58% of the subjects had average physical activity among the total activities in all three fields. As well the study showed that the average physical activity among lactating mothers in the field of work was 38 min per day, going from one place to another using bicycle or walking for 15 min per day and 5 min per day of exercise in the field of sport activities.Among the most important factors of having no sport activity the reasons were having no enough time, having small children, giving no importance to sport activities and lack of exercise space for women respectively. However most of breast feeding mothers in this study had high knowledge and positive attitude toward the benefits of exercises during lactation, their activity level was so limited. So it is recommended that health employees, especially those in health and treatment centers should encourage mothers to perform and follow both health behaviors, namely exercise and breast feeding and arrange short term exercise plans for lactating mothers in post labor and lactation care services. Further researches on the effects of health training models on exercises in lactating mothers seem to be necessary.

To assess the intake of food groups and the related factors in lactating women. In this descriptive study, 1112 lactating women were selected from health centers in Qom. Data were gathered using the 24 hour dietary recall questionnaire. Efficiency of food groups was calculated by the formula: [(reported dietary intake ÷ predicted dietary requirement) ×100]. Food consumpsion was compared with food guide pyramid The dietary intakes of lactating women in food groups except fruit and vegetables were less than the recommended levels. There was significant relationship between occupation and consumpsion of bread and cereal (P<0.05) and milk and dairy products (P<0.05). There was also a significant relationship between consumpsion of meat and nuts (P<0.05) and milk and dairy products (P<0.05) and level of education. Based on finding educational planning is recommended to housewives, illiterate mothers and women with children younger than 3 years old.

Withdrawal contraception accompanied with high unwanted and morbidity. the aim of this study to gain of the knowledge, perceptions and experiences of using contraceptive methods withdrawal users to design effective effective intervention for them. In the first stage qualitative methods used to elicit questionnaire with 50 women. In the second stage cross-sectional study was performed 300 women attending to the health care centers in west Tehran were selected randomly. In the both of them women were not intended to become pregnant and use withdrawal contraception. data analyzed by using descriptive statistical tests. They had used modern contraceptive methods before withdrawal in 70.7 percent. The mean withdrawal usage was 60.5 4.9 and modern contraceptive was 2.3 2.9 years. The most common source of information on modern contraceptive was health care providers and informal sources. The women are familiar with emergency contraception in 34 percent. Unwanted pregnancy related to withdrawal contraception was 33/7 percent. The most common beliefs related to oral pills nervousness (79.3%) obesity (26.7%) infertility (79.3%), IUD infection (34%) pregnancy (22.7%), spontaneous movement (21%) condom, pregnancy (73.7%) and three monthly injection, pregnancy (33.3%). It was important that planners will be design family planning packages should contain programs to correct the wrong beliefs. Side effects of modern contraception should be as soon as possible recognizing. They counselors must be guided them. Positive attitude related to withdrawal contraception suggests that family planning programs disseminated essential information among this groups.

Objective (s): To explore barriers of condom use among women at risk for HIV/ AIDS.

Grounded theory approach has been implemented for data gathering and analysis. Participants were 22 women at risk (homelessness and/ or drug abuser, multi partners and/or having husband with one or more condition as below: HIV positive and/or IDUs drug user, extramarital relationships). Twenty-five semi-structured interviews were conducted with a purposive sample of at risk women aged 21 to 49 years at VCT Centers or DICs in Tehran. Qualitative content analysis of the data was conducted manually and was guided by constant comparative analysis.

The major themes emerged were; insufficient social support, poverty and economic factors, drug abuse, and some socio-cultural norms such as gender roles.

Findings can be implemented for effective HIV/ AIDS prevention strategies and interventions.

Objective (s): To determine maternal and umbilical cord levels of lead, cadmium, and selenium and study their relationships.

This was a cross-sectional study. Sampling of mother's blood during delivery and cord blood after delivery were performed and the blood levels of the 3 mentioned elements were measured. P-values less than 0.05 were considered significant.

The significant correlations found were: positive correlations between maternal and cord lead(r=0.522), maternal and cord cadmium (r= 0.733), maternal and cord selenium(r= 0.582), cord cadmium and maternal selenium(r=0.242), cord cadmium and cord selenium(r= 0.211), and negative correlations between maternal lead and selenium(r=-0.235), maternal lead and cord selenium(r=-0.271), maternal lead and cadmium(r=-0.377), cord cadmium and maternal lead(r= -0.387).

In this study, cord blood lead and cadmium levels had direct correlations with maternal levels of them, and cadmium concentrations in cord blood were less than those in maternal blood, suggesting the more effective placental barrier for cadmium transferring from mother to fetus. Selenium levels in cord blood had a direct correlation with maternal selenium levels, and were higher in cord blood, suggesting the active transfer of selenium to fetus.More studies in different populations of mothers and neonates are recommended to study these relationships more precisely.

Objective (s): Coping with stress is more important than the nature of stress itself. Coping with stress is a health promotion behavior and behavior is influenced by unintelligible factors. Theory of planned behavior makes a useful framework for understanding the health behavior and designing appropriate training. Integrating the theory of planned behavior with self-efficacy will increase the predictive capability of the theory.

This research is a qualitative approach based on the “Integrated Model of Planned Behavior and Self-efficacy”. Total 70 women aged between 20-45 works in industrial factories are chosen by purposeful sampling with maximum diversity to participate in focus group discussion. Ten group interviews in the form of seven groups of ten were conducted. After collecting information, analyzing data from the conventional method of content analysis was conducted.

Results showed that the majority of women workers have the attitude that stress is the effective factor on body and spirit health and also a cause of job absence and decreased quality of work in work places. Shouting, emptying stress on others, patience and silence, preying, listening to music and walking are the majority of techniques that women workers use to cope with stress. Significance and effects of understanding and social support are subjective norms of women workers. Susceptible morale, lack of job security, weakness, and working with pressure and lack of knowledge and skills of coping with stress are the most important barriers of coping with stress in women workers. results showed that training the methods and skills of coping with stress and increasing supports in work places and home; could empower women to have more self-efficacy and intention to cope with stress.

By rehabilitations of regular sessions and consulting and persuasion of women to reflect the problems in workplace; and also by informing and training the methods and skills of coping with stress; we can move toward a way of promoting health in our society.

Objective (s): To compare between the quality of life in menopausal and non menopausal women in Kashan, Iran. In this cross sectional study, 200 women aged 40-60 in Kashan city with purposeful sampling were investigated. Menopausal Specific Quality of life questionnaire (MENQOL) was used for estimation of QOL. Then mean score of different domains were comprised between two groups and data were analyzed with SPSS software package and statistical tests χ², paired t- test and Mann witheny U. Results showed that mean scores of quality of life in vasomotor, psychosocial, physical and sexual domains was higher in menopausal women versus non menopausal women and a statistically significant difference between two groups quality of life scores in four domains were seen (P=0.0001). The quality of life in menopausal periods is poor, therefore it is necessary to pay attention to women in these periods and emphasized on teaching about menopause, its symptoms and its adverse effects.

Objective (s): The effect of peer education on quality of life in women after mastectomy referred to cancer clinics affiliated with Shiraz University of Medical Sciences. Ninty Nine women in stage І and ІІ of breast cancer with one year after modified radical mastectomy took part in the study. Quality of life was measured using the European organization for research and treatment of cancer quality of life questions (QlQ-C30) and its breast cancer supplementary measure (QLQ-BR23) at three points in time: before, after, two months after intervention in both groups. The experimental group were randomly assigned to five groups. For the experimental group peer education was conducted weekly for one month. Data analysis was performed by using chi square, t test, and repeated measurement multivariate to compare quality of life differences over time. In the experimental group the results showed a statically significant increase in all performance aspects of life quality and decreasing symptoms (P<0.001), but in control group there was no significant difference in all aspects of life quality. peer led instruction is a useful intervention for people suffering from breast cancer by improving the quality of life.

Objective (s): Chronic character of diabet and complications decreases quality of life. According to Chronic character of illness use of suitable follow up is necessary. Thus. This study was designed to investigate the Effect of Nurse-led Telephone Follow up)Telenursing(on Quality of life among diabetic patients. In This quasi experimental study seventy diabetic patients selected with convenience sampling method. Data gathering instruments included a questionnaire for demographic variable and SF36 questionnaire for measurement Quality of life. Data gathered at baselin and 12 weeks after the intervention. Participants randomly assigned to the experimental and control groups. Telephone follow ups were applied in experiment group for 3 months; data were analized with SPSS software. Results showed that there was no significant difference in demographic variable and quality of life dimension between two group before intervention, but there was a significant difference between the two groups after the intervention in terms of scores quality of life in physical health)P<0.001(and emotional health)P=0.009(.Based on the results of applied paired t-test, there was a significant difference before and after the intervention in the case group in terms of their mean quality of life. According to the result Nurse-led Telephone Follow up)Telenursing) hasBeen highly effective on the diabetic patient's quality of life and we suggest this method to be applied on wider range in this patient and other chronic diseases.

Objective (s): To determine how nurses manage intercultural communication with their patients. The type of this qualitative study was content analysis. 21 nurses were participated in this study. Sampling was purposeful. They have a diversity of age, sex, clinical experiences and different positions. Data were collected via unstructured interview. Content analysis and constant comparative analysis method was used for data analysis. The strategies of prolonged engagement, peer debriefing, member checking and journal writing were used to establish the trustworthiness of the study. Data analysis showed that various strategies were used for inter cultural communication such as: member of family, secretaries of ward, nonverbal communication, using the previous vocabulary, and also translators. Different strategies such as relatives, bilingual and bicultural nurse, orderly, secretary of the ward, nonverbal language, use of previous words and translators are used. According to the results, it can be concluded that nurses when patients are facing cultural diversity, based on their professional and moral obligation, use a combination of strategies to provide complete and effective care.

Objective (s): Existing data show a considerable prevalence of non communicable diseases risk factors and their rising trend in our country. Unhealthy nutrition is an important underlying factor for mentioned diseases. Considering the necessity of understanding the underlying factors of a healthy nutrition from the perspective of society members and lack of related studies from Iran, the current study investigates perceptions and experiences of Tehranian men who are participating in Tehran Lipid and Glucose Study (TLGS). This is a qualitative study, conducted according to the grounded theory approach. In total 8 semi-structured focus group discussions were conducted in TLGS unit, during 2008 to 2009. Participants were 96 men, aged 25-65 years, who were selected and recruited in the current study from the fourth phase of TLGS. All interviews and focus group discussions were audio recorded and transcribed verbatim. Data collection and analysis were done simultaneously according to the Strauss and Corbin analysis method. Based on content analysis of data, barriers to a healthy nutrition are “inefficient education”, “behavioral models”,” lack of access”, “women’s role” and “personal taste and interest”. Study results demonstrated the main barriers for a healthy nutrition as perceived by men, barriers that any effective interventions require to address for tackling non-communicable diseases in Tehranian families.

Objective (s): To determine the effect of education on HIV/AIDS preventive behaviors of addict persons in Zarandieh. In this quasi-experimental study, 48 male addicted, were selected. A questionnaire was developed and it was used after taking reliability and validity. The educational needs were recognized, and then the educational intervention was designed and performed. After 2 month, KAP of samples were determined (post-test) and then compared with pretest information. %34 of addicted had tattooed, %32 of them had sexual intercourse extra family and %45 of had drugs injection, Heroin and Krak with %46 and %44 were common drugs. The mean score of knowledge, attitude and practice after educational intervention compared to before intervention (before intervention: 6.75, 6.89, 3. after intervention: 11.24, 11.53, 4.78). There was significant difference between KAP scores of samples before and after intervention (P<0.0001). the results of this survey indicated that designed educational intervention was effective on increasing of HIV/AIDS preventive KAP.

To determine the application of preventive measures by emergency medicine residents for blood born diseases and detection of possible constraints at Imam Hussein Hospital in 2009-2010. In this observational descriptive cross-sectional study, all 40 emergency medicine residents from the first to third year of practice, were observed and evaluated during work at emergency department of Imam Hussein Hospital in 2009-2010. Data were collected by utilizing an observational checklist & a personal characteristics information form. Content validity and inter rater reliability(r=0.89) of the instruments was confirmed. The mean age of the residents was 32.7±4.3 years. Twelve subjects (30%) were female. Fifteen residents (37.5%) were in first educational year, six subjects (14%) were in the second year, and 19 residents (47.5%) were in their third year of practice. Three most respected items were covering the hands by latex gloves before medical procedures (95±20 points), cleaning the bloody skin after phlebotomy or IV line preparation (88±32 points), and developing no blood spreading after phlebotomy, suction, or lines removal (77±43 points). Higher residency educational degree and IV line preparation were the effective factors for better application of preventive measures by emergency medicine residents for blood born diseases, compared to intubation procedure (P<0.05). The most common constraints for application of preventive measures by emergency residents for blood born diseases were high rate of patient's attending the emergency room (85%), high work load (80%), and need for fast performance at work (68%). Generally, according to the obtained results, it may be concluded that the preventive measures for blood borne diseases are not optimally practiced by emergency medicine residents, and therefore, it is necessary to promote their information & practical knowledge especially with explanatory classes & continuous quality improvement.