فهرست مطالب fereshteh ghaljaei

Most infants born prematurely are admitted to the NICU for their survival, an environment that is rich in stressors that has non positive effect on the sleep and wakefulness condition. The goal of this study was evaluating the effect of the QTP intervention on the sleep status of premature neonates admitted to the NICU.
This study was semi-experimental and 62 premature babies hospitalized in NICU, who were selected by available sampling method. The tools used included demographic information questionnaire and Als sleep and wakefulness tool. Infants in two groups were evaluated in 3 stages. before, during and after the intervention in the evening shift from 15:00 to 17:00 for 60 minutes. The data was analyzed using SPSS software (version 22). A  p value of less than 0.05 was considered statistically significant. The validity of the mentioned tool was investigated according to the content method according to the study of Rajaei in 2013 under the title of investigating the sleep-wakefulness of premature infants and its relationship with demographic characteristics, and the reliability of the tool was also investigated according to the same study.
The chi-square test showed that the variable frequency of deep sleep (type A) before (P=1)and after (P=0.05) the intervention in the two groups did not have a statistically significant difference and just during the intervention has a statistically significant difference (P<0.001). Comparison of the distribution of the frequency of deep sleep (type B) before, during and after the intervention in 2 groups shows that before the intervention, deep sleep (type B)  was not observed in the two groups. However, in the intervention group, 58.1% had deep sleep during the intervention and 6.5% after the intervention. The control group did not have deep sleep (type B) in these three time periods.
Considering the effectiveness of QTP in reducing environmental stimuli and improving sleep status, implementation of these items is recommended as a standard care to reduce stress, improve growth and development of preterm infants in the nicu.

Chemotherapy, as one of the most important treatments for cancer, may lead to complications such as anxiety and changes in children's sleeping habits. The present study aimed to evaluate the effectiveness of sand play therapy in improving anxiety and sleep habits of children with leukemia undergoing chemotherapy.

This quasi-experimental study was conducted on 80 children with leukemia undergoing chemotherapy. The participants were randomly assigned into a control group and an intervention group admitted to Abi Talib (AS) Hospital in Zahedan, southeast Iran, in 2020. Data collection tools included a demographic information questionnaire and the Revised Children's Manifest Anxiety Scale (RCMAS), and Children's Sleep Habits Questionnaire (CSHQ). The questionnaires were completed by the primary caregivers of the children, before and one week after the end of the intervention. Data analyses were performed through SPSS26 software, using independent-t, paired-t, and chi-square tests. The significance level in this study was set at (0.05).

Mean age of the children was 9.35±1.44 years in the intervention group and 9.48±1.57 years in the control group. Based on the results, sandplay therapy significantly reduced anxiety and poor sleep habits in the intervention group (P<0.001).

The findings showed that sandplay therapy can be used as a non-pharmacological and effective treatment method to reduce the complications caused by chemotherapy in children with cancer.

Letter To Editor

Surgery is a negative event that is associated with adverse effects on children. One of the most common complications of surgery is anxiety. The mother's voice can be used as an intervention to control children's anxiety. The aim of this study was to investigate the effect of maternal voice on postoperative pre-operation anxiety in children undergoing lower abdominal surgery in 2019.

In this clinical trial, 80 children aged 1-6 years admitted to the pediatric surgery ward of Imam Ali Hospital in Zahedan were selected by available and gradual sampling methods and randomly divided into two groups, intervention (40 people) and control (40. ( Data were collected using the modified- Yale preoperative anxiety scale. In the intervention group, the mother's voice was played before surgery. Anxiety was assessed in both groups when entering the operating room and after the sound was played.

The results showed the mean of the anxiety before playing the mother's voice in the intervention group was (57.12±6.59) which received a significant decrease to (52.82±6.90) after the intervention.  The mean of anxiety was significantly different in the two groups, (intervention and control) (P= 0.0001).

This study shows the effect of a mother's voice on reducing anxiety in children undergoing surgery. Therefore, nurses are advised to use the mother's voice to control anxiety in children undergoing surgery.

Premature neonates are a group of high-risk patients who need intensive medical care and hospitalization in the neonatal intensive care unit (NICU) for their survival. In theNICUenvironment, there are highly stressful stimuli that have a negative effect on the physiological parameters of premature neonates. One of the interventions that improve the physiological parameters of neonates is the implementation of the quiet time protocol.

The present study aimed to investigate the effect of the quiet time protocol intervention on the physiological parameters of premature neonates admitted to the NICU.

This quasi-experimental study was performed on 62 premature neonates selected through a convenient sampling method out of the neonates admitted to the NICU. First, the samples of the control group were collected. A demographic data questionnaire was employed. Neonates in the two groups were examined for 60 min during three phases before, during, and after the intervention in the evening shift of 15 - 17 o’clock. Data were analyzed using the SPSS software version 22 by the chi-squared test, repeated measures analysis of variance (ANOVA), and t-test. P-value < 0.05 was considered statistically significant.

The results of repeated measures ANOVA regarding arterial blood oxygen saturation (SaO2) percentage showed that changes over time were significant (P < 0.001). There was also a significant difference between the groups in terms of intervention effect (P = 0.004). In other words, the changes in SaO2 percentage were not the same in the two groups, and the changes in the score of the intervention group were higher than the control group. The results of repeated measures ANOVA showed that the changes in the heart rate and respiratory rate over time were significant (P < 0.001).

The quiet time protocol is effective in reducing environmental stimuli and improving physiological parameters. Therefore, the implementation of these procedures during each 8-hour shift, that includes a specific period which light, sound, and bedside stimulation is controllably reduced, is recommended as a standard of care to reduce stress and improve the growth and development of premature neonates in the NICU.

The family-centered empowerment model seems to be effective in empowering the patient and engaging family members in identifying the patient’s care needs and cooperating with the patient to control diabetes and its complications.

The present study aimed to evaluate the effect of the family-centered empowerment model on family functioning in children with type 1 diabetes.

This quasi-experimental study was conducted on 80 primary caregivers of children with type 1 diabetes admitted to the diabetes clinic of Hazrat Ali Asghar (AS) Hospital in Zahedan, southeast Iran, in 2021. The diabetic children were selected using convenience sampling, and then the participants were equally classified by the random block method and were assigned to 2 groups (intervention and control groups). The data were collected using the family assessment device (FAD) and a demographic information form. Repeated measures analysis of variance (ANOVA) was used to assess the effectiveness of the training intervention by modifying the effect of some quantitative variables. The significance level in this study was set at 0.05 (P = 0.05) using SPSS version 26.

The mean age of the children was 8.95 ± 2.18 years in the intervention group and 9.10 ± 1.97 years in the control group (P = 0.75). The mean family functioning scores were not significantly different between the intervention and control groups before the intervention. However, the 2 groups showed a significant difference in terms of family functioning scores one and a half and 3 months after the intervention (P < 0.001).

Teaching family members about disease control can be very useful because there is a strong connection between the family and the health status of its members. People, especially those with chronic diseases, are dependent on their family members, and even their attitudes are affected by the family.

Computer games have often been considered to have a negative impact on children’s sleep. The aim of this study was to determine the effect of distance teaching for mothers on the sleep habits related to computer games among the primary school boys living in Zahedan, Iran, during 2020. The present quasi-experimental study was carried out on the primary school students. 144 male students were randomly selected in two groups of intervention and control. Data collection tools included the Child Sleep Habits and demographic information Questionnaires. If the student was in the intervention group, before the intervention, the researcher held a face-to-face meeting with his mother to complete the questionnaire. Then, I created a group for mothers in Telegram and WhatsApp. The intervention was conducted in 4 weeks, during which the researcher sent the educational texts and videos to the students’ mothers, three times a week. Eight weeks later, the Sleep Habits Questionnaire was completed by the mothers. If the student was assigned to the control group, the demographic information and Sleep Habits Questionnaires were completed by the mothers, as the pre-test. No intervention was made for this group; and the post-test was completed after 8 weeks by the mothers. Data analysis was performed through IBM SPS. The results revealed that the mean and standard deviation of the sleep habits score and its dimensions were not significantly different in the intervention and control groups (P>0.05) before the intervention. However, after the intervention, the sleep habits score and its dimensions showed significant differences between the two groups (P<0.05). Maintaining the physical and mental health of students is an important responsibility of pediatric nurses and parents. It is suggested that teaching sleep habits to mothers should be considered.

Chemotherapy is associated with various physical and psychological complications such as fatigue and anxiety in children. Although hospital clowning completely affects health care in pediatric patients, it is a little-known distraction approach in children undergoing chemotherapy in Iran.

This study aimed to investigate the effect of hospital clowning on anxiety and fatigue in children with cancer undergoing chemotherapy.

The participants in this clinical trial were 7-15-year-old children (n = 18) with cancer undergoing chemotherapy in a hospital in southeastern Iran, 2019. Participants were selected using convenience sampling and randomly assigned to the intervention (n=40) and control groups (n=40). The intervention group and clown participated in different games for two weeks, 3 sessions per week, and each session lasted 2 to 3 hours in the playroom of the oncology ward. The control group received routine care. A demographic survey, the Revised Children's Manifest Anxiety Scale (RCMAS), and the Visual Analog Fatigue Scale (VAFS) were completed before and immediately after the intervention by interviewing the two groups. Data were analyzed by IBM SPSS v.21 using the Independent t-test, Paired t-test, and Chi-square.

The mean and standard deviation of the age in the intervention and control groups were 9.61±2.84 and 9.65±2.28 years old, respectively. The mean difference between anxiety and fatigue in the two groups was significantly different after hospital clowning (p <0.001). Implications for Practice: The present study indicated that hospital clowning reduced anxiety and fatigue in children with cancer undergoing chemotherapy. Using hospital clowning is recommended in clinical wards due to the negative effects of anxiety and fatigue on the treatment of children with cancer.

Pain is defined as an unpleasant sensory experience associated with actual or potential damage to body tissues. Therapeutic procedures cause fear in children, which in turn leads to physical and mental stress.

This study aimed to investigate and compare the effects of aromatherapy and distraction on the pain caused by venipuncture among hospitalized children.

In this clinical trial study, 90 children hospitalized in the pediatric ward of Ali-Ebne-Abitaleb Hospital in Zahedan in 2018 are examined. The eligible children were selected using the convenience sampling technique and were divided into three groups (n = 30) using stratified permuted block randomization. In the distraction group, a Kolah Ghermezi (Red Hat) puppet was used to play with the children before and during venipuncture. In the aromatherapy group, lavender essence was used 20 minutes before the beginning of venipuncture. No intervention was provided in the control group. The children’s pain intensity was measured using OUCHER standard instrument 10 minutes after the end of venipuncture. Data were analyzed by SPSS version 24 using descriptive statistics, one-way ANOVA, Kruskal-Wallis, and post-hoc tests analyses.

A significant difference was found between the two intervention groups and the control group. Accordingly, both interventions could significantly decrease the pain intensity (P < 0.001). However, there was no significant difference between the two intervention groups concerning the impacts of interventions on the pain intensity.

A significant difference was found between the two intervention groups and the control group. Accordingly, both interventions could significantly decrease the pain intensity (P < 0.001). However, there was no significant difference between the two intervention groups concerning the impacts of interventions on the pain intensity

Background :

Pain and anxiety are the common complications following surgery. The mother's recorded voice can be used to reduce the pain and anxiety. Current research aimed to investigate the effectiveness of the mother's recorded voice on the preoperative anxiety and postoperative pain in children undergoing surgery.

This clinical trial study was performed in two groups in the Ali Ebn Abitalib Hospital in Zahedan, Iran in 2019. Eighty children were selected using convenience sampling method and were randomly assigned into intervention group (n=40), and control group (n=40). In the intervention group, the mother's recorded voice was played through the TSCO TH 5335 wireless headphones for 10 min to the child. Anxiety was assessed by modified mYPAS. The pain was assessed 30 min after surgery by the FLACC and one hour after operation by TPPPS. Data were analyzed using software version 22.0.

The mean anxiety in the intervention group after playing mother's voice (52.82 ± 6.90) was significantly lower than before playing the mother's voice (57.12 ± 6.59), (P <0.001). The mean pain 30 min after surgery in intervention group (2.35 ± 1.09) was significantly lower than that in control group (4.9 ± 0.81), (P <0.001). Also, the mean of pain one hour after surgery in the intervention group (2.72 ± 0.716) was significantly lower than that in the control group (4.42 ± 0.675), (P <0.001).

The results suggest that the mother's recorded voice reduced the anxiety before surgery and pain after surgery in children; therefore, we propose that nurses can use the mother's recorded voice to control the pain and anxiety in children.

Caring for a child with cancer can be deeply frustrating for parents with high levels of anxiety and psychological distress. Parents who suffer from high psychological stress have poorer performance in the family and health-related quality of life in their children is significantly lower. Previous research has demonstrated the effectiveness of peer support in reducing levels of parental psychological distress. This study was aimed to investigate the effect of peer support of mothers of children with acute lymphoblastic leukemia (ALL) on quality of life of patients.

This is a quasi-experimental study which was performed on 74 mothers of children with ALL hospitalized in Hematology ward of Ali ibn Abi Talib Hospital in Zahedan in 2017. Convenience sampling was used to recruit the participants in accordance with the inclusion criteria. The subjects were randomly assigned to the control and intervention groups. Peer group training was then conducted for the intervention group for five days. KID-KINDL questionnaire to parent report was completed before intervention, immediately and two months after intervention for both intervention and control groups. Data were analyzed using descriptive and inferential tests at the significant level P-value<0.05.

  Before intervention, the mean score of total quality of life and its dimensions were not significantly different between the two groups (P>0.05). Analysis of variance with repeated measures indicated that the mean scores of total quality of life and its dimensions in the intervention group were significantly increased over time (P<0.001).

Using peer support program for mothers of children with ALL can improve the quality of life of children. Therefore, it is recommended to use this method alone or in combination with other methods to improve the quality of life of children with ALL.

Fever-related seizures are the most common problems in children between 6 months and 6 years of age. Control of anxiety and proper functioning of mothers are important factors in the management of children's seizure. The purpose of this study was to investigate the effect of training on understanding the uncertainty and anxiety of mothers in children with febrile seizure.

This is a semi-experimental study. 40 mothers who referred to Imam Ali hospital in Zahedan during 1396- 1396 participated in the study using available sampling method. The samples were divided into two groups: intervention (40 samples) and control (40 samples). The intervention group received training on seizure, individually and in person for 3 sessions of 30-45 minutes. Spielberger and Uncertainty Anxiety Scale (PPUS) was completed before, during and one month after the intervention.

The mean anxiety score at the beginning of the study was 56.63 in the control group and 56.68 in the intervention group and 57.85 in the intervention group and 40.89 in the intervention group, respectively. The uncertainty score of the mothers in the intervention group ranged from 87.53 ± 5.33 to 65.30 ± 5.49 after the intervention and the control group decreased from 84.81 ± 7.90 to 85.87 ± 5.41. There was a significant difference between two groups in terms of two variables (P = 0.0001).

Education can be suggested as one of the methods for reducing the anxiety and uncertainty of mothers in patients with febrile seizure. Increasing awareness and reducing anxiety can help improve mothers' performance during seizure.

Spiritual health is considered one of the most important components of health and palliative care that facilitates harmonious and integrated communication among one's inner forces. One of the basic principles of holistic nursing care is to pay attention to the spirituality and spiritual care of patients. Spiritual care is an important source of adaptation in refractory and chronic patients such as cancer.

The aim of this study was to determine the effect of spiritual care on the spiritual health of adolescents with cancer.

This pre-experimental, single-group, pre-post study was performed on 35 adolescents with cancer admitted to Imam Ali Teaching Hospital in Zahedan from May to September 2019. Convenient sampling technique was performed to carry out the study based on inclusion criteria. Data collection tools included demographic information questionnaire and Paloutzian and Ellison Spiritual Health questionnaire. Before and after the spiritual care intervention, the required data were collected by interviewing adolescents and using questionnaires. The data were analyzed using Shapiro-Wilk test and paired t-test.

Adolescents’ overall spiritual health score increased from 52 ± 7.34 before the intervention to 102 ± 6.57 after the intervention and the difference was significant (P = 0.001).

According to the findings of the present study, spiritual care is effective in the spiritual health of adolescents with cancer and can promote adolescent spiritual health. Therefore, it is suggested that nurses incorporate spiritual care into their patient care plans as a simple, accessible, safe and affordable way to promote their spiritual health.

Cancer is a common disease in children. Chemotherapy, as one of the most important treatments for cancer, is associated with feeling of depression that can have negative effects on the treatment process. The aim of this study was to determining the effect of clown therapy on depression in children with cancer under chemotherapy.

This clinical trial study, was carried out on 77 children aged 7-15 years with cancer undergoing chemotherapy in one of the educational hospitals of Zahedan in 2018. The participants were selected using convenience sampling method.  The researcher was dressed as a clown and welcomed the children. The intervention group and clown participated in various games during two weeks (each week 2 sessions and each session for 2 hours) in the oncology department room. The control group received routine care. Data were collected by Child Depression Inventory (CDI) before and immediately after the intervention.

The mean depression score in intervention group after intervention (28.94 ± 15.21) was significantly lower than before intervention (37.92 ± 13.98) (P<0.001), whereas in the control group, this difference was not significant. The mean difference scores of depression after clown therapy between the two groups was significant (P<0.001).

Clown therapy reduces depression in children with cancer under chemotherapy. Considering the negative effects of depression on the treatment of these children, the use of this method in children's clinical units is recommended.

A common procedure for the diagnosis of hyperbilirubinemia is the total investigation of total serum bilirubin (TSB); however, this procedure is invasive for neonates. For two decades, transcutaneous bilirubin (TCB) was used as a non-invasive and painless method to assess bilirubin.

This study aimed to compare the accuracy of TCB versus TSB before and after phototherapy.

This descriptive-analytical study included 85 neonates. Neonates were selected by convenience sampling methods. Neonates had a normal birth weight and physiological jaundice; having no need for blood transfusions. Data were collected using a BiliChek device (APEL, Japan). The researcher, before phototherapy and simultaneously by checking the TSB, pressed the BiliChek three consecutive times in the middle of the neonate’s forehead and then, recorded the results. The correlation between TCB and TSB were determined before and after phototherapy. Pearson, t-test, and ROC were used by SPSS v.18 for analysis data.

There was a strong correlation between the TCB and the TSB in neonates weighing 3001 to 4000g before phototherapy (r = 0.74, P < 0.001). Although, there was a low correlation between the TCB and the TSB in these neonates after phototherapy (r = 0.40, P > 0.05), the cut-off value of bilirubin was 6 - 8 mg/dL. The sensitivity was (100%) and specificity was 90% for bilirubin at the levels of 6.7 mg/dL.

TCB procedure can be a reliable alternative to the TSB, especially in the initiation of phototherapy with bilirubin levels of 6 - 8 mg/dL. However, it is not a device with a high accuracy after phototherapy.

Resilience has become a basic construct in theories and studies of welfare and mental health. The mother is the one most involved emotionally in the child’s cancer and its treatment and hence, she requires the most degree of resilience. Therefore, it is crucial to deploy effective methods to enhance the resilience of mothers. The purpose of this study was to determine the impact of peer education on the resilience of mothers of children with leukemia. This clinical trial was performed on 74 mothers of children with leukemia who had been hospitalized in the hematology ward of Ali ibn Abi Talib Hospital in Zahedan in 2017. Convenience sampling was used to recruit the participants in accordance with the inclusion criteria. The subjects were randomly assigned to the control and experimental groups. Peer group training was then conducted for the experimental group for five days. The Connor-Davidson Resilience Scale (CD-RISC) was completed for both groups before and immediately after the intervention, as well as two months later. The data were then analyzed using the chi-square test (Fisher’s exact test), independent t-test, repeated measures ANOVA, and Bonferroni post hoc test at the significance level of P < 0.05. The results showed that the mean total score of resilience and its subscales did not make a significant difference between the control and experimental groups immediately after the intervention (P > 0.05). Meanwhile, two months post-intervention, a significant difference was observed in this regard between the control and experimental groups, with the latter featuring a higher mean score (P < 0.001). Besides, the results suggested a significant increase in the total score of resilience and all its subscales over time in the experimental group (P < 0.001). Peer education could be implemented as an inexpensive easy method to improve the resilience of mothers of children with leukemia.

One of the non-pharmacological methods for relieving pain in children is to deploy cognitive-behavioral interventions such as distraction therapy. The aim of the present study was to examine the impact of distraction on physiological indices and the severity of pain caused by intra-spinal injection of chemotherapy drugs in children with cancer. This was a clinical trial with a pretest-posttest design. The subjects included 89 cancerous children aged 6 - 12 years who had been admitted to the Hematology Ward of Ali Ibn Abitalib Hospital, Zahedan, Iran. The patients were divided into the intervention (n = 45) and control (n = 44) groups. In order to distract the children, they were asked to choose one out of three animated series based on their interest. They received the injection while watching the cartoon. Then, the severity of pain caused by intra-spinal injection of the chemotherapy medication, heart rate, and arterial oxygen saturation (SaO2) were evaluated. Arterial oxygen saturation of the intervention group increased from 95.42 ± 4.53 before distraction to 98.04 ± 2.20 after distraction (P < 0.001). The mean heart rate in the intervention group decreased from 108.64 ± 13.36 before distraction to 104.00 ± 12.25 after distraction, suggesting a significant difference between the two groups (P = 0.04). The mean changes in the heart rate were significantly different between the two groups (P < 0.001). Moreover, the mean pain intensity after distraction was significantly lower in the intervention group (35.11 ± 14.71) than in the control group (42.5 ± 16.44) (P = 0.02). Based on the results, distraction therapy can be effective in mitigating the severity of pain caused by intra-spinal injection and improving hemodynamic indices (heart rate and SaO2).

BackgroundThe literature reviews show that taking care of dying newborns for a nurse is associated with stress and anxiety, and nurses will be faced with many challenges, the present study aimed to explain the spiritual challenges experienced by nurses in neonatal end of life in the NICU.
Materials and MethodsThe present study was conducted with a qualitative method ­and "purposive" sampling. The study environment was­ NICU in the hospitals of Zahedan, Iran. Semi-structured interviews­ used for interview and data collection. A number of 24 participants with inclusion criteria were interviewed. Qualitative content analysis method was used with the conventional approach and inductive method with Graneheim and Lundman approach.
ResultsData analysis explored were categorized in three main themes: spiritual challenge of neonatal care with two-categories (palliative care, and care with love and affection); psychological / spiritual support challenges of family with two categories (spiritual support of family, psychological support of family), and nurse's spiritual distress with one category (nurse's trauma in neonatal care).
ConclusionIn this study three themes were obtained: 1- Spiritual challenge of neonatal care with two-categories (palliative care, and care with love and affection); 2- Psychological / spiritual support challenges of family with two categories (spiritual support of family, psychological support of family), and 3- The nurse's spiritual distress with one category (nurse's trauma in neonatal care).

Contextual factors impact health the same way social and cultural conditions do. Women’s health, with its varying dimensions, is also under the influence of biological, societal, and cultural contexts. This typical condition has been developed along the continuum of their life cycle, bearing close correlation with their lif style. Therefore, identifying those marices within which women’s health behaviors are formed is important.This study aims at exploring the contextual factors affecting women’s health in Sistan and Baluchestan in Iran.
This study was carried out using a qualitative method, on a content analysis approach. Participants were 20 middle-aged women from Zahedan who entered the study with purposive sampling method. The method of collecting data was face-to- face and through conducting semi-structured interviews. After data collection, all interviews were transcribed, andreviewed, from which categories were extracted. The semantic similarities were revised and subcategories were identified, and then the related subcategories were arranged under one category.
Two main categories of “features of context-based structure” and “changes in the cultural context” prove to be the basis for health behaviors in women. As for the category of “characteristics of context-based structure”, individual, familial and environmental characteristics were identified, and regarding the category of “changes in the cultural context”, the context-based cultural features were identified.
The findings of the study suggest that effective contextual factors influencing women’s living conditions had a decisive role in their health behaviors. In fact, the context- based structure in association with the cultural changes that have occurred in the beliefs of men and women, have had a decisive role in the women’s health behaviors.

Rickets is a disorder due to impaired metabolism of bone mineralization which caused by low concentrations of extra-cellular calcium or phosphate. In children, hypophosphatemic rickets (HR) happen malabsorption of phosphate and increasing of renal tubular loss.
We present the case of a 4-year-old girl who had medical history of HR with failure to thrive (FTT). Child hospitalized several times due to osteomalacia and leg fractures. In physical examinations, there were obvious signs of rickets such as bow legs and hands, deviations of the wrist and chest pigeon. The results of blood tests showed low level of Phosphorus; but the level of calcium was normal. Radiography showed deformity of wrists and hands.
HR should be considered as one of the childhood disorders which impairs metabolism of bone mineralization and cause osteomalacia and bones fractures. If HR undiagnosed and remedies poor during childhood, in older ages would reveal automatic fractures and mineralization defects.

Background and Middle age is a developmental stage. Women in this stage are capable of preserving and promoting their health. Nonetheless, there seems to be several issues affecting their health-oriented behaviors. Identifying such behaviors from the perspective of middle-aged women are of great importance in protecting and promoting their health. This study aimed at defining health seeking behaviors in middle-aged women.
The study was conducted by qualitative approach and conventional content analysis was adopted. The participants included 20 middle-aged women who were recruited by purposive sampling. Semi-structured face to face interviews were conducted to collect the data. Then verbatim transcription of interview data was done and categories were extracted. First, semantic similarities were identified and sub-categories were specified, then in reconsideration related sub-categories were placed in a same category.
Four categories were identified including the status of health knowledge, understanding of health and diseases, controlling the health-oriented behaviors and "using self-soothing behaviors". Eight sub-categories were also determined: awareness of health risks, preventive/permissive behaviors, understanding of health, understanding of disease, health promoting behaviors, interactive behaviors, soothing and spiritual calming behaviors as health-seeking behaviors.
The findings expressed behaviors that women showed in their quest for health. In fact, this quest for health is manifested in strategies that women adapted to maintain and promote their physical and mental health. In such a quest women constantly rely on their own knowledge of health, perception of health and diseases and tranquilizing and relaxing methods.

Customer satisfaction is a factor in the efficacy of a hospital. To attain this goal, patients rights should be observed. Thus, all medical staff, especially physicians and nurses, should be aware of charter of patient rights and ought to observe it. This study was a descriptive analytical of cross-sectional one. Subjects of the study were 132 nurses and 55 hospital physicians. Instrument of data collection comprised two parts; the first part includes demographic information (age, sex, marital status, work experience, ward work, hospital work) and the second part was related to the awareness of evaluated 21 different legal situations in nurses and physicians about the charter of the patient rights. The results revealed that mean score of physician awareness of the charter of patient rights was 15.12, which determines the level of the physician awareness was good. The mean score of nurses awareness of the charter of the patient rights was 13.45, which determines their level of awareness was moderate. Generally, the level of awareness of the charter of the patient rights in physicians was more than nurses’. According to the findings, health service providers, specifically the medical staff, should be aware of tenor of the charter of patient rights and it is essential for hospital managers to run policies that make a ground for observing this charter.

Nurses are vulnerable to various sleep disorders because of the nature of their job. If nurses do not experience a good general health, they will not be able to do their job (patient care) well. We conducted a descriptive-comparative study in 180 nurses that were selected with the stratified sampling method who have been working in different work shift hours in teaching hospitals. We used PSQI and GHQ-28 questionnaire for collecting data. The study results showed a statistically significant difference in sleep quality and general health of nurses based on two questionnaires (p=0.01; p=0.05) respectively. According to our findings we suggest fixed working shifts versus rotating one for nurses to reduce the side effects.

Ecstasy abuse is one of the risky behaviors. According to World Health Organization, there is a relationship between knowledge and attitude and drug abuse. The purpose of this study was to determine adolescents’ knowledge, attitude and performance about ecstasy in west of Zahedan in 2008. It was a cross-sectional study. Eight hundred 18 years old adolescents residing in west of Zahedan participated in this study. Adolescents’ knowledge, attitude and performance were also determined by a questionnaire structured by the researcher. The questionnaires were filled out by participants after obtaining an informed consent and data was analyzed with some statistical software like SPSS and descriptive statistics methods, statistic tests, analysis and variance. The level of knowledge of most of adolescents about Ecstasy was fair (60.2 %) and most of them (77.4 %) had a neuter attitude toward using ecstasy. Findings regarding adolescents’ performance indicated that 100% of students have not experienced ecstasy through their life. On the basis of these findings, although the level of knowledge of most adolescents towards ecstasy was good and reasonable, lost of awareness was one of the most important reasons related to ecstasy abuse from the points of view of most of them. Therefore, it is recommended that informal educations should be performed in different advertising programs such as short messages, posters and video clips.