m.r. soroush
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Aims
Patient experience, along with clinical performance and safety, is known as a critical criterion for improving healthcare performance. This study aimed to assess the validity of the Persian version of the Picker Patient Experience Questionnaire.
Instrument &MethodsThis descriptive cross-sectional study was condcted in Nikan Gharb and Nikan Aqdasiyeh hospitals in Tehran from April to May 2022. The Persian version of the Picker Patient Experience Questionnaire was prepared based on the translation-retranslation method. The face and content validity of the questionnaire was evaluated with the opinions of 10 experts. To check the tool validity, all patients discharged from the two hospitals were interviewed by phone from April 21 to May 21, 2022. The main dimensions and constructs of the questionnaire were determined by the exploratory factor analysis method. The questionnaire reliability was evaluated using the test-retest method by participation of 30 subjects.
FindingsBy checking the validity of the questionnaire, the items were included in 7 aspects which were in accordance with the main sections of the questionnaire (information and education, coordination of care, emotional support, respect for patient preferences, physical comfort, involvement of family and friends, and continuity and transition). The tool reliability for the 7 aspects by Cronbach's alpha was in the range of 0.744 to 0.911, and for the whole questionnaire was 0.804.
ConclusionThe Persian version of Picker Patient Experience Questionnaire has the necessary validity to evaluate the experience of hospitalized patients in Iranian hospitals.
Keywords: Patient Satisfaction, Healthcare Systems, Validation Study, Questionnaire -
نشریه طب جانباز، پیاپی 47 (بهار 1399)، صص 109 -114اهداف
عوارض ریوی پوستی و چشمی ناشی از مواجهه با خردل گوگردی در جانبازان شیمیایی در مطالعات متعددی مورد بررسی قرار گرفته است. این مطالعه به ارزیابی مشکلات سلامت جانبازان شیمیایی مبتلا به عوارض شدید ریوی می پردازد.
ابزار و روش ها:
در این مطالعه مقطعی، 292 جانباز شیمیایی با عوارض شدید ریوی ناشی از مواجهه با خردل گوگردی در کل کشور توسط دو پزشک در سال 1395 معاینه شدند. سابقه بیماری ها و مشکلات سلامت در جانباز ثبت و معاینه بالینی انجام شد. داده ها با استفاده از نرم افزار SPSS 16 و آزمون آزمون کای دو و ضریب همبستگی لامبدا مورد تجزیه و تحلیل قرار گرفتند.
یافته ها:
بیشترین مشکلات جانبازان شیمیایی با عوارض شدید ریوی به ترتیب مربوط به مشکلات عضلانی-اسکلتی 92.1% (کمردرد 68.8%)، مغز و اعصاب 88.4% (سردرد 78./1%)، شنوایی 81.8% (کاهش شنوایی 62%)، دستگاه گوارش 78.1% (ریفلاکس 74.3%)، کلیه و مجاری ادراری 65.1%، قلبی-عروقی 52.4%، اختلالات سیستم ایمنی 43.4% و ناباروری10.6% بود. میانگین فشارخون سیستولیک و دیاستولیک جانبازان به ترتیب برابر 14.7±121.1 و 8.8±79.7میلیمتر جیوه بود. اکثرا تحت درمان کورتیکواسترویید تنفسی 72.2% و خوراکی 45% بودند. ارتباط معنی داری بین جنس، سن، دفعات مواجهه با خردل گوگردی با شیوع شکایت های جسمی و بیماری های اسکلتی-عضلانی، سیستم عصبی، دستگاه گوارش، سیستم قلبی- عروقی و شنوایی مشاهده نشد (0.05<p).
نتیجه گیری:
جانبازان شیمیایی شدید ریوی از مشکلات متعدد عضلانی-اسکلتی، نورولوژی و گوارشی رنج ها برده و مصرف طولانی مدت داروهای کورتیکواسترویید در آنان زیاد است. ناباروری بر خلاف مطالعات قبلی شیوع کمی داشت. این نتایج به سیاست گذاری در راستای ارتقاء سلامت کمک می کند.
کلید واژگان: خردل گوگردی، شیمیایی، آسیب ریوی، سلامت، بیماریAimsThe complications of sulfur mustard (SM) in lungs, eyes, and skin of exposed survivors have already been studied. This study evaluates health problems of other than the usual affected organs in survivors with severe respiratory injuries.
Instrument & MethodsIn this descriptive cross-sectional study, 292 chemical warfare veterans with severe pulmonary complications due to exposure to sulfur mustard were examined by two physicians in 2016. Health problems in the veterans were recorded and a clinical examination was performed. Data using SPSS software version 2016 and Chi-square test and Lambda correlation coefficient were analyzed.
FindingsThe most common problems of chemical warfare victims with severe pulmonary complications were related to musculoskeletal problems 92.1% (low back pain 68.8%), neurological system 88.4%(headache 78.1%), auditory system 81.8%(Hearing loss 62%), gastrointestinal tract 78.1% (reflux 74.3%), kidney and urinary tract (65.1%), cardiovascular (52.4%), immune system disorders (43.4%) and infertility 10.6%. The mean systolic and diastolic blood pressure of the veterans were 121.1±14.7 and 79.7±8.8mmHg, respectively. Most of them were under treatment of respiratory corticosteroids (72.2%) and oral corticosteroids (45%). There were no significant relationships between gender, age, frequency of exposure to sulfur mustard, and the prevalence of physical complaints and musculoskeletal diseases, nervous system, gastrointestinal tract, cardiovascular system, and hearing loss (p>0.05).
ConclusionThe most important health problems were musculoskeletal, neurological, hearing loss, and gastrointestinal problems. Moreover, the rate of using corticosteroids was very high while the rate of Infertility was less prevalent than previous studies. These results will help investment policies aiming at considering future health promotion planning.
Keywords: Sulfur Mustard, Chemical, Pulmonary Injury, Health -
BackgroundAlthough in the last few years there has been increasing awareness of the problem of landmines, there are still an increasing number of people especially children, illed and injured by landmine every week in the world including Iran which is estimated to have the second rank for landmine injuries. Eighteen years after cessation of Iraq-Iran war, the provinces located near the west border of Iran still suffer from the burden of vast areas highly infested with Landmines. This study aims to gather more information on the particulars of mine associated incidents and victims.MethodsThis is a retrospective study of people with documented deaths or injuries due to landmine and/or unexploded ordnances (UXO) explosions, as documented in their medical files between Jul 1988 (after ceasefire) and Feb 2003.Results3713 patients from 3 main organizations in charge of providing health care services for them were included in this study. Of these, 3461 (93.2) were male, and 252 (6.8%) were female. Most of the victims were civilians and the majority of them (40.4%) had one or more amputations. Most of the patients were injured in the period between1994 and 1998. The majority of them were young, and 41.8% were children.ConclusionThe occurrence of death and injuries due to landmine in Iran is regrettably high; this places a significant burden on the health care system, rendering increased commitment of the government a must. Collecting data on accident particulars and landmine victims can provide meaningful information on the risk factors.
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BackgroundAlthough in the last few years there has been an increasing attention to the problem of landmines, to date, the implications of women being victims of landmine has not been duly dealt with in the world including Iran, which is estimated to be the second most landmine infested country in the world. Still, provinces by the west border of Iran, 18 years after cessation of Iraq-Iran war suffer from the burden of vast areas, highly infested with landmines. This study aimed to provide a gender focused insight into landmine accidents in Iran.MethodsIn this retrospective study, women with documented deaths or injuries due to landmine and/or unexploded ordnances (UXO) explosions as documented in their medical records between Jul 1988 (after ceasefire) and Feb 2003 were studied in 5 western provinces of Iran. Data was analyzed by SPSS for Windows Version 11.P value under 0.05 was considered statistically significant.ResultsDuring the 14-year study period, 252 women from 5 western provinces of Iran were reported to have injuries or death due to landmine and UXOs. All of the victims were civilians and the majority of them (47.6%) had one or more amputations. Most of them were injured in the period between1994 and 1998. The majority of the patients were young.ConclusionWomen who should take care of themselves as well as their families are more prone to sufferings inflicted by landmines and UXO.
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Dear Editor, Sulfur mustard (mustard gas) is the most important vesicant agent, and among all chemical warfare agents it has caused the greatest number of casualties of particularly, during the Iran–Iraq War (1980- 1988).1 The designation of chemical weapons as "weapons of mass destruction" emphasizes their potential catastrophic effect on the health of a large number of population.2 According to Iraq''s declarations, some 105,000 munitions filled with chemical warfare agents were supplied to their armed forces during the Iran-Iraq war from 1981 to 1988.3 Iraq also declared that about 1,800 tons of mustard gas were consumed during these years.4 There are numerous studies regarding late pulmonary, ophthalmic, dermatologic, immunologic, hematologic or carcinogenic complications of mustard exposure following the Iran-Iraq war,5-10 but the role of mustard exposure in the survivors'' fertility is still unclear. Recently, we came across an article in your journal entitled "Long-term effect of exposure to mustard gas on male infertility," which reported a 44% infertility rate among subjects who were "highly suspicious of being exposed to mustard gas during the Iran-Iraq war".11 The study''s findings contrast markedly with the findings of the studies of mustardexposed survivors at the Janbazan Medical and Engineering Research Center (JMERC). In order to better understand this subject, the following notes should be considered: The authors neither specified how they drew their sample nor when the study took place. 1. It is difficult to draw conclusions about a causal relationship between mustard exposure and male infertility when the exposure is "highly suspected" rather than confirmed and when no data are presented on the level of exposure. 2. Although previous reports have demonstrated the ability of sulfur mustard to cause adverse reproductive effects,12,13 few correlations have been established between mustard exposure and human infertility. In 2004, a study on sulfur mustard exposed survivors of Sardasht reported that the infertility rate was 8.3% among the exposed victims with confirmed exposure, which compares with a worldwide rate of 10-15%.14 Numerous clinical studies in the JMERC on mustard gas exposed survivors did not support the theory of reproductive toxicity of sulfur mustard. 2. In our recent work, a collective examination program as a part of the national health monitoring project run by the Iranian Veterans'' and War Victims'' Organization,1 and JMERC, 419 victims with documented exposure to sulfur mustard now suffering from severe respiratory or ophthalmic complications were investigated for cumulative or lifetime infertility. Of these, 402 were married of whom 10 survivors (2.5%) were reported to have fertility problems. Of these 10 cases with fertility problems, 8 needed to use IVF or other assisted reproductive therapies and 4 were childless. Other than the four who had no child, the subjects who were married had 1 to 13 offspring (mean: 3.5±1.8). We have found that, in contrast with previously reported laboratory studies11,12 in the long term (21.2±1.6 years after their exposure), there is no evidence of clinical life-time infertility among survivors with high dose mustard exposure. Because unverified reports of infertility after exposure to sulfur mustard could possibly lead to unfortunate consequences among chemical warfare victims, we would be grateful for your kindness in considering this letter as an opening to discussion on this subject. Conflict of interest: None declared.
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