مجله دانشگاه علوم پزشکی رفسنجان
سال چهاردهم شماره 12 (پیاپی 83، اسفند 1394)

The world Health Organization’s publications show the important role of supportive supervision to improve the effectiveness of health service delivery. There is no specific tool to assess the supervision status generally and supportive supervision specifically in primary health care system in Iran. This study aimed to develop and do the psychometric of a tool to assess supportive supervision status from the perspective of health workers and supervisors. the plesent study is a cross- sectional study After reviewing scientific international documents about supportive supervision, and regarding Iran’s health system context, a question bank was made including 41 questions for health workers tool, and 33 questions for supervisors. Face and content validity were determined for these tools. For face validity, the questionnaires were evaluated by 10 experts considering difficulty level, appropriateness and ambiguity of questions. Both quality and quantity methods were used to evaluate content validity of tools. The quantity method was conducted by Content Validity Ratio and Content Validity Index. Cornbrash’s Alpha coefficients and test-retest methods using Pearson’s Correlation Coefficient were used to assess the reliability of the questionnaires. After completing validity and reliability tests, the health workers and supervisors tools had 30 and 32 questions, respectively. Cornbrash’s Alpha coefficients for these two questionnaires were 0.89 and 0.94. Pearson’s test was conducted to assess the correlation between test and retest. Pearson’s Correlation coefficient for health workers’ questionnaire was 0.78, and it was 0.95 for health supervisors (p=0.001). According to the appropriate level of validity and reliability of these tools, we can use them to assess the various aspects of supportive supervision in primary health systems.

Assessing quality dimensions in health care sector according to the sensitivity of the services is very important. This study was conducted to assess the quality of services in outpatient wards in Shiraz. This was a discriptive study conducted in summer 2014 on 200 patients referring to Shahid Motahari Health Center. The standard questionnaire of SERVQUAL was used for assessing 6 dimensions of the services quality (Physical factors, Creditability, Responsiveness, Assuredness, Empathy and Access) were used. Data was analyzed using independent t-test, paired t-test and one-way ANOVA. There were significant differences between patients’ perceptions and expectations in all six dimensions of quality (p<0.05). There were negative gaps in all the quality aspects so that means expectations were beyond perceptions. The mean of general quality gap was -0.63 and the highest mean was related to responsiveness (-0.85) and the lowest was for physical aspect (-0.45). There were significant associations between marital status and empathy (p= 0.031) and also between education level and physical aspect (p=0.011), assuredness (p=0.012), responsiveness (p= 0.032) and empathy (p= 0.020). Patients referring to this center did not consider the present quality of services in an acceptable level. It is necessary to plan effectively in order to decrease quality gap and improve it by related managers to achieve patients’ expectations.

Vaginal childbirth with least intervention and reliance on empowerment and participation of mothers can improve physical and mental outcomes of childbirth. This study aimed to compare personal control and its related factors, pain and labor outcomes in physiological and routine childbirth groups. This descriptive comparative study was conducted on 340 mothers who were divided into two groups of physiologic and routine method of delivery in Ayatollah Mosavai hospital، Zanjan، Iran. Convenience sampling was used for routine method of delivery group and census was done for physiologic group. Data were collected using a questionnaire included 5 section which was completed using interview method, 24 hours after childbirth. Data were analyzed using chi-square، independent t-test and Pearson correlation test. There was no significant difference in pain severity between the two groups (p=0/086). Physiological group had significantly higher levels of personal control (p=0. 005). In physiological group, personal control was significantly related to severity of pain, childbirth and environment satisfaction, maternal parity, previous knowledge of childbirth and perception of severity of pain (p<0/05). In routine group personal control was related to pain severity, childbirth satisfaction, maternal age and education and wanted pregnancy (p<0/05). Duration of first stage of labor was significantly shorter in physiologic group (p<0/0001). There was no significant difference in apgar score, perineal tears, and need to resuscitation between two groups (p>0/05). Physiologic delivery can reduce the length of labor and improve maternal personal control with out any unnecessary complications and interventions.

Most of women experience severe and intolerable labor pain. Today, due to side effects of pharmacological analgesics on mothers and neonates, attention to non-pharmacological and complementary medicine methods such as aromatherapy has increased. This study aimed to investigate the effect of aromatherapy with rose water on labor pain in nulliparous women. This clinical trial was performed on 80 nulliparous women who referred to Ahvaz Amir-Al-Momenin Hospital, Iran, during 2014. Women were randomly assigned into intervention and control groups equally. In the intervention group, inhalation with rose water was done during active phase of labor, while in control group women just received routine cares. Pain severity in both groups was measured once before the intervention and three times after intervention in dilation of 4-6 cm, 6-8 cm and 8-10 cm by visual analogue scale. Data was analyzed by chi-square, Fisher’s exact test, and independent t-test. There was no statistically significant difference between the studied groups regarding to pain severity before the intervention (p= 0.223). After intervention, in dilation of 4-6 cm (p= 0.312) and 6-8 cm (p= 0.300), no significant difference was observed between the groups; while in dilation of 8-10 cm this difference was significant (p= 0.023). Based on the results, it seems that aromatherapy with rose water can decrease labor pain; however, other studies are recommended to confirm our results.

Candidiasis Vaginitis is one of the most common reasons for infectious vaginitis. This study was carried out to determine the prevalence of Candida Albicans infection in women who visited the health centers of Kerman and determine their antifungal drug susceptibility. This was a cross sectional study carried out in 2013 on 703 women. Samples were transferred to dextrose agar and chrome candida agar media. Candida species-specific diagnosis was done based on the medium and germ tube. The four Clotrimazole, Nystatin, Miconazole and Aconazole drugs were used for antifungal drug susceptibility. In the univariate analysis, chi- square and Fisher’s exact test were used for qualitative variables and independent t-test and Mann – Whitney U for quantitative ones. Logistic regression was used to assess the adjusted effect of the variables. The mean age was 33.83 ± 6.14 years and the prevalence of Candida Albicans was 31.29% ± 0.05. Logistic regression revealed a significant association between the patient’s education (p<0.001), husband’s education (p=0.035), husband’s occupation (p=0.012), natural birth control and not using condoms (p<0.001), diabetes (p<0.005), existance of clinical symptoms(p=0.025), and candidiasis. Most infections were caused by the Candida Albicans fungus. Most patients were susceptible to Clotrimazole and Nystatin. The prevalence of candidiasis is higher in certain groups of women. Knowing these risk factors, Candida species and the effective antifungal drug helps in better diagnosis and treatment of women with candidiasis especially in remote settings.

One of the essential elements of improving the quality of education system is continuous assessment of educational process. The basic science courses are necessary for academic achievement, solving problems and clinical decision making in subsequent periods. Therefore, the purpose of this study was to investigate the factors influencing the results of the comprehensive examination of basic sciences from the perspective of medical students of Rafsanjan University of Medical sciences (RUMS). This is a discriptive cross-sectional study in which all of the medical student in years 2005-2009 were recruited by census method (185 students). The data was collected via a questionnaire and a checklist, and then descriptive statistics and analysis of covariance were (ANCOVA) utilized for data analysis. Response rate in this study was 64.9%. The results indicated a negative association between the age and the score of the comprehensive examination of basic sciences (p<0.013). There was a statistically significant association between the score of the comprehensive examination of basic sciences and the importance of teaching of embryology and immunology courses from the students’ viewpoints, the significance of nutrition, and embryology courses, the extent to which students were interested in embryology, the size of syllabus of the histology course, and the quality of teaching in mycology, entomology, and health courses (p<0.05). Due to the important role of basic science courses, in the development of competence of future doctors, and in order to develop and change medical education, establishing corrective steps are required in medical education.

Obesity with the growing trend in children and adolescents is a global health problem and food habits have an important role in obesity of children and adolescents. The aim of the present study was to determine the prevalence of obesity and its relationship with food habits among 10-14 years old school boys in Birjand. This cross-sectional study was conducted in 2014 on 270 boys of the fourth, fifth and sixth grades of primary schools of Birjand who were selected through cluster random sampling. Data collection was carried out using Food Frequency Questionnaire with questions about food habits and demographic variables, through interviews and measurements of height and weight. Data was analyzed using chi-square test, t test and one- way ANOVA and Pearson's correlation coefficient. Ten percant of the students suffered from overweight and 5.6% were obese. The findings showed that there was a significant and positive correlation between Body Mass Index (BMI) and the number of daily intake of bread and cereals (r=0.17, p=0.006), milk (r=0.21, p=0.001) and meat substitutes (r=0.24, p<0.001) and there was a significant relationship between BMI and age of students (r=0.13, p=0.037), mother's educational level (p=0.038) and father's job (p=0.018). Given the considerable prevalence of overweight and obesity in students, planing and implying appropriate interventions in order to modify food habits and prevent of growing trend of overweight and obesity, seems necessary.

Intraperitoneal primary hydatid cyst is a rare disease, and even in countries where the disease is endemic, only 2% of intra-abdominal cases are included. In this paper, a case of pelvic hydatid cyst in a young woman with abdominal pain, low blood pressure and a history of infertility is presented. The case was a 21 -year old woman with an abdominal pain that started a few days ago, the pain was generalized in the right and left lower quadrant. Patient in physical examination had low blood pressure and was pale. Laboratory tests especially hydatid serologic test were normal, in imaging reported 2 cysts were reported and the liquid was in the pelvic floor. According to the patient's condition, it was decided to perform laparotomy. Samples were sent to a laboratory for pathological examination, and hydatid cyst was confirmed. In the areas where hydatid cyst is endemic, the diagnosis of hydatid cyst should be considered as a differential diagnosis in a patient with lower abdominal pain and history of endemic regions.