نشریه پرستاری و مامایی ارومیه
سال چهاردهم شماره 11 (پیاپی 88، بهمن 1395)

Performance and efficiency assessment are two significant factors affecting the efficient evaluation of health system reform plan, and can help executive agents in better recognition of its strengths and weaknesses, and try to improve it. This study was conducted to compare the efficiency of hospitals affiliated with Urmia University of Medical Sciences, before and after the implementation of the reform plan.
This was an analytical-description study conducted in 23 hospitals of Urmia Medical Science University in the years 2013-14. To collect data, a checklist with input variables of the number of nurses, doctors, active beds, and other personnel and output variables of the number of discharges, surgeries and bed occupancy percentage for estimating technical, scale and managerial efficiency indexes of the hospitals to each year by Windeap2.1 software, was used.
Reform plan has affected technical, managerial and scale efficiency, and the average of them reached respectively from 0.772±0.225, 0.877±0.193 and 0.878±0.144 in 2013 to 0.886±0.141, 0.941±0.116 and 0.941±0.090 in 2014. Therefore, it reflects improvement in performance due to health system reform plan. Before implementation of reform plan 21.74% of hospitals have acted as inefficient, while after the implementation, this amount has decreased to 8.70%. Meanwhile, after the implementation of health reform plan, the performance of some hospitals was reduced considerably.
According to allocation of high percentage of budget from Health Ministry to health system reform plan, monitoring and periodic evaluation of performance are necessary factors in increasing the efficiency. After implementation of reform plan and decrease in the medical cost, hospitals were faced with increasing referral of patients and bed occupancy. Lack of supply of required facilities and human resource proportional in increasing of referral load to provide cares were most common causes of reduced performance in inefficient hospitals.

Poor sleep quality and loneliness in the elderly are associated with many physical and mental disorders, lead to increased demand of healthcare services. The living environment also affects these issues. Accordingly, this study aimed to determine the association between loneliness and sleep quality in older adults with a focus on their living environment in Tabriz.
This descriptive-correlational study was conducted on 400 older adults residing in families or nursing homes in Tabriz, Iran. The participants were selected using a multi-stage random sampling method. The Pittsburgh Sleep Quality Index (PSQI) and loneliness scale were used in collecting data. Descriptive and inferential statistics were applied to the data as well.
The loneliness score in older adults living in families is significantly lower than nursing homes residents, and the level of sleep quality in older adults living in families is significantly higher that elderly residents in nursing homes in Tabriz as well (p According to the Iranian sociocultural context, it is necessary to educate the families to reconsider their decision about transferring the elderly to nursing homes. In addition, it is recommended that schedule programs are carefully considered to enhance the quality of environment and welfare facilities of nursing homes, and resemble the nursing home settings to the family environment as much as possible, Also, It is necessary to encourage relatives and significant others to have regular communication with their older adults in nursing homes.

Postpartum depression is a public health problem with unknown etiology. In multiple studies, several factors have been reported asthe risk factors in postpartum depression. The present study aimed to determine the predisposing postpartum depression in women referred to health centers in Urmia.
175 postpartum women who were eligible for the study participated in this cross-sectional.research. After the sampling at selected health centers of urmia University of Medical Sciences, participants completed a questionnaire containing demographic and Beck Depression Inventory.Then Spss 17 was used to analyze the data.
The findings showed that the mean±SD age of the patients was 27.78 ±6.11 years. 50.9% of the baby's gender was male, 52% were caesarean delivery, and 63.2% of were wanted pregnancies. 18.2% mild depression, 16.6% moderate depression, 12.6% had severe depression. There was statistically significant difference between depression and economic status, type of delivery, unwanted pregnancy,a history of depression, and problems related to spouse’s family(p The present studywas the high prevalence of postpartum depression and as a critical alarm in threatening the health of mothers.Since many predisposing factors for this disorder is preventable with appropriate interventions it is recommended that the early detection of risk factors of depression after giving immediate consequence should be prevented.

Fatigue is one of the most common signs in Multiple Sclerosis that can cause undesirable consequences. This research aims to investigate the effects of reflexology massage on patients fatigue severity in women with Multiple Sclerosis.
This study is an Experimental study was performed on 52 patients with multiple sclerosis. Data collection instruments included a demographic questionnaire, and fatigue severity scale for Fatigue.
Participants were randomly assigned into two groups of experimental and control by minimization method. In the experimental group, reflexology was performed within Four weeks, three weeks for 30 minutes while the control group received medical treatment as directed by a physician. Data were collected through fatigue severity scale before, and one month after intervention in both groups. Data analysis was performed by Spss version 22 using descriptive and inferential statistic.
Mean score of fatigue in the experimental group before intervention was 49/2 ± 4/3 and after intervention was 29/8 ± 4/41. Results showed that there was a statistically significant difference between fatigue scores in the experimental group before and after the intervention (p Reflexology massage has an effect on Multiple Sclerosis of women’s fatigue. Therefore, the amount of fatigue after the massage has been less than the fatigue before it. As a result, this intervention as an action can reduce fatigue with the aim of peace and health promotion in Multiple Sclerosis women.

Psychological health has an important role in efficacy of the communities. The psychological health status of girls at their adolescence is an effective factor on their behavioral manifestations. Regarding the families willing for having a single-child, the current study conducted to assess the relationship between single-child being and multi-child being on general health and happiness score of high school girls in Qom.
A cross sectional study conducted on 341 girl students in 2016. The general health (GHQ-28) and happiness questionnaires were used for data collection. Analysis of Variance and Pearson correlation coefficient tests were used for data analyses.
According to the general health score, 51% of the students were affected by psychological disorders, and 53.3% of them were affected by abnormal happiness. The mean score of happiness in high school girls was 39.6±16.4 and the mean of general health was 27.5±15.5. The mean score of happiness in single-child, two-child, and multi-child families were 40±15.9, 36.1±15.6, and 40.3±17.6, respectively, which were statistically significant. On the other hand, the mean of general health in single-child, two-child, and multi-child families were 26.5±14.3, 29.6±16.1 and 25.9±14.1, respectively that was not statistically significant (p According to our results, the general health and happiness in single child girls were lower than two-child and multi-child. In addition, among four subscale of general health, the prevalence of anxiety was higher than other subscales in single children. Regarding the results of the present study, much more attention should be paid to the psychological status of high school girls as the future mothers of our community.

Paying attention to the mental health of adolescents especially girls, has got a specific importance, and apparently happiness is one of the most important factors to mental health promotion. The aim of this study was to determine the relationship between happiness and mental health status among high school female students in Kermanshah.
In this descriptive - analytic study, 629 senior female students were recruited by simple random sampling method from 3 sections of Kermanshah city in 2015. The tools for gathering data were: a) General Health Questionnaire (GHQ28), and b) Oxford Happiness Questionnaire. The results were analyzed by SPSS 22 by doing Pearson correlation and linear regression statistical tests.
The mean score of happiness in students was 39.60, and the mean score of mental health was 34.15. There was a reverse but significant relationship between happiness and mental health scores (r=-0.678). Also happiness and all its components have significantly correlated with subscales of GHQ28 scores (p Happiness and its components were associated with mental health status in female students, so increasing happiness could be useful to improve mental health status in the community.

Adherences to treatment recommendations has got a key role in the treatment of hemodialysis patients. Poor adherence will result in more severe clinical consequences in the mentioned patients. The aim of this study was to investigate the relationship between perceived social support, adherence to treatment and clinical outcomes in hemodialysis patients.
In this study, 255 hemodialysis patients who referred to the hemodialysis centers in 4 cities of West Azerbaijan province were selected by purposive sampling. The data collected through a questionnaire consisting of three parts: demographic and clinical variables, adherence in hemodialysis patients and social support questionnaire. Clinical outcomes (calcium, phosphorus, urea, creatinine, Intradialytic weight gain, etc.) of the patient were recorded. To analyze the data, descriptive and correlation statistics were used.
The results showed that there is a significant relationship between perceived social support and adherence to diet restrictions, adherence to fluid restriction and adherence to medical prescriptions (p Hemodialysis patients are in a situation which affects their relationships with other people. Thus, nurses and other health care staff should adopt strategies to increase communication with such patients, and be helpful in compliance with the treatment regimen.

Maintaining the nutritional and metabolic condition is one of the consequential pillars in the post-operative care. Feeding through a Jejunostomy Tube (JT) has been advocated in patients who undergo major operations on the upper gastrointestinal tract to enhance and accelerate an early enteral feeding. The present study aimed to examine benefits and complications of a JT insertion in such patients.

This quasi experimental and case-control study was performed in 2009-2014 on 100 patients who underwent Esophagectomy. Patients were divided into two groups. In the case group, Jejunostomy Tube was inserted for 50 patients while control group was fed normally and through intravenous injection. In this study, the clinical and economic aspects of the two groups were recorded and compared. Descriptive and analytic statistics were used to analyze the data.

According to the results of this study, length of hospital stay and the beginning of oral intake interval were significantly shorter in the Jejunostomy group (P=0.02). Distention in Jejunostomy group was significantly more than other group (P = 0.04). The total cost of hospitalization in Jejunostomy group was significantly lower (P

JT is a safe and saving approach in nutritional support of patients after Esophagectomy and its routine insertion are recommended.