فصلنامه پژوهش های سلامت محور
سال دوم شماره 4 (پیاپی 7، زمستان 1395)

Since late diagnosis of diabetes or missing it during pregnancy can leave severe maternal and fetal complications, and on the other hand information on the prevalence and risk factors of diabetes in pregnancy in Iran is limited, this study aimed to determine the prevalence and risk factors of gestational diabetes in Shahdad/ Kerman/ Iran.
This cross-sectional, descriptive-analytical study was performed on 160 post partum women who had prenatal care files in health care center of Shahdad city from 2014 to2015. Subjects were selected through census sampling and their information was extracted from their files. Data were analyzed through SPSS version 16 and using t-test, chi-square, Fisher's exact test and logistic regression.
The prevalence of gestational diabetes mellitus (GDM) in the studied women was 12.5 percent. Gestational diabetes showed significant relationships with history of stillbirth (P=0.04), family history of diabetes (P The prevalence of gestational diabetes is high in the region of Shahdad/ Kerman and history of stillbirth has the highest correlation with GDM. Therefore, screening of gestational diabetes and its risk factors in this community seems necessary.

Discharge Against Medical Advice (DAMA) is one of the important concerns of health systems. This could be potentially life-threatening and cause readmission. The purpose of this study was to determine causes of DAMA in patients of some selected hospitals.
This cross-sectional, descriptive-analytic study was performed in winter 2016. The medical files of 261 patients discharged against medical advice were selected by simple random sampling and reviewed. Data were gathered through Hospital Information System and using a self-designed check list. Data were analyzed through SPSS software and using descriptive statistics and Chi-square test.
From all, 58.6% were male, 66.3% were married and 22.2% did not have any insurance coverage. The most common reason of DAMA was feeling better (43.3%). Discharge against medical advice showed significant relationship with marital status (P= 0.02), and insurance type (P= 0.05).
Since the most common reason of DAMA was feeling better, more attention of authorities and also a stronger patient-physician relationship are recommended in order to aware patients of their clinical conditions and treatment process.

Hospitals, due to their role in improving the health of populations, should have adequate organizational health. Organizational health is critical for organizational productivity. This study aimed to evaluate the organizational health of university hospitals of Isfahan, Iran.
This descriptive-analytic and cross- sectional study was conducted in 7 hospitals in 2015. A researcher-made questionnaire with 18 dimensions and 54 questions was used to gather data. A total of 283 hospital employees were randomly selected from seven hospitals. Data analysis was performed through SPSS21 and using descriptive statistics such as frequency, percent, mean ± SD as well as inferential statistics like regression and ANOVA.
The mean score Mean score of organizational health in studied hospitals was 3.08 ± 0.63 from 5. Organizational health was good in one hospital, moderate in five hospitals and poor in one hospital. Dimensions of morale, planning and formality had the highest and dimensions of justice, decision- making and control had the lowest scores. Intra-ward relationships, efficient use of resources, adaptability, leadership and independence showed the most effect on organizational health. Specialty hospitals had better organizational health compared to general hospitals. There was significant relationship between managers’ work experience and organizational health.
University hospitals of Isfahan have moderate organizational health and hospital managers should apply necessary activities for improvement of organizational health.

Changes in twenty-first century and incidence of development gap among countries has caused particular attention of all economic schools to the problem of poverty and the factors affecting it, as a consequence of underdevelopment. Health and health expenditures are considered as a tool for governments to get out from poverty.
This study is one type of econometric studies with using panel data for Iran and 30 developing countries during 2005 to 2012. To determine the effect of health expenditures on poverty headcount ratio, Hassman and Chow tests were used in order to select the type of random or fixed effect regression model. Data analysis was done through Eviews 6 software.
Among factors affecting poverty, health expenditure had more significant impact on poverty. So that, one unit increase in public and private health expenditures caused respectively -2.93 decrease and 1.19 unit increase in headcount poverty ratio. In comparison to health expenditure, access to health facilities and primary school enrollment rate with respectively coefficients of -0.81 and 0.34 had less impact on poverty headcount ratio.
Governments should pay more attention to policies of financing health sector and more expansion of governmental functions in financial support of health sector rather than private sector.

Reform in health system aimed to improve healthcare, affected all organizations and institutions (in particular, NGOs) operating in health care services. NGOs in health system, are one of the main players to promote healthcare performance and system. The aim of this study was to investigate the impact of Health System Reform plan on NGOs which are active in health sector.
This cross-sectional, descriptive-analytical study was performed during Summer-Autumn 2015. By a stratified-random sampling, 91 health care staffs selected from nine NGOs to fill–in a 27-item questionnaire designed by the researchers. Data analysis was done using structural equation modeling (SEM) and through AMOS Ver22.
According to the results, 67.9% of respondents recoded lower patients’ referral, one year after the implementation of the reform plan in healthcare. Financial saving was the main advantage of this plan. In addition, this reform had positive effects on health services development, financing and resource allocation, healthcare equipment providing, prevention and promotion of health literacy in NGOs.
Healthcare reform plan had a significant positive effect on NGOs activities. It can get benefit from the present potentials for increasing the chance of success of this reform plan in healthcare system through good interaction of healthcare system authorities and NGOs.

Communication skills have been considered as one of the basic social skills and in medicine field, too, communication is the main component of patient care. Therefore, in students of medical-related fields, the ability of establishing efficient communication with members of medical team leads to the advancement of educational and therapeutic goals and has a significant impact on their performance in patient care. The aim of this study was to investigate interpersonal communication skills in nursing and midwifery students and its related factors.
This descriptive-analytic study was conducted on 347 nursing and midwifery students of Azad University of Rasht Selected randomly in 2016. Data gathering tool was a standardized questionnaire of interpersonal communication skills containing 19 items. Data analysis was done using analytical statistical tests such as Pearson correlation coefficient, t- test and chi-square and through SPSS version 22.
Mean age of students was 22.59±6.38 years. Mean score of communication skills was 64.17±8.72 in midwifery students and 65.62±7.97 in nursing students. In whole, 57.3% of students had communication problems. Students’ interpersonal communication score showed no statistically significant association with variables of age, educational level and marital status. But, there was a significant correlation between the midwifery students’ grade point average and their interpersonal communication level (P= 0.03).
Due to the unfavorable status of interpersonal communication skills among students, planning for teaching these skills and holding practical workshops in this area should be considered as a priority.

Background & Objectives: The importance of mental health in personal and social life of people as well as the high cost of health services in today's world necessitates people to attempt for acquiring personal skills for maintaining and improving their health. In this regard, self-care and health literacy, as dynamic and available tools for individuals, can play a decisive role in promoting equity in mental health.   This study was a descriptive-analytic study performed on 414 citizens over 15 years of age in Tabriz, Iran who were selected through multi-stage cluster sampling. Data gathering was done using general health questionnaire with three dimensions, literacy questionnaire consisted of five dimensions of reading comprehension, access, understanding, evaluation and decision making and a researcher-made questionnaire about self-care. Data analysis was performed using t-test, Fisher test, Pearson correlation coefficient and multivariate linear regression and through SPSS22 software. Mean score of mental health was 58.38, mean score of self-care was 54.46 and mean score of health literacy was 77.20. There was a significant and direct relationship between mental health and variables of age, marital status, education level, and self-care. The present study emphasizes on the importance of training on and accepting responsibility for mental health. People can maintain and improve their health and accept responsibility in this regard through acquiring sufficient knowledge on health aspects.

Background & Objectives: Core competencies are used to order organizational skills and techonlogies for the purpose of satisfying the customers' needs. Critical thinking and mental maturity help to achieve this goal. The aim of this research was to study the relationship between core competencies and critical thinking with regard to the moderating role of mental maturity in staff of Rafsanjan University of Medical Sciences in 2016. This descriptive - analyctical study was done on 267 staff of Rafsanjan University of Medical Sciences selected through randomized stratified sampling. Data collection was conducted through using core competencies questionnaire (14 qeustions), critical thinking questionnaire (23 qeustions) and mental maturity questionnaire (19 qeustions). The relationship between variables were analyzed using Partial Least Squares (PLS) and through Smart PLS 2 software. The coefficient between core competencies and critical thinking variables was 11.223 and core competencies directly explained 36 percent of critical thinking variations. But, the coefficient between core competencies and mental maturity variables was 0.993. Therefore, the effect of mental maturity as a moderating variable was not approved. The presence of critical thinking in organization and the opportunity for employees to express their opinions and suggestions lead to the presence of core competencies in organizations and it is possible through gathering, sharing and saving data.