مجله علوم پزشکی صدرا
سال دوم شماره 1 (زمستان 1392)

In spite of the worldwide emphasis on exclusive breastfeeding during the first six months of birth, many mothers stop breastfeeding. Home visit, as an interventional method, may influence the duration of exclusive breastfeeding. The aim of this study was to assess the impact of a home visit educational intervention on the nutrition pattern and duration of exclusive breastfeeding in preterm newborns.
In this experimental research, preterm newborns with the gestational age of below 37 weeks were randomly allocated to an intervention (n=30) and a control group (n=30). The educational program of home visit was presented to the intervention group for a period of 6 months. On the other hand, the control group received the routine hospital care. The two groups were compared regarding the nutrition pattern and duration of exclusive breastfeeding during the first, second, third, and sixth months of birth. The data were analyzed using independent samples t–test and chi–square test.
The results indicated a significant difference between the two groups regarding nutrition pattern in the second, third, and sixth months. In these months, a higher percentage of the children had been exclusively breastfed. Moreover, the duration of exclusive breastfeeding was higher in the intervention group (1.75±2.69 months) compared to the control group (0.67±1.24 months) (P The results of this study indicated that the home visit educational program was effective in the nutrition pattern and duration of exclusive breastfeeding in preterm newborns. Considering the importance of continuation of cares and the positive effects of breastfeeding, healthcare providers are recommended to incorporate home visit educational plan into their programs so as to promote the preterm newborn's health.

Diabetes is a metabolic disease which is diagnosed by an abnormal increase in blood glucose. The disease can have destructive effects on various body organs, such as mouth and teeth. Dental caries is a local progressive dental destruction.
This research aimed to investigate the prevalence of dental carries in diabetics and to determine the relationship between diabetes and dental carries in Sheshdeh Qarebolaq region of Fasa County, Fars, Iran.
This cross–sectional study was conducted on 130 diabetic patients. The study data were collected using a questionnaire including the patient's demographic characteristics, educational level, and hygiene status. The number of carious and remained teeth and plaque index of the patients were recorded, as well. Oleary Plaque Index was measured by disclosing agents. The plaque index less than 20%, between 30% and 60%, and over 70% was considered as good, average, and bad oral hygiene, respectively.
In this study, the prevalence of dental caries in the diabetic patients was 43% and the prevalence of tooth loss was 69%. The results of this research revealed a significant relationship between the level of education and the patient's number of remained teeth; such a way that as the level of education increased, the number of remained teeth increased, as well (P=0.0005). Besides, improvement of the hygiene status was associated with a larger number of remained teeth (P=0.0006). Moreover, increase of the education level (P=0.0005) and improvement of hygiene status (P=0.0004) led to a significant reduction in the number of carious teeth.
The high prevalence of dental caries and tooth loss in diabetic patients indicated the need of the people living in this region for appropriate health and treatment measures and experienced health workers for training the people regarding proper oral hygiene, oral complications of diabetes, and the preventive measures.

In the recent years, women’s health has been proposed as one of the indicators of countries’ development because women are more vulnerable to damage in comparison to men. The present study aimed to investigate the effect of gender inequality on women’s health indicators in 2011.
The statistical community of this cross-sectional, descriptive - analytical study included all the countries of the world. However, due to the lack of access to all the countries’ data, convenient sampling was used. All the data were related to 2011 and were based on the report by World Health Organization. The data were entered into the SPSS statistical software (version 16) and analyzed using Pearson correlation coefficient and one-way ANOVA.
The study findings revealed significant negative relationships between gender inequality index and all the indicators of access to health services, including births attended by skilled health personnel (r=-0.73, P Increase in gender inequality was negatively associated with the indicators of access to health services. Therefore, by reducing gender inequality, access to health services can be enhanced thereby leading to prosperity and sustainable development.

The nurse-physician relationship seriously affects the treatment outcome. Moreover, the treatment process is influenced by the type of clinical relationships and interactions and various challenges are encountered in this regard. Therefore, the present study aimed to evaluate the nurses’ experiences about the challenges of nurse-physician professional relationships.
In this qualitative, phenomenological study, the data were gathered from 16 nurses using 12 open ended questions. The participants were selected through purposive sampling. After all, the data were analyzed using qualitative content analysis and Colaizzi method.
The nurses’ most important problem was not being respected by the physicians (40%). In addition, lack of coordination mostly resulted from the physicians’ unfamiliarity with the nurses’ roles (20%) and clinical rounds without the presence of nursing staff (20%). Yet, this relationship was believed to improve by respecting the nurses (33.3%) and team work (73.3%). The phenomenological issues in this study included the nurses’ problems in their professional relationships with physicians, lack of coordination among the nurses and physicians, execution of orders by nurses, physicians’ features according to nurses’ opinions, the nurses’ mental image of physicians, nurses’ reaction to physicians’ notifications, and nurses’ ideas about improvement of their professional relationships with physicians.
Considering the importance of respect among the treatment staff in treatment processes, ethics and interactional skills are necessary to be trained in both medical and nursing groups. Moreover, supervising and controlling the professional relationships in treatment centers and hospitals can improve the professional and occupational statuses to a great extent. Yet, further studies are required to be conducted in other treatment centers.

The knowledge of parents affects their children's general wellbeing as well as oral health. The present study aimed to assess the mother's knowledge of time and sequence of deciduous and permanent teeth eruption in children.
This cross-sectional study was conducted on the mothers referring to four health centers in Shiraz, Iran. A researcher-made questionnaire was used to collect information about the participant's demographic characteristics and their knowledge about tooth eruption, including the time and sequence of teeth eruption, number of permanent and deciduous teeth, and oral care. The percentage of correct responses was considered as the level of knowledge. Analysis of Variance and Spearman and Pearson correlation coefficient were employed to determine the relationship between the participant's knowledge and their demographic variables. Besides, the significance level was set at P A total of 200 mothers aging 23-49 years (31.5±4.4) completed the questionnaires. The mean of correct responses was 47.8±16.3% for all the mothers. The results revealed no significant correlation between the mother's age and their specific and overall knowledge (P>0.05). However, the overall knowledge showed a significant correlation with the level of education (r=0.42; P Based on the findings of the present study, the knowledge regarding the pattern of teeth eruption in children was higher among the mothers with higher education levels and smaller number of children. Thus, regular oral health education is necessary for mothers, particularly those with a low level of education.

Around nine million people across the world are imprisoned at the centers of criminal punishment. Almost all these prisoners experience signs of stress or depression. The present study aimed to assess the effectiveness of anger management and problem solving training on depression in the prisoners of the central prison in Shiraz, Iran.
The statistical community of the present clinical trial included all the male prisoners who had been imprisoned due to robbery. Among the prisoners, 30 were selected and randomly divided into an intervention and a control group (each containing 15 participants). The data were collected using Beck’s depression inventory before, immediately after, and one month after the training sessions. Then, the data were analyzed using MANCOVA.
At pre-test, the mean scores of depression were 28.60 and 29.46 in the intervention and the control group, respectively. These measures were respectively obtained as 17.73 and 26.13 in the post-test and 16.06 and 25.40 in the follow-up test.
The results revealed no significant difference between the two group regarding depression at pre-test. However, a significant difference was observed in this regard at post-test (F=5.9, P=0.02) and follow-up (F=5.70, P=0.02).
The results of this study indicated that problem solving skills and anger management improved the depression symptoms among the prisoners. Thus, problem solving skills and anger management are recommended to be considered for preventing and reducing the symptoms of depression in prisoners.

Patients’ escape from hospital imposes lots of costs on the patients as well as the health system. Besides, adverse events are more likely to occur for these patients compared to others. The present study aimed to investigate the rate of patients escape from general hospitals in Shiraz between 2011 and 2012.
This retrospective, descriptive study was conducted in one of the hospitals affiliated to Shiraz University of Medical Sciences. In this study, the data on the escaped patients were collected from the medical records of a general hospital using a checklist in 2011-2012. Then, the data were analyzed using the SPSS statistical software (v. 21) and descriptive statistics.
A total of 454 people had escaped from the hospital during the study period. The highest frequency of patient escape was related to the emergency department, males, and married patients. Also, most of the escaped patients had stayed in the hospital for less than a day and hospital franchise was free for 60% of them.
Considering the increase in patients’ escape from hospitals in the recent years, these behaviors should be prevented using appropriate strategies, such as controlling the patients’ entrance and exit, improving the relationship between the patients and the treatment staff, and controlling the patients with an escape history.

Multiple Sclerosis (MS), as one of the most common disorders of the central nervous system, is accompanied by various cognitive problems. About 50-60% of MS patients are involve with cognitive problems and this is the main factor leading to their job loss and decreasing their quality of life. The current survey aimed to compare high cognitive processes in MS patients and normal individuals.
Among the 1293 members of MS association in Mazandaran province in 2011, 44 patients (22 females and 22 males) were selected non randomly (biased sampling). Also, 44 individuals who were matched with the patients regarding sex, age, and education level were considered as the control group. The exclusion criteria of the study were depression, lack of computer knowledge, and EDSS>4. In order to assess higher cognitive processes, London tower test was used in which, the number of errors, total test time, and delay time were evaluated. The data were analyzed using independent t-test.
The results revealed a significant difference between the MS and control groups regarding the number of trials made for solving the problems. Besides, the number of errors was higher in the patients group (12.73.90) compared to the control group (6.48.49) (P Among the variables evaluated using London tower test, decrease in the speed of data analysis was the major cognitive impairment in MS patients.

Emergency department has the responsibility to provide healthcare services for the patients day and night all through the year. The present study aimed to investigate the patients’ waiting time in the emergency department of an educational hospital in Shiraz.
This cross-sectional study was conducted in an educational hospital in Shiraz in 2011. For timing the workflow in the hospital emergency department, a 180-patient sample size was selected for the study. Besides, emergency workflow form was used for data collection. The validity of this form was confirmed through several expert meetings. After all, the data were entered into the SPSS statistical software and analyzed using descriptive statistics and T-test.
The findings showed that the mean interval between patient arrival and the first doctor visit was 4.73±5 minutes. Besides, the mean interval between patient arrival and triage and referral to internal, surgical, and gynecology emergency departments or discharge was 48.13±55 minutes. Also, the mean interval between referral to internal and surgical emergency departments and the first visit by a specialist was 10.45±9 and 39.10±20 minutes, respectively and the difference was statistically significant (P=0.002). Considering the diagnostic procedures, the mean interval between referral and receiving the laboratory test results, radiology results, and ECG was 104.91±33, 24.50±11, and 11.83±4 minutes, respectively.
The results indicated that the waiting time was long in the emergency department of the study hospital. Thus, employing expert residents in each department, expansion of the space and facilities of the emergency department, and modification of service delivery processes are essential.

In spite of considerable advances in medical sciences, cancer is one of the major causes of death in the world. Cancer is one of the most important diseases of the time and is considered as the second cause of mortality after cardiovascular diseases. The rate of cancer-related deaths in the world was estimated to be about 7.9 million individuals (about 13% of all deaths) in 2007. Cancer patients suffer from depression, anxiety, unrealistic fear of death, and reduction of social energy. Moreover, continuous hospitalization and concerns for the patients and their families lead these patients towards mental disorders.
Ethical issues are highly challenging in cancer patients. Some cancer patients may not be in an appropriate mental state to decide regarding increasing the life span or decreasing the life quality and its complications. In any event, the patients’ decision must be respected.
The present study aimed to investigate the clinical relationship between the cancer patients and the physicians as well as nurses. Such a relationship involves all the stages from screening to creation of trust between the patients and the physicians. Furthermore, euthanasia has been investigated in various cultures and different levels of interaction between the patients and physicians have been assessed. Finally, strategies have been recommended for improving the physicians’ and nurses’ interaction with these patients.