Shiraz Emedical Journal
Volume:20 Issue: 7, Jul 2019

Nurses are the largest group in the health care system. They should have a good quality of life to be able to provide patients with high-quality care. The aim of the present study was to investigate the health-related quality of life (HRQoL) among Iranian nurses. In this systematic review and meta-analysis, a systematic search was conducted in 2018 for Persian and English articles on the nurses’ quality of life published in the Scientific Information Database (SID), MagIran, Google Scholar, ISI/Web of Science, PubMed, and Scopus. The Cochrane Q test and I2 test statistic were used to test heterogeneity between studies. Because of heterogeneity, the data were analyzed using the random and fixed-effects models. All analyses were performed using stata, version 14. Overall, 13 articles with a total sample size of 4274 patients were included in the analysis. The mean HRQoL score of Iranian nurses was 60.52 (95% CI: 57.10 - 63.93). The mean score of the physical dimension of HRQoL (63.34 with 95% CI: 57.98 - 68.71) was higher than the score of psychological dimension (60.72 with 95% CI: 57.80 - 63.64) in Iranian nurses. The results of the meta-regression analysis showed no significant association between the total HRQoL score and the nurses’ age (P = 0.973) and the sample size (P = 0.12). The HRQoL of Iranian nurses is not very good. It seems necessary to develop strategies aimed at improving the HRQOL of Iranian patients, especially their physical domain.

Leg muscle cramps (LMCs) and sleep disorders are a common problem during pregnancy, and may be correlated. The aims of this study were to determine the features of LMCs and sleep quality as well as their association in the third trimester of pregnancy. This cross-sectional study was conducted on 439 pregnant women referred to health centers/posts of Tabriz, Iran, in 2014. The participants were selected through double stage cluster sampling method. Data were collected by using a socio-demographic questionnaire, Pittsburgh sleep quality index and leg muscle cramp characteristics questionnaire. Chi-square, Independent t, Pearson and Spearman correlation and Mann-Whitney U tests were used for data analysis. The mean ± SD total sleep quality score was 8.8 ± 3.9, within a possible score range of 0 to 21. About 84% of the women had sleep quality disturbances. LMCs were observed in more than half of the participants and there was a statistically significant correlation between the occurrence of LMCs and total sleep quality score (P = 0.001) and sub domains of sleep disturbances and daytime dysfunction (P < 0.001). There was also a significant relationship between occurrence of sleep quality disturbances and occurrence of LMCs (P = 0.006). The present study showed that leg muscle cramps and sleep disorder are common during pregnancy and sleep quality disturbances are correlated with occurrence of leg muscle cramps. Prevention and treatment actions should be considered in the prenatal care.

Increasing expenditures in health sector and scarcity of resources are the main bases to investigate productivity and efficiency; such studies are effective in better management of resources and reduction of expenditures and their results can be used as an instrument for policy-making. The current study aimed at analyzing the productivity of hospitals affiliated to Lorestan University of Medical Sciences, Lorestan province, Iran. In the current study, productivity changes of all product factors in the hospitals (N = 12) were evaluated and the means of total factor and marginal productivity were measured using the Malmquist and the Kendrick-Creamer indices from 2010 to 2016. Also, efficient hospitals were ranked based on the Anderson-Peterson coefficient. The changes in the mean total factor productivity were 1.023 using the Malmquist index, which indicated a decrease in productivity during the studied period; however, technological changes had the highest impact in this regard compared with other factors. Also, the means of total factor and marginal productivity of the physicians, nurses, and active bed inputs were 209.06, 38.1, 78.8, and 137.1 using the Kendrick-Creamer index for the studied years, respectively. In the current study, the decreased productivity was mostly attributed to technological changes, which indicates that the hospitals are not equipped properly with advanced medical technologies in terms of diagnosis and treatment processes. Therefore, holding educational courses for personnel for appropriate use of technology as well as optimal resource utilization and improving resource allocation can enhance the productivity and efficiency of all the production factors.

The p28 is a small-sized cell-penetrating peptide derived from bacterial protein azurin and can function as a cancer-specific anti-proliferative agent. It can penetrate cancer tissues easily without involving the immune system, and increase the intracellular concentration of p53. In this study, we have expressed and purified recombinant p28, then evaluated its anti-proliferative and pro-apoptotic effects on Raji cancer cell line. The p28 gene was amplified and cloned into pTZ57R cloning vector and was sequenced subsequently. Afterward, it was transformed into E. coli BL21 bacterial host by using pET-28a expression vector. Peptide purification was carried out using Ni-NTA ‎chromatography system. Bradford, SDS-PAGE, and western blotting assays were applied to assess the concentration and expression level of the recombinant peptide. The proficiency ‎of p28 in inhibition of tumor growth and induction of apoptosis in cancerous cells was investigated by evaluating the Raji and HEK-293 cells treated with different concentrations of p28. The overexpression of the p28 peptide in the bacterial host was confirmed by SDS-PAGE and western blotting. Moreover, Bradford assay revealed desirable concentrations of the recombinant p28 before and after dialysis. The MTT and PE-Annexin V apoptosis assays indicated the specific function of p28 in impeding the proliferation of cancerous cells and triggering the apoptosis. The p28 induces apoptosis in cancerous cells but not in normal control cells. ‎In summary, p28 is a non-immunogenic small peptide that can penetrate cancerous cells ‎preferentially, impede the cell proliferation, and induce the apoptosis. Overall, these ‎findings suggest p28 as‎ a promising anticancer drug.

Endometriosis is routinely treated with laparoscopy, which despite significant advantages over laparotomy cannot diminish postoperative pain. Insufficient postoperative pain control decreases patient satisfaction. This study was designed to evaluate the efficacy of intraperitoneal dexmedetomidine (DEX) combined with bupivacaine on postoperative pain in endometriosis laparoscopic surgery. Fifty-three patients with endometriosis, scheduled for laparoscopy in Rasoul-e-Akram Hospital, Tehran, from January 2016 to May 2017 who were randomly divided into three groups, including group 1 (G1, n = 21) received 50 mL intraperitoneal saline, group 2 (G2, n = 16) received 50 mL intraperitoneal instillation of bupivacaine 0.25%, and group 3 (G3, n = 16) received 50 mL bupivacaine 0.25% plus dexmedetomidine 1 µg/kg. Each patient with a history of allergy to local anesthetics or dexmedetomidine, cardiac disease, renal or hepatic failure, severe pulmonary disease; in addition, pregnant and comorbid obese patients were excluded from the study. Patients’ postoperative pain was assessed in the recovery room after 2, 6, 12, 24, and 48 hours using visual analogue scale (VAS). Total analgesic consumption was also recorded. The postoperative VAS scores were significantly lower in group 3 than other groups in the recovery room, and 2, 6, 12, 24 and 48 hours after the surgery (P < 0.001). However, there was no significant difference between 1 and 2 groups. Furthermore, total VAS in the first 24 hours in group 3 was significantly lower than the two other groups (P < 0.001). We conclude 1 μg/kg intraperitoneal DEX administration combined with bupivacaine may prolong postoperative analgesia and decrease rescue analgesia requirement compared with bupivacaine alone.

Compact fluorescent lamps (CFLs) could be a source of ultraviolet (UV) radiation with potential harmful effects. We assessed the effects of ultraviolet radiation on leukocyte and platelet counts in rats and also investigated the preservative effects of curcumin on hematologic disorders caused by UV radiation. We randomly divided 48 male Sprague-Dawley rats into six groups (n = 8). Two control groups received ethyl oleate (0.2 mL, IP) for 10 (group I) and 30 days (group II), without exposure to fluorescent light. Two fluorescent groups treated daily with 12 hours fluorescent light exposure for 10 (group III) and 30 days (group IV). Group V and VI received curcumin (20 µmol, IP) and 12 hours fluorescent light exposure for 10 and 30 days, respectively. The blood samples were collected and the leukocyte indexes were measured by cell counter and blood smears were obtained. The number of leukocytes was significantly lower in groups III (8.36 ± 0.23 × 103/µL) and IV (7.85 ± 0.18 × 103/µL) compared with groups I (8.78 ± 0.14 × 103/µL) and II (8.50 ± 0.20 × 103/µL). (P value III:I = 0.004, IV:II < 0.0001). The number of leukocytes insignificantly increased to normal levels of 8.85 ± 0.29 × 103/µL and 8.30 ± 0.16 × 103/µL in groups V and VI, respectively (P value V:I = 0.79, VI:II = 0.09). The number of platelets (PLTs) was significantly lower in the groups IV and VI in comparison with the group II (750 ± 6.52 × 103/µL, 808 ± 2.13 × 103/µL and 846 ± 2.73 × 103/µL, respectively (P value IV:II < 0.0001, VI:II < 0.0001). In the morphological pattern of leukocytes, the CFLs lead to atopic cells, bond cells, and cell lysis, however, administration of curcumin prevented this disturbance. Curcumin has a protective role in reducing complications caused by CFLs in reduced leukocyte and platelet counts, which is probably due to its antioxidant agent.

Medication adherence (MA) is one of the crucial aspects in the management of chronic diseases such as diabetes. This study aimed to evaluate MA and its predictors in type 2 diabetic patients referring to urban primary health care centers. This cross-sectional study was carried out among type 2 diabetic patients referring to urban primary health care centers in 2017. The data were collected by the Persian version of the eight-item Morisky MA scale. Demographic and disease-related data were also collected. The data were analyzed using SPSS version 22. Of 589 patients under study, more than 70% used oral hypoglycemic agents as the medication regimen and 29.2% received insulin as monotherapy or in combination with oral antidiabetic agents. Over half of the diabetic patients (51.1%) had other comorbid chronic diseases; moreover, 51.3% of them had at least one of diabetes-related complications. The mean MA score was 6.27 ± 1.81. One-third (33.3%, n = 196) of the patients had a moderate level of MA while 35.4% (n = 208) and 31.3% (n = 184) showed low and high MA levels, respectively. Binary logistic regression analysis showed that education level, type of medication, age, and treatment duration were the predicting factors of MA. MA was at a suboptimal level among diabetic patients referring to the urban primary health care centers. Poor medication adherence can have negative outcomes for diabetic patients. Thus, primary health care providers should consider self-care behaviors of patients and monitor their medication adherence, as well as other aspects of diabetes management.

The cost of working staffs covers almost one-third of all the expenses spent in women and motherhood healthcare services. The present study aimed at comparing the timing of motherhood and prenatal care healthcare services in comprehensive health centers after the implementation of health system reform plan. Following an analytical cross-sectional research, 264 occurrences of motherhood health cares were studied, including 88 preconception cares, 88 prenatal cares, 88 postpartum cares, and 92 reproductive health care (356 person-services in total) in two urban texture and two suburban health posts in Qom city, during year 2018. Two chronometers were used to measure the timing of each of the healthcare components and healthcare services from the time the patient arrived to the end of the service. The timings were then enlisted in checklists. Descriptive statistics and independent samples t-test were used to analyze the data. The general timings of preconception care, prenatal care, and postpartum care were 23 ± 6, 35 ± 9, and 20 ± 4, respectively. The timing of reproductive health care was 7.3 ± 3. There was a significance difference between the timing of preconception cares (27.4 ± 4 and 18 ± 3 minutes, P = 0.005) and prenatal cares (28 ± 7 and 39 ± 8 minutes, P = 0.005) in the urban texture and the suburbs of the city. However, there was not a significant difference between these two areas in terms of the timing of postpartum cares (18 ± 3 and 21.5 ± 6 minutes, P = 0.156) and reproductive health care (6.8 ± 2.7 and 7.7 ± 3 minutes, P = 0.139). The timing of preconception care and prenatal care was different in suburban and urban texture of the city. Therefore, it is suggested that the required personnel in healthcare centers should be distributed based on the service timing and workload rather than based on the relevant population of the city so that an optimal management of the working staffs is acquired and both the personnel and patients are satisfied.