Journal of Kermanshah University of Medical Sciences
Volume:11 Issue: 2, 2007

Regarding the dramatic increasing of AIDS in the world, women are mainly considered both as transmitters and sources of this fatal disease, who not only threatened their husbands but also their infants. The main goal of this research was the survey of the effect of health educational program on preventing AIDS in self-reported addicts wives in Kermanshah in 2004. This study is a quasi- experimental one in which 40 were randomly selected among the 237 patients. Data gathered in this study through reliable and validated questionnaires consisting 4 sections (General information, Knowledge, Attitude and Checklist). This research was carried out at two steps. After the completion of the questionnaires by the subjects, at the pre-test stage, an education al program based on the research results and their needs was designed and during 3 weeks it was performed by proper educational methods (lecture, question/answer, pamphlet, visual educational materials etc). To reduce the effect of interfering factors, the post test was performed two months later and the same questionnaires were completed by the same subjects. Finally the data was analyzed by T-test, Correlation, and Anova. The findings indicated that 77.5% of the individuals were housekeepers. The most frequent age group was between 26-31 years old and the least one was between38-48. According to the results, there is a significant difference (p<0/0001) between the rate of knowledge before and after the educational program in other words, educational health program was effective in promoting the knowledge, attitude level and positive performance of the subjects so that it increased knowledge, attitude and performance by %6.5, 69.9% and 65% respectively. The results also showed that media (TV & radio), by 100%, was the greatest resource of information about AIDS, while other resources such as Health Centers, friends etc were 50% and 45% respectively. The results of this research showed that Health Educational Program had a positive effect on the promotion of health behavior of the subjects. Thus for promotion of the health behavior of people, educational and training program by media is strictly recommended.

Lower limb surgeries are commonly done by using general anesthesia, regional anesthesia and blockade nerve. Patients who are exposed to danger such as cardiovascular and cardiopulmonary patients and hemodynamic instability, for reducing complications in below knee surgery, can use lower limb blockage nerve in popliteal region which is a safe method. In this experimental research 34 available patients, who were divided into two groups of 17, underwent lower limb surgery at Taleghani Hospital. Dorsal anesthesia method was performed by using 40 milliliters Lidocaine 1.5% in one group, and 20 milliliters Lidocaine with 100 milligrams Phentanil in another, then starting time, period of anesthesia and immobility, degree of senselessness and immobility at two groups were recorded, and eventually the two groups were compared by using appropriate statistical tests (t, χ2 & Fisher Exact). Most of the patients were men at the age 20-82. The onset of sensory blockade, in 64.7% of group one, was 1-2 minutes, and in the rest was 3 minutes (this time, for 84.2% of the patients in the second group, was 2-3 minutes). The difference of the starting time, between the two groups, was not statistically significant (P=0.724). The averages of the starting time of motor blockade in the two groups were 3.64 and 4.4 minutes respectively, and the difference was statistically significant (P=0.014). The period average for motor blockade in the two groups were 296.5 and 190.6 minutes respectively, which is statistically significant (P=0). The results of this study revealed that using pure Lidocaine or Lidocaine with Phentanil in sciatic nerve blockage of popliteal fossa has no significant effects on the period, extent and complications of nerve blockage in patients, so it is well recommended, instead of using a large amount of pure Lidocaine, a little amount of it plus an appropriate amount of Phentanil to be used.

Since hypercalciuria is implicated in renal stone formation, random urine calcium to creatininee ratio (UCA/CR) is the practical use in screening for hyperalciuria. However, due to worldwide variations in reference values for human population and difficulty of 24 hr urine collection for detection of hypercalciuria, we decided to conduct this study to determine normal confecting random UCA/CR ratio in the west part of Iran, Kermanshah. This descriptive analytical cross-sectional study was performed through classification and cluster sampling technique on 3600 healthy people of both genders in Kermanshah They were divided into four groups, as fallows: [1] girls 13 years old, [2] women>13 years old, [3] boys 13 years old, and [4] men>13 years old. A non-fasting random urine specimen from each subject was analyzed for calcium and creatininee. The mean values and standard deviation for random UCA/CR ratio, with the accuracy of 95%, in the four above-mentioned groups revealed as 0.22 0.14, 0.20 0.14, 0.22 0.19 and 0.19 0.12 respectively. According to the results, there was a reverse and significant relation between UCA/CR and Age, and also a direct and significant relation between UCA/CR and Age. UCR/CR ratio in children was more than that of adults, and showed to be the same in both sexes. To sum up, it seems that UCA/CR ratio in female is more than that of male. The variations of UCA/CR in different studies emphasize on the role of geographic location. This, as well as other extrinsic factors such as nutritional habits, source of drinking water etc, may influence normal values of UCA/CR ratio.

Vitamin D deficiency is still a common serious health problem among women of reproductive age and their infants in developing countries at the outset of the third millennium. Information on vitamin D status of urban lactating women in Islam Abad Gharb is not available, but it seems that, as in other physiologic groups in other areas of Iran, vitamin D deficiency may be common there, too. The aims of this study were: 1) To determine the serum 25-hydroxyvitamin D concentration and its association with independent variables (age, occupation, family size), and 2) To determine the vitamin D status of urban lactating women and its association with the independent variables. In this descriptive analytical cross-sectional study, using a simple randomized sampling technique, a total of 155 lactating women, whose babies were less than 12 months, were selected from 8 urban health centers in Islam Abad Gharb in winter 2004. A general questionnaire was completed to obtain information on age, occupation, family size, and fasting blood samples were taken for biochemical analysis. The concentration of 25-hydroxyvitamin D in serum was measured by Chemiluminescence Method. Normal status, moderate deficiency, and sever deficiency were defined as a concentration of 25-hydroxyvitamin D serum ≥ 10 ng/ml, 6ng/ml ≤ concentration of 25-hydroxyvitamin D serum < 10 ng/ml, and vitamin D deficiency as concentration of 25-hydroxyvitamin D< 6 ng/ml. The results revealed that the mean serum 25-hydroxyvitamin D concentration was 5.36 ng/ml. 8.4% of women had a normal status, 18.7% and 72.9% suffered from moderate and severe deficiency. Age and family size affected the serum 25-Hydroxyvitamin D negatively. Also working women had a significantly better vitamin D status than housewives. We conclude that vitamin D status of urban lactating women is poor and needs immediate attention.

The present research studies the evaluation of drug prescriptions for under-5-year-old children and their effective factors carried out by junior paramedics at Rey City. In this study 28 health houses, medical family files of 589 patients/children, 55 junior paramedics for their drug prescription to children under 5 years old, and their regular follow-ups were assessed. Two questionnaires were used for the study. The first questionnaire contained information about children’s drug prescriptions and variables evaluated in relation to drug prescription dose, duration of consumption and the cure duration period, which carried out in 589 under 5 year children. The second questionnaire contained information of junior paramedics in health houses. Since, in most of the health houses, more than one junior paramedic works, and we cannot find out which one of them has prescribed drugs for children, therefore we use the average of age and combination of some of the codes related to educational status. The interval between drug prescriptions, in 73.2% of cases, and the length of treatment in 84.1% of them were appropriately chosen. In 50.5% of the cases in dire need of management, no appropriate and necessary follow-ups to make sure that earlier actions have been successful or effective were fulfilled by the junior paramedics. One of the important constraints of the research is the high percentage of unrecorded cases by the junior paramedics. Although the results indicated logical prescription of drugs by the junior paramedics, they are far from satisfactory conditions, thus those who are responsible in this regard, should supervise their performances much more carefully.

Myocardial infarction (MI) is the most prevalent disorder causing a high mortality rate. In patients, chest pain is a common compliant, but sometimes it occurs without pain. Painless infarction may occur in diabetic patients. It is believed that infarction without and with slight pain, is more possible in diabetic patients due to autonomic neuropathy. Consequently, these patients are hospitalized and undergo diagnostic procedures more than non-diabetic patients. But it remains unclear whether diabetic patients with MI have similar symptoms compared to non-diabetic ones. Therefore, this study was conducted to compare the chest pain pattern and type of infarction in diabetic and non-diabetic patients with myocardial infarction. This analytic-descriptive study was conducted in the emergency wards of Imam Reza and Ghaem Hospitals. 40 diabetics and 70 non-diabetics with MI were selected by convenience methods. The needed data was collected through using interview, samples, demographic, pain characteristics, and observation forms for selecting the samples, and also recording the electrocardiogram and laboratory results, pain numerical rating scale, Mc-Melzac questionnaire and electrocardiogram device were used, then the data was analyzed. The results of this research revealed that there was no significant difference in age (P = 0.26) and family history (P=0.63). Most of the diabetic patients were significantly female (55% VS 45%; P<0.0001). Intensity of infarction angina in diabetic patients was lower (6.504.11 VS 7.732.71;P=0/37) and duration of pain was shorter (238/5097.35 VS 250/89148/98; P=0.99) than those of non-diabetic patients, but these differences were not statistically significant. There was also no statistically substantial difference between the two groups in location, radiation, associated symptoms, alleviating and aggravating factors of pain and infarction type. Inferior infarction was more common in the two groups. According to the results of this research, clinical characteristics and chest pain pattern possibility are similar in diabetic and non-diabetic patients with MI. Therefore, it seems that these patients do not need more hospitalization and diagnostic tests and other evaluations. Further studies about chest pain pattern in diabetic patients are particularly recommended.

AML is the second most common leukemia in children after ALL. The rate of AML in 14-year-old children is reported to be 6.6 cases per million. This study reviews 40 children with AML within 5 years. These patients have been evaluated for clinical findings and overall survival. All Patients with AML have been evaluated from 1996 to 2000 for clinical findings, age, gender, lab data, AML subtypes, geographic distribution, treatment results and overall survival. Myeloblast, over 30 percent, was compatible with AML. FAB classification was applied for AML subtypes. BM flocytometry and special staining were applied, if necessary. CBC test was performed through sysmex counter. In this study, 40 cases were diagnosed to have AML during 5 years, 60% of patients were male & 40% female, among whom 17.5% were less than one year old. Age distribution was between 2 to 15 years old, and the most common clinical findings were bleeding, weakness, respiratory symptoms and pallor. More than 90 percent of patients suffered from anemia and thrombocytopenia. M3 was the most common subtype. In this survey, overall survival was less than 35 percent, which proves that chemotherapy without BMT is an incomplete therapy; there was also no significant difference between sexes, but 17.5% of patients were less than one year old and 22.5% of them reported by parents to have anemia.

Iranian Ministry of Health has chosen Total Quality Management/TQM and FOCUS–PDCA as the best tools for improving medical and health services. Kermanshah University of medical sciences attempted and performed several workshops on TQM and FOCUS – PDCA for staff and managers. Evidence revealed that those who attended these workshops would have been expected to make better use of their training at work, but surprisingly they didnt. This research was aimed to find the trainees opinions in this respect. In this descriptive-analytical study we used purposive and convenience sampling. Subjects were 400 people whom all participated. They completed a two-part questionnaire, containing questions about demographic information and obstacles of using FOCUS–PDCA dealing with 5 variables _budget, system, method, management and staff. The reliability of questionnaire, through pilot study, it was determined by test-re test and for validity, content validity was applied. Χ2, Benferoni post hoc test and ANOVA was employed to analyze data gathered via this questionnaire. 390 subjects completed the questionnaire. 45.7% male and 71.8% were BS or higher BS. 40.5% had over 15 years of work experience, and 42.7% worked in the Health Field. 88.5% showed to be familiar with FOCUS– PDCA. 45.5% attended in the promotion of at least one process. There was no significant relation between knowledge and practice at their work. 45.3% introduced Management as the main obstacle of using FOCUS – PDCA. There was a significant difference between the mean of 5 variables in different departments (p=0.001). Although the trained staff have had a good knowledge about FOCUS – PDCA, they didn’t use it appropriately due to lack of support from managers and enough money, therefore we recommend the administrators to choose enthusiastic, efficient and knowledgeable managers concerning the matter, and also consider provision of enough budgets for it due to long-term benefit of TQM as a managerial philosophy.

Leptospirosis is a worldwide disease which affects wild and domestic animals as well as human beings, and has become a major public health problem throughout the world, particularly in the tropics and temperate regions, especially in costal region of northern par tap Iran. It is caused by the pathogenic Leptospira sp. strains that are often responsible for nervous system abnormalities. The disease varies from subclinical infection to a severe illness with multi organ involvement. Rodents and domestic animals are the reservoir of this disease. Rural inhabitants are mainly farmers, therefore all of them could be affected with direct contact by animals and working on farms, since most of them are working specially in warm seasons and bare-footed with paying no attention to any basic advice. In this research, we wanted to determine the incidence rate of Leptospira between the rural inhabitants, and detect the serum titers of the patients. This study carried out on 552 people in a selected area of Guilan Province based on the stratified sampling criteria. All of these rural inhabitants who were cultivators and animal husbandmen were volunteers for this research. All samples were tested through MAT (Microscopic Agglutination Test) method, then positive serums and different titers were all reported. 21% of the population had positive serum reaction to different strains of Leptospira spp. and according to the results, 21% and 22% of men and women had positive serum reaction respectively. Prevalence of disease is more visible in the 30-50-year-old rural inhabitants. Area L. icterohaemorrhagiae is the majority of different strains of leptospira spp with the serum titers ranged from 1:100(54% of cases) to The prevalence of leptospirosis among cultivators is higher than others. According to the findings, we could say that leptospirosis exists in Guilan province, but since this test has been performed on limited people in this province, and since the tropic and temperate climate in this province is seen in the most time of the year, then it is necessary to do this test in all parts of this province.

Although the main hazard in cement processing is dust, and respiratory tract disorders are the most important group of occupational diseases in this industry, evidence for association between exposures to cement dust and either respiratory symptoms or functional impairment has not been conclusive. This study was, therefore, undertaken to examine, more thoroughly, the effects of occupational exposure to cement dust on the respiratory system. The present study was a historical cohort investigation. The study population, as evaluated by statistical procedures, consisting a group of 88, randomly selected, male workers with current exposure to cement dust and 80 healthy male office workers without present or past history of exposure to dust that served as the reference group. Both groups had identical socioeconomic, demographic status and length of employment. Subjects were interviewed, and respiratory symptom questionnaires were administrated to them. They also underwent chest X-ray and lung function tests. Additionally, using gravimetric method with a filter holder containing a membrane filter connected to a cyclone, personal dust monitoring for airborne inhaling and respiring dust was carried out at nine different worksites. Moreover, X-ray diffraction (XRD) and X-ray fluorescence (XRF) techniques were performed to determine the silica phases and the SiO2 contents of the dust samples, on a fee for service basis. Levels of exposures to inhaling and respiring cement dust were estimated to be 53.4±42.6 and 26±14.2 mg/m3 respectively (Mean ±SD). These values exceeded current TLV of 5 mg/m3 for such particles. Statistical analysis (T-test and Chi-square) of the data revealed that symptoms like regular cough, phlegm, wheezing and shortness of breath were significantly (P<0.05) more prevalent among exposed workers. Similarly, chest radiographs of exposed workers showed various degrees of abnormalities. However, no significant changes were noted in the radiographs of the referent group. Furthermore, exposed workers compared to their referent counterparts showed significant reductions in the parameters of lung function as diagnosed by the specialist. Furthermore, no significant differences were noted between the two groups as far as the number of smokers and the length of smoking were concerned. Given the fact that both groups had identical socioeconomic and demographic status and were similar as far as important confounding variables such as cigarette smoking was concerned, it is very likely that the significant reductions in the parameters of pulmonary function, as well as a significantly increased prevalence of respiratory symptoms among exposed workers, could be attributed to their exposure to cement dust. Therefore, our data provides further evidence to support the proposition that exposure to cement dust is associated with respiratory symptoms, radiographic changes in the lungs and functional impairments.

Satisfaction evaluation is a good way to assess hospital conditions and try to upgrade hospital care. In Health Care System, parents considered as childrens main supporters, thus they may act as the patients viewpoints representatives. Assessment on patients satisfaction can, and must, improve the care quality, yet it presents essential information appropriately used for improving the management planning and recognition of staffs functions. The main objective of this study was to determine the mothers satisfaction from the hospital care for their children hospitalized in the pediatric ward. A Cross-sectional descriptive-analytical study was performed on 200 mothers at Shahid Sadoqi Hospital through simple sampling. They filled out standard questionnaires PFSQ (Pediatric Family Satisfaction Questionnaire) before being discharged from Hospital. Our findings revealed the mothers Mean age to be 29.47.3, and the satisfaction of 45-56- year-old mothers was more than the other age groups. Also, the research showed: the higher mothers education the less their satisfaction, but not significantly (P=0.098). Factors, like mothers age (Mean=29.47.3, P=0.174) and length of the hospitalization (Mean=4.053.4) showed no substantial difference (P=0.149). Generally, 85.5% of mothers evaluated the hospital care relatively good. The main points, regarding medical care, evaluated weakly, in order of importance included as follows: to inform parents about the tests results and the medical managements (9%), regarding nursing care: to aware parents about medical care and post-charge care (10.5%) and then in regard to welfare services: availability of playing conditions for children in the ward (56.5%). Overall mean score for welfare, nursing and medical care were 32.014.58, 47.327.43 and 38.366.13 respectively. To satisfy mothers and to improve medical care for children, it is widely recommended to bring about the means of conditions for medical staff and parents to have a close, open and effective relation in the pediatric ward, we need a place for playing, and indeed it is necessary to spend some time for explaining the treatment procedures to parents.