Payesh
Year:2017 | Volume:16 | Issue:2|Papers Count:18

Objective (s): Satisfaction of medical services has been considered as one of the most important outcomes. In Iran veterans and their families are covered by supplementary health insurance. The aim of this study was to assess the satisfaction of veterans and their families with outpatient care.Methods: This was a cross-sectional study A random sample of 1224 veterans and their families who attended outpatient care were studied. The trained interviewers collected the data through telephone interviews. Descriptive and analytical statistics were performed too analyze the data using chi-square test and logistic regression analysis.Results: The mean age of participants was 45.7 ± 13.9 years, 67% were male and 85% were living in urban areas. In outpatient visits, the satisfaction with the services was 94%. Satisfaction with the distant from service delivery location was 83 % and with the process of refunding the costs was 42%. Veteran groups and place of living were the important factors that were related to the satisfaction with the distant from service delivery location.Conclusion: The results indicated that care receivers were satisfied with the service of outpatient visit. Comparing to the desirable satisfaction with the service outpatient visit, satisfaction with the distant from service delivery location and the process of refunding the costs were lower and should be improved.

Objective (s): A major share of health system financial resources are dedicated to hospitals and any reform in the health system can affect the performance of them. The aim of this study was to determine the effect of Iran's health system reform and tariff change on income and expenditure of cardiovascular ward of a big tertiary Hospital in Iran in 2015.Methods: This cross-sectional study was conducted in cardiovascular department of a big tertiary hospital in Mashhad, Iran, using activity based costing. Data relating to performance, revenue and expenditure of the cardiovascular department were collected using a designed form.Results: After both health system evolution and tariff change, total health service related income of cardiovascular department has increased respectively by 31% (real value = 29% increase). The governmental funds which dedicated to this department has also increased by 104% (real value =10% increase). Total income of this department has increased respectively by 39% 26% after health system evolution and tariff change. The highest increase of income has related to operating room after tariff change (203%). After both health system evolution and tariff change, total expenditure of this department has increased respectively by 21% and 31%. The highest increase of expenditure has related to physician wage (97%) after tariff change. Totally, before health system evolution, profit of cardiovascular ward was 135 million rail while has changed after health system evolution and tariff change respectively by 3.452 and 3.257 million rail.Conclusion: Performance and financial indicators of Imam Reza cardiovascular ward have been effected substantially by health system reform; however, has not equally effected all revenue and expenditure items.

Objective (s): Exercise-based rehabilitation is an important and effective part of comprehensive care of patients with heart diseases, which in addition to controlling the disease, declines its progression and improves its symptoms. The aim of the present study was to evaluate the effect of 8 weeks cardiac rehabilitation program on cardiometabolic risk factors and serum levels of C-reactive protein in patients with coronary artery diseases.Methods: This quasi-experimental was conducted in 2015. In all 30 patients with coronary artery diseases (15 patients in experimental group and 15 patients in control group) were entered into the study. The experimental group received 24 sessions of cardiac rehabilitation program according to their health condition. The control group only received the usual care. Serum C-reactive protein levels (immunoturbidimetric method), body mass index and metabolic parameters (enzymatic method) were assessed before and after the intervention.Results: Overall 80% of participants were men and their mean age was 56.4±6.1 years. After an 8-weeks cardiac rehabilitation program, body mass index (P= 0.02), systolic blood pressure (P= 0.01), total cholesterol (P= 0.04), triglycerides (P= 0.02) and LDL-cholesterol (P= 0.03) were significantly decreased in intervention group. Cardiorespiratory fitness (Vo2max) increased significantly in the exercise group after the 8-weeks rehabilitation program (P= 0.01). In contrast, C-reactive protein concentrations did not change significantly in response to cardiac rehabilitation program (P= 0.28).Conclusion: The study findings demonstrated that the 8 weeks cardiac rehabilitation program could improve cardiometabolic risk factors in patients coronary artery diseases without change in concentrations of C-reactive protein.

Objective (s): Post-Traumatic Stress Disorder (PTSD) is a set of illness symptoms that happen in people who experience or witness a traumatic event. Various factors may have a role in the intensity of these symptoms. This research was conducted with the aim of finding the role of attachment to God and perceived social support in prediction of the intensity of these symptoms. Also, the two variables of age and the time passed since the traumatic event were taken into consideration.Methods: The population included all mothers in Tehran who received rehabilitation and welfare services. One hundred and three mothers were selected via the purposeful (qualitative) sampling method. Data were collected using a PTSD questionnaire, a questionnaire on attachment to God and a questionnaire on perceived social support. The stepwise regression model was used to analyze the data.Results: Results showed that attachment to God and social support from friends was predictors of reduced PTSD. It was also determined that age and the time since the traumatic event have no meaningful relationship with PTSD.Conclusion: It seems that spiritual and social factors with multiple functions can be largely effective in reducing PTSD.

Objective (s): Newspapers along with other mass media have a significant role in increasing health literacy of the general public. Pediatrics related information is one of the most important issues in newspapers. The goal of this study was to perform a content analysis of the newspapers in Iran for pediatrics information.Methods: This was an applied survey performed in year 2014 using the content analysis method. Data were collected via a checklist designed by the researchers. The statistical population consisted of all of the messages printed in 694 volumes in five most widely circulated Iranian newspapers (Iran, Jamejam, Keyhan, Resalat and Etelaat).Results: In all 426 articles were assessed. Distribution of pediatrics related information published was as follows: Jamejam (7.50%), Etelaat (5.26%), Iran (18%), Keyhan (5.3%) and Resalat (17.1%). ‘Mental disorders’ (19.6%) and ‘Nutrition’ (19.27%) had the highest and ‘Pathophysiology of body fluids and fluid therapy’ and ‘Gynecological problems in childhood’ had the lowest (0%) frequency. There was little attention to ‘Human Genetics’, ‘Metabolic disorders’ and ‘Children with special needs’.Conclusion: The Important messages in newspapers were more compatible with the needs of Iranian society. Iranian pediatricians and journalists have to pay more attention to the neglected subjects and perhaps update themselves with newer information in pediatric filed.

Objective (s): It is more than a decade that pre-marriage counseling is launched in Iran. However, the quality of the program has not been changed despite changes in situation and couples' needs. The aim of this study was to assess couples' and counselors' perspectives towards the program in Iran.Methods: This qualitative study was conducted on 153 couples and 6 pre-marriage counseling providers in an urban health center in 2013, in Iran. The sample included couples participated in pre-marriage counseling program, and counseling providers. Sampling was performed purposefully through typical case sampling and expert sampling. Couples selection was done based on participants’ educational level and socio-economic status. Thirty focus group discussions were performed to obtain couples and counseling providers' perspectives. Individuals’ opinions was recorded and written. Content analysis was performed for data analysis. Transcripts were read for several times, main themes were extracted, and coding was done.Results: Overall participants’ were unsatisfied with the program. Reasons of unsatisfactory sessions were brief and vague presentation of topics; simple, not elaborate topics; mistimed, short sessions; and using a lecture for all topics. They believed that the proper content of the program must include teaching life skills, family planning, and health issues. They also proposed different sessions for men, women, and inviting experienced experts for teaching some topics.Conclusion: The present pre-marriage counseling program does not meet the various needs of couples. Both its content and presentation needs major revision.

Objective (s): Breastfeeding has many benefits for both mother and child. However, in recent years breastfeeding has declined. This study aimed to determine the association between participation in childbirth preparation classes and breastfeeding.Methods: This was a cross sectional study of 600 pregnant women attending to prenatal education classes in Babol, Iran during year 2014 to 2016. Data were collected by a questionnaire including items on demographic and reproductive content. To determine the relationship between participation in childbirth preparation classes and breastfeeding chi-square and logistic regression analysis were used.Results: Statistically significant difference observed between number of sessions before birth with breastfeeding from birth to 24 months. Mothers participating in 4 sessions and more were more likely to use less formula milk for feeding their babies (p<0.05). Also, compared with term newborns, preterm newborns used more formula milk (p<0.05). Significant association between breast feeding status with demographic and reproductive characteristics and kind of delivery were not found.Conclusion: Prenatal education classes might be useful in improving breastfeeding.

Objective (s): Normal vaginal delivery is defined as the best method of delivery. However, its rate is decreasing. The purpose of this study is to assess the knowledge and attitudes of pregnant women towards mode of delivery.Methods: In this cross- sectional study, 702 pregnant women were studied. They were referring to public and private urban health care centers and hospital in Tehran, Iran. The data were collected by a questioner with items on demographic, knowledge and attitude.Results: The results showed that the majority of the participants had moderate knowledge on selecting a mode of delivery (47.6%). Overall 62.5% had a positive attitude to vaginal delivery, 31.5% were neutral, and 3.3% had a negative attitude to vaginal delivery. The figures for cesarean delivery ere: 20.5%, 60.1%, 19.4% respectively.Conclusion: Despite government efforts to promote natural childbirth, yet actual knowledge and attitude towards natural delivery is not desirable. Perhaps educational interventions are needed to promote vaginal delivery.

Objective (s): Nausea and vomiting of pregnancy is a list of the most common pregnancy problem. The combination of non-drug treatments involves nutrition, lifestyle changes, and alternative medicine to treat nausea and vomiting of pregnancy is paid less attention as a published guidelines. The aim of this research was to determine the effect of an educational intervention based on Ottawa Guideline in nausea and vomiting at first trimester of pregnancy.Methods: This single-blind clinical trial was conducted on 60 pregnant women with nausea and vomiting complication from a selected primary healthcare centers in Mashahd (Iran). The participants were randomly assigned to two groups, an experimental group and a control group. The experimental group received the Ottawa training guide (two sessions: general, attention, nutrition, lifestyle, alternative medicine, and acupressure) during two 60-minute sessions and the control group received the usual care. Depression Anxiety and Stress Scale (DOS-21(, the Rhodes index of nausea and vomiting, and Czech playlists training manual Ottawa were used. The Chi-square tests, Fisher Mann-Whitney U, independent and paired t-test were used for analysis.Results: There was a statistically significant difference between the two groups in terms of nausea (p= 0.002), vomiting (P = 0.007), and retching (P = 0.009) on the fourth weeks after the initial intervention. (p =<0.001). The mean of total score of nausea, vomiting and gagging in the second and fourth weeks in the experimental group were significantly lower than the control group (p <0.001).Conclusion: The Czech playlists training manual Ottawa can be effective in reducing nausea, vomiting in pregnant women.

Objective (s): Supporting parents has been proposed as one of the main nursing roles. This study was conducted to determine the views of mothers with premature babies in Neonatal Intensive Care Units (NICU) about nursing support.Methods: In a cross-sectional design study, a sample of 153 mothers with premature infants in NICU was recruited through the convenient sampling method. Data were collected using a demographic questionnaire, and Miles’s nurse parent support tool. This Likert scaled tool contained four dimensions of emotional support, information-communication support, self-esteem support, qualitative care support.Results: The Qualitative care support (3.38) and self-esteem support (3.05) were the most types of supports mothers have received, respectively. The least types of support were information-communication support (2.94) and emotional support (2.76), respectively. In terms of the importance of different types of supports, mothers believed that qualitative care support (3.62), information-communication support(3.5), self-esteem support (3.45), and emotional support(3.31) were the most important expected supports, respectively. A significant difference was found between the mean score of all types of supports; and the total score of received support, and the importance of the support (p<0.05).Conclusion: Preceived support by mothers was less than expected support.

Objective (s): First birth interval has received special attention in public health and demographic investigations due to its implication in fertility, and maternal and child health. Study of ideal first birth interval also is a very important issue since it demonstrates people’s attitude towards fertility. The aim of this study was to investigate the factors, which affect ideal first birth interval among pre- marriage youths.Methods: A sample of 12500 pre-marriage male and female youths in all provinces of Iran who visited pre-marriage counseling centers was selected. The sample selection was based on multistage stratified sampling method. Data were collected in year 2014 using a structured questionnaire. The ideal first birth interval as outcome variable was indicated by univariate survival analysis and stratified Cox model while controlling for some independent covariates.Results: Based on univariate survival analysis, age, ideal numbers of children and employment status were found to have significant effects on the mean of ideal first birth interval in all provinces. However by fitting different stratified Cox models to different groups of provinces, different covariates were found to play significant effect.Conclusion: Although there were different factors for influencing ideal first birth interval in different provinces, the differences were in the same direction. In all provinces, ideal first birth interval decreased by increase in age and university students favored longer ideal first birth interval than other participants. Risk of early childbearing for women, people who lived in rural area, had lower educational levels, had greater ideal number of children and had sex preferences were higher compared to the other groups.