[Survey of attitude of physicians and nurses toward physician-nurse collaborative relationships in general hospitals of Tehran university of medical sciences]

Introduction: Physicians and nurses have to effectively communicate together and believe that none of them can reach to the expected results without another's help. As a representative of an effective communication, collaboration is process through which physician and nurse discuss healthcare problems of the patients and each one presents his/her information based on mutual respect to complete a healthcare program. The main objective of this study is to define the attitudes of the physicians and nurses occupied in public hospitals of Tehran University of Medical Science about Collaboration

Method: This is a cross sectional comparative study in which the study population was selected among the physicians and nurses employed in hospitals of Tehran University of Medical sciences. The tool applied in this study consists of two parts. The first part involves demographic characteries of the research samples, whereas the second part includes Jefferson questionnaire to measure attitudes toward physician-nurse collaboration. The collected data were subjected to statistical analysis using SPSS v.14 software package. To obtain research objectives, after collecting required information, data were analyzed using descriptive statistical indexes a and T test, chi[2] test, and ANOVA were used

Results: In this study 160 sample participated for each group. The results of this study indicated a significant difference [P<0.001] between mean scores of the physicians [44.5 +/- 5.05] with that of nurses [50.8 +/- 3.84]

Conclusion: Based on findings of this study, it was concluded that it is required to do some cultural practices about the cooperation between physicians and nurses. In addition, it seems that holding workshops to define the objectives and strategies for creation of collaboration toward physicians and nurses is of highest significance for medical and nursing students. Through elucidating the attitude of physician and nurse toward collaboration, this research can provide some strategies for creation of effective communication between physician and nurse through which both can be benefited

[Factors associated with quality of life in people with lower limb amputations]

Amputation of a body part is a "life-changing event". Amputation affects almost all aspects of an individual's life. Many issues arise following the loss of all or part of a person's limb[s]. Disability as a consequence of amputation has a devastating effect on the quality of life of the disabled people. The aim of this study was to investigate the factors associated with quality of life in people with lower limb amputations. It was a descriptive, cross-sectional study. The study population consisited of all above 18 years refferd to the rehabilitation center of Tehran during 2008 who had lost part or all of their lower limb due to disease or accident. Data was collected by the Short Form 36 Item Health Survey Questionner [SF36], and a researcher made tool, and analyzed using SPSS-PC [v.12]. The score of the quality of life of most study sample [%59/2] was 34-46. The mean and standard deviation of total quality of life was 55.02 +/- 17.226. there were a significant relationship between the quality of life and the samol's age, marital status, number of children, education, job status [before and after amputation], financial status, residence, the status of residence, type of insurance, type of home, the amputated limb, the level of amputation, the time after amputation, using prosthesis, use of assistive devices, and the reson for amputation [P<0/05]. The regression analysis revealed that the factors associated with quality of life in order of importance were using prosthesis, financial status, the reson for amputation, and the number of children. Identification of these factors for consultation, planning and implementing appropriate health policies to improve quality of life of these individuals is recommended

[Health research priority setting in Iran]

Priority setting is one of the most important issues in health research systems. No national health system can afford to finance all research projects proposed by researchers, especially in developing countries. Therefore, we decided to set the main national health research priorities in Iran using the Essential National Health Research [ENHR] method. All of the Iranian universities of medical sciences and other stakeholders collaborated in this study. The methodology for research priority setting was based on needs assessment and ENHR. The total number of research priorities gathered from universities of medical sciences was 6723. The proportions of topics related to basic science, applied and development subjects were 17%, 78% and 5%, respectively. Further analysis of the data showed that almost half [46.3%] of the research priorities were descriptive, 36.0% analytical, and 17.6% interventional. The research priorities were divided into 9 main areas, namely, communicable diseases, noncommunicable diseases, health system research, pharmaceutical sciences and industrial pharmacy, basic science, traditional and herbal medicine, nutrition, environmental health, and dentistry. Up to now the common procedure for research priority setting has been, with a top-to-bottom approach, managed by a limited number of researchers and experts, while in the method presented in this paper a bottom-to-top approach is used, which is more effective

[ comparative study of an experimental model of tendon healing process between healthy rats and streptozotocin induced-diabetic rats by a biomechanical evaluating method]

The aim of the present investigation was to compare the healing process of repaired Achilles tendons of healthy rats and streptozotocin induced diabetic [STZ-D] rats by evaluating strength and toughness of repaired tendons via tensiometrical test. 14 healthy male adult rat were divided into control [n=6] and experimental rats [n=8]. Type 1 diabetes was induced in experimental rats by an injection of 55 mg/kg STZ intraperitoneally. Control rats were received distilled water. Blood Sugar of all rats was recorded after seven days. Animals of experimental group that failed to develop average blood glucose concentration greater than 250mg/dc were excluded from the study. Right Achilles tendon of all rats was transected completely 30 days after STZ injection. Repairing Achilles tendons were extracted and were submitted to a tensiometerical examination10 days after surgery. Data were compared by student t test. Independent sample t test analysis showed that Young's modulus of elasticity [18.5 +/- 12.1MPa/mm] and stress high load [3.04 +/- 1.38, MPa/mm] of control group were significantly higher than those of experimental group [2.5 +/- 2 and 0.975 +/- 0.269 respectively], [p=0.003 and p=0.004 respectively]. It is concluded that induction of type one diabetes by STZ in rats after 30 days reduced significantly tensiometrical parameters of repairing Achilles tendon in comparison with control rats

effect of hands-off and hands-on methods on perineal status

Background and Purpose: Perineal damage is one of the traumas most frequently suffered by women during delivery. There are several techniques aimed at reducing the perineal damage. The present study is aimed at determining and comparing the frequency and degree of perineal rupture in hands-off and hands-on techniques of protecting perinea during labor

Method and Materials: This blind clinical trial [with the CI of 95% and test power of 80%] involved 187 women who, after signing their informed consent, were divided into the hands-off [n= 98] and hands-on [n=89] groups through random allocation. In the experimental [hands-off] method, the midwife guides the parturient and observes the process of labor without touching the perineum or the head. In the control [hands-on] group, the midwife protects the infant's head using Ringen maneuver. The data were analyzed in SPSS using chi-square and Fisher's exact test

Results: The result showed that the undamaged perinea in the hands-off group was 44.9%, versus 10% in the hands-on group, where the difference was statistically significant [P < 0.0001]. Perineal laceration was 51% in the hands-off group and 47.2% in the hands-on group but the difference between the two groups was not significant [p = 0.55]. Most ruptures were of the firstdegree type [50% in the hands-off and 64.3% in the hands-on group]. In the hands-off group, 3.1% underwent episiotomy as compared with 75.3% in the hands-on group

Conclusion: The results suggest that a policy of hands-off technique in protecting perinea can be safe and efficient technique and can be an alternative method in perineal protection during labor

[ effect of using The organizational culture improvement model of patient education on anxiety and satisfaction of patients with coronary artery disease]

Cardiovascular diseases and their related complications, disability and mortality are proliferating in Iran. Developing and applying native models can be an important strategy to control such complications, more effectively. Organizational Culture Improvement Model of patient education was developed through a native qualitative research study which was tested in this study. The study aimed at investigating the effect of Organizational Culture Improvement Model of patient education on anxiety and satisfaction of patient with coronary artery disease. Using quasi- experimental method, 70 patients with coronary artery diseases purposely and five nurses through randomized sampling were selected. Data were collected using "The Eshpel Burgers' anxiety questionnaire" and "patients' satisfaction questionnaire". Findings demonstrated significant statistically reduced level of anxiety [before 58.81 and after 30.15 in intervention group and / before 58.74 and after 54.36 in control group] and increased patients' satisfaction [before 23.86 and after 52.57 in intervention group and / before 24.88 and after 26.7 in control group] in intervention group, compared to control group, after the intervention. Organizational Culture Improvement Model of patient education can have impacts on anxiety and satisfaction in patient with coronary artery disease

Spatial modeling of malaria incidence rates in Sistan and Baluchistan province, Islamic Republic of Iran

To identify the effect of environmental factors on malaria risk, and to visualize spatial map of malaria standard incidence rates in Sistan and Baluchistan province, Islamic Republic of Iran. In this cross-sectional study, the data from 42,162 registered new malaria cases from 21 March 2001 [Iranian new year] to 21 of March 2006 were studied. To describe the statistical association between environmental factors and malaria risk, a generalized linear mixed model approach was utilized. In addition, we used the second ordered stationary Kriging, and a variogram to determine the appropriate spatial correlation structure among the malaria standard incidence rates, and provide a proper malaria risk map in the area under study. The obtained results from the spatial modeling revealed that humidity [p=0.0004], temperature [p < 0.0001], and elevation [p < 0.0001] were positively, and precipitation [p=0.0029] was inversely correlated with the malaria risk. Moreover, the malaria risk map based on the predicted values showed that the south part of this province [Baluchistan], has a higher risk of malaria, compared to the northern area [Sistan]. Since the effective environmental factors on malaria risk are out of human's control, the health policy makers in this province should pay more attention to the areas with high temperature, elevation, and humidity, as well as, low rainfall districts

[Marital adjustment and quality of life in chronic hepatitis]

Background and Aim: The mutual relations between Quality Of Life[QOL] and Marital Adjustment[MA] is well documented in general population and in patients with specific types of chronic illness. However, there is no evidence in this regard in patients with chronic viral hepatitis. This study was conducted to assess the correlation between Health-Related QOL [HR-QOL] and marital adjustment in patients with chronic viral hepatitis

Method and Materials: Seventy-six [76] patients with chronic viral hepatitis type B [N = 63] or C [N = 13] who were referred to Tehran Hepatitis Center[THC] at summer 2007 were consequtively enrolled in this cross-sectional study. Demographic data [age, sex, marital status and level of education] as well as illness- related data [the type of viral agent, illness duration, treatment history and history of cirrhosis co-morbidity] were collected. The 36-item short-form of HR-QOL questionnaire [HR-QOL-SF36] and Dyadic Adjustment Scale Revised form [DAS-R] were then administered to respectively assess QOL and MA

Findings: Mean scores of many HR-QOL-SF sub domains such as role limitation due to physical problems, body pain, social functioning, general mental health, vitality and physical health were correlated with mean DAS-R total score, as well as all its subscores but marital cohesion. Domain scores of role limitation due to emotional problems and general health perception were correlated with total DAS-R score and two of its subscores[marital satisfaction and affection expression]. Total HR-QOL-SF36 mean score was correlated with mean DAS-R total score and two of its subscores [consensus with spouse and affection expression]. The mean score of physical functioning domain of HR-QOL-SF36 was not correlated with any of the DAS-R subscores

Conclusion: Considering the correlation between HR-QOL and different aspects of MA, family seems to play an important role in the life of patients with chronic viral hepatitis. So, psychological and psychiatric consultations for improving marital adjustment should be focused as a part of approach to these patients

[ effect of spring loaded posterior occlusal bite-block on treatment of skeletal open bite]

One of the most difficult procedures in orthodontics is the treatment of skeletal open bite. This malocclusion is characterized by backward rotation of mandible, an obtuse gonial angle, an increased anterior facial height, and a long face appearance. The treatment strategy of skeletal open bite has been mainly based on vertical growth inhibition, forward autorotation of mandible, and intrusion of posterior dentoalveolar structures. Early treatment of this malocclusion is of great interest because the therapeutic approach is functional before growth has been completed and is surgical afterwards. Posterior bite-blocks are one of the functional appliances which are commonly used. The purpose of this study was to evaluate the effect of spring loaded posterior occlusal bite block [SLPOBB] on dento-facial structures in patients with skeletal open bite. In this clinical trial study, our sample group consisted of 23 skeletal open bite subjects [9 males and 14 females] having a mean age of 9.8, treated by SLPOBB until the open bite was completely dissolved and a favorable overjet was achieved. Cephalometric tracing was carried out on the lateral cephalograms taken prior to and after treatment. The data were analyzed using paired t-test to determine significant changes [alpha=0.05]. Skeletal changes: A statistically significant increase in SNB, ArGoGn, mandible length, anterior facial height, UFH, LFH, and posterior facial height was found. Decrease in ANB, Palatal plane/MeGo, SArGo, SNGoAr, and Y-Axis was also significant. Dental changes: The results revealed a significant increase in Upper1/Palatal plane height, Lower1/GoMe height and Upper6/Palatal plane height and a decrease in Lower1/GoMe angle. SLPOBB was found to be effective in treatment of skeletal open bite by: 1] A significant decrease of mandibular posterior angles, an increase of posterior facial height, and upward and forward rotation of mandible. 2] Intrusion of mandibular first molars. 3] Extrusion of anterior dentoalveolar height, and lingual inclination of lower incisors

Stress distribution of maxillary first molar PDL with high pull headgear traction: a Finite Element Analysis

Application of heavy forces to maxillary dentition during treatment with headgear, induces high concentration of stresses in periodontal tissue. Quantification of this stress is of great concern in orthodontics. This study was designed to investigate the quantity and quality of stress response in the PDL of maxillary first molar which was subjected to high pull headgear traction using Finite Element method. In an experimental study, a three-dimensional finite element model of maxillary dentition, consisting of 17096 elements and 23013 nodes, was developed based on a young human skull. The forces were applied to the maxillary first molar in the stabilized Arch by means of a rectangular full size arch wire in [022] slot bracket. Mechanical properties of this model were based on previous studies. A 350 gram force was used for high pull headgear to affect the dentition [+30 degree] and stress distribution was investigated in buccal, palatal, mesial and distal side and in cervical, middle, apical sections of the PDL. The quantity of stresses were expressed as principal stresses [1,2,3], while the negative and positive signs indicated compressive and tensile stresses. The buccal surface of PDL of mesiobuccal root and the buccal, palatal and distal surface in cervical region of PDL of distobuccal root and the distal surface of the PDL of palatal root had received a great deal of stresses, in addition, the over all stress distribution in roots of molar had intrusive nature. The extension of high stress concentration areas observed after using high pull headgear is limited to.some root surfaces specially the distobuccal root

[Apgar score and arterial blood gas in the first hour of birth in neonates]

Background: Despite the high efficacy of Apgar score to find the neonates with respiratory distress, a low Apgar score is not a definite sign of asphyxia, as other factors can influence it as well

Methods: This case control study was carried out in Mirza Koochek Khan Hospital. Arterial blood gas in the first hour and Apgar score in minute 5 were evaluated in asphyxiated newborns [half of them had an Apgar score > 7 and the rest

Results: All of neonates were divided into two groups based on Apgar score [below 7 or over] each group consisting of 100 newborns. We found a significant association between Apgar score and ABG in the first hour of life [pH and BE being the most important factors of ABG]. A positive association between Apgar score and ABG was shown in male gender, Cesarean delivery and gestational age over 37 weeks

Conclusion: According to an association between Apgar score and ABG, we recommend evaluation of ABG as a routine procedure in neonates with a low Apgar score

[ related factors with lactating mothers' desires for choosing contraceptive method]

Introduction: One of the important factors for contraceptive choice is personal desires. There are various factors affecting mothers' desire in choosing contraceptive method in postpartum period. These factors cause two different mothers in the same conditions not to desire to use the same method. The aims of this research are determining lactating mothers' desires for choosing contraceptive method and the related factors

Methods: This study is a descriptive analytical cross sectional research type. The samples for this study are 384 lactating mothers referring to family planning services for the first time after delivery in Isfahan health centers. The sampling method was convenience and the data were collected with a questionnaire by interview. Descriptive and analytical statistical methods have been used in order to analyze the data in SPSS and EPI soft wares

Results: The findings indicated that the most common desired contraceptive method in lactating mothers was coitus interrupts [27.4%]. Also the following variables are as husbands, number of parity and alive children, age of the latest child, having knowledge of contraceptive methods and marital duration [P<0.05]

Discussion: Lactating mothers desires should be investigated in family planning consultation and the mothers should be obliged to avoid using contraceptive method with high failure rate [coitus interrupts]

[Neonatal septicemia caused by aerobic bacteria in newborn infants]

Background: bacterial sepsis in neonates is a clinical syndrome characterized by systemic signs of infection and accompanied by bacteremia in the first month of life. The mortality rate is high and sometimes has reported up to 50%

Objective: isolation of aerobic bacteria which are responsible for neonatal sepsis and determination of their antibiotic sensitivity patterns

Methods: the study was cross-sectional and undertaken in Imam Khomaini Hospital, Ahwaz during year 2000. Blood culture, identification of isolated species and susceptibility testing were done according to the standard techniques used in microbiology laboratories

Findings: the results showed that ten cases had positive blood culture which all of the isolated bacteria were gram negative bacilli. Enterobacter species were the predominant pathogens [50%]. Klebsiella pneumoniae and Escherichia coli had similar frequencies [20%]. One case was recognized as Alcaligens xylooxidans [10%]. All of the isolated bacteria were nearly susceptible to amikacin and resistant to ampicillin

Conclusion: based on the overall results of the study, entric gram negative bacteria were the common cause of neonatal sepsis

Dietary salt reduction potentiates the action of hypotensive drugs

Hypertension is a common health problem. Hypotensive drugs and low salt diet are used in its treatment. This study was designed to compare the effectiveness of a low-salt diet and drug therapy in the treatment of arterial hypertension. A total of 256 randomly selected patients with essential hypertension consulting the Non-contagious Diseases Clinic in Shahreza, Isfahan, Iran, were included in the study for a period of 28 days. They were divided into four groups. Groups A and B received both methyldopa [250 mg t.i.d.] and hydrochlorothiazide [daily 10 mg], the former consuming a normal and the second a low-salt diet. Groups C and D consumed a low-salt and a salt-free diet, respectively, with no drugs. Both treatments A and B caused statistically significant reductions in blood pressure even after seven days, but treatment B was much more effective. Reductions in blood pressure in Groups C and D were very little, even after 28 days. Using the three-way classification of analysis of variance, it was revealed that interactions existed among the three factors, i.e., age, diet and length of treatment, as regards lowering blood pressure. We conclude, confirming previous reports in the literature, that a low-salt diet potentiates the hypotensive action of antihypertensive drugs