The Causes of Discharge against Medical Advice from the Emergency Department of a Teaching Hospital of Tehran in 2012

Background: Discharge against medical advice (DAMA) occurs when a patient leaves the hospital against the physician’s advice. The aim of this study was to investigate the causes of discharge against medical advice. Methods: In this cross-sectional study, all patients who were discharged against medical advice from the Emergency Department of Shohada-e-Tajrish teaching hospital in the second half of 2012, were included. Data were collected by a researcher-made checklist that its validity and reliability had been confirmed. Data were analyzed by using Chi square and independent two-sample t-test. Results: The results show that among all the units of Emergency Department, the units of general surgery (14.4%), internal medicine (11.9%), and neurosurgery (11.9%) had the highest rate of discharge against medical advice, respectively. The main causes of discharge against medical advice were partial recovery according to patients’ opinion, the distance from home to hospital, and patients’ exhaustion from the hospital environment. However, there was no statistically significant relationship between discharge against medical advice and the type of Emergency Department unit, work shifts, or income. Conclusion: Due to the high rate of discharge against medical advice in teaching hospitals of Iran, it is essential to pay more attention to this important issue as the main issue emphasized on in clinical governance in teaching hospitals of Iran, and also prioritize providing high quality services in order to increase patients’ satisfaction and decrease the rate of discharge against medical advic

Evaluation of Temporal and Spatial Variations of Water Quality Parameters in Zohreh River, Iran

Discriminant analysis (DA) and principal component analysis (PCA), as multivariate statistical techniques, are used to interpret large complex water quality data and assess their temporal and spatial variation in the basin of the Zohreh river. In this study, data sets of 16 water quality parameters collected from 1966 to 2013) in 4 stations (1554 observations for each parameter) were analyzed. PCA for data sets of Kheirabad, Poleflour, Chambostan and Dehmolla stations resulted in 4, 4, 4, and 3 latent factors accounting for 88.985%, 93.828%, 88.648%, and 88.68% of the total variance in water quality parameters, respectively. It is indicated that total dissolved solids (TDS), electrical conductivity (EC), chlorides (Cl−), sodium (Na), sodium absorption ratio (SAR), and %Na were responsible for water quality variations which are mainly related to natural and anthropogenic pollution sources including climate effects, gypsum, and salt crystals in the supratidal of Zohreh river delta, fault zones of Chamshir I and II, drainage of sugarcane fields, and domestic and industrial wastewaters discharge into the river. DA reduced the data set to only seven parameters (discharge, temperature, electrical conductivity, HCO3-, Cl-, %Na, and T-Hardness), affording more than 58.5% correct assignations in temporal evaluations and describing responsible parameters for large variations in the quality of the Zohreh river

Mentors' and Postgraduate Students' Perception about Characteristics of Effective Education, Kerman University of Medical Sciences, Iran

Background & Objective: Little attention has been paid to generating systematic evidence-based qualitative approaches to effective education. This study aimed to explore postgraduate students' and mentors' view points, experiences and perceptions about effective education and its related factors in Kerman University of Medical Sciences, Iran. Methods: In this qualitative study, using content analysis method and purposive sampling, 32 postgraduate students and 7 mentors were recruited. An interview guide was used to collect data through focus groups via in-depth interviews. After obtaining verbal informed consent, data were recorded, transcribed and analyzed using content analysis method. To ensure validity of the data, the acceptability and confirmability criteria were utilized. Results: Two main themes were extracted from the viewpoint of postgraduate students and the mentors, the direct and indirect factors related to effective education. Direct factors included the factors related to student, mentor, educational environment and motivation. Indirect factors were national educational system, evaluation system for students and economic factors. Conclusion: Both postgraduate students and mentors believe that effective education is a complex issue and macro-factors such as educational system and micro-ones such as mentors, and students, characteristics are important. In addition, there is inconsistency in students' and the mentors' perception about the roles of the other one; mentors believe that this is the responsibility of the students to learn and be self-motivated, while the students mentione that this is mainly the mentor' responsibility. This is an important topic which should be considered for planning effective education. Key Words: Effective education, Perception, Postgraduate student

Social Capital and Quality of Life among University Students of Yasuj, Iran

Background: Nowadays, quality of life (QOL) is largely associated with social capital and its components such as groups and networks, trust and solidarity, collective action and social cohesion, where social capital can both lead and improve QOL. The aim of this study was to determine the association between social capital and QOL among university students. Methods: A random sample of 338 students from University of Yasuj participated in this cross-sectional study in 2016, during 8 months. Data is collected using demographics checklist, Iranian version of WHO Quality of Life-BREF (WHOQOL-BREF), and Onyx and Bullen Social Capital Scale. All statistical analysis is performed using STAT 12. Results: Mean age of the participants was 24±3.8 years (boys 24.9±4.6; girls 23.3±2.8). Students scored highest and lowest on physical health (69.2±16.8) and environmental health (51.5±22.3) dimensions of QOL and average score of total social capital scale was 85.5±12.9. A multiple linear regression analysis confirmed the significant association between all four health-related dimensions of QOL and social capital (P<0.001). Conclusion: According to the results, a higher social capital can be indicative of an improved QOL among university students. Therefore, we may seek to build-up social capital by utilizing strategies such as developing social networking, social interactions, security, trust and sharing among university students

Factors Contributing to Mother-Daughter Talk about Sexual Health Education in an Iranian Urban Adolescent Population

Background: Parent-adolescent dialog on sexual issues reduces high-risk sexual behavior in adolescents. However, many adolescents are deprived of such training. Several factors may affect the sexual dialog between parents and adolescents. This study aimed to investigate the factors associated with mother-adolescent daughter dialog on sexual health matters in Iran. Materials and Methods: This cross-sectional study was carried out on 363 female adolescents aged 14-18 years in Ahvaz-Iran, between June 2015 and January 2016. Data collection was conducted utilizing multi-stage cluster sampling in high schools using the Parent-adolescent sexual dialog questionnaire and the parent-adolescent general dialogue questionnaire. The validity of the questionnaires was confirmed using content and face validity and their reliability was confirmed through internal consistency. The data were analyzed using descriptive statistics, Pearson's correlation coefficient, independent one-sample and two-sample t-tests, one-way ANOVA, and Post-HOC (Duncan) test. Results: The mean score of mother-daughter sexual dialog had a significant relationship with mother's education (F = 4.03, p > 0.003), adolescent's major (F = 4.48, p < 0.004), mother-daughter general communication (p < 0.001), and emotional relationship with parents (F = 6.47, p < 0.002). The more is the mother-daughter general communication, the more will be their sexual communication (p < 0.001). There was no relationship between the score of mother-daughter sexual communication and the age of mother or adolescent, parents' job, parents' marital status, and having sisters (p = 0.86). Conclusions: Some demographic characteristics of parents and adolescents, and the parent-adolescent emotional relationship can affect the communication between them about sexual issues. So efforts to enhance this communication should consider these factors as mediator variables

Harmful Effects of Alcohol Use in Iran: Acting Now is Crucial

Commentar

COMPARING THE EFFECT OF TWO METHODS OF ANESTHESIA INDUCTION ON CONSCIOUSNESS DURING ORTHOPEDIC SURGERY

Objectives: Consciousness during anesthesia is a non-reversible complication that may expose the patient to severe, long-term, emotional injuries and post-traumatic stress. Therefore, this study aimed to compare the effect of two methods of induction maintenance of anesthesia with thiopental sodium–remifentanil and propofol–alfentanil on consciousness during orthopedic surgery using a bispectral index (BIS) device.Methods: In this triple-blind clinical trial, 111 patients who underwent orthopedic surgery in Dezful Hospital (southwestern Iran) were investigated. Patients were randomly assigned into two groups: The intervention Group A†received thiopental for the induction of and fentanyl for maintenance and intervention Group B†received propofol and alfentanil. The patients underwent BIS monitoring before the end of surgery, and the BIS value was recorded. The Brice questionnaire was used to measure the consciousness. The data were analyzed using repeated Measure ANOVA test.Results: In the intervention Groups A and B, the mean BIS score was 63.71 and 60.62 in the first 5 min after surgery, reaching 65.25 and 67.73 60 min after surgery, respectively. The results of repeated measures ANOVA test showed that the mean BIS score was significantly different from the preoperative value (baseline) group during repeated measurements after surgery (5, 10, 15, 30, 40, and 60 min) (p&lt;0.001). According to the Brice questionnaire, the prevalence of hearing loss during surgery showed a statistically significant difference between the two intervention Groups (A and B), and the incidence of hearing during surgery in intervention Group B†was approximately 3 times higher than intervention Group A†(odds ratio=3.22, 95% confidence interval: 1.32–7.79).Conclusion: The results indicate that none of the induction and maintenance pharmacologic methods have any superiority in terms of optimal depth of anesthesia in patients undergoing orthopedic surgery

Prevalence of asthma and other allergic conditions in adults in Khuzestan, southwest Iran, 2018

Abstract Background Health information on the dimensions of asthma and allergic conditions in Khuzestan Province, as a major industrial and polluted area in Iran as and the Middle East, is inadequate. This study was performed to measure the prevalence of asthma and other allergic conditions in adults in Khuzestan Province. Methods This population-based cross-sectional study was carried out in 17 villages and 27 cities of Khuzestan Province during the years 2017–2018 on 20 to 65 year old respondents. Two-stage cluster sampling was used. The ECRHS (European Community Respiratory Health Survey) questionnaire was completed for individuals with additional questions regarding other allergic conditions. Results In the study, 5720 questionnaires were distributed of which 5708 were returned. The prevalence of current asthma was 8.5% and that of asthma-like symptoms was 19.0%. The most common symptoms of asthma were nocturnal cough (13.6%), chest tightness (12.3%) and wheezing (13.1%). The prevalence of allergic rhinitis (AR), eczema and airway hyperresponsiveness were 27.2, 10.7, and 38.7%, respectively. The prevalence of current asthma was strongly correlated with age, current location (city, village), and the smoking status of respondents (p < 0.05). Conclusion The prevalence of current asthma and asthma-like symptoms in Khuzestan Province is almost twice as high as in Iran. Given the high prevalence of symptoms of airway hyperresponsiveness in the entire province, it is necessary to take environmental measures to mitigate the emergence of new cases of asthma among the residents. In addition, surveillance studies are necessary to monitor the trends in the prevalence of asthma in this province

The effect of an education program based on the family-centered empowerment model on addiction severity among methamphetamine users

Introduction: In the process of treatment and prevention of relapsing to drug use, it is important to pay attention to mental health and supportive training interventions based on empowerment models. The present study was conducted to investigate the impact of training intervention based on the family - centered empowerment model upon the severity of damages caused by addiction among methamphetamine (MA) users. Material and methods: This study was a randomized trial. Subjects were divided into the intervention (95 individuals) and control (95 individuals) groups, randomly. The data collection tools included a demographics checklist and the Addiction Severity Index (ASI) standard questionnaire which were completed before, and three and six months after the educational intervention. The educational intervention was conducted in nine 90-minute sessions using the 5As method, group discussion and distribution of educational pamphlets. Statistical tests like the independent and paired t-test were used to analyze data. Results: The research findings indicated that the average scores of ASI subscales including family status, mental status and use of drugs were significantly different between before and three months after the training intervention in the intervention group (P < 0.05). The results also showed that the average scores of ASI subscales including medical status, employment, income, family, mental status, legal status and use of drugs were significantly different before and six months after the training intervention in the intervention group (P < 0.05). Conclusions: It was feasible to implement the family-centered empowerment model among MA users and it improved the severity of damages caused by drug abus

Rainfall-Associated Bronchospasm Epidemics: The Epidemiological Effects of Air Pollutants and Weather Variables

Background. This study compares different risk factors in patients visiting a hospital during five rainfall-associated bronchospasm epidemics in Ahvaz and those visiting on other occasions. Methods. This case-control study was conducted on 5307 patients with bronchospasm admitted to the Emergency Department of Imam Khomeini Hospital in Ahvaz (Iran) from late October to December (as the epidemic) and 916 patients admitted from late January to March (as the nonepidemic) in 2011 to 2015. Results. A total of the 41.7% of the cases and 48.8% of the controls had episodes of bronchospasm, suggesting a significant difference between the two groups (P<0.001). The mean concentrations of PM10, NO, NO2, and NOx pollutants (except O3) were significantly higher in the nonepidemic periods (P<0.05). The adjusted analysis showed a direct significant relationship between emergency respiratory admissions and each unit of increase in NO and SO2 concentration during the epidemic periods and NO2 concentration during the nonepidemic periods. During the epidemic periods, a direct and significant relationship was also observed between respiratory admissions and each unit of increase in relative humidity and evaporation. Conclusion. The results suggest that certain pollutants and weather variables are associated with the risk of emergency respiratory admissions during epidemic periods