Shiraz Emedical Journal
Volume:15 Issue: 4, Oct 2014

“Clinical reasoning«is the key skill in medical practice, and well beyond mere medical knowledge. However, regarding the current medical school curriculums, little attention has been paid to develop such skills. It might be the reason why diagnostic errors are still the major causes of the patients'' harm.. The purpose of this study was to investigate the effect of teaching clinical reasoning skills (problem-based training in small groups) on improvement of the clinical performance of medical interns.. This quasi-experimental study was conducted from September 2012 to September 2013. All of the interns entering the Pediatrics Department of Hamadan Medical Faculty (4 three-month courses) were enrolled. Courses were assigned alternately as intervention and control. Interns in the control group had conventional training but for intervention group, a clinical reasoning workshop was held in addition to the conventional education. To assess both groups, the Clinical Reasoning Problem (CRP) test was used as the pretest and posttest. Data were analyzed with t test and paired t test.. Out of 62 participants, 30 (48%) were in the control group and 32 (52%) in the case group. Two groups were similar in baseline characteristics such as age and sex (P > 0. 05). There was no significant difference between the scores of the two groups’ pretests (P > 0. 05). The mean pretest and posttest scores of the control group had no significant difference (P > 0. 05), but comparison of the mean pretest and posttest scores of case group represented significant difference (P < 0. 05).. Clinical reasoning workshop will probably have a positive impact on upgrading clinical problem-solving skills..

Breastfeeding is an economic and valuable method to protect infant''s health during the life and provides unique biological and emotional effects for mothers and infants.. This study aimed to determine the effect of herbal tea containing Fennel seed on breast milk sufficiency signs and growth parameters of Iranian infants in medical health centers of Tehran University of Medical Sciences, Tehran, Iran..Patients and This study was a randomized clinical trial performed on 78 girl infants aged 0-4 months who were exclusively breastfed. After getting informed consent infants were randomly assigned into the intervention group (received herbal tea containing 7.5 g Fennel seed powder in addition to 3 grams black tea three times a day) and the control group (received herbal tea containing 3 grams black tea powder three times a day). Before and during four weeks of study, signs of breast milk sufficiency were evaluated through measuring the growth parameters and the number of wet diapers in a day, frequency of defecation and infant breastfeeding times.. Before intervention, there was no significant difference between weight, height, head circumference, the number of wet diapers and frequency of defecation times between the two groups (P > 0.05), but the number of breastfeeding times of control group was more than the Fennel group. After fourth weeks, Fennel significantly increased weight from (5261.0256 ± 1167.65801) to (6393.3333 ± 1083.42132), head circumference from (38.6103 ± 2.20033) to (40.1538 ± 2.00510), the number of wet diapers from (5.5000 ± 1.05131) to (8.5421 ± 1.21182), the frequency of defecation times from (1.7692 ± 1.03139) to (2.6410 ± 1.14655) and the number of breastfeeding times from (9.9359 ± 1.85380) to (16.7399 ± 1.63766) (P < 0.001), but it had no effect on height (P = 0.066).. Herbal tea containing fennel seed improved breast milk sufficiency signs..

Psychological problems have significant associations with HIV-related high-risk behaviors among female sex workers (FSWs).. The present study aimed to investigate the relationship between mental health and high-risk behaviors among FSWs in Shiraz, Iran..Patients and This cross-sectional study, conducted from October 2011 to May 2012, used a convenience sampling method to recruit 125 FSWs and 125 control women. After providing informed consent, each participant completed a validated questionnaire (SCL-90-R and high-risk behaviors).. In comparison to the control group, the mean age at first sexual relationship was lower among sex workers, and most of them (80.4%) had not used condoms in their most recent sexual intercourse. The mean scores on all subscales of the SCL-90-R were lower in the control group (P < 0.003), whereas psychological symptoms were significantly more prevalent among FSWs. A significant inverse relationship was found between global severity indexes (GSR) scores and use of condom in the most recent sexual intercourse.. Considering the association of high-risk behaviors with lower mental health among FSW, psychological interventions are needed in order to prevent high-risk behaviors and HIV transmission..

On the 21st century, due to advances in treatment and medical care, significant increases in life expectancy and decrease of birth rate, most countries including Iran have faced with the population aging problem.. Due to the increasing elderly population phenomenon and its physical and social impacts on seniors'' health, further research is necessary to improve the quality of life (QOL) for elderly. In this regard, the aim of the present study was to compare the QOL between two groups of elderly who were residents of nursing homes as well as those who live with their families..Patients and A cross-sectional study was conducted, in which 110 home-resident elderly people and 110 residents of three nursing homes in Shiraz, Iran, were selected by convenient sampling. In this study, two questionnaires were used. Demographic information of participant was recorded by the first questionnaire and their QOLs were assessed by SF-36 QOL questionnaire, which had been standardized in Iran (its validity and reliability had been confirmed for the Iranian population) by the second questionnaire. SPSS 15 was used and P < 0.05 was considered as a significance level for data analysis. Data were analyzed using the Kolmogorov-Smirnov test, t-test, chi-squared and correlation test.. The mean scores of the elderly QOL in all the scales for elderlies living with families were significantly higher than those of the nursing home residents. Furthermore, with the increase in the level of education, the scores of QOL in all the scales were higher. Furthermore, in all the eight scales, the highest QOL belonged to single or widowed elderlies and the lowest to divorced or spouse-died ones.. This study suggested that keeping elderly at home rather than nursing homes could be helpful to increase the QOL by providing chances for marriage, education and more social activities..

The necessity of correct management of costs in hospitals as an economic agent and their significance as the largest and most cost-consuming operational units of health system emphasize the importance of applying managerial tools and methods.. This study was conducted to estimate the production function of all hospitals affiliated with the Social Security Organization (SSO)..Patients and This was a cross-sectional study conducted on 64 hospitals affiliated with SSO during 2007-2009. The Cobb-Douglas model was applied, estimating the above hospitals production functions. The numbers of physicians, nurses, other staff and active beds were considered as inputs and the numbers of outpatients and inpatients were mentioned as the study outputs. Log form of production function, EViews 5 and SPSS, were used.. The production function of the studied hospitals showed that all the production factor indexes except for other staff had significant positive relationships with the number of inpatients as our output; meanwhile, the most and the least marginal production rates were related to active beds and other staff, respectively. Other findings showed a decreasing return to scale (DRS) in these hospitals. Moreover, during the whole study period, the highest average of surplus belonged to other staff.. According to the present results, it seems that these hospitals have to revise their human resource management policies to be able to apply this valuable input in an optimum manner. Furthermore, using appropriate economical tools may help them to recognize their surplus factors and in this way improve their productivity and efficiency..

Migraine is a chronic neurological disorder, which affects the quality of life (QOL). The burden of this disease could be improved by adequate prophylactic treatment. We aimed to assess the quality of life in patients with migraine treated with both propranolol and topiramate in Shiraz, Iran.
Patients and In this interventional study, we enrolled 100 newly diagnosed migraine patients who were referred to multidisciplinary clinic of Motahari in Shiraz. Reliable and valid Persian SF-36 questionnaire were used for the evaluation of baseline health-related QOL (HRQOL) and after treatment with 25 mg topiramate (twice daily) and 20 mg propranolol (three times daily) as prophylactic treatment. We used SPSS version 13 for data entry and analysis. Scale differences were statistically significant in all scales before and after the intervention, except in vitality scale. After treatment, the highest score belonged to physical problem and the lowest one was emotional problem. Men had significantly higher scores in body pain compared to women (P = 0.039).
Conclusions;: Combined migraine prophylaxis with propranolol and topiramate improved HRQOL in migraine sufferers in our study. Adequate prophylaxis improved especially physical problem scale, which manifests with better performing activity and work. More study on the effect of monotherapy along with combined therapy with different doses on HRQOL may be helpful to further evaluate this effect.

Following recommendations of Ayatollah Khamenei, supreme leader of Iran, about increasing knowledge and empowerment of community to provide, maintain and promote its health, on 7th of August 2014 and around the world day of reporters, Health Policy Research Center (HPRC) in cooperation with Shiraz university of medical sciences, United Nations International Children''s Emergency Fund (UNICEF) and the Islamic Educational, Scientific and Cultural Organization (ISESCO) offices in Iran hosted the 1st national seminar on Media and Health at Velayat convention center, shiraz, southern Iran. The lecturers discussed in details about complexity of media and health, role of media, information communication technology (ICT) and art in the health of the communities, health-media literacy and health management cycle, health and life style and role of women, media and its role on health promotion interventions, media and people’s rights and social responsibilities, media and health of school-age children, good experiences, challenges and suggestions about media and health in Iran, social media and complementary role of media on the health, media and self-care toward non-communicable diseases, media-induced harmful demands and contradictory messages..

Inflation rate is an important indicator of macroeconomics. The trade-off between inflation rate and the social welfare is an important issue, which leads to decreased access to health services.. The aim of the present study was to investigate the relationship between inflation rate of three components of healthcare, namely, hospitalization, medication, and specialist consultation. The study also attempted to determine the overall health inflation rate in Iran and the relationship between general and health inflation rates.. The available data on inflation rates from 1985 to 2013 were used to estimate the econometrics'' models. The stationary condition of variables was assessed by applying Augmented Dickey-Fuller test. Then, two econometrics models were estimated. The first model was used to evaluate the effect of inflation rate of health subcategories on overall health inflation rate, and the second model was applied to analyze the relationship between the rates of health and general inflation.. With 1% increase in the rates of inflation related to hospitalization, medication, and specialists’ consultation, the inflation rate of health would respectively increase by 0.41888%, 0.25372%, and 0.16307% in long term. In Iran, 88% of changes in health inflation rate are related to the changes in inflation rates of aforementioned subcategories. In addition, with 1% increase in health inflation rate, the general inflation rate would rise by 0.3070% in long term and more than 11% of changes in general inflation rate can be explained by changes in health inflation rate.. Inflation rates of hospitalization, medication, and specialists’ consultation have the greatest effects on overall health inflation rate. Moreover, general inflation rate is directly correlated with health inflation rate..

The underlying mechanisms of HIV infection and its social and economical consequences significantly differ between men and women.. The aim of this study was to examine gender differences in Human Immunodeficiency Virus (HIV) progression to acquired immune deficiency syndrome (AIDS) and death among people living with HIV in Shiraz..Patients and A historical cohort study (1996 to 2012) was conducted using data obtained from Shiraz voluntary counseling and testing center. Subjects infected by HIV, who were 17 years or older and antiretroviral therapy (ART) naive were included in this study. Basic demographic information, such as age at diagnosis, current age, gender, mode of HIV transmission, and education were extracted based on the dates of the reported positive Western-Blot (WB) tests.. Among the 1721 enrolled subjects who met the inclusion criteria, 1456 (84.6%) were male and 265 (15.4%) were female. Among all transmission routes, injecting drug use (IDU) was the most frequent for men (1262 = 86.7%) and sexual transmission was the most frequent for women (226 = 85.3%). The mean (SE) time of HIV to AIDS was 35.98 ± 0.95 months; 38.04 ± 1.09 for men and 27.85 ± 1.80 for women (P < 0.001, log rank test). Mean (SE) time of HIV to death was 31.74 ± 1.36 months; 31.83 ± 1.41 for men and 31.15 ± 4.47 for women (P = 0.773, log rank test).. This study showed that HIV-infected women, as compared with men, had faster progression to AIDS. This result may indicate that women refer to health centers late, so they are diagnosed during the developed stages of the infection. Uninvited and multivariate tests were used and no difference was found between survival time of men and women..