Shiraz Emedical Journal
Volume:16 Issue: 5, May 2015

Most pregnant women who deliver in obstetrics units require pharmacological or non-pharmacological pain relievers that could provide potent analgesic effects with least maternal and neonatal adverse effects.. The aim of this investigation was to compare the efficacy and adverse maternal and neonatal effects of Remifentanil given by bolus patient-controlled analgesia (PCA) versus continuous intravenous (IV) infusion for labor analgesia..Patients and This randomized, single-blind clinical trial was conducted on 82 nulliparous parturient women in the active phase of labor, admitted to Ali Ebn-e Abitaleb Hospital, Zahedan, Iran from January 2010 to March 2013. The participants were randomly assigned into two equal groups of 41. In the infusion group, patients received incremental Remifentanil IV infusion from 0.025 to 0.1 µg/kg/min. In the bolus group, participants received incremental PCA bolus Remifentanil from 0.25 to 0.4 µg/kg with a lock-out time of four minutes. Average Visual Analog Scale (AVAS) pain scores in stages 1 and 2, labor duration, adverse effects, neonatal outcomes, total amount of administered Remifentanil and maternal satisfaction were assessed.. In both methods, the pain scores were significantly reduced after Remifentanil administration in both stages of labor (P < 0.001). There were no statistically significant differences in the pain intensity reduction between the groups (P = 0.49, P = 0.36, in the stages I and II of labor, respectively). There were no statistically remarkable differences between the two groups for labor duration (P = 0.4), neonatal outcomes (P = 0.9) and maternal satisfaction (P = 0.8). The total amount of administered Remifentanil was significantly lower in infusion group compared to bolus group (P = 0.001).. Remifentanil in both infusion and bolus methods could decrease labor pain in both stages without serious maternal or neonatal adverse effects and without increasing the duration of labor. The average dose of Remifentanil needed to reduce pain was significantly lower in the infusion method compared to the bolus method..

Providing healthcare for mothers and children is one of the major health duties in any community and is considered as a health index. Regarding the analysis of healthcare services, Anderson’s behavioral model has received great attention. According to this model, social factors play a determining role in consumption of healthcare services.. The present study aimed to determine social factors affecting healthcare consumption..Patients and This descriptive, cross-sectional, population-based study was conducted on 735 women who were mothers and were aged between 15 and 49 years old. These subjects were selected through multi-stage cluster random sampling. The study data were collected using a researcher-made data gathering form. The data were entered into the SPSS software and analyzed using descriptive statistics and multiple logistic regression tests with the enter method. The significance level was set at < 0.05.. The mean age of the studied women was 30.6 ± 5.7 years. Most of them (628 cases, 85.4%) were housewives and 317 (43.1%) had high school education. Besides, 570 women (77.6%) had no incomes and 94 (12.8%) mentioned that they had received no services during pregnancy. Nevertheless, 74 (56.1%), 248 (33.8%) and 74 (10.1%) had received services from governmental, private, or both centers, respectively. Women’s and husbands’ education levels as well as women’s occupation affected reception of services.. According to the results, a large number of the subjects had not received services and in case they had, it was from the private sector. Moreover, social factors, such as education level, income and occupation, were influential factors regarding received services..

Disease often occurs unpredictably and, in the absence of adequate coverage, its expenditures can have significant economic impacts on a family.. This study aimed to identify the determinants of exposure to catastrophic healthcare expenditures in the hospitalized patients, in the selected hospitals of Shiraz University of Medical Sciences, Shiraz, Iran..Patients and This study was conducted on 376 patients hospitalized in similar wards of a public and a semi-private hospital in Shiraz, Iran. The study data were collected using World Health Organization questionnaire, the Persian version of which it was validated in a previous study. Catastrophic health expenditures payments were calculated based on the households’ capacity. Data were analyzed using chi-square test, T-test, Mann-Whitney, and logistic regression by SPSS.. Based on the findings of the present study, 175 (47.3%) of the hospitalized patients were exposed to catastrophic healthcare expenditures in 2013. Additionally, the results of regression analysis indicated that the type of hospital, ward, supplemental insurance status of the head of household, duration of diagnosis, duration of hospitalization, and ability to pay, and not the household''s economic status, were effective in reducing the exposure to catastrophic healthcare expenditures.. The high percentage of households, facing catastrophic expenditure in hospitalized patients, revealed an expenditure bottleneck in the health system. Therefore, when planning to reduce excessive expenditures in the health system, a crucial point is to consider hospitalizations..

Measurement of common carotid artery intima–media thickness (IMT) is considered a safe, inexpensive, precise and reproducible measure of atherosclerosis. It is also considered an early predictor of vascular events such as cerebrovascular and cardiovascular complications.. This study aimed to determine the predictors of common carotid Intima-Media Thickness (IMT) and cardiovascular risk factors in a sample of Iranian general population..Patients and This cross-sectional study was performed on a randomly selected sample of Iranian general population in Shiraz, southern Iran, during a 10-month period from November 2010 to September 2011. All patients underwent anthropometric and blood pressure measurements and medical history assessment and physical examination were also performed. Laboratory measurements included Fasting Blood Glucose (FBS), lipid profile, Complete Blood Count (CBC) and thyroid hormones. Moreover, IMT was measured in the subjects with a cut-off point of 0.8 mm and its correlation with other risk factors was assessed.. From a total of 777 eligible subjects included in the study, 326 cases (42%) were male and 451 (58%) were female with the mean age of 42.64 ± 13.89 (ranging from 18 to 88) years. Overall, 78 (10.1%) subjects had hypertension, 51 (6.5%) were diabetic and 158 (20.3%) had metabolic syndrome. Moreover, IMT was found to be normal in 605 (77.9%) subjects while 172 (22.1%) subjects had thick IMT. Patients with IMT thicker than 0.8 mm were significantly older (P < 0.001) and had a higher prevalence of hypertension (P < 0.001), Diabetes Mellitus (DM) (P = 0.016), smoking (P = 0.002), higher levels of Triglyceride (TG) (P = 0.022), higher Body Mass Index (BMI) (P = 0.005) and larger waist circumference (P < 0.001). Thicker IMT was associated with higher risk of metabolic syndrome (P = 0.008). Women had also a higher prevalence of thick IMT compared to men (50.6% vs. 49.4%; P = 0.027).. The prevalence rates of cardiovascular risk factors as well as metabolic syndrome are relatively high in our region. Intima-media thickness is affected by age, hypertension, DM, smoking, BMI, waist circumference and TG levels and is an appropriate predictor of atherosclerosis. Appropriate policies and actions should be undertaken to prevent the cardiovascular events in our regions..

The active participation in protection of environment is the responsibility of all, but this attitude needs to be encouraged from childhood. Religious beliefs could be one of the best bases to promote Environmental Ethics (EE) in this period. Children could be well-informed and convinced through multiple modes, including distant learning on the importance of EE and the way that they should interact with environment. This would hopefully help to protect the environment for the next generation..