International Journal of Community Based Nursing and Midwifery
Volume:3 Issue: 1, Jan 2015

Relapse is a common problem in drug user’s rehabilitation program and reported in all over the country. An in-depth study on patients’ experiences can be used for exploring the relapse process among drug users. Therefore, this study suggests a model for relapse process among Iranian drug users. In this qualitative study with grounded theory approach, 22 participants with rich information about the phenomenon under the study were selected using purposive, snowball and theoretical sampling methods. After obtaining the informed consent, data were collected based on face-to-face, in-depth, semi-structured interviews. All interviews were analyzed in three stages of axial, selective and open coding methods. Nine main categories emerged, including avoiding of drugs, concerns about being accepted, family atmosphere, social conditions, mental challenge, self-management, self-deception, use and remorse and a main category, feeling of loss as the core variable. Mental challenge has two subcategories, evoking pleasure and craving. Relapse model is a dynamic and systematic process including from cycles of drug avoidance to remorse with a core variable as feeling of loss. Relapse process is a dynamic and systematic process that needs an effective control. Determining a relapse model as a clear process could be helpful in clinical sessions. Results of this research have depicted relapse process among Iranian drugs user by conceptual model.

Home visit program can be effective in infants’ growth and development. The present study aimed to investigate the effect of home visit program on preterm infants’ growth and development within 6 months. It was a double-blind clinical trial study. The study was conducted in Hafez, Hazrat-e-Zeinab, and Namazee Hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran from 2010 to 2011. Preterm infants were divided into intervention (n=30) and control groups (n=30) through blocked randomization. The intervention group received home visit training program for 6 months, while the control group only received the hospital’s routine care. Then, the infants’ growth indexes, including weight, height, and head circumference, and development criteria were compared on the first day of admission in Neonatal Intensive Care Unit, and then first, second, third, and sixth months. The data were analyzed using Chi-square, independent t-test, and repeated measures ANCOVA. The mean weight of the intervention and control group infants was 7207.3±1129.74 and 6366.7±922.26 gr in the sixth month. Besides, the intervention group infants’ mean weight was higher compared to the control group after six months (t=-3.05, P=0.03). Also, a significant difference was found between the two groups regarding development indexes, such as following moving objects with the head, keeping the head stable when changing the position from lying to sitting, producing “Agha” sound, and taking objects by hand (P<0.05) during six months of age. The results showed that the home visit program was effective in preterm infants’ weight gain and some development indexes at the sixth month. Considering the importance of infants’ growth and development, healthcare staff is recommended to incorporate home visit training into their programs, so that steps can be taken towards improvement of preterm infants’ health.

Adherence to prescribed therapeutic regimen is an important element of self-care behaviors in cardiac patients. Awareness of disease may play an important role in patient adherence. Thus, this study was conducted to examine the relationship between awareness of the disease and adherence to therapeutic regimen among cardiac patients admitted to selected hospitals in Mashhad, Iran. Using a descriptive correlational design, 340 patients with heart disease were selected using convenience sampling from five hospitals in Mashhad during December 2009 to May 2010. Data were collected using three questionnaires including demographic information, awareness of disease and treatment adherence (including medication, diet and physical activity). Validity and reliability of the questionnaires were examined by content validity and test-retest, respectively. Also, inter-rater reliability was examined for two data raters. Data were analyzed by SPSS software, using Spearman and Kruskal-Wallis tests. The results showed that only 15 percent of the study subjects had a good awareness of their disease. The majority of patients followed a good medication adherence (79 %), good diet adherence (60%), and weak physical activity adherence (61%). A significant correlation was found between knowledge and adherence to therapeutic regimen (P=0.001, rp=0.32). This study showed that awareness of disease and adherence to physical activity was low in the majority of patients. It is recommended that studies should be conducted to explore effective educational programs and strategies to improve adherence to therapeutic regimen among cardiac patients.

Aging and its social-biological process naturally impair the functions of different body organs and cause progressive disabilities in managing personal affairs and performing social roles. Laughter therapy is an important strategy which has been recommended by experts for increasing health promotion in older adults. Therefore, we aimed to investigate the effect of laughter therapy program on public health of senior citizens. In a randomized controlled trial, we enrolled 72 senior citizens aged 60 and over referring to Jahandidegan (Khold-e-Barin) retirement community center in Shiraz, southwest Iran during January to February 2014. The participants were assigned into experimental (N=36) and control (N=36) groups. Data were collected using General Health Questionnaire (GHQ-28) and demographic questionnaire. The participants of experimental group attended a laughter therapy program consisting of two 90-minute sessions per week lasting for 6 weeks. We found a statistically significant correlation between laughter therapy program and factors such as general health (P=0.001), somatic symptoms (P=0.001), insomnia and anxiety (P=0.001). However, there was no statistically significant correlation among laughter therapy, social dysfunction (P=0.28) and depression (P=0.069). We concluded that laughter therapy can improve general health and its subscales in elderly people.

Cesarean section (C-section) in the North of Iran accounts for 70% of childbirths, which is higher than the national average of 55%. Understanding women’s perceptions towards modes of delivery in different cultures can pave the way for promoting programs and policies in support of vaginal delivery. We aimed to investigate women’s perceptions towards modes of delivery in the North of Iran. Using a focused ethnographic approach and purposive sampling, 12 pregnant women, 10 women with childbirth experience, nine non-pregnant women, seven midwives, and seven gynecologists were selected from hospitals, healthcare centers, and clinics of Tonekabon and Chaloos, Mazandaran, Iran, during 2012-2014. Data were collected through in-depth interviews and participant observation. Data analysis was performed using thematic analysis using MAXqda software. Two major themes emerged from the data including: “vaginal delivery, a facilitator of women’s physical and mental health promotion”, and “C-section, a surgical intervention associated with decreased labor pain”. Six sub-themes subsumed within these major themes were: vaginal delivery as a safe mode of delivery, fullfilment of maternal instinct, a natural process with a pleasant ending, and C-section as a procedure associated with future complications, a surgical intervention and sometimes a life saving procedure, and a painless mode of delivery. In the North of Iran, women’s justified cultural beliefs overshadow their micsconceptions, so it is hopped that through implementing appropriate training programs for raising awarness and correcting miscomceptions, vaginal delivery could be promoted even in regions with high rates of cesarean section.

Relaxation-training, as an anxiety-reducer intervention, plays an important role in fetal health. The present study aimed to analyze the effect of maternal relaxation on stress test (NST), basal fetal heart rate, and number of fetal heart accelerations. In this randomized controlled trial, 84 pregnant women were randomly divided into two groups of teaching relaxation and control groups in 2012. In the intervention group, 60-90 minute classes were held every week lasting for 4 weeks. Besides, home practice charts were given to the mothers and researchers controlled the home practices by phone calls every week. The control group received routine prenatal care. In the 4th week, NST was performed in the intervention group 30 minutes before and after the 4th session. In the control group, NST was done in the 4th week. The quantitative variables in the two groups were compared through ANOVA and Chi-square test. The results of paired t-test showed that relaxation could improve the NST results (P=0.01). Mean and standard deviation of basal fetal heart rate was 138.95±8.18 before the intervention and 133.07±6.9 after the intervention. Paired t-test also showed that relaxation reduced the basal fetal heart rate (P=0.001). Mean and standard deviation of the number of fetal heart accelerations was 1.5±0.8 before the intervention and 2.2±0.9 after it. The results of paired t-test also showed that relaxation increased the number of fetal heart accelerations (P=0.001). Relaxation could improve the NST results, reduce the basal fetal heart rate, and increase the number of fetal heart accelerations. Therefore, relaxation is recommended during pregnancy.

There are critical gaps in assessment and research on health among the elderly living in rural communities. The state of aging and health in rural areas provides a snapshot of our older adults’s need to necessary public health measures. The aim of this study was to determine the self-rated general health of adults residing in rural areas and compare the general health of the elderly with younger adults. In this population based study using multistage random sampling, 2259 adults aged (≥15 years old) were selected from rural areas of Shiraz, southern Iran. The participants were divided into three age groups: young adults (15-39 years old n=1574), middle aged adults (40-59 years old, n=530), and the elderly (≥60 years of age, n-155). Data were gathered using a translated version of the general health questionnaire (GHQ-28) and analyzed using Chi-square, one-way ANOVA, Kruskal-Wallis tests and ANCOVA analysis. SPSS software, version 16, was used for analysis. 34.8%, 31.6%, 52.3% and 7.7% of the elderly had a probable mental disorder in the somatization, anxiety, social dysfunction and depression categories, respectively. Moreover, 9.7, 7.1, 3.9 and 4.5% of the elderly had a severe mental disorder in the four mentioned subscales, respectively. Compared with younger adults, the elderly showed a significantly higher disorder in all subscales except for anxiety. Our findings showed that chronic disease had a great effect on general health. Screening programs and prevention of chronic disease by the newly established family physician in rural districts can improve the overall community health.

Thalassemia is a chronic disease with serious clinical and psychological challenges. The incidence of thalassemia in a family member may cause a psychological crisis in all family members and in this case coping strategies are required. This clinical trial study aimed to determine the impact of training coping strategies on their use by major thalassemic adolescents referred to Dastgheib Hospital in Shiraz. In this randomized clinical trial, 87 adolescents with major thalassemia who were randomly assigned to two groups of experiment and control were enrolled. Then the experiment group attended six sessions of coping strategies training program in isolation, each lasting for one and half hour. In order to examine the coping strategies, Jalowice’s coping strategy questionnaire was used in three periods including pre-intervention period and one month and two months after the intervention. The collected data were analyzed using independent t-test and Chi-square. Mean scores of problem-focused coping strategies in the experiment group increased in one month and two months after the intervention from 45±12.7 to 54.8±7.3 and 55.7±7.2, respectively. Also, the difference in mean scores of problem-focused coping strategies was significant in the two groups (P<0.001). Furthermore, the difference in mean scores of emotion-focused coping strategies was significantly different between the two groups in two months after the intervention (P=0.007). Based on the obtained results, teaching coping strategies has improved the use of problem-focused coping strategies and also effective coping with stress and disease problems in patients with thalassemia major. Therefore, it is recommended that authorities should consider this as a part of treatment program.