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Background and purpose : Macrosomia can increase maternal & neonatal complications.These complications and their relevance to macrosomia was evaluated in this study.
Materials and Methods: This was a cohort study done , by selecting 5440 delivery files, in which 4400 cases had natural delivery and 104 patients with cesarean section . Patients with full term delivery of neonate with 4000 grams were selected as a case group and the patients with full term delivery of neonate with 25000-3999 grams weight were selected as a control group. Factors like , parity , and delivery status were the same for both groups , the patients with repeated cesarean were omitted in this study.
Results : The results of this study showed that the total rate of cesarean section in control group was 15.5% against the rate of 11.5% in control group (P<0.037) , and the main reason of cesarean in macrosomic group was due to fetal distress. Shoulder dystocia and excretion of moconium was the only complication of Macrosomic infants , which showed no statistically significant difference (P<0.002) , post delivery bleeding and administration of oxytocin for acceleration of labour in case groups showed no significant difference with cantrol groups (P<0.01).
Conclusion : This study indicated that , despite high rate of vaginal delivery , of macrosomic infant , excluding shoulder dystocia , delivery of macrosomia and post delivery bleeding , there was no significant difference in maternal complications and further study is recemmonded in such type of deliveries

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Background and purpose : The master patient’s index (MPÏ) card is the key to locate the patient’s record in medical records department. Üse of MPÏ in hospital information systems is important. Ân accurate MPÏ is noted in evaluation and accreditation program. Ôur study was done on MPÏ at medical records depatment of teaching hospitals in Mazandaran medical university in respect of using indexing rules and arrangement of cards for filing.
Materials and methods : This survey was done on patient’s cards in 5 teaching hospitals of Mazandaran medical university and 1999 MPÏ cards were checked. Â part of data related to using indexing rules and filing was gathered with checklist and factors associated with management of department collected in questionnaire. Data processed with SPSS software and analyzed with descriptive and inference statistics.
Results : Findings showed that 20% of staff responsible for indexing and filing of MPÏ were technician (post diploma course) in medical records. Ïn 100% of hospitals, guide card and cross-index card wasn’t use. Ïndexing error increased with the increasing the number of admitted patients (p= 0.003), low experience (p= 0.001) and degree and no course study relation of medical records department managers (X2= 9./03 , p = 0.000). Ïn addition, indexing error increased in staff with no academic training (X2= 3.84 , p = 0.05). Âlso results showed that there is 64.2% indexing error and 9% of cards are misfiled.
Çonclusion: Âccording to the findings, staffing professional personnel, training them with up dated knowledge, periodic control of issued cards, creating needed rules and regulation based on new scientific materials, exact indexing and filling rules suggested.

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Background and Purpose: One of the important problems of major abdominal surgery is post-operative pain control. There are different modalities to control the pain after surgery, such as oral, local or intravenous analgesic drugs, regional nerve block, epidural catheters and pain killer pumps with their own benefits and complications. The aim of this study was to evaluate the effect of continuous peritoneal infusion of lidocaine by a pain killer pump for post-operative pain management following laparotomy.
Materials and Methods: This double blind randomized clinical trial was performed on 76 patients (38 cases and 38 controls) who underwent laparotomy with midline incision, in Imam Hospital, Sari, Iran, in 2008. Two groups were matched in age and sex. After surgery a catheter infusion pump was prepared for all patients. In case group, 2% lidocaine (20mg/kg/day) and for control, normal saline infused for 24 hours. Pain score (Visual Analog Scale), blood pressure, heart rate, respiratory rate, temperature and analgesic requirement was evaluated in 4, 10, 16 and 24 hours after surgery. Results analyzed by means of SPSS (15) software and chi-square, t test and repeated measurement. The p value less than 0.05 was considered to be significant statistically.
Results: 76 patients, 39 (51.3%) females and 37 (48.7%) males, with mean age of 47.03±15.2 years were studied. There was no significant difference in age, sex and weight between two groups. The mean of admission days was 5.03±0.6 in case and 5.29±1.3 in control, with no significant difference between them. Mean of opiod consumption was 16.05±13.05 mg and 25.39±11.4 mg in case and control respectively (P= 0.002). Mean of VAS score, blood pressure, heart rate, respiratory rate and temperature in case group was less than control group and the difference was significant statistically. Pain severity changes during 4, 10, 16 and 24 hours following surgery were significantly different in two groups, with linear correlation between time and pain reduction.
Conclusion: Our study demonstrates that continuous infusion of 2% lidocaine by a pain killer pump can reduce pain and opioid requirements after abdominal surgeries.

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The purpose of this study is to investigate the relationship between stress & time management skills. In this descriptive study, 103 personnel were selected from Sari Health Center, by stratified random sampling, and data was gathered by two questionnaires from samples. Results: There is a significant negative relationship in two component study. Also, females´ stress level was higher than in males. However, these groups did not have a significant difference in time management. Regression analysis showed there is a significant relationship between gender, with stress and time management scores. For reducing stress and increasing organizational productivity, it is recommended to train these skills in orientation and employee training.

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Background and purpose: In spite of many studies on composting from municipal solid wastes, rural solid wastes have not been studied. A high percentages of rural solid wastes containing domestic, animal and agricultural solid waste is biodegradable. The objective of this research was to study the chemical and microbial quality of compost produced by mixed rural solid wastes and other composts.
Materials and methods: In this study, food wastes mixed with animal and agricultural wastes with a weight ratio of 2, 5 and 2 (with a final mixed weighting 150 kg) were studied. For investigation of chemical quality of these materials, some indexes such as carbon/ nitrogen ratio, percentage of carbon, phosphorus, potassium, lead, cadmium and zinc were measured. Microbial quality of these compost materials were defined by assessing the amounts of coliforms and parasite ova.
Results: The average amounts of some indices in mixed, household and animal composts were: C/N (14 ± 1.5 20 ± 1.7 17 ± 1.8), percentages of organic material (73 ± 3.9 64 ± 3.8 76 ± 2.5), carbon (32 ± 2.2 40 ± 2.4 37 ± 4.5), nitrogen (2.5 ± 0.5 1.5 ± 0.6 1.9 ± 0.3) and lead in mg/Kg (3.5 ± 0.7 16 ± 2.9 11 ± 1.9), cadmium (0.3 ± 0.05 3 ± 0.9 1.5 ± 0.4), respectively. The number of total fecal coliforms in compost produced by mixed solid materials was 643 ± 176 131 ± 52 respectively in 10 g of solid materials and the number of parasite ova was less than 2 in 4 g solid materials. The compost quality of mixed materials was in agreement with class A of USEPA guidelines hence, usable for flower and plant culturing.
Conclusion: Composting may be considered a method to manage the rural solid waste problem.

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Background and purpose: Transition from high school to university is a stressful phenomenon for most students, so it is imperative that they gain a variety of skills to adapt with the new situation. This study aimed at investigating the effectiveness of teaching life skills including: stress management, self-consciousness, and effective communication on the general health of freshmen.
Materials and methods: This study employed quasi-experimental method and had a control group as a standard of comparison. Âmong the undergraduate freshmen of Ïslamic Âzad Üniversity, Ürmia Branch, 100 students were selected through a multi-stage sampling method and were randomly divided into four equal groups (three experimental groups and one control group). Then, three types of instructions, namely, stress management, self-consciousness and effective communication were offered to them in six sessions (each 1.5 hours). Finally, the difference between the pre-test and post-test scores of general health questionnaire was compared.
Results: Ôverall, the difference between pre- and post-test scores related to general health components was significantly meaningful in favor of experimental groups (P<0.05). Ït was found that two elements i.e. anxiety and insomnia in stress management and self-consciousness groups, and the element of body indications in effective communication group improved more than the other elements. Âltogether, the means of dyadic analyses showed that teaching effective communication skills influenced all components of general health and the total scores achieved in effective communication skills resulted in better improvements in comparison with other two instructions.
Çonclusion: Ôur findings showed that teaching the life skills to students resulted in improved general health. Thus, it is suggested that these types of skill instructions, particularly communicative skills be included as a part of the university mental health programs.

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Background and purpose: Hypertension is a common chronic and relapsing disease caused by extensive and long-term changes in behavior related to lifestyle and is considered as a challenging issue throughout the world. The aim of this study was to assess the effect of self-management program on self- efficacy among hypertensive patients. Materials and methods: This quasi-experimental study was performed in 150 patients with mild-to-moderate primary hypertension attending health centers affiliated to Tehran University of Medical Sciences. The subjects were randomly assigned into two groups of experimental (n= 75) and control (n= 75). The intervention consisted of a one-day workshop for four hours and the scenario project. The subjects were then followed up through phone call: within two months. The data was analyzed using SPSS-16 and descriptive and analytical statistics. Results: The results showed significant differences among experimental and control group regarding the rate of self-efficacy after the intervention (P=0.000). In fact self-management program increased the patients' level of self-efficacy. Conclusion: Self-management program which results in higher level of self-efficacy could motivate the patients to change their behaviors, adherence to diet, medication, exercise and physical activity. Blood pressure thereby would be controlled.

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Background and purpose: Today, most organizations have recognized the value of their invisible assets and seek multiple methods to use them efficiently. One of these invisible assets is knowledge and knowledge management is a process of creating value from knowledge implementation. Execution of knowledge management requires paying attention to important factors such as organizational culture and information technology. The importance of these factors varies in different organizations according to organizational goals, organizational activities, the environment in which the organization is located, the amount of information and knowledge of the staff and facilities. This study was conducted to investigate the key factors in the establishment of knowledge management in administrative offices of Mazandaran University of Medical Sciences Materials and methods: This descriptive survey was conducted among the managers and the staff working in administrative offices of Mazandaran University of Medical Sciences. Morgan table was used and 200 people were selected of whom 189 (97 female and 88 male) completed a questionnaire. The questionnaire included 55 questions regarding information technology, organizational culture and knowledge management, and some questions on demographic features. Data analysis was done using IBM SPSS 20. Results: The result of this study showed significant differences between the knowledge of female and male subjects and the female case’s knowledge was lower than male cases (P <0.039). On the other hand there were significant association between support executives, sense of organization, collaboration, and management of information technology and knowledge management, but no significant correlation was found between trust and process information Conclusion: Due to the importance of knowledge management for organizations and interconnected nature of organizational culture and IT, staff should receive supports to maximally benefit from their experience and knowledge, thereby the most advanced information systems are created.

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Background and purpose: Proper and efficient management of hospital wastes because of its infection potential and possession of dangerous wastes is inevitable and this goal can be achieved only when we have a good understanding of the quality and quantity of hospital wastes and enough available information about separation, collection, treatment and disposal of hospital wastes. The aim of this study was to determine the health status and the quality and quantity characteristics of Tabriz hospitals that could help policy makers in the health sector to improve the quality of comprehensive planning and health services. Material & methods: This is a cross-sectional study and was conducted by completing the questionnaire, interviewing hospital health experts and visiting 10 hospitals out of the 11 hospitals of Tabriz University of Medical Sciences. Results: Total occupied beds in ten investigated hospitals were 2383 beds, which produced 8779 kg/d of solid wastes and capita waste generation was calculated 3/79 kg/d. Also, the average production rate of general wastes, infectious and chemical wastes, sharp wastes and pathological wastes were calculated respectively, 2.75, 0.875, 0.128 and 0.043 kg/d per bed. Conclusion: Unfortunately, the average capita waste generation per bed in Tabriz has a high rate of production in comparison to other cities of Iran. This research is a warning to the concerned authorities to remove this problem immediately by doing the best practices, taking the most appropriate decisions and the costs that are not too high.

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Background and purpose: The role of health system managers has always been emphasized in the efficient running of system of hygienic and remedial services and much attention is paid to the selection of the best persons to do that. The main purpose of this study was to design the managers' competency model of health sector and evaluate them from the standpoint of middle managers of health system. Material and methods: The study population included all the health system managers in Iran. The questionnaires were distributed among 385 people. The data were collected through the researcher's questionnaire which was used to assess the model proposed by applying library and field studies (interviewing with 30 person of health system managers of Iran). The questionnaire contains 8 main categories in competency criteria of managers and includes 63 questions. It was validated in terms of construct validity and Cronbach' alpha was used to ensure its internal consistency reliability. (more than 0.79 for each category). Inferential statistics (confirmatory factor analysis and structural equations model by specifying T-Value) and "LISREL" software was used to analyze the data collected from the questionnaire. Results: 280 filled out questionnaires of the participants (75.1%) were analyzed in this study. Based on the collected data, T. values for knowledge of and professional awareness competencies, behavioral and intellectual, personal traits, service, responsibility, and considering the ideological and moral (ethical) values equal 11.90, 11.06, 8.39, 10.68, 6.55, 9.31, 3.43, and 2.17 Conclusion: Considering and applying the presented criteria in proposed competency model of health system managers which are ranked by the middle managers can be one of the way of improving the quality of management in the health system of Iran.

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Abstract Background and purpose: The aim of this study was to evaluate the efficiency of stress management skills training in reducing aggression among university students. Material and methods: This experimental study was done with pretest-posttest and control group design. The subjects included 45 students who were randomly selected and assigned to either experimental or control group (experimental group: n = 23, control group: n = 22). The Buss and Perry aggression questionnaire was used to collect the data and analysis of covariance was performed. Results: Significant differences was seen in per- and post- test scores for all aggression components in experimental group (P<0.001). Conclusion: According to this study stress management skills training was found helpful in reducing aggression. Hence, this method could be of great benefit in reducing aggression, thereby improving the mental health state among university students.

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Background and purpose: Providing excellent patient care requires effective leadership. The aim of this study was to codify accreditation standards based on scientific evidences and local conditions for management and leadership in hospitals in Iran. Materials and methods: In this applied study the codification process lasted for three years (2007-2010) and several activities were done in different stages. They were reviewing the accreditation standards of selected countries, reviewing the standards of Iranian hospital evaluation, forming expert panel and determining the type of accreditation model, preparing a standard draft and feedback form, organizing symposium and expert panel, performing a pilot study, holding workshops and subsequent revisions, codification and notification standards. Results: National hospital accreditation standards for leadership and management in Iran consists of 9 categories and 151 standards (65 clauses, 86 sub clauses) including governance, executive, chairman- managing director, hospital administration, management of educational and research activities, risk management, crisis/disaster management, failures and adverse events, and financial management. Financial management included most of the standard clauses (24 clauses and 23 sub clauses). Conclusion: Hospital managers play an important role in developing hospital accreditation standards in different wards and departments (clinical and non-clinical), patient safety, and quality improvement

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Background and purpose: Nurse managers are responsible for creating and maintaining a professional work environment and their leadership styles are of great importance in reinforcing effective environment for promoting clinical competence. The purpose of this study was to explain the ward management concerns or self-protection as a paradox of ward management by head nurses. Materials and methods: In a qualitative research, 22 head nurses participated. Data was collected through unstructured interviews and purposive sampling which continued until data saturation. Conventional content analysis was applied to analyze the data. Results: During data analysis, three main themes resulted including "negligence and indulgence" with self-protection and patient protection as the subcategories, "communicative capability" with interpersonal relationship and relationship between occupational groups as the subcategories, and "management competencies" with providing the ward necessities and creating confidence in nurses as the subcategories. The experiences and functioning dimensions of head nurses were found as the concerns in managing the ward or self-protection in the clinical management. Conclusion: This study indicated that the communication and management abilities were not practically effective, probably due to lack of applied management knowledge and also inappropriate structure and performance of the organization which causes unsatisfactory managerial behaviors and negligence and indulgence. Therefore, promoting communicative abilities and professional management in practice are inevitably necessary by head nurses.

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Background and purpose: The office of disaster management and emergency medical service is one of the most important subdivisions of the Ministry of health. Analyzing the tasks and functions of this office is critical to its evaluation. This study aimed at analyzing the information needs of this office to develop statistical indicators required.

Materials and methods: This qualitative-quantitative study was carried out during 2015. The study population included the managers and expert panels in disaster management and emergency medical service in the Ministry of Health and Medical Education of Iran. We interviewed 14 individuals in different departments within the office and reviewed the administrative tasks and the available documents. After analyzing the data, different information needs of all departments were identified and classified.

Results: According to the administrative tasks and practices, 69 groups of information needs were identified of which 17.4% are not met. 45.3% of the information needs did not have any standard sources or forms to collect the data required.

Conclusion: Lack of standard sources for the most identified information needs, decentralized information systems, and out-of-date information are the major problems of managers and expert panels. So, designing national standard forms to collect data, designing a comprehensive statistics and information system and reviewing current paper forms and databases seem to be essential.

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Background and purpose: Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder of childhood that is associated with parent-child conflict and parental stress. The aim of this study was to compare the effectiveness of delivering behavioral management training to parents and narrative therapy to children on the quality of mother-child relationship in children with ADHD.

Materials and methods: A quasi-experimental study with pretest-posttest and control group was performed. The research population included all children aged 7 to 12 years old with ADHD and their mothers in Sari, Iran. A total of 30 cases were selected and divided into three groups. The mothers in first group attended nine sessions of behavioral management training which were presented according to Barkley’s pattern. Group narrative therapy was done among children in second group for eight sessions, while the third group received no training. Parent-child Stress Index was used for data collection.

Results: The results showed that the mean of post-test score for parent-child conflict in first group was 78.11±16.78 and in narrative therapy group was 76.9±13.92, indicating no significant difference between these two groups, but the score in control group was 96.22±22.95 that was significantly higher compared with the experimental groups (P<0.05).

Conclusion: The results showed no significant difference between behavioral management training to parents and narrative therapy in improving the quality of mother-child relationship in children with ADHD and compared with the control group, both methods were found to be significantly effective in improving the quality of mother-child relationships.

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Background and purpose: In order to improve the efficiency, effectiveness and quality of health care services, it is necessary to manage their organizational knowledge and information. In this paper, the readiness of Iran’s health centers for establishing knowledge management was studied.

Materials and methods: We conducted a descriptive study in which the status of some indicators for the establishment of knowledge management was studied. The indicators included the leadership, human resources, technology, culture, structure and processes of Iran’s health care centers. A questionnaire was administered that consisted of items scored according to Likert scale from very high (5) to very low (1). The research population included the managers and administrators in health centers who were selected from 15 provinces. Data analysis was done in SPSS V.16. 

Results: The indicators of information technology 3.24±1.06, organizational processes 3.21±1.04, human resources 3.21±0.93, organizational structure 3.19±0.84, and organizational leadership 3.16±1.05 were in appropriate state for establishing knowledge management. But the organizational culture 2.91±0.99 was found to have inappropriate condition.

Conclusion: Health policy makers are needed to plan for enhancing health care centers readiness for establishing knowledge management. The poor state of health centers in organizational culture calls for appropriate planning to improve its sub-indicators such as creativity and critical thinking, collaboration between experienced staff and newcomers, institutionalization of knowledge among the staff, supporting innovation in knowledge and teaching methods, and performance evaluation based on the individuals’ contribution in the organization.

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Background and purpose: Nowadays, human and financial losses caused by natural and non-natural disasters have a great impact on human health. This research was conducted to determine the ability of selected hospitals in crisis management according to the World Health Organization.

Materials and methods: A descriptive study was done in which the authorities (n=45) in three selected hospitals (Razi, ValieAsr, and Shafa) in Mazandaran province, Iran were participated in 2015. Data was collected by world Health Organization check-list and was analyzed using numerical taxonomy in Excel software.

Results: The check-list included five scales: general information, identification of the risks and the level of functional safety, structural safety, and non-structural safety. Compared with two public hospitals (Razi and ValieAsr) the overall safety level in private hospital (Shafa) was higher (57.84%). Considering the ranking and developmental status, except Vali-Asr hospital (0.5 0.75).

Conclusion: This study showed the need for a standard management system in crisis management and serious attention to general indices, risks and safety levels in hospitals.

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Background and purpose: Considering the importance of pain management in cancer patients, this study aimed to assess the prevalence of pain, its severity, analgesics used to control pain, and the extent of pain control in cancer patients attending a medical center in North of Iran.

Materials and methods: One hundred cancer patients attending Ramsar Imam Sajjad Hospital (2015) were prospectively enrolled in the study. Clinical and demographic data and all analgesics used were recorded. Pain intensity were determined based on the Numeric Rating Scale from 0 (pain-free) to 10 (the most severe pain ever experienced) in two sequential visits, 3 weeks apart.

Results: The average age of participants was 54.7±3 years. NSAIDs (98 cases, 98%) and opioids (49 cases, 49%) were the most common analgesics prescribed. Among opioids, codeine (67.3%) and morphine (24.5%) were used more frequently. The pain score was 3.94±0.342 at first visit and 3.65±.316 following analgesic use (P=0.002).  For opioid users, the pain scores were 4.29±0.53 and 3.84±0.506, respectively (P=0.007).

Conclusion: The pain scores statistically reduced, however, the decrease was not clinically prominent since the pain severity was between 3 and 4 in NRS scale. More attention to pain control is recommended in cancer patients while considering the standard pain management guidelines.

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Background and purpose: Pregnancy creates permanent changes in life of women and brings new responsibilities which could lead to a great level of stress in women. Stress could result in some complications to mother and her neonate during delivery. This study aimed at determining the effect of cognitive behavioral therapy (CBT)-based self-management intervention on labor outcome in nulliparous women.
Materials and methods: This randomized clinical trial was performed in 64 nulliparous women in Ahvaz, Iran 2016. The subjects were selected using purposive sampling and were assigned into two groups of case (n=32) and control (n=32). The intervention group attended eight sessions of CBT-based self-management programme in 28-32 weeks gestational age, while the control group received routine prenatal care. Demographic characteristics were recorded at the beginning of the study and variables of labor outcome (length of delivery, labor pain, infant’s Apgar score, the use of oxytocin for augmentation of labor pain, and satisfaction from delivery process) were recorded using a researcher-made questionnaire.
Results: The mean values for pain intensity in the active phase of labor, length of active phase and second stage of labor, the use of oxytocin for augmentation of labor pain, neonatal Apgar score in 1 and 5 min were significantly different in case group compared with those in the control group (P<0.05). The mean of pain intensity in second stage of labor and length of third stage of labor decreased in the intervention group, but showed no significant differences between the two groups (P>0.05).
Conclusion: According to current study, CBT-based self-management programme could improve labor outcome.
 

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Background and purpose: Health Impact Assessment (HIA) evaluates positive and negative consequences of development on human health, which is recently proposed in Iran. Human health involves a wide range of factors, therefore, predicting and estimation of their effects require convenient and efficient tools.
Materials and methods: In this case study, data was collected and a database on regional health status was created. The research was then carried out in three main stages, including 1- assessment of the epidemiology of important diseases and health risks, 2- health impact assessment of the project via micro-activities, 3-assessment of impacts on three health components, including physical health, metaphysical health, and socio-economic and cultural factors. After assessing negative and positive effects, scoring was performed based on a multidisciplinary panel of experts.

Results: According to the final scores calculated, most concerns were associated with diarrheal diseases, intestinal parasites, conjunctiva, and leishmaniasis. On the other hand, preventing and reducing the likelihood of illness due to lack of awareness and the challenge of new people in the region call for extensive cultural and social planning.

Conclusion: Quantitative, accurate, rapid, and reliable results of multilateral approach matrix, were able to predict positive and negative effects, thereby leading to an integrated management solutions to mitigate the negative impacts and improving the quality of the project. Implementation of the project proposed was found to be non-problematic while carrying out corrective actions and authorized health monitoring program.