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History and Objectives: The high prevalence of non-ulcer dyspepsia controversy surrounding its treatment and the high costs of excessive use of medication led us to conduct this study on the effects of metoclopramide in patients with non-ulcer dyspepsia referred to Kashan’s Shaheed Beheshti hospital in 1995-96.

Materials and Methods: In this double blind clinical trial, cases were selected through continuous sampling. Patients with at least one symptom of epigastric pain, flatulence, heartburn, nausea, vomiting, regurgitation, bad breath, stomach fullness or belching for a duration of at least 3 months were included. Following a thorough physical exam, tests including a complete and differential blood count, serum sodium, potassium, erythrocyte sedimentation rate, alkaline phosphatase, SGOT, SGPT, calcium, phosphorus. Fasting blood sugar, creatinine, blood urea nitrogen, 3 successive stool exams, THS, T3RIA, T4RIA, abdominal sonography and electrocardiography were performed to exclude underlying diseases. Endoscopy was also performed to exclude organic gastrointestinal diseases and patients avoiding medications for the past 2 weeks were studied. Patients were randomly divided into two groups. Cases were given 10 milligrams of metoclopramide 4 times a day for 2 weeks, while the controls received placebo. Drug effects were measured based on the patient’s clinical improvement.

Results: 70 patients were thus studied 37 were male and 33 female. Age mean and standard deviation were 29.1±9.1 years in the controls and 30.1±8.1 years in the cases, with no statistically significant difference. Complete or relative improvement rate was 82.9% in the controls (17.1% complete and 65.8% relative) and 100% in the cases (25.7% complete and 74.3% relative).

Conclusion: We therefore conclude that metoclopramide has no significant effect in patients with non-ulcer dyspepsia and we suggest a similar study be performed to assess the effect of cisapride in these patients.

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History and Objectives: Due to importance of preterm labor problems and its complications and regarding the controversies on the relationship of interpregnancy intervals of less than 15 months and preterm labor and in order to define effect of interpregnancy interval of less than 15 months on preterm labor, the present study was performed at Shabihkhani Maternity hospital during 1997-1998.

Materials and Methods: In a case study, control group (N=100) consisted labors after 37 weeks of pregnancies and a case group (N=70) of labors before 37 weeks of pregnancy. Interpregnancy interval of less than 15 months in two groups after termination of preceding pregnancy and start of next pregnancy was evaluated. Case and control groups were matched for influencing factors on preterm labor. Chi-square statistical analysis was used to test the results and Odd’s ratio were determined.

Results: No significant differences were observed among case and control groups (N=100). Short interpregnancy interval was 9% and 21.4% among case and control group respectively (P<0.02). Preterm labor was 2.7 times higher among women with interpregnancy interval of less than 15 month.

Conclusion: Interpregnancy interval of less than 15 months has an effect on incidence of preterm labor. Further research in required pinpointing the factors involved with the short interpregnancy interval.

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History and Objectives: Due to the prevalence of breast cancer and its complications and the necessity of cancer screening by health workers including midwives and lack of accurate data on the knowledge, attitude and practice of midwives, the present study was carried out on midwives working in the health clinics of Tehran in 1994.

Materials and Methods: A descriptive study was performed on 100 midwives working in the health treatment centers in Tehran. Data were collected by multi-stage cluster and then by simple randomized sampling method. Information regarding age, educational level, marital status, work history, family history for breast cancer, breast self-examination, breast examination of patient and questions regarding midwives attitude and knowledge via separate questionnaire were collected. The performance of midwives was evaluated with a corresponding checklist.

Results: Most midwives have a fair knowledge (41%), strong positive attitude (58%) and moderate practical skills (50%) on breast examination. A direct statistical correlation was found between knowledge and type of attitude and between knowledge and practical skills of midwives on breast examination. In addition, a close relationship was found between educational level and family history of breast cancer with midwives knowledge. A statistically significant correlation was found between breast examinations of patients with midwives attitude. However, there were no relationship between other characteristics and midwives knowledge, attitude and practical skills.

Conclusion: Since midwives have fairly moderate knowledge and practical skills on breast examination and due to the importance of breast examination in early detection of cancer further studies are needed to determine the effect of continuing education on the level of midwives knowledge and practical skills and their performance of breast examination.

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History and Objectives: Due to the prevalence and complications associated with pregnancy in adolescents, the present research was carried out on the quality of concentrations among adolescent women referred to Gholabchi Medical Clinic.

Materials and Methods: A descriptive study was performed on adolescent women referred to the Gholabchi Medical Clinic for prenatal educational courses. Personal records concerning age, educational level of women and her husband, duration of marriage, type of contraceptive methods and factor associated with the contraceptive methods were collected. If a combination of different pills is used, it is considered low risk contraction and other methods are considered high-risk contraceptive method.

Results: From total of 191 of adolescent women, 176 were qualified with mean age of 16.9±1.6 years with a minimum of 11 years and a maximum of 19 years of age. Mean length of marriage was 11±3.7 months with a minimum of 5 months and a maximum of 18 months. 42.6% of individuals did not use any contraceptive method, 40.3% used high-risk method and 17.1% used low risk method. Owing to husband’s inclination for pregnancy, 44% of women did not choose contraception. Desire for pregnancy was the most prevalent cause of discontinuation of contraception. 50.6% of contraceptive users had previous pregnancy. 46.6% and 2.8% of cases had one and two successful pregnancies respectively.

Conclusion: Due to complications associated with pregnancy and delivery among adolescent women, further research is recommended to detect factors involved in the pregnancy and to reduce possible complications.

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History and Objectives: Head traumas are the main causative factor of mortality in human society and its most critical form is the fracture of basal cranium. Therefore, this study was conducted to determine the symptoms and complications of 100 cases of basal cranium fractures and its 6-month follow-up in Rahnemoun hospital in Yazd in 1997.

Materials and Methods: The descriptive and cross-sectional protocol of this study was carried out on selected patients. In this respect, history taking, clinical examinations, radiographic evaluation and computer-assisted tomography without contrast was performed. Then, they were followed up for a 6-month period with monthly examination. Treatment results, especially the occurrence of meningitis (Through LP) and the role of cranial nerves were analyzed statistically using McNemar test.

Results: The most frequent occurrence was that from male patients with an age range of 10-29 years (26%), the most common causative factor was that from motorcycle accidents (45%), the most frequent complaint was nose bleeding (60%), the most common cranial nerve damage was those from 8th (35%) and 1st nerve. After a 6-month follow-up, there was an involvement rate of 21.7% for 8th nerve and the best treatment result was for 1st nerve (26.5%) (P<0.001). In addition, 4% out of the patients was afflicted with meningitis.

Conclusion and Recommendations: Since there is little complications for meningitis and there is no indication for antibiotic administration for fractures of basal cranium, therefore, it is recommended to design and conduct an experimental study in this field.

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Background: Mood disorders are of utmost importance during pregnancy, thus the present study was conducted to determine the prevalence of depression in parturients referring university hospitals in Tehran in 1999.

Materials and Methods: It was a cross sectional study. Parturients aged 15-49 years were included. Our exclusion criteria were history of psychiatric disorders, drug usage, chronic disease, infectious disease and pregnancy-induced complications. Demographic data including age, level of education, occupation, economic status, gestational age, gravidity, abortion, preterm delivery, family size, infertility, history of PMS, social support and unpleasant happens were all recorded. Beck test was used to determine the depression and its severity, Pikayl test was used for determination of unpleasant happen and Wienfiled and Tiggemann had assessed social support. Beck score of 0-15 was considered as normal, however, higher than that was considered as depression.

Results: Of 580 parturients, 45.7% were depressed. Depression has shown significant association with level of education (P<0.002), economic status (P<0.000), family size (P<0.000), gravidity (P<0.000), gestational age (P<0.000), unintentional pregnancy (P<0.000), history of PMS (P<0.001), social support (P<0.000) and unpleasant happens (P<0.02).

Conclusion: Depression is frequent during pregnancy, thus screening tests are highly recommended.

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Background: Problems in recording, data collection and reporting are common in university hospitals. Thus, the present study was carried out to determine these problems and also facilitate the conditions of reporting statistical data in Kashan university in 2000.

Materials and Methods: All statistics units of Kashan university were included in this descriptive study. A questionnaire was considered for data collection in different wards, emergency room, admission unit, operation room, radiology department, laboratory and different clinics. These questionnaires were completed by interview and direct observation. Calculation of different statistical indices were observed and matched with standard methods.

Results: All study units have medical record system. Previously designed sheets were used for data collection and reporting in 83% of study units, however, clinics have not these sheets. 35% of hospital indices were calculated, of which 48% were correctly calculated. These indices were reported to 14% of hospital managers. Data were collected daily in 56% and monthly in 44% for the hospitals.

Conclusion: Despite the presence of facilities for data collection, the process of data collection and reporting was not appropriate. Further studies are highly recommended to determine the underlying factors.

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Background: Maternal and fetal complications following the macrosomia are of utmost importance. The present study was carried out with the aim of determining the prevalence of fetal macrosomia and post-term delivery and multiparity as its risk factors in Kashan in 1999-2000.

Materials and Methods: It was an analytical study. During the first phase the prevalence of macrosomia was determined during a two-year period (1999-2001), then, the second phase was conducted on 110 infants with macrosomia (Case group) and 110 without macrosomia (Control). Groups were matched according to the sex, BMI, level of education, prenatal care, mother’s nationality and age. A questionnaire was used for data collection, then the role of post-term delivery (>40 weeks) and multiparity was determined.

Results: Macrosomia was found in 3.04% of the infants. Post-term delivery was reported in 45.5% and 61.8% of the control and case group, respectively (P<0.02). The mean parity was 2.39±1.34 and 2.54±1.37 in the control and case group, respectively (NS).

Conclusion: The prevalence of macrosomia is not high in Kashan. Post-term delivery has increased the rate of macrosomia, however, multiparity has no statistically significant association. Further studies are highly recommended.

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Background: Accident-induced trauma is a common problem with short- and long-term complications. The present study was conducted in Naghavi hospital in Kashan in 2000 to determine the external factors influencing the incidence of accident-induced trauma.

Materials and Methods: It was an existing data type study. Medical records of patients hospitalized in 2000 in Naghavi hospital were reviewed and initial data including sex, age, type of accident and site of injury were all determined.

Results: The study population included 1543 males and 498 females. 35.5% of females referred to the hospital because of falling down. Males aged 10-30 and females’ aged ?50 years were more commonly affected. Vehicles were the cause of accident in 49.2% of the cases, of which motorcycle was more common (56%). Head and neck regions were injured in 32% of the cases.

Conclusion: Trauma has affected young adults more frequently. This seeks further attention since this age group are more actively involved in society activities. Results have revealed that in Kashan, motorcycle accidents required more precise observations.

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Background: With respect to the prevalence of short-interval pregnancy in our country and also lack of information data in Kashan, the present study was conducted in Kashan to determine the prevalence of short-interval pregnancy and also its association with birth height and weight.

Materials and Methods: A descriptive study was carried out to determine the prevalence of short-interval pregnancy whereas a historical cohort study was performed of determine its association with birth height and weight. Our case group consisted of two groups: 150 mothers with interval of less than 15 months and 90 mothers with interval of less than 12 months, between their pregnancies. 150 mothers with adequate interval between pregnancies were Surveyed in cone and control groups and analyzed by t-test. Relative and absolute risks of short-interval pregnancies were determined for birth weight of less 3000gr and birth height of less 49cm.

Results: Of 2300 mothers, 216 (94%) had short-interval pregnancy. Results have revealed that there is no association between interval of less than 15 mothers and birth height and weight, however of less than 12 months and birth height and weight. The mean (±SD) of birth weight was 3356±443 and 3237±430 gr in the control and case group (Interval <12 months), respectively (P<0.05). Meanwhile, their birth height was 50.4±2 and 49.7±1.8 cm, respectively. The RR of weight <3000gr was 105 and for height <49 was 2.1. The AR for these values were 0.5% and 16.5%, respectively (P<0.05%).

Conclusion: Pregnancy with interval of less than 12 months is associated with lower birth and weight. Further studies are highly suggested.

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Background : Breast cancer has been increased rapidly during the recent decades, however, self examination and clinical evaluation have been revealed to be effective for early diagnosis. The present study was conducted to determine knowledge, attitude, and performance of women referring health care centers in Kashan towards breast cancer and its screening tests.

Materials and methods : For this descriptive study 400 women were selected through a cluster sampling. Then, initial data such as age, marital status, educational level, occupation, familial history of breast cancer, self examination training, and other breast related diseases were recorded meanwhile knowledge and attitude were considered and performance was surveyed by direct observation.

Results : The mean ( ± SD) age of women was 29.7 ±7.9. The vast majority of participants were housewives, married and had under diploma education. Poor knowledge of breast cancer was revealed in 43%.,however, negative attitude and poor performance were observed in 5.5% and 65.3% of women, respectively. Better performance is achieved by increment in knowledge.

Conclusion : Most of the women had poor knowledge and performance regarding the breast cancer and its screening test. With respect to the importance and efficacy of self-examination in early diagnosis we highly suggest educational programs to promote knowledge, attitude, and performance towards the breast cancer.

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Background : Employing statistics and the extend of this employment is a common problem in hospital management. The excessive amount of health care expenses, unemployment of hospital capacity, and mismanagement of available facilities have made our hospital less effective. Regarding the utmost importance of statistics in making decision in hospitals, the present study was conducted to determine how often managers employ the statistics for hospital management in Kashan city in 2002.

Materials and methods : It was a descriptive study. Statistical indices were categorized in 5 groups according to the manager’s duty in the hospital. Then the managers were asked to fulfill the questionnaire. Meanwhile, a checklist was prepares to control the managers’ responses.

Results : Totally, 55% of all statistical indices were used by managers. Delivery room- and operation room-related indices were used more (64%), however, mortality rate indices were used less (47%).

Conclusion : Managers do not frequently used statistical indices. Needless to say, proper management is associated with higher efficacy and better implication of hospital’s facilities. It seems as if employment of expert managers is necessary and controlling systems should be applied to evaluate their activity and performance.

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Background: Emergency department has a vital role for dealing with life and death situation. Monitoring and evaluating the quality of care issues with an accurate and adequate data information system is of utmost importance. The aim of this study was to determine the rate of data information which was documented in emergency record in two hospitals of Kashan city.

Materials and Methods: In spring 2002 , this existing type data study was performed. 540 records were selected through simple random sampling. Data collection was based on legal, administrative and financial issues as well as personnel who were responsible to complete the data (physicians, nurses and administrative unit).

Results: The survey has revealed that 14%, 12%, 14% of legal, administrative, and financial issues were remained undocumented. Meanwhile, 17% of admission-related, 11% of nursing-related and 17% of medical-related documents were uncompleted. The highest rate of documented data was achieved by nurses and the lowest belonged to physicians. There were significant statistical differences between two hospitals for type of issues and personal, time of discharge, external causes and orders to discharge, where the lowest elements were completed.

Conclusions : The rate of documented information in emergency records of these two hospitals was comparatively good however, some documentation items such as time of discharge, recommendations in discharge would need to be improved.

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Background : Due to controversies in etiology of malnutrition, mother’s BMI and child’s sex, the present study was conducted in order to determine the role of mother’s BMI and child’s sex on malnutrition of children younger than 5 years old that referred to health care centers in Kashan in 2002-2003.

Materials and Methods : In a case-control study using cluster and random sampling,125 children with malnutrition based on weight for age using -2 standard deviations criteria NCHS (case group) and 125 children without malnutrition (control group), from 10 health centers in Kashan were enrolled during the study period. Mother’s BMI and child’s sex was compared in two groups. Case and control groups were matched in confounding variables.�Information was obtained from medical records through interview . Results were judged with Chi- square, t-test and mantel haenszel. Also Odd's ratio and confidence interval were determined.

Results : Results showed that matched factors such as maternal age, maternal employment, parity, birth weight and height, duration of breastfeeding and child age were similar in two groups. Mean mother’s BMI was significantly different in two groups (P<0.002). Also results demonstrated child’s sex was related to malnutrition, (P<0.02). Odd's ratio and confidence interval for effect of BMI<22 and female sex on malnutrition were ) OR=2.1 CI=3.74-1.16 P<0.05, OR=1.81 CI=3.05 -1.07 P<0.05) respectively. Although malnutrition was showed to be related to each variable separately, mantel haenszel test demonstrated that two factors were not concurrently related to malnutrition.

Conclusion : Low mother’s BMI and female sex, increased risk of malnutrition alone but not related with malnutrition together. Further studies are recommended to determine other risk factors.

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Background: Considering the adverse effects and difficulties due to formula feeding or early commencement of supplemental diet and also different reports from their status, this study was conducted to investigate the nutritional status and related factors in 4/5 month-old infants referred to health care centers in kashan in 2002.

Materials and methods: This cross - sectional study was performed on 350 mothers who had children aged 4/5 months. The sampling was done randomly in several phases. The information about kinds of diet, maternal age, maternal education, occupational status, infant sex, order of infant’s birth, the commencement time of first feeding, exclusive breast feeding period and the commencement time of supplemental diet were collected . Also the weight and height of infants were measured. Then the collected data was analyzed.

Findings:  Non exclusive breast feeding was observed in 17.7% of infants and in 3.7% of them, supplemental diet had begun earlier than their 4-month age. Breast feeding period in 82.3% of infants was more than 4 months. There was a statistically significant correlation between kinds of diet and maternal age (P<0.002), occupational status (p<0.001) and the commencement time of first feeding (p<0.0005). Infant weight in exclusive breastfeeding group (N1= 288) was 7243 ±792.1 gr and in non exclusive breast feeding group (N2=62) was 6891 ±1059 gr (P<0.002). Their height was respectively 62.63± 2.9 cm and 62.25± 3.1 cm (P<0.1)

Conclusion: Early beginning of breast feeding in postpartum period, paying further attention to old mothers and employed mothers have an important role in exclusive breastfeeding development and prevention of infant mortality.

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Background: Development of efficient and effective systems is one of the aims of Medical centers.Standards are criteria for evaluation of affairs and without them ,evaluation is impossible.this study was carried out to determine the extent of application of standard to Medical records department .

Materials and Methods: This is a descriptive study.and all of Kashan Hospitals are enrolled to it. Data were collected by direct observation and completion of a questionnaire about procedures and practices, equipments , environment and personels of medical recording departments of the Hospitals.Collected data were analysed with scaling.

Results: Findings showed that scale of paying attention to standards was 61%. Procedures and practices had a scale with 55/8%. Statistic unit had least scale with 53/5% and coding unit had the highest scale with 65/2%.

Conclusion: Totally ,paying attention to medical records department standards was in middle level.Lack of procedural standards was the most important defect.

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Background: Preeclampsia is one of the most important risk factors for maternal mortality in the world. The immune maladaptation theory suggests that the tolerance to paternal antigens, resulting from prolonged exposure to sperm, protects against the development of preeclampsia. Due to controversies in this regard the present study was conducted with main objective to determine the relationship between the extent of exposure to sperm, before pregnancy, and the risk of preeclampsia in pregnant women referring to Shabih-Khani maternity Hospital of Kashan during 2005-2006.

Materials and Methods: A case-control study was carried out on 150 mothers with preeclampsia (case group) and 150 mothers without preeclampsia (control group). Preeclampsia was determined by blood pressure≥ and proteinuria≥+1 by dipstick testing. The duration of sperm exposure prior to pregnancy, and the frequency and duration of the use of barrier method contraception before pregnancy were compared in the two groups. All results were analyzed using c ² , t-test , and Mann-Whitney U statistical test.

Results: There was no significant difference between the two groups in confounding variables. The mean duration of sperm exposure prior to pregnancy in the case and control groups was 11.4 ± 14 and 12.4 ± 13.8 months, respectively. Mann-Whitney U test showed that this difference was not significant. c ² statistical test appeared no significant difference between the two groups in barrier methods contraception (80 and 88 women in the case and control groups, respectively). Also Mann-Whitney U test showed that regarding duration of using barrier method contraception no important variation is evident between the case and control groups (25.8 ± 21.9 and 28.7 ± 23.7 months, respectively).

Conclusion: We concluded that pre exposure to sperm, frequency and duration of using barrier contraception are not effective in the etiology of preeclampsia.

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Background: Considering high complications of labor induction with drugs, finding an easy, inexpensive, confident method for induction of labor is important. This study was performed to evaluate the effect of castor oil on initiation of labor in pregnancies after 40 weeks in Shabihkhani Hospital in Kashan during 2004-2006.
Materials and Methods: This randomized clinical trial study was performed on 200 women after their 40 weeks of pregnancy. Women were divided to two groups (100 women in case group and 100 women in control group). The case group took 60 ml castor oil while control group didn’t take any treatment. The two groups were compared for onset of labor in 24 hours, time of onset of labor, delivery time and method and Apgar score of their newborns by X2, CI, OR and t-tests.
Results: Labor was induced in 70% of women in the case group versus 12% in the control group during 24 hours (p<0.001, OR=17.11, CI=8.17-35.84) and vaginal delivery happened in 28% of women in the case and 1% of women in the control group (p<0.001. OR=29.5. CI=5.86-226.4). There was no significant difference between the two groups in the method of delivery and newborns Apgar score.
Conclusion: The use of castor oil can induce labor in pregnant women after 40 weeks without any increase in the complications of pregnancy including caesarean section, and drop in Apgar score. To confirm findings, it is recommended to perform further clinical randomized studies.

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Background: The third stage of labor has been described as the most dangerous stage. Concerning importance of the third stage, this study was performed to determine the length of this stage and its related factors.

Material s and Methods: This cross-sectional study was carried out on 1000 deliveries in shabihkhani Hospital, in Kashan, during 2005-2006. Gestational age >20 weeks, singleton pregnancy, and vaginal delivery without any instrument were the including criteria. Data were analyzed using c ² , OR and CI .

Results: Mean and median of the third stage of labor were 6.03 and 5 minutes, respectively. There was significant association between the number of parturitions (p= 0.04), induction with oxytocin (p=0.002), analgesia during labor (pethedin) (p=0.008), and umbilical cord drainage for the third stage management (p<0.001). There was no significant association between history of abortion, gestational age, third stage management (oxytocin), fetal sex, and weight.

Conclusion: Use of induction, and analgesics during labor and umbilical cord drainage increased the length of the third stage but multiparty decreased it. It is recommended to consider these factors for prediction and prevention of dangers of prolonged third stage of labor.

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Background: Using hospital databases to retrieve information, doing epidemiologic researches and making administrative decisions extremely depend on an accurate classification based on clinical coding. The researchers aim was to determine the validity of diagnostic coding based on ICD10 .

Materials and Methods: 370 medical records were selected from KAUMS teaching hospitals in 2008. We abstracted and recoded the first - sequenced diagnostic codes based on ICD10. The validity was determined by the agreement between original codes and recodes as gold standard. The coding errors were classified into major and minor. The major code errors were those happened in nature and topography. Others were considered as minor. Possible determinants were studied through a checklist and observation methods. The data were analyzed through X², fisher test, OR, and CI 95% for OR.

Results: Diagnostic codes accuracy was 77.3%. There were 84 (22.7%) errors in diagnostic codes so that 28 (33.3%) of them were major and 56 (66.7%) were minor. Using coding book and not using abbreviation reduced errors significantly. Complete records review reduced errors . Documenting more information especially diseases etiology increased errors. In addition, the relationship between readability of records and code accuracy was not significant.

Conclusion: Majority�of diagnostic codes were accurate. to reduce current errors, Coders’ factors such as�more attention to available information and better documentation (e.g. not using abbreviation) can increase the quality of diagnostic coding and its databases.