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   2014| September-October  | Volume 19 | Issue 5  
    Online since October 25, 2017

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Menarche age in Iran: A meta-analysis
Nasim Bahrami, Mohammad Ali Soleimani, Yiong Huak Chan, Morteza Ghojazadeh, Parvin Mirmiran
September-October 2014, 19(5):444-450
Background: Research shows that the age at menarche, as an essential element in the reproductive health of women, had been decreasing in the 19 th and 20 th centuries, and shows a huge variation across different countries. There are numerous studies performed in Iran reporting a range of age at menarche. Thus, this meta-analysis aimed to determine the overall mean age at menarche of the girls in Iran. Materials and Methods: All relevant studies were reviewed using sensitive and standard keywords in the databases from 1950 to 2013. Two raters verified a total of 1088 articles based on the inclusion criteria of this study. Forty-seven studies were selected for this meta-analysis. Cochran test was used for samples' homogeneity (Tau-square). The mean age at menarche of the girls in Iran with 95% confidence interval (CI) from the random effects was reported. Results: The homogeneity assumption for the 47 reviewed studies was attained (Tau-square = 0.00). The mean (95% CI) menarche age of Iranian girls from the random effects was 12.81 (95% CI: 12.56-13.06) years. Conclusions: The results of this study showed that mean age at menarche was less than that of some European developed countries such as Switzerland, Sweden, and Denmark, more than that reported in some countries such as Greece and Italy, and similar to the values obtained in the United States of America and Colombia. Lower age at menarche in Iran may be largely attributed to the changes in lifestyle and diet of the children.
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Homeopathy satisfaction in Iran
Ahmad Mahmoudian, Gholamhosein Sadri
September-October 2014, 19(5):496-502
Background: Patient satisfaction is a key indicator of the quality and effectiveness of a therapeutic method. Assessing the satisfaction of patients undergoing homeopathic therapy is essential in the early steps of educating the community, if suitable outcomes are to be achieved. Materials and Methods: This descriptive cross-sectional study was conducted in 2008 on 125 patients from the city of Isfahan. Patients aged above 15 years who had referred to the homeopathic practitioners and received homeopathic drugs for at least three times were randomly selected and included in the study. Patient satisfaction was assessed in three main areas (general health, physician performance, and symptoms relief) using a valid questionnaire. The results were compared with those of a similar study conducted in 2004 on 240 patients. Results: Mean score of satisfaction with homeopathic treatment was 77.48 ± 6.36 out of 100. In 2004, it was 77.4 ± 8.13. Median age was 36.41 ± 11.25 years. Median time of therapy was 16.80 ± 17.94 months. The highest level of satisfaction was related to relief of symptoms. Satisfaction of physician performance and improvement of general health came next. The degree of satisfaction with therapy was not significant between the different groups with regard to their sex and different levels of education, but there was significant difference in the duration of treatment. The four symptoms that showed better improvement in 2008 were headache, gastrointestinal (GI) disturbances, fatigue, and insomnia. Conclusions: After using homeopathy for several years, patients' satisfaction was found to be still high. Shifting the area of satisfaction from general health to relief of symptoms could be related to physicians' experiments for remedy selection. Scientific centers should do more surveys about the effectiveness of homeopathic treatment. Integration of homeopathy with medicine may bring in more success at less cost. It  seems rational to support homeopathy as an effective practice.
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Religious coping and psychological well-being among Iranian stroke caregivers
Sakineh Gholamzadeh, Tengku Aizan Hamid, Hamidon Basri, Farkhondeh Sharif, Rahimah Ibrahim
September-October 2014, 19(5):478-484
Background: This study aims to explore the relationship between religiosity and psychological well-being of caregivers of stroke survivors in Shiraz, Iran. Materials and Methods: A purposive sample of 96 family members, which included 34 daughters-in-law and 62 daughters, who were caring for severe impaired stroke survivors were enrolled in the study. Results: The results showed a significant correlation between positive religious coping and caregivers' psychological well-being. Positive religious coping accounted for 7.2% of the change in psychological well-being. There was no significant association between demographic factors and caregivers' psychological well-being. Conclusions: Our results indicated that religious and spiritual belief have a role in caregiver adaptations with the situation. Therefore, in future studies, it is  suggested to concentrate on the effects of other characteristics than the demographic variables on psychological well-being.
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Strategies to overcome type 1 diabetes-related social stigma in the Iranian society
Mehri Doosti Irani, Samereh Abdoli, Iraj Bijan, Soroor Parvizy, Naimeh Seyed Fatemi, Massoud Amini
September-October 2014, 19(5):456-463
Background: This study explored the strategies to overcome diabetes-related social stigma in Iran. Materials and Methods: This paper is part of an action research study which was designed in Iran in 2012 to plan and implement a program for overcoming diabetes-related stigma. Participants were people with type 1 diabetes, their family members, people without diabetes, and care providers in a diabetes center. Data collection was done through unstructured in-depth interviews, focus groups, e-mail, Short Message Service (SMS), and telephone interview. Data were analyzed using inductive content analysis approach. Results: Participants believed that it is impossible to overcome the stigma without community-based strategies. Community-based strategies include education, advocacy, contact, and protest. Conclusions: The anti-stigma strategies obtained in the study are based on the cultural context in Iran. They are extracted from statements of a wide range of people (with and without diabetes). However, during planning for stigma reduction, it is necessary to note that the effectiveness of social strategies varies in different studies and in different stigmatizing conditions and many factors are involved. These strategies should be implemented simultaneously at different levels to produce structural and social changes. It should be accepted that research on reducing health-related stigma has shown that it is very difficult to change beliefs and behavior. Evidence suggests that individuals and their families should be involved in all aspects of the program, and plans should be made according to the local conditions.
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Comparison of the effects of two levels of negative pressure in open endotracheal tube suction on the physiological indices among patients in intensive care units
Hojatollah Yousefi, Jahanbakhsh Vahdatnejad, Ahmad Reza Yazdannik
September-October 2014, 19(5):473-477
Background: Most of the patients admitted in the intensive care units (ICUs) require an endotracheal tube and mechanical ventilation. In order to clear and maintain patency of the airways, endotracheal suctioning is required. Therefore, the least detrimental way of endotracheal tube suctioning which can diminish the complications should be selected. The present study aimed to compare the effect of two levels of negative pressure (100 mmHg and 200 mmHg) in open endotracheal tube suction on the physiological indices among patients in the ICUs. Materials and Methods: In this single-blind clinical trial, 60 patients meeting the inclusion criteria were selected by convenience sampling and randomly allocated in two groups. First group of patients were suctioned with negative pressure of 100 mmHg and the second group with 200 mmHg. Effects of two levels of suction pressure on oxygen saturation (SPO2) and heart rate (HR) values were measured and recorded at four time points. Repeated measure analysis of variance (ANOVA), Chi-square test, and independent t-test were adopted to analyze the data. Results: In the two groups consisting of totally 60 subjects (30 in each group), 34 subjects were males and 26 were females, with a mean age of 60.63 years (minimum 18 years and maximum 75 years). Repeated measure ANOVA showed a significant difference in the mean SpO2 and HR before, during, and 5 and 20 min after suction within each group ( P < 0.05), but not between the two groups ( P > 0.05). Conclusions: The present study revealed that with regard to the detrimental effect of endotracheal tube suctioning on arterial oxygen saturation and HR, suctioning with negative pressure of 200 mmHg is considered to be a low-risk procedure compared to suctioning with negative pressure of 100 mmHg, if standard procedures in open suction system are followed.
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The impact of sleep healthy behavior education on the quality of life in the pregnant women with sleep disorder: A randomized control trial in the year 2012
Elham Rezaei, Zahra Behboodi Moghadam, Saharnaz Nejat, Nahid Dehghannayeri
September-October 2014, 19(5):508-516
Background: About 79% of pregnant women in the world suffer from sleep disorders. These disorders result from physiological changes during pregnancy, originate from different factors, and can affect pregnant women's quality of life before, during, and after delivery. This study aimed to investigate the effect of sleep healthy behavior education on the quality of life among pregnant women with sleep disorders in the second trimester. Materials and Methods: This is a clinical trial conducted on 112 pregnant women with sleep disorders referring to two selected health care centers in Makou affiliated to Urmia University of Medical Sciences during June-Oct 2012. Data collection tools included demographic characteristics questionnaire, Pittsburgh Standard Sleep Quality questionnaire, and World Health Organization, Quality of Life (WHOQOL-BREF) WHOQOL-BREEF questionnaire. Sampling was done by convenient sampling. Firstly, Pittsburg Standard Sleep Quality Questionnaire was completed and the pregnant women with sleep disorders were selected as the subjects. After completion of sampling, the subjects were randomly assigned to two groups of study and control. Education of sleep health behavior was provided in the study group by the researcher during four 1-h sessions. Then, WHOQOL-BREEF and Pittsburg Standard Sleep Quality questionnaire were completed again in two groups in the first follow-up session (1 month after educational intervention) and in the second follow-up session (2 months after educational intervention) held by the researcher. Control group only received conventional prenatal care. The obtained data were analyzed by Chi-square test, independent t-test, Fisher's exact and repeated measure tests through SPSS 18. Results: Mean scores of quality of life showed an increase in 1 and 2 months after intervention in the study group compared to the control group. A significant difference was observed in the QOL in the two groups, 1 month ( P < 0.000) and 2 months ( P < 0.001) after intervention. Conclusions: Education of sleep healthy behaviors was effective on the QOL of pregnant women with sleep disorders. The results obtained in the present study can be used to support the pregnant women with sleep disorders and sleep disorders clinics, as well as for administration of prenatal care.
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The effect of cognitive-behavioral group therapy on depressive symptoms in people with type 2 diabetes: A randomized controlled clinical trial
Farkhondeh Sharif, Maria Masoudi, Ahmad Ghanizadeh, Mohammad Hossein Dabbaghmanesh, Haleh Ghaem, Samira Masoumi
September-October 2014, 19(5):529-536
Background: Diabetes mellitus is considered as the most common metabolic disorder. The patients with diabetes are likely to be affected by mental distress, especially depression. Nurses should pay attention to the psychological needs of depressive patients by participating in an application of non-pharmacological treatment such as cognitive-behavioral therapy. This study aimed to assess the effect of cognitive-behavioral group therapy on depression in patients with diabetes. Materials and Methods: This randomized controlled trial was performed in 2010 in the diabetes clinics affiliated to Shiraz University of Medical Sciences, Shiraz, southern Iran. In this study, 60 eligible patients suffering from depression were randomly divided into two groups by convenience sampling method, using random block allocation. The experimental group was randomly subdivided into three groups of 10 each and received eight sessions of cognitive-behavioral group therapy. The level of depression was checked before as well as 2 weeks, 4 weeks, and 2 months after the intervention in both groups. Glycosylated hemoglobin (HbA1c) level was also checked before and 2 months after the intervention. Results: Both groups were demographically homogeneous with no statistically significant difference. The trend in depression scores before as well as 2 weeks, 4 weeks, and 2 months after the intervention was statistically significant in the experimental group ( P ≤ 0.001), but not in the control group ( P = 0.087). The results showed that HbA1c variation was statistically significant before and after the intervention in both groups ( P ≤ 0.001). However, the mean variation of HbA1c was not statistically significant between the groups ( P = 0.473). Conclusions: Cognitive-behavioral group therapy was effective in reducing depression in patients with diabetes. Therefore, this method can be recommended for such patients.
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Iranian senior nursing managers' experiences and understanding of social capital in the nursing profession
Houman Manoochehri, Hamideh Azimi Lolaty, Parkhideh Hassani, Paul Arbon, Seyed Afshin Shorofi
September-October 2014, 19(5):464-472
Background: This study aimed to explore the role of social capital within the context of the nursing profession in Iran, based on the experience and perspectives of senior nursing managers. Materials and Methods: The study was conducted using the Graneheim and Lundman content analysis method. Using purposive sampling, 26 senior nursing managers from the Ministry of Health and Medical Education, the College of Nursing and Midwifery, the Iranian Nursing Organization, nursing associations and hospitals were selected, who participated in semi-structured in-depth interviews. Results: Content analysis revealed three main themes (social capital deficit, applying multiple strategies, and cultivating social capital) as well as eight categories which included professional remoteness, deficiency in professional potency, deficiency in professional exchanges, accumulation of personal social capital, accumulation of professional social capital, socio-political strategies, psychological-cognitive strategies, and ethical/spiritual strategies. The results  show the perceived level of social capital in nursing in Iran, the application of some key strategies, and the principal rewards accrued from active participation in improving the social capital in nursing environment and profession. Conclusions: Efforts should be made to strengthen the social capital and apply key strategies with the aim of achieving personal and professional benefits for nurses, their patients, and co-workers, and for the delivery of healthcare in general. In this respect, the role of senior managers is vital in stimulating collective action within the profession, planning for the development of a culture of participation in healthcare services, helping to develop all fields of the profession, and developing and strengthening intra- and inter-professional exchanges and networking.
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Investigating the effects of the neonatal factors and therapeutic modalities on neonatal mortality in neonatal intensive care unit of Shahid Motahhari Hospital, Urmia
Hamideh Mohaddesi, Hamid Reza Khalkhali, Zahra Fakour, Zhila Azadi
September-October 2014, 19(5):485-490
Background: A newborn is highly fragile whose death can be caused by embryonic, intrapartum, and postpartum factors. Identifying the causes of death is the first step to be taken in order to decrease the death rate. The present study was aimed at finding out how neonatal factors and therapeutic actions affect death of newborn babies. Materials and Methods: The is a case-control study where the case group included 250 dead neonates who were hospitalized in the neonatal intensive care unit during 2007-2009. The control group also included 250 newborn neonates who were hospitalized in the same unit and were discharged alive and healthy after they were treated appropriately. Researcher-designed questionnaires including demographic characteristics of mothers and infants, causes of hospitalization, treatment and its complications, and causes of death were used to collect the required data. Chi-square test, odds ratio (OR), and logistic regression were applied to analyze how the variables were related. P < 0.05 were considered significant. Statistical analyses were carried out using software SPSS 16.0. Results: The results of advanced logistic regression model showed that first-minute Apgar less than 6 (OR = 4.02), existence of birth asphyxia (OR = 6.16), hyaline membrane disease (OR = 4.08), and sepsis (OR = 6.42) increased the death rate of neonates hospitalized in the intensive care unit, and applying nasal continuous positive airway pressure and multiparity decreased the death rate of newborn babies. There was no  significant correlation between variables such as low birth weight, consanguinity, blood group, pr eterm labor history, and baby's gender, and the death rate of neonates. Conclusions: The results of the study show that factors such as low Apgar score, asphyxia, hyaline membrane disease, sepsis, prematurity and congenital anomalies, and method of delivery have a positive effect on the death of neonates. They also prove that suitable management and carrying out appropriate therapeutic actions and intensive care decrease the death rate of newborn babies.
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The effect of oral propranolol plus oxytocin versus oxytocin only on the process and outcome of labor: A double-blind randomized trial
Ashraf Direkvand-Moghadam, Molouk Jaafarpour, Ali Khani, Safoura Taheri, Ali Delpisheh
September-October 2014, 19(5):491-495
Background: Prolonged labor can lead to maternal and neonatal complications. The purpose of this study was to investigate the effect of oral propranolol plus oxytocin versus oxytocin only on the process and outcome of labor. Materials and Methods: In a randomized, double-blind, controlled trial performed in Ilam Mustafa hospital, a total of 146 nulliparous pregnant women at gestational age of 40-42 weeks were randomly allocated to receive 20 mg oral dose of propranolol or placebo plus oxytocin infusion (73 participants in each group). The outcome measures were the mean duration of labor stages, type of delivery, and neonatal outcome. Results: The mean duration of active phase and the second stage of labor were significantly shorter in the propranolol group than in the placebo group on both the first and the second days of induction. The mean duration of third stage of labor was shorter in the propranolol group than in the placebo group, but the difference was not significant statistically on the first ( P = 0.159) and second ( P = 0.065) days. Frequency of cesarean section deliveries significantly decreased in the propranolol plus oxytocin group compared to the placebo plus oxytocin group ( P = 0.005, P = 0.015) on the first and the second days, respectively. No significant difference in the neonatal outcome measures, such as Apgar scores at 1 and 5 min and the need for neonatal intensive care unit (NICU) admission, was found between the groups. Conclusions: This study showed that oral propranolol is an effective agent in both shortening the labor duration and reducing the frequency of cesarean section.
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Association between women's autonomy and family planning outcome in couples residing in Isfahan
Shahnaz Kohan, Ferdos Talebian, Soheila Ehsanpour
September-October 2014, 19(5):451-455
Background: One of the important factors in the prediction of family planning outcome is paying attention to women's role in decision making concerning fertility and household affairs. With the improvement of women's status and autonomy, their control over fertility is expected to increase. The present study aimed to investigate the association between women's autonomy and family planning outcome of the couples residing in Isfahan. Materials and Methods: This is cross-sectional study. Two hundred and seventy women of childbearing age, eligible for family planning and residing in Isfahan, were selected through random cluster sampling and they filled a researcher-made questionnaire. Women's autonomy was measured with the questions on their decision-making autonomy concerning household affairs and physical mobility autonomy. The association between women's autonomy and family planning outcome was analyzed through statistical methods. Results: The results showed that the mean of women's decision-making, physical mobility, and general autonomy was 50. Women's autonomy had a direct significant association with the type of contraception method ( P = 0.01) and the length of usage of their present contraception method ( P = 0.04) as well as where they received family planning services ( P = 0.02). Conclusions: Analysis of data revealed women with higher autonomy used a more efficient contraception method and continued their contraception method for a longer time, which leads to improvement of couples' family planning outcome. Therefore, family planning services should be planned and provided with women's autonomy under consideration.
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Impact of stepwise sodium and ultra filtration profiles and dialysis solution flow rate profile on dialysis adequacy
Nahid Shahgholian, Azam Salehi, Mojgan Mortazavi
September-October 2014, 19(5):537-541
Background: Inadequate dialysis is one of the main causes of mortality of the patients undergoing hemodialysis. The methods that lead to improvement of dialysis adequacy in these patients are of great importance due to them causing an improvement of quality of life. As numerous factors can play a role in improvement of dialysis adequacy, the present study aimed to investigate the level of impact of stepwise sodium and ultra filtration profiles and dialysis solution flow rate profile on dialysis adequacy. Materials and Methods: This is a cross-over clinical trial conducted on 32 patients selected from two hemodialysis centers in Isfahan in 2013. The patients were assigned to two identical groups through random allocation, and each patient in group 1 underwent hemodialysis for four routine dialysis sessions, four stepwise sodium and ultra filtration profile sessions, and four sessions by stepwise dialysis solution flow rate profile. The patients in group 2 underwent hemodialysis for four sessions of stepwise dialysate flow rate profile, four sessions of stepwise sodium and ultra filtration profiles, and four sessions of routine dialysis method. Dialysis adequacy was on line calculated by Kt/V ratio in each session, and was analyzed by repeated measure analysis of variance (ANOVA), least significant difference (LSD) post-hoc test, and independent t-test. Results: Means of dialysis adequacies were 1.239 (0.25) in the routine method, 1.407 (0.26) in stepwise sodium and ultra filtration profiles, and 1.414 (0.26) in dialysis solution flow rate profile. There was a significant difference between the routine method and the other two profiles ( P < 0.05), but the difference in dialysis adequacy means in the two profile methods was not significant ( P > 0.05). Mean scores of dialysis adequacy in the three treatment methods in the two groups showed that the sequence of methods had no effect on treatment outcome ( P > 0.05). Conclusions: Stepwise sodium and ultra filtration profiles and stepwise dialysis solution flow rate profile are suggested as they can increase dialysis adequacy compared to the routine method.
  1,041 54 -
Similarities and differences in cultural values between Iranian and Malaysian nursing students
Abdolghani Abdollahimohammad, Rogayah Jaafar, Ahmad F Abul Rahim
September-October 2014, 19(5):542-544
Background: Cultural values are invisible and relatively constant in societies. The purpose of the present study is to find diversities in cultural values of Iranian and Malaysian nursing students. Materials and Methods: Convenience sampling method was used for this comparative-descriptive study to gather the data from full-time undergraduate degree nursing students in Iran and Malaysia. The data were collected using Values Survey Module 2008 and were analyzed by independent t-test. Results: The means of power distance, individualism, and uncertainty avoidance values were significantly different between the two study populations. Conclusions: The academics should acknowledge diversities in cultural values, especially in power distance index, to minimize misconceptions in teaching-learning environments.
  1,036 48 -
Efficacy of neurolinguistic programming training on mental health in nursing and midwifery students
Mohammad Sahebalzamani
September-October 2014, 19(5):503-507
Background: Neurolinguistic programming (NLP) refers to the science and art of reaching success and perfection. It is a collection of the skills based on human beings' psychological characteristics through which the individuals obtain the ability to use their personal capabilities as much as possible. This study aimed to investigate the efficacy of NLP training on mental health in nursing and midwifery students in Islamic Azad University Tehran Medical Sciences branch. Materials and Methods: In this quasi-experimental study, the study population comprised all nursing and midwifery students in Islamic Azad University, Tehran Medical branch, of whom 52 were selected and assigned to two groups through random sampling. Data collection tool was Goldberg General Health Questionnaire (28-item version). After primary evaluation, NLP training was given in five 120-min sessions and the groups were re-evaluated. The obtained data were analyzed. Results: In the nursing group, paired t-test showed a significant difference in the scores of mental health (with 39 points  decrease), physical signs (with 7.96 scores decrease), anxiety (with 10.75 scores decrease), social function (with 7.05 scores decrease) and depression (with 9.38 scores decrease). In the midwifery group, it showed a significant difference in mental health (with 22.63 scores decrease), physical signs (with 6.54 scores decrease), anxiety (with nine scores decrease), and depression (with 8.38 scores decrease). Conclusions: This study showed that NLP strategies are effective in the improvement of general health and its various dimensions. Therefore, it is essential to conduct structured and executive programs concerning NLP among the students.
  1,021 52 -
The effect of short-term vitamin D supplementation on lipid profile and blood pressure in post-menopausal women: A randomized controlled trial
Sedigheh Moghassemi, Abdoljalal Marjani
September-October 2014, 19(5):517-521
Background: Hypovitaminosis D has been associated with a series of cardiovascular risk factors, such as hypertension, metabolic disorders, obesity, peripheral artery disease, coronary artery disease, myocardial infarction, heart failure and stroke. Objective: To assess the effect of oral vitamin D3 on cardiovascular risk factors in post-menopausal women with vitamin D insufficiency. Materials and Methods: In this parallel, randomized, placebo-controlled trial, 76 healthy post-menopausal women with vitamin D insufficiency (defined as a 25-[OH] D level <75 nmol/L) were randomly assigned to receive vitamin D3 2000 IU once daily (n = 38) or placebo (n = 38). The trial was undertaken in the different health centers in Gorgan, north of Iran. Lipid profile, fasting blood sugar (FBS) and blood pressure of the patients was assessed at the beginning of the study and 12 weeks after the trial. Data were entered into the computer using SPSS and analyzed by t-test. Results: FBS, lipid profile and blood pressure were not significantly different between the groups after 12 weeks ( P > 0.05). No participant discontinued treatment due to adverse events. Conclusions: Vitamin D dietary supplementation is unlikely to reduce cardiovascular risk factors in post-menopausal women with vitamin D deficiency.
  1,004 57 -
Designing university students' health surveillance system in Iran from stakeholders' opinion
Ahmad Shafaeizadeh, Mojtaba Sedaghat, Azita Kheitash, Saharnaz Nedjat
September-October 2014, 19(5):522-528
Background: The university student health surveillance system can play a key role in the health promotion of the educated class of the society. This can be done through collecting information related to health and using it for screening and prevention of disease. Hence, this article will be based on the necessity of existence of such system. Materials and Methods: We used interview and focus group discussion in this qualitative study. The participants were the health system authors, experts, student service administrators, and also students. Content analysis was done after data saturation by the research team. Results: Based on thematic analysis, 249 codes were obtained, and about 20 themes or main expressions were extracted by separating purported sentences and combining them, and omitting overlaps. These themes were summarized into 13 subcategories and finally 4 main categories. The four categories included necessity of surveillance, stewardship, components of health surveillance system, and administrative consideration. Conclusions: From the participants' point of view, it seems necessary to have a health surveillance system for students; this system must be in accordance with the health system of the country. The Ministry of Health is the best option for stewardship of the system; however, it needs universities' support. Need assessment, performing a pilot study, and considering a program for quality control can guarantee for success in this program.
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September-October 2014, 19(5):536-536
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