kufa Journal for Nursing sciences

Objective: The study aims to evaluate the effectiveness of nursing education program on the nurses practice toward cardiac rehabilitation phase one for Patients with Heart Attack.
Methodology: A quasi-experimental design study was carried out at the AL-ShaiqZiad; AL-Sader; Al Karkh; AL-Karama; Imamein kadhimein medical city and Baghdad hospital in Baghdad city in September 1st 2013 to September 10th 2014. The program and instrument were constructed and developed by the researcher for the purpose of the study were random sample comprised of (80) nurses was divided in to two groups , study group consisted of (40) nurses exposed to the nursing educational program and control group consisted of (40) nurses were not exposed to the program. The measurement of the effectiveness of nursing educational program through the observation check list includes (60) items concern Practice related health assessment of the heart, assessment chest pain, evaluated Cardiogenic shock, evaluated activity daily living and Health education. Reliability of instrument was determined through the use of test and retest and the instrument validity was determined through a panel of experts. The analysis of data was use descriptive statistic (Frequencies, Percent’s, and Cumulative Percentages, Mean of Score, Standard Deviation and Inferential statistical (Contingency Coefficients, Chi-Square test, Fisher to present the differences between the study and control groups.
Results: The results of the study showed that they were highly significant deference between pre and posttest in the study group in overall main domains related to nurses\\\\' practice.
Conclusion: Deficit practices\\\\' nurses in the coronary care unit toward cardiac rehabilitation phase one for patients with heart attack.
Recommendation: Cardiac rehabilitation program should be included continuous training for all nursing staff and curricula structured for cardiac rehabilitation

Objectives : To assess the patient's knowledge about avoidance of recurrent Urolithiasis, and to identify the relationship between some variables (age, gender, level of education) and patient's knowledge.
Methodology: a descriptive quantitative study is carried out at Al-kindy teaching hospital in 15th July 2013 to 20th August 2014. A non-probability (Purposive sample) of (100) patient's with Urolithiasis who attended to Extra Corporal Shock Wave Lithotripsy (ESWL) department within (18) years and more. The data are collected through the use of semi-constructed questionnaire, which consists of two parts (1) Sociodemographic data of that consist (6) items, (2) factors contributed to recurrent Urolithiasis consist (43), by means of direct interview technique with the Urolithiasis patients. Reliability of the questionnaire is determined through a pilot study and the validity through a panel of (12) experts. The data were described statistically and analyzed through use of the descriptive and inferential statistical analysis procedures.
Results: The findings of the present study indicate that the patients have poor knowledge about stone formation and composition, and the factors contributed to stone recurrence about life style related to diet, fluid intake, family and medical history, physical activities, medication intake.
Conclusion: The study concludes that stone disease more common in male than female, the most of them were married and low economic status and have family history of urinary stone, also the study concluded that the decrease fluid intake, increase( calcium, oxalate, protein) diet, decrease physical activities, medication intake are the essential cause of Urolithiasis.
Recommendations: The study recommends that all urological departments in hospitals in every governorate in Iraq should include instructional division about the avoidance of recurrent Urolithiasis, provide patients with a booklet about the risk factors of recurrent Urolithiasis.

Objective: The aim of this work is to study the alterations in the vascular endothelial growth factor (VEGF-A), and its role in pathogenicity of bladder cancer in serum of men who are initially diagnosed with this disease.
Methodology: The current study was applied in pathology department of British United Kingdom kings college hospital during April 2012 to August 2013 by using Enzyme Linked Immuno Assay (ELISA) on serum taken from 42 men infected with bladder cancer, and other 38 benign considered as a control group to detect vascular endothelial growth factor type A (VEGF-A). Data analysis: SPSS computerizing system has been used for statistically analysis of data.
Results: The results revealed a highly significant (P <1.15) level of VEGF-A in serum of patients in comparison with the control group.
Conclusion: It was concluded of the results of the present study that VEGF-A was good prognostic biomarker for urinary bladder cancer in men ,and these results significantly correlate with the early stages of disease.
Recommendation: It may be recommended that using VEGF-A to predict and diagnosis the bladder cancer

Objectives: to evaluated the effectiveness of nursing intervention on patient's knowledge regarding percutaneous coronary interventions procedure.
Methodology: An quasi- experimental study (pre-posttest) took place between 10th October 2013 to 30 Julia 2014 was carried out in the medical ward (Al-razi) at Ibn Al-Bitar specialized center for cardiac surgery. Total (100) patients in the study sample, the sample was randomly divided into two groups of (50) patients each. The study group was providing nursing interventions to them by the researcher. The group that was didn't provide nursing interventions to them by the researcher was considered the control group. Three instruments were used to conduct this study. They were a demographics form, clinical characteristics and knowledge assessment tool. Knowledge assessment tool consisted of (22) question. It consists of three parts: understanding coronary heart disease (CAD), coronary risk factors, percutaneous coronary interventions procedure. Reliability of the questionnaires was determine by calculating Cronbach’s' Coefficient alpha =0.82. Descriptive data analysis was done through (frequency, percentage mean, standard deviation and relative sufficiency), inferential data analysis was done by (Fisher Exact Probability Test, Chi-Square test and Wilcoxon signed rank test).
Results: The results of the present study shows that there are highly significant differences between the study group and control group regarding main domains of patients' knowledge (understanding coronary heart disease (CAD), coronary risk factors, percutaneous coronary interventions procedure) and overall main domains at posttest at P = 0.00 value.
Conclusion: the health educational program is effective to improve the patient's knowledge concerning PCI in the study group.
Recommendations: Nurses should be playing a greater role to provide the nursing interventions to the patients undergoing PCI procedure

Objectives: The purpose of this study was to assess and describe baccalaureate nursing student's attitudes towards clickers in the classroom.
Methodology: A descriptive study was utilized to assess and describe student's attitudes with the use of clickers in the classroom. Attitude scales consisted of (20) items were developed by the authors with content validity established through review of the items by (13) expert nursing faculty. The 70 of Mosul Nursing students were participated in the study for the period 16-20 October, 2013. Statistical analysis was conducted to determine a frequency distribution of responses for each item as reported for the entire sample.
Results: Overall, the findings demonstrated that students were satisfied with the use of clickers in the classroom and encouraged the instructor to continue to use them for this class in the future. Students' overall perceived the clickers to help with their knowledge acquisition and retention.
Conclusions: This paper contributes to the literature on the use of innovative technology such as clickers in large class lectures in the Iraqi higher education context in particular and Nursing teaching context in general.
Recommendation: Further research regarding the motivation of students within the classroom and clicker implementation should be investigated

Objectives: the present study aims to find out the effectiveness of an educational program concerning the nurse's knowledge about nosocomial infection, and to find out the relationship between effectiveness of program and nurses year of experiences, level of education, and training course.
Methodology: A quasi-experimental design study was carried out at Baghdad teaching hospital for medical ward, during the period of December, 20th 2013 to September, 30th of July 2014. The objectives of the present study are to assess the nurses knowledge about nosocomial infection in medical units and to find out the effectiveness of educational program on nurses knowledge. The study samples is composed of (60) nurses who have been actually working in the medical wards in Baghdad Teaching Hospital, those nurses are divided equally into the study and the control groups. Instruments: The researchers constructed the educational program and instruments in order to reach the aims of this study. The questionnaires consist of two parts; first is concerned with the demographic data for nurses; the second part is concerned with the assessment of the nurses' knowledge about nosocomial infection Statistical Methods: The data have been analyzed through the application of: descriptive frequency, percentages; mean of scores; and the inferential analysis that include: Analysis of variance and the researcher used the SPSS version 20 to analysis of data.
Results: Most of the nurses 63.3% was females at age 20-29, in relation to marital status most samples was married, and graduated of nursing institute as educational level, 53.3% of nurses have (1-9) years of experience and majority of nurses included with training course in Iraq but not related to nosocomial infection, and the findings of present study revealed that there were statistical differences in nosocomial infection knowledge of nurses between pre and post program and between post study and post control group also there are statistical differences between level of education of nurses and nosocomial infection knowledge at P ≥0.05.
Conclusion: the present study concluded that the educational program was effective on nurse's knowledge about nosocomial infection.
Recommendation: The study recommends working to application of national program of nosocomial infection program at all health centers and continuous medical educational program for all staff in the health center, and continuous follow up to applying the program to prevent nosocomial infection after admission patients to hospital

Objectives: to assess nurses’ knowledge and attitudes toward health promotion at Al-Hussein medical city in Kerbela.
Methodology: A descriptive study was carried out during the period of March 25th through June 30th, 2014 to assess the nurses’ knowledge and attitudes toward health promotion at Al-Hussein medical city in Kerbela on a sample of 120 nurses. A questionnaire was used in the study, which contain information about the demographic data of the nurses (5 items) & selected questions about their knowledge (14 items) and attitudes regarding health promotion (16 items). Data were analyzed through a descriptive, and inferential statistics (t-test and correlational statistics) using the SPSS, version 19.
Results: it was found that more than two thirds of nurses (68.3%) were no participate in training courses about health promotion .The study revealed that most of the nurses have adequate knowledge regarding majority aspects of health promotion except in the aspect of (Regular exercise is highly recommended for the obese, and obesity is always bad for health) were they have inadequate knowledge. Also, most of the nurses have positive attitude toward health promotion.
Conclusions: the present study concluded that there is a shortage in the training courses about health promotion for nurses; there is a lack of knowledge level about the importance of regular exercise for the obese; and, "obesity is always bad for health". In addition to the education level, years of experience and training have a positive effect on the level of nurses' knowledge. As well as training courses affect positively on nurses' attitudes toward health promotion.
Recommendations: the study recommended education program should be designed and implemented to nurses who were working in the hospital to increase their knowledge concerning health promotion. Also to carryout additional studies with larger sample in other Iraqi governorates.

Background: The inter-pregnancy interval is the time between the last delivery and conception of the current pregnancy. Also, known as birth spacing,
Objective: The study aimed to assess the relationship between inter-pregnancy interval and adverse birth outcomes.
Methodology: A descriptive study design was consist of (200) women selected by purposive sampling technique. Data collected during the period of 10th of November- 2013 to 13th of April 2014. The setting of the study was carried out in hospitals of Mosul city (AL-Khansa Teaching and AL Batool Teaching). Data were collected with a structured questionnaire. This questionnaire consist of four parts, part one included demographic data and characteristics of the women included (Age, Educational level, Resident, Occupation, Gestational age, Prenatal care visits and Maternal illness during pregnancy), part two included intervals of inter-pregnancy that divided into months, part three included the reasons for not using family planning, part four included the most common adverse birth outcomes that occur for women and their babies after delivery. The validity of the questionnaire was examined by (10) experts and reliability of the questionnaire was (0.82). Data were analyzed by descriptive statistics inferential statistical.
Results: The newborn with low birth weight, the risk was higher among mothers with a short inter pregnancy interval (27%), the maternal characteristics of the sample demonstrates that according to age, the highest percentage was of the study age group (21-25) year that was (37%), As regard the resident, about (62%) of the sample was rural, And more than half of the samples (59.5%) were not visited a specialized maternal health care during their pregnancy period. With regard the maternal illness during pregnancy and the highest percentage was (42 %) in anemia., the main reasons for not using birth control at the time of conception among mothers was they thought will not get to have a pregnancy at this time (49%).
Conclusion: short inter-pregnancy intervals (three to six) months are associated with increased risks of maternal: anemia , gestational hypertension, low birth weight, preterm delivery and small for gestation age.
Recommendations: The researchers recommended that should be continued efforts to prevent repeat pregnancies among teenagers and interventions to lower short birth spacing among young adult mothers deserve high priority. The women should be succeeding in influencing and achieving an optimal birth spacing of at least eighteen to twenty four months.

Background: In areas of endemicity without sufficient laboratory infrastructure, identification of Leishmaniaparasites is useful for control and preventive plan and very important since species differentiation is instrumental in selection of optimal therapy and treatment regimens.
objectives: The present study was performed to identify the species and strain of Leishmaniaparasites isolated of different endemic areas.
Methodology: In a consecutive series of 126 patients referred for a suspected CL lesion during October 2010 to December 2012 in five Iraqi provinces, direct smear and culture followed by molecular and biochemical analysis were done using nested-PCR and cellulose acetate electrophoresis.
Results: Direct smears revealed that 90 (70%) patients gave positive results under light microscope. Out of 126 cases, 83 (467) gave positive growth in modified NNN medium and RPMI-1640 with fetal bovine serum followed by sub-culture in drosophila Schneider’s media. Out of 83 positive growth culture, only 52 specimens were studied by nested - PCR .It was found that 45 (89.5%) cases in the generation of a 560 bp DNA and 7(13.4%) patients displayed a fragment of 750 bp, corresponding to L. major and L. tropica, respectively. Cellulose acetate electrophoresis (CAE) was performed by 4 enzyme systems (glucose phosphate isomerize, leucilphosphate, mannose phosphate isomerize and 6 phosphogluconate dehydrogenase). The results showed that L. Major(LV39) isolate were in 20 mass cultivated culture
Conclusion: Nested-PCR and cellulose acetate electrophoresis was an ideal method for discrimination of Leis mania. spp. and variants. Both L. major and L. tropica were the causative agents of cutaneous Leishmaniasis but L. major was the main species in study area.
Recommendations: As a result of the observations made during the whole study period, nested- PCR is very suitable method, which can be used as a basis for future applications. Opening number of research centers situated in the country offer DNA applications for so-called “parasite tracking.” Such an application is probably more relevant for epidemiological purposes than for diagnosis. (e.g., in outbreak investigations or tracking drug-resistant parasite strains). After collection in the field, samples can be simply transferred to such a center for further analysis. More experimental studies for effective vaccine are developed for Leishmaniasis.

Objective: the aim of the study is to determine the prevalence of LADA among group of clinically diagnosed type 2 diabetes mellitus.
Methodology: sample size equal to 280 patients with type 2 D.M. were subjected in this study, participating patients were consecutively recruited of Diabetes outpatient clinic in AL-Hussein Teaching Hospital in Karbala of June, 2013 through January, 2014. A clinical questioner containing personal data, family history, type of diabetes, type of treatment, FBS, HA1C, BMI, diabetes duration & complications of diabetes. For analysis of data Prevalence of LADA among D.M.2 cases was calculated as the proportion of LADA cases in the D.M.2 cases. The Chi square test (X2) was used to assess the significance (P-value) of differences in frequencies of categorical variables.
Results: prevalence of LADA among D.M.2 patients was 12.1%. A significant difference in family history, BMI, FBS, HA1C and duration of D.M was found between the studied groups.
Conclusion: The prevalence of LADA is clinically underestimated among D.M2 patients and age of onset of diabetes should no longer be considered as a valid way to differentiate diabetes.
Recommendation: the study recommends screening for islet cell autoantibodies as GAD65 for all patients with diabetes at onset or beginning of disease.

Background: using physical restraints is a highly preferred practice in intensive care units. Most of the studies show that the main reasons for restraining patients is to prevent dislodgment of medical equipment’s and nurses have positive attitudes about restraining practices.
Objectives: this research was conducted for the purpose of evaluating the use of physical restraints, and observing ongoing practices and perceptions about physical restraints among intensive care unit nurses.
Methodology: A descriptive–cross sectional study done with 3 intensive care unit nurses in the 1st of Jan to end of May 2014. Nurses who agree to participate in the study were (63) filled out the questionnaire prepared by the researcher. The questionnaire consisted of three parts. The first part included questions related to nurses demographic variables; the second part included questions related to restraint practices of nurses; the third part included phrases to determine nurses perceptions for restraint use where nurses gave agree/ disagree answers.
Results: the study indicated that the Prevalence of physical restraint use is high in all ICUs. Gauze is the mostly used but not a proper material for restraining patients in all intensive care units. Reasons for using restraints as described by nurses are to prevent equipment dislodgement and providing safe working environment for themselves.
Conclusions: In this study, physical restraining practices of intensive care nurses and materials used for this practice are not appropriate for patient care. Perceptions and knowledge of nurses play an important role on the selection of the restraining method.
Recommendation: The study recommended that in order to get a better nursing care it is very important to develop a restraint policy and educate nurses to provide awareness about this highly used practice in intensive care units in these hospitals

Objective: The main objective of the study is to assess the emergency accident among primary school pupils, and type of managements.
Methodology: A descriptive study, was conducted in 10 primary school to identify the emergency accident among primary school pupils of Kirkuk city in 1st September 2009 to the 1st April 2010. The sample for the study comprised of 156 primary school pupils selected by purposive sampling technique. The data was collected between 1st October 2009 to 30th April ,2010. Structured questionnaires were used for the data collection. The data of present study was analyzed through the application of descriptive and inferential statistical approaches. Results were determined as significant at (P< 0.05) and high significant at (P <0.01).
Results : The study finding revealed that the most accident among the pupils at age 8 and 9 years old with 32(20.5%) ,34(21.8%) percentage respectively, Majority of the sample ware males 99(63.46%), most incidence among 2nd ,3rd ,4th Class with 32(20.52%), 30(19.23%), 34(21.79%) percentage respectively, the study shows that there is high percentage of wounds and bleeding 73(46.79%) denoted among pupils as a type of incidence most of them denoted in the arm 27(17.31%) due to of running and fill to ground 27(17.29%), high parentages of first aid given to study sample as Wound washing 28(17.95%) most of them send to home 82(52.56%).
Conclusions: Most accident are among the pupils within age 8 and 9 years old, at 2nd ,3rd ,4th Class, majority of them as wounds and bleeding due to of running and fill to ground and Collision between pupils ,most of them send to home without any first aid.
Recommendation The findings of this study indicated the need for educating about first aid practices, both pupils and teachers must be motivated to adopt special training, safety measures and practice to promote first aid.

Objective: To assess of contributing factors for adult with osteoarthritis and to find out the relationship between demographic characteristic with contributing factors for osteoarthritis.
Methodology: A descriptive analytic study was carried out throughout the present study to determine the contributing factors for adults with osteoarthritis who attended the outpatient clinic department of hospitals in Al-Diwaniya governorate. The study was carried out during the period extended of the November 10th 2013 to August 10th 2014. A purposive ''non-probability'' sample of (70) patients with osteoarthritis. Questionnaire form was constructed for the purpose of the study and it comprised of two parts. The questionnaire consists of (50) items. They include (1) demographic characteristics (2) assessment of contributing factors. Content validity of the questionnaire was determine through a panel of (16) experts. Reliability and validity of questionnaire was determined through test re-test (r= 0.931) of pilot study. Data was collected by the researcher who interviewed those patients and filled out the constructed questionnaire form. Data were analyzed by using descriptive statistical approach (frequency, percentage and mean of score) and inferential statistical approach (stander deviation and correlation coefficient).
Results: The findings of the study have revealed that the majority (40%) of the age group were more than 60 years old and the mean of age were (54.3) year. Most of the study sample (54.3%) was female. Most of them (91.4%) were married and (45.7%) were no read and write. The findings of the study sample indicated that the majority (47.1%) of the occupation were housewife. Most of the study sample (47.1%) were have appropriate of environmental of employ and (77.1%) living in urban area. Most of them (65.7%) were obese patients and (51.4%) were medium on the economic status. The result of the study also showed that the (45.7%) of the site joint injured were knee and hip joint and the second joint (38.6%) were knee and ankle joint. Most of the study sample (48.6%) of duration of injured of (1-2) year. Most of them (65.7%) were had underwent surgery.
Conclusions: The findings of the study indicated that the Osteoarthritis has been linked to obesity and high blood pressure. The findings of the study sample indicated that important items were (Do not best eat food of plant origin and eat white meat) in diet and the first quarter items were (Do not eat food of plant origin, eat white meat, Does not want to drink milk, Do not like eat fish oil, Do not like eat cheese, Do not best eat beans, Do not like exposed to sunlight, eat egg yolks, and Do not prefer to eat fish).
Recommendations: The study recommended an education program to be developed and implemented of patients about contributing factors for adult patients with osteoarthritis

Background: Pseudomonas Aeruginosa is one of the primary opportunistic pathogens responsible for nosocomial infections. Aminoglycosides are an important component of antipseudomonal chemotherapy. The inactivation of drugs by modifying enzymes and 16S rRNA methylase are the most common mechanisms of aminoglycoside resistance.
Aim of the study: Investigate the occurrence of aminoglycoside resistance and the incidence of the 16S rRNA methylase and resistance-modifying enzyme genes in P. Aeruginosa isolated of several hospitals in Al-Nasiriya province.
Methodology: A total of 355 clinical isolates were collected of three main hospitals in Al-Nasiriya city. The isolates were classified according the source of collection to three groups (160 ear swab, 105 burn swab and 90 urine samples). The results of culture and biochemical tests showed that 65 isolate was Pseudomonas Aeruginosa, which then confirmed by API-20E. Antibiotic susceptibility test (by using the Kirby-pour technique) was performed to all these isolates by using 18 type of antibiotics. The isolates that resistance to at least one type of aminoglycosides were screened for the presence of modifying enzyme genes (AACs, APHs, ANTs) and 16S rRNA methylase genes by polymerase chain reaction.
Results: 65 (18.3%) isolates of P. Aeruginosa were identified. The results of antibiotic susceptibility test showed that 29 isolate (44.6%) resistance to at least one type of aminoglycosides which represented by gentamicin the highest (44.6%) and amikacin (18.5%) the lowest. Four genes of AAC were found in 21 (72.4%) aminoglycosides resistant isolates, aac(6')-Ib (69%), aac(6')-I (24.1%), aac(3)-II and aac(3)-I (10.3% each). The most repeated combinations, aac(6')-Ib+aac(6')-I and aac(6')-Ib+aac(3)-II, were detected in 12.7% and 6.9% of isolates, respectively. Negative results for the presence 16rRNA methylase (armA, rmtA, rmtD, and npmA), aph (3')-VI and ant (4')-IIb genes.
Conclusions: The aminoglycosides resistance rates in P. Aeruginosa were roughly high in Al-Nasiriya, and most of the resistance isolates harbored aac (6')-Ib gene.
Recommendations: In order to overcome the worrisome development of increased resistance to antibiotics in general and aminoglycoside in particular, continued national surveillance programs are crucial.

Objectives: to assess school violence patterns toward the intermediate schools‟ students and to determine the effect of school violence on the psychological status of the students.
Methodology: A descriptive cross-sectional study was conducted at intermediate schools in Baghdad. A self-administered questionnaire was used as a mean for data collection. It composed of three parts: part 1 represented the sample characteristics; part 2 concerned with the violence behavior, it was constructed by the researchers to achieve the study objectives; and part 3 included 2 scales (GHQ-12 and self-esteem scales), it concerned with the psychological status of the students. A random sample of 600 intermediate school’s students was selected of different Baghdad districts‟ schools through a formal steps of administrative arrangements. The researcher visited and interviewed the sample at their schools to distribute the questionnaire for them to collect the required data. Data was analyzed by using the descriptive statistics like frequencies, percentages, means, and standard deviations and inferential statistics like Pearson correlation coefficient.
Results: Results revealed that there were a significant negative relationship between violence of teachers toward school students and the psychological wellbeing and self-esteem levels of the students (r= - 0.194, r= - 0.291 respectively) at p <0.01.
Conclusions: The study concluded that intermediate schools‟ students (males and females) face different types of physical and psychological violence of their teachers that have a significant effect on their psychological status.
Recommendations: The study recommended that antiviolence awareness workshops should be implemented to stop and prevent violence behaviors by teachers toward student and further similar studies on a nationwide should be carried out to assess the prevalence of school violence behavior and its effects on the student's psychological wellbeing.

Objective: The present study aims to investigate the effectiveness of instructional program on the physical and psychological status of patients undergoing upper gastrointestinal endoscopy.
Methodology: A quasi-experimental study was conducted in the outpatients and medical unite for the Gastroenterology and Herpetology unit in Baghdad teaching hospital and Al-Kindy teaching hospital Imamein Kadhimein Medical City for the period of the 5th of January 2014 to 17th August 2014. A non-probability sample was selected and composed of 100 patients divided into (50 patients within the study group who received the instructional program about upper gastrointestinal endoscopy and 50 patients within the control group were not exposed to the instructional program the instructional program was developed by the researcher and consisted of the information domain and trained domain and giving at least 7 day before the endoscopy procedure. A questionnaire was prepared for evaluating of patient physical status (through measuring the intensity of pain during the procedure by visual analogue scale and patient discomfort by (retching, attempt grabs the endoscope, body movement and moaning) and measuring the pulse rate and oxygen saturation blood pressure) during the procedure. While evaluating the psychological status (through measuring (state and trait anxiety) before and after the procedure. Identified validity of the questionnaire and instructional program by a panel of 28 experts, and identified the reliability of the search tool by adoption of a pilot study. Data were analyzed using descriptive statistics and inferential statistics.
Results: The results of the study in regards of physical status (measurement of the pain intensity) there is a high significant difference between the study group and the control group, while the measurement of the discomfort also a highly statistically significant were founded between the study and the control group related retching, attempt grab the endoscopy, the movement of the patient's body and moaning except retching were no statistical observed. In addition the study revealed statistically significant between the study and control groups when measuring the pulse rate and oxygen saturation except measuring blood pressure As for the psychological status (anxiety state) There are no significant differences between the study and the control groups during the pre-test, but there are highly statistically significant between the each group during the post-test, while ( anxiety trait) no statistical significance between the each group during the pretest, post-test.
Conclusion: The study concluded that there is a positive effect of instructional program implementing on physical and psychological status of patients undergoing upper gastrointestinal endoscopy in Baghdad teaching hospitals.
Recommendations: The study recommended to circulate the pamphlet that prepared by the researcher for upper gastrointestinal endoscopy units in Baghdad teaching hospitals affiliated to the Ministry of Health, which serves as a guide for patients to comply with all instructions to reduce patient discomfort during endoscopy procedure and also reduce anxiety.

Objective: To evaluate the nurse’s practices and to find out association between practices and their demographic characteristics of age, gender, education, and training crosses.
Methodology: An evaluative descriptive study was conducted at primary health care centers in Al-Amara city during Nov 1th, 2013 to 1th August 2014, in order to evaluate the nurse’s practices concerning vaccination in immunization units. The sample was selected a non-probability (purposive) consist of (70) nurses and the data collection process has been performed of February 9th to the May 13th 2014. The data were described analyzed through use of the descriptive (frequencies, percentage,…) and inferential (Chi-square) statistical analysis procedures.
Results: The findings of the study indicated that the majority of the sample within (40-49) years-old age group (54.3%). In regard to their gender, most of participants were males (70%). Concerning to their educational level, the highest percentage of the sample was technician institute graduate who represented (58.6%). Concerning the number of training courses (63.3%) of the subjects had between 1 to 3 training courses regarding to vaccination.
Conclusion: Findings of the study had demonstrated that majority of the participants had correct practice concerning vaccination; and showed there were a significant association between the nurse’s practices and their demographic characteristics of age, gender, education, and training crosses.
Recommendation: The study recommended the need to develop the skills necessary to perform the process of vaccination for nurses in order to improve their practices; in addition, the study recommended the establishment of scientific conferences and development courses for nurses working in immunization units.

Background: Polycystic ovary syndrome is the most common endocrine disorder in women with reproductive age. it has a multifactorial etiology characterized by menstrual irregularities, manifesting as oligomenorrhea or amenorrhea, a part of abnormalities of hyperandrogenism and polycystic ovaries. Recent evidence has demonstrated the complex function of adipose tissue and stomach as endocrine organs through release of hormones into the blood stream involved in physiological activities of the body with potential implication in PCOS development. One of the most important of these hormones are ghrelin, leptin and insulin that have role in process of PCOS development.
Aims of the study: The aim of present study to evaluate serum ghrelin, leptin and insulin resistance in clomiphene resistance PCOS women and to find correlation between these parameters.
Methodology: During Sep 2013 to May 2014, already diagnosed infertile Iraqi women with PCOS they are recruited in the private medical clinic of Dr. Ahlam ali naser during their periodic visit. There were 23 girls at mean age 21.3±1.2 on clomiphene therapy as clomiphene resistant PCOS group (CR-PCOS), 25 PCOS girls at mean age 23.5±1.4 consumed drugs other than clomiphene for PCOS treatment consider as (OT-PCOS) and 20 girls at mean age 22±2.4 as control group included in the present study. Blood samples were taken after at least 8 hours of fasting in all PCOS girls and control, serum glucose, ghrelin and leptin were measure, insulin resistance value were calculated using HOMA-IR model.
Results: The highest Ghrelin, leptin and IR levels were observed in CR-PCOS group and this level considered significantly high when compared with control and OT-PCOS groups. The only significant positive correlation between IR and ghrelin was observed in CR-PCOS group with no significant correlation in all study groups were observed. In other hand when we make correlation between ghrelin and study parameters, significant negative correlations that observed with leptin in control group not observed in CR-PCOS and OT-PCOS, meanwhile no significant correlation between ghrelin and leptin or IR in OT-PCOS group.
Conclusions: Women with clomiphene resistance PCOS exhibit significantly increased serum ghrelin, leptin and insulin resistance levels than control subjects and PCOS women taking therapy other than clomiphene indicating good biochemical markers in detection clomiphene resistance status in PCOS women. Furthermore we speculate significant positive correlation between ghrelin and IR in CR-PCOS group.
Recommendation: Assessment of ghrelin and leptin levels in women taking metformin and clomiphene combination therapy for PCOS treatment

Objectives: the aim of present study was to search for Cryptosporidium spp. in our children and tracking different epidemiological effects.
Methodology: Random fecal specimens were collected from 467 of children whom attended to hospitals of four Iraqi governorates, modified Ziehl-Neelson staining for all samples, two advanced PCR techniques (Nested PCR and Real Time PCR) were used for all positive samples to detect species. Data was analyzed by use of Yat’s Chi-square test.
Results: Among the 467 examined children, Cryptosporidium Oocytes’ were found to be excreted in 39 (8.35%) of them. Molecular tests showed that C. parvum and C. hominis found in 72.9% and 24.3% of positive samples respectively, two samples (5.1%) explain mixed species infection, whilst one sample (2.7%) don’t reveal any amplification, that may mean species other than of C. parvum or C. hominis.
Conclusions: The present study emphasized the public health importance of Cryptosporidium spp in the study area. It seems that zoonotic species (C. parvum) is the most important cause of infection in the region. According to our knowledge, this report is the first that recorded the species of Cryptosporidium in Iraq.
Recommendations: Further studies at different areas and age groups are required to investigate the molecular epidemiology of cryptosporidiosis in our community, and also in the animals to evaluate the role of zoonotic transmission in cryptosporidiosis epidemiology.

Background: Autistic disorder is a neurological disorder that causes a broad area of behavior impairments in children, including: hyperactivity, short attention span, impulsivity, aggressiveness, self – injurious behavior, tempers tantrum and abnormalities of eating or sleeping may be found. There is an increased rates of autism reached to 10-17% per year. It is the fastest-growing serious developmental disability in the worldwide over the past decades.
Objective: The study aims to assess the autistic child behavior.
Methodology: A descriptive correlational study was conducted in Jun 15th 2013 to October 15th 2013 on children with autism in Baghdad city. Purposive (non-probability) samples of 78 autistic children who are clients and receive care in the private specialization centers for autism were selected to participate in the current study. The study uses a parent-completed questionnaire for data collection. The behavior of autistic child was assessed using the Indian Scale for Assessment of Autism (ISAA).
Results: The findings indicated that most children were males of 4-12 years old with mean 5.78 years. The highest percentage of children reported a moderate level of the impairment in social interaction, behavioral pattern problems, sensory responses abnormalities and lack of emotional responses. And the highest percentage of children reported a mild level in communication difficulties and delay in cognition and perceptual functioning. Half of children reported a moderate level of the total score of behavioral problems for all domains.
Conclusions: All autistic children displayed the same behavioral disorders with different levels of severity. There is no significant relationship between the severity of autistic behavior and the child’s age and the child’s sex.
Recommendations: The study recommends that Ministry of Health and the Ministry of Labor and Social Affairs policy should give the autistic children support and high quality of services to help them to coping with this disorder. Those children need for special rehabilitative and behavioral programs dealing with their behavioral problems.

Objective(s): The objective of the study to evaluate the nurse manager performance of planning in hospitals.
Methodology: A descriptive "Evolutional" design was carried out to determine the quality of nurse manager role performance of planning in middle Euphrates governorates hospitals. Non-probability sampling was performed. Convenient sampling of (62) nurse manager was selected of the middle Euphrates governorates hospitals. Through extensive review of relevant literature, a questionnaire was constructed for the purpose of the study. A pilot study is conducted in order to determine the reliability of the study instrument which was used for measuring the determination of quality of nurse manager administrative role performance in middle Euphrates governorates hospitals. The study was conducted for the period of June 2nd, 2013 through June 30th, 2013. Data were analyzed through the application of the descriptive statistical data analysis approach (frequency, percentage, mean) and inferential statistical data analysis approach (t-test, person correlation coefficient, stepwise logistic multiple regression, Spearman Brown, chi-square).
Results: The findings of the study indicated that through the course of data analysis more than one half of the study sample are in Babylon governorate, the most hospitals are distributed in the city center rather than in the city side or in rural areas, the males nurses are more attend to working as an administrative nurse than the female nurses, the study sample responses to overall evaluation for the majority of the administrative nurse managers' role and duties is highly significant, study subjects overall responses to the planning function performance are highly significant.
Conclusion: The study concludes that the nurse managers have a good opportunity to continue their education, because they are to the top working side by management, The nurse managers have a good level of performance relative to their managerial roles and duties, and Working as managers in teaching hospital increases their knowledge about the planning function determine the quality of nurse manager performance.
Recommendations: The study recommended that the Further studies should be conducted to involve a larger geographical area in Iraq, The Ministry of Health should apply a continuing education courses for the nurse managers to increase their knowledge and performance about the managerial roles and duties especially in the non-teaching hospitals, and Management courses should be developed and improved to increase students' managerial knowledge and performance

Objectives: The aim of study is to assess job stress for nurses who are working in psychiatric hospitals in Baghdad city and its relation to socio-demographic characteristics of the nurses.
Methodology: descriptive analytic study was conducted on 100 nurses were present in at three psychiatric hospitals in Baghdad city. The data are collected through the use of constructed questionnaire which divided into two sections; the 1st section included general information (demographical characteristic) of nurses. The 2nd section was based on job stress scale; it's consisting five domains which are: Dealing with patients and their families, Workload, problems with doctors, Problems with supervisors and Conflict relating peers. The content validity of the instrument was established through penal of (11) experts. Reliability of the questioner was 93%. Descriptive data analysis was done through frequency, percentage mean, standard deviation and inferential data analysis was done by Independent t-test, Analysis of variance (ANOVA).
Results: the results show the majority of nurses were middle age male, married, graduated of nursing institutes, have less than or equal 5 years of experienced in psychiatric hospitals, most of them participated in training courses related to psychiatric mental health care inside Iraq, while few of them participated in the courses outside Iraq. Results revealed that both nurses (male& female) suffering of moderate level of stress in their work in all of domains and there was a significant relationship between nurse's stress and their training courses especially outside the country.
Conclusion: the results revealed that job stress in all domains were found moderate among nurses in psychiatric mental health hospitals because of lack of participation in training courses and especially outside country.
Recommendation: Reconsider and improving of employees in psychiatric nursing profession by establishing training courses (especially in psychiatry- mental health nursing) inside and outside of country in order to develop nurses' skills according to scientific programs through development of nurse's abilities and performance

Background: Every day, health care worker are exposed to dangerous and deadly blood borne pathogens through contaminated needle sticks, sharps, or splash exposures. In hospitals, nurses are the first level of the staff whom contact with risk of infection in unsafe practices related to needles and sharps.
Objective: Assess of nurse knowledge regarding needle prick injuries and its risks in Erbil hospitals.
Methodology: A descriptive study was conducted in some hospitals of Erbil City. The Sample size for the study was 60 nurses. Purposive sample was selected and Data was analyzed by using descriptive and inferential statistic by SPSS version (19).
Results: It showed that the most of nurses had good knowledge regarding the needle prick injuries and its risks. Also there are no significance relationship between nurse's knowledge and their demographic data.
Conclusion: The researchers concluded that the nurse's knowledge regarding needle prick injuries generally were good.
Recommendation: conducting educational teaching programmed for nurses regarding needle prick injury to improve their knowledge about it to protect themselves of its risks.

Objective: To find out the ways of coping to deal with stress used by the Iraqi repatriated prisoners of Iran-Iraq war, and also to find out the relationship between these ways and some demographic characteristics.
Methodology: A descriptive study was carried out of Oct. 18th, 2010 through Jan. 10th, 2011. A Snowball sampling as a non-probability sampling technique was used to recruit 92 repatriates who had visited Ministry of Human Rights. An instrument was constructed for the purpose. The constructed instrument consisted of six demographic characteristics, and twenty eight items for measuring the level coping in POWs. Data were collected with using the constructed instrument and the process of the interview as means for data collection. Data were analyzed through the application of descriptive statistical analysis, which are; percentages, frequencies and inferential statistical analysis (Pearson correlation coefficient).
Results: The study revealed that the majority of IRPOWs have some levels of coping that 31.5% (n= 29) of IRPOWs have weak level of coping; 64.1% (n= 59) have medium level of coping; and only 4.3% (n= 4) have good level of coping. The findings also indicated that there is no significant relationship between coping relative to; current age, age at capture, duration of captivity, marital status, and level of education.
Conclusions: The present study concluded that all the IPOWS were males and married, the majority were stayed in captivity sixteen years and more, high percentage of them had Bachelor degree. The study indicated that the majority of IPOWS used the religious commitment and mediation as a mean of coping to deal with stress.
Recommendations: The study recommends that it is very important to establish special mental health services centers within the primary health care centers deal with those repatriates for counseling and in order to diagnose and treat them and further studies in this field with follow-up studies for the repatriates.

Objective: To identify the association of neural tube defects with some possible risk factors in Iraqi neonates.
Methodology: This is a hospital based case control study carried out in two major hospitals in AL Najaf province during the period (first of February through the end of May 2014). All the available fifty responded cases of neonates with gross Neural Tube Defects (NTDs) who were diagnosed and confirmed as neural tubes defects by specialist pediatrician were studied as cases and compared with (100) randomly selected sex and age matched control group neonates ( Free of neural tube defects). Data collection were done through a structured questionnaire by interviewing mothers of both groups single handy by the researcher ,Odds Ratios (OR)were calculated to identify the probable risk factors of neural tube defects.
Results: The proportions of types of neural tubes defects in this study were; spina bifida (52%), encephalocele (36%) and anencephaly (12%). the factors that significantly associated with increased risk for NTDs were a lack of folic acid supplementation (OR=12.55, (95% confidence interval CI 5.59-28.17); poor ante natal care OR=3.67(95% CI 1.80-7.48), abortions OR=5.52(95% 2.64-11-54) ,previous still birth OR=2.02( CI 95% 0.79-5.14), number of parity OR=1.10( CI 95% 0.48-2.30), maternal smoking OR=2.25( CI 95% 0.87-5.83) maternal age 0R=1.95 (0.88-4.31), maternal family history OR=1.36(0.37-5.1), maternal educational level [low educational level] was OR=4.86[2.2-10.9], while paternal factors were father family history of neural tube defect OR=21.7[2.67-53.42] ,father smoking OR=3.8 [1.77-8.34] father age OR=4.04 [1.55-10.55]. Residence OR=3.78[1.85-7.72], consanguinity OR=3.84[1.77-8.34] ,while the association between neonates factors and anomalies were age of neonates OR=2.125[1.10-4.30], birth weight OR=1.52[0.72-3.30].
Conclusion: The main factors that associated positively with neural tube defects among others factors were ( father family history of neural tube defects, lack of folic acid supplementations ,mothers with low education and consanguinity marriages) which highly significant and strongly effects in neural tubes defects among others factors ,while mothers with higher education was protected them siblings of this anomaly and found the number of parity had no relation on neural tube defects formation.
Recommendation: Confirmation to avoid internal marriages and especially for families that have birth defects and an emphasis on taking the tab of folic acid before and during pregnancy in dose (400-500 micrograms) for women with children deformed previously or frequent abortion or who take drugs interferon Folic acid, parents should avoid smoking and urge the supplement level of science education due to increasing awareness of the health help them avoid all the factors causing neural tube defects

Objectives: The study aims to determine the prevalence of anxiety among the students of the Faculty of Medicine of Qadisiyah.
Methodology: The study was cross-sectional at 290 students in the Faculty of Medicine Qadisiyah (101 males and 189 females) , in the province of Diwaniya, for the period of 1st of March up to 31st of May 2012. a questionnaire self-reports of the students was used. The students covered study based on their readiness after the purpose of the study was explained to them, the study included all phases of the first stage to the sixth stage. The result was analyzed by using descriptive statistical methods like percentage and frequency, and inferential statistical methods appropriate such as Chi-square by using spss 12.
Results: out of (290) there were (139) suffer of mental disorders positive (anxiety), giving a prevalence rate of 47.9% The prevalence is highest among students of first and second phases (65.7 % and 57.5 %) compared with the rest of the stages {third 39.5 %, fourth 30.5 %, fifth 36.8 %, and sixth 29%} respectively.
Conclusions: The study concluded that there is a high percentage of students in the Faculty of Medicine Qadisiyah suffer of anxiety in all stages.
Recommendations: providing psychiatric counseling Clinics, to diagnose cases of concern and to provide the necessary support. In addition, encourage future studies to discover the causes of these cases

Objectives: The study aims to identify the nurses knowledge toward skin care for patients undergo radiotherapy breast cancer
Methodology: Seventy nurses were selected to achieve the objectives of the study. The study was conducted during Feb./2014 at Al –Amal National Hospital for Cancer Management in Baghdad City. The questionnaire consists of two parts first part: included demographic characteristics of the nurses and the second part: included clauses relating to the knowledge of nurses about skin care to patients undergoing radiation therapy consisted of (20) items .Data were analyzed by using Frequency, percentage and chi-squared test.
Results: The study results showed that most of nurses Knowledge was range between low (40٪) and moderate (45.7٪) and there were significant differences between nurse’s knowledge and nurse’s variables age, level of education, years of experience in radiotherapy unit and number of training sessions at (p <0.05)
Conclusion: The researcher concluded that the nurse’s knowledge is insufficient about skin care for patients undergoing radiotherapy of breast cancer.
Recommendation: It is recommended increase the researcher to focus on the nurses knowledge about skin care for patients undergoing radiotherapy of breast cancer and to identify the symptoms of the side effects of radiation therapy and prevention

Objectives: This study aims to find out the immune response (antibodies and cytokines) for women with disease T.Gondii and correlation between them calibrated and the effects on the patients of the difference age groups.
Methodology: Were collected (200) samples of blood and (30) samples of umbilical cord of women and pregnant women with disease T.Gondii and revisions to hospitals in Najaf and laboratories for the purposes of abortion or treatment of disease, while the number of women samples control amounted to 30 samples . Pregnant women and control were divided into three age groups, namely, (15-25), (26-36) and (37-47) respectively. The study involved collecting samples and tested the first test by latex and then examined by the technique of adsorption-linked immunosorbent assay (ELISA) for the detection of antibodies (IgG and IGM). The study reported that technique is more important than the ELISA test for latex which was (P = 0.007).
Results: The results of this study include following : the difference between the age groups and abortion rate in women was age groups (15-25) and (26-36) is the highest at 40% and 51%, respectively, and compared with the pregnant women and the disease infected T.Gondii. The study pointed to the existence of a significant difference in the proportion of antibodies in different age groups when compared with the control group. Adding to the cytokines. The study showed that there is a relationship between genes Toxo B1, ITS-1, Tg-8, Tg-9, SAG-1 and SAG-2 by examining the DNA taken of the blood and placenta of women with T.Gondii. And recorded the highest number of positive samples (52) in the sample ITS-1 of the rest of the other genes. Statistical relationship was the most important in the diagnosis of the parasite (P = 0.001).
Conclusion: The correlation between of the cytokines and toxoplasmosis with according of abortion.
Recommendations: To detect genotypes that lead to spontaneous abortion