Mosul Journal of Nursing

Background and Objective: Stress is a psychological state of fatigue or physical fatigue affects an individual in response to psychological pressure or unexpected real life. Stress can be short-term or longterm, Feeling stressed is common during pregnancy, but too much stress can make a pregnant woman uncomfortable. Stress can make trouble sleeping, headaches, loss of appetite or overeating. Some studies show that high levels of stress in pregnancy may cause certain problems during childhood. The purpose of this study was to assess the psychological distress among pregnant women's in Kirkuk city, as well as to find a relationship between psychological distress and some socio- demographic characteristics such as (No. of children, socioeconomic status, pregnancy stage, woman's age). Material and Method: A descriptive study was carried out in gynecological consultation at hospitals
(Azadi teaching, general Kirkuk) in Kirkuk city, to assess the psychological distress in pregnant women for a period from the 15th of June 2013 and up to the 25th of November, 2013 to achieve the objectives of the study. A probability (purposive) sample of (120) pregnant women's. Developed questionnaire was constructed for the purpose of the study, which consisted of three parts: the demographic characteristics; medical data and assessment psychological distress among pregnant women. The data were collected through the use of the interview. They were analyzed through the application of descriptive statistical analysis (frequency , percentage) and inferential statistical (chi-square) . Results: The findings of the study indicated that (35%) were in the age group ( 22-26), and (85%) were from the urban, (30.84%) of the sample were graduate from Institute and above, (70%) of them housewife , (65.83 %) of the sample had barely sufficient monthly income. Regarding to the medical data finding of the study indicated that (57.5%) of them in the 3rd trimester , the Miscarriage in the whole
study represented (75.83%) is null, (29.17) have null children, (55.83%) overweight, (94.17%) no smoking, (88.33%) have no history of chronic disease ,(79.1%) have no pregnancy induced hypertension ,(98.23%) have no pregnancy induced diabetic mellitus. Conclusions: The psychological distress in the study sample was founded in the third Trimester and founds a Significant relationship between Pregnancy Stage and Psychological Distress. Also founds a Significant relationship between socioeconomic status and Psychological Distress. As the study
concluded that most of the pregnant women were to have moderate psychological distress. Keywords : Assessment ,Psychological Distress, Pregnant Women, Pregnancy, Trimesters , Miscarriage.

Background and objectives:- Thalassemia is a blood disorder passed down through families (inherited) in
which the body makes an abnormal form of hemoglobin, the protein in red blood cells that carries oxygen.
The disorder results in excessive destruction of red blood cells, which leads to anemia. Hemoglobin is made
of two proteins: Alpha globin and beta globin. Thalassemia occurs when there is a defect in a gene that helps
control production of one of these proteins. There are two main types of thalassemia Alpha thalassemia
occurs when a gene or genes related to the alpha globin protein are missing or changed (mutated) ,it’s occur
most commonly in persons from southeast Asia, the Middle East, China, and in those of African descent.
.Beta thalassemia occurs when similar gene defects affect production of the beta globin protein and it’s occur
in persons of Mediterranean origin, and to a lesser extent, Chinese, other Asians, and African Americans.
There are many forms of thalassemia. Each type has many different subtypes. Both alpha and beta
thalassemia include the following two forms the first is Thalassemia major(Cooley's anemia ) while the
second is Thalassemia minor patients must inherit the defective gene from both parents to develop
thalassemia major while Thalassemia minor occurs if the patients receive the defective gene from only one
parent. Persons with this form of the disorder are carriers of the disease and usually do not have symptoms
(DeBaun, MR et al. 2011 ). This study aims to assess the thalassemic children’s parents awareness toward
thalassemia.
Materials and method: a Descriptive study have been carried out in Kirkuk Governorate / Al-Azadi
teaching hospital ,which the nursing and medical care are provide to thalassemic children from
September / 2012 to august 2013 .
Results: The results of the study showed that Most of the sample is female in age (30 and more) years old.
Most of the samples’ (56%) level of education is read and write while only 6% have bachelor degree .The
result indicated that most of the sample (60%) have three or more children in their family in addition most
of them(72%) have only one child incidence by thalassemia, while only (2%) of them have three child with
incidence of thalassemia. the study indicated that the parents have high rates (66%),(64%)(90%),(72%) of
acceptable level in knowledge related to definition, singes and symptoms, the transmission method and
classification of thalassemia to alpha and beta. The finding also showed that the parents have high rate of
unacceptable level in knowledge regarding the genetic factor that causes the disease (62%),carriers in
thalassemia (78%),the genetic role in disease transmission (78%),the causes of each of α and β types of
thalassemia(60%), Pathophysiology (94%), diagnosis methods (74%) and treatment of minor
thalassemia(70%) .
Recommendations: Based on the result of, the investigator recommends Educational program for the
parents and families of the children who experienced blood disease including thalassemia. Establishing a
special consulting unites for the families of blood disease children’s to answer their questions. Encourage the
parents of these children to work as a volunteer in the consulting unites to help the new diagnosed cases of
thalassemia and their parent to be oriented with their new situations. Provide a Socioeconomic supports to
thalassemic patients and to their families.
Keywords: awareness, thalassemia, patients' parents, Kirkuk city

Background and objectives: Nursing is a health care profession, which is focused on the care of
individuals, families, and communities; so that they can attain, maintain, or recover optimum health.
Nurses care for individuals of all ages and cultural who are healthy or ill in a holistic manner based on the
individual's needs. The aim of the study was to assess the nurses’ perception about the nursing profession
in Al-Jamhory Teaching Hospital.
Material and methods: A cross-sectional is design has been adapted at Al-Jamhory teaching hospital in
Mosul city for period from 10th November 2012 till 25th March, 2013, a simple random sample selecting
of (180) nurse. The questionnaire validity was determined by presenting the items to a panel of experts'
tutors of nursing college. The test and re-test approach used to determine the reliability of the
questionnaire (r = 0.80), the statistical analysis organized by (SPSS, Version 16).
Results: the analysis of data revealed that (40%) of nurses' haven't good perception towards their
profession, and (54%) of nurses are intended to leave the profession because low salary their percentage
was (72%). The personal factors represented the highest percentage (32%) among the factors affecting
nurses' perception for their profession. The study founded the significant relationship between perception
nursing professions and intends to leave profession.
Conclusion: The present study shows some of the nurses in Al-Jamhory teaching hospital have a poor
perception towards nursing profession, and the nurses had an intention to leave their profession because
low salary.

Background and Objectives: As a learning strategy, Problem Based Learning (PBL) offers the potential
to bridge the theory – practice gap in professional practice, through the recognition and evaluation of
practice – based problems. It is based on principles and cognitive psychology, it differs from the much
criticized traditional methods of learning which are largely teacher centered. The study was carried out to
determine the opinions of faculty teaching members in nursing schools about PBL method
Methods and Materials: The descriptive study conducted throughout the period of 1st January till 28th
March / 2013. Convenience sample of (68) faculty members were attained; almost of them were
baccalaureate –as a trainers- and master in nursing, 82.4% of them were nursing faculty members and
more than half of them (58.8%) had less than (6) years as a tenure in nursing schools. The sample was
approximately equal distributed among the settings of the study (two nursing colleges and two nursing
institutes). Anonymous questionnaire was structured depended on many previous related literatures, it
consists of (46) items (Tutor-related=5, Student-related=12 and Design-related=29). Each item has five
options (Strongly disagree=1 – Strongly agree=5). Validity of the instrument was checked by review of
(5) experts in nursing, while reliability was measured through split-half technique (r=0.87).
Results: The main results of the study were: low acceptable level of opinion about PBL method among
faculty members, while the attributes of the sample didn't indicate any significant statistical differences.
Conclusion: It concluded that nursing curriculums tend to be traditional method as lecture-based.

Background and objective: Before, during and after treatment, nurses and allied health professionals
should inform and educate patients about the risks and complications of any planned diagnostic test,
intervention or treatment. Patients and families should be taught about some of the common side effects
of treatment after operation including weight loss, malnutrition, pain, fatigue, and depression. This study
aimed to assess nurse’s knowledge about health education for patients with brain tumors during their
post-operative period.
Materials and Method: descriptive design study was conducted at two teaching hospitals, Neurosurgical
hospital and surgical specialties hospital in Baghdad in which craniotomy was performed. Data have been
collected by using prepared form, from the period (September 5th 2012 to November 5th 2012. 50 nurses
male and female participated in the study.
Results: Most of the convenient sample of the study was females 56% their educational levels were high
institute and college graduate.34%. The study showed that nurses gender, educational level have a
significant association with their abilities of providing of health education about brain tumors
postoperatively.
Conclusion: The main result of the study revealed that there were significant associations between
nurse’s educational level and their knowledge about health education regarding post-operative patients
with brain tumors.

Background and Objective: Violence at work is becoming an alarming phenomenon worldwide.
Affecting the dignity of millions of people, violence is a major source of inequality, discrimination,
stigmatization and conflict in the workplace. Therefore, a cross section study was conducted to assess the
types of work place violence and to find out the consequences of work place violence on nursing staff
who working in educational Baghdad hospital
Material and Method: Sample was selected from intentional nurses those who work in Baghdad
Teaching Hospital. (100) of nurses who agreed to participate in this study during the period from
February to March 2012 in the city of Baghdad. Data was collected through the filled application
questionnaire form, descriptive statistical methods used in data analysis.
Results: the results indicate that the highest percentage (25%) of the study sample in the age group (40-
44) years, the mean age and SD of study sample is 36.79 ±8.70190. and (59%) of the study sample were
male, and the majority (95%) of them living in Baghdad. the highest percentage (47%) of study sample
were working in surgical ward. (46%) of study sample were at secondary school level. the highest
percentage (77%) of study sample were married. According to Workplace Violence Sources the highest
grade (92) at high level of RS of the work place Sources regarding Patient and his Relative refers to Bad
Working conditions (excessive heat or cold, noise, bad furniture). Concerning Colleagues or Supervisors
the highest grade (94.5) at high level of RS of the work place regarding colleagues or supervisors
violence which refers to absence of proper insurance. According to the Consequences of Workplace
Violence Level the highest grade (86.5) at moderate level of RS of the consequences on a personal level
for nurses which refers to anger. The consequences on work level the highest grade (87) at moderate level
of RS refers to Underestimation and disrespect of the profession of nursing in the society. Concerning
consequences on health care setting the highest grade (90) at high level of RS refers to .more shortage of
healthcare professionals (many healthcare professionals shift to other fields.
Conclusion: The study highlights the sources of workplace on nurses. All study samples had experienced
workplace violence either from patient and his relatives or from colleagues or supervisors. Exposure to
work place violence often has a great consequences regarding personal, working and health setting level
on the satisfaction of nurses and the quality of health care service.
Key words: Consequences, Workplace, Violence, Nursing Staff

Background and Objective: The identification and diagnosis of acute myocardial infarction (AMI) in
patients presented with chest pain pose significant challenges, as the rate of missed AMI cases among
patients who present to the emergency department remain inappropriately high. The aim of this work was
to study the performance of three cardiac biomarkers, these are heart-type fatty acid binding protein (HFABP),
troponin I (3rd generation TOSOH AIA pack-assay) and myoglobin, for early identification of
acute myocardial infarction.
Material and Methods: This study was designed as a case –control study. Participants were divided into
two groups, the first one included 82 patients diagnosed to have AMI and the second group included 50
apparently healthy control subjects. Troponin I and myoglobin were measured by AIA-Pack assays from
TOSOH bioscience while H-FABP was measured by ELISA technique.
Results: The area under the curve (AUC) for troponin I was the highest between the tested biomarkers
(0.972 ± 0.012) compared with H-FABP and myoglobin which were found to be (0.968 ± 0.013) and
(0.921±0.022) respectively. Furthermore, by using the optimal cut-off values of the tested biomarkers, the
sensitivity of H-FABP was the highest for those patients presented within the first six hours of the onset
of chest pain (90.6%), followed by troponion I and myoglobin (81.3% and 78.1% respectively). From the
other hand, the sensitivity of troponin I was the highest (98%) for those patients presented after the sixth
hour up to 12 hours from the onset of chest pain compared by H-FABP and myoglobin (90% and 78%
respectively).
Conclusion: The present study demonstrates that both improved sensitivity troponin I assay and H-FABP
can provide valuable information for the diagnosis of AMI. However, for those patients who presented
within the first 6 hours of the onset of chest pain, H-FABP will provide superior sensitivity, as application
of an early biomarker potentially reduces diagnostic uncertainty for patients with suspected AMI that
allow an earlier initiation of treatment, while for those patients who presented later after the 6th hour up to
12 hours of the onset of chest pain, it is more appropriate to use troponin I assay as it provide higher
sensitivity.

Background and objectives: Hypertension is an extremely common co-morbid condition in diabetes.
Peripheral insulin resistance (IR) plus compensatory hyperinsulinaemia is a common mechanism
underlying both hypertension and diabetes. The aim of this study was to compare the effects of
telmisartan and captopril on IR in type2 diabetes mellitus with hypertension.
Materials and Methods: This study was conducted in the Department of Pharmacology, Mosul College
of Medicine, University of Mosul and Al-Wafaa center for diabetes management, Mosul, Iraq, from 1
March, 2012 to 30 March, 2013. Sixty-eight patients on oral hypoglycemic agents were assigned to
receive two month treatment of either telmisartan (n = 34) or captopril (n = 34). Forty diabetic
normotensive patients, with age and BMI, matched to the diabetic hypertensive patients, served as a
control group. The oral hypoglycemic agents remained unchanged during the two- months study period.
Insulin resistance was estimated by homeostasis model assessment of insulin resistance (HOMA-IR) and
quantitative insulin sensitivity check index (QUICKI).
Results: This study showed that the two groups of diabetic hypertensive patients who were assigned to
receive captopril or telmisartan have a non-significant difference in fasting serum glucose (FSG), fasting
serum insulin (FSI), QUICKI and HOMA- IR before starting therapy. Telmisartan and captopril groups
showed insignificant change in body mass index (BMI). HOMA-IR, QUICKI, FSI and FSG were
changed non-significantly in telmisartan group; while FSI, FSG and HOMA-IR decreased significantly
(from 18.1± 9.69 to 15.14 ± 7.49, p=0.022; and from 187.32± 65.34 to 162.95 ± 56.87, p=0.048; and from
8.27 ± 6.28 to 6.02 ± 3.73, p-value= 0.027, respectively) and QUICKI increased significantly (from 0.293
± 0.024 to 0.306 ± 0.031, p-value = 0.022) in the captopril group versus baseline.
Conclusion: Captopril, but not telmisartan, significantly improves insulin sensitivity in diabetic
hypertensive patients.

Background and objectives: Chronic kidney disease (CKD) is a common problem in public health. Its prevalence has been studied using the estimated glomerular filtration rate (eGFR) by the creatinine-based equations developed in Modified Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) study. Recently, new equations based either on cystatin C alone (Cystatin C1) or cystatin C with the age (Cystatin C3), or estimating equation including all of Cystatin C, serum creatinine and age (Cystatin C4) have been proposed by the CKD-Epidemiology collaboration. The aim of this study was to measure the differences between these estimating equations to achieve the closest one to the gold standard 24 hours corrected creatinine clearance (Corrected CrCl).

Methods: Corrected 24 hours urine creatinine clearance from 185 patients with different stages of CKD was compared with eGFR derived from six equations which are Cockcroft–Gault (CG), (4-MDRD), CKD-EPI, Cystatin C4, Cystatin C3, Cystatin C1 equations, the results were analyzed using Receiver Operating Characteristics Curve (ROC) and correlation analysis by SPSS computerized statistical analysis program.

Results: the result revealed depending on corrected 24h creatinine clearance as a gold standard that the most accurate eGFR equation was in the following order Cystatin C1 and Cystatin C3, Cytatin C4, CKD-EPI, 4MDRD, then Cockcroft–Gault respectively.
Conclusions: Cystatin C dependent eGFR equations are good, reliable, simple and accurate method for estimating renal functions.
Recommendations: Physician involved in diagnosis and treatment of patients with kidney diseases are better to be advised to use Cystatin C eGFR equations rather than the other previously known eGFR equations which were less accurate.