Annals of Tropical Medicine and Public Health
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   Table of Contents - Current issue
Coverpage
November-December 2017
Volume 10 | Issue 6
Page Nos. 1401-1845

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EDITORIAL COMMENTARIES  

Meeting the health care needs of the millions of the refugee population through the mobile clinics approach Highly accessed article p. 1401
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222667  
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World Health Organization calls for the adoption of updated guidelines for the management of chlamydial, gonococcal, and syphilitic infections p. 1403
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222670  
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Saving lives of mothers and newborns from infections around the time of childbirth by strengthening health sector response to the public health concern of antibiotic resistance p. 1405
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222671  
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World Health Organization raises concern over the urgent need to respond to the multiple outbreaks of infectious diseases reported in South Sudan amidst the ongoing conflict p. 1407
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222682  
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Zika virus disease outbreak in Brazil: Existing challenges and role of young people in containing the infection p. 1409
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222687  
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World Health Organization appeals for investment in the strengthening of the global health workforce to accomplish financial growth p. 1411
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222692  
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Strengthening childbirth services in conflict-affected regions of South Sudan p. 1413
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222700  
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Expanding the coverage of preventive chemotherapy for the prevention and control of neglected tropical diseases p. 1415
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222705  
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Implementing mTobacco Cessation program in India to assist users in quitting tobacco: World Health Organization p. 1417
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222706  
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Streamlining efforts to fight against the global problem of malnutrition in the 2016-2025 decade of action on nutrition p. 1419
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222711  
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Encouraging pregnant women to deliver in upright position: UnitedNations Population Fund p. 1421
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/ATMPH.ATMPH_625_16  
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Dealing with the issues of gender inequality and aiming for the empowerment of adolescent girls p. 1423
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/ATMPH.ATMPH_634_16  
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REVIEW ARTICLES Top

Seroepidemiology of pertussis disease in Asia: A literature review p. 1425
Reza Ghotaslou, Yalda Mohammadzadeh Asl
DOI:10.4103/ATMPH.ATMPH_198_17  
Context: Pertussis is a highly communicable acute respiratory tract infection caused mainly by Bordetella pertussis. Since pertussis is life-threatening to young infants, it remains a growing public health concern in many countries in spite of vaccination coverage. Evidence Acquisition: We performed a selective literature search about the pertussis epidemiology in Asia over the past 15years to provide a picture of the B. pertussis incidence rate in the area and help design an effective strategy for adolescent and adult vaccination. Results: The overall prevalence of B. pertussis seropositivity among the evaluated people(16,785) in Asia from 2000 to 2015 was 36%. The calculated prevalence rates were 38.4% for Iran, 29% for Japan, 29% for Turkey, 40% for Korea, 8% for China, 59% for Pakistan, 52.4% for Israel, 34% for Taiwan, and 97% for Singapore. The mean age of the total individuals was 27±3years. Ahigh percentage of seropositivity was found in the warm months(between the early summer and early autumn). Conclusions: Results show that pertussis is endemic in Asia, particularly in adolescents and adults and in warm seasons. This study also shows the importance of laboratory diagnosis for pertussis, booster vaccinations for adolescents, development of a highly efficacious pertussis vaccine, and improving surveillance system.
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Biodiversity loss: Public health risk of disease spread and epidemics p. 1432
Rajan R Patil, Ch. Satish Kumar, M Bagvandas
DOI:10.4103/ATMPH.ATMPH_269_16  
Background: Biodiversity and human health are intimately linked to each other, human beings are an integral and inseparable part of the natural ecosystem as human health depends ultimately on the health of its species. Human interference with biodiversity affects ecosystem both structurally and functionally, consequently biodiversity is continuously declining globally. Objective: The objective of this study is to understand the effect of biodiversity loss on dynamics of infectious disease transmission and its impact on the magnitude and impact of epidemics. Methods: This is a literature review. Discussion: Correlation has been observed between decrease in disease frequency with increase in biodiversity. Aregion rich in diversity of species of vertebrates has protective effect against vulnerability of Infectious diseases especially Vector-borne zoonotic diseases. This phenomenon in nature is known as Dilution effect. Biodiversity in host can either lead to amplification or buffering of epidemics. Dilution effect lowers the incidence of the disease among humans while the richness of biodiversity reduces the prevalence of directly transmitted diseases leading to buffering effect. Fragmentation of natural habitat leads to lowered biodiversity leads to higher risk of exposure to diseases. Conclusion: While some human health effects due to biodiversity loss may be direct and easily perceptible while others are indirect may not be appreciated currently. According to the World Health Organization, the adverse health effects brought in by loss of biodiversity far exceeds dangers of implication of climate change to human health. Health professionals should advocate for the preservation of biodiversity as it has a powerful impact on frequency of disease transmission in the community.
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ORIGINAL ARTICLES Top

Insecticide resistance of temephos on Aedes aegypti as dengue vector in Samut Songkhram, Thailand p. 1439
Tanawat Chaiphongpachara, Laddawan Moolrat
DOI:10.4103/ATMPH.ATMPH_127_17  
Background: Dengue hemorrhagic fever, vector by Ae. aegypti, is a world common public health problem, particularly in tropical and subtropical area including Thailand. Samut Songkhram also has an epidemic of this disease. To control the spread, we focus on decreasing Ae. aegypti larva in the area. In Samut Songkhram, people mostly use temephos, which might cause a resistance in mosquitoes. Aims: The purpose of this research is to test resistance of Ae. aegypti against temephos(GPO-1 and Zeolite) and compare temephos's resistant rate in epidemic subdistricts, Ladyai; Suan Luang; and Jompluak of Samut Songkhram province, Thailand. Settings and Design: Experimental research. Subjects and Methods: We used temephos chemicals from 2 brands: GPO-1(Temephos 1% W/W Sand Granule) and Zeolite(Temephos 1% W/W Zeolite Granule). First, prepare solutions of GPO-1 and Zeolite into 5 concentrations: 100, 10, 1, 01, and 0.012 ml/L of water. Then, pour 100 ml of each solution into sampling containers for tested Ae. aegypti and 100 ml of distilled water for controlled Ae. aegypti. After that, add 10 larvae in each container, classifying by area.Repeat the experiment in all concentrations 3times and compared with controlled Ae. aegypti and Bora Bora strain F181(susceptible strain). Statistical Analysis Used: Calculate data of the death of mosquito larvae at 5 concentrations: 100, 10, 1, 0.1, and 0.012ml/L to find median lethal concentration(LC50and LC90) and (RR50and RR90) with probit analysis method. Compare average death of mosquito larvae in each subdistrict by Kruskal–Wallis One-way ANOVA, using SPSS software. Results: From the studies, we found that Ae. aegypti in these 3 areas has no resistance against temephos of both brand(RR<5) and no statistic difference(P<0.05) among all three subdistricts. Conclusions: Alsthough, there are reports of temephos resistance of mosquito larva in many areas of Thailand, but the results of our study showed no resistance in Samut Songkhram provice. This support is that the mortality of the larvae in experiment groups were not different among control groups. thus, this research result showed that temephos chemical is still an efficient insecticide to eradicate Ae. aegypti in Samut Songkhram province, Thailand.
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Seroprevalence of hepatitis B virus/hepatitis C virus among human immunodeficiency virus-infected patients at a tertiary care teaching hospital in Mangalore, South India p. 1443
Jutang Babat Ain Tiewsoh, Rekha Boloor, Beena Antony
DOI:10.4103/ATMPH.ATMPH_131_17  
Background: The human immunodeficiency virus(HIV) pandemic has continued to be a major public health problem even after more than three and a half decade of existence. According to the World Health Organization estimates, 36.7 million people were living with HIV by 2015 end while chronic infection of hepatitis B virus(HBV) and hepatitis C virus(HCV) occurs in 240 and 130–150 million people worldwide, respectively. Since the general modes of transmission are similar to HIV, coinfection of HIV with HBV/HCV is commonly found, being variable worldwide. Aims and Objectives: The aims and objectives of this study were(1) To investigate the seroprevalence of HBV/HCV in HIV-positive patients and(2) To analyze the demographic pattern and laboratory parameters. Settings and Design: This was a descriptive cross-sectional study. Materials and Methods: The serum samples from confirmed HIV-positive patients were screened and confirmed for HBV and HCV following standard operative procedures. The demographic pattern and laboratory parameters were also obtained. Statistical Analysis Used: SPSS software version23.0 was used for statistical analysis. Results: The seroprevalence of HBV and HCV in HIV-positive patients was found to be 6.6% and 0.7%, respectively. Males(n=7) were more commonly infected than females(n=3) with the age group of 31–40years being the most common and majority were married(n=9). In HBV-HIV coinfection, the mean values of serum globulin, serum total bilirubin, conjugated bilirubin, aspartate amino-transferase, alanine aminotransferase(ALT), and alkaline phosphatase were increased, but in the only case of HCV-HIV coinfection, only hemoglobin and platelet count were decreased. Amajority(n=8) improved on discharge. Conclusions: The seroprevalence of HBV/HCV was high with laboratory test showing a significant correlation between HBV-HIV coinfection and serum globulin and ALT. Hence, creating awareness, understanding these diseases, and providing screening test in suspected individuals is the need of the hour which will improve the mortality rates related to them.
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Atypical manifestations of dengue fever in a recent dengue outbreak p. 1448
Ravinder Singh Ahlawat, Tanisha Kalra
DOI:10.4103/ATMPH.ATMPH_18_17  
Context: Dengue fever is highly prevalent in tropical and subtropical regions. The disease is caused by RNA virus, flavivirus and is transmitted by a mosquito to humans. Aims: The aim is to study the various atypical manifestations that can occur in dengue fever. Settings and Design: The patients presenting with acute febrile illness from September to December 2015 were admitted in a tertiary care hospital of North India and were screened for dengue fever. Atotal of 141patients were screened for dengue fever out of which 61patients were positive for dengue fever. Adetailed history of each patient reporting to the hospital was taken followed by the general physical examination and systemic examination. Subjects and Methods: Complete blood count was performed in all patients and other investigations such as liver and kidney function test, chest X-ray, ultrasound, magnetic resonance imaging, and cerebrospinal fluid examination were done wherever required. Results: Atypical manifestations were present in 24 of 61patients who were diagnosed positive for dengue fever(39.3%). Acalculous cholecystitis was the most common manifestation(32.7%), followed by encephalitis(6.5%) and hepatitis(3.2%). Transverse myelitis, acute respiratory distress syndrome, and renal failure had a frequency of 1.6%. There was no mortality as none of the patients had DSS in our study. Liver function tests(alkaline phosphatase and aspartate aminotransferase) were deranged in most patients(52.4%) out of which only 3.2% had raised serum bilirubin levels. Hepatomegaly was present in 19.6% of patients, and splenomegaly was observed in 3.2% of the patients. Conclusions: Dengue fever this year had various atypical manifestations–acalculous cholecystitis having the maximum occurrence. Neurological manifestations were also present. Transverse myelitis which is a rare manifestation was also observed.
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Work stress and organizational citizenship behaviors among nurses p. 1453
Reza Agheli, Fariborz Roshangar, Kobra Parvan, Parvin Sarbakhsh, Solmaz Shafeh
DOI:10.4103/ATMPH.ATMPH_272_17  
Background: Work stress is one of the effective factors responsible for developing physical, mental, and behavioral consequences among nurses. The effect of occupational stress on nurse's organizational citizenship behaviors(OCBs) has not been fully understood. Thus, this study aimed to assess the relationship between work stress and nurse's OCB. Materials and Methods: In this descriptive-correlational study, 301 individuals of the personnel of the hospitals of Tabriz were recruited by stratified systematic random sampling. Instruments for gathering data were the Nurses Stress Scale and OCBs Questionnaire. Data were analyzed by the SPSS version23 software using descriptive analysis and Pearson correlation coefficient tests. Results: Most of the nurses were highly stressed in work, having a significant association with sex and type of employment. Furthermore, work stress had a negative correlation with age and work experience. Nurses' level of OCB was high and had a significant association with type of hospital, ward of service, organizational position, and type of employment. In addition, OCB had a positive correlation with age, work experience, and salary. There was no significant association between nurse's stress at work and OCB. Conclusion: According to results, nurses were highly stressed. Thus, educating hospital managers regarding the features of work stress is essential. Furthermore, establishing appropriate educational workshops in the field of OCB for improving work condition and organizational efficiency among the personnel is a vital manner.
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Factors affecting quality of life and marital satisfaction among married nurses and nursing assistants p. 1460
Jafari Roodbandi Akram, Feyzi Vafa, Mohammadi Pejman
DOI:10.4103/ATMPH.ATMPH_28_17  
Introduction: Although working is human's best recreation, due to adverse physical, social, and psychological stimuli, it has adverse effects on family relationships, marital satisfaction, and the quality of people's lives. This study aimed to investigate the factors affecting the quality of life and marital satisfaction of married nurses and nursing assistant in three teaching hospitals of Kerman University of Medical Sciences. Materials and Methods: Four hundred and forty-six married nurses and nursing assistant participated in this study. Participants were selected by simple random sampling, and data were collected with the World Health Organization Quality of Life Standard Questionnaire and Enrich Marital Satisfaction Scale. Data were analyzed using SPSS version11 and the significance level was 0.05. Statistical single parameter and logistics tests were carried out to detect significant relationships. Results: Happy hours spent with family, working hospital, and belief in the negative effect of night shift work on personal, family, and social life were found to be effective parameters on four domains of life quality. Marital satisfaction and communication domain in the Enrich questionnaire were significantly correlated with total score of quality of life(P=0.008). Idealistic distortion domain in the Enrich questioner was significantly correlated with the social domain of quality of life(P=0.031). Conclusion: Organizational and administrative support, including training in the effective communication skills between couples, making balance between work and family and flexibility in shift work programs can improve the quality of life and marital satisfaction.
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Nursing staff retention: Effective factors p. 1467
Mohammad Heidari, Bahar Seifi, Zahra Abdolreza Gharebagh
DOI:10.4103/ATMPH.ATMPH_353_17  
Background: Nursing retention requires managers to focus on the retention of staff. Understanding the factors that influence the intent to stay of the staff is one of the strategies to keep nurses in the same work environment. Objective: The objective of this study is to find personal factors(physical, mental-emotional, social) and organizational factors(job stress, social support, and job satisfaction and organizational factors) that influence the nursing staff retention. Materials and Methods: Across-sectional, descriptive, quantitative study was carried out in Tehran, the capital city of Iran. Atotal of 500 newly graduated staff nurses completed the questionnaire. Inclusion criteria were the minimum of a master's degree in a nursing course. The research environments were 10 general hospitals. The data collection tool is a questionnaire including personal(physical, mental-emotional, social), job stress, social support, and job satisfaction and organizational factors. Results: The results show that job stress, social support, and job satisfaction and organizational satisfactions are an influence on retention. Attention to requesting shifts of staff(98.9%); insufficient of staff(63.9%); enjoying working with the supervisor(75.1%); and salary, reward, and benefit(90%) were mentioned as the effective factors on retention. Conclusion: New graduate nurses' turnover intentions are a recurring problem, which could be reduced by improving nurses' working conditions. Retention of nurses could be enhanced by creating supportive working environments to cut the susceptibility to the workplace and lower turnover intentions. The findings of the study support the claim that job satisfaction affects the staff nurses' intent to stay in the same workplace and that it could improve the quality of nursing cares.
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Screening for cervical cancer in Senegal: Contributing factors p. 1474
Adama Faye, Ndeytou Diagne, Khadim Niang, Anta Tal Dia
DOI:10.4103/ATMPH.ATMPH_354_17  
Context: Cervical cancer is first cancer in women in Africa. The disease is often diagnosed at a late stage. Aims: The purpose of this survey is to study the factors of cervical cancer screening. Settings and Design: This is a descriptive and analytical cross-sectional survey carried out in the health district of Thiès in Senegal. Subjects and Methods: Sampling was in two-stage clusters. The data were collected during an individual interview at home. The collection focused on knowledge, attitudes, and practices on cervical cancer. Statistical Analysis Used: Logistic regression was used for data analysis. Results: A total of 498 women were interviewed; 77% of them lived in urban areas, 38% have not been to school, and 82% were married. Nearly, 82.7% of them have already heard about the disease. Infection was the most reported risk factor(55.8%). The screening practice was 35.5% in our sample. Nonschooling reduced screening, while women living in urban areas were seven times more likely to be screened. Screening increased from the poorest quartile to the richest quartile. The knowledge of risk factors and the possibility of recovery increased by 4.80 and 2.34, respectively, the chance of being screened. Conclusions: Improved screening requires multiple strategies that target particularly poor uneducated people living in rural areas but also the strengthening of the capacity of health-care providers.
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Significant difference between the frequency of glutathione-S-transferase M1, glutathione-S-transferase T1 and glutathione-S-transferase P1 polymorphisms in type1 diabetes patients and controls p. 1479
Arvand Akbari, Zivar Salehi, Shahin Koohmanai
DOI:10.4103/ATMPH.ATMPH_359_17  
Background and Aim: Oxidative damage can lead cells to apoptosis which is believed to be the main cause of pancreatic β-cell death and eventually end up to the development of type 1 diabetes (T1D). Glutathione S-transferase enzymes (GSTs) play a crucial role in counteracting reactive oxygen species (ROS). In this study, we evaluated the association of three well-known polymorphisms of GSTM1, GSTT1 and GSTP1 in the pathogenesis of T1D which are whole gene deletions in GSTM1 and GSTT1 and a single nucleotide polymorphism (SNP) in GSTP1 known as Ile105Val. Materials and Methods: Samples were collected from 159 patients diagnosed with T1D and 210 control subjects. Genotyping for GSTM1 and GSTT1 was performed by Multiplex Polymerase Chain Reaction (PCR) and by PCR-Restriction Fragment Length Polymorphism (PCR-RFLP) for GSTP1. Results: The GSTM1 and GSTT1 null genotypes were present at frequencies of 54 % and 59.1 % in T1D cases, whereas in controls the frequencies were 41.4 % and 43.3 %, respectively. Double-null genotype was found to be elevated among T1D patients (Odds Ratio [OR], 2.04; 95 % Confidence Interval [CI], 1.08-3.85; P = 0.027). No effect of any genotype for GSTP1 on T1D susceptibility was detected. Individuals with both the double-null and GSTP1 Ile/Val genotype combined appeared to be at increased risk of T1D (OR, 4.95; 95% CI, 2.11-11.6; P = 0.0002). Conclusion: This is the first study conducted on Iranian children with T1D. The absence of GSTM1 and/or GSTT1 may be important risk factor for T1D. Furthermore, presence of Val allele for GSTP1 could strengthen this risk.
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Poor utilization and wrong preparation of oral rehydration salt solution during childhood diarrhea in Ilesa, Nigeria p. 1485
Olufunmilola Olubisi Abolurin, Oyeku Akibu Oyelami, Saheed Babajide Oseni
DOI:10.4103/ATMPH.ATMPH_370_16  
Background and Aim: Diarrheal deaths are largely preventable with the use of oral rehydration salt(ORS) solution. The aim of this study was to investigate the preparation and use of ORS for the treatment of childhood diarrhea in Ilesa, Nigeria. Materials and Methods: The characteristics of the present diarrheal illness as well as biodata, social class, use of ORS solution, and the method of preparation were documented in 250 children with diarrhea at the Wesley Guild Hospital, Ilesa, Nigeria. Data were analyzed using the statistical program for the social sciences(SPSS) version16.0. Results: A total of 151(60.4%) of the children had been given ORS before the presentation. The ORS was correctly prepared in 38(25.2%) of them, whereas hypertonic ORS solution was mostly given to the others. Asignificantly higher proportion(66.7%) of those from high social class had their ORS correctly prepared, compared with 16.1% of those from low social class(P=0.000). The use of ORS was more prevalent among children with longer duration of diarrhea(P=0.004). Asignificantly higher proportion of children who were still breastfeeding were given ORS, compared with those who had stopped breastfeeding(P=0.007). Conclusion:Teachings on the use and correct preparation of ORS should not be limited to diarrhea treatment units, but should rather be included in the routine health talks given to mothers at antenatal and immunization clinics. The provision of a 1 L measure to be used for measuring water for ORS preparation should be seriously considered to combat the problem of hypertonic ORS preparations.
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Climatic phenomenon and meteorological variables influencing the dengue fever incidence in Colombian South Pacific region: Modeling study p. 1489
Adriana Lorena Sanchez, Nazly Efredis Sánchez, Andrés Mauricio Gómez Sánchez
DOI:10.4103/ATMPH.ATMPH_395_17  
Background: Dengue fever is a viral disease transmitted by the Aedes aegypti mosquito, whose propagation has spread rapidly throughout the world. There is growing evidence that outbreaks of dengue fever are becoming more frequent and appear to be strongly correlated with the phenomenon of the El Niño Southern Oscillation. Materials and Methods: Cases of dengue fever that were registered in the Department of Cauca (2006–2015) by the National System for Public Health Surveillance were included in the study. Climate periods were classified according to the National Oceanographic Atmospheric Agency (NOAA) per month. Meteorological data (precipitation and temperature) were obtained from the National Institute of Hydrology, Meteorology, and Environmental Studies of Colombia (IDEAM). A multivariate linear regression model was used to determine the relationship between temperature, precipitation, and cases of dengue fever. Results: During the period from January 2006 to December 2015, a total of 4464 dengue cases were reported. The year with higher outbreak was 2010, where unusually high temperatures were recorded. According to the predictive model, 2000 mm of rain is required to increase dengue fever in one case per month. In addition, the increases of temperature by 2°C cause the rise of one case of dengue. Conclusion: Dengue cases increased during the period of study with higher presence during the months with El Niño phase. The mean temperature had a higher influence than precipitation on dengue cases. The first semester of the year is characterized by high incidence of dengue cases, especially April.
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Prevalence of proteinuria and abnormal urinary cytology in HIV+ve asymptomatic patients p. 1496
Sumana Mukherjee, Pranab Kumar Bhattacharya, Suprakas Hazra, Soma Das
DOI:10.4103/ATMPH.ATMPH_403_17  
Context: A variety of renal abnormalities have been described among HIV-infected patients leading to various clinical presentations. However, early renal disease in HIV+ve patients is asymptomatic. Aims: This study aims to detect the prevalence of proteinuria and abnormal urinary cytology in HIV-infected patients. Subjects and Methods: Atotal of 140patients asymptomatic for renal disease and HIV infected were tested for proteinuria(dipstick method), urinary cytology, CD4 count, and serum creatinine(to determine estimated glomerular filtration rate[eGFR]). Statistical Analysis: The data were analyzed using the Chi-square test and Fisher's exact probability test(www.vassarstats.net). Results: About 30.7% of patients were detected with proteinuria. Asignificant proportion of patients with proteinuria had low eGFR. Low CD4 count(<200) and age(≥40) were highly associated with presence of proteinuria. However, urinary cytology was not significantly associated with low eGFR, although abnormal eGFR was more common in the presence of abnormal urinary cytology. Conclusions: Asignificant proportion of HIV+ve patients asymptomatic for renal disease may have proteinuria(which is an indicator of nephropathy). The test for proteinuria is simple and therefore should be regularly done in all patients. Abnormal urinary cytology is relatively common in this group and should also be tested in all patients.
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Tanacetum parthenium relieves chronic constriction injury-induced neuropathic pain in male rats p. 1500
Hossein Ali Safakhah, Masoumeh Tatar, Ali Ghanbari
DOI:10.4103/ATMPH.ATMPH_418_17  
Background: Neuropathic pain is a chronic developing pain due to injury or disease-involving somatosensory systems such as vascular disorders, autoimmune diseases, inflammation, and traumatic injuries. Herbal medicines were utilized for the treatment of various diseases too late. The aim of this study was to evaluate the effect of Tanacetum parthenium(TP) extract on chronic constriction injury(CCI)-induced neuropathic pain. Materials and Methods: In the present study, 48 adult male Wistar rats weighing 200–250g were used. After anesthetizing the animals, CCI was performed on the left sciatic nerve for inducing neuropathic pain. TP extracts were intragastrically administered daily for 2weeks by a gavage tube. Mechanical allodynia and thermal hyperalgesia were assessed using Von Frey hairs and plantar test device, respectively. The data were analyzed using the one-way analysis of variance and Tukey's post hoc test. Results: CCI led to mechanical allodynia and thermal hyperalgesia. TP extract with higher doses used in this study significantly increased(P<0.001) paw withdrawal threshold in response to mechanical stimulation. Further, it increased(P<0.01) paw withdrawal latency in response to thermal stimulation. Conclusion: Chronic orally used TP extract alleviates CCI-induced neuropathic pain in male rats.
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Study of possible association of chronic typhoid infection in patients with chronic leukemia p. 1505
Nilesh Kumar, Pankaj Kannauje, Yashwant Kashyap, Kailash Kumar, Ranjan Bhattanagar, Ravindu Tiwari
DOI:10.4103/ATMPH.ATMPH_438_17  
Objective: The study of the possible association of chronic typhoid infection in patients with chronic leukemia. Materials and Methods: A total of twenty patients with chronic myeloid leukemia(CML) either newly diagnosed or follow-up patients with or without chemotherapy in the chronic phase of the disease and ten patients with chronic lymphocytic leukemia had comprised of the study. Bone marrow(BM) samples of 20 controls had been taken from the Orthopedic department during surgery. BM was aspirated from iliac crest under aseptic precautions and BM biopsy was done, samples were stored at 4°C. BM samples were subjected for polymerase chain reaction(PCR) analysis for Salmonella typhi. Blood and stool sample from the patients were also collected for Salmonella culture, serological assays. BM samples from control had been taken during orthopedic surgery. Results: S.typhi infection, the comparison between CML patients and healthy controls had been made based on the PCR results. The result is significant with 40% positivity for S.typhi PCR in CML patients when compared to 20% positivity in healthy controls with P=0.028 which is statistically significant. In patients with chronic lymphocytic leukemia, 10% of BM samples showed positivity for S.typhi by PCR targeting flagellin gene-specific nucleotide sequences and 10% of controls showed positivity for S. typhi and was statistically insignificant(P=1.00). Conclusion: The early incidence of the disease in tropical country like India favors the hypothesis of chronic inflammation in the early process of leukemogenesis. The result of the study also questions whether attenuated bacteria can be used safely for vaccination and delivering therapeutic agents. Moreover, in a tropical country like India where S. typhi infection is endemic, the infection with the same can be taken as a marker of chronic inflammation and its role in the etiopathogenesis of CML remains to be understood.
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Nonmedical stream students' insight into oral cancer: A school-based study p. 1511
Anushree Rathore, Manisha Tijare, Monal Yuwanati, Shreenivas Kallianpur
DOI:10.4103/ATMPH.ATMPH_451_17  
Context: Oral cancer incidences are increasing in young generation for the past few decades. Gutkha chewing and cigarettes smoking being responsible for oral cancer, increase in consumption of these products among younger generation have significant impact on incidence of oral cancer. Those who are having nonmedical background may have less exposure to the information of oral cancer. This study was aimed to find out the information of nonmedical stream students perception about oral cancer. Materials and Methods: Nonmedical stream students between ages 19 and 25years were evaluated for their insight about oral cancer using self-administered questionnaire. Questionnaire has included the questions about general knowledge about oral cancer, causative factors, signs and treatment of oral cancer. Students habits in relation to tobacco-related products were also evaluated. Results: Majority of the students has heard about oral cancer, but hardly have picture about causative factors and their clinical signs. Gutkha and cigarette smoking are still the major forms of tobacco product consumption among nonmedical stream students. Oncologist is the preferred choice for consultation of oral cancer treatment, though nearly half of the participants do not know about the treatment and how to seek it. Conclusion:The nonmedical stream students have less awareness about oral cancer. There is a great need for increase in oral cancer awareness programs as well as may be educational syllabus can have dedicated portion for such a preventable disease such as oral cancer.
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Evaluation of oxidative stress marker in patients with human papillomavirus infection p. 1518
Jalhe Bagheri Hamzyan Olia, Mohamad Hasan Khadem Ansari, Parichehreh Yaghmaei, Haleh Ayatollahi, Hamid Reza Khalkhali
DOI:10.4103/ATMPH.ATMPH_464_17  
Introduction and Objective: Human papillomavirus(HPV) unenveloped viruses with double-stranded circular DNA cause infection in skin epithelial cells and mucosal surfaces. HPV infection has been detected in more than 70% of cervical cancers throughout the world. Among the effective factors in the progression of HPV infection are oxidative stress and oxidative markers, and the oxidative stress during viral infection can be due to the host immune responses to viral proteins or as a result of viral genes expression. This study aims to compare the mean serum level of oxidative malondialdehyde(MDA) marker and the mean of 8-Hydroxyguanosine(8- OhdG) in two groups of healthy people and patients with HPV infection. Methods: This is a descriptive, cross-sectional study in which 30patients with HPV infection and 35 healthy people(as the control group) were selected using convenience sampling method. After obtaining written consent from the subjects, the researchers took fasting blood samples and morning urine samples from them. Serum MDA was measured using the spectrophotometric method, and 8-OHdG was measured using the competitive enzyme-linked immunosorbent assay method. Finally, the data were analyzed using SPSS version 17. Results: The results of this study showed that the mean and standard deviation of serum MDA concentration have increased significantly in patients with HPVs infection(4.56±1.64 nM) than in the control group(1.64±0.37 nM). The mean and standard deviation of urinary concentration(8-OHDG) in patients with HPV infection was 14.61±1.39ng/ml while it was 9.66±1.74ng/ml in the control group. It was significantly higher in people who had high-risk HPV infection than in the group with low-risk HPV(P<0.001). Conclusion: Based on the results of this study, oxidative reactions and biological damage caused by these reactions as a result of the increased oxidative stress in the body can be suggested as a mechanism involved in the progression of the cervical papillomavirus infection and the cancer caused by it.
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Prevalence of the waterborne diseases(diarrhea, dysentery, typhoid, and hepatitis A) in West of Iran during 5years(2006–2010) p. 1524
Meghdad Pirsaheb, Kiomars Sharafi, Elham Ahmadi, Masoud Moradi
DOI:10.4103/ATMPH.ATMPH_493_17  
Background: Evaluation of the microbial quality of drinking water can prevent the waterborne diseases outbreak that is one of the most important challenges in the world. Objective: The aim of this study was to assess the seasonal variation of waterborne diseases prevalence associated with the microbial quality of drinking water and the comparison between rural and urban areas in Kangavar city, West of Iran. Materials and Methods: To accomplish this, the results of the microbial quality of drinking water and cases of simple diarrhea, dysentery, typhoid, and hepatitis A were received from all rural and urban health centers of the city during 5years (2006–2010). To determine the relationship between diseases and microbial quality of water, correlation instruction, and Pearson's correlation coefficient were used. Results: The results showed that except hepatitis A, the incidence of all diseases in different areas(urban or rural) and seasons had significant relationship with microbial contamination of drinking water(P<0.05). The stronger relationship was observed in rural areas than in urban areas(except simple diarrhea) and in warm seasons than in cold seasons. Conclusion: With respect to the impact of the microbial quality of water on the incidence of dysentery and typhoid diseases, keeping up the quality of drinking water in places and times with high sensitivity(rural areas and warm seasons) should be considered strongly.
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Genetic polymorphism of glutathione S-transferase A1 promoter in patient with colorectal cancer p. 1529
Hamid Nomani, Naser Nazari
DOI:10.4103/ATMPH.ATMPH_494_17  
Background: Novel allelic variants have been found in the glutathione S-transferase(GST) A1 gene. The former GSTA1 B allele is associated with low expression. Objective: The aim of this study was to determine the GSTA1 genotype in the Iranian patient with colorectal cancer and determine if there is any populational correlation between genotype and colorectal cancer in Kermanshah-Iran and Tehran-Iran individuals. Material and Methods: Atotal of 186 participants were included in the study, 52 Tehranian and 41 Kermanshahian patients with colorectal cancer, plus 52 Tehranian and 41 Kermanshahian healthy controls. GSTA1 genotype was determined by polymerase chain reaction-restriction fragment length polymorphism. Differences in genotype distributions between the different populational groups were evaluated us in Chi-squared test and a logistic regression was used to investigate the possible association of the genotypes with the disease in both populations. Odds ratio estimates were analyzed for allele frequencies. Results: The GSTA1 B/B genotype prevalence in patients with colorectal cancer(12.2%) was significantly higher than control group in Kermanshah(0.0%), No significant association of GSTA1 B/B genotype with the colorectal cancer was determined in Tehran subjects. No significant association of GSTA1 B/A genotype with the colorectal cancer was determined either population. Conclusion: These findings indicate that the GSTA1 B/B genotype in the Kermanshah population was related to colorectal cancer although there is no significant association between of GSTA1 B/B genotype and colorectal cancer in Tehran population. This study showed different results between populations.
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The effect of meperidine on lidocaine-induced axillary block in patients undergoing upper extremities surgery p. 1533
Naser Hemmati, Abdolhamid Zokaei, Sara Joreir Ahmadi
DOI:10.4103/ATMPH.ATMPH_497_17  
Background: The increasing use of regional anesthesia and peripheral nervous blocks and also local anesthetic effects of meperidine, made us adding this drug to lidocaine-induced axillary block for patients undergoing upper extremities surgery to measure its effects and especially block length time. Objective: The aim of this study is effect survey of meperidine on lidocaine-induced axillary block in patients undergoing upper extremities surgery. Materials and Methods: This randomized double-blinded clinical trial was conducted on consecutive forty patients aged between 15 and 56years, rated as the American Society of Anesthesiology I-II who were scheduled for upper extremities surgery. The study protocol was approved by the ethics committee at Kermanshah University of Medical Sciences. These 40patients divided into two groups which were similar in terms of age, gender, and weight. The patients were randomly assigned to receive one of the two following protocols for axillary block:(1) 40ml lidocaine 1% plus 0.01ml/kg normal saline and(2) 40ml lidocaine 1% plus 0.01ml/kg equaling 1mg/kg meperidine. The blocking method was similar in both groups(Ultrasound-Guided Axillary block). The analysis was done with Chi-square and Fisher's exact test for complications and t-test for quantitative variables in both groups. Results: Both two groups were similar in terms of block onset time, the intensity of analgesia block and side effects such as nausea, vomiting, hypotension, dizziness, arrhythmia, and convulsion. The obtained results from this study suggest that meperidine added to lidocaine-induced axillary block prolongs the duration of blocked(238±67.04vs. 166.7±39.6) which is statistically significant(P<0.001). Conclusion: According to the study findings, the axillary block onset time was not statistically different between two groups. Totally adding meperidine to lidocaine-induced axillary block did not lead to increase the systemic side effects, but prolonged duration of blockade significantly. It is suggested to use this method for prolonged surgeries especially in emergency patients with contraindication for general anesthesia and also for general populations who have short time upper extremity surgery and also to provide a long-term postoperation analgesia.
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A comparative study of homesickness, depression, and internet addiction between native and nonnative students at University of Sistan and Baluchestan, Iran p. 1537
Safoora Khushde, Malihe Farhangi, Behzad Rigi Kouteh, Farhad Kahrazei, Arash Ziapour
DOI:10.4103/ATMPH.ATMPH_498_17  
Background: Due to dealing with stress caused by transition from adolescence to adulthood, attempting to adapt themselves with various conditions, maintaining good academic performance, planning for the future, and being away from home, students often encounter high levels of anxiety. Objective: The present study aimed to compare native and nonnative students at University of Sistan and Baluchestan(Iran) considering homesickness, depression, and Internet addition. Materials and Methods: The method of this study was casual-comparative. Among all postgraduate students at University of Sistan and Baluchestan(in the academic year 2015-2016), 204 native and nonnative students were selected using the convenience sampling method and were asked to complete the Archer et al's. Homesickness Questionnaire, the Beck Depression Inventory, and the Young Internet Addiction Test. Results: The results indicated statistically significant differences between native and nonnative students such that nonnative students' scores on homesickness and subscales of attachment to home and dissatisfaction with being at the university, Internet addiction and subscales of salience, neglecting work, anticipation, and neglecting social life, and depression were all higher than those of native students. Considering subscales of excessive use and lack of control, no statistically significant difference was found. Conclusion: Given the obtained results, it can be concluded that nonnative students experienced higher levels of homesickness, depression, and Internet addiction. Therefore, providing theoretical and practical guidance on reducing homesickness, depression, and Internet addiction is highly suggested.
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Prophylactic efficacy of levetiracetam on migraine headaches in children aged 4–14-year-old p. 1547
Mostfa Sediqi, Bahare Yavari, Afshin Almasi
DOI:10.4103/ATMPH.ATMPH_499_17  
Background: Migraine is the most common type of episodic headache. Migraine can affect the pediatric patients' life through absence from school and restricting inside-home and social activities. Objective: This study was done with the objective of investigating the prophylactic effect of levetiracetam on pediatric migraine headaches. Materials and Methods: In this before-after clinical trial, 30 children aged 4–14years with migraine headache were included and followed for 6months. The required data were gathered through observation, examination, paraclinical studies, and interview. The data were entered into a checklist. Furthermore, the Pediatric Migraine Disability Assessment(PedMIDAS) questionnaire was used to assess disability. Levetiracetam tablet was administered for 6months. The frequency and duration of migraine headaches as well as migraine-related symptoms and possible side effects were documented. The data were then analyzed by theSPSSsoftware(ver.20.0, IBM Company). Results: The frequency of headaches, their severity, and duration decreased significantly at the end of the study(P<0.001). After 6months of treatment, migraine attacks were recovered completely in six patients(20%). Only three patients(10%) showed side effects such as nagging and negotiating, poor sleep, and lack of appetite which neither resulted in cessation of the medication. Furthermore, the PedMIDAS score decreased significantly at the end of the study(P<0.001). Conclusion: Levetiracetam had acceptable efficacy and tolerability to be used for prophylaxis of migraine headache in children and can be a good substitute in such patients.
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Communication barriers between staff member with family member intensive care unit: A grounded theory study p. 1552
F Borhani, L Loghmani, A Abaszadeh, M Mahmoodi
DOI:10.4103/ATMPH.ATMPH_508_17  
Introduction: The patients with critical disease do not able to decision for care. Then, family and providers do it. One of the most important factors improve care is relationship between family member and staff members in Intensive Care Unit(ICU). Creating an effective communication with patients is an essential aspect of nursing care. This study aimed to explore communication process among team members with patients' families in ICU. Methods: Based on the nature of the research question, qualitative study using grounded approach was used for collecting and analyzing data. Atotal of 22 participants(10 family members, 8 nurses, and 4 physicians) were selected based on purposive sampling. Sampling was terminated after saturation of emergent categories Data were collected through nonstructured individual interviews, observation. Subsequently; the data were analyzed according to the Strauss and Corbin constant comparative analysis method. Results: Data analysis has led to discover the main category that is called “superficial and ineffective individual relationship”as a main challenge for care team and hospitalized patients, families. They have used strategy is titled “effort” to solve this problem and strengthen the relationship. Extracted themes from this study include, unsuitable organizational conditions of social subclasses(social and cultural factors, inhibitory organizational atmosphere, job problems, indifference and disinterest of care team, and negative features of care team) also it needs strengthening the relationship, and mutual cooperation between care team and hospitalized patients, families in ICU. Conclusion: There are numerous problems and obstacles between care teams and hospitalized patients, families in ICU in communication process thus, to create effective and desirable communication, we must consider policies in educational, clinical and management plans of care and cure teams in universities and hospitals, also we must consider communication as the most important factor in this process.
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Nurses' psychological empowerment in Iran: Asystematic review and meta-analysis p. 1558
Sanaz Royan, Mahtab Alikhani, Mohammad Mohseni, Samira Alirezaei, Omid Khosravizadeh, Ahmad Moosavi
DOI:10.4103/ATMPH.ATMPH_509_17  
Background: Empowerment is one of the most effective techniques for improving productivity of employees and optimum use of their capacities and capabilities toward organizational goals. This systematic review and meta-analysis aimed to evaluate nurses' psychological empowerment in Iran. Methods: The required data were collected using keywords which are Empowerment, Psychological Empowerment, Nurse, Iran and their Persian equivalents. The databases searched were as follows: PubMed, Scopus, Medlib, SID, Magiran, and Iranmedex. Comprehensive meta-analysis software was used to data analysis. Results: Six eligible studies were entered into the systematic review. The results of this study show the mean score of nurses' psychological empowerment based on the random effect model was 3.6(95% confidence interval: 3.41-3.64). In the dimension of psychological empowerment, the higher score was related to competence(3.96). The next dimensions were meaningfulness(3.83), impact(3.47), self-determination(3.33), and trust(2.98), respectively. Conclusions: Nurses' psychological empowerment was in a moderate level. Nursing managers need to further promote this dimension in their planning.
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Human pathogenic bacteria isolation from tilapia fishes(Oreochromis niloticus), a possible reservoir for zoonotic transmission p. 1563
Kanittada Thongkao, Yuttana Sudjaroen
DOI:10.4103/ATMPH.ATMPH_511_17  
Context: Rare report of bacterial isolation and drug resistance from farmed tilapia fishes in Thailand where high yield of tilapia fish products and export. Aims: 1) To isolated and identified of human pathogens in Tilapia fishes (Oreochromis niloticus) from seven aquacultures at Surat Thani, Thailand, including 4 of well-typed fish ponds, 2 of floating baskets and 1 of nursery fish pond 2) To determine water quality of each fish farm. Materials and Methods: The internal organs from 210 of fish samples were collected for pathogen isolation and identification, and then, tested for antibiotic susceptibility. All microbiological laboratory techniques were performed by Clinical and laboratory standards institute (CLSI) criteria. Water quality was evaluated and compared with standard of water quality criteria. Results and Discussion: The three of most bacterial isolations in Tilapia fish from well-typed fish ponds were Klebsiella pneumoniae, Edwardsiella tarda and coagulase negative Staphylococci. While, K. pneumoniae, Proteus mirabilis, and Streptococcus group D non enterococci were isolated from Tilapia fish, which feeding on river floating baskets. Therefore, only K. pneumoniae and C. albicans were isolated from fry in nursery fish pond. Penicillin and ampicillin resistance were occurred in K. pneumoniae and P. mirabilis. Water qualities of fish water farms were evaluated and almost of water parameters were to water standard quality, except ammonia and alkaline values were higher and lower than reference values, respectively. Conclusions: We were deduced that growing of pathogens in fishes, especially K. pneumoniae may relate to water environment. However, antibiotic resistance of isolated bacteria may concern as zoonotic pathogens.
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Is early leukocytosis a predictor of hemoglobin drop in trauma patients? p. 1569
Hamideh Akbari, Alireza Jalali, Masoumeh Hosseinpoor, Atefeh Abdollahi, Kamyar Shahkolahi
DOI:10.4103/ATMPH.ATMPH_518_17  
Objective: The objective of this study was to determine whether white blood cell(WBC) count at admission can predict hemoglobin(Hb) drop in multiple trauma patients and can be considered a predictive sign for the need for transfusion of packed red blood cells in multiple trauma patients. Patients and Methods: This retrospective study was performed on 227 trauma patients, evaluated over a 30-month period(January 2014 to July 2016). Data collected included demographics, injuries, leukocyte count, and Hb at admission time of 0, 24h, 48h, transfusion requirement. Leukocytosis and Hb drop were defined as leukocyte count≥16,000/mm3 and 2g/dL, respectively. We compared two groups of multiple trauma patients with leukocytosis at admission time and normal WBC count with Hb drop in hospital course. The patients had similar injury severity scores. Data were analyzed by SPSS version21. Results: Of the 227patients admitted for durations longer than 24h, WBC count was available for them. Leukocyte count showed a strong association with severe injury(P=0.01). The logistic regression was used for the prediction of Hb drop of participant. The Cox and Snell R Square and Nagelkerke R Square indicated that the variances in this research between 0.006 and 0.008 have been explanations. Conclusion: The results showed that early leukocytosis has a relationship with severity of injury, but it is not beneficial in predicting Hb drop and transfusion requirement.
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Is there any correlation between the severity of an injury and thrombocytosis in multiple trauma patients? p. 1572
Hamideh Akbari, Alireza Jalali, Atefeh Abdollahi, Masoumeh Hosseinpoor, Hamid Dowlatkhah
DOI:10.4103/ATMPH.ATMPH_519_17  
Objective: Trauma is often the result of an overwhelming amount of stress that exceeds one's ability to cope or integrate the emotions involved with that experience. However, trauma differs between individuals according to their subjective experiences. People react to similar events differently. Platelets are acute-phase reactants. Patients and Methods: This is a retrospective study of all patients with trauma admitted to the trauma center. Atotal of 242patients with multiple traumas were identified through a prospective registry. The severity of illness was evaluated on the first day using the injury severity score(ISS). The platelet count was checked in all trauma patients at admission time, 24h later, and after 72h. Results: The 242patients with multiple traumas who were in the emergency department of Peymanieh Hospital showed that there was correlation between the severity of injury in multiple trauma patients and a change in the platelet count after 24h(P<0.05). The platelet count after 24h in minor and moderate ISS groups had decreased. However, in critical ISS group patients, the count increased after 24h. Conclusion: There was a correlation between the severity of the injury and thrombocytosis in multiple trauma patients.
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Accuracy of ultrasonography compared to laboratory in fetal screening, which one is more reliable? p. 1575
Rasekhjahromi Athar, Davari Nazanin, Zarei Babaarabi Zahra, Damshenas Mohammad Hasan
DOI:10.4103/ATMPH.ATMPH_521_17  
Background: The aim of this study is to compare the efficacy of nuchal translucency(NT) measurement with laboratory screening tests in prenatal diagnosis of Down syndrome(DS) and neonatal outcomes. Materials and Methods: In this cross-sectional-descriptive study, data were collected from 260 pregnancy files. Ages of pregnant women were 20–34year old who referred for prenatal care. NT was measured by ultrasound at 11–13+6 and quad marker tests at 15–18 gestational week. Data analysis was performed bySPSS21 (IBM, USA) that was considered significant with P<0.05. Result: Two-hundred and twenty-one pregnant women with average age of 26.6±4.44years were screened. Frequency of negative screening tests for DS was 188 pregnant women(88.7%) and 24(11.3%) of them positive. Amniocentesis was performed for those who had positive screening test, but their NT measurement was<3.5mm. All reports of amniocentesis were negative which was consistent with fetal NT ultrasonography reports, and all neonatal outcomes were normal after delivery follow-up. Conclusion: NT measurement and quad marker test cannot accurately predict the fetal health in the future; however, NT is more reliable than laboratory screening tests because it is more consistent with the results of amniocentesis. NT is also a safer and cheaper method than amniocentesis. Pregnant women tolerate an unfavorable psychological stress and high cost during amniocentesis. The suggested option is to assess the cell-free fetal DNA in pregnant blood instead of amniocentesis.
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Evaluation of key capabilities for hospital information system: Amilestone for meaningful use of information technology p. 1579
Mehrdad Farzandipour, Zahra Meidani, Hamidreza Gilasi, Raziyeh Dehghan
DOI:10.4103/ATMPH.ATMPH_531_17  
Objective: In line with socio-technical approach, evaluation of successful adoption of hospital information systems(HISs) is associated with several factors including operational, organizational, technical, managerial, legal, and social factors. This study attempts to evaluate these systems in five areas of technical, functionality, usability, and vendors' capabilities, and care quality provided by HIS vendors. Materials and Methods: Through a cross-sectional study, the key HIS capabilities were evaluated in Iran. The key capabilities/requirements for HIS were specified by expert panel focus group meeting through the idea webbing and review of related literature. Modified Delphi technique was employed to collect and analyze data. The expert panels express their view on each of the HIS key capabilities on a 5-point scale from “strongly agree” to “strongly disagree.” Checklist was designed based on expert panels' viewpoints and employed for evaluating HIS capabilities. Results: Technical requirements with 68.3% and vendors' capability requirements scored the highest marks(68%) while improved quality of patient care requirements scored the lowest mark(24.8%). Functional requirement of the studied eight departments showed that financial department scored the highest(71.6%) while nutrition department scored the lowest marks(22.8%). Results on the evaluation of technical requirements showed that response time scored the highest(75%) while communication services scored the lowest marks(59.7%). Conclusion: The favorable status of Iran's HISs in technical area, their poor performance on the requirements of quality patient care place emphasis on financial and reimbursement objective, and neglect of Systemized Nomenclature of Medicine-Clinical Terms as a basis to support quality of patient care requirements endorse the fact that Iran's current HIS is still in its infancy. To narrow the variability and diversity in structure and requirements of HIS vendors, reducing the gap between required and adopted HIS functions, and moving toward “meaningful use of HIS,” well-organized actions at the level of Iran Ministry of Health appear essential.
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The association between conscience understanding and clinical performance among nurses working at education hospital of Arak p. 1587
Mahboobeh Khosravani, Hedar Ali Abedi, Saeed lak, Fatemeh Rafiei, Kobra Rahzani
DOI:10.4103/ATMPH.ATMPH_533_17  
Background: Patient care with strict professional and ethical standards is an important element in maintaining health-care standards. In this regard, moral behavior of nurses toward patients has an important role in the recovery and return of their health. Conscience acting is suggested to have a positive impact on patients and their relatives. Acting in accordance with the guidance of good values is an incentive to provide good quality care and restricts low-quality performance. In this study, the aim is to determine the clinical relevance between conscience understanding of nurses and their clinical performance. Materials and Methods:In this cross, 194 nurses working in hospitals of Arak Medical Sciences University in 1395 were recruited by random sampling. Demographic and clinical data were collected through questionnaires and were analyzed in terms of descriptive statistics using SPSS 16 software(Chi-square test). Results: The results showed that the perceptions, conscience, and clinical performance based on Chi-square test is not statistically relevant(P≥0.05). However, there was a significant correlation between the areas of health-care interventions and understanding of conscience(P=0.02) so that 83%(6/50) of the nurses whose caring interventions were at best were also having a higher score on moral conscience. Among the different dimensions of conscience understand, only the moral(ethical) conscience showed a significant relationship with nursing care interventions is(P=0.03), so that 75(9.46%) of nurses who scored good in terms of moral(ethical) conscience, also showed a desirable health-care interventions. Conclusion: Nurses, have the main role in improving the quality of health-care services. According to our results, moral conscience considerations have a positive impact on nurses' approach toward patients in terms of health-care interventions. Hence, the moral approach of nurses toward patients and health-care issues can be very fruitful in fulfillment of health-care organization's mission to provide a healthy society. Based on these results, more intention is recommended regarding the nursery education and training in terms of moral and ethical practice.
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Analysis of maternal mortality in Isfahan, Iran: Acase series study p. 1591
Somaye Bahreini, Marjan Beigi, Mojtaba Rahimi, Mahboubeh Valiani
DOI:10.4103/ATMPH.ATMPH_535_17  
Introduction: According to international agreement, all pregnant women mortalities are unacceptable since many of them are preventable. Therefore, reviewing and analyzing the root causes of maternal mortality to find the causes prevents repetition of the possible defects and modifies processes. This study using root cause analysis(RCA) aims to determine the causes of maternal mortalities. Materials and Methods: This research is a case series study. The required data were collected from the files of dead mothers, and the interviews were conducted with the relevant human resources. The causes of maternal mortality were determined according to the opinions of the experts and through a checklist of RCA. The causes consisted of the factors related to health services(human and structural factors), sociofamilial status, and the medical conditions of the dead mothers. Results: In this study, human factors including factors related to health services were introduced as the main defects of services related to the death of the pregnant women. Structural factors, family status, and medical conditions were, respectively, the other influential factors. The root of all these errors was identified to be managerial factors at academic and ministerial levels. Discussion and Conclusion: According to the obtained results, the importance of human resources should be considered specifically to enhance job performance and minimize their errors through manager's planning. Doing this will promote health, and reduce morbidity, disability, and mortality in both mothers and newborns.
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Investigating the relationship between self-efficacy and emotional divorce among nurses in the city of Rasht, Iran(2015) p. 1596
Mohammad Hassan Sahebihagh, Zahra Khorshidi, Shirin Barzanjeh Atri, Mohammad Asghari Jafarabadi
DOI:10.4103/ATMPH.ATMPH_536_17  
Introduction: One of the divorce processes is called emotional divorce which is common in Asian families. In such a condition, couples live together under the same roof due to necessity and compulsion, but they have no constructive and appropriate relationships. Given the positive effects of self-efficacy on the levels of family and marital satisfaction, the purpose of this study was to investigate the relationship between self-efficacy and emotional divorce rate among nurses in the city of Rasht in northern Iran. Materials and Methods: This study was a cross-sectional research of correlational type. To this end, 382 qualified nurses from Educational-Medical Centers in the city of Rasht in the north of Iran were selected by systematic quota and random sampling methods. The research instruments consisted of the two-part questionnaire of demographic characteristics and Gottmann's Emotional Divorce Scale as well as General Self-Efficacy Scale by Sherer. To analyze the data, independent t-test and Pearson correlation coefficient methods through the SPSS 19 software were used. Results: The results of this study showed that the mean age of participants was 39±7years old. In terms of gender, 346 participants(93.5%) were women and 24(6.5%) were men. Moreover, it was assumed that emotional divorce rate was low, but self-efficacy was at a high level. There was also a significant and inverse correlation between emotional divorce rate and levels of self-efficacy equal to−0.157(P=0.002). Conclusion: It was concluded that self-efficacy was effective in all areas. Promoting self-efficacy could lead to a rise in the levels of marital satisfaction and a decline in emotional divorce rate. Therefore, due to the sensitive occupational status of nurses, it was recommended to include life skills training and improved self-efficacy in job promotion planning to enhance the performance of nurses.
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One-staged anterolateral thoracotomy for bilateral lung hydatid cysts p. 1601
Manouchehr Aghajanzadeh, Azadeh Rafipoor Kiaabadi, Bahareh Mohtasham, Masoud Kerman Saravi, Omid Mosafai, Farzad Ghotbi
DOI:10.4103/ATMPH.ATMPH_538_17  
Background: Hydatid cyst disease is still a health problem in many countries. Surgical removal is the treatment of choice for lung hydatid cysts. However, operating on bilateral lung hydatid cysts is still controversial. The aim of this retrospective study was to evaluate the results of surgical treatment in bilateral hydatid disease of the lung. Methods: In this retrospective study, we reviewed our experience in the surgical treatment of 22patients with bilateral, and at least three, lung and liver hydatid cysts. These 22patients(14male, 8female) with an average age of 22years(range 5–50years) underwent one-staged bilateral anterolateral thoracotomy. Results: Out of 316patients with hydatid lung, 22(5.55%) were managed surgically. In total, 48 lung cysts were removed from 22patients who underwent one-staged bilateral anterolateral thoracotomy. The most frequent symptoms were cough, chest pain, and dyspnea. Most of the cysts(38.2%) were located in the right lower lobe. Three patients had cysts associated with hepatic hydatid cyst; they were treated through phlebotomy during thoracotomies. All cysts were evacuated with capitonnage and without lung resection. We observed some complications such as prolonged air leaks(n=3), atelectasis(n=2), pneumonia(n=2), and empyema(n=1). No further surgery was required for the management of complications. The mean hospital stay was 5days(range 8–12days). No deaths occurred in hospital stay. Oral albendazole was started on the 2ndpostoperative day thoracotomy in the dose of 10mg/kg and was continued for 3months with a gap of 2weeks after each 28days. No recurrences occurred during the follow-up period. Conclusions: One-stage surgery is superior to a classic two-stage approach as it decreases the morbidity, hospital stay, and costs. MS is an excellent approach, but in some cases, video-assisted thoracic surgery mini-thoracotomies could be indicated. In our experience, one-staged bilateral anterolateral thoracotomy is an appropriate surgical option for bilateral pulmonary hydatid cysts because morbidity rates are minimal, and the hospital stay is acceptable for the treatment of bilateral pulmonary hydatid cysts in one-staged option.
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Effects of the self-management program on the quality of life among kidney-transplant patients in Isfahan's Hazrat Abolfazl Health and Medical Charity in 2015 p. 1607
Somayyeh Kuwaiti, Ahmad Ghadami, Hojjatollah Yousefi
DOI:10.4103/ATMPH.ATMPH_543_17  
Introduction: After transplantation, patients require lifelong follow-up care. The present research was conducted to explore effects of the self-management program on the quality of life among renal-transplant patients in Hazrat Abolfazl Health and Medical Charity in Isfahan in 2015. Materials and Methods: This randomized controlled clinical trial had 2 groups involving 3 stages, namely, before, right after, and 3months after the intervention. It was conducted on 72 kidney-transplant patients. The participants having inclusion criteria were selected using the simple sampling method and were randomly placed in the experimental and control groups. Each group included 36 participants. The chronic disease self-management program(CDSMP) workshop was presented for the experimental group in a 2½-h session held once a week for 6months. The control group attended a training session on diet. To collect data, the standard Kidney Transplant Questionnaire was used. Data analysis was performed using SPSS. Results: After the intervention, the means of the quality of life among the patients in the experimental group were 3.82±1.03, 4.49±0.81, and 5.12±0.62 before, right after, and 3months after the intervention, respectively(P<0.05). However, the means of the quality of life in the control group at the 3time points were not significantly different(P>0.05). Conclusion: Due to the positive effect of the CDSMP on the quality of life among the kidney-transplant patients, it is recommended that authorities accept the self-management program much more.
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The impact of support programs on attachment of mothers of infants with gastrointestinal disorders: Arandomized controlled clinical trial p. 1613
Mahnaz Jabraili, Alehe Seyyed Rasouli, Morteza Qojazadeh, Soraya Heykal Abadi
DOI:10.4103/ATMPH.ATMPH_548_17  
Introduction: The birth of a malformed infant and hospitalization in the Intensive Care Unit will create different psychological effects in the mother and while increasing the level of anxiety will affect important psychological processes such as attachment. On the other hand, the implementation of support programs and providing the required information and training to mothers make them feel more in charge and have more power over their positions. Objective: The objective of this study is to determine the effect of the support program on the attachment of mothers of infants with gastrointestinal abnormalities. Methodology: The study is a randomized controlled clinical trial that was conducted after the verification of the Ethics Committee(approved on November 9, 2014, with the ethics code of 5/4/7621) of Tabriz University of Medical Sciences and registering in Iran Clinical Trial Center(IRCT201409264617N10). Moreover, the study was conducted in neonatal ward of children's Hospital of Tabriz/Iran from late October 2015 to mid-May 2016 on 50 women with abnormal infants. This study is a randomized controlled clinical trial. Fifty mothers, who met the conditions of inclusion in the study, were randomly placed in two groups of intervention and control, and maternal attachment was examined using Korean test. In the intervention group, support program was conducted in two aspects: psychological support by clinical psychologist and caring by researcher, each in two sessions of 45min. After obtaining the posttest from both groups, the data obtained were compared using the statistical test of comparing means and Chi-square test. Results: Some demographic characteristics of mothers(such as level of education, age, occupation, number of children, financial support resources, and baby's gender) showed no significant differences in the two groups using the Chi-square test. Comparing attachment changes in the two groups after the implementation of the support program showed that the rate of changes in the intervention group was more than the control group(P<0.05). Conclusion: This study showed that the implementation of the support program is effective in the attachment of mothers of infants with gastrointestinal abnormalities. Thus, creating and developing support programs by nurses to empower these mothers in taking care of infant and the efforts to promote attachment between mother and infant in hospitals seem essential.
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Strategies to promote hope and spirituality in the elderly: Anarrative review p. 1619
Zohreh Taraghi, Hamideh Azimi Lolaty, Reza Ali Mohammadpour, Afsaneh Oladzad Abbasabadi
DOI:10.4103/ATMPH.ATMPH_552_17  
Introduction: Aging is a period of life travel experiences during which elderly people are subjected to potential threats, such as increased risk of chronic diseases, loneliness and isolation, and lack of social support. In some cases, their individual independence is also threatened due to physical and mental disabilities. These factors may result in decreased quality of life and put their physical and mental health at risk. Beneficial effects of positive components (e.g., optimism, hope and spirituality) on physical and mental health has been confirmed in various studies. Methods: The purpose of this study is to review the strategies to promote hope and Spirituality among the elderly people. Available databases were assayed using appropriate keywords, both in Persian and English, during 2000-2016. 78 articles were obtained and finally 46 articles relevant to our desired objectives were selected and analyzed. Similar studies were excluded at the discretion of the author, or merged together as far as possible. Conclusion: Strategies were proposed to promote spirituality and hope among the elderly people.
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Comparison of muscular relaxation quality between the combination of remifentanil-atracurium and succinylcholine in rapid sequence induction and intubation p. 1627
M Khalili, E Moshiri, Hesameddin Modir
DOI:10.4103/ATMPH.ATMPH_554_17  
Introduction: Rapid sequence induction and intubationis the method of choice for anesthesia induction in nonfasted, full stomach patients in the operating room. The aim of rapid sequence induction is to quickly secure the airway to reduce the risk of regurgitation and aspiration of gastric contents. Succinylcholine, which is the most commonly used neuromuscular blocker in rapid sequence induction, has several side effects. The aim of this study is to compare the effects of succinylcholine and atracurium on muscular relaxation quality in rapid sequence induction and intubation. Materials and Methods: In this blinded, controlled clinical trial, seventy patients undergoing elective herniorrhaphy or orthopedic limb surgery randomly received one of the drug combinations, fentanyl/remifentanil/atracurium/nesdonal or fentanyl/nesdonal/succinylcholine and were evaluated for relaxation of the jaw muscles, vocal cord condition, and muscular response to intubation. Results: There was no significant difference in jaw relaxation, vocal cord condition, and muscular response to intubation between groups. Mean systolic and diastolic blood pressure and pulse rate were significantly lower in remifentanil-atracurium group compared to the succinylcholine group. Conclusion: Keeping the side effects of succinylcholine in mind, it seems that using remifentanil-atracurium combination for rapid sequence induction and intubation of the trachea produces results comparable to succinylcholine and consequently can be used as an alternative approach.
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Evaluating personality traits and suicidal ideation in substance-dependent patients on methadone maintenance therapy in addiction treatment centers in Rasht p. 1631
Somayeh Shokrgozar, Robabeh Soleimani, Hasan Esfandyari, Setareh Aram, Elahe Abdollahi
DOI:10.4103/ATMPH.ATMPH_564_17  
Introduction: Opium dependence and abuse are a topic of interest for clinicians due to its negative social consequences and risk of suicide. Suicide itself is correlated with some personality traits. This study is aimed to assess the relationship between suicidal thought and personality traits in opium dependent patients who are currently on methadone maintenance therapy. Materials and Methods: Ninety opium-dependent men on methadone maintenance therapy were randomly selected from addiction treatment centers in Rasht and entered this cross-sectional study. Beck scale for suicidal ideation(BSSI), big five inventory(BFI), beck depression inventory(BDI-II), and demographic questionnaire were used for evaluation. Data were analyzed by SPSS 22. Results: Mean ages of patients were 45.6±21.37years. 58.9% were married. 40% were minimally depressed, 36.7% were mildly depressed, and 23.3% were moderately depressed. There was a correlation between BDI and BSSI scores(r=0.613, P=0.001). Spearman correlation coefficient showed a positive correlation between BFI and BSSI scores, regarding occupational states and methadone dosage. Conclusion: Regarding the high prevalence of suicidal attempt among addicted patients, assessing personality traits and social factors in patients on agonist therapy is necessary to find appropriate solutions to reduce or prevent suicide.
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Identifying supportive care needs of patients with gastrointestinal cancer treatment in the selected centers of Isfahanin 2016 p. 1637
Alireza Fazeli, Masood Bahrami, Mehdi Mahmoodzadeh, Akbar Hasanzadeh
DOI:10.4103/ATMPH.ATMPH_569_17  
Background: The concept of supportive care needs includes essential services for people affected by cancer and their caregivers. This concept considers the need of physical, emotional, psychological, social, and informational of patients during the diagnosis, treatment, and survival. However, research studies, in which supportive care needs of patients with gastrointestinal cancers were studied, are very limited in an Iranian context. Therefore, the aim of the study was to identify supportive care needs of patients with gastrointestinal cancer treatment in the selected centers of Isfahan in 2016. Methods: This study was a cross-sectional study which was conducted in Isfahan in 2016. Supportive Care Needs Survey-Long Form 59 questionnaire was completed by 350patients who were undergoing gastrointestinal cancer treatment in the selected centers affiliated to the Isfahan University of Medical Sciences. The patients were selected by convenience sampling. This questionnaire considers supportive care needs of patient across five domains including daily life and physical, psychological, patients care and support, sex, and health system information. Demographic and clinical information of patients was also collected by a form. Results: Findings showed that the frequency of supportive care needs of patients with gastrointestinal cancer was equal to 62.6%. As well as the supportive care needs of patients were in daily life/physical 67.9%, psychological 59.6%, patients care and support 56.7%, sexual 54.7%, and health system information 74.1%. Frequency of health system information and sexual was the highest and lowest, respectively. Conclusion: According to the findings of this study, health system information need was the main supportive care needs of patients with gastrointestinal cancer in Isfahan. Some services that support these needs should be considered. It is suggested to training session for people affected by cancer should be improved.
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Comparative study of life quality of relatives of cancer and noncancer patients p. 1643
Fatemeh Najafi, Mansooreh Tajvidi, Mohammad Zare
DOI:10.4103/ATMPH.ATMPH_570_17  
Introduction: Cancer is a chronic and incurable disease that can have a significant impact on patients and their families. If the family members of the patient in nuclear family as the main caregivers of the patient do not receive required supports from health caregivers and do not have enough information on disease, caring, and complications of the treatments, not only the patient's health but also their own health will be endangered. The main objective of this article is to compare the life quality of relatives of cancer and noncancer patients. Method: This study is a correlational type of cross-sectional descriptive study. In this study, 245 relatives of cancer patients and 245 relatives of noncancer patients were selected using available sampling method and according to inclusion criteria. Data were collected using life quality questionnaire(SF-36). To analyze the data, SPSS 19 software and descriptive and inferential statistical tests, Pearson correlation coefficient, and t-test were used. Result: The results show that there is a significant difference between life quality of relatives of cancer patients and noncancer patients(t=3.33) at the level of(P<0.01). Conclusion: After obtaining necessary permissions form the administrators of the hospital, we referred to the clinic, got familiar with its administrators, and started to recruit family to the study. relatives of cancer and noncancer patients with the following took part in the study: having a certain year-old patint with a confirmed diagnosis of desease for at least many months, being able to read and write Persian, and suffering from no mental disorder.
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Evaluation of short-term and long-term effect of health training courses on knowledge, attitude, and practice of food handlers p. 1649
Meghdad Pirsaheb, Kiomars Sharafi, Masoud Moradi, Mehdi Fazlzadeh, Davoud Adham
DOI:10.4103/ATMPH.ATMPH_571_16  
Background: Good personal hygiene and sanitary handling practices at work are an essential part of any prevention program for food safety. Objective: This study conducted to investigate short-and long-term effect of public health training courses on knowledge, attitude, and practice of managers and food handlers in Kermanshah city. Materials and Methods: This study was conducted on 370male food handlers participating in public health training courses. Hygiene knowledge and attitude of subjects were evaluated at the beginning, 1month, and 2years after completion of public health training courses. Data were collected using self-designed questionnaire and checklist. Results: Knowledge scores of subjects improved from 20.55±4.03 to 23.73±3.75, attitude scores from 107.2±14.6 to 112.2±14.5, and practice scores from 43.93±7.6 to 46.1±3.75 resulting in 9.94%, 3.87%, and 4.66% improvement in food dealers' knowledge, attitudes, and hygiene practices, respectively. Conclusion: The results showed that the educational intervention improved knowledge, attitude, and practice of preparation, distribution and sale food handlers, after a short period of training. Besides, after a long time, the knowledge and attitude level of participants are reduced and conversely, the level of practice has been increased.
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Analysis of the association between IL-23R rs11209026 polymorphism in rheumatoid arthritis and systemic lupus erythematosus in an Iranian population p. 1656
Shadi Soleymani Motlagh, Mahmood Deghani Ashkezari, Kolsum Ahmadi, Azam Soleymani, Ali Asghar Kiani
DOI:10.4103/ATMPH.ATMPH_571_17  
Introduction: Rheumatoid arthritis(RA) and systemic lupus erythematosus(SLE) are two autoimmune inflammatory diseases with possible genetic links. In this study, the polymorphism R381Q IL-23R in patients with RA, SLE, and healthy controls and its relation to genotype was investigated. Materials and Methods: In this case-control study of 100patients with SLE, 100patients with RA and 112 healthy individuals who were referred to the rheumatology ward of some hospitals in Khorramabad(Lorestan province, west of Iran) were selected. Genomic DNA was extracted from peripheral blood and genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism method. Fisher's exact test was used to compare data from genotypes and alleles between all groups. Results: It was found that polymorphism A>G rs11209026 of IL-23R gene in the control group and patients with RA had significant difference(P=0.046). However in the control group and SLE patients, there was no significant difference(P=0.51). Conclusion: The results indicate that single nucleotide polymorphism rs11209026 G>A of the IL-23R gene is possibly associated with RA. IL-23 is an important inflammatory cytokine and essential for the differentiation of Th17cells. Hence studies related to the role of Th17cells in the pathogenesis of RA would help provide more insights into its regulatory mechanisms.
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Identifying and investigating exercise activity on the factors of physical fitness and well-being of the staff at the Isfahan University of Technology p. 1661
Jahangir Hamidi Tehrani, Mojtaba Babaei Khorzoghi
DOI:10.4103/ATMPH.ATMPH_574_17  
Objective: The results of the conducted studies investigating the prevalence of machinery life and increase of cardiovascular diseases imply that motor poverty and especially low aerobic power and increase in blood fat are among primary risk factors in cardiovascular diseases. To prevent these discomforts, doing regular physical and exercise activities are recommended; hence, people's participation in physical activities and their awareness of physical status and well-being factors, especially blood fat and cardiovascular profile are of utmost importance. The general purpose of this study, besides awareness of the participants' physical well-being, is to investigate the effect of exercise activities on physical fitness and blood fat profile in the staff of Isfahan University of Technology. Methods: A semi-experimental method with clinical experiments was used in this research, and the effect of 8 weeks of 45–50-min sessions of exercise, twice a week, and on the staff's physical performance was investigated. An experimental and a control group were randomly selected from volunteer male staff. The research variables were measured from the participants, and the results were addressed through SPSS software and statistical formulas and considering research hypotheses regarding the degree of variable changes. Results: The results of this study showed that comparing the degree of changes of the variables of body weight, body mass index, 1600-meter race, sit-ups 94-meter race, Swedish swimming, and blood cholesterol was significantly changed at P < 0.05 level after training period compared to before-training, and there was no significant change at P < 0.05 level in other research variables. Moreover, it was observed that the degree of changes of the variables of 1600-meter race, sit-up, stretch board, Swedish swimming, low-density lipoprotein (LDL), high-density lipoprotein, and the experimental group was significantly different at P < 0.05 level compared to the control group, and there was no significant difference at P < 0.05 level. Conclusion: It was observed from the results of this study that aerobic exercise trainings cause the increase of power, cardiovascular endurance, muscular endurance, and suitable changes in blood fat and the degree of the staff's flexibility. Therefore, attending program to increase the staff's physical activity level and physical fitness seems necessary. Furthermore, to control body fat, it is advised that men regularly measure their blood cholesterol after the age of 35, and LDL should be lower than 130 mg/dl but better to be lower than 100 mg/dl in the patients suffering from cardiovascular disease.
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A study of the views of bachelor students in operating room on evaluation of clinical performance using paper logbook, Isfahan University of Medical Sciences p. 1668
Milad Hosseini, Ali Reza Irajpour, Aygineh Hayrabedian, Maryam Khusravi, Saeid Amini Rarani, Ahmad Ghadami
DOI:10.4103/ATMPH.ATMPH_576_17  
Introduction: Evaluation is the most efficient way to enhance the quality of education. The quality of education cannot be understood without it. Enhancing the quality of clinical education requires continuous assessment of the current situation, identification of strengths, and correction of weaknesses. The present study aimed to investigate the bachelor students in operating room on evaluation of clinical performance using paper logbook, Isfahan University of Medical Sciences. Methods: In this descriptive cross-sectional study, 60 bachelor students in operating room in the School of Nursing and Midwifery, Isfahan University of Medical Sciences, were selected by simple randomly sampling. The data collection tools were self-made questionnaires. Their validity and reliability were confirmed. Descriptive statistics(frequency, percentage of frequency, mean and standard deviation) was used to analyze the data. Results: About 56.7% of students believed that current logbook did not create necessary motivation of learning for them. According to 58.3% of the students, evaluation based on logbook was not entirely fair. About 63.3% of them fully believed that there was not proper physical space to keep and transport logbook in operating room. According to 70% of them, the contents of logbook were not in accordance with educational objectives. Furthermore, the results showed that 83.3% of students believed that the contents were not designed in an appropriate order in the logbook and 66.3% believed that evaluation with logbook can create stress. Conclusion: The results suggest the need to review the content of the current logbooks, to create more interest through change and variety in evaluation methods. It is recommended to use updated methods such as electronic methods, especially in the operating room environment, to reduce pollution.
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Impact of training the components of emotional intelligence to mothers on the life quality of 2–6-year-old children with congenital heart disease p. 1673
S Zare, Z Montaseri, G Setoodeh, S Hosseini Teshnizi, H Amoozegar
DOI:10.4103/ATMPH.ATMPH_580_17  
Introduction: According to research, congenital heart diseases reduce the quality of life of children. Child's diseases can cause many challenges for family, especially for mother. The family environment can be the first place for teaching emotional intelligence. Management of emotions and reduced pressure of life can increase the life quality of people. The objective of this study was to investigate the effect of training emotional intelligence components to the mothers on life quality of 2–6-year-old children with congenital heart disease. Materials and Methods: In this interventional study, 80 mothers of 2–6-year-old children with congenital heart disorders referred to hospitals affiliated to Shiraz University of Medical Sciences in the year 2015–2016 were randomly divided into two intervention and control groups. The resulting data were analyzed using SPSS 16 software and using Pearson's correlation test, the relationship between emotional intelligence of mothers and life quality of children with heart disorders was investigated. In all statistical tests, P<0.05 was considered as significance level. Results: The results showed that training the components of emotional intelligence to mothers of 2–6-year-old children quality of life with heart diseases is effective(P<0.001). In addition, training components of emotional intelligence have a positive effect on emotional intelligence score of mothers, and their emotional intelligence score increases after educational intervention(P<0.001). Conclusion: Emotional intelligence training of mothers can be effective as a solution to improve the quality of life of children with congenital heart disease.
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The relationship between job satisfaction and social support for employees with chronic fatigue p. 1681
Mohammadreza Pirmoradi, Naser Foroghinejad, Fariba Asadi Bedmeshki
DOI:10.4103/ATMPH.ATMPH_582_17  
Objective: Chronic fatigue as a permanent and debilitating disorder causes weakness in personal, social, and professional life of a person. Thus researchers pay the necessary attention to it, and hence, the aim of this study was to investigate the relationship between job satisfaction and social support for employees of Ahvaz Water and Sewage with chronic fatigue. Methods: This research was descriptive of correlational type. The statistical society of this study consists of all staffs of Ahvaz Water and Sewage who were working in 2015. The statistical sample consisted of 190 employees who were selected randomly. To collect data, we used Ironson's job satisfaction scale, Chalder's fatigue scale, and Phillip's social support audit. The gained data were analyzed with the use of descriptive statistical method such as Pearson's correlation multivariate regression analysis and through software SPSS 20. Results: The results showed that there is a significant relationship between job satisfaction and social support for employees with chronic fatigue(P ≤0.001). Regression analysis showed that job satisfaction and social support can predict chronic fatigue significantly. Conclusion: The results showed that job satisfaction and social support reduce chronic fatigue in employees of Ahvaz Water and Sewage.
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Comparing turmeric extract plus animal butter synthetic poultice effect in two home-based and aseptic-based preparation methods in terms of microbial load p. 1686
Zahra Tazakori, Mansoureh Karimollahi, Zahra Haghighi, Mansoureh Karimollahi
DOI:10.4103/ATMPH.ATMPH_585_17  
Background and Objective: Based on increase in individuals' inclinations toward the use of natural and traditional products in curing some diseases in a systemic and localized manner, the survey of the pathogenic factors which are transferred through such products is of a great importance from the health perspectives. Furthermore, because the emergence of infections due to nonstandard method of preparing some of these natural drugs has not been accurately determined, a poultice mixture consisting of turmeric extract and animal butter was compared in two home-based and aseptic-based preparation methods in terms of microbial load and their effects on the process of pressure ulcer healing is investigated in this study. Materials and Methods: In this study, two poultice mixtures were initially prepared in a home-based method and the other under aseptic conditions, transferred to the laboratory where the specimens were cultured under sterile conditions, in microbe-culturing plates under microbiological hood with a dilution rate of 1–10. After the specified time duration elapsed, the plates containing the culture media were evaluated in terms of bacterial and fungal growth. To prepare a poultice based on standardized methods, turmeric was sufficiently bought from the medicinal herbs market and then put in ethanol 95%v/v. Animal butter underwent separation during a 24 h period in rotary evaporation device under reduced condensation pressure, and after its water was oozed out in 70°C, the concentrate was placed in the incubator. Turmeric extract and animal butter were mixed under bacteriology hood with sterilized wheat flour in autoclave. Finally, the poultice prepared aseptically was tested on seven human specimens and the results were evaluated using pressure ulcer scale for healing(PUSH). Results: Based on the experiments, the homemade poultice mixture was found contaminated with Gram-positive microbial factors, but when the poultice mixture was prepared seven times in the laboratory, no microbial load was found(above USP standard). The mean area of the ulcer was 13.41 before the study, but in the last evaluation, value decreased to 2.21. PUSH mean score from the 1stday until the 4thweek reduced from 13.42 to 5.85. It was shown that the ulcer recovery trend decreased considerably. Furthermore, regarding the tissue surveys through observing the samples at the end of intervention, it was seen that the ulcer was free of necrosis and granulated tissues were visible on the ulcer. Conclusion: The aseptic specimen was found in an standard level in terms of microbial load and practically caused effective recovery of the pressure ulcer through increasing the circulation in blood veins, reducing the secretions and edema, and is not indicative of traces of any infection; thus the consumption of this poultice was recognized as safe in improving the pressure ulcers.
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A study of emergency medical technicians' cognitive and practical skills in airway management and its relationship with some related factors in emergency medical centers selected in Isfahan in the year 2015–2016 p. 1691
Habiballah Alikhanizadeh, Fakhri Sabouhi, Fariba Haghani, Hojat Allah Yusefi
DOI:10.4103/ATMPH.ATMPH_586_17  
Introduction: Prehospital care is a fundamental and decisive component in the treatment of emergency patients. In accidents, the first contact with emergency patients is by emergency prehospital staff. Hence, they must have sufficient knowledge and skills in all fields with airway management been one of the important measures. Various factors are involved in emergency personnel's knowledge and skills whereas the evidences show that staff performance is not desirable. This study aimed to investigate emergency medical technicians' cognitive and practical skills in airway management and its relationship with some related factors. Materials and Methods: This study is a cross-sectional, descriptive-analytical research. Sixty-eight emergency medical technicians were randomly selected by simple convenience sampling method. The tools used for data collection were personal and demographic characteristics form, cognitive skills inventory, and clinical skills checklist, including five skills in airway management. Face and content validities of tools were investigated and verified by ten experts and lecturers. The data were collected using personal and demographic characteristics form, cognitive skills inventory, and filling out the clinical skills checklist and observing the skills performed by technicians and then analyzed by SPSS version20 software. Results: The results showed that, in airway management, 49.2% of technicians had good cognitive skills and 81% of them had practical skills. There was a direct relationship between the score of cognitive skills and the score practical skills(P<0.001; r=0.556). Conclusion: Although emergency medical technicians' practical skills were in good range, they got low scores in inserting the laryngeal mask airway, and it is required that they are trained in this field.
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The relationship of alexithymia with depression, anxiety, stress, and fatigue among people under addiction treatment p. 1698
Shokoofeh Rostami Nezhad, Mohammad Mazloumi Rad, Nazanin Farrokhi, Fatemeh Viesy, Shahrbanoo Ghahari
DOI:10.4103/ATMPH.ATMPH_589_17  
Aim and Background:Addicted people suffer from many psychiatric disorders. Therefore, this study was conducted to examine the relationship of alexithymia with depression, anxiety, stress, and fatigue among people under addiction treatment referred to Addiction Treatment Centers in the west of Mazandaran, Iran. Materials and Methods: The research method is of correlational type. Statistical population of the study included all 20–50-year-old men referring to Addiction Treatment Centers in the west of Mazandaran. The study sample size included a cluster of 304 members who were randomly chosen among people referred to these centers at the first half of 2015. Sample members who participated in research filled out questionnaires such as Depression, Anxiety, Stress scale 21, Toronto Alexithymia Scale 20, and Fatigue Inventory of Chalder. The obtained data were analyzed using regression test throughSPSSversion22 software. Findings: The findings indicated that there is a significant relationship between alexithymia with depression, anxiety, stress, and fatigue among people under addiction treatment(P<0.001). Conclusion: Asignificant correlation is between alexithymia, depression, anxiety, stress, and fatigue was found among the people under addiction treatment and this correlation is as follows: depression(53%), anxiety(54%), stress(46%), and fatigue(52%).
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Evaluation of awareness and high-risk behavior associated with genital wart in married female students p. 1704
Nasibeh Roozbeh, Ali Safari-Moradabadi, Mojdeh Banaei, Asiyeh Pormehr Yabandeh, Elham Sadeghifar, Shila Mahdavi, Sakineh Dadipoor
DOI:10.4103/ATMPH.ATMPH_600_17  
Introduction: Human papilloma virus(HPV) is a widespread sexually transmitted disease that could cause serious consequences for women. Students' high-risk behavior and lack of preventive activities are associated with an increased risk of HPV infection. This study evaluates the awareness and high-risk behavior associated with genital wart in married female students. Methods: This is a descriptive study conducted on 410 married female students of nonmedical majors in Scientific-Practical Center of Health Department in Bandar Abbas, Iran. Sampling was done based on systematic random sampling method. Data were collected by valid and reliable questionnaires made by researcher that had 3 parts(demographics, awareness investigation, and high-risk behaviors detection). The data were entered into SPSS statistical software and were analyzed using t-test, Chi-square, correlation, and regression test. Results: The average age of students was 23.1years .Most of subjects(88%) did not pass check-ups for regular screening of genital wart in the last two years. Most of them had never heard the name of genital wart(82%) and those students who had heard the name of genital wart were informed by their friends as the source of information(98%). Evaluation of awareness about genital wart in married female students showed that most of the students had not complete awareness(score 9) toward the illness. The relationship between age and high-risk behaviors of students was statistically significant(P<0.05). Conclusion: Based on this study, students' awareness about genital wart disease was very poor. Therefore, a deeper and practical training by qualified personnel for nonmedical students as well as educational program of media can be very effective.
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The effect of acceptance and commitment therapy on the mental health of women patients with typeII diabetes p. 1709
Marziyeh Kaboudi, Fateme Dehghan, Arash Ziapour
DOI:10.4103/ATMPH.ATMPH_607_17  
Background: Diagnosis of diabetes will have a significant impact on patients' psychosocial functioning and patients should devote sufficient time and energy to self-manage the disease. This study aimed to evaluate the effectiveness of treatment based on acceptance and commitment model on the mental health of women with diabetes typeII. Methods: The present study is an experimental study with pretest-posttest control group design. The sample consisted of 26 women with diabetes from Kermanshah who were recruited using convenience(availability) sampling and were randomly divided into experimental and control groups. All patients completed the 28-item general health questionnaire before and after the intervention. Data were analyzed using univariate analysis of covariance and applying SPSS version23. Results: The results clearly showed that the posttest scores of mental health in the experimental group were significant compared to the control group(P<0.05). Conclusions: According to the results of the study regarding the effectiveness of treatment based on acceptance and commitment-based model on mental health, it can be used as a complementary treatment to enhance mental health and the overall mental state of patients with diabetes along with drug therapy.
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The factors associated with childbearing intentions in Iranian female University students p. 1714
Maryam Moradi, Nourossadat Kariman, Masoumeh Simbar, Mohamad Amin Pourhoseingholi, Sara Baki
DOI:10.4103/ATMPH.ATMPH_609_17  
Background: Population and its dimensions are considered the focal point of any social system and the present study seeks to determine the factors associated with childbearing intentions in female students. Materials and Methods: This cross-sectional study randomly examined 294female students of Shahid Beheshti University(SBU) and Shahid Beheshti University of Medical Sciences(SBUMS) in Tehran. Data were collected using a Demographic Questionnaire, the Factors Associated with Childbearing Intentions Questionnaire, and the Multidimensional Scale of Perceived Social Support Questionnaire. The relationship of childbearing intentions was assessed with marital age, duration of marriage, ideal number of children, and ideal birth spacing. Results: Of the factors examined, marriage age had the highest correlation with childbearing intentions(P<0.001, r=0.959). After eliminating the statistically insignificant paths, the spouse's role(β =0.325), personal factors(β = −0.100), and family factors(β = −0.072) were found to have a direct effect on childbearing intentions. The variables of age(β = −0.007), educational stage(β = −0.007), family factors(β = −0.013), beliefs(β =0.002), spouse's role(β = −0.033), and financial status(β = 0.015) were found to have indirect effects. Conclusions: Many factors are involved in childbearing intentions, including personal factors, family factors, spouse's role, perceived social support, social support, beliefs, and financial factors. Health teams and policymakers should adopt strategies that can aid the socioeconomic status and family conditions of university students and enable them to have their desired number of children at the most appropriate timing.
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Comparing the effect of two methods of group education and education by multimedia compact disk on mothers' knowledge and attitude about child sexual abuse p. 1720
Peymaneh Lak, Mahnaz Noroozi, Soheila Ehsanpoor
DOI:10.4103/ATMPH.ATMPH_610_17  
Background: Sexual abuse is one of the main health problems of children around the world. Mothers are the most important reliable source for providing information to children. The aim of this study was to compare the effect of two methods of group education and multimedia compact disk(CD) on mothers' knowledge and attitude about child sexual abuse. Materials and Methods: In this clinical trial, 100 mothers of children under 18years of age who had a medical file at health centers of Isfahan, Iran, were selected randomly. Participants were randomly allocated into two groups: group education and education with multimedia CD about child sexual abuse. Data were collected by a researcher-made questionnaire and analyzed using descriptive and inferential statistics. Results: The mean score of knowledge and attitude of mothers about child sexual abuse after the intervention in the group education (92.6 and 84.1) compared to before the intervention(69.7 and 58.4) and also in the multimedia CD group after the intervention(92.3 and 81.4) compared to before the intervention (67.5 and 56) had a statistically significant increase. No significant difference was observed between the mean scores of knowledge and attitude of mothers of both groups about child sexual abuse after the intervention. Conclusions: Two methods have been similarly effective in improving the knowledge and attitude of mothers about child sexual abuse. Therefore, considering the benefits of educating with multimedia CD including its affordability and the possibility of using it at any time, it is recommended to use it for mothers' educational programs.
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Emotion regulation difficulties in drug abusers p. 1724
Iraj Zareban, Nour Mohammad Bakhshani, Mohsen Hossein Bor, Saeed Bakhshani
DOI:10.4103/ATMPH.ATMPH_617_17  
Introduction: Various factors, including personality characteristics, are involved in addiction and perpetuation of it. Emotions and the way they are felt and responded are a part of personality that may play a role in showing tendency to drug abuse and perpetuation of this behavior. The present study aimed at investigating emotional difficulties in drug addicts. Methodology: The statistical population of this cross-sectional study included 268 individuals, of which 166 individuals were drug dependence who visited medical centers in Zahedan and Iranshahr. The remaining 120 individuals had no addiction history and were assessed with difficulty in emotion regulation scale. Sample selection was done through convenience sampling technique. Findings: Results suggested that drug-dependent people had significant difference from nondependent individuals in five aspects, namely nonacceptance of emotional responses, difficulty engaging in goal-directed behaviors, difficulty in impulse control, limited access to emotion regulation strategies, and lack of emotional clarity(P<0.01). These two groups were not different only in one aspect, namely the lack of emotional awareness(P>0.05). Evaluation of emotional difficulties and gender showed a difference between men and women in nonacceptance of emotional responses, difficulty in impulse control, limited access to emotion regulation strategies(P<0.01), and lack of emotional clarity(P<0.05). There was no between-groups difference in difficulties engaging in goal-directed behaviors and the lack of emotional awareness. Conclusion: Although emotional difficulties are not the main factor in the onset and perpetuation of drug abuse, abusers suffer from them. Given the research results and those of other studies, the importance of emotion in etiology, prevention, and treatment of addiction can be highlighted.
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Using of Cornell measuring tool(Cornell musculoskeletal discomfort questionnaires) for assessment of the musculoskeletal disorders prevalence among Ilam teaching hospitals nurses: Cross-sectional study in 2016 p. 1729
Maryam Omidi, Mohsen Jalilian, Meghdad Kazemi, Maedeh Kamalvandi, Maryam Jamshidzad, Nematullah Kurd
DOI:10.4103/ATMPH.ATMPH_619_17  
Introduction: Nurses in compare of other health practitioners have a greater risk for musculoskeletal injuries due to high physical activity together with bending, twisting, prolonged standing, patient moving, and lifting heavy objects. Therefore, the aim of this study was to evaluate musculoskeletal disorders by Cornell measuring tool among Ilam teaching hospitals nurses. Materials and Methods: This study was a cross-sectional analysis in 2016. Atotal of 120 people of Ilam teaching hospitals nurses randomly interred the study. Participants completed the questionnaire set for assess demographic characteristics(employment, working hours, shift work, and work experience) and musculoskeletal disorders(Cornell musculoskeletal discomfort questionnaires). Data collected were analyzed using SPSS version21 software and with the conduct of Pearson's correlation test and independent sample t test. Results: The results showed that 52cases(3.43%) of participants were male and 68(7.56%) were female. The highest discomfort incidence was reported to the lower back(70%) and neck(69.2%), respectively. Pearson's correlation test showed statistically significant relationship between the age, gender, and work experience with discomfort(P<0.05) and no significant relationship between powers working and discomfort(P>0.05). Discussion: According to the high prevalence of musculoskeletal disorders in the lower back and neck in the population studied, ergonomic interventions suggested. Conclusion: The use of appropriate educational programs, ergonomic intervention, and the use of health and safety equipment can reduce MSDs and increase productivity of nurses.
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Decreased level of the anti-inflammatory adipokine, secreted frizzled-related protein 5, in patients with coronary artery disease p. 1735
Aghdas Gharibi, Parichehr Yaghmaei, Gholam Basati, Kourosh Soleimannejad, Naser Abbasi
DOI:10.4103/ATMPH.ATMPH_621_17  
Background: Secreted frizzled-related protein 5(SFRP5) is an anti-inflammatory adipokine that excreted by adipose tissue and functions to modulate metabolic and inflammatory dysregulations. The exact contribution of SFRP5 toward coronary artery disease(CAD) is largely unclear. Objectives: In the current study, the potential role of SFRP5, by particular focusing on its anti-inflammatory effects, was sought in CAD. Patients and Methods: Serum levels of SFRP5 and the inflammatory biomarkers, oxidized low-density lipoprotein(Ox-LDL), and high-sensitivity C-reactive protein(hsCRP), were measured in 40 CAD patients and 40 controls who were identified based on coronary angiography examinations. The status of CAD severity (in accord with Gensini score) and traditional CAD risk factors were also determined. Association of SFRP5 with Ox-LDL, hsCRP, CAD severity, and traditional CAD risk factors was analyzed. Results: Serum SFRP5 level in CAD patients was significantly decreased compared to controls(28.60ng/mL[25.67–34.58] vs. 39.92ng/mL[32.82-49.91], P=0.000). The correlation of serum SFRP5 level with hsCRP, Ox-LDL, body mass index, and Gensini score was reveal to be significant and negative(P<0.05). Serum SFRP5 level was independently and inversely associated with CAD(odds ratio, 0.28[95% confidence interval, 0.11–0.56], P=0.001) and differentiated between CAD patients and controls(P=0.01). Conclusions: Decreased level of serum SFRP5 is associated with CAD, highlighting its implication in CAD. It may also be a clinically useful biomarker for CAD.
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Evaluation of noise effects on standard threshold shift employees of technical and professional organization according to the audiogram and sound overall level measurement in Ilam: Across-sectionalstudy p. 1740
Farnaz Safarpor, Mohsen Jalilian, Meghdad Kazemi, Maryam Jamshidzad, Maedeh Kamalvandi, Nematullah Kurd
DOI:10.4103/ATMPH.ATMPH_622_17  
Background: Noise is one of the most prevalent physically harmful factors in working environment which can cause many problems that one of them is hearing loss. Therefore, the aim of this study was to assess occupational exposure with sound(noise) in training workshops of Technical and Vocational Organization of Ilam and to determine the rate of change in hearing threshold of people working in these workshops. Materials and Methods: A cross-sectional study was carried out on 60 people which working in 8 workshops of Technical and Vocational Organization of Ilam which are selected by census report. Demographic data of studied people are collected using a researcher-made checklist and measuring the overall balance of sound level meter set model 450 is used. Changes in hearing threshold of people are assessed using audiometer. Finally, data are analyzed using SPSS 20 by conduct Spearman correlation and Pearson's correlation statistical tests in asignificant level of 0.05. Results: The results show that there have been 8.62dB change in hearing threshold of the left ear, 8.73dB in right ear, and 6.74dB in both ears of studied people averagely. The highest level of sound pressure balance is related to cutting-wood workshop, and the Equivalent exposure level(Leq) is more than national standard level(85dB) in mosaic, lapidary, and welding workshops. Spearman correlation test shows a significant relationship between the highest level of sound balance in welding workshop(112dB) and the average total loss(8.15dB) for both ears(P<0.05). Conclusion: According to the findings of this study, there is an urgent need for monitoring, assessing and control of other workshops of Ilam Technical and Vocational Organization to investigate the overall balance of sound and change in hearing threshold of people working in the workshops.
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Adolescents' awareness of fruit and vegetable consumption in Iran: An unacceptable status p. 1746
S Rakhshanderou, A Ramezankhani, Y Mehrabi, M Ghaffari
DOI:10.4103/ATMPH.ATMPH_625_17  
Background: Knowledge and awareness of fruit and vegetable consumption is considered as one of the determining factors of this behavior in children and adolescents. This study is conducted to assess adolescents' awareness of fruit and vegetable consumption in Tehran city. Materials and Methods: The present research is a cross-sectional, descriptive-analytic study which is conducted to assess Tehranian adolescents' awareness of fruit and vegetable consumption. In this research, 500 students aged 11–14years from middle schools in Tehran(250 boys and 250 girls) were studied. Participants were selected by multistage random sampling method. The inclusion criteria were age 11–14years, informed consent and voluntary participation of students in the study. Data were collected by means of a researcher-made questionnaire which included 11 questions about demographic characteristics and 17 questions about participants' awareness. The face validity and content validity of this questionnaire are assessed, and its reliability is measured by internal consistency method(α =0.7). Completed questionnaires were collected, and data were entered into the computer. T-test, one-way analysis of variance, and descriptive statistics were used to analyze the collected data by means of SPSS 18. Results: The mean scores of adolescents' awareness of fruit and vegetable consumption was 27.21 with standard deviation of 3.26. The awareness of fruit and vegetable consumption in 35 students(7%) was poor, in 266 students(53.2%) was moderate and in 181 students(36.2%) was good. The findings of this study showed a significant difference between boys' and girls' awareness of fruit and vegetable consumption. There was a significant association between student' awareness and age, number of family members, and mothers' education level as well. However, there was no relationship between participants' awareness and their fathers' education level and also a residential area. Conclusion: Tehranian adolescents' awareness of fruit and vegetable consumption is not acceptable. It is recommended to design and implement some interventional programs to promote adolescents' awareness of fruit and vegetable consumption.
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An investigation of the impact of Kelussia odoratissima extract on mice with secondary hyperlipidemia p. 1752
Kaveh Berenjian, Amir Kiani
DOI:10.4103/ATMPH.ATMPH_639_17  
Introduction: For many years, human beings have applied plants as medicine and their healing impact has been proved for many years. Kelussia odoratissima is a biennial, edible, and fragrant plant with medicinal and food applications. This plant is dedicated to some pastures of Iran and this plant is not reported in other regions around the world. Flavonoids are the most important ingredient of this plant. Materials and Methods: In this study, to evaluate the effect of feeding mice with secondary hyperlipidemia with K.odoratissima, we used thirty mice with secondary hyperlipidemia of similar weight and divided them into three equal groups. For 3weeks, the first and second groups were fed with the extract of K.odoratissima with doses of 600mg/kg weight of mice and 1200mg/kg weight of mice, respectively, and triglyceride, low-density lipoprotein(LDL), total cholesterol, and weight of mice were evaluated. Results: The results showed that, at the end of the 1stweek, there was no significant change in any of the groups, but at the end of the 2ndweek, in the first group, there was a reduction of LDL; in the second group total cholesterol and triglyceride without any weight change were reduced and LDL factors, total cholesterol, and triglyceride had low weight change; and in the third group, there was an increase of LDL factors, total cholesterol, and triglyceride and an increase of weight. At the end of the 3rdweek, in the first group, there was a reduction of LDL factors, total cholesterol, and triglyceride and a little weight reduction; in the second group there was a reduction of LDL factors, total cholesterol, and triglyceride and a considerable reduction of the weight; and in the third group, LDL factors and total cholesterol, triglycerides, and weight of mice were increased. Conclusion and Discussion: Hydroalcoholic extract of the plant reduced total cholesterol, triglyceride, LDL, and weight of mice using K.odoratissima. Except two groups that were administered K.odoratissima, the weight of the other animals was increased. The increase in the activity of lipoprotein lipase as the mediator of hydrolysis of triglyceride in chylomicron causes free fatty acids to generate energy or be stored as fat.
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Impact of skin-to-skin care on satisfaction and experience of cesarean mothers: Arandomized, double-blinded clinical trial p. 1756
Mahnaz Jabraeili, Aleheh Seyedrasouli, Ziba Kheiri, Homayoun Sadeghi-Bazrgani, Abdollah Jannatdoost
DOI:10.4103/ATMPH.ATMPH_642_17  
Introduction: During the infancy period, it is vital to take a good care of mother and infant to promote their health. Furthermore, mothers' satisfaction is a good indicator to evaluate the quality of services. Objective: The aim is to examine the impact of skin-to-skin contact of infants by mother immediately after caesarean on the satisfaction of the mothers and to study the experience of mothers who received the care. Materials and Methods: This randomized, controlled, double-blinded clinical trial performed on the mothers who had cesarean in 2015 in Miandoab city, West Azerbaijan Province, Iran. One hundred and five participants were randomly divided into the experiment and control groups using randomized blocks method. Experiment group received skin-to-skin contact in the recovery room, and then, for 3days, at 7 am, 1 pm, and 7 pm for 30min. To measure the satisfaction of the mothers, a questionnaire, previously was approved, was applied. Experience of the mothers with the kangaroo mother care method only in the experiment group was measured. Results: Mean satisfaction of mothers in the experiment group was significantly higher than the control group(P<0.001). The experience of mothers for skin-to-skin contact in the intervention group was close to “totally agree=5.” In the multivariate analysis, based on backward method, the age was the only significant variable with an odds ratio of 1.90 and B=0.64 and 95% confidence interval for the B value(1.14, 0.14) which was statistically significant with mothers' satisfaction(P=0.013). Conclusion: Skin-to-skin contact of infants by mothers might be improves mothers' satisfaction and postnatal care.
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Impact of counseling on sexual intimacy of lactating women p. 1763
Mojdeh Banaei, Sanaz Safarzadeh, Hadis Shahrahmani
DOI:10.4103/ATMPH.ATMPH_643_17  
Introduction: The first sexual intercourse after childbirth is an important step for couple to create intimate relationships. This study was conducted to determine the impact of counseling based on PLISSIT model on sexual intimacy of breastfeeding women during 6months after childbirth. Materials and Methods: This study is based on randomized clinical trial. The samples of study consisted of 82 nulliparous and breastfeeding women during the first 6months after childbirth. Samples were assigned randomly in intervention group and control group. To collect data, demographic and midwifery characteristics questionnaire and intimacy questionnaire were used. Sexual intimacy of person was measured in three phases: before intervention, 1month, and 3months after intervention. Results: Three months after intervention, the mean of sexual satisfaction and sexual intimacy scores increased significantly in intervention group(P>0.001). There was a significant difference between sexual intimacy and sexual satisfaction scores in the experimental and control groups, 1month(P>0.001) and 3months(P>0.001) after the intervention by doing Mann–Whitney test. Conclusion: Based on the results of this study, sexual counseling increased sexual intimacy of breastfeeding women, and the impact of the counseling was still stable1 and 3months after the intervention.
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Prognostic factors of sepsis rapid progression in patients admitted to Intensive Care Unit p. 1770
Maryam Roham, Abolfazl Abbaszadeh, Abolfazl Zendehdel, Mahnoush Momeni, Nahid Mirzae, Mohammadreza Gholami
DOI:10.4103/ATMPH.ATMPH_646_17  
Background: Immediate identification and treatment of patients at the risk of developing sepsis would contribute to a more efficient diagnosis. This study aimed to examine the effective determinants bringing about the rapid progression of this disease towards septic shock and severe sepsis. Materials and Methods: This study is a retrospective cross-sectional research on the patients, above 12 years, admitted to one of the hospitals in Tehran. It took 18 months to conduct this study that included merely patients with sepsis. Patients' cases were examined thoroughly, and eventually the progression of their diseases towards septic shock (low blood pressure despite adequate fluid intake) or severe sepsis (organ dysfunction) and related factors were investigated. Results: We included 230 patients, among whom 84 individuals developed septic shock and severe sepsis within 72 h. The Effective factors in the progression of their diseases were old age, high temperature, female sex, vascular catheter-related infections, low serum albumin, and diastolic pressure <52 (P = 0.025, 0.04, <0.001, 0.006, <0.001, and <0.001) respectively. Conclusion: A significant number of patients with sepsis developed septic shock and severe sepsis. Our study indicated that factors such as age, sex, low albumin, and low diastolic pressure play major roles in the progression of this disease in patients.
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A comparison of cognitive emotion regulation, lifestyle, and dimensions of adjustment in 3 groups of patients with multiple sclerosis, patients with cancer under chemotherapy and patients relieved from brain tumor p. 1774
Khadijeh Jahan Miri, Siamak Samani
DOI:10.4103/ATMPH.ATMPH_647_17  
The purpose of the present study WAS to compare cognitive emotion regulation, lifestyle, and dimensions of adjustment in 3 groups of patients with multiple sclerosis(MS), patients with cancer under chemotherapy and patients relieved from brain tumor. The statistical sample included 72patients that were all selected by convenience sampling method. They filled out the questionnaires of cognitive emotion regulation questionnaire, multidimensional adjustment scales, and lifestyle questionnaire. The results showed that in the score of positive and negative cognitive emotion regulation, the mean score of the MS group was significantly more than the cancer group. In lifestyle, the mean score of the brain tumor group was significantly more than the other two groups. In adjustment and personal, social, job, and family dimensions, the scores of the cancer group were significantly more than the other two groups.
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The effect of stabilization exercises on lumbar lordosis in patients with low back pain p. 1779
Mohammad Hosseinifar, Fateme Ghiasi, Asghar Akbari, Mohsen Ghorbani
DOI:10.4103/ATMPH.ATMPH_654_17  
Background and Purpose: There is a hypothesis that restoring the lumbar lordosis will increase a patient's voluntary muscular strength and decrease back pain symptoms. This study aimed to evaluate the effects of stabilization exercises on lumbar lordosis and functional improvement. Methods: Thirty-two patients with chronic low back pain(LBP) were recruited through simple nonprobability sampling for this double-blind, randomized clinical trial, performed at the Razmejo-Moghadam Physiotherapy Clinic, Zahedan University of Medical Sciences. Participants were randomly assigned to either stabilization exercise group(n=16) or control group(n=16). Before and after intervention, we assessed pain(ordinal) through the McGill Pain Questionnaire, disability(ordinal) with the Oswestry Disability Index(ODI), and lumbar curve(degree) with flexible ruler. Twelve sessions daily exercise program was performed for both groups.t-tests were used for data analysis(P<0.05). Results: Amount of lumbar curve was significantly changed after training in both groups(P<0.05). Pain score and The ODI also showed significant change after intervention in both groups(P<0.05).There was no significant differences between both groups in lumbar curve variable(P>0.05). However, pain score and Oswestry score showed significant differences between two groups after intervention(P<0.05). Conclusion: The results showed that both lumbar stabilization and routine physiotherapy cause decreasing in pain, disability, and change lumbar lordosis in patients with chronic LBP. Therefore, lumbar curve evaluation and therapeutic exercise for restoration lumbar curve were recommended.
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The effects of self-care training on health-promoting behaviors of asthmatic patients p. 1785
Abbaszadeh Arefe, Hosseini Meimanat, Borhani Fariba, Estabsari Fatemeh, Shakeri Nezhat
DOI:10.4103/ATMPH.ATMPH_656_17  
Background and Purpose: Asthma is one of the most common chronic diseases in the world, and promoting self-care behaviors is known as critical in the successful management of asthma. Since self-care training probably causes patients with asthma to have an active role in the management and control of the symptoms of their disease, this study was conducted to determine the effects of self-care training on health-promoting behaviors in asthmatic patients referring to private clinics in Mashhad. Methodology: This experimental study was conducted on 110patients(21–40years old) with asthma diagnosis. Sampling was done in two phases: purposive method for selecting physicians' clinics and simple random for selecting control and intervention groups of patients. In the intervention group, eight training sessions on the aspects of health-promoting behaviors were held and the control group received no training. Data collection tools included demographic characteristics questionnaire, Health-Promoting Lifestyle Profile II, and asthma control questionnaire. Data were analyzed using SPSS 21, nonparametric Mann–Whitney U and Friedman tests, paired parametric independent t-test, and repeated measures test. Results: A statistically significant difference was observed between the score of asthma control and health-promoting behavior scores in intervention and control groups immediately and 2 months after the training, indicating the effectiveness of the intervention. Conclusion: Overall, this study showed that training in asthma could be considered as a special part of care programs so that the patient is actively involved in self-care and can be encouraged in the therapy.
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The relationship of digestive system diseases in pregnant women with stillbirth and neonatal death in Iran: Apopulation-based case–control study p. 1792
Halimeh Yaghoobi, Fatemeh Zolfizadeh, Tannaz Valadbeigi, Maryam Soltani, Hamid Reza Tabatabaee, Ali Reza Mirahmadizadeh, Sepideh Mahdavi, Abdolhalim Rajabi, Ali Ghasemi, Naeimeh Kevghobadi, Cirrus Salehnasab, Mahmoud Hajipour
DOI:10.4103/ATMPH.ATMPH_658_17  
Background: The most important digestive system diseases implicated in pregnant mothers' stillbirth and neonatal death include large intestine diseases, Crohn's disease, ulcerative colitis, and stomach problems. This study aimed to determine the relationship between digestive system diseases in pregnant women and stillbirth and neonatal death. Methods: This population-based case-control study was conducted on 3573 mothers (1223 mothers experiencing stillbirth, 1091 mothers with neonatal death, and 1259 mothers with live births) in 10 provinces of Iran. The study data were analyzed using logistic regression analysis. Results: A total of 461 pregnant women(12.9%) suffered from digestive system diseases before the last pregnancy among whom 171 women(14.1%) experienced stillbirth, 149(13.7%) reported neonatal deaths, and 141 women(11.2%) were in the control group. The results showed that the women with digestive system diseases were more likely(32%) to experience stillbirth when compared to those with no digestive system diseases(odds ratio[OR]: 1.32; 95% confidence interval[CI][1.008−1.74]). Neonatal mortality was also higher(58%) among the mothers with digestive system diseases as compared to the control group(OR: 1.58, 95% CI[1.19−2.09]). Conclusion: Pregnant mothers with digestive system diseases were exposed to higher risks of severe prenatal consequences. The odds of stillbirth and neonatal death, were, respectively, 0.32 and 0.58times higher in the pregnant mothers affected by digestive system diseases than those without such problems. This shows the undesirable effects of digestive system diseases on the fetus. Mothers' knowledge of appropriate nutrition and digestive system diseases has to be improved to prevent these consequences.
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Prevalence and pattern of parasitic infestations among nomadic Fulani children in a grazing reserve in Northwestern Nigeria p. 1799
Halima Bello-Manga, Aisha Indo Mamman, H Idris Suleiman, Adebola Olayinka, Abubakar Umar Musa, Kana Abubakar Musa
DOI:10.4103/ATMPH.ATMPH_664_17  
Background: Nomadic pastoralists lack access to basic sanitary and health-care facilities mainly because their mode of life makes them a hard to reach group. In the Nigerian context, there is dearth of knowledge about the interplay between their lifestyle and health indices.Therefore, this study is aimed at determining the association between the prevalence of parasitic infestation among nomadic Fulani children in Ladduga grazing reserve, Kaduna, Northwestern Nigeria. Aim: The aim of this study was to assess the prevalence and pattern of parasitic infestation among nomadic Fulani children in Ladduga grazing reserve, Kaduna, Northwestern Nigeria. Materials and Methods: A cross-sectional descriptive study was conducted using questionnaires, physical examination, automated hemocytometry, enzyme-linked immunosorbent assay-based serum ferritin assay, and formol-ether concentration-based stool tests on 337 children(5–15years) at Ladduga grazing reserve, Northwestern Nigeria. Data were analyzed using SPSS version20.0. Results: The prevalence of parasitic infestation was 14.4%(49/337). The predominant parasites found were hookworm species, i.e., Necator americanus and Ancylostoma duodenale(46.9%) and Schistosoma mansoni(26.6%) while Ascaris lumbricoides, Hymenolepis nana, and Enterobius vermicularis accounted for 26.6%. Anemia was found in 40.4%(137/340) of the children with a statistically significant difference between younger(5–9years) and older children(10–15years; P<0.05). Of those with parasites in the stools, 53% of children had anemia. Iron deficiency anemia was found in only 8.1%(4/49) of children. Conclusion: The prevalence of anemia was high in the studied population, but iron deficiency was not a major cause despite hookworm infestation, thus necessitating the need for further studies to identify other causes of anemia among this group.
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The effect of using mobile phone on medical students' mental focus in respond to knowledge questions p. 1805
Zeinab Asgari, Amir Jamshidnezhad, Fatemeh Forghany, Golnaz Abdolahi
DOI:10.4103/ATMPH.ATMPH_689_16  
Background: Today, using the mobile phone has grown widely. This massive growth captures the attention of researchers on biological effects of the mobile phone. Evidences have shown that the excessive use of mobile phone has negative impact on the physical and psychological health of users. Aims: The aim is to evaluate the effect of using mobile phones on the students' mental focus when they answer to general scientific questions, simultaneously in Ahvaz, Iran. Materials and Methods: In this practical study, a group of 60 students in the field of health information technology were participated. Participants were evaluated to verify the same level of information homogeneity and the ability of using a mobile phone. Therefore, the students were asked at the first step to respond to general information questions showed in computer monitor. Then, a message including 6–9 words by mobile phone was typed by the subjects while the typing time was registered. Next, they were asked to send a message while answering the questions showed on the monitor screen of the computers, simultaneously. At this step the difference between response accuracy to questions of the graphical test in two phases was analyzed. Results: The study results showed that the average scores of the correct response to graphical test, as typing a text on the mobile phone, was(26.8000) and the average scores of correct response to graphical test without typing a text on mobile phone was(30.2000). Moreover, the average scores when typing a text on mobile phone was 74.40 while the average scores for typing a text on the mobile phone and responding to graphics test, simultaneously was 194.12. Conclusions: The results showed that using the mobile phone has a negative impact on the selected students' performance to respond simultaneously to the general scientific questions.
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Methicillin-resistant Staphylococcusaureus nasal colonization in human immunodeficiency virus-infected patients p. 1809
Aaron Alexander, Shashidhar Vishwanath, Archana Sellvaraj, Muralidhar Varma, Kavitha Saravu, Kiran Chawla
DOI:10.4103/ATMPH.ATMPH_794_16  
Background: Staphylococcusaureus infections account for significant morbidity in human immunodeficiency virus(HIV)-infected individuals. Colonization by methicillin-resistant S. aureus(MRSA) usually precedes the development of subsequent infections. Aim: To study the frequency of MRSA colonization and to analyze its risk factors among HIV-infected adult patients. Materials and Methods: A prospective study was conducted including 194 HIV-infected patients. Anterior nasal swabs were obtained and processed for isolation of MRSA following standard guidelines. Risk factors for MRSA colonization were assessed, and the antimicrobial susceptibility profile of the MRSA isolates including low-level resistance to mupirocin was studied. Data were analyzed using SPSS statistical software. Results: MRSA colonization of anterior nares was found in 49patients(25.3%). Patients put on antibiotics in the prior 3months(P=0.001) and those with percutaneous device in the past year(P=0.001) were more likely to be MRSA colonized. Antiretroviral therapy was found to be protective against MRSA colonization(P=0.004). Low-level mupirocin resistance was found in four(8.2%) isolates of MRSA. Conclusion: A significant proportion of HIV-infected patients were found to have MRSA colonization. Detection and monitoring for MRSA carriage status may be considered to reduce infections caused by MRSA in HIV-infected individuals.
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A comparison of the 2015 Indian Academy of Pediatrics, International Obesity Task Force and World Health Organization growth references among 5–18-year-old children p. 1814
Inaamul Haq, Malik Waseem Raja, Mir Mujtaba Ahmad
DOI:10.4103/ATMPH.ATMPH_98_17  
Background and Rationale: The Indian Academy of Pediatrics(IAP) Growth Charts Committee has constructed revised IAP growth references for 5–18-year-old Indian children. This study was conducted with the objective of comparing these growth references with those prescribed by the International Obesity Task Force(IOTF) for Asian population and by the World Health Organization(WHO). Methods: Information about age, weight, and height was obtained from school-age children and adolescents between 5 and 18years of age attending a health center as patients or accompanying persons. Three reference systems-the new IAP, “Asian” IOTF, and WHO-based on age-and gender-specific body mass index cutoffs were used to classify children as obese, overweight, or nonobese nonoverweight. The three reference systems were compared using weighted kappa. Results: The prevalence of overweight using new IAP, “Asian” IOTF, and WHO reference systems was 6.6%, 6.6%, and 4.0%, respectively. The prevalence of obesity using new IAP, “Asian” IOTF, and WHO reference systems was 5.0%, 5.0%, and 4.3%, respectively. The prevalence of overweight and obesity was lower when the WHO reference was used, especially for adolescents. There was an excellent agreement between new IAP and “Asian” IOTF references(weighted kappa=0.9558, 95% confidence interval 0.9134–0.9982). Conclusions: The WHO reference may be less suitable for use in the Indian context, especially in adolescents.
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CASE REPORTS Top

Atherosclerosis-induced leg ulcers in a young female unassociated with risk factors: A rare presentation of a systemic disease p. 1820
Angoori Gnaneshwar Rao, Uday Deshmukh Reddy, Aparna Karanam, Amit Kolli, Kranthi Javadevapuram, Ruhi Hakkani, Saba Syeda Farheen
DOI:10.4103/ATMPH.ATMPH_195_17  
The occurrence of arterial leg ulcers due to atherosclerosis is common among old individuals. However, the development of leg ulcers due to atherosclerosis in a young female unassociated with risk factors like hyperlipidemia is rare. Herein, we present a case of leg ulcers consequent to atherosclerosis in a young female having normal lipid profile and unassociated with other risk factors. Characteristic morphology and site of the ulcers along with supportive investigations such as color Doppler study and histopathology of ulcer corroborated in establishing the diagnosis.
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Motor axonal neuropathy in sequence with acute transverse myelitis p. 1824
Smita Nath, Pinkesh Parmar, V Prabhu, Sandeep Garg, Suresh Kumar
DOI:10.4103/ATMPH.ATMPH_478_17  
Acute transverse myelitis(ATM) is an upper motor neuron disease of the spinal cord, and its association with peripheral polyneuropathy, particularly the axonal type, is rarely reported. This case presented with features of noncompressive upper motor neuron type of quadriplegia with bladder, bowel and sensory involvement at C4 spinal level. The diagnosis of ATM was confirmed by magnetic resonance imaging scan. The patient responded to high-dose steroids and was discharged. However, after 2weeks of recovery, the patient again developed acute-onset pure motor flaccid paralysis. Nerve conduction test was diagnostic of pure motor axonal neuropathy. This time she was treated with immunoglobulins after which she improved.
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LETTERS TO THE EDITOR Top

Improving the access of assistive products and aiming to make it more affordable p. 1827
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222641  
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Blastocystosis and hepatitis: A case study p. 1828
Viroj Wiwanitkit
DOI:10.4103/1755-6783.188515  
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Drinking juice and tongue bee sting: A case p. 1829
Won Sriwijitalai, Viroj Wiwanitkit
DOI:10.4103/1755-6783.188516  
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When a patient complains for passing of worm in stool: How about the reliability? p. 1830
Won Sriwijitalai, Viroj Wiwanitkit
DOI:10.4103/1755-6783.188517  
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“This death snake bit the patient!”, is it usually venomous after examination ? p. 1831
Won Sriwijitalai, Viroj Wiwanitkit
DOI:10.4103/1755-6783.188518  
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Breast milk composition and reference p. 1831
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/1755-6783.188519  
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Breastfeeding by mother in endemic area of arboviral disease: Any risk during performing? p. 1832
Somsri Wiwanitkit, Viroj Wiwanitkit
DOI:10.4103/1755-6783.188520  
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Snake in toilet and snake bite at genitalia: A concern for tropical countries p. 1833
Won Sriwijitalai, Viroj Wiwanitkit
DOI:10.4103/1755-6783.188521  
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Perception of the secondary school students toward the university education on medical media technique p. 1834
Suphattra Wpatcha, Wasana Kaewla, Viroj Wiwanitkit
DOI:10.4103/1755-6783.188522  
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Remote food photography p. 1834
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/1755-6783.188523  
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Advocating for the implementation of recommended measures to improve infant and young child feeding p. 1835
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.196625  
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World Health Organization prequalifies tests to respond to the challenge of early diagnosis of HIV in infants p. 1837
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.196676  
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Advice to the international visitors to Rio Olympics: World Health Organization p. 1838
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222645  
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Cutaneous leishmaniasis situation at present and the way of ahead p. 1840
Ali Mehrabi Tavana
DOI:10.4103/1755-6783.222646  
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Aiming to reduce salt intake in the world's population and minimize risk of cardiovascular diseases p. 1841
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222647  
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Fast mutation rate of Zika virus: Observation in sequences in Asian lineage isolated from Southeast Asian countries p. 1842
Somsri Wiwanitkit, Viroj Wiwanitit
DOI:10.4103/1755-6783.222648  
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We Decide: An initiative by the UNFPA to fight for the rights of disabled individuals p. 1843
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/1755-6783.222649  
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Structural and functional analysis of Zika virus nonstructural protein 1 by structural genomics approach p. 1844
Won Sriwijitalai, Viroj Wiwanitkit
DOI:10.4103/1755-6783.222650  
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