Assessment of Knowledge, Attitude and Practice of Inmates, Prison Staff and Soldiers Regarding Cimex lectularius (Hemiptera: Cimicidae) in Mazandaran Prisons

Background

Bed bugs (Cimex lectularius) are blood-sucking insects that bite humans usually at night and cause nuisance, psychological and social problems. These insects are considered a health hazard in densely populated places such as prisons. The aim of this study was to evaluate the knowledge, attitude and practice of inmates, soldiers, and prison staff regarding bed bugs in Mazandaran prisons.

Methods

This is a descriptive-analytical study in which 450 inmates and 210 staff (105 personnel and 105 soldiers) from prisons of Mazandaran Province were included in the study. Data on knowledge, attitude, and practice of the participants regarding bed bugs were collected using a structured questionnaire. To determine the relative content validity coefficient, the questionnaire was assessed by 10 specialists in terms of difficulty, inappropriateness, and ambiguity of the phrases. The reliability of the questionnaire was measured using Cronbach's Alpha and then the data were analyzed using SPSS software version 20.

Results

The maximum mean scores of knowledges, attitude, and practice between the three target groups were 16.42%, 44.07% and 71.21% respectively. Prison staff had the highest knowledge and practice, and inmates showed the highest attitude regarding bed bugs. There was no significant difference between the knowledge and attitude of inmates, prison staff and soldiers (P> 0.05) but there was a significant difference in their practice (P< 0.05).

Conclusion

Results of this study confirmed that all three groups of people in the prisons need appropriate education regarding all aspects of bed bug including its control.

Bioecological Study on the Sand Flies (Diptera: Psychodidae, Phlebotominae) in Sari County, North of Iran

Background: Phlebotomine sand flies are vectors of Leishmania species, the causative agents of leishmaniasis in the world. Present study aimed to evaluate the bioecological aspects of sand flies in different ecotopes in Sari County, north of Iran.        Methods: Sand flies were collected from four villages in mountainous, forest, plain and peri-urban areas monthly using sticky traps in May–October 2016. Mounted specimens were identified using valid identification keys under optical microscope. The Arc GIS 10.5 software was applied for showing the distribution of sand flies. Shannon-Weiner, Simp­son and Evenness species diversity indices were calculated. Results: Generally, 334 specimens were captured and identified, namelly Phlebotomus kandelakii, Ph. papatasi, Ph. major, Ph. sergenti, Ph. longiductus, Ph. halepensis, Ph. tobbi, Sergentomyia dentata, Se. theodori, Se. sintoni, Se. an­tennata and Se. sumbarica. The most common species was Ph. kandelakii (n= 128, 38.32 %). The highest Simpson in­dex (0.81) and abundance (N= 141) were recorded in the mountaineous area. Shannon diversity index was higher in the forest (H'= 1.53) and the highest evenness index was in the plain area (J'= 0.93). The highest richness (S= 9) and Shan­non indices (H'= 1.57) were observed in June. Conclusions: Phlebotomus kandelakii, Ph. sergenti, Ph. tobbi, Ph. longiductus, Se. theodori, Se. antennata and Se. sumbarica were recorded for the first time in the study area. Since some species are incriminated for leishmaniasis transmission, further studies are required in the northern regions of Iran to timely control measures planning.

Investigating the predictive power of constructs of extended Pender's health promotion model and some background factors in fruit and vegetable consumption behavior among government employees

BACKGROUND

Daily consumption of fruit and vegetable (F and V) can effectively reduce the risk factors of cardiovascular diseases; therefore it is necessary to identify the factors affecting this behavior. This study aimed to determine the Predictive Power of Pender's Health promotion model (HPM) constructs in F and V consumption behavior and the effects of some background variables on this behavior.

MATERIALS AND METHODS

A descriptive-correlation study was conducted on 418 employees working in different offices of Qaemshahr, Mazandaran Province from April 8, 2019, to July 23, 2019. The participants filled out a questionnaire about perceived F and V Consumption behavior based on Pender's HPM Constructs. The data were statistically analyzed by descriptive statistics and parametric tests, including the Pearson correlation, Independent- Sample t-test, One-Way analysis of variance test, and multiple linear regression, in SPSS-22.

RESULTS

The mean age of participants was 40.25 ± 7.56 years. The results showed that F and V consumption behavior was positively correlated with some constructs of Pender's HPM including, behavioral outcome (r = 0.51, P < 0.001), previous related behavior (r = 0.48, P < 0.001), commitment to action (r = 0.47, P < 0.001), perceived self-efficacy and behavior-related emotions (r = 0.39, P < 0.001). Behavioral outcome alone explained 26% of the dependent variable changes (F and V consumption behavior). The results also indicated that there was a significant relationship between gender and F and V consumption behavior (P = 0.01).

CONCLUSION

The study findings demonstrated that some of Pender's HPM Constructs could predict F and V consumption behavior. Behavioral outcome alone was a strong predictor of this behavior. Therefore, in addition to background variables, these constructs should be taken into account in the development of training interventions and courses.

Ecology of sand flies (Diptera: Psychodidae, Phlebotominae) in Jajarm County, an area with high risk of cutaneous leishmaniasis, in North Khorasan, Iran

The present study was conducted to investigate the ecological aspects of sand flies in southwestern North Khorasan, in which cutaneous leishmaniasis caused by Leishmania major has been reported with the highest annual incidence in Iran. Sampling was carried out in four localities including: Khorasha (natural), Ghamiteh (natural), Jorbat (semi urban) and Brick kilns (urban), twice a month using 105 sticky paper traps from indoors and outdoors dwellings during May-December 2017. Specimens were removed from sticky papers, washed in acetone, preserved in 80% ethanol, mounted on microscopic slides by Puri’s medium, and identified using valid morphological keys. Simpson (D), richness (S), Menhinick (DMg), Margalef (DMn), Shannon-Weiner (H′), evenness (J’) were calculated for species diversity. The synanthropic index was determined for the first time in the area. Totally 517 specimens were collected, 47% in outdoors and 30.4% in human indoor dwellings and 22.6% in animal. Eight species of sand flies including 5 species of the genus Phlebotomus and 3 species of the genus Sergentomyia were identified. Phlebotomus papatasi and Sergentomyia sintoni were the most common and Eudominant species, active in all months, collected in the maximum number and percentage in September and August, respectively, and showed the highest abundance in outdoors. The synanthropic index ranged from 6.25 to 38.9 in the study area. The Shannon-Wiener index was estimated to be up to 1.4 and 1.37 in Khorasha and November, respectively, which showed the highest diversity due to maximal richness and evenness compared to other areas. High abundance of Ph. papatasi, as the main vector of cutaneous leishmaniasis, can enhance the potential risk of emerging CL in new areas, the data can be equally important when vector control measures are considered.

Determination of susceptibility levels of three different cockroach species including hospitals German cockroach, Blattella germanica L. (Blattodea: Blattellidae), to common insecticides, cypermethrin, propoxur and fenitrothion

Objective

German cockroach is highly adapted to different environments like hospitals. This pest is an important carrier of pathogenic agents and allergic compounds. Hence, it is important to German cockroaches always be monitored and controlled. This study investigated the toxicity and resistance levels of technical-grade of cypermethrin, propoxur, and fenitrothion against adult males of four strains of the German cockroach.

Methods

Four German cockroaches' strains including laboratory-reared susceptible strain (S) and three hospital-collected strains (B, F, and Z) were tested in this study. Adult male cockroaches were treated topically with three technical grade insecticides on the first abdominal segment of the insects using a hand micro-applicator.

Results

Using topical application methods, fenitrothion showed the most toxicity to all four strains. The LD₅₀ values of fenitrothion in the susceptible strain (S) and the hospital-collected strains B, F, and Z were 1.89, 21.48, 25.73, and 31.55 μg/grBW, respectively. All hospital-collected strains showed different resistant levels to all insecticides. The field-collected Z strain was the most resistant strain to cypermethrin, propoxur, and fenitrothion. The resistance ratios of strain Z to cypermethrin, propoxur, and fenitrothion were 10.9, 10.47 and 16.67, respectively.

Conclusion

Based on the susceptibility and resistance ratios for each insecticide, we conclude that there are high rates of insecticide resistance in Blattella germanica from different hospitals of Sari County which can be caused by different insecticides treatment histories.

A comparison between the effects of school-based education programs provided by peer group versus health practitioners on premenstrual syndrome in adolescents: A protocol for a non-masked clinical trial

Aim

To compare the effect of school‐based education programs, by peer group versus health practitioner on Premenstrual Syndrome (PMS) in adolescent girls.

Design

Non‐masked three‐armed clinical trial.

Methods

Ninety 11th‐grade students with moderate to severe PMS will be allocated to Intervention Group 1 (IG1), Intervention Group 2 (IG2) and Comparison Group (CG). Three weeks (six online sessions) of parallel education will be implemented in IG1 by trained peer educators and in IG2 by a health practitioner. The primary outcome will be changes in PMS severity score between three groups over time (measured by Daily Record of Severity of Problems). Secondary outcomes include changes in Premenstrual Dysphoric Disorder and General Health. Data collection will be conducted in two‐time points, at baseline, and at the end of the intervention.

Results

Our study will explore the effect of school‐based education programs, by peer group versus health practitioner on PMS. This will add to the evidence‐based interventions to PMS management and the effectiveness of peer education in health promotion of adolescents girls.

Reduced Expression of Galectin-8 May Contribute in Carcinogenic Pathway of Head and Neck Squamous Cell Carcinoma

Background & Objective:

Galectin-8 has relationships with cell growth and metastasis of some cancers. Due to controversy in the clinical significance of this protein in the cancer process, we investigated its roles in the development of head and neck squamous cell carcinoma.

Methods:

This study was performed on 93 samples of patients with Squamous Cell Carcinoma or dysplasia of the head and neck, who underwent biopsy or surgery from 2015 till 2017 in Boo-Ali SINA hospital of Sari, Iran. The relevant paraffin embedded tissue blocks were obtained from archive of pathology and evaluated for galectin-8 by immunohistochemistry. The association between expression of galactin-8 and age, sex, location and stage of disease were assessed. To compare expression rate between the groups, Mc-Nemar, Chi-square and Fisher's exact tests were used. The P-value<0.05 was considered significant.

Results:

Strong cytoplasmic and nuclear galactin-8 staining was observed in 97.6% cases of normal tissues while 77% of dysplastic lesions and 69% of the cancers revealed negative immunoreactivity. The intensity of expression in dysplastic and malignant tissues was significantly reduced compared with normal tissues (P=0.0001). The expression of galectin-8 did not correlate with stage (P=0.303), lymph node involvement (P=0.326), tumor grade (P=0.769), distant metastasis (P=0.748), and age (P=0.574).

Conclusion:

We observed that the expression of galectin-8 in dysplastic and malignant squamous epithelium significantly reduced compared with the normal counterpart of them in the head and neck. It may contribute to malignant transformation of head and neck squamous cells.

The Urinary Level of Liver-type Fatty Acid Binding Protein in Children with Febrile UTI

INTRODUCTION

We assessed the urinary level of L-FABP in patients with APN and compared between patients with scar versus normal kidneys.

METHODS

We enrolled children aged 2 months to 12 years old with APN. The urine concentration of L-FABP and L-FABP/Cr were measured. Patients divided into three groups; patients with scarring APN as group 1, patients with non-scarring APN as group 2, and controls.

RESULTS

79 children (aged 57.4 ± 40.5 months, (87.5%) female) enrolled in the study. Group 1 was composed of 19 (16 female) cases, group two 35 (32 female) cases, and group three 26 (2 female) healthy controls. There was no significant difference in absolute urinary level of L-FABP between APN groups and controls. Group 1 patients had a significantly higher concentration than group 2 (P < .05). The UL-FABP /Cr was significantly higher in group 1, than groups 2 and 3 [(0.28 ± 0.39 pg/mg, 0.08 ± 0.08 pg/mg, and 0.10 ± 0.09 pg/mg; respectively), (P < .05, P < .05)]. The difference between group 2 and 3 was not significant (P > .05). The sensitivity and specificity of UL-FABP32 /Cr ratio in prediction of scar was 50% to 72% and 44% to 56%, respectively.

CONCLUSION

The urinary ratio of L-FABP to creatinine is not a useful tool for diagnosis of APN or VUR but could be helpful in prediction of long-term potency to renal parenchymal scar formation.

Radiation dose-response (a Bayesian model) in the radiotherapy of the localized prostatic adenocarcinoma: the reliability of PSA slope changes as a response surrogate endpoint

Purpose

One of the characteristics of Prostate-Specific Antigen (PSA) is PSA slope. It is the rate of diminishing PSA marker over time after radiotherapy (RT) in prostate cancer (PC) patients. The purpose of this study was to evaluate the relationship between increasing RT doses and PSA slope as a potential surrogate for PC recurrence.

Patients and Methods

This retrospective study was conducted on PC patients who were treated by radiotherapy in the Cancer Institute of Iran during 2007–2012. By reviewing the records of these patients, the baseline PSA measurement before treatment (iPSA), Gleason score (GS), clinical T stage (T. stage), and periodic PSA measurements after RT and the total radiation dose received were extracted for each patient separately. We used a Bayesian dose-response model, analysis of variance, Kruskal–Wallis test, Kaplan–Meier product-limit method for analysis. Probability values less 0.05 were considered statistically significant.

Results

Based on the D’Amico risk assessment system, 13.34% of patients were classified as “Low Risk”, 51.79% were “Intermediate Risk”, and 34.87% were “High Risk”. In terms of radiation doses, 12.31% of the patients received fewer than 50 Gy, 15.38% received 50 to 69 Gy, 61.03% received 70 Gy, and 11.28% received more than 70 Gy. The PSA values decreased after RT for all dose levels. The slope of PSA changes was negative for 176 of 195 patients. By increasing the dosage of radiation, the PSA decreased but these changes were not statistically significant (p = 0.701) and PSA slope as a surrogate end point cannot met the Prentice’s criteria for PC recurrence.

Conclusion

Significant changes in the dose-response relationship were not observed when the PSA slope was considered as the response criterion. Therefore, although the absolute value of the PSA decreased with increasing doses of RT, the relationship between PSA slope changes and increasing doses was not clear and cannot be used as a reliable response surrogate endpoint.

Comparison of azithromycin vs doxycycline prophylaxis in leptospirosis, A randomized double blind placebo-controlled trial

INTRODUCTION

Leptospirosis is an important zoonotic disease in paddy field with 29.5% prevalence rate in Mazandaran province and 4% to 52% mortality rate among hospitalized patients. Prevention is an important strategy for the control of this disease. This study aimed to compare the prophylactic effect of azithromycin versus doxycycline against leptospirosis in an endemic area in north of Iran.

METHODOLOGY

In this randomized double-blind placebo-controlled trial, paddy field workers (n = 187) were randomized to receive azithromycin (500mg weekly), doxycycline (200 mg weekly) or placebo starting one week before exposure to paddy field, during and to four weeks after. Paddy field workers aged 18- 65 years who signed the informed consent form were assessed for signs and symptoms of leptospirosis in addition to serologic evidence of the disease 6th and 12th week. Data were analyzed with SPSS version 13 using Chi-square and Fisher exact test and ANOVA.

RESULTS

From June to September 2016, 187 participants were entered the study to receive azithromycin (n = 66), doxycycline (n = 71) or placebo (n = 50). In terms of preventing against clinical leptospirosis, there was not any significant difference between three arms, though there was statistically significant difference of seropositivity after 6 and 12 weeks in comparison to baseline among all three groups (P = 0.029) and between active treatment (eg. azithromycin and doxycycline) groups and placebo group (P = 0.01).

CONCLUSION

Azithromycin like doxycycline decreased seropositivity without significant effect on clinical leptospirosis.

The effect of eucalyptus vapor on cough after coronary artery bypass surgery

Cough is postoperative complication following endotracheal intubation as well as inflammation of the pharynx, larynx and trachea. The aim of this study was to evaluate the effect of eucalyptus vapor on cough after tracheal extubation in patients undergoing coronary artery bypass graft (CABG). In this randomized controlled trial, 100 patients undergoing CABG were randomly divided into two groups by accessible sampling. Before the intervention and after tracheal extubation, demographic and clinical data, as well as data on cough by a scoring system were collected from interventional and control groups. The patients in the interventional group after tracheal extubation were exposed to eucalyptus vapor for about 10 min. This treatment was performed at 1 and 12 h after extubation. The severity of cough was recorded in both interventional and control groups at 0, 1, 6, 12 and 24 h after extubation. The present study showed that the severity of cough after extubation in the patients undergoing CABG in the interventional group had no significant difference at the times of immediate to 24 hours after extubation. Risk of cough had respectively 9.5% increase in the control group as compared to the interventional group.

Comparison of Efficiency GEE and QIF Methods for Predicting Factors Affecting on Bipolar I Disorder Under Complete-case in a Longitudinal Studies

BACKGROUND

Mood variation in manic and depression phases during time is common in type I of Bipolar disorder. Analyzing recurrence require to the related statistical methods. In this paper, we compare the two methods of estimating the GEE and the QIF in recurrence data.

METHODS

In this study, data of 255 patients with Bipolar I disorder hospitalized during years of 2007-2011. Recurrence in Bipolar I disorder was as outcome. Patients' characteristics were gender, age of onset, recurrence history in first degree family, and economic status. Under simulation, percentage of missing were generated to vary and handled by complete-case(cc) strategy. Data were analyzed using GEE and QIF methods. Performance of the methods was assessed using Relative Efficiency.

RESULTS

QIF method had more efficiency than GEE method in the data with missing /without missing. Odds of recurrence in a first-degree family history was 30% more than those without a family history (p=0.009). Also, odds of recurrence in high/moderate level of economic status was 23% more than low level status (p=0.014).

CONCLUSION

QIF method was more appropriated for modeling recurrence during time with the structure of more correlation and low dropout rate in data. Family history and economic status were more affected recurrence in type I of Bipolar disorder.

A cross-sectional analysis of intestinal parasitic infections among the general population in north of Iran

INTRODUCTION

Intestinal parasitic infection (IPIs) is one of the most important health problems in the developing countries. Study on the prevalence of IPIs in various communities is a prerequisite for the development of appropriate control strategies. The aim of this study was to evaluate the prevalence of intestinal parasites among the general population in Mazandaran province, northern Iran.

METHODOLOGY

This study was conducted on 4,788 specimens collected from 17 urban areas (2,515 samples) and 34 rural areas (2,273 samples) within January-December 2016. Fecal specimens were examined by direct wet mounting, formalin-ether concentration, modified Ziehl-Neelsen, and trichrome staining methods.

RESULTS

The overall infection rate of intestinal parasite was 14.2% (680/ 4,788). Blastocystis hominis and Giardia lamblia were identified as the most frequent parasites. Protozoa, helminths, and polyparasitism (co-infections with two or more parasite species) were observed in 12.3%, 1.03%, and 0.85% of the specimens, respectively. Furthermore, IPIs showed a significant association with household income, place of residence, washing of vegetables, exposure to soil and season (p < 0.05).

CONCLUSIONS

Based on the findings, parasitic infections are still a major public health concern in the north of Iran that requires special attention. Therefore, the major key to success in the prevention of IPIs is the execution of some interventions, including patient screening and treatment, public education, and improvement of sanitary conditions.

Randomized Double-blind Placebo-controlled Trial of Celecoxib for the Prevention of Skin Toxicity in Patients Receiving Radiation Therapy for Breast Cancer

BACKGROUND

The skin toxicity-induced by ionizing radiation may limit the duration of treatment and may lead to discomfort in quality of life of patients during radiotherapy.

OBJECTIVE

The purpose of this randomized, placebo-controlled, double-blind study was to investigate the preventive effect of oral administration of celecoxib (CLX) on the acute radiation- induced skin toxicity in patients with breast cancer.

METHODS

Sixty breast cancer patients were randomly assigned to use CLX (400 mg per day) or placebo capsules during radiotherapy. Radiation-induced dermatitis was classified according to the radiation therapy oncology group (RTOG) criteria, as well as pain and itching were scored according to the VAS (Visual Analogue Scale) for six weeks of treatment. Breast swelling was evaluated through increase in the size of the breast during radiotherapy.

RESULTS

Oral administration of CLX capsule during and after radiotherapy reduced significantly radiation-induced itching and pain in patients with breast cancer. CLX reduced the frequency of increased breast size caused by radiotherapy in patients as compared with placebo; however, this difference was statistically not significant. Patients who received CLX had insignificantly skin dermatitis when compared with placebo group.

CONCLUSION

However, CLX was unable to reduce the dermatitis caused by ionizing radiation; it significantly reduced itching and pain in patients during radiotherapy. CLX may have beneficial effects in the quality life of breast cancer patients for treatment.

A Second-Order Confirmatory Factor Analysis of the Moral Distress Scale-Revised for Nurses

Background:

Moral distress is a growing problem for healthcare professionals that may lead to dissatisfaction, resignation, or occupational burnout if left unattended, and nurses experience different levels of this phenomenon.

Objectives:

This study aims to investigate the factor structure of the Persian version of the Moral Distress Scale–Revised in intensive care and general nurses.

Research design:

This methodological research was conducted with 771 nurses from eight hospitals in the Mazandaran Province of Iran in 2017. Participants completed the Moral Distress Scale–Revised, data collected, and factor structure assessed using the construct, convergent, and divergent validity methods. The reliability of the scale was assessed using internal consistency (Cronbach’s alpha, Theta, and McDonald’s omega coefficients) and construct reliability.

Ethical considerations:

This study was approved by the Ethics Committee of Mazandaran University of Medical Sciences.

Findings:

The exploratory factor analysis ( N = 380) showed that the Moral Distress Scale–Revised has five factors: lack of professional competence at work, ignoring ethical issues and patient conditions, futile care, carrying out the physician’s orders without question and unsafe care, and providing care under personal and organizational pressures, which explained 56.62% of the overall variance. The confirmatory factor analysis ( N = 391) supported the five-factor solution and the second-order latent factor model. The first-order model did not show a favorable convergent and divergent validity. Ultimately, the Moral Distress Scale–Revised was found to have a favorable internal consistency and construct reliability.

Discussion and conclusion:

The Moral Distress Scale–Revised was found to be a multidimensional construct. The data obtained confirmed the hypothesis of the factor structure model with a latent second-order variable. Since the convergent and divergent validity of the scale were not confirmed in this study, further assessment is necessary in future studies.

The effect of pleasant olfactory mental imagery on the incidence and extent of atelectasis in patients after open heart surgery

BACKGROUND AND PURPOSE

Atelectasis is the most common pulmonary complication after open heart surgery. This study was intended to examine the effects of pleasant olfactory mental imagery on postoperative atelectasis in patients undergoing open heart surgery.

MATERIALS AND METHODS

This is a randomized controlled clinical trial. The sample consisted of 80 patients who were randomly assigned to either practice olfactory mental imagery (test group) or receive routine care (control group). A card with the image of roses was given to patients and they were asked to look at the image, visualize the scent of roses in the mind, and then sniff as much as possible, hold their breath for 2s and eventually exhale slowly through the nose. This procedure was consecutively repeated five times. After a fifteen-minute break, patients proceeded to practice olfactory mental imagery with other fruit images (banana, apple, and lemon). The test group executed the olfactory mental imagery for two hours in the morning and two hours in the afternoon on postoperative days 1 and 2. The control group received the routine ICU care. A questionnaire collected information on sociodemographic characteristics and clinical parameters. Chest radiographs were used to diagnose atelectasis, which were evaluated by the hospital radiologist.

RESULTS

No statistically significant differences were observed between the two groups regarding sociodemographic, medical and surgical information. The incidence of atelectasis in the test group (40%, n=16) was significantly lower than in the control group (67.5%, n=27) on postoperative day 2 (p=0.02).

CONCLUSION

Our findings suggest that olfactory mental imagery can improve respiratory function and reduce the risk of atelectasis in patients with cardiac surgery.

Effects of pleasant olfactory mental imagery on the arterial oxygenation in patients with open heart surgery: A randomized controlled trial

BACKGROUND AND PURPOSE

Arterial hypoxemia is one of the most common respiratory complications following cardiac surgery. This study was intended to examine the effects of pleasant olfactory mental imagery on postoperative hypoxemia in patients undergoing open heart surgery.

MATERIALS AND METHODS

This is a randomized controlled clinical trial. The sample consisted of 80 patients who were randomly assigned to either practice olfactory mental imagery (experimental group) or receive routine care (control group). A card with the image of roses was given to patients and they were asked to look at the image, visualize the scent of roses in the mind, and then sniff as much as possible, hold their breath for 2 s and eventually exhale slowly through the nose. This procedure was consecutively repeated five times. After a fifteen-minute break, patients proceeded to practice olfactory mental imagery with other fruit images. The experimental group executed the olfactory mental imagery for two hours in the morning and two hours in the afternoon on postoperative days 1 and 2.

RESULTS

No statistically significant differences were observed between the experimental and control groups regarding sociodemographic characteristics, medical and surgical information. This study also demonstrated that the mean Spao2 was significantly higher in the experimental group (97.400 ± 1.70) than the control group (96.465 ± 1.70) (p = 0.015).

CONCLUSION

The results of this study suggest that olfactory mental imagery can improve arterial oxygenation in patients with cardiac surgery.

Relationship of Hemodialysis Shift With Sleep Quality and Depression in Hemodialysis Patients

This descriptive correlational study was aimed at determining the relationship of hemodialysis shift with sleep quality and depression in 310 hemodialysis patients. Demographic and Clinical Questionnaires, the Pittsburgh sleep quality index, and Beck's Depression Inventory were used to ascertain the aforementioned relationship. Among the patients, 59.6% reported poor sleep quality and 44.8% reported experiencing depression. Results show that these conditions were significantly related to many factors. Although dialysis shift was not significantly related to sleep quality and depression, sleep quality was found significantly associated with age, female gender, illiteracy, unemployment, residence in rural areas, diabetes, addiction to sedatives, and phosphorus levels. A significant relationship was also found between depression and phosphorus levels. Logistic regression predicted age, gender, illiteracy, unemployment, residence in rural areas, and addiction to sedatives as factors for poor sleep quality. A body mass index (BMI) above 30, decreased urea, and increased phosphorus were predicted as factors for increased depression.

Relationship between moral distress and ethical climate with job satisfaction in nurses

BACKGROUND:

Moral distress and ethical climate are important issues in the workplace that appear to affect people's quality of work life.

OBJECTIVES:

This study was conducted to determine the relationship of moral distress and ethical climate to job satisfaction in critical care nurses.

MATERIALS AND METHODS:

This descriptive-correlation study was conducted on 142 critical care nurses, selected from five social security hospitals in north Iran through census sampling. Data were collected using a demographic questionnaire, the Moral Distress Scale-Revised, the Olson's Hospital Ethical Climate Survey, and the Brayfield and Rothe Job Satisfaction index.

ETHICAL CONSIDERATIONS:

The research project was approved by the Ethics Committee of Mazandaran University of Medical Sciences and the Medical Deputy of the Social Security Organization.

FINDINGS:

The mean scores obtained by the critical care nurses for moral distress, ethical climate, and job satisfaction were 87.02 ± 44.56, 3.51 ± 0.53, and 62.64 ± 9.39, respectively. Although no significant relationships were observed between moral distress and job satisfaction, the relationship between ethical climate and job satisfaction was statistically significant (p < 0.05).

CONCLUSION:

Identifying ethical stressors in the workplace and giving proper feedback to the authorities to eliminate these factors and improve the ethical climate in these workplaces can help enhance job satisfaction in nurses and lead to higher quality care.

Identification of High and Low-Risk Areas of Tuberculosis in Lorestan Province, West of Iran

BACKGROUND

Nowadays, tuberculosis (TB)-an infectious disease caused by Mycobacterium tuberculosis-presents with different location patterns. Spatial analysis is one of the most important tools to detect and monitor public health disease patterns. This study aimed to identify the low and high-risk areas in Lorestan Province (west of Iran) to help the health programmer for the best intervention.

MATERIALS AND METHODS

Lorestan has 9 counties, 22 cities, 25 zones, 81 villages, and 2842 residential villages. Our study cases were 1481 patients registered in the TB center of Lorestan Province. We investigated the spatial distribution of TB in Lorestan between 2002 and 2008 using a multilevel model. STATA Ver. 10 software was used for the data analysis.

RESULTS

The multilevel model was a better fit to the data for the spatial correlation structure. It adjusted relative risks by borrowing information of the neighboring areas in each village. Maximum risk of disease was seen in the central zone of Koram-Abad, and all villages of Delphan were identified as low-risk areas.

CONCLUSION

Various factors such as improvement of socio-economic conditions, implementation of programs, culture, genetic background, health-related behavior, and lifestyle can influence TB control substantially. A deprived region located in the southern part of Khoram-Abad was identified as the highest risk area in our study. The poor socio-economic structure can be an important factor for the increased risk of TB in this region.

Treatment Delay and Total Delay among Pulmonary Tuberculosis Patients in the North of Iran: Application Survival Data Analysis

BACKGROUND

Tuberculosis (TB) remains the leading cause of death among infectious diseases worldwide. Identifying the factors associated with the treatment delay and total delay would be helpful in the prevention of tuberculosis and in reducing the burden on the health care system. The objective of this study was to assess the treatment delay and total delay in TB patients and investigate the factors causing these delays.

MATERIALS AND METHODS

This was a longitudinal study conducted in 2009-2015. Our study consisted of 1694 TB patients registered in the TB center of Mazandaran province. Data regarding the patients' demographic characteristics and clinical factors associated with treatment delay and total delay were analyzed. Kaplan Meier plots and log rank tests were used to assess the survival pattern. Cox proportional hazards model for multivariable analysis was discussed. We used mean values and median (Q2) [first quartile (Q1)-third quartile (Q3)] to describe delays.

RESULTS

The median treatment delay and total delay were 35 (ranged 23-80) and 36 (ranged 24-82) days, respectively. The mean age of TB patients was 47.40±20.3. No significant association was found between the location of residence, nationality, gender, and type of pulmonary TB patients with treatment delay and total delay. Additionally, age, prison status of patients, HIV test, and contact history had a significant relationship with the treatment delay and total delay (p-value <0.05). It was shown that the median total delay in men patients in the ≤14 year-old age group, imprisoner patients, rural patients, patients who have not received an HIV test, smear negative patients, those who are Iranian, and TB patients whose contact history was unknown was lower than that of others. The highest median treatment delay and total delay was in the >60 age groups, and were 41 and 44 days, respectively. Treatment delay was the same as the total delay except in the place of residence variable; median treatment delay among urban patients was less than that of rural patients.

CONCLUSION

According to this study age, prison status of patients, HIV test and contact history had a significant relationship with the treatment delay and total delay (P-value<0.05). Understanding the factors that are closely associated with these delays is essential to effectively control TB and could be helpful in reducing these delays.

The Prevalence of Allergic Rhinitis, Eczema and Asthma in Students of Guidance Schools in Mazandaran Province, Iran

BACKGROUND:

Eczema, allergic rhinitis and asthma are common chronic allergic disorders in childhood.

AIM:

The aim of this study was to determine the prevalence of common allergic disorders among Iranian guidance schools students in Mazandaran Province, northern Iran.

METHODS:

This analytical cross-sectional study was performed on 3000 children aged 11-14 years old during 2012-13 according to ISAAC study. Of 3000 recruited children 1576 (52.54%) were female and 1424 (47.46%) were male. Data gathered by ISAAC first phase questionnaire analysed by SPSS software 20.

RESULTS:

The prevalence of wheezing, allergic rhinitis symptoms (sneezing and pruritus) and atopic dermatitis symptoms (pruritus skin lesion) were 30.5%, 30% and 15% respectively. History of pets contact and smoking was positive 6.6% and 36 % respectively. About 52% was born with caesarian section. There was wheezing in 32.5% during sport. The diagnosis of asthma, allergic rhinitis and eczema were 12.2%, 28.5% and 15% respectively. Eczema, asthma and allergic rhinitis were significantly more common in boys students (p < 0.05).

CONCLUSIONS:

The results of this study showed that asthma, allergic rhinitis and eczema have a high prevalence and they are more common in boys.

Psychosocial needs of families of intensive care patients: Perceptions of nurses and families

Background:

Admission to an intensive care unit (ICU) is not only stressful to the patients but the patients' family members. Families are believed not to receive their required attention because their needs are incorrectly and inaccurately evaluated by the health care team. Therefore, the present study aimed to examine the perceptions of ICU nurses and families regarding the psychosocial needs of families of intensive care patients.

Materials and Methods:

This descriptive-analytical study was conducted on a randomly selected population of 80 nurses and 80 family members of ICU patients. Data were collected using a two-part questionnaire containing sociodemographic characteristics and the Critical Care Family Need Inventory (CCFNI).

Results:

The rank order of the five most important CCFNI item needs identified by families were as follows: “To feel that the hospital personnel care about the patient”, “to be assured that the best care possible is being given to the patient”, “to have questions answered honestly”, “to know specific facts concerning patient's progress”, and “to be called at home about changes in the patient's condition.” The top five CCFNI item needs identified by nurses were in the following order: “To be assured that the best care possible is being given to the patient”, “to be told about transfer plans while they are being made”, “to feel that the hospital personnel care about the patient”, “to have questions answered honestly”, and “to know specific facts concerning patient's progress.”

Conclusion:

The present study showed there are similarities and dissimilarities between nurses and family members in their perceived importance of some family needs in the ICU. It can thus be inferred from our results that the participating nurses misestimated the needs of family members, attested by their wrong estimation of the most need statements.

Green Tea Gargling Effect on Cough & Hoarseness After Coronary Artery Bypass Graft

Introduction:

Endotracheal intubation is a method necessary for controlling and maintaining airway during general anesthesia. Cough and hoarseness are common complications after endotracheal intubation. Inflammation has an important role in postoperative cough and hoarseness outbreak. Also it has been stated that green tea has anti-inflammatory properties. Therefore, the current study has been conducted to investigate green tea gargling solution effect on cough and hoarseness after coronary artery bypass graft (CABG) surgery.

Methods:

In this single-blind, randomized, & controlled clinical trial, we enrolled 121 patients undergoing CABG admitted to the ICU. The intervention group participants were asked to gargle 30 cc of green tea solution. The control group patients gargled 30 cc of distilled water. An hour after extubation, the intervention group patients were asked to gargle 30 cc of green tea and the control group patients were required to gargle 30 cc of distilled water every 6 hour up to 24 hour (each patient for 4 times). Moreover, the cough and hoarseness questionnaire was also filled in 6, 12, and 24 hours after endotracheal extubation.

Results:

The results showed no significant differences among the patients in both groups regarding age, gender, body mass index, smoking history, and anesthesia duration. There was a significant difference between the two groups in terms of cough 12 hours after removing the endotracheal tube. At other times, there was no significant difference between the two groups considering cough and hoarseness.

Conclusion:

The present study results showed that green tea gargling does not decrease hoarseness. Though, cough occurrence was less in the intervention group than the other group.

Spatial clustering of tuberculosis incidence in the North of Iran

Background and Purpose:

Tuberculosis (TB) poses a serious threat to public health throughout the world but disproportionately afflicts low-income nations. The aim of this study is to identify the high-risk areas in Mazandaran province (North of Iran) in helping the heath programmer for the best intervention.

Materials and Methods:

This is an ecological study conducted from 1999 through 2008. The sample included 2444 Tuberculosis (TB) patients. The variables were age, gender, type of disease and residential location, analyzed by descriptive statistical methods and spatial analysis to identify cluster of disease incidence. Geographical information system software applied to map of smooth rate of TB.

Results:

Of 2444 registered patients, 1283 (52.5%) were male. The data showed 61% urban and 96.4% of them with the Iranian nationality. There was insignificant difference between genders, but the main difference was observed between locations that are the incidence rate in the Tonekabon and Behshahr cities were 30% higher than mean incidence rate of Mazandaran province (P-value<0.05). The comprising chance of acquiring infection between urban and rural was 1.46 with confidence interval of 95% (1.35, 1.59).

Conclusion:

Geostatistical method showed spatial variability of TB incidence rate in all districts and identifying high-risk area (core areas). The most important core of TB incidence has been noticed in the eastern boundary of Mazandaran in the city of Behshahr which is due to proximity to Golestan Province. The incidence rate of TB in Behshahr city is about two times more than the number observed in Mazandaran province. Lower TB incidence rate has been observed in Golestan province is because there is usually a delay in the diagnosis of the disease especially in the positive smear patients.

Spatial analysis and geographic variation of fatal and injury crashes in mazandaran province from 2006 to 2010

Background:

Road safety and traffic accidents change in time and space. Although, time variations have always been considered the subject being focused by researchers, the effect of spatial correlation and spatial components on the risk of accident have been less investigated. Due to its specific geographical position, Mazandaran Province is one of the highest traffic provinces. This study aims to investigate the factors influencing suburban crashes of Mazandaran province by considering the spatial correlation.

Methods:

This study is aggregated (descriptive -analytical) and the study period was 2006 to 2010. Social and environmental factors effects on the risk of accidents have been studied considering the correlation structure of the regions and regardless of this structure with Poisson regression, negative binomial and Full Bayes hierarchical models. Geographical pattern of risk distribution for the observed values of SMRs and the estimated values after smoothing have been plotted and analyzed.

Results:

Comparing the measures of models goodness of fit indicates that hierarchical Bayes model fits the data better. Plotting the geographical pattern, the north central parts of the province have been identified as the high-risk areas. Human factors were identified as the important factors for the risk of accident.

Conclusions:

The purpose of this procedure is to separate the random effect of residuals correlation. Using this method, the measure of the model goodness of fit got reduced reflecting a better model than the prototype model. The significance of the structured spatial effect shows the existence of unknown explanatory variables with correlated structure whose identification and control can reduce the risk of accidents.

Survival of patients with stomach adenocarcinoma in North of Iran

AIM

This study was proposed for estimation of survival time in patients with stomach adenocarcinoma.

BACKGROUND

North of Iran has a high mortality rate of stomach adenocarcinoma.

PATIENTS AND METHODS

The study was historical cohort. The samples were the patients with stomach adenocarcinoma referred to Tooba Clinic between three years (2007-2010). Survival estimates were calculated using the Kaplan-Meier method the effects of covariates on survival time were assessed by, using survival parametric regression model with gamma frailty.

RESULTS

The survival probability of more than two years of patients was calculated 27.7% by using Kaplan Mayer method. The stage, metastasis, surgery, and age were the variables which affect the survival probability of patients, by using survival parametric regression model with gamma frailty and hazard ratio of patients with three treatment protocol was 0.43 times of others (P<0.01) and increasing of patients ages decrease life time of them significantly as per year increasing patient age, risk of death increased by 4% (P<0.04) and patients with staging disease lower 4 had hazard ratio lower than 0.46 times of stage 4 (P<0.01).

CONCLUSION

The survival time of our patients is much lower than the developed countries, which are related to latency in diagnosis and therapeutic limitations.