Payesh
Year:2010 | Volume:9 | Issue:1|Papers Count:15

Objective(s): There is little doubt that medical students are subject to considerable amounts of physical and mental stress, resulting in high rates of depression and anxiety as well as other health problems. The present study- conducted from June to August 2006- looks at the problem of stress among Iranian medical students. Methods: A total of 742 students in different stages of their general medical training filled in a questionnaire dealing with personal and demographic characteristics, physical and mental stress, social relations and perceived job perspectives as well as problems faced at home and the campus. For each participant, a total stress score computed and its association with putative risk factors examined using Mann-Whitney test, non-parametric correlations and logistic regression analysis.Results: In logistic regression analysis, the following factors were found to have significant, independent associations with a high degree of stress: female gender (P=0.001), living in a large family (P=0.01), low income (P=0.05), training in clinical rotations (P<0.001) and internship (P<0.001) and separation from the family (P=0.01). From a student's perspective, the most important problems (stressors) faced by the students included crowded campus and dormitories, poor learning facilities, work overload, humiliation and abuse from staff and faculty members.Conclusion: Addressing the financial needs of the students (e.g. easier access to student loans), developing better communication skills, education in various relaxation and stress reduction techniques, and measures to reduce workload are recommended to mitigate the effects of physical and mental stress in medical students.

Objective(s): The objectives of this study were to determine the frequency of risk behaviors in high school students.Methods: In this cross sectional study 2400 high school students in urban areas of Tehran were selected by multy stage sampling. They filled in a questionnire in clasroom. Then, data were analysed in a descriptive function.Results: Frequency of health risk behaviors were intentional injuryis (41.5%), unintentional injuryis (88.7%), smoking cigarette (8.7%), alcohol drinking during the 30 days preceding survey (7.4%), other drug abuse (2.7%), sexual intercourse during life (20.2%), unhealthy dietery behaviors (14.7%) and physical inactivity during 7 days preeceding the survery (32.6%). Sex differences were detected in health-risk behaviors.Conclusion: In high school students frequency of health-related risk behaviors were high. School personnel should work with community leaders and health care professionals to provide educational materials for students and their parents. Collaboration of school personnel and health care provider, as a team can develop the knowledge and skill necessery to help students make healthier choices.

Objective(s): To assess reliability and construct validity of the Manchester Driving Behavior Questionnaire (MDBQ).This questionnaire intends to determine abnormal driving behavior (errors and violations) that having psychological reasons and different modifying methods.Methods: In first step, in order to verify construct validity, 293 drivers with second grade driving liscence were selected to complete questionnaire.In the second step, to assess reliability, 40 experienced drivers were selected and asked to answer questions.Results: The results of factor analysis differentiated clearly four factors: slips, mistakes, intentional and unintentional violations. The results showed that all four factors have high internal consistency coefficients (slip: 0.77, mistakes: 0.81, intentional violation: 0.86, unintentional violation: 0.65).Conclusion: This questionnaire is a valid and reliable instrument in assessing driving behavior.

Objective(s): Injuries and realed wounds are one of the most common causes of admission in emergency departments. In this study the national protocol for tetanus prevention is compared with Eliza as the golden standard for detecting immunity of person.Methods: In a cross sectional study 200 individuals with wound admitted at Imam Hussein hospital (a teaching hospital in Tehran, Iran) were assessed and questionnaires were filled in based on physician decision as protocol recommended and also the result of Eliza. Agreement of physician decision and Eliza result has been evaluated by Kappa index. Sensitivity, specificity, predictive values, likelihood ratios and accuracy were also detected for different methods of vaccine and immunoglobulin administration.Results: Immunoglobulin was administered for 30 percent of persons and vaccine for 23.5 percent. Kappa index for agreement between protocol administration and real administration in emergency department was 0.307 for immunoglobulin and 0.136 for vaccine (p<0.05). It was 0.081 (P>0.05) and 0.199 (P<0.001) for agreement of protocol administration and Eliza and 0.008 and 0.054 (P>0.05) for agreement of administration in emergency depertment and Eliza respectively.For immunoglobuline sensitivity was 0.33, specificity 0.24, positive predictive value 0.25, negative predictive value 0.82, positive likelihood ratio 1.38, negative likelihood ratio 0.88 and accuracy 0.68. For vaccine sensitivity was 0.82, specificity 0.52, positive predictive value 0.29, negative predictive value 0.92, positive likelihood ratio 2.2, negative likelihood ratio 0.35 and accuracy 0.58.Conclusion: The sensitivity, specificity, predictive value, likelihood ratio and accuracy for national protocol are not enough for using in emergency department. It seems that there is need for another reliable and valid substitute method.

Objective(s): To assess the effect of processes of change on resistance skills against substance abuse among petrochemical workers in Assaluyeh Plant in Iran.Methods: This was an experimental study (randomized intervention trial). In all 181 workers of petrochemical company in Assaluyeh were enterd into the study (90 participants in intervention group and 91 participants in control group). Data were collected by a questionnaire that was designed and validated by the researchers based on the Trans Theoretical Model (TTM). Both groups were interviewed before the intervention, based on which the educational needs were identified. One of the diagnostic surveys showed lack of resistance skills against substance abuse that required further education. To meet this requirement a TTM based education for intervention was applied.Results: The study showed significant improvement in most of the resistance skills among the  intervention group, while both groups showed no significant differences in use of processes of change before the intervention (except for construct self revolution, that was higher in control group). The results after the intervention showed that intervention group had used all elements of processes of change (except dramatic relief).Conclusion: This study showed that processes of change in the TTM would lead to improved knowledge, attitude, self efficacy and self control. It also confirmed that the training materials based on the trans theoretical model can develop resistance skills against substance abuse that will ultimately result in a better health among the workers and could create a drug free workplace (safe workplace). Based on these findings the investigators recommend that all studies on health–related change behavior should continually use the behavioral theories and models.

Objective(s): To develop and test clinical performance self-efficacy (CPSF) scale for nursing students.Methods: Literature review indicated there is no existing nursing clinical performance self-efficacy instrument for nursing students. A qualitative study was conducted to explore the self-efficacy concept in clinical performance of nursing students. A self-efficacy framework with well-developed theoretical constructs was formed. A methodological study design was used, consisting of two phases. A review of literature and also content analysis of the interview and focus group transcripts identified subscale and key items to be included in the instrument. CPSF scale was developed into 69 Likert-format items, which were evaluated by twenty nursing experts followed by testing in a random sample of 207 nursing students. The scale’s validity and reliability were tested.Results: After measuring content validity index and factor analysis, the final scale of four dimensions with 37 items was developed. In addition, concurrent validity was obtained (r=0.73, P<0.01). The overall scale internal reliability had a=0.96; Cronbach’s α for scale's dimensions ranged from 0.90 to 0.92. Test-retest reliability with a 2-week time interval was: r=0.94.Conclusion: The CPSF had demonstrated evidence of content validity, construct validity, concurrent validity, internal consistency, and stability. Statistical analysis provided an objective tool for assessing nursing students’ clinical performance self-efficacy.

Objective(s): To evaluate the effect of a rehabilitation program on quality of life in breast cancer patients.Methods: Fifty-seven patients who underwent modified radical mastectomy, had finished chemotherapy and radiotherapy and received hormone therapy were selected and randomly assighned into case and control groups. Control group was under medical care and the case group in addition to medical care received a rehabilitation program (physiotherapy, education and individual counseling) for two months. Quality of life was measured by the EORTC QLQ C30 before one week and 3 months after rehabilitation in both groups. Results: Before intervention there were statistically significant differences in physical (P< 0.001) and emotional functioning (P=0.02) in cases compared to control group, while no other significant differences were observed in other scale. One week after the program, differences among two groups in 6 scales were significant indicating a better condition in intervention group. Three months after the intervention the cases showed a statistical meaningful improvments in 11 scales.Conclusion: Rehabilitation programs might improve the quality of life after mastectomy in breast cancer patients.

Objective(s): To assess quality of life in pregnant women.Methods: This was a cross-sectional study of 600 pregnant women receiving prenatal care in health centers of Kashan University of Medical Science. The Short Form 36 Health Survey (SF-36) was used to assess quality of life. Results: The lowest perceived well-being was role limitation due to physical problems 56.23±18.77 and vitality 56.40±18.07. The results indicated that women's scores on the SF-36 were correlated with age, gestational age, gravidity, education, income, wanted and unwanted pregnancy and satisfaction with life (P<0.05).Conclusion: To improve guality of life in pregnant women it is important to improve background conditions for women.

Objective(s): Analysis of measles serum antibody responses is an important tool for evaluating the level of immunity in vaccinated people and for determining the factors which influence protective immunity. Usually antibody concentration values which are determined by quantitative assays are left censored, so standard analysis such as simple linear regression model may not be appropriate.Methods: Measles antibodies were measured using Enzyme Linked Immunosorbent Assay (ELISA) in 200 person aged 5-25 years before and after vaccination. A censored regression model proposed in order to reduce the effects of censored data in parameter estimating.Results: Twenty two persons (11 percent) of the sample had titer below detection limit which made censored data. 83 percent of children and teenagers (less than 16 years) and 88 percent of participant aged 16 and more were protective against measles disease, but there was no statistically significance between age and immunity (P=0.4).Conclusion: Although the number of females who had protective antibodies against measles was less than males, they possessed an average titer 42 percent higher than males (without considering covariates). This proportion changed into 39% by using the censored regression model and adjusting with respect to “antibody titer before vaccination”. Both ratios showed higher vaccine- induced protection in females (P<0.05).

Objective(s): This study was conducted for external evaluation of one intervention that has been carried out by traffic police. In this study the efficacy of provisional driver licensing on reducing traffic injuries and the intensity of injuries (fatal or non-fatal) was investigated.Methods: Data on traffic accidents and injuries from one year before till two years after the implementation of provisional driver licensing were obtained from traffic police data base. After data cleaning and stratification traffic injuries and mortalities, the implementation of graduate driver licensing compared in those in early years of their driving experience.Results: Drivers under 23 years of age consisted 22.8% of total road traffic injuries (RTIs) in the year prior to the implementation of graduate driver licensing. This proportion reduced to 15.5% and 16.1% in the first and second year after implementation, respectively, among holders of provisional B1 type driver license (P<0.001).Conclusion: Our findings suggested that this intervention was efficient in reduction of intensity of traffic injuries and provisional driver licensing was also efficient in reducing the crude number of traffic injuries. More interventions such as demerit points, license suspensions and vehicle confiscation might be implemented to prevent RTIs in long term.

Objective(s): To develop and validate a questionnaire for measuring healthy lifestyle in Iranian elderly.Methods: This is a triangulation study, developed in Isfahan city 1385-86. An item pool was developed based on semi-structured interviews with elder people and experts in Geriatrics, literature review and other lifestyle questionnaires. We used principal-component analysis (used SPSS15) and a focus group to reduce the items and assessment the face and content validity. Internal reliability was estimated using Cronbach’s alpha coefficient.Results: The questionnaire contains 46 items and 5 dimensions including exercise, nutrition, prevention, stress management and relationship. The validity was confirmed by experts and Cronbach’s alpha coefficient was 0.76.Conclusion: The Elderly Lifestyle Questionnaire is a valid and reliable instrument and will enable researchers to investigate lifestyle patterns in the elderly and to assess the impact of interventions of lifestyle change in this population. The instrument warrants further testing and development with different elderly populations.