Iranian Red Crescent Medical Journal
Year:2016 | Volume:18 | Issue:5|Papers Count:20

Background: Several new types of polyomavirus have been discovered in recent years mainly because of the recent state-of-the-art detection technologies. Among the polyomaviruses, Merkel cell polyomavirus (MCPyV) has attracted the most attention because of its possible role in the etiology of Merkel cell carcinoma, a rare but lethal form of skin cancer.Objectives: This study aimed to determine age-specific seroprevalence of MCPyV in Tehran.Patients and Methods: In this cross-sectional study, we collected 440 serum samples from healthy individuals 2 to 78 years of age who visited the Pasteur Institute’s clinic in Tehran, Iran, using a convenience sampling strategy. We developed a virus-like particle-based enzyme-linked immunosorbent assay that uses VP1, the major capsid protein of MCPyV, to detect and quantitate serum antibodies to MCPyV. We compared the prevalence of MCPyV between males and females and across eight age groups.Results: A total of 255 (57.9%) of the serum samples were MCPyV positive. The seroprevalence in children under 10 years of age was 25%. The seroprevalence increased to 56% over the next decade of life (10 - 19 years of age). The seroprevalence rate in males and females was 56.1% and 59.7% respectively, and a binary logistic regression showed no significant difference between males and females (P=0.77). However, the prevalence of MCPyV increased with age (P=0.012).Conclusions: Our results suggest that human exposure to MCPyV occurs throughout life. The MCPyV antibody levels remained high among older adults in our population, consistent with reports from other populations.

Background: Nowadays, one of the major public health problems among children is growth failure. It can be characterized in terms of either inadequate growth or the inability to maintain growth.Objectives: The main objective of this study was to examine the effects of some factors on growth failure among a sample of infants less than two years old.Materials and Methods: The present longitudinal archival study relied on data gathered from health files from February 2007 to July 2010 for 1, 358 children under two years of age, selected from eight health centers in the east and northeast parts of Tehran, Iran. In the present study, growth failure refers to at least a 50 g decrease in an infant’s weight as recorded at each attendance in comparison to the previous measurement. The impacts of risk indicators were assessed using the Bayesian hierarchical logistic regression modeling technique.Results: The highest and lowest percentage of growth failure was 5.8% and 0.1%, respectively, in the eleventh and the first month after birth. The obtained results from the Bayesian hierarchical modeling revealed that diarrhea (95% credible interval (CrI): 0.70-3.31), discontinuation of breastfeeding (95% CrI: 0.77-5.96), and respiratory infections (95% CrI: 2.07-4.61) were significant risk factors for growth failure. The random term at the child level was significant (95% CrI: 0.74-7.82), while the variation in centers was extremely small (95% CrI: 0.004 - 4.22).Conclusions: It was noted that a relatively high prevalence of growth failure was observed in the study sample. For minimizing the impact of significant risk factors on growth failure, the early detection of growth failure and its risk indicators is of great importance.In addition, when the focus of the analysis is on the different nested sources of variability and the data has a hierarchical structure, using a hierarchical modeling approach is recommended to achieve more accurate results.

Background: Pentavalent antimonials remain the choice of treatment for leishmaniasis, despite their toxicity, high cost, and difficult administration. As an alternative, morphine may induce the healing process of cutaneous leishmaniasis by its immunoregulatory characteristics.Objectives: To study the effect of morphine on the wound-healing process of cutaneous leishmaniasis (CL) in a mouse model.Materials and Methods: This was an experimental study in which 40 BALB/c mice (female, 6 - 8 weeks) were divided into four groups (each n=10) who received either placebo alone (group 1), morphine ointment after parasite inoculation (group 2), morphine ointment after wound occurrence (group 3), or placebo after wound occurrence (group 4). Wound size was measured weekly for eight weeks.Results: On the first day of treatment, the lesions measured 1.5mmin diameter. After eight weeks of treatment, the wound size was significantly smaller in the mice who received morphine ointment (4.81±3.22 mm) compared to those who received placebo after parasite inoculation (8.95±5.71 mm; P=0.0001) or placebo after wound occurrence (P=0.028).Conclusions: The above data suggest that topical application of morphine accelerates the healing process of CL wounds. We are cautiously optimistic that the results of this study can be used clinically for potentiating CL wound-healing.

Background: Diaper dermatitis (DD) is a common inflammatory disorder in infants, including newborns.Objectives: This study aimed to compare the effects of a traditional medicine product (containing natural henna oil 25%) and hydrocortisone 1% cream on DD in infants.Patients and Methods: In a triple-blind, randomized trial, 82 children aged two years or less were randomly divided into two groups of 41 children each to receive either hydrocortisone ointment or henna medicinal product. Infants were treated 3 times a day for 5 days. The severity of dermatitis was assessed on the first, third, and fifth days using a six-point scale. The study was conducted in 2013 in a children teaching hospital in Qazvin, Iran.Results: Both groups showed an improvement in the severity of DD (mean DD severity on the first, third and fifth days, respectively, was 3.20, 1.39, and 1.20 in the henna group versus 3.20, 2.05, and 1.90 in the hydrocortisone group; P<0.001). The henna group showed a better response when compared with the hydrocortisone group: the rate of improvement on the fifth day of treatment was 90.2% (37 of 41 children without erythema) in the former versus 61% (25 of 41 patients) in the latter (P=0.042). No significant side effects were observed in both the groups.Conclusions: Henna, a traditional medicine product, can be considered an effective and appropriate treatment for DD in infants and children.

Background: An absolute prerequisite to the effective management of dementia is its early diagnosis. Successful dementia screening requires precise and sensitive instruments that can be completed even by illiterate elderly people.Objectives: The aim of this study was to evaluate the psychometric properties of the Persian version of the cognitive state test (COST).Materials and Methods: This methodologic study was conducted in Kashan, Iran, during 2013 - 2014. A purposeful sample of 150 healthy elderly people and 50 elderly patients with dementia was recruited. After translating the instrument by using the standard forward-backward technique, we assessed its qualitative and quantitative face and content validity. The validity of the test was assessed by using the concurrent validity and the exploratory factor analysis. We also calculated Cronbach’s alpha and employed the test-retest method for evaluating the internal consistency and the stability of the test, respectively. Study data were analyzed by using the SPSS v16.0, the Spearman-Brown, and the intraclass correlation coefficient tests and the principal components factor analysis with varimax rotation.Results: The Persian COST consists of nineteen items. The impact scores, the content validity ratios and the content validity indices of all test items were greater than 4.5, 0.69, and 0.84, respectively. The COST had a significant correlation with the clinical dementia rating (rS=-0.76, P value<0.001), indicating an acceptable concurrent validity for the test. The exploratory factor analysis revealed a five-factor structure that explained 60.59% of the total variance of the total cognitive state score. The Cronbach’s alpha, Spearman-Brown, and interclass correlation coefficients were 0.82, 0.95, and 0.88, respectively (P value<0.001).Conclusions: The Persian version of the COST can be used as a valid and reliable instrument for assessing cognitive state and screening dementia in literate and illiterate elderly people.

Background: To explore practical applications of carbon nanotubes (CNTs) in biomedical fields the properties of their interaction with biomolecules must be revealed. Recent years, the interaction of CNTs with biomolecules is a subject of research interest for practical applications so that previous research explored that CNTs have complementary structure properties with single strand DNA (ssDNA).Objectives: Hence, the quantum mechanics (QM) method based on ab initio was used for this purpose. Therefore values of binding energy, charge distribution, electronic energy and other physical properties of interaction were studied for interaction of nucleic acid bases and SCNT.Materials and Methods: In this study, the interaction between nucleic acid bases and a (4, 4) single-walled carbon nanotube (SCNT) were investigated through calculations within quantum mechanics (QM) method at theoretical level of Hartree-Fock (HF) method using 6-31G basis set. Hence, the physical properties such as electronic energy, total dipole moment, charge distributions and binding energy of nucleic acid bases interaction with SCNT were investigated based on HF method.Results: It has been found that the guanine base adsorption is bound stronger to the outer surface of nanotube in comparison to the other bases, consistent with the recent theoretical studies. In the other words, the results explored that guanine interaction with SCNT has optimum level of electronic energy so that their interaction is stable. Also, the calculations illustrated that SCNT interact to nucleic acid bases by noncovalent interaction because of charge distribution an electrostatic area is created in place of interaction.Conclusions: Consequently, small diameter SCNT interaction with nucleic acid bases is noncovalent. Also, the results revealed that small diameter SCNT interaction especially SCNT (4, 4) with nucleic acid bases can be useful in practical application area of biomedical fields such detection and drug delivery.

Background: Patients with coronary heart disease are at high risk for mental health disorders, such as depression and anxiety. Psychoeducation is a well-known intervention for psychiatric patients, but its use has been limited in other health conditions, such as coronary heart disease.Objectives: The aim of this study was to evaluate the effect of psychoeducation on mental health in coronary heart disease patients.Patients and Methods: This randomized clinical trial included 70 patients with coronary heart disease at Shahid Beheshti hospital, in Kashan, Iran, in 2014. The patients were randomly assigned into two groups: the experimental group, which received eight sessions of psychoeducation, and the control group, which received routine care. Data were collected with the Goldberg mental health questionnaire (GHQ) and were analyzed using independent and paired t-tests performed with SPSS version 16.Results: The means of overall GHQ scores were significantly decreased post-test in the intervention group, and the differences between the two groups were statistically significant in the overall GHQ scores (P=0.0001). A significant difference was observed between the mean GHQ scores of the intervention group prior to and after the psychoeducational program (PEP) intervention (30±4.66 vs.20.50±3.30) (P=0.0001). No significant changes were observed in the control group pre- and post-test (P=0.07).Conclusions: Psychoeducation resulted in improved mental health in patients with coronary heart disease. Therefore, it is recommended that this approach be performed as a complementary, effective, non-invasive, low-cost nursing intervention to reduce psychological problems in these patients.

Background: Iran is facing an epidemiologic transition, with one of its features being the tendency towards smoking by adolescents. The findings of previous studies in Iran have shown that the pervasiveness of tobacco products among school students is high. No previous study has reported the prevalence and determinants of smoking in various socioeconomic statuses (SESs) and at the subnational level in Iran.Objectives: To compare the prevalence of smoking and the factors that influence the initiation and continuation of tobacco use in a nationally representative sample of Iranian adolescents living in different regions with diverse socio-demographic patterns.Patients and Methods: This nationwide, cross-sectional study was conducted in 2011-2012 among 14, 880 students, aged 6-18 years, selected by cluster sampling from 30 provinces. Anonymous questionnaires were completed about tobacco use and the main psychological determinants of initiation and continuation to smoke. The questionnaire was modeled on the world health organization global school-based student health survey (WHO-GSHS). The sub-national regions were defined by the criteria of geography combined with SES. According to this classification, the lowest to highest SESs were considered for the southeast, north-northeast, west, and central regions, respectively. Data were analyzed using the STATA statistical software package.Results: Overall, 13, 486 students completed this survey (participation rate of 90.6%). They consisted of 50.8% boys, 75.6% urban residents, with a mean age of 12.47±3.36 years. According to the self-report of students, 2.6 % (3.5% of boys and 1.7% of girls) were current smokers, and5.9% (7.5% of boys and 4.2% of girls) had ever been smokers. The current use of tobacco was higher in participants aged 14-18 years (6.11%) than in those aged 10-13.9 years (1.18%) and 6-9.9 years (0.51%). Current and past tobacco use, respectively, had the lowest prevalence in the region with the lowest SES (2.2%, 3.7%) and the greatest prevalence in the highest SES region (4.3%, 8.9%). Entertainment was the most common reason for smoking initiation (83.65% of smokers) and continuation (77.01% of smokers), followed by feelings of pleasure, and enjoying the tobacco smell. These influencing factors did not differ significantly according to SES or gender.Conclusions: Smoking is a health problem for Iranian adolescents, and has a higher prevalence in areas with higher SES. Entertainment and feeling pleasure were the commonest reasons for initiation and continuation of smoking. Tobacco-control programs should begin from childhood and family-centered preventive counseling should be intensified in Iran.

Background: Utility values are a key component of a cost-utility analysis. The EQ-5D and SF-6D are two commonly used measures for deriving utilities. Of particular importance is assessing the performance of these instruments in terms of validity.Objectives: This study aimed to compare the performance of the EQ-5D and the SF-6D in different states of breast cancer.Patients and Methods: This was a cross-sectional study of 163 patients with breast cancer who attended the breast cancer subspecialty clinic affiliated with the breast cancer research center (BCRC) at ACECR, in Tehran, Iran, and were consecutively recruited. Patients completed several questionnaires, including the EQ-5D, SF-36, and general questions regarding their demographic characteristics. Utility values for different states of breast cancer were obtained using predetermined algorithms for the EQ-5D and SF-6D. The distribution of the utility values and the differences between the different states for both instruments were statistically assessed. Furthermore, the agreement between the two instruments was evaluated using intra-class correlation coefficients and Bland-Altman plots.Results: The mean and median EQ-5D utility scores for the total sample were 0.685 and 0.761, respectively. The mean SF-6D utility score for the total sample was 0.653, and the median utility score was 0.640. The mean utility values of the EQ-5D for "state P," "state R," "state S," and "state M" were estimated as 0.674, 0.718, 0.730, and 0.552, respectively. The SF-6D provided mean utility values of 0.638, 0.677, 0.681, and 0.587 for those states. Both instruments assigned statistically significant (P<0.01) scores for different states. The intra-class correlation for the two measures was 0.677 (95% confidence interval (CI): 0.558 - 0.764). The Bland-Altman plot indicated a better agreement on the higher values and that at higher values, the EQ-5D yields a higher score than the SF-6D; this relationship was reversed at lower values.Conclusions: Although the two instruments were able to discriminate between various states, the values derived from these instruments were quite different. This distinction could have influenced the conclusions of an economic evaluation. Further research is required to determine which instrument should be used in economic evaluations.

Background: The World Health Organization identifies oral health as a necessity for public health through the entirety of life. This issue has been considerably addressed due to susceptibility to tooth decay during pregnancy and maternal and fetal health.Objectives: Investigate the effect of educational intervention on perceived susceptibility, self-efficacy, and DMFT of pregnant women.Patients and Methods: A quasi-experimental survey (pretest, posttest, and control group) was implemented in 88 primiparous women in the first trimester of pregnancy who attended private clinics in Delfan city, Iran. It was conducted using random sampling and then assigned to intervention and control groups. Data were collected using a questionnaire that included demographic characteristics, a DMFT checklist, and some health belief model (HBM) constructs. After collecting baseline information, an educational intervention consisting of 4 training sessions for the intervention group was scheduled. In the sessions, lecture, focus-group discussion, video, and role-playing were used as the main educational strategies. Four months after the intervention, a post-test questionnaire and DMFT checklist were conducted. Data were analyzed using SPSS (ver20) software and Chi-square, independent t-test, and repeated measure ANOVA at the significant level of a<0.05.Results: According to the independent t-test, the mean score of knowledge, perceived susceptibility, self-efficacy, and DMFT was not different between the two groups before the education (P>0.05), during the intervention, or after intervention. Repeated measure ANOVA explained that the aforementioned score was different in the three cases (pretest, 2 months after intervention, and 4 months after intervention) after intervention (P<0.05). Paired t-test also showed that the DMFT mean in creased 4 months after intervention in the control group (P<0.001). It was not, however, augmented in the intervention group (P=0.92).Conclusions: Results showed that education on some of the HBM constructs resulted in increased knowledge of oral health, perceived susceptibility, and self-efficacy of pregnant women. It is also possible to prevent increased DMFT during pregnancy.

Background: Intoxication due to carbon monoxide (CO) is one of the most common types of poisoning. Cardiac effects of carboxyhemoglobin (COHb) range from simple arrhythmias to myocardial infarction.Objectives: The current study aimed to investigate the relationship between blood carboxyhemoglobin and high-sensitivity cardiac troponin T (hs-cTnT) level with a highly sensitive assay in patients with acute carbon monoxide poisoning.Patients and Methods: This retrospective study was conducted on 141 (54 males and 87 females) patients, with acute CO intoxication, admitted to the Sevket Yilmaz research and education hospital emergency unit during a one-year period (January 2012 - January 2013). The patients were divided into three groups based on COHb levels: Group I, mild COHb level<15%; Group II, COHb between 15% and 25%; Group III, severe acute CO intoxication COHb levels>25%. COHb, hs-cTnT (Stat), creatine kinase (CK) and creatine kinase-myocardial band (CK-MB) levels were measured on admission.Results: The mean age of the patients was 38 ± 16 years. COHb levels ranged from 8 to 35. hs-cTnT levels on inclusion in this study were slightly different between the groups (P=0.05). COHb levels with hs-cTnT values were weakly correlated (r=0.173, P=0.041); on the other hand, CK-MB levels were not correlated with COHb (r=0.013, P=0.883).Conclusions: In patients without clear signs of myocardial infarction, even mild CO poisoning was associated with quantifiable circulating levels of hs-cTnT when TnT was measured using a highly sensitive assay in the current study patients. Plasma levels of the hs-TnT and CK-MB assays were not correlated with the COHb levels in the current study patients.

Background: The beliefs, attitudes and behaviors of the society toward mentally ill patients may prevent these people from seeking help and accessing a successful treatment.Objectives: The current study aimed to investigate mental illness among Turkish females residing in rural areas and their attitudes toward mental illness.Patients and Methods: The current study was inferential cross-sectional. The population of this study consisted of 1000households registered at the primary healthcare centre in Ademyavuz area who met the study inclusion criteria. The sample sizewas387 females.Using the simple random sample selection method, certain females living in these households were included in the study. The socioeconomic status of the population in this region is low and middle-class. The adult population of the region is 10, 960. Females comprise 39.8% of Ademyavuz population. The prevalence of mental illness in the district is unknown. Data were collected by faceto- face interviews using a researcher made questionnaire and the opinions about mental illness scale (OMI) in autumn 2008. The interviews were conducted at the participants’ houses and lasted for 20 - 30 minutes. The females gave their informed consent and were assured that their information would be treated as strictly confidential.Results: The females in the rural research area had negative attitudes and stigmas about mental illness. The subject of the current study exhibited a total mean score of 155.6±24.5 in terms of their attitudes toward mental illness. Mean scores in the unsophisticated benevolence sub-scale were 42.5±8.2, 34.2±7.9 in the authoritarianism sub-scale, 25.5±6.3 in the mental illness ideology sub-scale, 34.0±7.4 in the social restrictiveness sub-scale, and 20.0±6.0 for the interpersonal etiology sub-scale. The current study found that individuals exhibited more positive attitudes towards mental illnesses as they got older (Kvx2=19.42; P<0.0001), married people exhibited a more positive attitude towards mental illnesses than singles did (Kvx2=19.42; P<0.0001), those who considered themselves to have a good economic status exhibited a more negative attitude towards mental illnesses compared to the ones who thought their economic status as poor or average (Kvx2=5.11; P=0.024).Conclusions: Nurses have an important role in creating and maintaining a mentally healthy society. It is advisable to provide the public with training and consultancy services within the context of primary healthcare services, especially during home visits to change the negative attitudes of individuals against the mentally ill and prevent approaches that promote social isolation and denouncement.

Background: Surgery is an essential component of health care, yet it has usually been overlooked in public health across the world.Objectives: This study aimed to perform a situational analysis of essential surgical care management at district hospitals in Iran.Materials and Methods: This research was a descriptive and cross-sectional study performed at 42 first-referral district hospitals of Iran in 2013. The World Health Organization (WHO) Tool for the situational analysis of emergency and essential care was used for data collection in four domains of facilities and equipment, human resources, surgical interventions, and infrastructure. Data analysis was conducted using simple descriptive statistical methods.Results: In this study, 100% of the studied hospitals had oxygen cylinders, running water, electricity, anesthesia machines, emergency departments, archives of medical records, and X-ray machines. In 100% of the surveyed hospitals, specialists in surgery, anesthesia, and obstetrics and gynecology were available as full-time staff. Life-saving procedures were performed in the majority of the hospitals. Among urgent procedures, neonatal surgeries were conducted in 14.3% of the hospitals. Regarding non-urgent procedures, acute burn management was conducted in 38.1% of the hospitals. Also, a few other procedures such as cricothyrotomy and foreign body removal were performed in 85.7% of the hospitals.Conclusions: The results indicated that suitable facilities and equipment, human resources, and infrastructure were available in the district hospitals in Iran. These findings showed that there is potential for the district hospitals to provide care in a wider spectrum.

Background: Diabetes is one of the most serious metabolic disorders to affect different organs in the body. Patients with diabetes are hence at risk of developing other problems. Urinary tract infections (UTI) are one of the problems that occur more commonly in diabetic patients than in others. There are several risk factors that lead to the incidence of UTI in diabetic patients.Objectives: We conducted this study to determine the effect of different factors on the incidence of UTI in diabetic patients in order to decrease the incidence of this problem.Patients and Methods: In this cross-sectional study, data concerning 233 patients who were referred to the largest diabetes center in Khorramabad, Lorestan province, Iran, were recorded. The relationships between various factors and the incidence of UTI in these patients were evaluated using SPSS version 16. We used chi-square and logistic regression to analyze the data. A P<0.05 was considered to be statistically significant.Results: The incidence of UTI increased significantly with increasing age (P=0.009). The incidence of UTI was higher among females than among males, and it was higher among unemployed people than among those in other occupations. The prevalence of UTI among patients who control their diabetes through diet and exercise was lower than that among those undergoing other types of treatment; however, no significant relationship was found between the different types of oral medication and the incidence of UTI. We did not find any relationship between the incidence of UTI in diabetic patients and other factors such as literacy, marital status, BMI, addiction, history of hospitalization, and level of HbA1c.Conclusions: We found that age, gender, occupation, and the type of medication used are all risk factors for the incidence of UTI in diabetic patients. Other factors such as literacy, marital status, addiction, and history of hospitalization did not have any significant association with the incidence of UTI in diabetic patients.

Background: The sexual function of menopausal women is influenced by several factors.Objectives: We aimed to investigate the association between exercise and sexual function among postmenopausal women residing in Northern Iran.Patients and Methods: Using a multistage, randomized sampling method, 405 postmenopausal women, aged 40 to 65 years, were recruited to participate in this population-based, cross-sectional study. The female sexual function index (FSFI) questionnaire and a researcher-designed questionnaire were completed by every subject.Results: Overall, 61% of the women reported having experienced sexual dysfunction, and 53.6% reported that they had not performed any kind of exercise within the last 6 months; among those who did exercise, the most common form was walking (79.8%). The FSFI total scores (P=0.013), as well as the scores in the lubrication (P=0.007) and pain (P<0.001) domains, were significantly lower for the women who performed exercises other than walking compared to those who only walked or who did not exercise at all. The frequency of weekly exercise had a positive correlation with the scores in the lubrication (r=0.18, P=0.014) and orgasm (r= 0.146, P=0.045) domains. The logistic regression analysis demonstrated that the chances of reduced sexual desire were decreased by 80.2% (P=0.044) with every unit increase in the frequency of weekly exercise.Conclusions: More frequent exercise will improve the sexual function of post-menopausal women.

Context: Medication non-adherence is a commonly observed problem in the self-administration of treatment, regardless of the disease type. Text messaging reminders, as electronic reminders, provide an opportunity to improve medication adherence. In this study, we aimed to provide evidence addressing the question of whether text message reminders were effective in improving patients’ adherence to medication.Evidence Acquisition: We carried out a systematic literature search, using the five electronic bibliographic databases: PubMed, Embase, Psyc INFO, CINAHL, and the Cochrane central register of controlled trials. Studies were included on the basis of whether they examined the benefits and effects of short-message service (SMS) interventions on medication adherence.Results: The results of this systematic review indicated that text messaging interventions have improved patients’ medication adherence rate (85%, 29.34). Included in the review, those who had problems with adherence, or those whom text messaging was most helpful had HIV, asthma, diabetes, schizophrenia and heart disease (73.5%). The period of intervention varied from 1 week to 14 months. The most common study design was randomized controlled trials (RCTs) (66%) carried out in the developed countries.Conclusions: This study demonstrated the potential of mobile phone text messaging for medication non-adherence problem solving.

Background: Hospitalization and surgery are crucial adverse life events that lead to considerable anxiety in patients.Objectives: The present study aimed to investigate stressors after coronary artery bypass graft surgery and identify stressors that predict anxiety.Patients and Methods: This is a descriptive-analytical study that uses a non-random convenience sampling method on patients undergoing coronary artery bypass graft surgery at the cardiac surgery intensive care unit of Fatemeh Zahra Cardiac center in Sari, Iran. A total of 186 patients completed the post-surgical stressors questionnaire and the Spielberger State-Trait Anxiety Inventory on postoperative days 2 or 3 in the cardiac surgery intensive care unit. Data were analyzed using descriptive statistics including frequencies, means, and standard deviations. The Mann–Whitney U test was used to determine the relationship between the observed variables, and the logistic regression model was used to identify the relationship between stressors and anxiety after-surgery.Results: Post-surgical anxiety predictors included insufficient sleep during hospitalization (Odds ratio [OR]: 5.42; 95% confidence interval [CI]: 1.46-20.00; P=0.010), treatment not explained to the patient by the nurse (OR: 4.83; 95% CI: 1.82-12.84; P=0.002), being away from family members (OR: 3.88; 95% CI: 1.46-10.26; P=0.006), presence of a chest tube (OR: 3.27; 95% CI: 1.83-5.84; P=0.000), and pain in any part of the body (OR: 1.95; 95% CI: 1.06-3.58; P=0.031).Conclusions: Physical or physiological and psychological stressors impose greater stress and are predictors of anxiety. When preparing their nursing care plan, nurses should consider these stressors that affect anxiety levels in patients undergoing CABG surgery and those hospitalized in intensive care units.

Background: The surveyors in hospital accreditation program are considered as the core of accreditation programs. So, the reliability and validity of the accreditation program heavily depend on their performance.Objectives: This study aimed to identify the dimensions and factors affecting surveyor management of hospital accreditation programs in Iran.Materials and Methods: This qualitative study used a thematic analysis method, and was performed in Iran in 2014. The study participants included experts in the field of hospital accreditation, and were derived from three groups: 1. Policy-makers, administrators, and surveyors of the accreditation bureau, the ministry of health and medical education, Iranian universities of medical science; 2. Healthcare service providers, and 3. University professors and faculty members. The data were collected using semi-structured in-depth interviews. Following text transcription and control of compliance with the original text, MAXQDA10 software was used to code, classify, and organize the interviews in six stages.Results: The findings from the analysis of 21 interviews were first classified in the form of 1347 semantic units, 11 themes, 17 sub-themes, and 248 codes. These were further discussed by an expert panel, which then resulted in the emergence of seven main themes - selection and recruitment of the surveyor team, organization of the surveyor team, planning to perform surveys, surveyor motivation and retention, surveyor training, surveyor assessment, and recommendations - as well as 27 sub-themes, and 112 codes.Conclusions: The dimensions and variables affecting the surveyors’ management were identified and classified on the basis of existing scientific methods in the form of a conceptual framework. Using the results of this study, it would certainly be possible to take a great step toward enhancing the reliability of surveys and the quality and safety of services, while effectively managing accreditation program surveyors.

Background: Fall is a worldwide health problem among elderly people and a known leading cause of disabilities. Fall prevention programs have been implemented in various forms. The Otago exercise program (OEP) is one of the most recent home-base exercise training program.Objectives: This study was conducted to examine the effectiveness of OEP to reduce falls among elderly people in Shahroud, IR Iran.Materials and Methods: This randomised control trial was conducted among the elderly community dwellers in Shahroud city of the Semnan province, IR Iran, with experience of falls in the last 12 months. Subjects of the study (n=317) were recruited from elderly senior citizens at public health centers. Block systematic random sampling was applied to categorize the subjects in experimental and control groups. The experimental group (n=160) received OEP for six months and was compared with the control group (n=157) who received general health training. This study was registered with the following ID, IRCT2014012016285N1.Results: The findings of the study showed that OEP improved physical performance (Berg-Balance-Score with P>0.025, and Timed-Up-Go-Test with P>0.017) and functional capacity (Arm-Curl-Test with P>0.00 and Chair-Stand-Test with P>0.01). In addition, OEP significantly reduced the incidence of falls (P£0.00) among senior citizens in the experimental group.Discussion: The OEP as a home-based exercise is effective for the reduction of the incidence of falls among senior citizens with a history of falls. The OEP can be recommended for elderly homebound people who do not have access to facilities.

Background: Cardiovascular patients need information to preserve and promote their health, but not all of them have the necessary motivation to seek relevant health knowledge.Objectives: The present study analyzed experiences of patients, family caregivers, and healthcare providers to explore the motivating factors that cause cardiovascular patients to seek important health information.Patients and Methods: This study was conducted using a qualitative approach and conventional qualitative content analysis method. Thirty-six people, including 18 cardiovascular patients, 7 family caregivers, and 11 healthcare providers (from multidisciplinary backgrounds) participated in the study. The data were collected through semi-structured interviews and purposeful sampling and continued until data saturation. Data collection and analysis proceeded simultaneously and with constant comparison; this study was carried out from May 2012 to May 2013.Results: During the analysis process, three main themes were extracted that characterized participants’ experiences, perceptions, and motivations to seek health information. The themes were “Optimizing quality of life, “Desire for personal rights to be respected,” and “Gaining confidence through consultation.” Conclusions: Our findings showed that, through seeking information, patients try to achieve well-being and realize their personal rights as well as their right to security. They should also be encouraged to enhance their quality of life by using the Knowles’ learning theory to formulate their needs and learning priorities.