سال:1397 | دوره: | شماره: |تعداد مقالات:20

When sun rises, the hyperactive day begins in operation room (OR). Management of OR needs regular programs for human and material resources. For deciding about OR programs, there should be requirement to obtaining information of multidisciplinary stakeholders (1). It appears that we go to OR, we enter to new world in new time zone and time will stand here (2). It is well known that trained staff are required for coordination between OR and several departments and providing advanced patient care. The major duties of these personnel, especially surgery and anesthesia nursing included to keep patient safety and navigation of various type of surgery throughout their course. OR staff work in closed, relatively isolated environment and spent several hours of their life here!....

Objectives: There is a wide range of interventions available for managing labor pain. Complementary medicine and non-pharmacological approaches to relieve pain are the components of midwifery practice that can simply be started by midwives. This study aimed to examine the effect of breathing technique with lavender on labor pain compared to breathing technique alone in an Iranian setting in 2015. Materials and Methods: A single-blind randomized trial was conducted on the pregnant women hospitalized in labor room in Fatemieh maternity hospital. A total of 120 laboring mothers who were eligible for the study were randomly assigned to two groups of breathing technique with lavender and breathing technique with sterile water. The labor pain was measured using the visual analogue scale at different dilatations. Data analysis was done by t test and χ 2 using SPSS version 18. 0. Results: The mean age of women in the group of breathing technique with lavender and of breathing technique with sterile water were 25. 5± 4. 3 and 26± 4. 9, respectively (P = 0. 6). The mean total pain scores in the experimental and control groups were 6. 77± 1. 89 and 7. 44± 1. 66 (CI:-1. 35, 0. 014), respectively (P = 0. 05). Conclusions: The results of the study indicated that breathing technique with lavender reduced labor pain at the end of labor (i. e. at the cervical dilatation of 9-10 cm) compared to breathing technique without lavender. Further research is needed to confirm the effect of lavender aromatherapy on labor pain.

Objectives: The first step in designing a plan is need recognition. Given the fact that rural women are among the most deprived groups in terms of healthcare services, this study aimed to determine the most common reproductive health needs of rural women of reproductive age, which can provide the foundation for designing proper programs with regard to budget constraints. Materials and Methods: This cross-sectional study was conducted on rural women of reproductive age referred to rural healthcare centers of Neyshabur, Iran, during 2016-2017. In total, 405 subjects were selected through randomized sampling. The data collection tool was standardized questionnaire evaluating sexual and reproductive health needs. This instrument consists of seven sections, including background information, safe motherhood, family planning, sexual behaviors, sexually transmitted infections, HIV/AIDS, and physical and sexual violence. The answer to each question was categorized into 2 groups of favorable (Score 1 was given to it) and unfavorable (Score 2 was given to it), so low scores were indicative of favorable condition, whereas high scores reflected unfavorable status. Data analysis was performed using descriptive tests in SPSS version 17. 0. Results: In this study, about half of the women were within the age range of 31-40 years, and 44. 2% of them were illiterate or had low literacy levels. In addition, 84% of the subjects were housewives. Safe pregnancy domain had the most proper status (14. 12± 10. 55), whereas HIV/AIDS domain was the least favorable condition (47. 65± 21. 63). Conclusions: We recommend designing focused programs to improve the health of rural women in the domains of HIV/AIDS and sexually transmitted diseases (STDs), which are the most prioritized areas of reproductive health.

Objectives: The theory of planned behavior (TPB) has been used in pregnant women’ s choice of delivery method and other health-related behaviors. This study extended TPB to predict the role of social support in pregnant women’ s choice of delivery method. Materials and Methods: This prospective cohort study was conducted on pregnant women referred to Fatimah hospital in Hamadan, Iran, from 2015 to 2016. A total of 206 nulliparous pregnant women, who referred to Fatimah hospital, completed a self-report questionnaire including measures of intentions, attitudes, subjective norms, perceived behavioral control and social support. These women were followed up until the end of their pregnancy. Results: On the basis of structural equation modeling, adding social support variable improved the indices of the model slightly, but this variable cannot be regarded as a predictor of behavior. A gap between intention and behavior and other factors together with social factor may be the reason. The perceived behavioral control of the individuals was a significantly effective predictor for selecting the type of delivery. Conclusions: Attitude, subjective norms, perceived behavior control, and social support were distinguished as significant predictors of the choice of delivery type. Therefore, it seems that designing an intervention with emphasis and focus on making changes in these variables and considering different dimensions of social support can increase people’ s intention towards natural delivery by providing facilities in the childbirth environment.

Objectives: Individuals with generalized joint hypermobility (GJH) have motions beyond the normal range in the shoulder, and less shoulder stability. Scapular dyskinesis is likely to be a consequence of weakness in scapular stabilizer muscle. This study intended to identify the relationship between GJH and scapular dyskinesis in young women. Materials and Methods: One hundred women (47 hypermobile and 53 non-hypermobile) participated in this case control study. The Beighton score was used to diagnose GJH. Visual scapular dyskinesis test (proposed by Uhl et al) was used for the evaluation of scapular dyskinesis. Scapular winging and/or dysrhythmia is observed during a set of bilateral, active, shoulder flexion, abduction and scaption (40° anterior to the frontal plane) for 5 times while having the thumbs pointed up. These movements were performed, bearing the weight on their hands. Generalized estimating equations were used in order to compare the scapular dyskinesis prevalence during shoulder flexion, abduction and scaption between the females with and without GJH. Results: The prevalence of scapular dyskinesis in the females with GJH was twice more than that in the females with no hypermobility [OR = 2. 18(95% CI: 1. 18-4. 03)]. It was also found that there were not any significant differences in the prevalence of scapular dyskinesis between shoulder elevation planes (flexion, abduction and scaption) in the females with and without GJH (P > 0. 05). Conclusions: Higher prevalence of scapular dyskinesis in the females with GJH may place them at the risk of future shoulder pain and pathology, which should be considered in the evaluation and management of hypermobile individuals.

Objectives: Natural killer cells (NKs) are one of the most important cells which play a key role in fetomaternal immune tolerance. This immune tolerance is induced by the interaction of fetal human leucocyte antigens (HLAs) and maternal killer-cell immunoglobulin-like receptors (KIRs). Hence, we intended to investigate the relationship of maternal KIR, parental HLA-C, and maternal-parental KIR+HLA-C with the risk of recurrent spontaneous abortion (RSA). Materials and Methods: The present regional study in Lorestan province of Iran was conducted as a case-control study on 200 couples. Polymerase chain reaction with sequence-specific primers (PCR-SSP) was used in order to detect genes. Results: A significant correlation was found for maternal KIR2DS1 in combination with paternal HLA-C2 (P=0. 0089; OR=2. 25). Likewise, a significant relation was found for maternal C1C2 in combination with paternal C1 or C2 (P=0. 0289; OR=2. 25). No significant relation was found for KIR genes alone. Conclusions: Our study showed a significant relation for maternal KIR2DS1 in combination with paternal HLA-C2 as a risk factor in our region. Investigations on this combination for increasing the success rate of assisted reproduction, for first trimester abortions occurring after implantation and early placentation, for stillbirth groups, and for successful and unsuccessful pregnancies with malformed embryos and fetuses are suggested.

Objectives: Pain is one of the major problems for patients after cesarean section. The aim of this study was to assess the effect of amniotic membrane as cesarean wound dressing on pain after cesarean section. Materials and Methods: This study was conducted on 90 pregnant women who underwent cesarean section in Amir-al-Momenin hospital, Gerash, Iran. The participants were divided into 2 groups each of 45. The wound was dressed with amniotic membrane in one group and with simple gauze in the other group. Pain was measured and recorded in the 2 groups by visual analogue scale (VAS). The need for receiving analgesics 24 hours after the cesarean section was also assessed and compared between the 2 groups. Results: The results showed no significant difference between the 2 groups regarding the mean pain, 4 and 12 hours after the cesarean section (P = 0. 308 and P = 0. 628, respectively). However, a significant difference was observed between the 2 groups, in this regard, 24, 36, and 48 hours after the operation (P = 0. 026, P = 0. 026, and P = 0. 004, respectively). Moreover, the patients in the amniotic membrane group needed less analgesics compared to those in the control group 24 hours after cesarean section (P = 0. 041) Conclusions: Use of amniotic membrane dressing can be effective in reducing pain after cesarean section and can eliminate the patients’ need for analgesics. Hence, it can be used as an effective complementary method along with usual analgesics for pain relief.

Objectives: As a metabolic syndrome, type 2 diabetes mellitus (T2DM) has had a worldwide increase associated with the incidence of obesity. Vaspin acts as a new biomarker for obesity and interactive exercise. Our study aimed to survey the effect of aerobic exercise on vaspin level in the female patients with T2DM. Materials and Methods: Forty female patients (age = 33. 00 ± 8. 08 years) as diagnosed with T2DM based on the International Diabetes Federation (IDF) were selected. The participants were randomly divided into exercise (E) and control groups (C). At the beginning and at the end of the study, all the variables were measured. Group E participated in 8-week training sessions, 3 days/week for 60 minutes, with an intensity of 60%-70% of maximum heart rate. The C group continued its usual life. Results: Thirty-one subjects completed the study period ((E [n = 18] and C [n = 13]). Statistical analysis showed that group E had a significant increase in vaspin level (F = 8. 888, P = 0. 001) and a significant decrease in BW (body mass weight), BMI (body mass index), WC (waist circumference), FP (fat percentage), FM (fat mass), FFM (fat free mass), TC (total cholesterol), FBS (fast blood sugar) and insulin level, whereas there was no significant change in HC (hip circumference), WHR (waist to hip ratio), TG (triglyceride), HOMA-IR, and quantitative insulin sensitivity check index (QUICKI) in the E group compared with the C group (P < 0. 05). Conclusions: Our data suggested that vaspin behavior is reversed by increasing the duration and progressive stage of T2DM and its level increases following exercise and weight loss.

Objectives: Lack of information on the symptoms of menopause may aggravate symptoms and reduce the quality of life in postmenopausal women. This study aimed to determine the effect of self-care trainings, based on Orem’ s model, on self-care behavior, and the quality of life in postmenopausal women. Materials and Methods: In this randomized controlled trial, postmenopausal women, referred to the health care centers of Saqqez city, were randomly assigned into 2 groups. Pre-test questionnaires including socio-demographic, SF-12 quality of life, and self-care questionnaires were filled out by all participants. The intervention group received 4 training sessions based on Orem’ s model. Participants in the control group were only given routine recommendations in the health care centers. Four weeks after intervention, participants filled out the questionnaires once again. Primary outcome was self-care behavior and secondary outcome was quality of life. Results: In the present study, 130 participants were equally and randomly assigned into 2 groups. There was no significant difference between the 2 groups in terms of socio-demographic characteristics. Statistical analysis showed that the intervention group had significantly better performance compared with the control group in terms of the self-care behaviors and quality of life (P < 0. 05). Conclusions: Training is one of the most important factors in improving self-care behavior and quality of life. The use of self-care programs is a safe, noninvasive and inexpensive way to control physical and psychological problems. These programs can be easily taught to the patients (clients); and their impact on postmenopausal women is very important.

Objectives: Keloids are raised fibrous scars that extend beyond the boundaries of the original wound and usually reappear after surgical excision. Hypertrophic scars are similar lesions but are limited to wound edges and may regress over time. The aim of the present study was to provide a comparative assessment of intralesional cryotherapy with 2 methods of intralesional injection of triamcinolone and 5-fluorouracil. Materials and Methods: The study was conducted on Iranian Azeri patients with hypertrophic and keloid scars in Sina hospital (Tabriz-Iran) from August 2016 to May 2017. Twenty-one scars were assigned to each group. The first group received intralesional cryotherapy and the second and third groups were treated with intralesional triamcinolone acetonide (40 mg/mL) 0. 2 mL/cm2 and 5-fluorouracil (50 mg/mL) 0. 2 mL/cm2, respectively. Dimensions of the scars (including surface area, height and volume) were measured before and after the study. Therapies were repeated every 4 weeks and would be reapplied for 6 sessions depending on the presence of scar tissue. Results: A significant decline was found in surface area, height and volume of the scars with cryotherapy after the first session compared to other 2 methods. The decline in surface area, height and volume after the sixth session was 52. 9%, 61. 37%, and 78. 06% respectively with steroid injection and 32. 16%, 58. 07%, and 60. 67% with 5-FU injection. Results also showed that in terms of surface area, height and volume of the disease, there was a significant difference between steroid and 5-FU groups in the sixth session, with the results being more favorable in the former group. Side effects were permanent hypopigmentation, telangiectasia and atrophy in the steroid group; surface wound, hyperpigmentation and increased pain in the 5-FU group; and temporary hypopigmentation in the cryotherapy group. Conclusions: Results showed that intralesional cryotherapy accelerates keloid healing and has fewer side effects than other treatments.

Objectives: This study aimed to compare the efficacy of surfactant administration by laryngeal mask airway (LMA) and endotracheal intubation in the management of respiratory distress syndrome (RDS) in preterm infants. Materials and Methods: In a prospective interventional study in NICU at Al-Zahra hospital, 50 premature infants with gestational age of 33-37 weeks and birth weight of 1800 g or more who needed surfactant replacement therapy for RDS were randomly allocated to 2 groups. Twenty-five neonates in ETT group received surfactant by endotracheal intubation and the LMA were used for the administration of surfactant in 25 neonates (LMA group). Results: The mean gestational age in LMA group was 32. 88± 1. 32 and it was 33. 76± 2. 12 weeks in ETT group (P = 0. 15). The mean RDS score was not statistically different 2 two groups, 7. 68± 0. 80 vs. 7. 24± 1. 17 (P = 0. 79). Mechanical ventilation was needed for 1 neonate in the LMA group and 3 infants in the ETT group (P = 0. 16). After surfactant administration, the mean FiO2 requirements to maintain oxygen saturation between% 88 to 92% showed a statistically significant decrease in both groups. The needed FiO2s were 0. 60± 0. 12 and 0. 57± 0. 12 before surfactant therapy and decreased to 0. 42± 0. 15 and 0. 36± 0. 10 after surfactant administration in LMA and ETT groups, respectively (P < 0. 001). No choking or vomiting occurred during surfactant therapy in either group. Conclusions: Based on our findings, the LMA may be a safe and effective alternative way for surfactant administration in late preterm infants. Future multicenter studies are recommended for determining safety and efficacy of LMA in preterm infants.

Objectives: Acute kidney insufficiency is a prevalent and serious disease that follows coronary artery bypass graft (CABG). One of the important symptoms of acute renal failure (ARF) is the increased level of urea and serum creatinine. This study examined the rate of renal failure in patients undergoing on-pump and off-pump CABG. Materials and Methods: In this descriptive– comparative survey, we selected the patients undergoing heart surgery. Levels of urea, creatinine, sodium, potassium and urinary output were controlled and recorded in the first days of admission and ICU discharge. Data collection tool was a checklist, the first part included demographic information and the second part was related to the information on kidney function. The data were analyzed using SPSS version 21. 0. Results: The findings of this study showed a statistically significant difference in terms of age and the incidence of renal failure based on the increased levels of urea and serum creatinine before and after CABG (P < 0. 05). Results of this study also showed that the incidence of renal failure significantly increased after CABG based on the levels of urea and serum creatinine (P < 0. 00). No considerable difference was observed between 2 surgery procedures (on-pump and off-pump) in terms of renal failure incidence (P > 0. 05). Conclusions: Patients’ age was an important factor for kidney insufficiency following CABG. Type of the surgery (on-and off-pump) and gender had no influence on the incidence rate of ARF. Stronger measures to protect the kidneys in older patients may reduce this high-risk complication.

Objectives: Because of the high prevalence of chronic wounds, wound repair has become one of the health challenges. Numerous therapeutic strategies have been proposed for repairing wounds and recently, the use of herbal medicines has been considered because of lower costs and complications. The use of mummy is recommended in traditional medicine for treating bone fractures, bleeding control, poisoning treatment, headache relief and wound repair. Therefore, the purpose of the present study was to provide a scientific assessment of the effect of mummy on wound healing. Materials and Methods: Human fetal foreskin fibroblast cells (HFFF-2) were purchased from Pasteur Institute (Tehran, Iran). The fibroblast cell lines and stem cells derived from Wharton’ s jelly (WJSCs) were isolated by means of explant culture. MTT assay was used to determine the effective concentration of mummy. Scratch assay method was used to examine the effect of mummy on cell migration rate and flow cytometry was used to assess the rate of cell proliferation using Ki-67 antibody. WJSCs and HFFF-2, each under mono-culture and two-cell co-culture condition with 50-50 and 30/70 ratio respectively, were in an experimental group including culture medium and mummy and in a control group including culture medium only. Results: Scratch assay results for HFFF-2 cell migration showed a significant increase (P ≤ 0. 0001), but the mummy had no significant impact on WJSCs and a significant increase was observed in 50/50 and 30/70 co-culture conditions with P ≤ 0. 001 and P ≤ 0. 0001, respectively. The proliferation rate of WJSCs increased significantly while no significant increase was found in fibroblast groups in mono-culture and co-culture conditions. Conclusions: Results showed that by stimulating fibroblast cell migration both in mono-culture and co-culture conditions with stem cells and by increasing WJSCs proliferation, the mummy can be used as a treatment to accelerate wound repair procedure.

Objectives: Gynecologic cancers are common in women. One of the most important challenging risk factors for many cancers is lifestyle, which can affect health. This study was therefore conducted to determine the status of health-promoting lifestyle and its predictors in women under the chemotherapy for reproductive system cancers. Materials and Methods: This cross-sectional study was conducted in 2016 on 151 patients. They were undergoing chemotherapy for gynecologic cancers in oncology wards of Alzahra and Shahid Ghazi hospitals in Tabriz, Iran. The participants were selected through convenience sampling method. The sociodemographic questionnaire and health-promoting lifestyle profile II (HPLP-II) were completed. The data were analyzed using the independent t test, one-way analysis of variance (ANOVA), and multivariate linear regression. Results: Mean (standard deviation, SD) total score of women’ s health-promoting lifestyle was 2. 30 (0. 38) in the score range 1-4. The highest mean (SD) score pertained to nutrition subscale (2. 50 ± 0. 49), and the lowest mean (SD) score pertained to physical activity subscale (2. 10 ± 0. 50). The predictors of lifestyle included age, income level, number of pregnancies, marital problems, number of children, and family history of gynecologic cancers. Conclusions: The data analysis showed that the mean score of the health-promoting lifestyle was average. It appears necessary to use health education and promotion programs emphasizing the health-promoting behaviors and their determinants.

Objectives: The aim of the present study was to evaluate methylene tetrahydrofolate reductase (MTHFR) gene C677T polymorphism in human pre-implantation embryos. Methods: Fifty embryos after biopsy at cleavage stage (which were inappropriate for assisted reproductive techniques) were analyzed in order to study MTHFR C677T polymorphism and sex determination. After cell lysis, in the first step, whole genome amplification (WGA) was performed by primer extension pre-amplification (PEP) PCR method. In the next step, fluorescence PCR with labeled primers was used to examine this polymorphism in the blastomeres. Finally, the Hinfl enzyme was employed to cut the fragments and the capillary electrophoresis was used to determine the size of PCR products. Results: only 37 blastomeres among 50 samples were successfully amplified; 23 male and 14 female embryos were observed. The frequencies of CC, CT and TT genotypes in embryos were 67. 56%, 24. 32%, 8. 10%, respectively. Additionally, the frequencies of 677C and 677T alleles were 80% and 20%, respectively. Conclusions: In this study, the frequency of MTHFR c. 677C˃ T genotype was evaluated in human embryonic blastomeres before implantation. Therefore, this polymorphism may provide a new and valuable biomarker for evaluating the embryo usefulness and improving the In vitro fertilisation (IVF) process by choosing the best embryo. Our findings revealed that the detection rate of C677T polymorphism was 74% in the samples.

Objectives: Cerebral stroke is a common multifactorial trait that does not follow Mendelian pattern of inheritance. The phenomena of gene-gene or gene-environment interactions may be responsible for the multifactorial traits. Any mutation may be associated with silencing implicated in other disorders. This case-control study explored the association between Notch3 polymorphism and stroke in Iranian-Azeri population. Materials and Methods: In this case-control study, C381T polymorphism in Notch3 gene was evaluated among 65 patients with ischemic stroke and 65 individuals without any stroke as control group. The samples were recruited from 5 clinical centers during 2014-2015. PCR-SSCP and sequencing methods were used to obtain the data. Results: In this study, the frequencies of C and T alleles in the patient group were 85% and 15%, and in the control group were 94% and 6%, respectively. The frequencies of CC, CT and TT genotypes were 72%, 26% and 2% in the patient group, and 88%, 12% and 0% in the control group, respectively. Both control and patient groups had significant difference considering their both allele and genotype frequencies. The individuals with C381T polymorphism in Notch3 gene were in a significantly higher risk of thrombotic stroke (P = 0. 02, CI: 0. 128-0. 256: 95%, odds ratio [OR]: 2. 72). Conclusions: Our results showed that combination of T allele of this gene conferred higher risk for cerebral stroke. The interaction of gene mutation with post-translation modification may serve as a novel field for stroke research.

Objectives: Hydronephrosis is a common problem of renal disease in neonates, and it is shown that ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Several therapeutic surgical approaches have been introduced among which pyeloplasty have some advantages. In this study, the efficiency of this technique was studied on 30 patients with UPJO. Materials and Methods: In this prospective clinical trial, 30 patients with UPJO who had undergone pyeloplasty during 2013 to 2017 were studied and the intraoperative and postoperative complications, as well as the success of the operation, were evaluated. Results: In this study, 30 patients with UPJO participated. Their mean age was 24. 76 ± 13. 95. The results of this study showed that none of the patients needed blood transfusion, and 28 patients responded well to surgery while 2 patients had postoperative complications such as pain and urinary tract infection at the end of follow-up. Conclusions: The results of this study indicated that since the operation time, recovery, and duration of hospital stay, in addition to postoperative complications such as blood loss, and the need for blood transfusion were reduced in pyeloplasty method, this surgical method can be considered as the method of choice for both surgeons and patients for the treatment of hydronephrosis.

A 20-year-old Iranian male after injury in a football match with pain in the finger was referred to the hospital. X-Ray images of his hand showed no fractures, but the shortening of third to fifth metacarpal bones was clearly observed. The short metacarpal bone is a very helpful diagnostic marker in the patients suffering from idiopathic hypoparathyroidism (IHP), pseudohypoparathyroidism type Ia (PHP-Ia) with Albright’ s hereditary osteodystrophy (AHO) phenotype, pseudopseudohypoparathyroidism (PPHP), and brachydactyly type E. Briefly, in hypoparathyroidism disease, the serum calcium level decreases and the serum phosphorus level increases in blood. PHP-Ia disorder is clinically similar to hypoparathyroidism; in this disease, the level of parathyroid hormone is normal but there is resistance to it. PPHP disease is not an endocrine disorder but is related to PHP-Ia. In this disease, serum levels of calcium and phosphorus are normal, also symptoms and signs in PPHP are similar to PHP-Ia, but there is no resistance to parathyroid hormone. In brachydactyly type E, shortening of metacarpal or metatarsal bones is caused by abnormal development of phalanxes, metacarpals, or both. His laboratory tests revealed a low serum calcium level, high serum phosphate level, and low serum PTH level; therefore a diagnosis of IHP was reached.

Trismus is one of the side effects of methamphetamine use which is associated with contractions of the jaw muscles. Acupuncture is a traditional and complementary treatment that is effective in reducing pain and psychological indices. The purpose of this study was to investigate the effectiveness of the acupuncture in a case of trismus caused by methamphetamine abuse. The patient was a 31-year-old man with a history of chronic methamphetamine use, reported to have dependence and severe jaw pain. In a single case study and in an ABAB design with multi-baselines, we used acupuncture for 3 weeks to reduce pain and addiction severity index (ASI). Data were analyzed through a generalized estimating equation (GEE). The results showed that there was no significant correlation between severity of addiction and pain (P > 0. 05). Due to damage caused in the process of production of tyrosine hydroxylase and mitogen-activated protein kinase and the role of these precursors in the production of dopamine as an effective factor in the acupuncture, the effectiveness of this treatment can be limited.

One of the important parts of public health surveillance is to track flu (influenza) and similar respiratory conditions. School-based surveillance of flu or influenza-like illness (ILI) is critical as children are more susceptible to infections due to their developing immune system and the nature of interaction they have in the school. Establishing enhanced flu surveillance systems could be useful in monitoring the spread and severity of flu, observing disease trends and finally implementation of the health promotion strategies. An effective surveillance method starts with the establishment of multiple stakeholder contacts and effective collaborations. This is followed by the development of data flow mechanisms to obtain absenteeism information from each participating school. The collected data can be comprised of information such as the total number of enrolled students and staff, the number of absent students and staff, and the number of absences due to ILI. Additionally, school response rates can also be monitored periodically in order to assess the effectiveness of a program.