Koomesh
Year:2020 | Volume:22 | Issue:4 (80)|Papers Count:18

Introduction: Community participation in health programs is essential for their success, and community health volunteers (CHVs) program is a favored form of participation. Given that three decades have passed since the launch of the Health Communicator Program (as a form of health volunteers) in Iran and the importance of evaluating its achievements, the purpose of this study was to evaluate the effectiveness of health communicators program in promoting knowledge, attitude and practice of community health thorough educational interventions. Materials and Methods: This is a systematic review and its literature review was conducted in February of 2020. The search of resources was conducted using ‘ community health communicator’ , ‘ community health volunteer’ , and ‘ Iran’ in PubMed, Scopus, Web of Sciences and their Persian equivalent in SID, Magiran and Elmnet database/ search engine. The number of 13558 was obtained from this search, which finally the number of 15 articles was included in study and their quality were appraised. In continue, the related contents of included articles were reported as extraction and comparative tables, and final conclusion was done based on them. Results: The health communicators program in Iran had good positive effect health knowledge and attitude of community in different health areas but this program has not been successful in improving community health performance/behavior. Assessing the targeted areas to improve in community health performance through provided educational interventions by CHVs in the final included articles showed that from 34 targeted health areas, CHVs have succeeded in promoting six areas, only. Conclusion: The health communicators' program needs to be promoted or replaced with a more effective one in community participation due to its low impact on community health behavior.

Introduction: Mastalgia is a common complaint among women that requires proper medical treatment. The aim of this study was to investigate the comparison of fluoxetine versus tamoxifen effects on the mastalgia. Materials and Methods: In this clinical trial, 62 women, who referred to surgical clinic of Rafsanjan Ali-Ibn AbiTalib hospital in 2017, with a complaint of breast pain were selected and treated with fluoxetine or tamoxifen. Correspondingly, informed consent, demographic checklists and the visual scale of the pain were completed in pretreatment and then 4, 8 and 12 weeks after the treatment. Results: There was no significant difference between two groups in body mass index, duration of illness and duration of pain (P>0. 05). Both fluoxetine and tamoxifen significantly reduced pain (P<0. 001), but there was no significant difference between pain reduction in two groups (P>0. 05). Conclusion: Both fluoxetine and tamoxifen were equally effective as alternative therapies against mastalgia.

Introduction: Exclusive breastfeeding does not continue until six months in many places. It is seem, many factors are involved. The interventions for increase mothers’ social support during breastfeeding could be effective. The aim of this study was to examine effect of home visit on social support and the continuity exclusive breastfeeding in Bokan city from kurdestan province. Materials and Methods: In this research, 108 mothers which have 3-5 day’ s old neonates that were referred to 8 health care centers of Bokan (Iran). They were entered into the study by random allocation using randomized block design and were divided into intervention and control groups. The intervention consisted of six home-based training programs of about 30 minutes. The instruments used included demographic questionnaire and midwifery history, perceived social support tool of Zimet, and a researcher-made questionnaire on exclusive breastfeeding. Results: Most mothers in the intervention group continued exclusive breastfeeding until the fourth month, and the majority in the control group continued exclusive breastfeeding until the first and second months. In general, the mean number of breastfeeding months in the intervention group was 3. 15± 1. 01 months and in the control group 1. 71± 0. 906 months. Also, most people in the intervention group (76%) had more than 8 times breastfeeding per day, while most mothers in the control group (88%) had less than 8 times breastfeeding. Mothers’ perception social support score were not significant difference in two groups. Conclusion: Home visit and follow-ups have led to a long-term exclusive breastfeeding and more often overnight, so it's possible to set up such plans to enhance breastfeeding status. Home visit did not effect on mothers’ perceive social support and fathers’ attitude. It is seem to need future further interventions in this field with long time follow up and qualitative study with influence in deep layer in culture people in Bokan city.

Introduction: More than half a century, studies reported about strong association between preterm birth and development disorders. Therefore, the aim of this study was to follow the effect of a period of tactile kinetic simulations on motor development quotient in preterm neonates. Materials and Methods: So, among all of Iranian neonates healthy and preterm of Amiralmomenin hospital neonatal unit of Semnan city, 40 neonates selected purposefully and divided into experimental and control groups (20 person each group). Then, mothers of the experimental group conducted tactile kinetic stimulations on neonates to completion of the fetal period (40 weeks gestation) for 20 minutes and three times a day whereas the control group received only usual care. Peabody Development Motor Scale test was used to measure motor development quotient. Results: The results showed that tactile kinetic stimulations led to significant improvement in motor development quotient of neonates in the experimental group as measured in the end of intervention and after 4 months compared to the control group. Conclusion: It can be concluded that tactile kinetic stimulation can allow cost and stable way in order to increase motor development of preterm infants.

Introduction: Head lice contamination has a global outbreak. Head lice infestation is more common among children than adults and can cause absence from the school. In this study, the severity of the problem in primary schoolchildren in Semnan city (Iran) was evaluated. Then health education has given to the students/parents and the effects of education on its prevention was evaluated. Materials and Methods: This study was conducted from March 2018 to May 2018 in two stages. In the first stage, the city of Semnan, Iran was divided into 4 regions and from each district, a girl school and a boy school were randomly selected. In this account, in the vicinity of each school, one school was selected as a control. In selected schools, at least five students were selected systematically from each grade (767 people) and the condition of head lice infection was evaluated. In the second stage, all students and their parents of 50% schools were taught through lecture and pamphlet. Then, about 2 months after the training, 767 students in the trained and control schools were selected again by the mentioned sampling method. Children were examined for head lice and the personal details were recorded in checklist. Results: Before the intervention, in 5. 2% (95% CI: 3. 6-6. 8%) of the children were seen head lice infection. Gender (OR=2. 71, 95% CI: 1. 32-5. 54, p=0. 006) and father's level of education (p<0. 001) were significantly correlated with head lice infection. The chance of head lice in girls was 2. 71 times higher than boys. In addition, the chance of infection to head lice in students with illiterate fathers or elementary literacy, were 9. 15 times of students with college-educated fathers. The prevalence of head lice in trained schools decreased by 2. 7% after intervention but did not change in control schools. The difference was statistically significant (p<0. 05). Conclusion: In general, the prevalence of head lice infection in primary school children in Semnan is relatively high. Particular attention is needed to girls' schools, also families with low literacy levels. The effectiveness of education emphasizes that the corporation between the University of Medical Sciences & health services and primary schools authorities to raising the awareness of students and their parents, helps to decrease this problem.

Introduction: Chronic low back pain is one of the major musculoskeletal problems. The presence of trigger points in the gluteus maximus muscle is a factor in increasing back pain. The aim of this study was to evaluate the effect of electro acupuncture on pain, functional disability and ultrasonographic changes of gluteus maximus muscle in patients with nonspecific chronic low back pain with trigger points of gluteus maximus muscle. Materials and Methods: This clinical trial study was performed on 38 non-specific chronic low back pain participants aged between 20-50 years. The participants were randomly assigned in 2 intervention and control groups. The scores of visual analogue scale of pain and disability questionnaire were recorded. The thickness of the gluteus maximus muscle was measured. Therefore, the control group performed 10 sessions routine physiotherapy (3 repetitions per week). The intervention group received 4 sessions’ electro acupuncture of gluteus maximus muscle (2 repetitions per week) and routine physiotherapy as mentioned above. At the end of intervention and two weeks after the last treatment session, the variables were assessed in both groups. Results: The results showed that there was no significant difference between the two groups in gluteus maximus thickness and lumbar pain; but there was a significant reduction in gluteal pain (P = 0. 000) and the score of disability questionnaire (P = 0. 007) in the intervention group compared to control group. Conclusion: Electroacupuncture is an effective method in nonspecific chronic low back pain patients with trigger points of gluteus maximus muscle. The combination of electroacupuncture and routine physiotherapy compared to routine physiotherapy can help to decrease pain and functional disability significantly.

Introduction: In the Iranian Healthcare System, emergency departments (EDs) face many challenges such as limitations of the physical environment and overcrowding, meanwhile, unnecessary presence of relatives at their patients' bedside goes beyond EDs challenges and has made the situation worse. Therefore, the aim of this study was to explore, gain an understanding of, and describe the cultural beliefs and behaviors in an Iranian ED. Materials and Methods: A focused ethnographic approach based on Spradley's (1980) developmental research sequence was conducted at the ED of Imam Reza University Hospital in Tabriz, Iran. Purposive sampling was used to identify eligible participants from patients, their relatives, and the healthcare professionals of this ED. Participant observation, ethnographic interviews, and examination of related documents and artifacts were used for data collection and continued until data saturation achieved. Results: The overarching cultural pattern of "perceived constructive/destructive duality of relatives' presence" emerged within which there were two main themes as follows: constructive presence (includes two sub-themes of compensation and support) and destructive presence (includes two sub-themes of dissuasion and workplace violence). Conclusion: Our findings provide valuable insight into the perceived duality of relatives' presence which strenuously affect not only the patients and their relatives but also the healthcare professionals, healthcare system, and healthcare quality. Conspicuously, most of the time, the relatives played the role of "12th man" in our healthcare system. However, their violent and aggressive behaviors against healthcare professionals were the most destructive aspect of their presence.

Introduction: The objective of this study was to compare two methods of dry needle treatment in active trigger points of Gastrocnemius muscle on pain and height jump in non-professional athletes. Materials and Methods: Forty male athletes were selected with active trigger points in each Gastrocnemius muscle. Relatively, subjects were assigned randomly in two conventional dry needle piston method groups and rotational method groups. Vertical jump and pain were evaluated before, after, the first, second and third days of intervention by visual analog scale and the motion analysis system. Results: There was a significant difference in pain intensity and jump height in both groups (P<0. 001). Also, the behavior of pain intensity was different in the needle rotation group from the piston group (P<0. 001). But the height of jump between the two groups was not significant (P=0. 304) Conclusion: Needle rotation had a strong antinociceptive effect and little annoyance in trigger points. However, both techniques reduced pain and improved vertical jump in non-professional athletes with active trigger points in gastrocnemius muscle.

Introduction: Nurses, as one of the most important groups of care providers, always face with many stressors, which have negative effects for both the nurses and the patients. This study was aimed to investigate the role of perceived social support and job satisfaction on psychological distress of clinical nurses working in hospitals of Babol University of Medical Sciences. Materials and Methods: This was a correlational study and the statistical population consisted of all nurses working in hospitals of Babol University of Medical Sciences in 2018-2019 (Iran). Using stratified random sampling method, a number of 330 nurses were selected as the sample (264 females and 66 males). A four-part questionnaire was used for data collection which included the Demographic Characteristics, Perceived Social Support Scale, Minnesota Job Satisfaction Questionnaire, and Kessler Psychological Distress Scale. Results: The results showed that perceived social support had a significant negative relationship with the psychological distress in nurses (with a regression coefficient of-0. 25). Also, job satisfaction had a significant negative relationship with nurses' psychological distress (with a regression coefficient of-0. 15). The perceived social support and job satisfaction explained 10% of the variance in nurses' psychological distress. Conclusion: The results showed that perceived social support and job satisfaction decreased nurses' psychological distress. Considering that psychological distress causes mental health disorder and decreases nurses' efficiency, emphasis on the need to develop strategies by nursing managers to increase social and organizational support and improve working conditions.

Introduction: Clustering of human brain is a very useful tool for diagnosis, treatment, and tracking of brain tumors. There are several methods in this category in order to do this. In this study, modified balanced iterative reducing and clustering using hierarchies (m-BIRCH) was introduced for brain activation clustering. This algorithm has an appropriate speed and good scalability in dealing with very large data using a new concept of Clustering Feature. Materials and Methods: In this study, data from the brain scan had been used. This dataset consisted of 74 consecutive brain scans. After data preprocessing, brain scan images were clustered through the BIRCH and mBIRCH algorithms. Data were analyzed using WFU-PickAtlas in Matlab software and were compared with the TD Lobes Standard Atlas. Results: The speed of implementation of the m-BIRCH algorithm decreased as threshold limit increased. The mBIRCH clustering algorithm showed that there was no specific ascending or descending pattern between branch factor and the run-time of the algorithm. The maximum runtime value of the algorithm was related to the branching factor of 30 which was 94 seconds, equivalent to the upper threshold limit of the BIRCH algorithm. Conclusion: Applying the m-BIRCH algorithm on high-dimension data set such as brain scan images has relative advantages and provides a tradeoff between time and space complexity. By simultaneously increasing the branching factor and threshold limit, the sensitivity of clustering will be decreased.

Introduction: Auditory processing disorder (APD) is a type of abnormal perceptual processing of auditory information within the central auditory nervous system that could be influenced by cognitive factors, such as attention. Attention is one of most important cognitive functions in the development of learning in children, so it is important to recognize and evaluate a variety of attention deficits in children with auditory processing disorder with a reliable test. The aim of this study was to compare the auditory sustained attention in children with auditory processing disorder and normal children with Test of Everyday Attention for children. Materials and Methods: This cross-sectional study was performed on 45 students aged 7-11 years, 23 normal children (mean age, 9. 88, SD; 1. 5) and 22 children with a diagnosed APD (mean age, 9. 32, SD; 1. 2). Remarkably, test of Everyday Attention for children with five subtest (Score, Score Dual Task, Code Transmission, Sky Search Dual Task, Walk, Don’ t Walk) in sustained attention domain was performed in the both groups. The mean scores of the two groups were compared in each of the sub-tests. Results: The results of Mann-Whitney U test indicated that there were significant difference in two groups in all of the subtests (Score, Score dual task, Code Transmission, Sky Search dual task, Walk, Don’ t Walk) (P<0. 001). Conclusion: The results showed that children with auditory processing disorders were significantly worse than their normal peers in all subtests of auditory sustained attention domain.

Introduction: Housekeeping is one of the occupations that have a variety of physical and psychological stresses. On the other hand, the prevalence of musculoskeletal disorders (MSDS) is intensified by factors such as high physical and mental workload. Therefore, this study was aimed in order to investigate the relation between prevalence of musculoskeletal disorders with mental workload and general health in housewives. Materials and Methods: This descriptive cross-sectional study was carried out on 200 housewives by available sampling method. The Persian version of Nordic Questionnaire, Cornell (CMDQ), General Health (GHQ28) Mental workload (NASA-TLX) Questionnaire, were used for data collection. Results: Demographic characteristics showed that 90. 5% of selected society are married, 62% had no university education and the average age was 42. 33 ± 0. 87 years. Interestingly, the results of this study show that, the highest prevalence of musculoskeletal disorders was found to be in the low back region (48%), followed by mean score of general health questionnaires (19. 05± 8. 34) and mental workload (52. 16 ± 12. 21). The result showed that there is a significant difference between musculoskeletal disorders with mental workload and general health. Conclusion: Considering the role of housewives in human resource productivity, suggested that interventions to prevent MSDS and increase public health be considered by health authorities. Taking actions such as using the MSDS questionnaire, counselling, workshops, awareness sessions, posture correction and training on how to get things done, work-rest cycle program, diversification at work, and recreational programs can increase mental health, reduce mental workload and reduce musculoskeletal injuries.

Introduction: There are few studies regarding the treatment of vitamin D deficiency with a high dose of vitamin D and the comparison of serum vitamin D levels and hematological indices (Hemoglobin, Hematocrit, Platelet and Ferritin) in the first and second trimesters of pregnancy. The aim of this study was to evaluate the effect of vitamin D supplementation on these hematological indices in pregnant women with vitamin D deficiency. Materials and Methods: The present study was performed in October 2019 from a secondary and nonpredetermined analysis of the effect of vitamin D supplementation and comparison of serum vitamin D levels on blood parameters from a randomized controlled clinical trial. 215 pregnant mothers with vitamin D deficiency were entered in the study and were divided into two treatment groups of 50, 000 units and 1000 units. Results: Mean serum levels of Hematocrit, Platelets, and Ferritin after treatment in the treatment groups with 50000 and 1000 unites were 38. 6± 3. 03 vs 36. 05± 2. 8 (P<0. 38), 243083 ± 55302 vs 215942 ± 45513 (P<0. 29) and 42. 3± 33. 5 vs 28. 8± 21. 7 (P<0. 04), respectively. The mean Hemoglobin level in the treatment groups with 50, 000 and 1000 units were 12. 08± 1. 17 vs. 12. 3± 2. 5 (P<0. 84), respectively. In both groups, there was a significant relationship between serum vitamin D level, Hemoglobin and Hematocrit levels before treatment. (Respectively P<0. 02, P<0. 02 and P<0. 05). The serum Ferritin level was significantly higher with serum vitamin D after treatment (P<0. 04). Conclusion: This study showed that the results of two therapeutic groups in pregnant women with vitamin D deficiency, especially a dose of 50, 000 units of vitamin D, compared to the first trimester of pregnancy, had different effects on the hematologic indices.

Introduction: Alzheimer's disease (AD) is the most common cause of dementia worldwide. Mild cognitive impairment (MCI) is often the prodromal stage to AD. Most patients with MCI harbor the pathologic changes of AD and demonstrate transition to AD at a rate of 10-15% per year. Accumulating evidence indicates that the asymmetry changes of left and right brain have happened in the early stage of AD. However, the features of asymmetry changes in anterior cingulate cortex (ACC) is still unclear. Materials and Methods: We examined the left-right asymmetry changes of metabolites in ACC. In this account, 14 cases of mild AD patients meeting criteria for probable AD of NINDS-ADRDA, 12 cases of MCI according to the Mayo Clinic Alzheimer's Disease Research Center criteria, and 15 cases of age-matched normal controls (NC) received Proton magnetic resonance spectroscopy (1H-MRS) for measurement of NAA/mI, NAA/Cr, Cho/Cr, and mI/Cr ratios in the ACC bilaterally. We analyzed MRS data by paired t-test to validate the left-right asymmetry of MRS data in the ACC. Results: In AD, there was a significant difference in mI/Cr between the left and right ACC (P<0. 001). In MCI, there was a significant difference in mI/Cr between the left and right ACC (P<0. 001). In NC, there were no differences in the ratio value of metabolites NAA/mI, NAA/Cr, Cho/Cr, and mI/Cr between the left and right ACC. Conclusion: The left-right asymmetry of mI/Cr in the ACC may be an important biological indicator of mild AD.

Introduction: Various drugs are used as adjuvants for various purposes such as increasing analgesia, reducing analgesic complications and generally improving the quality of anesthesia with topical anesthetics. The use of alpha2 agonists has recently been considered. One of these drugs is dexmedetomidine, which has been studied recently. The aim of this study was to evaluate the effect of dexmedetomidine as an adjunct to bupivacaine in spinal anesthesia in femoral fracture orthopedic surgery. Materials and Methods: This double-blind randomized clinical trial study was performed on 60 patients 18-50 years old with Class I and II anesthesia who were candidates for tibia and femur orthopedic fracture surgery. Patients were randomly divided into two groups of intervention: 12. 5 mg bupivacaine (2. 5 cc) and 5 µ g dexmedomidine (0. 5 ml) and control group: 12. 5 mg bupivacaine and 0. 5 ml normal saline. Systolic, diastolic, and mean arterial blood pressure and pulse counts were recorded before spinal anesthesia, after anesthesia and then every 15 minutes until surgery and at recovery time. At 2, 8, 4, 12, and 24 hours postoperatively, patients were evaluated for pain, opioid administration during the first 24 hours, and the time of first analgesic administration. Results: There was a significant difference between the bupivacaine-normal saline and bupivacaine-dexmedetomidine groups in terms of systolic and diastolic blood pressure at 15, 30, 45 and 60 minutes during surgery (P<0. 05). There was a significant difference in the frequency of pain between the Bupivacaine-Normal Saline and Bupivacaine-dexmedetomidine groups at 4, 8 and 24 hours postoperatively (P<0. 05). Conclusion: The results of this study showed that addition of 5 μ g dexmedetomidine to bupivacaine in spinal anesthesia method prolonged analgesia time, decreased pain intensity, decreased postoperative opiate requirement. Conspicoiusly, there was no risk of respiratory suppression even at higher doses than other medicines used. Conclusively, dexamethasone seems to be an appropriate supplement to be added to bupivacaine to reduce postoperative pain.

Introduction: Due to the increasing trend of heart diseases and their complications, programs such as cardiac rehabilitation can reduce the complications and faster recovery of patients. Therefore, the aim of this study was to design and evaluate the usability of smartphone-based application for training outpatient cardiac rehabilitation. Materials and Methods: This applied-developmental study was conducted at Kashan University of Medical Sciences in 2019. In order to specify the app information content and feature, a checklist was designed based on the relevant literature and opinions cardiologists (10 peoples) and nurses (10 peoples). The application was designed and developed in JAVA environment and on the Android operating system. The usability evaluation was performed using the think aloud method and the System Usability Scale questionnaire by cardiac patients (10 peoples), nurses (10 peoples) and cardiologists (10 peoples). Results: The most important information contents were education, diet, physical activity and medications and the most important features were, pulse count, harmful cholesterol level record, Body mass Index calculation and triglyceride levels chart display. Usability evaluation showed that patients, nurses and cardiologists rated the application at a desirable level with mean score of 74. 25, 74. 5 and 75. 36, respectively. Conclusion: Based on the users' opinions in this study, smartphone_based applications had potential to transfer educational contents to heart patients to prevent acute cardiac events, lifestyle modification and rehabilitation education.

Introduction: Diabetes is one of the chronic diseases that can endanger people's health. Lack of quality of life can be observed if diabetes is not controlled and the complications of the disease occur. Therefore, the aim of the present study was to improve the quality of life of patients with type 2 diabetes by combined exercise. Materials and Methods: In this clinical trial study, after examining 692 volunteer patients suffering from type 2 diabetes, 30 patients were randomly divided into two different groups of combined exercise and control. In the combined exercise group, participants walked on a treadmill 3 times a week for eight weeks treatment duration. The intensity of walking were considered 50-70% of maximum heart beat rate for 30 minutes, and participants were forced to wear a vest containing weights. The control group did not receive any intervention and ended their 8-week lifestyle. Results: Individuals in the two groups had not any significant differences in age, height, weight, body mass index, and medical history. The quality of life, the disease control, and exercise behavior variables in the combined exercise group increased significantly (P<0. 05) but no significant change in the control group was reported (P>0. 05). There was a significant difference in the above variables between the combined exercise and control groupd (P<0. 05). Conclusion: Eight weeks of aerobic exercise with external load improves the quality of life for people with type 2 diabetes.

Introduction: Previous findings from our laboratory indicated that exercise alleviates the deficits in cognitive and anxiety disorders in healthy female rats. But the effect of exercise on cognitive and anxiety disorders induced by chronic morphine in experimental monopose of rats (ovariectomized) not known. Aim of this study was to investigate the effects of mild and modorate forced exercise on anxiety-like behaviors, and object location memory in ovariectomized of morphine-dependent rats during spontaneous withdrawal period. Materials and Methods: Sham or ovariectomized rats were injected with bi-daily doses (10 mg/kg, at 12 h intervals) of morphine or saline over a period of 10 days. Then the rats were trained under mild and moderate exercises for 30 minute in a session of five days per week for four weeks. Then object location memory, and anxiety profile in elevated plus maze (EPM) were examined. Results: Chronic morphine induced the anxiogenic-like behaviours (reductions in time spent, and entry into the EPM open arm) in intact, but not ovariectomized rats, which alleviated by both mild and moderate treadmill exercise. Also, both mild and moderate exercise produced anxiolytic behaviours in the non-morphine depedent intact and ovariectomized rats. Chronic morphine did not change object location memory in the intact and ovariectomized rats. Meanwhile, moderate exercise enhaced spatial location memory in non-morphine dependent, but not morphine dependent intact and ovarietomized rats. Conclusion: In general, our findings demostrate that sex ovarian hormones modulate the effects of chronic morphine on congnitive function and anxiety behaviour. It seems the nature of this interaction is complex and needs further investigation.