[Effect of early clinical exposure on attitude and performance of first year medical students]

Background and aim: Encountering clinical environments as an inseparable part of studying medicine could bring about tension and anxiety for medical students. Early clinical exposure has been suggested to decrease these stresses and to motivate students for a better attitude and awareness. This study was performed to determine the effect of a short-term period of exposing to clinical environment on medical students' attitude toward medical education and their educational function

Methods: In an interventional study performed as pre-test/post-test, 43 first year medical students were encountered clinical environments in rounds, operating rooms and emergency ward. Students' attitude was assessed by a questionnaire using Likret scale. We compared students' function in specific lessons and result of comprehensive basic examination with previous entrance students as an external control group

Results: Significant differences were found in the student's attitude before and after the course [P<0.01]. Results showed a significant increase in the student's attitude toward importance of the patients' history and physical exam versus para-clinical exams. In addition, their attitude about therapeutic stuff duties in all levels. The rules between physician and patient, patients rights in hospital, diagnosis and therapeutic management, different steps of medical education and merging basic and clinical sciences, simple physical exam and assistance management were increased significantly after the course. No significant difference was observed in the students' educational function in any items

Conclusion: Based on the results of this study, we found a positive effect of early clinical exposure on attitude of first year medical students. Therefore, we suggest that early clinical exposure be added to educational curriculum for medical students

[ causes of formula milk consumption in the infants under 1 year old in Charmahalva Bakhtiari provins Iran, 2007]

Background and aims: In spite of the importance of breast feeding, as an exclusive manner, continuing the breast feeding is ignored frequently. So identifying the factors related to non tendency for breast feeding could be effective in planning for progress of breast feeding. This study was performed to determine the causes of formula milk consumption in infants in Charmahal va Bakhtiari province

Methods: In a descriptive-analytical study, 411 under one year old infants in Chaharmahal va Bakhtiari, Iran were selected through cluster randomized sampling. In this study a self making questionnaire was used which was consisted of some demographic information about mother and infant, diseases related to breast feeding and evaluating some factors related to tendency for using formula milk. This study conducted in 2007. The data were analyzed using chi-square and t-test

Results: In this study, %51.6 of mothers were from rural areas and most of them [%59.7] were between 20-30 years of age. Generally about %76.1 of infants were using formula milk after 6 months. Our Results showed that most of the mothers and infants did not demonstrate any disease related to breast feeding. There was a significant difference between rural and urban infants, educational level of mother, age, and the kind of feeding [P<0.05]. Inadequacy of mother milk was the most [%43.1] important reason of using formula milk

Conclusion: This study showed the limited knowledge of the mothers and health care personnel about the breast feeding and it is needed to continue educating the mothers during their pregnancy period and afterward

[ evaluation of anti-rabies antibody titer in vaccinated individuals in Shahrekord district]

Background and aims: Rabies is a viral disease which occurs commonly through the bite of a rabid animal. Anti rabies vaccination is an important prophylaxis after having contact with the disease agent. The aim of this study was to evaluate the anti-rabies anti-body titer among individuals who have had received 3-5 times anti-rabies vaccine

Methods: In this descriptive-analytical study, according to the data collected from Shahrekord health centers, the blood serums of 63 individual's encountered animal bites within 4 years were collected and their anti-rabies antibody titer was tested using Rapid Fluorescent Focus Inhibition Test [RFFIT]. The anti-rabies titer more than 0.5 ul/ml was considered as protected against rabies. Data were analyzed using Spearman and the dependant t-test

Results: In this study, 30 individuals were vaccinated 3 times and other 33 individuals were vaccinated 5 times. In all cases, 5 individuals received rabies vaccine together with Human Rabies Immune Globulin [HRIG]. The mean time since last vaccination was 23.3+/-9.6 months [range, 5-38 months] and the mean antibody titer against rabies was 2.5+/-1.9 IU/ml [range, 0.4- 14 IU/ml] only 3 individuals [4.8%] had the anti rabies titer less than recommended titer [0.5 IU/ml]. There was no significant relationship between the numbers of vaccinations, individual's gender, mean time since last vaccination and the age of the individuals with antibody titer against rabies [P>0.05]

Conclusion: In the case of encountering to suspected human rabies, it is better to check their serum anti-rabies antibody titer. If their anti body value is below than the global standard, they should receive a secondary doze of anti-rabies vaccination

[Immunization following hepatitis B mass vaccination in the 18 years old students in Chaharmahal va Bakhtyari province in Iran]

Background and aims: The main objective of immunization by hepatitis B vaccine is to generate adequate concentration of anti hepatitis B antibody [HBsAB] in the serum. This study was aimed to determine the effectiveness of hepatitis B vaccination campaign in 18 years old students in Chaharmahal va Bakhtiari province

Methods: In a cross- sectional study, 360 students with 18 years old [born in 1989] and have taken 3 doses of hepatitis vaccine in national vaccination campaign in 2007, were selected by cluster sampling. This study was performed in 2008 in Chaharmahal va Bakhtiari province in the central of I.R of Iran. The level of hepatitis B antibody was detected by quantitative ELIZA method using Dialab Kit. The collected data was analyzed using SPSS 16.0 software by X[2] and t-test

Results: Of 360 students, 164[45%] cases were male and 174 [48/3%] cases were from urban areas. Just 349 students [96/95%] have acceptable immunization responses, [In those anti hepatitis B antibodies were more than 20 IU/ml]. There was no significant relationship between the level of antibody and variables such as: sex, born places, smoking, contact history, previous disease and Hejamat [P>0.05]

Conclusion: Considering the results of the present study and previous researches from others countries, we can emphasize that the mass vaccination has been effective in those 18 years old students and we can be sure that the vaccination has been performed perfectly in Chaharmahal va Bakhtiari province

[Effective strategies for empowerment of experts staff in health deputy of Shahrekord University of Medical Sciences, Iran, 2005]

The most valuable resource in every organization is its employees. Organization mobility depends on its staff empowerment. The aim of this study was to recognize and determine the priority of empowerment strategies in experts staff in health deputy in Shahrekord University of Medical Sciences in 2005. In a descriptive and analytical study, in 2005, all experts staff in provincial health center and health networks in 6 districts [approximately 210 persons] were introduced in this study. Need assessment questionnaires with 60 questions adjusted by Likrett indices were designed by surveyor. Data was collected and its suitability of factor analysis was confirmed by Bartlet test and Kaiser, Mayer, Olkin [KMO] test of sampling adequacy. Finally, 60 variables included 5 factors were selected and factor analysis was done by Varimax Yolling method. According to variables, factors and condition of each factor, 5 strategies were determined: 1-Liberty in job activities [42.25%], 2-Effective management of man power resources [5.99%], 3-Motivation [5.07%], 4-Self management [3.71%], 5-Development of organizational learning [2.84%]. There was a statistical relationship between expert's ideas about 5[th] strategy [development of organizational learning] and job location [P<0.01], between 2nd strategy [effective management of man power resources and age [P<0.01, r=0.19], between 5[th] strategy [development of organizational learning] and age [P<0.05, r=0.18]. The main strategies for health expert's empowerment are liberty in job activities and effective management of man power resources, motivation, self management and development of organizational learning. In point of view of older and more experts' staff development of organizational learning is more effective in organization development

Ten year breast cancer screening and follow up in 52200 women in Shahre-Kord, Iran [1997-2006]

This study was conducted to determine the outcomes of the project of 'Integration of Breast Cancer Screening and Early Detection' into Primary Health Care [PHC] System and to detect the incidence rate, mortality rate and the stage of reported breast cancers, during the timeframe of the project in Shahre-Kord. A prospective cohort study was conducted, reviewing medical records of all women aged over 30 in Shahre-Kord district who participated in the screening project between 1997 and 2006. Patients' demographic data, risk factors, diagnostic approach, treatments after definite diagnosis, and time of death of the deceased patients due to breast cancer were investigated from four sources: Provincial Health Centre, direct conversation via telephoning and interview, medical records of patients admitted to Seyed-Al Shohada Hospital, Isfahan [as the only referral oncology hospital in the region], and the provincial vital registry system as a part of national cancer registry Overall 52200 women were eligible to enter the study and in this population, 40 breast cancer cases were detected. Incidence rate of breast cancer in women older than 30 years, during the timeframe of study, is estimated as 77.6 per 100000. Clinical features of the patients were as follow: stage-IIA [20%], stage-IIB [40%], stage-IIIA [30%] and stage-IIIB [10%]. All 40 cases of cancer underwent pathology diagnosis, which showed infiltrative ductal carcinoma in 38%, invasive ductal carcinoma in 33%, ductal carcinoma in 25%, and infiltrative colloidal carcinoma in 4% of them. During the study, 31 cases [77.5%] survived and 9 cases [22.5%] died, all due to breast cancer The mean age of breast cancer in this study was significantly lower than Western countries. Mortality rate due to breast cancer in this study during ten year follow up was 1.73 in 100000 women population, which is less than the national figure of 3.16 in 100000

[ evaluation of Papanicolaou [Pap] smear processing in the health centers of Shahrekord in 2005]

Papanicolaou [Pap] smear screening is an effective method of detecting cytological changes in cervix before they lead to cervical cancer. To determine the quality of process of Pap smear and comparison of pathologist and cytologist reports about quality of obtained samples and accuracy of diagnosis, this study was performed. In this cross sectional study which performed during spring and summer 2005, the processing of a total of 160 Pap smears were observed randomly by standard checklist. Also a total of 360 Pap smear samples reported by a cytologist were examined by a pathologist and the Kappa correlation coefficient was compared between the two reports. The function of midwifes in patient recording was 96.15% good and 3.85% poor. The function for Pap sampling was 88.72% good and 11.28% poor. In the pathologist report, the quantity of specimen, infection cellular changes, inflammation reactive changes, cell abnormality were reported were 308[85.5%], 12[3.3%], 232[64.4%] and 3[0.83%], respectively. There was significant relationship between pathologist and cytologist reports [p<0.05]. According to the result, the quality of processing of Pap smear, the quality of obtained samples and accuracy of diagnosis were acceptable. However, we suggest more supervision and attention about midwifes and cytologists practices

[Frequency and severity of Post Traumatic Stress Disorder and efficacy of mental health intervention in children and young adults from a rural region in Chaharmahal and Bakhtyari Province, Safilan]

Disasters cause disability, economic burden and death, annually. The casualties following the catastrophes such as earthquake, hurricane, and etc. leads to stress, anxiety, depression, and somatizaten. Post Traumatic Stress Disorder [PTSD] is one of these complications occurred after the unpleasant events. One of these events was happened in a rural region in Chaharmahal and Bakhtyari province, Safilan. Therefore, the aim of this study was to assess the frequency of post disaster psychologic complication in the children of the area and the effect of mental health intervention on them. This is a quasi-experimental study in which all children aged 5-15 years from this region who experienced this event were interviewed. The face to face interview was performed with the parents of the children and the Yoll questionnaire was filled immediately after the event. Subsequently, the psychologic interventions including psychological re-explanation, recognition of social thinking and treatment mechanisms were used for two weeks through 4 seasons. Repeatedly, five months after the event, the same procedures were performed. Results were analyzed with paired t-test, independent t-test and ANOVA. In the first round of measurement, the mean score of PTSD was 61.14 +/- 15.03, and in the 2nd time it was 48.19 +/- 9.6 [p<0.001]. This score in the age groups of 5-10 and 10-15 years was 54.26 +/- 13.8 and 65.5 +/- 14.3, respectively before the intervention [p<0.05] and was 43 +/- 5.7 and 51 +/- 10.28, respectively after that [p<0.01]. This difference was not sex dependent. Analysis of variance showed that with increasing education, score of PTSD significantly was increased and using Tukey test, it was shown that the difference was significant between the two level of education [p<0.01]. The results of this study showed the effect of hygienic interventions and educations in the problem faced. Therefore, use of preventive mechanisms in all 3 preventive levels is essential in the case of this event

[Effect of allium sativum l. extract on acid and pepsin secretion in basal condition and stimulated with vag stimulate in rat]

Garlic is used world wide to give flavor to foods as pecols ect. by different nations specially by Iranian society. The dominant believe is, the garlic therapeutic effects on patients with gastric discomfort and digesting problems. In this study we aimed to investigate the garlic effect on gastric acid and pepsin in both basic and stimulated condition by electrical stimulus of vogues nerve in rat. In an experimental study two groups of 12 wistar rats were selected, to make the animal unconscious, 50[mg/kg] Sodium tiopantal were given ip. and each rat was tracheostomized, laparatomized, gastrodeodbnostomized and then 100[mg/kg] of garlic extract dissolved in 9% saline was introduced to stomach of animal. The vagus nerves of both side of the neck released from carotid sheet and stimulated with ISmillivolts, frequency 4 Herts and 1 milisecond wide. The stomach secretions then washed out in following stages; first base, second base, vagus stimulated conditions and reverse to base. The acid amounts of washing were measured by titrometry and pepsin amounts were measured with Anson technique. The acid and pepsin secretion were significantly increased in rats received garlic extracts [p<0.000 p<0.05 respectively]. Stimulation by vagus nerves in control group significantly increased the level of acid [p<0.05] and pepsin [p<0.05] and garlic treated group had similar secretion rate to stimulated group. Furthermore there were no significant relationship between sex of studied rats. Consumption of garlic in the diet has lots of benefits for digestion of foods, so it can be beneficial for those patients with digestive problems, however it should be noted that people with digestive dysfunction related to increased level of gastric acid or pepsin must avoid garlic consumption. Therefore patient with gastritis and duodenal ulcer are not allowed to take garlic in their diet

[Effect of allium sativum extract on acid and pepsin secretion in basal condition and stimulated with pentagastrin in rat]

Allium Sativum [garlic] is used widely in the world and especially in Iran. This plant is used in cooking food as an odorant. In Iran it is believed that it is useful for gastrointestinal disorders. So in this study the effect of Allium Sativumextract on acid and pepsin secretion in rat is investigated. This experimental study is performed on two groups of rats [12 in each group: control group and allium sativum group]. After anesthesia with nesdonal [50 mg/kg, ip], rats had gone under surgical tracheotomy, laparatomy and gasterodeodenostomy. In garlic group Allium Sativum extract [100mg/kg] was introduced into the stomach by gasterodeodenostomy canula. In order to stimulation of acid and pepsin secretion, Pentagastrin was used [25mcg/kg, ip]. Stomach secretion was washed out and acid was measured using titerimetery and pepsin using Anson method. Data was analyzed using T test. Allium Sativum caused a meaningful increase in acid and pepsin secretion in garlic group comparing to control group [p<0.001]. Pentagastrin also increased acid and pepsin secretion in control group [p<0.001]. Using garlic in nutritional regimen causes an increase in acid and pepsin secretion in those using this plant

incidence rate of chronic brucellosis following one-year antibiotic therapy in Koohrang district of Chaharmahal and Bakhtyari province

Brucellosis is a common zoonotic disease with different clinical pictures such as chronic brucellosis. The aim of this study was to determine the incidence rate of chronic brucellosis after one-year of antibiotic therapy in tribal patients of Koohrang district of Chaharmahal and Bakhtyari province from 2003 to 2004. The patients with acute brucellosis were recognized using both standard tube agglutination [STA] [Wright] and 2-mercaptoethanol [2ME] tests. Also a questionnaire about demographic variables of the patients, their signs and symptoms and how they were infected was filled in by the patients. Subsequently, they were treated using conventional regimen. After one year, the patients were reviewed for the signs and symptoms of the disease and their sample sera were tested for related antibodies. The patients with specific antibody [>1/160 for both tests] regarded as positive. The data was analyzed by t, Chi square, and regression tests. During the peak of brucellosis in 2003. 119 persons were infected, 63.9% male and 36.1% female. Arthritis [88.7%] and fever [78.54%] were the most common signs and symptoms. In the second visit 97 new patients were recognized, rifampin with cotrimoxazole [57.7%] and doxycycline with rifampin [15.5%] were used for treatment of the patients. 17.5% of the patients had final titer of STA test titer and 15.5% of them had a 2ME titer higher than 1.160. 16.5% of the patients had recurrence signs and symptoms and 11.3% of them had mild symptoms. There was significant statistical relationship between antimicrobial drugs regimen and final titer of STA and 2ME tests and clinical course in the following year [p<0.001], Using both rifampin and cotrimoxazole resulted in a higher chance of chronic brucellosis [p<0.001]. The incidence rate of chronic brucellosis in this area was higher than that in the other regions of Iran and other countries. This was mainly due to lack of standard antimicrobial regimen, using single drug regimen, short-course antimicrobial therapy, low level of training of the patients and low access to health facilities in the region

Risk factors of Atopic dermatitis in Shahrekord schoolchildren

Atopic dermatitis is one of the common skin diseases of childhood that creates considerable side effects on patients, their families and the health care system. This study was carried out to identify both prevalence rate and risk factors of the disease in Shahrekord schoolchildren in 2003. In a cross-sectional study from all Shahrekord schoolchildren. 1500 students [750 female, 750 male] were randomly selected and the questionnaires of atopic dermatitis were distributed among the selected students and then collected after being filled by their parents then all selected students were examined by a general physician. Suspected students were examined by a dermatologist and an ophthalmologist. The serum IgE of students with any evidence of AD was then serologically tested and the collected data were analyzed with both X[2] and student-t test. The mean ages of students participated in the survey was 9.2 +/- 1.4 years. According to AD criteria, the prevalence rate was 2.1 percent [32 students]. There was no significant statistical relationship between sex and age with atopic dermatitis prevalence rate, but there was significant statistical relationship between AD prevalence rate and signs and symptoms of asthma, allergic renitis, family history of the atopic dermatitis and atopy [p<0.05]. Our results showed that atopic dermitis was more frequently seen in those individual with asthma, allergic renitis, familial history for atopic eczema or familial history for atopic dermitis. But no relationship between atopic dermitis and age as well as sex was observed