Eclectic approach to anxiety disorders among rural children / Abordagem eclética a transtornos de ansiedade em crianças de zona rural

Abstract Introduction Anxiety disorders in primary school-aged children negatively affect their mental health and psychological development. Available non-medical treatments for these conditions are time-consuming and expensive. In this context, eclectic therapy is a therapeutic approach that incorporates some therapeutic techniques and philosophies to create the ideal treatment. In this study, eclectic therapy consisted of art therapy and cognitive-behavioral therapy designed for children suffering from high level of anxiety in their middle childhood years. The therapy also included group guidance sessions for their mothers. The effectiveness of this intervention was examined in the study. Methods 61 students aged 9-12 years with high levels of anxiety participated in the study. Intervention A (n = 20) consisted of 9-hour eclectic therapy for children with 3-hour group guidance sessions for their mothers. Intervention B (n = 20) consisted of 9-hour eclectic therapy for children. There was also a control group (n = 21). Results Teacher ratings of children's mental health difficulties and self-report ratings of anxiety disorders indicated a significant difference from pretest to posttest, revealing a large effect size between the two interventions. Higher levels of pretest scores significantly predicted higher posttest scores for all domains of anxiety and mental health difficulties. Furthermore, age, gender, mothers working a 15-hour day, mother's educational level, parental divorce rates, parental death, and family monthly income predicted therapy outcomes. Conclusion Results provide support for the effectiveness of eclectic art and CBT to improve children's mental health and reduce anxiety through changing thoughts, beliefs, emotions, and behaviors that may cause fear and anxiety.

Resumo Introdução Transtornos de ansiedade em escolares afetam sua saúde mental e seu desenvolvimento psicológico. Tratamentos alternativos disponíveis consomem tempo e são dispendiosos. Nesse contexto, a terapia eclética é uma abordagem terapêutica que incorpora algumas técnicas e filosofias terapêuticas para criar o tratamento ideal. Neste estudo, terapia eclética consistiu de terapia artística e terapia cognitivo-comportamental (TCC) planejada para escolares com altos níveis de ansiedade. A terapia também incluiu sessões de orientação em grupo para as mães. A eficácia da intervenção foi examinada. Métodos 61 escolares com idade de 9-12 anos e altos níveis de ansiedade participaram do estudo. A intervenção A (n = 20) consistiu de 9 horas de terapia eclética para crianças com sessões de 3 horas de orientação em grupo para as mães. A intervenção B (n = 20) consistiu de 9 horas de terapia eclética para crianças. Houve também um grupo controle (n = 21). Resultados Escores atribuídos pelos professores às dificuldades de saúde mental das crianças e escores de ansiedade autoaplicados indicaram diferenças significativas entre resultados pré-teste e pós-teste, revelando grande tamanho de efeito entre as duas intervenções. Escores pré-teste maiores foram preditores significativos de escores pós-teste mais altos para todos os domínios de ansiedade e dificuldades de saúde mental. Idade, gênero, mães trabalhando 15 horas/dia, nível educacional da mãe, índice de divórcio, morte de um dos pais e renda familiar mensal foram preditores de desfechos da terapia. Conclusão Os resultados sugerem a eficácia de arte eclética e TCC para melhorar a saúde mental de crianças e reduzir a ansiedade através de mudança em pensamentos, crenças, emoções e comportamentos que possam causar medo e ansiedade.

Short and long term evaluation of the efficiency of PermaNet® 2. 0 bed net against environmental factors and washing using bioassay tests

ABSTRACT The aim of the present study was to examine the resistance of PermaNet® 2.0 bed nets against repeated washing and environmental factors by using bioassay tests. After 5, 15 and 21 washings with detergents and by using bioassay tests, the resistance of 40 PermaNet® 2.0 bed nets was compared with that of 40 bed nets conventionally treated with one K-O tablet. To examine the long-term resistance, 31 PermaNet® 2.0 bed nets were also distributed among villagers, and were re-collected to perform bioassay tests after 1, 2 and 5 years. In the first phase of this study, the insecticidal effect of the conventionally-treated nets significantly decreased due to repeated washings (P < 0.001); however, it was not significant regarding PermaNet® 2.0 bed nets (P = 0.92 in continuous exposure and P = 0.12 in mortality tests). In the long-term phase of this study, the time required for knockdown of PermaNet® 2.0 increased over the first 2 years and then decreased. In addition, the mortality rate decreased over the first 2 years and then increased. In conclusion, it seems that the technique used by the manufacturer for impregnation of PermaNet® 2.0 bed nets has an acceptable efficiency in comparison with conventional techniques.

The internal consistency of medical students' scores in their physiopathology and clinical courses.

Background: To quantify the internal consistency of medical students' scores. Aim: We assessed the associations between medical students' scores in physiopathology and clinical courses and compared these scores with their scores in their comprehensive exams. Settings and Design: We collected medical students' scores in their courses and also in their comprehensive exam in six consecutive years. Materials and Methods: We assessed the associations between students' scores and their personal characteristics, and the consistency between theoretical and practical courses. Statistical Analysis: We used Pearson correlation coefficient and linear regression. In addition, we computed difficulty and discrimination indices of students' scores in their courses by comparing these scores with comprehensive clinical exam (CCE). Results: Generally, females and younger students were more successful. CCE were predicted by students' scores and their characteristics relatively accurate (the adjusted R2 of the model was 0.59). Students' scores in the pathology and in thesis had the maximum and minimum discrimination indices, while the difficulties of these two courses were in reverse order. The strongest association was observed between theoretical and practical scores in internal medicine while the associations between theoretical and practical scores in the other courses were not strong although all of them were statistically significant. Conclusions: Using this approach to explore the students' score, might highlight the weak points of the current educational system. For example we found that the students' score in thesis had the minimum accuracy; although students obtained very high score in this course. Hence, for better comparison of the accuracy students' scores in colleges around the world, we recommend similar quantitative approach.

Estimating the relapse risk of Plasmodium vivax in Iran under national chemotherapy scheme using a novel method.

OBJECTIVES: This study aimed to estimate the relapse risk of Plasmodium vivax under national chemotherapy scheme using a novel method, and assessed its pattern in Kahnooj, a malaria endemic area in Iran. METHODS: The authors traced repeated episodes of malaria attack between 1994 and 2001 and then, estimated the risks of secondary attack of P. vivax, classified by the species in their primary attack. It is suggested that the difference between the secondary attack rate in those who were infected by P falciparum and P. vivax in their primary attack may estimate the P. vivax relapse rate indirectly. RESULTS: This method showed that the relapse risk of P. vivax with in one and two years after the primary attack were 16.8 and 24.5% respectively. The risks of relapse before three or after 18 months were very low. INTERPRETATION & CONCLUSION: The relapse pattern of P. vivax was compatible with the dominant pattern in most of the temperate areas. In addition, the relapse risk was very close to the estimated relapse risks in clinical trials on anti-relapse drugs. Therefore, we concluded that the anti-relapse therapy in the study area was effective; also, this method may estimate the relapse risk of P. vivax accurately.

Comparing the results of light microscopy with the results of PCR method in the diagnosis of Plasmodium vivax.

BACKGROUND AND OBJECTIVES: Although polymerase chain reaction (PCR) is a new technique in the diagnosis of malaria with very high accuracy; light microscopy is still conventional diagnostic method in Iran. In this study we checked the accuracy of light microscopy using the results of PCR as gold standard in Iran. METHODS: The blood samples were collected from 124 febrile cases in Kahnooj district. The blood slides were read by microscopists, and double checked by experts in provincial referral laboratory. DNA samples were processed by PCR to amplify species-specific sequences of 18s subunit ribosomal ribonucleic acid (18ssrRNA) genes of Plasmodium vivax and P. falciparum. RESULTS: The sensitivity and specificity of microscopy in the detection of Plasmodium spp infection were 77% (95% CI: 46-94%) and 100% (95% CI: 95-100%), correspondingly. Also, the estimated positive and negative predictive values were 100% (95% CI: 66-100%) and 97% (95% CI: 91-99%), respectively. INTERPRETATION AND CONCLUSION: According to these results, we believe that the accuracy of light microscopy in the diagnosis of malaria in Kahnooj was acceptable. Expert micorscopists in endemic areas of Iran such as Kahnooj and available equipments in one hand and expensive PCR test on the other hand may convince that in current situation we do not have to change the diagnostic method.