Strategies to avert preventable mortality among mothers and children in the Eastern Mediterranean Region: new initiatives, new hope

We conducted an assessment of maternal, newborn and child health and progress towards achieving Millennium Development Goals [MDG] 4 and 5 in the Eastern Mediterranean Region [EMR]. We provide recommendations for scaling up and sustaining gains post-2015. Data were obtained from global data repositories. We constructed time trends from 1990 to 2013 and evaluated inequities across the Region. Under-5, neonatal and maternal mortality rates decreased 46%, 35%, and 50% respectively from 1990 to 2013. Pneumonia and diarrhoea accounted for 50% of all post-neonatal deaths; pregnancy- and delivery-related complications were the leading causes of neonatal and maternal deaths. Coverage of maternal, newborn and child health interventions is suboptimal, and poverty, food insecurity and conflict are pervasive across the Region. The EMR has made progress but is unlikely to attain MDG 4 and 5 targets. To sustain and further accelerate gains, the Region must reduce inequities and scale up implementation of recommendations made by the independent Expert Review Group

[Development of a picture receptive vocabulary test and evaluation of its validity and reliability for normal 36-71 months Persian children]

Vocabulary assessment is one of the most important screening indexes and language evaluation. Receptive vocabulary has a strong correlation with verbal intelligence and it is a strong predictor of children future academic achievement specially in reading comprehension. The goal of the current study was to develop a picture receptive vocabulary test and to evaluate its validity and reliability for normal 30-71 months Persian children. The type of this study is test construction which was conducted in descriptive- analytic method. In this study, 91 normal Persian children aged between 30 and 71 months in 7 age groups, with a 6- month-age interval participated. For developing Persian picture receptive vocabulary test, words were extracted from books and dissertations which were related to our study, afterward one picture was selected for each word. In order to consider selected picture validity, test with a questionnaire was sent for professional speech and language pathologists. At the end, final edition of the test was administered to 7 age groups. Test retest reliability and correlation between A half and B half were calculated using Spearman Rank- order correlation. In order to consider the effect of age on total scores, Kruskal Wallis test was administered and to investigate the relation between gender and total scores independent sample t test was applied. The results of this study indicated that Persian picture receptive vocabulary test is valid and reliable. [CVI=1], test retest reliability=0.81 and split- half reliability =0.91 .This study provided evidence that there is a significant difference [p=0/000] between different age groups scores, and there is no significant difference [p=0.08] in total scores between genders. Persian picture receptive vocabulary test can show differences in vocabulary comprehension ability in the study age groups

[ investigation of effect of non-word length and syllable structure on frequency of disfluency in adults with stuttering]

Stuttering is one of the most prevalent speech and language disorders. Etiology of stuttering has been surveyed from different aspects such as biological, developmental, environmental, emotional, learning and linguistic. Literature shows that word length and syllable structure as linguistic features may influence frequency of disfluency in this disorder. Therefore, the aim of this study was to determine the effect of non-word length and syllable structure on frequency of disfluency in adults with stuttering. This cross- sectional descriptive- analytic study was performed on 18 adults who stutter with the age ranged between 20 to 39 years. Disfluency frequency was evaluated by asking the subjects to read a list contained 24 non- words. The non-words were selected based on word length [two and five syllables] and syllable structure [simple and difficult]. The obtained data were statistically analyzed through paired t-test using SPSS statistical software. The results showed that there was a significant difference between the frequency of disfluency in two and five syllable groups of non-words list [p=0.000]. There was a significant difference in the frequency of disfluency between simple and difficult syllable structure in two and five syllable groups of non- words list [p=0.000]. The findings of this study indicate that speech motor system performance in adults who stutter is affected by certain linguistic features such as word length and syllable structure

Psychological responses to breast cancer: a qualitative study

Background and objective: Breast cancer has high incidence among Iranian women and their long term survival lead to have more challenges with cancer complication. This qualitative study aimed to identify psychological responses following breast cancer

Materials and methods: A qualitative phenomenological method has been designed for the study. A sample of 11 women with breast cancer by purposive sampling selected and semistructured in-depth interviews were conducted. The interviews were transcribed verbatim,then Information have been analyzed during 5 steps using smith's method

Results: Two main themes emerged from the interviews included basic reactions and residual reactions and The following six sub themes of despair of life, trying to find a guilty, social isolation, irritability-sensitivity, feeling incompetence and fear of disease recurrence has been determined

Conclusions: Although breast cancer is a physical disease but it has great impact on a person's mental health. Also So many psychological problems caused by breast cancer and its treatment, remains until many years after completion of therapies

[ effect of empowerment programs on geriatric depression in daily rehabilitation Farzanegan center of Khorramabad city]

This study examined the effect of empowerment programs on geriatric depression in daily rehabilitation center Farzanegan of Khorramabad city. In this interventional study, 40 elderly subjects were participated in the city of Khoramabad with a mean age of 65 years old. They were 8 men and 12 women in each group. These people have the ability to perform common tasks without dependence on others and they had no systemic and restrictive disease. Subjects randomly divided into two groups [case and control]. In case group, empowerment programs was performed for 40 days and 3 hours in a day. Empowerment program included lifestyle education, rehabilitation services, support services, cultural, sports, arts, tourism and leisure services. Part of the program was general such as training of healthy lifestyle and daily exercise and another part of services was presented based on assessment and diagnosis of treatment and rehabilitation team. This program was produced by designers and experts from the office of country welfare elderly. Depression scores in both group, before the intervention and at the end of intervention was assessed by the beck depression inventory. Using the empowerment program, depression scores were reduced after intervention [P

[ effect of neurofeedback training and neurofeedback with occupational therapy based on cognitive rehabilitation on executive functions in autistic children]

Many key problems in autistic children are related to executive dysfunction. This dysfunction is usually occurred due to structural and functional dissociation between brain regions. So neurofeedback can be used as a new treatment procedure in improving children's executive function through modifying brain waves but behavioral changes are usually reflection of long-term changes in the brain level. Therefore the purpose of this study is to investigate the overall effect of neurofeedback training and behavioral effects caused by adding occupational therapy based on cognitive rehabilitation. Single system [A-B-A-B+C-A] design was used in this study. Participants were 2 children with autism spectrum disorder who completed 41 sessions during the study. They received neurofeedback intervention alone [B] during 20 sessions and in the following 12 sessions neurofeedback with occupational therapy [B+C]. In this study, Wisconsin card sorting and tower of london tests were used for collecting information on children,s executive functions. According to the obtained results, the effect size of neurofeedback training on executive function was high for both participants. The rate of shifting attention was improved as one of the executive function items after adding occupational therapy and also the increasing effect of neurofeedback in planning was maintained. The results of this study showed that neurofeedback can improve executive function in autistic children and the effect of neurofeedback can be more obvious if occupational therapy will be added. But gaining more significant behavioral changes after receiving occupational therapy needs more sessions

[Factors affecting quality of life in elderly diabetic residents of the Kahrizak Geriatric Nursing Home of Tehran]

Investigating problems of the elderly, as they age is very important, since any chronic disease can affect their quality of life. Diabetes is one of the diseases that affects the physical, mental and social aspects of such individuals. This descriptive analytical study was conducted on elderly diabetic residents of the Kahrizak Geriatric Nursing Home during 2011. A total of 93 individuals, selected randomly, completed demographic and the World Health Organization quality of life questionnaires. Data were analyzed by SPSS16 software, using t-test and ANOVA. In this study, 34 men and 59 women, average age 74.2 +/- 8 years, were evaluated in different domains of quality of life. Based on data analysis, men earned higher scores in the physical domain [P=0.017]. Social domain had a significant [P=0.009] relationship with marital status and married individuals had higher scores. There was a significant correlation between the income and quality of life in the mental domain [P=0.035], but no significant relationship was found between educational status and quality of life. The increasing rate of elderly diabetic populations among geriatrics groups, indicates the urgent need for strategic planning of interventions aimed at improving of environmental, social, physical and mental status of these age groups

[Measurement of the components of community-based rehabilitation [CBR]: a factor analysis]

Community-based rehabilitation is a strategy that can help satisfy the needs of people with disabilities within the community in every nation. Measurement of the components effective on the community-based rehabilitation in Iran. This descriptive, analytical and cross-sectional study was performed in two stages in 2011. The owners of qualitative step were 45 expert and factor analysis step were 564 CBR experts CBR responsible expert rehabilitation authorities of 31 provinces CBR experts and rehabilitation assistant of the studied city. Data were collected by a developed questionnaire. The validity of its content was assessed as Expert panel and their credit structures by exploratory factor analysis [main component analysis] using alpha internal parallelism of Coranbach. For adequacy of sample size Keiser Mayer Olkin scal and for suitable data, Bartlett test were used. In exploratory factor analysis we identified 7 acceptable factors with special values more than1and total variance of%61/84. 54 items with acceptable factor load[more than 0/4] were under this 7 factors. These 54 items are considered as effective factors on community-based rehabilitation and finding trust step for all 7 factors with respective items achieved appropriate reliability coefficient [greater than%0/84]. The use of semi-professional [expert community], social and political support, educational services, financial supply, health services, medical services and social integration of the disabled people, approperiate for cultural, economic, political and social contexts of our country can empower the disabled people, promote human dignity of them and their families in the community

[Repeatability assessment of quantified measurement method in hand drawing skills]

Because of high incidence of hand injuries and the need for a quantitative method that provides measures of patient improvement in treatment period a precise and easy-to-apply quantitative procedure is necessary. As a first step in validating of such a method, the intersession repeatability of quantified measures was assessed in this study. Measurement of hand drawing skills by drawing circle shape in two speeds [preferred and maximum] and spiral shape just in a preferred voluntary speed with two repetitions for each subject was assessed in 15 subjects. Digital data was recorded by a Tablet PC using special software with average sampling rate of 120 Hz. The quantified variables computed for circle and spiral drawing tests with preferred speed were reliable [0.55 < ICC < 0.85], so they can be used for drawing quantifications. Results of drawing circles with maximum speed were not reliable [ICC < 0.5]. Repeatability analysis revealed that measures based on drawing circles with maximum speed are not repeatable and cannot be used for process monitoring. This may be due to large variation in providing maximum drawing speed during test time. On the other hand, spiral and circle drawing parameters with preferred speed had a better repeatability and can be used for quantification of hand drawings in researches

[Identification of substances in the essential oil and antibacterial activities of heptaptera anisoptera [DC.] Turin]

Heptaptera anisoptera from Umbelliferae was growth in some spaces of Iran. Some researches have been carried out on the herb about isolation and structure elucidation of some phytochemicals. There isn't any report about identification of substances in the essential oil and antibacterial activities of this plant. Identification of substances in the essential oil and antibacterial activities of Heptaptera anisoptera [DC] Turin. Literature survey has shown that the herb has not previously been investigated for essential oil and antibacterial activities. The essential oil of aerial parts from Heptaptera anisoptera [DC] Turin. [Umbelliferae] was obtained by hydrodistillation. The oil was analyzed by GC/MS. The effects of methanol, chloroform and hexane extracts of this plant were tested on 10 G[+] and G[-] bacteria in different dilutions. 91.3% of the oil [10 components] was identified. Method of identification was based on comparison of the mass spectra and retention indices of the components with standards. Thymol [48.8%], 3-carene [17.6%], phytol [7.9%], methyl linolenate [5.6%], and methyl palmitate [4.7%] were the major components. None of the extracts are any effect on tested bacteria. While thymol is the major component of some herbs such as thymes and ajowan, other plants can have thymol as major component. In the oil of thymes, carvacrol is reported, too, but it didn't identify in the oil of H. anisoptera. Similar to other essential oils, monoterpenoides were major compounds. As a result of use of long time for oil extraction [3 hours], non-terpenoides components [diterpenoide, fatty acids and esters] came in the oil, too. Despite the fact of antibacterial activity of plants, none extract of H. anisoptera in 4 test models, have significant antibacterial effect

Direct technetium radiopharmaceuticals production using a 30MeV Cyclotron

Technetium-99m is the major radionuclide used in the world and mainly is provided by fission product. However extensive research has been conducted on the use of accelerators for production of [99m]Tc. This investigation reports the production of [99m]Tc radioisotope using cyclotrons followed by the preparation, quality control and biodistribution studies of four major Tc-radiopharmaceuticals. The high purity molybdenum natural target [130mg/cm[2]] was irradiated in a Cyclone 30 accelerator using 160 microA of 25 MeV proton beam energy for 1000 microA-h. After dissolution, the technetium radionuclides were extracted using methyl ethyl ketone [MEK] followed by preparation of Tc-MIBI, Tc-DTPA, Tc-DMSA and Tc-phytate as radiopharmaceutical samples. The results of quality controls and animal biodistribution studies showed successful production of Tc radionuclides [including [99m]Tc] in the bombarded target and subsequent labelling of the kit with Tc. The developed high power Mo target if constructed using enriched [100]Mo, could be a practical method for large-scale production of [99m]Tc and promising as an alternative to fission product [99m]Mo- [99m]Tc generators for local applications near cyclotron facilities

[Public health customers' experiences of health accessibility: a phenomenological study]

Custom-orienting is a critical issue for public health service. Peoples with a variety of developmental health care needs and perspectives are health care clients. Health accessibility through "Primary health care" has been approved and emphasized in Alma Ata in 1978. It is important to have a clear and transparent understanding of clients' health needs and problems that would enable us to address such needs and prevent the negative consequences that might otherwise ensue. The aim of this study was to understand and gain deeper insight into health service customers' lived experience of public health accessibility. This study has been conducted with a phenomenological approach. Max van Manen six steps method of hermeneutic-phenomenology has been used. Nine health care clients were selected purposefully and interviewed semi-structured. The results of this experiment revealed the following six themes: to encounter with holistic learning chance, custom-oriented communications, qualified health care service, appropriate time-place health services, equality- orienting, and individual participation. The participants believed that health accessibility is something more than just to have health services. Therefore, health education and social equality will bring about optimum health services. To develop multi-dimensional learning and to promote individual participation will be useful for more community empowerment

[Effect of adjustable wrist hand splint on upper limb spasticity in post stroke patients]

Spasticity is common problem in stroke patients. Spasticity couse dysfunction and restricted activity. The most of patients have hand dysfunction due to stroke. This study was done to determine the effect of adjustable wrist hand splint on upper limb spasticity in post stroke patients. This randomized clinical trial study was carried out on 15 patients with stroke referred to rehabilitation centers in Tehran-Iran during 2009. Patients randomly were divided into interventional [4 female, 3 men] and control [5 female, 3 men] groups. Common occupational therapy practice was carried out for 4 weeks for both groups equally. In treatment group intervention was based on the use of adjustable wrist hand splint moreover common occupational therapy practice. Upper limb spasticity pre and post intervention based on the Modified Ashworth Scale was evaluated. Data were analyzed by SPPS-17 software, pair-t-test and independent t-test. Mean age of patients in interventional and control groups were 61.37 +/- 4.10 and 58.85 +/- 5.01 years respectively. After 4 weeks of treatment, the mean of spasticity was not significant between interventional and control groups, but internal analysis of spasticity were significant in interventional and control groups [P<0.05]. This study showed that the adjustable wrist hand splint is not useful in reduction of upper limb spasticity in post stroke patients

[Effect of barley [Hordeum vulgare l.] seed extract on fasting serum glucose level in streptozotocin induced diabetic rats]

diabetes mellitus and its related disorders are associated with significant burden on individuals and health care system. In Traditional Iranian Medicine [TIM] the consumption of barley products has been recommended for treatment of diabetes mellitus. The aim of this study is to examine the effect of oral barley seed aqueous extract on fasting serum glucose level and body weight of normal [non-diabetic] and Streptozotocin-induced diabetic rats. Forty male wistar rats were randomly divided in to diabetic and non-diabetic group. Diabetes was induced by single intraperitoneal injection of 45 mg/kg Streptozotocin. After one week the diabetic group [fasting blood glucose more than 200 mg/dL] and non-diabetic group were randomly divided in to control group and barley seed extract group. Body weight and fasting serum glucose level were measured and compared among groups at 1[st], 3[rd] and 4[th] weeks of study. Significant reduction [p<0.05] of fasting serum glucose level was seen at 4[th] week of treatment with aqueous extract of barley seed in diabetic rats in comparison with diabetic control group. In non-diabetic group, significant reduction [p<0.05] of fasting serum glucose level was seen after one week treatment comparing to non-diabetic control group. No significant effect was detected on the body weight of diabetic and non-diabetic groups. The aqueous extract of barley seed significantly reduced serum glucose level after 4 weeks in diabetic and after 1 week in non-diabetic group. In non-diabetic rats this reduction was not continued after first week

Removal of cadmium and humic acid from aqueous solutions using surface modified nanozeolite A

The sorption of cadmium and humic acids from aqueous solutions using surface-modified nanozeolite A has been investigated under various examination conditions. The morphology of untreated and treated nanozeolite was studied under scanning electron microscope and transmission electron microscope. Isotherms of cadmium adsorption onto surface-modified nanozeolite A were studied at different pH, solid to liquid ratio, adsorbate concentration and interaction time. Kinetic and equilibrium studies were conducted and the equilibrium data have been analyzed using Langmuir and Freundlich isotherm models. The study revealed that experimental results were in agreement with the Freundlich model. The Langmuir monolayer adsorption capacity was found to be 1666.67 g cadmium and 6.75 g humic acid per gram of modified nanozeolite A, which is higher than that of reported value for other zeolites. The sorption ability was enhanced by surface modification and reduction in size and enabled the zeolite to adsorb cadmium. The adsorption of cadmium and humic acid on nanozeolite was found to be the highest at pH 6 and 3, respectively. Results showed that solid to liquid ratio and pH are the most important factors for cadmium and humic acid removal, respectively. Effect of competitive ions was studied and results showed that there is no competition between cadmium and humic acid sorption and presence of these ions

[Cloning of catalytic domain of exotoxin A from pseudomonas aeruginosa]

Antibody against Pseudomonas aeruginosa exotoxin A can be used in immunotherapy together with antibiotics to treat acute burn patients. Exotoxin A is one of the virulence factors in Pseudomonas aeruginosa that comprises of three domains, binding domain, translocation and catalytic domain. The purpose of this study was to construct the recombinant domain of the catalytic part of this microorganism in order to produce antibody against it. Pseudomonas aeruginosa samples were isolated from burn patients hospitalized in Mousavi Hospital, Zanjan, Iran and its species was identified by Biochemical tests. Bacteria genomic DNA and also the catalyhc domain of exotoxin A was amplified by PCR. PCR Products and plasmid extracts was digested by restriction enzymes. Subsequently PCR products and plasmids transformed into E. coli BL21 [DE3]. Clones containing gene of interest was determined by restriction enzyme digestion and sequencing. The sequence homology of the catalytic domain of exotoxin A was compared with that of the published gene data bank. The results showed a complete homology between our gene species and the published genome in data banks. The results of this study showed that about 90% of the isolated bacteria contained exotoxin A and there was a sequence homology between our species and published gene data banks

[Oculomotor function in idiopathic Parkinsonian patients]

Parkinson could be regards the most prevalent degenerative disorder in the central nervous system. In addition to neuromuscular disorders, some degree of oculomotor dysfunction may be observed in these patients. The assessment of oculomotor system function may provide a viewpoint about the balance status of Parkinosonian patients and cold be regarded as an appropriate tool for the extent of movement disorders. The purpose of this study was the evaluation of oculomotor system in patients with idiopathic Parkinson's disease. Certainly, better understanding of mechanisms involved in this disorder, may help in designing rehabilitation programs and quality of life increment in these patients. In an analytic cross-sectional study, 30 patients [M:18, F: 12] with idiopathic Parkinson's disease and 30 [M: 20, F: 10] normal subjects, aged 35-70 years, were evaluated. Gain and phase of smooth pursuit eye movements [during horizontal and vertical situations] were recorded in 0.2 Hz velocity for all participants. Independent T and man-Whitney U tests [when the data distributions were not normal] were used for the comparison of mean gain and phase of responses between groups. Data analysis was carried out by SPSS 15. The average of pain, except for horizontal right eye condition, in normal subjects was significantly higher than patients with Parkinson's disease [P < 0.05]. Additionally, the average of phase, except for horizontal right eye condition, in patients with Parkinson's disease was significantly increased compared to normal subjects [P<0.01]. Serious oculomotor system dysfunction, both in horizontal and vertical situations, in idiopathic Parkinsonian patients may representative of dopaminergic control decrement in these patients

[Water extract of juglans regia L. and diabetes mellitus in Iranian traditional medicine]

There are many reports about the glucose lowering effects of medicinal plants in animal models. There are a some reports in Iranian traditional medicine about glucose lowering effect of septum water extract of Juglans Regia L. In the present study, effect of aqueous extract of the septum of Juglans Regia L. on plasma glucose is assessed. After preparing the water extract of Juglans Regia L. and concentrating of it the lyophilized extract, was tested in diabetic [ip injection of streptozocin] and normal rats. Comparison between groups was made by analysis of variance [ANOVA] and the differences between the means assessed using student's t test. In an oral glucose tolerance test [OGGT], a single oral administration of the water extract at doses of 50, 250 and 750 mg/kg body weight didn't lowered the plasma glucose level in the normal rats. Although that insulin administration [5IU/kg] caused a reduction of serum glucose[P<0.001], none of the extract doses [1000, 750, 500, 250mg/Kg] could cause a significant reduction in such level [P>0.005]. These results demonstrated that the water extract of the septum of Juglans regia's fruit didn't have a significant hypoglycemic effect in rats

[ effect of "sitting pelvic tilt exercise" on low back pain and sleep disorder in primigravidas during the third trimester]

Low back pain is one of the most common complaints in pregnancy that interferes with work, daily activities and sleep. The aim of this study was to determine the effect of sitting pelvic tilt exercise on low back pain and sleep disorder during the third trimester in primigravidas. In this quasiexperimental study, 60 primigravidas who attended 3 prenatal clinics of Zanjan University of Medical Sciences, Zanjan, Iran, were selected by simple sampling, then they were randomly allocated into two groups, case and control. The case group did the sitting pelvic tilt exercise for 8 weeks during the third trimester. The control group just received usual prenatal care. Data collection was done by interview, using a Visual Analogue Scale [VAS] and a questionnaire which was carried out by the researcher on 0 and 56 days [pre and post intervention]. T- Test and Chi Square were used for data analysis. The intensity of low back pain in the case group after exercise was significantly decreased [P=0.0001], but in the control group, the intensity of low back pain increased as pregnancy advanced [P=0.0001]. Also in the case group, sitting pelvic tilt exercise reduced the sleep disorders in comparison with pre treatment and control group [P<0.05]. It seems that sitting pelvic tilt exercise is an imperative cure in pregnancy low back pain and sleep disorders that arise from it

[Chemical components of essential oil and antimicrobial effects of rhizomes from cyperus rotundus L.]

Cyperus rotundus L. belongs to Cyperaceae family, which grows in around of Iran and its roots with other herbs uses as antiflatulant and nervous tonic. Identification of chemical components of essential oil and antimicrobial effects of rhizomes from Cyperus rotundus L. The roots and rhizomes of C. rotundus were purchased from Tehran herb shops in June 2007. After confirmation, the essential oil was obtained by hydrodistillation and was subjected to GC/MS. The antimicrobial effects of the root extract were studied on Salmonella, Escherichia coli, Micrococcus luteus, Staphylococcus aureus, Aspergillus niger and Cladosporium herebaceum. The major components of the essential oil were found alpha-cyperone [32.0%] and spathulenol [11/0%]. The study of antimicrobial activity showed that the methanolic extracts have effects on Micrococcus luteus and Staphylococcus aureus, but any effects on Salomonella, Escherichia coli, Aspergillus niger and Cladosporium herebaceum were not showed. 25 Components [91.2% of the oil] were identified, totally. Sesquiterpenoides are major components [0.82%], and then monoterpenoids [8.8%]. Alpha-cyperone as major compound of our oil, was identified in the other research on oil of C. rotundus. Inhibitory concentrations for Micrococcus luteus and Staphylococcus aureus were 31.25 and 125 mg/ml