Immediate Antecedents of Intentions for Having Children in Southeast Iranian Women / 가정의학회지

Background@#Over the last decade, Iran has experienced a declining birth trend. Identifying the proximate determinants of fertility intentions among married women is informative for population studies. This study aimed to examine the importance of three immediate antecedents of fertility intention. @*Methods@#We invited 1,100 married women to complete a well-validated questionnaire based on the theory of planned behavior (TPB). The sampling framework consisted of visitors attending hospitals in two cities in southeastern Iran. Intention for having children was measured using the item “Do you intend to have a/another child during the next 3 years?” Attitude, subjective norms, and perceived behavioral control were measured using eight, three, and three items, respectively. Structural equation modeling was used to specify the model and to test the predictive ability of the TPB constructs. @*Results@#The response rate was 90.7% (N=998), and the mean±standard deviation age of the respondents was 34.8±7.4 years. More than 50% of the respondents reported intending to have a child in the next 3 years. All three TPB model constructs showed significant associations with fertility intentions. The standardized beta coefficients for attitudes, subjective norms, and perceived behavioral control were 0.74, 0.41, and 0.55, respectively. @*Conclusion@#The TPB model showed that psychological mechanisms play an important role in predicting the childbearing intentions of married women in Iran. Of the three TPB constructs, attitude was the strongest predictor of the intention to have a child.

Frequency of antibiotic associated diarrhea caused by Clostridium difficile among hospitalized patients in intensive care unit, Kerman, Iran

Aim: This study evaluated the frequency of C. difficile and CDAD in the ICU of Shahid Bahonhar Hospital, Kerman, Iran

Background: Clostridium difficile [C. difficile] is the most important antibiotic associated diarrhea agent in intensive care unit [ICU] patients. Based on its toxin producing ability, C .difficile is divided to toxigenic and non-toxigenic strains

Methods: A total of 233 diarrheal samples were collected from ICU patients. The samples were cultured on Clostridium difficile medium with 5% defibrinated sheep blood containing cycloserine [500 mg/L], cefoxitin [16 mg/L] and lysozyme [5mg/L]. The isolates were confirmed as C. difficile by polymerase chain reaction [PCR] of 16s rRNA gene and the presence of toxins genes [tcdA, tcdB, cdtA and cdtB] was also confirmed. Then, the toxin production of isolates was evaluated using ELISA

Results: C. difficile was isolated from 49 [21%] out of 233 samples. The total isolates fell into the A-/B-/CDT- [48.97%], A+/B- /CDT- [28%], A+/B+/CDT- [20.4%] and A+/B+/CDT+ [2%] types. Both types of C.difficile, A-/B-/CDT- and A+/B-/CDT-, which account for 77.5% of all isolates, were unable to produce the toxin [nontoxigenic]. On the other hand, A+/B+/CDT+ and A+/B+/CDT- [22.5%], were able to produce toxin or were toxigenic

Conclusion: The frequency of C. difficile was about 21% and only 22.4% of C. difficile isolates were able to produce toxins. It is expected that C. difficile A+/B+/CDT+- are toxigenic and related to C. difficile associated diarrhea [CDAD]. Additionally, about 4.7% of hospitalized patients in ICU suffered from CDAD, which is higher than the rates reported from industrialized countries. Notably, 28% of isolates were C. difficile A+/B-/CDT- which only carries tcdA genes without toxin production

Effect of aspirin on spinal cord injury: an experimental study

Aspirin is an anti-inflammatory drug, peroxyl radical scavenger, and antioxidant agent that inhibits phospholipases, nitric oxide synthetases, and cyclooxygenase enzymes. The existing literature contains no studies on the effects of various doses of aspirin on spinal cord injury [SCI]. Therefore, we sought to investigate the putative effects of aspirin on experimental SCI. The weight-drop injury model was used to produce SCI in 100 albino Wistar rats. The animals were allocated to five groups: a control group, where the rats did not undergo any surgical or medical intervention except for anesthesia; a sham-treated group, where laminectomy was performed without SCI and no further therapy was administered; and three other groups, where the rats with SCI received low-dose aspirin [20 mg/kg], high-dose aspirin [80 mg/kg], and a vehicle, respectively. Half of the rats were sacrificed 24 hours later, and their spinal cords were excised for biochemical studies. The other rats were subjected to Basso, Beattie, and Bresnahan [BBB] locomotor rating scale scoring once a week for 6 consecutive weeks. Aspirin decreased lipid peroxidation following SCI as the mean [ +/- standard error] catalase level was significantly higher in the high-dose aspirin group [46.10 +/- 12.01] than in the sham-treated group [16.07 +/- 2.42] and the vehicle-treated group [15.31 +/- 3.20] [P<0.05; P<0.05, respectively]. Both of the groups treated with high-dose and low-dose aspirin demonstrated a higher mean BBB score than did the control group [P<0.001] and the sham-treated group [P<0.001]. Our data provide evidence in support of the potential effects of aspirin in biochemical and neurobehavioral recovery after SCI

The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain

OBJECTIVES: Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. MATERIALS AND METHODS: Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. RESULTS: At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. CONCLUSIONS: There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain

OBJECTIVES: Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. MATERIALS AND METHODS: Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. RESULTS: At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. CONCLUSIONS: There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

Shortcomings in dealing with psychological effects of natural disasters in Iran

Natural disasters result in numerous economic, social, psychological and cultural consequences. Of them, psychological consequences of disasters will affect the lives of people long after the critical conditions finish. Thus, concerning the importance of psychological support in disasters, this study has identified problems and weaknesses in dealing with the psychological effects of the disasters occurred in Iran. This qualitative study was carried out using semi-structured in-depth interviews and focus groups. Sample volume consisted of 26 experts in the field of disaster management. Content analysis was used to analyze data. Nine major problems were identified as weaknesses in handling the psychological effects of the disaster. These weaknesses include: rescuers' unfamiliarity with the basic principles of psychosocial support, shortage of relevant experts and inadequate training, paying no attention to the needs of specific groups, weaknesses in organizational communications, discontinuation of psychological support after disaster, unfamiliarity with native language and culture of the disaster area, little attention paid by media to psychological principles in broadcasting news, people's long-term dependence on governmental aid. Disaster management has various aspects; in Iran, less attention has been paid to psychological support in disasters. Increasing education at all levels, establishing responsible structures and programming seem necessary in dealing with the psychological effects of disasters

Ethical issues in the end of life care for cancer patients in Iran

In the recent years, advances in medical technologies for end stage cancer patients' care have affected the end-of-life decision-making in clinical practice and exposed oncologists to serious ethical dilemmas. But little is known about oncologists' viewpoints in our country regarding their ethical problems in this mention. We aimed to clarify the ethical dilemmas which Iranian oncologists may face in our health care setting and to determine factors influencing decision-making process. In this qualitative study, a phenomenological approach was used. We interviewed 8 cancer specialists in teaching hospitals in Iran and used content analysis to identify codes and categorize themes in the data. During the process of analysis, three main themes emerged about ethical dilemmas in end of life care for advanced cancer patients: illness factors, socio-cultural context and patient-physician relationship. Cancer specialists identified ethical problems on several main issues, the most important of which were telling the truth in Iranian cultural context, uncertainty in end stage definition, multidisciplinary team working and cost consideration in Iranian health care system. Health care and insurance system in Iran face to end of life care challenges; therefore, health care providers and policy makers need to allocate appropriate resources and programs to improve quality of care in terminal stages. Appropriate physicians' communication skills training, multidisciplinary team working and supplementary insurance services that provide essential health care can improve the quality of care of patients with end stages of cancer. the findings of this study can help us to provide ethical policies for decision-making in end-of-life care

[Faculty evaluation by students: a review of criticisms]

Background and Objective: The aim of faculty evaluation is to improve teaching quality. One of the most common methods of faculty evaluation is student evaluation of teaching [SET]. The original purpose of SET was to provide feedback that can be used by faculties to improve their teaching [formative evaluation]. In time, this function was replaced by summative evaluation [for administrative purposes]. Using the SET results to guide improvements in the teaching process is viewed generally as an acceptable practice, but utilization of the SET results for administrative purposes is a matter of hot debate. Regarding the pivotal role of the SET results in promotion of an individual faculty this narrative review was carried out to gain an overview of critiques that have been voiced on SET. In-country studies reveal that a high percentage of faculties have criticisms towards SET so that its validity becomes questionable. According to some international studies not only the SET is an invalid measure for assessing teaching effectiveness but also it may lead to decrement in teaching quality. Nationwide studies enrolling a representative sample of Medical Universities are warranted to reply to the question that "Does administrative use of the SET results lead to improvement in teaching quality?"

Screening utility of umbilical artery Doppler indices in patients with preeclampsia

Doppler indices of umbilical artery are used as indicator of fetal well being. To compare Doppler parameters of umbilical artery including pulsatility index [PI] and resistance index [RI] in patients with preeclampsia with those of normal pregnancies and to evaluate the diagnostic characteristics of these parameters in preeclampsia. In a case control study, umbilical artery pulsatility and resistance indices were calculated at a free loop of umbilical cord in 25 preeclamptic patients and 75 uneventful pregnancies. Measurements were compared and diagnostic characteristics of the indices were determined. Mean of pulsatility and resistance index were significant higher in preeclampsia patients than the control group. Besides, patients with severe preeclampsia showed significantly higher values of PI and RI in comparison to those with mild preeclampsia. For PI, the cut-off of >/= 0.98 yielded the highest sensitivity and specificity. Also, RI of 0.64 acquired a sensitivity of 100% and specificity of 44%. Umbilical artery pulsatility index and resistance index increase in preeclampsia and these changes tend to be greater in severe preeclampsia. Umbilical artery PI and RI seem to be more appropriate in excluding preeclampsia rather than confirming it, and we propose the cut-off values of 0.98 for PI and/or 0.64 for RI, to rule-out the disease

Acceptability and side effects of cyclofem [copy right sign] once-a-month injectable contraceptive in Kerman, Iran

When family planning programmes offer a wide variety of contraceptives, contraceptive prevalence would be higher overall. To determine the acceptability of Cyclofem [copy right sign] and to evaluate its side effects and continuation rate in Iran. An introductory study of Cyclofem [copy right sign] was conducted in seven districts of Kerman Province, the largest province of Iran, in three phases. At first, 14394 women attending randomly selected urban and rural health centers representing different socioeconomic classes were invited to choose Cyclofem [copy right sign] after a standard schedule of counseling. At the second phase 418 of those who accepted Cyclofem [copy right sign] and 354 of those who refused to use the method were randomly selected to participate in an interview. At the third the first group was followed up for one year at regular one-month intervals. Nearly 12.6% [n=1809] of 14394 women counseled to choose Cyclofem [copy right sign] accepted the contraceptive method. They had a mean [ +/- SD] age of 28.5 [ +/- 6.5] years. Fear of side effects was the most common cause of refusal to use Cyclofem [copy right sign]. The one-year continuation rate was 21.2%. The three main side effects leading to early discontinuation of Cyclofem [copy right sign] were nausea [18%], prolonged menses [15.8%], and amenorrhea [14.7%], respectively. The one-year continuation rate of Cyclofem [copy right sign] use in Iran has been lower than other counties. Further research is necessary to improve continuation rates

[Proposing disciplinary charter of research misconduct: a qualitative study]

The number of research misconduct cases seems to be increasing so the need for developing a disciplinary charter of research misconduct is felt more than ever. This study was aimed to propose and develop a charter to determine types of research misconduct and dealing with them. In this qualitative study, three consensus rounds were conducted. Each round consisted of five to six qualified experts with related specialties. They included one member of academic staff with sufficient experience in research management, two experts in professional ethics, and two experts in legal affairs. Each session lasted for 1.5 to 2 hours. Based on an extensive literature review and personal experiences, the different types of research misconduct were extracted in the first two sessions and in the third round, agreement on classification of research misconduct was made In general, 49 types of research misconduct were explored and defined including 17 mild, 22 moderate and 10 severe ones. Based on the severity of each type, an appropriate penalty like "verbal warnings and summons" to "early retirement with reduced payment base" was determined. Finally the expert panel made some comments. The results of this study revealed different types of research misconduct and dealing with them. Such an understanding can lead to a better design of national charters compatible with Iranian culture and it can also be as a base for preventive interventions

Diabetic pdyneuropathy: effect of omega-3 fatty acids on nerve conduction velocity [NCV] and F-wave latency

Diabetes mellitus with the prevalence rate of 8.9-12.3% in human population, ultimately leads to the peripheral nervous system involvement in many patients. It causes various types of polyneuropathies which may manifest abnormalities such as impaired nerve conduction velocity [NCV] and prolonged F-wave latency. The aim of this study was to investigate the effect of omega-3 fatty acids on NCV and F-wave latency. This clinical trial was performed on diabetic patients referring to the Diabetes Center of Shahid Bahonar Hospital in Kerman/lran. Subjects were randomly divided to Omega-3 and Control [no treatment] group. Patients in the case group received three capsules of omega-3 daily and for the duration of 12 weeks. NCV and F-wave latency were determined in all patients before and after the treatment period. The rate of alterations in these variables in the two groups was analyzed by using statistical tests. Controlling for baseline NCV and F- wave latency measures, follow up results showed no significant difference between the Omega-3 and the no-treatment group in accordance to somatic nerve measures. No significant difference in electro diagnostic indices was found before and after Omega-3 administration. This result may be due to using the combination of docosahexaenoic acid [DHA] and eicosapentaenoic acid [EPA].Short term administration and lack of sufficient time for drug efficacy can be other probable reason. Further studies with the administration of pure forms of EPA or DHA and longer period of administration are suggested

Prevalence of waterpipe smoking among rural pregnant women in Southern Iran

To estimate the prevalence of waterpipe smoking among rural pregnant women in Southern Iran and to identify the impact of maternal waterpipe smoking on baby's birth weight. Subjects and Methods: A population-based survey was conducted in rural areas of Southern Iran in 2004 using existing health records and interviewing all mothers during the 10 days after delivery. Maternal exclusion criteria included cigarette smoking during pregnancy, a history or occurrence of epilepsy, diabetes and hypertension [gestational and/or essential] during pregnancy, factors that have been proved to have detrimental effects on birth weight. Of the 2,808 mothers interviewed, 224 [8%] were waterpipe smokers of which 90 [3.2%] and 134 [4.8%] were occasional [smoking less than once per day] and daily [at least once per day] smokers, respectively. Six hundred and seventy-four [24%] were passively exposed to waterpipe smoke during pregnancy and 322 [11.5%] were exposed to second-hand cigarette smoke. Mothers who started smoking during the first trimester had lower birth weight babies [3,215 +/- 612 g] compared to those who started smoking during the second or third trimesters [3,447 +/- 550 g, p = 0.04]. Waterpipe smoking during pregnancy is prevalent in Southern Iran and appears to be a risk factor for low birth weight babies

Investigation of medical students9 opinions on cheating and its frequency

Cheating among university students is highly common so that some experts havedescribed it as [epidemic].To determine the opinion of medical students in one of medical universities towardscheating and to estimate its frequency. A self-administered questionnaire, content valid and reliable, was distributed amongmedical students [between years 1 to 6] at the end of lectures. They were asked to estimate thefrequency of cheating among their classmates, and to show whether or not they approve thecheating behavior types on a likert scale. Of three hundred and two students participated in the study, all replied. 68% ofrespondents were female and the rest were male. The range of the students in each level was 31persons [level three] to 85 ones [the sixth level]. According to the findings, [attendance of anotherperson in the exam session], was the most rejected cheating type [x =4.13] and the most approvedtype of cheating was [not informing the teacher about the wrong higher score][x=2.63].A considerable rate of students [about 50%] approved some types of cheating. The relativefrequency of some types of cheating has been estimated to about 50%. Comparing the studentsopinions showed no significant difference in terms of sex. Paying attention to cheating among students is necessary

[ opinions of medical interns about the acquired basic clinical skills]

Establishing centers for clinical skills training in medical schools with the purpose ofimproving students' ability in practical skills has provided an adequate environment for practicing in anexperimental setting and consequently can be effective in decreasing the rate of probable mistakes in realsituations.The aim of this study was to determine the opinions of interns in Kerman University of MedicalSciences about the rate and sources of acquired basic clinical skills through self- evaluation.All available interns of Kerman School of Medicine [including 120 ones] who had passed theclinical skills course participated in this cross- sectional study in 2004. Data were gathered by an investigator-made questionnaire and analyzed by using t-test and ANOVA.Based on the results, most of the respondents [90.8%] believed in the necessity of a specific courseAS clinical skills in medical education program. In regard to the rate of acquired skills, "vital signsmeasurement", "nasogastric tube insertion" and "patient communication skills" got the highest mean scores[18.35, 17.76 and 17.3 respectively] in interns' self-evaluation, while the lowest mean scores belonged to'cauterization", "intubation" and "using surgical set" [9.09, 12.84 and 14.11 respectively]. The percent of self-evaluation total score was 76.7%. In regard to the source of acquiring clinical skills, "clinical skills center" [41%], "self- learning" [29%] and "professors and others" [27%] obtained the highest percents respectively.Considering the low self- evaluation scores in some skills and the highest percent for clinical skills center as source of acquiring clinical skills, improving the quality of training in this center and expanding its activities are necessary

[Investigation of medical students opinions on research fraud in thesis and its frequency]

Tomorrow doctors or today student should be honest in all the aspects of academic work including conducting a research project and writing the thesis. This study was conducted to explore the prevalence of research fraud among medical students according to their subjective experiences and to clarify the attitudes of them tow wards the issue. A questionnaire which its reliability and validity were confirmed, was distributed among 104 interns. It consisted of 7 items concerning major types of research fraud which were determined based upon an extensive literature review and a focus group discussion with interested medical students. They were asked about the prevalence of each type of the research misconducts and their prevalence among medical students. The response rate was 100% Fifty four percent of the respondents were female. Fabrication of data and falsification of the findings were reported to be as high as 37 and 40 percent, respectively. The subjectively estimated prevalence of plagiarism was between 25 to 50 percent. About 58 percent of them approved copying others' work whilet 71 percent of them disapproved unethical research behavior towards the patients. If the results could be generalized to the whole country they might be regarded as a major educational and ethical problem. The result warrant further research and concern about the mandatory research system and alternative approaches

[Comparison of student assessment of educational performance of the faculty with the teacher's self assessment in kerman University of Medical Sciences]

Investigation of the opinions of individuals involved in education [faculty and student] makes the assessment of the faculty, educational performance more valid and help us improve quality as an objective of evaluation. A method to decrease subjectivity in evaluation of teachers by student is self assessment, especially when evaluation aims to find shortages and help to improve education. This survey is to compare the self assessment of the faculty with student assessment about the faculty teaching method. To do this descriptive-analytical study, two questionnaires with ten questions in four categories designed in EDC were randomly distributed among 600 students and 160 faculty members teaching theory lessons. 1530 questionnaires were returned by students and 137 questionnaires by the faculty members. Data were analyzed using t and, Man-Whitney U tests and Spearman's, correlation confident. The mean of self assessment score of the faculty was more than mean of student evaluation score about their teachers [4.28 +/- 0.49 vs 3.39 +/- 0.51, P<0.0001]. There was a significant although poor relationship between students and teachers assessment on evaluation by student [r = 0.25, P<0.05] and discipline [r = 0.25, P<0.05]. But there was no significant relationship between teaching method and scientific level of the faculty [P>0.5]. In this survey, the scores the faculty members considered for themselves were higher than the scores the students assigned to them and the faculty's satisfaction on teaching methods and scientific performance is different from what the students considered. In this way presenting an appropriate evaluating system, using various methods of evaluation and giving proper feedback to the faculty is necessary