[Assessing satisfaction, technology usability, and therapeutic alliance in Tele-psychotherapy from patients' and counselor's perspective]

Introduction: telemental health is one of the most successful aspects of telehealth. In this study, we focus on family therapy as a branch of psychotherapy and analyze its efficacy in telecommunication settings

Methods: this is a descriptive study conducted between October 2014 and February -2015. The sample of the study consisted of 30 patients having family therapy sessions via an internet based connection in a clinic in Mashhad. Data were collected by a questionnaire. The content validity of the questionnaire was established using a panel of 3 experts, and reliability was assured with internal consistency method. We also conducted a semi-structured interview with the psychotherapist in order to obtain his opinions on this method

Results: the findings on three indices examined in this research showed that 80 percent of participants were satisfied with the interviewee/interviewer interaction, 73.3 percent of participants rated usability of the technology as moderate to high, while 93.3 percent of the participants reported high satisfaction with this method of telecounseling. The open-ended questions and the debriefing interview with the psychotherapist were reviewed, and general features of responses were extracted and classified

Conclusion: Iran with the wide land area and considerable number of rural and deprived areas, has a good potential to benefit from telehealth advantages. As it is the first study examining the efficacy and acceptability of telepsychotherapy in Iran, further research is needed in order to examine other aspects of this field to find the best solution suitable for our country

Medical faculty members' perspectives on the components of cross-cultural competence in the Islamic Republic of Iran: a qualitative study

Despite the importance of cultural competence in health care, there has been no research to develop a framework for cultural competence in the Iranian context. This qualitative study at Mashhad University of Medical Sciences aimed to elucidate the views of medical faculty staff on the components of cross-cultural competence and compare these with similar studies published in English. Using a combination of archival studies, semi-structured interviews and focus group discussions among faculty members 3 major domains [knowledge, attitude and behaviour] and 21 components were identified to describe the cross-cultural competence of faculty members in medical schools. Participants expressed the importance of knowledge as a precursor to changing attitudes and the 6 knowledge components related to knowledge and awareness of values, beliefs and norms of different ethnic, racial and cultural groups. Experts mostly emphasized the importance of interaction between faculty members and clients [students and patients]

Medical faculty members' perspectives on the components of cross-cultural competence in the Islamic Republic of Iran: a qualitative study

Despite the importance of cultural competence in health care, there has been no research to develop a framework for cultural competence in the Iranian context. This qualitative study at Mashhad University of Medical Sciences aimed to elucidate the views of medical faculty staff on the components of cross-cultural competence and compare these with similar studies published in English. Using a combination of archival studies, semi-structured interviews and focus group discussions among faculty members 3 major domains [knowledge, attitude and behaviour] and 21 components were identified to describe the cross-cultural competence of faculty members in medical schools. Participants expressed the importance of knowledge as a precursor to changing attitudes and the 6 knowledge components related to knowledge and awareness of values, beliefs and norms of different ethnic, racial and cultural groups. Experts mostly emphasized the importance of interaction between faculty members and clients [students and patients]

[Evaluation of training competency of health care workers in training clients and patients]

Examining the training competency of the health care workers in training their clients and patients can lead to identification of the training problems, improving training qualities, and promoting the health of society as a whole. The current study which was conducted in the city of Mashhad aimed to determine the training competency of the urban health care workers in training the clients referring to these centers. In this cross sectional-descriptive study, 250 health care workers at Mashhad s' urban health care centers were enrolled in the study using probability sampling. Data collection instrument was a researcher-made questionnaire consisting of two parts; demographic data and training competency status. Data were analyzed using SPSSv.16 software and descriptive statistical tests [Frequency and cumulative frequency] and analytical tests [Spearman, correlative tests, Independent t-test, one way variance analysis]. Significant level of difference was considered for measuring difference between demographic and training competency [P<0.05]. The results of the study indicated that the training competency of 159 workers [5.63%] in health care centers were good and acceptable, and there was a significant difference between training competency of workers and individual differences such as work experience, age, educational degree, employment status, and job satisfaction of health workers. There were also significant differences between courses taken by the health workers to promote their educational level and educational workshops based on promoting educational skills and training competency [P<0.05]. Although the training competency of health workers were very good, competency in areas such as training skills, development, performance, and professional responsibility were not satisfactory. Results of the current study provided appropriate data about training competency of the workers for managers of health care centers. Since the status of training competency of the workers can be assessed by managers and clients, it is suggested that for gaining more comprehensive information, training competency of the health workers be examined from the managers and clients point of view

Human bone marrow-derived mesenchymal stem cell: a source for cell-based therapy

The ability of mesenchymal stem cells [MSCs] to differentiate into many cell types, and modulate immune responses, makes them an attractive therapeutic tool for cell transplantation and tissue engineering. This project was designed for isolation, culture, and characterization of human marrow-derived MSCs based on the immunophenotypic markers and the differentiation potential. Bone marrow of healthy donors was aspirated from the iliac crest. Mononuclear cells were layered over the Ficoll-Paque density-gradient and plated in tissue cultures dish. The adherent cells expanded rapidly and maintained with periodic passages until a relatively homogeneous population was established. The identification of adherent cells and the immune-surface markers was performed by flow cytometric analysis at the third passage. The in vitro differentiation of MSCs into osteoblast and adipo-cytes was also achieved. The MSCs were CDllb [CR3], CD45, CD34, CD31 [PCAM-1], CD40, CD80 [B7-1], and HLA-class II negative because antigen expression was less than 5%, while they showed a high expression of CD90, and CD73. The differentiation of osteoblasts, is determined by deposition of a mineralized extracellular matrix in the culture plates that can be detected with Alizarin Red. Adipocytes were easily identified by their morphology and staining with Oil Red. MSCs can be isolated and expanded from most healthy donors, providing for a source of cell-based therapy

[Bilateral hydrosalpinx and cystic endometrial hyperplasia in doe: a case report]

Hydrosalpinx is characterized by the accumulation of thin mucus within the lumen of the oviduct and it is rare in small ruminants. A5-year-old, horned, mixed breed doe with a history of infertility was necropsied for teaching purposes. Preslaughter examination revealed mucopurulent keratoconjunctivitis, rhinitis, synovitis and mastitis with watery purulent discharge from the mammary glands indicated mycoplasmal infection [agalactia]. At necropsy, the carcass was congested. The proximal portions of oviducts [Ampula] were distended, thin-walled and fluctuating in palpation. They were filled with clear thin mucus and were conic shaped, with 12 cm in length and 1.3 cm in width at the base and 0.5 cm at the top. The distal part of oviducts [Isthmus] was filled with semisolid purulent discharge causing total tube obstruction. The wall of the uterus and the uterine horns were thickened and mucosa was hyperplastic in appearance with small cysts which were measured at 0.3-0.5 cm. There was a slight fibrous adhesion between the mesosalpinx and the ovaries. The right ovary contained a corpus luteum, a large graafian follicle and numerous corpora albicans. Microscopically, atrophy of the wall of ampula, chronic inflammation of the isthmus and cystic endometrial hyperplasia was seen. Direct examinations and culture of the exudate showed mucus without any secondary infection. On the basis of macroscopic characteristics and laboratory findings, the condition was diagnosed as a bilateral hydrosalpinx due to obstruction of the distal part of the oviducts along with cystic endometrial hyperplasia

[Investigating the results of coronary artery angiography in persons with positive exercise test]

Background: Exercise test is a non-invasive method to assess the cardiovascular situation. The results of exercise test alone cannot determine the presence or absence of coronary artery diseases and for definite diagnosis the application of angiography is necessary

Objective: To investigate the results of coronary artery angiography in persons with positive exercise test

Methods: This was a cross-sectional study performed on 200 clients with chest pain who underwent exercise test at Imam Sajjad Hospital in Ramsar during 2009-2010. Study population was selected based on simple sampling and data were collected through interview and observation. Data were further analyzed using chi-square and t-independent tests

Findings: Of 200 clients participated in the study, 49 [24.5%] had positive exercise test, 122 with negative exercise test [66%], and 19 [9.5%] needed further evaluation. Among those with positive exercise test, 29 had positive angiography indicating a real-positive exercise test of 59.2% and a false-positive figure equal to 28.56%. There was a significant relationship between the positive exercise test and both BMI and sex [P<0.05, P<0.04]

Conclusion: It seems that the application of exercise test to be a suitable screening tool especially in people with chest pain. However, caution must be taken when interpreting the result of an exercise test for a patient

[ survey on the attitude of professors and residents of clinical wards about disclosing the results of diagnoses for incurable patients at Urmia university of medical sciences]

One of the most important and complicated problems in medical ethics is to disclose the full truth about diagnosis of incurable diseases which leads to death, and each therapist may be encountered with it during the years of medical profession. The aim of this study was to survey on attitude of professors and residents of clinical wards to disclose the diagnosis for incurable patients leading to death. In this descriptive study, sampling was carried out by a survey. All faculty members and their residents of teaching hospitals of Urmia University of Medical Sciences, Urmia, Iran, were surveyed as sample in 2007. Of 145 subjects, 138 responded to the questionnaire. The collected data were analyzed using Pearson and Spearman correlation tests with a p

[Effects of brewer's yeast on blood pressure and serum lipoproteins in type-2 diabetes mellitus patients]

The increasing trend of prevalence of diabetes mellitus, a diet-related chronic disease has prompted research to find ways to control it. Brewer's yeast may have a potential role because its glucose tolerance factor [GTF] may have beneficial effects on insulin receptors in diabetic patients. This study was conducted to investigate the effects of brewer's yeast supplementation on serum lipoproteins and blood pressure in patients with type-2 diabetes mellitus [T2DM] patients. In a randomized double-blind controlled clinical trial 84 adults [21 men and 63 women, 46.3 +/- 6.1 years old] with T2DM were recruited and divided randomly into 2 groups of 42 subjects each, one receiving brewer's yeast [six 300-mg capsules/day, total 1800 mg] and one [control group] receiving a placebo [6 capsules/day] for 12 weeks. Body weight, height, body mass index [BMI], food consumption [based on 24-hour food recall], fasting serum lipids and lipoproteins [total cholesterol, triglyceride, LDL-c and HDL-c], and systolic and diastolic blood pressure were measured before and after the intervention. Data analysis was performed using the Statistical Package for Social Sciences [SPSS-Ver 18.0], the statistical tests being the independent t-test, paired t-test, Kolmogorov-Smirnov test, and analysis of covariance. Brewer's yeast supplementation brought about statistically significant reductions in diastolic and systolic blood pressures [5.7 +/- 0.6 mm Hg, p=0.001 and 4.1 +/- 1.5 mm Hg, p=0.007, respectively] after 12 weeks. Changes in LDL-c, HDL-c, triglycerides and total cholesterol were no-significant. Further analysis of the data showed significant differences between the brewer's yeast and control groups with regard to diastolic [p<0.03] and systolic [p<0.05] blood pressure at the end of the period. Dietary supplementation with brewer's yeast can reduce systolic and diastolic blood pressure in type-2 diabetes mellitus patients

[Comparative study of the effect of dry and moist dressing on burn wound]

Consistent with recent scientific advances in wound treatment, modern dressing, using technology and knowledge were designed and produced. Such a dressing can provide an appropriate environment for moisturizing wound healing by maintaining and controlling moisture along with other conditions. This study aims to compare the effect of dry and moist dressing on burn wound healing. It was a quasi experimental research. Sampling was done constantly according to inclusion criteria. The final sample consisted of 60 patients hospitalized in Shahid Motahari burn center with second degree burn and a TBSA less than or equal to 10% on both hands or legs. Data collection tools included demographic information form and observation checklist. Part of the burned area was covered with a dry dressing according to hospital routine and the other part covered with the wet dressing of NA ultra. The stage and duration of wound healing was observed and recorded in the third, seventh, thirteenth and twenty-first days. Data was analyzed using descriptive statistics and pair t-test by SPSS-PC [v. 13]. There was a significant difference between the mean scores of the stage [P<0.001] and duration [P=0.004] of burn wound healing. According to the findings, the use of wet dressings in treating burn wounds is advisable

Malaria in Mazandaran, Northern Iran: passive case finding during 1997-2012

Malaria is one of the most important parasitic diseases in tropical and temperate regions. The aim of this study was to determine the trend of malaria in Mazandaran Province, northern Iran during 1997-2012. This retrospective study was conducted from 1997 to 2012. The population's study was individuals who registered at health centers of Mazandaran Province. Peripheral blood smear were prepared for each case, stained with Giemsa and examined by light microscope. In addition to demographic data, other parameters including Slide Positive Rate [SPR], Annual Parasite Incidence [API] and Annual Blood Examination Rate [ABER] were analyzed. In total, 844 cases of malaria were reported. Plasmodium vivax was predominant species with 821 cases [97.4%]. The number of malaria cases increased from 1997 to 2005 and then decreased to 3 cases in 2011. Some cities had not reported any cases during last three years. The highest infection rate, 163[20.07%], was seen in 2001-02. The SPR had the highest value [0.54%] in 2004-05. The maximum API and ABER were observed in 2001-02 and 1997-98. 641[75.9%] of cases were imported from hyperendemic areas such as Afghanistan and South-eastern Iran and 94 [11.1%] malaria patients were recorded as introduced cases. The highest infection rate of malaria [21.3%] was seen in Babolsar. Extensive malaria control should be continued to Mazandaran to become malaria-free region and in prevention of re-introduction stage

Endothelial nitric oxide synthase gene t-786c polymorphism in renal transplant recipients

Nitric oxide [NO] is a major mediator in vascular biology, regulating regional blood flow. NO and the enzymes required for its production contribute to ischemia-reperfusion injury. The T-786C functional polymorphism in the promoter region substantially reduces promoter activity of the endothelial nitric oxide synthase [eNOS] gene and compromises endothelial NO synthesis. To examine the association between T-786C [rs 2070744] single nucleotide polymorphism [SNP] in eNOS gene and the development of acute rejection in renal transplant patients. 60 renal transplant recipients [30 with episodes of acute rejection [ARs] and 30 without rejection [non-ARs]], between June 2008 and March 2010, were included in this study. The polymorphism was determined by PCR-restriction fragment-length polymorphism analysis. The distribution of the genotypes were TT/TC/CC 60%, 33.4%, 6.6%, and 43%, 46.7%, 13.3% in ARs and non-ARs, respectively [p=0.28]. The frequency of T-allele was 76.7% and 66.3%; and for C-allele was 66.6% and 33.3% in ARs and non-ARs, respectively [p=0.09]. There were no significant associations between these polymorphisms and acute and chronic kidney allograft rejection. We could not detect any significant association between polymorphism in T-786C of eNOS gene and the development of acute rejection

[Relationship between spiritual intelligence and nurses' clinical competency]

Clinical competency is one of the requirements in nursing profession, for which nurses have recently been criticized. For this reason, health educational systems always intend to discover and improve factors that affect clinical competency. On the other hand, spiritual intelligence is considered as a significant factor in nurses' success and efficacy. Therefore, the present study was designed to determine the spiritual intelligence status and its relationship with nurses' clinical competency. This descriptive correlational study was conducted on 250 nurses of Mashad educational hospitals selected by multi-stage sampling. Demographic, clinical competency and spiritual intelligence questionnaires were used for data collection; the obtained data were analyzed in SPSS 11.5 using ANOVA, Kruskal Wallis, t-test, correlation and simple linear regression and covariate analysis. The results showed that%53.3 of the nurses' scores on spiritual intelligence were above the mean, and%46.7 below the mean. Most nurses' [%53/8] scores of clinical competency scores was reported good [by self-assessment],%48.2 of the scores in the average range [by matron assessment], and%53.3 of them in the average range [by the overall assessment]. A significant positive correlation was observed between spiritual intelligence and clinical competency, as Pearson correlation coefficient indicated [p < 0.001]. A positive significant correlation was observe between spiritual intelligence of nurses' clinical competency

[Comparison of the therapeutic effects of fluoxetine, citalopram, estrogen and progesterone and placebo in the treatment of hot flushes in perimenopausal women]

Frequency and morbidity of hot flushes has led to development of multiple hormonal and non hormonal treatments in the recent years. Fluoxetine and citalopram with limited side effects and high tolerability by most women with hot flushes have attracted the researchers' attention but there are plenty of rooms for disagreement on their effectiveness. In this study the effects of fluoxetine, citalopram, hormone therapy and placebo on perimenopausal flushes, were compared with one another. This study was a randomized clinical trial [RCT]. The study population included 46 to 55 year old women with hot flush who had lack of menstruation and reached menopause for at least 1 year. Sampling method was blocked randomization and the patients were divided into four groups including fluoxetine, citalopram, hormone therapy and placebo groups. The collected data were introduced into the SPSS software and analyzed by chi-square, ANOVA and Kruskal-Wallis tests. There were no significant differences between the groups in the mean duration of menopause, history of any chronic disease, drug use and frequency of hypertension before intervention [p<0.05]. But there was significant differences between the values of the mean age of the groups before intervention [P=0.03]. The mean frequency of hot flushes decreased by 57%, 74.7%, 81.8% and 80% after intervention in estrogen+progesterone, fluoxetine, citalopram and placebo groups respectively [P<0.001]. Considering the high rate of success of the treatment of the hot flushes with citalopram and fluoxetine and few side effects of these drugs, they can be regarded as good alternatives to hormone therapy and for thoese who are not willing to take estrogen

effect of problem-solving education on self- management and hba1c in adolescents with type 1 diabetes

Background and Purpose: Diabetes mellitus is the most common endocrine disease in children. Achieving selfmanagement of the child and her family is one of the important goals nursing these patients. The present research was conducted to examine the effect of problem solving education on the self-management and HbA1C in adolescents with type 1 diabetes

Methods and Materials: In this experimental study, adolescents 10-19 years old with type 1 diabetes for at least on year, were allocated randomly into two control and problem-solving education groups. The intervention group received 6 sessions of problem-solving process education; the family function of caregivers, self-management and HbA1C of adolescents with type 1 Diabetes before and 3 months after the intervention were evaluated. Data analysis was done using independent and paired t-test, Mann-Whitney U and Wilcoxon tests

Results: Problem-solving education increased self-management in adolescents by 76.57% in terms of public health, 49.11% regimen therapy, 112.20% social presence and 75% in terms of overall self-management [p<0.001]. Problem solving education also decreased HbA1C by 0.62 on average. There was a significant negative correlation between frequency of insulin injections per day and HbA1c levels [p<0.0001]

Conclusion: Problem-solving education is remarkably effective in promoting the self-management in adolescents with type 1 diabetes

[Effect of a family-centered problem solving education method on self-esteem in drug-users]

Introduction: Drug addiction is amongst current crisis of the world including nuclear crisis, environmental degradation, poverty, and social crisis. Drug addiction is a major health problem in many countries worldwide. One of the most common characteristics of addicted individuals is low self-esteem. Self-esteem increases flexibility and reinforces progression of positive attitudes toward self-sufficiency. There are limited studies on non-medical treatment strategies for drug-users. The aim of the present study was to assess the effects of a family-centered problem solving education on self-esteem of drug-users

Methods: This study had a pretest-post test experimental design. First, validity and reliability [r=0.85] of the self-esteem Cooper-Smith questionnaire was confirmed. After completing the consent forms by the participant [n=60], they were randomly assigned into two equal experimental and control groups. At baseline, questionnaires were completed. The education was performed using family-centered problem solving teaching method in a two months period within eight 45-minute sessions in the intervention group. The Cooper smith self-esteem questionnaire was completed at the follow up

Results: The paired t-test showed that family-centered problem solving education method led to a significant increase [p=0.001] on the self-esteem scores in the intervention group. Although self-esteem scores of the control group increased significantly either after two months, the increase was 4.5 times more in the intervention group

Conclusion: To sum up, using the family-centered problem solving education method with family centered approach could improve the process of addiction treatment in addiction clinics

Association of the co-stimulatory molecules polymorphisms with CMV infection in liver transplant recipients

Co-stimulatory molecules play a critical role in regulating T-cell function during CMV infection after liver transplantation. To investigate the relationship between the polymorphisms of the co-stimulatory genes and the susceptibility to CMV infection after liver transplantation. Single nucleotide polymorphisms [SNPs] in PD-1 gene [PD1.1 A/G, PD1.3 A/G, PD1.9 C/T] ICOS [-693 A/G, 1720 C/T], CTLA-4 gene [-318 C/T, 1722 T/C, 1661 A/G, 49 A/G] and CD28 [+17 C/T] were analyzed by PCR-RFLP in 70 liver transplant patients. CMV infection was determined in these patients by antigenemia test. CTLA-4 49G showed significant association with CMV infection [p=0.03, OR=3.82, 95% CI: 0-3.5; p=0.01, OR=004, 95% CI: 0-1.3]. G and T alleles in CTLA-4 gene [-318 C/T and 1661 A/G] [p=0.03, OR=0, 95% CI: 0-3.5; p=0.01, OR=0.04, 95% CI: 0-1.3] were significantly higher in CMV-infected rejector group. CTLA-4 have significant role in CMV pathogenesis and rejection among CMV-positive liver transplant patients

molecular and antigenic tissue impact of viral infections on liver transplant patients with neonatal hepatitis

Pathogenesis of neonatal hepatitis relates to various underlying causes including viral infections. Both hepatotropic and non-hepatotropic viruses may induce liver failures in infants before birth, during delivery, or shortly after birth. The tissue impact of HCMV, HSV, HBV, HCV, and rotavirus and adenovirus infections was evaluated in studied infants with neonatal hepatitis. The history of viral infections was analyzed in paraffin-embedded biopsy and autopsy tissues of 22 infants with neonatal hepatitis between years 1996 and 2007, retrospectively. The tissue molecular presentation of HBV, HCV, HCMV, HSV, adenovirus, and rotavirus was evaluated by different qualitative simple and nested PCR and RT-PCR protocols. Immunohistochemistry [IHC] method was used for studying the antigenic prevalence of HSV-1, 2; HBV, HCMV and adenovirus infections. Also the laboratory liver indices of all patients with neonatal hepatitis were analyzed. The HBV and HSV genomes were detected in 3 [14%] of 22 infants. The rotavirus and HCV-RNA and also the HCMV-DNA were detected separately in 1 [4%] of 26 paraffin-embedded autopsy and biopsy tissues. The HBV and HSV-1 specific antigens were separately diagnosed in 1 [4%] of 26 neonatal samples by IHC protocols. Also the HSV-2 antigen was seen in 5 [23%] of 22 liver autopsy and biopsy specimens. Co-infections with HCMV, HSV, HBV, HCV, and rotavirus were detected in these infants with hepatitis. Diagnosis of single and mixed molecular and antigenic traces of HCMV, HSV, HBV, HCV and rotavirus underlines the etiologic role of these viruses in clinical pathogenesis of neonatal hepatitis

[Identifying the effective factors in human resources management in earthquake in Imam Sajad Hospital]

Human resources management is one of the bases of crisis management in earthquake especially in hospitals and also it is the most important part of health system in response step. The aim of this research is to identify the effective factors in human resources management in Imam Sajad hospital of NAJA. In this research which is applicable, case study and descriptive, about 100 personnel of Imam Sajad hospital in different levels were participated. The questionnaire was confirmed by the key informants. The questionnaire was included demographic and structural data and also 80 questions were about the ideal and available situation. With regard to questions, the factors prioritization to each other was analyzed by using Friedman Test. According to the findings, most respondents were satisfied with the mentioned factors in all aspects and also all factors were effective in responding and preventing earthquake [about 95%]. Some factors have greater influence on human resources management to response earthquake as follow: management factors [specialized, public and operational]; motivational, environmental and organizational, maintenance [health, safety, financial, facilitate and welfare], research and educational, structural and spiritual