Psychometric Properties of Nursing Manager Communication Competency Questionnaire (CCCQ): An Instrument Design Study.

Introduction: One of the most important factors that can enhance the efficiency and success of hospitals for achieving the objectives is the communication competency of nursing managers. Due to the lack of a local questionnaire to measure the communication competency of nursing managers, the present study has been conducted aimed to design and validate the Nursing Manager Communication Competency Questionnaire (NMCCQ). Method: First, after designing the questionnaire (production of primary items), based on the definition of the results of the study, the analysis of Schwartz, Barcott, and Kim's hybrid concept was performed and then it was evaluated. According to the definitions of the results of Schwartz, Barcott, and Kim's Hybrid concept analysis study, the questionnaire was designed and then it has been assessed psychometrically. Face validity with the opinion of 15 participants and content validity have been assessed using the opinion of 15 experts. Construct validity has been assessed by 300 nurses via completing the questionnaire using factor analysis. Results: First, a questionnaire with 83 items of qualitative data was made. After confirming content validity, the number of items reduced to 62 items. Exploratory factor analysis included five constructs of non-verbal communication skill, negotiation, reporting, communication ethics, and the application of communication knowledge, which consisted of 56 items that together accounted for 61.410% of the observed variance. Cronbach's alpha coefficient for constructs ranged from 0.862 to 0.987 and the intra-class correlation coefficient (ICC) ranged from 0.969 to 0.994. Conclusion: The results showed that nursing managers' communication competency questionnaire is a valid and reliable scale that can help managers select, assess, and appoint nursing managers. As a result, this tool can be used in future studies.

Self-Efficacy of People with Chronic Conditions: A Qualitative Directed Content Analysis.

BACKGROUND: Given the increasing prevalence of chronic illnesses and their complications, supporting and empowering chronically ill patients seems crucial. Self-efficacy is considered as a predictor for empowerment. The purpose of this study to explore of different aspects of self-efficacy among persons with chronic physical conditions based on the Family-Centered Empowerment Model (FCEM). METHODS: this qualitative study is part of a larger study; sequential exploratory mixed-method for designing an instrument for the FCEM was conducted from May 2015 to March 2016 in two university hospitals. The sample was 22 participants, including chronically ill patients, family caregivers, and nurses. Data were collected through personal semi-structured interviews. Data analysis was performed concurrently with data collection through directed qualitative content analysis. RESULTS: after determining the self-efficacy attributes in the family-center empowerment model, a category matrix was developed and the codes are placed in subcategories of the matrix. Most participants were female (58.0%), with a mean age of 49.50 years. The final analysis yielded a total of 247 units of analysis dispersed in eight subcategories belonging to four generic-categories. CONCLUSIONS: the findings of this study represent the dimensions of chronically-ill individuals' self-efficacy that can be used to develop and implement programs for empowering chronic ill patients.

Effect of counseling on sexual function and behavior in postmenopausal women and their spouses: a randomized, controlled trial (RCT) study.

Sexual dysfunction is present the most important problem among menopausal women and thus counseling may have a major role for improving menopausal sexual state in this population. We aimed to assess effects of counseling on sexual function of menopause women and their spouses. An interventional trial study was performed on 120 consecutive Iranian couples (menopause women and their spouses) who were resident in Hamadan, Iran in 2015. The subjects were randomly assigned to receive counseling service (n = 60) or did not receive this service (n = 60). Couples were asked to complete a standardized validated questionnaire assessing sexual function and behaviors. The frequency of sexual intercourse was considerably increased following first and second counseling sessions compared with the time before counseling in former group, while sexually state was remained unchanged in those who not received these counseling. Furthermore, dyspareunia in interventional women with counseling was significantly reduced after the first and second counseling, whereas this complaint was not significantly removed in the control group within the study period. Also, unsuccessful intercourse was significantly decreased in men who received counseling sessions, while this parameter was remained unchanged in other men. In addition, talking with the partner about sexually and Satisfaction degree of wife's love was significantly improved in both men and women in interventional groups compared with the control groups. Active and structured counseling effectively improve sexual functions and behaviors in menopausal women and their spouses.

The effects of Pilates exercise on sleep quality in postpartum women.

Prolonged poor sleeping quality can decrease women's ability to perform their maternal and family duties after delivery. The aim of this study was to investigate the effects of a Pilates training program on sleep quality in primigravida postpartum women in a randomized clinical trial. Eighty postpartum women were randomly divided into intervention and control groups (n = 40). Home-based 30-min Pilates exercises were started 72 h after the delivery and performed five times per week for consecutive 8 weeks. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) prior to the intervention and 4th and 8th weeks afterwards. The intervention group showed a significant improvement in subjective sleep quality, sleep latency, daytime dysfunction and global PSQI score (P < 0.001); however, there was no difference in sleep duration, habitual sleep efficiency and sleep disturbance between the groups. In conclusion, Pilates exercises appeared to improve sleep quality in primigravida postpartum women.

Iranian mothers' selection of a birth method in the context of perceived norms: a content analysis study.

OBJECTIVE: to describe women's perceptions of choosing a particular birth method; normal childbirth or caesarean section in the absence of medical indications. DESIGN: a descriptive qualitative content analysis was used for data gathering and analysis. Interviews were held with 18 pregnant and postnatal women. The participants were recruited using a purposive sampling method. Interviews were begun with a general question and were followed with specific questions. SETTING: three semi-public and public hospitals and two health care centres in an urban area of Iran were the locations of data gathering. Data analysis and data collection were conducted concurrently and interviews were discontinued when data saturation was reached. PARTICIPANTS: the participants consisted of 18 women (four pregnant and 14 postnatal) recruited using a purposive sampling method. FINDINGS: 'socio-economic and cultural norms' was the main theme that emerged in this study. Four other categories comprised the content of interviews: 'cultural and religious acceptance', 'social acceptance', 'psychological-social support', and 'economical acceptance'. CONCLUSIONS AND IMPLICATIONS: socio-cultural, religious and economical norms in the Iranian society play main roles in the selection of the birth method by Iranian women. Health care policy-makers are expected to attend to the factors influencing women's decision-making on the childbirth method to reduce the number of unnecessary caesarean sections.

Investigation The Role of Gender on The HLA-DRB1 and -DQB1 Association with Type 1 Diabetes Mellitus in Iranian Patients.

OBJECTIVE: Type 1 diabetes mellitus (T1D) is an autoimmune and multifactorial disorder. Subsequent analysis on human leukocyte antigen ( HLA) region shows that HLA-DRB1 and -DQB1 genes have the strongest association with T1D. In this study, for the first time, we investigated the influence of gender on the HLA-DRB1 and -DQB1 association with type 1 diabetes mellitus in Iranian patients in order to determine gender dependent HLA heterogeneity in Iranian T1D patients. MATERIALS AND METHODS: In this case control study, the HLA-DRB1 and -DQB1 typing were performed on 105 Iranian T1D patients and 100 healthy controls. The data were evaluated by using Fisher exact test. RESULTS: Our results indicate that DRB1*04:01, DQB1*03:02 alleles and DRB1*04:01- DQB1*03:02 haplotype were significantly more frequent in male T1D patients than females. Also, DRB1*03:01, DRB1*15:01, DQB1*06:01 alleles, DQB1*03:01/05:01 genotype, DRB1*03:01-DQB1*02:01 and DRB1*15:01-DQB1*06:01 haplotypes were significantly higher in female T1D group than males. Furthermore, our results showed that DRB1*04:01 and DQB1*03:02 alleles were significantly more frequent in male T1D patients 1-5 years old at onset than females with similar condition. The DRB1*03:01 allele and DRB1*03:01- DQB1*02:01 haplotype were significantly higher in female T1D patients 6-10 years old at onset than males with similar condition. The DRB1*15:01 allele and DRB1*15:01-DQB1*06:01 haplotype were significantly more frequent in female T1D patients 16-20 years old at onset than males with similar condition. CONCLUSION: Our findings suggest that gender has a significant influence on the distribution of HLA-DR and -DQ alleles, genotypes and haplotypes. Also, distribution of the HLA-DRB1 and -DQB1 alleles, genotypes and haplotypes vary based on the gender of T1D patients in different age at onset.

Evaluating the Validity and Reliability of PDQ-II and Comparison with DDST-II for Two Step Developmental Screening.

OBJECTIVE: This research was designed to identify the validity and reliability of the Prescreening Developmental Questionnaire 2 (PDQ-II) in Tehran in comparison with the Denver Developmental Screening Test-II (DDST-II). METHODS: After translation and back translation, the final Persian version of test was verified by three pediatricians and also by reviewing relevant literature for content validity. The test was performed on 237 children ranging from 0 to 6 years old, recruited by convenient sampling, from four health care clinics in Tehran city. They were also evaluated by DDST II simultaneously. Interrater methods and Cronbach's α were used to determine reliability of the test. The Kappa agreement coefficient between PDQ and DDST II was determined. The data was analyzed by SPSS software. FINDINGS: All of the questions in PDQ had satisfactory content validity. The total Cronbach's α coefficient of 0-9 months, 9-24 months, 2-4 years and 4-6 years questionnaires were 0.951, 0.926, 0.950 and 0.876, respectively. The Kappa measure of agreement for interrater tests was 0.89. The estimated agreement coefficient between PDQ and DDST II was 0.383. Based on two different categorizing possibilities for questionable scores, that is, "Delayed" or "Normal", sensitivity and specificity of PDQ was determined to be 35.7-63% and 75.8-92.2%, respectively. CONCLUSION: PDQ has a good content validity and reliability and moderate sensitivity and specificity in comparison with the DDST-II, but by considering their relatively weak agreement coefficient, using it along with DDST-II for a two-stage developmental screening process, remains doubtful.

Abdominal hollowing and lateral abdominal wall muscles' activity in both healthy men & women: An ultrasonic assessment in supine and standing positions.

The objective of this study was to investigate the effects of Abdominal Hollowing (AH) maneuver on External Oblique (EO), Internal Oblique (IO) and Transversus Abdominis (TrA) muscles in both healthy men and women during the two postures of supine and upright standing. The study was conducted on 43 asymptomatic volunteers (22 males and 21 females) aged 19-44 (27.8±6.4) years. Rehabilitative Ultrasonic Imaging (RUSI) was simultaneously performed to measure muscle thickness in both rest and during AH maneuvers while activation of the TrA during AH was controlled by Pressure Biofeedback (PBF) device. Mixed-model ANOVA with repeated measures design, and Pearson correlation tests were used to analyze the data. Muscle thickness of all muscles was significantly higher for male subjects (F>6.2, p<0.017). The interaction effect of gender and muscle status was significant only for IO (F=7.458, p=0.009) indicating that AH maneuver increased the thickness of IO in men. Interaction effect of posture and muscle status on muscular thickness indicated that changing position only affects the resting thickness of TrA (F=5.617, p=0.023). Standing posture significantly affected the TrA contraction ratio (t=3.122, p=0.003) and TrA preferential activation ratio (t=2.76, p=0.008). There was no relationship between age and muscle thickness (r=0.262, p=0.09). The PBF has been introduced as a clinical and available device for monitoring TrA activity, while RUSI showed that both TrA and IO muscles had activated after AH maneuver. We recommend performing further investigations using electromyography and RUSI simultaneously at more functional postures such as upright standing.

Validity and Reliability Determination of Denver Developmental Screening Test-II in 0-6 Year-Olds in Tehran.

OBJECTIVE: This research was designed to identify the validity and reliability of the Persian version of Denver Developmental Screening Test II (DDST-II) in Iranian children, in order to provide an appropriate developmental screening tool for Iranian child health workers. METHODS: At first a precise translation of test was done by three specialists in English literature and then it was revised by three pediatricians familiar with developmental domains. Then, DDST-II was performed on 221 children ranging from 0 to 6 years, in four Child Health Clinics, in north, south, east and west regions of Tehran city. In order to determine the agreement coefficient, these children were also evaluated by ASQ test. Because ASQ is designed to use for 4-60 month- old children, children who were out of this rang were evaluated by developmental pediatricians. Available sampling was used. Obtained data was analyzed by SPSS software. FINDINGS: Developmental disorders were observed in 34% of children who were examined by DDST-II, and in 12% of children who were examined by ASQ test. The estimated consistency coefficient between DDST-II and ASQ was 0.21, which is weak, and between DDST-II and the physicians' examination was 0.44. The content validity of DDST-II was verified by reviewing books and journals, and by specialists' opinions. All of the questions in DDST-II had appropriate content validity, and there was no need to change them. Test-retest and Inter-rater methods were used in order to determine reliability of the test, by Cronbach's α and Kauder-Richardson coefficients. Kauder-Richardson coefficient for different developmental domains was between 61% and 74%, which is good. Cronbach's α coefficient and Kappa measure of agreement for test-retest were 92% and 87% and for Inter-rater 90% and 76%, respectively. CONCLUSION: This research showed that Persian version of DDST-II has a good validity and reliability, and can be used as a screening tool for developmental screening of children in Tehran city.

Ethical challenges in pain management post-surgery.

This qualitative study describes ethical challenges faced by Iranian nurses in the process of pain management in surgical units. To address this issue, semistructured interviews were conducted with 26 nurses working in surgery units in three large university hospitals in Tehran. An analysis of the transcripts revealed three main categories: institutional limitations; nurses' proximity to and involvement with pain and suffering; and nurses' fallibility. Specific themes identified within the categories were: insufficient resources, medical hierarchy; difficulties with believing patients' complaints regarding pain and suffering; and experiencing the consequences of poor judgments. Our findings lead us to conclude that, as nurses are much closer to patients' pain and suffering than other health professionals, being aware of their ethical problems, and being able to reflect on them and discuss and learn from them, will reduce the burden of the ethical challenges faced. The findings will help nurses in other countries to devise suitable ways to reduce the ethical burdens they bear in their daily practice.

Spiritual job satisfaction in an Iranian nursing context.

This article reports the results of a qualitative study that used a deep interview method. The aim was to gather lived experiences of clinical nurses employed at government-funded medical centres regarding the non-materialistic and spiritual aspects of the profession that have had an important impact on their job satisfaction. On analysing the participants' concepts of spiritual satisfaction, the following themes were extracted: spiritually pleasant feelings, patients as celestial gifts, spiritual commitment, spiritual penchant, spiritual rewards, and spiritual dilemmas. Content analysis of the data indicated that nurses who viewed these dimensions of job satisfaction as a significant factor considered nursing as an opportunity to worship God while providing care for patients, and regarded their aim as achieving patients' contentment by providing nursing care compatible with scientific care methods.

Communication training and patient satisfaction: A randomized trial study from Mashhad, Iran.

BACKGROUND: In many healthcare systems, client satisfaction has been considered as an important indicator of primary healthcare quality. Hence communication education might be leading to better quality of family planning services and higher client satisfaction. This study aimed to evaluate to what extent the communication skills training program could improve client satisfaction. METHODS: This was a randomized controlled trial undertaken in health centers of Mashhad University Medical Sciences, Mashhad, Iran from July to September 2004. Eligible participants were from two population targets, including healthcare providers and their clients. All 35 health centers were randomly divided into intervention (n = 17) and control groups (n = 18). The healthcare providers were working in intervention centers (n = 24) not in control centers (n = 27) received an additional communication skills training program in spite of routine education. Data regarding communication knowledge, attitude, and skills from healthcare providers and the satisfaction rate from the their clients (n = 47 client for each group) were collected at two time points. RESULTS: This study showed that communication knowledge and skills of health workers improved significantly in the intervention group (P < 0.05). Furthermore the score of client satisfaction was significantly improved in the intervention group after 1 month follow-up (p < 0.05). CONCLUSION: The communication skills training program is an effective intervention and may improve the satisfaction rate of clients.

Diagnosis and monitoring of human cytomegalovirus infection in bone marrow transplant recipients by quantitative competitive PCR.

OBJECTIVES: Human cytomegalovirus (HCMV) is a common cause of infection worldwide. Severe cytomegalovirus disease is usually observed in immunodeficient individuals such as bone marrow transplant (BMT) or AIDS patients. In these patients, proof of viral presence is not enough for making clinical decisions; one must report the quantity of virus or viral load in appropriate clinical specimens to demonstrate the relationship between disease severity and HCMV infection. The goal of this study was to use quantitative competitive polymerase chain reaction (PCR) to determine HCMV viral load in 26 BMT recipients. MATERIALS AND METHODS: Peripheral blood was collected weekly for 100 days from 26 BMT recipients. Qualitative and quantitative competitive PCRs on 10(5) mononuclear cells were performed for each patient. The same tests were performed once for each of 26 donors. In addition, the anti-HCMV humoral response was detected by performing IgM and IgG ELISAs in donors and recipients prior to transplantation. RESULTS: Of 26 BMT donors and recipients, 25 and 26 were IgG positive, and 2 and 6 had HCMVspecific IgM antibodies, respectively. From 313 total clinical specimens tested, 255 had positive qualitative PCR results. Results of quantitative PCR on the same specimens demonstrated that in 14 patients, viral copy number per 10(5) cells had increased, pointing toward HCMV reactivation. In others, changes in viral copy number were mostly around 100/10(5) cells, with an upper limit of 300/10(5) cells. CONCLUSIONS: Owing to the high prevalence of cytomegalovirus in our country, the chance of viral reactivation and HCMV infection/disease upon transplantation must be seriously considered. Therefore, use of quantitative PCR in PCR-positive patients is highly recommended to demonstrate active infection that may lead to HCMV disease during the posttransplant period. This also could help physicians begin pre-emptive therapy that would be for a shorter treatment period and provide for better outcomes in infected BMT patients.

The effect of DNA priming-protein boosting on enhancing humoral immunity and protecting mice against lethal HSV infections.

Herpes simplex virus produces primary and latent infections with periodic recurrency. The prime-boost immunization strategies were studied using a DNA vaccine carrying the full-length glycoprotein D-1 gene and a baculovirus-derived recombinant glycoprotein D, both expressing herpes simplex virus glycoprotein D-1 protein. Immunization with recombinant DNAs encoding antigenic proteins could induce cellular and humoral responses by providing antigen expression in vivo. Higher immune response, however, occurred when the recombinant proteins followed DNA inoculation. While all groups of the immunized mice and positive control group could resist virus challenge, a higher virus neutralizing antibody level was detected in the animals receiving recombinant protein following DNA vaccination.

Association between Asthma Severity and Obesity in Two Asthma Clinics in Tehran.

The prevalence of both obesity and asthma has increased in recent years. Thus we decided to investigate the relation between obesity and asthma severity. We undertook a cross-sectional study in outpatient asthma clinics of 2 tertiary hospitals in Tehran. Obesity was defined as a body mass index greater than 30. Asthma severity was defined by using the Guide for Asthma Management and Prevention 2004 guidelines, according to patients' clinical and/or spirometerical parameters. Active cigarette smoking patients and patients with a history of other lung diseases were excluded.A total of 116 individuals, aged 16-83 years with a mean age of 46.57+/-15.05 years, met the entry criteria. There were 73 females and 43 males. The prevalence of obesity in our study population was 29.3%. The Spearman correlation coefficient between asthma severity and body mass index was r= 0.275 (p= 0.001). Mean body mass index of females and males were 28.95+/-5.41 and 25.17+/-4.17, respectively. Mean body mass index of females with asthma was significantly higher than males (p< 0.0001). The odds ratios for obesity were 8.650, 8.746, and 22.491 for mild, moderate and severe persistent asthma, respectively, compared to patients with mild intermittent asthma.With increasing asthma severity, we observed higher occurrence of obesity in adults. The association of asthma severity with obesity suggests that obesity may be a potentially modifiable risk factor for asthma or asthma exacerbation.

Seroprevalence of neutralizing antibodies to measles virus in a vaccinated population in Iran, 1998.

Measles is an acute highly infectious viral disease. Although live attenuated vaccine is used throughout the world, outbreaks of disease still occur in many countries including Iran. In this cross-sectional study, by implementing a viral neutralization test and cell culture techniques, the seroprevalence of neutralizing anti-measles antibodies was assessed. Three hundred and fifty-four blood samples were collected and random-cluster classified from healthy subjects 6 months to 16 years old, residing in the town of Khodabandeh and its rural areas. Of the total subjects, 174 (49.2%) were girls and 180 (50.8%) were boys. From 354 subjects studied, 310 (87.6%) had neutralizing anti-measles antibody titer of 1:8 or higher and were considered to be immune and 44 (12.4%) had lower antibody titers. At the time of specimen collection, information with regards to age, sex, history of vaccination and place of residence were collected. Chi2 statistical test demonstrated a significant association between immune status and grouped age at the time of first vaccination (p < 0.009). The proportion test indicated significant differences in rate of seropositivity in paired age groups (3-8 vs. 9-11 and 9-11 vs. 12-64 months) (p < 0.02). The use of reliable techniques for assessing success of vaccination programs and performing seroepidemiological studies in order to organize national programs of control and eradication of measles are necessary.