Adult ADHD screening scores and hospitalization due to pedestrian injuries: a case-control study

BACKGROUND: The aim of this study was to investigate the association between adult ADHD screening scores and hospitalization due to pedestrian injuries in a sample of Iranian pedestrians. METHODS: Through a case-control study, a case population of 177 pedestrians injured by the vehicles in road traffic crashes were compared with 177 controls who lacked a record of intentional or unintentional injuries enrolled from various wards of Imam Reza University Hospital which is a specialty teaching hospital located in the same city with similar referral level. The cases and controls had an age range of 18-65 years and were matched on gender and age. ADHD symptom profile was assessed using the Persian Self-report Screening Version of the Conner\u27s Adult ADHD Rating Scales (CAARS-S:SV). The association of ADHD screening score and pedestrian injuries was investigated using multiple binary logistic regression to investigate the independent effect of ADHD index score on belonging to case group. Both crude and adjusted odds ratios were reported. RESULTS: Men comprised 86.4% of the study subjects. The crude odds ratios for all the four ADHD subscales to be associated with pedestrian injuries were 1.05, 1.08, and 1.04 for the subscales A (attention deficit), B (hyperactivity/impulsiveness) and ADHD index respectively. However, the association for subscale A was not statistically significant with a borderline p-value. The final multivariate analysis showed that variables associated with pedestrian injuries in the road traffic crashes were ADHD Index score (OR = 1.06, 95% CI: 1.01-1.12); economic status (including household income and expenditure capacity); educational level and total walking time per 24 h. CONCLUSIONS: Adult ADHD screening score can predict pedestrian injuries leading to hospitalization independently from sex, age, economic status, educational level and pedestrian exposure to traffic environment (average walking time)

Design and implementation of pay-for-quality in primary healthcare

BackgroundThe common methods of payment to healthcare providers such as capitation and salary are not designed to be stimulation for high quality healthcare. The pay-for -quality (P4Q) programs are designed to provide the financial incentives to the service providers in order to improve quality of services based on specified criteria.AimsThis study describes the design and implementation of a P4Q program in the primary healthcare (PHc) in East Azerbaijan Province, Iran.Methods The present study is a case study that describes the process of designing and implementing the P4Q program in PHC in East-Azerbaijan province in 2015. To design the P4Q program, after identifying core components of the program through literature review and Focus Group Discussion (FGD), final decision about each component was made by achieving consensus from a panel of recognised experts in the area of PHc. Altogether two FGD and seven expert panel sessions were hold in EAPHC in order to design the P4Q program.Results Key components of P4Q program were selected by qualitative studies and the results were categorized in five headings including P4Q formula, quality measures, payment strategy, data reporting and performance evaluation. The formula consists of five elements including fixed payment, individual, team and organization performance and managerial appraisal. A total of 37 measures, which covers the domains of quality of PHc, human resource development and responsibility were selected. 'Improvement' and 'absolute level of measures' were selected as the payment strategy. The methods of data reporting included valid questionnaire, organization’s documents and medical records. The final P4Q program was used for paying incentives to all primary health care providers in public health centres affiliated to Tabriz University of Medical Sciences.ConclusionDesigning and implementing the P4Q program led to a shift in paying the incentives to healthcare providers from passiveness and subjective judgment to rational and quality based payment. Linking the incentive payment to individual, team, and organizational performance, the P4Q program will lead to an increased capacity of staff morale to improve teamwork and integrated health care

Low Anterior and Very Low Anterior Resection in Patients with Rectal Cancer with or without Diverting Colostomy: A Comparison

Introduction: In colorectal cancer surgery, diverting colostomy after low anterior resection (LAR) and very low anterior resection (VLAR) operations is an issue of great significance to the surgeons. This study set out to compare the results of operation in patients with rectal cancer, undergoing VLAR and a type of LAR of the rectum, with or without diverting colostomy. Materials and Methods: 100 patients with rectal cancer undergoing VLAR and LAR, with or without diverting colostomy at a tertiary care hospital (Imam-Hossein Medical Center) were prospectively assessed from March, 2011 to February, 2015. Demographic data, radiotherapy history, and surgery-related data such as duration as well as post-operative complications were collected and analyzed. Results: Of 100 patients, 50 underwent VLAR or LAR without diverting colostomy, and 50 underwent surgical resection with diversion. The age, male to female ratio, and history of radiation were not different in the two groups (P>0.05). The surgery was successful for 47 (94%) patients without diverting colostomy and for 48 patients (96%) with diverting colostomy. The age, gender, history of radiotherapy, and surgery duration did not affect the surgery success rate (P > 0.05), which is fairly significant. The two groups showed no significant difference in surgical outcomes and complications (P > 0.05). Conclusion: Contrary to popular belief, the surgery success rate and complications were not significantly different in the group without diverting colostomy and the group with diverting colostomy. VLAR and LAR without diverting colostomy are recommended. &nbsp

Postmodernism in T. S. Eliot's major poems

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Wandering through Endless Nothingness: Reading Fictional Mind in David Markson’s Wittgenstein’s Mistress

AbstractThe present article attempts to investigate David Markson’s Wittgenstein’s Mistress through the lens of cognitive narratology. To understand “the whole mind” of Kate, the protagonist of the novel, this study endeavors to explore her intermental thoughts (interpersonal relationships), intramental thoughts (inner speech), and dispositions. The central questions of the present study are: How does Kate, the major female character of Wittgenstein’s Mistress reconstruct the minds of others in her own thought, and how does her mental state is manifested in her narration of episodic traumatic memories and qualia? And how does her internal world emerge from a combination of collective minds as far as Alan Palmer’s conception of “intermental thought” is concerned? Alan Palmer’s humanizing approach to postclassical narratology, which provides the theoretical backbone of the present research, underscores the mental interactions of fictional characters and explores actions, dispositions, and interpersonal relationships. The article concludes that Kate’s internal world is constructed out of a combination of collective minds and her “intermental thoughts.

Living through Precarity: A Butlerian Study of Jhumpa Lahiri’s The Lowland

This article aims to explore Judith Butler’s concept of precarity in Jhumpa Lahiri’s The Lowland. The questions this study seeks to find answers to are: What are the various manifestations of Butler’s notion of precarity in The Lowland? And to what extent does the Butlerian sense of agency allow the main characters of The Lowland the possi- bility of overcoming precarity? This research shows how enforced dispossession, which is a product of globally-imposed precarity, incites violence and leads to the involuntary migration of the subjects. In addition, it is revealed that precarity plays a segregative role in escalating religious and tribal conflicts in the post-Partition India. More importantly, in the final analysis, this study suggests that Butler’s reiterative sense of agency fails to account for the normative dynamics of precarity which is at work in the diasporic context of The Lowland

Effectiveness of psychological empowerment training program based on individual psychology Adler's theory on female-headed household’s learned helplessness

Purpose: The objective of this study was to determine the effectiveness of psychological empowerment training program based on individual psychology Adler's theory on female-headed household’s learned helplessness. Methods: This study was counducted by semi-experimental method , and its design was pretest posttest with a control group. The population of this study were female-headed households of Imam Khomeini Relief Foundation in Hamedan province, that was selected by the multi-stage cluster sampling and 30 samples were selected. Research instrument was learned helplessness scale (LHS). To analyze the data, univariate analysis of covariance was used. To achieve the study objectives quantitative methods were used. The study sample consisted of female-headed households in Hamedan provine. The participants in the study consisted of 30 women who were were assigned by clustering sampling. To validate increased psychological empowerment interventionist model, the experimental group was exposed to nine determined one-and-half- an hour group intervention sessions. Findings: The results showed that psychological empowerment training program has effects on the reduction of learned helplessness female-headed household’s learned helplessness (p<0/07) and follow up testing also confirmed the same. Results: Psychological empowerment is the process of empowering people by helping them improve their feeling of ability and competence, and overcome the feeling of their impotence and helplessness. So, It is suggested that training programs for women's empowerment be supported by the agenda Relief Committee and other institutions, as one of the effective programs

Investigation of Views and Experiences of Medical Interns on the Facilitating and Inhibiting Factors Affecting the Quality of Education in the Clinical Education System

Introduction: Clinical education is the most important part of medical education that provides a golden opportunity for medical students to combine their theoretical mix with the clinical environment, and this is important in the countries of the style of the arena of medicine Special attention is paid. Therefore, this study was conducted to examine the views and experiences of medical students as facilitators and inhibitors of clinical education quality. Methods: This is qualitative research and a phenomenological approach was used. The study population consisted of medical students of Kerman University of Medical Sciences. Target-based sampling was performed on 40 medical students. The method for collecting information was a deep interview with the participants. The data were analyzed by the Colaizzi method. Results: Two initial codes were extracted in the form of two main themes (facilitating and inhibiting factors) and 10 sub-themes including providing motivational patterns and creating interest in interns, the high scientific and educational level of attending professors, use of technology, authorizing more responsibility, inappropriate treatment, inappropriate educational planning, inappropriate evaluation method, low-quality mornings, lack of facilities, and overwhelming of some wards were classified. Conclusion: Considering these factors, it is possible to raise the quality of clinical education to the highest possible level and educate responsible and responsible physicians for generations

Maternity and child health care services delivered by public health centers compared to health cooperatives: Iran's experience

Reform programs in some developing countries are focused in transferring these services to nongovernmental organizations or groups. In this WHO grant study our aim was to implement and evaluate the efficacy of a new model for transferring state service delivery governance to nongovernmental groups and studying if they can be efficient in field of child and maternity health services compared to public health centers. In this comparative study a total of 1000 households were selected systematically from the population covered by 9 health centers transferred to cooperatives and 18 current public health centers. Data were collected during a three months long study period and analyzed by SPSS 10 statistical package. Chi-Square and t-tests were used to analyze data. Overall health care coverage was higher for either cooperative or public health centers compared to private sector physicians (p = 0.005). Around 88.8% of under 6 years aged children were under coverage of health services provided by health centers in both groups and no difference was found. There was no statistically significant difference in quality of child health care services in declaring the date of health care visit and follow up in due time. There was no difference between the groups in perfect filling child growth cards but the ability of mothers in interpreting child growth cards was statistically higher for the population covered by cooperative health centers (p = 0.02). Growth status of children based on growth percentiles were relatively similar in two groups. Some health indices of target groups covered by public and cooperative health centers such as family planning, child health cares, perinatal cares, and the numbers of households covered by health volunteers were studied. The results showed that in all of these fields cooperative health centers had better rates. Observed differences were statistically significant (family planning: p = 0.03, infant health care: p = 0.03, 1-6 years old children cares: p = 0.009). The proportion of those women owning a vaccination record (card) was higher in population covered by cooperative health centers (p = 0.004). The rate for performing a cervical smear examination during the national program for cervical cancer screening was higher for the women covered by cooperative health centers (p = 0.01). No difference was found between the knowledge level of women covered by cooperative health centers about the importance of cervical examination when compared with public health centers. We conclude that in the field of target group children's health care and maternity health services, cooperatives sector not only acts as well as public sector meeting the standards of the program, but also has got a better function in some areas. This can be assumed as an achievement for the policy of transferring the health services to cooperative health centers along with ongoing governmental supervision