The efficacy of prolonged speech technique in boys with mild stuttering

زمینه و هدف: لکنت زبان اختلالی حرکتی در جریان روان و پیوسته گفتار بوده که می تواند در شدت های مختلف بروز کند. بر اساس تجربیات بالینی اینگونه به نظر می رسد که پاسخ افراد دارای لکنت در گروه خفیف، متوسط و شدید به انواع شیوه های گفتار درمانی مشابه و یکسان نمی باشد. لذا هدف از این پژوهش، بررسی اثربخشی شیوه گفتار کشیده در درمان افراد دارای لکنت خفیف است. روش بررسی: در این مطالعه نیمه تجربی 44 پسر 14-8 ساله (با میانگین سنی 9/1±8/10 سال) مبتلا به لکنت خفیف از بین جمعیت دانش آموزی مدارس پسرانه شهر اهواز به روش در دسترس انتخاب شدند. در گروه مورد 30 نفر تحت 20 جلسه گفتار درمانی فشرده با شیوه گفتار کشیده قرار گرفتند. در گروه شاهد 14 نفر بدون شیوه گفتار کشیده فقط جلسات مشاوره و کتابخوانی داشتند. نمرات شدت لکنت قبل، بلافاصله و 3 ماه پس از مداخله به وسیله نسخه سوم ابزار سنجش شدت لکنت (SSI-3) تعیین شده و به کمک آزمون های آنالیز واریانس مقادیر تکراری وt مستقل، مورد تجزیه و تحلیل قرار گرفت. یافته ها: نتایج مطالعه نشان داد که در گروه مورد نمرات شدت لکنت، بلافاصله و سه ماه بعد از مداخله به طور معنی داری کمتر از گروه شاهد بود (001/0PP) در صورتی که در گروه شاهد این اختلاف مشاهده نگردید (067/0=P). نتیجه گیری: نتایج نشان داد شیوه گفتار کشیده روشی موثر و کارآمد در کاهش شدت لکنت پسران دارای لکنت خفیف بوده و همچنین ماندگاری و ثبات این شیوه درمانی در گفتار این افراد حتی تا 3 ماه پس از مداخله نیز وجود دارد

Survey of the foot care status in type II diabetic patients: application of the theory of Planned Behavior

زمینه و هدف: در بین عوارض ناشی از بیماری دیابت، مشکلات پا نظیر زخم یا عفونت پاها و آمپوتاسیون های اندام تحتانی ناشی از عدم رعایت مسائل ایمنی و پیشگیرانه در حال افزایش است؛ لذا مطالعه حاضر با هدف ارزیابی وضعیت مراقبت از پا در مبتلایان به دیابت با استفاده از نظریه رفتار برنامه ریزی شده انجام شد. روش بررسی: در این مطالعه توصیفی- مقطعی، 69 بیمار مبتلا به دیابت نوع دو مراجعه کننده به کلینیک دیابت بیمارستان گلستان اهواز طی یک دوره سه ماهه از خرداد تا شهریور ماه 1392 به صورت تصادفی انتخاب شدند. داده ها با استفاده از پرسشنامه پژوهشگر ساخته (59 سوال) مشتمل بر سه بخش اطلاعات دموگرافیک، طبی و آگاهی، ابعاد نظریه رفتار برنامه ریزی شده (نگرش، هنجار انتزاعی، کنترل رفتاری درک شده و قصد رفتاری) و عملکرد مراقبت از پا جمع آوری و ارزیابی شدند. یافته ها: آگاهی 60/53 از شرکت کنندگان در زمینه فعالیت های مراقبت از پا ضعیف بود؛ در حالی که 71/79 نگرش بالایی به انجام این فعالیت ها داشتند. 17/52 فشارها و حمایت های اجتماعی را در حد بالا و 10/52 سطح متوسطی از کنترل بر این فعالیت ها را گزارش نمودند. اکثریت افراد (70/79) قصد بالایی جهت انجام این فعالیت ها را گزارش نمودند؛ در حالی که 40/43 عملکرد ضعیفی داشتند. همبستگی مستقیم و معنی داری بین میانگین نمره آگاهی و عملکرد با تمام سازه های نظریه رفتار برنامه ریزی شده مشاهده شد (05/0>P). نتیجه گیری: نتایج این مطالعه بر لزوم توجه به مجموعه ای از عوامل موثر در تغییر رفتار مبتلایان به دیابت تآکید داشته و می تواند مبنای توسعه مداخلات آموزشی نظریه محور با هدف ارتقای عملکرد مراقبت از پا قرار گیرد

Effectiveness of Blended Instruction on Pain and Requirement for Analgesic after Knee Arthroplasty Surgery

Background and aims: Most patients undergoing knee replacement surgery have pain and limited range of motion during recovery and rehabilitation and due to pain and lack of experience and knowledge are not able to run an effective rehabilitation program. So, this study was aimed to determine the effect of blended instruction on the intensity and the admission palliative of patients undergoing knee surgery. Methods: 64 patients scheduled for knee replacement surgery randomized block Foursome assigned to two experimental and control groups. The training program including film screenings and providing face to face training, manual and training video in the individual manner was implemented days before the surgery for the experimental group. The control group received routine care. Data by demographic and clinical form and pain assessment checklist were collected using a visual analogue scale. Numerical data about the pain from the second to fifth days and one month after surgery were collected and analyzed useing the SPSS software and Independent t-test, Chi-square and Repeated measure tests. Results: The results of this study showed that the experimental group reported significantly less pain than the control group at most times (P=0.012). According to independent t-test statistically significant difference between the 2 groups in terms of the amount of admission palliative at the time was found (P>0.054). However, based on analysis of variance with repeated measures between the admission palliative on study, there was a significant difference in both groups (P<0.001). Conclusion: According to our results, the combined intervention before surgery can reduce the level of pain experienced after surgery and as a training method used to teach these patients after surgery

Effects of clinical education and evaluation with portfolio method on nursing students' satisfaction: a clinical trial

زمینه و هدف: لزوم بازنگری در روش های فعلی آموزش در پرستاری و استفاده از روش های آموزش و ارزشیابی نوین در سال های اخیر مورد توجه جدی قرار گرفته است؛ لذا این مطالعه با هدف مقایسه رضایتمندی دانشجویان پرستاری از به کارگیری روش آموزش و ارزشیابی بالینی پورت فولیو و روش روتین صورت گرفت. روش بررسی: در این پژوهش کارآزمایی بالینی، کلیه دانشجویان ترم 6 کارشناسی پرستاری دانشکده پرستاری و مامایی دانشگاه جندی شاپور اهواز (37 دانشجو)که طبق برنامه ریزی دانشکده به 4 گروه تقسیم شده بودند، جهت گذراندن کارآموزی به روش پورت فولیو و روتین انتخاب شدند. روش کار بدین صورت بود که در یک واحد کارآموزی به صورت روتین و واحد کارآموزی بعدی به شیوه پورت فولیو آموزش داده و ارزشیابی شدند. رضایت دانشجویان از دو شیوه آموزشی با استفاده از پرسشنامه محقق ساخته رضایت سنجی مقایسه گردید. یافته ها: در موارد مشابه بودن موضوعات موجود در روش آموزش و فرم ارزشیابی با تجربیات بالینی مواجه شده، ایجاد علاقه و انگیزه برای مشارکت دانشجو در یادگیری، ایجاد انگیزه برای استفاده از کتاب ها و سایر منابع علمی، کمک به یافتن موارد نقص و جبران آن طی کارآموزی، همسو بودن موضوعات موجود در روش ارزشیابی به شیوه پورت فولیو با اهداف آموزشی و میزان یادگیری در روش پورت فولیو میزان رضایتمندی دانشجویان بیشتر و معنی دار بود (01/0>P). همچنین متوسط نمره کل رضایت مندی دانشجویان از روش پورت فولیو (25/2±83/29) بیشتر از روش متداول (06/3±89/27) بود (01/0>P). نتیجه گیری: رضایت بیشتر دانشجویان در برخی زمینه ها از شیوه آموزش پورت فولیو، مؤید مزایای استفاده از این روش آموزشی جدید می باشد و می توان آن را به عنوان یک روش تلفیقی از آموزش و ارزشیابی دانشجو محور به کار برد

Effects of “FIRST2ACT” Model on Knowledge and Practical Skills of Difficult Airway Management in Nurse Anesthesia Students: An Interventional Study

Introduction: An important part of anesthesia management is opening and maintaining the patient’s airway. Failure to establish and maintain a safe airway for patients during anesthesia is a life-threatening condition. Despite advances in science and technology, difficult airway management is far from ideal. Providing a simulated environment for critical situations seems to be the best way to better educate and prevent medical errors. This study aimed to compare the effect of the FIRST2ACT (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trend) model on knowledge and practical skills of difficult airway management and respiratory accidents between the intervention and control groups.Methods: This study was a quasi-experimental intervention with before and after design. Sampling was done by census method and the participants were third and fourth-year nurse anesthesia students (n=62). The students were randomly allocated to an intervention group (n=31) educated and practicing based on the FIRST2ACT model and a control group (n=31). The intervention consisted of five stages: developing core knowledge, assessment, simulation, reflective review, and performance feedback, all based on the FIRST2ACT model. Theoretical and practical skills were examined in the participants. Data collection tools included a questionnaire and a checklist.Results: The results showed that after applying the FIRST2ACT model, the intervention group scored higher than the control group in both theoretical knowledge (17.87±1.43 vs. 12.67±1.35) and practical skills (134.28±3.21 vs. 81.58±8.55). This difference in results between the two groups was statistically significant (P˂0.001).Conclusion: It can be concluded that using this model was effective to improve the knowledge and practical skills of nurse anesthesia students in the field of difficult airway management and respiratory accidents during anesthesia

Identification of airborne fungi’s concentrations in indoor and outdoor air of municipal wastewater treatment plant

Background: Airborne fungi play an important role the quality of indoor and outdoor air. The aim of this study was to investigate the concentration of airborne fungi around different parts of the wastewater treatment plant (WWTP) in the west of Ahvaz and its relationship with some important meteorological parameters. Methods: This study was conducted on a WWTP in the west of Ahvaz during 4 months in both cold and warm seasons. Samples were collected from 2- and 10-m intervals of the grit chamber (GCh), primary sludge dewatering basin (PSDB), and aeration tank (AT), as well as 60 m upstream (US), downstream (DS), and administrative building (AB) of the WWTP. Bioaerosols were collected using passive sampling method. Temperature, humidity, wind speed, wind direction, and ultraviolet index (UV) were also measured at the time of sampling. Results: The total concentration of fungi was 46.1 ± 43 CFU/plate/h. The highest concentration of fungi (92.2 ± 28.12 CFU/plate/h) was found 2 m away from the GCh in the cold season and the lowest one (24.6 ± 6.67 CFU/plate/h) was found at the 10-m distance of the AT in the warm season. The dominant fungal genus included Cladosporium, Alternaria, Yeast, and Aspergillus, respectively. Also, there was a significant relationship between the degree of fungal contamination in different units, the US and DS of the WWTP, and there was a negative relationship between the release of fungi and UV. Conclusion: According to the results, grit chamber plays an important role in releasing airborne fungi. Also, airborne fungi were reduced with an increase in distance and UV. Keywords: Bioaerosols, Fungi, Meteorological parameters, Wastewater treatment plan

Association between diabetes mellitus and rs2868371; a polymorphism of HSPB1

Introduction: Diabetes (DM) is a type of metabolic disorder that its types are generated by collectingof genetic and environmental risk agents. Here, the association between HSPB1 polymorphism as a genetic risk factor and DM was investigated. Methods: Total 690 participants from MASHAD cohort study population were recruited into the study.Anti-HSP27-level was assessed followed by genotyping using Taqman®-probes-based assay. Anthropometric, demographic and hematological/biochemical characteristics were evaluated. Kaplan-Meier curves were utilized, while logistic regression models were used to assess the association of the genetic variant with clinical characteristics of population. Results: Finds was shown there are meaningful differences among groups of age, height, waist circumference, systolic blood pressure, FBG,TG, HDL-C, and hs-CRP, and was no big -significant difference between theexists in different HSP27 SNP in the two studied groups (with and without DM), also was no remarkable relation between genetic forms of HSPB1and T2DM. This investigation was the first research that analyzed the relationship between the genetic type of the HSPB1 gene (rs2868371) and Type 2 diabetes (DM2). In our population, the CC genotype (68.1%) had a higher prevalence versus GC (26.6%) and GG (5.3%) genotypes and the data shown that no genetic difference of HSPB1 gene polymorphism (rs2868371) was related with DM2. Conclusion: HSPB1 polymorphism, rs2868371, was not associated with type 2 diabetes mellitus

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. FINDINGS: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30-30·30 million) new cases of TBI and 0·93 million (0·78-1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40-57·62 million) and of SCI was 27·04 million (24·98-30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (-0·2% [-2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (-3·6% [-7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0-10·4 million) YLDs and SCI caused 9·5 million (6·7-12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. INTERPRETATION: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

The Global Burden of Diseases, Injuries and Risk Factors 2017 includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting

Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2)