Effect of electrode distance in grid electrode: Numerical models and in vitro tests

Electrochemotherapy is an emerging local treatment for the management of superficial tumors and, among these, also chest wall recurrences from breast cancer. Generally, the treatment of this peculiar type of tumor requires the coverage of large skin areas. In these cases, electrochemotherapy treatment by means of standard small size needle electrodes (an array of 0.73 cm spaced needles, which covers an area of 1.5 cm2) is time-consuming and can allow an inhomogeneous coverage of the target area. We have previously designed grid devices suitable for treating an area ranging from 12 to 200 cm2. In this study, we propose different approaches to study advantages and drawbacks of a grid device with needles positioned 2 cm apart. The described approach includes a numerical evaluation to estimate electric field intensity, followed by an experimental quantification of electroporation on a cell culture. The electric field generated in a conductive medium has been studied by means of 3-dimensional numerical models with varying needle pair distance from 1 to 2 cm. In particular, the electric field evaluation shows that the electric field intensity with varying needle distance is comparable in the area in the middle of the 2 electrodes. Differently, near needles, the electric field intensity increases with the increasing electrode distance and supply voltage. The computational results have been correlated with experimental ones obtained in vitro on cell culture. In particular, electroporation effect has been assessed on human breast cancer cell line MCF7, cultured in monolayer. The use of 2-cm distant needles, supplied by 2000 V, produced an electroporation effect in the whole area comprised between the electrodes. Areas of cell culture where reversible and irreversible electroporation occurred were identified under microscope by using fluorescent dyes. The coupling of computation and experimental results could be helpful to evaluate the effect of the needle distance on the electric field intensity in cell cultures in terms of reversible or irreversible electroporation

An evaluation of a walking and socialization program in long-term care: Impact on injurious falls

The effects of a walking program in long-term care (LTC) are affected by multiple comorbidities and the LTC milieu. We randomly assigned residents 60 years and older into three groups (walking, socializing and control). Interventions were delivered five days weekly up to 30 minutes daily. Measurements were performed at baseline, 8, 16, 24 and 32 weeks, and included falls, grip strength, Berg Balance Scale, Senior Fitness Test, and Geriatric Depression Scale Short Form. Survival analysis with 168 participants for time to first injurious fall showed a significant (p=0.001) interaction between age and sex, with fall risk increasing with age in females, but lowest in the oldest age group in males. The hazard ratio for first injurious fall was more than doubled by the use of an antidepressant (HR=2.198, p=0.005), decreased by the score on the Berg Balance high fall risk rating (HR=0.471, p=0.010), but not affected by the activity-socialization intervention. The increased hazard of injurious falls related to antidepressants, but not depressive symptoms, suggests that the high prevalence of antidepressants in LTC needs re-evaluation. Further research efforts will need to control for alternate physical activities. This work was supported by the Saskatchewan Health Research Foundation Health Research (SHRF) Team Grant. Trial registration: ClinicalTrials.gov NCT0127780

The Prevalence of Problematic Internet Use and the Related Factors in Medical Students, Kerman, Iran

Abstract Background: Although problematic internet use (PIU) is a growing problem among adolescents, few studies have examined its prevalence among university students in Iran. This study was designed to investigate the prevalence of PIU and its potential risk factors among students at Kerman University of Medical Sciences, Kerman, Iran. Methods: In a cross-sectional study, data was collected from 976 university students. PIU was assessed by the 18-item Problematic Internet Use Questionnaire. In addition, information on demographics and Internet usage pattern was also collected. Findings: A total of 920 students completed the survey (response rate = 94.8%). Of them, 98% were Internet users. Overall, 21% of the students were identified as problematic Internet users. Logistic regression analysis showed that spending more time online, having a history of psychiatric disorders, and using the Internet for chatting and playing games were risk factors for PIU. Conclusion: PIU is a common problem among university students. These results suggest the need for preventive and interventional strategies for this vulnerable group

A Biopsychosocial-Spiritual Model for the Care of Patients at the End of Life

Purpose: This article presents a model for research and practice that expands on the biopsychosocial model to include the spiritual concerns of patients. Design and Methods: Literature review and philosophical inquiry were used. Results: The healing professions should serve the needs of patients as whole persons. Persons can be considered beings-in-relationship, and illness can be considered a disruption in biological relationships that in turn affects all the other relational aspects of a person. Spirituality concerns a person's relationship with transcendence. 'therefore, genuinely holistic health care must address the totality of the patient's relational existence-physical, psychological, social, and spiritual. The literature suggests that many patients would like health professionals to attend to their spiritual needs, but health professionals must be morally cautious and eschew proselytizing in any form. Four general domains for measuring various aspects of spirituality are distinguished: religiosity, religious coping and support, spiritual well-being, and spiritual need. A framework for understanding the interactions between these domains i s presented. Available instruments are reviewed and critiqued. An agenda for research in the spiritual aspects of illness and care at the end of life i s proposed. Implications: Spiritual concerns are important to many patients, particularly at the end of life. Much work remains to be done in understanding the spiritual aspects of patient care and how to address spirituality in research and practice

Knowledge and Attitude of Health Network Staff toward Illegal Drug Use

The Editor Iran has fallen victim to the dire repercussion of malady certain historical, social, and geographic influence namely the proximity with Afghanistan as the largest producer of narcotics in the world.1 With addition prevailing in Iran,2 Iran has been reported to have the highest rate of opiate (opium and heroin) use worldwide (450 mt a year).1,3,4 Available statistics, namely United Nations Office on Drugs and Crime (UNODC), has it that more than 2 million of Iranians (3.0% of population) were addicted to illegal drugs including opium, hashish, and stimulants in 2010.1,4,5 The study described attitude as “a tendency to respond positively or negatively toward a certain idea, object or person” which is “reflected in person’s emotions and behavior.” People’s attitude has a very imperative role in their future performance, this effects accumulates with the depth of knowledge, experience, and education. Supporting addicts, or those under treatment and rehabilitation is directly influenced by the knowledge and understanding of addiction, treatment efficiency and rehabilitations benefits. Assessing people’s attitude in any given time and also evaluating attitude changes through the time is one of the main components of interventional evolution, which is intended to improve attitude.6,7 Despite the key role of health care staff in promoting health goals and also their critical position in community education, there is a few study regard to their level of knowledge, attitude, and performance pertaining to drug use. This information is necessary for health care programmers to devise appropriate training programs for health care staff and their target community. We aimed to obtain these data in the study. Our study population consisted of the health care staff employed in Sarakhs Health Network, Iran. This population included health care staff (physicians, nurses, midwives, paramedical staff, and professional health workers). The self-designed questionnaire for collecting information had three parts (demographic information and history of substance use-9 questions to evaluate knowledge in Likert scale-2 questions to assess attitude in Likert scale). To assess the reliability, two steps were taken: Item analyses method and test-retest method. Cronbach’s score was measured 0.61-0.86 and 0.78-0.91 for knowledge and attitude assessment, respectively. The overall Cronbach’s alpha of questionnaire was 0.84. Before distributing questionnaires, participants were assured about the confidentiality of their responses and their choice of participation. 185 questionnaires were filled. The relations between variables were evaluated with crosstabs, Chi-square and Spearman tests by SPSS (version 11.5, SPSS Inc., Chicago, IL, USA). Mann-Whitney non-parametric test and Kruskal–Wallis were used to detect differences between means of independent variables. P < 0.05 was considered significant in all calculations. The mean age of participants was 32 ± 7.4 (22-47) years and 50.0% were male (92 people). Ethnicity of participants were as follow: 126 Fars (68.0%), 32 Zaboli (17.0%), 19 Baloch (10.0%), 5 Turk (3.0%) and 3 others (2.0%). 163 persons (88.0%) were Muslim Shiite whereas 22 persons (12.0%) were Muslim Sunny. 9 participants (5.0%) reported smoking in their history while 10 participants (5.0%) had a history of illegal drug use. The prevalence of illegal drug use in family, relatives, and acquaintances (neighbors, co-workers and friends) were 5.4, 24.9, and 48.6 percentage, respectively. The participants estimated the prevalence of addiction in society between 20.57 ± 28.24. As to the participants’ self-assessment of their own knowledge of drug addiction, a fraction of 15.7% believed their insight to be rudimentary whereas 43.9% assumed they were well aware in this respect. Participants believed that psychiatrist, physiologist, and NA were related less influential compared to family, friends and acquaintances in this respect. Most of participant’s believed that police actions have a limited role in addiction control. As to efficacy of treatment modalities, the most effective methods were respectively “hospitalization in clinic” (37.9%), “staying in camp” (25.6%), and “maintenance treatment with methadone” (21.4%) respectively. The least effective methods included: “prison” (76.0%), “outpatient care/home care” (65.9%), and “ultra rapid opioid detoxification” (51.6%). We found a significant relation between the selected item of “methadone maintenance treatment” and ethnicity (P = 0.04). This highlights the importance of education as participants’ awareness was apparently insufficient in this respect. “Addicted friend” (79.2%), “lack of appropriate support” (75.1%), and “irresistible” (73.5%) were the most potent stimuli in incompliance or relapse. These results are similar to other studies conducted in Tehran and Bam, Iran.6,8 Participants believed that glass (methamphetamine) (81.7%), heroin (crystal/crack) (81.3%), and opium (79.5%) were the most dangerous drugs for individual health. On the other hand, most of the staffs had an appropriate level of information about the side effects of most available drugs in the community. Considering participants answers, continuous and updating educational sessions on addiction-related topics, different types of illegal drugs and their harms must be planned for health care staff in their annual educational programs. It is also necessary to assess the efficacy of these educational sessions in promoting knowledge, attitude, and function afterward. This study reflects the opinion of a group of health care staff about addiction and drug misuse, but these results cannot be generalized to all the health care workers or people in the community. Ethnicity is diversity in Sarakhs, which is also applying to health care staff. Our results suggest that attention to culture and attitudes of different ethnicities and faiths absolutely essential, contributing substantially to healthcare planning. Therefore, it is suggested that similar studies should be performed, assessing other ethnicities and cultures; particularly their high-risk groups namely immigrants, with the aim of raising awareness as to the most effective means of education and mode of interaction. Health care staff has a distinguished and influential position in advancing and improving community health. With this approach, considering health care staff, an important role in community education and also their role in preventive programs, their information and attitudes about addictive drugs, preventive programs and performing educational sessions are very vital. In the last part of the questionnaire, there we included a space for opinions and suggestions. Most of the participants understood their need for more information and were keep on participating in educational programs or receiving educational material such as pamphlets, booklets, and videos. These suggestions showed health care staff high determination to participate in drug use prevention and addiction treatment programs. Conflict of Interests The Authors have no conflict of interest. Acknowledgements We appreciated vice presidency for research of Mashhad University of Medical Sciences (MUMS‎), Iran, which supported this study in different ways. Furthermore, we are grateful to all of the Sarakhs Health Network staff who participated in this study. We have special thanks for professional supports of Dr. Farhodian (Welfare and Rehabilitation Sciences University) and Addiction Research Center (ADRC) of MUMS

Internet Addiction Based on Personality Characteristics of High School Students in Kerman, Iran

Abstract Background: The new phenomenon of Internet addiction among teenagers and young adults is one of the modern addictions in industrial and post-industrial societies. The purpose of this research was to predict the Internet addiction based on the personality characteristics of high school students in Kerman. Methods: This research was a descriptive correlational study. The statistical population included 538 male and female students in the second grade of high school in Kerman during 2010. The subjects were randomly selected by multistage clustering. Data was collected by two questionnaires including the five-factor Revised NEO Personality Inventory and the Internet dependency questionnaire. The data was analyzed using ANOVA test and multivariable regression analysis. Findings: The findings showed a significant relationship between the personality trait of emotional stability and academic fields, i.e. students with higher emotional stability experience less negative emotions when confronting with problems. Therefore, it is less likely for them to alleviate the negative emotions by the extreme and obsessed usage of the Internet. In addition, it appears that the students with high extroversion scores prefer social, face to face interactions with other people to interaction with the virtual world. Conversely, more introvert students avoid interactions with other people due to their shyness. Thus, they communicate with the virtual world more. Conclusion: Three personality traits of loyalty, emotional stability, and extroversion are the most significant predictors of Internet addiction in high school students

Challenges in the Area of Training and Prevention at the HIV Triangulation Clinic, Kerman, Iran

Abstract Background: Since 2000, Iran has been delivering training and treatment services, including methadone therapy, to human immunodeficiency virus (HIV) positive patients through triangular clinics. This study aims to evaluate the effectiveness of these activities at the HIV Triangulation Centre in the city of Kerman, Iran, through clients’ views. Methods: Participants were recruited using a convenience sample and assessed through in-depth interviews, and observations. Data were analyzed using a thematic analysis, matrix based method. Findings: The results found problems in training and counseling which was described by the staff to be due to the effects of the economic difficulties of the clients, not being of the same sex as the consultant, and lack of utilization of a variety of training methods by the clients. Furthermore, the absorption of clients was perceived as being affected by the appearance of the center, gossip around the center, limited working hours, and interpersonal relations between clients and staff. The clients also criticized the building of the center as it failed to maintain anonymity of the patients. The need for supplementary services, such as dentistry, was perceived by many clients. Conclusion: The application of appropriate strategies such as providing adequate training and removing the obstacles of absorption should be taken into account to increase the utility and coverage of the triangular clinic. These interventions could be a range of activities, such as relocating the center to a more decent place and encouraging the staff to appear in a professional white coat to help gain the trust of clients. Keywords: HIV, Triangulation clinic, Counseling, Methadone therap