The viewpoints of interns and clerkship students about community medicine course

Introduction. Community-Oriented Medical Education (COME), compared to traditional education in hospitals is considered a new educational approach in the school of medicine. This study was designed to determine the quality of education during the Clerkship and internship in community medicine course in Shahrekord Medical University. Methods. In a descriptive cross-sectional study, 41 clerckship students and 14 interns selected by convenience sampling method were studied. The data was collected by a valid and reliable questionnaire and analyzed by descriptive statistics using SPSS software. Results. Eighty percent of Clerkship students and less than 50% of interns were satisfied with the course plan, the content of the workshop, the presence of faculty members and answering Students’ questions. In addition, more than 80% of Clerkship students and less than 42% of interns revealed their satisfaction from teaching health management such as collecting data, data analysis, prioritizing the problems, and planning and evaluation. Teaching specific programs such as vaccination, family planning and so on was supported by more than 85% of clerkship students, and almost 97.5% of them were satisfied with teaching situational analysis of health care system. Conclusion. Considering community oriented education approach in medical schools of the world and spending one month community medicine as an obligatory course in all medical schools of Iran, the revision of community medicine course seems necessary

Epidemiology of mental disorders among over 15 years old population in rural and urban area of Borujen, 1994

براساس تحقیقات سال های اخیر میزان شیوع اختلالات روانی در سراسر جهان رو به افزایش است. طبق آمارهای منتشره از طرف سازمان بهداشت جهانی (World health organization=WHO) بیش از نیم میلیارد نفر از جمعیت سراسر جهان در سنین مختلف از بیماری های شدید و خفیف روانی، عقب ماندگی های ذهنی، صرع و دمانس رنج می برند. شیوع اختلالات روانی در کشورهای درحال توسعه رو به افزایش است و بررسی های همه گیرشناسی می تواند در تعیین حجم مشکل، پیشگیری و درمان این گونه بیماری ها نقش مهمی داشته باشد. در این تحقیق میزان شیوع اختلالات روانی در جمعیت بالای 15 سال مناطق شهری و روستایی شهرستان بروجن (N=450) در راستای طرح تحقیقاتی سلامت برای همه (Health for all) به شیوه نمونه گیری تصادفی سیستماتیک و با استفاده از آزمون SCL-90-R یا (Symptom checklist-revised) و مصاحبه بالینی مورد بررسی قرار گرفته است. نتایج نشان داد 18.33 از افراد مورد بررسی دچار انواع اختلالات روانی بودند. میزان شیوع اختلالات خلقی در مردان 6.31 و در زنان 15.76، اختلالات اضطرابی در زنان 5.76 و در مردان 0.52، اسکیزوفرنیا در زنان 0.76 و در مردان 1.05، اختلالات روانی عضوی در زنان 1.15 و در مردان 0.52، اختلالات شبه جسمی در زنان 1.15، اختلالات انطباقی در زنان 0.38 و سایر 0.52 بود در بین اختلالات خلقی افسردگی اساسی (Major depression) یک دوره و عود کننده با 4.66 و در بین اختلالات اضطرابی اختلال اضطراب منتشر (Free floating anxiety) با 1.55 در هردو جنس شیوع بیشتری داشته است. همچنین اختلالات روانی بطور معنی داری در زنان بیشتر از مردان، در افراد بی سواد و کم سواد بیشتر از افراد باسواد و در گروه سنی 44-25 سال بیشتر از سایر سنین بود. در افراد متاهل و دوباره ازدواج کرده، زنان خانه دار، افراد خانواده های پرجمعیت و بازنشستگان شیوع بیشتری داشت. باتوجه به نتایج فوق و مطالعات سال های اخیر که به منظور تعیین حجم مشکل و محاسبه شاخص های بهداشت روانی در نقاط مختلف کشور صورت گرفته می بایست مشکلات روانی به عنوان یکی از زمینه های مهم در خدمات بهداشتی درمانی مورد توجه خاص قرار گیرد

Asymptotically Non-Static Kerr-deSitter Spacetime With No Event Horizon

We present our derivations for Kerr-deSitter metric in a proper comoving coordinate system.It asymptotically approaches to the deSitter metric in Robertson-walker form.This has been done by considring the stationary axially-symmetric spacetime in which motion of particle is integrable.That is the Hamilton-Jacobi and Klein-Gordon equations are separable.In this form it is asymptotically consistent with comoving frame.Comment: Title changed,revised arguments,results unchanged

Caregiver burden among Iranian heart failure family caregivers: A descriptive, exploratory, qualitative study

Background: Living with patients of chronic diseases such as heart failure (HF) is a diffi cult situation for the caregivers. This study explored the Iranian family caregivers’ burden of caregiving for patients with HF. Materials and Methods: Eighteen family caregivers of the HF patients from two governmental medical training centers in Isfahan, Iran were recruited using purposive sampling. Data were collected through face-to-face semi-structured interviews. Each interview was transcribed verbatim and was thematically analyzed concurrently. Results: Four major themes emerged from the analysis of the transcripts: Lack of care-related knowledge, physical exhaustion, psychosocial exhaustion, and lack of support. Family caregivers believed that they have little knowledge about the patients’ disease, drugs, and how to perform caregiving roles. They experienced negative physical and psychosocial consequences of full-time and highly extended caregiving roles, such as musculoskeletal disorder, fatigue, and sleep disturbance, and a high level of anxiety, stress, and social isolation. Caregivers believed that they receive little familial and organizational support on the emotional and fi nancial dimensions of caregiving. Conclusions: The fi ndings of this study can be used by healthcare providers, especially nurses, to provide more effective social, informational, and professional support for family caregivers

The effectiveness of a supportive educative group intervention on family caregiver burden of patients with heart failure.

BACKGROUND Living with heart failure patients is a complex situation for family caregivers. Few studies have been conducted to examine the effects of interventional programs to ease this condition. The purpose of this study was to determine the effectiveness of a supportive educative group intervention in reducing family caregivers' burden of caregiving. MATERIALS AND METHODS This randomized clinical trail was conducted at a selective teaching hospital in Isfahan, Iran in 2012. The intervention consisted of four weekly multimedia training sessions of 2 h that included education and family support for 50 family caregivers. Caregiver burden was measured using the Zarit Burden Interview (ZBI). Paired t-test, Student's t-tests, and repeated measures analysis of variance (ANOVA) were used to test for significant differences of the mean scores of burden between the intervention and control groups over a 3-month period. RESULTS The intervention was successful in reducing caregiver burden over time both at the end of the intervention period (P = 0.000) and 3 months after the intervention (P = 0.000). CONCLUSIONS Nurses and other healthcare providers can use the findings of this study in order to implement effective programs to reduce family caregivers' challenges and to provide them more support

The survey of family history of diabetes in patients with type 2 diabetes in Chaharmahal va Bakhteyari province, Iran, 2008

چکیده: زمینه و هدف: دیابت از گروه بیماری های متابولیک و یک اختلال چند عاملی است که با افزایش مزمن قند خون مشخص می شود. از آنجایی که در زمینه اپیدمیولوژی ژنتیک دیابت نوع 2 در کشور ما، مطالعات اندکی انجام شده و هنوز بطور قطعی مشخص نیست که توارث دیابت نوع 2 بیشتر از طرف کدام یک از والدین (پدر یا مادر) به فرزندان منتقل می شود، این مطالعه با هدف بررسی زمینه ژنتیکی بیماران دیابتی نوع 2 استان چهارمحال و بختیاری طراحی و اجرا گردید. روش بررسی: این بررسی یک مطالعه اپیدمیولوژیک از نوع توصیفی-تحلیلی است که جامعه پژوهش آن افراد مبتلا به دیابت نوع 2 در استان چهارمحال و بختیاری در سال 1387 بود. تعداد 254 نفر به روش تصادفی دو مرحله ای انتخاب و مورد بررسی قرار گرفتند. داده ها بوسیله مصاحبه و با تکمیل فرمی، جمع آوری و با نرم افزار STATA9 و آزمون مجذور کا مورد تجزیه و تحلیل قرار گرفت. یافته ها: از254 نفر بررسی شده 150 نفر (59) مونث و 104 نفر(41) مذکر بودند. متوسط سن آنها 6/8±8/54 سال و متوسط مدت زمان ابتلا به دیابت در آنها 8/5±4/7 سال بود. 116 نفر (7/45) از آنها دارای سابقه خانوادگی مثبت دیابت بودند که از این میان، 4/61 مادر دیابتی، 8/19 پدر دیابتی، 9/62 خواهر دیابتی، 1/18 برادر دیابتی، 5/40 دختر دیابتی و 1/18 پسر دیابتی داشتند. سابقه خانوادگی دیابت در مادر بیشتر از پدر، در خواهر بیشتر از برادر و در دختران بیشتر از پسران بود (001/0>P). نتیجه گیری: نسبت شانس ابتلا به دیابت برای کسانی که سابقه خانوادگی مثبت دیابت در مادر دارند بیشتر و مهم تر از پدر بوده و می توان اظهار نمود که به احتمال قوی، توارث دیابت نوع 2 بیشتر از طریق مادر به فرزندان منتقل می شود.

Family Caregivers' Experiences of Caring for Patients With Heart Failure: A Descriptive, Exploratory Qualitative Study

Background: Living with heart failure is a complex situation for family caregivers. Many studies addressing the challenges faced by heart failure family caregivers have already been conducted in Western societal settings. Sociocultural factors and perspectives influence the family caring experience and roles. The ethnic/culturally based differences in family caring behavior make this a subject worth further exploration and clarification. Purpose: This study explores the experiences of family caregivers in Iran of caring for patients with heart failure. Methods: A descriptive, exploratory, and qualitative approach was applied to gain authentic insight into the experiences of participants. Purposive sampling was used to recruit 21 family caregivers from three educational hospitals in Isfahan, Iran. Data were collected using semistructured interviews and field notes. Interviews and field notes were transcribed verbatim and concurrently analyzed. Results: Three major themes emerged from the analysis of the transcripts: caregiver uncertainty, lack of familial and organizational support, and Allah-centered caring. Participants believed that they did not have the basic knowledge related to their disease and drugs. In addition, they received little guidance from the healthcare team. Lack of support and insurance as well as financial issues were major problems faced by the caregivers. They accepted the providence of Allah and noted that Allah always helps them accomplish their caregiving responsibilities. Conclusions/Implications for Practice: The care performed by the caregivers of patients with heart failure exceeds their individual capabilities. Nurses, other healthcare providers, and health policy makers may use the findings of this study to develop more effective programs to address these challenges and to provide more effective support. Sociocultural factors and perspectives were the primary factors affecting the caregiving experiences of participants in this study. Improved understanding of these factors and perspectives will help healthcare providers develop and implement suitable intervention programs for caregivers. Healthcare professionals should develop context-based intervention programs to promote caregiver capabilities and encourage caregivers to participate to facilitate the caregiving roles of caregivers

The Effect of Mesalazine on Pain Management in Patients with Diarrhea-Predominant Irritable Bowel Syndrome

Background and Objective: Irritable bowel syndrome is one of the common gastrointestinal complaints that is often resistant to standard treatment. Since mesalazine reduces abdominal pain and diarrhea through its anti-inflammatory effects, this study was conducted to investigate the effect of mesalazine on pain management in patients with diarrhea-predominant irritable bowel syndrome (IBS-D). Methods: This case-control study was conducted among 100 patients diagnosed with diarrhea-predominant irritable bowel syndrome referred to Ayatollah Rouhani Hospital in Babol. Patients were randomly divided into two groups of 50, receiving standard treatment (amitriptyline 25 mg) and a group that received mesalazine at a dose of 500 mg for 4 weeks three times a day in addition to standard treatment. Subjects were examined and compared in terms of pain intensity and frequency of discharge and recovery. Findings: The intensity of pain after treatment in the case group was lower than before treatment (4.66±2.29 vs. 7.80±2.01) (p=0.004). Out of 50 patients, 38 people (76.0%) in the case group and only 20 people (40%) in the control group recovered (p<0.001). In the case group, the number of bowel movements after treatment (2.20±0.92) was significantly less than before (4.92±0.92) (p<0.001). In the control group, the number of bowel movements showed a statistically significant difference before and after treatment (5.22±1.07 vs. 2.50±1.19) (p<0.001). Conclusion: Based on the results of this study, mesalazine is significantly effective in reducing the intensity of pain caused by irritable bowel syndrome. However, there was no difference in the number of excretions

Evolution of Thick Walls in Curved Spacetimes

We generalize our previous thick shell formalism to incorporate any codimension-1 thick wall with a peculiar velocity and proper thickness bounded by arbitrary spacetimes. Within this new formulation we obtain the equation of motion of a spherically symmetric dust thick shell immersed in vacuum as well as in Friedmann-Robertson-Walker spacetimes.Comment: 8 pages, 1 figur