Publications by authors named "Nouzar Nakhaee"

100 Publications

Health Promoting Self-care Behaviors in Patients With Multiple Sclerosis in the Southeast of Iran: Developing a Model for Practice.

Basic Clin Neurosci 2020 Sep-Oct;11(5):687-699. Epub 2020 Sep 1.

Department of Epidemiology, Research Center for Health Sciences, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: Promoting self-care practice, as a critical strategy for enhancing the quality of life in patients with Multiple Sclerosis (MS) is a challenging issue. This study aimed to propose a model of health-promoting self-care behaviors in MS patients.

Methods: In this cross-sectional study, 200 patients with MS, who had referred to the Hospital for Special Diseases in Kerman City, Iran, were chosen. The main data collection instruments were the multiple sclerosis knowledge questionnaire, the Rosenberg self-esteem scale, multiple sclerosis self-efficacy scale, questionnaire of perceived barriers and benefits of self-care behaviors, social support, the health promotion lifestyle profile II, and resilience and sense of coherence scale. Data analysis was conducted in SPSS V. 22 and AMOS18 software. The Structural Equation Modeling (SEM) was also used for further analysis of data.

Results: The model explained 82% of variance in Health-Promoting self-care Behavior (HPB). The results of the final model obtained from the SEM showed that self-efficacy (β=0.53, SE=0.04, P= 0.007), self-esteem (β=0.39, SE=0.04, P=0.005), social support (β=0.36, SE=0.04, P=0.009), sense of coherence (β=0.34, SE=0.07, P=0.006), resilience (β=0.33, SE=0.07, P=0.018), and perceived benefits (β=0.25, SE=0.05, P=0.009) had a positive and significant relationship with HPB.

Conclusion: The self-care empowerment model in patients with MS presented in this study can be used as a framework for designing health promotion interventions to improve the quality of life of patients with MS.
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http://dx.doi.org/10.32598/bcn.11.5.1670.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878060PMC
September 2020

Posttraumatic growth after earthquake: A systematic review and meta-analysis.

Int J Soc Psychiatry 2021 Feb 22:20764021995856. Epub 2021 Feb 22.

Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Iran.

Background: Posttraumatic growth (PTG) represents a positive personal change adverse events, such as natural disasters, including earthquake. However, the association between exposure to earthquake and level of PTG is still unknown. Thus, the aim of this systematic review and meta-analyses (MA) is to assess the level of PTG in people exposed to earthquake.

Methods: Studies were identified via Scopus, PsycInfo, Web of Science, PubMed, EMBASE, ProQuest, Cochran Library, Ovid, Google Scholar, OpenGrey, congress, and conferences research papers. The level of PTG was presented as mean and standard deviation. Subgroup analyses were conducted to control for the amount of time that had passed since stressor onset and age of the study population. The meta-regression was used to explore the sources of between-study heterogeneity, including sample size and age.

Results: The MA of all 21 studies using no restrictions related to age and time of the PTG measurement since traumatic event showed low level of PTG (41.71; 95%CI = 34.26; 49.16, : 62.44%, : .000). Subgroup analyses controlled for the age demonstrated that level of PTG was higher in adults (49.47; 95% CI = 42.35; 56.58, : 0%,  = .466) when compared to children and adolescents (35.38; 95% CI = 23.65; 47.11, : 69.09%,  < .00). Moreover, the pooled weight mean of PTG measured 1 year and less than 1 year since the earthquake varied between medium (46.04; 95%CI = 34.45; 57.63, :51.2%, : .037) and high (59.03; 95%CI = 41.46; 76.41, : 0%, : .990) levels, respectively.

Conclusion: The results of our MA showed low level of PTG in earthquake survivors. However, the mean value of PTG in adults was higher when compared to children and adolescents. In addition, the mean PTG was found to decrease over time since traumatic events.
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http://dx.doi.org/10.1177/0020764021995856DOI Listing
February 2021

Development and validation of a questionnaire to determine medical orders non-adherence: a sequential exploratory mixed-method study.

BMC Health Serv Res 2021 Feb 12;21(1):136. Epub 2021 Feb 12.

Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Patients' non-adherence with medical orders of physicians in outpatient clinics can lead to reduced clinical effectiveness, inadequate treatment, and increased medical care expenses. This study was conducted to develop and validate a questionnaire to determine the reasons for patients' non-adherence with physicians' medical orders.

Methods: A sequential exploratory mixed-method study was conducted in two stages. The first stage comprised a qualitative stage to generate the primary items of the questionnaire. This stage provided findings of two sub-stages comprising a literature review and the findings of a qualitative conventional content analysis of 19 semi-structured interviews held with patients, physicians, and managers of the outpatient clinics in Kerman, an area located in southeastern Iran. The second stage comprised a quantitative study aiming evaluation of the instrument psychometric properties, including the face, content, construct, and reliability assessment of the questionnaire. Construct validity assessment was evaluated using exploratory factor analysis (EFA). The reliability assessment was done using assessing internal consistency (Cronbach's alpha). To assess the construct validity of the questionnaire, four hundred and forty patients referred to outpatient clinics in Kerman were selected using stratified convenience sampling to fill out the questionnaire. The sample size was calculated using the Cochran formula. Qualitative and quantitative data were analyzed by MAXQDA 10 and Stata version 14, respectively.

Results: The primary items contained 57 items, of which 42 met the minimum acceptable value of 0.78 for item-level content validity index (I-CVI = 1 for 24 items and I-CVI = 0.8 for 18 items). Item-level content validity ratio (I-CVR) was confirmed for 18 items with a minimum acceptable value of 0.99 for five experts. Finally, 18 items obtained the acceptable value for both I-CVI and I-CVR indicators and were confirmed. Using EFA, four factors (intrapersonal-psychological, intrapersonal-cognitive, provider-related, and socio-economic reasons) with 18 items and Cronbach's alpha coefficient of 0.70, 0.66, 0.73, and 0.71, respectively, were identified and explained 51% of the variance. The reliability of the questionnaire (r = 0.70) was confirmed.

Conclusion: The questionnaire with four dimensions is a valid and reliable instrument that can help determine the perceived reasons for non-adherence with medical orders in the outpatient services system.
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http://dx.doi.org/10.1186/s12913-021-06147-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881677PMC
February 2021

"Students in public and private schools-which are at higher risk of drug use?": a survey from Iran.

Subst Abuse Treat Prev Policy 2020 11 23;15(1):88. Epub 2020 Nov 23.

Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: Recent evidence from Western countries suggests that private school students are more prone to drug use. Such an evidence is lacking in Muslim countries. The aim of this study was to examine whether the risk of drug use is higher in private schools than public schools.

Methods: This cross sectional study was conducted on 650 tenth grade students of Kerman city, the center of largest province of Iran using cluster sampling. Well-validated questionnaires regarding current, lifetime substance use, and perceived use by classmates were utilized. Substances included in the questionnaire were waterpipe, cigarette, alcohol, marijuana, opium, methamphetamine, and Naas. Drug Use Tendency Scale was used to measure the attitudes of students towards drug use.

Results: The response rate was 93.7%. More than 82% of sample were public school students (n = 504). Current use of cigarette and marijuana was higher in private schools (12.2 and 3.0%, respectively) than public schools (4.4 and 0.5%, respectively) (P < 0.05). Perceived prevalence of cigarette smoking by classmates was higher among private school students.

Conclusion: Despite the popular belief that private schools are better than public schools regarding the risk of substance use, students who attend private schools may be at a higher risk of turning to some drugs comparing to public schools in Iran.
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http://dx.doi.org/10.1186/s13011-020-00330-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686712PMC
November 2020

Swimming Exercise Training Attenuates the Lung Inflammatory Response and Injury Induced by Exposing to Waterpipe Tobacco Smoke.

Addict Health 2020 Apr;12(2):109-117

Neuroscience Research Center, Institute of Neuropharmacology AND Department of Physiology and Pharmacology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.

Background: The use of waterpipe tobacco smoking (WTS) is on the rise throughout the world, especially among young people and even athletes. There is a belief among consumers that exercise prevents the harmful effects of hookah smoke on the body. We examined this belief by evaluation of lung injury following to concurrent WTS and swimming endurance training in male Wistar rats.

Methods: Animals were randomly divided to sedentary control (CTL) group, exercise training group (Ex group), sedentary WTS (S) group, and exercise plus WTS (S + Ex) group.

Findings: 8 weeks of WTS was associated with significant increase in serum level of cotinine, lung damage, reduction in alveolar number AN/SA (mm2) and increase in malondialdehyde (MDA) level of lung tissue. Combination of exercise with WTS significantly decreased these negative effects; however, it could not fully protect the lung from smoking damage. Waterpipe smoking (WPS) also significantly increased the pro-inflammatory cytokines of lung tissue such as tumor necrosis factor alpha (TNF-α) (P < 0.001), interleukin 1 beta (IL-1β) (P < 0.010), and IL-6 (P < 0.050) in comparison with CTL group. Exercise training to some degree reduced the levels of pro-inflammatory cytokines and increased the level of IL-10 as an anti-inflammatory IL and glutathione peroxidase (GPX) activity in animals exposed to WTS.

Conclusion: It is suggested that combination of mild to moderate exercise with WTS may attenuate the hookah smoking-induced lung damage. This effect partly is mediated through balancing of pro/anti-inflammatory and redox systems.
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http://dx.doi.org/10.22122/ahj.v12i2.264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395931PMC
April 2020

Validity and reliability of the Persian version of the Adverse Childhood Experiences Abuse Short Form.

J Educ Health Promot 2020 30;9:140. Epub 2020 Jun 30.

Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.

Background And Aim: Measuring child abuse and adverse experiences is a critical task with regard to its long-term impact on the health of individuals and communities. The purpose of this study was to validate the Persian version of the International Adverse Childhood Experiences Abuse Short Form (ACE-ASF) in Iranian society.

Materials And Methods: This cross-sectional study was conducted in Kerman, southeast of Iran, in 2019, on 494 students from Kerman University of Medical Sciences, selected by convenience sampling method. Psychometric properties of the questionnaire were examined after the forward and backward translation processes. The factor structure of the questionnaire was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The concurrent validity of the questionnaire was assessed using the childhood trauma questionnaire (CTQ). Cronbach's alpha and corrected item-total correlation were used to measure reliability.

Results: The mean age of participants was 24.3 ± 5.3 years. Based on EFA, two physical-emotional abuse and sexual abuse factors were obtained. The CFA fit indices well supported two extracted factors. The CFA showed acceptable factor loadings. The internal consistency coefficient of Cronbach's alpha was 0.75 for the physical-emotional abuse factor and 0.77 for the sexual abuse factor. The correlation coefficient of ACE-ASF and CTQ was r = 0.56. The reliability index of intraclass correlation coefficient was 0.73 (95% confidence interval: 0.60-0.84).

Conclusion: The Persian version of the ACE-ASF questionnaire has acceptable psychometric properties.
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http://dx.doi.org/10.4103/jehp.jehp_15_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377151PMC
June 2020

Gender-based differences in risk-taking behaviors among high school students in Southeast Iran.

Int J Adolesc Med Health 2020 Jun 7. Epub 2020 Jun 7.

Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Islamic Republic of Iran.

Objectives Risk-taking behaviors among adolescents can negatively affect different dimensions of their health. This study was conducted to identify the gender-based differences in risk-taking behaviors among high school students in a Muslim population. Methods Grade 10 students studying in high schools located in Kerman Province, Iran were enrolled through cluster sampling (n=2,676), and data were collected using a well-validated questionnaire about violence, sexual behaviors, and traffic-related conduct over the past 12 months. The tool also consisted questions regarding drug use over the past 30 days and over lifetime (i. e., current and ever use of drugs, respectively) Results The number of female participants was 1,407 (52.6%). The boys who had girlfriends (33.0%) were almost twice as many as the girls who had boyfriends (17.1%). Among the respondents, 27.8 and 12.0% of the boys and girls engaged in physical fighting, respectively. Overall, the prevalence of water pipe use in the last 30 days (18.7%) and over lifetime (43.5%) was higher than that of the consumption of other substances. The second and third most popular substances used in the past 30 days among boys and girls were alcohol and cigarettes and cigarettes and alcohol, respectively. On the whole, marijuana figured in the lowest lifetime use among the respondents. Conclusions The rate of risk-taking behaviors in female students was lower than in males, and this difference was more evident than in Western countries. This discrepancy seems to be more obvious in cases where the religious prohibition of a behavior is greater such as extramarital intimacy.
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http://dx.doi.org/10.1515/ijamh-2019-0205DOI Listing
June 2020

Marital satisfaction and emotional divorce among Iranian married individuals: A survey of hospital visitors of nine provinces.

J Educ Health Promot 2020 28;9:83. Epub 2020 Apr 28.

Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Background: Evidence is accumulating that the pattern and nature of marital relationships are very different in different cultures. This nationwide study aimed to determine marital satisfaction and the prevalence of emotional divorce as well as to identify the sociodemographic correlates in a Muslim population.

Materials And Methods: In this cross-sectional study, one-third of Iran's provinces were selected randomly and a representative sample of inhabitants of their central city was included in the study. The ENRICH marital satisfaction scale was used to determine marital satisfaction levels. A single-item measure with confirmed validity and reliability was used to find out about emotional divorce. The demographic variables included respondent's age, spouse's age, gender, educational level, residency, childbearing, and premarriage familiarity.

Results: Of the 2033 participants, 1034 were women (50.9%). Nearly one-third of both men and women had academic degrees. Almost 53% of them were satisfied with their marital life and 9.7% had emotional divorce. Men with academic degrees had a higher probability of marital satisfaction (odds ratio [OR] =1.26, 95% confidence interval [CI]: 1.04-1.53) and a lower prevalence of emotional divorce (OR = 0.37, 95% CI: 0.24-0.58).

Conclusion: This study showed a relatively high percentage of marital dissatisfaction as well as emotional divorce. Policymakers should strengthen premarriage education programs and postmarriage counseling centers.
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http://dx.doi.org/10.4103/jehp.jehp_570_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271926PMC
April 2020

Toxin A and B genes expression of in the sub-minimum inhibitory concentration of clindamycin, vancomycin and in combination with ceftazidime.

Iran J Microbiol 2020 Feb;12(1):18-24

Immunology of Infection of Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

Background And Objectives: Antibiotics prescribed for infections have diverse effects on microbiota and the pathogen as the most important antibiotic-associated diarrhea. This study aims to determine the gene expression of toxins A and B at the transcription level in the sub-MIC of vancomycin (VAN), clindamycin (CLI), and ceftazidime (CAZ) alone and in combination.

Materials And Methods: The MIC and fractional inhibitory concentration (FIC) of two samples (a clinical isolate and ATCC 9689) were determined by microdilution and checkerboard microdilution methods, respectively. The total RNA was extracted from the medium inoculated with ∼10 CFU/mL of fresh bacteria in the pre-reduced medium containing ½ MIC of antibiotics alone and ½ FIC of antibiotics in combination. Real-time PCR was performed by sybrGreen methods in triplicate, and the data were analyzed by the comparative ΔΔ method.

Results: All antibiotics except CAZ (alone and in combination) decreased the gene expression of toxins A and B within 24 hours. VAN and CLI reduced toxin gene expression within 24 and 48 hours. However, CAZ alone and in combination with VAN as well as CLI increased the gene expression of toxins A and B.

Conclusion: The results confirmed toxin gene transcription and toxin production are associated with the type of isolates and antibiotics, as well as the combined form of antibiotics. This could be the reason which can explain the occurrence of infection among patients who were treated with the third generation of cephalosporins alone and in combination with another antibiotic in the form of combinational therapy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7163043PMC
February 2020

Application of Social Cognitive Theory to Prevent Waterpipe Use in Male High-school Students in Kerman, Iran.

Int J Prev Med 2019 17;10:186. Epub 2019 Oct 17.

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: The growing supply and prevalence of waterpipe (WP) smoking among Iranian adolescents have become a concern for both families and policymakers. The aim of this study was to determine the factors underlying WP use and also to design an intervention program based on social cognitive theory (SCT) aimed to reduce the demand for WP smoking among male adolescents.

Methods: This quasi-experimental study involved 189 high-school students in Kerman, Iran, who were split into two groups, an intervention group and a control group. A validated questionnaire based on SCT constructs was used to collect data. The intervention was performed over four sessions with a focus on preventing WP smoking.

Results: Before intervention, the lifetime and current-use prevalence of WP smoking across both groups was 48.5% and 20.2%, respectively. In the intervention group, the most change was related to knowledge score from 10.70 ± 4.38 to 16.52 ± 3.89 ( < 0.0001) and outcome values score from 12.40 ± 3.81 to 13.53 ± 4.23 ( = 0.007); however, in the control group, no significant changes were seen in posttest scores. The scores for self-efficacy ( = 0.21), outcome expectations ( = 0.09), and environment constructs ( = 0.06) did not show any statistically significant changes after the intervention in both groups. Overall, there was no significant difference in the rate of WP smoking after the intervention.

Conclusions: Based on the results of this study, although some construct scores showed significant differences after the intervention, there was no significant change in the prevalence of WP smoking. More effective educational interventions based on this theory but with a greater focus on self-efficacy and environmental influences may be warranted.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_235_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852196PMC
October 2019

A Review of Alcohol-Related Harms: A Recent Update.

Addict Health 2019 Apr;11(2):129-137

Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran.

In the early decades of the 20 century, discussions regarding alcohol were dominantly directed toward its therapeutic uses, but authorities now state that any level of alcohol consumption poses negative effects on health. Over recent months, increased attention has been devoted to disease burdens attributable to alcohol use worldwide. As more and more studies are conducted to illuminate the harmful effects of alcohol on different body systems, the mounting evidence generated requires documentation and publication. The current review was aimed at providing an overview of the recent literature on the adverse consequences of alcohol consumption.
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http://dx.doi.org/10.22122/ahj.v11i2.225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6633071PMC
April 2019

Effective factors in non-compliance with therapeutic orders of specialists in outpatient clinics in Iran: a qualitative study.

BMC Health Serv Res 2019 Jun 24;19(1):413. Epub 2019 Jun 24.

PhD in Health Policy, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: Non-compliance with prescribed treatment is an important cause of preventable mortality and economic burden. Recognition of the factors for non-compliance with the therapeutic orders of specialists from the perspective of patients and health care providers sheds more light on the issue for policymakers and stakeholders. The current study aimed at determining the factors for non-compliance with therapeutic orders in outpatient clinics in Kerman, Iran.

Methods: The current qualitative study was conducted using the phenomenological method and semi-structured interviews with 10 patients, five specialists, and four health care managers and treatment officials in outpatient clinics in Kerman. The interviewees were selected by purposive sampling. The codes extracted from the interviews were transcribed using conventional content analysis to identify the viewpoints. The MAXQDA 10 software was used to analyze the data.

Results: The reasons for non-compliance with specialists' orders were categorized into five themes including patient-related (patient-centered), disease-related, therapy-related, the healthcare provider related (healthcare system), and socioeconomic factors. Themes were composed of fifteen categories and forty-one sub-categories. The dominant sub-categories extracted from interviews were health literacy and knowledge of the patient, communication and patients' trust in physicians and direct costs of treatment.

Conclusion: This study identified a wide range of different individual, disease, treatment, health care provider, and socio-economic factors and the interactions between them which may result into non-compliance with therapeutic orders prescribed by specialists. Therefore, specific attention should be paid to integrate the service provision system into the collaborative approach of the patient and his/her family in order to promote the level of compliance with therapy and care in planning and policy-making to improve the health service provision system.
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http://dx.doi.org/10.1186/s12913-019-4229-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6591863PMC
June 2019

The effects of selective Pilates versus extension-based exercises on rehabilitation of low back pain.

J Bodyw Mov Ther 2018 Oct 20;22(4):999-1003. Epub 2017 Sep 20.

Department of Physical Education and Sports Sciences, Karaj Branch, Islamic Azad University, Karaj, Iran. Electronic address:

Introduction: Chronic non-specific low back pain (LBP) may lead to functional impairment and physical disability. The aim of this study was to compare the effects of selective Pilates (SP) and extension-based (EB) exercises on pain, lumbar spine curvature, lumbar forward flexion range of motion (ROM), and physical disability in such individuals.

Materials And Methods: In this randomized clinical trial, Forty-seven patients with chronic non-specific LBP (Mean of age: 39.7 years) were randomly allocated into either SP (N = 16), EB (N = 15), or control (N = 16) groups. The measurements included pain intensity, physical disability, lumbar forward bending ROM, and lumbar spine curvature at the baseline, after receiving the 6-week interventions, and also following one month of cessation of the exercises The analysis of co-variance (ANCOVA) and Post-hoc Bonferroni tests were administered to compare the three groups after the interventions and one month later (P < 0.05).

Results: More significant improvement was observed in SP group compared to the subjects receiving EB exercises in terms of pain, ROM, and physical disability (P < 0.001), however, there was no significant difference between the two experimental groups for lumbar curvature (P > 0.05). Furthermore; in follow-up, the patients in SP group significantly achieved a higher level of pain intensity improvement and lumbar flexion ROM than the EB exercises (P < 0.001).

Conclusions: It is estimated that core muscles activation and improving lumbopelvic rhythm in SP training may play a role in decreasing pain and physical disability in chronic LBP patients. Further high-quality studies are required to investigate the details of this mechanism.
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http://dx.doi.org/10.1016/j.jbmt.2017.09.012DOI Listing
October 2018

Development of a questionnaire to measure perceived reasons for divorce seeking: an instrument development study.

Electron Physician 2018 Jul 25;10(7):7071-7077. Epub 2018 Jul 25.

M.D. Professor, Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Background: Subjective accounts of divorce seeking individuals is a useful complement to sociological and psychological causes of divorce at both individual and community level. Regarding the increasing trend of divorce worldwide, the need for a questionnaire measuring subjective reasons of divorce is felt more and more.

Objectives: The aim of this study was to develop and validate perceived causes of a divorce questionnaire in Iranian society.

Methods: This was an instrument development study that carried out in 2016, based on extensive literature reviews and interviews with individuals referring to "Family Intervention Centers to Reduce Divorce" in Kerman, Fars and Alborz provinces (Iran). At first, 38 items expressing the perceived reasons for divorce were extracted; then, 29 items were used in the questionnaire according to the experts' judgment. After that, the questionnaire was given to 570 participants. The structural validity was evaluated using two methods: exploratory factor analysis via principle axis factoring, and known group comparisons by paired-samples t-test. The internal consistency of the questionnaire was also examined by calculating the Cronbach's alpha and corrected item-total correlation. SPSS version 20 was used for statistical analysis.

Results: The mean age (± SD) of women and men was 32.3 (±8.9) and 36.8 (±10.6), respectively. Based on an expert panel, content validity of 29 items was approved. Using principle axis factoring and varimax rotation, two components were extracted. These two factors were called "instrumental/external reasons" and "expressive and relationship-centered reasons." Factor loading of all 29 items was higher than 0.32. Cronbach's alpha of the two subscales was 0.84 and 0.85, respectively. Corrected item-scale coefficient of all items was more than 0.2.

Conclusions: According to the acceptable validity and reliability of the Perceived Reasons for Divorce Seeking Questionnaire, it can be used to ascertain people's reasons for divorce seeking.
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http://dx.doi.org/10.19082/7071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092131PMC
July 2018

Efficacy of Pre-Medication with Ibuprofen on Post-Operative Pain after Pulpotomy in Primary Molars.

Iran Endod J 2018 ;13(2):216-220

Department of Pediatric Dentistry, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: Pain management following dental procedures, particularly pulpotomies and extraction, is of great importance in pediatric dentistry. The aim of this study was to investigate the efficacy of pre-treatment with ibuprofen on post-operative pain following pulpotomy of primary molars.

Methods And Materials: In a split mouth double-blinded randomized clinical trial, 49 children aging between 6-10 years old were given either ibuprofen or a placebo 45 min prior to the treatment. After pulpotomy and placement of a stainless steel crown (SSC), the pain level was evaluated using the Wong-Baker face visual analogue scale for up to 7 days post-treatment. McNemar and Wilcoxon tests were used for data analysis.

Results: Forty-five patients were eligible to participate in this study. Pre-medication with ibuprofen significantly reduced pain during the first 24 h post-treatment (=0.032). However, there was no significant difference in the pain levels between placebo and ibuprofen groups at 48 and 72 h post-treatment (=0.154 and =0.197, respectively). The number of times patients needed analgesics in ibuprofen group was significantly lower compared to that in the placebo group (=0.008).

Conclusion: Pre-medication with ibuprofen resulted in less pain following pulpotomy and SSC placement in primary teeth.
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http://dx.doi.org/10.22037/iej.v13i2.16624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911297PMC
January 2018

Comparison of Postoperative Pain Following One-Visit and Two-Visit Vital Pulpectomy in Primary Teeth: A Single-Blind Randomized Clinical Trial.

Iran Endod J 2018 ;13(1):13-19

Dental Research Center, Department of Pediatric Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran.

Introduction: The aim of this study was to compare post-operative pain following one-visit pulpectomy and placing stainless steel crown (SSC), with two-visit treatment (performing pulpectomy at the first visit followed by placing SSC at the next visit one week later) in vital pulp of primary molars with carious involvement.

Methods And Materials: In this randomized clinical trial, 100 children aged 6-12 years with a carious primary molar tooth in need of pulpectomy were randomly divided into two groups of 50 each. In one-visit group, pulpectomy and placement of SSC were carried out at the same appointment. In two-visit group, pulpectomy of root canals was carried out at the first visit and placement of SSC was performed at the second visit one week after the first appointment. Post-operative pain was recorded using visual analogue scale (VAS) during one week after each treatment visit.

Results: No significant difference was found in the mean age and gender distribution between the two groups (˃0.05 for both comparisons). Findings revealed that in the two-visit (pulpectomy) group during first three days and 4-7 days after the first treatment appointment, pain felt by the children was significantly lower than that felt by the one-visit group at the same time period (˂0.0001 for both comparisons). Moreover, children in two-visit (pulpectomy) group consumed significantly lower amount of analgesics than those in the one-visit group (<0.0001).

Conclusion: No significant difference was found between pain felt by children during the first three days following one-visit pulpectomy and placement of SSC at the same appointment. Therefore, one-visit treatment of vital primary tooth is recommended.
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http://dx.doi.org/10.22037/iej.v13i1.18205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800435PMC
January 2018

The efficacy and complications of a new technique of Abobotulinum-toxin A (Dysport) injection in patients with glabellar lines.

J Cosmet Dermatol 2019 Feb 23;18(1):55-58. Epub 2018 Mar 23.

Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran.

Background: Abobotulinum- toxin A is used extensively for the treatment of frown (glabellar) lines.

Aims: The aim of this study was to evaluate the efficacy and complications of a new injection technique and to assess the amount of satisfaction in patients with the frown lines.

Methods: This cross-sectional study was conducted in 104 patients with moderate-to-severe glabellar lines. In the new technique by reassessing the responsible anatomic muscles of wrinkles, we tried to modify the injection technique of Abobotulinum-toxin A to yield more favorable results. The range and severity of frown lines were assessed by a 4-score test and a photograph taken before and 2 weeks after the injection. Patients were followed up to 180 days after injection.

Results: The response time of 87.5% of patients was within the first 48 hours and the remaining 12.5% showed the symptoms within the first week after injection. At 30 days after injection, the frown lines had disappeared in 88.5% of patients in static mode and 85.6% in mechanic mode. Maximum injection durability in the first 3, 4, and 6 months after injection was 82%, 52%, and 38%, respectively. The amount of complete satisfaction after 3 months was reported to be 86.5%.

Conclusions: This study indicated that the new injection technique of Abobotulinum-toxin A could be beneficial in the treatment of frown lines with more satisfactory results, especially in those patients who were not contented with the present conventional method.
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http://dx.doi.org/10.1111/jocd.12529DOI Listing
February 2019

Voluntary exercise impact on cognitive impairments in sleep-deprived intact female rats.

Physiol Behav 2018 05 31;188:58-66. Epub 2018 Jan 31.

Department of Physiology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran; Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran. Electronic address:

Sleep loss is a common problem in modern societies affecting different aspects of individuals' lives. Many studies have reported that sleep deprivation (SD) leads to impairments in various types of learning and memory. Physical exercise has been suggested to attenuate the cognitive impairments induced by sleep deprivation in male rats. Our previous studies have shown that forced exercise by treadmill improved learning and memory impairments following SD. The aim of the current study was to investigate the effects of voluntary exercise by running wheel on cognitive, motor and anxiety-like behavior functions of female rats following 72 h SD. Intact female rats were used in the present study. The multiple platform method was applied for the induction of 72 h SD. The exercise protocol was 4 weeks of running wheel and the cognitive function was evaluated using Morris water maze (MWM), passive avoidance and novel object recognition tests. Open field test and measurement of plasma corticosterone level were performed for evaluation of anxiety-like behaviors. Motor balance evaluation was surveyed by rotarod test. In this study, remarkable learning and long-term memory impairments were observed in sleep deprived rats in comparison to the other groups. Running wheel exercise ameliorated the SD-induced learning and memory impairments. Voluntary and mandatory locomotion and balance situation were not statistically significant among the different groups. Our study confirmed the negative effects of SD on cognitive function and approved protective effects of voluntary exercise on these negative effects.
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http://dx.doi.org/10.1016/j.physbeh.2017.12.030DOI Listing
May 2018

Impact of Drug Abuse on Family Quality of Life.

Addict Health 2017 Apr;9(2):118-119

Professor, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742419PMC
April 2017

Frequency of antibiotic associated diarrhea caused by among hospitalized patients in intensive care unit, Kerman, Iran.

Gastroenterol Hepatol Bed Bench 2017 ;10(3):229-234

Department of Microbiology and Virology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.

Aim: This study evaluated the frequency of C. difficile and CDAD in the ICU of Shahid Bahonhar Hospital, Kerman, Iran.

Background: () is the most important antibiotic associated diarrhea agent in intensive care unit (ICU) patients. Based on its toxin producing ability, C .difficile is divided to toxigenic and non-toxigenic strains.

Methods: A total of 233 diarrheal samples were collected from ICU patients. The samples were cultured on Clostridium difficile medium with 5% defibrinated sheep blood containing cycloserine (500 mg/L), cefoxitin (16 mg/L) and lysozyme (5mg/L). The isolates were confirmed as C. difficile by polymerase chain reaction (PCR) of 16s rRNA gene and the presence of toxins genes (tcdA, tcdB, cdtA and cdtB) was also confirmed. Then, the toxin production of isolates was evaluated using ELISA.

Results: C. difficile was isolated from 49 (21%) out of 233 samples. The total isolates fell into the A-/B-/CDT- (48.97%), A+/B-/CDT- (28%), A+/B+/CDT- (20.4%) and A+/B+/CDT+ (2%) types. Both types of C.difficile, A-/B-/CDT- and A+/B-/CDT-, which account for 77.5% of all isolates, were unable to produce the toxin (nontoxigenic). On the other hand, A+/B+/CDT+ and A+/B+/CDT- (22.5%), were able to produce toxin or were toxigenic.

Conclusion: The frequency of was about 21% and only 22.4% of isolates were able to produce toxins. It is expected that A+/B+/CDT± are toxigenic and related to associated diarrhea (CDAD). Additionally, about 4.7% of hospitalized patients in ICU suffered from CDAD, which is higher than the rates reported from industrialized countries. Notably, 28% of isolates were A+/B-/CDT- which only carries genes without toxin production.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5660274PMC
January 2017

Promoting physical activity in Iranian women: A qualitative study using social marketing.

Electron Physician 2017 Sep 25;9(9):5279-5286. Epub 2017 Sep 25.

M.D., Ph.D. of Health Education, Associate Professor, Social Determinant of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.

Background And Aim: In social marketing, at the center of the program is consumer perception. The objective of this study was to explore the viewpoints of Iranian women for tailoring interventions so as to increase physical activity.

Methods: The social marketing model served as the framework of the study. Qualitative data were collected via six semi-structured focus group discussions (FGDs), in 2014 in Iran. Participants were 51 women, 20 to 60 years old, selected by purposive sampling, with a maximum diversity. Qualitative content analysis of the data was conducted by researchers.

Results: After data analysis and extracting initial codes, they were all categorized in four predefined categories of social marketing model (product, price, place and promotion) and related sub-categories. Most of the participants were inactive. Price was addressed by women as the dominant category of this study. The majority of participants emphasized the benefits of prevention of chronic diseases, fitness, staying young, and improving family relations. Most women preferred to do physical activity in a secure and enclosed female environment. And the majority of participants considered radio, television, face to face training, texting, and advertising billboards as promotional strategies.

Conclusion: This study provides a unique insight into consumers' values and motivations that affect consumers' decisions to adopt physical activity, in Iran. It could also help researchers to design and implement intervention programs to increase physical activity.
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http://dx.doi.org/10.19082/5279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633226PMC
September 2017

Development of Risk-Taking Tendency Tool for High School Students.

Addict Health 2017 ;9(4):237-242

Professor, Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Background: Adolescence is the age of increased sensation-seeking and risk-taking. To prevent such behaviors, the adolescent tendency to engage in high-risk behaviors must be measureable. This study aimed to develop a questionnaire about risk-taking tendencies among Iranian students.

Methods: This study was conducted using cluster sampling of the tenth-grade students in three cities in Kerman province, Iran. The students were assured that the questionnaires would remain anonymous and unlinked. Construct validity was assessed using exploratory factor analysis (EFA) and comparison of known groups. Corrected item-scale correlation and Cronbach's alpha were calculated to evaluate reliability.

Findings: A total of 551 high school students participated in this study. Of these, 57 were excluded after checking the "non-existent drug" item (10.3%). Girls accounted for 49.2% of the sample. Of the 33 initial questions, 13 were removed due to factor loading of less than 0.5. Two factors were extracted using the scree plot ("drug abuse tendency" and "other risky behavior tendency"). The tendency toward high-risk behavior was significantly higher in male students than in female ones (P < 0.001). This indicates the known group validity of the questionnaire. The Cronbach's alpha of the above-mentioned factors were 0.93 and 0.83, respectively.

Conclusion: The questionnaire measuring the tendency toward high-risk behavior among students showed acceptable validity and reliability.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294484PMC
January 2017

Estimation of the Cost of Smoking-Attributable Diseases (Five Selected Diseases): A Case in Kerman City, Iran, 2014.

Addict Health 2017 ;9(4):190-198

Associate Professor, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: Cigarette seems to be the least valuable of addictive drugs. It is easily accessible to the public, and its harmful personal and social effects have attracted less attention. Therefore, the present research was carried out with the aim of presenting cost estimations of smoking-related diseases in smokers who aged 35 or higher in Kerman City, Iran, in 2014.

Methods: Using the prevalence approach, the direct and indirect costs of smoking-attributable diseases including lung cancer, gastric cancer, myocardial infarction, stroke, and chronic obstructive pulmonary disease (COPD) were estimated. The initial data were obtained from the information in documents of medical document units as well as the 2014 income statements of teaching hospitals of Kerman University of Medical Sciences, Kerman City.

Findings: In this research, total economic costs of diseases attributed to smoking were estimated to be 50 million dollars in 2014 in Kerman City, and calculations suggest that this figure accounts for 0.02% of Iran's gross domestic product (GDP). Total direct cost of diseases caused by smoking in Kerman City adds up to 17 million dollars, whereas the estimated indirect cost of diseases caused by smoking is 33 million dollars. The yearly per capita cost of any of the selected five diseases is 270 dollars.

Conclusion: Smoking places a high economic burden on health system and society as a whole. Therefore, stronger intervention measures against smoking should be taken without delay to reduce the health and financial losses caused by smoking.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294483PMC
January 2017

Effect of sub-MIC of vancomycin and clindamycin alone and in combination with ceftazidime on Clostridium difficile surface layer protein A (slpA) gene expression.

Microb Pathog 2017 Oct 1;111:163-167. Epub 2017 Sep 1.

Department of Microbiology and Virology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran. Electronic address:

Clostridium difficile (C.difficile) infection is often established in the presence of antibiotics and probably antibiotics can influence surface layer protein A (slpA) expression as a colonization factor. The aim of this study is to evaluate the effect of vancomycin (VAN), clindamycin (CLI) alone and in combination with ceftazidime (CAZ) on slpA gene expression to determine whether such antibiotics can have any effect on slpA expression. About ∼10 CFU/mL was inoculated to medium containing an appropriate concentration of antibiotics alone and in combination. After 24 and 48 h incubation under anaerobic condition, 3 mL of culture was excluded and centrifuged in 8000 × g per 3 min. The pellet was washed and used for RNA extraction. The RNA extraction, Dnase I treatment and cDNA synthesis was performed by RNA extraction, Dnase I, and cDNA synthesis kits, respectively. The real-time PCR were carried out by sybrGreen methods and data were analyzed based on comparative ΔΔC. All antibiotics alone and in combination, except VAN/CAZ in clinical isolate, decreased the level of slpA gene expression in the 24-h incubation. While the expression profile of slpA was different in the 48-h incubation period. The VAN and CLI decreased the slpA expression, although the template of expression is closed to control medium. CAZ alone and in combination increased slpA expression. C. difficile may down-regulate slpA expression in the early stages of growth in sub-inhibitory concentration of antibiotics. But, over time C. difficile increases or over expresses the slpA expression level. Consequently C. difficile binds strongly to epithelial cells and continues to survive in the presence of sub-MIC concentration of antibiotics. This effect is observed especially with regard to CAZ and probably other third generation cephalosporins or in combination therapy with VAN or CLI, which are prescribed in the clinic. CAZ can interfere with the anti-down regulatory feature of VAN, CLI, and maybe other antibiotics.
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http://dx.doi.org/10.1016/j.micpath.2017.08.034DOI Listing
October 2017

Moral competency: meta-competence of nursing care.

Electron Physician 2017 Jun 25;9(6):4553-4562. Epub 2017 Jun 25.

Ph.D. in Community Medicine, Professor of Community Medicine, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.

Introduction: To follow the progress of technology and increasing domain of nurses' duties, ethical challenges can be observed more than ever. Therefore, the growing and dynamic system of nursing requires nurses with professional and ethical competence who can provide optimal care. The aim of the present study was to define and explain dimensions of moral competency among the clinical nurses of Iran.

Methods: This qualitative content analysis study was carried out in the years 2014 and 2015 in Iran. Data were collected through in-depth semistructured interviews and field notes. The resulting data were analyzed by Graneheim and Lundman's method of conventional content analysis. The participants were 12 clinical nurses who were selected using purposive convenient sampling and continued interviews until data saturation.

Results: Themes obtained in the present study were posited in three main categories of "moral character," with subcategories of altruism, search for meaning, be pioneering, perfectionism, self-control, honesty, and forgiveness; "moral care" with subcategories of dignified care, safe care, fair care, and holistic care; and "moral decision-making" with subcategories of moral sensitivity, moral thinking, moral reasoning, and moral courage.

Conclusions: Findings of the present study suggest that nurses' moral competency is an adorable character with a wide range that includes moral virtues and character, moral decision-making, and ultimately providing moral care; therefore, moral competency is a meta-competence in the field of nursing. Because there are many competencies in different fields.
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http://dx.doi.org/10.19082/4553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5557135PMC
June 2017

Effects of Maternal Separation on Nicotine-Induced Conditioned Place Preference and Later Spatial Learning and Memory Function in Adolescent Male Rats.

Addict Health 2016 ;8(4):261-269

Professor, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.

Background: Disturbances in maternal care have been associated with increased risk for drug abuse later in life. However, there has been little investigation of the effects of maternal separation (MS), a model of early life stress, on nicotine dependence, specifically during adolescence. In the present study, we aimed to investigate the effect of MS on nicotine-conditioned place preference (CPP) in adolescent male rats. We also examined the impact of nicotine on spatial learning and memory impairments induced by MS.

Methods: Rat pups were exposed to daily MS for 15 (MS15) or 180 (MS180) minutes during the first 2 weeks of life or reared under normal animal facility rearing (AFR) conditions. In postnatal day (PND) 28-34, they were conditioned with nicotine [0.6 mg/kg, subcutaneously (SC)] or saline and tested for preference over a period of 6 conditioning trials. Morris water maze (MWM) testing was performed to assess spatial cognitive function.

Findings: The MS procedure used in our study failed to affect nicotine reward as measured by CPP in the adolescent male rats. Notably, significant spatial learning deficit was seen in the MS180 rats compared to those in the AFR and MS15 groups and nicotine administration modified the MS-induced learning defect in adolescent male rats.

Conclusion: In conclusion, although MS revealed no influence on the sensitivity to the nicotine's reinforcing effects in adolescent male rats, the simultaneous effect of MS on learning performance may be altered by nicotine intake.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5554806PMC
January 2016

The Effects of Opium Addiction on the Immune System Function in Patients with Fungal Infection.

Addict Health 2016 ;8(4):218-226

Infectious Disease and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.

Background: The use of narcotics such as opium exposes addicts as susceptible targets of different diseases so that they might easily be exposed to different diseases such as fungal infections. The present study aimed to investigate the effects of addiction to opium and fungal infection on plasma levels of certain cytokines including interleukin-4 (IL-4), IL-6, IL-17, Interferon gamma (IFN-γ) and transforming growth factor-β (TGF-β).

Methods: Present study included 72 individuals who were divided into 4 groups: 1) opium-addicted with fungal infection; 2) opium-addicted without fungal infection; 3) non-opium-addicted with fungal infection; and 4) normal individuals (non-opium-addicted and non-fungal infection). The fungal samples, after being detected and confirmed by a physician, were prepared based on clinical symptoms and then analyzed by direct smear and culture method. The measurement of the plasma level of cytokines was done by enzyme-linked immunosorbent assay (ELISA) method.

Findings: The comparison of the mean of the plasma level of cytokines showed that addiction to opium and fungal infection had significant effect on the plasma levels of IL-17, IFN-γ, TGF-β cytokines in all studied groups. The interaction of addiction to opium and fungal infection was only significant in the case of plasma level of IL-6.

Conclusion: Addiction to opium and fungal infection, either separately or simultaneously, poses significant effect on the immune system and causes disorders in the cytokine network and the immune system and also provides a suitable environment for fungal infection.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5554801PMC
January 2016

Correlates of waterpipe smoking among Iranian university students and the role of religiosity.

Int J Psychiatry Med 2016 08 9;51(6):494-507. Epub 2017 Mar 9.

1 Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Waterpipe smoking among youth and adolescents in Iran has gained in popularity. The aim of this study was to investigate the relationship between waterpipe smoking and different dimensions of religiosity in a sample of students attending two major universities in South East Iran. A total of 682 students completed a waterpipe and cigarette smoking questionnaire along with the Duke University Religion Index. The lifetime prevalence of dual cigarette and waterpipe use was 48.3%, with prevalence of current use (within the last 30 days) of 24.9%. The proportions of lifetime and current waterpipe-only users were 27.0% and 18.8%, respectively. Students who participated more often in private religious activities were less likely to report engaging in waterpipe smoking (odds ratio: 0.82; 95% confidence interval: 0.71-0.98). A higher level of attendance of religious services was negatively associated with dual cigarette and waterpipe smoking (odds ratio: 0.71; 95% confidence interval: 0.54-0.93). Waterpipe-only use was significantly higher among males, students who had lower grade point averages, those who reported having a close friend or a family member who was a waterpipe smoker. To conclude, it is possible that religious observance may have a protective role in lowering waterpipe usage among Iranian university students.
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http://dx.doi.org/10.1177/0091217417696735DOI Listing
August 2016

Crowd Simulations and Determining the Critical Density Point of Emergency Situations.

Disaster Med Public Health Prep 2017 Dec 30;11(6):674-680. Epub 2017 May 30.

5Health Management and Economic Research Center,Isfahan University of Medical Sciences,Isfahan,Iran.

Objective: In modern societies, crowds and mass gatherings are recurrent. A combination of inadequate facilities and inefficient population management can lead to injury and death. Simulating people's behavior in crowds and mass gatherings can assist in the planning and management of gatherings, especially in emergency situations.

Methods: We aimed to determine the crowd pattern and the critical density point in the grand bazaar of Kerman in Iran. We collected data by use of a census method with a questionnaire. To determine the critical density point, height and weight data were placed in the equation $\,s\,{\equals}\,\sqrt {{{L{\vskip -1.5pt \,\,\asterisk\,\,}M} \over {3600}}} $ and the outer body surface of all the individuals in the bazaar was calculated. The crowd was simulated by use of flow-based modeling. Flow rate was determined by using the equation (flow rate=density * speed). By use of SketchUp Pro software (version 8; Trimble, Sunnyvale, CA), the movement of each person and the general flow rate were simulated in the three-dimensional environment of Kerman bazaar.

Results: Our findings showed that the population critical density point in Kerman bazaar would be 6112 people. In an accident, the critical density point in Kerman bazaar would be created in about 1 minute 10 seconds after the event.

Conclusion: It seems necessary to identify and provide solutions for reducing the risk of disasters caused by overcrowding in Kerman bazaar. It is suggested that researchers conduct studies to design safe and secure emergency evacuation of Kerman bazaar as well as proper planning for better and faster access of aid squads to this location. (Disaster Med Public Health Preparedness. 2017;11:674-680).
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http://dx.doi.org/10.1017/dmp.2017.7DOI Listing
December 2017

Toxin production of Clostridium difficile in sub-MIC of vancomycin and clindamycin alone and in combination with ceftazidime.

Microb Pathog 2017 Jun 7;107:249-253. Epub 2017 Mar 7.

Department of Microbiology and Virology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran. Electronic address:

Toxin production in Clostridium difficile (C. difficile) is a key process for induction of diarrhea. Several factors such as sub-MIC of antibiotics impact on toxin production. The aim of this research is investigation of sub-minimum inhibitory concentration (sub-MIC) of vancomycin (VAN), clindamycin (CLI) separately and in combination with ceftazidime (CAZ) on toxin production in C. difficile. About ∼10 colony forming units (CFU) from 18-h culture of C. difficile ATCC 9689 and clinical isolates A/B/CTD, were cultured anaerobically in the pre-reduced medium with appropriate concentration of separated and in combination antibiotics. After 24 and 48 h, 1 mL of culture was removed, centrifuged and the supernatant stored at-70 °C for later use. The evaluation of toxin production was carried out by the ELISA technique. All antibiotics alone and in combination formats inhibited toxin production over a period of 24 h. This effect is also observed in presence of VAN and CLI during a period of 48 h. Over a 4 h period, CAZ increased toxin production alone and in combination, especially with CLI. The data showed VAN and CLI decrease the level of toxins. In contrast, the CAZ not only increases the level of produced toxin, but also can interfere with VAN and CLI. Based on the results, combination therapy which is performed for treatment or prevention of other infections may cause toxin production and probably the severity of C. difficile AAD to increase.
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http://dx.doi.org/10.1016/j.micpath.2017.03.002DOI Listing
June 2017