Fatemeh Ghaffari

Epidemiological status of malaria in Iran, 2011–2014

OBJECTIVES To aim to determine the status and epidemiological aspects of malaria in Iran in favour of gaining a better understanding of the national control of malaria. METHODS This epidemiological study examined the status of malaria from 2011 to 2014 in Iran. Data were collected from the Ministry of Healths protocol for controlling and eliminating malaria, which is currently in use. This malaria information reporting system is automated in all Iranian provinces and cities, and all information is submitted online to the center for communicable disease control in the Ministry of Health. Information about malaria is available for researchers to evaluate. RESULTS The incidence rates decreased from 2011 to 2014. There were 4.76, 2.12, 1.80, and 1.59 per 100000 people, respectively from 2011 to 2014. During the four-year period (2011-2014), the highest numbers of cases occurred in those aged 16-25 years, by age, and in men, by sex. Most of the cases were workers and located in rural areas. An average 52.58% of cases were Iranian. The highest incidence rates from 2011 to 2014 were located in Sistan and Baluchestan province. There were 89.94, 43.9, 38.3, and 30.66 per 100000 people. The highest numbers of malaria cases were recorded in the cities Sarbaz, Nickshahr, and Chabahar in Sistan and Baluchestan province and Bandar Abbas, Bandar Jask, and Bandar Lengeh in Hormozgan province. During the four-year period, 57.05% of cases were caused by imported factors. The majority of cases were related to the trophozoite lifecycle of parasites. Regarding surveillance, there was inactive care in the majority of cases. Vivax malaria was the most prevalent. CONCLUSIONS Despite the recently declining trend in reported cases, the expansion of local transmission, especially in areas with cross-border travel, is very worrying. Improved malaria control interventions can be effective for elimination of malaria in Iran; these can include programs to control border travel and focused interventions for high incidence areas and high-risk groups such as rural residents, men, workers, and people <35 years old.

Effects of Sexual Rehabilitation Using the PLISSIT Model on Quality of Sexual Life and Sexual Functioning in Post-Mastectomy Breast Cancer Survivors

Background and Objectives: As one of the most common treatments for breast cancer, mastectomy has adverse effects on the quality of sexual life and sexual functioning in the impacted women. Various strategies have therefore been proposed to resolve their sexual problems. The present study was conducted to determine the effect of sexual rehabilitation using the PLISSIT model in post-mastectomy breast cancer survivors. Materials and Methods: The present quasi-experimental study was conducted on a population of post-mastectomy breast cancer survivors and their husbands. Sample size was calculated as 50 each for intervention and non-intervention groups. The former received sexual counseling based on the PLISSIT model consisting of four levels of intervention: permission, limited information, specific suggestion and intensive therapy, presented in four 90-minute sessions. Data were collected using the Sexual Quality of Life-Female (SQOL-F) questionnaire and the Female Sexual Function Index (FSFI). Results: No significant differences were observed in the mean quality of sexual life scores between the intervention and control groups (P>0.05) before the intervention; however, a significant difference emerged between the groups after the intervention (P<0.01). Thus the mean score for sexual functioning in the intervention group was 26.3±3.76 before and30.0±4.38 after the intervention (P<0.0001). In the control group, however, the difference between the pre- and post-intervention mean scores was not statistically significant (P=0.713). Conclusion: The present study showed that nurses can use the PLISSIT model in conjunction with chemotherapy and radiotherapy to teach coping and problem-solving skills to women with breast cancer and their husbands and to encourage their participation in group programs for expressing their feelings and attitudes about their current sex life and thus help enhance quality of sexual life and sexual functioning in this group.

The design and evaluation of psychometric properties for a questionnaire on elderly abuse by family caregivers among older adults on hemodialysis

Introduction Older adults with chronic disease are more vulnerable to abuse. Early and accurate detection of the elderly abuse phenomenon can help identify health-promoting solutions for the elderly, their family, and society. The purpose of this study was to design and evaluate the psychometric properties of a questionnaire on elderly abuse by family caregivers among older adults on hemodialysis. Methods Qualitative and quantitative research methodologies were used to develop the questionnaire. The item pool was compiled from literature reviews and the Delphi method. The literature reviews comprised 22 studies. The psychometric properties of the questionnaire were verified using face, content, and construct validity, and the reliability was tested using Cronbach’s alpha reliability. Results A 57-item questionnaire was developed after the psychometric evaluation. The Kaiser–Meyer–Olkin index and Bartlett’s test of sphericity showed reliable results. Seven components from the exploratory content analysis including psychological misbehavior, authority deprivation, physical misbehavior, financial misbehavior, being abandoned, caring neglect, and emotional misbehavior explained 74.769% of the total variance. Cronbach’s alpha was 0.98 and the interclass correlation coefficient was r=0.91 responding to the items twice (p<0.001), which shows a high level of tool stability. Conclusion This study developed a questionnaire to assess elderly abuse by family caregivers among older adults on hemodialysis. It is recommended as a mini scale that can be used both in statistical and practical studies, and that is valid and reliable. Nurses or other health care providers can use it in health centers, dialysis centers, or at the house of the patient.

The Life Process of Children Who Survived the Manjil Earthquake: A Decaying or Renewing Process

Introduction: Among earthquake survivors, children are more vulnerable than other age groups due to their exposure to harrowing scenes of devastation as well as their drastically new living situations that result from an earthquake disaster. The life process of children survivors undergoes many different changes that are affected by a wide range of factors. Understanding the life process of these children may lead to effective outcomes and interventions. In addition, observing children survivors establishes knowledge and understanding of the challenges that correspond with earthquake disasters. Further, observing this group may be further effective in decision-making and establishing types of assistance in similar circumstances. Objectives: This study was done to explain the life process of children who survived the earthquake of Manjil in northern side of Iran. Methods: This qualitative study is based on the grounded theory approach. The sampling involved purposive interviews with 12 children who survived the Manjil earthquake and were under 12 years of age at the time of the earthquake. The initial interviews were followed by continuous comparative analysis, and thus the sampling process adopted a theoretical trend. In the end, by the formation of categories and the central variable of the study, interviews were conducted with 16 subjects and sufficient data was provided. Data was collected through face-to-face, in-depth interviews using an interview guide. In order to enrich the categories formed in data analysis, we had also 6 telephone interviews with the same participants in order to complete missed needed information. Data collection began in 2015 and continued up until 2016. Data was analysed using the Strauss-Corbin approach. Results: The life process of children earthquake survivors consists of ‘unexpected encounter’, ‘transient relief activities’ and ‘long-lasting consequences’. The central variable of this study is ‘the dark shadow of pain and the light shadow of life expectancy’. The life experience of this group of children is immersed in painful memories and varies under different conditions. Discussion and Conclusion: According to the results of this study, one of the factors affecting the lives of children earthquake survivors which could threaten their health is providing non-specific and transient services. Training relief staff to consider the specific needs of these children at the time of the rescue operation could contribute to improving their health level in various aspects. Considering the effective and comprehensive rehabilitation program in Disaster Management by policymakers can prevent permanent complications caused by earthquakes. Planning and taking action to identify misbehaviours in this group of children as well as raising public awareness, particularly for parents, on how to manage the outcomes of natural disasters are some of the most significant public health priorities. Providing public mental health services for parents and children who survive an earthquake helps to address potential psychological problems in this group of survivors.

The relationship between the spiritual attitude of the family caregivers of older patients with stroke and their burden

Introduction Stroke is a chronic condition that necessitates multidimensional and overwhelming care. The caregivers of stroke patients are faced with various stressors that can threaten different aspects of their health, especially their mental health. Spiritual attitude and being spiritually oriented contribute significantly to mental health and can be used as a strategy for adapting to the stressful events that are part of the role of caregiving. This study was therefore conducted to investigate the relationship between the spiritual attitude of the family caregivers of older patients with stroke and their burden. Methods This descriptive cross-sectional study was conducted in 2016. The study population consisted of all the family caregivers of older patients with stroke presenting to health care centers and nursing service companies of Gilan Province in Iran. The participants were selected through convenience sampling and consisted of 407 participants. Data were collected using the Spiritual Attitude Scale and the Caregiver Burden Inventory and were then analyzed in SPSS-18 using Pearson’s correlation coefficient at a significance level of 0.05. Results The results showed that 88.9% of the caregivers were females. The mean age of the participants was 38.3±8.8 years. The duration of caregiving was <5 years in 84.4% of the participants, while its mean was 4.2±2.5 years. The mean score of spiritual attitude was 108.77±6.20. The majority of the participants (49.3%) had moderate and relatively favorable spiritual attitude (a score of 72–120), 27.8% had high or favorable spiritual attitude; 8.7% had mild burden, 54.4% had moderate burden and 37% had favorable burden. The mean score of burden was 28±12.75. A statistically significant positive relationship was observed in this study between the mean score of spiritual attitude and the total score of burden in all its dimensions, namely, time dependence, as well as the developmental, physical, social and emotional dimensions. Conclusion Providing strategies for improving spirituality, such as teaching spiritual self-care, can improve their burden. Given that such strategies are psychologically approved and pose no side effects, they can be used as an effective, low-cost and risk-free approach for all caregivers, so that they can acquire the necessary spiritual support for overcoming the stress caused by caring for family members through the reinforcement of their spiritual beliefs in the ultimate effort to provide effective care to older patients while maintaining their own health and quality of life.

Development and psychometric evaluation of a women shift workers’ reproductive health questionnaire: study protocol for a sequential exploratory mixed-method study

BackgroundAlthough shift works is a certain treat for female reproductive health, but currently, there is no standardized instrument for measuring reproductive health among female shift workers. This study aims to develop and evaluate the psychometric properties of a Women Shift Workers’ Reproductive Health Questionnaire (WSW-RHQ).MethodsThis is a sequential exploratory mixed-method study with a qualitative and a quantitative phase. In the qualitative phase, semi-structured interviews will be held with female shift workers who live in Mazandaran Province, Iran, additionally, the literature review will be performed by searching electronic databases. Sampling will be done in different workplaces and with maximum variation respecting female shift workers’ age and job and educational and different economic situation. Interview data will be analyzed using conventional content analysis and then, the primary item pool for the questionnaire will be developed. In the quantitative phase, we will evaluate the psychometric properties of the questionnaire, i.e. its face, content, construct as well as reliability via the internal consistency, stability. Finally, a scoring system will be developed for the questionnaire.DiscussionThe development of WSW-RHQ will facilitate the promotion and implementation of reproductive health interventions and assessment of their effectiveness. Other scholars can cross-culturally adapt and use the questionnaire according to their immediate contexts.

Cytotoxicity Enhancement of Paclitaxel by Loading on Stearate-g-dextran Micelles on Breast Cancer Cell Line MCF-7

Objective: Paclitaxel (PTX) is a chemotherapeutic agent used for treating breast cancer. The study aimed to prepare PTX loaded dextran stearate (Dex-SA) and evaluate its efficacy against human breast cancer cell line MCF-7. Methods: Dex-SA/PTX micelles were prepared by dialysis method. The micelles size, zeta potential and particle size distribution were measured by dynamic laser light scattering method. Amount of loaded PTX on the polymer measured by HPLC. Release profiles of the drug from the micelles were obtained in buffer (phosphate pH=7.4). Then the cytotoxicity of blank micelles, Dex-SA/PTX micelles and free PTX were evaluated in the MCF-7 cells by MTT method. Result: Loading efficiency of PTX on the Dex-SA was measured about 84.24±9.07%. The smallest particles size was about 193.9±7.1 nm but the other formulation with larger particle size had better zeta potential (-33.5±6.74 mV). The drug release from the micelles was slowly and reached steady state after about 12 hours. The cytotoxicity experiment showed that Dex-SA/PTX micelles have more cytotoxicity compared to free PTX against MCF7 cell lines. Conclusions: Dex-SA polymeric micelle is a suitable carrier for hydrophobic cytotoxic drugs such as PTX.

Pathology of apprenticeships for masters of nursing critical care

Introduction The increasing complexity of patient care conditions in intensive care units, along with the development of these units, has increased the need for qualified nurses and health professionals. Therefore, due to recent changes and in response to the shortage of capable nurses, a master’s major in intensive care nursing has been created. One of the main challenges of this curriculum is to ensure that graduates have the required competencies. The current study aimed to explain the pathology of apprenticeships for a masters in nursing critical care. Methods This qualitative study was conducted for masters in nursing critical care students of Tehran University of Medical Sciences in 2014–2015. The sampling was purposeful. Data were collected through face-to-face interviews with 15 students. Conventional content analysis was used to analyze the data. Results Three categories “ineffective management, unfavorable context for achieving skills, and lack of clinical instructors and sufficient competence” were extracted. Conclusion Preparing settings for entering students such as having an adequate training field and expert educators, providing conditions for orientation of educators and participation in the related workshops, and recruitment of experienced instructors in the apprenticeships field can increase the quality of MS levels.

Malaria Four-year Epidemiological Trends in Sistan and Baluchistan Province, Iran

Introduction Malaria is one of the foremost public health concerns in Iran, where more than 90% of malaria cases are reported in the southern and south-eastern areas of the country. The aim of this study was to assess the epidemiological trends of malaria over a four-year period in in the Sistan and Baluchistan province in south east of Iran. Methods This descriptive epidemiological study examined malaria trends in Sistan and Baluchistan province from 2011 to 2014. The study used data collected in accordance with the Iranian Ministry of Health’s malaria control and elimination protocol. This protocol has digitized the data reporting system for malaria, and all information were sent online to the Center of Disease Control in the Ministry of Health. In this manner, information on malaria cases in Sistan and Baluchistan were made available for the researchers to analyze. Descriptive and comparative analyses were conducted using the SPSS version 13. Results Annual incidence rates reported in 2011, 2012, 2013, and 2014 showed the prevalence of 89.9, 43.9, 38.3 and 36.6 (per 100,000 persons), respectively. Across all 4 years, the highest numbers of cases were found in persons 16–25 years old and among males. Most of the infected individuals were villagers and workers. In total, 64.8% of patients were Iranian and 29.5% were Pakistani. The highest number of cases was diagnosed in the cities of Sarbaz and Chabahar, with 1,742 and 1,707 cases, respectively. The results showed that over the last 4 years, 50.8% of cases have entered into Iran from foreign countries. The majority of cases involved parasites in the trophozoite stage of the life cycle. In terms of surveillance, passive care was reported in the majority of cases, and vivax malaria had the highest prevalence in comparison with other types. Conclusion The findings are showing that the care, control and treatment system applied to Sistan and Baluchistan province has had a positive effect on decreasing the prevalence rate of Malaria disease. Meanwhile, it is recommended to policy makers to provide more health controls for border entries, stop irregular immigration and apply more precise case searches in order to have a complete and on time treatment in a way that the chain of transmission of the disease would be cut. Health education and knowledge-ability promotion programs are better to be set in order to develop self-protection and environment improvement among people.

The effectiveness of ibuprofen and lorazepam combination therapy in treating the symptoms of acute Migraine: A randomized clinical trial.

Background Migraine is a common, episodic and debilitating disease. The migraineur not only suffers from pain, but also lives with a diminished to poor quality of life. Several medicinal therapies are used to abate the debilitating symptoms of this disease. Objective The present study was conducted to determine the effectiveness of Ibuprofen and Lorazepam combination therapy in treating the symptoms of acute migraine. Methods The present randomized clinical trial study used the pretest-posttest design with three comparison treatments, to examine 90 patients with an average of two to six attacks per month and an initial diagnosis of migraine based on the International Headache Society (HIS) criteria. The study was conducted on patients during the first half of 2014 with a diagnosis of acute migraine attack who were referred to Babol Ayatollah Rouhani Hospital in Iran. The patients were randomly divided into three groups of 30. The first group was administered 200 mg Ibuprofen capsules, the second group 400 mg Ibuprofen capsules and the third group a combination of 200 mg Ibuprofen capsules and 1 mg Lorazepam tablets. The medications were taken in the presence of the researcher. A checklist was used to assess the severity of headache and other migraine symptoms such as nausea, vomiting, photophobia and phonophobia in the patients, before and two hours after the intervention. Data were analyzed in SPSS-18 using the Mann-Whitney test, the McNemar test, Wilcoxon’s test, the NOVA and the Chi-squared test at the significance level of p<0.05, and power analysis with 30 patients in each group to perform this study was 0.8(1-β). Results The mean age of participants was reported as 52±8 years and the condition was more frequent in women (56%). All three treatment regimens reduced the severity of headache significantly in the patients (p<0.001); nevertheless, the combination therapy used, produced the lowest mean severity of headache (p<0.001). The highest reduction in nausea and vomiting was (3.3%). None of the patients in either of the three groups reported phonophobia after the intervention, but only the patients in the combination therapy group reported no instance of photophobia. Conclusions Given the greater effectiveness of combination therapy with Ibuprofen and Lorazepam in alleviating the symptoms of acute migraine compared to single-drug treatments with Ibuprofen, Lorazepam is recommended to be used as a first line treatment for acute migraine. Clinical trial registration The trial was registered at the Thai Clinical Trials Registry (TCTR) (http://www.clinicaltrials.in.th/) with the ID: TCTR20160927003. Funding The authors received no financial support for the research, authorship, and/or publication of this article.