مجله دانشگاه علوم پزشکی گیلان
پیاپی 80 (زمستان 1390)

Colorectal cancer is a major cause of cancer-related morbidity and mortality. Performance status is a concept of great importance in the care of cancer patients, used to assess the respective impact on a patients’ activity levels, ability for self- care, and ability to work. To determine the predictors of performance status in patients with colorectal cancer. In this cross-sectional study, we assessed 110 patients with colorectal cancer, referred to Razi hospital. Demographic and clinical features were collected by data collection forms and through interview with patients and review of their medical records. Performance status was assessed by KPS and ECOG Scales. The data were analyzed using Spearman Correlation, Mann-Whitney, Kruskal-Wallis tests and Stepwise multiple linear regression at α = 0.05 using SPSSv.16 software. Out of 110 patients with colorectal cancer, 41.8% were female and 58/2 % men. Mean age of the patients+ _ SD was 58.33±12.39 years. Mean of Karnofsky Performance Status and ECOG Performance Status were 87.64±9.27, 1.02±0.717 respectively. In univariate analysis, mean of KPS was found to be related with age, marriage status, living condition, complementary insurance, social support system and hospitalization numbers. Mean of ECOG performance status was related with age, marriage status, living condition, social support system, colostomy, co morbidity and hospitalization numbers. In multiple regression analysis, the predictors of KPS were age (P>0.002), marriage status (P>0.029), complementary insurance (P>0.019) and the predictors of ECOG performance status were age (P>0.001), colostomy (P>0.032) and co morbidity (P>0.041). The results of the present study showed the majority of patients with colorectal cancer had good performance status. Age was an important predictor of Karnofsky and ECOG performance status both in univariate and multivariate analyses. We can conclude that consideration of the predictors could be very helpful for the above-mentioned patients’ care and treatment.

Health care department has a special place among service departments, and customer expectations are important in respective medical centers. Thus, providing good quality services and understanding the customers’ expectations are critical in such centers. Organizational citizenship behavior is one of the factors influencing the perceived quality service by customers. To promote the quality service, it is better to study the organizational citizenship behavior periodically and improve the effective factors, which can help customers’ understanding of service quality. Measuring organizational citizenship behavior and service quality in the hospitals of Guilan province, northern Iran. This research is descriptive-correlation type and unit of analysis is organization. The statistical community consists of public and private hospitals of Guilan. Samples were selected based on the available data by the researcher, which included 22 public hospitals and 4 private ones. The method of collecting data was field method and the collecting tools of information were questionnaires. Servqual questionnaire included 22 items for evaluating the service quality and the questionnaire of organizational behavior included 15 items approved by the respective experts and professors in terms of validity and reliability. Cronbach alpha was used in them and the alpha for organizational citizenship behavior was 0/83 and for service quality variable was 0/90. Since alpha values for both were higher than 0/70, the questionnaires had the effective reliabilities. The questionnaire of citizenship behavior was distributed accidentally among 15 workers and service quality questionnaire among 15 customers and were collected during 2 months. There was a positive correlation between organizational citizenship behavior and its elements such as loyalty, obedience, participation and service quality. Means of all variables were above the average value. As shown, there is a relationship between organizational citizenship behavior and service quality in the hospitals of Guilan province. By enhancing the organizational citizenship behaviors, we can improve costumers’ satisfaction with service quality.

Various scales have been suggested for surveying of disability in the elderly. One of these tools is Disability Index for General Household Survey (DI-GHS). Evaluating the reliability and validity of DI-GHS in older people residing in Kashan Golabchi nursing home The DI-GHS was translated from English to Persian through back & forward method. The sampling was performed using census method in Kashan Golabchi nursing home in 2006 (n=100). Inter-rater agreement was assessed. Internal consistency was determined via Item-total Correlation; Cronbach’s alpha and split-half. Validity was determined via Concurrent validity, Exploratory factor analysis and Known-groups approach. The data were analyzed using Pearson correlation coefficient, Intra-class correlation coefficient (ICC), Kappa, Equal - Length spearman-brown, Guttman, Cronbach’s alpha coefficient, Kruskal-wallis test and factor analysis via principal component analysis with varimax rotation by SPSS-16. Inter-rater reliability coefficient for every item was excellent (Kappa>0/8); Inter-rater reliability in the total ِDI-GHS was reported to be 0/992 (ICC). The questionnaire reliability coefficient (internal consistency) was calculated 0/9-0/95. Item-total correlation confirmed its reliability, too. Its concurrent validity with original Barthel index was confirmed (r=-0/91, p<0/0001). The known-groups approach revealed this tool is valid (p<0/0001). The factor analysis extracted two main factors whose Eigen values were more than one; and these factors could explain %85/8 of the total variance. The Persian DI-GHS could be valid and reliable for the evaluation of disability in elderly people residing in Golabchi nursing home.

Knowledge and attitudes of teachers about attention deficit hyperactivity disorder (ADHD) play an active role in their correct behaviors towards the respective students. To assess the elementary school teacher’s knowledge, attitude and behavior towards ADHD students. In this cross-sectional study, 400 elementary school teachers in Rasht in 1388 completed a self-report, anonymous questionnaires which included demographic data, knowledge, attitude and behavior towards ADHD. The schools were randomly selected from both government and non profit ones, and ten teachers from each participated in the survey. The validity of the questionnaires was confirmed by 5 pediatric psychiatrists and a pilot study was carried out to test the reliability of them (Cronbach's alpha = 0.78) Teachers (56 males and 344 females) had average knowledge about diagnosis and treatment of ADHD. Most of the teachers had neuter attitude toward ADHD students. Most of the teachers had good behaviors toward ADHD students. The mean scores of attitude and behavior were higher in female teachers and mean score of attitude was higher in higher educational level (P=0/003). There was a significant correlation between teachers’ knowledge and their behaviors.(Respectively, P=0.001, r =0.18; P =0.001, r = 0.16) As demonstrated, teachers with greater knowledge and more positive attitude had better performance in dealing with ADHD students. Good performance and neuter attitude seem to be due to different intervening factors related to the complexity of human mental and behavioral performances.

Anabolic-androgenic steroids abuse is one of the major problems in many kinds of sports, specially bodybuilding and power lifting. Common and sometimes life-threatening complications of these drugs have always been important among athletes. The aim of the present study was to determine the prevalence of anabolic-androgenic steroids abuse, Knowledge and Attitue of users among the bodybuilding athletes in Rasht, northern Iran. The present study is a descriptive one. Target population included all male bodybuilding athletes in Rasht. The measuring instruments were self–reported questionnaires AAS, including 19 questions (five questions on background information, 9 questions related to knowledge, and four questions related to attitudes and three questions related to the prevalence of abuse) (Cronbach Alpha 0.87) which were distributed among 223 male bodybuilding athletes in Rasht. The collected data were analyzed by descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics) Spearman correlation coefficient test, t-test (was used for data analysis. The results of data analyses indicate that anabolic-androgenic Steroids are used currently by 67% of the athletes. There was a significant relationship between the prevalence anabolic -androgenic steroids abuse and a history of bodybuilding championship records. (p<0.05). Also, there was a significant relationship between prevalence of anabolic - androgenetic steroids abuse– and attitude and awareness (P <0.05(. The results of this study showed overuse of such drugs among the young athletes and their lack of awareness of the respective adverse effects. Therefore, prevention programs and education about the adverse effects of anabolic-androgenic steroids are highly recommended.

Cervical cancer is the commonest malignancy among women in developing countries. Pap smear is only one proven strategy for the prevention by diagnosis of cervical cancer. The assessment of Health Belief Model construct about the performance s of Pap smear Test and its effective factors among Women's urban centers in Zarandieh. This is a cross-sectional analytical study carried out with 265 Urban Women in Zarandieh. This survey was done by completing a questionnaire based on health belief model. Data were analyzed using chi-square tests, independent samples t-test, logistic regression and descriptive statistics. The mean age of participants was 34.6 ± 4.25 years, and the mean score of all the constructs in this group was higher than that in the group with no history of pap smear (P<0.001).The most common reasons for testing was recommendation by health workers (71%). Among those who were never tested, low levels of perceived susceptibility (79%) were the most common barrier. Significant differences were detected between those tested and not tested in mean of score of all the variables HBM (sensitivity, benefits, barriers, threat and intensity perceived)) p<0.001). Based on the findings of this study, health care professionals must design educational program about cervical cancer in which both the benefits of Pap smear test and other HBM constructs including sensitivity are utilized.

Burnout is a specific kind of occupational stress reaction prevalent among human service professions such as nursing. It is characterized by feeling of emotional exhaustion, depersonalization and reduced personal accomplishment. Occupational support is a factor reducing stress in workplace. The purpose of this study was to examine the level of burnout and relationship between it and occupational support in nurses. In a descriptive study, 257 nurses were randomly selected through stratified sampling, and were classificated into eight medical educational hospitals in Rasht. Participants completed MBI (Maslach burnout inventory) and Spooner occupational support questionnaires. T test, chi square test, Fisher’s exact test and logistic regression were used to analyze the data. Emotional exhaustion was low in %51.4 and it was moderate to high in %48.6, depersonalization was low in %94.2 and moderate to high in %5.8, reduced accomplishment was low in %33.9 and it was moderate to high in %66.1. Coworker support in most nurses (%82.9) was moderate to high and manager support in %73.6 of the nurses was moderate to high. There was a negative correlation between manager support and emotional exhaustion and a positive correlation between dialysis unit and depersonalization and a negative correlation between age and depersonalization. Findings indicate that nursing managers can increase organizational support and consequently prevent nursing burnout. In doing so, high level of nursing care and job satisfaction are achieved.

Cardiovascular diseases are the most prevalent cause of human mortality in the world. Although clinical signs are the most important index in coronary artery diseases, they are different in male and female patients. Comparison of signs and symptoms of acute coronary syndrome in male and female patients admitted to emergency department of Dr. Heshmat and Rasoul– e – Akram hospital in 1389. This study was a descriptive and cross- sectional one carried out with 200 patients suffering from acute coronary syndrome admitted to emergency departments of the above – mentioned hospitals. Data collection tools included questionnaires for personal information, spreading region, signs and symptoms in male and female patients in different shifts of morning, afternoon and night which were filled in by the researcher and his or her colleagues. Most studied cases suffered from chest pain (97%) and dyspnea (73%), tachycardia (71%), perspiration (67%), numbness (62.5%), flushing (61%), weakness (59.5%), fatigue (57%), and nausea (53.5%). Statistical test X2 showed a significant difference between the two groups of male and female patients in terms of fatigue, headlight dizziness, nausea, indigestion and fear, so that these symptoms were observed more in female than in male patients, while coughing and perspiration were more common in male than in female patients. Considering the different rates of signs and symptoms of acute coronary syndrome in male and female patients, the appropriate treatment seems to be based on such differences and their rapid diagnosis.

Radial Nerve Palsy (RNP) is the most common nerve lesion complicating humeral shaft fractures in 2%-17% of cases. Exploration timing (early or delayed) and various nerve repair procedures are still matter of dispute. The objective of this study is to determine the functional treatment outcome of microsurgeric repair of RNP associated with humeral fractures. In this retrospective study of 20 patients (15 males and 5 females with a mean age of 35±12.5) with humeral fractures, 15 cases had primary RNP and the other 5 cases experienced nerve palsy after their orthopedic manipulations (secondary or iatrogenic RNP). Of the first 15 patients, 7 cases had open humeral fractures which were treated using ORIF and early exploration procedures and 8 cases with closed humeral fractures treated conservatively with closed reduction-casting and delayed exploration after 3months because of no recovery. Iatrogenic RNP were observed for 3 months and explored after no sign of recovery. Nerve repair procedures were performed based on nerve injury and patients were followed up for a mean of 24.4± 2.5 months (19-20 months). Exploration findings, kind of nerve repair and functional recovery rate (based on Alnot criteria) were recorded and analyzed using SPSS-19 software. Of the 7 cases who suffered from total radial nerve transection (repaired by interfasicular grafting) 3 cases had good outcome, 2 cases had fair outcome and 2 cases were failed. Exploration of 3 cases revealed partial nerve tearing (repaired by neurorrhaphy) with good results. Eight cases with perineural fibrosis and 2 cases of nerve entrapment in callus were treated by interfasicular neurolysis and the results were good. Overall recovery rate of these three procedures was 90%. In patients with RNP associated with humeral fractures, choosing proper microsurgeric nerve repair and determining proper exploration timing (early or delayed) could result in desirable functional outcomes.

The Management behavioral training for the mothers of ADHD children has an effective role in decreasing behavioral problems in children. This study examined the efficacy of the Management Behavioral Training on the levels of marital satisfaction in the mothers of ADHD children. In this clinical trial study, twenty mothers (10 in each experimental and control group) who had at least one child with clinically diagnosed ADHD and aged between 6 to 12 years old, were recruited from the consecutive referrals to the child and adolescent psychiatric clinic of Gil and baby clinic, Rasht, Iran. The mothers in the two groups were matched in some demographic variables including age, education, occupation, number of children, the birth sequence of children and family income. Mothers in both groups completed two scales: Enrich Marital Satisfaction Inventory as a pre test and post test assessment. Subjects in experimental group participated in nine subsequent management behavioral training workshop sessions. The discrepancies of pre and post intervention were compared between two groups by SPSS software using repeated measure ANOVA statistical method. The obtained data were analyzed using SPSS and variance analysis. AS revealed, intervention group had significant improvement on the levels of marital satisfaction in comparison with the control group (P<0.005). According to the findings of this study, use of Management Behavioral Training is recommended to increase the level of marital satisfaction of the mothers with ADHD children.

Depression is one of the most common mental health problems and one fifth of people experience depression in some levels of their life. Depression is a state which influences mood and reduces activities and can affect thoughts, behavior, feelings and physical problems. This study aims to investigate the influence of group mindfulness-based cognitive therapy (MBCT) on reducing depression and increasing marital satisfaction in married women referred to counseling centers in Ahvaz, southern Iran. The subjects were selected based on sampling method by the researcher's recall. Then, all the women who responded to the recalls achieved short-form of Beck’s Depression inventory and short-form Questionnaire of Marital Satisfaction. In addition, clinical diagnostic interview based on DSM-IV-TR was used to evaluate their Marital Satisfaction and Depression. In the next phase, test and control groups were randomly placed in a cut off two instruments and clinical interview of 28 patients. Experimental groups were treated in 7 sessions of mindfulness-based cognitive therapy. At the end of intervention, both were re-evaluated (post-test). And after a month, the same instruments were applied (follow-up). The results of multivariate analysis of variance (MANOVA) showed that the ratio of pre-test and post-test differences in the rates of depression related to the test and control groups was equal to (80/63), F ratio obtained between the two groups GD related test and followed the equal rates of depression (F=2/12) analysis of variance and differences related to pre-test scores and marital satisfaction in the test groups and control test was F=109/44 and analysis of variance related to differences step after step follow-up test related to marital satisfaction test and control groups was equal to (F= 0/960). Analysis revealed that this type of treatment resulted in decreasing levels of depression and is stable over time. It also led to increased levels of marital satisfaction scores in the experimental group, but in stage after stage of the follow-up test, there was no significant difference in the experimental group's marital satisfaction. This can be attributed to the gender limitation of the study, while the components of marital satisfaction are multidimensional and can influence the spouse’s stability and change.

Pheochromocytoma is a rare cathecolamine-producing tumor that arises from chromaffin cells of the adrenal medulla or extra-adrenal paraganglionic tissues, and has different and variant presentations. Only 10% of pheochromocytomas occur in children with an incidence of approximately 1 case per 100,000 patient-years. It may be completely asymptomatic, or present with symptoms and signs such as headache, dizziness, palpitation, diaphoresis or hyperhydrosis, and hypertension. Bilateral pheochromocytoma - specially in children-is very rare and almost familial, but it has few sporadic cases. The diagnosis of isolated bilateral pheochromocytoma depends on ruling out of congenital etiologies such as type 2 Multiple Endocrine Neoplasia (MENII), Von Hippel Lindau disease (VHL), type 1 Neurofibromatosis (NF I), Tuberous Sclerosis (TS), and Sturge Weber. Case Report: The patient was a 12 year old boy who was referred with unusual suspicious symptoms of pheochromocytoma (weakness, dizziness, and hyperhydrosis) since the last year. During the disease, he had episodic headaches without hypertension. He had not any problem or disease until one year before. Hematologic exam revealed an elevated Erythrocyte Sedimentation Rate. In renal sonography and scan, we had hydonephrosis and pyelocaliceal dilatation.The collected 24hour urine contained elevated load of cathecolamine methabolites. Abdominal CT showed solid enhanced tumors in both adrenals, confirmed by MIBG scan. The patient was treated with bilateral adrenalectomy and diagnosis was confirmed by pathology and IHC staining. Although most pheochromocytomas have typical presentations, they may present with unusual symptoms and signs like the present case. So we should consider pheochromocytoma in patients with familial history of the disease, patients with typical symptoms or hypertension, and also patients with unusual presentations.