فهرست مطالب زهرا محتشم امیری

Varicella is a highly contagious viral infection with self-limiting presentation, yet, it can be more severe in adults. There is a major risk of transmission between health care workers and patients who are susceptible. This study was done to investigate anti-VZV (varicella zoster virus) antibody among nursing students. The anti-VZV IgG was measured in all nursing students in Nursing and Midwifery School of Langeroud who participated in this cross-sectional study. That is, the antibody was measured in 101 students by ELISA method. Seventy-three (72.3%) students had anti-VZV IgG, 27 students (26.7%) were seronegative and one student had borderline IgG. There are a noticeable proportion of seronegative nursing students who were susceptible to VZV infection. They can develop the infection from other staff and patients in hospital and also transmit it to others, especially immunocompromised patients. Therefore, it is recommended that we screen anti-VZV antibody in nursing students and vaccinate seronegative ones.

Physical inactivity as a reason of 6 percent of mortality is identified as the fourth leading risk factor for global mortality. Women are more inactive than men. Health volunteers are one of the most important loops of primary health care networks for educating the urban community. Applying the Stage of Change Model as an integrated pattern in behavior change is a good guide to exercise interventions. To determine the effect of intervention based on Stage of Change Model on the promotion of physical activity of Health Volunteers in Rasht as pineers in learning healthy lifestyles. This randomized controlled trial was conducted on 176 Health Volunteers in Rasht that randomly assigned into experimental and control groups by multistage sampling. Data were collected by a valid and reliable self-administered questionnaire including demographic data, Stages of Change Model constructs, and International Physical Activity Questionnaire (IPAQ-long form) before and 3 months after intervention in two groups. Data were analyzed by Independent T-Test, Paired T-Test, Wilcoxon, Mann-Whitney U, McNemar, Chi-square, one-Sample and two-sample Kolmogrov-Smirnov in SPSS-18 software. After educational intervention, there was a significant difference in the movement toward physical activity in the experimental group (p=0.005). Also, there was a significant difference between the mean score of physical activity after intervention in the experimental group (p=0.03). The results indicate a positive effect of intervention based on Stage of Change Model on the promotion of physical activity of Health Volunteers. Conflict of interest: non declared

Sport is an important issue in matter of health. It can increase the risk of injury, which in turn causes economic, physical and psychological burden. Due to adverse effects of sports injuries on life, it is of great importance to investigate sports injuries and the factors influencing them. This study aimed to determine the prevalence of sports injuries and the factors associated with injury in patients admitted to Poursina Hospital in Rasht, Iran, in 2014.
This cross-sectional study was conducted on patients admitted to Emergency Department of Poursina Hospital, Rasht in 2014. All patients with sport injuries were studied by an available sampling method instead of sampling. In this study, data were collected via questionnaire including items on demographic characteristic and items on factors associated with sports injuries. Data collected after obtaining a license and Satisfaction with research samples. Finally, the data were analyzed with SPSS (version 20) using descriptive statistics and inferential statistics (ANOVA and chi-square).
The mean age of study population was 22.98±10.01 years. Most participants practiced ball games (63.4%) and martial arts (16.5%). The most common type of injury was fracture (58.5%) and the most prevalent anatomical part was upper and lower extremities (74.4%). 46% of injured patients were treated with splints or casts. There was a statistically significant relationship between the body part injured and sport type (p=0.008), type of injury and treatments received (p=0.0001), and injury outcomes (p= 0.007).
Many sports injuries and resulting complications are preventable. Therefore, the best way to deal with injuries is to become familiar with causes of injury before prevention and treatment.

Widespread demographic changes have led to a new challenges in the name of an aging crisis in the world, due to increased life expectancy and reduced birth rates, along with lifestyle changes. Aging is a phenomenon with different biological, psychological and social aspects, This article was written with the aim of study the changes in the aging population in Iran based on the latest census and the introduction of indicators, services and facilities for the elderly.

Childhood obesity is a serious public health problem and epidemiological studies are important to identify predictive factors. It is the aim of this study to analyze birth weight as a predict factor of obesity among preschool children.
554 preschool children (4-6years-old) were selected by multistage random sampling from rural areas in Rasht. Data collected from health records of households of health systems and interview with parents. Weight and height of children was measured. We considered children with weight- for- height>/= 85th percentile to be overweight and weight- for- height>/= 95th percentile to be obese. Data Analysis was done with SPSS Software Ver. 16. ödescriptive statistics and X2 was used.
Overall, 256 children(46.4%) were boys, 37 (6.7%) of children were overweight and 36 (6.5%) of these were obese. At birth, 42(7.2%) of children were low birth weight and 28(5%) of them were high birth weight. There was a positive relation between birth weight and catch –up weigh in other periods of life but There were not any differences between overweigh and obesity rate with low birth weight, appropriate birth weight and high birth weight in children.
It seems that birth weight does not predict obesity in childhood and environmental factors have more power on obesity that must be noticed.

Psoriasis is a common inflammatory skin disorder with humeral and cellular immune system involvement. On the other hands¡ Vitamin D has important immunomodulatory effects and its relations with many autoimmune diseases were shown. The relation between Serum Vit D Level and Psoriasis disease remained controversial issue that this study was done to show this relationship.
Methods and Materials: In this comparative cross sectional study¡ 30 psoriatic patients who attended to Razi dermatology clinic in Rasht¡ by sequential sampling underwent study as case group. 30 healthy people from hospital at the same age¡ gender and skin-colored also were selected as control group. Inclusion criteria were patients and people without Ca or Vit D supplements usage or underground diseases in relation to hypovitaminosis D. Demographical data were gathered by interviewing and then blood samples from all participants were sent for analysis of serum Ca¡ P¡ Vit D and parathormone level. Data analysis was done by SPSS ver. 18 using T-test and Chi 2 test.
Mean and SD serum level of Vit D in case and control groups were 25.8± 12.6 ng/ mL and 23.7± 8.9 ng/ mL¡ respectively (ρ>0.05). Out of all¡ 24 participants (40%) suffered from Vit D Deficiency and 20 people (33.3%) from Vit D insufficiency ¡ only 26.7% study subjects had acceptable serum Vit D level. There were not any significant difference between Vit D deficiency rates and other measured biochemical indices in two groups (36.7% vs. 43.3%).
This study showed high level of Vit D deficiency in both psoriatic and normal people that must be notice.

Despite the many benefits of physical activity, sedentary lifestyle is still a public health problem among women. This study was conducted to identify factors associated with physical activity based on Stages of Change Model as one of the most effective models of behavior study among health volunteers in Rasht in 2014. In this cross-sectional study, all of the active health volunteers in Rasht (N=176) completed the self-administered questionnaire consisting of 3 parts: demographic information, validated questionnaire of stages of change model constructs, and International Physical Activity Questionnaire (IPAQ-long form). Data were analyzed through descriptive statistics, ANOVA, Kruskal-Wallis, Correlation and regression through SPSS 18. Intensity of physical activity among health volunteers was respectively 10.2%, 61.4% and 28.4% in low, moderate and severe level. Among the structures of Stages of Change Model, self-efficacy (β = 0.2) and Cons (β = 0.17), had predictive power on the promotion of physical activity (p <0.05). 17% were in the pre-contemplation stage, 10.3% were in the contemplation stage, 17.6% in the preparation stage, 12.5% were in the action stage, and 42.6% were in the maintenance stage of regular physical activity. Since most of the health volunteers were in the middle-ages, and also the majority of them had moderate physical activity, appropriate for their age, therefore, due to the effective constructs (self-efficacy and Cons), it is necessary that these constructs to be strengthened in order to maintain the moderate level of physical activity in this group.

Ano-Genital Warts are one the most common complaint among patients referred to dermatology, gynecology and urology clinics and the most prevalent sexually transmitted disease. Nearby 20% of patients with Ano-Genital Wart who had infected due to papilloma virus are also infected by other sexually transmitted diseases. The aim of this study was to determine HIV, HBV, HCV and syphilis Infection among Patients with Ano-Genital Warts referred to Dermatology Clinic of Razi Hospital of Rashtin 2014.

In this cross-sectional study, all 62 patients with ano-Genital Warts who referred to Razi hospital in 2014 were studied. Demographic data were gathered by interview and blood samples were collected for immunological assay. Descriptive analysis and chi square test were used for data analyzing.

sixty two patients with mean age of 34.3 ± 10.4 years and mean duration of wart infection about 11 months were studied. 82.3% of patients were male, most of them in 4th decade, 69.4% married and more than 70% of them had diploma or higher educational levels. Regardless of risk factors, ninety patients (30.6%) had positive history of sexually transmitted diseases, 11.3% had taken drug, 35.5% used alcohol, 9.7% and 32.3% had history of blood transfusion and hospitalization, respectively, 24.2% got tattoo and one patient was imprisoned. None of patients was positive for HCV, HIV, HBV or syphilis.

According to low prevalence of HCV, HIV, HBV among patients and high price of laboratory test of these infections, more studies in other geographic area are recommended.

Pre-hospital emergency system is an important part of the health care system, so that an appropriate and timely care in nervous system injures can prevent death, disability, medical costs and economic losses to society. This study was conducted to determine the quality of pre-hospital emergency care and its related factors in traumatic patients. In a cross-sectional study, the quality of neurological care by the EMS and its related factors in 577 traumatic patients were transported to Poursina Teaching Remedial Hospital from 20 October to the end of March 2012 was assessed. This study was done by a simple sampling method using researcher-made checklist. Data analyzed with ANOVA, Spearman and t-test in SPSS v. 16. The most provided care was the control of level of consciousness (36.2 %) and the lowest care was the use of back board (12.2%) and collar (15.6%), respectively. Mean of provided care in nervous system was 81.33 ± 2.00 percent. There were significant correlations between provided care in nervous system and traffic roads (p<0.03) and shift of working (p<0.04). This means care in rural ways and in the morning was more. This study demonstrated fixation (use of back boardand collar) in most cases was not performed. This study could provide information on the status of pre-hospital emergency to officials and managers to develop standard protocols and staff training to enhance this important step.Keywords: Neurological System, Pre-Hospital Emergency, Trauma.

Damage caused by traumatic brain injury (TBI) depends on the extent of primary and secondary damages. The latter can cause induced neurological inflammation by releasing pro- and anti-inflammatory cytokines and chemokines. Measurement of serum interleukin-6 (IL-6), as a pro-inflammatory cytokine, can be useful in predicting outcome in patients with TBI. In a cross-sectional study, 44 patients with GCS≤8 (Glasgow Coma Scale) and age ≥ 14 years, hospitalized in Poursina teaching hospital, were included in the study. Blood samples were collected from patients in the first 6 hours after the accident; and serum was tested by ELISA method for the determination of IL-6 levels. Patient's outcomes were recorded 6 months after head injury according to Glasgow Outcome Scale (GOS), and were divided in two good (GOS ≥4) and bad (GOS<3) outcome groups. Data were analyzed in SPSS software version18 using the Spearman's rho, independent-t test, Fisher Exact test and Mann-Whitney test. Comparison of IL-6 serum levels, in the two groups after 6 months of head injury, showed that mean serum levels of IL-6 in good outcome group was lower than bad outcome group (85.2 ±51.6 vs. 162.3±141.1, respectively) (P <0.03). Elevated serum levels of IL-6 in patients with severe TBI, is associated with poor clinical outcome.

Emergency Department (ED) is the most important ward of hospital which its function can have enormous effect on function of other wards and patients'' satisfaction. One of the most important criteria in evaluation of ED is the duration of time spent by patients for receiving diagnostic and treatment services. Prolonged waiting and visiting time in ED reduce the quality of care and increase the adverse events.

This study aimed to determine number of patients discharged in less than 6 hrs before and after presence of medical emergency specialists.

This cross-sectional study was conducted on hospitalized patients three months before and after the presence of EM specialists in Poursina Educational-therapeutic Hospital from September 2009 to March 2010 and patients'' condition was assessed considering the variable of discharge in less than 6 hours. Data were collected by hospital information system (HIS) and analyzed using chi-square statistical method and logistic regression model.

Findings of this study showed that only 856 patients (15. 54%) of all hospitalized patients in ED (5506) were discharged in less than 6 hours 3 months before the presence of EM specialists. However، this rate increased from 5271to 1621 (30. 75%) in first three months after presence of EM specialists in ED. According to regression model there was a significant association between presence of EM specialists and percent of patients discharged in less than 6 hours (P< 0. 0001).

By on time diagnosis and treatment waiting time and hospital stay can be decreased and patient satisfaction increased. Therefore for prevention of wasted time in diagnosis and patient treatment it is suggested to provide opportunities that ED could benefit from continuous ED specialists'' care.

colonized by staphylococcus aureus were reported in more than 50% of psoriatic lesions. Due to role of epidermal barrier dysfunction on colonization and on the other hands staphylococcal super antigen effect on flare up of disease, this study was conducted to evaluate relationship of staphylococcal aureus colonization with severity of psoriasis disease according to PASI Score. In a descriptive analytic study, 42 psoriasis new cases that had not received any topical or systematic medication for disease underwent study. Necessary demographic and clinical data were collected and PASI score for severity of disease according to erythema, infiltration, desquamation and area was calculated. Skin lesions samples were taken by a swab and sent to the laboratory for culture. Data analysis was done by SPSS ver. 13 using T test. lesions of 19 cases (45.2%) were colonized with staphylococcal aureus. Mean of PASI score in positive culture group was 16.07± 3.6 in comparison to negative culture group as 12.43± 3.67 that this difference was significant (P=0.001). There was not any significant difference between duration of disease between positive and negative culture groups (7.11±4.98vs. 6.39±5.25 years). This study showed a significant difference between PASI Score among negative and positive culture groups that this difference may be due to the staphylococcal super antigen effect on psoriasis lesions.

Traumatic brain injury (TBI) is one of the most common causes of seizure and about 10% of patients with severe and moderate trauma develop seizure. Phenytoin is an anti-seizure medicine which is widely prescribed to prevent seizure in TBI patients. Even it has non-linear pharmacokinetics in therapeutic concentrations, the prescription of which necessitates continuous evaluation of plasmatic level of medicine and regulating the dosage.

This study aimed at surveying the variability of Phenytoin serum level in TBI patients in Poursina Teaching Hospital to determine the dosage of medicine more precisely to reach the Prophylactic level.

In a descriptive longitudinal study, 90 patients of Trauma Ward of Poursina Hospital were studied. Phenytoin serum level was estimated in first, second, and seventh day after hospitalization by using RAN DOX kits, the results were then analyzed by SPSS software (ver16). Exact Test, Fisher, and Pearson T-test were utilized to analyze the data.

Out of 90 studied patients, 79 (87.7%) were men and 11(12.3%) women. Mean age was estimated 36.3±15.6 for men and 41.7±16 for women. There was no significant difference between the Phenytoin level in first and third day in two groups. The Phenytoin serum level in 24 first hrs didn’t reach therapeutic level in 75.6% of patients. The average of Phenytoin serum level was in therapeutic level in third day and Phenytoin serum level didn’t reach therapeutic level only in 5% of patients (p≥0.05). This average figure was 20-30 mg/dl in more than half of the patients on seventh day, during which all patients reached therapeutic level (p≥0.05). A significant relationship was observed between age and Phenytoin serum level in all three levels (p<0.05).

Phenytoin is considered as an anti-seizure medicine which is vastly used in TBI victims. Using Phenytion requires exact monitoring due to its limited therapeutic range and linear pharmacokinetics. Since the changes of medicine dosage can lead to blood poisoning and make the medicine ineffective, its prescription needs much more attention regarding its gender, age, and needed dosage.

ADHD is a common disorder in children and adolescents. The children and adolescents with ADHD are at a high risk for cigarette smoking and substance abuse. Studies show earlier age of the onset of cigarette smoking in these groups of children and adolescents. This study was performed to determine the attitude towards cigarette smoking in attention deficit- hyperactive children from 7 to 12 years of age compared to that among their normal siblings and control group. This was a comparative cross sectional study performed on three groups of 7 to 12 years old children. The first group was the patients referred to Shafa Hospital with the diagnosis of ADHD based on clinical interview of child and adolescent psychiatrist and semi-structured K- SADS (Kiddie Schedule for Affective Disorders and Schizophrenia for school age children) interview. The second group was siblings of the first group and the third group was the patients referred to dentistry clinic of Guilan University، that were not ADHD by clinical interview and K- SADS. Attitude toward cigarette smoking and demographic data also were gathered by another questionnaire. Our study shows negative attitude of ADHD group towards cigarette smoking and there was no difference between different groups، and between boys and girls. But there was a negative correlation between age and attitude toward cigarette smoking (r= -0. 618). There was a significant difference between ADHD group’s attitude towards smoking as a relaxing act and other groups. Negative attitude toward cigarette smoking in the above-mentioned groups shows that the age of changing attitude toward cigarette smoking in the adolescents would be higher. The attitude of being relaxed by cigarette smoking in ADHD adolescents show motor and mind restlessness، which is so important that treatment is essential. The results of this study could be a preliminary step for performing more studies to determine target groups for preventive education of adolescents about cigarette smoking.

Staphylococcus aureus is the main cause of surgical site infection, causing morbidity and mortality in patients undergoing surgery. Despite a lot of research on the best diagnostic method and Methicillin-Resistant Staphylococcus aureus (MRSA) screening in patients undergoing surgery, the most appropriate diagnostic method is still unknown. The question is whether Rapid Molecular (PCR) or the traditional microbial culture is the most suitable method?

This study aimed at systematic reviewing of articles to evaluate molecular method in MRSA diagnosis and the necessity of screening patients before and after surgery to prevent infections and its subsequent outcomes e.g. mortality.

Many searches in databases including the digital and medical inlm library and sites such as Science, JAMA, BMD, Springer were done since 2007 to August 2010. In total, 118 studies were selected regarding the following keywords; site surgical infection, Staphylococcus aureus, PCR, and culture. Two independent persons who selected the articles evaluated the designs of the studies and extracted the information using blinded method objectively. After a complete study of other articles, 50 articles were also eliminated, and 8 articles were finally entered the study. Data of culture diagnostic methods and PCR and the statistics of infection prevalence in surgical site were analyzed by Cumulative Pooled analysis.

Eight randomized clinical trials of culture methods and PCR had been studied in MRSA diagnosis and screening in different surgeries. The average duration of study was 11.6 months in all articles. The relative risk of site surgical infection was 7.3% with MRSA in all articles and CI was 95 % (0.696, 0.367). The conformity between culture and PCR was 91%, PCR sensitivity 99.2% and PCR specificity 82.2%. The rates of MRSA infection before (0.65 %) and after (0.35 %) surgery were significantly different with screening. When screening was applied, the rate of infection with 0.95% CI decreased to 28.9% - 31%.

Findings confirm the necessity of screening before surgery in order to determine the antibiotic prophylaxis preceding the surgery in those who carry MRSA. Thus, considering the specificity and sensitivity of PCR to microbial culture, molecular method is rapid and effective in diagnosis and screening of the patients who undergo surgery.

Training of family physicians in order to respond to their needs is one of the main tools for improving health system performance. Ministry of Health has run an electronically educational package consist of current family physician program. Thus, this study was designed to investigate the attitude of family physicians towards E- learning at Guilan University. This descriptive cross-sectional study was conducted on all family physicians who were used the educational package. Data was collected by structural questionnaire consisted of 18 questions with likert scale. Data was analyzed by SPSS. In this study, 124 family physicians with the average age 36 ± 5 years participated that 96 (75.7%) of them had positive attitude towards e-learning. 26.1% of negative attitude was about software program and 20 % towards the content of educational programs. Since all physicians have good attitude towards e-learning because of saving of time and costs, therefore, it is necessary to initiate suitable infrastructures to implement on-line program as well as enriching educational contents for all health care system.

The most important pillar of Islam is the teachings of the Holy Quran, and although the rules and regulations of Islam haven’t had detailed emphasis, there are many verses in the Quran about the role of a mother’s breast milk. In this paper, the benefits of breast milk as a type of preventative medicine are discussed. With reference to resources and various databases such as Ovid, Cochran, Medline all available published articles were studies about the effects of breastfeeding in prevention of diseases. In different articles breast milk was studied from different angles including the composition of milk during different conditions and different times, the rate of secretion based on the need of children, the impact of the duration of breastfeeding on the future of the child and the mother, and also it’s effects o infectious and non-infectious diseases and other issues that research can total them into two categories: the effect of mother’s breast milk on the child and the impact on the child’s mother; all of which have been mentioned in the articles. breast milk is considered as a complete, indisputable and appropriate food for all children no matter their condition, and a suitable method for prevention of common fatal contagious diseases in childhood and non-contagious fatal diseases in adulthood.

To determine the prevalence of Ecstasy use and high risk behaviors among college students in Guilan; Iran. We conducted a cross sectional study of a representative sample drawn from college students (3958 students) of Guilan in 2005. The questionnaire was adapted from a number of the questionnaires used in the United States and the European countries. Data were analyzed performing χ2 test and logistic regression. Out of 3958 students, 3700 students (93.5%) responded, 1966 students from private colleges and 1734 students from state universities. The mean age of student was 224.2± 3.5 years (ranging from 18 to 46 years); and 49% were male. The life- time prevalence of Ecstasy use was 4.2% (157 students). Ecstasy use was significantly associated with gender, other substances us, cigarette smoking, participation in friendly parties, sharing home with friends, alcohol consumption, type of university, educational level of family, family situation and history of educational abruption in last years (χ2 test, p< 0.0001) but not with age and university courses. Howevere, logistic regression analysis indicated that the factors influencing Ecstasy use were use of other drugs, alcohol and cigarette smoking (P< 0.0001). Ecstasy use appears to be a serious problem in college students. Whatever the causes behind the rise in Ecstasy use, personalized and informative educational programs should be conducted in all colleges.