سیداحمد محمودیان

Cognitive behavioral therapy is used for psychiatric disorders and several medical conditions, including sleep disorders. The aim of the study was to find a significant relationship between improving sleep quality and the severity of migraine headaches using cognitive behavioral therapy.

This is a clinical trial studythat has performed on 80 paitents whom were suffering from in Migrainein 2 Healthy Centerin Esfahan. We divided patients to two groups of Control and Intervention. Every group had 45patients.The patients of Intervention groups received 5 academic meetingson the subject of Cognitive Behavioral Treatment. The methods of academic meetings were including: lecturediscussion and conversation. The aims of meetings were: recognition of sleep mechanism, sleep promotion and well-being. Standard questionnaires of sleep quality of Pittsburgh and Midas were completed by patients before and 3 months after finishing of intervention.

The education of Cognitive Behavioral Therapy on Sleep Quality and Headache Intensity in Migraine Patientshad a positive virtually effect on all sleep quality components(P < 0.001), Except using of sleeping drugs user, and had a negative virtually effect on  number of headache days during 3 months ago and number of attacks during last month (P = 0.02).

These study findings have emphasis on effectiveness of:education ofCognitive Behavioral Therapy on Sleep Quality and Headache Intensity in Migraine Patients, and offer this strategy for dealing with pain, number of attacks and sleep well-beinga.

Domestic violence against the women is a common problem in the world. Providing health services in Iran contain anger management training intervention as a major step for reducing domestic violence and consequences. In this study, we evaluated the effect of stress and anger management training program, which belonged to the Iranian Ministry of Health, Treatment, and Medical Education. This randomized quasi-experimental study, with pre/posttests, was performed in 2018, in one of the health centers in Isfahan City, Iran. The score of anger management skills, as well as the prevalence exposure to violence were compared between two equal groups of 44 married woman with exposure to violence, without any interventions (control group), and with 4 sessions of training anger management skills (interventional group). Before and 3 month after training, anger management skills questionnaire and Iranian violence screening checklist were completed for both groups. Data were analyzed using analytical tests such as chi-square, t, and paired t, via SPSS software. Both groups were similar in age and exposure to violence (P = 0.530). The score of anger management skills before the training was 24.75 ± 9.92 and 23.25 ± 9.47 in interventional and control groups, respectively (P = 0.470). After training, the score became 31.30 ± 6.48 and 23.34 ± 8.72 in interventional and control groups, respectively (P < 0.001). The exposure to violence did not change in both groups after the intervention. The training program belonged to the Iranian Ministry of Health, Treatment, and Medical Education increased anger management skills in women. Many studies showed that other training methods are effective on anger management skills. Moreover, long-term studies even showed that exposure to domestic violence had been decreased.

There are serious challenges for treatment of depression in the war veterans. Complementary therapies; such as homeopathy، are proposed to incease successful of their treatment. In one study، ultrahigh-dilution of NaCl (Natrium muriaticum) was used in depressed war veterans for this aim and in this study، their homeopathic dynamisms were evaluated for preparing the special treatment protocols. The patients got the remedies every 2-3 weaks and changing of their symptoms after using natruium muriaticum were evaluated. One homeopath diagnosed their homeopathic dynamisms via discussing about their mental and somatic symptoms with the help of software. Aggravations were defined as both، increasing of previous or appearing new trouble symptoms. Accessory symptoms related to remedy proving were omitted by waiting. At the end of study، data were extracted from the patients’ files and classified. Files of 28 depressed war veterans had adequate information and in 7 of them، had not. The most common homeopathic dynamisms were similar to Sulphurous، with rage and eczema as main symptoms، and Belladaonna، with headache and anger. The other dynamisms were Phosphorous، Aconitum، and Calcarea، respectively. 25 percent of patients reported mild to moderate aggravation. They were headache، desquamation of skin eruptions، anxiety and obstinacy with their families. Trend of clinical course of depressed war veterans، after getting a homeopathic remedy، indicated some dynamisms. This is an opportunity to prepare a special protocol with speedy use of remedies for treatment of them in another research.

Reaserchers consider variety of methods of complementary medicine such as homeopathy in addition to classical treatment of depression to improve response of the patients. This trial designed to evaluate the efficacy of homeopathy for 6 months in the treatment of depression in war survivor diagnosed with PTSD warfare patients. A randomized double blind clinical trial enrolled patients with depression conform with Natrium muriaticum dynamism in Shahid rajai Hospital of Isfahan. They randomly allocated to two groups of intervention (homeopathy drugs) and control(placebo). The severity of depression and Quality of life were evaluated based on the Beck Depression Scale and WHO Quality of life Scale pre- and post-treatment respectively. Data were analysed by mann-whitney and Covariance in the Spss20 software. 65 subjects completed 6 months treatment with homeopathy or placebo. The average age was 48.6±6.9 and the average years Of their depression was 20±10.2 years. Two groups were similar in beginning of the study. By co variance analysis, there wasn’t any significant differences for depression severity after intervention with controlling score of quality of life and depression severity between groups (P>0.05). Total score of quality of life after intervention with controlling score of quality of life and depression severity between groups wasn’t significant but the Physical and psychological domains were statistically significant (P<0.05). 6 months Homeopathic treatment wasn’t effective on depresion severity of chronic janbaz patients but it changed psychologic and somatic fraction of their quality of life. We suggest long duration treatment on early disease by some homaeopathic remedies to evaluate homeopathy effectiveness on depressive patient in future trials.

Acupuncture with classical anatomical bioenergetic base is one of ancient complementary medical methods in the world. The correct application of acupuncture is an advantageous method since it does not cause any serious and life threatening side effects. Although acupuncture has not been long practiced in Iran, its use is constantly growing. However, there is not any accurate statistics about the reasons it is used and the level of satisfaction from the treatment. Therefore, we decided to evaluate these parameters in Isfahan. This was a descriptive analytical study conducted in Isfahan,Iran, during spring 2011. The target group included people who referred to acupuncture clinics in this city. According to the formula, the sample size was estimated as about 227 patients who were randomly selected. Subjects were included if they participated at least 10 sessions of acupuncture treatment and did not begin any new treatment method. The only exclusion criterion was refusing to fill the questionnaire. Data was collected through questionnaires and was analyzed by SPSS. In this study, we evaluated patients who were treated with acupuncture. Most of them were women (77%). Their mean age was 38.4 ± 11.99 years. The majority of the patients had university education. The commonest complaints among the patients were obesity, backache, joint pain, anxiety, headache, neck pain, hypertension, dermatological disorders and nausea. Most patients tried acupuncture since conventional medicine has been unsuccessfulness to treat their problems. The average scores of satisfaction from the acupuncture method and specialist were 27.72 ± 3.6 and 28.71 ± 5.45 (out of 35), respectively. Patients reported acupuncture to be able to reduce their issues including headache (61%), obesity (58%), musculoskeletal pain (56%), anxiety (51%), and dermatological disorders (20%). According to the satisfaction rates from acupuncture, Iranians may be more willing to use acupuncture in the future. Chronic pain and obesity are important problems in modern societies that lead to disabling situations either as part of a disease progression or side effects of drugs used for their treatment. Therefore, considering the fewer side effects of acupuncture in comparison with conventional medicine, it is necessary to perform more research about different aspects of this therapy.

Pathologic fracture is a very serious complication of osteoporosis,we don’t have any effective treatment for osteoporosis so determination of risk factors for osteoporosis and pathologic fracture and subsequently prevention of the disease is attended. The goal of this study was to access the frequency of osteoporosis risk factors and need for bone mineral density testing in patients with pathologic fractures. 240 patients with pathologic fractures were conducted to this description study in year of 2010 and some risk factors related to pathologic fractures were collected by questionare from all patients and the need for bone mineral density testing was assessed on basis of national osteoporotic foundation criterias(NOF). The most frequent risk factors among of them for pathologic fracture was belonged to inadequate calcium and vitamine D intake(75%). Smoking,use of glucocorticoid drugs and underlying diseases had less frequency among our risk factors. Patients with one,two and three criterias for necessarity of bone mineral density testing were respectively 22.1%,55% and 8.3%. In attention to inadequate calcium and vitamine D intake, as the most important risk factor in osteoporotic patients in esfahan we can conclude that national program for provide these supplementation is necessary.

25-50 percent of all patients who are visited by GPs, have complains that are not medically explained. Their management is a challenge for GPs. In homeopathy (a method of alternative medicine) these symptoms are important for selection of remedies and in an effort to treat them. This study aimed at describing this existing situation by investigating the frequency of such complaints in the patients under study. This study is a cross-sectional study conducted in Isfahan in 2008 on 240 Patients who were visited in some of the clinics affiliated to Isfahan university of medical sciences. The patients were selected by convenient method. Data were gathered by the questionnaire and analyzed via SPSS 13.5 software using Chi-Square test. Out of 240 patients, 150 were women (%65.4) and 90 were men(34.6%). 75.4 percent were 20-40 years old. 1.7 percent had no symptoms, 31.3 had 1-5 symptoms and 40.8 percent had 6-10 symptoms. The females had more symptoms than males. Symptoms of mind, GI, sleep and miscellaneous ones were 81.3, 80.4, 72.1 and 87.1 percent, respectively. The most frequent symptoms in each group were intrusive thought, salivation in sleep, waking frequently and dyspnea wearing tight collared clothes. Only 10.97 percent of patient referred to the physicians for these symptoms. The symptoms registered in homeopathy references have notable prevalence in the society but most of people with such symptoms will not go to a doctor for examination and treatment Therefore, it is very important to carry out more research regarding these symptoms. General population should receive more information and physicians, in turn, should use appropriate methods of therapy for treating these patients.

In order to improve the motivation and attitude of the elderly for regular and continuous physical activity, it is inevitable to use methods and models of effective education. Spiritual doctrine can improve the elderly's motivation for activity increase. This study was performed to assess the effect of faith-based education on physical activity and compare that with routine education (non faith- based) on the elderly in 2011.

A quasi-experimental field trial study was done on a number of the elderly of Isfahan pensioners in two random groups: control) 53 sample) and experiment (45 sample). The educational content was prepared in two kinds of faith- based and routine education. The researcher-made questionnaire whicht was derived from a valid questionnaire _ physical activity scale for elderly (PASE) _ was used to estimate the elderly's physical activity before and after the educational intervention in the two groups.

Before the educational intervention, the physical activity score for the experiment group was 873.15±197.98 and for the control group, it was 864.15±269.85, which were not statistically significant (P=0.853). After the intervention, the score for the experiment group was 944.09± 262.88 and for the control group, it was 930.60±259.03.This showed a statistically significant differences. (P =0.043 in the experiment group and P=0.045 in the control group), but despite a little difference, there was statistically no significant differences between the groups.

The level of elderlies physical activity improved after two kinds of education and faith based teaching hadnt obvious differences in outcome than routine education.

Suicide is an important problem of communities. This indecent behavior can cause organic, psychological, and social morbidities such as organ defects, family derangement, and rejection from family and community. Suicide repetition rate is high with only limited research been put to its prevention. With considering the situation of health care system of Iran, are uses of resource and guideline in this system useful for this care?

This research was a randomized controlled trial. Attempted hospitalized suicide persons were entered into the study. Persons from villages or marginal area of Isfahan city in the supervision of health centers were divided to two groups randomly. WHO guideline was translated and revised according to situation of Iran. Then simple follow chart was designed. We integrated this protocol as a mental health pilot program to the health network of Isfahan province. The Behvarz (Primary health personnel) were educated several sessions about support and follow up of the patient. Intervention was done with telephone and verbally. Researcher visited the health house randomly. Intervention lasting 3 months; a control group was established prospectively without intervention. The outcome was measured by severity of suicidal ideation and repetition of suicide attempt.

Mean score of suicidal ideation in intervention group before and after was19.8 and 10.5, that difference was statistically significant (P <0.001). In control group also this score was significant, let down 19.6 to 14. In run of this period no suicide was occurred.

According to Beck score, integration of the model can decrease suicidal ideation so health system of Iran is appropriate site for care to these persons. In control group people also improved their mental status in many ways. Attraction of supportive resources such as family, friend, and spirituals do a significant role to improve mental health status and is an opportunity for managers.

Nutritional status of pregnant mothers is one of the key factors in fetal growth. Micronutrients including Zinc lead to various biological consequences on mother and fetus. We therefore investigated the effect of supplemental zinc sulfate during pregnancy on the newborns weight, height and head circumference. Using a double-blinded controlled clinical trial, 465 pregnant women from Isfahan province with gestational age of 14-18wks were recruited. 229 as cases received 50 mg Zinc sulfate daily and 149 as controls obtained placebo throughout the pregnancy. The subjects regularly were checked up. Statistical analyses were performed using Chi-Square tests. Both groups showed similar maternal characteristics. The mean weight, height and head circumferences of newborn cases were 3.11 kg, 49.82 and 34.17 cm; whereas of controls were 3.09 kg, 49.48 cm and 34.48 cm, respectively. No significant difference was observed between the indices of growth in both newborn groups. There was not any significant difference between frequency of low birth weight (less than 2500 gr) among cases and controls. No beneficial effect of Zinc supplementation on fetal growth was observed in our study. The majority of Meta-analysis studies showed similar results but some not.

How to care for the patients has a principle role in the quality of the services provided, so patient's management is one of the major duties of doctors. However, in Iran there is not a comprehensive program to achieve this goal and medical training is based on diseases while it should be patient based. This study tries to provide a practical approach in training how to manage patients. In this research 60 general practitioners working in urban health centers in Isfahan were randomly selected and studied. 30 physicians from health center number 1 were put in case group and the other 30 from health center number 2 were placed in control group. In conducting the project 4 physicians who had received necessary training worked as instructors. In the beginning of the study, the case group attended in theory classes about integrated patient management, and at the end of this class a package of integrated patient management was given to them. Then the plan was performed practically in the field. Throughout the study both case and control group received the usual training of health centers. The performance of the physicians were evaluated through check list both in the beginning and end of the study. Before the study the mean scores of physician's performance in both groups was the same; however, after the intervention the mean score of the case group was significantly higher than that of the control group. In the end of the study the mean score of clinical performance in case group was 48.9 and in control group was 42.1 (P< 0. 05), mean score of management performance in case group was 38.6 and in control group 32 (P< 0.05), and mean score of training performance in case group was 26.4 and in control group 22.1 (P< 0.05). Results indicated that integrated management training can enhance educational, clinical and management performances of physicians.