طاهره خزاعی

Hepatitis B virus (HBV) is one of the most popular causes of chronic liver diseases through the world. There are approximately 350 million individuals infected with the HBV that 15 to 20 million of them are co-infected with HDV. It is known that co-existent infection with HDV tends to accelerate the progress of chronic HBV infection to chronic hepatitis, cirrhosis and hepatocellular carcinoma. As HBV and hepatitis C virus (HCV) have the same transmission routes, co-infected of HBV and HCV may lead to increasing of chronic liver diseases and high mortality rate. The aim of this study is to determine the seroprevalence and the risk factor of HDV and HCV infection with HBV chronic patients. This study (descriptive-analytic, type of sectional) is done on 300 patients with chronic hepatitis B referring to hepatitis diseases clinic during 2013-2014 in Birjand. All patients had a document containing demographic information, virus transmission way and the way aware of disease. Then physical examinations were done and laboratory tests and medical sonographies were recorded in documents. The data collected with checklist then entered in SPSS software and analyzed with statistical tests (p<0.05). Mean age for 300 patients was 38.61±11.98 that %54.7 of them were female. There was found no risk factor at %45.3 of patients. Among the chronic hepatitis B patients, 11 individuals (%3.7) were co-infected with hepatitis C, 10 (%3.3) with hepatitis D and 2 (%0. 6) with both hepatitis C and D. %91.7 patients were negative HBeAg and positive HBeAb. There was no significant association between prevalence of HDV and HCV with HBV and age, sex, educational state and job. In risk factors patients co-infected HBV and HCV blood transfusion was significant (p=0)but in patients co infected HBV and HDV IV addiction and sharing needles were significant(p=0),(p= 0.01). Practitioners and all health care managers in our area should be acknowledged about the risks of dual infection with HCV and HDV in HBV-infected patients. Patients co-infected HBV and HCV blood transfusion was significant but in patients co-infected HBV and HDV IV addiction and sharing needles were significant.

Health promotion and providing health for the wholepopulation is an important factor of progress in societies. Students of medical sciences have a significant role in the health promotion as health promoter and professional health care providers. Therefore, the health-promoting behaviors among these students have noticeable importance. Inthiscross-sectional descriptive-analytical study,400studentswere assessedbyHPLP II questionnaire through two-stagestratifiedsampling. This questionnaire has six dimensions:responsibility, physical activity, nutrition, spiritual growth, Stress Management, and interpersonal relationships. Descriptive statistics and T-test was used for data analysis through SPSS11.5. The mean age ofstudents was21.36±1.6. The total meanscore of health-promoting behavior was 113.08±25 (total score 208). The highest score was gained by spiritualgrowth (20.81±6.2), and the lowest score was by responsibility domain (19.26±6.8). Interpersonal relationsbetween two sexeswas statistically significant (p<0.05). Due to the state of the health-promoting behaviors among students of medical sciences (intermediate levels),educational planning in health-promoting behaviors is recommended for students.

Due to various factors، college education is a stressful period and the students may experience educational burnout for different reasons such as demanding high level of endeavor for learning or lack of supportive mechanisms for effective coping with the problems. In this correlation type cross – sectional study، 200 paramedic students were selected through randomized stratified sampling with standardized educational burnout and mental health questionnaires. The obtained data were analyzed by SPSS software (v: 11. 5)، T test، Chi square، and correlation statistical tests. Mean age of the students was 21. 67±1. 4 years، mean educational burnout score 40. 56±8. 5 and mean mental health score 28. 03±11. 2. Mean educational burnout score in lab technology students and anesthesia students were higher in comparison with radiology and operation room students. However، there is no statistically significant difference. It was found that there was a statistically significant association between the students'' educational burnout score and mental health score (p<0. 05). According to the given results، it can be concluded that some fields in the college education can cause educational burnout and therefore have negative impact on mental health of the students.

Recognizing the factors affecting the quality and quantity of clinical education (CE) is helpful in solving CE problems. Also, CE healthy constituents can enhance the quality of education. This study aimed to determine the viewpoints of students and instructors of Birjand University of Medical Sciences regarding CE quality. This descriptive and cross-sectional study covered all senior students at Paramedical and Nursing-Obstetrics Schools of Birjand University of Medical Sciences during 2011-2012. The instrument involved a questionnaire which covered 5 domains including the educational objectives and plans, the trainer’s performance, his/her manner of treating the students, educational setting, and supervision and evaluation. The data were analyzed in SPSS using descriptive and analytical tests. There were 93 students and 22 instructors in this study. There was a significant difference (p<0.05) between students’ mean scores of the five domains on the basis of their major. The difference between instructors’ viewpoints mean scores concerning their way of treating students and the educational setting was significant on the basis of their educational and clinical experience (p<0.05). Finally, students and trainers’ mean scores concerning trainers’ performance and treatment of students was significantly different (p<0.05). CE is complicated and widely-dimensioned. Students and instructors’ views of different fields of study have different views on the domains influential in CE. It is through frequent evaluations of clinical areas and comparison with the current status that the strengths and weaknesses can be recognized.

Inappropriate use of mobile phones may lead to pathological stress in some people. Identification of people at risk, the underlying conditions, and prevention are necessary. Uncontrolled emotions can lead to addictive and compulsive behaviors. Thus, this study aimed to determine the relationship between mobile phone dependency and student's emotional intelligence in Azad University of Birjand in 2012. This descriptive-analytical study was conducted on 312 students who were chosen with systemic random sampling method. Tools to collect data included Bar-On’s 90-item five-scale Emotional Intelligence Scale and 20-item mobile dependency questionnaire in three areas. In the mobile questionnaire, scores greater or equal to 70 indicated addiction, between 63-70 suggested intensive uses, and scores less than 63 implied moderate use. Reliability coefficient was 0.93. Students were selected by systematic random sampling. The data were analyzed in SPSS (version 14) using Chi-square, Fisher exact test, independent t test, and ANOVA as well as Pearson correlation and regression. From among the 312 students with the mean age of 22.16±3.39 years, 90% (283) were moderate users, 7.4%(23) intensive users, and 1.9%(6) were addicted. M obile dependency had a significant difference with time of mobile use but not with the mean score of emotional intelligence. Mobile dependency was more in married and master students. Mean score of students’ mobile dependency was 45.59±11.61, and the highest score was related to insisting field (18.91±4.70). There was a positive significant relationship between emotional intelligence and mobile dependency; the correlation coefficient between mobile dependency and emotional intelligence was 0.29. Regression suggested that emotional intelligence can predict dependency on mobile use. Mobile dependency can be predicted on the basis of emotional intelligence. Mobile dependency can be prevented by identification of individuals at risk and underlying conditions and controlling emotional stresses.

The ability of critical thinking and clinical decision making is a professional necessity in nursing. Concept map is one of the novel and constructive methods of educational technology in nursing that can lead to meaningful deep learning. This study was conducted to determine the effect of teaching concept map on critical thinking and clinical decision making of nurses. This quasi-experimental study of pre-test and post-test method was performed on nurses of Vliasr Hospital working in neonatal intensive cares units (n=30) selected through census. Five specialized scenarios of neonatal ward were taught to nurses through concept map for 5 consecutive weeks. Data was gathered before and after intervention using a questionnaire consisting three parts of demographic characteristics، B California Critical Thinking Test Questions، and clinical decision making cards by Q-Sort. Data was analyzed using paired and independent t-test at a significance level of (P<0. 05). Both mean scores of critical thinking and clinical decision making showed a significant improvement from 12. 6±3. 3 and 84. 3±4. 9 respectively before the intervention to 26±5. 1 and 98. 2±1/9 after the intervention out of a total of 64 (P<0. 001). Moreover، the increase in clinical decision making score was significantly higher among impermanently employed nurses compared to officially employed ones (P=0. 004، 16. 5±5 versus 11. 4±3. 9). Furthermore، this score was higher among those with working background of less than 10 years compared to those having longer working backgrounds (P=0. 002، 16. 7±4. 9 versus 11. 2±3. 8). Concept map in nursing education could result in development of critical thinking skills and clinical decision making. So it is recommended to employ this method in clinical nursing education.

Pre-identification of practical educational objectives and provision of equal learning opportunities، corresponding to the objectives، for students are among the needs of the educational system that should be fulfilled using the clinical handbook (Logbook). The current research tried to assess the effect of using this handbook on the learning of the students of the department of obstetrics and gynecology.

This quasi-experimental study was carried out on 117 medical students composed of trainees and interns in the academic year 2010-2011. The students were randomly divided into an experimental group and a control group. The experimental group participants were trained with the help of the logbook while the control group''s training followed the normal established method. The skills of the two groups were evaluated at the end of the term through direct observation based on a checklist.

The average of the total scores of the trainees and the interns of the experimental group was significantly higher than that of the control group (P < 0. 05). However، with regard to a number of skills، there was no difference between the scores of the trainees of the two groups.

The Logbook is efficient but not sufficient for teaching clinical skills، and therefore، there should be an appropriate ground for a more efficient usage of the book.

Taking patient's history and doing physical examinations help physicians to diagnose correctly and treat accordingly. There are several factors which may affect the quality of taking patient's history. This study aims to assess determinants of taking patient's history from the viewpoint of the students of Birjand Medical School.

This descriptive study was carried out in 2010-2011 on all 137 medical trainees and interns studying at Birjand Medical School. To determine the students’ attitudes towards history taking and to evaluate their performance a questionnaire and a check-list were used, respectively. The data analyzed using SPSS software. Descriptive-deductive statistics (T-test) were applied on the data.

The average score of the motivational factors was more than the preventive factors. Among the motivational factors, the statement “taking patient history is a basis of proper diagnosis and treatment” (3.58); and among the preventive factors the statement “taking patient history just to evade responsibility”(2.57)had the highest scores. Moreover, there was a significant difference between the performance of trainees and interns in taking and recording patients’ history (P<0.005).

Although the students held a positive attitude toward taking patient's history, they didn’t have satisfactory performance in recording disease symptoms, diagnosis and treatment plans this entails more attention. Observation of trainers on the process of history taking may help.

one of the fundamental rights of patients is giving consent to a particular treatment method, and all health care centers are required to obtain consent from the patients or their guardians. Informed consent is defined as free and voidable agreement of a qualified person regarding participation in treatment; by understanding the nature, purpose and consequences of the consent. Studies show that informed consent and shared decision-making can be related to the speed of the patients’ recovery. This study seeks to study the level of awareness in consents obtained from patients under surgery at the Medical University of Birjand. In this descriptive-cross-sectional study, 248 patients (content provider) in Surgery wards of Birjand University of Medical Sciences enrolled randomly in this study in 2011. Data were collected through interviews with patients after surgery using a self-designed questionnaire and were analyzed by descriptive and inferential statistics. The 44.9% of consents were received of patients themselves, out of which 88% were in written form, and the time to get 57/6% of them was at the time of patient's admission. The extent to which patients were informed at the time of clinical decision-making and giving informed consent was poor, but the patient's understanding and participation in clinical decision-making and physician's interaction with patients were moderate. Patient's understanding of the consent form was significant according to the hospital and the time of receiving the consent form. Also, the patient's participation in clinical decision-making had significant differences according to the hospital. According to the results, strategies must be devised to increase patient's information in order for their better understanding of the consent form and their participation in clinical decisions.

Academic evaluation is one of the strategies applied for the enhancement of teaching conditions. Student-based evaluation is one of the most common kinds of evaluation. The current study is aimed at the identification of important criteria of academic evaluation from the viewpoint of medical school students. This is a descriptive, cross-sectional study. The society consists of all the students of Birjand medical school in the academic year 2009-2010 (n=200), according to the census carried out in this regard). The assessment tool was a researcher-made questionnaire that consists of 55 questions in 6 fields of teaching skills, personal characteristics, communicational skills, evaluation skills, clinical skills, and also observing rules and principles. The data were analyzed by SPSS software using descriptive-analytic statistics. In the category of teaching skills the highest priority in evaluating professors was reported for verbal skills and the ability to get the lessons through (88.5%). In the category of personal characteristics, being well-dressed and polite (58.5%), in the category of communicational skills, fairness to all (68.5%), in the category of considering rules and principles, delivering comprehensive pamphlets for related studying materials and observing start and end time of the classes (34%), and in the category of evaluation skills, the suitability of academic evaluation for studying materials (48.5%) had the highest priorities. Moreover, there was a significant relationship between the gender of students and the personal characteristics of professors and was significant relationship between the degree with category of evaluation skills (P<0.05). Although students can well realize the most important criteria of academic evaluation, they don’t prioritize all characteristics that make a professor scientifically qualified for his profession. This can reduce the validity and reliability of academic evaluation.

Diabetes is the most prevalent medical complication in pregnancy and regarding that the disease is asymptomatic but associated with many complications controlling blood sugar and identifying of gestational diabetes and great care can prevent from harmful complications to affect on the mother and the fetus. The aim of the present study was to determine the prevalence of both gestational and overt diabetes in women who had referred to the health centers of Birjand. This descriptive- analytical study was conducted on the file of 980 cases that had referred to the health centers of Birjand during their parturition period. Sampling was a randomized and classifi8ed one. The necessary information was collected by means of a self-made questionnaire Then the data was analysed by using SPSS software and independent Fisher test and Chi-square and a=0.05 was taken as the significant level. Fifty out of the 980 cases studied (almost 5.1%) suffered from gestational diabetes mellitus and 11 cases of all (almost 1.1%) had overt diabetes. Mean age of the pregnant women and their mean gestation time(s) was 27.6±5.2 and 1.1±1.7, respectively. There was also a significant relationships between BMI index, mean gestational age, having a history of gestational diabetes and familial history of diabetes with gestational diabetes (P<0.001). Regarding the great importance of gestational diabetes and its complications on the fetus, diabetes preventive practices demand special attention to pregnant women. In order to facilitate and increase accuracy in determining gestational diabetes, it is recommended to use the same criteria and to provide a good general education using mass media and educational pamphlets to raise public awareness about the effects of diet and activity on this disease.

In recent years, there has been an increase in the trend for cesarean section. Due to surgical complications, financial costs and mother's long period of hospitalization, the normal way of delivery is suggested. Cesarean rate in Khorasan was estimated to be 28/1 in 1999, though the desired rate in the world was 15 per cent for 2000. This study was performed to define cesarean rate and causes and complications in Vali-e-Asr hospital in Birjand.

In this descriptive study, which cross-sectionally was carried out, 1500 pregnant women referring to Vali-e-Asr hospital were studied. A questionnaire in 4 portions was filled out at mothers’ bed, in delivery room, operation room, and women's ward. Data were analyzed by chi square test in SPSS software. (P<0.05)

From 1500 pregnant women in this study 895 (59.7%) had a normal delivery and 605 (40.3%) by Cesarean. There was a significant relationship between age, job, education level, number of pregnancies, previous delivery, live births, abortion number and the route of delivery (P<0.05). The comparison of mother's complications with delivery route was significant, but not for neonatal ones.

Cesarean choice rate is high and intervention programs are necessary to change women attitudes toward it and to increase the knowledge of painless delivery to reduce Cesarean.

Teaching some clinical skills to students of medicine and paramedics for the first time on patients is unsafe therefore, a number of skills are primarily practiced on models. This study was conducted in order to determine the effect of practical training in clinical skills center. This quasi-experimental study was performed on 60 students entering the university in 2003-2004. The intervention group received the training on clinical skills (ventilation, laryngoscopy, and tracheal intubation) in clinical skills center before stepping into clinic, but the control group did not receive the training. The performance of the students of both groups was evaluated at the end of the term through direct observation checklist and it was compared in two groups using descriptive test, Chi², and Fisher. The mean score of the investigated skills was compared by t test. The difference of the accuracy rate of the skills of ventilation, laryngoscopy, and tracheal intubation in two groups of intervention and control was significant using Fisher test. In addition comparing the skill of chipset intubation and fixing it in trachea and the manner of fixation and making sure about its placement in two groups revealed a significant difference. Training and practical performance of critical skills on models before performing it on patient may reduce detriments due to lack of proficiency by improving student's abilities.

Injuries resulting from needle stick and probable contamination by infectious factors transferring infections through blood such as HCV, HBV, HIV, are important threatening job dangers for health providers. Considering the importance of the issue, the present study was designed and done to defme knowledge and performance of the staff of Imam Reza and Vali-Asr hospitals in Birjand regarding needle stick injuries.

This descriptive-analytical study was carried out on a sample of 59 persons in Vali-Asr and Imam Reza hospitals in 1997. The performance check lists were completed under direct observations of the plan executors, while knowledge questionnaires were filled in by under-study individuals in order to examine the preventative actions in needle stick injuries and also necessary actions after needle stick cases. Data were analyzed by statistic SPSS software using chi square, t test and one way variance analysis (P<0.05).

23.7% of the under-study individuals were men and 76.3% were woman. 13.6% of them had a high school diploma, 22% high school education, 49.2% had a BA degree, 13.3% an Msc degree or higher. The mean for age was 33.4 years and for job history 9.6. On the whole, awareness of the most of the under study individuals was average (66.1 %), while the performance of most of them, regarding under examine criteria, was weak. 36 persons (61%) of the under-study individuals were afflicted at least once with this injury, which 80% of them did not follow-up actions, despite the fact that most of them were aware of the necessary actions after injury resulting from needle stick and believed that they did all-out cautions dealing with all the patients. There were significant relations between the performance of under-study individuals and gender, educations and jobs (P<0.05).

Regarding the high rate of injuries resulting from needle sticks, continuous training and starting care systems and changing the incorrect customs in the curative staff can be useful in reducing the injuries resulting from needle stick and also reducing the probability of acquisition the infectious factor.