فصلنامه کومش
سال دوازدهم شماره 2 (پیاپی 38، زمستان 1389)

Student evaluations provide teachers with important feedback from the consumer's point-of-view. Although substantial research has been conducted with regard to the factors influencing reliability and accuracy of student evaluation of teaching quality, but the results are controversial and need to further research. Thus, this comprehensive study was conducted to determine the role of different factors influencing student evaluations of teacher faculty at Semnan University of Medical Sciences students, Iran. This analytical-descriptive study was conducted with participation of all students at least at the levels of the second semester to up of their education program at Semnan University of Medical Sciences in the academic year of 2009. A questionnaire containing demographic data and some factor influencing on teacher evaluation including effective teaching skills (9 questions), faculty personal characteristics (15 questions), educational principles and laws (1 question), personal characteristics and attitudes of students toward lessons (10 questions), daily time and place of lecture presentation (4 items), and teacher evaluation process at the University (6 questions) was given to each student before the starting of lecture at the classroom. The questionnaires were collected, and the data were analyzed using appropriate statistical methods appropriate. Results. Results showed that from the viewpoints of students proficiency on the course (94 %), good-tempered (93 percent), confidence (92.7%), expressive power (91 percent), organizing the contents and having interest to teaching (90%), personality (90 percent), and old or up-to date of teaching materials (83%) have high and higher influences on student evaluation of teacher quality. Most Students (63.3%) expressed that their personal issues have low up to very low influence on teacher evaluation. Additionally, a significant relation between the gender (P<0.001), native and non native status (P<0. 01) and study field of students (P<0. 01) with teacher evaluation score was found. Finally, no significant relation was observed between student rating with faculty evaluation (P>0. 05). The results of this study showed that acdamemic capability (such as academic proficiency and providing new and updated scientific information on the course subject) is one of the most important factor influencing teacher evaluation outcomes. Also, it seems that not only teaching methods, but also teacher personality can increase student enthusiasm and motivation for learning that ultimately improve the quality of education.

Internal evaluation is a fundamental determinant to quality development in teaching departments and faculties. The purpose of this study was an internal departmental evaluation in the public health department of Semnan university of medical sciences (SUMS). This work was performed (during 2008-2009) in department of public health of SUMS utilizing an accreditation model. The assessment covered 9 areas, namely: educational missions and objectives, management and organization, educational programs, scientific board, students, educational resources, research activities, assessment and evaluation, and graduates. Questionnaires were developed by the scientific members of the department. After collecting the data, results were categorized according to Gourman scoring scale, from unsatisfied class to very strong class, with the range of 1-5 scores. The mean scores in the 9 evaluation areas were obtained and the rankings were as below: Educational programs area was in strong ranking; educational missions and objectives, scientific board, and assessment and evaluation areas were in good ranking; management and organization area was in more than satisfied ranking; students area was in satisfied ranking; educational resources and research activities areas were in borderline ranking; and finally, the department was ranked as unsatisfied in the graduates area. Results showed that by achieved mean of 3.19 in whole of the evaluation areas, the public health department has placed in "more than satisfied" class. Although the overall status is acceptable, there is a need to modify the weak points in the suboptimal areas to improve the educational quality in this department.

IntroductionIn accordance with evaluation of universities and high educational societies and by using accreditation model, parasitology and mycology department of Urmia University of Medical Sciences was evaluated. This study was done in parasitology and mycology department of Urmia university of medical sciences in 2007. This department with 4 scientific members, 3 educational districts, and 4 laboratories, and with 27 years archaism is involved actively in teaching of students of medical and health sciences. The assessment covered 9 areas, namely: department manager, scientific members, educational districts, human resources, education resources and research facilities, and the status of students. Questionnaires and check lists were developed by the scientific members of the department. After collecting the data, the results were categorized into three levels according to the gained points: non-desirable level (less than 25 % of the total score), semi-desirable level (between 25-75 % of the total score) and desirable level (more than 75% of the total score). The obtrained mean scores revealed that the department of parasitology and mycology was located in the "desirable level" in the fields of department manager, scientific members, educational district, and the status of students. The department was located in the "semi-desirable level" in the fields of human resources, education resources and research facilities. Overall, the deparment was gained the "semi-desirable" score (103 from 140). This study demonstrates that the deparment of parasitology and mycology is located in the semi-desirable level. Although the overall status is acceptable, but there is a need to modify the weak points in the suboptimal areas to improve the educational quality in this department.

Colorectal cancer is the most common cancer of digestive system and also fourth cause for death of cancer around the world. Different studies indicate that survival of patients suffering from colorectal cancer has recently developed in some areas of the world. However, it is not clear which factors involve in this improvement. This study aims at investigating some clinical and pathologic factors in prognosis of these patients with colon and rectum cancers separately. Data recorded from 1194 patients with colorectal cancer in Cancer Record Center of Research Center for Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences (Tehran, Iran) was used in this study. Data analysis was performed using competing risks model. Software used for data analysis was STATA, 11 version, and significance level was regarded as 0.05. Body mass index, alcohol consumption, tumor site, inflammatory bowel disease, metastasis to lymph nodes and metastasis to other organs had significant effect on death of colon cancer, while body mass index, metastasis to other organs and kind of the first treatment had significant effect (P<0.05) on rectum cancer. Median survival was 7.75±1.118 and 3.917±0.26 years for patients with colon cancer and rectum cancer respectively. Also, 1, 2, 3, 4 and 5 years of survival rates for colon cancer were 88.7%, 77.9%, 68.5%, 61.4% and 56.8%, respectively, while they were 89.1%, 74.2%, 60.7%, 47.1% and 41.9% for rectum cancer, respectively. According to the results of this study, some variables may have different impacts on colon and rectum carcinoma; therefore it is needed that the effects of the factors on different parts of the large bowel be considered separately in the future studies.

Family history of colorectal cancer has been shown to be related to the risk of developing colorectal cancer. This risk depends on the number of affected relatives and the age at diagnosis. In this study we aimed to estimate the frequency of a positive family history of colorectal cancer in a random sample from Tehran population. This study was a community-based cross-sectional survey conducted from May 2006 to December 2007 in Tehran province, Iran. A total of 5,500 peoples (age≥20 years) drawn up randomly by random sampling according to postal codes and invited to participate in the study. All participants completed a detailed health data registry form on family history status of colorectal cancer. The mean age of men with a positive family history was significantly different from men with negative family history. There was no significant difference between mean age of women responders with or without positive family history. Among all participants (n=5,500), 162 responders (2.9%) had a history of colorectal cancer. Of 162, 67 responders (1.22%) had one and 4(0.07%) had two or more first-degree relative with colorectal cancer. Of 5,500 participants, 18 subjects (0.33%) reported having two or more first-degree relative with colorectal cancer or one first-degree relative with colorectal cancer diagnosed at age <50 years. Four subjects (0.07%) had three or more first-degree relative with colorectal cancer. Based on the findings, we estimate that more than 570,000 subjects in the Iran in the age group≥20 years have at least two to three times increased risk of developing colorectal cancer which should be identified and encourage to participate in screening and surveillance protocols of colorectal cancer.

Nursing care is an essential component of health services. Patient's health and improvement depends on the quality of nursing care. Nurses and patients views as well as their active participation for making decision have an important role in quality of services, so it must be regarded as a principle. The purpose of this research was to study nurse's and patient's viewpoints regarding quality of nursing care in teaching hospital of Semnan (Iran). In this descriptive-comparative study, 52 nurses and 300 patients from internal, surgical, gynecology and pediatric wards of Fatemieh and Amir Hospitals were selected by systematic sampling. Nursing care quality was assessed in psychotic, social and communicative aspects using a Quality Patient Care Scale questioner. The questioner had 41 questions with 3 answer choices (rarely, occasionally and usually) that marked from 1 to 3. Mean scores were calculated for all subjects and then were categorized in undesirable (less than 1.5), low desirable (1.5-2.49) and desirable (2.5-5) groups. 31.6 % of patients and 92.6% of nurses evaluated psychotic-social aspect of care quality as desirable. The desirability percent for communicative aspect of care quality was 24.7% in patients and 56.8% in nurses. There was a significant statistical difference between patients and nurses views in both aspects (P<0.001). In psychosocial aspect, 73.5% of patients expressed that nurses do not introduce themselves and 77.9% of them expressed that nurses rarely introduce new patients to other patients. In communicative aspect, 42.5% of patients declared that they ensured about their secrets rarely. Nurse's and patient's viewpoints on quality of nursing care were different because of their various experiences and insight. Thus, re-evaluation of the quality standards of nursing care based on client approach, choosing some strategies to increase nurse-patient communication and considering psycho-social patients needs seems to be a necessity.

Spirituality is an important aspect of health of people with chronic health conditions such as diabetes. Awareness from adolescents’ perception about life quality and its effective factors is useful for controlling blood glucose in adolescents and causes motivation in adolescents for self care. The aim of this study was to explore spirituality effects on life quality in diabetic adolescent girls. A qualitative design using content analysis was applied in order to seek the purpose. Data were collected using in-depth semistructured interviews and focus groups with participation of 28 adolescent girls with type 1diabetes. The participants were recruited by purposeful sampling of "West Azerbaijan Diabetes Association" members as well as some patient's referral to Urmia city hospitals diabetes clinics. Following data analysis, participants in this study were categorized in four general groups; people with religious attitude and satisfied from their life, people who perform religious etiquettes and satisfied from their life, people with spiritual beliefs and adaptation with diabetes, and finally people with spiritual beliefs and self care. Spirituality is an important factor that influences on the life quality of diabetic adolescent girls. In addition, spirituality helps adolescent girls with diabetes to cope with stressful situations and needs to be considered in management and care from these patients.

The words to be used as symbolic tools for communication. In the beginning of procedure of language development, children acquire nouns, and frequency of nouns application in this period, is the most of another type of words. With due attention to importance of nouns in procedure of language development, the study was carried out with aim to gathering of norm data for pictorial expression test and determination of expression ability in an Iranian normal Farsi-speaking children. It was a descriptive-analytic and cross-sectional study. 110 normal Farsi-speaking children (54 girls and 56 boys) were selected randomly throughout Arak kindergartens. The pictorial expression test was used in this study. Mean scores was statistically different between all age groups (2.5, 3, 3.5 and 4) with and without limited 4 seconds response time (P< 0.05) except between 3 and 3.5 years-old group. Also, mean scores decreased in all age groups, with limited 4 seconds response time. The expression ability was different in 4 age groups. The picture-naming test could show these differences. Also, the “limited 4 seconds response time” increases difficulty of this test. In addition, mean scores of expression with limited 4 seconds response time, could be used for evaluating of children with various language disorder.

Patients with chronic, painful diseases often seek alternative therapy. The rhizome of Zingiber (Z) officinalis is a common constituent of diets around the world and its extracts have been reported to exhibit several pharmacological activities. We investigated the effects of alcoholic Zingiber oficinalis rhizome extract on two different models of acute and chronic inflammation and pain. Formalin, xylen and acetic acid were used to induce acute inflammation in paw, ear and peritoneum, respectively. The amount of Evan's blue dye leakage into these tissues was used as an index of acute inflammation. For chronic inflammation, a piece of sterile cotton (30 mg) was impalnated into the groin region for a period of seven days. Following, t he weight of the cotton piece before implantation is subtracted from the weight of the dried piece and used as an index of chronic inflammation. Finally, acute and chronic pain assessment was carried out via the formalin test protocol. In acute inflammation model, the formalin-induced inflammation in paw and peritoneum was significantly (P <0.05) reduced by the extract of Z. oficinalis rhizome at doses of 200 and 400 mg/kg. Also, the extract at the dose of 400mg/kg significantly (P<0.05) reduced the paw diameter. In chronic inflammation model, the extract at the dose of 200 mg/kg significantly (P< 0.01) dimished inflammation. Finally, both acute and chronic pain significantly (P< 0.05) suppressed by the extract at the dose of 200 mg/kg. Findings of this study indicate that alcoholic extract of Z. oficinalis has anti-inflammatory and antinociceptive effects. Thus, using the extract of Z. oficinalis could be a potential alternative therapy in ameliorating inflammation and pain in patients suffering from chronic diseases.

Effects of extremely low frequency magnetic fields (ELF-MF) with different intensities and frequencies has been investigated by several researchers. In most of these studies, the applied magnetic field has uniformly encountered whole brain and it has shown that changing intensity and frequency causes anomaly changes in electroencephalograms. The aim of current study was to investigate the effect of local exposure to ELF-MF with different intensities on EEG signals.

Magnetic field with frequency of 10 Hz and intensity of 100, 120, 160, 200, 240, 280, 320 and 360 µT was applied to F3 zone in 10-20 system of 3 men locally. Finally, relative power spectrum in 5 points of head in conventional frequency bands was assessed.

An increase in alpha band in regions under exposure such as F3 and O1 in intensities of 100 and 360 µT was observed. No changes in other bands such as theta band were found. It should be noted that none of the above effects was observed in closed-eye position.

Regular effects due to increasing intensity of magnetic field was not observed and changing potential of EEG signals from magnetic field with intensity of 100 and 360 µT is more than other intensities. Changing pattern of alpha band in F4, Cz, O2 and O1 was similar to exposed F3 zone and no resonance effect was observed at 10 Hz magnetic field.

Acute lymphoblastic leukemia is one the most common malignancies in children and adolescents. L-asparginase (L-ASP) is one of the leading medications in treatment of ALL. L.ASP interferes with the synthesis of some coagulation proteins and therefore causing disturbance in normal coagulation. In this study, the effects of L-ASP on anticoagulant proteins (protein C, protein S, and antithrombin III) and platelet function were assessed.

This was a before-after study on 41 patients with ALL who refered to Mahak hospital (Tehran, Iran). Before and after the injection of L.ASP, a bleeding time test was performed based on Ivy method. Protein C and protein S performance was assessed by turbidometry and antithrombin III performance was evaluated by chromogenic method.

48.8% of patients were female. Mean (±SD) of age was 4.0±7.2. A significant reduction in the mean amount of protein C, antithrombin III and bleeding time was recorded. However, the reduction in protein S was not significant. No patient showed the symptoms of thrombosis.

The results of this study showed that L. ASP drug reduced coagulation proteins (except the protein S). This decrease along with other concomitant genetic factors can lead to thrombosis in some patients with ALL during induction therapy.

Rheumatoid arthritis (RA) is more prevalent in women than men and its incidence is in all age group. Patient with RA significantly experience more disability and co-morbidities including cardiovascular diseases in compared with people without RA and this is due to reduced physical activities in the patients. The effect of aerobic training on patients with RA is still unclear. Thus, the aim of this study was to investigate the effects of 8 weeks aerobic training in patients with RA. Twenty three women (mean age 51.96±7.73 yr and mean weight 72.37±10 kg) with a diagnosis of RA for more than three years and without any known cardiovascular and brain symptoms were voluntarily enrolled in the study. The patients were divided into aerobic training (n=11) and control groups (n=12). The patients in the aerobic group performed an aerobic training using a stationary bike (3 d/wk for 8 weeks). All subjects in this group were administered the same medicine at the same dose. A fasting blood sample was collected prior to and after 8 weeks of aerobic training from the patients. Serum C-reactive protein (CRP), fibrinogen and rheumatoid factor (RF) were measured using standard methods. There was a significant difference in CRP, fibrinogen and body mass index before and after 8 weeks of aerobic training in the experimental group (P≤ 0.001), but not in the control group. Moreover, no significant difference between the control group and experimental group with respect to all studied variables. These findings showed that aerobic training could reduce inflammation in patients with RA and consequently plays an important role in preventing the occurrence of cardiovascular diseases in these patients. Therefore, we recommend the use of aerobic exercise training as a safe therapeutic method for reduceing the dosage of the anti-inflammatory drugs in patients with RA.

Intense exercise activity has been known as one of the immune system suppressor. The purpose of the present study was to examine the effect of a single incremental exhausting exercise on circulting numbers of T cell and NK cell subsets in healthy young male athletes. Twenty male subjects with mean age 22/4±1/8 (SD) yr, mean Vo2max 41/7±7/1 (SD) ml/kg/min and mean BMI 23±1/87 (SD) kg/m2 were divided randomly into two control group (n=10) and experimental group (n=10). The experimental subjects performed a standard bicycle ergometer test whereas the control subjects did not participate in any exercise activity. Blood samples were collected pre-, immediately post-, and 2 hours post-exercise. The T and and NK lymphocyte subsets were analyzed with flow cytometry. There was a significant increase in the percentage of T (CD8) and NK (CD16/56) and a significant decrase in the the percentage of T (CD4) and the ratio of CD4/CD8 from pre-, to immediately post-exercise (p < 0.05). Both changes returned to pre-exercise values at 2 hours post-exercise. Addtionally, no significant changes was found in the percentage of CD56 and CD16 (NK) cells following exercise Findings of this study indicate a single intense and short-term training session caused transient and temporary changes in circulating lymphocytes counts. Thus, it is reommonded that the interval between training designed in a way that the immune system reverts back to its original status.

Many pregnant women like to avoid pharmacological or invasive methods of pain management in labor. Acupressure is a non- invasive method that has been suggested for labor pain relief. The purpose of this study was to evaluate the effects of LI4 acupressure on labor pain in the first stage of labor. This single-blind randomized clinical trial was performed on 100 eligible women who were at the beginning of active phase of labor (3-5 cm dilatation of cervix). The case group (n=50) received LI4 acupressure at the onset active phases for duration of each uterine contraction over a period of 20 minutes, while the control group (n= 50) received a touch at this point without massage. Labor pain was measured several times using a subjective labor pain scale (Visual analogue scale) before intervention, immediately, 20, and 60 minutes after intervention and then each hour until delivery. Finally, severities of pain were compared between the two groups. There were significant differences between the groups in subjective labor pain scores at immediately, 20, 60 and 120 minutes after intervention (P<0.001). These finding showed that LI4 acupressure was effective for decreasing pain in women during labor. LI4 acupressure can be an effective nursing management for women in labor.

Urinary tract infection (UTI) is the most common disease of urinary tract. This disease lacks characteristic signs and symptoms and occasionally occurs with atypical presentations such as weight loss, anorexia, and growth failure. Zinc improves host immune-system response to many infections and has a significant role in immune system integrity. The aim of this was to study of zinc supplementation on treatment of UTI in children. In this clinical trial study, 200 children with UTI who were admitted to Amir Kabir hospital (Arak, Iran) were randomly divided into two control and case groups. Two groups were matched in age, gender, urine laboratory profiles, and clinical signs and symptoms such as fever, dysuria and frequency. The control group received only routine treatment of UTI. The case group, in addition to routine treatment of UTI, received oral zinc sulfate syrup. Findings showed that dysuria and frequency in zinc-supplemented subjects recovered significantly sooner than control subjects, while the abdominal pain persisted longer. There were no significant differences in onset of fever remission and negative urine culture time 48h and 7-10 days after treatment between two groups. Zinc supplementation has a significant effect in ameliorating severe dysuria and frequency of urinary in UTI. When the abdominal pain is present, usage of this drug is not recommended.

The screening of patients with dyspepsia, may allow an early identification of affected individuals. The aim of this study was to determine the prevalence of celiac disease in dyspeptic patients submitted to routine diagnostic upper gastrointestinal endoscopy. From November 2007 to October 2008, 407 patients who underwent endoscopy for any reason (193 male, 214 women; mean age36.1 years) were studied in this work. Histological characteristics in duodenal biopsy specimens for celiac disease were evaluated according to the modified Marsh Classification1999. In addition, all patients were tested for total immunoglobulin A and anti-transglutaminase (tTG) antibodies. The patients with IgA deficiency were tested with IgG tTG. Duodenal histology showed the malabsorption pattern (Marsh I-IIIc) in 26 (6.4%) cases and 33 cases had serological positive test for tTGA. In term of the serological analysis, 10 out of 33 tTGA positive patients had malabsorption pattern (Marsh I,-IIIc), and all of them had a positive tTGA (2.45%). Four of the 407 recruited patients were IgA deficient and none of them were positive for IgG tTG. In this study, about 6.4% of patients had malabsorption pattern and 8.1 % presented with positive serology for CD. However, both histology and serology were positive in 10/407 (2.45%). The high prevalence of celiac among dyspeptic symptomatic individuals indicates that they are a higher risk group for developing celiac disease.

Formaldehyde is used in many industrial applications as raw material and therefore high concentrations are found in their effluents. Activated sludge processes based on biofilm growth are increasingly used because of appreciate abilities in controlling of high organic load industrial effluents. The main objective of this study was to determine the effect of biofilm in improvement of activated sludge efficiency for treatment of industrial effluents containing formaldehyde.

Two lab scale activated sludge reactors (with and without fixed bed for biofilm growth) were investigated in organic loading rate of 0.7 – 10.5 kgCOD/m3.d, aerobic condition and the room temperature. In this study, the effects of organic and hydraulic loads were investigated for the mentioned two processes.

The most COD removal efficiency for biofilm activated sludge was 98.86%. The reactor containing biofilm had removal efficiency of more than 64% up to the organic loading rate of 10.5 kgCOD/m3.d, while the conventional activated sludge reactor collapsed in organic loading rate of 7.5 kgCOD/m3.d.

Findings of this study indicate that activated sludge reactor containing fixed bed for biofilm growth is significantly more efficient than the conventional activated sludge one.