Iranian Red Crescent Medical Journal
Volume:18 Issue: 3, Mar 2016

‘Palpitation’ is one of the most common complaints in patients referring to cardiologists. In modern medicine era, these patients suffer from much distress and some cases are known to be difficult to treat. Although the clinician’s first duty is obviously to search for an organic basis for this symptom, the diagnostic evaluation is frequently unrevealing. However, clinical experience suggests that psychiatric causes are relatively common.
This research aimed to screen for mental disorders in patients complaining of palpitation and healthy persons in order to perform a preliminary comparison between them.
Patients and This is a case-control study to screen mental disorders. The target population consisted of adult volunteers with benign palpitation and their matched healthy persons. They were referred during a 10-month-period to the cardiology outpatient’s clinic of Mostafa Khomeini hospital in Tehran, Iran. Sampling was accidental and eventually 110 participants comprised the sample size. The measuring tool was GHQ-28 (28-item general health questionnaire) and the main variable was the questionnaire score obtained from the Likert scoring method.
Comparing two groups showed that the number of participants with the scores more than cut-off point in palpitation group was significantly more than healthy person group (85.4% vs. 43.6% with P Palpitation is the most common symptom in psychiatric disorders such as anxiety and somatization disorders. According to the results of this study, psychiatric causes have an important role in Iranian patients complaining of palpitations (benign form). Considering this fact may lead to a more effective treatment of benign palpitations.

A sedentary life without sufficient physical activity is recognized as a risk factor for various diseases, and a major modifiable risk factor for noncommunicable diseases. This study was conducted to investigate the effect of intervention using socioecological model in promoting women’s physical activity in the city of Kerman, Iran.
In this randomized, double-blinded, controlled study, 360 women were studied at health and medical centers of Kerman. This educational intervention was based on socioecological model and conducted on 4 levels of personal, social, organizational, and political. Data collection tool included a researcher-made questionnaire based on constructs of socioecological model and the international physical activity inventory.
The results indicated insignificant differences between the two groups in terms of perceived social, physical, and political support and also with regard to level of physical activity before intervention. However after the intervention and according to independent t test, significant differences were observed between two groups in perceived social, physical, and political support and also level of physical activity (P According to the results, interventions based on socioecological model can positively affect women’s physical activity.

Ananas comosus has long been used for medical purposes. Currently, we are experiencing an unprecedented interest in the use of complementary medicine as well as a growing attention to traditional products such as bromelain for wound healing and reducing pain.
The aim of this study was to determine the effect of oral bromelain on perineal pain and wound healing after episiotomy in primiparous women.
Patients and In this double-blind placebo-controlled clinical trial, 82 primiparous women fulfilling the inclusion criteria received bromelain or placebo randomly. Participants were given three tablets, three times a day for six successive days. The initial dose was given 2 hours after delivery. Episiotomy pain was measured using VAS scale before the initial dose, as well as on the 1st hour and on the 3rd, 7th and 14th days after the initial dose. Wound healing was measured using REEDA scale on the 3rd, 7th and 14th days after delivery.
Episiotomy pain significantly reduced in bromelain group compared with the placebo group (P The results showed the effectiveness of bromelain on episiotomy pain and wound healing. Therefore, it is suggested to use bromelain in postoperative stage to improve wound healing and reduce pain.

Advances in treatment options of breast cancer and development of cancer research centers have necessitated the collection of many variables about breast cancer patients. Detection of important variables as predictors and outcomes among them, without applying an appropriate statistical method is a very challenging task. Because of recurrent nature of breast cancer occurring in different time intervals, there are usually more than one variable in the outcome set. For the prevention of this problem that causes multicollinearity, a statistical method named canonical correlation analysis (CCA) is a good solution.
The purpose of this study was to analyze the data related to breast cancer recurrence of Iranian females using the CCA method to determine important risk factors.
Patients and In this cross-sectional study, data of 584 female patients (mean age of 45.9 years) referred to Breast Cancer Research Center (Tehran, Iran) were analyzed anonymously. SPSS and NORM softwares (2.03) were used for data transformation, running and interpretation of CCA and replacing missing values, respectively. Data were obtained from Breast Cancer Research Center, Tehran, Iran.
Analysis showed seven important predictors resulting in breast cancer recurrence in different time periods. Family history and loco-regional recurrence more than 5 years after diagnosis were the most important variables among predictors and outcomes sets, respectively.
Canonical correlation analysis can be used as a useful tool for management and preparing of medical data for discovering of knowledge hidden in them.

Despite the paramount importance and direct relationship of spirituality and spiritual care with health and well-being, they are relatively neglected aspects of nursing care.
The aim of this study is to explore Iranian nurses’ perceptions and experiences of the facilitators of spiritual care delivery.
For this qualitative content analysis study, a purposive maximum-variation sample of 17 nurses was recruited from teaching and private hospitals in Tehran, Iran. Data were collected from 19 individual, unstructured interviews. The conventional content-analysis approach was applied in data analysis.
The facilitators of spiritual care delivery fall into two main themes: living to achieve cognizance of divinity and adherence to professional ethics. These two main themes are further divided into eight categories: spiritual self-care, active learning, professional belonging, personal and professional competencies, gradual evolution under divine guidance, awareness of the spiritual dimension of human beings, occurrence of awakening flashes and incidents during life, and congruence between patients’ and healthcare providers’ religious beliefs.
The study findings suggest that the facilitators of spiritual care delivery are more personal than organizational. Accordingly, strategies to improve the likelihood and quality of spiritual care delivery should be developed and implemented primarily at the personal level.

The stage of youth is critical for human development in several ways. On the one hand, it can lead people towards the adoption of a healthy lifestyle during adulthood based on these earlier practices. On the other hand, it can comprise the development of healthy living practices later on in live, an outcome which is often caused by the youth adopting a risky lifestyle early on.
The primary objective of this study was to determine the effectiveness of implementing an educational intervention program based on the BASNEF Model (a simplified approach to understanding behavior), designed to cultivate self-administered lifestyle control skills in youths.
This was a quasi-experimental intervention study, implemented during 2010 - 2011. A total of 288 randomly selected high-school students between the ages of 15 and 17 participated in this study. These students were later divided into experimental and control groups. Subjects completed a BASNEF questionnaire at the baseline (pre-test), one month later (post-test) and three months after the educational intervention (follow-up). Four educational sessions were held, each of a 120 - 150 minute duration. After the data had been collected, the ANOVA test was used to compare trends in changes. The Pearson correlation coefficient was then used to analyze the correlation between components of the BASNEF model. Finally, regression analysis was used to determine the predictive power of the study.
Results from the intervention study reveal that the beliefs and attitudes about nutrition of the intervention group, calculated in terms of scores, improved significantly for both male and female subjects (P The BASNEF model could be effective in encouraging the adoption of nutritious eating habits and more active lifestyles at an early age in order to foster long-term health and well-being.

Gradual weight reduction has been shown to be associated with improvements in liver enzymes. However, some evidence demonstrated that liver enzymes may transiently increase immediately after a diet-induced weight loss.
This study was designed to assess the effects of a hypocaloric, almond-enriched diet (AED) compared with a hypocaloric nut-free diet (NFD) on liver function tests in the context of a three-month weight reduction program in overweight/obese women.
Patients and This randomized controlled clinical trial was registered at Iranian Registry of Clinical Trials with ID number of IRCT2013062313751N1. Overweight and obese Iranian women [n = 108; age = 42.7 y, body mass index = 29.6 kg/m2] were randomly assigned to consume an AED or NFD. The carefully planned hypocaloric diets were identical for both groups except for the AED group who consumed 50 grams of almonds daily for three months. Anthropometric measurements and laboratory measurements including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and γ-glutamyltransferase (GGT) were assessed before and immediately after the intervention.
Of 108 participants, 50 women in AED group and 50 women in NFD group completed the protocol of the study (response rate: 92.6 %). The AED led to a median weight loss of 3.79 kg (interquartile range: 4.4 kg). Significant decreases within AED and NFD were observed in ALT (-16.6 ± 16.3 and -11.7 ± 16.8, P AED improved liver enzymes in obese women. However, mild, transient increases in ALT and AST values can be observed immediately after an NFD in women.

Each year, around 1.2 million people die in the road traffic incidents. Reducing traffic accidents requires an exact understanding of the risk factors associated with traffic patterns and behaviors. Properly analyzing these factors calls for a comprehensive system for collecting and processing accident data.
The aim of this study was to develop a minimum data set (MDS) for an information management system to study traffic accidents in Iran.
This descriptive, cross-sectional study was performed in 2014. Data were collected from the traffic police, trauma centers, medical emergency centers, and via the internet. The investigated resources for this study were forms, databases, and documents retrieved from the internet. Forms and databases were identical, and one sample of each was evaluated. The related internet-sourced data were evaluated in their entirety. Data were collected using three checklists. In order to arrive at a consensus about the data elements, the decision Delphi technique was applied using questionnaires. The content validity and reliability of the questionnaires were assessed by experts’ opinions and the test-retest method, respectively.
An (MDS) of a traffic accident information management system was assigned to three sections: a minimum data set for traffic police with six classes, including 118 data elements; a trauma center with five data classes, including 57 data elements; and a medical emergency center, with 11 classes, including 64 data elements.
Planning for the prevention of traffic accidents requires standardized data. As the foundation for crash prevention efforts, existing standard data infrastructures present policymakers and government officials with a great opportunity to strengthen and integrate existing accident information systems to better track road traffic injuries and fatalities.

Context: Alzheimer disease (AD) is the most common cause of dementia. In regards to the world’s aging population, control and treatment of AD will be one of the major concerns of global public health in the next century. Alzheimer disease was not mentioned with the same phrase or its equivalent in traditional medical texts. The main of present paper was to investigate symptoms and causes of alzheimer disease from the view point of Iranian traditional medicine.
Evidence Acquisition: In this qualitative study, we searched reliable sources of Iranian traditional medicine such as Canon of Medicide by Avicenna (Al-Quanon fi- tibb), Aghili cure by Aghili’s (Molajat-E-aghili), Tib-E-Akbari, Exire -E-Aazam and Sharh-E-Asbab and some reliable resources of neurology were probed base on keywords to find a disease that had the most overlap in terms of symptoms with alzheimer disease. By taking from the relevant materials, the extracted texts were compared and analyzed.
Findings showed that alzheimer disease has the most overlap with Nesyan (fisad-e-zekr, fisad-e-fekr and fisad-e-takhayol) symptoms in Iranian traditional medicine. Although this is not a perfect overlap and there are causes, including coldness and dryness of the brain or coldness and wetness that could also lead to alzheimer disease according to Iranian traditional medicine.
According to Iranian traditional medicine, The brain dystemperement is considered the main causes of alzheimer disease. By correcting the brain dystemperement, alzheimer can be well managed. This study helps to suggest a better strategy for preventing and treating alzheimer in the future.

Physicians continually need to update their knowledge to ensure appropriate decision making about patient care.
We aimed to identify and compare information sources used by specialists and residents, their reasons for choosing these sources, and the level of their confidence in these sources.
We conducted a cross-sectional study among specialists and residents using a validated questionnaire in the five academic hospitals affiliated with Mashhad University of Medical Sciences (in northeast Iran). We compared the specialists with residents in term of gender, age, years since graduation, use of information sources, confidence in use of information sources, and reasons for selecting the information sources. Within each group, we also investigated the effect of work experience and gender on frequently used information sources and users’ confidence in them.
The questionnaire was sent to 315 physicians, including 155 specialists and 160 residents. One hundred twenty-six specialists (response rate: 81 %) and 126 residents (response rate: 79%) completed it. The most frequently mentioned sources by all specialists included “English textbooks” (84.9%), “web/internet” (74.6%), “English medical journals” (62.3 %), and “discussions with colleagues” (57%). Among residents, “web/internet” (65.9%), “discussion with colleagues” (61.3%), and “Persian textbooks” (50.4%) were the most frequently used sources of information. In both groups, high confidence was demonstrated in “English textbooks,” “English medical journals,” and “international instructions/guidelines.” Both groups counted reliability, easy accessibility, and being up to date as their primary reasons for the selection of their information sources. There was also a significantly negative correlation between using the internet as an information source and age in specialists (Spearman’s rho=- 0.238, p=0.01), but not in residents.
Reliability, easy accessibility, and being up to date should be considered in establishing information sources for physicians.

Quality-of-life therapy (QOLT) is an integrative psychotherapy that was formed by adding positive psychology concepts to cognitive-behavior therapy (CBT).
The aim of the current study was to evaluate the efficacy of QOLT on the sexual self-concept of Iranian women.
Patients and A double-blind randomized experimental study was done from February 2011 to January 2012. The study subjects were recruited from a mental health nongovernmental organization in Isfahan, Iran. They were assigned randomly to two groups. The first group was under ten sessions of QOLT, and the second, as a control group, was under psycho-sexual education (PSE). General Health Questionnaire-28 (GHQ-28), the Multidimentional Sexual Self-Concept Questionnaire, and the Female Sexual Function Index (FSFI) were completed for participants before and after the intervention. The ANCOVA model was used for analysis.
The findings revealed no significant differences between the two groups in mental health (GHQ-28 scores) and female sexual dysfunction, but sexual self-concept changed. Two subscales of sexual self-concept, sexual monitoring (QOLT group = 6.3 ± 2.7 vs PSE group = 4.7 ± 3.1 P QOLT did not impact mental health, but it could change many dimensions of sexual self-concept.

The use of weight-loss dieting has always been overemphasized as the first modality to treat obesity. Success in weight loss is considered a major problem in obese individuals. The processes of behavior change have been used to facilitate intervention promoting change. Only a minority of studies have employed this construct for weight loss.
The purpose of this study was to assess the effect of a balanced low-calorie diet with or without nutrition education on the weight loss and processes of change among obese women.
Patients and In a randomized clinical trial, 90 apparently healthy obese women age 18 - 50 with body mass index (BMI) of 30 - 40 kg/m2 were recruited from the nutrition clinic in Ardabil, located in the northwest of Iran. Participants were assigned randomly to receive a balanced low-calorie diet with or without nutrition education. Participants completed a processes of change questionnaire at baseline and at three and six months after intervention. A generalized linear model repeated measures analysis of variances was used to assess the time effect as well as the interaction between the time and the group effect.
Significant differences were found in the time effect for weight (F = 12.64, df = 2, P The findings support the use of nutrition education for more weight loss and improvement in the counter conditioning and stimulus control subscales among obese women attending the nutrition clinic. It seems that nutrition education should be considered important in effective weight-loss interventions.

Victims of sexual assault need comprehensive healthcare services to deal with the consequences of their experience. However, there are still many girls/women that delay seeking healthcare after they experience sexual assault.
To explore the process of health care and clinical services for victims of sexual assault in the health care centers of Iran.
Patients and This was a qualitative study based on the grounded theory method. The sample consisted of 23 health care providers and 10 victims of sexual violence. Unstructured interviews and observations were used for data collection. Constant comparative analysis was used according to the Strauss and Corbin method.
The analysis of all data led to the extraction of four categories: “performing routines”, “victims’ expectations”, “conflict between expectations of victims and existing healthcare services”, and the core category of “neglect of healthcare providers to address the needs and expectations of victims”. Providers were offering health care to the victims of sexual violence regardless of their needs. Due to this neglect, victims sought illegal solutions to overcome the consequences that led to social stigma.
The findings indicate the lack of mutual understanding between health care providers and victims of sexual violence in relation to the expectations and priorities of victims.

Mapping from non-performance-based measures onto generic performance-based measures provides an appropriate solution to derive utilities to be used in economic evaluations.
This study aimed to create a model through which EQ-5D utilities for cataracts can be obtained from scores on the disease-specific Catquest measure.
Patients and One hundred ninety-nine observations from 103 patients who self-administered the EQ-5D, the Catquest and questions on demographic and clinical characteristics were included in the analysis. Data was divided into estimation and validation datasets. To predict EQ-5D utilities, multiple regression analysis, using the Ordinary Least Square (OLS) and the censored least absolute deviation (CLAD), was performed. Catquest scores, age, gender, and performing surgery were included as explanatory variables. An estimation dataset was used to derive the coefficients, and these coefficients were then validated using a validation dataset. Based on the explanatory power, the consistency, the simplicity, the mean absolute error (MAE) and the correlations between observed and fitted utilities, the most appropriate model was selected.
The mean EQ-5D and Catquest scores of the total sample were 0.631 and 15.8, respectively. Age and surgery showed no significant effect for either method. Removing age and surgery, model II was built and given an R2 of 0.697, an MAE of 0.1176 for the OLS and an R2 of 0.614, and an MAE of 0.1153 for the CLAD method. In the validation stage, the CLAD revealed better prediction ability, with an MAE of 0.198 versus an MAE of 0.209 for the OLS. ICC and Bland-Altman analysis put the CLAD as a preferred method with the following equation: Utilities (EQ-5D) = 0.988 - 0.0281 × Catquest (PD) 0.102 × gender (male = 1).
Based on these results, a mapping function was obtained which appears to be valuable in predicting EQ-5D utilities from Catquest scores. This function gives an appropriate solution to estimate utilities when primary EQ-5D data is not available. Although the model represents good consistency and predictive ability, further examination of obtained function is required with large samples.

The consumption of different types of fast food is increasingly growing in all parts of the world, both in developed and developing countries. Because of the changes and transitions in the lifestyle and dietary habits of people, an increasing number of people from different age groups, particularly adolescents and young adults, are inclined toward consuming fast food.
The objective of this study was to investigate the factors influencing fast-food consumption among adolescents in Tehran, Iran.
Patients and The present qualitative study was conducted in 2012 - 2013 in Tehran, the capital of Iran. To achieve the objective of this study, 42 adolescents were enrolled in this study through a purposive sampling method, and the required data was collected via individual semi-structured in-depth interviews. Data collection and analysis were carried out simultaneously, and the collected data was analyzed via a thematic content analysis and using MAXQDA 10 software.
In this study after coding the transcribed interviews, the findings were categorized into three main themes as follows: personal views, social factors, and family factors. Each theme included several categories and subcategories, and the coded sentences and phrases were placed under each category and subcategory.
The results of this study showed that the number of factors promoting fast-food consumption appeared to be more than the inhibiting factors and that the diverse factors at the individual and social level influenced fast-food consumption among adolescents.

In recent years, the caregiving responsibilities of cancer patients’ family members have increased dramatically. Reducing caregiver strain and burden supports the mission of professional nursing.
The aim of this study was to determine and compare the caregiver strain index scores of breast cancer informal caregivers, before and after a patient-caregiver educational and telephone follow-up program.
Patients and This is an experimental two-group design study. Participants were recruited from an outpatient chemotherapy unit of the largest hematology and oncology research center in Northwest Iran. Thirty patient-caregiver pairs were randomly allocated to intervention and control groups. The intervention group received 2 face-to-face education sessions at bedside and 4 subsequent telephone follow-up sessions. The control group received routine care. Pre and post tests were administered in both groups pre and post intervention. To analyze the data, SPSS (13th version) software was used.
The caregiver strain index decreased significantly in the intervention group after the patient-caregiver education and follow-up (P It appears that the patient-caregiver education and follow-up program had a beneficial effect on the caregiver strain index compared to the usual care.

The palmaris longus is a degenerating weak flexor muscle in the anterior of the forearm. Many techniques for clinically determining the presence of the palmaris longus have been described. Ethnic variations in the prevalence of the absence of the palmaris longus are well known.
This study considered the prevalence of absence of the palmaris longus muscle tendon in the north of Iran.
Patients and The presence of the palmaris longus was clinically determined in 562 men and women from the Guilan population, using the standard technique (Schaeffer’s test). In subjects with an absent palmaris longus, three other tests (Thompson, Pushpakumar and Mishra tests) were performed to confirm the absence.
The overall prevalence of right, left, bilateral and total absence of the palmaris longus were 4.1%, 5.2%, 3.9% and 13.2%, respectively. There was no significant difference in its absence with regard to the body side or gender (P > 0.05).
This study demonstrated that the presence of the palmaris longus muscle tendon in the Guilan population was considerably higher than the absence of the palmaris longus tendon. The overall prevalence of right, left, bilateral and total absence of the palmaris longus was not significantly different between men and women. The prevalence of the left-absent palmaris longus was more common in the present study.

Nurses are considered the largest and most important human resource for healthcare organizations. Self-efficacy as the main predictor of nurses’ behavior plays an important role in nurses’ professional behavior. However, the various dimensions and threats of caring self- efficacy concept have not been taken into consideration.
The present paper attempts to identify threats to self-efficacy as an important aspect of the concept of pediatric nurses’ caring self-efficacy.
This study is part of a larger study on the caring self-efficacy concept that was conducted through content analysis and from a qualitative approach in 2014 in Iran. Twenty-seven nurses and pediatric clinical instructors participated in this research according to the purposive sampling method employed in the study. Data were collected through semi-structured interviews. The collected data were analyzed using the conventional content analysis method.
“Threats to self-efficacy” was one of the main themes extracted from the interview analysis results in the present study. The theme consists of two main categories “individual barriers,” including not having a caring attitude and not being interested in children, and “organizational barriers,” including an inefficient educational system, not developing professional capabilities, non-valuation of the organization in a caring context, a poor rewards system, and inappropriate managerial policies.
Nursing management and custodians of nursing trainings can break through the barriers to self-efficacy by knowing these factors and making changes in the educational programs and providing supporting policies. This can be an important step toward improving nurses’ inefficacy and ultimately improving the provision of quality healthcare services.

Diabetes mellitus is a chronic metabolic disease with life-threatening complications. Metformin and acarbose are two oral antidiabetic drugs.
This experimental study was designed and carried out at the Arak University of Medical Sciences in Arak, Iran, to investigate the effects of these drugs (both alone and in combination) on glycemic control, lipid profile, and serum visfatin levels in nicotinamide/streptozotocin type 2 diabetic rats.
Type 2 diabetes was induced in 30 male Wistar rats by the administration of streptozotocin (STZ) (60 mg/kg body weight) intraperitoneally (IP) 15 minutes after the IP administration of nicotinamide (110 mg/kg body weight). After one week, the diabetic rats were randomly divided into four groups. Three diabetic groups were treated with 150 mg/kg/day of metformin, acarbose (40 mg/100 g of diet), or a combination of the two for six weeks, respectively. Biochemical parameters, including fasting blood glucose, glycated hemoglobin, lipid profile, insulin, and visfatin were assessed and compared with those of the control diabetic group.
The data showed metformin, acarbose, and acarbose metformin downregulated visfatin levels in diabetic rats, but only the reduction in metformin-treated rats was significant (162 ± 21.7, 195.66 ± 6.45 (ng/l), P = 0.001). Fasting blood glucose and glycated hemoglobin decreased significantly in all treated rats, specifically in the treated group that received the two drugs in combination. The serum insulin level was also reduced in all treated groups, and it was significant in the acarbose (P Compared with acarbose or metformin monotherapy, the addition of acarbose to metformin had superior antihyperglycemia efficacy and provided an efficacious and safe alternative for the treatment of type 2 diabetic rats. Acarbose/metformin reduced the fasting blood glucose and glycated hemoglobin without significant changes in serum visfatin levels.

Given the rapid pace of changes in community health needs and the mission of healthcare organizations to provide and promote the community’s health, the growing need to increase health system responsiveness to people as a key element of observance and fulfillment of justice is felt more than ever.
This study was aimed at designing the native model of responsiveness for Iran and to validate the aspects of the proposed model.
Our study had a cross-sectional design and was a validation study performed in 2014. In order to define and identify responsiveness model aspects, the first phase recorded the views of 200 key informants from 19 provinces of Iran. Snowball sampling was used to select experts (based on WHO guideline). Then, the opinions of 18 comments were received from service recipients in the form of three focus group discussions and were analyzed by the frame framework analysis (interviewed recipients were selected using the purposive sampling method). Finally, in order to confirm the model’s efficacy, a responsiveness questionnaire with 7 aspects (domains) and 52 indicators (items) obtained from the initial proposed model was answered by 600 members of the selected families in the two provinces of Fars and Yazd. A multi-stage cluster sampling approach was used for the household survey. The results were analyzed by the Confirmatory Factor Analysis (CFA) test and through the use of Lisrel software.
Confirmatory Factor Analysis, based on the results of the key informant survey and group discussions, showed that according to quantities of GFI = 0.91, CFI = 0.93, NFI = 0.91, RMSEA = 0.074, SRMR = 0.061 and Hoelter (CN) = 178.54 in outpatient services and where GFI = 0.89, CFI = 0.91, NFI = 0.86, RMSEA = 0.064, SRMR = 0.053 and Hoelter (CN) = 158.93 for inpatient services, seven factors (F) (dignity, informed choice, confidentiality, patient training and informing, access to services, quality of basic amenities, and access to social support) are the main determinants of the responsiveness model and proposed model validity.
Given the comprehensiveness of presented aspects and indicators in this proposed model and its validity test, the aforementioned responsiveness model can be considered a suitable model to use when assessing the levels of health system responsiveness in Iran.

Fear of the stigma associated with reproductive health services has always been one of the reasons why youth and unmarried individuals avoid making use of such services. This stigma imposes a great deal of mental stress, fear, and depression on patients and causes delays in the diagnosis and treatment of their conditions.
This paper explores the concept of stigma in the context of the utilization of reproductive health services by unmarried women.
Patients and This study is qualitative in nature. Purposive sampling was employed, and semi-structured interviews were conducted with 16 unmarried women, five midwives, and two physicians. The data were analyzed using the conventional content analysis method.
Four main categories constituted the general concept concerning the stigma suffered by unmarried women for using reproductive health services, i.e., prevalent stereotypical thinking patterns in society, the fear of being judged and labeled by others, discrimination, and feeling ashamed of seeking reproductive health services.
The findings indicated that society associates reproductive health issues with sexual relations, which in turn shapes the stigma and places limitations on unmarried women for using reproductive health services. Thus, while reproductive health services are planned and provided to unmarried women, strategies are demanded for overcoming this stigma.

Physical activity (PA) patterns during pregnancy have not been explored in depth and most previous studies lack assessment of variables such as type, frequency, duration and intensity of activity.
This study had two goals: 1) to analyze PA patterns during pregnancy according to weekly time spent on different types of activity; and 2) to determine women’s perception about health care providers regarding PA advisement during pregnancy.
Patients and A longitudinal prospective study was carried out with a 118-pregnant women cohort. Participants were evaluated during all trimesters. Self-reported questionnaires were used to collect personal and obstetric data. Type, duration and frequency of PA were evaluated using the pregnancy physical activity questionnaire (PPAQ) and intensity levels were calculated. Repeated measure analysis of variance was performed to determine differences between trimesters, and Wilcoxon signed-rank test was performed when appropriate.
A decrease in values of self-reported PA (MET.h.wk-1) was found from the first to the second and the first to the third trimester of pregnancy, respectively; total (270.91 vs 220.54 vs 210.35; P Self-reported PA decreased, especially from the first to the second trimester, in total, light and moderate intensity. Women spent most of their weekly time on domestic, occupational and leisure activities, except sport activities. There are some health care providers that do not recommend physical activity during pregnancy.

Non-syndromic hearing loss (NSHL) is the most common birth defect and occurs in approximately 1/1,000 newborns. NSHL is a heterogeneous trait and can arise due to both genetic and environmental factors. Mutations of the transmembrane channel-like 1 (TMC1) gene cause non-syndromic deafness in humans and mice.
The aim of the present study was to investigate the association of TMC1 gene mutations of the locus DFNB7/11 in exons 7 and 13 in a cohort of 100 patients with hearing loss in Iran using polymerase chain reaction–single-stranded conformation polymorphism (PCR-SSCP), heteroduplex analysis (HA), and DNA sequencing.
Patients and In this experimental study, the blood samples of 100 NSHL patients were collected from 10 provinces in Iran. These patients had a mean age of 16.5 ± 2.01 years and 74.15% of their parents had consanguinity. DNA was extracted from specimens and mutations of exons 7 and 13 of the TMC1 gene were investigated using PCR-SSCP. All samples were checked via HA reaction and suspected specimens with shift bands were subjected to DNA sequencing for investigation of any gene variation.
In this study, no mutation was found in the two exons of TMC1 gene. It was concluded from these results that mutations of the TMC1 gene’s special exons 7 and 13 have a low contribution in patients and are not great of clinical importance in these Iranian provinces.
More studies are needed to investigate the relationship between other parts of this gene with hearing loss in different populations through the country. More research could clarify the role of this gene and its relation with deafness and provide essential information for the prevention and management of auditory disorders caused by genetic factors in the Iranian population.

Extended-spectrum β-lactamases (ESBLs) is one of the most important mechanisms of resistance to β-lactams especially among Enterobacteriaceae family including Klebsiella spp. Different types of extended-spectrum β-lactamases including CTX-M-type and PER enzymes are identified among gram negative bacteria.
The current study aimed to determine the prevalence of CTX-M-type and PER extended-spectrum β-lactamases among Klebsiella spp. isolated from clinical specimens in the teaching hospital of Kashan, Iran.
Patients and One hundred Klebsiella spp. were isolated from clinical specimens of hospitalized patients at Shahid-Beheshti hospital from December 2012 to November 2013. Disk diffusion method was used to determine the susceptibility of these isolates to 14 different antimicrobial agents; disks were purchased from MAST company (United Kingdom). The phenotypic double disk synergy confirmatory test was used to screen the isolates to produce extended-spectrum β-lactamase. DNAs of isolates were extracted using boiling method and PCR assay was used to characterize the blaCTX-M type and blaPER genes. The purified PCR products were sent to Macrogen research company (Korea) for sequencing.
Of the total 100 Klebsiella isolates, %93 was susceptible to imipenem. Resistance to ampicillin, ceftazidime, ceftriaxone, aztreonam and cefotaxime was (92%), (67%), (65%), (64%) and (59%), respectively. The phenotypic confirmatory test (PCT) confirmed that 35% (n = 35) of the isolates were ESBL-producing Klebsiella strains. The prevalence of blaCTX-M type and blaRER genes among Klebsiella isolates were 28% (n = 28) and 9% (n = 9), respectively.
The prevalence of ESBL-producing Klebsiella strains in Shahid-Beheshti hospital in Kashan has increased. The study concluded that there was a high prevalence of the blaCTX-M type gene among ESBL positive isolates.

Physical exercises increase quality of life (QoL) in diabetics. However, the optimal exercise type for patients with diabetes has not yet been established. It is unknown whether pilates is a suitable form of exercise for the QoL of patients with diabetes.
The aim of this study was to investigate effects of Pilates-based mat exercise (PBME) on glycemic control, anxiety, depression, and QoL in women with type 2 diabetes.
This prospective and randomized study was conducted with 24 women in the Pilates group and 21 women in the control group. Socio demographic data were collected from both groups, including the duration of diabetes since diagnosis, medications being taken, insulin injections, sleep problems, and so on, as well as hospital records of blood laboratory test outcomes (fasting blood glucose, postprandial blood glucose, and glycosylated hemoglobin). Pain and fatigue symptoms were assessed using the visual analogue scale. Participants completed the 36-item short form health survey and the hospital anxiety depression scale. Participants in the exercise group performed PBME three times per week for 12 weeks. Both groups continued their routine diet and medical follow-ups during the intervention. Data from the groups were compared before and after the program.
Pain (3.00 ± 4.00, 2.00 ± 2.00, P = 0.001), fatigue (5.00 ± 2.00, 4.00 ± 1.00, P = 0.0001), mental health-related QoL (29.00 ± 5.00, 35.00 ± 3.00, P = 0.0001), anxiety (8.00 ± 3.00, 7.00 ± 3.00, P = 0.023), depression (9.00 ± 2.00, 8.00 ± 2.00, P = 0.019), fasting blood glucose (140.00 ± 31.00, 139.5 ± 32.00, P = 0.026), and glycosylated hemoglobin values (6.70 ± 1.16, 6.30±1.00, P = 0.001) in the Pilates group differed before and after the intervention. In the control group, only glycosylated hemoglobin values (6.53 ± 1.42, 6.40 ± 1.27, P = 0.008) differed before and after the intervention.
PBMEs affect the parameters of QoL in women with type 2 diabetes, and they might be recommended as a part of their treatment program.