فصلنامه کومش
سال سیزدهم شماره 1 (پیاپی 41، پاییز 1390)

The mean age of menopause have been reported at the age of 51 in the world and regarding the increase in life expectancy in many countries more than a third of the life time of women i s in menopause period. The importance of menopause is due to its relationship with various diseases and quality of life. The present study was conducted to estimate the average natural age of menopause in women based on a meta-analysis study.

In a meta-analysis study on all the existing articles in the natural age o f menopause in Iran, 21 articles were selected based on inclusion criteria. Begg and Egger tests fo r publication bias and Cochrane test were used to determine the heterogeneity among samples.? ??? estimate of mean calculated based on Random effect model in Stata11 software.

The publication bias assumption was rejected by Begg and Egger tests with significant value s equal to 0.174 and 0.446 respectively. There was a heterogeneity among samples (Q=4626.3, df=20, P<0.001). So based on random effect model the mean age of menopause was calculated as 48.183 with 95 % CI=47.457-48.91.

The average age of natural menopause in Iranian women is favorable to some places of Middle East, but is less compared with developed countries and the world mean. Because of the importance of this period in women, educational programs seem to be necessary.

Childhood cancers are very rare diseases and accounting for about one percent of all cancers, also it is one of the main causes of death among children. The aim of this paper was to ascertain of childhood cancers epidemiology in Fars province. In this epidemiological study that Fars province cancer registry was used, frequency distribution of childhood cancers in less than 19 year old in 2001up to 2008 was evaluated and incidence rates were calculated per 1000,000 people a year. Data were analyzed by running SPSS software, version 16 (SPSS Inc., Chicago, IL) and M.S. Excel version 2007. Out of 1610 registered new cancer cases that were resident of Fars province, blood cell cancers were most common type of cancers. 57 % of cases were male and 15-18 year old age group in comparison to other groups has been the most frequent (30.7%). The mean age of cases at diagnose time was 10.3 years old. Over in eight years period, lowest and highest age standardized incidence rate was 64 (year 2001) and 235 (year 2006) cases per every one million person, respectively. Based on this paper’s results, and despite of our prospect, childhood cancer incidence rate in less than 19 year age in Fars province was similar to developed countries.

Body Image of everyone includes a feel of body satisfaction, self-esteem, and beliefs about appearance. The beliefs about appearance scale (BAAS) was designed to measure dysfunctional attitudes about bodily appearance. The aim of the present study was to validate the Iranian Version of the BAAS in student population. A total of 214 Iranian students (144 females and 70 males) from student club members participated in the study. They were recruited by stratified random sampling from Zanjan's clubs. Participants completed a dysfunctional attitudes scale and a self-esteem questionnaire. Exploratory factor analysis, item-total correlation and reliability analyses were undertaken to assess the psychometric properties of the BAAS. In addition, confirmatory factor analysis was administered to assess the measurement model and the construct of internal relations of items. Exploratory and confirmatory factor analysis confirmed the hypothesized model of the BAAS. A four-factor model with an abbreviated 17-item version was confirmed. The BAAS distinguished normal and overweight people significantly. The relationship of BAAS with age in overweight or fat people was more than normal people. The BAAS had positive relationship with dysfunctional attitude positively and negative relationship with self-esteem. The BAAS has good psychometric properties and it could be used as a clinical tool. Theoretical implication was discussed.

Communication is an important aspect of nursing care and much of nurses’ duties such as providing physical care, emotional support, and exchanging of information with patients can not be performed without communication. The quality of care is improved through nurse-patient relationship. Nurse and patient relationship in clinical settings is influenced by multiple contextual factors which recognize them can improve the important role of nursing. This study aimed to explore the contextual factors influencing nurse and patient relationship. The study was performed by qualitative research approach. Participants were 17(8 nurses and 9 patients) in medical and surgical wards of Imam Khomeini hospital of Tehran university of medical sciences that selected by purposive sampling method. Data were gathered by interview (unstructured and semi-structured) and observation. Data analyzed by content analysis approach. Three theme emerged form data analysis which influenced the nurse-patient relationship. Those were formative factors, continuative factors and deterrent factors. These themes were explained in detail in the main text of article. Findings showed that in spite of nurses’ positive attitude to communicate with patients and caring their needs, there were problems in nurse-patient communication that prevent from a patient-centered communication between nurses and patients

Down syndrome is considered as one of the most important causes of disability. In children with Down syndrome, compliance with poor motor coordination has a considerable effect on different motor skills including dexterity. Purdue Pegboard test is one of the tools used in occupational therapy to assess fine motor skills of upper extremity. The purpose of this study was to determine the test-retest reliability and practice effects of the Purdue Pegboard in children with Down syndrome. Twenty-four children with Down syndrome aging 7-14 (mean:9/7±2/7) of both sexes were non-randomly selected from rehabilitation clinics and hospitals of Tehran. A demographic questionnaire was used for documenting participant s general data and the Purdue Pegboard test and a timer were used to determine the reliability. Each subtest was administered three times in a row. The time interval between test and retest was one week. The relative reliability in repeated measures was above 80% in different items of Purdue Pegboard test in single and mean of testes, thus it indicates an optimum reliability. The absolute reliability was lower than 10% of maximum obtained scores at each subtest in one and three trial of test that indicates acceptable errors of measurement. The results of the present study indicate that Purdue Pegboard test is enough reliable in one and three trials for evaluating a manual dexterity of children with Down syndrome.

Today, Fuzzy expert systems have helped physicians in cases of uncertainty in medical decision making for prescribing drugs. Narrowing of coronary heart and reduction in heart blood flow are important causes of coronary heart disease (CHD). Control of blood lipid level is a routine treatment in CHD patients. But damage to liver is a common side effect of lipid lowering drug medication. Measurement of plasma Alanine aminotransferase level is considered as a marker of liver damage. The aim of this study was to determination of optimal dose of atorvastatin using Fuzzy expert system. in this study, Fuzzy expert system based on drug dose determination was chosen for prescribing atorvastatin dose as a lipid lowering drug that sets with demographic information of patients. Here, optimum dose is defined as a dose that decreases plasma LDL with the least side effects. In our model, decrease in LDL, Cholesterol and LDL/ HDL blood ratio consider as positive consequence and increase in plasma ALT as the side effect of this drug. output of our model is compared double blindly with prescription of many different randomly chosen expert physicians in the same practical case and the physician decision shows %65 similarity with our model. Practically, this percent of similarity between model and practical results was considered to be sufficient to approve this model. This result showed that the quality of this fuzzy models output is close to clinically approved decision. Thus this model can be considered as an applicable decision making model for physician and pharmaceutical industries about dosing of this drug in a similar situation.

Adenosine deaminase (ADA) is a purine catabolic enzyme that removes amino group of adenosine or 2' deoxyadenosine irreversibly. ADA enhances immune system and also intervenes the inflammation process. In this study, the effect of ibuprofen as an anti- inflammatory drug has been studied on the ADA activity in the physiologic and pathologic temperatures.

ADA was assessed in the presence of 3 different doses of ibuprofen at 37oC and 42oC via spectrometry in 265 nm.

Ibuprofen at high and low doses had an activation effect on the ADA activity at 37oC and moderated the sensitivity of enzyme activity to its substrate. It also decreased the anti-inflammatory effect of adenosine via decrease of its concentration and had a positive effect on immune system as well. The activation of the enzyme by Ibuprofen was decreased at 42oC and also Ibuprofen moderated the effect of temperature on dependency of enzyme activity to its substrate. Ibuprofen effects on immune system and anti-inflammatory effects of adenosine decreased at 42oC.

Ibuprofen is a putative activator for adenosine deaminase and administration of this drug could be useful for immune deficiency. Since there is no activator for ADA so far, this drug is important. Ibuprofen decreases anti-inflammatory effect of adenosine. In-vivo studies would be needed.

''Lichtenstein'' tension-free mesh repair is the most common surgical techniques used for inguinal hernia repair." Read-Rives" method is tension-free, too, but here prosthesis is placed just over the peritoneum, and there is no weak area. The aim of this study was to compare the results of "Read-Rives" and Lichtenstein method in the hernioplasty. Methods and Materials: In this prospective randomized clinical trial 126 patients who had unilateral inguinal hernia were examined: 64 patients operated with Lichtenstein and 62 patients operated with Rives method. They evaluated for early post-operative complications, duration of surgery and hospital stay, return to normal activity, and then they followed for recurrence of hernia.

Postoperative pain was significantly lower and the return to normal activity was shorter in Rives group. Duration of surgery and hospital stay and recurrence rate was equal, lower postoperative wound infection was found within Rives method.

Although the ''Read-Rives'' method is not technically as simple as ''Lichtenstein'' method, but this procedure is easy to learn, so it is recommended because of its better final outcome in comparison with Lichtenstein repair.

Sex is one of the main recovery parameters after traumatic brain injury (TBI). During estrus cycle phase, plasma estrogen and progesterone levels are very different. So in this study, we have assessed different effects of these phases in brain edema and neurological outcomes. Adult female Albino-N-MARI rats were divided into 6 groups (14 per group) including metestrus, diestrus, proestrus, estrus, ovarictomized (OVX) rats, and sham group (without TBI and ovary). In all groups, brain water content for the measurement of brain edema, evans blue content for the measurement of brain vascular permeability, neurological scores, plasma estrogen and progesterone levels were assessed after severe TBI. Brain water content in diestrus, proestrus and estrus groups showed a significant decrease as compared with OVX group (P<0.001) but it was not significant in metestrus group. Evans blue content in proestrus group was lower than estrus and OVX groups (P<0.001). Also, in diestrus group it was lower than OVX group (P<0.01).Neurological scores showed significant increases in proestrus group 4 hours after severe TBI as compared with metestrus, diestrus and OVX groups (P<0.01). 24 hours after severe TBI, neurological scores in all groups were higher than OVX (P<0.001). Brain water content and brain vascular permeability in sham group was lower than OVX, besides neurological scores in sham group were higher than OVX (P<0.001). This study showed that brain edema, evans blue content and neurological scores after severe TBI are related to estrus cycle different phases. This could be related to differences in female sex hormones in different phases of estrus cycle.

Taurine has an important role in regulating the cardiac electric activity and anti-arrhythmias effects and it may improve heart failure. This study was designed to investigate the effect of taurine supplementation on response of the cardiac injury biomarkers to Bruce diagnostic protocol and exhaustive time in patients with heart failure. Sixteen patients between 50 to 65 years with heart failure, who were classified in II and III classes, were randomly divided into the taurine and placebo groups. The taurine received 1.5g taurine supplement 3 times a day in 500 milligram capsules and the placebo group consume starch capsules for two weeks. Plasma taurine, cardiac troponin I and CPK-MB concentrations were measured before and after taurine supplementation and also in each stage before and after performing the Bruce protocol (totally, 4 stages). Plasma taurine, cardiac troponin I and CPK-MB concentrations were detected by using HPLC, ELISA and immunological methods, respectively. Results showed that Bruce protocol led to significant increase in cardiac troponin I and CPK-MB concentrations and significant decrease in plasma taurine. Furthermore, taurine supplemen­­­­­­­­tation results in the resting level decrease of cardiac troponin I and CPK-MB. Also, taurine supplementation led to increase exhaustive time in comparison with placebo group and before supplementation stage, but it couldnt completely create preventive effect on cardiac troponin I and CPK-MB concentration after the Bruce protocol. Taurine supplementation in patients with heart failure who are taking standard medical treatment can increase their exercise capacity. Furthermore, our study supports this idea that the use of taurine supplementation can be recommended to people who suffer from cardiac events as a preventive strategy.

Using anti-inflammatory medicine injection such as dexamethasone acetate (DXA) is a common treatment for carpal tunnel syndrome (CTS). Iontophoresis and phonophoresis of DXA are two other ways which may help to introduce DXA locally to inflammated tissues. This study has been deigned to compare the effect of iontophoresis and phonophoresis of DXA on the CTS treatment. 35 mild or moderate CTS patients (51 affected hands) were randomly assigned in one of the two experimental: iontophoresis (25 affected hands) and phonophoresis (26 affected hands) groups. Subjects in iontophoresis group received 10 sessions of iontophoresis of %0.4 DXA solution (DC, 0.2 mA/cm2, 20 min) over the wrist of the affected hands while the other group received 10 sessions of phonophoresis of %0.4 DXA jell with pulsed ultrasound (1 MHz, 1 W.cm-2, 5 min). The strength of hand and thumb grips, paresthesia, pain, motor and sensory distal latency and evoked potential of median nerve were measured before and after intervention and after 4 weeks follow-up. Comparisons of the mean changes showed more increase in hand grip (P=0.006) and thumb grip (P=0.0002), less pain perception (P=0.001), shorter sensory (P=0.0001) and motor (P=0.0008) distal latency and higher sensory and motor (P=0.0001) action potential in the phonophoresis in compared with the iontophoresis group. Our results show that using phonophoresis of DXA is more effective for CTS treatment, than the iontophoresis method. More studies are needed to investigate the role of different parameters used during phonophoresis of DXA in the CTS treatment.

Children with profound sensorineural hearing loss are at risk for language delays that can impact their academic and social development. A suitable way to develop speech and language of deaf children is cochlear implantation (CI). The main propose of this study is the evaluation of child's development in language skills like information, similarities, arithmetic, vocabulary and comprehension after CI surgery and rehabilitation.

This quasi - experimental study was conducted in Shiraz CI center during 2008-2009. For this reason we did the Raven test on all of the CI children of Fars CI center, who were at least 6 years old and had finished their rehabilitation program about 3 years ago. After that we selected 23 cases that had the selection criteria for answering the verbal part of Wechsler intelligence scale for children (WISC -R). For statistical analysis we used SPSS software version 11.5.

The verbal intelligence quotient (IQ) developed after surgery and rehabilitation program of CI children, but was not the same as normal children of their age. The most important factors that affect this, is child's age and family education. Also there was no significant relation between verbal and non-verbal IQ.

Although CI is a suitable way to increase verbal IQ, and cognitive development, for better results, it's recommended in children under 3 years.

β-carbolines alkaloids suchv as harmane have been found in common plant-derived foodstuffs (wheat, rice, corn, barley, grape and mushrooms). These alkaloids have many cognitive effects including alteration short and long term memory. In the present study, the effect of intra-CA1 injection of the nicotinic receptor antagonist mecamylamine on amnesia induced by harmane was examined in mice. Mice were bilaterally implanted with chronic cannulae in the CA1 regions of the dorsal hippocampus. One week after cannulae implantation, mice were trained in a step-down type inhibitory avoidance task, and were tested 24 h after training to measure step-down latency as a scale of memory. Pre-training or post-training systemic injection of harmane induced amnesia. Pre-testing intra-dorsal hippocampus administration of the high dose of nicotinic receptor antagonist, mecamylamine (4 µg/mice) also induced amnesia. On the other hand, pre-test intra-CA1 injection of ineffective doses of mecamylamine (0.5, 1 and 2 µg/mice) fully restored harmane induced amnesia. The present finding in this study indicated that a complex interaction exists between nicotinic receptor of dorsal hippocampus and amnesia induced by Harmane.

Alopecia areata is a common disease that affects the life quality of patients. Iron deficiency has been suggested to play a role, but its effect is controversial. We decided to evaluate the relationship between alopecia areata and serum ferritin, TIBC and serum iron levels.

In this study, 30 patients who were diagnosed with alopecia areata by a dermatologist and 30 healthy individual as the control group were evaluated. All the cases (patients and control group) were referred to Semnan Central Lab for the following laboratory tests: CBC test (WBC, HGB, PLT, MCV, MCH, MCHC), serum ferritin, serum iron and serum TIBC.

Mean serum ferritin (P<0.001), serum iron (P<0.001), transferin saturation (P<0.001) and mean hemoglobin (P=0.002) were significantly lower in patient group comparing to the control group. Mean TIBC (P<0.001) was significantly higher in patient group in compared with the control group (P<0.001).

Our findings indicate that there is a relationship between alopecia areata and low serum ferritin, low serum iron and increased TIBC. Therefore evaluation of serum iron status and treatment, if needed, with iron supplements is recommended in alopecia areata patients.

Major depression is one of the most common psychological disorders that exert a high impact on the life of patients and their families. There are many treatment methods for depression. The purpose of the present study was to determine the effects of cognitive-behavior therapy and drug therapy on improvement of major depression.

This clinical trial was performed in Semnan (Iran) in 2008. 56 Patients with major depression were selected and assigned into 4 groups. All of the patients completed the Beck test and a demographic questionnaire before start of interventions as pre test. The post test was completed after the end of intervention.

Findings showed that all of the methods have significant effects on improvement of depression, but combined therapy (cognitive behavioral therapy + drug therapy) is the best (P<0/05).

According to findings of this work, we suggest that team work approach consists of psychologists and heart Psychiatrists can be suggested for treatment of the patients with depression.

Gastric cancer is the second leading cause of cancer death worldwide and is the most common type of cancer in Iran. The objectives of this study were to assess the effects of prognostic factors on survival of patients with gastric cancer using the Aalen additive hazards model, and to illustrate the advantage of Aalen’s plot. Information of total of 213 patients with gastric cancer who underwent surgery in the gastroenterology ward of Taleghani hospital in Tehran between 2003 and 2008 were included in this historical cohort study. Age at diagnosis, sex, presence of metastasis, tumor size, histology type, lymph node metastasis, and pathologic stages were entered into analysis using the Aalen additive hazard model. To visualize a covariate effect over time, the estimated cumulative regression function by the Aalen’s model is examined. The univariate and multivariate analysis identified that age at diagnosis, tumor size and pathologic stage were independent prognostic factors for the survival of patients with gastric cancer (p<0.05). Moreover, pathologic stage has a late or delayed effect according to the Aalen’s plot. Other clinicopathological characteristics were not statistically significant (p>0.05). In spite of using Cox model in survival analysis by many researchers, Aalen’s model may yield new insights in prognostic studies of survival time of patients with gastric cancer over time. Our results suggest that early detection of patients in younger age and in primary stages is important to increase survival from gastric cancer.

The prevalence of anemia in pregnancy is nearly 8% in the first quarter, 12% in the second quarter and 29% in the third quarter based on hemoglobin levels. The purpose of this study was to examine the influence of a selected aerobic exercise period on hemoglobin, hematocrit, and red blood cells count in pregnant women after delivery. This Study was a quasi-experimental. From all women who were referred to the maternity unit of the clinic in Shahreza, 40 inactive pregnant women in second trimester aged 20-35 years were selected and then randomly divided in two experimental (n=20) and control (n = 20) groups. The women in the experimental group had selected aerobic exercise under an experienced instructor for 8 weeks (three sessions of 45 minutes per week with the intensity of 40-75 percent of maximum heart rate reserve), while the control group was only followed up. Blood hemoglobin, and hematocrit levels and also red blood cells count were measured before and after exercise in both groups. A significant improvement were observed in the blood hemoglobin and hematocrit levels and also the number of red blood cells in the women of the experimental group following 8 weeks exercise with compared to the baseline levels of those variables and also to the control group (P<0.01). Unlike the control group, the experimental group showed an increase in blood hemoglobin and hematocrit levels and also number of red blood cells (P<0.05). Our findings indicate that the selected aerobic exercise program is an effective and safe method in reducing disease of anemia in pregnant women in second trimester.

The use of back support is one of the common methods aimed to prevent low back pain. The purpose of the present study was to investigate the effect of wearing a lumbosacral support on lumbar spine velocity and torque in six directions during combined trunk motion.

In this interventional study, 30 young healthy men were selected simply from convenient samples. They were asked to stand in Isostation B200 system and perform three-dimensional trunk motion against a resistance of 50% of maximal voluntary contraction torque while wearing or not wearing a lumbosacral support. Under each condition of test, five successive motions of trunk were performed in downward direction (as flexion, right lateral flexion, and right rotation) and upward direction (as extension, left lateral flexion, and left rotation), and the variables of average velocity and average torque were recorded during motion.

With the use of a lumbosacral support, average velocity was significantly increased in flexion (P=0.015) and extension (P=0.005), but no significant changes were found in other directions (P>0/05). Back support decreased average torque of right rotation significantly (P=0.006), but did not significantly changed this variable in other directions (P>0/05).

Wearing a lumbosacral support can increase velocity in sagittal plane. Decreased rotation torque of trunk, as a result of using a back support, may reduce the twisting forces on lumbar spine joints.