Journal of Arak University of Medical Sciences

Application of a Marginal Model for Assessing Some Determinants of Height and Weight Growth Among Children Less Than Two Years Old in Khorramabad

Mehdi Safari

Background: Height and weight growth failure are among the most important health disorders affecting children less than two in the developing countries. Failure to treat this disorder can lead to the development of serious conditions including increased mortality and types of disability. The aim of the present study is to investigate the factors affecting the height and weight growth of children less than two years old.

Materials and Methods: This historical cohort study was conducted on a sample of 2030 children less than two in Khorramabad who were selected using stratified and cluster sampling methods. Based on household records, data related to the height and weight were recorded as quantitative variables and finally were modeled using a longitudinal marginal model, identity link functions and the R software.

Results: Based on the marginal model, the effect of such variables as child's age, child's gender and mother's educational attainment were significantly related to the child's height and weight. Moreover the child's birth order had significant relationship with only the child's height. However, the variable of exclusive breastfeeding during the first six months was no significantly related to weight and height growth of the children.

Conclusion: Given the results, it seems that monitoring the growth of the children of the illiterate mothers, specially the girls and the children with first birth orders are the most important approaches to deal with growth disorders among this population.

The Investigation of Direct and Indirect Impact of Self-Efficacy Beliefs on Parent̓s Anxity and Marital Adjustment with Mediating Role of Cognitive Emotion Regulation Strategies Among Parents With Chronically Ill Children of Ahwaz

Athar Afshar

Background: The aim of this study was to test the proposed model for the impact of self-efficacy beliefs on parent’s anxiety and marital adjustment with mediating role of cognitive emotion regulation strategies among parents of chronically ill children of ahwaz city.

Materials and Methods: The statistical universe was all the parents of chronically ill children who was selected by Convenience sampling method.The research tools are included the self-efficacy questionnaire (SES), anxiety questionnaire (STAI), Spanier marital adjustment questionnaire and Garnesfki cognitive emotion regulation strategies questionnaire.Amos 18 program software was applied for structural equation modeling (SEM).The indirect relationship was tested with bootstrap Amos 18 program software.

Results: The results revealed that the tested model had good fit indices.

Conclusion: Results revealed that self-efficacy beliefs directly influenced on parent's anxiety, marital adjustment, and adaptive and nonadaptive cognitive emotion regulation strategies. Also, adaptive cognitive emotion regulation strategies have a direct relation with parent's anxiety and marital adjustment. In addition, there was a direct relation between nonadaptive cognitive emotion regulation strategies and marital adjustment. Alternatively, self-efficacy beliefs directly influenced on anxiety and marital adjustment with mediating role of adaptive cognitive emotion tegulation strategies and indirectly influenced on adjustment with mediating role of nonadaptive cognitive emotion regulation strategies.

Studying the Effect of Auditory Training on Cervical Vestibular Evoked Myogenic Potentials in Primary School Age Deaf Children

Seyede Faranak Emami

Background: Saccule is part of the vestibular organ that is responsible for balancing the linear acceleration saccular can be evaluated performance by cervical vestibular evoked myogenic potentials (cVEMPs). This study aimed to determine the relationship between time delay and amplitude of the waves of cVEMPs with auditory training in deaf children of primary school age group of Hamadan in autumn 2014.

Materials and Methods: In this comparative cross-sectional study, the case group were children with profound hearing loss received six months of regular auditory training (n=20). The control group of children with profound hearing loss had no history of auditory training (n=20). Both of groups were evaluated by cVEMPs test.

Results: T-test between the two groups showed no significant difference in the time delays of waves p13 and n23 (p = 0.15, f = 18.58 and p = 0.20, f = 23.32, respectively). However, the difference of the peak-to-peak amplitude of waves p13-n23 was significant (p = 0.00, f = 10.13).

Conclusion: Voice vocalization and more experience of hearing can strengthen the saccular performance.

Evaluation Of the Effect of Combination Of N-Acetylcysteine and Vitamin C on Improving Outcomes Following CABG

Mehrzad Sharifi

Background: Post ischemic myocardial reperfusion can impair CABG outcomes and cause increased mortality, hospital stay and costs. Then, increased oxygen free radicals lead to lipid peroxidation and sulfhydryl group oxidation. The aim of this study is to evaluate whether N-acetylcysteine and Vitamin C as antioxidants could effect postoperative outcomes of on-pump CABG.

Materials and Methods: In this clinical trial, patients who had undergone CABG were studied in 4 groups receiving Vitamin C, N-acetylcysteine, Vitamin C & N-acetylcysteine and traditional drugs. The study population consisted of 50 patients in each group. Data were recorded in a checklist and analyzed by using SPSS 20.

Results: Mean pump time, ICU stay, hospital stay, the distribution of troponin positive serum, arrhythmia and need for reoperation were significantly different between groups. Gender distribution, mean cross-clamp time, serum creatinine level before and after surgery, the need for inotropic drugs and required dose level of it, showed no significant differences between groups.

Conclusion: It seems that the combination of N-acetylcysteine and Vitamin C had a stronger effect on the defference between the mean of pump time, hospital length stay and length of ICU stay versus the administration of N-acetylcysteine or Vitamin C alone.

Comparing the Effectiveness of Cognitive-Behavioral Stress Management, Optimism Training and Medical Therapy on Somatic Symptoms, Perceived Stress, Illness Perception and Quality of Life in Patients with Ulcerative Colitis

Marzieh Sadat Sajjadinezhad

Background: Recently it is accentuated on the role of psychological symptoms in the course of chronic diseases and applying psychological interventions as complementary interventions. The aim of this study was to compare the effects of cognitive-behavioral stress management, optimism training and conevntional medical therapy on somatic symptoms, perceived stress, illness perception and quality of life in patients with ulcerative colitis.

Materials and Methods: In this study, thirty female patients were selected accidentally, and randomly assigned into three groups including cognitive-behavioral stress management(n=10), optimism training(n=10) and conventional medical therapy(n=10). All patients completed Perceived Stress Scale, Illness Perception questionnaire, WHO Quality of Life questionnaire, and Lichtiger Colitis Activity Index. Then, experimental groups participated in 9 sessions of cognitive-behavioral stress management and optimism training group interventions. Thereafter, three groups answered to scales again. This course was repeated in a 6-mounth follow-up. Analysis of covariance (ANCOVA) was used to analyze the data.

Results: The findings indicated that the effects of two interventions were significant on patient´s illness perception, perceived stress and quality of life however, these interventions did not change somatic symptoms.

Conclusion: Totally, it can be said that psychological interventions such as stress management and optimism training can be effective on improving the psychological symptoms in patients with ulcerative colitis and their cure.

The Prevalence of Food Insecurity and Its Association with Socio-Economic Factors and Nutritional Status Among Hospitalized Children in Tabriz Pediatric Hospital

Jamal Saraei

Background: Under-nutrition has multiple negative impacts on child's growth and development and it has a high prevalence among hospitalized children. Assessment of the food insecurity status is one of the most important indicators of malnutrition among communities, therefore the aim of the current study is to evaluate the prevalence of food insecurity and its social, economical and nutritional determinants among children hospitalized in Tabriz pediatric hospital.

Materials and Methods: The current cross-sectional study was carried out among 236 hospitalized children in Tabriz pediatric hospital. Demographic information including age, weight, height, household size, child order and household income were gathered by face to face interviews with parents. Food security was assessed by a Household Food Security questionnaire. Statistical analysis was performed by Excel 2007, Epi-info and IBM SPSS Statistics 21 software.

Results: The prevalence of food insecurity among hospitalized children in Tabriz pediatric hospital was 44.9%, while 26.3% and 18.6% had moderately and severely food insecurity, respectively. Its prevalence in females was more than in males. Low household income, low educational attainment of parents, rural residency and household size were potent determinants of food insecurity(p<0.05). All indices of nutritional status in food insecure group were lower than in secure group. Although this difference did not achieved significant threshold.

Conclusion: In the current study, a high prevalence of food insecurity in hospitalized children in hospital has been reported. Therefore the need for suitable interventions to reduce its prevalence has been warranted.

Analysis of Genetic Variation of rs4898352 Marker in F8 Gene Region as a Highly Informative Marker for Stidy of Hemophilia A in the Isfahanian Population

Sadegh Valian Boroujeni

Background: Hemophilia A is an X-linked bleeding disorder caused by heterogenous mutations in factor VIII gene that encodes coagulation factor VIII (F8) protein. Due to the high heterogeneity of mutations, large size (186 kb) and structural complexity of the F8 gene, direct mutation analysis is costly and time consuming. Alternatively, linkage analysis using informative polymorphic markers such as single nucleotide polymorphism (SNP) markers has been introduced as a rapid and cost effective method for hemophilia A carrier detection in families with an affected individual. Several SNP markers associated with the F8 gene region have been studied.

Materials and Methods: In this exprimental study, the characteristics of A/T SNP (rs4898352) as an informative marker located in intron 18 of F8 gene region was investigated in Isfahanin population. rs4898352 marker was genotyped using tetra primer ARMS PCR method followed by agarose gel electrophoresis in 140 unrelated control healthy females in mentioned population. New primers were designed for rs4898352 marker using the oligo 7 software. The allele frequency, degree of heterozygosity and Hardy-Weinberg equilibrium were estimated by use of Genepop program. The polymorphism information content (PIC) value was estimated using the Powermarker software.

Results: The results showed that the allele frequency of rs4898352 polymorphism for A and T alleles was 0.482 and 0.518, respectively. The observed heterozigosity rate was 60%. Analysis of Hardy-Weinberg Equilibrium demonstrated that the Isfahan population was in equilibrium (p>0.05) for rs4898352 marker. Moreover, analysis of PIC value revealed that this marker could be considered as a highly informative marker in the mentioned population.

Conclusion: Together, the data suggested that rs4898352 could be introduced as an informative marker for molecular diagnosis of hemophilia A in Isfahan Population

Comparing the Effects of Sedation Induced by Fentanyl and Remifentanil in Patients Under Mechanical Ventilation

Fatemeh Sadat Mazhari

Background: Reducing the duration of the effect of sedatives and increasing their quality is one of the tasks of ICU staff. The aim of this study is to compare the sedative effects of these medications on neurosurgery patients under mechanical ventilation.

Materials and Methods: In this double-blind clinical trial, 70 patients requiring mechanical ventilation in neurosurgery ICU were enrolled. Patients were randomly assigned to one of remifentanil or fentanyl groups. The first group received 0.05 µg/kg/min remifentanil and the second group received 1 µg/kg/hr fentanyl infusion for sedation and analgesia in the first 24 hours. Sedation score, Minogue scale and hemodynamic parameters were evaluated throughout the study and at regular intervals.

Results: There was no significant statistical difference in demographic variables such as age, sex, and body weight between two groups. The results of this study showed a significant difference in sedation score (p=0.0001) and Minogue scale (p=0.0001) and both variables were lower in remifentanil group. Also, heart rate (p=0.011) and mean arterial blood pressure (p=0.007) were significantly higher in fentanyl group.

Conclusion: Generally, sedative effect of remifentanil has several relative advantages over older medication of fentanyl and causes more effective sedation and better control of hemodynamic parameters in patients under mechanical ventilation.

Determining the Predictive Value of Rockall Scoring System in Predicting Outcomes in Patients with Upper Gastrointestinal Bleeding

Somayeh Bonyadi

Background: Upper gastrointestinal bleeding is a common medical emergency condition which can be very costly with potential risks. Prompt evaluation of the patients’ status and determination of the risks involved are of utmost significance. Rockall score is one of the Methods determining the risk of bleeding. The aim of the present study was to determine sensitivity, specificity and negative and positive predictive values of Rockall scoring system during a 3-month follow-up period in patients with upper gestronintestinal bleeding.

Materials and Methods: 340 hospitalized patients with acute upper gastrointestinal bleeding in Imam Reza hospital were studied from December 2013 to September 2014. The full and clinical Rockall scores, sensitivity, specificity and negative and positive predictive values were specified for all the subjects who were followed for 3 months in relation to complications and mortality.

Results: Of all patients, 204 were males and 136 were females who 15.6% of the subjects had a clinical Rockall score under 3, with 84.4% having a score over 3. In relation to endoscopic Rockall score, 15.6%, 66.8% and 17.6% of the subjects had a score under 3, between 3-8 and over 8, respectively. During the 3-month follow-up period, in the low-risk group, 92.5% did not exhibit hemorrhage again, 3.8% had one recurrent episode of hemorrhage, 1.9% exhibited 2 hemorrhage episodes, with 1.9% having 3 hemorrhage episodes. In the moderate-risk group, 90.9% experienced no recurrence and 9.1% exhibited 1 case of recurrent hemorrhage (p=0.4). There was no mortality in the low-risk group. In the moderate-risk and high-risk groups, the mortality rates were 8.07% and 22.7%, respectively (p<0.001). The sensitivity and specificity of the test were calculated at 11.1% and 81.1%, respectively. The positive and negative predictive values were 5% and 91.4%, respectively.

Conclusion: With due attention to the specificity of 81.8% and negative predictive value of 91.4% for the Rockall score, it might be guaranteed the patient will not suffer from the complications resulting from recurrence of hemorrhage. Given the low sensitivity of the test, the test is not appropriate to rule out disease.

Investigating the Relationship Between Health Belief Model Structures With the Mothers' Performance in Preventing Growth Retardation in Children Aged 1-5 Years in Shazand City, 2014

Mahboobeh Khorsandi

Background: One of the common and important public health problems is failure to thrive in during childhood .The purpose of this study was to investigate the relationship between health belief model structures with mothers' performance in preventihg growth retardation in children aged 1-5 years in Shazand city in 2014.

Materials and Methods: In this analytical and cross-sectional study, 202 mothers with children aged one to five years in the Shazand city were selected by random sampling. The data were collected by using a researcher-developed valid and reliable questionnaire by self-report method. The questionnaire included demographic characteristics of the mothers, the maternal practice cheklist and health belief model dimensions. Finally, the data were analyzed by SPSS20 T-test, Chi-square, correlation, ANONV and regression.

Results: The mean age of subjects was 28.76±5.28 years and a mean age of children was 26.49±14.74 months. Most common level of education for mothers was diploma (76.7%). The mean score of mothers' behavior was 70.65. Among the structures, self- efficacy had the largest score(69.8) and external practice guide had the lowest (38.91). In regression analysis, for predicting behavior by health belief model stuctures, self efficacy, perceived benefits and barriers were main predictors of behavior that predicted 10% of behavior changes(R²=0.101).

Conclusion: The results of this study reveale that the design of educational interventions should be based on self-efficacy, perceived benefits and perceived barriers as the most important predictors of maternal behavior.