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Introduction: It is well recognized that hearing is critical to speech and language development, communication, and learning. Otoacoustic emission (OAE) is an efficient and sensitive method to identify subjects at risk for auditory impairment. Infants who require admission to neonatal intensive care unit are reported to be at 10-20 times greater risk for hearing impairment. The porpuse of this study was to investigate the incidence of hearing impairment in neonates screened by OAE. Materials and Methods: In a cross-sectional study, 148 newborns having risk factors for hearing impairment reffering to Taleghani hospital of Arak and Aboozar hospital of Ahwaz were evaluated. All clients had normal otoscopic findings. Transient evoked (TEOAE) and distortion-product otoacoustic emissions (DPOAEs) were measured in both ears. If the results of otoacoustic emissions were not normal, these tests were repeated one month later. Patients who did not pass the second stage were reffered for comprehensive auditory evaluations. Data analysis was performed using Kolmogrov-Smirnov and t-tests. Results: 41 and 28 cases could not pass the examining test at the first TEOAE and DPOAE examination, respectively. Also, 23 and 16 cases did not pass the examining test at the second TEOAE and DPOAE evaluations, respectively. These participants underwent auditory brainstem response evaluation and 11 of them had abnormal responses. In 5 cases of confirmed ones, hearing impairment was due to aminoglycoside side effects. Conclusion: OAE hearing screening of at-risk newborns is a clinically beneficial approach to early detection of hearing impairment. Regarding the high prevalence of hearing loss in our subjects (7.43%), prevention of its complications is highly recommended in this population.

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Introduction: Menopause is a natural period of life. It means the permanent cessation of menstruation and the end of reproductive period which occurs between 45-52 years old. It also serves as an indicator of population health as the occurrence of menopause indicates the increased risk for the onset of several chronic diseases. In this study, the mean age of natural menopause among women in Arak (Central Iran) was investigated, considering their reproductive and socio-economic-demographic factors and their health behaviors. Materials and Methods: This study was an observational cross-sectional study on a population base, carried out in 2007 year. Interviews and questionnaires were used for gathering data from 458 women resident in Arak city, who had undergone a natural menopause. Sampling was multistaged using postal zones and selecting samples in each zone. Data was analyzed using variance analysis, multiple regression, T and correlation coefficient tests. Results: Findings showed that the mean age of menopause in our sample was 48.2±2.34 years (95% CI: 47.98- 48.41) and its median was 49 years. The mean age of menopause in women who were never married was less than married women (P= 0.015). Low income level (P= 0.003), having physical activity (P= 0.004), number of pregnancies (P<0.001), age of last pregnancy (P=0.026) and place of birth (P=0.003) were meaningfull factors in age of menopause. Conclusion: This phenomenon must be documented in Iran because of its strong link with mortality and morbidity of the growing number of women who are reaching advanced ages whose one forth of life is after menopause. Therefore health education as the best way for changing their lifestyle is suggested.

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Introduction: Diabetes mellitus is a chronic disease that has well known effects on most organs, but there have been controversies in few different studies about the effects of diabetes on hearing. So this study was carried out in 2003-2004 in Kermanshah Diabetes Research Center to assess the effect of diabetes on hearing. Materials and Methods: This is a case-control study. 82 diabetic cases (26 types I and 56 type 2 cases) were studied along with 82 controls matched both in age and sex. Cases were selected randomly, their range of age was 15 to 55 years and their duration of diabetes was more than 3 years. After completing questionnaires, all cases and controls undergone autoscopic examination. Those with other ear disease with hearing impairment were omitted. Audiometery including pure tone audiometery, speech audiometery, and impedance audiometrey with well tone AD19 formed was done on 164 (diabetic and control) persons. Data was analyzed using t-test. Results: Audiometric findings with different frequencies in the two groups revealed that there was a significant relationship between diabetes and hearing impairment (p<0.001). This relationship was more significant in high frequencie, older age and type 2 diabetes, but there were no relationship between control of blood sugar (HbA1c), duration of diabetes, sex, microvascular and macrovasculur complications with hearing loss in diabetic patients. Conclusion: These finding demonstrate that diabetes can cause mild to moderate hearing impairment especially in high frequencies. The mechanism of this effect is unknown. Complementary studies with more patients and with more accurate devices such as Otoacustic Emission (OAE) and Audiometric Brainstem Reflex (ABR) are recommended

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Introduction: Optimum management of medical equipment in hospital settings has tremendous effects on decreasing costs and providing desired health and treatment services. This research has been undertaken to design a medical equipment management model for public hospitals of Iran. Materials and Methods: In this adaptive research, medical equipment management among United States of America, United Kingdom, Germany, Canada, Australia, Sweden and Italy, which have successful experiences and determined patterns for medical equipment management, are assessed with respect to 6 dimensions as structure, purchase, control, maintenance, training and distribution and according to the shared strategies in the mentioned countries, a model was designed for Iran's public hospitals. This model was validated using expert's survey in DELFI method. Results: In all of the studied countries, the medical equipment engineering unit is established for effective management of medical equipments and in direction with the main purpose of ensuring safety and improving patient care, clinical engineers are being trained. Trainings are designed according to international federation course plan for clinical engineers “which are combination of necessary engineering and managing courses for activities of hospital medical equipment management”. Under study issues include: precise need assessment for medical devices, balancing, use of life span expenditure, stock management, location finding, and needed physical space prediction, selection and purchase committee establishment, entering controls plus reception test, performance and safety control, activities documentation, using computerized systems for preventive maintenance and semi-centered distribution, are among necessary processes in the medical equipment management cycle of under studied countries' hospitals. Conclusion: Management and medical equipment engineering unit establishment in hospitals, selection and purchase committee formation, continuous equipment performance control during calibration process, equipment preventive maintenance according to workforce training schedule, training needed experts, and with respect to the topics of international federation courses for clinical engineering training in universities, will improve medical equipment efficiency in hospitals.

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Introduction: Delivery of immediate medical interventions appropriate to the severity of clinical status of patients is a main public expectation of emergency departments. Waiting time and length of stay are the key measures to asses the quality of care in emergency departments. This study is done to investigate the waiting time and length of stay of attendants to emergency department of Vali-e-Asr Hospital, Arak-Iran. Materials and Methods: This analytical cross-sectional research was conducted in a general emergency department of a teaching hospital in Arak to asses the waiting time and length of stay of patients. In the first stage of the study all attendants during a 6 weeks period were classified regarding to the severity of their clinical status by an educated nurse and a general practitioner using a three category scale (guideline) presented by ministry of Health and Medical Education (2001). Also waiting time for a general practitioner visit was measured and documented by the resident general practitioner. In the second stage, a sample of 100 documents of patients in group 1 and 2 admitted for specialist visit were assessed for the waiting time and length of stay in emergency department. Mean of waiting time according to patients clinical status and the specialty of the first physician were analyzed by t-test and ANOVA (p =0.05). Results: During a 6 weeks period, of 1963 patients, 179(9.1%) were categorized as emergent (category 1), 391(19.9%) urgent (category 2) and 1393 (71%) non urgent. The mean waiting time for general practitioner visit was 5 minutes. The median and mean of waiting time for specialist visit in group 1 and 2 of patients were 225 and 262±156, 220 and 227±153 minutes, respectively. The median and mean of length of stay was 1 and 2 days, respectively. No differences were found between waiting time of various specialties visit in patients of categories 1 and 2. Conclusion: Regarding the long waiting time for specialist visit, using triage in emergency departments is necessary. This needs planning and organization for the presence of specialists in the hospital, over the time. Also regarding the large number of nonurgent patients, 24 hours presence of a general practitioner is necessary.

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Background: The face the main channel through which the individual communicates. It is the site of beauty and attractiveness. Physical attractiveness has stereotyping nature. Because the precise content of the stereotype depends on cultural values. The aim of this study was described the range of psychosocial issues burned disfigurement people that psychosocial support programmes may need to address after hospitaization. Methods and Materials: Part of data from a larger study grounded theory approach was reported by this Paper. In this qualitative study, individual in depths interview performed with 21 participants. Interviews were analyzed using a content analysis. Results: After data analyzed five axial category emerging from this qualitative study included social behaviors and beliefs (reproach, retirement, wrong thoughts and beliefs, stigmatize, pity) emotional problems (grief, shame, fear of expulsion, aversion, hopelessness) reactions assessment (positive assessment, Negative assessment) strategy (hidden, separation, self-presentation) and weariness. Conclusion: Findings indicated negative behaviors' and beliefs' of people cause emotional problems in disfigured people. Thise persons perform inappropriate strategy against behaviors' and beliefs' of people. Therefore This persons need to appropriate supportive programs for community, family and person instruction to knowledge, attitude and practice promotion.

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Background: Breast cancer is the most prevalent type of all cancer in women. In this study form various methods for treatment of depression due cancer. This study conducted for comparison drug therapy and drug-cognitive therapy on decreasing depression, effect of drug and cognitive theray on decreasing depression. Methods and Materials: This is a clinical trial study. Form patient refered to oncology clinic and ward of vali-e-Asr hospital 78 women were selected by simple sampling. Based on Beck depression test, 42 of them had depression. They randomly divided to case and control groups. Both groups received antideresant drug as usual. But case group had also cognitive- drug therapy. Afrer 6 Month treatment both group were tested again for depression. Data was analyzed by spss using independent and paired t tests. Results: The mean depression score hadnot signigiant difference between case and control grops beor and after treatment. The mean depression score in control group had no significant deference before and after treatment the mean depression score in the case group was significantly different after treatment (p<0.05). The mean score of depression in control group was more than case group after treatment. Conclusion: In the present study cognitive therapy cause a significant decrease in depression score of case group.

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Background: Pain management is the challenging concepts in health workers. Since neonates have higher pain sensitivity in compare to childhood and adults. The objective of this study was to examine the pain relieving effect of breast feeding during immunization injections in healthy neonates. Methods and Materials: In this control randomized clinical trial, Samples were divided two groups (by age and sex) of 76 healthy 2- 4 months old term infants. In breast-fed group, 2 minutes before, during, and 15 seconds after the DPT immunization injection were in mother hug, and in control group as routine of clinic, were lied on the examining table during injection. Appearance of Neonates were observed and assessed by Modified Behavioral Pain Scale (MBPS) during 5 second before immunization to 15 second after it. Results: In breast fed and control group mean of age were 81.53±41.46 and 81.61±40.59 day and for weight were 6.65±1.17 and 6.70±1.14 kg for hight were 64.27±5.5 and 63.38±5.06 cm respectively. There were significant differences in Behavioral Pain Scores of two groups include: facial expression (4 items), cry (5 items), and movements (6 items). (P<0.0001). There is no statistically significant difference between the 2 groups for age, sex and the time of feeding prior to vaccination Conclusion: Regarding to significant difference in behavioral of pain responds in two groups, it is suggested, with simple and safe intervention method of straight breast feeding reduce pain during immunization and muscular injections too.

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Background: Medical equipment improvement and tremendous expenditure is allocated costs annually, so that optimum and proper maintenance management of equipment would have outstanding effects on health and treatment of medical training and research economies of the country. Present research was implemented aiming to examine effect of the medical equipment maintenance management systems on the hospital setting expenditures. Methods and Materials: In an interventional research, the model of medical equipment maintenance management system implemented in Imam Khomeini Hospital was examined precisely and based on appropriate software for Vali-e-Asr Hospital was designed. According to the model for all available medical instruments in Vali-e-Asr hospital with usage of more than 5 years (240 medical equipment) all costs were recorded in 2006 and compared with previous year (2005). Results: There wasn't any training for medical equipment operators and for its implementation necessity on 21.7% of equipment in the installation and start up phase with for 83.7% of equipments the operator was not fixed using of medical equipment maintenance management system, the repair events decreased from 78 events in 2005 to 58 events in 2006. Vali-e-Asr hospital recorded costs for maintenance and repair of medical equipment in 2006 was 801765375 Rials(Iran)which decreased to 513212912 Rials (Iran) according to accurate calculation of costs and auditing by medical equipment engineer and shows 36% saving in expenditures by medical equipment maintenance management system. Conclusion: Medical equipment computer–based maintenance, management system implementation and also using of medical engineers potentialities in hospital are necessary.

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Background: Breast Cancer is the most common malignancy and is the second largest cause of death among 35-55 years old women. The aim of this study is explore and to describe women's experiences with breast cancer for achieving a deeper comprehension of their individual experiences. Methods and Materials: This is a qualitative study with a phenomenological approach. Sampling method was purposive and continued till data saturation. Twenty two participants (patients,families and treatment team) attended in the study.Data were collected by using in-depth interviewing and were analyzed by “Parse”method. We tried to analyze qualitative data based on valid criteria. Results: The findings of this research were summarized into four core concepts:delay in diagnosis and treatment, treatment rejection, drowning in suffering (reaction to disease,facing with outcome of treatment,exposure to treatment system, ineffective care and disturbance in daily life of the family) and moving toward normal life. Conclusion: Knowledge of treatment team from the expriences of women suffering from breast cancer helps them to play a better role in their treatment. It seems, this is essential for make a shift from terminal treatment to early diagnosis. Also it emphasise to use of source for support of patients.

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Background: Diabetic patients face many challenges related to their illness and treatment in their life. So they need to use coping strategies for adjustment. The purpose of this study was determined the coping styles among diabetic Iranian patients. Methods and Materials: In a case-control study, 100 consecutive diabetic patients admitted to Amin and Sedigheh Taherah Medical Centers, Isfahan, were selected based on the inclusive and exclusive criteria and compared with one hundred normal people who selected from general population. Data collected by using demographic questionnaire, the Jalowiec Coping Scale, then MANCOVA and co-variance were used to analyze the data. Results: Difference between two groups in coping styles were significant (F=2.835, p=0.005). Significant differences was in supportant coping style (F=11.204, p=0.001). There was no significant difference in other coping styles between two groups. Conclusion: It seems that the diabetic patients likely differ from normal people only in supportant coping style when deal with daily stress. But they are similar to normal people in other coping styles. In addition, both groups use problem solving styles when deal with daily stress. The findings emphasis the role of illness representation to determine coping styles.

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Background: Cervical cancer is a preventable disease and we can determined preventive methods by discovering ethiology of disease. There are no appropriate research about the relation between coitus during menstruation and cervical cancer in Iran. This study is done to investigate the relationship between coitus during menstruation and cervical cancer in women referring to health care centers of Shahid Beheshti University of Medical Sciences in 2007-2008. Methods and Materials: This case-control study was carried out on 100 patients with cervical cancer (case) and 100 healthy women (control). All participates were Moslem with Iranian nationality and habitant in Iran. They had no previous history of frequent pelvic radiotherapy and alcohol consumption. Two groups were matched with age, age of first coitus, age of first vaginal delivery, parity and type of delivery. Data was collected through structured interview and analyzed using Chi-square and logistic-regression. Result: The study showed that 40% of case group and 10% of control group had coitus during menstruation. Coitus during menstruation in case group was 6 times more than control group (p<0.0001, odds ratio =6.0, CI= 2.7-12.9). Discussion: Coitus during menstruation may increase the risk of cervical cancer. A research is recommended to find out the best educational method which to prevent this disease.

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Background: Researches showed that there is a relationship among alopecia areata, psychological factors and prevalence of psychological disorders. In addition alopecia areata has a great effect on the quality of life of these patients. The purpose of this study is to investigate the effectiveness of cognitive-behavioral stress management therapy on female patients`s the quality of life with alopecia areata. Methods and Materials: This is a case-control study with pre and post-test exam which is carried out in Isfahan Skin Disease and Leishmaniasis Research Centre. The participants consisted of 20 alopecia areata patients diagnosed by specialists. The questionnaire was Skindex-16 which was completed by patients before and after the intervention. Cognitive-behavioral stress management therapy was done on the case group in eight sessions over a period of two months. Data was analyzed with covariance (ANOVA). Results: The mean of quality of life scores in experimental group in v.s control group significantly decreased (P<0.05). Conclusion: It seems, cognitive-behavioral stress management therapy couses in quality of life improvement in patients with alopecia areata.

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Abstract Background: Employed women like men, with their income have many physical and psychological problems and their mental health has been threaded. In our country the most rate of employed women are in Health and Education Ministries. So, we decided to determine the mental health of employed women in this both areas. Materials and Methods: This descriptive-analytic study was compared the mental health of 131 employed women in University of Medical Sciences with Education office in Arak city with General Health Questioner (GHQ) in 2008. Also effective factors on mental health based on age, education, income, number of children, mental and physical diseases history, marital status, habitancy condition, job satisfaction and experience were determined and data were analyzed by descriptive and analytical statistics. Results: There was difference between mental health level in women working in Medical Sciences University and Education office of Arak (p=0.041). Also income, age, mental disease history and job satisfaction had direct relationship with mental health Conclusion: Difference between psychological health level of women working in office of Medical Sciences University and Education were significant and income level, age, experience, mental disease history and job satisfaction are the most important factors for mental disorders.

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Abstract Background: Vitamin A is an important messager molecule for differentiation setting, cells proliferation and morphogenesis. In this research, an effect of vitamin A on limb bud development of Balb/C mouse was determined. Materials and Methods: In this experimental study, 10 female pregnant mice were divided to control and experimental groups. Control mice were maintained in natural situation and experimental mice were received vitamin A 15000IU/kg intraperitoneal injection at gestational day 10.5. Control and experimental mice were dissected in day 15.5 of gestation and after a morphology study their embryos were prepared for histological studies with microscope and were stained by Hematoxylin & Eosin method. Results: Comparison of crown- rump length, fore limb width, length of zone 1 (finger and palm) and zone 2 (wrist) of fore limb and total length of hind limb in experimental embryos with control group didn’t have significant difference in means. But, mean of embryos weights and length of total fore limb and length zone 3 (arm and forearm) of experimental embryos fore limb were more then control (p<0.001). Also, in comparison mean of hind limb width of experimental to contol embryos, increase was observed (p<0.006). But number and size of chondrocyte in 4 zones of fore and hind limb in experimental group didn’t have significant difference to control group (p>0.05). Conclusion: Concentration of 15000IU/kg vitamin A has progressive effects on the fetuses’ weight and fore limb bud development of Balb/C mouse.

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Abstract Background: Aloe Vera species have diverse immunomodulatory and antitumor activities. The present study was set out to define the immunomodulatory activity of Aloe Vera extract on tumor necrosis factor-alpha (TNF-α) and development of experimental autoimmune encephalomyelitis (EAE) as an animal model of multiple sclerosis (MS). Materials and Methods: In this experimental interventional study, EAE was induced by MOG35-55 peptide and complete Freund's adjuvant in C57BL/6 mice. Mice were placed in two therapeutic groups (n=8 per group) with the same age and weight. Therapy with Aloe Vera extract (120mg/kg/every day given oral) was started on day 5 before the immunization until 25 day after that. EAE control received phosphate buffer alone with same schedule. Signs of disease were recorded daily until the day 25 when mice were bled and sacrificed. Produced TNF-α by cultured spleen mononuclear cells was detected by ELISA. Results: The Aloe Vera treatment significantly reduced the clinical signs of EAE and delayed onset of disease. Mononuclear cells isolated from spleen of treated-mice with Aloe Vera showed a significant decrease in TNF-α in compared with control mice (p=0.012). Conclusion: Aloe Vera ameliorated the EAE and reduced TNF-α level in MS animal model.

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Background: Diabetes Mellitus is a heterogeneous group of different metabolic disorders that are characterized by chronic increase of blood glucose and proteins, lipids and carbohydrates metabolism disorder. The aim of this study was to investigate the effect of 8 weeks of aerobic exercise on metabolic factors, quality of life and mental health of women with type II diabetes. Materials and Methods: In this semi-experimental investigation, 18 women with type П diabetes referring to Arak Petroleum Company Clinic were selected and divided into two groups: aerobic (10 participants) and control (8 participants). Aerobic group performed selected exercises in 8 weeks (three 30-50 min sessions per week). In this investigation, we used metabolic factors (such as total cholesterol, triglycerides, HDL, VLDL, LDL, FBS, HbA1c and Insulin serum) and SF-36 quality of life (QOL) and GHQ mental health (MH) questionnaires. The level of significance was considered to be 95% (P<0/05). Results: There were significant differences between the means of pre-test and post-test measures of FBS, HbA1C, Insulin serum, QOL and MH in aerobic group. There were no significant differences between the means of pre-test and post-test measures of TC, HDL, LDL, VLDL and triglycerides in aerobic group and all factors in the control group (P<0/05). Conclusion: Aerobic exercise affects metabolic factors, QOL and MH in type П diabetic patients and it results in their improvement.

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Background: Noticing the daily advancement of the role of electromagnetic field generators in human life, examination of the biologic impacts of these waves has come to be extensively appreciated by researchers. During pregnancy, vitamin A is extremely essential for the development of fetus and its lack, insufficiency or excess can result in embryonic malformations. This study investigated the synergetic effects of vitamin A and extremely low frequency electromagnetic fields on the development of embryo skin in Balb/C mice. Materials and Methods: This study was experimental in nature. Eighteen pregnant mice were divided into control, sham-exposed and experimental groups. The mice in the experimental group were given an intra-peritoneal injection of 15000 IU/kg vitamin A on the 10.5th day of gestation and were, then, exposed to a 50Hz electromagnetic field 4 hours a day from 10 through 12th day of gestation. The animals were dissected and investigated morphologically and histologically on 17.5th day of gestation. Results: The results showed an increase in the mean weight of fetuses in the experimental group in comparison to the sham- exposed group (p<0.05). Also, Crown-Rump of fetuses in the experimental group increased in comparison to those in the sham- exposed group (p<0.001). Epidermis thickness increased significantly in experimental group in comparison to sham- exposed (p<0.05), while the average number of basal, spinous cells and hair follicles decreased significantly in the experimental group compared to the sham- exposed (p<0.001). Conclusion: The findings indicate that vitamin A usage and synergetic exposure to low frequency electromagnetic fields (50Hz) profoundly affect the development and growth of skin epidermis in the fetus of Balb/C mouse.

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Abstract Background: Necessary to making constant revisions in the continuous education programs and updating the physicians’ knowledge in accord to the needs of society seems to be essential. The present study was conducted to conformity of continuous educational programs’ content of radiology department with needs of Continuous medical education learners, Markazi province, 2008. Materials and Methods: In this cross- sectional study, in 2008, the opinions of 40 physicians falling under continuous medical education (CME) were collected through a questionnaire on a Likert scale in more than 30 instructional topics. Before educational program performance, priorities in education were assessed and after performance, rate of coverage and requirements conformity with content was determined. Results: The most educational need was indication of chest x-Ray with mean of 4.21 and the less need was wrist MRI with mean of 2.42. After program performance, the greatest conformity of needs with educational content was indication of mammography (mean= 83.1) and wrist and shoulder MRI (mean=53.2) which was the least required. Though, there was a general correlation between need and content coverage in both areas of graph indication order and interpretation, but was not base on priority needs. There was significant relationship between physicians needs with educational needs (p<0.001). But about gender and work experience was not significant relationship. Conclusion: Lake of complete coverage of needs base on educational priority of CMS learners will seek greater attention and emphasis or scientific secretary and lecturer on needs in special educational objectives frame for accelerating of continuous education effectiveness.

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Abstract Background: What makes a physician to a proficient one is accompanying science and moral together, especially observing religious features of the patient. Therefore, present study was conducted to evaluate the knowledge of Arak University of Medical Sciences students in medical religious in pre and post training, 2005-06. Materials and Methods: In a descriptive cross-sectional study, questionnaire was prepared including 50 questions on medical religious commandments. After filling questionnaires by 227 students, were confidentially collected in a box. In next stage, the book on medical commandments according to four religious authorities was freely presented to the participants to be read within two weeks then 50 questions about medical commandments were prepared again. Results: In the present study, 81.9% were female and 18.1% were male. The basic sciences students were lower acquaintance before reading the book and midwifery students had better acquaintance (43%). The changing percentage of knowledge in all groups had significant difference with medical commandments in second period as compared to the first period, (p‹0.001). Conclusion: The knowledge of students in different courses in medical religious commandments was not significant. But, after training, there have been considerable changes in their medical commandments knowledge. Therefore, it is recommended to train medical commandments in parallel with training scientific and practical courses.