Standardised mortality ratios in people exposed to sulphur mustard during the Iran-Iraq war: a retrospective study with 39-year follow-up

OBJECTIVES

Sulphur mustard (SM) is a chemical weapon agent that was extensively used by Iraqi troops during the Iran-Iraq war (1980-1988), resulting in exposure among Iranian military personnel and civilians. However, there is limited and conflicting information about the long-term mortality effects of SM exposure. This study aimed to determine the standardised mortality ratios (SMRs) in individuals exposed to SM gas during the Iran-Iraq war.

STUDY DESIGN

This was a retrospective follow-up study.

METHODS

Data were obtained from the Veterans and Martyr Affair Foundation of Iran (VMAF) regarding all confirmed individuals who were exposed to SM during the Iran-Iraq war (1980-1988) up to 30 March 2019. The mortality rate, cumulative mortality and SMR with 95 % confidence intervals (CIs) were calculated to assess mortality in chemical warfare survivors (CWS), and results were compared with the general Iranian population. Overall survival was analysed using the Kaplan-Meier curve, and the log-rank test was employed to compare survival probability across different categories.

RESULTS

Among the 48,067 confirmed CWS, a total of 4358 (9.1 %) individuals had died by the end of the study period (30 March 2019), with a mean age of 55.5 ± 14.4 years at the time of death. Overall, at the 39-year follow-up, the mortality rate due to all causes of death for people who were exposed to SM was lower than the general Iranian population (SMR: 0.70, 95 % CI: 0.68-0.72). However, cause-specific SMR analysis showed that the mortality rate due to liver cancer (SMR: 1.98, 95 % CI: 1.59-2.45), poisonings (SMR: 1.92, 95 % CI: 1.52-2.38), respiratory disorders (SMR: 1.59, 95 % CI: 1.46-1.73) and multiple myeloma (SMR: 1.72, 95 % CI: 1.06-2.62) were approximately twofold higher in CWS than the general population.

CONCLUSIONS

This study provides valuable insights into the mortality effects of SM exposure among the Iranian population affected by the Iran-Iraq war. The results emphasise the importance of continued monitoring and support for individuals exposed to SM, particularly in the context of managing and addressing the heightened risks associated with liver cancer, poisonings, respiratory disorders and multiple myeloma. Further research and interventions may be necessary to mitigate these specific health challenges in the affected population.

Investigation of Neurocognitive Deficits, Quality of Life, and Functional Performance in Ultra-High-Risk Individuals Compared to Familial High-Risk Individuals for Schizophrenia

Objective: This study aimed to investigate neurocognitive functioning, quality of life, and global functional performance in Ultra-High Risk (UHR) individuals compared to Familial High-Risk (FHR) individuals for developing schizophrenia. Method : An observational cross-sectional study was conducted using a convenient sampling method at Roozbeh Hospital in Tehran, Iran, from June 2017 to January 2020. The study included 40 UHR individuals based on the Structured Interview for Psychosis Syndrome (SIPS) interview, as well as 34 FHR individuals due to genetic risk. Neurocognitive functioning, quality of life, and global functional performance were assessed by using the Cambridge Automated Neuropsychological Test Battery (CANTAB) and Controlled Oral Word Association Test (COWAT), Quality of Life Scale (QLS), and Global Assessment of Functioning (GAF). Results: UHR individuals for schizophrenia demonstrated significant lower scores in phonemic and semantic verbal fluency (t = 6.218, P < 0.001; t = 4.184, P < 0.001, respectively), more total errors for spatial working memory (t = -5.874, P < 0.001), and fewer problems solved in minimum moves in Stocking of Cambridge (SOC) (t = -2.706, P < 0.01) compared to FHR individuals. Intra-Extra Dimension (IED) did not differ significantly between the two groups. Moreover, the study indicated significant GAF decline (F = 79.257, P < 0.001) and lower total score on the QLS (t = -10.655, P < 0.001) in UHR compared to FHR individuals. Conclusion: It is possible to differentiate UHR individuals from FHR individuals through neurocognitive, quality of life, and global functioning assessment.

What we think about professional and unprofessional behaviors: differences between the perception of clinical faculty members and medical students

INTRODUCTION

Differences in the viewpoints of clinical faculty members and medical students about prioritizing professional norms accepted by the professional community and lack of alignment of these views can lead to distortion of understanding, problems in learning and assessment of professionalism, and failure in students' professional identity formation. This study aimed to identify the differences in viewpoints of clinical faculty members and medical students about prioritizing the importance and prevalence of professional and unprofessional behaviors among undergraduate medical students.

METHODS

A multi-stage qualitative study was conducted at Tehran University of Medical Sciences during 2020-2021. At first, a systematic search was conducted to identify professional and unprofessional behaviors using the directional content analysis method. A panel of experts was formed to check the codes obtained from reviewing the literature and to evaluate its compliance with the context. Then, the modified nominal group technique sessions were held with clinical faculty members and medical students to strengthen the codes extracted from the studies and systematically integrate their views to achieve a comprehensive list of professional and unprofessional behaviors in accordance with the context. Finally, a consensus was made among them about prioritizing the importance and prevalence of these behaviors in undergraduate medical students.

RESULTS

A total of 490 codes of professional behaviors and 595 unprofessional behavior codes were identified in the literature review. In the following sessions of the modified nominal group, 13 clinical faculty members listed 105 codes of professional and unprofessional behaviors, and 51 medical students also listed 313 codes. The results of the modified nominal group technique showed that the faculty members reported the importance of unprofessional behaviors higher than professional ones. At the same time, students rated the importance of professional behaviors higher than unprofessional ones. Both faculty members and students rate the prevalence of professional behaviors as high and the prevalence of unprofessional behaviors as low.

CONCLUSION

The results showed a difference of views between clinical faculty members and medical students about prioritizing professional and unprofessional behaviors. It is essential to align their viewpoints to understand, learn and value professionalism to develop a professional identity.

Neutralising the testosterone enanthate-induced oxidative stress in rats uterine tissue by propolis and chicory as natural antioxidants

The objective of this study was to investigate the effect of eight weeks of propolis and chicory on oxidative stress of uterine tissue in rats consuming testosterone enanthate. Thirty-five female Wistar rats (8 weeks old and weighing 200±12 g) were randomly divided between five groups (n=8) resistance training+ testosterone enanthate (RT+TE), resistance training+ testosterone enanthate+ chicory (RT+TE+CH), resistance training+ testosterone enanthate+ propolis (RT+TE+PR), control (CO), and sham (RT). The protocols were as follows: exercise protocol including climb on a 1-meter ladder with 26 steps five days a week for eight weeks, received a dose of 20 mg/kg of body weight of testosterone weekly for eight weeks, and received a dose of 400 mg/kg proplis and 6 g/kg chicory of body weight all days a week for eight weeks. Superoxide dismutase (SOD), glutathione peroxidase (GPX), and malondialdehyde (MDA) were measured as oxidative stress markers. Testosterone treatment resulted in a significant decrease in the amount of SOD and GPX only in RT+TE group compared to the RT+TE+CH and RT+TE+PR groups (P=0.001). There was no significant difference in mean SOD and GPX levels between RT+TE+CH and RT+TE+PR with CO and RT groups (P>0.05). MDA level was significantly higher in RT+TE group compared to the other groups (P=0.001). This level was also significantly higher in RT+TE+CH group compared to the CO group (P=0.000) and in RT+TE+PR group compared to CO (P=0.000) and RT (P=0.003) groups. Although testosterone enanthate leads to oxidative stress in uterine tissue, propolis and chicory reduced this oxidative stress. It seems that more research can be done on the potential effects of natural antioxidants to neutralise the harmful effects of steroids.

The Consequences of Discontinuing a Home Care Service for Patients with Severe Mental Illness After the COVID-19 Pandemic

Continuity of care has been considered, as a key component of the treatment process, especially after discharge from the hospital. Establishing treatment continuity is critical to achieving successful treatment outcomes. Roozbeh Home Care Program was developed to ensure the continuity of care in patients with severe mental illness. This study aims to investigate the consequences of discontinuing a home care service including; relapse, readmission, service satisfaction, severity and disability, in patients with severe mental illness in Iran. Forty-three patients who received home care service for more than 6 months were included. They were assessed 3 and 6 months after receiving the service; and 12 months after the program discontinuation. There was a significant difference between the hospitalization rate during (0.42 ± 0.64) and 1 year after the program's discontinuation (0.65 ± 1.46). The majority of the caregivers (70%) were highly satisfied with the home care services. Among the patients who received the homecare services, 40.4% were highly satisfied; and 21.2% were moderately satisfied. There was no significant difference between disability (as measured by World Health Organization Disability Assessment Schedule), clinical improvement (as measured by Clinical Global Impression-Improvement Scale), or severity of illness (as measured by Clinical Global Impression Severity of the Illness Scale) during and 1 year after program's discontinuation. During the time of receiving the service, hospitalization rate was reduced. Patients and caregivers were satisfied with the service. Providing psychiatric services at home should be considered as a solution to maintain the continuity of care.

Ultrafine particle exposure for bicycle commutes in rush and non-rush hour traffic: A repeated measures study in Copenhagen, Denmark

Ultrafine particles (UFP), harmful to human health, are emitted at high levels from motorized traffic. Bicycle commuting is increasingly encouraged to reduce traffic emissions and increase physical activity, but higher breathing rates increase inhaled UFP concentrations while in traffic. We assessed exposure to UFP while cycling along a fixed 8.5 km inner-city route in Copenhagen, on weekdays over six weeks (from September to October 2020), during morning and afternoon rush-hour, as well as morning non-rush-hour, traffic time periods starting from 07:45, 15:45, and 09:45 h, respectively. Continuous measurements were made (each second) of particle number concentration (PNC) and location. PNC levels were summarized and compared across time periods. We used generalized additive models to adjust for meteorological factors, weekdays and trends. A total of 61 laps were completed, during 28 days (∼20 per time period). Overall mean PNC was 18,149 pt/cm³ (range 256-999,560 pt/cm³) with no significant difference between morning rush-hour (18003 pt/cm³), afternoon rush-hour (17560 pt/cm³) and late morning commute (17560 pt/cm³) [p = 0.85]. There was substantial spatial variation of UFP exposure along the route with highest PNC levels measured at traffic intersections (∼38,000-42000 pt/cm³), multiple lane roads (∼38,000-40000 pt/cm³) and construction sites (∼44,000-51000 pt/cm³), while lowest levels were measured at smaller streets, areas with open built environment (∼12,000 pt/cm³), as well as at a bus-only zone (∼15,000 pt/cm³). UFP exposure in inner-city Copenhagen did not differ substantially when bicycling in either rush-hour or non-rush-hour, or morning or afternoon, traffic time periods. UFP exposure varied substantially spatially, with highest concentrations around intersections, multiple lane roads, and construction sites. This suggests that exposure to UFP is not necessarily reduced by avoiding rush-hours, but by avoiding sources of pollution along the bicycling route.

Developing and validating an instrument to measure: the medical professionalism climate in clinical settings

This study was conducted to develop and validate an instrument to measure the medical professionalism climate in clinical settings. The item pool was developed based on the Tehran University of Medical Sciences Guideline for Professional Conduct. The items were distributed between two questionnaires, one for health-care providers and the other for patients. To assess the construct validity of the questionnaires, 350 health-care providers and 88 patients were enrolled in the study. The reliability of the questionnaires was evaluated by calculating Cronbach's alpha and ICC. At first a 74-item pool was generated. After assessing and confirming face and content validity, 41 items remained in the final version of the scale. Exploratory factor analysis revealed the three factors of "personal behavior", "collegiality" and "respect for patient autonomy" in a 25-item questionnaire for service providers and a single factor of "professional behavior" in a 6-item questionnaire for patients. The three factors explained 51.775% of the variance for service providers' questionnaire and the single factor explained 63.9% of the variance for patients' questionnaire. The findings demonstrated that from the viewpoints of patients and service providers, this instrument could be applied to assess the medical professionalism climate in hospital clinical settings.

Exposure to ultrafine particles while walking or bicycling during COVID-19 closures: A repeated measures study in Copenhagen, Denmark

Ultrafine particles (UFP; particulate matter <0.1 μm diameter) emitted from motorized traffic may be highly detrimental to health. Active mobility (walking, bicycling) is increasingly encouraged as a way to reduce traffic congestion and increase physical activity levels. However, it has raised concerns of increased exposure to UFP, due to increased breathing rates in traffic microenvironments, immediately close to their source. The recent Coronavirus Disease 2019 (COVID-19) societal closures reduced commuting needs, allowing a natural experiment to estimate contributions from motorized traffic to UFP exposure while walking or bicycling. From late-March to mid-July 2020, UFP was repeatedly measured while walking or bicycling, capturing local COVID-19 closure ('Phase 0') and subsequent phased re-opening ('Phase 1', '2', '2.1' & '3'). A DiSCmini continuously measured particle number concentration (PNC) in the walker/bicyclist's breathing zone. PNC while walking or bicycling was compared across phased re-openings, and the effect of ambient temperature, wind speed and direction was determined using regression models. Approximately 40 repeated 20-minute walking and bicycling laps were made over 4 months during societal re-opening phases related to the COVID-19 pandemic (late-March to mid-July 2020) in Copenhagen. Highest median PNC exposure of both walking (13,170 pt/cm³, standard deviation (SD): 3560 pt/cm³) and bicycling (21,477 pt/cm³, SD: 8964) was seen during societal closures (Phase 0) and decreased to 5367 pt/cm³ (SD: 2949) and 8714 pt/cm³ (SD: 4309) in Phase 3 of re-opening. These reductions in PNC were mainly explained by meteorological conditions, with most of the deviation explained by wind speed (14-22%) and temperature (10-13%). Highest PNC was observed along major roads and intersections. In conclusion, we observed decreases in UFP exposure while walking and bicycling during societal re-opening phases related to the COVID-19 pandemic, due largely to meteorological factors (e.g., wind speed and temperature) and seasonal variations in UFP levels.

Quantitative analysis of taste disorder in COVID-19 patients, the hypersensitivity to salty quality

Recently, many of the studies have illustrated that the new pandemic SARS-CoV-2 can affect Central Nervous System through the olfactory bulb. In addition to investigating anosmia or hyposmia induced by this virus, a quantitative analysis was needed to clarify the taste and smell disorder of the new coronavirus. The four basic taste quality with five concentrations for sweet, sour, bitter, and salty were administered to 75 subjects divided into three groups: COVID-19 patients with taste disorder, COVID-19 patients without taste disorder, and control group.

The results indicated the increment of sweet (2.68 ± 0.14), sour (3.34 ± 0.12) and bitter (3.39 ± 0.2) thresholds in COVID-19 patients with taste disorder in comparison with patients without taste disorder that the threshold were: 2 ± 0.16, 2.11 ± 0.2 and 2.55 ± 0.5 for sweet, sour, and bitter respectively. On the other hand, the patients inversely showed a significant decrease in the salty taste threshold (0.51 ± 0.03) compared to COVID-19 positive control groups (1.11 ± 0.11).

Additionally, despite taste disorder in almost all of the patients with smell deficiency, only 30% of cases with taste disorder reported smell deficiency. It may be concluded that some of the taste disorders in patients with COVID-19 disorder could be associated with taste receptors dysfunction or the spread of infection to the cranial nerves responsible for the conduction of tastes sensation.

COVID-19 pandemic-induced physical inactivity: the necessity of updating the Global Action Plan on Physical Activity 2018-2030

To prevent and reduce inactivity, the World Health Organization (WHO) designed a global plan called Global Action Plan on Physical Activity 2018–2030 (GAPPA) in 2017. In this plan and according to the state of physical activity in 2016, actions and goals were set. However, the world is facing a COVID-19 pandemic, which has affected various aspects of lifestyle, including physical activity. Some studies have shown that physical activity reduced during the pandemic. For this reason, the WHO should review the GAPPA and update goals and actions according to the state of physical activity in 2020.

Association of suicide with short-term exposure to air pollution at different lag times: A systematic review and meta-analysis

BACKGROUND

Suicide is a major public health problem, with some environmental risk factors.

OBJECTIVES

This meta-analysis study explored the association between short-term exposure to air pollution and suicide mortality, with an emphasis on different lag times.

METHODS

A systematic search was used to find relevant studies in databases including Scopus, Web of Knowledge, Pubmed, and Embase published up to 19 May 2020. The inclusion criteria included case-crossover or time-series studies assessing the association of criteria air pollutants with suicide mortality at different Lag Days of 0-7 (LD0 to LD7) and Cumulative Lags of 1-7 days (CL1 to CL7). Odds ratios (OR) were calculated with 95% confidence intervals (CI).

RESULTS

Of 1436 retrieved articles, 11 were eligible for data extraction, representing data on 283,550 suicides published between 2010 and 2019. The odds of suicide death increase with each 10 μg/m³ increase in the mean concentrations of NO₂ at CL1 (1.013: 1.006-1.021), CL2 (1.028: 1.003-1.053), CL3 (1.035: 1.001-1.070), and LD2 (1.011: 1.001-1.022), SO₂ at CL1 (1.024: 1.014-1.034), CL2 (1.030: 1.012-1.048), CL3 (1.029: 1.009-1.049), and CL4 (1.027: 1.005-1.049), O₃ at CL6 (1.008: 1.000-1.016), PM₁₀ at CL1 (1.004: 1.000-1.008), and PM_2.5 at CL1 (1.017: 1.003-1.031). Besides, the odds of suicide death increases with each 0.5 mg/m³ increase in the mean concentration of CO at LD6 (1.005: 1.000-1.011). However, it decreased with increased O₃ exposure at LD3 (0.997: 0.994-1.000).

CONCLUSION

The study supports a positive association between air pollution and suicide mortality. No immediate risk was elucidated but the possible effects seem to be exerted cumulatively.

Scoping Review of Questionnaires on Stigma of Mental Illness in Persian

bjectives: In order to plan according to the needs of psychiatric patients, there is a need to study different aspects of social stigma in target groups. Due to the limited access to questionnaires used for assessment of social stigma in Persian, this study aims to review all of the tools available for assessment of social stigma, which have been designed in Iran or have been translated to Persian. Methods: This is a conceptual review study. After extensive review of resources, articles related to social stigma in the health system and conducted on health care staff, students, caregivers or patientschr('39') families, psychiatric patients, mothers with children with autism, mothers with children with Down syndrome, and the general population were included in the study. We extracted the information of Persian questionnaires used in the reviewed articles. The questionnaires and additional information were collected by contacting the authors of the articles via E-mail. Results: There were 21 questionnaires for assessing social stigma in Persian language. Of these, 19 questionnaires could be accessed and analyzed. Most of the questionnaires were the translated version of other tools, and only 4 questionnaires had been developed and validated in Persian. Conclusion: Most of the questionnaires in Persian are used to measure social stigma in health care staff and students followed by caregivers or patientschr('39') families. There is limited number of questionnaires for the assessment of social stigma in general population and patients. This is in contrast to the other languages that have mainly focused on assessment of stigma in general population and patients. To date, no questionnaire in Persian exists for the assessment of social stigma in children and adolescents.

Effects of vibration therapy and vitamin D supplement on eccentric exercise-induced delayed onset muscle soreness in female students

Delayed onset muscle soreness (DOMS) appears after unaccustomed exercise and peaks 24-48 h after exercise. Vitamin D micronutrient and vibration therapy may have an effect on DOMS. The present study investigated the effects of vitamin D micronutrient and vibration therapy on DOMS. Sixty female students were randomly assigned to one of the four groups (n=15 in each group): vitamin D, vibration therapy, vitamin D + vibration therapy, and control. The participants of vitamin D groups received vitamin D (3,800 IU, 1 session daily for 7 days), while the participants of the control groups received placebo. The participants of vibration therapy groups received vibration therapy (50 Hz; 3 sets of 1 min, 1 session daily for 7 days). One day later, the participants performed eccentric exercise (a quadriceps leg extension exercise). Immediately after this exercise protocol, the participants received vitamin D or vibration therapy on basis of their groups. Pain perception, creatine kinase (CK), interleukin (IL)-6, superoxide dismutase and malondialdehyde (MDA) concentration were measured at baseline (before 7 days of intervention), after 7 days of intervention (before eccentric exercise) and 24, 48 and 72 h after eccentric exercise. Statistical analysis was employed and P≤0.05 was considered as the significant level. CK and IL-6 concentrations, as well as pain perception, were significantly lower in the vibration therapy and vitamin D groups compared to the control group 24 to 48 h after eccentric exercise. MDA concentration was significantly lower in the vibration therapy and vitamin D groups compared to the control group 48 to 72 h after eccentric exercise. In conclusion, the present study suggests that vibration therapy and vitamin D supplement may have effects against eccentric exercise-induced delayed onset muscle soreness in female students.

Personal factors affecting medical professionalism: a qualitative study in Iran

Professional behavior with patients and interactions with colleagues, the institution and professional bodies are influenced by many factors. The purpose of this manuscript is to clarify those personal factors affecting medical professionalism in clinical settings affiliated with Tehran University of Medical Sciences. For this purpose, a qualitative study was carried out. One hundred and eighty-two participants were recruited through purposive sampling of clinical staff, physicians, and medical students in Tehran. Data were collected through 22 focus group discussions, and conventional content analysis was used to analyze the data. The results were reported in five categories to present the participants' views. Categories were extracted from 103 codes and consisted of 1) people's belief in professionalism, 2) personality traits, 3) problems in family, 4) mental or physical health status, and 5) communication skills. The results showed that despite the facilitator roles of some personal factors, others act as barriers to professional behaviors. In order to control their impact, it is crucial to pay attention to them at the time of student/staff selection. Strengthening support systems in the organization is also essential for decreasing the effect of family problems or physical and mental health problems.

Relationship between suicide mortality and lithium in drinking water: A systematic review and meta-analysis

BACKGROUND

Lithium at therapeutic doses has protective effects against suicide in clinical practice. This meta-analysis aimed to investigate the relationship between lithium concentration in drinking water and suicide mortality in the general population.

METHODS

A systematic search was conducted in Web of Knowledge, PubMed, ScienceDirect, and Scopus to find papers reporting the crude relationship between drinking water lithium and suicide incidence in the general population until June 2019. The pooled effect measure was expressed as odds ratio (OR) and 95% confidence interval (CI) using the random-effects model.

RESULTS

We retrieved 308 English original articles, of which 13 ecologic studies with a total sample size of 939 regions and one cohort study with a sample size of 3,740,113 people were eligible for the meta-analysis. A significant relationship was found between the lithium concentration in drinking water and reduced suicide mortality (OR= 0.42; 95% CI: 0.27-0.67; p-value <0.01). Ten studies reported gender-specific responses to lithium, with the pooled estimates as follows: OR= 0.54; 95% CI: 0.35-0.84; p-value <0.01 for men, OR= 0.70; 95% CI: 0.48-1.01; p-value =0.057 for women, and OR= 0.63; 95% CI: 0.47-0.83; p-value <0.01 for total.

LIMITATIONS

The study was limited to the assessment of the crude relationship between lithium exposure and suicide rate without considering the role of confounders.

CONCLUSIONS

Lithium in drinking water is dose-dependently associated with reduced suicide mortality at least in ecological studies. However, we need well-designed clinical trials to confirm the protective effect of drinking water lithium intake against suicide.

A framework for participatory selection of the school dean: Report of an experience

INTRODUCTION

Selection of the managers and leaders is a major concern of leading organizations. Recruitment of the qualified individuals in an educational organization depends on effective selection techniques. The present study reports the experience of Tehran University of Medical Sciences (TUMS) in designing a framework for selection of school dean.

MATERIALS AND METHODS

First, a literature review was conducted to identify the common frameworks for the selection of deans in academic environment. Then, the perceptions of key stakeholders were collected via focus group discussions. Thematic analysis was used to categorize participants' comments. Following, an institutional guideline for selection of school dean was developed based on the derived themes and subthemes by a task force and approved by the board of directors.

RESULTS

Three themes and nine subthemes were extracted, resulting in the selection framework for the school dean at TUMS with three phases of preparation, selection, and appointment. The preparation phase includes organizational needs analysis, designing the selection strategy and determining the eligibility of nominee. In the selection phases, various methods such as personal resume, interview, and consultation with beneficiaries were recommended, and the appointment phase includes formal appointment of the selected nominee by the university chancellor.

CONCLUSIONS

We developed a framework for selection of school dean at TUMS. It recognizes the process that top managers would look out when selecting school deans. The framework may result to choose the proper individuals who have suitable plans and stronger Curriculum Vitae, while involving key stakeholders and collecting wisdom.

Educational system defects and observing professional behavior: A qualitative study

BACKGROUND

Observing professional behavior in clinical settings encounters many obstacles. In this research, the effect of defects of the educational system in observing professional behavior in clinical settings of Tehran University of Medical Sciences (TUMS) has been investigated.

MATERIALS AND METHODS

This qualitative content analysis study was conducted using focused group discussions in TUMS. Twenty-two focused group discussions with 182 faculty members, medical students, and clinical staff were conducted. Conventional content analysis was used to analyze the data.

RESULTS

One hundred and sixty codes (90 codes from the viewpoint of clinical staff and 70 codes from the viewpoint of faculty members and medical students) were extracted. The codes are categorized into 4 categories and 17 subcategories. The categories include "educators' imperfections," "inadequate initial training," "lack of attention to continuous professional education," and "lack of passion for professionalism education."

CONCLUSION

Greater efforts to empower educators, planning for the effectiveness of initial education, and motivating employees might play a role in promoting the observance of professional behavior in clinical settings. Professional behavior training should be considered at the entrance into the system. This education should be strengthened by continuing theoretical and practical training and addressed by proper supervision. It is also important to focus on attracting the attention of teachers to their own model role in observing professional behavior by others.

Twelve-month course and outcome of methamphetamine-induced psychosis compared with first episode primary psychotic disorders

BACKGROUND

To assess the clinical course and outcome of patients with methamphetamine-induced psychosis in comparison with patients with primary psychotic disorders.

METHODS

This prospective study was conducted on patients with methamphetamine-induced psychosis, and 2 groups of primary psychotic disorders: affective psychosis and non-affective psychosis admitted to 2 psychiatric hospitals in Tehran, Iran, with a first episode of a psychotic illness. A total of 165 subjects (55 in each group) were selected using convenience sampling. They were assessed at the time of admission, discharge and 6 and 12 months after discharge using the Positive and Negative Syndrome Scale, the Young Mania Rating Scale and the Global Assessment of Functioning Scale. The frequency of readmissions and suicide attempts were also assessed.

RESULTS

Significant differences were found in the trend of changes of symptoms and functioning among the 3 groups. At all-time points, the severity of negative psychotic symptoms and dysfunction in the non-affective psychosis group were greater than those in affective or methamphetamine-induced psychosis groups, with latter 2 having similar profiles. However, the course of positive symptoms in methamphetamine-induced psychosis was more similar to non-affective psychosis. Number of suicide attempts and readmissions were non-significantly higher in methamphetamine-induced psychosis than in the other groups.

CONCLUSION

Methamphetamine-induced psychosis does not have a satisfactory course and in some cases symptoms may remain even after many months of follow-up. Rate of certain outcomes such as re-hospitalization is also considerably high. It is a challenge for the health-care system that requires evidence-based interventions.

Health State Utilities for Patient's Current Health from Bipolar Type I Disorder

BACKGROUND

Bipolar Type I Disorder (BID) is a disabling mental disorder among young adults that places enormous psychological, social, and economic burdens on patients, their families, and health care systems and decreases quality of life (QOL). Few studies have investigated the quality-adjusted life-years (QALY), health state preferences, and utilities in patients with BID.

AIM OF STUDY

The aim of this study was to elicit health state utilities for current health among a sample of individuals with BID irrespective of their clinical conditions at the time of evaluation.

METHODS

One hundred individuals with BID were consecutively enrolled in this cross-sectional study. Preferences were elicited from patients with visual analogous scale (VAS) and time trade-off (TTO). To assess quality of life, the Farsi version of the World Health Organization's QOL Instrument-Short Version (WHOQOL-BREF) was used. In addition, health state was assessed with the Short Form-36 (SF-36) health survey, and then a specially- derived reduced version of the SF-36 (the `SF-6D') was calculated as an alternative to existing preference-based measures of health for conducting economic evaluation of various interventions. Moreover, several clinical measures were administered to participants.

RESULTS

The mean (S.D.) VAS, TTO, and SF-6D utility scores were 0.59 (0.21), 0.44 (0.33), and 0.61 (0.11), respectively. There were significant associations of most selected clinical characteristics with VAS and TTO scores. Additionally, there were strong correlations between all domains of WHOQOL-BREF and VAS scores as well as moderate to strong correlations with TTO scores. Furthermore, there were strong correlations between all scales of SF-36 scores and VAS scores as well as moderate to strong correlations between the scales of SF-36 scores and TTO scores.

DISCUSSION

The current study showed that even unstable patients could evaluate their own health states. Furthermore, the present study showed substantial decrements in health-related life preferences among persons with BID. Additionally, the patients with most recent depressive or mixed episodes reported lower VAS scores than those with most recent manic episodes.

LIMITATIONS

This study was performed on a group of patients with BID in a referral psychiatric center. This sample can potentially make a selection bias. Furthermore, this study was cross-sectional.

IMPLICATIONS FOR HEALTH CARE PROVISION AND USE

Generally, clinical features could explain more than half of the variances in VAS utility scores. Among all clinical features, severity of symptoms and duration of disease were among the main factors significantly associated with the utility decreases.

IMPLICATION FOR HEALTH POLICIES

The present study data provide health state preferences useful for cost-utility and outcome-modeling studies as well as health policy and decision-making. Also, the evaluations were partially affected by severity of symptoms. Therefore, utilities obtained in this study can be utilized to develop QALY and provide utility values that can be used in economic models for cost-utility studies.

IMPLICATIONS FOR FURTHER RESEARCH

The comparison of the utility in a group of patients in different mood episodes and in their controlled periods and calculating the proportion of each episode to total duration of disease and to the patient's life span in future investigations may add crucial information to the present knowledge. The evaluation of biological and non-biological therapies by measuring utility and health value as health output indicators is strongly suggested.

Cost-effectiveness Analysis of an Aftercare Service vs Treatment-As-Usual for Patients with Severe Mental Disorders

BACKGROUND

There have been claims that community mental health principles leads to the maintenance of better health and functioning in patients and can be more economical for patients with severe and chronic mental disorders. Economic evaluation studies have been used to assess the cost-effectiveness of national health programs, or to propose efficient strategies for health care delivery.

AIMS OF THE STUDY

The current study is intended to test the cost-effectiveness of an Aftercare Service when compared with Treatment-As-Usual for patients with severe mental disorders in Iran.

METHODS

This study was a parallel group randomized controlled trial. A total of 160 post-discharge eligible patients were randomized into two equal patient groups, Aftercare Service (that includes either Home Visiting Care, or Telephone Follow-up for outpatient treatment) vs Treatment-As-Usual, using stratified balanced block randomization method. All patients were followed for 12 months after discharge. The perspective of the present study was the societal perspective. The outcome measures were the rate of readmission at the hospitals after discharge, psychotic symptoms, manic symptoms, depressive symptoms, illness severity, global functioning, quality of life, and patients' satisfaction with the services. The costs included the intervention costs and the patient and family costs in the evaluation period.

RESULTS

There was no significant difference in effectiveness measures between the two groups. The Aftercare Service arm was about 66,000 US$ cheaper than Treatment-As-Usual arm. The average total cost per patient in the Treatment-As-Usual group was about 4651 USD, while it was reduced to 3823 US$ in the Aftercare Service group; equivalent to a cost reduction of about 800 USD per patient per year.

DISCUSSION AND LIMITATIONS

Given that there was no significant difference in effectiveness measures between the two groups (slightly in favor of the intervention), the Aftercare Service was cost-effective. The most important limitation of the study was the relatively small sample size due to limited budget for the implementation of the study. A larger sample size and longer follow-ups are warranted.

IMPLICATIONS FOR HEALTH CARE PROVISION, USE AND POLICIES

Considering the limited resources and equity concerns for health systems, the importance of making decisions about healthcare interventions based on cost-effectiveness evidence is increasing. Our results suggest that the aftercare service can be recommended as an efficient service delivery mode, especially when psychiatric bed requirements are insufficient for a population.

IMPLICATIONS FOR FURTHER RESEARCH

Further research should continue the work done with a larger sample size and longer follow-ups to further establish the cost-effectiveness analysis of an aftercare service program compared with routine conventional care.

The Effect of Clinical Exposure to Patients on Medical Students' Attitude Towards Mental Illness

BACKGROUND

Stigma of mental disorders causes a reduction in seeking help from the health care professionals and is evident across the world.

OBJECTIVES

The current study aimed to compare medical students' attitude towards mental illness after two different psychiatry clerkships in terms of the level of clinical exposure to patients with mental illness.

PATIENTS AND METHODS

Through a quasi-experimental study, all of the 4^th-year medical students were invited to enroll this study conducted in Tehran University of Medical Sciences (TUMS). They were non-randomly assigned into two different psychiatry clerkships from January 2009 to January 2010. One group was enrolled in the traditional lecture-based course (low-exposure) while the second group participated in a novel method with increased hours of patient exposure (high-exposure). Attitude towards mental illness (AMI) was measured by a 22-item questionnaire before and after the clerkship and data were compared between the two groups in terms of changing attitude towards mental illness in five different categories.

RESULTS

A total of 211 participants were enrolled in the study (115 female) of which 115 students (54.5%) were in low-exposure group and 96 students (45.5%) in the high-exposure group. Generally, AMI scores did not differ between the two groups and did not show any significant changes before and after the psychiatry clerkship. The only exceptions to this were AMI4 category (the concept of etiology of the mental illness), which significantly improved after the clerkship in the low-exposure (P = 0.011) and the high-exposure groups (P = 0.024), respectively.

CONCLUSIONS

Exposure of medical students to patients with mental illness did not improve attitude towards mental illness and psychiatric conditions.

Evaluation of the performance of general practitioners in a collaborative care program by employing simulated patients

OBJECTIVE

To compare the performance of the general practitioners (GPs) in a collaborative care (CC) program in Iran with a control group of GPs in the usual care by employing simulated patients.

METHODS

Six trained simulated patients (SPs) made unannounced visits to 26 GP offices participating in the CC program and to 26 age and sex matched controls. The SPs role played five clinical scenarios of mental disorders and filled out checklists to evaluate the GPs' performance regarding interviewing, taking history, establishing rapport, showing empathy, and giving advice to patients. Additionally, the GPs' plan of care and prescriptions were evaluated later by a psychiatrist based on the documents provided by the SPs.

RESULTS

There was a significant difference between collaborative care and control group physicians in their global performance; CC physicians built up better patient-physician relationship. They performed better in evaluating a psychotic patient, although not better in their management. CC physicians were marginally better in approach to patients with generalized anxiety disorder (GAD) and mild major depressive disorder.

CONCLUSION

The overall performance of physicians in CC was better than the GPs in the control group in making an effective patient-physician relationship, and evaluating a psychotic patient. The main weakness of the GPs was in proper treatment of the minor and more common psychiatric disorders and in evaluation of patients with suicidal ideations who were in need for emergent referral. Evaluating performance of the practitioners is feasible employing SPs and the findings can be translated into improvements in the available services.

Sensor-less force-reflecting macro-micro telemanipulation systems by piezoelectric actuators

This paper establishes a novel control strategy for a nonlinear bilateral macro-micro teleoperation system with time delay. Besides position and velocity signals, force signals are additionally utilized in the control scheme. This modification significantly improves the poor transparency during contact with the environment. To eliminate external force measurement, a force estimation algorithm is proposed for the master and slave robots. The closed loop stability of the nonlinear micro-micro teleoperation system with the proposed control scheme is investigated employing the Lyapunov theory. Consequently, the experimental results verify the efficiency of the new control scheme in free motion and during collision between the slave robot and the environment of slave robot with environment, and the efficiency of the force estimation algorithm.

Working Memory and Response Inhibition in Patients With Bipolar I Disorder During Euthymic Period

Background:

Several cognitive domains, including attention, memory, and executive functions are impaired in bipolar disorder.

Objectives:

This study aimed to investigate two executive functions (working memory and response inhibition) in patients with bipolar I disorder during remission of the symptoms.

Patients and Methods:

In this case-control design, 30 bipolar I patients (18 to 45 years old) were matched with 30 ones in the control group in terms of age, gender, and education. The patients were selected from Roozbeh Psychiatric Hospital (a hospital affiliated to Tehran University of Medical Sciences) from May to October 2013. They were evaluated and contrasted using working memory (Spatial Span and Spatial Working Memory (SSP and SWM)) and response inhibition (Stop Signal Task (SST)) tests.

Results:

We used independent t-tests for comparing and contrasting 2 groups on total and sub-scales scores of these 3 tests. In terms of SWM test there was a significant difference in between-group error between the two groups (P = 0.05); there was also a meaningful difference between the strategies used by two groups (P = 0.05). In SSP test, a significant difference appeared between averages of span length of the two groups. In the first and last item delays, there was also a clear difference, but the total error index was not noticeably different. In SST test, the direction error indicator in start-stop trials indicated a major difference, while in successful stops ratio, the case group had a lower ratio. In addition, reaction time to stop signs in bipolar group was meaningfully lower than the control group.

Conclusion:

In conclusion, even during remission phase, executive dysfunction is detectable at least in some areas in patients with bipolar disorder.

Rapid antidepressant effects of repeated doses of ketamine compared with electroconvulsive therapy in hospitalized patients with major depressive disorder

Accumulating evidence suggests that N-methyl-d-aspartate receptor (NMDAR) antagonists (e.g. ketamine) may exert rapid antidepressant effects in MDD patients. In the present study, we evaluated the rapid antidepressant effects of ketamine compared with the electroconvulsive therapy (ECT) in hospitalized patients with MDD. In this blind, randomized study, 18 patients with DSM-IV MDD were divided into two groups which received either three intravenous infusions of ketamine hydrochloride (0.5 mg/kg over 45 min) or ECT on 3 test days (every 48 h). The primary outcome measure was the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS), which was used to rate overall depressive symptoms at baseline, 24 h after each treatment, 72 h and one week after the last (third) ketamine or ECT. Within 24 h, depressive symptoms significantly improved in subjects receiving the first dose of ketamine compared with ECT group. Compared to baseline level, this improvement remained significant throughout the study. Depressive symptoms after the second dose ketamine was also lower than the second ECT. This study showed that ketamine is as effective as ECT in improving depressive symptoms in MDD patients and have more rapid antidepressant effects compared with the ECT.

Comparison of two different curricula in psychiatry clerkship at tehran university of medical sciences

OBJECTIVES

The aim of this study was to evaluate the efficacy of a new psychiatry clerkship curriculum which was designed to improve the knowledge and skills of medical students of Tehran University of Medical Sciences (TUMS), Iran.

METHODS

This quasi-experimental study was conducted in two consecutive semesters from February 2009 to January 2010. In total, 167 medical students participated in the study. In the first semester, as the control group, the clerks' training was based on the traditional curriculum. In the next semester, we constructed and applied a new curriculum based on the SPICES model (student-centered, problem-based, integrated, community-based, elective and systematic).At the end of the clerkship, the students were given two exams: Multiple Choice Questions (MCQ) to assess their knowledge, and Objective Structured Clinical Examination (OSCE) to assess their skills. Baseline data and test performance for each student were analyzed.

RESULTS

Compared to the control group, students in the intervention group showed significantly higher OSCE scores (P= 0.01). With respect to MCQ score, no significant difference was found between the two groups.

CONCLUSIONS

The results suggest that the revised curriculum is more effective than the traditional one in improving the required clinical skills in medical students during their psychiatry clerkship.

A multicenter randomized controlled trial of aftercare services for severe mental illness: study protocol

BACKGROUND

Severe mental illness is responsible for a significant proportion of burden of diseases in Iranian population. People with severe mental illnesses are more likely to have high rates of non-attendance at follow-up visits, and lack of an active follow-up system, particularly in the country's urban areas that has resulted in the revolving door phenomenon of rehospitalizations. Therefore, there is an increasing need for implementation of effective and cost-effective aftercare services.

METHOD/DESIGN

This is a randomized control trial with the primary hypothesis that aftercare services delivered to patients with severe mental illnesses in outpatient department and patient's home by a community care team would be more effective when compared to treatment as usual (TAU) in reducing length of hospital stay and any psychiatric hospitalization. Patients were recruited from three psychiatric hospitals in Iran. After obtaining informed written consent, they were randomly allocated into aftercare intervention and control (TAU) groups. Aftercare services included treatment follow-up (through either home care or telephone follow-up prompts for outpatient attendance), family psychoeducation, and patient social skills training that were provided by community mental health teams. Patients were followed for 12 months after discharge. The primary outcome measures were length of hospital stay and any hospitalization in the 12 month follow-up. Secondary outcome measures included patients' clinical global impression, global functioning, quality of life, and patient's satisfaction. The trial also allowed an assessment of direct cost-effectiveness of the aftercare services.

DISCUSSION

This paper presents a protocol for an RCT of aftercare services delivered to patients with severe mental illnesses within patients' home or outpatient department. The findings of this study can influence policy and program planning for people with severe mental illnesses in Iran.

TRIAL REGISTRATION

IRCT201009052557N2.

Senior medical students' attitudes toward psychiatry as a career choice before and after an undergraduate psychiatry internship in Iran

OBJECTIVES

The study aimed to assess 1) the attitudes of medical students in the sixth and seventh years (known as interns in Iran) toward psychiatry as a career choice, and 2) the degree of attractiveness of psychiatry as a career choice, with regard to various defined aspects, before and after an undergraduate psychiatry internship (similar to the medical school psychiatry rotation in the United States, but mandatory in Iran) in three major medical schools in Tehran, the capital of Iran.

METHOD

Sixth- and seventh-year medical students (locally called interns, N=347) at Tehran, Shahid Beheshti, and Iran Universities of Medical Sciences were consecutively invited to complete anonymous self-report questionnaires designed to assess their perceptions of careers in psychiatry before and after internship in psychiatry wards. Also, students evaluated psychiatry in terms of the factors that reflected the degree of attractiveness of this specialty.

RESULTS

Positive responses toward choosing psychiatry as a career were seen in 18.8% before and 20.0% after psychiatry rotation. No significant differences were observed in the positive responses before and after psychiatry internship. The students' opinions changed to a more attractive degree in terms of only 3 out of the 13 defined aspects. There was also no significant difference in the total score on attractiveness of psychiatry before and after the psychiatry internship.

CONCLUSIONS

The study indicated that undergraduate psychiatry internship might not induce more students to consider psychiatry as a possible career. The present pattern of psychiatry education in Iran seems not to positively affect most aspects of medical students' attitudes toward psychiatry.

How Mental Illness is Perceived by Iranian Medical Students: A Preliminary Study

The study aimed to assess medical students' attitudes toward mental illness following a 4-week psychiatry clerkship. All fifth-year medical students from three academic centers in Tehran were asked to participate in the study. They completed the questionnaire on the last day of their 4-week psychiatry clerkship. A self-administered questionnaire was used to examine participants' Attitudes Toward Mental Illness (ATMI). One hundred and sixty eight students completed the questionnaires (88.9% response rate). In general, the students had favorable attitudes toward mental illness at the end of their clerkship, with mean (± SD) ATMI total score of 78.6 (± 8.1) (neutral score, 66.0). The students showed the most favorable opinion (95.2%) about Category 5 (stereotypic attitude toward people with mental illness) whilst they revealed the least favorable opinion (64.3%) regarding Category 1 (social relations with people affected by mental illness). In addition, the students thought that movies were on the top of influential media on shaping the attitudes toward mental illness. Overall, most of Iranian medical students had generally favorable attitudes toward people with mental illness at the end of their clerkship. Therefore, it may be expected next generation of medical doctors show more favorable attitude toward mental illness.

Iranian medical students' perception of psychiatry: before and after a psychiatry clerkship

OBJECTIVE

We aimed to compare the medical students' attitude towards psychiatry before and after psychiatry clerkship, and to examine the association of choosing psychiatry as a future career with some personal characteristics.

METHOD

In a self-controlled, quasi-experimental study, all of the medical students entering the psychiatry clerkship in three major medical schools of Iran located in Tehran (Tehran, Shahid Beheshti, and Iran University of Medical Sciences) were asked to participate anonymously in the study on the first and the last 3-days of their psychiatry clerkship. From 346 invited 4th-5th year medical students, 225 (65%) completed anonymous self-report questionnaires before and after a 4-week psychiatry clerkship.

RESULTS

Positive response to choose psychiatry as a career was seen in 13.3% and 18.3% before and after psychiatry rotation, respectively. However, the difference was not statistically significant; about one-quarter of the students were turned on to psychiatry and 25% were discouraged during the clerkship. Individual pair wise comparisons revealed significant improvements only in two out of 13 measured aspects of psychiatry. Seventeen out of 38 (47.7%) students who identified psychiatry as the career of choice or strong possibility reported that one of their family members or close friends' mental illness had an impact on their choice. Those students who considered psychiatry as the strong possibility claimed that they are more interested in humanities (OR = 2.96; 95% CI: 1.17, 7.49), and playing a musical instrument (OR = 2.53; 95% CI: 1.15, 5.57).

CONCLUSION

It may be concluded that exposure to psychiatry clerkship could influence medical students' opinion about psychiatry positively, or negatively. Personal characteristics and individual interests of students may play an important role in choosing psychiatry as their future career.

Evaluation of the Persian version of modified fatigue impact scale in Iranian patients with multiple sclerosis

BACKGROUND

Fatigue, a major cause of disability in individuals with multiple sclerosis (MS), is associated with reduced quality of life. The aim of this study was to evaluate the reliability and reproducibility of the Persian version of Modified Fatigue Impact Scale (MFIS) in Iranian patients with MS.

METHODS

This study included 15 subjects with clinically definite MS, 15 hospitalized patients with MS, and 15 hospitalized patients with other chronic illnesses (as controls). They filled in the Persian version of the MFIS twice with a three-day interval. MFIS items were analyzed and the correlation coefficient was calculated.

RESULTS

THERE WAS A GOOD CORRELATION BETWEEN THE SCORES OF THE TWO MEASUREMENTS (CORRELATION COEFFICIENT: 0.984, P < 0.001) especially in physical and cognitive subgroups. The reproducibility of psychosocial subscale was lower than physical and cognitive subscales.

CONCLUSION

According to our findings, the Persian version of the MFIS has a good reliability and reproducibility for assessment of fatigue in patients with MS.

Anger in Adolescent Boy Athletes: a Comparison among Judo, Karate, Swimming and Non Athletes

OBJECTIVE

Karate and judo are originally Japanese martial arts which may have different influences on adolescents' behavior. This study was conducted to examine the total anger rate and its subscale-reactive anger, instrumental anger, and anger control-rates in young karateka and judoka.

METHODS

A cross-sectional study was carried out in 11 to 19-year old boys. Adolescents included in the study were judoka (n=70), karateka (n=66), swimmers (n=59), and non athletes (n=96). One stage cluster sampling method was used to select judoka, karateka, and swimmers from sport clubs in Tehran. Students of governmental schools at the same area were chosen as the non-athletes group. The "Adolescent Anger Rating Scale" questionnaire was utilized to assess the anger rate.

FINDINGS

The mean age of participants was 12.90(±2.06) years. The total anger rates were 45.40 (±5.61) in judoka, 41.53(±5.63) in karateka, 41.19(±5.33) in swimmers, and 45.44 (±8.58) in non athletes. In total anger scale karateka and swimmers had a significantly lower score compared to judoka and non athletes. In instrumental anger subscale the difference was significant just between karateka and non athletes. In reactive anger subscale judoka showed higher scores than swimmers. In anger control subscale the difference was significant between judoka and swimmers and also judoka and karateka. The difference of anger control between karateka and non athletes was significant.

CONCLUSION

The findings of this study propose a difference in the anger rate between judoka and karateka. In contrary to the results of previous studies, judo training may have no influence on anger control, while karate training could be beneficial.

Association of serum retinol-binding protein 4 with insulin resistance and metabolic parameters during olanzapine therapy

OBJECTIVE

Retinol-binding protein 4 (RBP4) has been shown to be associated with insulin resistance (IR), metabolic indices and metabolic syndrome (MetS) in various patient populations and in obesity. We investigated the association between metabolic parameters, IR and RBP4 during olanzapine therapy.

DESIGN

A prospective study.

PATIENTS

Thirty-seven participants with psychiatric disorder who were atypical antipsychotic naive and newly initiated on olanzapine were assessed.

MEASUREMENTS

Fasting RBP4, anthropometric and metabolic variables were measured before and after 3 months of olanzapine therapy.

RESULTS

Participants who developed MetS showed higher RBP4 levels compared with those without MetS, although not significant (P = 0·053). The variation in RBP4 level was correlated with changes in systolic blood pressure (r = 0·423, P = 0·009), diastolic blood pressure (r = 0·390, P = 0·017), total cholesterol (r = 0·446, P = 0·006) and low-density lipoprotein (LDL) (r = 0·407, P = 0·012). Multiple linear regression analysis illustrated that end-point log insulin level was the most significant independent predictor of final log RBP4 levels (standardized ß = 0·353, P = 0·024).

CONCLUSIONS

Our results suggest that RBP4 levels might be associated with at least some olanzapine-induced metabolic abnormalities and cardiovascular disease risk factors.

Persian translation of perception of psychiatry survey questionnaire and evaluation of its psychometric properties

OBJECTIVE

Test the psychometric properties of the Persian version of the Perception of Psychiatry Survey questionnaire, which is being used in a large multi-site international study, of which we were part. This instrument was designed to measure the attitudes of medical educators to psychiatry.

METHOD

We used World Health Organization guideline as the methodological model for Persian translation. The Persian version of Perception of Psychiatry Survey questionnaire was administered to a convenience sample of 100 medical teachers at Tehran University of Medical Sciences and Azad University. The content validity, internal consistency, and test-retest reliability of the instrument were assessed.

RESULTS

No item changed completely during the process of translation and cultural adaptation. The content validity of translation and back translation was 0.74 and 0.86 according to Feliss Kappa Statistic. The Cronbach's α coefficient was 0.76 for the Persian version and for its subdivisions ranged from 0.59 to 0.81. The inter class correlation (ICC) coefficient for test-retest reliability of the whole instrument was 0.89.

CONCLUSION

The Persian version of Perception of Psychiatry Survey questionnaire could be considered as a good cross-cultural equivalent for original English version. The instrument is a reliable instrument in terms of internal consistency and test-retest reliability.

Emotional Intelligence in a group of patients with first-episode psychosis in Iran

This study was aimed to evaluate the Emotional Intelligence (EI) of a group of patients with first episode psychosis in Iran as compared with a healthy control group. A case-control design was used. EI was assessed using Persian version of Bar-On Emotional Quotient inventory (EQ-i) administered on 25 patients with history of a single psychotic episode in the last two years, as well as 64 healthy participants. The mean (±SD) of EI scores of patients' and healthy controls' group was 319.8 (±40.9) and 328.8 (±33.3), respectively. Two-independent sample t-test revealed no significant difference in the EI scores of two groups (P=0.29). In contrast with chronic schizophrenia, the patients with first-episode psychosis were not different from the healthy subjects in terms of emotional intelligence score. It might be implied that the low emotional intelligence of the patients with chronic psychotic disorders is an accumulative result of the underlying disease over time.

Isolation of free-living amoebae from sarein hot springs in ardebil province, iran

BACKGROUND

Free-living amoebae (FLA) are a group of ubiquitous protozoan, which are distributed in the natural and artificial environment sources. The main aim of the current study was to identify the presence of FLA in the recreational hot springs of Sarein in Ardebil Province of Iran.

METHODS

Seven recreational hot springs were selected in Sarein City and 28 water samples (four from each hot spring) were collected using 500 ml sterile plastic bottles during three month. Filtration of water samples was performed, and culture was done in non-nutrient agar medium enriched with Escherichia coli. Identification of the FLA was based on morphological criteria of cysts and trophozoites. Genotype identification of Acanthamoeba positive samples were also performed using sequencing based method.

RESULTS

Overall, 12 out of 28 (42.9%) samples were positive for FLA which Acanthamoeba and Vahlkampfiid amoebae were found in one (3.6%) and 11 (39.3%) samples, respectively. Sequence analysis of the single isolate of Acanthamoeba revealed potentially pathogenic T(4) genotype corresponding to A. castellanii.

CONCLUSION

Contamination of hot springs to FLA, such as Acanthamoeba T(4) genotype (A. castellanii) and Vahlkampfiid amoebae, could present a sanitary risk for high risk people, and health authorities must be aware of FLA presence.

Relationship between GDx VCC and Stratus OCT in juvenile glaucoma

PURPOSE

To compare the ability of scanning laser polarimetry (GDx VCC) and optical coherence tomography (OCT) to discriminate eyes with juvenile glaucoma from normal eyes and to assess the relationship between their parameters.

METHODS

A total of 24 glaucomatous eyes of 24 patients and 24 normal eyes were enrolled. The age range of the patient was 11-40 years with a mean age of 25.1+/-8.2 years. Control groups consisted 24 eyes of 24 individuals without glaucoma with a mean age of 33.2+/-8.2 years. All subjects underwent a full ophthalmic examination, automated perimetry, GDx VCC, and OCT. Correlation coefficients between the parameters of OCT and GDx VCC were calculated. We calculated the area under the receiver operating characteristic curve (AROC) for the main parameters of GDx VCC and OCT.

RESULTS

Statistically significant correlations were observed between GDx VCC and OCT parameters. Pearson coefficients ranged from 0.75 for inferior average to 0.86 for nerve fibre indicator (NFI)/average thickness OCT. The greatest AROC parameter in OCT (inferior average: 0.92) had a lower area than that in GDx VCC (NFI: 0.99). There was a significant statistical significance in all visual field, GDx VCC, and OCT variables between two groups (P<0.05).

CONCLUSIONS

Many GDx VCC parameters were significantly correlated with those of the OCT in patients with juvenile glaucoma. Inferior average and NFI had the greatest AROC parameter in OCT and GDx VCC, respectively. NFI had high sensitivity and specificity for the diagnosis of JOAG.

Freshmen versus interns' specialty interests

PURPOSE

The purpose of this study was to determine career preferences of medical students at the time of entering medical school compared with interns who were graduating; and to determine what factors influence the choice of a special discipline as a career.

METHODS

A cross-sectional, questionnaire-based survey study involving freshmen and interns at Tehran University of Medical Sciences was conducted in 2006 - 2007. Respondents anonymously completed a specialties questionnaire developed by Feifel et al. The questionnaire was translated into Persian (Farsi) and several items were modified based on the circumstances.

RESULTS

The response rate was 91 (73%) among freshmen and 137 (77%) among interns. Forty-six freshman students (50%) and 71 interns (51.8%) indicated that they had not developed a strong decision about any particular field of medicine and needed more time. The preferred specialties among freshmen were surgery and internal medicine; whereas graduating students were more interested in "other specialties". There was no significant difference between pediatrics, gynecology, psychiatry, and general practice among the two groups. There was a significant difference in rating when it came to "anticipated income", "prestige" and "helping patients" of which interns were less interested compared to freshmen in these three areas.

CONCLUSION

Approximately one-half of the medical students were unclear about their future goals. The experience of medical school may play a role in diminishing students' interest in surgery and internal medicine as prospective careers.

Buspirone versus methylphenidate in the treatment of attention deficit hyperactivity disorder: a double-blind and randomized trial

The efficacy and side effects of buspirone compared with methylphenidate (MPH) in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). A total of 34 children with ADHD as defined by DSM-IV-TR were randomized to buspirone or methylphenidate dosed on weight-adjusted basis at buspirone (0.5 mg/kg/day) and methylphenidate (0.3-1 mg/kg/day) for a 6-week double-blind clinical trial. The principle measures of outcome were the teacher and parent ADHD Rating Scale. The side effects were assessed by the special side effect checklist of each drug. In both groups, the scores of teacher and parent ADHD Rating Scale significantly declined on the 6th week as compared to baseline (p = 0.001). These effects were observed in the subscales too. No significant differences were observed between the two protocols on the total scores of parent and teacher ADHD Rating Scale, but methylphenidate was superior to buspirone in decreasing the symptoms of inattention. The side effects of buspirone were mild and rare in comparison with MPH. Buspirone has a favorable side-effects profile. It also has clinically and statistically significant impacts on improving the ADHD symptoms in children. These preliminary findings of the efficacy of buspirone in children with ADHD need large and cross-over studies.

Duration of untreated psychosis and pathways to care in patients with first-episode psychosis in Iran

AIM

This is the first study on the duration of untreated psychosis and pathways to care among patients with first-episode psychosis in Iran as a developing country.

METHODS

Ninety-one patients with a first episode of non-organic psychosis admitted to a university-affiliated psychiatric hospital in Iran were assessed for duration of untreated psychosis (DUP), pathways to care and mode of onset.

RESULTS

Median DUP was 11 weeks (mean = 52.3 weeks). Following the onset of psychosis, most patients were first seen by a psychiatrist (n = 23, 25.3%), a traditional healer (n = 21, 23.1%) or a general practitioner (n = 16, 17.6%). Most referrals to the psychiatric hospital were made by the family (n = 30, 33.1%), or health professionals (n = 29, 31.9%). Acute onset and rural place of residence were associated with shorter DUP in multivariate analysis.

CONCLUSIONS

Median DUP was not long in an inpatient sample with first-episode psychosis, which may be due to the preponderance of affective and acute psychoses in this sample and some help-seeking or service variables.

A Persian translation of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: psychometric properties

OBJECTIVE

The aim of this study is to assess the reliability and validity of a Persian translation of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders (SCID-I) through a multicenter study in a clinical population in Iran.

METHOD

The sample consisted of 299 subjects admitted to outpatient or inpatient services of 3 psychiatric centers in Tehran, Iran. The SCID was administered by trained interviewers. To study the test-retest reliability, a second independent SCID interview was administered to 104 of the entire sample within 3 to 7 days of the first interviews. For the assessment of validity, the SCID diagnoses were compared with the consensus clinical diagnoses made by 2 psychiatrists for all 299 patients.

RESULTS

Diagnostic agreements between test and retest SCID administration were fair to good for most diagnostic categories. Overall weighted kappa was 0.52 for current diagnoses and 0.55 for lifetime diagnoses. Specificity values for most psychiatric disorders were high (>0.85); the sensitivity values were somewhat lower.

CONCLUSIONS

The Persian translation of the SCID yields diagnoses with acceptable to good reliability and validity in a clinical population in Iran. This supports the cross-cultural use of the instrument.

Psychotic-like ideations among a group of young normal subjects in Iran

BACKGROUND

Recent studies show that self-reported psychotic-like experiences in general population samples are quite common and on a continuum with psychotic symptoms in clinical samples. However, most evidence comes from western settings and there is a dearth of research in developing countries. Examination of these experiences across different cultures adds to their validity.

AIMS

To assess psychotic-like ideations and its association with poor mental health in a group of young normal individuals in Iran.

METHODS

A total of 150 medical students with no history of a psychiatric disorder completed the Peters et al. Delusions Inventory (PDI-40) and the General Health Questionnaire (GHQ-28). Psychotic-like ideations were rated on the basis of their presence, as well as their levels of distress, preoccupation and conviction (PDI sub-scores).

RESULTS

On average, 9.4 psychotic-like ideations were reported by the subjects (range 0-28). More frequent psychotic-like ideations and higher distress and preoccupation associated with these ideations were correlated with poor mental health as assessed by the GHQ.

CONCLUSION

Frequency of psychotic-like ideation and its dimensions, as well as its association with poor mental health, were comparable to the studies on healthy subjects conducted in Europe.

Acute treatment response and its predictors in patients with first-episode psychosis in Iran

OBJECTIVE

The aim of this paper was to investigate the acute treatment response and its predictors in a sample of patients with first-episode psychosis admitted to a psychiatric hospital in Iran.

METHOD

A total of 163 patients with first-episode psychosis were treated with antipsychotics and other medications as prescribed by their treating psychiatrists. Sociodemographic and premorbid data at baseline and clinical data at both baseline and discharge (6+/-1 weeks after admission) were collected.

RESULTS

Patients showed a response rate of 71.4% for negative symptoms, 91.5% for positive symptoms and 67.5% for functioning. Those having a positive family history and less severe negative symptoms at baseline were less likely to respond in terms of negative symptoms. Higher premorbid and lower baseline functioning as well as acute onset were associated with the treatment response.

CONCLUSIONS

Acute treatment response of first-episode psychosis in a clinical sample of a developing country seems to be higher than that of developed countries. However, predictors of response are comparable.