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Objectives: This study aimed to investigate neuropsychological rehabilitation’s effectiveness on stroke patients’ cognitive status. Methods: This quasi-experimental study examined 22 adults with ischemic stroke of the left hemisphere (with an average age of 64.31 years) before and after the intervention. The patients had fluent aphasia (10 people) and non-fluent aphasia (12 people), along with cognitive disorders such as memory or attention disorder. Medical examination and para-clinical diagnosis of magnetic resonance imaging (MRI) with different causes, along with the Persian diagnostic aphasia battery bedside version (P-DAB-AQ1, 2016), were conducted. The severity of language disorder and type of aphasia were investigated using the Persian diagnostic aphasia battery (P-DAB-1) and Persian picture naming battery tests. Also, the mini-mental state examination (MMSE) test checked the cognitive dimensions. Verb network strengthening therapy, treatment of underlying forms, Persian verb, and sentence production protocol, and semantic feature analysis (SFA) for patients were also used. Results: Findings show that the participants’ average aphasia quotient (AQ1) score increased from 74.80 to 80.12, and the average MMSE score increased from 17 to 22.59. The main variables do not follow a normal distribution (P

Objectives: Children with disabilities need assistive technology (AT) to explore their surroundings, participate in social activities, and gain developmental skills. This study aimed to assess AT needs and barriers to access it for these children. Methods: The study participants comprised 217 children with disabilities aged 6-12 years, randomly selected from the registration list of Chaharmahal and Bakhtiari Welfare Organization, Chaharmahal and Bakhtiari Province, Iran, in 2022. After obtaining informed consent from their parents, study data were gathered by phone interview using the rapid assessment of AT (rATA) tool of the World Health Organization (WHO). Results: Among the 217 participants, 108(49.8%) used AT devices, and 102(47%) had unmet needs. Of the 55 AT devices named in the rATA, only 14 were used by the children. The most commonly used devices were hearing aids, glasses, and wheelchairs. Unmet needs of ‘chairs for bath/toilet,’ ‘wheelchairs,’ and ‘therapeutic footwear’ accounted for 50% of 132 unmet AT needs. The most common reasons for lacking AT were lack of financial resources (52%) and knowledge about AT devices (30.1%). Most clients were satisfied with AT-use training (92.3%), but only 20.2% were satisfied with AT device repair services. Discussion: This study highlights the need to improve AT device repair services, overcome financial challenges, and increase parental knowledge about AT devices as the most prevalent barriers to using AT devices. Developing a child-specific version of the rATA tool that includes questions about education and play engagement AT needs is suggested for better estimation of AT needs for children with disabilities in the future.

Background & Aims: Glycemic control is very important to prevent or suspend complications in patients with type 2 diabetes (PT2D). The aim of this study was to investigate the status of glycemic control and its related factors in patients with type 2 diabetes (PT2D) based on HbA1c, fasting blood glucose, and non-fasting blood glucose levels in Golestan Province, Northern Iran. Materials & Methods: The study employed a retrospective cohort design, collecting data longitudinally and retrospectively from 500 patients with type 2 diabetes (PT2D) who were referred to health centers in Golestan Province between 2013 and 2016 (every three months). The study focused on hbA1c, fasting blood glucose (FBG), and non-fasting blood glucose (NFBG) levels, which were recorded as binary data (1 = abnormal; if the value exceeded its cut point), indicating a lack of control over these markers. The Index of Glycemic Control (IGC) was calculated for each patient, with an IGC of 3 indicating inadequate glycemic control. Related factors were analyzed using a generalized linear mixed model with a beta-binomial distribution. Results: The results indicated that 93% of patients had an Index of Glycemic Control (IGC) equal to 3 in the first year, and this percentage decreased to 60.7% by the third year. The downward trend in IGC was gradual over the three years. Factors contributing to poor glycemic control included younger age, shorter duration of diabetes care, elevated blood lipid levels, high blood pressure, insulin therapy, and overweight or obesity as indicated by BMI. Conclusion: The results obtained from the samples in Golestan Province indicate inadequate blood glucose control and poor quality of care. It is essential to implement more intensive diabetes management strategies within national healthcare plans.

Abstract Introduction: The Posttraumatic Cognitions Inventory (PTCI) is a widely used measure for assessing negative posttraumatic cognitions that are common among individuals with trauma-related disorders. There was a need for a valid and reliable short form of the PTCI in Persian. Objectives: This study aimed to translate the 9-item version of the PTCI (PTCI-9) into Persian and evaluate its characteristics and psychometric properties. Methods: This was a cross-sectional psychometric study using the translation and back-translation technique. Experts assessed the scale's content validity. Participants were 207 Iranian individuals recruited from the general population, 151 of whom were trauma-exposed. Participants completed the Persian version of the PTCI-9, the Beck Depression Inventory (BDI-II), and the World Health Organization Quality of Life (WHO-QOL) scale. The psychometric properties of the Persian version of PTCI-9 were assessed using exploratory and confirmatory factor analysis (CFA) methods. Cronbach's α coefficient and Pearson's correlation coefficients were also calculated. Results: Factor analyses supported a three-factor model including the Self, World, and Self-Blame subscales. The Cronbach's alpha of the Persian version of PTCI-9 (α = 0.74) and its subscales (0.76, 0.82, 0.78) demonstrated acceptable reliability. The Persian PTCI-9 also had strong test-retest reliability (r = 0.79). The correlations between the Persian version of the PTCI-9 and the BDI-II (r = 0.60) and the WHO-QOL (r = −0.54) indicated that the scale also has convergent validity. Conclusion: The Persian version of the PTCI-9 showed acceptable psychometric properties. It is a brief and pragmatic measure that can be used in Iranian trauma-exposed patients for research and clinical purposes.

Abstract One of the informal diagnoses in DSM-5 is Caffeine Use Disorder (CUD). CUD and high levels of caffeine consumption could impact mental health conditions. This study aimed to estimate the prevalence of CUD, caffeine consumption, caffeine-related harms, and related psychiatric symptoms in Iran. A cross-sectional survey with a convenience sample of 1228 adults were conducted in Iran. Caffeine consumption was assessed across 20 products in Iran. Caffeine Use Disorder Questionnaire (CUDQ), Caffeine Withdrawal Symptoms Questionnaire (CWSQ), 14-item Caffeine-related Harm Screening (CHS), and Symptom Checklist-25 (SCL-25) were used in the present study. We used SPSS (desktop version 26.0) to analyze the data using descriptive statistics, chi-square, and the least significant difference (LSD) post hoc test. The daily average caffeine consumption was 146.67 mg. The prevalence of CUD and caffeine withdrawal (C.W.) were estimated at 19.5% and 46.62%, respectively. Also, 12.9% of responders received CUD and C.W.s simultaneously. The prevalence of CUD was higher in men than females (25.08% vs. 13.93%). 95% of participants (n = 1166) reported using at least one caffeine product yesterday. Moreover, the most reported caffeine-related harms were the desire for sugar (42.9%), insomnia (39.3%), and caffeine dependence (38.3%). Age significantly correlates with CUD (− 0.07) and daily caffeine intake (0.08). Moreover, all SCL-90 subscales had a significant correlation with daily caffeine intake. Finally, responders at younger ages reported higher levels of CUD and caffeine consumption than older adults(P

Abstract Background Smoking is a significant public health problem, and there is a scarcity of documents regarding its severity, particularly in developing countries. This study aimed to determine factors related to the number of cigarettes consumed daily by adult smokers in Tehran. Methods This study was conducted within the framework of the longitudinal study of Tehran Lipid and Glucose Study (TLGS). The study included 786 adult smokers living during four consecutive follow-ups from 2005 to 2016. The intensity of smoking was measured by the number of cigarettes consumed daily by adult smokers. Data analysis was done longitudinally and based on the mixed effects zero-inflated discrete Weibull (ZIDW) regression model. Results The mean age of the individuals was 40.35 ± 12.68 years, and 643 (81.8%) of them were men. Also, 52.7% of individuals were daily smokers, 15.6% were occasional smokers, and 31.7% were non-smokers who became smokers during the study. Variables of age 1.005 (95%CI: 1.001–1.008), gender of male 1.196 (95%CI: 1.051–1.39), and marital status (divorced/widowed vs. single) 1.168 (95%CI: 1.015–1.39) were positively associated with smoking intensity. Education level (master and higher vs. illiterate) 0.675 (95%CI: 0.492–0.926)), employment status (student vs. unemployed) 0.683 (95%CI: 0.522–0.917), (housewife vs. unemployed) 0.742 (95%CI: 0.606–0.895), (Unemployed with income vs. unemployed) 0.804 (95%CI: 0.697, 0.923), implementation of smoking prohibition regulations (yes vs. no) 0.88 (95%CI: 0.843–0.932), and history of cardiovascular disease in male relatives (yes vs. no) 0.85 (95%CI: 0.771–0.951) were associated with lower smoking intensity. Conclusion We showed that demographic factors are associated with the intensity of smoking among adults and should be considered in policymakers’ intervention programs to reduce smoking and quit smoking.

Objective The present study aims to examine the effect of a play-based intervention on the anxiety of mothers of premature babies admitted to the neonatal intensive care unit (NICU). Materials & Methods This is a non-blinded randomized controlled clinical trial. The participants were recruited from among the mothers of premature babies (0.05). The ANCOVA results showed that the effect size of intervention on state anxiety (P=0.001) and total anxiety score (P=0.004) was 27% and 20%, respectively. Conclusion The play-based intervention, can reduce the anxiety of mothers of premature babies admitted to the NICU and consequently affect the growth of children and mental health of family and society.

Objective Schizophrenia is the most debilitating psychiatric disorder with the highest psychiatric ward admission rate. Drug therapy is the first line of treatment. However, it does not result in appropriate therapeutic responses in many patients, and they experience emotional regulation difficulties and psychosis symptoms after initial symptom resolution. Cognitive-behavioral therapy (CBT) is currently an adjuvant treatment besides drug therapy to target the persistent symptoms of psychosis. The present study aims to determine the effectiveness of CBT on the positive and negative symptoms and emotional regulation of those suffering from schizophrenia spectrum disorders. Materials & Methods The research design was single-subject and of the AB type (baseline and intervention) with a follow-up phase. Besides the routine therapy sessions, CBT sessions were held for the study participants. They were patients admitted to Razi Educational and Therapeutic and Research Psychiatric Center in Tehran City, Iran, who were selected based on the inclusion criteria. Thirty patients were selected with convenience sampling, and 5 were randomly placed in the CBT group. They were evaluated with the scales of positive and negative symptoms of Kay, Fiszbein, and Opler (1986) and difficulties in emotional regulation by Gratz and Roemer (2004) in the baseline, intervention, and follow-up phases. The treatment sessions were planned based on the CBT protocol developed by Laura Smith, Paula Nathan, Uta juniper, Patrick Kingsep, and Louella Lim (2003). Non-overlap of all pairs (NAP), percentage of non-overlapping data (PND), percentage of all non-overlapping data (PAND), percentage of data points exceeding the median (PEM), Cohen’s d effect size, and improvement percentages were used to analyze the data, and visual graphs were used for data presentation. Results The outcomes showed that in the intervention phase, compared to the baseline phase, the effect sizes of the positive and negative symptoms in the first to fifth participants were 1.6, 3.1, 3.2, 1.9, and 2.4, respectively. Only the effect sizes of the second and third participants were large. The effect sizes of the emotional regulation factor in the first to fifth participants were 2.8, 1.2, 1.1, 2.2, and 1.9, respectively. The effect size of the second participant was large, and the rest were average. The findings of this study showed that during the post-therapy and follow-up stages, while patients who had received CBT still experienced positive and negative symptoms of psychosis and difficulties in emotional regulation; these symptoms decreased in comparison with the baseline phase. Furthermore, their improvement percentages were not significant. Conclusion Data analysis showed that although CBT is effective in reducing positive and negative psychotic symptoms and improving the emotional regulation of patients, the data obtained from Cohen’s d effect size and recovery indices showed that the results are not clinically significant. In other words, although the patients who received CBT showed a slight improvement in psychotic symptoms and difficulty in emotional regulation, they could not maintain the therapeutic gains in the follow-up phase.

Objectives: The presence of skilled, motivated therapists is critical to meet the rehabilitation needs of children with disability. This study aimed to determine whether on-the-job training on applying goal attainment scaling (GAS) affects pediatric occupational therapists' burnout and job motivation. Methods: This study was quasi-experimental with a pre-test-post-test design. After signing the informed consent, 35 pediatric occupational therapists at a child rehabilitation center attended a course of five 1.5-2 h workshop sessions during 5 consequent weeks on applying GAS in their workplace. Through the workshop, the trainees practiced setting goals and making 5-point scales to measure the degree of reaching those goals. The participant asked to bring some of their client's descriptions (anonymous) to the workshop as samples to talk about them. Afterward, they were asked to fill in the GAS documentation form as part of their rehabilitation records. Participants' job motivation and burnout scores were measured by the Maslach questionnaire and Loudahel Kitchener's Job Motivation Scale, respectively, before the workshop and 30 and 60 days later. The paired t-test and Wilcoxon test were used for comparisons. Results: The Mean±SD job motivation scores, which were 42.37±6.73 before the intervention, rose to 52.82±8.51 and 56±7.59 at the end of the workshop (day 30) and on follow-up measurement (day 60), respectively (P

Mental health system responsiveness (MHSR) is one of the important indicators in measuring the performance of mental health systems. Recognizing this function can be effective in responding appropriately to the needs of People with Pre-Existing Psychiatric Disorders (PPEPD). This study aimed to investigate MHSR during the COVID-19 period in PPEPD in Iran. Using stratified random sampling, 142 PPEPD who were admitted to a Psychiatric Hospital in Iran one year before the onset of the COVID-19 pandemic were recruited for this cross-sectional study. Participants completed a demographic and clinical characteristics questionnaire as well as a Mental Health System Responsiveness Questionnaire through telephone interviews. The results show that the indicators of prompt attention, autonomy, and access to care were reported as the worst-performing and the confidentiality indicator as the best-performing. The type of insurance affected the access to care and the quality of basic amenities. MHSR has been reported to be poor in Iran in general and this problem worsened during the COVID-19 pandemic. Considering the prevalence of psychiatric disorders in Iran and the degree of disability of these disorders, structural and functional changes are needed for adequate MHSR.

Abstract The multivariate marginal model can be used to simultaneously examine the factors affecting both FBS and HbA1c using longitudinal data. The model fitted to multivariate longitudinal data should prevent redundant parameter estimation in order to have greater efficiency. In this study, a multivariate marginal model is used to simultaneously investigate the factors affecting both FBS and HbA1c with longitudinal data for patients with type 2 diabetes in Northern Iran. The present research is a retrospective cohort study. Overall, 500 medical records with complete information were reviewed. The multivariate marginal model is used to determine the factors associated with FBS and HbA1c using longitudinal data. Data have been analyzed in R-3.4.0 using ‘mmm2’ package. Given that the coefficients for the interactions of rtype with the intercept, time, family history of diabetes, history of hypertension, history of smoking, insulin therapy, systolic/diastolic blood pressure and duration of disease at first visit are significantly different from zero (P 0.05), indicating that their effect on the two response variables is similar and only one coefficient should be used for each. We examined the similarity of coefficients when fitting the longitudinal multivariate model for the relationship between FBS/HbA1c and sex, age, history of high blood cholesterol, and body weight. If an independent variable has similar effects on both responses, only one coefficient should be estimated, which will increase the efficiency of the model and the reliability of the results.

Objective: The burden on caregivers of patients with severe mental disorders is significantly higher than the care burden of patients with other medical conditions. Substance use disorder is also one of the most common psychiatric disorders that has negative effects on people's quality of life. This study was designed to investigate caregiver burden in severe mental disorders versus substance use disorder. Method: First-degree relatives of patients admitted to the Razi Psychiatric Hospital of Tehran with a diagnosis of schizophrenia, bipolar disorder type1, schizoaffective disorder, or substance use disorder entered this study. They completed the sociodemographic questionnaire for patients and caregivers and the Zarit burden interview for caregivers. Results: Our study shows that caregiver burden in substance use disorder has no significant difference with that in severe mental disorders (P > 0.05). In both groups, the highest spectrum of burden was moderate to severe. To find caregiver burden related factors, a general linear regression model with multiple predictor variables was fitted. In this model, caregivers’ burden was significantly higher in patients with comorbidity (P = 0.007), poor compliance (P < 0.001), and in female caregivers (P = 0.013). Conclusion: Statistically speaking, the caregiver burden in substance use disorders is as severe as other mental disorders. The considerable burden on both groups necessitates serious efforts to minimize its negative effects.

Medullary thyroid cancer accounts for 5-10% of thyroid carcinomas. RET proto-oncogene mutations occur in all of the hereditary MTCs and about 66% of the sporadic MTCs. So, the detection of the RET mutations is necessary for rapid and proper diagnosis and treatment. This systematic review seeks to find a comprehensive list of RET gene mutations in the diagnosis of medullary thyroid cancer. The previous studies on RET proto-oncogene mutations in the diagnosis of medullary thyroid cancer were searched in the major databases including PubMed, Scopus, Medline, Embase and NCBI between 2010 and 2021. Missense mutations in exons 10, 11, 13, 14, 15, and 16 of the RET proto-oncogene have the highest frequency in MTCs. The most common mutations in FMTC, are in codons 609, 611, 618, and 620 in exon 10, codon 768 in exon 13, codon 804 in exon 14, and codon 634 in exon 11. In the case of MEN2A, RET gene mutations have been observed in exons 5, 8, 10, 11, with the highest mutations in exons 10 (codons 609, 611, 618, and 620) and exon 11 (codons 630 and 634). Moreover, M918T mutation in exon 16 and A883F mutation in exon 15 have been detected in 95% and 5% of the patients with MEN2B respectively. In the case of MTC, the M918T mutation in exon 16 is the most common mutation, which is associated with a poor prognosis. RET genetic screening is crucial for an exact approach to the diagnosis and treatment of MTC. Anyone with MTC, even without a family history of MEN2, should be genetically tested for the RET mutations to confirm or rule out the inherited disease and, if necessary, preventive thyroidectomy. This systematic review provided a comprehensive list of the reported mutations in the RET gene for the diagnosis of medullary thyroid cancer.

Objective Knee osteoarthritis is a common, progressive, and chronic disease that affects approximately 13% of the population over the age of 60. Osteoarthritis causes progressive disability and changes in gait parameters, decreased function and quality of life of patients by causing malalignment of the knee in the frontal plane following destruction of articular cartilage. Braces as a mechanical intervention are a successful treatment for osteoarthritis knee and its associated malalignment. Using a three-point pressure mechanism, braces create a natural alignment in the knee by straps attached to the thigh and shank shells, which reduce the medial knee load and correct the varus alignment. This distributes the force properly while walking. However, applying a constant force on three pressure points of the leg, thigh and affected knee joint reduces the adduction angle of the knee in all phases of gait cycle , while the correction of the adduction angle of the knee in patients is essential only in phases between 30% to 60% of the stance phase, when the knee deviation reaches its peak. The aim of this study is to design and fabricate a brace joint with a new intermittent correction mechanism for patients with osteoarthritis medial compartment knee and to investigate its effect on a patient's gait parameters. Materials & Methods The new joint design of the knee brace was based on the conversion of the knee extension movement at the end of the swing on the sagittal plane to the abduction movement on the frontal plate by stretching the converter piece. Participant gait was assessed in two ways with and without braces. Kinematic variables including knee joint angles in the sagittal and frontal planes and spatio-temporal variables of patient gait were measured and recorded. Results The results of the new brace joint function on the knee showed that the angle of flexion of the knee in the swing phase increased from 44.72° to 46.19° when using brace. Also, knee adduction angle in the stance phase decreased from 4.25° to 2.3° and patient's walking speed while wearing the brace increased from 0.88 m/s to 0.93 m/s. On the other hand, step length increased from 1.125 m to 1.451 m when using brace and the percentage of stance phase decreased from 63.53 to 62.68 when using brace. Conclusion In this one-sample study, a knee brace with a new joint was able to help correct the direction of knee joint in the frontal and sagittal plane and affect the patient's gait parameters. It seems that if the same results are obtained in a large-scale clinical study, this brace could be a suitable replacement for invasive methods and inappropriate orthoses.

Objective Activities of daily living are activities that are formed in order to take care of the body and are essential for life and well-being and fundamental survival. These activities begin in infancy and are modified at different stages of development. Cultural values, parental expectations, social routines, and the physical environment influence daily activities. Concerns about children's use of time and daily activities are not new, but studies on them are rare. So to have more information and knowledge about children's lives and well-being, we need to have more information about their daily activities. The aim of this study was to investigate the time allocated to daily life activities based on the day of the week, age and gender in healthy children under 5 years in Isfahan. Materials & Methods In this survey (descriptive-analytical) study in which healthy children under 5 years old in Isfahan were present, from different age groups according to the population of that age group, 240 girls and boys so that the number of girls and boys were equal in the age categories of less than 1 month, 2 to 3 months, 4 to 6 months, 7 to 12 months, 1 to 2 years and 3 to 5 years, were selected by multi-stage, stratified, cluster and convenience sampling . In order to collect research data, demographic questionnaire and time use diary tools were used. Results The results showed that on weekdays, among the components of daily life activities, the most time with an average of 150.59 minutes per day is devoted to eating (and drinking) and the least time with an average of 0.02% per day is devoted to caring of Personal belongings, while in the last days on average the most time is spent eating (and drinking) and the least time is spent on other daily activities. In different age groups on weekdays, infants 0 to 1 month with an average of 273.35 minutes per day have the most time and children 25-60 months with an average of 154.65 minutes per day have the least time devoted to daily life activities on weekdays. Meanwhile, infants in the age group of 0-1 months on a weekend spent the most time on daily activities and children in the age group of 25-60 months spent the least time on daily activities. Girls and boys spent the most time eating (and drinking) among the activities of daily living on a weekend, while boys and girls spent the least time on other daily activities that are not categorized in this study. There was no significant difference Between the time allocated to daily life activities on weekdays and weekends and between the time allocated by girls and boys under 5 years old living in Isfahan on one day a week to activity of daily livings, both on weekdays and weekends (P>0.05). However, there is a significant difference between the time use of daily life activities in different age groups on weekdays and weekends (P

The presence of the antibodies against the main thyroid antigens, which include thyroid peroxidase (TPO) or microsomal antigen, thyroglobulin (Tg) as well as thyrotropin receptor or Thyroid Stimulating Hormone Receptor (TSH-R), is a hallmark and symbol of the autoimmune thyroid diseases (AITDs) as one of the most common autoimmune diseases (AD) around the world. The prevalence of the thyroid peroxidase antibodies (anti-TPO antibody) and the thyroglobulin antibodies (anti-Tg antibody) is considerably higher in patients suffering from Graves’ disease (GD) and Hashimotochr('39')s thyroiditis (HT, chronic autoimmune thyroiditis, autoimmune hypothyroidism). While the TSH receptor antibodies (TRAbs) are common in the patients suffering from GD, they are relatively rare and infrequent in HT patients. This fact may indicate that TRAbs are more specific than other antibodies. In fact, TRAbs as one of the most important autoantibodies against the different thyroid antigens, are a set of the heterogeneous group of antibodies that based on the function, fall into three categories, including TSHR-stimulating antibodies (TSAbs), TSHR-blocking antibodies (TBAbs), and the neutral antibodies (no effect on receptor). TSAbs and TBAbs result in overproduction and reduction of intracellular cAMP respectively. Therefore the induction of the relevant signaling pathways can be the cause of different clinical symptoms in the form of hyperthyroidism or hypothyroidism consecutively. The extra-thyroidal effects of TRAbs as the extra-thyroid GD manifestations, such as ophthalmopathy and dermopathy, often have an effect on the eyes as well as the skin with the relatively well-known immunological mechanisms of the antibodies functions. Hashimoto encephalopathy is an extra-thyroidal effects of anti-TPO that provokes the central nervous system. On the other hand, anti-TPO like anti-Tg can affect the reproductive organs of women and lead to infertility by an unknown mechanism. Moreover, the circulating antibodies against the thyroid antigens can also be detected in other autoimmune diseases such as rheumatoid arthritis (RA), type I diabetes (T1DM) and celiac disease (CD). In this review article, the most important types of thyroid autoantibodies, their essential immunological processes in AITD as well as the main and important clinical extra-thyroidal manifestations of them have been discussed and reviewed.

Background: Functional performance plays an important role in the independence and participation of people with severe psychiatric disorders. The Bay Area Functional Performance Evaluation-Task-Oriented Assessment (BaFPE-TOA) is a tool that evaluates functional performance. The present study aimed to assess the convergent validity and inter-rater reliability of the BaFPE-TOA tool using the classic test theory. Methods: In this psychometric study, the population comprised people with severe psychiatric disorders. Participants were selected according to the inclusion criteria and convenience sampling. Consent to participate in the study was given by all participants. To examine the convergent validity, two tests, the BaFPE-TOA test and Kohlman Evaluation of Living Skills (KELS) test, were performed for 55 patients. To assess the inter-rater reliability, two examiners (occupational therapists) performed the BaFPE-TOA test for 26 patients simultaneously. Then, the Pearson correlation coefficient was used to examine convergent validity, and the intraclass correlation coefficient was used to assess inter-rater reliability. Results: Participants in this study comprised 44 men (81.8%) and 10 women (18.2%). The age of participants ranged from 22 to 69 years with a mean of 41.5 years (SD = 10.5). The Pearson correlation coefficient between the BaFPE-TOA and the KELS was good (r=0.74, p -value

Objective: This study aimed to design a “gait enhancer” and investigate its effect on standing ability and gait speed of children with cerebral palsy spastic diplegia. Materials & Methods: A new gate trainer was designed based on Theo Johnson mechanism. Johnson's two separate movement chains were placed on either side of the gate trainer body and attached to the lower limbs by a foot plate. To investigate the effect of the designed device, a single-item experimental study with baseline design, treatment and maintenance (ABA) was performed on four children with available spastic diplegia cerebral palsy. These children received routine occupational therapy sessions. Results: The designed “gait enhancer” increased standing ability and gait speed scores in all subjects. Non-overlapping measures also indicated the improvement in both variables. Measured by Cohen’s d, the effect size for standing ability were 1.95, 2.29, 1.83, and 2.3 for the child No. 1, 2, 3, and 4, respectively. Regarding walking speed, the effect size for these children, No. 1 to 4, were 1.13, 3.37, 2.15, and 2.21, respectively. Cohen’s d values were greater than 0.8, indicating the considerable effect of the intervention. Hedges’ g was also calculated due to the small sample size, which was greater than 0.8 for all subjects in standing ability and gait speed. Conclusion: Following the use of Gait Enhancer along with conventional occupational therapy, we observed an increase in the ability to stand and walk at children with cerebral palsy. Findings showed that the change in standing ability and walking speed occurred more during the period of using the designed device than other stages, which could be a consequence of using Gait Enhancer along with routine occupational therapy sessions at this stage of the study. However, it should be noted that this study was only a single case study and to prove the effectiveness of this tool in children with cerebral palsy, it is necessary to conduct clinical trial studies.

Background: Voice production is a complex mechanism, and the primary tool of the population of professional voice users requires special care. Hence, one area of learning provided by speech and language pathologists to this population is vocal hygiene. The current study was conducted to investigate the effectiveness of vocal hygiene education on actors' knowledge. Method: In this semi-experimental study of one-group clinical trials, 50 actors (29 males and 21 females aged 18-50 years) were selected based on available sampling. Participants were asked to complete the "assessment of actors' vocal knowledge" questionnaire. During 4 sessions lasting 60 minutes each, the participating actors were trained on the vocal hygiene package. One week after the last training session, participants were again asked to complete the questionnaire. Data was analyzed using SPSS software version 21, and indicators of descriptive statistics were analyzed. Results: The mean score of voice abuse and non-abusive behaviors, which was 23.34 before training with the vocal hygiene package increased to 28.56 after education, a statistically significant change (p

Objective: One of the most significant issues in children with attention deficit hyperactivity disorder (ADHD) is emotional/behavioral problems, which disrupt their social communication at home and school. Some of these problems include social problems, rule-breaking behavior, and aggressive behavior. These problems, if left untreated in childhood, can cause problems in adulthood such as substance abuse, insubordination in the workplace, shorter stay at a job, and more anti-social acts. Nowadays, the use of play therapy for children with ADHD has become common. It is an active approach that allows the children to express their feelings through play. In group play therapy, children are asked to evaluate their personality according to their peers’ reactions. The study investigates the effect of group play therapy on emotional/behavioral problems in children with ADHD aged 6-12 years. Materials & Methods: This is a randomized controlled trial. The study population consists of all children with ADHD referred to the Dostdaran Koodak Occupational Therapy Clinic in Isfahan City, Iran. Of these, 28 children aged 6-12 years (average age: 8 years), including 8 girls and 20 boys, were selected using a convenience sampling technique. First, the study objective was explained to the parents, and children were then randomly assigned into the intervention and control groups. Considering error (d)=3, with 95% confidence level and 80% test power, the sample size was determined 14 for each group. The intervention group received 12 sessions of group play therapy (2 sessions per week, each for 45-60 minutes), besides two sessions of individual occupational therapy per week. However, the control group received two sessions of occupational therapy per week only. The emotional/behavior problems of subjects in both groups were assessed before and after the intervention using the CBCL. Data analysis was performed in SPSS V. 21 software using the Shapiro-Wilk test and ANCOVA. Results: After the group play therapy, there was a significant decrease in the scores of emotional/behavioral problems, including social issues, aggressive behavior, and rule-breaking behavior, as well as in the overall score (P˂0.001). Conclusion: Group play therapy can be used as a complementary method with other common occupational therapies for reducing the emotional/behavioral problems in children with ADHD.

Objectives: The most distinctive group of people with sensory disabilities is those with visual impairment. This study aimed to evaluate the relationship between behavioral problems and demographic variables in students with visual impairment in the academic year of 2018-2019 in Tehran City, Iran. Methods: This cross-sectional, descriptive, and analytical study was conducted on students with visual impairment studying in four schools of exceptional children at the elementary and high school levels. The research population was 400, and the sample size was estimated at 200 using Cochran’s formula. The sampling was carried out using the random cluster sampling method, where the floors of the school were considered and visually-impaired students were selected randomly from each school based on the number of students. Demographic characteristics questionnaire and Rutter behavior evaluation questionnaire (teacher form) were used to collect data. Results: The Mean±SD behavioral problems score was 12.9±10.7. According to the results, there was a negative and significant correlation between the subscales of behavioral problems with age and duration of the impairment. A significant difference was found in the mean of behavioral problems of visually-impaired or blind children caused by accident with those with congenital and hereditary problems. The regression model showed a significant difference between male and female subjects in terms of behavioral problems in a short duration after the injury (≤5 years). Discussion: Given the relationship between behavioral problems with gender and duration of injury, it is recommended that interventions be carried out during the first few years of injury, especially for female individuals, to prevent or reduce the severity of behavioral problems.

Objective: Cerebral Palsy is one of the most common neurodevelopmental disorders in children. Due to the increase in the number of students with Cerebral Palsy (CP) entering ordinary schools and facing problems with independent functioning, there is a need for a valid and comprehensive assessment tool for their successful entry as well as providing a proper treatment plan. The School Function Assessment (SFA), by measuring many school-related functional skills, can identify the strengths and weaknesses affecting the students’ independence and participation in school assignments. It has 320 items and three main parts of participation, task support, and activity performance. The test score can be reported in general or based on each part, separately. The purpose of this study is to examine the validity and reliability of the Persian version of the SFA in children with CP. Materials & Methods: This is a cross-sectional study with methodological design. The study population consists of all children with CP aged 7-12 years in Tehran. Of these, 120 were selected from exceptional public school using a convenience sampling method. The inclusion criteria were: CP diagnosed by a neurologist, age between 7 and 12 years, no other disabilities (e.g. deafness or blindness), and the willingness of children’s parents to participate in the study. A demographic form and the Persian SFA were used for data collection through interview. In order to measure the content validity, Content Validity Index (CVI) and Content Validity Ratio (CVR) were calculated according to the standard protocol of International Quality of Life Assessment. In this regard, 8 experts in the field of pediatrics completed the Persian SFA. To determine the test-retest reliability, the questionnaire was completed by the parents of children with a 4-week interval. The internal consistency and test-retest reliability were examined by using Cronbach’s alpha coefficient and Intra-class Correlation Coefficient (ICC), respectively. Data was analyzed in SPSS V. 22 software. Results: Participants were 64 boys and 56 girls with CP (mean age= 9.4 years). The distribution of CP was as follows: 10% hemiplegic CP, 27.5% diplegic CP, 5.8% monoplegic CP, and 56.7% quadriplegic CP. Eighty hundred-eight percent of respondents were the mothers of students. The CVR and CVI values were in a range of 0.7-1 and 0.87-1, respectively indicating an acceptable validity. All the items had acceptable content validity. The Cronbach’s alpha coefficient was obtained 0.95 for participation, 0.95-0.99 for task support, 0.83-0.99 for activity performance, and 0.92 in total. Moreover, the ICC value was reported 0.90 for participation; 0.84-0.91 for task support; 0.84-0.97 for activity performance; and 0.89 for the overall test. Conclusion: The Persian version of SFA has acceptable content validity and reliability (internal consistency and test-retest) for children with CP. Therefore, it can be applied as a research and clinical tool to assess the school-related performance of these children.

Objective: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects the person’ life. The prevalence of ASD in Iran is increasing. The complicated nature of this disorder disrupts the balance and work routines in the family, which puts a lot of stress on the entire family, especially mothers. Mental health of the mother affects all family members, including a child with ASD. On the other hand, mothers’ confusion and failure in relation to their ASD child causes more stress and discomfort for them. In this study, we aimed to investigate the effect of filial therapy, as a play therapy, on the parenting stress of mothers with ASD children. Materials & Methods: In this experimental study, participants were the mothers of 32 children with ASD (9 girls and 23 boys) aged 4-12 years referred to autism centers and occupational therapy clinics in Isfahan, Iran who were selected using a convenience sampling method. After obtaining an ethical approval from the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (code: IR.USWR.REC.1396.97), and necessary permissions, researchers referred to the clinics and after explaining the purpose of the study to the mothers, an informed consent was obtained from them. Then, they completed a demographic form, Gilliam Autism Rating Scale-2 (GARS-2), and Abidin’s Parenting Stress Index-Short Form (PSI-SF). Participants were randomly divided into two intervention and control groups after matching for the child’s age, GARS score, and the education of children and mothers. The intervention group received 10 sessions of filial therapy, once a week, each for two hours, while the control group continued routine treatment. After intervention, PSI-SF was completed by all mothers again. The collected data were analyzed by using ANCOVA, paired t-test and independent t-test. Shapiro-Wilk test was used to determine the normality of PSI-SF data distribution at Pre-test and Post-test phases. Results: Paired t-test results showed that there was no statistically significant difference in the mean total parenting stress score between the two groups in the Pre-test phase (P= 0.679) but it was significant in the Post-test phase (P=0.010). The results of independent t-test showed that the difference between the mean Pre-test and Post-test scores of total parenting stress in the control group was not significant (P= 0.268) but it was significant in the intervention group (P=0.001). ANCOVA results showed that the Pre-test score of parenting stress had an effect on the total parenting stress score after intervention such that it could explain 82% of variations in this variable. After controlling the Pre-test score, the total parenting stress was significantly different in two groups (P=0.001). Eta squared value indicated that the intervention could explain 54% of changes in total parenting stress of mothers. Conclusion: Filial therapy can help better acceptance of the ASD children by their parents and reduce parenting stress by improving child-parent relationships. This method can be taught as a complementary intervention to the mothers of ASD children.

Background: Qualified care and decreased blood sugar can prevent or suspend the side effects in patients with type 2 diabetes mellitus. The present study aimed to determine the state of glycemic control and related factors in patients with type 2 diabetes mellitus in the post-diagnosis care period using generalized estimator equations (GEE) model. Methods: In this historical cohort study, data from 500 patients with type 2 diabetes mellitus that were under care in health centers in Golestan Province, Iran, were collected for three years (2013-2014). For each individual, the biological markers [fasting blood sugar, non-fasting blood sugar, and glycated hemoglobin (HbA1c)] outside the standard cut-point were counted as the response variable (called the "count of abnormal markers"). This variable could have numbers from zero to three. A higher number indicated less glycemic control. Findings: The mean age of the patients was 45.2 years, and 58.8% were women. The "count of abnormal markers" variable had a very slow downward trend over three years. The results of the model showed that associated significant factors with increasing "count of abnormal markers" included short duration of care (b = 0.77), no family history of diabetes (b = 0.47), low age of diagnosis (b = -0.06), obese-overweight (b = 0.03), having a history of hyperlipidemia (b = 0.31), and having insulin therapy (b = 0.24). Conclusion: According to the results, glycemic control does not show the desired condition, and in addition to continuous care and more strictness of patients, their weight, blood lipids, and insulin treatment should be controlled as well.

Objectives: The present research aimed to determine the effect of time-use training on the quality of time management in the mothers of girls with Intellectual Disability (ID) attending special schools. Methods: This was a quasi-experimental study with a control group design. In total, 80 mothers (40 mothers in the intervention group & 40 mothers in the control group) of children with ID (age range: 6-13 years) were studied. The study participants were selected by cluster sampling method. The required data were collected using a demographic data questionnaire and the Mothers’ Time Use Questionnaire (MTUQ). A time management training program was provided in a one-day workshop for the intervention group. The obtained data were analyzed in SPSS using Independent Samples t-test, Paired Samples t-test, and Chi-squared test. Results: After the intervention period, the quality of time management of the mothers in the intervention group significantly increased, compared to the controls (P

Objective: After respiratory disorders, musculoskeletal disorders are the second prevalent cause of short-term sickness absence (less than 2 weeks). The nature of the work in physiotherapy requires physical activities, which include repetitive skills, manual techniques, putting direct pressure on a particular joint, unskilled posture during special maneuvers, and having long postural positions. Several studies have reported that physiotherapists frequently experience musculoskeletal disorders. This study aims to determine the relationship between Work-Related Musculoskeletal Disorders (WRMDs) and the common therapeutic methods used by Iranian physiotherapists. Materials & Methods: This is a descriptive-analytical epidemiological study with a cross-sectional design. The study population consists of physiotherapists working in Iran. Data collection tools included a demographic form, as well as general Nordic questionnaire designed by Kuorinka et al. to detect the WRMD symptoms in 9 body areas in the past year. The questionnaires were distributed among participants in cooperation with the Iranian Physiotherapy Association during the 27th Iranian Physiotherapy Congress. Data analysis was performed in SPSS using the Chi-square and Fisher exact tests. Results: Of 1200 questionnaires distributed among physiotherapists, 685 questionnaires were returned after completion. Of these, 16 were excluded due to missing some inclusion criteria, 4 due to having a work experience less than one year, and 11 due to having other diseases, such as neurological and rheumatic diseases, malignancies, and joint replacement. The mean±SD age of the participants was 37.9±9.91 years ranged from 22 to 69 years; 53.9% of them were female and 46.1% male. After obtaining the prevalence of WRMDs, its significant association with the type of used treatment method was examined by the Fischer exact test. The results showed a significant correlation of WRMDs with treatment methods in 7 out of 9 areas. In particular, WRMDs were associated with manual massage (P=0.001), myofascial release (P=0.011), mobilization (P=0.007), muscle energy technique (P=0.007), and dry needling (P=0.032) in the neck area; with mobilization (P=0.005) and taping (P=0.014) in the shoulder area. Also, WRMDS are associated with respiratory physiotherapy (P=0.007) in elbows. WRMDS are correlated with manual massage (P=0.027), myofascial release (P=0.001), mobilization (P=0.046), muscle energy technique (P=0.004), and taping (P=0.016) in wrists/hands. In the upper back, WRMDs are associated with manual massage (P=0.007), mobilization (P=0.014), and taping (P=0.004). In the lower back, WRMDs are seen with myofascial release (P=0.036), mobilization (P=0.015), taping (P=0.035), and muscle energy technique (P=0.044). Finally, WRDMs are observed with water therapy (P=0.037) in knees. Conclusion: There is a high prevalence of WRMDs among physiotherapists in Iran. Its rate has a significant relationship with the type of treatment methods. Some physiotherapy methods can increase the prevalence of WRMDs.

Objectives: The current study investigated the potential acceptability and effectiveness of Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) in developing children’s participation and mothers’ parenting self efficacy. Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) involving contextually reflective occupational therapy combines 3 elements: parent coaching, child’s sensory processing patterns, and social support of parents. Intervention sessions comprised group parents training and (individualized) coaching sessions, which reflective questions and discussions with mothers support them in identifying best plans to achieve their therapeutic goals. Method: In this pilot research, we employed a single subject, A-B-A interrupted time series design across 3 participants (3 mothers of children with the diagnosis of Autism Spectrum Disorders) reffered to Navid-e-asr rehabilitation center in Tehran, in spring of 2017. The participants were selected among families who have children with diagnosis of Autism Spectrum Disorders, ages 3-10 years and had at least one sensory pattern outside typical range based on the Short Sensory Profile II. Recruitment was based upon parent reports, Short Sensory Profile II data, demographic questionnaires and informed consents. The mothers’ education participated in this research were diploma or above diploma, and they could understand and speak Persian very well. We conducted the study for eighteen weeks in 3 phases. During baseline period or phase 1, the participants received treatments as usual (TAU) for 4 weeks. During intervention period or phase 2, the participants received Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) for 10 weeks, 1 week group parents mothers training (two sessions) and 9 weeks individualized coaching sessions (1 session per week), in addition to treatments as usual (TAU). During phase 3 or follow up, participants received only treatment as usual (TAU) for 4 weeks. The intervention therapist and coach was an occupational therapist, with 20 yrs. of clinical experience in pediatric rehabilitation implemented CI-ASD sessions during the study. In this pilot research, we administered outcome measures four times: prior to the study before phase 1 (pre- intervention1), after phase 1 (pre- intervention2), after phase 2 (post- intervention) and, after phase 3 (follow- up). We measured child participation by Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS), and parental self efficacy by Parent Self Efficacy Measure (PSEM). We conducted semi-structured interviews after completing the intervention period to explore acceptability of treatment and participants’ experiences of Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD). We used visual inspection of graphed data to identify variations between phases. Results: Two of three participants )two mothers( completed the program and described growth in children occupational performance (COPM1) [13, 14, 22, 26] and [12, 12, 23, 29], satisfaction of occupational performance (COPM2) [13, 17, 22, 25] and [7, 7, 23, 29], goal attainment (GAS) [-6, -6, +2, +6] and [-6, -6, +2, +6], and parental self efficacy (PSEM) [50, 53, 57, 57] and [44, 43, 49, 55]. Two participants (mothers) found Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) highly acceptable. Data showed development in occupational performance (COPM1), satisfaction of occupational performance (COPM2), goal attainment (GAS) and parental self efficacy (PSEM) continued after 4 weeks follow up. One of three participant (one mother) had difficulty accepting Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) and left the study after 3 coaching sessions. Conclusion: On the report of two participants, Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) was acceptable to deliver and may show promise as an intervention for children with the diagnosis of Autism Spectrum Disorders and their families. Further research is needed to determine the effectiveness of Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD). Since one family did not accept the Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD), it would be useful to identify characteristics of families who may benefit most from this intervention.

Objective: High-risk behaviors are seriously threatening health and wellbeing, and increasing the likelihood of physical, psychological, and social consequences. High-risk behaviors, such as tobacco use, drug abuse, alcohol use, or malicious behaviors can endanger the health and wellbeing of adolescents and hinder their success and future growth. Today, the prevalence of high-risk behaviors among adolescents has become one of the most important concerns in society and despite the provisions made in recent years, its rate has increased. One of the vulnerable groups is orphaned/abandoned adolescents who face various social and psychological problems during their stay in welfare bearding centers that requires special skills to deal with. This study aimed to investigate the effect of social competence training on the tendency towards high-risk behaviors in male adolescents living in welfare boarding centers. Materials & Methods: This is a quasi-experimental study with a pre-test-post-test design. The study population included all male adolescents aged 12-18 years living in welfare boarding centers located in Sabzevar and Mashhad cities in Iran. For sampling, 15 adolescents were selected from a boarding center in Sabzevar City by census method and assigned to the experimental group, and 15 from a boarding center in Mashhad City selected randomly and assigned as controls. The experimental group received social competence training program in twelve 60-min sessions, while the control group received only two 8-hour first aid training. Iranian Adolescents Risk-Taking Scale (IARS) and a demographic form were used to collect data before and after the intervention. The collected data were analyzed by Multivariate Covariance Analysis (MANOVA) in SPSS V. 22. Results: The mean IARS scores in the experimental group decreased from 93.9 to 86.81 after the intervention, and the t test results indicated a significant difference between the mean scores before and after the intervention (t=2.97, P=0.010). The MANCOVA results revealed a significant difference between the mean overall score of IARS (F=24.08, P

Background The most common cognitive dysfunctions in patients with schizophrenia are information processing, memory, and learning. Based on the hypothesis of rehabilitation and brain stimulation in memory and learning, adding a form of neuromodulation to conventional rehabilitation might increase the effectiveness of treatments. Aims To explore the effects of psychosocial occupational therapy combined with anodal Transcranial Direct Current Stimulation (tDCS) on cognitive performance in patients with Schizophrenia. Methods Twenty-four patients diagnosed with schizophrenia were randomized into the experimental and control groups. We used The Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Loewenstein Occupational Therapy Cognitive Assessment battery (LOTCA) to assess spatial recognition, attention, visual memory, learning abilities, and high-level cognitive functions like problem-solving. All participants received customized psychosocial occupational therapy activities. Furthermore, the experimental group received 12 sessions of active anodal tDCS for 20 minutes with 2 mA intensity on the left dorsolateral prefrontal cortex (DLPFC) while the patients in the sham group received sham tDCS. Results Combining tDCS to conventional psychosocial occupational therapy resulted in a significant increase in spatial memory, visual learning, and attention. Conclusions Anodal tDCS on the left DLPFC improved visual memory, attention, and learning abilities. Contrary to our expectations, we could not find any changes in complex and more demanding cognitive functions.

Objective: Seizure is the most common neurological disorder in pediatric medicine. This disorder is often chronic and requires continuous treatment. Developmental disorders are conditions that can occur due to abnormal development or damage to the brain and central nervous periods (out-of-hospital). However, in most studies, the severity of seizure relapse is mistakenly considered the same for each period. The present study aimed to identify factors related to the recurrence of seizure in children with developmental disorder. Materials & Methods: In this retrospective cohort study, 228 children with developmental disorder and a history of seizures referred to the emergency department of the Children’s Hospital Medical Center in Tehran, Iran in 2016. Relapse times, admission duration and discharge time, age, sex, birth weight, type of delivery, parental relatives, maternal age during pregnancy, mother's history of medication use and disease during pregnancy, history of seizure with fever, family history of seizure, maternal delivery problems, length of pregnancy, history of admission to neonatal intensive care unit were recorded as factors affecting recurrence of seizure. Inclusion criteria were having developmental disorder and a history of seizure recurrence. The patients who were hospitalized for any reason other than seizure were excluded from the study. No intervention was performed in this study. Patients' information was recorded with their permission and based on ethical principles and the results were presented in the form of tables. Survival model was used to investigate the effect of risk factors on the seizure recurrence. If the seizure recurrence in children was controlled in hospital by medical staff, response variable (relapse time) was considered as censored. A frailty parameter was used to explain the correlation between recurrence of seizures in one subject, and a correlation parameter was used to justify the difference in in the rate of correlation between seizures in a hospital and in somewhere other than hospital. The collected data were analyzed using frailty model for recurrent event by considering restraint period. To achieve an effective and flexible approximation for estimating base intensities, the piecewise constant intensity method was used. Estimation of the parameters was performed using the Gaussian quadrature method and by NLMIXED procedure in SAS v. 9.2 software. Results: Of 228 children, 125 (54.8%) were boys and half of them were under 3 years of old. The mothers of 200 children (87.72%) had age of 18-35 years at the time of pregnancy; 96 (41.67%) of these patients were admitted to neonatal intensive care unit during neonatal period. The birth weight of 199 (28.27%) children was about 2.5-4 kg and 119 did not experience any seizure during the restraint period (in the hospital). The frequency of seizure recurrence in hospital ranged from 1 (25.88%) to 16 times (0.44%), while in out-of-hospital, it ranged from 1 (7.46%) to 11 times (0.44%). The duration of seizure recurrence was between 1 to 6196 days. Furthermore, children aged 1-2 years (P

Background: One’s voice is one of the most important tools for professional voice users, especially actors. Actors have limited knowledge of vocal hygiene that leads to vocal abuse and misuse of vocal behavior. For this reason, special care must be taken by this group in the form of vocal hygiene. Currently, no validated instrument determines knowledge levels of vocal hygiene education in actors as professional voice users. The "Assessment of actors' vocal hygiene knowledge" questionnaire is designed to measure actors' awareness of vocal hygiene. The purpose of this study was to investigate the validity and reliability of the "Assessment of actors' vocal hygiene knowledge". Methods This study was a methodological research that was conducted in two phases of designing and evaluating the validity and reliability of the "Assessment of actors' vocal hygiene knowledge” questionnaire. The participants in this study were 150 actors (91 men and 59 women) ranging in age from 18 to 45 years (mean age: 26.13 years and SD = 4.7). In this study, content validity ratio (CVR) and content validity index)CVI) was used to assess content validity. The reliability was examined using Cronbach’s alpha and test-retest. Results: All test items had good content validity (CVR> 0.62 and CVI> 0.79). Cronbach's alpha coefficient for the whole test was 0.75. The questionnaire also had a high test-retest reliability including intra-class correlation coefficient) ICC (= 0.91 with 95% confidence interval. Conclusion: The results of this study indicate that the "Assessment of actors' vocal hygiene knowledge” questionnaire has good validity and reliability for actors.

Objective Responsiveness is a process that all organizations, such as hospitals and rehabilitation centers, need to implement it in order to legitimize their activities; and on the other hand, the recipients of rehabilitation services as a citizen of the community have a special place. Therefore, the main purpose of this study was to determine and compare the response status of rehabilitation service providers from the perspective of people with disabilities (PWD) and their families in Tehran in 2016. Materials & Methods The study is descriptive-analytical and cross-sectional. The statistical population of the study consisted of all people with disabilities and their families who received rehabilitation services (Red Crescent, Wellbeing, Private Sector) in 2017. Samples were collected from rehabilitation centers of 5 districts of Tehran, using available sampling. The questionnaire was distributed based on the Response Questionnaire (World Health Organization, 2000) and 357 samples were collected. Adults with physical and motor disabilities and families with children with physical disabilities were included in the study, as well as those with mental disabilities and those who did not wish to participate in the study, as well as incomplete and unread questionnaires. The questionnaire has eight domains and included 25 questions. The questionnaire was distributed among 11 rehabilitation specialists with CVI=0.91 and the reliability of the questionnaire was confirmed by 30 questionnaires in four centers in two weeks with a correlation coefficient of 0.83 and Cronbach's alpha of 0.77. Data were analyzed through descriptive statistics (mean and standard deviation) and inferential statistics (Mann-Whitney and Kruskal-Wallis) by using SPSS V. 22. Results The results showed that the age of the majority of patients (49.6%) was in the group of 30-39 years. Depending on the type of center, the mean age included 49.5% in private centers, 49.5% in the welfare centers, and 50% in Red Crescent. The highest responsiveness was related to the dimensions of the right to choose and environmental quality (2.6 and 2.41 out of 5, respectively) in private centers, environmental quality (2.1 out of 5) in welfare centers, and then, right to choose had the highest score. The lowest accountability was reported for dignity (2.18 out of 5). The mean scores of social support dimensions in the three types of center were statistically different (P=0.001), as well as the mean scores of immediate attention (P=0.002), participation in decision-making (P=0.009), confidentiality (P=0.010), and total responsiveness (P=0.04) there was a statistically significant difference between the two groups of referral type and mean scores of immediate attention dimensions in the two sex groups (P=0.022). However, the mean scores of total responsiveness dimensions in marital status (P=0.446) and type of insurance (P=0.535) were not statistically significant. Conclusion The findings of this study displayed that responsibility as a criterion of quality of rehabilitation services, in fact, provides a clear picture of the clients’ performance. Responsibility of welfare centers was better than private and Red Crescent Centers. In this study, rehabilitation centers had the lowest performance in areas of transparent communication, dignity, and social support which may result in lower dignity which may indicate less attention to the dignity of the recipient of the service and the deficiency of insufficient insurance coverage to support rehabilitation services. While these dimensions of responsiveness are important for services recipients. Therefore, it is necessary to respond to the rehabilitation system in these areas (transparent communication, dignity and social protection). Also, it is recommended further studies in the area of responsiveness of rehabilitation system.

Objectives As Iran is one of the countries in the world which its population moves toward aging rapidly, it is essential to consider older adults' needs and concerns, which might have an impact on their health-related quality of life. Quality of life is a multi-dimensional concept that has physical, mental, and social components. The present study has been conducted to determine the correlation between economic status and educational level with health-related quality of life in community-dwelling and institutionalized older adults living in Mashhad City, Iran. Methods & Materials In this descriptive-analytic cross-sectional study, we recruited 135 (77 [57%] men and 58 [43%] women) community-dwelling older adults (Mean±SD =71.7 ±5.9 y), and 135 (65 [48.1%] men, 70 [51.9%] women) institutionalized older adults (Mean±SD =071.2±5.6 y). They were living in Mashhad City, Iran. Through the interview, we collected the subjects’ demographic characteristics, monthly income, and the level of education. The Persian validated version of SF-36 questionnaire was used for assessment of health-related quality of life. The questionnaire assesses 8 physical and mental health subscales. The statistical analysis was conducted by SPSS version 19. The Mann-Whitney U test was used to compare monthly income and health-related quality of life between community-dwelling and institutionalized older adults. The Chi-square test was used to compare the educational level of the two groups. Also, the effect of some independent variables on physical and mental health domains of quality of life was assessed by multiple regression models. Results The education level community-dwelling older adults was lower than that in institutionalized older adults (P =0.03). In general, in terms of physical and mental dimensions of quality of life, the institutionalized older adults had a lower quality of life than community-dwelling older adults ( P

Objective Autism spectrum disorders are among the most prevalent developmental disorders. Diagnostic criteria for these disorders consist of the two general categories of symptoms, including deficiencies in communication and social interactions, and limited, repetitive and stereotypic patterns in behavior, interests, and activities. Routines are well-established and the regular patterns of occupations and activities that provide structure and stability for everyday life and add meaning to it can affect health. The disabling nature of autism and its numerous associated problems unable families to develop effective and meaningful routines; consequently, the integrity and solidarity of family are lost and family is disturbed. A proper tool is required to evaluate everyday routine in the families of children with autism. The present study investigated the validity and reliability of the Family Time and Routines Index (FTRI) in the Iranian families of children with autism. Materials & Methods This was a non-experimental methodological study. The statistical population of the study consisted of all children with autism in Tehran City, Iran. Among them, 100 parents of children with autism referring to autism centers and private clinics in Tehran were selected by the convenience sampling method; they were entered into the study, according to the inclusion criteria. Inclusion criteria were the diagnosis of autism by a child psychiatrist, based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), the age of 3-11 years, and the absence of blindness, deafness, epilepsy, and other disabilities in the child. Moreover, the subjects with no desire to cooperate or uncompleted the questionnaires were excluded from the study. The required data were collected using demographic information questionnaire and FTRI completed by parents. After obtaining the permission of the designer of the questionnaire for translation and the investigation of its psychometric properties, the questionnaire was translated according to the International Quality of Life Assessment (IQOLA) project. The face validity and content validity of the questionnaire were evaluated using experts and parents’ opinions; then, a preliminary test was conducted in which the questionnaire was completed by 10 parents of children with autism to determine the appropriate time to complete the questionnaire. Consequently, 100 parents of children with autism completed the demographic information questionnaire and FTRI. Furthermore, to determine the test-retest reliability, after 2 weeks, 33 parents of children with autism re-completed the questionnaire. To examine the face validity, item impact score was calculated. To assess the content validity, Content Validity Ratio (CVR) and Content Validity Index (CVI) was used. Internal Consistency Coefficient (ICC) was used for assessing the test-retest reliability of the scale. Moreover, the internal consistency of the whole questionnaire and its subscales was assessed by Cronbach's alpha coefficient. Results Item impact score for all items of the questionnaire was over 1.5. The CVR for each item of the questionnaire was between 0.8 and 1 and for the whole questionnaire was equal to 0.87. The CVI for the items of the questionnaire was between 0.83 and 1 and for the whole questionnaire was equal to 0.97. Additionally, the intraclass correlation coefficient for the total score was equal to 0.96 and Cronbach's alpha coefficient was calculated as 0.88. Moreover, the lowest Cronbach's alpha coefficient related to the subscale of child routines (0.70) and the highest related to the subscale relative's connection routines (0.86). Conclusion The obtained results indicated that FTRI has acceptable validity and reliability in the Iranian samples and can be a useful research and clinical tool for assessing the family routines.

Background: Gambling disorder (GD) and substance use disorder (SUD) have mutual impact and each couldaggravate the effects of the other. This is the first study on GD among Iranian substance users to develop andvalidate a GD Screening Questionnaire-Persian (GDSQ-P).Methods: Iranian male adults (n = 503) with SUDs were recruited via clustered sampling. Problem gamblingscreening instruments and Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5)criteria for GD were used to develop the tool which was sequentially assessed for face validity, contentvalidity index (CVI), content validity ratio (CVR), and reliability (Kuder-Richardson coefficient). To establishconstruct validity, interviews based on DSM-5 as a gold standard method were used. A receiver operatingcharacteristic (ROC) curve was conducted to determine sensitivity and specificity.Findings: After removing items with low CVI values, 27 final items remained in GDSQ-P with impact scoregreater than 1.5. Card games (33.8%), dice gambling methods (26.6%), betting on sports teams and players(24.1%), and betting on horseback, rooster, pigeon, dog, or other animals (16.7%) were common gamblingmethods among participants. Overall Kuder-Richardson coefficient was 0.95. Cut-off threshold for GDSQ-Pwas calculated as 4.5 with 98.9% sensitivity and 98.3% specificity. The interviewers confirmed GD forparticipants based on DSM-5 as the gold standard. The prevalence of GD among participants was 17.9%based on GDSQ-P and 19.1% based on DSM-5 criteria.Conclusion: GDSQ-P is a valid and reliable tool to screen for GD in SUD treatment centers and probably inthe general population.

Objectives Considering the importance of assessing living standards in society, the present study aimed to design a living standards questionnaire. We also assessed the validity and reliability of the developed questionnaire in the Iranian elderly population. Methods & Materials This was a methodological study. Initially, by reviewing the relevant theoretical and empirical bases like questionnaires in English, 45 questions were selected for developing living standards questionnaire. Then, the content and face validity of the questionnaire were evaluated using the comments of 10 university experts. Moreover, its structural validity (factor analysis by varimax rotation) was investigated. After determining the validity of the scale, the questionnaire was completed by 150 elderly people aged ≥60 years. The internal consistency reliability of it was investigated using Cronbach's alpha coefficient and split-half reliability. The obtained data were analyzed by SPSS. Results The Mean±SD age of samples was 63.74±2.99 years. The content validity of the questionnaire was equal to 0.85. In the structural validity assessment, the Kaiser-Meyer-Olkin (KMO) value was obtained as 0.853, and three factors (living facility, housing situation, and household expenditures) together explained 56.8% of the total variances. The Cronbach's alpha coefficient was equal to 0.859 for the total scale and the Gutmann split-half coefficient was calculated as 0.859. Conclusion The obtained results revealed that the living standards questionnaire was a valid and reliable scale in Tehran's elderly population.

Objectives: The categorical data analysis is very important in statistics and medical sciences. When the binary response variable is misclassified, the results of fitting the model will be biased in estimating adjusted odds ratios. The present study aimed to use a method to detect and correct misclassification error in the response variable of Type 2 Diabetes Mellitus (T2DM), applying binary logistic regression. Methods: Data from the Diabetes Screening test in the Health Center of Zahedan City, Iran, were explored. It included 819 Iranian adults with a binary response variable (T2DM). By a new method, the misclassification parameters and the estimated parameters in logistic regression were validated. Statistical analysis was performed using SAS, and P

No Abstract

Objective The Bay Area Functional Performance Evaluation-Task Oriented Assessment (BaFPE-TOA) is a standard test developed by Williams and Bloomer in 1977-1978 in order to evaluate functional performance. This test consists of five tasks (sorting shells, money and marketing, home drawing, block design, kinetic person design), twelve parameters (memory for written and verbal instructions, organization, attention span, evidence of disorder, ability to abstract, completion, errors, efficiency, motivation and compliance, frustration tolerance, self-confidence, general affective impression) and three components (cognitive, affective, and performance components). The purpose of this study was to translate the BaFPE-TOA in Persian and to evaluate the face and content validity, and internal consistency in patients with severe psychiatric disorders. Materials & Methods A non-experimental and methodological study was carried out in Tehran in 2017; the study population included adult patients diagnosed with severe psychiatric disorders according to Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In this study, demographic questionnaire and BaFPE test were used. Convenience Sampling was done on patients who were admitted to Razi Psychiatric Hospital. In order to prepare the Persian version, the translation of the BaFPE-TOA test was carried out in accordance with the International Quality of Life Assessment (IQOLA) project, which included: 1. Translation of the original version into Persian; 2. Review by translators and professors; 3. Translation quality; 4. Translation of the Persian version into English; and 5. Comparison of the English version with the original version. The Persian version was assigned to five experts to evaluate the content validity in terms of simplicity, relevance, clarity, and necessity. The face validity of the test was performed on three patients and two healthy individuals in order to find difficulties in the understanding of words and phrases, the appropriateness of the items, the likelihood of ambiguity and inadequate perceptions of expressions or the lack of meaning in words. After confirmation, a Persian version of the test was performed on 55 patients with severe psychiatric disorders who qualified the inclusion criteria. Inclusion criteria for this study included: 1. People with psychiatric disorders based on DSM-5 and are listed in the medical records by a psychiatrist; 2. Over 18 years old; 3. Complete consent to enter the study; 4. Aability to write and read; 5. Lack of comorbidity (mental retardation, drug abuse); 6. Lack of physical constraints affecting the performance of specified tasks; 7 Lack of visual impairment or severe hearing loss. Cronbach’s alpha coefficient was used to evaluate the internal consistency with respect to the four options of the test. Data analysis was performed using SPSS v.16 software. Results Experts’ opinions about the quality of translation and replacement of words in the translation process were according to the IQOLA method. The face validity of the test according to the experts’ opinion and its association with healthy subjects and patients showed that the clarity and implementation of common language were of good quality. The content validity of the test was performed according to the opinion of the five experts in mental health; the Content Validity Ratio (CVR) and the Content Validity Index (CVI), were equal to one for all domains. The minimum acceptable value for content validity based on CVI and CVR indices was 0.80 and 0.99, respectively, which indicated validity of the content and the lack of impact of culture on the parameters, tasks, and components of the BaFPE-TOA test. The results of the Cronbach’s alpha coefficient for all fields was related to the twelve functional parameters, the three components, and the five tasks; the efficiency parameter was above 0.7 (the minimum acceptable value), indicative of the good internal reliability of this test. Conclusion According to the experts’ opinion, the Persian version of the BaFPE-TOA test has a proper translation, with acceptable face and content validity and internal consistency. Therefore, this test can be recommended for the evaluation of functional performance in patients with severe psychiatric disorders.

Objectives: This study aimed to compare the behavioral problems and abilities of 7-12-year-old students with a physical/motor disability at mainstream and special schools. Methods: The data in this comparative (cross sectional-analytic) study were collected using total population sampling, A sample of 247 students with a physical/motor disability including 153 students (67 females and 86 males) at special schools and 94 students (41 females and 53 males) at mainstream schools participated in this study. Data were collected using the Teacher and Parents versions of the child’s Strengths and Difficulties Questionnaire (SDQ). Each version includes five aspects, namely, emotional symptoms, conduct problems, attention deficit / hyperactivity disorder, peer relationship problems for measuring behavioral problems and the Prosocial Behaviors Questionnaire for estimating behavioral skills. Data analysis was performed using non-parametric Man-Whitney U and Kruskal-Wallis tests. Results: Students with a physical/motor disability studying at mainstream schools significantly differed from those studying at special schools in terms of behavioral problems (P

Objective Balance system and postural control are one of the major problems in people with multiple sclerosis. Therefore, the assessment of the balance system and postural control is very essential. Identification and use of standard tools can be a practical solution for more purposeful plan in this issue. Several tools have been used to investigate the balance disorders in these patients, which solely able to screen equilibrium problems, and only predict the risk of falling in the elderly. These questionnaires cannot help the therapist to diagnose the underlying causes of imbalance and also are not useful in directing the purposeful therapeutic process. The Balance Evaluation Systems Test (BESTest) was designed from 1990 to 1999 by Dr. Horak in the Continues Medical Education System. This questionnaire is based on the Bernstein’s theory of motor control, and the test evaluates Biomechanical, Stability Limits, Postural Responses, Anticipatory Postural Adjustments, Sensory Orientation, and Dynamic Balance through 36 questions. The objective of this study was to determine the validity and reliability of the BESTest evaluation system in patients with multiple sclerosis after providing a coherent version of the questionnaire in Persian. Materials & Methods This is a methodological and non-experimental study. The BESTest questionnaire was translated by the researcher. The face validity of the questionnaire was evaluated by a survey of 21 patients with multiple sclerosis. The content validity of the questionnaire was further evaluated by a survey of 6 specialists in the field of rehabilitation (three occupational therapists and three specialists in the field of physiotherapy). After that, the BESTest questionnaire and Berg questionnaire were completed by two researchers (the author and another examiner) for 110 people diagnosed as multiple sclerosis, considering inclusion and exclusion criteria, from north, south, east, west, and center of Tehran in the years 2016-2017. After one week, 36 patients from the first stage were reevaluated in with a BESTest questionnaire by the researcher to evaluate the test-retest reliability. The internal consistency with Cronbach’s alpha coefficient, test-retest reliability by intra-class correlation coefficients traces, inter-rater reliability coefficients of correlation between the traces, and convergent validity between the two questionnaires (BESTest and Berg) with Pearson correlation coefficient were investigated. Results The content validity of the questionnaire (the comprehensibility, relevance of the questions, and the cultural matching of words), which were measured by the CVR and CVI statistical methods, were approved by the specialist (CVI>0.79 and CVR>0.99). Pearson correlation coefficient between all the domains of the BESTest questionnaire (except for the second domain) with the score of the Berg questionnaire was between 0.79 and 0.93. Given that the numbers are above the minimum acceptable value of 0.70 indicates a good convergence between these two questionnaires. By removing a part of a 6th item from the second domain, the Cronbach’s alpha coefficient calculated in all domains were between 0.71 and 0.93, which were much higher than the minimum acceptable value of 0.70. These results indicate an excellent internal consistency. Correlation coefficients between two testers in six domains were reported 0.76 to 0.98. Therefore, these coefficients were above 0.70 in all domains, which indicates the good reliability between two examiners. Furthermore, the Intra-sectional correlation coefficient for two repetitions of the questionnaire for the test-retest reliability of the test were 0.84 to 0.99, which were higher than 0.70 (minimum acceptable), which shows that the questionnaire has an excellent test-retest reliability. Conclusion After changing and removing part of question 6 of the second domain, results demonstrated that the questionnaire BESTest is a valid and reliable test for assessing balance performance in multiple sclerosis patients. It can be used as an accurate tool, both in the areas of clinical (to evaluate the patients’ equilibrium status and purposeful therapy planning) and to apply for scientific research in patients with multiple sclerosis.

Purpose: In recent years, many people show interest to Paralympics competition because it is dedicated to athletes with disabilities. In order to affect the throwing, static stretching can be applied on the two muscles, i.e. pectoralis major and latissimus dorsi that play an important role in the arm acceleration phase. Normally, before sport activities, static stretching is applied. Stretching increases the flexibility that is effective in the throwing. The important point is the effect of this type of stretching on the throwing function, which is a combination of muscular strength, range of motion and productive torque. This study is going to examine this issue. Methods: In this study, 45 disabled male athletes (15 discus throwers, 15 shot put throwers, and 15 javelin throwers) participated. Before stretching, each athlete did 3 throws, then a static stretching session consisting of 5 sets of 30 seconds stretching followed by 30 seconds of rest between each set, was performed. One minute after the stretching, the athletes did throwing 3 more times. Stretch was of the static type applied on the pectoralis major and latissimus dorsi muscles. Results: Based on study results, no significant change was observed in the amount of throw before and after the stretching (Discus: P=0.47, Shot put: P=0.46, Javelin: P=0.14). Conclusion: Considering data analysis, one session of static stretching of pectoralis major and latissimus dorsi muscles does not create a significant change in the magnitude of throw in disabled athletes engaged in discus, shot put, and javelin throw.

Purpose: Low Back Pain (LBP) is one of the most common musculoskeletal problems in the world so that about 80% of people are affected by LBP at least once in a lifetime. Therefore, knowing the risk factors for LBP is an important topic. Obesity is also a major health problem that is dramatically rising. If there is a proven relationship between obesity and LBP, losing weight can be an effective advice to help treat effectively LBP. This study aimed to evaluate the association between LBP and Body Mass Index (BMI), Body Fat Percentage (BFP), Waist to Hip Ratio (WHR), and Waist to Height Ratio (WHtR). Methods: In this cross-sectional study, 60 women aged 20 to 40 years were randomly recruited by convenience sampling method during 2016-2017. They were living in one of the dormitories of Tehran, and were selected according to the inclusion and exclusion criteria. Of them, 30 persons suffered from LBP during the past year and 30 were healthy. Therefore, the participants were divided into two groups: LBP and healthy. Height, weight, waist circumference, hip circumference, and also the skin folds at triceps, quadriceps, and suprailiac were measured for all participants. Statistical analyses were done using SPSS22. Results: The mean BMI value, although, was higher in patients with LBP, but showed no statistically significant difference between the two groups (P=0.17). The mean values of WHR (P=0.04), WHtR (P=0.04), and BFP (P=0.03) in participants with LBP were significantly higher than those in the control group. Conclusion: The present study confirmed the relationship between the WHR, WHtR, and also BFP with the incidence of LBP in women. The strongest relationship was found between LBP and BFP.

Background & Aim: Diabetes is a chronic disease that needs lifelong special self-care behaviors. Adolescents with type 1 diabetes need self-care education for the control of diabetes and the prevention of its complications. Therefore, this study aimed to determine the impact of self-care education on the control of diabetes complications, medications and HbA1C in adolescents with type 1 diabetes. Methods & Materials: This study is a non-randomized clinical trial (IRCT2015051322258N1) carried out on seventy four adolescents aged 12-18 years old with type 1 diabetes referred to the Iran diabetes association. They were selected using convenience sampling method and allocated into two groups (intervention: 34 people, control: 40 people). An educational intervention was performed in five sessions for the intervention group. After education, the patients were trained and followed up using mobile services for three months. The instruments consisted of a demographic characteristics form and a section of the self-care behaviors scale evaluating medications and the control of complications. Data were analyzed by the SPSS software v.18. Results: Before the education, no significant difference was observed in the mean scores of medications and control of complications and level of HbA1C between the two groups of intervention and control (P>0.05). After the education, there was a significant difference between two groups in the mean scores of medications and control of complications and level of HbA1C (P0.05). After the education, there was a significant difference between two groups in the mean scores of medications and control of complications and level of HbA1C (P

Lymphedema is sometimes accompanied by high degrees of anxiety and depression. This study aimed to assess the effects of relaxation techniques on the level of edema, anxiety and depression in women undergoing Comprehensive Decongestive Therapy (CDT).This clinical trial compared two treatment methods in 31 women with post-mastectomy lymphedema, including 15 cases who received CDT and 16 who received RCDT (Relaxation plus CDT). The edema volume, anxiety and depression scores were compared at the first and last sessions of the first phase of the treatment and six weeks afterwards.The edema, anxiety and depression scores were 63.6%, 54.1% and 65.5% in the RCDT group and 60.7%, 31.4% and 35.2% in the CDT group. There were significant differences between the two groups in terms of the reduction in depression (p = 0.024) and anxiety (p = 0.011) scores throughout the study. This significant relationship was due to the differences in the depression score in the 3rd and 9th weeks of the study between the two groups. Similarly, anxiety levels differed significantly between the two groups at the 9th week of the study (P = 0.013).Relaxation techniques reduced the anxiety and depression scores and the volume of edema in the patients with lymphedema. The addition of this intervention to the therapeutic package for lymphedema patients requires further studies in terms of cost-effectiveness.

Background: Control of diabetes plays an important role in improving complications and disabilities and quality of life. This study aimed to evaluate the 3-year changes in fasting blood glucose (FBG) values and its related factors in patients with type 2 diabetes. Methods: In this retrospective cohort study, 500 patients with type 2 diabetes covered by the National Diabetic Prevention and Care Plan during 2013–2016 were selected based on random cluster systematic sampling. A linear mixed model was used to study changes in FBG levels and their related factors. The data were analyzed using the R3.2.0 software. Results: The patients' mean age was 47.7 years. Among these patients, 58.6% were female, 19.8% had a history of smoking. High FBG was associated with high disease duration, high body mass index (BMI), low age, normal BMI at baseline, insulin therapy, smoking, and family history of diabetes. Trend of FBG in follow-up was decreasing. Conclusions: Given that patients who received insulin therapy had higher mean FBG, it is recommended to examine their insulin dose and modifications should be made in terms of the patients' needs during their continuous follow-up. Weight loss during follow-up and cessation of smoking indicate a favorable prognosis of disease. More attention should be paid to younger patients in care. Patients are encouraged to start treatment and care at the same time diagnose.

The purpose of this study is to investigate the effect of emotional intelligence on the behavior problems of boys with Externalized behavior disorder in Primary Schools. Method: This quasi-experimental study was conducted along with a pre-test, post-test, with a control group and a follow-up test. For sampling, 40 students identified with Externalized behavioral problems through the Teacher Report Form (TRF) and the Child Behavior Checklist (CBCL) were chosen and randomly divided into two groups (20 in the experimental group and 20 in the control group). The experimental group received emotional intelligence training program in 17 sessions (2 sessions per week, 60 minutes per session) and the control group received no training beyond their regular school program. After two months, in order to examine the stability (durability) of training effect, the follow-up test was conducted. Finally, the data obtained were analyzed using the statistical method of generalized estimating equations. Results: The results showed that the intervention program had created a significant difference between the scores of the experimental and control group (p

Background: This study assesses influences of baseline psychological risk factors on prevalence of low back pain (LBP) at baseline and follow-up among nurses. Methods: A prospective longitudinal study was performed at two phases, baseline and 1-year follow-up among 246 nurses of university hospitals in Shahroud, Iran. A standardized Cultural and Psychosocial Influences on Disability questionnaire was used for data collection. Logistic regression was performed for analysis. Results: At the baseline of the study, 58.9% of nurses reported back pain in the previous 12 months. Age (p = 0.001), belief that work causes pain (p = 0.022), and somatization tendency (p = 0.002) significantly increased risk of LBP. At 1-year follow-up, prevalence of LBP was 45.7% and expectation of back pain at baseline (p = 0.016) significantly increased risk of LBP in this phase (p

Objectives: Visual impairment is among the ten most prevalent conditions leading to disability. More than 2/3 of adults who suffer from visual problems are at ages of 65 years and over. The aim of this research was to determine the relation between visual functioning and quality of life in elderly who receive health services at the governmental out-patient clinics of the City of Boushehr. Methods & Materials: The present research is a descriptive analytical study which was implemented by cross-sectional method. The random cluster sampling was used. Two questionnaires consisting of visual function questionnaire (VFQ-25) and short form (SF-36) were used for collecting data. Gathered data were analyzed using correlation coefficient of Spearman, Mann-Whitney and Kruskal-Wallis tests. Results: Gathered data from 173 participants analyzed. The mean age of study subject was 69.3±6.8 years, and 71.1% were male. Results showed that visual functioning (67.82±17.24) and quality of life (56.41±23.29) of the participants were at the intermediate level and there was a direct and significant relation between visual functioning and quality of life of the participants (P≤0.0001). This relation stood in spite of the varying age, sex and educational levels. Advanced age, not having a spouse, and illiteracy enhanced the correlation of visual functioning with quality of life. Conclusion: Delivering preventive, screening, visual treatment along with its rehabilitation services in elderly, especially to the mentioned at risk groups, are recommended.

Background & Aim: Esophageal cancer is one of the main common causes of death. The high prevalence of esophageal cancer in northern Iran is an important public health problem. The main aim of this paper was to assess the factors affecting survival of atients with esophageal cancer in neighbor provinces around the Caspian Sea using Weibull mixture cure model and mixture cure model based on a non-proportional hazard. Methods & Materials: This prospective study was designed to gather data of esophageal cancer from the Babol cancer registry, Iran, registered during 1990 to 1991. The study cases were also followed for a period of 15 years up to 2006. Mixture cure model via non-proportional hazard modeling was used to calculate cure fraction and investigate the factors responsible for the cure probability of patients. Estimates were obtained by maximization of the likelihood via SAS proc NLMIXED. Results: The median survival time was about 9 months and survival probability in 1, 3, and 5 years following diagnosis were 23%, 15% and 13%, respectively. The family history affected the cured fraction independently of its effect on the early outcome In addition, it had significant effect on the probability of uncured state in the both models. Conclusion: The results demonstrated the great potential in cure modeling survival data via nonproportional hazard model compared to Weibull mixture cure model.