Spirituality and health care in Iran: time to reconsider.

Spirituality is increasingly recognized as an essential element of care. This article investigates the role of spirituality in Iranian health care system and provides some guidelines to integrate spirituality in routine health care practice in Iran.

Spiritual well-being and quality of life in Iranian women with breast cancer undergoing radiation therapy.

PURPOSE: Psychological distress and morbidity are common consequences of diagnosis and treatment of breast cancer and associated with poor quality of life (QOL). Spiritual well-being is an important aspect of QOL, but little is known about the spiritual well-being and its relationship with QOL in patients of different cultures such as Iranian Muslim patients. The aim of this study was to investigate the association of QOL and spirituality among patients with breast cancer undergoing radiation therapy. METHODS: This was a cross-sectional study which was conducted in the Breast Cancer Research Center of St. S. Al-Shohada Hospital, Isfahan, Iran. Spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp12). The European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) and its supplementary breast cancer questionnaire (QLQ-BR23) were used to assess the quality of life of patients. Descriptive analysis, Pearson's correlation, and multiple regression analysis were performed for statistical assessment. RESULTS: In all, 68 patients fulfilled the study's inclusion criteria and were interviewed. The mean global QOL was 41.42 (SD = 18.02), and the mean spiritual well-being was 28.41 (SD = 6.95). There was a significant positive correlation between general QOL and total spiritual well-being scores. Also, spiritual well-being, social functioning, pain, and arm symptoms were significant predictors of global QOL. DISCUSSION: The results of this study provide evidence that breast cancer survivors in Iran experience a poor quality of life across a broad spectrum of health domains, particularly social, emotional, and spiritual, indicating that psychosocial-spiritual support should be considered in caring for patients with breast cancer.

The effect of spiritual therapy for improving the quality of life of women with breast cancer: a randomized controlled trial.

Diagnosis of breast cancer is a devastating psychological experience for a woman. Also, treatments such as radiation therapy may cause psychosocial distress in these patients and threaten their quality of life (QOL). Among several approaches, spirituality has been shown to be significantly associated with improving the QOL. The aim of this study was to assess the role of spiritual therapy intervention in improving the QOL of patients with breast cancer undergoing radiation therapy. This was a randomized controlled trial study undertaken in a radiotherapy clinic, Isfahan, Iran. Between October 2010 and February 2011, 68 patients under radiation therapy were randomized to either spiritual therapy intervention group or control group who received routine management and educational programs. Before and after six weeks of spiritual therapy sessions, the QOL was evaluated using Cancer quality-of-life questionnaire (QLQ)-C30 and breast cancer-specific questionnaire (BR-23). Multivariate, repeated-measures ANOVA, t-test, and Paired t-test were used for analysis using Predictive Analytic Soft Ware (PASW, version 18) for windows. In all, 65 patients actually completed the six-week intervention and were evaluated for the outcome. The mean Global health status score/QOL reached from 44.37 (SD = 13.03) to 68.63 (SD = 10.86), (p = 0.00). There was a statistically significant difference in all functional scales of QLQ-C30 after intervention (p < 0.05). The results of this trial showed that the spiritual therapy program can improve the overall QOL of women with breast cancer; therefore, it could be adopted in comprehensive care programs for women with breast cancer.

Translation and validation of the Persian version of the functional assessment of chronic illness therapy-Spiritual well-being scale (FACIT-Sp) among Muslim Iranians in treatment for cancer.

OBJECTIVE: The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) scale is a valid and reliable instrument to provide an inclusive measure of spirituality in research and clinical practice. The aim of this study was to translate and investigate the reliability and validity of the Persian version of the FACIT-Sp. METHOD: The 12 item spiritual well-being subscale of the FACIT-Sp Version 4 was translated into the Persian language, Farsi, using the FACIT translation methodology. The questionnaire was administered to a diverse sample of 153 patients in treatment for cancer. Internal consistency was assessed by Cronbach's α coefficient, confirmatory factor analysis (CFA) was applied to assess construct validity, and regression analysis was used to assess the predictor role of the FACIT-Sp in health-related quality of life (HRQOL). RESULTS: Cronbach's α reliability coefficient for the FACIT-Sp subscales ranged from 0.72 to 0.90. The CFA generally replicated the original conceptualization of the three subscales of the FACIT-Sp12 (Peace, Meaning, and Faith). All three subscales significant predicted HRQOL. SIGNIFICANCE OF RESULTS: The Persian version of the FACIT-Sp scale is a reliable and valid tool for the clinical assessment of, and research into, the spiritual well-being of Muslim Iranian and Farsi-speaking patients in other regions of the world who are in treatment for cancer.

A new species group and species of the genus Pavania (Acari: Dolichocybidae), phoretic on Onthophagus vitulus (Coleoptera: Scarabaeidae) from Iran.

Pavania setiformis Loghmani & Hajiqanbar sp. nov. (Acari: Heterostigmatina: Dolichocybidae) associated with Onthophagus (Palaeonthophagus) vitulus (Fabricius) (Coleoptera: Scarabaeidae) is described from northeastern Iran. This remarkable new species represents a new setiformis species group characterized by seta-like sc(1), instead of capitate trichobothria. The genus Pavania is thus divided into three species groups: the fusiformis group (15 species), the gymnopleuri group (3 species) and the setiformis group (1 species). We also found P. sabzevarensis Hajiqanbar & Khaustov, 2010 and P. onthophagi Hajiqanbar & Khaustov, 2010 phoretic on Gymnopleurus mopsus (Pallas) and Onthophagus (Euonthophagus) amyntas alces (Fabricius), respectively.

Difficult Diagnosis of Colon Adenocarcinoma Metastasis to Retina: A Case Report and Literature Review.

Intraocular metastatic tumors have been increasingly reported in the recent past. Unlike choroidal metastasis, metastasis to retina is very rare and so far has been reported in very few case reports only. A 56 year-old male who presented with a history of adenocarcinoma of the cecum and underwent lap colectomy for the primary cecal tumor, received adjuvant chemotherapy for a year after surgery and decided to stop. He was also diagnosed with metastasis to liver and lung at this time. He presented with left eye pain, pressure and decreased vision suspicious for retinal metastasis from cecal primary lesion, 2 years after initial diagnosis. A mass of 5 x 10 mm was found on ophthalmoscopic examination and on ultrasound of the eye, in spite of normal results of MRI of the orbit. Palliative radiation therapy of the left eye resulted in decreased eye pressure and improved vision. As retinal metastasis carries a poorer prognosis due to higher risk of spread to central nervous system, the diagnosis of retinal metastasis in case of gastrointestinal cancers patients who present with vision changes should be made urgently. These patients should be thoroughly investigated with a synergistic approach of opthalmoscopic examination, ultrasound of the eye along with other imaging modalities like MRI of the orbit and just not MRI of orbit. Immediate action in the form of surgical or radiation treatments of the metastatic tumors of the eye should be instituted early on for a better prognosis.

Spiritual well-being and quality of life of Iranian adults with type 2 diabetes.

Introduction. Diabetes is a major public health problem. Little is known about the spiritual well-being and its relationship with quality of life (QOL) in Iranian Muslim patients with diabetes. This study investigated the spiritual well-being and QOL of Iranian adults with type 2 diabetes and the association between spiritual well-being, QOL, and depression. Methods. A cross-sectional study was done among 203 patients with type 2 diabetes mellitus in Isfahan, Iran. Quality of life and spiritual well-being were measured using the functional assessment of chronic illness therapy-spiritual well-being (FACIT-Sp). Depression was assessed using the Patient Health Questionnaire-2 (PHQ-2). Descriptive analysis, Pearson's correlation, and multiple regression analysis were performed for statistical assessment. Results. The mean QOL was 61.00 (SD = 9.97) and the mean spiritual well-being was 30.59 (SD = 6.14). Sixty-four percent of our studied population had depressive disorders. There was a significant positive correlation between all QOL subscales and meaning, peace, and total spiritual well-being score. Conclusion. The results of this study showed poor QOL and spiritual well-being and high prevalence of depression in Iranian patients with type 2 diabetes compared to other studies' findings especially western studies. This indicates the need for psychosocial and spiritual support in caring for Iranian patients with diabetes.

Musculoskeletal symptoms and job satisfaction among office-workers: a cross-sectional study from Iran.

OBJECTIVE: Office-work poses a high-risk for musculoskeletal disorders (MSDs), with consequences for workers, employers and society. The aims of this study were to determine the prevalence of musculoskeletal symptoms in a sample of Iranian office workers, to investigate the association between pain severity and job satisfaction and to investigate the association between MSDs and job satisfaction. MATERIALS AND METHODS: Iranian office workers from a university setting (n=91) were randomly selected and included in this cross-sectional study. The Nordic musculoskeletal questionnaire plus visual analogue scale of pain, and the Brayfield-Rothe Job Satisfaction Index were used to study the prevalence of MSDs, pain intensity and job satisfaction, respectively. Descriptive analysis, Pearson's correlation, and multiple regression analysis were performed for statistical assessment. RESULTS: Eighty-nine percent of participants reported musculoskeletal symptoms during the past 12 months, most commonly in the neck (69.2%), low back (58.2%), knees (41.8%), shoulders (35.2%), and upper back (34.1%). There was a significant negative correlation between pain intensity and job satisfaction. Pain intensity, low-back pain in the last week, wrist pain in the past 12 months and shoulder pain were significantly associated with job satisfaction (p<0.05). CONCLUSION: This study provides evidence that musculoskeletal symptoms are common in Iranian office workers, associated with low job satisfaction. These findings indicate the need for more attention to MSDs among office workers and designing effective preventive interventions.

International Students of Isfahan University of Medical Sciences: A Survey about Their Needs and Difficulties.

CONFLICT OF INTEREST: none declared. INTRODUCTION: International students experience difficult situations in a foreign country that may intensify other problems, which are expected in these situations and may have harmful effects on the potential function of students. As the main problems of international students may vary in different situations, the aim of this study was to investigate the main problems of international students in Iran. METHODS: In this cross sectional survey, all international students in Isfahan University of Medical Sciences who were in Iran during 2006-2007 were evaluated by a questionnaire consisting of six scoops of educational, psychological, supporting-communication, familial, economical and sociocultural. RESULTS: Problems referred to sociocultural scope had greater mean (2.44) followed by communication problems (2.30) and economical problems (2.16). CONCLUSION: We suggest that consulting centers should employ experts familiar with international students problems capable of communicating well with international students.

Spiritual therapy to improve the spiritual well-being of Iranian women with breast cancer: a randomized controlled trial.

Purpose. The aim of this study was to investigate the role of spiritual therapy intervention in improving the spiritual well-being and quality of life (QOL) of Iranian women with breast cancer. Methods. This randomized controlled clinical trial (RCT) recruited 65 women with breast cancer, randomly assigned to a 6-week spirituality-based intervention (n = 34) or control group (n = 31). Before and after six-week spiritual therapy intervention, spiritual well-being and quality of life (QOL) were assessed using Functional Assessment of Chronic Illness Therapy Spiritual Well-being scale (FACIT-Sp12) and cancer quality-of-life questionnaire (QLQ-C30), respectively. t-test, Paired t-test, pearson's correlation, and hierarchical regression analyses were used for analysis using Predictive Analytic software (PASW, version 18) for Windows. Results. After six spiritual therapy sessions, the mean spiritual well-being score from 29.76 (SD = 6.63) to 37.24 (SD = 3.52) in the intervention group (P < 0.001). There was a significant difference between arms of study (F = 22.91, P < 0.001). A significant positive correlation was detected between meaning and peace with all subscales of functional subscales on European Organization for Research and Treatment of Cancer quality of Life (EORTC QLQ-C30) (P < 0.05). Hierarchical regression analyses of participants indicated that the study arm, pain, and financial impact were significant predictors of spiritual well-being and overall QOL. Social functioning was another significant predictor of spiritual well-being. Conclusion. The results of this randomized controlled trial study suggest that participation in spiritual therapy program is associated with improvements in spiritual well-being and QOL. Targeted interventions to acknowledge and incorporate spiritual needs into conventional treatment should be considered in caring of Iranian patients with breast cancer.

Mental health of Medical Students in Different Levels of Training.

OBJECTIVES: Medical education and training can directly contribute to the development of psychological distress in medical students. This can lead to catastrophic consequences such as impaired academic performance, impaired competency, medical errors and attrition from medical school. This study aimed to assess the prevalence of psychological morbidity among Iranian medical students. METHODS: This was a cross-sectional study. Samples of medical students in different levels of training (basic science, clinical clerkship, internship, and residency stage) were entered into the study. The 12-item General Health Questionnaire (GHQ-12) was used to measure psychological morbidity. Both univariate and multivariate analyses were used to report on findings. RESULTS: In all, 220 medical students were invited to take part in the study. Of these, 192 students agreed to fill in the questionnaire. The mean age of respondents was 25.4 (SD = 5.2) and 53% were female. Overall 49.5% of the students scored above the threshold on the GHQ-12 (score > 3.5). The results obtained from logistic regression analysis indicated that female gender and level of training were the most significant contributing factors to increased psychological distress [OR for female gender = 2.99; OR for the basic science group = 6.73]. CONCLUSIONS: Psychological distress appears to be common in medical students and significantly varies by gender and level of training. The psychological well-being of medical students needs to be more carefully addressed, and closer attention to eliminating the risk factors is critical to prevent consequent adverse outcomes.

Evaluating the effectiveness of local dexamethasone injection in pregnant women with carpal tunnel syndrome.

BACKGROUND: Most of the medical treatments for carpal tunnel syndrome (CTS) have focused on suppressing the inflammatory process. An injection of dexamethasone acetate might provide the necessary cellular and humoral mediators to induce a healing cascade. Dexamethasone is a water-soluble steroid which is safe to be used in the third trimester, especially as a local treatment. The aim of this study was to evaluate the effectiveness of 4 mg dexamethasone acetate injection to treat carpal tunnel syndrome in pregnancy period. METHODS: Twenty pregnant women with CTS were recruited using strict inclusion and exclusion criteria. All the patients had been injected with 4 mg of dexamethasone acetate and 0.5 ml lidocaine 1% under the carpal tunnel. Pain intensity (based on visual analog scale or VAS) and electro physiologic parameters of median nerve (transcarpal median sensory nerve conduction velocity (SNCV), distal motor latency (DML) and distal sensory latency (DSL) were recorded before and 3 weeks after the injection. RESULTS: The average pain scores before and 3 weeks after the dexamethasone acetate injection was 8.70 ± 0.92 and 4.30 ± 0.76 respectively (p < 0.005). In addition, transcarpal SNCV of median nerve was 33.7 ± 6.3 m/s and 24.5 ± 6.8 m/s (p = 0.001); DML of median nerve was 5.16 ± 1.04 ms and 4.70 ± 0.53 ms (p = 0.001) and DSL of median nerve was 4.84 ± 0.77 ms and 4.2 ± 0.6 ms (p = 0.001), respectively. CONCLUSIONS: After dexamethasone acetate injection, pain intensity and electrophysiological parameters were significantly improved. This study offered encouraging results for an alternative minimally invasive treatment for CTS in pregnant women.

Prevention of communicable diseases after disaster: A review.

Natural disasters are tragic incidents originating from atmospheric, geologic and hydrologic changes. In recent decades, millions of people have been killed by natural disasters, resulting in economic damages.Natural and complex disasters dramatically increase the mortality and morbidity due to communicable diseases. The major causes of communicable disease in disasters are categorized into four sections: Infections due to contaminated food and water, respiratory infections, vector and insect-borne diseases, and infections due to wounds and injuries. With appropriate intervention, high morbidity and mortality resulting from communicable diseases can be avoided to a great deal.THIS REVIEW ARTICLE TRIES TO PROVIDE THE BEST RECOMMENDATIONS FOR PLANNING AND PREPARING TO PREVENT COMMUNICABLE DISEASE AFTER DISASTER IN TWO PHASES: before disaster and after disaster.