Effectiveness of a social-emotional learning program on developmental assets and subjective well-being.

The present study was done to evaluate the effectiveness of a Social Emotional Learning (SEL) intervention designed based on social marketing on developmental assets and the well-being of female adolescents in Yazd, Iran. This mixed-method quasi-experimental study was conducted in 2018-2019. A total of 190 female students were selected by multi-stage sampling from the female middle and high schools in Yazd, Iran. A SEL intervention designed based on social marketing principles was implemented among the parents and students of the intervention group. The control group did not receive any intervention. Quantitative data were collected in three stages: pre-test, post-test after two months, and follow-up after six months via Developmental Assets Profile and EPOCH measure of wellbeing. A qualitative evaluation was also performed after the intervention. Results of the Repeated-Measures test indicated that the intervention significantly influenced social competence (p-value = .02). However results did not show improvement in the positive identity development of the participant girls. Qualitative findings suggested the effectiveness of the intervention on social competencies and positive identity. Based on the results of the present study, the SEL program might have a significant but small positive effect on the social competencies of the participating adolescents.

Comparison of the Effect of Teaching Methods of Flipped Class and TBL in Enhancing Psychological Empowerment.

Introduction: Today, it is felt as necessary to promote the psychological empowerment of individuals, especially at the postgraduate level using an appropriate educational approach. Therefore, the aim of the current study was to investigate the effect of flipped class (FC) and team-based learning (TBL) in enhancing psychological empowerment. Methods: This semi-experimental study (pretest-posttest model) was conducted on postgraduate students in the Faculty of Medicine. Ninety students were included in the study using census method. After applying the inclusion and exclusion criteria, forty students were divided into two groups of 20 in a non-random way according to their gender and educational level. The workshop teacher randomly selected one of the groups as a TBL and the other as an FC. A two-day workshop was held for each group (12 hours of training in total). The educational method was TBL in one group and FC in another. Spritzer's Psychological Empowerment questionnaire was used for data collection in pre- and post-test (one month apart). This questionnaire includes 12 questions (based on a five-point Likert scale) to assess the 4 aspects of job meaningfulness, feeling to be qualified, feeling to be effective, and feeling to have the freedom of choice. The minimum and maximum scores are 12 and 60, respectively. The experts of the field have confirmed its reliability. Its Cronbach-Alpha values were reported in previous studies at 0.86 and 0.89, respectively. Data were analyzed using statistical tests in SPSS16 and Wilcoxon and Mann-Whitney non-parametric tests. Results: The Mann-Whitney U-test indicated no significant difference between the total mean of the two groups (FC: 35.20±1.73, TBL: 34.30±1.26) in the pre-test (P=0.157). However, there was a significant difference between the psychological empowerment scores of the two groups in the post-test (P<0.001). The Wilcoxon test showed a significant difference between pre-test and post-test scores for each group (P<0.05) and the psychological empowerment scores increased in the post-test for the two groups. However, the mean of post-test score in the TBL group (M: 42.55±1.82, P<0.001) was higher than the FC group (M: 38.45±2.64, P>0.001). Conclusion: Due to the influence of the TBL technique on psychological empowerment at the postgraduate level, it seems that TBL is more useful and practical for enhancing psychological empowerment.

Investigating the relationship between high-risk behaviors and mental health in adolescents in Rabor city, Iran.

OBJECTIVES: High-risk behaviors (HRBs) represent significant health threats for adolescents and significantly affect adolescents' mental health. Adolescents often engage in risky behaviors. The present study was conducted to investigate the relationship between high-risk behaviors (HRBs) and mental health in adolescents in Rabor. CONTENT: The present study was a cross-sectional analytical study that was performed on 334 girl and boy students aged 12-18 years in Rabor city in 2021. In this study, adolescents answered high risk behaviors and mental health questionnaires. Data were analyzed using SPSS-26 software and the spearman correlation coefficient and linear regression analysis (univariate and multivariate analysis) were used to analyze the data. SUMMARY AND OUTLOOK: In this study, the mean age was 15.25 ± 1.78. The findings indicate that smoking and hookah use were higher in boys than girls. Among the demographic variables, age and level of education had a positive and significant relationship with HRBs and mental health (p<0.05). The mean score of total mental health for all subjects was 12.83 ± 10.82. The variables of age, sex, marital status of parents, the number of children in the family, educational level, smoking, hookah, and alcohol have been determined as influential and facilitating factors in HRBs of adolescents. Father's literacy was considered as a facilitator and age variables, alcohol consumption and parents' marital status were considered as deterrents to mental health. The present study showed that the male gender is one of the risk factors for alcohol, smoking and other substances, the tendency to high-risk sexual behaviors, depression, and suicide in adolescents. Among the determinants of the tendency to HRBs in adolescents, psychological variables are of particular importance at the individual, social, and family levels. Good mental health can improve quality of life, while poor mental health can make it worse.

Breastfeeding Duration and Its Effective Factors in Kerman Province, Iran.

Introduction: Complete cessation of breastfeeding (CCB) at the right time is as important as starting breastfeeding, as well as identifying the factors that affect the duration of breastfeeding, so that breastfeeding promotion programs focus on these causes, to increase mothers' ability and desire to breastfeed. This study aimed to determine the time of CCB and its related factors. Methods: This analytical cross-sectional study was conducted in 2020. This study was performed at all health centers and health homes affiliated to Kerman University of Medical Sciences, in Kerman province, Iran. A total of 802 urban and rural mothers with children aged from 30 to 36 months completed the questionnaire. The validity and reliability of the questionnaire were confirmed by Cronbach's alpha of 85%. Data were analyzed using SPSS software version 16. Results: The mean time of breastfeeding was 19.23 ± 7.09 months and the median was 22-month-year. About 41% of children were breastfed until 24-month. There was a significant relationship between the time of CCB with contraception, number of households, place of residence, and weight at 6-month at the level of 0.05. Conclusion: Duration of breastfeeding is influenced by some demographic and cultural factors. The timing of the CCB is near to the suggestions of the World Health Organization (WHO) and religious teachings.

Communication barriers to education to referrals from the perspective of referrals to health centers and health care providers.

Introduction: One of the most important factors affecting the increase of clients' satisfaction is how health care providers (HCP) communicate with clients. On the other hand, different factors can hinder proper communication and thus education, which is one of the main tasks of HCP. Therefore, the purpose of this study was to investigate communication barriers to education to referrals from the perspective of referrals to health centers (RHC) and HCP. Method: This descriptive-analytical study was conducted on RHC and HCP in Kerman in 2021. Using a multi-stage sampling method, 162 HCP and 414 RHC were included in the study. The data collection tool was two researcher-made questionnaires. Data were analyzed using SPSS 16. Findings: From the perspective of RHC and HCP, most communication barriers were related to environmental and then socio-cultural factors. Among the demographic variables of HCP, level of education showed a significant relationship with the physical-psychological, verbal-non-verbal, and informational domains. And in relation to RHC, a significant relationship was found between education and job in the socio-cultural field and environmental barriers (p < 0.05). Conclusion: HCP face a variety of barriers in educating people, most of which are related to environmental factors. Given the cost-effectiveness of education to the public, it is essential that planners and policymakers use strategies to eliminate environmental factors as well as the placement of indigenous HCP in health facilities to reduce communication barriers.

Lonely, harassed and abandoned in society: the lived experiences of Iranian homeless youth.

INTRODUCTION: Homelessness is increasing among young adults in large cities. According to the United Nations, there are more than one billion absolute or relative homeless people in the world. This study was conducted to explain the lived experiences of homeless youth in southeastern Iran. MATERIALS AND METHODS: In this qualitative study, we recruited 13 participants in a big city, southeast Iran, in 2020. The participant was young homeless adults aged 18-29 years who were using homeless shelters provided by the municipality, sleeping in parks or on streets. Data were collected through in-depth and semi-structured interviews and three focus group discussions. Data were analyzed by conventional qualitative content analysis. RESULTS: The main category of "lonely, annoyed, and abandoned in society" and three subcategories of avoidance of/by society, comprehensive harassment, and lack of comprehensive support were extracted. The experiences of young homeless adults showed that they escaped from the community due to addiction, feeling like a burden to others, and social isolation, and not only have they been left without support in society, but they have also suffered from all kinds of physical and psychological harassments. CONCLUSION: The lived experiences of homeless people show that in addition to appropriate facilities and living conditions, they require respect, reduced social stigma, discrimination, and favorable conditions for a return to life. Therefore, authorities should identify and settle their problems and needs.

The effectiveness of intervention based on the transactional model on improving coping efforts and stress moderators in hemodialysis patients in Tehran: a randomized controlled trial.

BACKGROUND: Present study was conducted to determine the effect of training on coping efforts and stress moderators, based on transactional model of Lazarus and Folkman, in hemodialysis patients. METHODS: This is a randomized controlled clinical trial on 116 hemodialysis patients referred to dialysis centers in Tehran from May to August 2018. The patients were assigned to two experimental and control groups using a simple randomization method. The intervention included 6 training sessions in the form of coping efforts and moderators of transactional model. Data were collected before and 3 months after the intervention. Data were analyzed using SPSS 16. RESULTS: After 3 months training intervention, there was significant increase in the intervention group in the mean scores of coping efforts (P < 0.001), moderators and subscales of emotional regulation from 51.18 ± 20.42 to 64.87 ± 13.18 (P < 0.001), dispositional coping style from 45.56 ± 19.45 to 55.84 ± 18.03 and social support from 49.61 ± 20.14 to 55.55 ± 17.35 (P < 0.005). CONCLUSION: The training based on transactional model was successful in the increase of social support, dispositional coping style and emotional regulation in hemodialysis patients. Therefore, Nurses and healthcare providers can use this program to help hemodialysis patients to increase their adaptation to the illness and reduce stress. TRIAL REGISTRATION: IRCT registration number: IRCT20180524039814N1 ; Registration date: 13-08-2018; Registration timing: retrospectively registered: Last update: 13-08-2018.

Investigating the current status of the student evaluation system in Iran University of Medical Sciences: A step to improve education.

BACKGROUND: Medical education has special features due to the need various areas of learning. The present study was conducted to provide a complete picture of the evaluation system in Iran University of Medical Sciences for improving the evaluation system and medical sciences examinations. MATERIALS AND METHODS: The research was cross-sectional study that conducted through self-reporting of educational departments, a comprehensive review of the student evaluation system in the affiliated faculties of Iran University of Medical Sciences from 2017 to 2018. Educational members and heads of nine faculties and 80 departments participated in this study. The research tool was a researcher-made questionnaire, include two parts: (1) 10 general questions about the activities of the educational groups regarding the student evaluation system and (2) 20 questions about the types and quality of examinations. RESULTS: From 80 questionnaires, 71 were completed by the managers of the departments. The results showed that 62% of the faculty members in the educational departments in the last 2 years did not participate in the workshop on the methods of evaluation and making tests. 56% of the faculties have a reference for continuous monitoring of students' assessment and evaluation, and in 87% of the cases, the content is given in accordance with the objectives. The use of logbooks was more common (28%) than other methods to assess practical skills. CONCLUSION: Empower faculty members on the use of various tools, strengthening the supervision of formative evaluation and use of medical education graduates to promote evaluation methods seems necessary.

Neonatal Outcomes in Pregnant Women Infected with COVID-19 in Babol, North of Iran: A Retrospective Study with Short-Term Follow-Up.

During the coronavirus disease 2019 (COVID-19) pandemic, the number of pregnant women and neonates suffering from COVID-19 increased. However, there is a lack of evidence on clinical characteristics and neonatal outcomes in pregnant women with COVID-19. We evaluated short-term outcomes (4 weeks postdischarge) and symptoms in neonates born to mothers infected with COVID-19. In this retrospective cohort study, we included all neonates born to pregnant women with COVID-19 admitted to Ayatollah Rohani Hospital, Babol, Iran, from February 10 to May 20, 2020. Clinical features, treatments, and neonatal outcomes were measured. Eight neonates were included in the current study. The mean gestational age and birth weight of newborns were 37 ± 3.19 weeks (30₊6-40) and 3077.50 ± 697.64 gr (1720-3900), respectively. Apgar score of the first and fifth minutes in all neonates was ≥8 and ≥9 out of 10, respectively. The most clinical presentations in symptomatic neonates were respiratory distress, tachypnea, vomiting, and feeding intolerance. This manifestation and high levels of serum C-reactive protein (CRP) in three infants are common in neonatal sepsis. The blood culture in all of them was negative. They have been successfully treated with our standard treatment. Our pregnant women showed a pattern of clinical characteristics and laboratory results similar to those described for nonpregnant COVID-19 infection. This study found no evidence of intrauterine or peripartum transmission of COVID-19 from mother to her child. Furthermore, the long-term outcomes of neonates need more study.

The effect of theory - Based educational intervention on consumption of smokeless tobacco products by merchants' guilds.

BACKGROUND: Smokeless tobacco (SLT) products are highly addictive and contain at least 28 carcinogenic chemicals. The purpose of this study was to determine the effect of theory-based on the Transtheoretical Model of Behavior Change on consumption of SLT products by Merchants' Guilds in 2018. MATERIALS AND METHODS: The present quasi-experimental research was conducted over one intervention group. The research population consisted of all consumers of the SLT products among the merchants' guilds in Chabahar City, Iran in 2018. Data were gathered from 320 individuals by simple random sampling using a valid and reliable researcher-made questionnaire. The intervention program was designed based on the Transtheoretical Model of Behavior Change cognitive processes and lasted 6 months. After the intervention, the same questionnaires were administered among the participants. The data were analyzed by SPSS version 20 using the descriptive and analytical tests. RESULTS: In the preintervention phase, the participants' mean scores of the cognitive processes at the precontemplation, contemplation, and preparation stages were 29.16 ± 4.63, 25.07 ± 3.84, and 12.12 ± 1.63, respectively. At the postintervention phase, mean scores of the precontemplation, contemplation, and preparation stages reached to 40.5 ± 5.96, 38.8 ± 5.03, and 35.5 ± 4.23, respectively. Furthermore, the participants' mean sores at the action and maintenance stages were 36.4 ± 4.57 and 43.3 ± 3.29, respectively. According to the ANOVA, a significant relationship was found between cognitive processes at the preintervention phase and stages of change (P < 0.001). CONCLUSIONS: Individuals can improve from the precontemplation, contemplation, and preparation phases to the action and maintenance stages by attending based on Transtheoretical Model of Behavior Change educational interventions. It is suggested that the structure of this model be used to reduce high-risk behaviors in other occupations.

Comparing peer education with TBL workshop in (EBM) teaching.

Background: Evidence-based medicine is one of the most important topics in medical sciences that requires a proper teaching method. Very few studies have evaluated EBM education outcomes through peers and TBL workshops. The purpose of this study was to compare the effect of evidence-based medicine (EBM) education through peers with TBL workshop method in medical students. Methods: This quasi-experimental study was conducted on 42 medical students of the Faculty of Medicine in Iran University of Medical Sciences (IUMS) in 2019 who were selected through convenience sampling. Students were divided into 2 experimental and control groups based on the randomized blocking method. The data collection tools were 2 questioners that evaluated EBM knowledge and satisfaction in both intervention and control groups. The knowledge of students was compared using pretest and posttest and their satisfaction was evaluated at the end of the TBL workshop and peer education. Data were analyzed by SPSS software and descriptive tests (t test and ANOVA), and significance level was set at 0.95. Results: A significant difference was found between the level of basic knowledge (pretest) and secondary knowledge (posttest) in the EBM education through TBL workshop method compared to peer method. The average scores gained by students in TBL workshop were 3.8 more than the peer teaching method. The results of the Satisfaction Questionnaire were 74% in control group and 86% in the experimental group. Conclusion: EBM education through TBL workshop both increased students' knowledge and satisfaction compared to peer education. Thus, it can be concluded that providing EBM education by expert and qualified teachers through face to face teaching strategy can be effective in knowledge translation. However, peers can participate in educational sessions as facilitators.

Quality assessment of DNA and hemoglobin by Fourier transform infrared spectroscopy in occupational exposure to extremely low-frequency magnetic field.

Previous studies have shown the effect of extremely low-frequency (ELF) magnetic fields on the hematopoietic system. However, molecular modification and biological toxicity are not known yet. The aim of this study was to investigate the effect of occupational exposure to ELF magnetic field on the hemoglobin and DNA alteration using Fourier transform infrared (FTIR) spectroscopy. Twenty nine individuals were selected among those working as the controller in a powerhouse in order to be studied as the population exposed to ELF magnetic field. Control group comprised of 29 administrative employees voluntarily participated who were matched with the exposed subjects in terms of sex, age, work experiences, smoking habit, and socioeconomic status. DNA and hemoglobin were extracted from blood samples and then were studied by FTIR spectroscopy. The results showed the level of magnetic field exposure was between 0.38 to 50 µT in the exposed subjects while the level of magnetic field exposure was between 0.19 and 20 µT for the unexposed people. Hemoglobin level was equal to 15.67 ± 1.42 g/dL for exposed subjects which is significantly lower than that of the unexposed people (p = 0.0001). There was a significant alteration in CH content and COO structure of the hemoglobin structure. Moreover, DNA showed significant changes by functional group of organic base. This change in the structure of DNA and hemoglobin can lead to the creation of risks in human health. In conclusion, FTIR method could reveal the quality of DNA and hemoglobin structure in subjects after exposure to ELF magnetic field.

Exploring the features of mobile phone application of anatomy in basic medical sciences: a qualitative study.

BACKGROUND: The importance of mobile phones has become one of the new research topics in health professions education due to the ease of access and flexibility. Although novel approaches to health professions education recommend the use of educational technologies, such as mobile applications, a limited number of studies have been conducted with regard to learning anatomy through mobile applications. Considering the increasing needs of medical students for mobile technology to meet their educational needs, wants and desires, we decided to explore the features of an anatomy mobile application. METHODS: This qualitative study was conducted in two stages of holding focus groups, and an expert panel session. Students of basic Medical sciences, and faculty members of anatomy at Iran University of Medical Sciences formed the research participants. Semi-structured interviews and note-taking were used to collect the data. Moreover, Brown and Clark methods were used for thematic analysis. Finally, four criteria presented by Lincoln and Guba for qualitative studies were used to ensure the credibility, confirmability, trustworthiness and transferability of the data. RESULTS: Based on the data analysis, 37 codes that could be used to design anatomy mobile content for medical students were extracted. These features were categorized into eight main themes of "visual richness", "scientific comprehensiveness", "auditory richness", "affordability", "user-friendliness", "self-assessment", "interactive content" and "user support". CONCLUSION: This study explored the features of an anatomy application that can be used by educational app developers. Anatomy departments at Medical Universities, policymakers, and curriculum planners in the field of medical education can also adopt the findings of the present study.

Effectiveness of interventions based on lazarus and folkman transactional model on improving stress appraisal for hemodialysis patients in Tehran.

Today, we witness an increase in the prevalence of chronic kidney disease, which is a very stressful process. In order to cope with the stress caused by this disease, the first step is to appraise the stressful situation correctly. Therefore, the present study was conducted with the aim of investigating the effect of training on the basis of Lazarus and Folkman transactional model on stress appraisal for hemodialysis (HD) patients. The present quasi-experimental study was conducted on 116 filed HD patients in two dialysis centers in Tehran. The patients were randomly divided into two groups: experimental and control groups. The data were collected using a researcher-made questionnaire whose validity and reliability were confirmed. After performing the intervention, the primary and secondary appraisals' scores were investigated before and three months after the intervention. The data were analyzed using independent /?-test, paired /-test, and covariance at a significant level of 0.05 using software Statistical Package for the Social Sciences version 16.0. The mean age of participants in the study was 52.86 years. In this study, the difference between the mean score of the primary appraisal and substructure of perceived susceptibility, motivational relevance, self-blame (casual focus), and secondary appraisal and self-efficacy substructure after the intervention was significant in the experimental group. However, these differences were not significant in the control group. According to the study results, it can be concluded that the use of training based on Lazarus and Folkman tran- sactional model can be useful for improving the correct appraisal of individuals for stressful situations.

Experiences of stress appraisal in hemodialysis patients: A theory-guided qualitative content analysis.

Chronic renal failure and prolonged hospitalization for the treatment of renal disease incur immense stress and anxiety in patients. Considering the increased prevalence of renal failure, the present study aimed to explain the experiences of stress assessment in hemodialysis (HD) patients based on the transactional model of Lazarus and Folkman. The data collection method was semi-structured interview with 22 patients from dialysis centers in Tehran. Sampling was purposive and continued until data saturation. Data were analyzed using the directed content analysis method. Data analyzed to the extraction of 80 codes that were classified into two predetermined categories of appraisal structures in the transactional stress model, including primary and secondary appraisal, and also seven subcategories (perceived susceptibility, perceived severity, motivational relevance, casual focus, perceived control over outcoms, perceived control over emotions, and self-efficacy). During this study, 15 sub-subcategories were obtained for the stress appraisal in HD patients. The results showed that the subcategories of perceived susceptibility, perceived severity, and casual focus were the most effective factors in the stress appraisal in HD patients. According to the results, an arrangement should be made so that HD patients can evaluate the stressful conditions properly. patients need help to improve their evaluation in subcategories of motivational relevance, perceived control over outcomes, perceived control over emotion, and self-efficacy. In this regard, one of the best models that can be used to identify the appraisals in HD patients and design appropriate interventions for them is the transactional model.

What Are the Hemodialysis Patients' Style in Coping with Stress? A Directed Content Analysis.

BACKGROUND: Nowadays, the prevalence of chronic diseases, such as chronic renal failure, is rising. These patients need hemodialysis to continue their treatment, which is a stressful process. This research was conducted with the purpose of explaining coping styles in hemodialysis patients regarding stress factors based on the Lazarus and Folkman's transactional model. METHODS: This qualitative study was conducted as a content analysis. The data collection method was semi-structured interview with 22 patients from dialysis centers in Tehran. The data were collected from October to January 2017. Sampling was purposive and continued until data saturation. Data were analyzed using the directed content analysis method. The process of data analysis proposed by Hsieh and Shannon's was followed. RESULTS: 106 codes and 24 sub subcategories were obtained through this research and classified into 8 sub-categories of transactional stress model including: problem management, emotional regulation, social support, dispositional coping styles, positive reappraisal, revised goals, spiritual beliefs and positive events; and 3 categories of coping structures that included coping efforts, meaning-based coping and moderators. CONCLUSION: Dialysis patients are making efforts to cope with their stress in order to reduce their stress; in some cases, these efforts lead to reduction in stress, and in some cases, due to using unsound coping style, they are ineffective or even harmful. Therefore, the necessity of planning and proper interventions is felt by health care providers to control stress in dialysis patients.

Core competencies for academic leaders in Iran University of Medical Sciences.

INTRODUCTION: Integrated educational, health, and medical services necessitate the development of high-competent academic leaders in medical universities of Iran. Most organizations attempt to limit the total number of competencies to a rational number and consider the most important competencies. Therefore, the purpose of this study was to determine core competencies which can be improved through development programs for the academic leaders in Iran University of Medical Sciences. METHODS: This study was conducted in two phases. The first phase was the critical review based on Carnwell and Daly's approach. The search time was from 2000 to 2017. The searches were conducted in PubMed, Emerald, ERIC, ProQuest, Web of Science, Scopus, SID, and nor gram. The second phase was modified Delphi in three rounds. The purposive sampling was used to employ appropriate participants. RESULT: According to the critical review results, competencies were categorized in two groups, including 62 personal competencies and 19 functional competencies. Also, according to modified Delphi results, 19 competencies, including 12 personal competencies and 7 functional competencies were selected as trainable core competencies. CONCLUSION: In order to design a development program for academic leaders in the integrated educational system in Iran University of Medical Sciences, both personal and functional competencies need to be considered together.

Extract critical factors affecting the length of hospital stay of pneumonia patient by data mining (case study: an Iranian hospital).

MOTIVATION: Pneumonia is a prevalent infection of lower respiratory tract caused by infected lungs. Length of stay (LOS) in hospital is one of the simplest and most important indicators in hospital activity that is used for different purposes. The aim of this study is to explore the important factors affecting the LOS of patients with pneumonia in hospitals. METHODS: The clinical data set for the study were collected from 387 patients in a specialized hospital in Iran between 2009 and 2015. Patients discharge summary includes their demographic details, reasons for admission, prescribed medications for the patient, the result of laboratory tests, and length of treatment. RESULTS AND CONCLUSIONS: The proposed model in the study demonstrates the way various scenarios of data processing impact on the scale efficiency model, which points to the significance of the pre-processing in data mining. In this article, some methods were utilized; it is noteworthy that Bayesian boosting method led to better results in identifying the factors affecting LOS (accuracy 95.17%). In addition, it was found that 58% of patients younger than 15 years old and 74% of the elderly within the age range of 74-88 were more vulnerable to pneumonia disease. Also, it was found that the Meropenem is a relatively more effective medicine compared to other antibiotics which are used to treat pneumonia in the majority of age groups. Regardless of the impact of various laboratory findings (including CRP, ESR, WBC, NA, K), the patients LOS decreased as a result of Meropenem.

Evaluation of the referral system in Iran's rural family physician program; a study of Jiroft University of Medical Sciences.

BACKGROUND AND OBJECTIVE: Referral systems are relatively easy in terms of design, but implementing them is extremely difficult. Considering the three levels of primary healthcare, access of people to specialized services through a referral system is possible. With regard to the importance of a referral system in a family physician program, this study was performed to assess the function of the referral system in the family physician program in Jiroft University of Medical Sciences. METHODS: This cross-sectional study was performed in the first half of 2014. The sample size included 700 patients selected using multistage sampling. Firstly 30% of health centers were randomly selected as a cluster. Then, the patients were randomly selected from each cluster. The study data were collected through a questionnaire consisting of 2 parts - demographic variables and the rules of the referral system. Data were analyzed using descriptive statistics, Chi Square, and Logistic Regression. RESULTS: From 700 patients who received the level 2 services, 69% of cases were female and 31% were male. One hundred eighty-two cases (26%) had referral form from health house. Only 56.4% of persons referred to the centers because of diagnosis of the family physician. For 34% of cases, the specialists wrote the results of their evaluation in feedback form. Four hundred sixty-three patients did not return to their family physician because of lack of knowledge. CONCLUSION: The referral situation to level 2, in the present study was poor. Ease of access to specialized services level 2, and educational intervention for healthcare staff and familiarizing people with the objectives of the family physician program and referral system are recommended.

Cultural competence dimensions and outcomes: a systematic review of the literature.

It has been widely suggested that cultural competence is an individual's core requirement for working effectively with culturally diverse people. However, there is no consensus regarding the definition or the components of this concept and there is a dearth of empirical proof indicating the benefits of cultural competence. Therefore, a systematic review was conducted to identify the most common cultural competence dimensions proposed in recent publications and to identify whether sufficient evidence exists regarding the efficacy of cultural competence in the healthcare context. A total of 1204 citations were identified through an electronic search of databases, of which 18 publications included cultural competence frameworks, and 13 studies contained empirical data on cultural competence outcomes. The overarching themes of the review were centred around the challenges faced by the healthcare sector in many countries due to growing cultural diversity, but lack of cultural competence, leading to predicaments that arise during intercultural interactions between patients and clinicians. This review will benefit researchers exploring cultural competence as one of the research variables impacting research outcomes.