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Background and purpose: Inhaled drugs increase the effect of medications prescribed in the treatment of chronic airways diseases with fewer side effects compared to other methods. There are many users of metered dose inhaler (MDI), but the rate of improper use in patients, nurses and general practitioners is high. The purpose of this study was a) to assess the rate of MDI misuse in patients compared to nurses and b) to evaluate the effect of verbal and practical education in the use of MDI in nurses.
Materials and Methods: Following ethical approval from Medical Ethics Board of the Mazandaran University of Medical Sciences, the present study was carried out in two separate stages. In the first stage which was a cross-sectional study, 110 subjects (55 nurses and 55 patients) were recruited from Mazandaran University Hospitals through a non-randomly and purposeful sampling method. A 0 -100 scale check list was used to measure the skill of nurses and patients in the use of MDI. In the second stage, a randomized clinical trial was designed to assess the effect of verbal and practical education in the use of MDI on 55 nurses (experimental group=25, control group=30). Nurses in the experimental group only, received the education and they were then asked to administer MDI after three weeks.
Results: The mean score for patients' skill was 63+37 which was not significantly correlated with age. The two lowest scores were related to slow inspiration (52.7%) and coordination between inspiration and using MDI (52.8%). The mean score for nurses' skill was 51±21/2. The lowest score was related to performance of a deep exhalation and holding the spray at 2.5-5cm distance (21.8%). Data analysis indicated that there was a significant difference between pre and post education score in the experimental group using paired t-test (P=0.0001, T=16.26). There was also a significant difference between the experimental and control group on MDI skill using t-test (p=0.0001, T=-8.19).
Conclusion: The results of this study demonstrate that patients had higher score compared with nurses in the use of MDI. It is also shown that educational program may have an important role in improving nurses' skill in the administration of MDI.

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Background and purpose: Down syndrome children not only have delayed motor development but also have many difficulties for acquiring motor skills, particularly in upper extremities. Hence, the aim of study was to investigate the effects of eye- hand coordination activities on hand skills in educable children with Down syndrome.
Materials and methods: Fifteen children with Down syndrome (7-10 years) participated in this interventional study through convenience sampling. Âfter familiarization with the test method, they were assessed by Purdue Pegboard Test. Then, they attended in an eye-hand coordination program for 8 weeks (three times a week forty-minutes each session). Finally, they were reassessed by Purdue Pegboard Test. Data were analyzed using Mc-Nemar and Wilcoxon tests.
Results: There were significant differences in the mean scores of movement rate of dominant and non-dominant hands, eye-hand coordination of both hands and their hand skills before and after interventions (P<0.001). However, no significant differences were found either in the two genders or in the right- and left-handed children (P>0.05).
Çonclusion: Âccording to the results of this study, eye-hand coordination activities had significant effects on the hand skills of children with Down syndrome. However, gender and hand dominancy didn’t have any effects on hand skill improvement.

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Background and purpose: Transition from high school to university is a stressful phenomenon for most students, so it is imperative that they gain a variety of skills to adapt with the new situation. This study aimed at investigating the effectiveness of teaching life skills including: stress management, self-consciousness, and effective communication on the general health of freshmen.
Materials and methods: This study employed quasi-experimental method and had a control group as a standard of comparison. Âmong the undergraduate freshmen of Ïslamic Âzad Üniversity, Ürmia Branch, 100 students were selected through a multi-stage sampling method and were randomly divided into four equal groups (three experimental groups and one control group). Then, three types of instructions, namely, stress management, self-consciousness and effective communication were offered to them in six sessions (each 1.5 hours). Finally, the difference between the pre-test and post-test scores of general health questionnaire was compared.
Results: Ôverall, the difference between pre- and post-test scores related to general health components was significantly meaningful in favor of experimental groups (P<0.05). Ït was found that two elements i.e. anxiety and insomnia in stress management and self-consciousness groups, and the element of body indications in effective communication group improved more than the other elements. Âltogether, the means of dyadic analyses showed that teaching effective communication skills influenced all components of general health and the total scores achieved in effective communication skills resulted in better improvements in comparison with other two instructions.
Çonclusion: Ôur findings showed that teaching the life skills to students resulted in improved general health. Thus, it is suggested that these types of skill instructions, particularly communicative skills be included as a part of the university mental health programs.

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Background and purpose: Critical thinking has a major role in desirable professional attribute and a highly valued educational outcome. The aim of this paper was to assess the dimensions of critical thinking abilities among medical students in Mazandaran University of Medical Sciences. Materials and methods: Using multistage cluster random sampling, 120 medical students were assessed. Critical thinking skills were measured using the California critical thinking skills test (CCTST). The data was analyzed through descriptive statistics and t-test in SPSS. Results: In this study 118 students completed CCTST questionnaire. The mean of critical thinking score for medical students was 10.91±3.37. Dimensions of critical thinking were not related to gender, marital status, and academic level (P>0.05). Conclusion: This study revealed that critical thinking did not enhance among medical students while studying at university. It is widely believed that critical thinking is essential to clinical decision-making, so lecturers in medical universities should focus more on nurturing critical thinking in order to improve the clinical competency of medical students.

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Background and purpose: Burnout is one of the most important factors in reducing productivity in organizations and involves physical and mental signs, especially in the human service professions. This research was carried out to examine the relationship of occupational burnout and communication skills in nurses in educational therapeutic hospital of Sari, Iran. Materials and methods: In this descriptive cross-sectional study, the population included all nurses in educational therapeutic hospital of Sari. Total number was 900. The sample size was 230. They were selected by stratified random sampling. We used three instruments in this study: demographic characteristic questionnaire, Maslach burnout inventory (MBI), and Queendom communication skills inventory. For analyzing the data, descriptive and inferential statistics including one sample size t and Pearson and Spierman correlation coenfficient tests were used. Results: The nurses were moderately high levels of communication skills. Using the MBI subscale, we found moderate levels of emotional exhaustion, low levels of depersonalization and low levels of sense of personal accomplishment. The communication skills had relation with the burnout in personal accomplishment (P < 0.001). Conclusion: We can take improving communication skills in nursing workplaces, in order to reduce the nurses' burnout.

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Abstract Background and purpose: The aim of this study was to evaluate the efficiency of stress management skills training in reducing aggression among university students. Material and methods: This experimental study was done with pretest-posttest and control group design. The subjects included 45 students who were randomly selected and assigned to either experimental or control group (experimental group: n = 23, control group: n = 22). The Buss and Perry aggression questionnaire was used to collect the data and analysis of covariance was performed. Results: Significant differences was seen in per- and post- test scores for all aggression components in experimental group (P<0.001). Conclusion: According to this study stress management skills training was found helpful in reducing aggression. Hence, this method could be of great benefit in reducing aggression, thereby improving the mental health state among university students.

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Background and purpose: Many authorities believe that university students face challenges in scientific reasoning. Metacognitive skills results in boosting and organized thinking in learning process. Students usually do not know how to use metacognitive skills, thus these skills should be strengthened in students. Material and methods: This comparative-causal study was carried out in 5096 students. Using korjesi and Morgan table, 357 students were randomly selected to participate in the study. The students were studying in undergraduate and postgraduate courses. Metacognitive skills questionnaire was used to collect the data. The student’s grade point average was used as the criterion for academic achievement. SPSS V.16 was applied to analyze the data. Results: The indices of planning, controlling, evaluating, and regulating skills were found to have significant roles in students' academic achievement (P<0.005). Metacognitive skills were found to be more effective in academic achievement in female students. These effects were similar in employed and unemployed students. Conclusion: There was a positive relationship between using metacognitive skills with increase in academic performance. Control skill was the only variable that could predict the students' academic achievement. Metacognitive skills were found to be highly influential in enhancing academic performance among university students. Hence, training programs in metacognitive skills could be of great benefit.

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Abstract Background and purpose: Interpersonal conflicts in clinical environments wastes many resources and have adverse effects on professional communication. Assertiveness skill is an important component of communication skills that helps in reducing interpersonal conflicts. This study was conducted to determine the effect of assertiveness training on nurses’ interpersonal conflicts. Materials and methods: In this experimental study, 60 nurses in Imam Reza Hospital in Mashhad were randomly assigned into either intervention or control groups. A two-day workshop was held for intervention group in which assertiveness skills were taught, while the control group did not receive any training. Assertiveness skills and conflicts level in both groups were measured before and 40 days after the intervention by Bar-on assertiveness questionnaire, Golparvar and Vaseghi Interpersonal conflict at work scale, and Jex and Spector's Interpersonal Conflict Scale. Results: Before the intervention, there was no significant difference between the two groups in nurses’ mean score for interpersonal conflicts (P=0.346) but after the intervention, this mean score decreased significantly in the group that had assertiveness training (11.6±5.9 vs.19.0±8.4, P<0.0001). Conclusion: In this study assertiveness skill training was found to have considerable effect on reducing the level of nurses’ conflicts, therefore, it is suggested to provide nurses with assertiveness training so that they could manage workplace conflicts appropriately.

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Background and purpose: Speech sound disorders are the most common speech disorders in children which are associated with other problems and can lead to social problems, attention deficit and academic skills challenges. The aim of this study was to investigate articulation characteristics, phonological awareness and language skills in children with speech sound disorders.

Materials and methods: In a descriptive analytical study 24 children with speech sound disorder and 16 normal children were participated. The patients were selected from speech therapy clinics and the controls were chosen from nurseries based on convenience sampling. Speech production, oromotor and language skills were assessed by P-DEAP, TOLD-P3 and Phonological Awareness Test, respectively. Data was analyzed in SPSS ver. 20 using independent-samples t-test.

Results: There were significant differences between the two groups in phonological awareness skills (except blending phonemes (P= 0.2)), syntax (P=0.002), semantic (P=0.009), spoken language (P=0.003), listening (P=0.002), organizing (P=0.004), and speaking (P=0.02).

Conclusion: Children with speech sound disorders had atypical errors demonstrating weaker performance in language skills such as syntax, semantic, and phonological awareness compared to normal children. According to this study despite evaluating speech production it is necessary to assess language skills and phonological awareness in children with speech sound disorders.

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Background and purpose: Previous studies have shown that smokers are deficient in social skills and it is possible that they have deficits in theory of mind. The aim of this study was to compare theory of mind and symptoms of attention deficit-hyperactivity between smokers and non-smokers.

Materials and methods: This study was conducted in 160 man (80 smokers and 80 non-smokers) who were selected by convenience sampling. Data was collected using the Persian version of Reading Mind from Voice (FVRMFV), Conners' Adult ADHD Rating Scale and a demographic questionnaire. Data was analysed in SPSS V. 16 applying multivariate analysis of variance and independent t-test.

Results: The findings showed higher scores of smokers in attention deficit (P<0.005), hyperactivity (P<0.006), impulsivity (P<0.007), problems in self-imagination (P<0.004), and whole range of ADHD symptoms (P<0.001) compared to non-smokers, but in mind reading test, smokers performed significantly weaker than non-smokers (P<0.001(.

Conclusion: Deficits in theory of mind is seen in smokers, therefore, deficits in social skills could be due to this reason in such groups.

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Background and purpose: Aging is associated with brain changes and reduction in motor skill acquisi­tion that can limit its functional capacity. One of the effective interventions is using transcranial direct current stimulation (tDCS). The aim of this systematic review was to assess the effect of tDCS on learning and motor skill in healthy older adults.

Materials and methods: A literature search for the period of 1995-2016 was performed using PubMed, Google scholar, Science Direct, OVID, PEDro, Cochrane library, and CINAHL databases. Studies investigating the effect of tDCS in different regions of cortex on learning and motor skill parameters in healthy older adults were included. The PEDro quality scale was used to investigate the studies included.

Results: According to the inclusion criteria of the study, seven articles were selected from 97 relevant articles. There were considerable differences among the studies in terms of methodology, outcome measures, sample size, procedure, etc. The results indicated that using tDCS on primary motor cortex and cerebellum regions could significantly improve motor learning and motor skill in older adults. In addition, tDCS in prefrontal, parietal and temporoparietal regions had significant, strong and long-term effects on cognition and working memory in older adults.

Conclusion: It seems that administration of tDCS in different regions of brain as a boosting technique can enhance motor learning, motor skill, and working memory capacity in healthy older adults. This method can control aging learning deficits.

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Background and purpose: Waiting period in fertility treatments lead to distress in infertile women. Current study aimed at comparing the effect of positive reappraisal coping intervention and problem-solving skills training on anxiety of waiting period in women going through IUI treatment.

Materials and methods: This clinical trial was conducted in 108 women attending Milad infertility center in Mashhad, Iran. In problem solving group three training sessions were held. In positive reappraisal coping group, two training sessions were held to accustom the participants to the components of positive reappraisal coping. The subjects in this group were asked to read the positive reappraisal coping cards (daily) and complete the monitoring form. Meanwhile, the control group received usual care. The mean score for anxiety was compared between all groups applying Spielberger anxiety Inventory on day 10 of the waiting period.

Results: The mean scores for anxiety showed significant differences between the control group (52.46±11.70), the group receiving problem-solving skills trainings (46.03±11.25), and the cases in positive reappraisal coping intervention group (47.34±10.5), (P =0.039). But the mean scores for trait anxiety was not significantly different between the control group (47.55±6.98) those in problem-solving skills group (45.02±8.84), and individuals receiving positive reappraisal coping intervention (45.92±8.89), (P =0.426).

Conclusion: According to the positive influence of both interventions, they are recommended for reducing anxiety in waiting period of IUI treatment.

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Background and purpose: Patients with systemic lupus erythematosus (SLE) suffer from a variety of psychological problems, including depression, anxiety, and stress. This study aimed to examine the effect of mindfulness-based metacognitive skills training on depression, anxiety, stress, and sense of well-being in patients with SLE.
Materials and methods: This randomized clinical trial with pre-test/post-test design was carried out in 60 patients with SLE attending Babol Shahid Beheshti Nephrology Clinic, 2018. They were randomly divided into two groups (n=30 per group). The experimental group received weekly sessions of mindfulness-based metacognitive skills training (1 hr/ 8 weeks), while the control group did not receive any intervention. The patients’ socio-demographic information was recorded and Depression Anxiety and Stress Scale (DASS-21) and Psychological Well-Being Scale (PWB) were administered. Descriptive and inferential statistical methods including generalized estimator equations with autoregressive correlation structure were applied in SPSS V24.
Results: In experimental group, the mean scores for depression, anxiety, and stress significantly changed after the intervention (P=0.001). In this group, the post-intervention mean score for well-being also significantly improved (P=0.006). Compared with the experimental group, the control group was not found with any significant changes in depression, anxiety, stress, and well-being.
Conclusion: Mindfulness-based metacognitive skills may improve depression, anxiety, stress, and sense of well-being in patients with systemic lupus erythematosus.
 
(Clinical Trials Registry Number: IRCT20171203037723N2)
 

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Background and purpose: Learning difficulty in mathematics is one of the most common problems in students. The purpose of this study was to investigate the effect of maternal stress management skills training on improvement of problem-solving skills in students with dyscalculia.
Materials and methods: A quasi-experimental study with pre-test post-test control group design was carried out in 30 elementary level school girls (grades 3 and 4) with disabilities in learning mathematics in Qaemshahr, north of Iran. Schools and classes were selected using cluster sampling. The students were selected based on interviews and were randomly assigned into control group or experimental group (n=15 per group). Data were collected using DSM-IV-TR diagnostic checklist, the KeyMath Diagnostic Assessment, the Raven's Progressive Matrices, and General Health Questionnaire-28 (GHQ-28). Both groups received metacognitive training on problem-solving (14 sessions/ 5 weeks). Meanwhile, mothers of students in experimental group attended a training course on stress management (8 sessions/ 4 weeks). Data analysis was done in SPSS V19 applying univariate analysis of variance and P values of less than 0.01 were regarded as astatisctically significant.
Results: Students in both groups showed improvements in problem-solving skills but in experimental group whose mothers received stress management skills training, the students were found with significant improvements compared to the control group (P<0.001).
Conclusion: According to current study, maternal stress management training has considerable effects on improving problem-solving skills in students.
 

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Background and purpose: Acquisition of basic skills and professionalism in medicine depends on the quality and quantity of education in clinical settings. This study aimed at assessing the quality of clinical education in different departments of Mazandaran University of Medical Sciences.
Materials and methods: This descriptive study was conducted in medical clerkships and interns (n=175). The participants were selected via census sampling in 2019. Data were collected using a checklist based on clinical education standards of Iran Ministry of Health and Medical Education. Written comments from clerkships and interns on the compliance of morning report training programs, clinical trainings, clinical rounds, grand rounds, journal club, and clinical skills center with clinical training standards were received. Data analysis was performed in SPSS V16.
Results: The morning report program and clinical skills center program had the highest (85.1%) and lowest (72.2%) scores in clinical education. We observed significant differences between these scores and the scores for other clinical programs (P>0.05). The quality of all clinical education programs was similar according to men and women. The clerkship and interns had different ideas about the status of all clinical education programs except in the morning report program and the clerkship were more satisfied with clinical education programs.
Conclusion: From the students' point of view, the morning report program was of acceptable quality, but the clinical training programs, club journal, grand rounds, and clinical skills center had some drawbacks. Training workshops for clinical professors is recommended to enhance the standards of clinical training programs.
 

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Background and purpose: Violence against nurses is a growing global problem in all countries such as Iran. Due to the importance of this issue, this study was performed to investigate the relationship between the communication skills of nurses and the violence they experience in emergency departments at Mazandaran University of Medical Sciences.
Materials and methods: This descriptive-analytical study was performed in 224 nurses in Mazandaran province in 2019. The samples were selected via census. Workplace violence in the health sector questionnaire and Burton G. E questionnaire were used to evaluate nurse’s communication skills, respectively. Data were analyzed in SPSS V25.
Results: Verbal violence was the most frequent form of violence against nurses (85.3%) and patients were the main source of violence. In this study, the mean score for nurses’ communication skills was 58.13 that indicated moderate levels of communication skills. The study showed no significant relationship between nurses’ communication skills and the incidence of violence (P=0.85).
Conclusion: Although there was no significant relationship between emergency nurses’ communication skills and incidence of violence against them, enhancing their communication skills should be considered by managers.
 

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Background and purpose: One of the factors influencing the quality of patient care and the desirable outcomes of nursing services is the mental workload; most individuals prefer specific coping strategies to reduce stress and mental workload in stressful situations. Coping strategies are a set of cognitive, emotional, and behavioral efforts to change stressful situations. The present study was conducted to determine the relationship between mental workload and coping strategies in nursing students at Mazandaran University of Medical Sciences in the year 2019.
Materials and methods: In this descriptive-analytic cross-sectional study, 160 students were randomly selected from three nursing and midwifery faculties in Sari, Behshahr, and Amol. Data were collected using the NASA Task Load Index (NASA-TLX) mental workload questionnaire and the Lazarus and Folkman emotion-focused and problem-focused coping strategies questionnaire. The data were then analyzed using SPSS version 20.
Results: A total of 88 females (55%) and 72 males (45%) with a mean age of 22.52±1.98 years participated in the study. Fifty-two (32.5%) used a problem-oriented strategy, and 96(60%) used an emotion-oriented strategy. The mental workload mean score was 72.80±14.55 and a statistically significant relationship was found between mental workload with age and physical demand subscale (P=0.032 and p=0.028, respectively). No statistically significant difference was observed between the mental workload and coping strategy in both genders (P=0.171 and P=0.397, respectively). Moreover, no significant association was found between the mental workload and the overall coping strategy score (P=0.066).
Conclusion: Nursing students had high scores for mental workload, which can negatively impact the quality of care provided by them. Additionally, the most frequently used coping strategy among these students was emotion-focused coping. The use of problem-focused coping strategies reduces emotional distress, decreases mental workload, and enhances individuals' efficiency. Considering the obtained results, there is a need to develop and provide appropriate solutions in the field of education, focusing on problem- focused coping strategies rather than emotion-focused strategies, to increase the efficiency of students.

 

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Background and purpose: Environmental pollution, is one of the main causes of increasing cognitive-neurological disorders. All pollutants, whether biodegradable or non-biodegradable, contribute to various neurological issues, including cognitive disorders, and affect human life, particularly in the early stages of development. Given the growing concern about the impact that air pollutants may have on children's learning and neural development, the current research aims to determine the relationship between exposure to pollution and neural development skills in children, in the early stages of education and schooling.
Materials and methods: The present systematic review was conducted following international standards and according to the PRISMA checklist. English-language articles were searched from PubMed, Scopus, and Web of Science, Science Direct, and Google Scholar databases until September 2023. Eligible articles were screened by reading titles and abstracts by the researcher. Then, the full text of relevant articles was evaluated, and discrepancies were resolved before making the final decision. The studies reviewed in this research included air and soil pollution, one of the cognitive and learning disorders such as attention, memory, intelligence, thinking, neural development, etc., preschool, and elementary school. In the present study, articles were fully reviewed, and research that did not fall within the age range of preschool and elementary school was excluded from the review; such as articles related to air pollution during the fetal period or children over the age of 12 years. Articles that simultaneously included children within and outside the age range of the study were only reviewed for the relevant age groups, and review articles were also used to find studies related to the research topic.
Results: The search strategy resulted in the identification of 528 studies related to the article’s topic. Based on the screening of inclusion and exclusion criteria, eventually 37 articles were selected that matched the objectives of this research. The results indicated a wide heterogeneity in neuropsychological assessment tools, geographical regions, and sample sizes recorded. Also, many findings reported significant detrimental effects of air pollutants on cognitive functions and sensory-motor abilities (reported a significant difference in terms of brain white matter volume and motor abilities among children exposed to pollution, indicating that living in a polluted area is a risk factor for disruption in sensory-motor functions), increased risk of ADHD, reduced intelligence and cognitive performance, reduced memory, reduced attention; and reduced learning power and perception, most of which examined the effects of several pollutants on cognitive changes in children in preschool and elementary stages. In two of the articles reviewed in this research, the relationship was analyzed based on gender. In these studies, boys were at greater risk in terms of active memory. Also, in the quality assessment of articles, most articles scored 15 or higher, indicating the desirable status of most of the selected articles.
Conclusion: The exposure to pollution with problems in cognitive skills; it is particularly associated with intellectual functions, attention, learning, comprehension, and memory skills. However, the association of pollution with specific neurodevelopmental skills in preschool and elementary school children is less clear and requires more research.
 

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Background and purpose: Mastery of clinical skills in emergency medicine is a key factor in effectively managing emergency patients. Given the critical importance of acquiring these skills, this study aimed to evaluate the self-assessment of medical interns at Babol University of Medical Sciences regarding their training and competence in the emergency department
Materials and methods: This study was conducted as a descriptive cross-sectional study on 100 interns from Babol University of Medical Sciences who had completed their emergency medicine internship in 2023. Participants completed demographic questionnaires and satisfaction surveys assessing their acquisition of clinical skills in managing emergency patients, performing essential therapeutic procedures, and their education in the emergency department. Data were analyzed using SPSS version 27 with descriptive and inferential statistical methods.
Results: The mean age of the students was 25.54±1.42 years. The results showed that students reported the highest satisfaction in the areas of acquiring clinical skills for managing emergency patients, performing primary therapeutic procedures, and the quality of education in the emergency department, specifically in handling abdominal pain, nasogastric tube insertion, gastric lavage, and the impact of the emergency medicine department on improving emergency activities. Conversely, the lowest satisfaction was reported in dealing with environmental emergencies, airway management, and motivating learners for study and research activities.
Conclusion: Based on the results of this study, there is a clear need for targeted planning
and strategies to enhance clinical skills in managing environmental emergencies, improving airway management, and motivating interns to engage in study and research activities.