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Background and purpose: Bipolar disorder is a severe psychiatric disorder with a variety of natural courses and manifestations, and a recurrent nature. The aim of this study was to determine the effective factors on recurrence using Andersen-Gill counting process model. Materials and methods: In an ambidirectional cohort study (4 years retrospective and 1 year prospective from 2007 to 2012), 255 patients (141 men, and 114 women) with bipolar type I disorder and history of hospitalization in Zare psychiatric center (Sari, Iran) were studied. Demographic, psychiatric and other variables related to recurrence were gathered from patients' medical records. Andersen-Gill counting process model via Statistical Package of STATA was used to determine predictive variables of recurrence. Results: 693 recurrences occurred during the 5 years follow-up period all the patients experienced recurrence at least once, 29 patients (11.4%) only once, 90 (35.3%) twice, 87 (34.1%) thrice, 25 (9.8%) four times, 21 (8.2%) five times, and 3 (1.2%) six time. Counting process regression model showed that the number of previous episodes and psychiatric family history in first-degree relatives (hazard ratio > 1 P < 0.05) increased the probability of recurrence and presence of psychotic features in each recurrence decreased hazard of recurrence (hazard ratio < 1 P < 0.05). Conclusion: Bipolar disorder has a high rate of recurrence. Predictor variables include number of previous episodes, first-degree relatives’ psychiatric family history and presence of psychotic features in each recurrence.

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Background and purpose: Appropriate health services including sexual health are regarded as human rights especially for women. The aim of this study was to determine the extent and causes of lack of sexual health services in women attending health centers, and providing a suitable strategy for their elimination.
Materials and methods: This study was conducted using a sequential explanatory mixed method in 2014. The first phase of the study was done in 514 women who referred to Sari health centers applying a cross-sectional design. Women who did not receive even one of the sexual health services entered the qualitative phase of the study, which was done by conventional qualitative content analysis. Then, the two phases were combined. Nominal group technique was used to prioritize the strategies about sexual health services.
Results: The quantitative phase showed that 20% of females and 50% of male partners did not seek treatments for genital ulcers or abnormal secretions. None of the males with multiple spouses have used condoms at their last sexual intercourses. According to the qualitative phase, two reasons were found for not receiving sexual health services: the lack of women's attendance to health centers and non-accountability of health centers to women's sexual health needs.
Conclusion: The current health system in Iran does not respond to women’s sexual health needs. Therefore, in Iran, sexual health services are suggested to be integrated with the health system alongside empowering women about their health needs and increasing men's awareness in providing women's sexual needs.
 

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 Background and purpose: Palpation of the radial pulse is a valuable clinical tool and one of the most useful physical examinations in medical care. The aim of the present study was to investigate the correlation between the number of pulses measured by the radial artery and the pulses recorded by electrocardiogram (ECG).
Materials and methods: We conducted a correlational study and the research population included patients attending Emergency Department in Sari Imam Khomeini Hospital. The pulse rate was recorded by measuring the radial pulse rate of the left hand and the heart rate using an electrocardiogram device. In case of regular rhythm, the number of beats was measured for 15, 30, and 60 seconds using a digital stopwatch and multiplied by 4, 2, and 1, respectively.
Results: There was a slight difference in pulse rate between the radial artery measurement for 15 seconds and the ECG that was statistically significant (P<0.001), but this difference was not significant for 30 and 60 seconds (P>0.05). The ICC correlation coefficient between pulse rates for 15, 30, and 60 seconds and ECG was high (above 0.98).
Conclusion: Based on the present study, instead of electrocardiogram, radial pulse count for 30 seconds multiplied by 2 can be used in clinical conditions, especially in emergency.