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Paper production is a process that consumes a lot of water, in this process the use of water should be carefully considered. Most of the industrialized countries have developed standards for the discharge of sewage or wastewater, the purpose of which is to ensure that the society does not have to bear the costs caused by the industrial use of water. Wastewater, after processing, should be returned in a suitable form for almost any type of purpose. The stricter standards have caused the complete closure of paper mill water systems (that is, bringing the amount of effluent to zero) to be emphasized more. In the discussion of recycling, the fibers should be separated from the wastewater due to their economic value and returned to the system. Therefore, in this research, in one of the OCC recycling factories, the amount of water consumption and effluent output and the amount of fibers in the effluent output of this factory before pre-treatment and after pre-treatment were investigated and it was observed that if the water intake is not controlled and If pre-treatment is not used, a significant amount of fibers will be thrown away along with the waste water, which is 8441 kg per 390.651 tons of production in one month based on TSS The basis of purchase price of OCC was done in the same period.

Background and Objective: Propofol is one of the most commonly used drugs in anesthesia with the pain during an injection is a side effect of this drug. This study was conducted to compare the effect of Lidocaine, Magnesium Sulfate, and Ketamine on reducing pain caused by intravenous injection of Propofol in patients Undergoing surgery. Methods: In this double-blind randomized clinical trial study, 80 patients aged 18 to 65 years were randomly blocked and assigned into four groups including Lidocaine, Ketamine, Magnesium Sulfate and Normal Saline. The pain was measured with the Ambesh Score. Hemodynamic changes of patients were evaluated in 1, 3, and 5 minutes. Results: The patients in Lidocaine, Ketamine, and Magnesium Sulfate groups with 75%, 70%, and 55%, respectively, did not feel pain after Propofol injection compared to Normal Saline group (25%) (P

Purpose: Iranians’ worry over the number of older patients negatively impacted by COVID-19 surged dramatically throughout the 5 waves of the COVID-19 pandemic, which lasted from January 2020 to September 2021. The goal of this research was to assess the physical and mental health of Iranian older persons throughout the COVID-19 pandemic’s major waves. Methods: The health condition of 507 older persons with a positive examination for COVID-19 illness was assessed before and throughout the 5 waves of coronavirus in south Iran in analytical and hybrid longitudinal research. Results: The primary consequences of COVID-19 incidence on frailty and mental health issues were revealed in this investigation. Using a linear mixed model, we found a reduction of 0.33 in loneliness (β = −.33, 95% CI −0.39 to −0.26) during the COVID-19 pandemic. The probabilities of becoming depressed, anxious, or frail rose 4.61 (95% CI: 3.77-5.63), 1.85 (95% CI: 1.52-2.24), as well as 1.42 (95% CI: 1.17-1.42) time, subsequently, with COVID-19 occurrence, according to the mixed logistic models. Furthermore, the influence of COVID-19 incidence on loneliness result differs by gender; for depression, it varies by education; and for anxiety, it changes by comorbidities and living independently. Conclusion: The COVID-19 pandemic significantly impacts the mental health and frailty of older persons with the positive COVID-19 situation, and this scenario is gender-based too.

OBJECTIVES Previous studies have estimated the risk of death associated with unemployment in the coronavirus disease 2019 (COVID-19) pandemic, but no studies have examined unemployment before COVID-19 infection as a risk factor for COVID-19-related mortality. Thus, this study aimed to investigate COVID-19 mortality among this population. METHODS Data on 50,038 people aged 25-59 years were collected from 38 agencies in Fars Province, Iran, from February 2020 to July 2021. Follow-up lasted from participants’ diagnosis with COVID-19 based on the results of a reverse transcription-polymerase chain reaction test to participants’ death or the end of the study period. The association between unemployment and COVID-19-related mortality was estimated using the Poisson regression method, and a sensitivity analysis was conducted to calculate the E-value. RESULTS Unemployment was associated with a 2.41-fold (95% confidence interval [CI], 2.01 to 2.90) higher age-adjusted and sex-adjusted risk of COVID-19-related mortality. The adjusted Poisson regression analysis showed 8.82 (95% CI, 6.42 to 12.11), 2.84 (95% CI, 1.90 to 4.24), and 1.58 (95% CI, 1.24 to 2.01) times higher risks of COVID-19-related mortality among unemployed people aged 25-39 years, 40-49 years, and 50-59 years, respectively, than among their employed counterparts. Unemployment increased the risk of COVID-19 mortality by 3.31 (95% CI, 2.31 to 4.74) and 2.30 (95% CI, 1.86 to 2.84) times in female and male, respectively. The E-value was 3.43, reflecting the minimum strength of confounding required to shift the association between unemployment and COVID-19-related mortality toward the null. CONCLUSIONS Unemployment prior to COVID-19 infection increased the risk of COVID-19-related mortality. COVID-19-related mortality disproportionately impacted unemployed women and younger unemployed people.

BackgroundStandard regression modeling may cause biased effect estimates in the presence of time-varying confounders affected by prior exposure. This study aimed to quantify the relationship between declining in modified creatinine index (MCI), as a surrogate marker of lean body mass, and mortality among end stage renal disease (ESRD) patients using G-estimation accounting appropriately for time-varying confounders.MethodsA retrospective cohort of all registered ESRD patients (n = 553) was constructed over 8 years from 2011 to 2019, from 3 hemodialysis centers at Kerman, southeast of Iran. According to changes in MCI, patients were dichotomized to either the decline group or no-decline group. Subsequently the effect of interest was estimated using G-estimation and compared with accelerated failure time (AFT) Weibull models using two modelling strategies.ResultsStandard models demonstrated survival time ratios of 0.91 (95% confidence interval [95% CI]: 0.64 to 1.28) and 0.84 (95% CI: 0.58 to 1.23) in patients in the decline MCI group compared to those in no-decline MCI group. This effect was demonstrated to be 0.57 (-95% CI: 0.21 to 0.81) using G-estimation.ConclusionDeclining in MCI increases mortality in patients with ESRD using G-estimation, while the AFT standard models yield biased effect estimate toward the null.

Despite the recommendation for early diagnosis and rapid initiation of HIV treatment, more than half of patients are in an advanced stage of HIV disease in Iran. This study aimed to investigate the factors related to baseline CD4 cell count and advanced HIV disease (AHD) in Southern Iran. The study comprised all adults between 15 and 87 years of age who were newly diagnosed with HIV in Southern Iran. Linear and logistic regressions were used to identify baseline CD4 cell count predictors and AHD, respectively. A total of 820 (53.9%) HIV-infected individuals over 15 years of age were at the AHD stage. Based on the results of the multiple logistic regression, older age at diagnosis (OR≥40/

Paper production is a process based on using water. Most of the industrialized countries set strict standards to protect the environment, and all industrial wastewater output must be based on such standards. Because of their economic value, recycled fibers must be separated from the effluent and returned to the system when the effluent leaves the factory. The purpose of this study was to investigate and measure the amount and costs of water consumption and the amount of fiber wastage in the controlled and uncontrolled output of the desired factory effluent. From observations of a local OCC recycling factory, the amount of water consumption and effluent output and the amount of fibers in the effluent output of this factory before pre-treatment and after pre-treatment were investigated. It was observed that if the water intake was not controlled and if pre-treatment was not used, a significant amount of fibers was thrown away along with the wastewater, which was 8,440 kg per 391 tons of production in one month based on total suspended solid. [ABSTRACT FROM AUTHOR]

Understanding the market situation in order to obtain a suitable position in the new inter-national production system has particular importance. Therefore, the aim of this study was to determine and rank the effective indexes on the selection and purchase of paper in the card board production industries of the country. The expansion of the market and the multiplicity of industries have led to the importance of finding competitiveness as well as an accurate un-derstanding of their relative position in the market for many industries in order to make their economic and industrial policies compatible with their market conditions and relative position. Knowing this fact will help them improve their capabilities to improve their performance. Therefore, the purpose of this study was to determine and rank the effective measures on the choice and purchase of cardboard in the country's carton industry. The results of the ranking showed that among the 24 sub-indicators influencing the purchase and selection of cartons sheet in the paper board manufacturing industry,

Introduction Obesity is a major health concern in postmenopausal women, and chronic low-grade inflammation contributes to the development of obesity. Cellular studies and high-fat-diet-induced obese mouse model mimicking obesity show the antiobesity effect of annatto-extracted tocotrienols (TT) with antioxidant capability. We aim to assess the safety and efficacy of TT consumption for lipid-related parameters in obese postmenopausal women.Methods and analysis Eligible obese postmenopausal women will be randomly assigned to placebo group (430 mg olive oil) and TT group (DeltaGold Tocotrienol 70%) for 24 weeks. In the present study, the primary outcome is total/regional fat mass and visceral adipose tissue. The secondary outcomes include lipid profile in serum, mRNA expression of fatty acid synthase and carnitine palmitoyltransferase 1A in fat tissue, oxylipins and endocannabinoids in plasma and adipose tissue, abundance and composition of intestinal microbiome in faeces, high-sensitivity C-reactive protein (hs-CRP) in serum and leptin in serum. Every participant will be evaluated at 0 (prior to starting intervention) and 24 weeks of intervention, except for serum lipid profile and hs-CRP at 0, 12 and 24 weeks. ‘Intent-to-treat’ principle is employed for data analysis. Hierarchical linear modelling is used to estimate the effects of dietary TT supplementation while properly accounting for dependency of data and identified covariates. To our knowledge, this is the first randomised, placebo-controlled, double-blinded study to determine dietary TT supplementation on an obese population. If successful, this study will guide the future efficacy TT interventions and TT can be implemented as an alternative for obese population in antiobesity management.Ethics and dissemination This study has been approved by the Bioethics Committee of the Texas Tech University Health Sciences Center, Lubbock. An informed consent form will be signed by a participant before enrolling in the study. The results from this trial will be actively disseminated through academic conference presentation and peer-reviewed journals.Trial registration number NCT03705845.

Introduction: Validity and reliability are essential criteria for clinical competency assessment tests. This study was conducted to determine the validity and reliability of the Objective Structured Clinical Examination (OSCE) for nursing pre-internship. Methods: This methodological study was done on 36 pre-internship Nursing students of Golestan University of Medical Sciences in 2016. Census method was used for sampling. The face validity and content validity of the twelve-station checklist were conducted with the viewpoint and expertise of specialists. The criterion validity was determined by the correlation of the mean scores of theoretical and clinical courses with the total OSCE score, and construct validity was determined by the correlation between score of each stations with total score. The predictive validity was determined by multivariable regression and the reliability was determined through internal consistency. Results: The face validity and content validity of the test checklists were approved by the specialist’s panel of the nursing educational departments. The criterion validity was approved by the correlation of the total score of the test with the mean score of the theoretical courses (r = 0.48) and clinical courses (r=0.35). The correlation of the twelve stations with the total score of the test approved the construct validity, and the mean score was the only predictive variable of the test results (P=0.004, r=.68, β=0.49). The internal consistency of the test was (α=0.92). Conclusion: Validity and reliability assessment of clinical competency tests can assure the tools used to determine the readiness of nursing students before entering the field and can resolve learning problems.

Background: The effect of new teaching method on study skill of students results in a significant improvement in learning performances. The aim of study was to determine the effect of Team-Based Learning on study habits of nursing students. Methods: The quasi-experimental study with a before-and-after design was conducted on nursing students of Golestan University of Medical Sciences in 2015. 101 students participated in this study through census sampling considering the inclusion criteria. The data was collected using Palsane and Sharma Study Habits Inventory (PSSHI) before and after intervention. The intervention was 16 sessions (a two-hour session per week) Team-based learning. The data was analyzed in SPSS-20 software using paired t-test. Results: Finding showed that most of the students were female (60.3%), and single (95%) with mean age of 21.47±1.5 years. When students were stratified into four groups based on the quartiles of the distribution of study habit, the number of students who had poor study habit decrease after intervention (%5.6) and the number of students with excellent study habit increase after intervention (%3.8). In addition, the mean and standard deviation scores of students' study habits of before and after the intervention were 42.53±7.46 and 48.75±8.94, respectively, which was significantly different (P

Introduction: Breast cancer and its treatment have notable adverse effects on patients’ body image, which could result in disability and psychological distress. Therefore, the present study investigated the association of anxiety, depression, and body image disorder with pain-related disability in post-mastectomy female breast cancer patients. Materials and Methods: This cross-sectional study was conducted on 137 post-mastectomy female breast cancer patients referred to two hospitals in Tehran, in 2015. Demographic data were collected, and all subjects completed questionnaires for patients with cancer, pain disability index and hospital anxiety and depression scale. Validity and reliability of all questionnaires used in the study had been verified previously.Results: There were significant inverse correlations between depression and body image (r=-0.24, P

Introduction: Mental and physical state of mothers during pregnancy affects the development of fetus. This study aimed to investigate the role of neonates’ gender in pain responses and its association with maternal stress during pregnancy and programming. Materials and Methods: This study was conducted on 105 neonates (53 females and 52 males) born in hospitals of Gorgan, Northern Iran. The pain stimulus was intramuscular injection of vitamin K, a routine procedure performed for infants at birth. The first injection was done for all subjects under the same conditions. The neonatal infant pain scale was used for assessment of pain intensity in newborns. Maternal stress during pregnancy was assessed by measuring hair cortisol levels. Data analysis was done using Kolmogorov-Smirnov test, independent t-test and Pearson correlation coefficient. Results: There was no significant difference in the mean pain intensity score before, during and after the injection between male and female newborns. During the injection, the mean pain score of male neonates whose mothers had higher cortisol levels was significantly higher than male neonates whose mothers had normal cortisol levels (P-value=0.01). However, there was no significant relationship between cortisol level and pain intensity score of newborns. Conclusions: Our results show that the mean pain score during the injection is significantly higher in male neonates whose mothers have higher cortisol levels. There is no significant relationship between cortisol level and pain intensity score of newborns

Introduction:Mental health refers to emotional and psychological well-being, impairment of which may adversely affect an individual's cognitive or social functioning, making it harder to cope with the demands of daily life. According to the biopsychosocial paradigm and, common psychological symptoms, such as low mood, importantly influence the occurrence and prognosis of musculoskeletal pain. The aim of this study is to survey of association musculoskeletal pain with Psychosocial and work-related factors among office staff in Gorgan. Methods and Material: This descriptive and analytical study was performed among office workers in Gorgan in 2016. By cluster sampling method 675 office staff was included to be interviewed from the 18 occupational sectors. Data were collected on individual factors, negative affectivity, workplace factor, work station and task demand, psychosocial risk factors, work environment and experience of pain during the past 12 months. With Nordic Musculoskeletal Questionnaire (NMQ-E, Self-Administered Physical Activity Survey and the standardized Dutch Musculoskeletal Questionnaire. Data were analyzed by logistic regression in spss version 16.Results:Among all participants, 17.3 % reported neck pain, and it was 8.4 % and 20% for shoulder and low back pain, respectively. Moreover, 6.4% of these patients had pain in more than one body area. Factors including adjusted back rest on chair, work with bent head, hours worked per week and also supervisor support and sex were significant for the neck pain (p < 0.001). Factors consist of staring at the screen, forearm parallel to the floor while working, Sitting at work station before taking a break, sitting in awkward postures during the work, sex, age group and negative affectivity remained significant for low back pain. Conclusion: Excessive use of the computer system combined with a poorly designed workstation, repetitive computer work, lack of rest time at work, the role of individual factors such as age, sex, and lack of awareness of the dangers of environmental and psychosocial factors in workplace formed risk factors that are associated with musculoskeletal disorders, then, it is basically necessary to identify mentioned factors to solve and improve disorders.

Background: Leishmaniasis is a parasitic disease caused by protozoan called Leishmania that is transmitted by sand flies. The aim of this study was to determine the demographic and clinical characteristics of children with cutaneous leishmaniasis in Isfahan province, Iran. Methods: This was a cross-sectional study on all children patients with age of five years and younger in Isfahan province during 2011 to 2015. Demographic and clinical characters of patients were presented as the number and percentage. The mean age of patients according to sex was compared using t test via SPSS software. Findings: Of 1529 patients, 51.8% were boys, 56.0% were in rural areas, and 92.9% were Iranian. The mean age of patients (± SD) was 2.71 ± 1.5 years. The smallest patient was 2 months old. Most of the patients were in the age group of one year (20.4%) and the lowest were in the age group of less than one year (5.6%). Leishmania major was the most common (91.8%) cause of disease. Wound size at 63.37% of patients was more than 2 cm. In 11.2% of patients the number of wounds was equal or more than 4 wound. In children, face was the most common (33.7%) region of wound. Conclusion: Leishmaniasis is endemic in Isfahan province, and children are in high risk for incidence of disease. However, the process for combating the animal reservoirs and mosquito vector should be considered as a priority to control the disease. Furthermore, the facilities should be provided for accurate and timely diagnosis and treatment of patients.

Introduction: To investigate 28 days survival rate following first acute myocardial infarction (AMI) associated with the presence of classical risk factors and treatment modalities in Gorgan, north of Iran. Materials and methods: Our cohort including all patients hospitalized due to AMI from 2010 to 2013. Data were collected on demographic, prophylactic drugs and classical coronary risk factors. Data were analyzed using Kaplan-Meier and log rank tests. Cox proportional hazard model was built to estimate relative risk by taking into account other variables. Results: Median age of subjects was 58 and 64 for men and women, respectively; moreover, the occurrence of diabetes was 52.5 and 24.5 for them. A poorer outcome was detected in survival rate for women in the final model. Excess death occurrence in Fars or non- Persian ethnicity, and those who were not prescribed statin was detected in the adjusted model. Conclusion: A better survival rate for those who were prescribed statin suggest that it could be beneficial in treatment modality and non-Persian ethnicities needed to be considered as a group of at risk for earlier screening programs. In spite of some other studies a poorer outcome following AMI for women was found even after taking into account age and comorbidity.

SO2-ethanol-water (SEW) pulping can be considered a hybrid between solvent and acid sulfite pulping processes. Recently this process in order to separation the principal components (cellulose, hemicelluloses and lignin) have been considered. The main objective of this study was to investigate the effects of washing method on the bagasse pulping characteristics by acidic fractionation of Sulfur Dioxide- Ethanol-Water (SEW). Variables included two washing pulp methods (water and 40 v/v% ethanol-water solutions), pulping duration (30-100 min.), and temperature (120 and 135 OC). Then, pulps were washed twice with 40% v/v ethanol-water at 60°C (L: W 2 L kg-1) and with deionized water at room temperature (L: W 20 L kg-1). The results showed that the final yield pulp due to lignin greater solubility in 40 v/v % ethanol-water compared to conventional systems (washing by water) decreased that the diminishing returns are statistically significant at the 1% level. Pulping result at 120 and 135 °C at different time period showed that increase in the pulping duration, kappa number is reduced.

Introduction: Musculoskeletal pain accompanied by psychological problem lead to reduce the efficiency of adolescents; so, this study aimed to determine the prevalence of musculoskeletal pain and its association with psychological factors among female adolescents. Materials and methods: The target population of this cross sectional study was female students (3625 in total) from both private and state funded high school children in Gorgan, northern Iran. Self - assessment questionnaires were distributed to 255 students across 8 female high schools. Self-report version of the Strengths and Difficulties (SDQ) questionnaires was used to screen adolescents with Psychiatric symptoms. To evaluate musculoskeletal pain Nordic questionnaire and numeric pain rating scale was used. Data were analyzed by binary logistic regression and the cumulative odds ratio (COR) was carried out for the ordinal level of musculoskeletal symptoms. Results: The prevalence rate of neck, shoulder and low back pain was reported, 23.1%, 27.8% and 27.7%, respectively. Hyperactivity-inattention (OR=2. 82; CI: 1.14-6.97) and peer problem (OR= 2.72; CI: 1.01-7.32) had significant relationship with neck pain, and prosocial behaviors (OR= 3.11; CI: 1.09-10.73) were associated with low back pain in the multivariate model. Ordinal regression showed that the increasing numbers of musculoskeletal symptoms related only to prosocial behavior (COR= 2.78; CI: 1.12-6.91). There was no significant association between shoulder pain and psychological factors. Conclusion: Based on the results, psychological factors were associated with musculoskeletal pain; so, it seems suffering from musculoskeletal pain need to be concurrently noticed with mental feeling for more effective response to attenuate pain.

Background and Objective: Vitiligo is one of the most frequent skin disorders with a prevalence of 1-2% in different populations. Although many theories have been suggested for its pathogenesis, but the most popular hypotheses is the role of autoimmunity in Vitiligo. This study was done to evaluate the thyroid dysfunction and thyroid autoantibodies in patients with Vitiligo. Methods: This case-control study was carried out on 45 patients with Vitiligo and 45 age- and sex-matched healthy individuals as control group. Age, gender, duration of the disease and type of Vitiligo were collected through a standard questionnaire. Thyroid autoantibodies including thyroglobulin antibody, anti- thyroglobulin and thyroid peroxidase antibody, and anti-TPO thyroid hormones Tetraiodothyronine (T4), Triiodothyronine (T3) and thyroid stimulating hormone (TSH) in Vitiligo patients and healthy volunteers were measeared. Results: Serum level of T4 was significantly reduced in Vitiligo patient compared to controls (P

Background: Congenital anomalies are important medical and public health conditions. The pattern and prevalence of birth defects may vary over time or with geographical location. We investigated the live birth prevalence and occurrence pattern of birth defects in Golestan Province, northern Iran. Methods: This cross-sectional descriptive study was carried out on 144920 live newborns in 13 hospitals in Golestan Province, northern Iran, from 21 Jan 2008 to 19 Mar 2013. The newborns were examined for the presence of birth defects and mothers were interviewed for variables such as maternal age and ethnicity. In addition, data for each newborn was filed in a questionnaire and the coding of birth defects was translated to the International Classification of Diseases 10th revision–clinical modification (ICD-10-CM). Results: Overall, 1690 infants were diagnosed as having birth defects among 144920 live newborns. The prevalence rate of birth defects was 11.66 per 1000 live births, the prevalence of birth defects per 1000 was11.62 in males and 11.42 in females. The prevalence of congenital anomalies among native Fars, Turkmen and Sistani were 13.03, 11.16 and 13.07, respectively, per 1000 live births. Anomalies of the cardiovascular system were the most common defects; the prevalence rate of cardiovascular system was 8.34 per 1000 live birth. Conclusion: The prevalence rate of birth defects in this area was lower than in the other regions in Iran (20.3 per 1000 live births) but higher than in some parts of Asia (7.33 per 1000 live births).

Background and Objective: Musculoskeletal disorders are the most common occupational complaints bringing about increased financial burden and reduced social productivity. This study aimed to determine the prevalence of musculoskeletal disorders and their relationship with psychosocial factors in the staff of organization. Material and Methods: In this cross-sectional study, 675 staff of the organizations in Gorgan where selected via cluster & stratified sampling. The instruments Nordic standard questionnaire and job content including areas of job demands, decision latitude, job nature, social interaction with managers and colleagues. We analyzed the data by independent t-test, chi-square test and logistic regression (P;le0.05). Results: Seventy-seven of participants (11.4%) suffer from neck pain, 39 (5.8%) from shoulder pain and 97 (14.4%) from back pain. Multivariate logistic regression showed a significant relationship between neck pain and the support given by supervisor and Colleagues. Respectively, Freedom of decision-making and support are the most common factors associated with shoulder and back pain. Conclusion: Based on the results, the support of supervisor & Colleagues and the freedom of decision are the risk factors associated with musculoskeletal disorders.

Background and Objective: Birth defects are important causes of childhood morbidity and disability. This study was done to determine the incidence and pattern of birth defects in live birth in cities of Golestan province, north of Iran. Methods: This descriptive study was carried out on 92420 live births in 13 hospitals in Golestan province, northern Iran from 21 January 2008 to 20 March 2011. The newborns were examined for the presence of birth defects. Gender, type of birth defects and residency of parents according to city in Golestan province was recorded for each newborn. Results: The incidence rate of birth defects, in Gorgan, Kordkoy, Aliabad and Gonbad was 20.46, 12.53, 10.86, and 8.99 per 1,000 live births, respectively. The incidence rate of birth defects western area (including Kordkoy, Bandargaz and Kordkoy), center (Gorgan, Capital city) and eastern area (including Aliabad, Gonbad, Minodasht and Kalaleh) of Golestan province) was 9.3, 20.46 and 8.79 per 1,000 live births, respectively. Cardiovascular anomaly was the most frequent birth defects. Conclusion: The incidence rate of birth defects varies in diferent area of Golestan provine and overally was lower than the other region in Iran.

Background and Objective: Subjective well-being, a field of positive psychology, attempts to assess the cognitive and emotional lives. Given the fact that nursing and midwifery students are exposed to stress in clinical settings, we aimed to assess subjective well-being to promote educational programs. Material and Methods: This across-sectional study was conducted on 104 nursing and Midwifery students selected via simple random sampling, 2013. The instruments, filled out by students, were a demographic checklist and Kyeez subjective well-being questionnaire consisting of three domains of emotional, social and psychological. We used mean and standard deviation for data description and T-test and ANOVA for analysis. Results: The mean score of subjective well-being was 203.20 in nursing and 210.21 in midwifery students. In nursing students, the Mean score in emotional, psychological and social domain was 44.05, 93.40 and 65.74, respectively, and it was 45.72, 94.78 and 69.55, respectively in midwifery students. Gender was the only variable associated significantly with subjective well-being of nursing students (P>0.05). Conclusion: Given the high score of subjective well-being and that of its domains, we recommend applying some educational programs with the consideration of emotional, psychological and social aspect of students.

Background. Diabetic patients’ delay in visiting a specialist doctor can have significant effects on blood sugar factors. The present study aimed to determine the effects of delay in visiting a specialist doctor in type 2 diabetic patients on glycaemic factors. Material and methods. The patients’ demographic and clinical information included in medical records of 209 type 2 diabetic patients referred to diabetes clinics in Shiraz city, south of Iran, were analysed using logistic mix-model regression. Due to the occurrence of COVID-19 during the follow-up period, data analyses were done separately before and after the pandemic. Results. The mean age of the patients was 63.47 ± 8.89 years, and 67.94% of the type 2 diabetic patients were female. After COVID-19, haemoglobin A1C (HBA1C) of the patients who had delays of < 3, 3–6 and > 6 months in referring to a specialist increased by 1.81 (OR: 1.12–2.93), 2.56 (OR: 1.81–5.56) and 3.69 (OR: 1.79–7.63), respectively, compared to the group without delays. In this period, 2-hour Postprandial Glucose (2-hpp) of the patients with delays of 3–6 and > 6 months and the Fasting Blood Sugar (FBS) of the patients with delays of > 6 months had a significant increase of 1.92 (OR: 1.01–3.65), 2.14 (OR: 1.09–4.21) and 2.36 (confidence interval of 95%: 1.27–4.39), respectively, compared to the patients without delays in visits. The above trends had a non-significant increase before COVID-19, though. Conclusions. Healthcare providers should ensure the continuity of providing services to diabetes patients, especially during health crises, by taking appropriate measures. [ABSTRACT FROM AUTHOR]

Background and Objective: Students are under pressure and stress because of their status in the society. So the university’s student counseling agent is offering consultative services in order to help and guide the students in solving problems and improve their compatibility. The objective of the current study was to investigate the student’s referral proof to the Golestan university of medical sciences’counseling agent. Materials and Methods: In this cross- sectional study conducted in 2008-2009,On, via census sampling, 345 students of various fields, who referred to the counseling agent. Gathering data’s methods were based on questionnaire that is designed based on Health Ministry’s counseling agent’s goals. Data were analyzed by SPSS statistical software and descriptive statistics and chi square test and ANOVA with significance level of 0.05. Results: Referred student’s reference’s abundance to the counseling agent in the years 2008-2009 showed that from the whole 345 referred people the highest number of referrals by order were: 154 people (44.6%) because of mental problems, 66 people (19.1%) because of marriage problems, 45 people (13%) because of educating problems, 39 people (11.3%) because of communicating problems, 29 people(8.4%) because of suicide problems and 12 people (3.5%) were because of other factors. Conclusion: This article’s results are showing mental, emotional, educating, behaving, cognitive and family problems and also the student’s marriage’s problems. Cognition, diagnosis, adjustment and early removal of failures, abnormalities and possible disorders confirm mental caring systems expanding importance and supportive cures.

Introduction: The main tasks of postoperative care are postoperative pain and complications control which play an important role in accelerating the recovery of patient’s general condition. Aim: This study was performed in order to compare the effects of diclofenac suppository, intravenous acetaminophen and their combination on the severity of postoperative pain in patients undergoing spinal anaesthesia for cesarean section in Sayyad Shirazi teaching Hospital, Gorgon, Iran. Materials and Methods: This was a double-blind clinical trial on 90 patients undergoing cesarean section. The patients were randomly divided into three groups, group A: 100 mg diclofenac suppository, group B: 1000 mg intravenous acetaminophen, group C: 100 mg diclofenac suppository and 500 mg intravenous acetaminophen. The same spinal anaesthesia circumstances were applied for all the participants. At the end of surgery, pain severity was assessed according to VAS scale at different times. Data were then analysed by SPSS 18 statistical software. Results: The mean age of participants was (28.27±6.07). There was significant difference between the mean pain scores of the three groups before the intervention (p=0.018), which was considered as co-variate. This difference was more notable between the combination of acetaminophen – diclofenac group and diclofenac alone. After the intervention, significant difference was observed in mean pain severity between acetaminophen group and the combination group and also between diclofenac and the combination group. During the study, the least mean pain severity was found in the combination group and the highest was observed in the diclofenac group. Conclusion: Results of this study indicates a significant effect of concomitant use of intravenous acetaminophen and diclofenac suppository on pain severity reduction and reducing the need for repeated doses of narcotics and prolonging the postoperative analgesia.

Background/Objective: Poisoning is One common cause of referred cases , especially in the adolescent and young group to hospital emergency department. This study was designed to determine Epidemiologic of poisoning in teaching hospitals, shiraz in 1387 Methods: This is a cross-sectional study that 266 sample via random sampling with 95% confidence interval and α 0.05 were considered. Results: There were 47% female and 53% male. 67.2 percent of poisoned patient were single and 32.8% were married. This study showed, highest rate of poisoning was between the age of 20-35 years. Most common season of poisoning was in spring. Overall mortality of our study was 1.6 percent. Conclusions: Regional epidemiological information, make rational use of resources in order to prevention and control of poisoning and with using analysis of effective factors will be reduced poisoning by policymakers and planners.

Purpose: Iranians' worry over the number of older patients negatively impacted by COVID-19 surged dramatically throughout the 5 waves of the COVID-19 pandemic, which lasted from January 2020 to September 2021. The goal of this research was to assess the physical and mental health of Iranian older persons throughout the COVID-19 pandemic's major waves. Methods: The health condition of 507 older persons with a positive examination for COVID-19 illness was assessed before and throughout the 5 waves of coronavirus in south Iran in analytical and hybrid longitudinal research. Results: The primary consequences of COVID-19 incidence on frailty and mental health issues were revealed in this investigation. Using a linear mixed model, we found a reduction of 0.33 in loneliness (β = −.33, 95% CI −0.39 to −0.26) during the COVID-19 pandemic. The probabilities of becoming depressed, anxious, or frail rose 4.61 (95% CI: 3.77-5.63), 1.85 (95% CI: 1.52-2.24), as well as 1.42 (95% CI: 1.17-1.42) time, subsequently, with COVID-19 occurrence, according to the mixed logistic models. Furthermore, the influence of COVID-19 incidence on loneliness result differs by gender; for depression, it varies by education; and for anxiety, it changes by comorbidities and living independently. Conclusion: The COVID-19 pandemic significantly impacts the mental health and frailty of older persons with the positive COVID-19 situation, and this scenario is gender-based too. [ABSTRACT FROM AUTHOR]

Background: Standard regression modeling may cause biased effect estimates in the presence of time-varying confounders affected by prior exposure. This study aimed to quantify the relationship between declining in modified creatinine index (MCI), as a surrogate marker of lean body mass, and mortality among end stage renal disease (ESRD) patients using G-estimation accounting appropriately for time-varying confounders. Methods: A retrospective cohort of all registered ESRD patients (n = 553) was constructed over 8 years from 2011 to 2019, from 3 hemodialysis centers at Kerman, southeast of Iran. According to changes in MCI, patients were dichotomized to either the decline group or no-decline group. Subsequently the effect of interest was estimated using G-estimation and compared with accelerated failure time (AFT) Weibull models using two modelling strategies. Results: Standard models demonstrated survival time ratios of 0.91 (95% confidence interval [95% CI]: 0.64 to 1.28) and 0.84 (95% CI: 0.58 to 1.23) in patients in the decline MCI group compared to those in no-decline MCI group. This effect was demonstrated to be 0.57 (-95% CI: 0.21 to 0.81) using G-estimation. Conclusion: Declining in MCI increases mortality in patients with ESRD using G-estimation, while the AFT standard models yield biased effect estimate toward the null. [ABSTRACT FROM AUTHOR]