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Background: Brucellosis is a common disease between humans and animals that still exists in most parts of Iran. This study investigated the epidemiology of brucellosis in Mazandaran province, Iran, during a nine-year period from the beginning of 2009 until the end of 2017. Methods: This descriptive-analytical study was conducted based on the guidelines of Iran’s Ministry of Health and Medical Education on the data of 3732 brucellosis patients. The data were retrieved from the private and public laboratories gathered in a Ministry’s database. We used the generalized estimating equation (GEE) for the Poisson regression model (Poisson GEE) to examine the disease incidence based on the studied variables. Results: The age-standardized incidence rate has been 13.2 per 100,000 people (15.6 in men and 21.3 in rural areas). The highest rate (17.2) was in 2012 and the lowest (10.6) was in 2014. The cities of Galugah (35.0) and Qaemshahr and Fereydunkenar (3.0) had the highest and lowest incidence rates. The patients’ professions had been 30% housewives, 14.9% ranchers, and 14.4% livestock-related professions. The highest standard incidence was in people older than 55 years old. The results of the Poisson GEE regression model showed that the disease incidence has been higher in men compared to women and in rural compared to urban areas (risk ratio = 1.5, 3.4, P = 0.001). Conclusion: Mazandaran faces the risk of increased brucellosis incidence rate. Taking preventive measures, including educating people, are recommended for the near future.

Background and purpose: Recurrent aphthous stomatitis or RAS is one of the most common lesions of the oral mucosa, which is recurrent and painful. So far, several factors have been known as predisposing factors to this disease. However, there is no specific treatment for it. Anxiety and stress are among the causes of these lesions. Quality of life reflects the level of satisfaction and sense of well-being in individuals. Since it is believed that these lesions affect the quality of life due to their chronic and painful nature, the present study aimed to evaluate the quality of life of patients with recurrent oral aphthous stomatitis using the COMDQ questionnaire. Materials and methods: The tool used to measure quality of life in this study was the COMDQ questionnaire. This questionnaire examines the quality of life of patients with chronic mucosal diseases using 26 questions in four subgroups, including pain and functional limitations, treatment and medication, psychological and social status, and patient support. In the scoring system for recurrent aphthous stomatitis, the characteristics of lesions in the last three months and factors such as the number of lesions, the rate of recurrence of lesions, and the affected areas should be considered to determine the severity of the disease. Thus, the USS system, which is derived from the combination of the above items, was used. The USS system includes 6 subgroups, including the frequency of the aphthous lesions in the last three months, diameter, duration, ulcer-free period, location of aphthous lesions, and pain. Pearson's correlation coefficient was used to calculate the correlation between age severity and duration of the disease with quality of life. To compare the average scores of this questionnaire in two genders, an independent t-test was used, and the Mann-Whitney test was used if the data were not normal. Data analysis was done by SPSS ver 25 software. Results: In this study, 251 questionnaires were completed using the census sampling method. Among the study participants, 116 (46.22%) were men and 135 (53.78%) were women. The average total COMDQ score was 43.34±13.78 and no significant difference was observed between men and women in any of the dimensions of quality of life and the total quality of life score, as well as age (P>0.05). The correlation between COMDQ total score and general health (P=0.014) and also in comparison with oral health was significant (P=0.014). Also, the severity of lesions (USS score) (P

Background and purpose: Noise pollution, as an unwanted and annoying sound that can negatively impact human health and well-being, has become one of the major environmental problems in the world. This type of pollution not only disrupts peace and comfort but can also have serious consequences for human physical and mental health. Despite the importance of the issue of exposure to harmful physical factors and their impact on health, few studies have been conducted on traffic noise based on the conditions in Iranian cities. Considering the importance of urban traffic noise, the lack of domestic studies on its characteristics and how it affects the cognitive and physiological performance of exposed individuals, and its importance and decisive role in the occurrence of errors and mental functions, this research aimed to investigate the physiological and mental performance in exposure to traffic noise pollution in Sari city. Materials and methods: This quasi-experimental intervention study was conducted in the summer of 1401 (2023) on 40 students of Mazandaran University of Medical Sciences. To minimize confounding factors, the inclusion criteria were as follows: age range of 20-30 years, normal hearing (hearing loss less than 25 dB), and no history of taking specific medications. All experiments were conducted in an acoustic chamber measuring 3 by 2 meters with a temperature of 23°C, humidity of 50%, and illuminance of 400 lux. Physiological parameters (heart rate, blood pressure, and core body temperature) were measured in acoustic comfort and traffic noise exposure conditions. Cognitive performance was assessed using the Continuous Performance Test (CPT) in exposure and non-exposure conditions. The structural correlation of this test was estimated by the researchers to be 0.89. Data analysis was performed using descriptive and analytical tests in SPSS v24. Results: According to the findings, 52% of the students studied were female. The mean age of the participants was 24.23 years with a standard deviation of 4.99 years, a minimum of 19 years, and a maximum of 38 years. 76.3% of the participants were single and 23.7% were married. Based on the exposure results, the average sound pressure level of traffic noise in the exposure group was reported as 75.45±0.11 dBA. It was observed that the heart rate and core temperature of the exposure group increased significantly (P

Background and purpose: Infertility has been raised as a reproductive health problem all over the world. Based on the other studies the prevalence of infertility in different regions of the world is different, and its prevalence in Iran is higher than the global average. There are various methods for treating infertility, one of the most important of which is the IVF microinjection method, which is considered one of the last treatment methods for infertile couples. Because various factors play a role in the success of this treatment, many of which may not be known yet, so this study was conducted to investigate the paraclinical and demographic factors affecting infertility treatment by IVF microinjection method in the infertility treatment center of Imam Khomeini Hospital in Sari. Materials and methods: The data of this cross-sectional study were extracted using information from the files of infertile women who are being treated at the Infertility Treatment Center of Imam Khomeini Hospital in Sari. Information was collected on cases that were Iranian couples, married women whose diagnosis of infertility was definite, and the problem of infertility was related to the woman. Paraclinical and demographic factors affecting the success of infertility treatment by IVF microinjection method were investigated using a logistic regression model. First, using a univariate model, important variables were identified, and a multivariate model was fitted. SPSS21 software was used for data analysis. Results: 64 people (19.9%) were successfully treated using the IVF microinjection method. Women who were successfully treated had a lower average age at the time of diagnosis of infertility than women who were not treated successfully (P= 0.015). Also, the treatment success rate in women who had a history of psychiatric diseases is higher than in women who did not have (P= 0.005). Also, less than one year after the diagnosis of infertility, an increase in the age of the woman at the time of diagnosis of infertility, reduces the chances of successful IVF microinjection treatment. The success rate of treatment for women who were treated for less than one year was 17/5% (13/3% - 22.4%), and for women who were treated for more than one year was 31.5% (20/3% - 44.6%). Conclusion: The overall success rate of microinjection IVF treatment in this study was lower than in similar studies, although, in women who had been treated for less than one year, this rate was lower than in women who had been treated for more than one year. So, continuing infertility treatment by IVF microinjection method for a longer period after the start of treatment increases the chance of treatment success. A woman's age when infertility is diagnosed is one of the most important factors in the treatment of infertility, and the younger the infertility is diagnosed and the sooner treatments are started, the higher the chance of success in treatment and fertility. Therefore, early referral to a specialist can affect the success of the treatment. The success of treatment was higher in women with a history of psychiatric diseases than other women, which could be due to their insistence on treatment.

Introduction and purpose: Noise is one of the most harmful physical factors in workplaces in both developed and developing countries. Still, low-frequency noise has not received enough attention, and the current regulations on its control are inadequate. To address this issue, the present study was conducted to examine the physiological response and cognitive functions of individuals before and after exposure to low-frequency noise. Methods: This study was conducted in the solar year 1401 and involved 40 students from Mazandaran University of Medical Sciences. Low-frequency noise with a level of 65 dB A was played for one hour. The patients' heart rates, blood pressure, and core temperatures were collected before and after exposure to low-frequency noise. Moreover, the continuous performance test was used to examine their cognitive performance. The data was analyzed using the Friedman and Voilcoxon tests in SPSS 25 software. Results: Low-frequency noise adversely impacted individual cognitive performance, increasing response error, omission error, and reaction time. However, according to the Wilcoxon test, only the increase in reaction time was statistically significant (P0.05). Conclusion: Exposure to low-frequency noise generates greater discomfort than background noise with the same intensity level and has adverse effects on the individual's performance. Thus, the adverse effects of low-frequency noise are particularly significant in workstations that require mental processing of information and specific attention, such as control rooms and offices.

Background: Type 1 diabetes mellitus (T1DM) is an autoimmune disorder characterized by the destruction of insulin-producing beta cells in the pancreas, leading to insulin deficiency. Objectives: This study determines the frequency of T1DM-specific auto-antibodies, namely glutamic acid decarboxylase, islet cell cytoplasmic, insulinoma-associated-2/tyrosine phosphatase, and insulin autoantibody. Methods: This prospective cross-sectional study was conducted from March 2019 to December 2020. Registered T1DM patients under 18 years of age who visited the Diabetes Clinic of Bu Ali Sina Hospital in Sari City, Iran, were included. The autoantibody, clinical, and biochemistries profile of each participant was recorded. Results: A total of 190 children diagnosed with T1DM were included in the study. The mean age of the patients was 13.14±0.36 years. Based on the mono test, the highest prevalence was seen in islet cell cytoplasmic (104 [66.67%]). Also, based on multiple tests, islet cell cytoplasmic+glutamic acid decarboxylase had the highest prevalence (135 [49.63%]). Patients with positive insulinoma-associated-2/tyrosine phosphatase and islet cell cytoplasmic compared to negative insulinoma-associated-2/tyrosine phosphatase and islet cell cytoplasmic had higher age at diabetes onset (8.93±4.11 vs 7.73±4.33, P=0.02; 8.8±4.22 vs 6.81±4.1, P=0.01), receptively. The HbA1c level at T1DM onset in patients with positive insulin autoantibody was lower than negative insulin autoantibody (7.84±1.82 vs 9.41±2.35, P=0.0009). There was a significant difference in hyperglycemia with positive and negative insulinoma-associated-2/tyrosine phosphatase, in which the chance of positive insulinoma-associated-2/tyrosine phosphatase was 54% lower in hyperglycemia than in euglycemia (odd ratio=0.46 [0.22-0.96], confidence interval=95%, P=0.04). Conclusions: The islet cell cytoplasmic and islet cell cytoplasmic + glutamic acid decarboxylase had the most prevalence in T1DM patients in Northern Iran.

Background and purpose: Aging is said to be a special pattern of natural changes in life that occurs as people age With increasing age, the elderly suffer from several problems, including a decrease in hope, happiness, and self-esteem, which may affect self-care, especially nutrition. Therefore, the present study was conducted to investigate the relationship between nutrition and self-esteem and happiness of the elderly Materials and methods: The present study was a descriptive-analytical study of the correlation type, and following the ethical standards and obtaining informed consent from the company. The research began Research sampling in this study was by multi-stage method (proportional and simple random). First, among the 18 health centers of Amel city, 7 centers were randomly selected, then again, by simple random and lottery method from among the target population (elderly people), until reaching the desired volume of the study, in 1401 became Simple random sampling was done by preparing a list of people eligible for the study in the selected health care center, then we selected the required number of samples by lottery. The inclusion criteria included being over 60 years old, living in Amel City, the absence of problems such as acute mental disability, the absence of cognitive impairment (using AMT, Alzheimer's, and cancer), and the ability to communicate. Non-cooperation during the implementation of the study was considered as an exit criterion. The tools used included demographic questionnaires, cognitive status assessment, elderly depression, happiness, self-esteem, and instrumental activities. The data were analyzed with descriptive (frequency, mean, and standard deviation) and inferential (focal correlation and parameter estimates) tests. Results: The results showed that the average age of the participants (60 to 81 years) was equal to 65.92±4.64 and the average body mass index of the participants was 23.75±2.54. 14% of the elderly were underweight and 33% were overweight. 12% were at risk of malnutrition. Most of the elderly had high happiness (99%) and high self-esteem (59%). The correlation coefficient of happiness and self-esteem is 0.378. As a result, in this study, nutrition had no significant relationship with the self-esteem and happiness of the elderly. Also, the results showed that the happiness and self-esteem of the elderly had a significant positive relationship with each other(P0.050, there is no relationship between the self-esteem of the elderly and the total score of the supplementary examination and nutrition. According to the value of P0.05). In other components of self-esteem, there is a statistically significant relationship with happiness(P0.050 Conclusion: This research was a descriptive-analytical correlation study. The results of this study showed that there is a relationship between happiness and self-esteem of the elderly. However, there was no statistically significant relationship between self-esteem and nutrition of the elderly. In general, according to the results of this research, it is suggested to pay attention to the role of general self-esteem, social self-esteem, and occupational self-esteem in the happiness of the elderly. Considering the expansion of the elderly population in Iran and the importance of paying attention to the physical and mental health of the elderly, the results of this research can be useful for planning to improve the capabilities of the elderly.

Abstract Background Communication and mutual understanding among healthcare providers is a significant concern within the healthcare system, and enhancing empathy is one way to foster effective communication and mutual understanding. The aim of this research is to evaluate and compare the impact of story reading on the level of empathy in medical students at Mazandaran University of Medical Sciences. Methods The study employed an intervention educational design (a quasi-experimental), with a convenience sample of 51 medical students selected as the statistical population. The process of story reading was conducted over six two-hour virtual sessions in the students' classroom, spanning six weeks. Selected stories were discussed in an online virtual class under the supervision of an instructor, focusing on story elements. To assess students' empathy in this educational program, the Davis General Empathy Questionnaire was administered before each of the six sessions, after, and one week later at the end of the course. Statistical analysis of the collected data was performed using repeated measures analysis of variance and Bonferroni's post hoc test through SPSS version 28 software, with a significance level set at 0.05. Results The findings revealed that 27 participants (58.7%) were female students, with the remaining being male students, having an average age of 19.5 ± 0.86 years. The level of general empathy among the students significantly increased after the intervention compared to before the intervention (P

Introduction: People’s risk perception in an emergency situation affects how they behave. During the pandemic of a disease like COVID-19, the fear of the disease and its consequences causes people to deal with anxiety. The present study was conducted with the aim of determining the relationship between the perception of the risk of COVID-19 and the experience of anxiety caused by it among workers in manufacturing industries. Material and Methods: The present descriptive-analytical study was conducted cross-sectionally in 2022 among 545 workers of manufacturing industries located in Tehran, Mazandaran and North-Khorasan provinces. In the study, data collection was conducted using three questionnaires: a demographic information questionnaire, the COVID-19 Disease Anxiety Scale (CDAS), and the COVID-19 Risk Perception and Psychological Predictors against COVID-19 questionnaire. Data analysis was done using descriptive (mean and standard deviation) and analytical statistics (Canonical Correlation Coefficients or CCC) in SPSS V25 software. Results: The mean ± SD of the workers’ age was 35.98 ± 7.58 years, while the scores for risk perception and anxiety were 12.89 ± 3.31 and 4.51 ± 1.51, respectively. The Concordance Correlation Coefficient (CCC) between risk perception and anxiety caused by the COVID-19 disease in the first Canonical point was 0.734, and in the second Canonical point, it was 0.229. The corresponding p-value was found to be less than 0.01. Psychological symptoms (Canonical loading = -0.725) and physical symptoms (Canonical loading = -0.421) played a significant role in predicting the variability of the risk perception of COVID-19. Conclusion: The perception of risk related to the COVID-19 disease resulted in a decrease in anxiety, having a more pronounced effect on psychological symptoms compared to physical symptoms. Therefore, in times of pandemic outbreaks similar to COVID-19, implementing measures that enhance workers’ awareness and understanding of the disease risks can prove effective in managing anxiety.

Introduction: Steel erection is known as one of the most hazardous construction activities. From an occupational health and safety perspective, this process carries high risk. Therefore, this study aims to conduct a qualitative risk analysis of steel structure assembly and model it using the Functional Resonance Analysis Method (FRAM). Material and Methods: In this cross-sectional study, the construction site of a high-rise building steel structure was first visited to identify the main processes involved. Then, semi-structured and open-ended interviews were conducted with 33 workers partaking in this process. Data from the interviews and process identification were entered into FRAM Model Visualiser (FMV) software to investigate and model complex relationships and interactions between daily tasks. Results: Of the 19 major system component functions identified, four functions had potential instability and defects due to complex human, organizational, and technological function interactions. By intensifying the FRAM graphic model, risks may be imposed on the system if the interactions of these four functions are neglected. These include coordination with the experienced rigger, preparation of the tower crane, attachment of parts at the installation site, and execution of the rescue rope. Conclusion: The findings demonstrate that conducting qualitative risk assessment and modeling the steel frame construction process using FRAM allows for an in-depth understanding of nonlinear conditions and dynamics resulting from escalating technical-social interactions. This approach enables a comprehensive analysis of system safety status.

Background: Due to the low consumption of fruits and vegetables in adults, most of them are employed in workplaces; this condition is a good opportunity to implement an intervention to influence the behavior of this group. This study aims to determine the effects of social marketing techniques in an intervention on fruit and vegetable (F&V) intake among office staff. Methods: This descriptive study was a formative research. This study was conducted on 70 administrative staff in a government office in Ghaemshahr City, Mazandaran Province, Iran in two stages, formative research and developing intervention strategies according to social marketing techniques. Formative research consists of two distinct phases, qualitative and quantitative. The categories were extracted using the direct content analysis method by MAX QDA at the qualitative stage, and the questionnaire data were analyzed by SPSS software, version 22 using descriptive statistics and stepwise multiple linear regression. Results: In the qualitative section, factors affecting F&V consumption were extracted into five main categories, including product, place, price, promotion, and organizational support. In the quantitative stage, the mean age of participants was 42.14±6.84 years, and the lowest percentage of mean scores related to the commitment to the action plan (29.16%) was related to the construct of Pender’s health promotion model (HPM). Previous related behaviors, behavioral outcomes, preferences, and immediate demand predicted 43% of F&V consumption behavior. The mean intake of F&V per day was 1.57±1.32 and 0.45±0.75 units, respectively. Conclusion: Although social marketing is a planning process, using theory can lead to the development of effective and accurate marketing strategies by covering all aspects of behavior to take more effective action to improve it.

Background and purpose: The coronavirus epidemic has had a significant impact on people's lives and has created many problems in the economic, scientific, environmental, and personal dimensions of people's lives. Fertility in women was one of the threats addressed during the Covid-19 pandemic. The purpose of this study was to evaluate the quality of life, marital satisfaction, and anxiety, depression, and stress in women of reproductive age referring to medical centers covered by Mazandaran University of Medical Sciences during the COVID-19 pandemic. Materials and methods: The current study was descriptive and analytical in a cross-sectional manner. The statistical population included all women referred to medical centers covered by Mazandaran University of Medical Sciences from March 1399 to March 1400, who were questioned in two periods. Data were collected using a questionnaire that included demographic information, pregnancy, and COVID-19 disease. Also, the information related to the quality of life of the participants in the study was evaluated using the SF-12 questionnaire, anxiety, depression, and stress of the participants with the Lovebond scale (DASS), and marital satisfaction with the Enrich questionnaire. The collected data were analyzed using SPSS 24 software. Results: 1759 women of reproductive age participated in this study. All participants (100%) were married, with an average duration of marriage of 8.5±1.5 years. 14.1% of women were infected with COVID-19 during the study. 7.2% of women had at least one underlying disease, hypothyroidism (4.3%), diabetes (1.3%) and hypertension (0.1%) being the most common cases. There were diseases. The results indicated a decrease in people's physical health and emotional problems due to the changes in their quality of life due to the outbreak of Covid-19. About 99% of women showed mild and moderate symptoms of mental disorders, including depression, anxiety, and stress, during the study. The participants' stress levels decreased over time (9.6±8.83 vs 8.3±69.7), and their marital satisfaction increased (2.91±0.3 vs 2.95±0.31, P=0.0). Also, the findings of the research showed that people's quality of life had a negative and significant relationship with the amount of mental disorders. Conclusion: The results of the study revealed an increase in marital satisfaction during the Covid-19 period. The study participants' quality of life had a significant difference in the two time periods. Consequently, special attention to Women of reproductive age, increasing their general and sexual awareness, and providing positive psychological programs in crisis conditions are recommended in formulating health policies and programs

Background and purpose: Stomach cancer is a multifactorial disease that may be influenced by many factors, including environmental and genetic factors. Therefore, it is important to investigate and recognize the prognostic factors in the survival of this disease. The purpose of this study was to investigate the factors affecting the survival of gastric cancer by parametric and semi-parametric regression methods and finally to fit the best model among these models. Materials and methods: A historical cohort study on 193 patients with gastric cancer in Mazandaran province 2011-2014 was carried out. Demographic, clinical and therapeutic information of patients were collected. The Schoenfeld test was utilized to evaluate the assumption of proportional hazards, while Cox-Snell residuals were employed to assess the adequacy of the model. The STATA software (v. 14) was used to analyze the data. The significance level of the tests was considered 0.25 for univariate analysis. Results: 30% and 70% of the patients were women and men, respectively. The average age at diagnosis of the patients was 64.92±14.04 years. The mean and median survival time were 21.92 and 8.06 months, respectively, with a standard error of 2.57 and 1.20. Based on Akanke’s information criterion and Cox-Snell's residuals, the log-logistic model was selected as the optimal model. The results of the log-logistic model showed that the variables of body mass index (acceleration factor= 1.11 and P= 0.003) and in terms of the type of treatment, the combination of chemotherapy and surgery compared to surgery (acceleration factor=3.12 and P=0.028) and three types of combined treatment of radiotherapy, chemotherapy and surgery to surgery (acceleration factor=7.58 and P=0.020) and kidney disease (acceleration factor=0.20 and P=0.014) were factors affecting survival. Conclusion: Despite the preference of the majority of researchers to utilize the Cox model, accelerated failure models can serve as a viable alternative to the Cox model in comparable circumstances

Background and purpose: Currently, there is a significant emphasis on utilizing empowering models to improve the health status and quality of life of patients. This study was conducted with the aim of investigating the effect of the empowerment program on the quality of life of the elderly with type 2 diabetes. Materials and methods: This randomized clinical trial study was conducted in 2021 on elderly patients with type 2 diabetes referred to the diabetes clinic of Vali Asr Ghaemshahr Hospital and Mostafavian Diabetes Clinic in Sari. 90 elderly patients participated in this study. The participants were randomly divided into two groups, including the intervention group (45 patients) and the control group (45 patients). The intervention group participated in eight empowerment sessions for 45 minutes, including 6-8 patients in each session. On the other hand, the control group received the conventional treatment. The demographic characteristics questionnaire and quality of life assessment for diabetic patients was completed by both groups before the intervention and two months after the intervention. Results: The mean score of overall quality of life in the intervention group was 29.95±3.94, which significantly increased to 33.86±3.70 after the intervention (P=0.001). In the control group, the average quality of life score before the intervention was 39.00±5.01, which decreased to 37.06±4.87 after the intervention, which was a significant difference (P=0.001). The result of the covariance test showed that the empowerment program had a significant impact on the quality of life of the elderly with diabetes (P=0.001). Conclusion: The empowerment program based on education about diabetes and its complications, healthy lifestyle and self-care in diabetes can be an effective approach to improve the quality of life of elderly patients with type 2 diabetes. Therefore, the implementation of such programs can strengthen the sense of independence and control among elderly patients and be a valuable help in the routine treatment of these patients. (Clinical Trials Registry Number: IRCT20180609040020N2)

Background and purpose: The status of axillary lymph nodes (ALN) is the most important prognostic factor in patients with primary breast cancer. The aim of this study is to measure the relationship between the factors influencing metastasis to the lymph nodes in patients with breast cancer. Materials and methods: The present study is a retrospective cohort study. The research data were extracted from telephone interviews and medical records of 241 breast cancer patients in Mazandaran Medical Sciences Hospitals. For data analysis, the chi-square test and multiple logistic regression model using principal component analysis were used to determine the relationship between factors affecting metastasis to lymph nodes. All statistical analyses were performed using Stata software version 17, R and SPSS software version 26. Results: The average age of patients at diagnosis is 52.03±10.932 years test revealed a significant correlation between the markers ER, PR, P53, Her2 and Ki67(P

Background and purpose: Time series models based on machine learning, including artificial neural network, perform better than classical methods. This study was performed to compare the use of a multi-layered perceptron neural network with weighted regression in determining the geographical pattern of brucellosis in Mazandaran province, Iran (2009-2018) on 3,732 patients. Materials and methods: The study type is ecological and existing data, which is registered. Multilayer perceptron neural network was used to model and predict disease occurrence, and the results were compared with weighted regression. The root mean square error (RMSE) and mean absolute percentage error (MAPE) were used to compare the models. All analyses were performed using SPSS software (version 26) and Microsoft Excel 2016. Results: The age-standardized rate of disease incidence was 13.2 per 100,000. The highest incidence rate (17.2) was in 2012 and the lowest (10.6) in 2014. Galugah city (35.0) and Qaemshahr and Fereydunkenar cities (3.0) had the highest and lowest incidence rates. The independent variables studied included male gender, rural residence, age over 55 years, contact with dairy products, being a homemaker, rancher and associated with livestock jobs, contact with livestock, and livestock vaccination on the standard incidence of brucellosis in both artificial neural network and weighted regression (other than variable over 55 years) models were effective. Conclusion: The predictive power of the model in the multi-layered perceptron neural network was higher than the weighted regression.

Background and purpose: The design of medical equipment is a crucial aspect of ergonomics, with the proper fit of tools in the user's hand being a significant consideration in production. This study aims to investigate the level of discomfort experienced by surgeons due to the use of latex gloves in the year 2021, to enhance user satisfaction and reduce workplace injuries. Materials and methods: This cross-sectional study was conducted on 135 surgeons in the city of Sari. The data collection tools included a questionnaire for measuring anthropometry in two dimensions and assessing local discomfort. The questionnaire consisted of 12 questions to evaluate discomfort levels in the hands. Two-dimensional anthropometry measured the dimensions of the participants' hands, presenting a 24-dimensional result. Results: Overall, the various dimensions of anthropometry in male participants were larger than those in female participants, except for the second dimension. Male surgeons (52.1%) mostly used gloves size 7, while female surgeons (74.2%) preferred sizes 5/6. The lowest average pain level was recorded in Region B (1.24), and the highest average pain level was in Region I (2.43). Conclusion: The study results indicated that women experience higher levels of discomfort compared to men. The areas with the highest discomfort levels were identified, and optimal dimensions for designing and producing suitable gloves for the study population were determined.

Traffic accidents are one of the most important causes of death and disability in the world, which cause much damage to countries and millions of people every year. Many researchers have focused on the time series caused by different aspects of these accidents. Box-Jenkins is one of the most common and widely used time series forecasting models, which is used under the condition of model stationarity. With the advancement of technology and the development of neural networks in time series, the discussion of comparing the predictive power of these models with traditional time series models has been raised. In this study, we investigated the traffic accidents leading to death or injury in iran during 2011 to 2021. Materials and methods: Statistical analyses related to the SARIMA time series model have been performed by using Minitab and EViews and the LSTM neural network model by Python and Visual Studio Code. Results: During period of the study, The trend of the number of deaths has always been decreasing, but the number of injured has been increasing before the coronavirus epidemic and decreasing after that. The highest number of dead and injured has always been in Shahrivar (August and September) every year and the months with 9 days off had significantly less deaths and more injuries. 21.38% and 27.56% of dead and injured were women. The ages of 20 to 29 had the highest number of deaths and injuries, but children and the elderly were more vulnerable and their share in the deaths was more than the injuries. According to the results, as the weather worsens, the share of accidents leading to death increases. In comparison of SARIMA and LSTM the results indicated that LSTM has been better in estimating data trends. The forecast shows the increasing trend of fatality and injuries in the comind years. Conclusion: Compared to the SARIMA model, the LSTM model showed better performance in predicting trend and time series components.

Background and purpose: Despite cardioprotective strategies against ischemia/reperfusion injury following coronary artery bypass graft (CABG), its complications still exist. Therefore, the present study aimed to determine the cardioprotective effects of propofol against ischemic/reperfusion injury following CABG. Materials and methods: In this double-blind clinical trial study, 70 patients undergoing CABG were admitted to Fatemeh Zahra Hospital, Sari, Iran, 2017 were evaluated. The participants were divided into two groups of the anesthetic induction group with the combination of propofol, midazolam, fentanyl, and ether and the anesthetic induction group with nesdonal, midazolam, fentanyl, and ether. The data were registered in the checklist made by the researcher. The data were analyzed by SPSS software using descriptive and analytical statistical tests. Results: An increase in the level of creatinine and C-reactive protein was observed in both study groups from the time of opening the aortic clamp until 15 min after, and a decrease in the ventricular ejection fraction from before surgery to 48 h post-surgery(P

Background and purpose: Obesity is a growing public health concern worldwide. This study examined the prevalence of obesity/overweight and its relation with cumulative socioeconomic risk in women of reproductive age in Mazandaran province, Iran. Materials and methods: In this descriptive correlational study using a multi-stage cluster sampling method, 540 married women aged 15-45 referred to primary health centers in Mazandaran province were recruited (2020). Body mass index was categorized into three levels: obese (≥30), overweight (25-29.9), and normal (18.5-24.9). Socio-economic status was classified using generalized Oaxaca-Blinder decomposition method. Each of the socio-economic variables (8 indicators) was given a score of zero or one, and then the scores were added up. The scores of ≥5, 3-5, and ≤2 were considered good, average, and poor, respectively. The relationship between socio-economic variables and different levels of body mass index was assessed once separately and once cumulatively in binary regression. Results: The prevalence of obesity and overweight was 23.3% and 48.5%, respectively. The socio-economic status of 26.2% of the participants was classified as good, 64.3% as average, and 9.5% as poor. There was a significant positive and negative relationship between obesity in women with their number of children (OR: 2.72, 95% CI: 1.50-5.17) and obesity in their parents (OR: 0.43, 95% CI: 0.19-0.94) respectively. Statistical tests did not show significant relationship between women's obesity and their cumulative socio-economic status (P>0.05). Conclusion: The prevalence of obesity and overweight among women of reproductive age, regardless of their socio-economic status, has reached epidemic proportions. Extensive studies are suggested to better understand the factors that contribute to obesity and to provide a more accurate explanation for the rapid increase in obesity among various socio-economic groups.

Ramezan-Ali Dyanati-Tilaki1, Zabihollah Yousefi1, Jamshid Yazdani-Charati 2, Seyed Mehdi Ghasemi3 1 Department of Environmental Health Engineering, Health Sciences Reasearch Center, School of Health, mazandaran univesity of Medical Sciences, Sari, Iran 2 Department of Biostatistics, Health Sciences Reasearch Center, School of Health, mazandaran univesity of Medical Sciences, Sari, Iran 3 MSc student, Department of Environmental Health Engineering, Health Sciences Reasearch Center, School of Health, Medical Mazandaran univesity of Medical Sciences, Sari, Iran In the article published in volume 24, issue 120, 2015, the second author’s first name is Zabihollah Yousefi, and third author’s last name is Jamshid Yazdani-Charati, were incorrect which is now corrected.

Ramezan-Ali Dyanati-Tilaki1, Zabihollah Yousefi1, Jamshid Yazdani-Charati 2, Davoud Belarak3 1 Health Sciences Research Center, Department of Environmental Health Engineering, School of Health, Mazandaran University of Medical Sciences, Sari, Iran 2 Health Sciences Research Center, Department of Biostatistics, Mazandaran University of Medical Sciences, Sari, Iran 3 Student Research Committee, School of Health, Mazandaran University of Medical Sciences, Sari, Iran In the article published in volume 23, issue Suppl-2, 2013, the second author’s first name is Zabihollah Yousefi, and third author’s last name is Jamshid Yazdani-Charati, were incorrect which is now corrected.

Mohammad Ali Zazouli1, Zabihollah Yousefi1, Mahmoud Taghavi1, Behrouz Akbari-adergani2, Jamshid Yazdani-Charati3,4 1 Department of Environmental Health Engineering, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 2 Food & Drug Laboratory Research Center, Food & Drug Organization, Ministry of Health and Medical Education, Tehran, Iran 3 Department of Biostatistics, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 4 Psychiatry & Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran In the article published in volume 23, issue 98, 2013, the second author’s first name is Zabihollah Yousefi, and fourth author’s last name is Jamshid Yazdani-Charati, were incorrect which is now corrected.

Mohammad Ali Zazouli1, Zabihollah Yousefi1, Jamshid Yazdani-Charati2, Hajar Tabarinia3, Farzaneh Tabarinia4, Behrouz Akbari Adergani5 1 Associate Professor, Department of Environmental Health Engineering, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 2 Associate Professor, Department of Biostatics, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 3 MSc in Environment Health Engineering, Student Research Committee, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 4 MSc in Chemistry, Mazandaran Standard Office, Sari, Iran 5 Food & Drug Laboratory Research Center, Food & Drug Organization, Ministry of Health and Medical Education, Tehran, Iran In the article published in volume 24, issue 111, 2014, the second author’s first name is Zabihollah Yousefi, and third author’s last name is Jamshid Yazdani-Charati, were incorrect which is now corrected.

Background: Optimal dimensional stability is required for successful root canal treatment. A sealant called EndoSeal mineral trioxide aggregate (MTA) was recently introduced to the market due to its favorable physical and chemical properties. On the other hand, AH Plus (AHP) is considered the gold-standard seal. Materials and Methods: In this ex vivo quasi-experimental study, 24 single-canal premolars extracted from humans were cleaned and shaped with a motorized and rotary file, then that is divided into two groups. The teeth of each group were filled with gutta F3 and each type of sealant. The teeth were scanned by a micro-computed tomography device after 24 h. After 7 days of storage in phosphate-buffered saline solution, the samples were re-scanned. Data were analyzed using SPSS software (version 21). Descriptive data were presented as frequency, percentage, mean, and standard deviation. The Shapiro–Wilk and Kolmogorov–Smirnov tests were used to investigate the normality of the data. The Mann–Whitney test was used to compare the two groups, and the differences were ultimately not significant. The level of significance was set at 0.05 (P < 0.05). Results: The mean differences between sealer volumes before and after the intervention were not significantly different between the two groups indicating that the EndoSeal MTA sealer is not inferior to the gold-standard root canal sealer, AHP. Conclusion: EndoSeal MTA can be considered a reliable sealer in endodontic treatments and be subjected to further investigation.

Background and purpose: Leukemia is one of the most common and deadly diseases which is an important health problem. The aim of this study was to evaluate the survival of patients with acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) using the penalized splines model and comparing that with the Cox proportional hazards model. Materials and methods: This is a longitudinal survival research that used data from patients referred to Tehran Imam Khomeini Hospital between 2011 and 2014 and followed until 2016. Patients' information was collected through census, using a researcher-made checklist based on their files. Furthermore, the patients' latest status was obtained via phone calls. All medical records of the patients referred to Amir Al-Momenin hospital in Maragheh and diagnosed with prostate hyperplasia and underwent prostatectomy between 2014 and 2019 were examined taking a census. Kaplan-Meier nonparametric method was used to assess the 5-year survival rate, and Cox's semiparametric model was used to determine the risk factors in subgroups. Then, the penalized spline regression model was fitted using the R software version 4.2.2. Results: The average age of patients was 36.29±16.01 and 36.7% of the patients were men. Half of the patients died, and 12.7% experienced recurrence. Acute lymphoblastic leukemia affected 34.7% of the patients, whereas acute myeloblastic leukemia affected 63.3%. The 5-year-survival rates for patients with ALL and AML were 18% and 29%, respectively. Age, white blood cell count, platelet count, and hemoglobin levels were found to be significantly associated with patients' survival (P

Background and purpose: Recently, many studies have been conducted on the role of selenium in autoimmune diseases. Trace element deficiency is not an uncommon finding in autoimmune diseases. This deficiency may be a consequence of autoimmune diseases or may contribute to their aetiology. The aim of this study was to investigate the level of selenium in patients with sarcoidosis compared to healthy controls in teaching hospitals affiliated with Mazandaran University of Medical Sciences. Materials and methods: In this case-control study, serum selenium levels were measured in 42 patients with sarcoidosis and compared with 42 healthy, age- and sex-matched controls. Two cc non-fasting blood samples were collected. The serum selenium level was measured using Atomic Absorption Spectrometry (AAS). The normal range for serum selenium is between 46 to 143 micrograms per liter. Results: The mean ages in the case group and controls were 47.45±7.6 and 47.24±7.23 years, respectively (P=0.898). Serum selenium levels were significantly lower than the controls (82.42±24.11 vs. 94.79±27.01 µg/ml, P=0.03). In case group, there was no significant difference between serum selenium levels and sex (P=0.165). The study showed no relationship between serum selenium levels and age (P=0.258), duration of disease (P=0.121), duration of treatment (P=0.837), delay in initiation of treatment (P=0.316), and type of treatment (P=0.859). Conclusion: Serum selenium levels were significantly lower in patients with sarcoidosis than the healthy controls, so, these patients may benefit from selenium supplements.

Background and purpose: Enhancing hospitals’ resilience is an essential step towards improving the ability of the system to deal with crisis and minimizing the consequences. Job satisfaction is an important factor in the nurses’ turnover intention that can increase the quality of patient care. In this study, the level of hospital resilience and job satisfaction and the relationship between these two factors were investigated. Materials and methods: The present descriptive cross-sectional study was conducted using a questionnaire to assess crisis management in hospitals based on Resilience Engineering approach and Job satisfaction Scale developed by Brayfield and Rothe. The participants included 184 nurses working at a hospital in Mazandaran province, 2021. Data analysis was done using SPSS V25 applying Pearson correlation and Spearman correlation, Bonferroni test, and simple linear regression. Results: There were 83% female participants and the average age was 36.36±6.66 years with 8.5±5.91 years of work experience. The average resilience score of the hospital was 2.685, indicating moderate levels of resilience. The highest to the lowest scores for the dimensions of resilience were associated with flexibility, management commitment, learning, and awareness. The resilience score showed a downward trend; ICU> operating room and internal ward> emergency unit. Also, the average score for job satisfaction was 59.066 which indicates a moderate level of job satisfaction. The correlation between organizational resilience and job satisfaction of employees was 0.312. Conclusion: The moderate level of organizational resilience and job satisfaction and the moderate correlation between these two variables require measurements to improve resilience and job satisfaction in order to effectively deal with crises and increase the quality of services.

Background and purpose: Chronic kidney disease-associated pruritus (CKD-aP) is a common symptom in patients with end-stage renal disease. So far, no clear explanation has been found about the pathogenesis of CKD-aP. Therefore, the present study aimed at investigating the relationship between pruritus in hemodialysis patients and serum iron, ferritin, total iron binding capacity, and transferrin saturation. Materials and methods: In this cross-sectional descriptive correlational study, 112 patients in hemodialysis clinics at Ghaemshahr Razi Hospital and Sari Shahrvand Clinic were investigated. The presence of pruritus and its severity were measured by a questionnaire and Visual Analogue Scale (VAS), respectively. Demographic information including age, gender, underlying diseases, dialysis information, and laboratory data, including urea, creatinine, potassium, calcium, phosphorus, alkaline phosphatase, parathyroid hormone, hemoglobin, albumin, serum iron, ferritin, total iron binding capacity, and transferrin saturation were recorded. Results: Out of 112 patients, 38 (33.9%) had CKD-aP and 74 patients (66.1%) did not report pruritus during the last six months. Findings showed no significant relationships between pruritus and its severity and demographic variables, information related to dialysis, and laboratory results (P> 0.05). Conclusion: We found no significant relationship between the presence and intensity of pruritus and demographic and paraclinical variables in hemodialysis patients, through which the hypothesis of the role of iron deficiency and anemia in causing pruritus in hemodialysis patients was rejected.

Background and purpose: Nurses in emergency departments are under high levels of work pressure that reduces the quality of care and patient safety. This study aimed to investigate the nurses’ workload using the WANE tool and determine the relationship between that and patient safety culture in selected hospitals affiliated with Mazandaran University of Medical Sciences. Materials and methods: This cross-sectional study was performed in 106 nurses working at emergency departments in 2021 selected via convenience sampling. Data were collected using the Persian forms of Workload Assessment of Nurses on Emergency (WANE) and Hospital Survey on Patient Safety Culture (HSOPS). Data analysis was carried out in SPSS V25. Results: The mean values for burden of direct care and indirect care were 13.38±6.5% and 19.53±5.7% of the total 24-hour care time. Direct care burdon was higher in the morning at Heart Hospital and in the afternoon at Sari Imam Khomeini Hospital and Zare Hospital. Indirect care in the afternoon was found to create the highest burdon at all hospitals. The total score for patient safety culture in all nurses studied was 136.04±15.6. The most direct and indirect care times in 24 hours was related to nurses with moderate level score for patient safety culture (138 to169), (210.44±103.8 and 303.11±95.68, respectively). Findings showed a direct relationship between patient safety culture and direct care and indirect care (r=0.211, P≥0.030 and r=0.309, P≥0.001). Conclusion: Using the WANE tool is recommended for measuring the accuracy of direct and indirect nursing care time. The workload of emergency nurses can be reduced as much as possible by modifying the physical environment, accurate performance assesment, and assigning the computerized tasks to non-nursing personnel.

Background and purpose: Asthma is a prevalent disease that affects oral health-related quality of life (OHQoL). There is no study on this issue in Iran, so this study investigated the OHQoL in asthmatic patients. Materials and methods: In this descriptive analytical study, 54 asthmatic patients in Sari Tuba Medical Center were examined. They were selected by convenience sampling. The Oral Health Impact Profile-14 (OHIP-14) was administered and Ramfjord teeth were selected to examine the OHI-S index. Data analysis was done applying descriptive statistics and Kolmogorov Smirnov test in SPSS V25. Results: The mean age of patients was 38.05±12.57 and 75.9% were women. The mean scores for OHIP-14 and OHI-S were 2.40±1.14. The highest score in the quality of life questionnaire was related to physical discomfort (1.17±0.96). There were no significant differences between gender, DI, and CI in OHQoL (P=0.893), and OHI-S and OHQoL (P=0.690). Conclusion: In current study, no relationship was found between oral health of asthma patients and the OHQoL, but dentists are recommended to consider the impact of oral problems on patients' quality of life in addition to professional measures.

Background and Purpose: Denture stomatitis is an inflammatory condition in the oral mucosa which develops under the removable denture and affects a considerable percentage of denture users. Due to insufficient studies on this issue in Iran, we investigated the prevalence of denture stomatitis in patients using dentures. Materials and Methods: In the current descriptive-analytical cross-sectional study, 130 patients referred to the dental school clinic and other dental clinics in Sari City, Iran, were examined using the census method. Demographic information about the patients, such as age, sex, systemic problems, and type of denture stomatitis (based on Newton’s classification), were recorded. The denture was also clinically examined for its suitability in the mouth. After entering the data in SPSS, version 20, the study variables were analyzed through bivariate correlation, descriptive analysis, and frequency analysis. Results: A total of 130 patients using dentures (85 male, 45 female) were studied. About 26.2% (n=34) of the patients had denture stomatitis, of whom 58.8% (n=20) were type II and 41.2% (n=14) were type III. There were significant differences between denture’s age (P

Background: The lack of primary health care (PHC) assessment will lead to the lack of knowledge of the final client's needs and to deviation from the mission of the health system. This study was conducted to compare the understanding and experience of PHC providers and recipients regarding the principles of PHC in Iran. Methods: This cross-sectional descriptive-analytical study was conducted on Comprehensive Rural Health Centers (CRHCs) in 2022. The research population consisted of health service providers and recipients in rural areas. A Primary Care Assessment Tool (PCAT) was used. 410 child/ adolescent and 402 adult PCAT were completed by stratified cluster sampling method and 413 service providers were randomly selected. This questionnaire had 6 core domains and 3 ancillary domains. After collection and entering the Excel; data were analyzed by inferential statistics tests including Independent T-test and one-way ANOVA, by SPSS26 and STATA16 at the significant level of P>0.05. Results: Except for the Cultural Competence and Services Available domains, in the rest of the domains, there was not the same understanding between the service provider and recipient regarding PHC services. Also. child/adolescent PHC recipients had the same understanding as adult PHC recipients in the domains of Cultural Competence, Family Centeredness, Information System, Ongoing Care, and Access. But a significant difference was between the two groups in other domains, Primary Care Score, and Primary Care Expanded scores (P >0.05). Conclusions: For the common understanding between all three compared groups, cultural competence was the strongest component, and coordination-referral system, services provided, and community orientation were the weakest components. To fill this gap, increasing the health literacy of service recipients, real needs assessment, and providing services based on the needs of the community, reforming the processes of the referral system, and the commitment of the government to implement the processes seem necessary.

Abstract Background ST-segment elevation myocardial infarction (STEMI) is usually caused by a rupture in the atherosclerotic plaque, followed by platelet aggregation which ultimately leads to acute coronary artery occlusion. So far, few studies have investigated the effect of maintenance dose of Eptifibatide (glycoprotein IIb/IIIa inhibitor) in STEMI patients who underwent primary percutaneous coronary intervention (PPCI). Therefore, in this study, we investigated the effect of maintenance dose of Eptifibatide in patients with STEMI who underwent PPCI. 264 patients who had acute chest pain suggestive of STEMI were entered in the study. All patients received the same dose of bolus dose of Eptifibatide in the cardiac catheterization laboratory. Then the patients were randomly divided into two groups, one group (n = 147) received a maintenance dose of intravenous Eptifibatide (infusion of 2 μg/kg/min) and the other group (n = 117) did not receive this treatment. Standard medical treatment of STEMI after PPCI was performed based on guidelines and the same in both groups. All patients were evaluated 1, 2, and 3 months after the start of treatment in terms of predicted outcomes. Results The occurrence of 3-month major adverse cardiovascular events (MACE) between the case and control groups did not have a statistically significant difference (28.6% versus 35.0%; P value: 0.286). Also, investigations showed that the rate of re-infarction (P value: 0.024) and target lesion revascularization (P value: 0.003) was significantly lower in the group that received Eptifibatide infusion. Conclusions Eptifibatide maintenance dose infusion in patients who undergo PPCI in the context of STEMI, does not significantly reduce MACE, although it does significantly reduce re-infarction and target lesion revascularization. It also does not increase the risk of bleeding and cerebrovascular events.

Background and purpose: There is no specific treatment for fibromyalgia. Previous studies suggest that exercise is helpful in controlling the symptoms and psychosocial aspects of the disease. Stretching exercises are emphasized less than aerobic and resistance exercises in these patients. The main reason for re-examining this issue in current study was the contradictory feedback of patients with fibromyalgia to stretching exercises which was observed during recent years in clinical treatments. The aim of this study was to evaluate the effect of stretching exercise on the quality of life of patients and the impact of fibromyalgia. Materials and methods: This study was a per-protocol randomized clinical trial. Forty-nine patients with fibromyalgia diagnosed based on 2010 diagnostic criteria for fibromyalgia who were referred to our sports medicine clinic by a rheumatologist and then a psychiatrist were studied. They were randomly divided into two groups. Twenty-five patients in the intervention group did stretching exercise and received medication while 24 patients in the control group received standard medication for five weeks. SF-36 questionnaire was used to evaluate the quality of life and Revised Fibromyalgia Impact Questionnaire (FIQR) was used to assess the disease state at the beginning of the study and also at weeks 5 and 9. Results: There are contradictory results about the effect of stretching exercises on fibromyalgia patients. The current study showed no significant differences between the two groups in the mean scores for physical health (P= 0.4), mental health (P= 0.88), and fibromyalgia impact (P= 0.36). Conclusion: Isolated stretching exercises are not effective in improving fibromyalgia. Further studies are suggested to investigate the effect of more specific stretching exercises on fibromyalgia. (Clinical Trials Registry Number: IRCT20200131046322N3)

Abstract Aim This study aimed to compare the effect of peer education and education provided by healthcare providers on PMS in high school students. Materials and Methods This quasi‐experimental non‐randomized controlled trial with a three‐armed parallel design was performed on 90 students allocated in three groups, namely, education by peer (intervention group 1 = 30), education by a healthcare provider (intervention group 2 = 30), and a control group (n = 30). The primary outcome was a change in the score of PMS, and the secondary outcomes were changes in the general health score and the frequency of premenstrual dysphoric disorder (PMDD). Education about PMS management was held in WhatsApp messenger in six sessions (two sessions per week) for both intervention groups. All three groups received routine school counseling. The researchers applied repeated‐measures ANCOVA, McNemar, and post‐hoc Bonferroni tests. Results Education in intervention group 1 (Partial Eta Squared = 0.67, p 0.05). Conclusion This study suggests education by peers and healthcare providers effects on PMS and general health in adolescents. It suggested that the effectiveness of these approaches be investigated in other adolescents' health conditions.

Background: Bed bugs (Cimex lectularius) are blood-sucking insects that bite humans usually at night and cause nui­sance, psychological and social problems. These insects are considered a health hazard in densely populated places such as prisons. The aim of this study was to evaluate the knowledge, attitude and practice of inmates, soldiers, and prison staff regarding bed bugs in Mazandaran prisons. Methods: This is a descriptive-analytical study in which 450 inmates and 210 staff (105 personnel and 105 soldiers) from prisons of Mazandaran Province were included in the study. Data on knowledge, attitude, and practice of the par­ticipants regarding bed bugs were collected using a structured questionnaire. To determine the relative content validity coefficient, the questionnaire was assessed by 10 specialists in terms of difficulty, inappropriateness, and ambiguity of the phrases. The reliability of the questionnaire was measured using Cronbach's Alpha and then the data were analyzed using SPSS software version 20. Results: The maximum mean scores of knowledges, attitude, and practice between the three target groups were 16.42%, 44.07% and 71.21% respectively. Prison staff had the highest knowledge and practice, and inmates showed the highest attitude regarding bed bugs. There was no significant difference between the knowledge and attitude of inmates, prison staff and soldiers (P> 0.05) but there was a significant difference in their practice (P< 0.05). Conclusion: Results of this study confirmed that all three groups of people in the prisons need appropriate education regarding all aspects of bed bug including its control.

Background and purpose: The COVID-19 pandemic resulted in an uncontrolled disease burden on healthcare workers (HCWs) worldwide. We aimed to investigate the prevalence and severity of COVID-19 in HCWs of selected hospitals in Mazandaran province and examine the association between COVID-19 and missed opportunities of HCWs. Materials and methods: In this retrospective descriptive-analytical study, 1105 HCWs in Qaemshahr Razi Hospital and Sari Fatemeh-Zahra Hospital were studied between February 2020 and June 2020. In order to evaluate the frequency and severity of the disease, clinical and paraclinical manifestations were recorded by a trained HCW. Data were analyzed in SPSS V18. Results: The frequency of COVID-19 was 16.19% among HCWs. The patients included 113 (63.13%) nurses, 47(26.26%) service providers and administrative personnel, and 19(10.61%) physicians. Duration of sick leave was found to be significantly associated with severity of COVID-19 (P=0.006). This length was also significantly associated with the job and was longer in nurses (P=0.013). Our findings revealed a significant relationship between the level of adherence to personal protective equipment (PPE) and the severity of COVID-19 (P=0.001). Conclusion: COVID-19 could exert remarkable impact on the quality of work in HCWs, especially among nurses. Effective training of HCWs regarding PPE instructions results in suitable protection against severe forms of the disease.

Background and purpose: Hypertension is a global problem due to its consequences. Recognizing warning signs and taking necessary measures are effective in preventing the disease and its complications. We used the logistic regression model to determine the factors affecting blood pressure based on the results of the Tabari Cohort Study. Materials and methods: This cross-sectional descriptive-analytical study was conducted in people older than 35 years old in Sari, whose information (demographic and anthropometric characteristics, and risk factors) was available at the Tabari Cohort Center in Mazandaran province. Logistic regression model was used to determine the factors affecting hypertension. We did statistical analyses using SPSS V26. Results: The participants included 6622 people (41.3% men) with an average age of 48.97±8.94 years old. There were 1481 people with high blood pressure (22.4%). According to multivariate logistic regression model, age (10-year period) (OR=2.04-8.11), body mass index (OR=1.72-2.35), total cholesterol (OR=1.34), triglyceride (OR=1.30), the ratio of waist to hip circumferences (OR=1.31), history of cardiovascular diseases (OR=2.09), and diabetes (OR=1.81) were among the factors associated with hypertension (P

Background and Purpose: The hospital environment was reported as a real habitat for different microorganisms, especially mold fungi. On the other hand, these opportunistic fungi were considered hospital-acquired mold infections in patients with weak immune status. Therefore, this multi-center study aimed to evaluate 23 hospitals in 18 provinces of Iran for fungal contamination sources.Materials and Methods: In total, 43 opened Petri plates and 213 surface samples were collected throughout different wards of 23 hospitals. All collected samples were inoculated into Sabouraud Dextrose Agar containing Chloramphenicol (SC), and the plates were then incubated at 27-30ºC for 7-14 days.Results: A total of 210 fungal colonies from equipment (162, 77.1%) and air (48,22.9%) were identified. The most predominant isolated genus was Aspergillus (47.5%),followed by Rhizopus (14.2%), Mucor (11.7%), and Cladosporium (9.2%). Aspergillus(39.5%), Cladosporium (16.6%), as well as Penicillium and Sterile hyphae (10.4% each), were the most isolates from the air samples. Moreover, intensive care units (38.5%) and operating rooms (21.9%) had the highest number of isolated fungal colonies. Out of 256 collected samples from equipment and air, 163 (63.7%) were positive for fungal growth.The rate of fungal contamination in instrument and air samples was 128/213 (60.1%) and 35/43 (81.2%), respectively. Among the isolated species of Aspergillus, A. flavus complex (38/96, 39.6%), A. niger complex (31/96, 32.3%), and A. fumigatus complex (15/96, 15.6%) were the commonest species.Conclusion: According to our findings, in addition to air, equipment and instrument should be considered among the significant sources of fungal contamination in the indoor environment of hospitals. Airborne fungi, Hospital, Indoor air, Equipment, Sources of fungal contamination in the indoor environment of hospitals.

Background and purpose: This study was carried out to determine the relationship between maxillary central incisors and incisive papilla in complete dentures and compare that with dentate people. Materials and methods: In this descriptive-analytical study, the horizontal distance between the maximum prominence of labial surface of maxillary central incisors to the middle and posterior points of incisor papilla was measured using a caliper, on the casts prepared from 30 dentate patients and 30 complete dentures made in Dental School affiliated with Mazandaran University of Medical Sciences. Results: Average distance between the midpoint of incisive papilla to the labial surface was 9.641±0.866 mm in dentate people and 8.851±1.504 mm in complete dentures. The mean distance between the posterior point of incisive papilla and the labial surface was 12.815±1.264 mm in dentate people and 10.788±1.837 mm in complete dentures. Independent t-test showed significant difference between the two groups in mean distance between the midpoint and the labial surface (0.790 mm, P

Background and purpose: Controlling the severity and death of the COVID-19 disease is still a major challenge. This research aimed at identifying the factors associated with mortality in hospitalized patients with COVID-19 applying generalized linear model. Materials and methods: In this cross-sectional study, demographic and clinical data of COVID-19 patients hospitalized with positive RT-PCR test results (n=6759) in Mazandaran hospitals (August 2019) were obtained from the national registration system for COVID-19. SPSS V27 and R V4.0 were used for data analyses and multivariate generalized linear model test with an ordinal logistic scale was applied. Results: Findings showed that full recovery and relative recovery occurred in 5888 (87.11%) and 400 (5.92%) patients, respectively. Mortality rate was 6.97%. The chance of death in patients with relative recovery (49.55%) compared with those with full recovery (21.61%) was almost 2.3 times higher. Predictors of mortality in these patients included age over 60 years (OR: 1.60), ICU admission (OR: 5.09), intubation (OR: 4.10), SpO2≤ 93% (OR: 2.41), cancer (OR: 1.74), diabetes (OR: 1.29), heart disease (OR: 1.41), and chronic kidney disease (OR: 2.17). Conclusion: Specific and timely medical care, considering the mentioned risk factors, should be introduced and provided to prevent mortality in patients hospitalized with COVID-19.

Background: There has been a growing international evolution of the role and purpose of quality improvement in primary health care. The present study aimed to develop a quality model of the Family Physician program in Iran. Methods: In the qualitative part of these mixed-method studies, grounded theory was used according to the systematic method of Strauss and Corbin. Semi-structured interviews were conducted with recipients and providers of Family Physician cares in the pilot provinces of Iran in 2020 to 2021 and continued until the theoretical saturation based on the purposive technique. The qualitative evaluation of the model was performed and approved. Structural equation modeling and Amos software were used to quantify the model. Results: The results of the structural equation analysis showed that the conceptual model of the research with chi-square test was 2.96 and RMSEA= 0.066, GFI=0.860 are well fitted. Structure, context, process, accountability, attitude, and empowerment factors directly and indirectly provide good predictors for the quality of care in the family physician program. The most important research findings in the field of quality improvement in the family physician’s cares included factors such as developing the attitude and vision of society, providers and policymakers in health subject and health needs, simultaneously corrections in all levels of the referral system, attention and adaptation to the context of society, developing the infrastructures and improving the related processes, systematic appraisal, and accountability and pay attention to the empowerment. Conclusion: To achieve the quality of care in the family physician program, we need change and development in our attitudes, context, infrastructures and processes, accountability and empowerment systems, and overall modification.

ABSTRACT: Objectives: Vancomycin-resistant enterococcus (VRE) is an emerging drug-resistant organism responsible for increasing nosocomial infections. Few data are available on the epidemiology of VRE colonization or infection in neonates, and is of recent interest. This study analyzes the prevalence of neonatal VRE colonization in a neonatal intensive care unit (NICU), and describes risk factors and molecular phenotypes associated with VRE colonization. Methods: We performed a prospective epidemiological study on neonates admitted to an NICU. We compared neonates with VRE isolates detected in rectal swab cultures to those without. Association of VRE colonization with risk factors was tested by using univariate and multivariate methods. Results: During a period of 18 months, amongst 180 neonates enrolled in the study, 76 (42.2%) were colonized by VRE. VRE isolates were resistant to amikacin in 68%, gentamicin in 26%, and ampicillin in 17.1% of cases. Molecular analysis showed the vanA gene in all isolates. Two VRE-positive patients developed infection during the observation time. No deaths occurred during this period. Prematurity (P = 0.023), low birth weight (P = 0.019), history of admission in other hospitals (P = 0.00), and antibiotic therapy for more than seven days (P = 0.01) were identified as risk factors for VRE colonization. Conclusion: Newborn susceptibility to early colonization with VRE in NICUs is increased in preterm and low birth weight newborns. All VRE colonization in the NICU was related to the acquisition of the vanA gene. Adherence to infection control policies and antimicrobial stewardship strategies are of the highest importance.

Background: Overweight and obesity are the most serious public health challenges of developed and developing countries. The prevalence of childhood obesity has increased worldwide. This study aims to identify the behavioral determinants of overweight and obesity among adolescents. Methods: This is a qualitative study with directed approach to content analysis of in-depth semi-structured interviews. A total of 27 obese and overweight students (11girls, 16 boys) were recruited in this study based on the PRECEDE model (predisposing factor). The participants were recruited using a purposive sampling method to reach the maximum variation sampling. This sampling took over 6 months in 2018 at the Ghaemshahr middle school. Content analysis approach (directed) was used to analyze the interview. Results: Five main themes and 20 sub-themes of behavioral determinant were emerged from the interview. The main themes included perceived benefit, perceived threaten, self-efficacy, cues to action, and locus of control. The subthemes included self-empowerment, motivation and diligence role, enough information and parent pressure, long term benefits, physical health, doing favorite sports, perceived susceptibility and perceived severity, and internal and external locus of control. Conclusion: Self-efficacy and perceived benefit are the most significant determinants of preventive behavior in obese and overweight students; therefore, considering these variables in students can be applied in designing an interventional program that affect obesity preventive behaviors, increase parents’ awareness and school authorities.

Background and purpose: Tooth extraction, for any reason, has negative effects on the human psyche. In addition, it causes problems in chewing food, appearance, and speech. The aim of this study was to investigate the causes of permanent tooth extraction in patients attending public health centers in Sari, Iran 2020. Materials and methods: A descriptive cross-sectional study was carried out and 522 who had their teeth extracted were selected by convenience sampling. People aged 18 to 65 years old were included and Chi-square test was used to compare the causes of tooth extraction in men and women and other characteristics. Data analysis was conducted in SPSS V25. Results: Causes of permanent tooth extraction included caries (64.8%), periodontal problems (15.7%), partial occlusion of teeth (6.1%), periapical abscess (5.4%), patient demand (4.8%), trauma (1%), and other reasons (1%). Conclusion: Tooth decay and periodontal diseases were the main reasons for removing permanent teeth in people studied.

Objectives: Functional abdominal pain (FAP) is a debilitating disorder that has a high prevalence among children. The goal of this study is to evaluate patients’ and parents’ perceptions of health-related quality of life (QoL) for children with FAP. Methods: Between April 2018 and June 2019, a total of 200 children (including 100 with FAP and 100 healthy individuals) and 200 parents participated in this study. The participants completed a health-related QoL scale (pediatric quality of life inventory) that is scored on a scale from 0 (poor) to 100 (best). Children with FAP and their parents were compared to a control group consisting of healthy children. Results: Children with FAP had lower self-report QoL scores (46.97±17.43) compared to their healthy peers (78.69±13.02) and the difference was significant (P

Background: Reconstruction of teeth using partial or complete dentures is the only treatment for most edentulous patients. The duration of edentulism and the use of complete dentures can affect the patient’s quality of life. Therefore, this study aimed to evaluate the quality of life associated with oral health in patients referring to the Prosthodontics Department, School of Dentistry, Sari, Iran. Methods: In total, 235 patients treated in the Prosthodontics Department, School of Dentistry, Sari, Iran were selected and studied in this descriptive-analytical cross-sectional study. The required information was collected using the Oral Health Impact Profile-14 questionnaire (OHIP-14). Data were analyzed through SPSS22 and using descriptive and analytical tests, such as Mann-Whitney, t test, one-way analysis of variance, and multivariate regression. Results: In total, 103 men (43.8%) and 132 women (56.2%) with mean age of 58 ± 10.3 years participated in this study. The duration of denture use was between 3 and 108 months. The mean score of patients’ quality of life had a statistically significant relationship with the type of treated jaw, the type of removable prosthesis, and the duration of prosthesis use (P < 0.05). However, no statistically significant relationship was observed between the mean score of quality of life with age and gender (P > 0.05). Conclusion: Based on the obtained results, the quality of life was higher among those who used dentures for a longer period of time and also in patients with complete dentures. However, the quality of life was lower in people who used mandibular dentures, compared to other groups.

Introduction: Introduction: The present study aimed to evaluate the coronal discoloration of human teeth induced by using a new Endoseal MTA compared to an AH Plus Sealer. Methods: A total of 40 premolars extracted for orthodontic reasons were used in the present study. Then, the teeth were incised in the coronal third of the root 3 mm below the cementoenamel junction. Samples were randomly allocated to two experimental groups (group 1: AH Plus sealer, group 2: Endoseal MTA) and 6 teeth as the negative control group. The color evaluation was determined at four different times: before placing sealers (T0), 1 month (T1), 3 months (T2), and 6 months (T₃) after that with an intraoral spectrophotometer. Data were analyzed using Multivariate Test and Hotelling's Trace. A P-value