rezaali mohammadpour

One of the challenges in the treatment of gout is patient adherence to prescribed therapy. The aim of this study was to investigate the frequency and factors influencing the discontinuation of uric acid-lowering treatment in gout patients during 2023-2024.

This study is a descriptive cross-sectional analysis conducted on 100 gout patients who visited clinics in Sari between 2023 and 2024. Demographic information, underlying conditions, and gout-related details, as well as the history of drug discontinuation during the course of the disease and in the past year, were reviewed. Adherence to treatment was defined as regular drug use for more than 80% of the days in the year. Descriptive and analytical statistics were performed using SPSS software, with the T-test and Chi-square test applied. A p-value of ≤ 0.05 was considered statistically significant.

The mean age of the patients was 51.09 ± 15.5 years, and the mean duration of gout was 6.38± 8.1 years. Fifty-six patients had underlying conditions, and 41 patients had a history of kidney stones, either past or current. Fifty-three patients had discontinued one or both medications at some point during the course of their disease. Medication discontinuations in the previous year included anti-inflammatory drugs in 34 cases, uric acid-lowering drugs in 36 cases, and both drugs in 30 cases. The most common reason for medication discontinuation was the patient's perception of lack of necessity for the medication. The number of attacks was higher in the group with treatment discontinuation (P = 0.01)

More than half of the patients discontinued medications during the course of the disease, and the adherence rate to uric acid-lowering medications over the past year was 64%. Physicians should place greater emphasis on ensuring the appropriate use of medications to effectively improve treatment adherence.

The majority of research on parent-adolescent sexual communication has predominantly focused on mothers, leaving fathers’ involvement in this matter largely unexplored. Therefore, this study seeks to identify the obstacles hindering sexual communication between fathers and adolescents.

This cross-sectional study was performed on 196 fathers of adolescents aged 15 to 19 from August 2020 to January 2021 in northern Iran. A socio-demographic medical information form, a culturally validated parent-adolescent sexual communication barriers questionnaire, and the sexual communication topics between parents and adolescents were used to gather information. A logistic regression test was administered using SPSS software, version 18 to determine the barriers to sexual communication. 

The mean age was 47.38±5.04 for fathers, 16.79±1.46 for boys, and 17.00±1.30 for girls. The prevalence of father-girl sexual communication (51.1%) was lower than that of father-boy sexual communication (55.8%). The most frequent barriers to fathers’ sexual communication with both genders were the adolescent’s embarrassment and the possibility of provoking their curiosity about sex. The logistic regressions showed that adolescents’ embarrassment and not trusting them and approving of them having sex were barriers to father-adolescent sexual communication (P<0.001). Conversely, adolescents asking more private questions were positive predictors of father-adolescent sexual conversation (P<0.001).

The findings underscore the prevalence of adolescent embarrassment and concerns about sparking curiosity about sex as key obstacles to such communication. Additionally, the results highlight the importance of adolescents feeling trusted and supported by their fathers in discussing sexual topics. These insights emphasize the need for targeted interventions to address these barriers and promote healthier, more open communication between fathers and adolescents regarding sexual matters.

Modifying and enhancing treatment methods is essential to meet effluent standards for treating landfill leachate. This study investigated the treatment of municipal solid waste leachate (MSWL) using coagulation, flocculation, advanced oxidation, and extended aeration processes.

The effects of different coagulant doses and pH values on coagulation processes were compared. The treatment procedure was analyzed to determine the impact of varying concentrations of potassium persulfate (K2S2O8) and hydrogen peroxide (H2O2) on the results after coagulation with FeCl3. The extended aeration process’s biological stages were studied using a sludge retention time (SRT) of 23 days and the effects of hydraulic retention time (HRT) of 18 and 36 hours.

The experimental results show that in the pH range of 5–8, the lower the pH value, the higher the treatment efficiency. The addition of 0.8 g L1− FeCl3 can achieve a 57% removal of chemical oxygen demand (COD). The addition of 2.5 g L1− K2S2O8 and 1.5 g L1− H2O2 with UV-C (15 W) for 70 minutes at pH 7 can effectively remove 86% of COD. Activated sludge extended aeration can attain an 88% removal of COD under optimal operating conditions (HRT = 36 hours, SRT = 23 days, and aeration = 36 hours). The studied hybrid process with the efficiency of 99%, 98%, 95%, 87%, and 83% removal of COD, biochemical oxygen demand (BOD), total suspended solids (TSS), turbidity, and total Kjeldahl nitrogen (TKN), respectively, is suitable for leachate treatment.

This study showed that flocculation-coagulation followed by the advanced oxidation process (AOP) and extended aeration can be an efficient and promising treatment method for MSWL.

Since 2013, Iran's health system reform has been implemented at the national level with goals such as increasing people's access to health services, reducing direct payments to patients, and improving the quality of services. As this initiative has been associated with significant changes in the financing of hospitals, this study aims to investigate the changes in income and expenses of public hospitals in Mazandaran province, as two important indicators of key hospital financial performance, before and after the implementation of the reform.

This is a retrospective study that was conducted in 2018. Since this study deals with the impact of the intervention carried out by the public sector by comparing the changes before and after the implementation of the intervention, it is therefore considered a type of quasi-experimental study. The statistical population includes all government hospitals in Mazandaran province. The sampling method was census and covered all 24 public hospitals of Mazandaran province. The time frame of the study covers from 2009 to 2016, that is, 4 years before and 4 years after the implementation of the reform. Secondary data that is routinely recorded in the information system of the country's hospital system has been used in this study. To collect the data, a researcher-made checklist was used based on the objectives of the study and the availability of data in the routine information recording system of hospitals, which mainly included the variables of staff cost, non-staff cost, cash income, insurance income, and working year. After collecting the data from the comprehensive and centralized Electronic Information System (HIS), which contains all the financial and functional information of all hospitals in the province, the data were extracted and analyzed using SPSS software and appropriate statistical methods.

In general, after the implementation of the reform, the average costs in the studied hospitals increased from 249,613 to 771,552 million Tomans (2.61 times) and the average incomes increased from 152,738 to 534,804 million Tomans (3.50 times). Therefore, both the average cost and the average income in the 4-year periods before and after the implementation of the initiative have generally increased, but the growth rate of costs and incomes in the period before the implementation of the reform was lower than the period after its implementation, although, in the same period, the gap between expenses and incomes has been widening. In the period after the implementation of reform, due to the rapid increase in income at the beginning of the implementation, the gap between cost and income has decreased relatively, but gradually the rate of income growth has decreased compared to the rate of cost growth, and as a result, the gap between the cost and income of the hospitals studied in the end of the study period has experienced an unprecedented gap. It has also been found that during the years of the study, the staff cost has continued to rise with more or less trends, while the non-staff cost has started to decrease sharply and unprecedentedly since 1995.

Although the implementation of the reform has increased the financial turnover of government hospitals, due to the increase in the average cost compared to the increase in their average income, the implementation of this plan has increased the financial pressure on the hospitals and widened the income deficit compared to their cost. Therefore, the gap between cost and income and the rising trend of this gap in government hospitals can be a challenge for funding hospitals and guaranteeing the relative access of people to these services now and in the future.

Sarcoidosis is a systemic disease with unknown etiology that is characterized by the presence of granuloma in various organs with diverse pulmonary and extrapulmonary manifestations. Regarding differences in the presentation of sarcoidosis in different geographical areas, the present study aimed to determine clinical, laboratory, and radiologic findings of patients with sarcoidosis in the north of Iran.
In a cross-sectional study, patients with sarcoidosis were enrolled, and demographic data in addition to disease manifestations including clinical, laboratory, and imaging findings were recorded.
A total of 58 patients with sarcoidosis were enrolled in the study. The mean age and disease duration were 51.10±10.2 and 3.07±2.7 years, respectively. 62.1% of patients were female. Clinical manifestations were: cough and dyspnea (55.2%), fever and weight loss (11%), arthritis (15.5%), dermatologic presentation (15.5%), and ophthalmic involvement (17.2 %). Abnormalities in liver, renal, and calcium levels are found in approximately 1-8% of cases. The ACE level was increased in 56.9 % of patients, especially in those who presented in summer and autumn.  Chest CT abnormalities were found in 94.8 % of patients, more predominantly hilar and paratracheal lymphadenopathy in 84.5% and 74.1%, respectively.
Although sarcoidosis presents with varying clinical, radiological, and laboratory features, knowledge of its epidemiology and the incidence of these features in different populations can aid in its diagnosis in a particular geographic area.

Fibromyalgia is a syndrome characterized by chronic musculoskeletal pain, tenderness, and other physical symptoms. We determined the frequency of Fibromyalgia in hypothyroid patients and the relationship between FM symptoms and hypothyroid status.

The current study is a cross-sectional descriptive study investigating the prevalence and demographic characteristics of fibromyalgia in hypothyroid patients referred to University clinic in Sari in 1401-1402. Ninety-one hypothyroid patients were included in the study. The sampling method was convenience sampling. The sociodemographic features and the clinical features of hypothyroid patients were recorded. Thyroid tests included T4, TSH, and Anti Tpo Ab. Patients were examined for Fibromyalgia using American College Rheumatology (ACR) criteria for FM 2010 and 1990. For the patients who were classified as FM, the FIQR questionnaire was completed. To analyze the data, descriptive statistics indicators such as central and dispersion indicators and calculation of ratios were used, and to check the relationship between qualitative variables, chi-square test and quantitative variable comparison in different groups were used by t-tests and ANOVA in SPSS-25 software was used.

The mean age and duration of hypothyroidism were 48.35 ± 13.8 and 9.84± 6.6 years respectively. The frequency of fibromyalgia in hypothyroid patients was 7(8%) patients based on ACR 2010 criteria. In patients with hypothyroidism and fibromyalgia, 6 patients (85.7%) were positive for Anti Tpo Ab, while in patients with hypothyroidism without fibromyalgia, 29 patients (34.5%) had this antibody (P=0.007).

It seems that Anti Tpo Ab is more important than thyroid dysfunction, and it is suggested to check this antibody in fibromyalgia patients in addition to thyroid function tests.

Stress hyperglycemia is a neuroendocrine physiological response to medical stress, hyperglycemic stress increases the risk of mortality and morbidity in ill patients. This study aimed to investigate the frequency of hyperglycemic stress and its related factors, as well as the relationship between hyperglycemia and the severity and clinical outcomes of hospitalized patients with COVID-19.

This cross-sectional study was conducted in Imam Khomeini Hospital in Sari in 2019. The patients were diagnosed based on clinical symptoms, CBC, CRP, ESR tests, RT-PCR test, and CT scan of the lungs and were hospitalized in the Covid ward. Data analysis was performed using SPSS Software.

312 COVID-19 patients were investigated, and 22 (7.1%) suffered from hyperglycemic stress. Hyperglycemic stress patients had more mortality, hospitalization in ICU, respiratory ventilation, and length of hospital stay compared to the normoglycemic subjects, but only in terms of mortality, there was a statistically significant difference between the two groups (P=0.46)

Considering the effect of hyperglycemia on the outcome of the disease and the death rate in ill and hospitalized patients compared to patients with normal blood sugar, it shows the importance of timely diagnosis and proper control of blood sugar in these patients.

A part of the expenses of every household in all societies of the world is health expenditures, which can sometimes be disastrous for families. This study was conducted to investigate the change in the share of health expenditure from the total Household costs in Mazandaran province and the possible impact of health system reforms on it in Iran during the recent two decades, especially the Health Transformation Plan.

This is a retrospective descriptive-analytical study, based on quantitative and secondary data. The data required for this study was taken from the Statistics Center including household income and expenditure for a period of 18 years from 2001 to 2018. Descriptive statistics indicators and trend charts were used to describe the quantitative data, and to analyze household health expenditures, the t-test was applied in SPSS software.

The results of the study showed that on average, the share of health expenditures in the total household expenses was 12.04% for urban households and 11.36% for rural households that is more than the stated and expected limit of 10%. The trend of changes in the percentage of health expenditures from the total household expenses at the time of the research compared to the base year has been variable and in some years it has decreased and in some years it has increased.

The health system reforms have not ultimately led to the reduction of household health expenditure to less than the expected level and its increasing trend in Mazandaran province.This means the risk of catastrophc health expenditure among households still exist. Even with the implementation of subsequent plans, the achievement of the previous plan has been neutralized. Considering the importance of financial issues in universal health coverage and also the limited resources of the health sector, more detailed policies and plans should be designed and implemented to target vulnerable groups so that families' financial hardship is prevented as well as the possibility of universal coverage is increased to the maximum.

Leachate, containing challenging-to-degrade organic substances and persistent toxins, poses significant environmental concerns. Advanced oxidation processes (AOPs) have emerged as a promising solution for effective leachate treatment. This research provides a comprehensive review of the impact of various AOPs in leachate treatment.

This systematic review was conducted, encompassing commonly used AOPs such as ozone, peroxone, O3/catalyst, Fenton, photo-Fenton, UV/TiO2, photolytic persulfate, O3/UV, and O3/H2O2/ UV. Extensive searches were performed using reputable databases, including EBSCO, PubMed, Web of Science, and Google Scholar. Specific keywords and inclusion/exclusion criteria were applied. Data regarding leachate treatment parameters were meticulously summarized and analyzed using descriptive statistical methods.

The efficiency of AOPs in removing leachate organic matter varied, with chemical oxygen demand (COD) removal ranging from 41% to 83% in treatment systems. The order of effectiveness was found to be: O3/UV/H2O2 > photo-Fenton > UV/TiO2 > Fenton > persulfate (PS) > O3/UV > O3/H2O2 > O3/catalyst > ozonation (O3). The highest COD removal efficiency of 83.75% was achieved using the O3/UV/H2O2 AOP approach. The removal efficiency of color also varied, ranging from 32% to 100%, depending on the leachate’s characteristics, concentration, and specific treatment process utilized.

AOPs, particularly the hybrid approach using O3/UV/H2O2, significantly enhance waste leachate treatment by effectively degrading persistent organic compounds through the generation of hydroxyl radicals. Further research is required to optimize AOPs and improve their efficiency in waste leachate treatment.

Context:

 Although spouses play the main role as caregivers, few intervention studies have been performed on the psychological health of breast cancer patients’ spouses.

 To determine Mindful‑Centered Self‑care Empowerment Training Program (MScETP) influencing the breast cancer patients’ spouses’ depression and their family functioning.

Setting and Design:

 A quasi‑experimental study with one‑group pre-and post-test design.

 The sample included 46 randomly selected cancer patients’ spouses meeting the inclusion criteria, referring to the specialized clinics of Mazandaran University of Medical Sciences, Sari, Iran. Firstly, the pretest was conducted and then the posttest was done a week following the intervention. Data collection was done by Beck Depression Inventory-II and Family Assessment Device-60 Questionnaire before and after implementing the MScETP.

Statistical Analysis: 

by ANOVA and dependent t-test by SPSS-22 at significance level as P < 0.05.

 The results reported the pre‑ and post-intervention mean (±SD) of the spouses’ depression as 15.65 (±6.79) and 12.95 (±4.99), respectively. The mean (± SD) of six FAD subscales was calculated as it follows: problem‑solving 2.30 (±0.33) and 2.15 (±0.29), communication 2.33 (±0.29) and2.27 (±0.19), roles 2.21 (±0.23) and2.31 (±0.19), affective responsiveness2.08(±0.32) and2.28(±0.32), affective involvement2.62 (±0.40) and 2.27 (±0.29), and behavior control 2.60 (±0.31) and 2.33 (±0.27), and General Functioning Scale 2.35 (±0.27) and 2.11 (±0.23) (P < 0.05). As the findings showed, the training significantly affected the breast cancer sufferers’ spouses’ depression and their family functioning (P < 0.05).

 The study findings revealed MScETP meaningfully reduced the breast cancer patients’ spouses’ depression and improved their family functioning.

To investigate the use of prognostic markers such as C-reactive protein (CRP) and D-dimer forclinical outcomes in patients with mild traumatic brain injury (TBI). This cross-sectional study was conducted on patients with mild head trauma who were admittedto the Emergency Department of Imam Khomeini Hospital (Sari, Iran). Data were collected from 2018 to2019. Age, sex, the time of injury hospitalization, length of hospitalization, length of unconsciousness, bloodpressure, heart rate, respiratory rate, and concomitant symptoms were all recorded using a pre-designedchecklist. The patient’s Glasgow Coma Scale (GCS), CRP, and D-dimer were also measured. Moreover, allpatients underwent CT scan. This study included 74 patients with TBI. The mean age of the participants was 36.92±3.54. Themean CRP and D-dimer values were 5.69±0.77 and 0.58±0.11 in these patients, respectively. At the cut-offpoint of 11.50 for CRP, the sensitivity and specificity to detect the pathological lesions in CT scan was 75%and 95.50%, respectively (p<0.001). Additionally, with a D-dimer cut-off point of 0.90, the sensitivity andspecificity for diagnosing pathological lesions in CT scan were 100% and 98.50%, respectively (p<0.001). In general, the CRP and D-dimer levels of patients with mild TBI (GCS≥13) can be assessed toprotect against CT-induced radiation exposure and subsequent disorders; if they do not exhibit clinical signs toincrease the risk of adverse brain damage, such as reduced level of consciousness, drowsiness, and prolongedperiods of unconsciousness.

The prevalence of Diabetes Mellitus is increasing, and its acute and chronic complications can increase disability and mortality of patients. The present study was conducted to investigate the relationship between attachment styles and blood sugar control in patients with type 2 diabetes.

The present study was cross-sectional (descriptive analytical type) study which 240 people with type 2 diabetes referring to the endocrinology clinics of Mazandaran University of Medical Sciences in 2018 were evaluated in the study using convenience sampling. Subjects with psychiatric disorders based on the SCL90-R, were excluded. Collins's Adult Attachment Scale Revised was used to evaluate attachment styles. Information related to disease control, including fasting blood sugar, 2hpp (postprandial), glycosylated hemoglobin, and the presence of retinopathy, neuropathy, and nephropathy, were extracted from the patients' medical records. The data were analyzed through SPSS version 22 and using the analytical and descriptive tests (mean, standard deviation, frequency) and inferential statistics (Pearson, stepwise regression).

The results of the correlation matrix have shown that neither of the attachment styles had a significant relationship with glycemic control(P>0.05).

Considering that people with psychiatric disorders were excluded from this study, suggested that future researches should investigate this population as well.

Worldwide, more than 10 million regions with an area of more than 20 million hectares are considered contaminated soils. The expansion in industrial activities and urbanization has led to accumulation of high concentration of cadmium (Cd) in soil and water resources, which is a serious danger for environment and human health. Phytoremediation is a technique recommended for the removal of heavy metals from contaminated soils, sediments, and waters. This study aimed to investigate the Portulaca oleracea in the removal of Cd from contaminated soil.

To investigate the effect of P. oleracea phytoremediation on the removal of Cd, in 5 pots, 3 kg of soil was poured. And in each pot, 10 seeds were pursued. The pots were irrigated twice a week for 8 weeks with concentrations of 25, 50, 75, and 100 mg/L Cd. After 8 weeks, the amount of Cd of roots, shoots, and leaves was measured by atomic absorption spectrometry.

The results showed that Cd accumulation in purslane plants was significant (P=0.008) and the highest Cd accumulation was in leaves and shoots, and increasing Cd concentration prevented plant growth and led to lower growth at higher concentrations.

According to the results, P. oleracea can be used for the phytoremediation of Cd.

 The COVID-19 pandemic has threatened global health and increased the possibility of anxiety symptoms. The present study aims to investigate the frequency of post-traumatic stress disorder (PTSD) symptoms after the outbreak of COVID-19 in patients referred to the Mazandaran Welfare Organization in Mazandaran Province, Iran, in 2020.

In this descriptive-analytical study, 255 people enrolled. All participants were evaluated based on calls or in-person visits to the Mazandaran Welfare Counseling Center in Mazandaran Province, Iran, using the post-traumatic stress disorder checklist (PCL-5) with a cut-off point of 33 to diagnose PTSD. Also, the quality of sleep was measured based on the Pittsburg questionnaire. The P<0.05 was considered significant.

 The prevalence of PTSD in the high-risk population of welfare referees was 40.4% (CI 95%: 34.4 -46.4). The prevalence of PTSD had a significant relationship with the level of education (P=0.03). There was a positive and significant correlation of 30.2% between sleep quality scores and PCL-5 scores (P< 0.001).

 Considering the high prevalence of PTSD in people who are referred to welfare centers, as well as the availability of most of these individuals, it is possible to reduce the damage to this group by identifying factors related to PTSD and health planning.

 The importance of coping strategies and the role of religion as indicators in the face of problems and adversity have been emphasized in numerous studies. Therefore, the present study was conducted to investigate the relationship between religious coping and the resilience of nurses in the emergency department of Mazandaran University of Medical Sciences.

 This is a descriptive-analytical correlational study. All nurses working in the emergency departments of Mazandaran University of Medical Sciences were enrolled in the study by the census. In this study, three questionnaires including a checklist of personal and job characteristics, a resilience questionnaire (Connor and Davidson), and a questionnaire of coping strategies of Aflak Sear and Coleman were used. All data analysis was performed using SPSS software version 25. The significance level was considered p> ​​0.05.

The nurses participating in the study ranged in age from 21 to 59 years with a mean and standard deviation of 4 ± 34 ± 7.9. Job interest (p = 0.021) and work experience (p = 0.007) had statistically significant differences between different levels of religious confrontation. Job interest (p = 0.000) and native status (p = 0.001) have statistically significant differences between different levels of resilience. Resilience and most of its components have a significant correlation with religious confrontation and its components (p <0.05).

 Spirituality and the use of religious coping methods can increase the potential for adaptability and a sense of support from a higher power and ultimately increase nurses' resilience.

Mothers are in the first line of adolescent sexual health education. The aim of this study was to determine the prevalence of sexual health dialogue between mothers and adolescents and related factors in households covered by urban health care centers in Sari, Iran.

This cross-sectional study was conducted in 196 mothers of adolescents (15-19 years) using simple random sampling between August 2020 and January 2021. Data were collected using a Medical Socio-Demographic Questionnaire, a researcher-made questionnaire investigating the barriers to sexual health dialogue between parents and adolescents, and the Sexual Health Dialogue. Data analysis was performed applying logistic regression analysis.

Almost all mothers (99.5%) had a dialogue about at least one of the topics associated with sexual health with their adolescents. However, good-quality dialogue about sexual health was observed in 49%. Embaressment (54.8% of boys and 38% of girls) and encouraging curiosity about sex (49% of boys and 58.7% of girls) were the most frequent barriers to sexual health dialogue between mothers and adolecents of both genders. Logistic regression analysis showed that the odds of good-quality dialogue about sexual health between mothers and sons were 93% less than that between mothers and daughters.

Considering the low frequency of good-quality dialogue about sexual health between mothers and adolescents, attention to the barriers involved in this dialogue and essential appropriate approaches are necessary measures in adolescent health policy.

Some patients need emergency dental care and people with low economic status are more likely to go to hospital emergency departments. There is lack of enough knowledge about dental emergencies and no accurate data is available on this issue. This study aimed at investigating clinical and epidemiological characteristics of patients in dental emergency departments.

A cross-sectional descriptive study was performed in patients with dental complaints attending emergency departments affiliated with Mazandaran University of Medical Sciences, 2017-2018. Data were analyzed in SPSS V 16.

A total of 1660 patients (mean age: 36.80±15.50 years) were studied. The most common reasons for attending the emergency department were dental trauma (n=886) and dental infections (n=353). The highest referral times were evenings and nights (n=1130). Compared with women, men were found with more dental trauma and soft tissue injuries (P= 0.0001).

Special training programs should be provided to the staff in hospital emergency departments so that they can obtain sufficient information and skills about triage, diagnosis, treatment, and follow-up of dental emergencies.

Stress and socio-economic and psychological consequences of COVID-19 pandemic have affected family and marital relationships. The present study investigated the frequency of marital conflicts and related factors in Mazandaran province, north of Iran during this pandemic.

In this cross-sectional study, 357 married people were selected by convenience sampling via social networks in 2020. Data were electronically collected using demoghraphic and medical checklist and the Marital Conflict Questionnaire- revised form (MCQ-R). Data were analyzed in SPSS V25.

The average age of participants was 38.2±9.9 years. The average duration of marriage was 14.9±10.7 years. The total mean score for marital conflicts was 103.8±28.3 indicating a moderate level of conflict. The respondents reported mild (n=188, 57.7), moderate (n=132, 40.5), and severe (n=6, 1.8) levels of marital conflicts. Significant direct relationships were found between marital conflicts and age, gender, educational level, remarriage, nuclear family or extended family, history of marital conflict before the pandemic, individual or family history of COVID-19, and number of children (P<0.05).

According to current study, social health authorities are suggested to be prepared to predict the family-marital consequences of a pandemic such as COVID-19 and take necessary preventive and treatment actions.

Around the world, about one in six older people has experienced some form of abuse. This study aimed at comparing the rate of abuse and related factors in urban and rural senior people attending health centers in Ghaemshahr, 2020.

In this descriptive-analytical study, 250 older people were selected by systematic random sampling. Data were collected using Domestic Elder Abuse Questionnaire, Abbreviated Mental Test (AMT), Geriatric Depression Scale (GDS), Assessment of Daily Activities of Instrumental Activity of Daily Livening (IADL), and Demographic-Medical Questionnare. Data were analyzed in SPSS V22 applying descriptive statistics tests, independent t-test, and one-way analysis of variance.

The mean age of participants was 69.10±8.57 years of whom 58.8% were women. At least one type of abuse was experienced by 60% of elder people in urban areas and 64.8% of the seniors living in rural regions. Psychological abuse was found to be more prevalent in both groups while rejection was the least common form of abuse. Findings revealed significant associations between elder abuse and gender, education, income, disease status, number of drugs used, urinary incontinence, life companions, number of children, and occupation (P<0.05).

High rate of elder abuse calls for alerting aged people and their caregivers. Appropriate interventions can also help in preventing the consequences of this problem.

Stigma and burden of care in caregivers of patients with schizophrenia have negative effects on the patient and their families. This research aimed to determine the effect of self-care training based on Acceptance and Commitment Therapy (ACT) on perceived stigma and caregiver burden of schizophrenic patients.

This randomized clinical trial included 80 caregivers of schizophrenia patients in Sari Zare Hospital. Participants in intervention group received self-care training based on ACT in 8 sessions twice a week, while the control group received only routine care. The scores for stigma and care burden were measured in both groups before and after the intervention using Shamsaei stigma questionnaire and Zarit Burden Interview (ZBI, 22-item). T-test and paired t-test and descriptive statistical methods were used to analyze the data.

The mean changes of the total score for perceived stigma before and after the intervention were found to be significantly different between the intervention group (65.45±6.79) and the control group (80.25±10.34)(P<0.05). Also, intergroup comparison showed a significant difference in mean changes of the total scores for burden of care before and after the intervention between the intervention group (44.35 ± 6.37) and the control group (55.05 ±10.29) (P <0.05).

According to current study, self-care training based on Acceptance and Commitment Therapy will improve perceived stigma and reduce burden of care in caregivers of patients with schizophrenia and such non-invasive interventions are recommended.

Treatment of rheumatic diseases depends on proper use of medications. The aim of this study was to evaluate the frequency and reasons for discontinuation of drugs in these patients.

A cross-sectional study was performed in patients with inflammatory rheumatic diseases in Sari, Iran 2020-2021 to investigate the frequency and reasons for discontinuation of drugs. Statistical analysis was performed using SPSS V20 and descriptive statistical methods were used to determine the frequency of drug discontinuation and its causes.

The participants (n=251) included 197 patients with rheumatoid arthritis, 31 with systemic lupus, 16 with ankylosing spondylitis, and 7 patients with psoriatic arthritis. The mean age of patients was 52.36±13.4 and mean duration of illness was 8.35±7.31 years. Drug discontinuation was seen in 73 patients (85 cases). The most common reason for drug discontinuation was drug side effects (55.4%). Drug shortage, transient improvement of symptoms, ineffectiveness of the drug, and fear of developing COVID 19 were some of the reasons for discontinuation of drug.

The most common cause of discontinuation of treatment was drug side effects, but in about one third of cases, there are factors that could be corrected to help preventing drug discontinuation and non-adherence to treatment.

BACKGROUND:

 Dyspepsia is a common complaint among patients who refer to gastroenterology clinics. Studies have shown that there is a strong relationship between dyspepsia and Helicobacter pylori (HP) infection. We have investigated the prevalence of HP infection in patients with dyspepsia and its correlation with age and socioeconomic status (SES) of patients in Mazandaran province, northern Iran.

In this cross-sectional study, patients with dyspepsia who had undergone upper gastrointestinal endoscopy were enrolled. Diagnosis of HP infection was according to the results of rapid urease test (RUT), and Giemsa staining of pathology samples. A questionnaire including endoscopic findings, demographic data, and SES information was completed for each patient.

The mean age of the 614 patients was 45.8±5 years, and 60% of them were female. Most patients had normal endoscopy (56.1%), and gastric ulcer and erosion was the most common abnormal endoscopic finding (24.7%). The prevalence of HP infection in patients with dyspepsia was about 66.6%. HP infection was associated with a lower prevalence in people aged below 30 years and good SES.

The prevalence of HP infection in patients with dyspepsia was 66.6%. In addition, HP infection rate was lower in people under the age of 30 years and patients with good SES.

Elder abuse is one of the major challenges in caring and supporting elderly people. Current research aimed to investigate the relationship between loneliness and experiencing abuse in elderly people attending emergency departments in Amol hospitals, Iran 2019.

A descriptive-analytical correlation study was conducted in 220 people aged>60 years selected by convenience sampling. Demographic information of the participants was recorded and Elder abuse questionnaire in the family and the Social and Emotional Loneliness Scale for Adults (SELSA) were used. Data analysis was performed applying descriptive statistics test, Spearman correlation coefficient, multiple regression model and analysis of variance in SPSS V22.

The mean age of the elderly was 66.5±5.45 years and 62.7% were female participants. Among the subjects, 50.9% reported at least one type of abuse. Emotional neglect (29.1%) and physical abuse (0.5%) were the most and least frequent types of abuse, respectively. The current study showed significant relationships between all dimensions of abuse and the sense of loneliness (P=0.001) except for authority deprivation (P=0.5) and physical abuse (P=0.1) and financial neglect (P=0.1(.

Education and increasing awareness of elderly people and their caregivers can reduce elder abuse and improve their relationship, which will consequently improve the sense of loneliness in elderly people.

Survival tree model is a nonparametric method which can be used to identify the affecting factors from a specific time to the onset of an event. In this method, the categories are selected according to the most important factors. The purpose of this study was to determine the factors affecting the duration of breastfeeding in mothers and introduce the homogeneous subgroups using a survival tree model.

 It was a historical cohort study analyzing the survival data of mothers with healthy single childbirths referring to the rural and urban health centers of Agh-Ghala County since 2011 until 2014. Data analyses and groupings of breastfeeding survival were performed using survival tree model with conditional inference algorithm in R Software. A separation criterion (SEP) confirmed the relevance of the model.

Survival tree model results revealed that the type of consumed milk with the complementary nutrition, ethnicity and the time interval between current childbirth and the previous delivery were the most important factors affecting the duration of breastfeeding. The SEPchr('39')s criterion was 2.082. Thus, due to the significant difference between the subgroups and the value of more than 1 for SEP criterion, the efficiency of the model was confirmed.

Survival tree model could be introduced as a suitable and powerful method for ranking the duration of breastfeeding rate which presents four homogeneous subgroups for analysis in addition to identifying the predictive variables.

Context:

 Depression is one of the most common psychiatric disorders, and poor sleep quality is a risk factor for it.

This study aimed at determining the effect of aromatherapy with lavender essential oil on sleep quality of patients with major depression. Settings and Design: This single-blinded randomized clinical trial in Psychiatric Clinic in Yahya Nejad Hospital, Babol, Iran, during 2019.

Eighty major depressive patients with sleep disorder were recruited from those referred to Psychiatric Clinic in Babol City, Iran. They were assigned into intervention and control groups(forty participants in each group). The intervention group inhaled lavender essential oil and the control group received almond oil as placebo. Sleep quality of the participants was measured before and after the intervention. Statistical Analysis Used: Data analysis was performed employing statistical tests including Chi-square, Kolmogorov–Smirnov, ANCOVA, independent t-test, and paired t-test.

The intervention and control groups were homogeneous in terms of demographic characteristics and the mean score of sleep quality before the intervention (P > 0.05). The patients in the intervention group had a better quality of sleep comparing to that in the control group, and the difference was statistically meaningful (P = 0.001).

Aromatherapy with lavender essential oil has positive effects on sleep quality in depressed patients. It can be used as a noninvasive complementary method to improve sleep quality in patients with major depression.