مجله علوم پزشکی رازی
سال بیست و نهم شماره 3 (پیاپی 217، خرداد 1401)

An increasing number of elderly individuals are now undergoing coronary artery bypass surgery. Elderly patients, compared with patients of a younger age group, present for surgery with a greater burden of risk factors and reduced functional levels. Short‐term outcomes are hence poorer in them. But symptom relief occurs in most survivors and is accompanied by excellent rates of long‐term survival and a good quality of life. Therefore, an individualised risk–benefit profile must be carefully constructed by clinicians, taking into account several different factors and not just age alone. This review summarises the current concepts of coronary artery bypass surgery from the perspective of the very old. This, unfortunately, is not an easy question to answer. Risk–benefit profiles are individualised, and each elderly patient must be assessed on his or her own merit. There are no universally accepted standards for selection or rejection of patients for surgery. An elderly person with few background illnesses and a good expected quality and length of life would probably stand to benefit from CABG. On the other hand, an octogenarian with several comorbidities and an expected suboptimal quality of life after surgery would probably be best managed conservatively. The greatest risk, however, is in the critically ill elderly patient for whom the CABG operation may be the best of several high‐risk options. Due to the effect of cardiac rehabilitation in the secondary prevention of cardiovascular diseases and accidents on the one hand and the high direct and indirect treatment costs imposed on insurance organizations due to drug and surgical interventions on the other hand is covered. Giving a cardiac rehabilitation program due to its high clinical benefits, including reducing blood pressure risk factors and blood lipid profile and increasing the functional capacity of vascular transplant patients, reducing per capita drug use, reducing mortality and increasing life expectancy for the benefit of patients and society It is also in the interest of insurance companies. Therefore, the researcher seeks to answer the question of whether eight weeks of cardiac rehabilitation affect hemodynamic parameters and blood lipid profile in male patients 55 to 70 years of age with CABG coronary artery bypass graft surgery.

For the present quasi-experimental study, which was performed with a pre-test-post-test design, among male patients with an age range of 55 to 70 years, coronary artery bypass graft referring to Sari Heart Center (120 people), 40 people were selected as volunteers and Were randomly divided into control and experimental groups. The research variables were measured 24 hours before and 48 hours after the exercises. Also, the experimental group performed rehabilitation exercises for 8 weeks, 3 sessions per week and each session for 45-60 minutes. Research variables were assessed using a heart rate monitor, hand barometer and blood sampling. Finally, descriptive statistics (mean and standard deviation) and Shapirovilk and independent t-tests were used using SPSS software at a significance level of p <0.05 for statistical analysis of data.

Before comparing the results of the two groups, the data were analyzed using Shapiro-Wilk test to determine the normal distribution, which showed that the data distribution is normal. Also, according to the assumption of equality of variances based on Levin test, the first row of t-test table was used, which showed that 8 weeks of cardiac rehabilitation has a significant effect on hemodynamic parameters and blood lipid profile of coronary artery bypass graft surgery patients.

The results of this study showed that eight weeks of cardiovascular rehabilitation has an effect on hemodynamic parameters and blood lipid profile in men 55 to 70 years old by bypass surgery. Coronary artery surgery for the elderly is now safer than ever before, owing to modern surgical techniques and pharmacological breakthroughs. Despite magnified perioperative and postoperative dangers, symptom relief occurs in most patients. Long‐term survival and quality of life are also preserved or enhanced in the majority. Clinicians must understand the normal physiological changes associated with ageing in order to construct a risk–benefit analysis that is specifically tailored to each patient. This analysis should take into account a patient's life expectancy and quality of life both before and after a procedure, and not just age alone. Discrepancies between chronological age and biological age must be dealt with. Further, the physician is expected to anticipate end‐of‐life issues and the potential need for rehabilitation or nursing home placement in the early postoperative period. Most important among all is that these issues must be discussed with the patients and their families. Hence, it is up to the patient and the clinician to explore the potential benefits of an improved quality of living with the attendant risks of the procedure versus alternative treatment. Advanced age alone should not be a deterrent for coronary artery bypass surgery if it has been determined that these benefits outweigh the potential risk. In this study, the findings showed that due to the high prevalence of cardiovascular disease in the country and the high per capita consumption of drugs and its high costs and the high importance of cardiovascular rehabilitation in reducing cardiovascular risk factors and secondary prevention and reduction Re-stroke in heart patients, including coronary artery bypass grafting, more attention to the issue of cardiac rehabilitation and the establishment of clinics and centers in this regard is necessary. It is hoped that using the results of this study, a clear view on the importance of the impact of these programs on officials and experts to pay more attention to these programs. However, lack of access to all members of society, lack of control over hereditary and psychological characteristics and lack of control over the economic and social conditions of the subjects are some of the limitations of the present study that may affect the results of the study.

About one-third of human life is in sleep (2). Adequate sleep plays a vital role in mental and cognitive motor development in children and adults (3). Lack of sleep can have adverse effects on endocrine function, cognitive function, metabolism and inflammatory responses (4). With sleep problems, cognitive and emotional issues such as depression, anxiety, cognitive impairment, learning disability and intellectual development disability (2). Sleep complaints are very common in the normal population and about 37% of people suffer from sleep problems, sleep problems are one of the associated problems in autistic patients (7). Autism spectrum disorders ASD (1) is a type of autism spectrum disorder It is a pervasive developmental disorder that starts before 36 months of age and begins before the age of 3 and its prevalence is estimated to be 5 to 10 cases per 10,000 births. Children with autism are also susceptible to sleep disturbances (8). Due to the high prevalence of sleep problems in children with autism, effective treatment is necessary in these children. Many of the behaviors that fertilizer has with autism such as hypersensitivity to environmental disturbances, repetitive behaviors, difficulty in social understanding, etc. are likely to contribute to sleep disturbances in children. Behavioral approaches improve sleep onset. These approaches include behaviors that make it easier to fall asleep and stay asleep (10). In the process of story therapy, children are trying to become more aware of their feelings and thoughts, face their painful emotions and feelings, and express them throughout the story (11). Recent studies have shown that behavioral interventions that are present in early life. Autistic children are considered as a valuable and effective treatment for behavioral symptoms of autism. Blossom fard and Mazaheri in 2015, a study aimed at investigating the effectiveness of attachment-based storytelling on reducing sleep time problems and improving the child-mother relationship, the results of this study showed that attachment-based storytelling, in addition to being a solution for female routines, showed that attachment-based storytelling, in addition to being a solution for female-born routines, showed that the results of this study were based on attachment-based storytelling. Beth was able to reduce the disturbances of the child's sleep time, leading to a significant improvement in the parent-child relationship as one of the correlatives of sleep problems, so the clinical work of attachment-based storytelling is not only about improving sleep problems, but also for improving the emotional and mental health of the child and their families (18). It is controlling diseases and considering the educational and therapeutic aspects of storytelling that can be used as a valuable and efficient tool for improving life and social skills as well as treatment of sleep disorders, therefore, the researcher has decided to study the effect of storytelling education on sleep disorders of children with autism in order to prove the hypothesis that "teaching storytelling" It is effective for parents to "perform sleep disorders in children with autism" that ultimately provide a successful way of treating with minimal cost and time so that children with autism benefit from reduced sleep problems.

This study is a clinical trial study, in which the research population consists of children with autism and their parents who have a medical record with a definite diagnosis of autism. The sample in this study is parents of children with autism who have records in Tehran autism center in 2018 and meet the inclusion criteria. Researcher after reviewing the records of children with autism, a certain number of them are used. The available method and the sample size were randomly assigned to the intervention group using a pre-test-post-test experimental design with 45 parents in the Autism Society and 45 as the control group. In this stage, sleep disorders were measured using the CSHQ children's sleep habits questionnaire. The questionnaire consists of 45 questions, some of which have only diagnostic and therapeutic value and not research, so in scoring it only 33 questions are identified, most of which are scored on likert scale from 1 to 3 and its options are usually (7-5 nights per week), sometimes (2-4 nights per week) and rarely (0-1 nights per week). The score is between 33-99 and the total score is more than 41 indicating sleep disturbances in the child. In Iran, the validity of the instrument in the research of Shoghi, Khanjari, Farmani, and Hosseini (2005) was evaluated by content validity method and its validity was determined by two-week interval testing for 10 children between 11-6 years old, 97.97. The Cronbach's alpha coefficient was obtained from two studies, 0.77 and 0.79 (23). The researcher used the treatment method only for the intervention group in five sessions each for 60 minutes and finally obtained the scores of the questionnaire from both intervention and control groups.

In describing the characteristics of the research units, the demographic and contextual characteristics of the sample were compared and tested in two groups and the homogeneity of each of these variables was evaluated in the intervention and control groups. Nominal variables were compared and tested using Chi-Square test, precision chi-square (for tables larger than two and expected low frequency) and Fisher's accurate test (for tables two in two and expected low frequency) in both groups.In the inferential statistics section, the main variable, i.e. sleep disorder score in the sample, was compared in the intervention and control groups and in the previous stage with after the intervention, it was compared and tested. Classical tests were used due to the high sample size and according to the central limit theorem in the statistics, which with the increase of the sample size, the average distribution of the sample is close to the normal distribution.For comparing the two groups before the intervention, independent T-test was used for intra-group tests and comparison of two stages before and after the intervention for each group, and finally, using covariance analysis (ANCOVA) by eliminating the effect of pre-test, the effect of storytelling education to parents on sleep disorders of children with autism was investigated. Comparison of sleep disorders in children with autism was done in the intervention and control groups after teaching storytelling to parents and in the control group after the second test using independent T-test. There was a significant difference between the mean score of sleep disorder in the control group and the intervention after teaching storytelling to parents and in the control group after the second test.

Table information regarding the research hypothesis about determining the effect of storytelling education to parents on sleep disorders in children with autism indicates that the score of sleep disorder in the intervention group decreased by 5.7 ± 7.3 and in the control group  increased by 0.1 ± 2.1 the independent T-test showed this significant difference (P<0.001). Therefore, based on the data and findings, it can be claimed that the research hypothesis has been confirmed. Comparative diagram of sleep disorder score in children with autism before and after the intervention in the intervention and control groups shows that the difference before and after the intervention in the intervention group is higher than the control group. Comparative diagram of sleep disorder score in children with autism studied Before and after the intervention in the intervention and control groups.

Sleep and epilepsy are complex interactions and are completely interdependent, so that some patients experience seizures while asleep or deprived of sleep or when waking up, and for some they occur during the day or night (1). The American Psychiatric Association defines sleepiness as symptoms of excessive quantity of sleep (e.g., extended nocturnal sleep or involuntary daytime sleep), deteriorated quality of wakefulness (i.e., sleep propensity during wakefulness as shown by difficulty awakening or inability to remain awake when required), and sleep inertia (i.e., a period of impaired performance and reduced vigilance following awakening from the regular sleep episode or from a nap) (2). Its prevalence is higher in seizures than in the control group (3, 4) and in different groups seizures have been reported between 31 to 60% (5-7). According to common clinical beliefs, sleep disruption can have a significant effect on memory, as REM sleep or slow-wave sleep is essential for optimal cognitive function (3), and excessive daily sleepiness can increase seizures (8, 9) and pain (10) in patients; However, the exact function of sleep remains unclear, and the findings have not always been consistent. These discrepancies require the conduct of research in which, through a comprehensive look, a large number of parameters related to sleepiness are present in seizures. In other words, the heterogeneity of the previous findings highlights the variability of the course of the disease as a result of the interaction of sleepiness and seizures, which makes it necessary to conduct more research to better understand the problems of patients. Therefore, the aim of the present study was to investigate the comorbidity effect of sleepiness and epilepsy on cognitive functions, quality and severity of pain and disease severity markers in patients with epilepsy.

The present research was conducted as a case-control study in 2020 in Shiraz Namazi Hospital. The statistical population of this study included all patients with focal epileptic seizures (temporal lobe epilepsy) (n = 30) and generalized (idiopathic generalized epilepsy) (n = 21) and psychogenic non-epileptic seizures (n = 17) in Shiraz. Through their follow-up treatment process, they referred to the epilepsy and seizure ward of Shiraz Namazi Hospital, from which 68 patients with inclusion criteria were selected through purposive sampling method. According to the inclusion and exclusion criteria, each patient completed a comprehensive list of demographic and clinical variables, the Stanford Sleepiness Scale, the Montreal Cognitive Assessment, the McGill Pain Questionnaire, and the Visual Analogue Scale under the supervision of an on-site clinical psychology PhD student. After collecting research data, patients with seizures were divided into two groups with sleepiness (n = 45) and no sleepiness (n = 23) through a cut score equal to or greater than 3 on the Stanford Sleepiness Scale. Data were analyzed using parametric and non-parametric tests in version 24 of SPSS software.

Preliminary findings showed that there was a significant difference between the two groups of patients with epilepsy with and without sleepiness in terms of mean age and frequency of antiepileptic drugs (P <0.05); While there was no difference between the two groups in terms of type of seizure, education, gender, marital status and employment status. In order to investigate the effect of sleepiness on cognitive function and components related to pain quality, multivariate and univariate analysis of covariance was used to control age variables and use antiepileptic drugs. The results showed that patients with sleepiness in functions of language, Abstraction, delayed recall, as well as achieving the overall Montreal Cognitive Assessment score performed worse. These patients had higher sensory perception of pain experience, rated their pain higher, scored higher in pain quality, and chose more words to describe their pain (P<0.05). Evaluations of disease severity markers through nonparametric tests also showed that compared to patients without sleepiness, patients with epilepsy with sleepiness have experienced more pain, more seizures, a higher incidence of comorbid physical diseases, a longer history of psychiatric diagnoses, and they have more concomitant use of antiepileptic and psychiatric drugs (P<0.05).

The results showed that patients with epilepsy with sleepiness had lower mean scores on some cognitive subscales than their counterparts without sleepiness; However, the two groups did not differ in terms of spatial visual function, naming, attention, and orientation. Using a methodology similar to this study, Vascouto et al. Found that there was no difference between the two groups of patients with seizures with and without sleepiness in most cognitive components such as attention and spatial visual skills; Only from the point of view of the total score of auditory verbal learning, there is a significant difference (11) that is relatively consistent with the present study. Although more research is needed to draw more detailed discussions, the discrepancies in some findings can be explained by differences in the type of patient samples in the two studies and the reduction in attention and performance resulting from sleepiness. The results also showed that patients with epilepsy with sleepiness compared to their counterparts, evaluated the qualitative dimensions of their pain higher and experienced more severe pain. Consistent with these findings, Gutter et al. Found that sleepiness comorbidity in epileptic seizures leads to increased chronic pain in patients (10) and Jaussent et al. Also reported that chronic pain is a significant predictor of sleepiness (12). In this regard, potential underlying mechanisms such as structural and functional changes in the prefrontal cortex (13), anterior cingulate cortex (14), hippocampus (15), amygdala (16), insula (17), subcortical regions (17) and shock spinal cord passages (18); Neural-glial interactions; Abnormalities in autonomic function and hypothalamic-pituitary-adrenal axis and other biological factors may contribute to the relationship between sleepiness and pain. Finally, the results showed that the frequency of seizures, the presence of comorbidities of physical disease, the history of psychiatric diagnoses and the simultaneous use of antiepileptic and psychiatric drugs in patients with epilepsy with sleepiness were higher than their counterparts. In this regard, Pizzatto et al. (19) and Xu et al. (20) evaluated patients with epileptic seizures and did not find a relationship between daily sleepiness scores and the frequency of seizures. But Lee et al. Showed that the presence of psychiatric symptoms is an independent predictor of sleepiness in patients (21). It seems that sleepiness reduces the ability to control seizures in patients (22) and contributes to their recurrence and worsening of the disease. Disruption of patients' circadian rhythms can also be involved as a consequence of sleepiness; Because circadian rhythms affect the frequency of seizures depending on the epileptogenic region (23,24). According to the findings, measuring sleep habits, sleep hygiene and comorbidity of sleepiness is an unavoidable necessity. In particular, early diagnosis and treatment of comorbid sleepiness and seizures can improve the prognosis and reduce the negative health consequences in patients (25). Lack of objective measurements of sleepiness and self-reported nature of the data are the limitations of the present study. Future studies can complement these findings by using objective measures of sleepiness. Patients with epilepsy with sleepiness have a poorer cognitive and clinical status than their counterparts.

One of the main complications of type 2 diabetes is cardiovascular complications, which greatly increases mortality and reduces the quality of life of these patients. Complications of type 2 diabetes, which are known as cardiovascular risk factors, include dyslipidemia (1, 3) and high blood pressure, which are common diseases in type 2 diabetes (1, 4). Another complication of type 2 diabetes is liver complications (5). Which is associated with cardiovascular risk factors (5, 8) in type 2 diabetes. Despite extensive research to identify the pathological causes of type 2 diabetes, no definitive treatment for type 2 diabetes has been found so far, and the annual death rate from type 2 diabetes and liver disorders due to diabetes due to cardiovascular events is increasing (5). Indicating the need for further research to reduce cardiovascular risk factors in these patients. Exercise is one of the main pillars in the treatment of type 2 diabetes (13), but these patients may be limited in performing continuous aerobic exercise due to overweight and low level of physical fitness (14); For this reason, interval training is recommended for these patients because resting between exercise intervals reduces the cardiac stress caused, leading to metabolic recovery and rebuilding energy systems, allowing for more exercise in one session (18); Therefore, the aim of this study was to investigate the effect of interval aerobic training on cardiovascular risk factors including cardiovascular and hepatic complications in men with type 2 diabetes.

In the present quasi-experimental study, 20 men with type 2 diabetes were randomly selected from volunteer patients aged 35 to 50 years, sedentary lifestyle (no physical activity in the last six months), no insulin injection, no acute cardiovascular disease, no respiratory disease, and no musculoskeletal disease. Then, they were randomly divided into two groups of aerobic interval training and control. Exercise training intervention in the present study included 12 weeks of aerobic interval training, three sessions per week and each exercise session included 1)10-15 minutes of warm-up, 2) the main exercise program (10-40 minutes aerobic interval training with 5 minute intervals and a rest-to-activity ratio of 1: 1), 3) and 10 minutes of coolingdown. 24 hours before the intervention and 48 hours after the last training session, the research variables were measured in fasting. Paired sample t-test and independent t-tests were used to examine changes within and between groups. All statistical analysis operations were performed at the significant level of P 05 0.05 by SPSS software version 22.

The results showed that after the training period there was founded a significant decrease in the levels of HbA1c (P <0.001), triglyceride (P = 0.038), low-density lipoprotein (P = 0.008), alanine aminotransferase (P <0.001), aspartate aminotransferase (P <0.001), systolic blood pressure (P = 0.06) and body fat percentage (P = 0.003) and significant increase in high-density lipoprotein (P = 0.002) And maximum oxygen consumption (P <0.001) was observed compared to the control group, but there was no a significant difference in changes in total cholesterol (P = 0.159), diastolic blood pressure (P = 0.211) and body weight (0.061). = P) between training and control groups.

Regarding the chronic effect of regular exercise on glycemic control in diabetic patients, it can be said that aerobic interval exercise has increased glycemic control in patients with type 2 diabetes by increasing cell sensitivity with insulin-dependent molecular pathways and insulin-independent pathways (19). Also, after the training period, was observed a significant decrease in body fat percentage. The ratio of fat to muscle mass plays an important role in insulin resistance and metabolic disorders (21); therefore, the decrease in HbA1c caused by exercise can be justified in relation to the reduction of body fat percentage. Also, after the training period, a significant improvement in lipid profile was observed in the form of a decrease in triglycerides and LDL and a significant increase in HDL levels. The improvement in lipid profile in the present study may be due to the reduction of insulin resistance and glycemic control in adaptation to periodic aerobic exercise (16). Also, a significant decrease in serum aminotransferases was observed in the exercise group compared to the control group; it can be said that improving insulin resistance in the liver has reduced the accumulation of triglycerides in hepatocytes, which has resulted in reduced hepatic steatosis and improved liver function in patients. It is reported that body composition and HbA1c levels were associated with NAFLD. Also, after the training period, a significant increase in VO2max was observed compared to the control group.Cardiorespiratory fitness, measured by maximal oxygen consumption (VO2max), is related to functional capacity and human function and has been shown to be a strong predictor of disease mortality (27). One of the complications of diabetes is decreased functional ability in patients during exercise, the optimal delivery and use of oxygen means the interaction of various physiological functions, such as pulmonary ventilation, gas exchange, cardiac output, muscle blood distribution, aerobic capacity and energy production in skeletal muscle, as well as perception of fatigue (14). It can be said that exercise improves the function of the cardiorespiratory system by increasing the absorption and delivery of oxygen to the active muscles. Also in the present study, a significant decrease in systolic blood pressure was observed compared to the control group. Due to the fact that exercise training can affect vascular function and thus the response to vascular flow, it can increase blood flow to active muscles during exercise and provide the need for muscle oxygen by increasing blood flow, as well as increasing flow. The blood expels the metabolites produced and thus reduces the accumulation of these metabolites in the muscles (4, 28). On the other hand, by reducing insulin resistance in muscle cells, glucose uptake increases and as a result, glycogen stores in muscle cells increase, which can be useful in performing long-term exercise. Improving insulin signaling also leads to better glucose uptake during exercise (27, 29), resulting in better performance in long-term aerobic activity.

Diabetes is one of the most common metabolic diseases worldwide. The disease affects millions of people around the world and its prevalence is increasing rapidly. Muscle atrophy eventually leads to changes in intracellular signaling pathways that are involved in maintaining a balance between protein synthesis and breakdown. Muscle atrophy in patients with type 2 diabetes reduces muscle function, interrupts daily activities, and reduces the quality of life. The aim of this study was to evaluate the effect of aerobic training and Tribulus terrestris hydroalcoholic extract consumption on Muscle Atrophy Indices in type 2 diabetic rats.

This experimental research was performed with 42 male Wistar rats that were randomly divided into seven groups. Dexamethasone (750 μg/kg/day) was injected intraperitoneally into rats. Rats were type 2 diabetic using peritoneal injection nicotinamide-STZ (60 μg/kg). Rats in supplemented groups received Tribulus terrestris hydroalcoholic extract with doses of 5 and 10 mg per day by gavage method. Aerobic training was performed on a treadmill at a speed of 23 m/min, 30 min/day, 5 days/week for eight weeks. 24 hours after the last training session, rat soleus muscle was collected. 24 hours after the last training session, the mice were anesthetized by intraperitoneal injection of ketamine [90 mg / kg] and xylazine [10 mg / kg], then a sample of horseshoe muscle tissue was collected. Horseshoe muscle tissue was isolated and after washing with PBS solution was immediately frozen in liquid nitrogen (-196 ° C) and then stored at -80 ° C. Concentration of 6-methylguanine using DLdevelop ELISA kit from Canada with detection range of 1000-125 pg / ml, sensitivity 27 pg / ml and coefficient of variation of 10-12%, expression level of Atrogin-1, MURF-1 and MiR-29b was measured by Real-time PCR and PAB horseshoe tissue was measured by immunoassay. Shapiro-Wilk test was used to ensure the normal distribution of variables. Two-way analysis of variance and Bonferroni post hoc test were used to compare the mean changes of the studied factors in the groups. Significance level was considered p≤0.05 in all cases. All statistical operations were performed with SPSS software version 23.

The results showed that aerobic training, Tribulus extract and combined intervention of Tribulus extract with aerobic training resulted in a significant decrease in the expression genes of Atrogin-1(p=0.001), MURF-1 (p=0.001) and MiR-29b (p=0.001), as well as a significant increase in methyl guanine (p=0.001) and oxidant-prooxidant balance (PAB) (p=0.001) levels in male wistar rats exposed to dexamethasone. Therefore, administration of Tribulus terrestris extract along with aerobic exercise may be useful and effective due to the antioxidant effects of Tribulus terrestris and aerobic exercise, as well as their effect on the elimination of destructive metabolites and the expression of genes involved in muscle atrophy in diabetes. One of the limitations of the present study is the lack of measurement of other factors related to oxidative stress in skeletal muscle. Measuring signaling pathways such as PKC pathway regulation can also more clearly show the effects of physical activity on the transcription factors involved in skeletal muscle atrophy in people with diabetes. However, more research is needed in this area.

The results of the present study showed that aerobic exercise significantly reduced the expression of Atrogin-1, MURF-1 and MiR-29b genes as well as significantly increased levels of O-6-methyl guanine-DNA-methyltransferase and oxidant-prooxidant (PAB) balance in rats. Became type 2 diabetic. Diabetes is widely and closely related to oxidative stress due to the intensification of the formation of oxygen free radicals. Various studies have shown that high blood sugar is associated with increased oxidative stress and this leads to many complications of the disease. In summary, the results of the present study showed that aerobic exercise, Tribulus terrestris extract and combined intervention of Tribulus terrestris extract with aerobic exercise reduced the expression of genes involved in muscle atrophy, as well as increased oxidant-prooxidant balance in male Wistar rats exposed to dexa. Metazone. Therefore, according to the results, it seems that the combined intervention of Tribulus terrestris extract with aerobic exercise can help improve the condition during diabetes by reducing the expression of genes involved in muscle atrophy. It is suggested that in the future, a study be conducted on the effect of different doses of Tribulus terrestris extract and exercise on signaling pathways affecting muscle atrophy in type 2 diabetic subjects. It seems that the combined intervention of Tribulus terrestris extract with aerobic exercise can help improve the condition during diabetes by reducing the expression of genes involved in muscle atrophy.

Diabetes is a metabolic disorder in which the body becomes insulin resistant and therefore the insulin produced cannot function normally. Among the long-term complications of this disease, the most common cause of death is cardiovascular disease, especially atherosclerosis (2). Researches has shown that the presence of levels of systemic inflammation, independent of glycemic control, contributes to the complications of diabetes, especially cardiovascular disease (3). Interleukin-33 and its receptor (ST2) play an important role in inflammation, infection, and autoimmune diseases. Interleukin-33 is known as "dual cytokine" and acts as a protective and detrimental effect or as a pro-inflammatory or anti-inflammatory factor as well as a nucleus transcription factor that depends on the disease model and cell type (7). Researches has shown that exercise training, with its effect on inflammation, plays a key role in improving inflammatory factors and insulin resistance in patients with type 2 diabetes and leads to a reduction in mortality from diabetes and its complications (9). Many studies have reported that exercise has anti-inflammatory effects in diseases such as obesity and cardiovascular disease and type 2 diabetes and improves metabolic disorders. Among the training methods, most of the studies on the effect of exercise on cardiovascular risk factors used continuous and often long-term aerobic activity in their studies. In contrast, interval training is a training method that requires less time with high intensity and low volume and improves diseases and body composition (10).

The statistical population of the present study consists of women 35 to 50 years with type 2 diabetes in Esfahan that were selected purposefully and divided randomly into two groups of experimental and control. Inclusion criteria included type 2 diabetes, fasting blood sugar above 126 to 250 mg / dL, no history of cardiovascular, pulmonary, renal disease, no drug addiction, no regular exercise during the last 6 months And there were no skeletal abnormalities. To measure the height of the subjects, the SECA model's gauge was used, to calculate the weight of the subjects, the GLMOR brand digital scale was used and to control the heart rate, the polar pacemaker was used. Regarding the measurement of blood variables, ELISA laboratory kit was used to measure serum levels of Suppression of  Tumorigenicity 2  and interleukin 33. Rockport test was also used to estimate the aerobic capacity of patients. diet 24-hour dietary recalls was used to control diet; Anthropometric and physiological measurements of the subjects were performed. Fasting blood sample were taken from the subjects 24 hours before the first session and 48 hours after the last exercise session. The interval Training conducted including 12 weeks, three sessions in a week with 75 to 90% of the maximum heart rate. Also, the collected information was presented in two levels of descriptive and inferential statistics.

The results of one-way ANOVA demonstrated that there was no significant difference in the values of anthropometric features at the beginning of the period between groups (P <0.05). This point is a sign of homogeneity of groups. The anthropometric and physiological characteristics of the subjects are shown in Table 1. The results of data analysis using correlated t-test showed that 12 weeks of training had significant effects on body weight loss, Suppression of  Tumorigenicity 2, Interleukin-33 and Vo2max. Also the results of data analysis using ANCOVA showed that serum levels of Suppression of  Tumorigenicity 2 after high-intensity interval training had a significant decrease compared to control conditions.

Disorders of lipid and glucose metabolism are characteristic of type 2 diabetes. The link between ST2 circulation and metabolic disorders in diabetes is not yet fully understood. The IL-33/ST2 signaling pathway may be involved in the development of type 2 diabetes through inflammation. Its mechanism is as follows: Interleukin 33 has a protective role against glucose metabolism and obesity in obese mice and a Suppression of  Tumorigenicity 2 for interleukin-33. Binding of the two stimulates the activity of Th2 cells and Th2 increases inflammation by releasing inflammatory cytokines. Therefore, increased levels of Suppression of  Tumorigenicity 2 in diabetes may impair the protective effects of interleukin 33 (20). Analyzes show links between immune status and exercise. Knowing the function of the immune system in the context of exercise and the mechanism regulation of nerve endocrine glands and the physiological significance of these changes is invaluable.  Recent findings show that high-intensity interval training is an useful way to reduce fat and inflammation and cause a negative energy balance (21). Overall, the present study showed that regular interval exercise can alleviate the inflammatory response and Control blood sugar in patients with type 2 diabetes. Therefore, exercise intervention can minimize the incidence of complications associated with type 2 diabetes. As a result, exercise training is widely recommended as a treatment option for these people.

Adolescence is a transitional period from childhood to adulthood during which a great qualitative change occurs in the biological, psychological, and social dimensions of the individual. High school coincides with adolescence with personality development. Almost all psychologists and educational scientists believe that adolescence is the most sensitive, critical, and important period of human development. During this period, the person experiences puberty. It seeks to discover its own identity, seeks independence and detachment from childhood attachments, which is why adolescents often experience the "worst" behavioral "problems" to overcome "crises" and developmental challenges. One of the most important factors in the formation of personality and behavioral characteristics, as well as changes in adolescence, is the family. Adolescents are more reckless, emotional, and erroneous than other age groups to transition from parental control to adolescence, and adolescence, as one of the most challenging periods of human development, can lead to high-risk behaviors and influence factors on high-risk behaviors. During adolescence, situations arise that can lead to increased negative emotional experiences and emotional instability.Because adolescents experience negative emotions in conflict with their parents, adaptive emotion management is essential for mental health. Much research has been done to determine the nature of parent-adolescent conflict, and it is generally believed that one of the causes of emotional maladaptation in adolescents is a conflict between them and parents. But more extensive research shows that this relationship (parent-child conflict and emotional dysfunction) is more complex than being summed up in a simple cause-and-effect relationship. The present study was conducted in this regard and according to the extensive study among these factors, the three dark components of personality were selected to investigate whether a logical model can be drawn for the relationship between parent-child conflict and adolescent emotional with the mediating role of these factors. The researcher hopes that this research will be a step to start extensive studies in this field and an introduction to draw the final map of the relationship between all the effective factors in the relationship between parent-adolescent conflict and the occurrence of emotional dysfunction.

In this survey study, the statistical population included all adolescents aged 14 to 18 in Tehran's District 5 high schools studying in 2018-19. According to statistics obtained from the Tehran District 5 Education Organization, the number of high school students was equal to 55,066 students. To determine the sample size, a Morgan table was used, based on which a sample of 381 people can be selected for a population of 50,000. In this study, to control the sample drop during the study, the sample size was considered equal to 400 people, which included 200 female adolescents and 200 male adolescents. To measure the research data, the parent-adolescent conflict questionnaire, the emotional dysregulation questionnaire, and the dark triple personality questionnaire were used.

The results showed that the relationship between parent-adolescent conflict with emotion dysregulation with the role of dark personality triple mediator in adolescents was more than the direct relationship between parent and adolescent conflict with emotion dysregulation and therefore the effect of dark personality triple mediation. It has been meaningful. Also, in fitting the designed model, it was found that because the value of GFI and AGFI index obtained is close to one, and also, the root mean square of the estimation error or RMSEA is less than 0.08 and in the acceptable range, we can say that the model variables Well fitted by data.

The results showed that the relationship between parent-adolescent conflict with emotion dysregulation with the role of dark personality triple mediator in adolescents was more than the direct relationship between parent and adolescent conflict with emotion maladaptation and therefore the effect of dark personality triple mediation was significant. In explaining these results, theoretical foundations can be used in this field. The overall structure and dimensions of personality are established in childhood and adolescence and are highly stable over time, and recognizing personality not only helps the individual to take an appropriate and informed stance in interaction with others but also in preventing or taking possible action about the occurrence. Disorders and disorders are also useful. Given the significant individual differences in the use of emotion regulation strategies, emotion regulation seems to be tied to certain dimensions of personality; these individual differences in emotion regulation have been examined to the dimensions of the five personality factors model, including neuroticism, extraversion, openness to experience, conscientiousness, and agreement. Explaining the role of gender, although there are important similarities between the components of the dark three personality traits between the two sexes, we must acknowledge the important differences between these components between girls and boys. One of these divergences is related to the fact that the traits of Machiavellianism and anti-socialism have been considered as darker and uglier personality traits of boys than narcissism. However, current research has shown that even though there is a fundamental difference in the quantity and nature of dark personality traits in girls and boys, this variable in both groups significantly plays a mediating role in the parental conflict with adolescents and their emotional dysregulation.

Women's employment is one of the most important issues of gender equality and essential for economic development. Which has been accompanied by a significant growth in the social status of women in society (2). However, most working women face a number of challenges with the pressures of work and housekeeping that can be affected by the type of job and its demands (7).Women in different occupations are viewed in such a way that among the general public, characteristics such as sensitive and affection are related to the feminine gender role schemas, and characteristics such as aggression and courage are related to the masculine gender role schemas. Comparatively, it has led to the presence of men in high-powered social roles (management and politics) and the presence of women in low-power social roles (education and care) in jobs (10).On the other hand, women's employment in traditional masculine occupations such as politics exposes them to double anxiety, which is rooted in gender stereotypes and hinders the promotion of women's success in these occupations and endangers their mental health (20). However, according to the World Health Organization statement (2015) on the reduction of psychosocial and occupational stress by 2020, it seems that a full understanding of the mental health of occupational workers, especially women, is necessary (24). So, considering the importance of the role and position of women in the family and society, it seems that employment in occupations that are considered masculine in terms of gender stereotypes can affect the gender role schemes and mental health of women working in these occupations. Therefore, the researcher seeks to answer the question of whether there is a difference between mental health and gender role schemas in women working in political and non-political governmental organizations?

The present study is a quantitative study. To conduct this research using the formula "Comparison of the average of two societies" among all women working in political governmental organizations(included: Khorasan Razavi Governor's Office, Mashhad Governor's Office, Representation of the Ministry of Foreign Affairs in the North and East of the Country)and women working in  non-political governmental organizations (included: Education, University of Medical Sciences, Welfare and…) in Mashhad in 2020, 114 women working in the political systems and 384 women working in the non-political systems , were selected as a sample. Then Bem sex role inventory (including 30 questions and 3 subscales) and Goldberg general health questionnaire (including 28 questions and 4 subscales) were distributed and collected among the samples. Finally, Kolmogorov-Smirnov and independent t-tests were used to analyze the data.

The results showed that there was a statistically significant difference between the two groups of women working in political and non-political governmental organizations in  terms of the mean score of the masculine gender role schemas (p = 0.001). However, there were no significant difference between the two groups of women working in political and non-political governmental organizations in terms of the mean score of feminine gender role schemas and social desirability scale (p>0.05) (Table 1).It was also found that there were a significant difference between the two groups of women working in political and non-political governmental organizations in terms of the mean total score of mental health and the subscales of physical symptoms and anxiety and insomnia (p<0.05). But there were no significant difference between the two groups of women working in political and non-political governmental organizations in terms of mean scores of social dysfunction and depression (p>0.05) (Table 2).

The results showed that there were no significant difference between the two groups in terms of mean scores of feminine gender role schemas and social desirability scale. However, the average score of the masculine gender role schemas in women working in political governmental organizations is significantly higher than women working in non-political governmental organizations.it seems that though women's employment and changing their social role from housekeeping to bread-winner in the community and family have been accompanied by increasing independence, self-confidence and strengthening masculine  gender characteristics in both groups of women working in political and non-political governmental organizations, However, women's employment in political governmental organizations that are not commensurate with their gender role (compared to women working in non-political governmental organizations, which is more commensurate with the feminine gender role of women), has further strengthened the reciprocal behaviors of gender stereotypes and the masculine gender role schemas.On the other hand, it was found that women working in non-political governmental organizations have significantly better mental health status than women working in political governmental organizations. It seems that most women working in masculine jobs, receive less support from men due to their limited number of them in these jobs and their lower control and decision-making power, which can greatly affect their mental health.Whereas, women working in feminine jobs often receive more support from both groups of women and men working in these workplaces due to higher control and decision-making power, and therefore, have a better mental health status (35).

Negative Affect is an action occurring when an individual is involved in a mutual interaction, triggered by verbal and non-verbal power in order to make the person to comply with the orders and ultimately, it accompanies with gaining benefits. Negative Affect in workplace in recent years has drawn lots of attention because it results in serious consequences for the individuals and the goals of the organization. For this reason, Negative Affect is viewed as one of the severe forms of organizational and interpersonal misbehaviors in organizational environments. Of such Negative Affect behaviors, we can mention some passive behaviors like: negligence, intentional inattention and active behaviors such as: overt and covert threat. Negative Affect at workplace lowers the staff’s efficiency and performance in the organization since this phenomenon is associated with job dissatisfaction, anxiety, depression, burnout and reduced job commitment. Of course, being exposed to bullying is viewed as a critical source of stress. On the one hand, one of the outcomes of bullying is psychosomatic complaint originating from psychological processes of human beings. Negative Affect is also characterized as a threating factor to the nurses’ health in hospital settings. The findings of a study revealed that by strengthening resilience and hope, it’s viable to control the consequences of encountering bullying on the psychosomatic health of the nurses. As the conducted studies suggest, various factors such as: lack of understanding among fellows and manager, personality traits, major changes in practice bring about bullying. The research by Johnson et al. (2019) suggested that Negative Affect outbreak is high among nurses and as Negative Affect increases, the quality of care provided by the nurses decreases and client’s safety declines and job burnout increases. Since one of the tasks in this profession is to maximally maintain people’s health, thus the nursing staff have to be equipped with maximum level of health. In particular, due to the nature of the ward, the nursing working in special wards are more exposed to the situations like the patients on the verge of death, emergencies and unpredictable conditions, noisy monitoring equipment and conducting clinical and drug administration processes with advanced and efficient devices. Despite the studies performed about hospital workplace related Negative Affect, nothing as exclusive has been discovered so far dealing with bullying association with special wards’ nurses’ mental health. This gap emphasizes the necessity for further studying. Consequently, the current study has been designed and performed pursuing the goal to outline the relationship between Negative Affect and special wards’ nurses’ mental health in the educational hospitals affiliated with MazandaranUniversity of Medical Sciences.

This study is a descriptive-analytical research done as cross-sectional in 2020. The statistical community is made up of all (ICUs, CCUs and dialysis wards) nurses from five educational hospitals of Mazandaran University of Medical Sciences. The nurses were selected through proportional and simple random methods, which overall resulted in 195 nurses. The data collection consisted of three questionnaires as the demographics, bullying and mental health. A) The demographics questionnaire including age, gender, hospital, marital status, job status and working history. B) Bullying (Negative Affect) questionnaire developed in 2001 and psychometrically assessed in Iran by Salimi et al. (2017). C) General Health Questionnaire (GHQ) was developed in 1972 and psychometrically assessed by Tehrani et al. (2011) in Iran and its reliability was reported as 0.93 using Alpha-Cronbach. The ethical considerations observed in the present research involved not requiring the name to be mentioned in the questionnaires, giving the samples information about the research objectives and the optional participation in the study. Having acquired the permit from Ethics Committee of Mazandaran University of Medical Sciences, the questionnaires were distributed in Google Form in the social networks of the nurses in the study hospitals and after completing and collecting the questionnaires, the obtained data were analyzed using SPSS -21 and descriptive statistics indices (frequency distribution tables, mean and standard deviation) and and correlation coefficient (predicting the random variable in terms of another variable) was analyzed.

The mean and the standard deviation of Negative Affect imposed on the CCU nurses got the max score as 62.53±14.90 and that of the ICU nurses got the min score as 55.68±15.77 and 72.6% of the participants were exposed to moderate rate of bullying. The mean and standard deviation of the mental health of the CCU nurses got the max score as 33.03 ±8.09 and that of the dialysis wards’ nurses got the min score as 29.11±2.61. Regarding the subscales of the General Health Questionnaire, the social area with a frequency of 93% was identified as the most prevalent disorder and depression with a frequency of 1.6% was detected as the least common disorder. According to the study findings, a significant positive correlation was discovered between Negative Affect and its dimensions and mental health and its dimensions (P≤0.00). Besides, in some cases, the correlation between the mental health dimensions and Negative Affect each other was achieved as poor: the correlation coefficient with social area was gained as 0.875 and with depression area as 0.225.

The positive correlation between Negative Affect and mental health indicates that as bullying score increases, the nurses' mental health decreases. Moreover, the findings revealed that the mental health of women and single individuals is more exposed to danger. Since one of the obligations in this profession is to maintain and promote people’s health, then the nursing staff have to be at the maximum level of health so that to be less affected by the consequences of this phenomenon when facing Negative Affect. Therefore, it’s imperative for the medical health system management to develop some programs to lower Negative Affect in nurses’ workplace environment. Regarding the significant relationship existing between Negative Affect and mental health, it can be inferred that by workplace bullying increases , the individuals’ mental health gets impaired .According to the study derived findings about the mental health of women and single individuals, it’s recommended to screen the organizational Negative Affect behavior in the professional health services of the organization, or to develop on-the-job training courses or some courses during their studies at university to increase their mental health and preparedness for Negative Affect behaviors among this group of people so that to be equipped with favorable mental health when encountered with Negative Affect behaviors. Moreover, to determine the proposed approaches’ effectiveness, it’s imperative to develop and conduct an intervention study.  Of the present study limitations, we can report lack of controlling the confounding factors of Covid-19 pandemic effect on nurses’ mental health which results in being cautious about generalizing and interpreting the study findings. Therefore, it’s required to perform extensive studies about Negative Affect and mental health of the nurses in other province located hospitals and also employ other tools such as qualitative approaches like interview in order to boost the accuracy of post-Covid-19 pandemic study findings.

One of the complex and disturbing issues of current societies that have attracted the attention of many sociologists is the issue of youth violence which is becoming more and more widespread. Violence is one of the social harms that have many harmful physical, psychological, and social effects. Violence not only affects the victim but also indirectly harms others in the community. The increase in the rate of violence and the victimization of violent crimes has increased in recent years, so that it has a major impact on the mortality of young people and adolescents in each country. Today, a large number of young people and adolescents carry firearms to save their lives, which indicates the relative insecurity of society. According to statistics recorded by legal centers, conflict and social violence have been on the rise in the country in recent years, and even this violence has peaked in men during the warmer seasons. Violence is a behavior that is observed in all countries and its victims are added every day and cause anxiety and insecurity of people, especially weaker and more vulnerable groups. The prevalence and increase of all kinds of violence in the society, in addition to the victims, also affect and endanger the social security and mental health of the people. Social media has been so influential in the online and offline lives of Internet users in recent years that forms of social communication have also been influenced by these new media. Introduction The topic of virtual social networks has been the main concern of Internet users in the world and in Iran since 2005 and for this reason, they are called the most powerful online media in the world. The multiplicity, variety of content, and numerous software and Internet capabilities are the features that have made the users of these networks very popular. The power to establish a network system between friends and like-minded users regularly is a feature of these networks. Today, it is mainly used to name websites where people can access other members' information, get to know their interests, share text, audio, and video products, and form interest-based groups. They find common ground with some other members of the base. The growing number of social media visitors reflects the many attractions of virtual communities to attract Internet users. One of the factors influencing violence among young people is the use of social networks. Violence is one of the social harms that have many harmful physical, psychological, and social effects, and the role of cyberspace on it is not known; therefore, the present study was conducted with the aim of the role of virtual social networks in reducing violence among adolescents and young people.

This descriptive-analytical study was conducted with a mixed approach. The statistical population of the study was the qualitative section of the experts of the university complex of the province and in the quantitative section, the students of the Islamic Azad University, Central Tehran Branch, and Allameh Tabatabai University. Using Cochran's formula, 384 people were selected as a statistical sample and selected by available random sampling method. The data collection tool was a semi-structured interview and a researcher-made questionnaire whose validity was assessed as content validity by referring to the opinions of 5 experts and professors of technology. Data analysis was performed using LISREL and SPSS20 software.

The results showed that the components of social networks including cultural, social values, communication, and ideological dimensions can be avoided by managing cyberspace policy along with increasing media literacy through integration, identity, civic character development, and student youth adaptation. Provided of violence.

In general, it can be said that social networks are effective in reducing violence among adolescents and young students; therefore, attention and planning for social networks is important in reducing crime and violence. In today's world, human life is interconnected with social networks, interconnected and interconnected communication networks have affected all areas, meanings and concepts, and everything in general. Network communication as the "basis of human communication activity" is transforming all human communication. It makes the world indigenous and the canvas global. The term social media is a subset of social media. Social media is a big concept that has emerged with the advent of new communication networks such as the Internet and mobile phones. Social networks are based on the interests of individuals and groups due to the location of the Internet. In fact, social networks are built on public participation. These social networking sites are increasingly drawing people into the online world by providing motivation and purpose to work in media that was previously unattractive. The main focus of these new media technologies is the simultaneous use of online and digital facilities concerning the audience. In this new relationship, the audience's behavior towards the media also changes and changes from a passive audience to an active audience. This two-way relationship creates a new structure in the new generation of media. In the new generation of media, in addition to the linear presentation, programs also have the property of being selected by the audience. Social networking sites have become a global phenomenon, with communities like Facebook having hundreds of millions of users. By creating friendly environments, these websites have brought the possibility of communication and harmony in social life for their users, but in addition to the advantages that social networks have, they have also created negative consequences and many challenges in people's lives. In other words, today, especially in our society, these networks are becoming a threat; these cases require an expert view to identify these threats and take steps to reduce or eliminate them.

The overall objective of this study was to identify the role of quantum management in Mazandaran University of Medical Sciences in order to present a model. The 21st century coincides with Einstein's theory of relativity, followed by his student Heisenberg, who proposed quantum theory. The message of quantum is that all the components of the universe, the universe, including human beings, are dynamic, conscious, and interconnected beings. Quantum means a moving particle with possible tendencies, and simple one-cause relationships give way to multi-cause and intertwined relationships. The basis of the quantum paradigm is based on complexity, uncertainty and cliché. In fact, the assumptions of traditional management are questionable, because traditional management is assumed to be rational, while the quantum paradigm acknowledges that not only is nothing predictable in the world, but that there is not even enough information to understand the current situation (1). The scientific development of quantum physics and its ability to explain many intangible and complex phenomena led to the use of quantum theory concepts in the form of a new paradigm in management science. This paradigm, while being able to explain many complex organizational concepts, has opened a new perspective on the science of organization and management. The quantum paradigm in management tries to use the rules, concepts and principles of quantum theory in the form of metaphors and guidelines to solve management problems and to describe and explain organizational phenomena (2). Organizations are the cornerstone of today's societies, and management is the most important factor in the life, growth, or death of organizations. A good manager guides the process of moving from the status quo to the desired situation. And at every moment, he is striving for a better future. Therefore, management is the most important issue that should be considered for the cultural, economic, industrial and political growth and excellence of society. In the past, organizational thinking has been profoundly influenced by Newtonian classical thinking. That is, the same traditional management skills that Fayol provided (including planning, organizing, coordinating, controlling, and commanding). These skills were essential to the organizational development of the twentieth century. But in today's fast-paced, complex world, these traditional management skills are useful, but not enough (3).

This research was applied in terms of purpose and descriptive in terms of survey method. The statistical population consisted of all managers and faculty members of Mazandaran University of Medical Sciences in the number of 492 people. According to Cochran's formula, 217 people were selected as a statistical sample by stratified random sampling method based on scientific rank.Researcher-made Quantum Management Questionnaire: This questionnaire has 36 questions and 7 dimensions or main components including quantum seeing, quantum thinking, quantum feeling, quantum cognition, quantum acting, quantum trusting and quantum being, which is in a 5-point Likert scale (very low, low, medium, high and very high Scored). The face and content validity of the instrument was confirmed by experts and specialists and its reliability was calculated using Cronbach's alpha coefficient of 0.81. SPSS25 and AMOS23 software and structural equation testing were used to analyze the data.

The Kaiser-Meyer-Olkin index was 0.863 and the significance level of Bartlett sphericity test was 0.0009 indicating the adequacy of the number of data for exploratory factor analysis. Based on Varimax rotation, seven dimensions: quantum seeing, quantum thinking, quantum feeling, quantum cognition, quantum acting, quantum trust and quantum being were identified. The results of confirmatory factor analysis showed that the quantum feeling dimension with a standard coefficient of 0.80 had the highest impact on explaining quantum skills. Exploratory factor analysis and determining the factor load of variables and quantum management skills items were performed by Varimax rotation method. Except for items 9, 19 and 36 of the questionnaire, whose communalities coefficient is less than 0.50, the rest of the items have a communalities coefficient of more than 0.50. Using second-order factor analysis, we present an explanatory model of each of the key factors of quantum management skills. To determine the effect of each of the variables and their importance coefficients, second-order factor analysis and standard coefficients were used. To evaluate the adequacy of the model, model fit indicators such as: NFI, GFI, CFI and IFI have been used. All of which are in an acceptable and appropriate level and the SRMR index is 0.093.

According to the research results, quantum management plays an essential role in the development of the University of Medical Sciences. It creates a suitable background for the application of this model in the management of the country's educational system. Today, rapid and continuous environmental changes have complexly derailed educational organizations and, consequently, Universities of Medical Sciences. Under such circumstances, managers' ability to plan, organize, direct, and control has become increasingly challenged. Quantum management changes and reverses the view of universities administrators in looking at phenomena from the top down and from the outside in. This is possible by equipping with quantum skills, which include; quantum seeing, quantum thinking, quantum feeling, quantum cognition, quantum acting, quantum trust, and quantum being. In medical sciences universities, due to the complexities of technology and the unstable conditions of the organizational environment, widespread competition, widening gaps, declining quality, globalization of education goals, concerns about preservation of identity, limited resources, etc., maintaining stagnation and preventing change. Management theories are classic, they do not have the desired efficiency. In order to eliminate or reduce inefficiencies, the use of quantum management principles enables managers to look at issues in a consultative rather than traditional way, to think creatively and intuitively, to have active positive emotions, and to be accountable to the organization. And prioritize their community. Trust the working life of staff and faculty. Managers must build a strong communication network between themselves and other people in the organization based on mutual trust and, most importantly, be prepared for any organizational change and create participation and innovation to adapt to the new conditions of the organizational environment.

The one of problem that infertile women face is negative social messages about their bodies. (Your body is not able to reproduce). So, people try to control a part of their body to avoid unpleasant emotions and annoying thoughts. This control is achieved through diet, extreme exercise, surgery, makeup, and avoiding social situations. In commitment-based counseling, control is not the solution but the problem itself. Exactly when a person wants to control something, he is not accepting it. Reality-based counseling also suggests that instead of blaming and criticizing one's body (external control), one accepts and respects one's body and does not seek to change it (internal control). Both counseling methods express the concept of control and try not to do it, so the combination of these two methods can be related to creating a favorable body image in infertile women and have a significant effect on their body image. Body image is the perception or mental belief about the appearance and the body in general. Infertile women with poor body image are more likely to have mental health problems, which can affect all aspects of their lives, and cause them to worry about physical attractiveness, overall self-esteem and general health. They suffer from mental disorders, especially emotional problems. Given the importance of mental health and its role in fertility, researchers suggest that the infertility treatment program be accompanied by psychological therapy. Counseling programs include a wide range of counseling approaches, including commitment-based counseling and reality therapy. Act treatment includes exposure-based exercises, language metaphors, and methods such as mental care. The ultimate goal of this treatment is to increase the abundance of valuable living. The main goal in this treatment is to establish the ability to make practical choices between different choices that are more appropriate. Research has also emphasized the effectiveness of group intervention in acceptance and commitment therapy and its important applications on adaptation, stress, anxiety, depression, resilience and psychosocial well-being. On the other hand, group therapy provides an opportunity for patients to come together in a supportive meeting to deal with the impact that the disease has on them. Studies have shown that some psychological interventions improve the health of infertile women. Common therapies that may affect these individuals include group therapy with acceptance and commitment therapy and group therapy with a reality therapy approach.Research has also been done in this area. Among them are Narimani, Alamdari and Abolghasem,,who studied the effectiveness of acceptance and commitment-based therapy on infertile women's quality of life. Cognitive attachment and flexibility in infertile women, Yaghoubi and Shahabizadeh, who studied the effectiveness of reality therapy training on cognitive emotion regulation strategies of women with experience of infidelity, Rahmanian, Nejad Ali and Oraki. The Effectiveness of Acceptance and Commitment Therapy on Cognitive Regulation of Emotion and Body Image Concern in Women with Overeating, Peterson and Efert , who in their study exposed 217 students to the theory of group therapy selection and counseling, Prinzella,  who in his study examined the interventional effect of reality therapy based on selection theory on PTSD patients, Hoggs, Clark, Klaklo, Dahl and McMillan, who in their research on the effectiveness of commitment-based therapy and acceptance on Examined chronic pain in women. Due to the prevalence and frequency of infertility and chronic infertility, a range of psychological problems for such women in various areas such as body image and resilience. The present study seeks to answer the question of whether the combination of group counseling based on commitment and acceptance with reality therapy is effective on body image and resilience in infertile women?

The present study is a quasi-experimental type of intra-subject - between subject and quarterly follow-up with an experimental group and a control group. According to this plan, the subjects were randomly assigned to an experimental group and a control group and then an experimental operation was performed. First, they were pre-tested and then for the experimental group, a combination of acceptance and commitment group counseling program (ACT) was performed, while the control group did not receive any training. Then, at the end of the training course, post-test was taken from both groups to compare the effect of the combination of acceptance and commitment group therapy (ACT) with reality therapy on the performance of the groups. The statistical population of the present study was all infertile women in Shiraz who had referred to one of the infertility clinics and treatment centers in Shiraz in a period of three months (summer 1398). Among infertile women referred, 30 were selected by convenience sampling. In order to control the effects of demographic, the two groups were matched based on age of 20-45 years. These groups included two experimental groups (combination of act therapy and reality therapy) and a control group. The measuring instruments were Connor and Davidson’s Resilience Questionnaire and Fisher’s Body image questionnaire. The validity of the questionnaires was calculated through face validity and their reliability was calculated using Cronbach's alpha coefficient, whose reliability was 0.89 and 0.86, respectively. Descriptive statistics methods were used to estimate the distribution of participants and research variables and inferential statistics such as analysis of covariance were used to compare the means of the experimental and control groups.

The results showed that the combination of group counseling based on commitment and acceptance with reality therapy is effective on resilience and body image in infertile women.

Due to the fact that infertility causes destructive psychological effects and various social reactions and many psychological problems, adverse social and psychological conditions for infertile women in society are formed. Therefore, using a combination of group counseling based on commitment and acceptance with reality therapy on resilience and body image in infertile women is important.

The outbreak of coronary heart disease in December 2019 in Johann, China, has infected the entire world (4). Corona is also widespread in Iran and endangers the physical and mental health of individuals (5). Recent studies have shown that negative emotions (such as anxiety, depression, and anger) increase during a pandemic, while positive emotions such as happiness and life satisfaction decrease (7). Also, the results of Hagh gadam et al. (2016) research in Iran showed that during the pandemic of this virus, many psychological problems such as anxiety and depression in people with increased and mental health of people have been affected by this disease (8). As mentioned, people's anxiety has increased in this critical period and along with this anxiety, death anxiety has also increased in people (9). Death anxiety is a complex concept that includes the fear of death for oneself and others (10). Anxiety about death is defined as an unusual and great fear of death with a feeling of dread of death or apprehension when thinking about the process of dying or what happens after death (14). Levels of death anxiety in individuals can vary due to individual differences and many social factors (15). Given the prevalence of the coronavirus, another important issue that has been addressed is the quality of life of people in the community. Quality of life is recognized as a component of health and is used to evaluate health care plans and anticipate needs related to social and health care (16-17). One of the factors that can be effective in predicting death anxiety is emotional cognitive regulation strategy. The concept of emotional cognitive regulation refers to the methodology of managing emotionally motivated information (21) and the cognitive part of coping, and emotion regulation through thoughts and cognitions has an inevitable relationship with human life. After experiencing stressful events, people are helped to manage their emotions (22). In a study, they stated that people with social anxiety disorder have less self-efficacy in using cognitive reassessment (27). Also, in another study by Qasempour et al. (2012) there is a significant correlation between cognitive emotion regulation strategies and death anxiety (28). Cognitive emotion regulation strategies also affect quality of life. A study showed that there is a positive and significant relationship between cognitive emotion regulation strategies and quality of life and quality of life can be predicted using cognitive emotion regulation strategies (29). In another study, Rostami et al. (2016) adaptive strategies for emotional regulation have a positive effect on quality of life (30).  There is also a positive relationship between coping strategies with emotion and quality of life (31). identify people prone to psychological disorders at different levels of society in order to maintain the health of these people with appropriate psychological strategies. Therefore, the aim of this study was to investigate the Predicting death anxiety and quality of life based on cognitive emotion regulation strategies in the COVID-19 epidemic.

The research design was correlational. The statistical population included all ordinary people in the city of Babylon. The research sample was 200 ordinary people in Babol who were selected based on the call and by available sampling method. Measurement tools included Cognitive Emotion Regulation Questionnaire (CERQ-P), Templer Death Anxiety Questionnaire and WHO Quality of Life Questionnaire. Data analysis was performed using Pearson torque correlation and multiple regression analysis.

The results of regression analysis showed that positive strategies of cognitive emotion regulation, ie acceptance, positive refocus, refocus on planning, positive reassessment and taking a total view (β = -0.113) can significantly predict death anxiety. Negative cognitive emotion regulation strategies, namely self-blame, rumination, blaming others, and catastrophe combined (β = 0.104) are significantly able to predict death anxiety, and positive cognitive emotion regulation strategies as a whole (β = 0.164) Are able to significantly predict the quality of life and also negative cognitive emotion regulation strategies as a whole (β = 0.281) are able to predict the quality of life.

The results showed that there is a significant negative relationship between positive strategies of emotional cognitive regulation and death anxiety, but there is a significant positive relationship between negative strategies and death anxiety. Here we can refer to the research (39-39). Findings of this study show that positive emotional cognitive regulation strategies are negative and negative emotional cognitive regulation strategies are positively for predicting and explaining anxiety disorders. In fact, people who use negative emotional cognitive regulation strategies are more prone to emotional problems than others. Anxiety is death, and people who use positive emotional cognition are less vulnerable to emotional problems such as anxiety than others. Explaining the effect of cognitive emotion regulation strategies on emotion and anxiety (including death anxiety) Since cognition, emotion, emotion and behavior are completely interacting with each other, cognitive emotion regulation by controlling attention and cognitive consequences of emotion changes cognitive memory function, Decision-making and awareness) and then emotion regulation (28). Explaining this finding, it can be said that positive strategies that are adapted strategies to deal with stressful events improve self-esteem, social competence, etc., in contrast to negative strategies that are not compromised strategies to deal with stressful events cause stress, depression, Other psychological injuries, etc. (41). Another important point is that the use of negative strategies is associated with the lack of proper management of emotions in the face of everyday life events and causes symptoms or developmental disorders such as depression and anxiety. In other words, bias in the interpretation of social environment events leads to erroneous hypotheses about oneself and the social environment, which leads to a negative evaluation of social situations (9). Also, positive strategies have a positive relationship with quality-of-life indicators and negative strategies have a significant negative relationship with quality-of-life indicators, which is consistent with the research of Ramesh et al. (2018) and Craciun (2013) (42, 43). In fact, those with adaptive cognitive emotion regulation strategies are more skilled and turn stressful events into an opportunity to learn rather than see it as a threat to their safety. Eventually, they develop fewer physiological and emotional disorders. Naturally, their lives will be of a better and higher quality (20). In other words, cognitive emotion regulation strategies, which are an important part of life skills, have a more significant role in improving the quality of life (44). In fact, these strategies are a necessity for life (45) which leads to an increase in quality of life (46). If people learn to manage their emotions and negative emotions and experiences properly, use adaptive strategies in regulating their emotions, they will be able to have a good and effective relationship with others, have progress, social support and consequently a higher quality of life. (47). This study, like other studies, had some limitations, including the fact that in this study, due to the conditions in the community, it was not possible to access the samples in person and the questionnaires were collected online, which may lead to more bias. Also, due to the online nature of the questionnaire, people who were not able to use cyberspace were not included in the research, which limited the generalizability of the results. It seems that cognitive emotion regulation strategies can predict death anxiety and quality of life in the COVID-19 epidemic.

One of the most important challenges of today's managers in organizations is the insufficient use of intellectual resources, mental capacity and potential capacities of human resources; In most organizations, the capabilities of employees are not used optimally and managers are not able to use their potential. Certainly, an organization is more successful if it has a capable and committed workforce, because empowerment is one of the newest techniques to increase effectiveness and efficiency by increasing the commitment and organizational citizenship behavior of human resources. However, in general, psychological competence and individual creativity are among the important variables in people's working lives and can play an important role in individual and organizational growth. Researchers believe that these variables are more individual and can be developed through intervention strategies. In this regard, psycho-individual strategies can be one of the effective strategies on the development of psychological ability and creativity of the individual that can provide the field of mental well-being to the field of mastery of job processes. Psychological education generally refers to a set of complementary therapeutic interventions that operate with a systematic, structured and educational approach to the development of mental and psychological aspects. In fact, this method takes steps to create lasting behavioral changes in the target individuals by providing individual and social educational goals. However, in general, considering the job pressures and increasing burnout, as well as psychological problems of employees and reducing innovation and job creativity in organizations, recognizing appropriate strategies for psychological empowerment and individual creativity is noteworthy and important. Therefore, considering the positive effects of psycho-individual mechanisms on various physical and psychological dimensions and research gap in the field of its effects on psychological competence and individual creativity, the aim of this study is to provide therapeutic solutions based on psycho-individual mechanisms on psychological competence and individual creativity.

This research in terms of Purpose is applied and in terms of how to do it is Descriptive correlation type (regression). The statistical population of this research in the qualitative part includes the elites in the field of organizational psychology as well as some selected managers of sports and youth departments. The interview continued until reaching theoretical saturation (10 people). The sampling method was purposeful. The statistical population in a small part includes all the staff of the Ministry of Sports and Youth, of course, except for the service staff who are working in this organization in 1399. The statistical population was equal to 890 people and the number of samples was equal to 500 people, of which 485 questionnaires were returned correctly. In this study, three questionnaires have been used, including a questionnaire of treatment strategies based on psycho-individual mechanisms, researcher-made and based on theoretical foundations and interviews with experts (20 items and four components), Spritzer Psychological Empowerment Questionnaire (1995) (18 items and Five components) and the Creativity Questionnaire Randsip (1979) (30 items).

To evaluate the fit of the structural model of the research, several criteria are used, the first and most basic of which are the coefficients of significance t or t-values. If the value of these numbers exceeds 0.95, it indicates the correctness of the relationship between the variables and thus confirms the research hypotheses at the confidence level of 1.96. Of course, it should be noted that the numbers only show the correctness of the relationship and the intensity of the relationship between the variables can not be measured with it. The value of R2 is zero for exogenous or independent variables. In this section, the value of R2 is equal to a strong value for the two variables of the research model of individual creativity and psychological empowerment. Q2 value: This criterion for both dependent variables of the research model is more than 0.15, which indicates that the exogenous variables (independent) are moderate in predicting the dependent variable and the proper fit of the structural model of the research is somewhat burdensome. Another confirms. General Model Fit (GOF): The general model includes both the measurement and structural model parts, and by confirming its fit, the fit of the model is checked. Considering the three values of 0.01, 0.25 and 0.36, which are introduced as weak, medium and strong values for GOF, in both variables, a value greater than 0.36 was obtained, which indicates a strong overall fit of the model. According to the results of structural equation modeling, the T-value of both relationships in the research model is more than 2.58, so at the level of 0.99, therapeutic strategies based on psycho-individual mechanisms on individual creativity and empowerment it is psychologically influential.

Reason for the effectiveness of psychological interventions is that psychological training disrupts the processing of dysfunctional thoughts and negative biases due to metacognitive monitoring and the person deals with it more consciously, so this leads to changing defective patterns of thinking and training attention control skills. , Increases the preventive aspect of treatment. Psychological training involves maintaining awareness voluntarily and based on attention to specific topics such as bodily emotions from one moment to the next. HoweverWhen the mind is distracted by thoughts, feelings, sounds, and experiences in general, the content of those experiences is memorized and then attention is slowly but surely turned to specific protected goals. This process is repeated many times. In fact, by using psychological techniques such as conscious breathing practice, it can be used again to return to the present. As in the technique of pervasive observation, thoughts are seen only as an object, not necessarily reality itself, and these factors improve coping and regulation of one's emotions. . However, in general, improving the mental and physical condition of individuals through psycho-individual mechanisms by creating favorable physical and psychological conditions for the individual can lead them to focus on career advancement, personal empowerment and increase creativity and innovation. Psycho-individual mechanisms can improve the process of information processing in the mind and provide the conditions for improving cognitive processes such as attention and memory. However, it is suggested that managers and officials of organizations to benefit from the psychological-individual mechanisms of employees. However, some of the limitations of the present study include the corona virus epidemic and difficult access to the statistical population and limited research background.

Some people who have taken on responsibilities in societies are not responsive to the needs and well-being of others and only consider personal gain and loss. According to this, when a person is responsive to the needs and well-being of others, a value can be called responsibility (1). Therefore, cultivating the value of responsibility in societies can be seen in the life and evolution of human beings.When a person can determine and regulate his thoughts, feelings and behavior and is responsible for his choices and their personal and social consequences, we can name the structure of responsibility (1, 2). As it turns out, the key element of accountability is accountability for choices and the consequences of choices, meaning that one is aware that one's choices belong to oneself (1).In order to create responsibility, it is necessary to pay special attention to educational situations and conditions and certain cognitive and social processes that affect its creation. In the following, various researches are pointed out to determine the characteristics and effective situations in the field of responsibility.As we have seen, it can be inferred that the kind of attitude and relationship that parents have with their children can be effective in their responsibility. Family communication in the family environment is considered in the form of family communication patterns. Family communication patterns; It includes two dimensions, dialogue orientation and compliance orientation (11, 12).A review of the research literature has shown that teaching emotion regulation skills may be part of programs to create and increase responsibility. Emotional knowledge helps regulate emotion. With this in mind, individuals need to develop competencies related to this level in order to apply its knowledge in practice. The ability to regulate emotion helps maintain mood and strategies to improve mood (17). On the other hand, emotion regulation plays an important role in the continuity and health of social relationships (18).

The statistical population of the present study included high school students in Shiraz who were studying in 2010-2011. The sample size includes 352 (163 boys and 189 girls). Participants were selected using a multi-stage random cluster method.In order to collect information about the research variables, three tools of Family Communication Patterns Questionnaire of Koerner & Fitzpatrick(2002) (12), Emotion Regulation Questionnaire of Gross and John (2003) (23) and Accountability Questionnaire of Soroush (1390) (24) were used.

As it turned out, dialogue through cognitive reassessment has a significant effect on responsibility (β = 0.16, p = 0.02). In addition, it was found that compliance with cognitive reassessment has a significant effect on responsibility (β = 0.05, p = 0.006). Also, The direct and indirect path of dialogue (mediated by cognitive reassessment) to responsibility and the indirect path of conformity (mediated by cognitive reassessment) to responsibility became significant. Also, it has been found that the coefficient of determining responsibility (R2 = 0.46) is higher than cognitive reassessment (R2 = 0.13) and repression (R2 = 0.07). Eventually, the indicators before modifying the model showed that the model did not have a good fit at first. After making corrections and removing the proposed non-significant paths from the model, the model fits.

In the direction of dialogue, the person in his family is able to express his opinions, listen to the arguments of family members and make appropriate arguments himself, using various skills to pursue these topics such as problem solving, effective communication, Gain control of emotions and manage them; Because the individual influences important family decisions and gains the necessary independence. Koerner and Fitzpatrick (2002) also believe that when a person is engaged in dialogue in his family environment, they are able to get acquainted with different opinions according to the arguments that are raised in the family environment in the field of various issues. Also, when there is a warm and friendly atmosphere in the family; One is able to use adaptive strategies to regulate one's emotions and is able to learn a variety of cognitive skills (12). Therefore, one can learn the strategy of cognitive reassessment following this communication style in the family and use it in other situations and situations. When a person uses this strategy in different situations and situations, he believes that his thoughts, emotions and behaviors are under his control and he can look at events from different aspects and perceive them. (23). This confirms that external situations do not affect a person, but it is his thoughts that create behavioral and emotional consequences, in other words, his choices and choices that cause different consequences. . This improves a person's responsibility to others and to himself. Because its main pillar, ie free choice, has taken place (3). Compliance orientation can also pave the way for cognitive reassessment and ultimately increase accountability. It should be noted that according to the results, the calculated indirect effect is very low. However, this effect was calculated to be significant. In the explanation, we need to pay attention to the features of compliance; In the direction of conformity, the person experiences high similarity of attitudes, values and beliefs; It tries to avoid conflicts and debates and to experience mutual dependence with the family. In this orientation, family cohesion is very high and the family has a hierarchy and emphasis is placed on relationships within the family and family interests are of paramount importance (12). All of this emphasizes the need to match one's views with others and emphasizes the interests and values of the family, and therefore, is able to provide a basis for understanding phenomena and events from different perspectives, and one can Use a cognitive reassessment strategy. Finally, the present study found that both dialogue orientation and conformity can increase personal and social responsibility through cognitive reassessment or correct emotion regulation strategies. This means that cognitive reassessment grows in the family components of dialogue and conformity, and this increases responsibility. In high-dialogue families, the arguments that take place lead to the use of positive and adaptive strategies, and also, in harmonious families, because individuals have to control their emotions in order to be consistent. And accept the opinions of others leads to the use of cognitive reassessment strategy because the person in that environment tries to view the phenomenon from a different perspective, and this is possible through cognitive reassessment. This is how responsibility increases.