فهرست مطالب

مجله علوم پزشکی رازی
سال بیست و نهم شماره 4 (پیاپی 218، تیر 1401)

  • تاریخ انتشار: 1401/06/27
  • تعداد عناوین: 19
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  • سمیرا علی حسینی، علی اکبر حق دوست، لیلا قالیچی*، سلیمه گوهری نژاد، بیتا مهروی، امید براتی، بابک عشرتی، طیبه نجفی مقدم، علی کبیر، فرشته عاضدی، مرتضی ناصربخت، جلیل کوهپایه زاده صفحات 1-9
    زمینه و هدف

    دانشگاه های علوم پزشکی کشور به عنوان مراکزی برای تفکر و نوآوری متولی تامین، حفظ و ارتقای سلامت جمعیت تحت پوشش خود و سایر نقاط کشور هستند. مدیران دانشگاه با شناسایی مشکلات و چالش ها و با تکیه بر ابزارهای توسعه خلاقیت و حل مساله و حرکت به سمت دانشگاه های نسل سوم می تواند اهداف دانشگاه را محقق کنند.

    روش کار

    این مطالعه یک پژوهش کاربردی است که به روش کیفی در سه مرحله به احصاء و دسته بندی چالش های عملکردی مراکز و واحدهای تحت پوشش دانشگاه علوم پزشکی ایران پرداخته است. جامعه مورد بررسی در این پژوهش را خبرگان، مدیران و کارشناسان مراکز مختلف دانشگاه تشکیل دادند. تحلیل داده ها به روش تحلیل محتوایی انجام شد.

    یافته ها

    مجموع 215 مساله جمع آوری شده در 3 محور کلی مدیریت مبتنی بر شواهد، وجود بروکراسی سنگین و فرهنگ سازمانی تقسیم بندی شد. پرتکرارترین مشکلات در حوزه مدیریت مبتنی بر شواهد ذکر شد و نقص در شایسته سالاری سرفصلی بود که در هر سه محور مورد توجه قرار گرفته بود. فقدان برنامه پایش و ارزشیابی موثر، نبود چارچوب مدون برای استفاده از نتایج پایش و ارزشیابی موجود، کمی گرایی، نبود سیستم تنبیهی و تشویقی کارآمد، ایرادات قانونی، مدیریتی، تشکیلاتی و فرایندی، مشکلات آموزش، ارتباطات، انگیزش، عملکرد و نگرش نیروی انسانی و ضعف در تعلق سازمانی پرسنل از سایر موارد مهم مورد اشاره بود.

    نتیجه گیری

     به نظر می رسد که مهم ترین مشکلات دانشگاه از منظر کارکنان به صورت مجموعه به هم مرتبطی از محدودیت های بوروکراتیک، تصمیم گیری های فاقد پشتوانه و تاثیرات سوء و متقابل این دو و مشکلات مربوط به  فرهنگ سازمانی نمود می یابد و هر نوع تغییری برای رفع این مشکلات باید با در نظر گرفتن اثرات احتمالی آن بر سایر عوامل ذکر شده انجام شود.

    کلیدواژگان: بروکراسی، عملکرد، فرهنگ سازمانی، مدیریت مبتنی بر شواهد
  • زهرا مصلحی، یاسین حسینی*، نادر فرهپور صفحات 10-19
    زمینه و هدف

    تغییر مسیر ناگهانی هنگام دویدن در بسیاری از ورزش ها اجتناب ناپذیر است. نقص عملکرد سیستم عصبی-عضلانی در تامین ثبات مفصل در این گونه مانور های حرکتی می تواند منجر به آسیب رباط متقاطع قدامی زانو گردد. هنوز تاثیر متقابل بین آسیب رباط های زانو و ضعف عملکرد عضلات آن بخوبی تبیین نشده است. هدف این پژوهش بررسی زمانبندی فعالیت عضلات اندام تحتانی در افرادی با سابقه بازسازی رباط متقاطع قدامی در مقایسه با افراد سالم حین حرکت برشی جانبی بود.

    روش کار

    تعداد 10 مرد سالم به عنوان گروه کنترل و 10 مرد با سابقه ی جراحی رباط متقاطع قدامی به عنوان گروه تجربی از بین فوتبالیست هایی که حداقل 3 سال سابقه داشتند مورد مطالعه قرار گرفتند. فعالیت الکترومایوگرافی عضلات درشت نی قدامی، دوقلوی داخلی، دوقلوی خارجی، پهن داخلی، پهن خارجی، نیم وتری و دوسررانی با دستگاه بی تی اس فری ای ام جی 300  هنگام حرکت برشی جانبی ثبت گردید. جهت تحلیل آماری از آزمون آنالیز واریانس چند متغیره با سطح معنی داری   05/0˂p استفاده شد.

    یافته ها

     شروع فعالیت عضلات درشت نی قدامی، دوقلوی داخلی و خارجی در گروه تجربی زودتر از گروه کنترل بود؛ (05/0≥p). همچنین زمان رسیدن به اوج فعالیت عضلات درشت نی قدامی و دوقلوی داخلی در گروه تجربی زودتر از گروه سالم بود (05/0≥p).

    نتیجه‏گیری

    بازسازی رباط متقاطع قدامی با تغییراتی در عملکرد عضلات اندام تحتانی از نظر زمان شروع به فعالیت همراه است. توجه به تغییر در عملکرد عضلات، به مربیان ورزشی و فیزایوتراپیست ها جهت ارایه برنامه توانبخشی مناسب برای افرادی با جراحی رباط متقاطع قدامی کمک بسزایی خواهد کرد.

    کلیدواژگان: حرکت برشی جانبی، رباط متقاطع قدامی، الکترومایوگرافی
  • علی اکبر بابازاده پهلوانلو، محمدعلی اصلانخانی*، علی محمد صفانیا، علی اصغر درودیان، مهدی گودرزی گودرزی صفحات 20-30
    زمینه و هدف

    یکی از ارکان اصلی آموزش رشته های ورزشی و نیز رهبری و هدایت تیم اند و نقش بسیار مهمی در آموزش، پرورش و رشد ورزشکاران دارند. هدف از انجام تحقیق حاضر شناسایی و اولویت بندی عوامل موثر بر توسعه دانش، سلامت روان و مهارت های کاربردی مربیان بود.

    روش کار

    جامعه آماری این تحقیق استراتژی آمیخته را در بخش کیفی خبرگان ورزشی و مربیگری ورزشی و در بخش کمی 508 نفر از مربیان رشته های ورزشی المپیکی و دارای مدارک بین المللی تشکیل دادند. حجم نمونه در بخش کیفی با توجه به اشباع نظری و در بخش کمی بر اساس نرم افزار SPSS Sample Power تعداد 306 نفر بود. از پرسشنامه محقق ساخته که به روش دلفی فازی آماده شد برای جمع آوری اطلاعات استفاده شد. روایی صوری، محتوایی و سازه پرسشنامه به ترتیب توسط متخصصین مربوطه در بخش کیفی، تحلیل عاملی و معادلات ساختاری به تایید رسید. همچنین پایایی پرسشنامه با استفاده از آزمون آلفای کرونباخ در تمامی مولفه ها بیش از 70/0 محاسبه گردید.

    یافته ها

     نتایج نشان داد که 11 عامل موثر بر توسعه دانش، سلامت روان و مهارت های کاربردی برای سطوح مربیگری در ایران شامل آموزش، مدیریتی، دانش افزایی، عوامل ساختاری، نظارت و کنترل، تجهیزات و تکنولوژی، عوامل حقوقی، عوامل فردی، بومی سازی، تبلیغات و رسانه و استعدایابی و پایه می باشد.

    نتیجه گیری

    عوامل متععدی بر توسعه دانش، سلامت روان و مهارت های کاربردی مربیان تاثیر دارد. نتایج مصاحبه با خبرگان می تواند در شناسایی و اولویت بندی این عوامل راهگشا باشد.

    کلیدواژگان: مربیان، سلامت روان، توانمندی، توسعه دانش، مهارت کاربردی
  • مژگان احمدی، نسیبه کاظمی* صفحات 31-48
    زمینه و هدف

    موفقیت بارداری به کنترل فرآیندهای متابولیک و تعادل بین سایتوکاین های التهابی و ضد التهابی وابسته است. رژیم غذایی و ورزش اولین گزینه برای پیشگیری و درمان دیابت بارداری است. هدف از پژوهش حاضر، مروری بر روی مطالعات انجام شده جهت بررسی تاثیر فعالیت های ورزشی بر پاسخ های متابولیک و عوامل التهابی و ضدالتهابی در زنان مبتلا به دیابت بارداری (GDM) می باشد.

    روش کار

    مطالعات مربوط به پاسخ فاکتورهای متابولیک، عوامل التهابی و ضدالتهابی به فعالیت های ورزشی در دیابت بارداری در مقالات منتشر شده را در Springer، Hindawi، PubMed، Google Scholar، Scopus، SID وISC  با استفاده از کلید واژه های ورزش، شاخص های متابولیک (گلوکز، انسولین، هموگلوبین گلیکوزیله و حساسیت انسولین)، عوامل التهابی (اینترلوکین-1 بتا، فاکتور نکروز دهنده تومور (TNF-α)، اینترلوکین-6 (IL-6) و پروتیین واکنشی C (CRP) و عوامل ضدالتهابی (اینترلوکین-10 (IL-10) جستجو کردیم. 20 مطالعه پاسخ متابولیک و عوامل التهابی-ضدالتهابی به ورزش در زنان مبتلا به GDM مورد بررسی قرار گرفت.

    یافته ها

    در مطالعات مربوط به فاکتورهای متابولیک، مزایای تمرین جهت بهبود کنترل قند خون، بهینه سازی غلظت گلوکز ناشتا و انسولین، کاهش سطح هموگلوبین گلیکوزیله و بهبود حساسیت انسولین در زنان باردار مبتلا به GDM مشاهده شد. همچنین کاهش سطح شاخص های التهابی در زنان باردار مبتلا به GDM گزارش شده است.

    نتیجه گیری

    به نظر می رسد مشارکت منظم در فعالیت های ورزشی می تواند باعث بهبود شرایط متابولیک و کاهش التهاب در زنان باردار مبتلا به GDM شود. با این حال مطالعات بیشتری با بررسی اثر فعالیت های ورزشی به ویژه بر عوامل التهابی و ضدالتهابی در زنان مبتلا به GDM  مورد نیاز است.

    کلیدواژگان: دیابت بارداری، فعالیت ورزشی، حساسیت انسولین، التهاب
  • سیروس زینلی، احمد ترک فر*، لیلا جمشیدیان، سید محمدعلی میرحسینی صفحات 49-57
    زمینه و هدف

    یکی از مشکلات موجود در میان دانش آموزان ورزشکار، عدم سازگاری آنان با محیط های ورزشی است. هدف از انجام تحقیق حاضر بررسی عوامل موثر بر بهبود سازگاری اجتماعی-روانی دانش آموزان در محیط های ورزشی در دوران پساکرونا بود.

    روش کار

    پژوهش حاضر از نظر روش گردآوری داده ها آمیخته بود که به صورت کیفی-کمی انجام شد. جامعه آماری پژوهش حاضر در بخش کیفی شامل افراد آگاه به موضوع پژوهش و در بخش کمی شامل تمامی دانش آموزان ورزشکار پسر دبیرستان های شهر شیراز بود. ابزار پژوهش شامل مصاحبه های نیمه ساختارمند و پرسشنامه محقق ساخته تشکیل شده از خروجی بخش کیفی بود. این پرسشنامه دارای 28 سوال بود که روایی محتوایی، روایی سوری و پایایی مورد تایید قرار گرفت. جهت تجزیه و تحلیل داده ها از کدگذاری باز، محوری و انتخابی در بخش کیفی و از آزمون آماری معادلات ساختاری در بخش کمی استفاده شد.

    یافته ها

    نتایج نشان داد که عوامل شناسایی شده در قالب 5 دسته عوامل انگیزشی، فرهنگی، اقتصادی، فردی و بهداشتی-محیطی دسته بندی شدند. همچنین مشخص شد که در میان عوامل شناسایی شده، عوامل انگیزشی بیشترین تاثیر را بر بهبود سازگاری اجتماعی دانش آموزان در محیط های ورزشی در دوران پساکرونا دارند.

    نتیجه گیری

    نتایج نشان دهنده تاثیر کرونا بر شرایط روحی دانش آموزان بوده و به نظر می رسد انگیزه آن ها را بیشتر تحت تاثیر قرار می دهد که به برنامه ریزی منظم جهت کاهش آثار منفی کرونا نیاز است.

    کلیدواژگان: کرونا، سازگاری اجتماعی-روانی، ورزش
  • سینا فلاحتی، مینا حکاک زاده*، محمد پوررنجبر صفحات 58-66
    زمینه و هدف

    اهمیت مشارکت در فعالیت های ورزشی در اوقات فراغت باعث شده است تا تمامی ابعاد مربوط به این مساله از جمله چالش های سلامت روانشناختی مورد بررسی و مطالعه قرار گیرد. تحقیق حاضر با هدف تحلیل چالش های سلامت روانشناختی افراد برای مشارکت در فعالیت های ورزشی در اوقات فراغت طراحی و اجرا گردید.

    روش کار

    روش تحقیق حاضر آمیخته می باشد. جامعه آماری تحقیق در بخش کیفی شامل متخصصان مدیریت ورزشی، مجریان و مدیران بخش های فرهنگی ورزشی، مدیران سازمان های ورزشی، متخصصان جامعه شناسی آشنا با حوزه ورزشدر ورزش (11= تعداد) می باشد. در بخش کمی، جامعه آماری تحقیق متشکل از افراد جوان در سراسر شهر تهران که از فعالیت های ورزشی در گذراندن اوقات فراغت به فعالیت های ورزشی می پردازند در نظر گرفته شد با توجه به نامحدود بودن تعداد آن ها در سراسر شهر تهران و با استفاده از جدول مورگان 384 نفر در نظر گرفته شد. کلیه روند تجزیه و تحلیل داده های تحقیق حاضر در نرم افزارهای SPSS و AMOS انجام شد.

    یافته ها

     نتایج کیفی تحقیق نشان داد که چالش های سلامت روانشناختی افراد برای مشارکت در فعالیت های ورزشی در اوقات فراغت شامل 23 مورد بود. به صورت کلی چالش های سلامت روانشناختی افراد برای مشارکت در فعالیت های ورزشی در اوقات فراغت در سه دسته چالش فردی، چالش ذهنی و چالش محیطی مشخص گردید.

    نتیجه گیری

     توجه به چالش های شناسایی شده شامل چالش فردی، چالش ذهنی و چالش محیطی و کنترل این چالش ها می تواند زمینه جهت بهبود وضعیت مشارکت افراد جهت حضور در فعالیت های ورزشی در اوقات فراغت را فراهم نماید.

    کلیدواژگان: سلامت روان شناختی، اوقات فراغت، ورزش
  • محسن کرمی، بهرام یوسفی*، سعید صادقی بروجردی صفحات 67-75
    زمینه و هدف

    مفاهیم حمایت سازمانی، سرمایه های روان شناختی و تاثیر آن بر ارتقای سلامتی کارکنان از اهمیت قابل توجهی برخوردار است، لذا هدف از انجام پژوهش بررسی اثر حمایت سازمانی و سرمایه های روان شناختی بر ارتقای سلامتی کارکنان در ادارات ورزش و جوانان غرب کشور بود.

    روش کار

    این تحقیق از نوع توصیفی - همبستگی بود. جامعه آماری تحقیق را کلیه کارکنان ادارات تربیت بدنی استان های غرب کشور تشکیل می داد (390 نفر)، داده ها از نمونه گیری کل شمار جمع آوری شد؛ که پس از توزیع و جمع آوری پرسشنامه ها، 350 پرسشنامه مورد تحلیل قرار گرفت. جهت جمع آوری داده ها از پرسشنامه سلامت عمومی گلدبرگ و هیلر (1970)، پرسشنامه حمایت سازمانی ادراک شده آیزنبرگر و همکاران (1986) و پرسشنامه سرمایه روان شناختی لوتانز (2007) استفاده گردید که روایی پرسشنامه ها با استفاده از AVE (میانگین واریانس استخراج شده) و پایایی آن ها به شیوه ترکیبی با PLS مورد تایید قرار گرفت.

    یافته ها

     یافته ها اثر مستقیم مثبت و معنادار در مولفه های سرمایه های روان شناختی و ابعاد آن و حمایت سازمانی ادراک شده با ارتقای سلامت کارکنان را نشان داد. همچنین نتایج تحلیل رگرسیون نشان داد که سرمایه های روان شناختی و حمایت سازمانی ادراک شده، قادر به پیش بینی توان انجام کار، می باشند.

    نتیجه گیری

     به طور کلی ارتقای سلامت کارکنان اهمیت زیادی برای سازمان ها دارد و بر اساس نتایج به دست آمده، افزایش حمایت سازمانی و سرمایه روانشناختی می تواند زمینه ارتقاء سطح سلامتی را در کارکنان فراهم آورد و لذا مدیران و مسیولین سازمان ها می بایست در این زمینه برنامه ریزی نمایند.

    کلیدواژگان: ارتقای سلامتی کارکنان، حمایت سازمانی، سرمایه روان شناختی
  • بابک اصغری، علی فهیمی نژاد*، باقر مرسل، حیدر لطفی صفحات 76-90
    زمینه و هدف

    هر چند امواج صوتی به عنوان یک عامل ضروری در زندگی انسان محسوب می شوند، اما در بعضی شرایط خاص، قرار گرفتن بیش از حدمجاز در معرض صداهای آزار دهنده، سبب افت شنوایی در انسان خواهد شد. لذا، سنجش آلودگی صوتی در حفظ سلامت افراد نقش بسزایی دارد.

    روش کار

    هدف تحقیق، سنجش آلودگی صوتی در استخرهای سرپوشیده با تاکید بر سلامت پرسنل و کاربران استخرهای سرپوشیده شهر مشهد بود. تراز صوتی به صورت تراز معادل توسط دستگاه پرتابل و نرم افزار Decibel X نسخه 2020 اندازه گیری و با استاندارد صوتی (OSHA-90 dBA) مورد مقایسه قرار گرفت. اندازه گیری ها در 3 نوبت به محاسبه پارامترهای تراز فشار صوت (SPL)، میانگین تراز صوتی (LP)، تراز پیوسته معادل صدا (Leq) و دز روزانه فردی LAEp,d پرداخت.

    یافته ها

     کمترین تراز فشار صوت در نوبت اول برابر 5/76 دسی بل و بیشترین تراز فشار در نوبت دوم برابر با 7/97 دسی بل بود. میانگین تراز فشار صوت متناسب با تغییر ساعت از صبح (11 صبح) به سمت شب (8 عصر) افزایش می یابد. میانگین تراز صوت در استخرهای سرپوشیده برابر با dB 4/78 و تراز معادل 42/85 و دز روزانه فردی LEp,d پرسنل و کاربران به ترتیب برابر 45/92 و 15/87 دسی بل است. مدت زمان مجاز مواجهه با صدا برای کاربران 1ساعت و 30دقیقه و برای پرسنل 5 ساعت برآورد شدکه نشان می دهد کاربران 30دقیقه و پرسنل 3 ساعت بیشتر از حد مجاز در معرض آلودگی صوتی هستند.

    نتیجه گیری

    در استخرهای سرپوشیده شهر مشهد، پرسنل و کاربران در معرض آلودگی صوتی بالایی قرار دارند و احتمال آسیب های جسمی و روانی زیاد است. تراز های صوتی موجود، از استانداردهای جهانی و ملی بالاتر بوده و حاکی از آن است که بهره گرفتن از اصول مدیریت مهندسی برای کاهش تراز صوت در استخرهای سرپوشیده الزامی است.

    کلیدواژگان: آلودگی صدا، تراز معادل صوت، سلامت ورزشکاران، استخرهای سرپوشیده، شهر مشهد
  • مژگان غیاثوندیان، مریم اکبری*، محمود گودرزی، امید مرادی صفحات 91-101
    زمینه و هدف

    به نظر می رسد درمان مبتنی بر پذیرش و عمل می تواند بر مادران کودکان استثنایی کمک کند، لذا هدف از این پژوهش، بررسی اثربخشی رویکرد پذیرش و عمل بر اساس طرح واره های ناسازگار اولیه با نقش واسطه ای دشواری های تنظیم هیجان بر ارتقاء کیفیت زندگی مادران کودکان استثنایی بود.

    روش کار

    پژوهش به روش همبستگی- مدل یابی انجام شد. جامعه آماری شامل کلیه مادران دارای کودکان کم توان ذهنی و کم توان جسمی شهر کرمانشاه می باشد، 30 نغر نمونه به شیوه ی هدفمند انتخاب شده و به طور تصادفی به دو گروه تقسیم شدند. مداخلات درمان مبتنی بر پذیرش و عمل روی گروه آزمایش دریکی از مدارس کودکان استثنایی فرایند هفته ای دو بار در جلسات 90 دقیقه ای طی هشت جلسه برگزار شد. ایزار جمع آوری اطلاعات شامل پرسشنامه کیفیت زندگی ویر و همکاران (1996)، پرسشنامه دشواری در تنظیم هیجانیگرتز و رویمر (2004)، مقیاس طرح واره های ناسازگار یانگ (2005) و پرسشنامه پذیرش و عمل بوند و همکاران (2017) بود.

    یافته ها

      نتایج به دست آمده حاکی از آن است که قطع ارتباط و طرد، خودگردانی مختل، جهت مندی، گوش بزنگی، محدودیت مختل بر دشواری تنظیم هیجان تاثیر مثبت و معناداری دارد؛ قطع ارتباط و طرد و خودگردانی مختل، جهت مندی و گوش بزنگی بر عمل و پذیرش تاثیر مثبت و معناداری دارد. برنامه آموزش مبتنی بر مدل علی عمل و پذیرش بر کیفیت زندگی مادران دارای کودکان استثنایی موثر بوده است.

    نتیجه گیری

    نتایج این پژوهش می تواند در راسنای بهبود حالات خلقی و روانشناختی و ارتقاء کیفیت زندگی مادران کودکان استثنایی مورد استفاده و بهره برداری قرار گیرد.

    کلیدواژگان: مدل علی پذیرش و عمل، دشواری های تنظیم هیجان، کیفیت زندگی
  • ساناز بهارستانی، ناصر امینی*، مولود کیخسروانی، شهدخت آزادی، کامران میرزایی صفحات 102-112
    زمینه و هدف

    پرداختن به موضوع تعارض زناشویی به منظور دست یافتن به راهبردهای پیشگیری، یکی از مهمترین ضروریات آموزش خانواده است. لذا هدف از پژوهش حاضر، بررسی اثربخشی آموزش غنی سازی رابطه جنسی بر باورهای روابط زناشویی، ابرازگری و کنش وری جنسی در زنان دارای تعارضات زناشویی بود.

    روش کار

    در این پژوهش نیمه آزمایشی تعداد 50 نفر از زنان دارای تعارضات زناشویی به روش نمونه گیری هدفمند انتخاب و به صورت تصادفی در دو گروه آزمایش و کنترل تقسیم شدند. برای گروه آزمایش 8 جلسه 90 دقیقه ای به مدت 4 هفته برگزار شد و گروه گواه در این مدت هیچ مداخله ای دریافت نکردند. شرکت کننده ها توسط پرسشنامه های تعارضات زناشویی براتی و ثنایی (1375)، باورهای ارتباطی  ایدلسون و اپستین (1982)، شاخص احقاق جنسی هالبرت (1992) و شاخص عملکرد جنسی زنان روزن و همکاران (2000) سنجیده شدند.

    یافته ها

    نتایج نشان داد که نمرات باورهای روابط زناشویی درمیان افراد گروه آزمایش، کاهش معناداری پیدا کرده است ولی در گروه گواه این کاهش معنادار وجود نداشته است و نمرات ابرازگری و کنش وری جنسی درمیان افراد گروه آزمایش، افزایش معناداری پیدا کرد ولی در گروه گواه این افزایش معنادار وجود نداشت؛ در نتیجه تفاوت معناداری بین دو گروه آزمایش و گواه وجود دارد. همچنین نتایج پیگیری نیز نشان داد که اثر مداخله آموزشی همچنان پایدار بود.

    نتیجه گیری

     بر اساس شواهد پژوهش حاضر می توان از این برنامه آموزشی جهت بهبود باورهای روابط زناشویی و ابرازگری و کنش وری جنسی زنان دارای تعارضات زناشویی استفاده کرد.

    کلیدواژگان: آموزش غنی سازی رابطه جنسی، باورهای روابط زناشویی، ابرازگری جنسی، کنش وری جنسی، تعارضات زناشویی
  • فریده غلامی، حسین بقولی*، مجید برزگر، مریم کوروش نیا صفحات 113-124
    زمینه و هدف

    بیماران مبتلا به اختلال شخصیت مرزی با یک ناهمگونی بالینی در رابطه با شدت بیماری و ویژگی های خاص، مانند خشم و افسردگی شناخته می شوند. هدف از انجام تحقیق حاضر تبیین نقش خود شیفتگی آسیب پذیر و خودشیفتگی بزرگ منشانه در اختلال شخصیت مرزی بود.

    روش کار

    برای انجام پژوهش توصیفی حاضر که با روش مدل یابی معادلات ساختاری و تحلیل عامل تاییدی  انجام شد، 102 زن و 58 مرد مراجعه کننده به کلینیک های روان پزشکی و روانشناسی در شهر شیراز به صورت در دسترس به عنوان نمونه انتخاب شده و پرسشنامه های خودشیفتگی مرضی پینکاس و اختلال شخصیت مرزی لیشنرینگ را تکمیل کردند.

    یافته ها

    نتایج نشان داد متغیر خودشیفتگی آسیب پذیر بر ترس از صمیمیت (37/0)، واقعیت آزمایی آسیب دیده (55/0)، مکانیزم های دفاعی اولیه (62/0) و آشفتگی هویتی (69/0) تاثیر مثبت و معناداری دارد.  همچنین مشخص شد بین خودشیفتگی بزرگ منشانه با ترس از صمیمیت (71/0)، واقعیت آزمایی آسیب دیده (64/0)، مکانیزم های دفاعی اولیه (38/0) و آشفتگی هویتی (26/0) تاثیر مثبت و معنادار دارد.

    نتیجه گیری

    با توجه به نتایج تحقیق پیشنهاد می شود مسیولین و متخصصین به متغیرهای خودشیفتگی آسیب پذیر و خودشیفتگی بزرگ منشانه توجه ویژه ای داشته باشند.

    کلیدواژگان: اختلال شخصیت مرزی، خود شیفتگی بزرگمنشانه، خودشیفتگی آسیب پذیر
  • فاطمه قنبری، قاسم نظیری*، بنفشه امیدوار صفحات 125-134
    زمینه و هدف

    اختلال کم توجهی/ بیش فعالی (ADHD) یکی از اختلالات عصبی رشدی است که با اختلال قابل توجهی در حوزه های رشدی، شناختی، هیجانی و تحصیلی همراه است. هدف از انجام تحقیق حاضر اثربخشی درمان مبتنی بر ذهنی سازی  بر همدلی کودکان مبتلا به اختلال کم توجهی/ بیش فعالی بود.

    روش کار

    برای انجام تحقیق کاربردی و نیمه آزمایشی حاضر از بین کودکان مبتلا به اختلال کم توجهی/ بیش فعالی (6 تا 12 سال) شهر شیراز به صورت هدفمند 30 پسر و 30 دختر به عنوان نمونه انتخاب شده و پس از انجام پیش آزمون ها اعم از مصاحبه نیمه ساختاریافته K-SADS-PL، تکمیل پرسشنامه همدلی بهر-تحلیل بهر (EQ-SQ) و فرم رضایت آگاهانه، به صورت تصادفی به 3 گروه درمان مبتنی بر ذهنی سازی، درمان دارویی با متیل فنیدیت، درمان ترکیبی تقسیم شدند. سپس آزمودنی های هر گروه 36 جلسه مداخله مربوط به خود را دریافت کرده و پس از خاتمه درمان و مجددا سه ماه پس از درمان به منظور پیگیری پرسشنامه ها تکمیل شدند.

    یافته ها

      نتایج نشان داد درمان مبتنی بر ذهنی سازی بر همدلی کودکان مبتلا به ADHD اثربخشی معناداری (001/0>P، 31/13=F) داشت و درمان ترکیبی و MBT-C در مقایسه با دارو درمانی اثربخشی پایدارتری بر همدلی این کودکان داشت.  

    نتیجه گیری

    نتایج تایید کننده تاثیر درمان مبتنی بر ذهنی سازی و درمان ترکیبی بر سطح همدلی کودکان مبتلا به ADHD می باشد. اما درمان ترکیبی با تمرکز بر تعامل دنیای درونی و بیرونی و تنظیم عواطف و روابط بین فردی می تواند مداخله ای اثربخش تری برای بهبود ظرفیت همدلی در کودکان مبتلا به ADHD  باشد.

    کلیدواژگان: درمان مبتنی بر ذهنی سازی، اختلال کم توجهی، بیش فعالی، همدلی
  • محراب مفاخری*، کامیار منصوری، علی صالحی، محسن اکبریان، نرگس سعیدی صفحات 135-149
    زمینه و هدف

    با توجه به اهمیت تروما و شیوع بالایی آن در بیماران درد مزمن ساخت ابزاری مناسب  برای غربالگری تجربه ی ترما در میان بیماران درد مزمن امری اساسی و ضروری به نظر می رسید. بنابراین هدف پژوهش حاضر تعیین ویژگی های روانسنجی چک لیست وقایع زندگی در نمونه ی بیماران درد مزمن ایرانی بود.

    روش کار

    در این مطالعه 309 نفر زن و مرد از بیماران درد مزمن شهر تهران که 18 سال به بالا و توانایی درک زبان فارسی داشتند به روش نمونه گیری در دسترس مورد بررسی قرار گرفتند. برای بررسی روایی همگرا از پرسشنامه ی 21-DASS و فاجعه آفرینی و برای بررسی روایی واگرا از پرسشنامه ی خودکارآمدی درد مزمن و مقیاس رضایت از زندگی استفاده شد. همچنین برای تعیین پایایی از روش همسانی درونی به شیوه ی آلفای کرونباخ و برای تعیین روایی سازه از تحلیل عاملی تاییدی به کمک نرم افزار لیزرل نسخه ی  8/ 8 و تحلیل عامل اکتشافی استفاده شد.

    یافته ها

    ضریب آلفای کرونباخ برای نمره کل مقیاس 86/0 درصد بدست آمده و همچنین نمره بازآزمایی آن در نمونه ی 40 نفره به فاصله ی 3 هفته برابر با 85/0 دردصد بود. چک لیست وقایع زندگی همبستگی مثبت و معنی داری با پرسشنامه ی DASS-21 و پرسشنامه ی فاجعه آفرینی درد مزمن نشان داد و همبستگی منفی و معناداری با پرسشنامه ی خودکارآمدی درد مزمن و رضایت از زندگی داشت. همچنین نتایج تحلیل عاملی اکتشافی چهار عامل را شناسایی کرد و تحلیل عامل تاییدی نشان داد ساختار چهار عاملی از برازش مناسبی برخوردار است.

    نتیجه گیری

     تجربه ی تروما می تواند باعث مشکلات روانشناختی زیادی شود. نسخه ی ایرانی چک لیست وقایع زندگی اعتبار و روایی مطالوبی را نشان داد و می توان از آن به عنوان یک ابزار غربالگری کوتاه و معتبر برای سنجش تروما  استفاده کرد.

    کلیدواژگان: روایی و اعتبار، تحلیل عامل تاییدی، چک لیست وقایع زندگی، درد مزمن
  • آیناز هلاکویی، سوگند قاسم زاده*، علی اکبر ارجمندنیا صفحات 150-159
    زمینه و هدف

    دوره نوجوانی از مهم ترین دوره های رشدی هر انسانی است. از سویی ریشه بسیاری از مشکلات نوجوانان در چارچوب خانواده شکل می گیرد. هدف از انجام پژوهش حاضر تعیین اثربخشی برنامه یکپارچه درمان فراتشخیصی بر نوجوانان مضطرب و فرزند پروری مادران آن ها بود.

    روش کار

    برای انجام پژوهش نیمه آزمایشی حاضر که با طرح پیش آزمون - پس آزمون انجام شد از بین دانش آموزان دوره اول متوسطه شهر تهران در سال تحصیلی 99-98 و مادران آن ها که مشکلات اضطرابی آنها با استفاده از مصاحبه تشخیصی بالینی و نیز نسخه خودسنجی نوجوانان آخنباخ و رسکولا مشخص شده بود، 20 نفر به صورت در دسترس انتخاب و بطور تصادفی به دو گروه کنترل و آزمایشی تقسیم شدند. سپس گروه آزمایشی 12-16 جلسه و هر جلسه 50 الی 60 دقیقه درمان فراتشخیصی را دریافت کردند. 24 ساعت قبل و 48 ساعت بعد از مداخله هر دو گروه پرسشنامه های اضطراب اسپنس و شیوه های فرزند پروری ارجمندنیا را تکمیل کردند. جهت تجزیه و تحلیل داده ها از آزمون تحلیل کوواریانس تک متغیره  و چند متغیره استفاده شد.

    یافته ها

     نتایج نشان داد که بین گروه آزمایش و کنترل در اضطراب نوجوانان و مهارت های فرزندپروری مادران تفاوت معناداری وجود دارد (01/0≤P) و برنامه یکپارچه درمان فراتشخیصی موجب افزایش معنادار کاربرد مهارت های مدیریت اضطراب نوجوانان و شیوه های فرزند پروری مادران آن ها شده است.

    نتیجه گیری

     با توجه به نتایج استفاده از درمان فراتشخیصی جهت کاهش اضطراب نوجوانان و فرزندپروری مادران آنها توصیه می شود.

    کلیدواژگان: اضطراب، درمان فراتشخیصی، شیوه های فرزند پروری، نوجوان
  • داوود همتیان خیاط، حمید نجات*، علی اکبر ثمری، احسان ارمز صفحات 160-168
    زمینه و هدف

    با توجه به لزوم بهبود سلامت روان بازماندگان ویروس کرونا و عدم انجام مطالعات کافی در این حوزه، هدف از انجام تحقیق حاضر مقایسه اثربخشی درمان های رفتار درمانی دیالکتیکی و شفقت درمانی بر تحمل آشفتگی، نگرانی و تنظیم هیجانی در بازماندگان بیماری کووید- 19 بود.

    روش کار

    برای انجام تحقیق نیمه تجربی حاضر که  با طرح پیش آزمون و پس آزمون با گروه های کنترل و آزمون انجام شد از بین بازماندگان جانباختگان بیماری کرونا در شهر مشهد که در بهار و تابستان 1399 در شبکه های اجتماعی عضو بودند، 60 نفر با روش نمونه گیری در دسترس انتخاب و به صورت تصادفی به سه گروه تقسیم شدند. سپس پرسشنامه های اضطراب کرونا (علیپور و همکاران، 1399)، 3 تنظیم هیجانی (گراتز و رومر، 2004) و تحمل آشفتگی (سیمونز و گاهر، 2005) در پیش آزمون از طریق شبکه های اجتماعی (کانال تلگرام، واتساپ و اینستاگرام) در اختیار آزمودنی ها قرار داده شد سپس گروه های مداخله 10 جلسه 90 دقیقه ای به تفکیک با روش های درمان دیالکتیکی و شفقت درمانی آموزش دیدند و مجددا پرسشنامه ها را تکمیل کردند. نهایتا داده ها با روش های تحلیل کوواریانس چندمتغیری و آزمون تعقیبی بونفرونی تحلیل شدند.

    یافته ها

     نتایج نشان داد دو روش درمان دیالکتیکی و شفقت درمانی باعث کاهش معنادار اضطراب کرونا، افزایش تحمل آشفتگی و افزایش تنظیم هیجانی شدند. همچنین روش درمانی دیالکتیک از اثربخشی بیشتری برخوردار بود.

    نتیجه گیری

    با توجه به نتایج استفاده از دو نوع روش و مخصوصا روش دیالکتیک جهت بهبود وضعیت روان شناختی بازماندگان بیماری کرونا توصیه می شود.

    کلیدواژگان: اضطراب، تحمل آشفتگی، تنظیم هیجانی، رفتار درمانی دیالکتیکی، شفقت درمانی
  • وحید سام مهر، فرناز فرشباف مانی صفت*، علی خادمی، رحیم شبانی صفحات 169-178
    زمینه و هدف

    تحریف شناختی یکی از مشکلاتی است که در  نوجوانان دارای اختلال ناغرمانی مقابله ای به وضوح دیده می شود، لذا مطالعه حاضر با هدف بررسی مقایسه ای اثربخشی درمان شناختی رفتاری و هیپنوتراپی بر کاهش میزان تحریف شناختی نوجوانان دارای اختلال نافرمانی مقابله ای انجام شد.

    روش کار

    این پژوهش در قالب طرح کارآزمایی بالینی با پیش آزمون و پس آزمون و دوره پیگیری یک ماهه اجرا شد. از میان دانش آموزان دختر و پسر  دوره اول متوسطه شهرستان ارومیه، با تشخیص اختلال نافرمانی مقابله ای که در سال تحصیلی 1400-1399 مشغول به تحصیل بودند، 51 نفر به شکل هدفمند در سه گروه (17 نفر درمان شناختی رفتاری، 17 نفر هیپنوتراپی و 17 نفر کنترل) به شکل تصادفی جایگذاری شدند. سپس گروه شناختی رفتاری و هیپنوتراپی براساس پروتکل های استاندارد مداخله ای  تحت مداخله قرار گرفتند. ابزارهای این پژوهش شامل: سیاهه رفتاری نسخه والدین آخنباخ و مقیاس تحریف های شناختی بین فردی حمام چی بود. برای تجزیه و تحلیل داده ها، آزمون تحلیل واریانس اندازه گیری مکرر استفاده شد.

    یافته ها

    نتایج نشان داد که بین درمان شناختی رفتاری و هیپنوتراپی بر کاهش تحریف های شناختی بین فردی؛ تفاوت معناداری وجود داشت به این صورت که هیپنوتیزم درمانی بر کاهش این تحریف ها اثربخشی ندارد، این در حالی است که درمان شناختی رفتاری از این منظر اثربخشی  قابل توجهی بر هیپنوتیزم درمانی دارد (127/0>P، 84.13 F=).

    نتیجه گیری

    به درمانگران توصیه می شود در کار با نوجوانان دارای اختلال نافرمانی مقابله ای که تحریف های شناختی بین فردی دارند از رویکرد درمانی شناختی رفتاری بهره بگیرند.

    کلیدواژگان: درمان شناختی- رفتاری، اختلال نافرمانی مقابله ای، نوجوان، تحریف شناختی، هیپنوتیزم
  • محسن پورمنتی*، فتح الله هاویل، مجتبی دلارام نسب صفحات 179-187
    زمینه و هدف

    دیابت یکی از بیماری های متابولیک و شایع است که علاوه بر هزینه های زیاد تاثیرات روانی بسزایی نیز بر جای می گذارد. هدف از انجام تحقیق حاضر تبیین تاثیر تمرینات ورزشی بر برخی عوارض جانبی متابولیک و ویژگی های روان شناختی بیماران مبتلا به دیابت نوع 2 بود.

    روش کار

     برای انجام تحقیق نیمه تجربی حاضر که با طرح پیش آزمون-پس آزمون انجام شد از بین بیماران دیابتی نوع 2 ساکن شهرستان زابل به روش نمونه گیری در دسترس 30 نفر انتخاب و به صورت تصادفی به دو گروه تمرین (سن: 94/6±70/38 سال: شاخص توده بدن 77/1±10/29 کیلوگرم بر مترمربع) و کنترل (سن: 52/7±45/40 سال: شاخص توده بدن 67/1±09/28 کیلوگرم بر مترمربع) تقسیم شدند. سپس آزمودنی های گروه تمرین 8 هفته، 3 جلسه در هفته و در 3 اینتروال با سیستم هرمی بدین ترتیب پروتکل مورد نظر را انجام دادند که در اینتروال اول تمرین با 35-50 درصد ضربان قلب ذخیره، اینتروال دوم با 50-65 درصد و در اینتروال سوم با 65-80 درصد اجرا شد. جهت جمع آوری داده ها از نمونه گیری خون، و تکمیل پرسشنامه DASS21 استفاده شد.

    یافته ها

    نتایج نشان داد تمرین هوازی هرمی بر استرس، اضطراب، افسردگی، کلسترول، LDL و HbA1c در بیماران مبتلا به دیابت نوع 2 تاثیر معنی داری دارد. بطوریکه میزان متغیرهای تحقیق در پس آزمون نسبت به پیش آزمون کاهش معنی داری یافت.

    نتیجه گیری

    با توجه به نتایج تحقیق حاضر استفاده از تمرینات اینتروال زیر نظر متخصص جهت کاهش آثار منفی روانی و متابولیکی بیماران دیابتی توصیه می شود.

    کلیدواژگان: دیابت نوع 2، تمرین ورزشی، عوارض متابولیک، ویژگی های روان شناختی
  • گونا فتحی، مریم اکبری*، امید مرادی، فردین عبداللهی صفحات 188-196
    زمینه و هدف

     اضطراب جدایی به عنوان یکی از اساسی‌ترین ترس‌ها در انسان شناخته شده است، بنابراین پژوهش حاضر با هدف تعیین اثربخشی آموزش تمایزیافتگی، همدلی مادران و رابطه والد-کودک بر اختلال اضطراب جدایی انجام شده است.

    روش کار

     در این تحیق شبه ‌آزمایشی، جامعه آماری پژوهش شامل تمامی مادران دارای کودکان دختر دارای نشانگان اختلال اضطراب جدایی بود که کودک/ کودکان آن‌ها در یکی از مراکز پیش دبستانی شهرستان کرمانشاه مشغول به تحصیل بودند که برابر با 380 نفر بود که 60 نفر از آنان به طور داوطلبانه در تحقیق شرکت کردند و در دو گروه 30 نفری آزمایش و کنترل تقسیم شدند. تمایزیافتگی، همدلی مادران و رابطه والد-کودک بر روی گروه آزمایش در 8 جلسه و هفته ای دو جلسه و هر جلسه 80 دقیقه اجرا گردید داده‌های پژوهش از طریق پرسشنامه استاندارد اختلال اضطراب جدایی هان، هاجلینیان، ایسن، وندر و پینکاس (2003) جمع‌آوری گردید. برای تجزیه و تحلیل داده‌ها از روش اماری تی وابسته استفاده گردید.

    یافته ها

     یافته‌های تحقیق نشان داد، بسته آموزشی طراحی شده بر اساس تمایزیافتگی، همدلی مادران و رابطه والد-کودک بر اختلال اضطراب جدایی تاثیر معنی‌داری دارد (001/0 = p).

    نتیجه‌گیری:

     با توجه به نتایج به‌دست‌آمده می‌توان گفت که آموزش اثربخشی آموزش تمایزیافتگی، همدلی مادران و رابطه والد-کودک می‌تواند زمینه کاهش اختلال اضطراب جدایی را فراهم آورد.

    کلیدواژگان: تمایزیافتگی، همدلی، رابطه والد-کودک، اختلال اضطراب جدایی
  • توران شهرکی، مریم نخعی مقدم* صفحات 197-204
    زمینه و هدف

     چاقی یک بیماری مزمن است که در حال حاضر به عنوانی یک اپیدمی جهانی در نظر گرفته می‌شود. پژوهش حاضر با هدف بررسی عوارض اندوکرین و متابولیک در کودکان چاق مراجعه کننده به کلینیک غدد بیمارستان علی اصغر زاهدان انجام پذیرفت.

    روش کار

     معیارهای ورود در جامعه مورد مطالعه شامل کودکان چاق 5 تا 18 ساله مراجعه کننده به کلینیک غدد بیمارستان علی اصغر شهر زاهدان در سال 1395 بود. معیارهای خروج عبارتنداز عدم تمایل به شرکت درمطالعه، عقب افتادگی ذهنی یا داشتن بیماری های سندرمیک، شرح حال بیماری مزمن یا مصرف دارو. در این مطالعه تعداد 60 کودک مبتلا به چاقی مورد بررسی قرار گرفتند.

    یافته‌ ها:

     نتایج نشان داد که 52% آزمودنی ها پسر و 48% دختر بودند. میانگین سنی کودکان مورد مطالعه 0/3 ± 9/9 سال (با حداقل 5 و حداکثر 17 سال) بود. 8/5% کودکان BMI بین صدک 95-85% برای سن و جنس و 2/94% آن ها BMI بالاتر از صدک 95% برای سن و جنس داشتند. در این مطالعه 57% کودکان در سونوگرافی کبد چرب داشته (%45 گرید یک و 12% گرید 2) و 43% نرمال بودند.

    نتیجه‌ گیری: 

    نتایج نشان داد که در کودکان چاق عوارض متابولیک مانند کبد چرب بیشتر وجود دارد و عوارض اندوکرین مانند هیپرانسولینمی و هیپرلیپیدمی نیز بیشتر دیده می‌شود. بنابراین اگر کودکی وزن بالایی داشته باشد، عوارض اندوکرین و متابولیک چاقی در وی بررسی گردد تا سریعتر درمان شود.

    کلیدواژگان: اندوکرین، متابولیک، چاق
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  • Samira Alihosseini, Aliakbar Haghdoost, Leila Ghalichi*, Salime Goharinezhad, Bita Mehravi, Omid Barati, Babak Eshrati, Tayebeh Najafimoghadam, Ali Kabir, Fereshteh Azedi, Morteza Naserbakht, Jalil Koohpayezadeh Pages 1-9
    Background & Aims

    In Iran’s health system, with integration of medical education and ministry of health, medical universities have a variety of responsibilities apart from delivering medical education to university students. Medical universities are playing an essential role in management of the health system. They are in charge of providing the necessary prevention and treatment services in provincial levels, as well as management and oversight of the health services needed by the population. Meanwhile, medical universities are expected to maintain and improve population health through scientific and innovative methods. Although the indicators highlight the success of these universities in many of their tasks, sometimes they fail to fulfil the expected targets. Identifying problems and challenges that hinder universities’ performance and supporting them with innovative problem solving methods can help managers in achieving university goals. Therefore, recognizing and analyzing the university challenges are essential steps that should be taken for the strengthening the university system and empower them to respond more successfully to the existing and future needs and to assure that the university continues its pathway toward growth and development and keeps up the track of achieving its goals.

    Methods

    This study is an applied research project, which has been designed to identify and categorize the challenges that affect the performance of different sectors of Iran University of Medical Sciences. The participants of this qualitative study were experts, managers, directors and officers of different sectors of the university, including faculties, deputies, offices, hospitals and health centers. In the first step, an open-ended questionnaire was developed and evaluated to extract challenges and problems faced by different units in the university. Then, this open-ended questionnaire was distributed and the challenges and problems of different academic and non-academic units of the university were collected through questioning the managers and staff of all units and subunits about the most important challenges they face. For each challenge they mentioned, title of the challenge, description, and the rational of their importance and priority was provided. The process continued until no new themes emerged. At the end of this step, a list of existing challenges and problems along with their description and rational for selection were available. In the next step, the collected concepts were analyzed in order to investigate the limiting role of these challenges on the performance of different units in the university. After organizing the answers and reviewing the suggested items, similar and overlapping items were merged or removed.  Also, challenges that targeted a limited number of units or those targeting people (instead of problems or processes) were removed. In the following step, reviewing and coding was performed and themes were extracted by two independent researchers. Finally, the themes were summarized based on the opinions of different experts and by achieving consensus. At the end of this step, affecting factors were identified, categorized and presented. In the last step, three rounds of focus group discussions were held to evaluate the accuracy of the obtained data. In all steps of the study, in order to benefit from the views of a wide range of experts and managers and officers with different experiences, purposive sampling was performed. The data collection continued until data reached saturation. Content analysis was undertaken to provide a complete understanding of the collected data. For maintaining the ethical considerations, the names of the study units and any reference to specific people and occasions were removed from the reports and texts.

    Results

    we achieved a response rate of 90 percent through multiple reminders and follow ups we sent to unit managers. Based on the responses from units, 215 problems were identified from 38 participating units. The identified problems were categorized into three main themes. Most of the mentioned problems could be categorized under the general theme of lack of evidence-based management. In fact, issues related to lack of evidence-based management was mentioned by almost every participant. This theme includes issues such as Lack of effective monitoring and evaluation systems, and poor frameworks and process flows for applying evaluation results; excessive focus on quantitative approaches for evaluating performance of teams and individuals, and lack of efficient and fair rewarding and punishing systems. The second emerged theme was inefficient bureaucracy, where issues such as legal, managerial, structural and process problems are addresses. Organizational culture was the third extracted theme and defective staff education, communication and motivation, poor workforce performance and attitudes to organization; and insufficient professional commitment were among the most frequently indicated problems. Lack of meritocracy was an issue mentioned across all three themes by participants and was considered as an important determining topic linking all three themes. This topic highlighted lack of predefined approaches for selecting staff at different levels and unclear process of succession in different organizational levels and units.

    Conclusion

    According to the university workforce, the main problems and challenges that hinder university performance are rooted in an environment of interrelated factors which can be categorized mainly in absence of evidence-based management, inefficient bureaucratic structure, undefined and underdeveloped decision-making process at different levels of the organization, and some aspects of the organizational culture that may adversely affect the processes of the organization. Based on these results, it can be concluded that the university’s existing performance management system, is generally hindering the evidence based management, which in turn, results in shaping of an overall ineffective approach to the decision making processes and a rather static organizational status. Moreover, such cultural environment can consequently cause a attitude of resistance versus different efforts toward evidence based management. Finally, it can be concluded that if a sustainable and effective change is intended to occur in the management of the university, the probable concurrent effects of the designed interventions an all three hindering factors should be considered with high caution. This consideration is especially important because it is believed that implementing an evidence based decision making system in an organization requires detailed evaluation of organizational culture and characteristics; and failing to provide these information properly can result in a serious obstacles in success of the interventions.

    Keywords: Performance, Improvement, Organizational Culture
  • Zahra Moslehi, Yasin Hoseini*, Nader Farahpour Pages 10-19
    Background & Aims

    Anterior cruciate ligament rupture is very common in athletes (1). Dysfunction of the musculoskeletal system leads to joint instability in various motor maneuvers, resulting in the introduction of abnormal forces into the anterior cruciate ligament (1). The cutting maneuver is one of the most common movements in various sports (3). During the descent from a height, the contraction of the hamstring muscle causes the tibia to pull back and reduce the amount of shear force applied to the anterior cruciate ligament. In contrast, the quadriceps muscle causes the anterior tibia to move over the femur and apply shear to the with anterior cruciate ligament (ACL) (4, 5). In some simulated models, the posterior leg muscles have been introduced as knee stabilizers (5).Usually, the average activity of quadriceps muscles in women is higher than in men (6) and the ratio of hamstring to quadriceps muscle activity in the stop stage of lateral shear maneuver is lower than the lateral movement stage (7). On the other hand, when walking, the timing of hamstring activity before the foot hits the ground is different between men and women (8). Due to the fact that hamstring muscle activity reduces the shear force in the knee joint, the relative decrease in hamstring muscle activity in women is one of the reasons for the higher risk of ACL injury in women than men (8). It is clinically important to evaluate the activity and timing of muscles in various sports movements, including lateral incision (9,10). Because in the cutting manuvre movement, the knee of the support foot is placed in the position of the valgus and this movement is one of the mechanisms of anterior cruciate ligament injury, there is very little information about the function of the knee muscles during this maneuver in athletes (9, 10). One of the limitations of previous research is that researchers often examine the intensity of muscle activity in this movement and no information is available on the coordination and timing of knee muscle activity. The interaction between knee ligament injury and poor muscle function has not yet been well understood. The aim of this study was to evaluate the activity of lower limb muscle activity in people with a history of anterior cruciate ligament reconstruction compared to healthy individuals during cutting maneuvers. 

    Methods

    10 healthy male soccer players participated as a control group and 10 soccer players with a history of anterior cruciate ligament reconstruction participated as an experimental group in this study. The experimental group underwent anterior cruciate ligament reconstruction using the technique of two Gracilis-semi- tendinous bundles. Electromyographic activity of tibialis anterior, medial gastrocnemius, lateral gastrocnemius, vastus medialis, vastus lateralis, semitendinosus, and biceps femoris with BTS Free EMG 300 device was recorded during cutting maneuvers. Before performing the main tests and recording the data, the subjects were first instructed to run at a speed of 2.5 m / s and perform a cutting maneuver. To perform a cutting maneuver, subjects ran a 5-meter path and then cut the path at a 45-degree angle to the side (left or right). Electromyographic signals with a frequency of 2500 Hz and a bandwidth of 1250 Hz were recorded in computer memory. Later, with a bandwidth filter, signals above 500 Hz and below 10 Hz were removed. A 50 Hz notch filter was also used to remove electrical device signals. The device GAIN was considered equal to 1250. The linear envelope technique was used in the EMG Graphing software environment to obtain the time to start muscle activity. This means that in the Linear envelop diagram, a point of 10% relative to the signal peak of each activity was considered as the beginning of muscle activity. Simultaneously with the recording of electromyographic signals, the kinematic variables of the lower extremities were recorded using the Vicon motion analysis system with 4 T-series cameras and a sampling frequency of 200 Hz. Plug-in-gait marking model was used to track the lower limb and determine the moment of heel contact with the ground (HC) and the moment of toe separation from the ground (TO). Before using this device, the cameras were calibrated using a space of 3 meters long /0 0.9 meters wide × 2 meters high. Camera system data recording and electromyography were simultaneous. For data analysis, first, the Shapiro-Wilk test was used to evaluate the normality of data distribution. All data had a normal distribution. Then, multivariate analysis of variance was used to compare the research variables between groups. Statistical analysis was performed using SPSS-23 software and p <0.05 was considered as the significance level.

    Results

    The activity onset of tibialis anterior, medial and lateral gastrocnemius muscles was earlier in the experimental group than the control group; (p<0.05). Also, the time to reach the peak of tibialis anterior and medial gastrocnemius major muscle activity in the experimental group was earlier than the healthy group (p≥0.05).

    Conclusion

    The results of the present study showed that in cutting maneuver motion, the moment of onset of tibialis anterior muscle activity in patients with ACL injury was earlier than in healthy individuals. This muscle plays an important role in dorsiflexion and supination of the foot (13, 14). The tibialis anterior plays an important role in dorsiflexion and supination of the foot. Researchers believe that the tibialis anterior muscle is one of the stabilizers of the ankle joint at the moment of the heel's initial contact with the ground when walking and running. Researchers have also shown that the tibialis anterior plays a role in stabilizing the ankle joint in the stance phase of cutting maneuvers (13, 14). This muscle helps maintain the stability of the knee by maintaining tibial stability. (13). Some researchers believe that this muscle stabilizes the ankle joint in the phase of the initial contact of the foot with the ground (19, 20). Changes in the timing and magnitude of muscle activity are considered as a compensatory mechanism in people with ACL rupture (20,21). Early-onset of gastrocnemius muscle activity in people with ACL rupture compared to healthy individuals can be a protective mechanism to maintain knee stability (22). The earlier activity of the gastrocnemius muscles in people with anterior cruciate ligament injury compared to healthy people can be explained by the fact that it is a protective mechanism to maintain the stability and strength of the knee. Muscular responses and the mechanism of joint mechanical behavior are closely related to the time to reach maximum muscle activity (22). These muscular responses may be related to muscle function in maintaining knee joint stability before, during, and after movement. In fact, due to the rupture of the ACL, the joint position and the sense of movement are disturbed and the movement pattern may change. Anterior cruciate ligament reconstruction is associated with changes in lower limb muscle function in terms of onset time. It seems that after the surgery, a new kind of muscular adaptation develops. Further investigation is needed to determine the association between this compatibility and the risk of osteoarthritis or re-rupture. Injury to a joint in the body causes a change in the activity of the muscles around the joint; ACL injury also affects the function of the quadriceps, hamstrings, and twin muscles of the knee joint (18). Evidence suggests that ACL injury affects twin muscle function and strategies (12. This research also has certain limitations. These limitations are that the research results are based on male subjects and due to individual differences between men and women in anatomical and biomechanical characteristics, the generalization of these results to the whole male and female community will be difficult. It seems that differences in size and body size and Q angle of women may show different results.

    Keywords: Cutting maneuvers, Anterior Cruciate Ligament, Electromyography
  • AliAkbar Babazadehpahlevanlo, MohammadAli Aslankhani*, Ali Mohammad Safania, AliAsghar Doroudian, Mehdi Goodarzi Pages 20-30
    Background & Aims

    One of the main pillars of sports education as well as leadership and leadership of the coaching team. The coach is the center of guidance and development of sports in any society. Coaches' efforts are successful when they have the necessary sports knowledge (1). The position and role of coaches and the effects of their performance and personality traits in sports are very important, so that coaches have a significant role in team development, development of technical skills and social and cultural behaviors of players (2). Another important issue in the present era and in the sports environment is the issue of mental health, which has attracted the attention of many researchers. The goal of mental health is to create mental health by preventing mental illness and creating a healthy environment for proper human relationships. According to the World Health Organization, a person's health does not simply include a state of complete physical health; It also includes the dimensions of mental and social health, the ability to communicate appropriately and in harmony with others, change and modify the individual and social environment, and resolve conflicts and personal desires in a positive, just and appropriate way, which is a necessity of coaching (6). The importance of coaching is so great that various researches have been done about it and contradictory results have been obtained. For example, Zare et al. (2019) in their research emphasized the role of coaches in the development of players' skills in all dimensions, especially the development of psychological skills (8). In general, the role and position of coaches is clear to everyone, but what remains an issue in this direction is how to prepare and promote coaches for this serious responsibility.Coaching is one of the most complex sports professions and one of the most effective areas that can lead to the development of sports and training of athletes. Therefore, in this regard, it is necessary to have a suitable system to promote knowledge, mental health and job skills so that trainers can use the most appropriate training courses (scientific and practical) to play their role and responsibilities (10) . Therefore, the researcher seeks to identify and prioritize the factors affecting the development of knowledge, mental health and practical skills.

    Methods

    The present research is quantitative and qualitative in terms of data, applied in terms of purpose, exploratory in terms of field, field data collection in terms of time and time in terms of time period. The statistical population of this research in the qualitative part included sports experts and sports coaching and in the quantitative part were 508 Olympic sports coaches, from which 306 people were randomly selected as a sample. A researcher-made questionnaire prepared by fuzzy Delphi method was used to collect information. The face, content and structure validity of the questionnaire were confirmed by experts in the field of quality, factor analysis and structural equations, respectively. Also, the reliability of the questionnaire in a pilot study on 30 people in the study population and using Cronbach's alpha test in all components was calculated to be more than 0.70. Finally, descriptive statistics, exploratory factor analysis, one-sample t-test and structural equation analysis using SPSS and Expert Choice software were used to analyze the data.

    Results

    The initial estimate of the share of each variable showed that the values of all of them are equal to one. It was also found that the common variance of all items is more than 0.5. Therefore, all variables (items) will remain in the analysis. According to Table 3, 71 items in the present study can be reduced to 11 factors and from the combination of these 71 items, a new structure can be designed based on the factors with the new combination and the data can be analyzed based on that data. Also, Table 3 showed that the contribution of each factor in explaining the variance of 71 items related to the factors affecting the development of applied knowledge and skills for coaching levels in Iran is different and decreasing.Finally, according to the results for level 3 coaches, the highest weight was related to individual factors, education, advertising and media. Also, according to the results for level 2 trainers, the highest weight was related to managerial factors, localization of knowledge and knowledge enhancement. And for level 1 educators, the highest weight was related to talent identification and basic factors, localization of knowledge and managerial factors.

    Conclsion

     Undoubtedly, the growth and development of coaching knowledge in the country on the one hand and its decline and decline on the other hand, is rooted in several factors, which will be difficult to determine the share of each. There is no doubt that the scientific study and identification of the existing problems in this field on the one hand and the efforts of the officials to solve these problems on the other hand will be successful in promoting it as much as possible. However, it should be noted that the research community is made up of experts and qualified trainers in the country and their opinion can really pave the way for success and development of knowledge and practical skills for coaching levels in Iran. Therefore, it seems that paying attention to the opinions of these experts can be one of the best data needed for managers to make decisions regarding the implementation of coaching promotion programs in the country. On the other hand, structural equation modeling also confirms this and shows that the identified factors can be effective in developing knowledge and practical skills for coaching levels in Iran and therefore using the results of this study can further improve the coaching of the field. Various sports in the country was promising.

    Keywords: Coach, Mental Health, Ability, Development of Knowledge, Applied Skills
  • Mozhgan Ahmadi, Nasibeh Kazemi* Pages 31-48
    Background & Aims

    Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy and is defined as glucose intolerance or high blood sugar (hyperglycemia), with the onset or first diagnosis during pregnancy. The prevalence of gestational diabetes varies from 1 to 20% and is increasing worldwide as maternal obesity and type 2 diabetes increase (1). Gestational diabetes increases the risk of short-term complications such as preeclampsia, cesarean delivery, macrosomia, hypoglycemia in infants, or hospitalization in neonatal intensive care units, as well as the long-term progression of type 2 diabetes (3). Some risk factors that predispose women to gestational diabetes include overweight and obesity, polycystic ovary syndrome (PCOS), pre-diabetes, gestational diabetes in a previous pregnancy, a family history of type 2 diabetes, maternal age and vitamin D deficiency (4).Blood glucose control is a vital factor in counteracting the side effects associated with GDM (5). Peripheral insulin resistance has been shown to help increase GDM-related blood glucose (6). In women with GDM, peripheral insulin sensitivity decreases and beta-cell dysfunction cannot meet the increased insulin needs during pregnancy and thus increase blood glucose (7).Metabolic disorders in GDM may be due to excessive accumulation of adipose tissue due to chronic low-grade inflammation associated with macrophage infiltration and secretion of many inflammatory cytokines. GDM is associated with an imbalance of various inflammatory processes that occur during pregnancy. Cytokines including interleukin-1 beta (IL-1β), interleukin-6 (IL-6) and Tumour necrosis factor α (TNF-α) as well as other inflammatory markers such as C-reactive protein (CRP) increase in the female bloodstream of Obese pregnant women and women with GDM. These cytokines are biologically active compounds that participate as mediators in many metabolic pathways and affect the use of energy substrate in the fetus and offspring (8).Gestational diabetes control is based on two different approaches: interventions aimed at promoting healthy lifestyles, such as changes in diet or exercise, and anti-diabetic drug therapy (11). However, it is not clear about the characteristics of the type of exercise needed to better manage gestational diabetes. Findings from clinical and epidemiological studies do not show any maternal or fetal side effects on women with mild to moderate exercise. In fact, pregnant women are now advised to exercise regularly in the absence of medical or delivery complications (12). In the present study, some of the most important pathophysiological aspects of gestational diabetes are investigated and discuss how exercise can bring about some physiological adaptations of GDM. Metabolic changes and the role of inflammatory and anti-inflammatory factors in gestational diabetes are examined and attempts are made to elucidate the mechanisms by which exercise can be useful as an adjunctive therapy in improving metabolic conditions and reducing inflammation during gestational diabetes. In view of the above, the present study intends to investigate the effect of exercise activities on metabolic responses and inflammatory and anti-inflammatory factors in women with gestational diabetes. The aim of this study was to review the effect of exercise on metabolic responses,
    inflammatory and anti-inflammatory factors in women with gestational diabetes (GDM).

    Methods

    Search performed for studies on the response of metabolic, inflammatory and anti-inflammatory factors to exercise in gestational diabetes in the reputable databases Springer, Hindawi, PubMed, Google Scholar, Scopus, SID and ISC using the keyword Exercise Training, Metabolic factors (glucose, insulin, glycosylated hemoglobin and insulin sensitivity), inflammatory factors (interleukin-1 beta, tumor necrosis factor (TNF-α), interleukin-6 (IL-6) and reactive protein C (CRP)) and Anti-inflammatory factors (interleukin-10 (IL-10) were performed. 20 studies of metabolic responses and inflammatory-anti-inflammatory to exercise in women with GDM were reviewed.

    Results

    In studies on metabolic factors, the benefits of exercise were observed to improve glycemic control, optimize fasting glucose and insulin concentrations, reduce glycosylated hemoglobin levels and improve insulin sensitivity in women with GDM. Also, decreased levels of inflammatory markers have been reported in women with GDM.

    Conclusion

    Evidence from randomized controlled trials shows that exercise as a supplement to standard care significantly improves postprandial control for glycemia and lowers fasting blood glucose for women with GDM (85-88). It was also found that people who exercise are prescribed less insulin (86, 89), so exercise is as effective as insulin in maintaining normal glycemia and can be helpful in meeting the need for insulin therapy. These results are clinically important because they show the potential of exercise to help lower acute blood glucose levels to normal. Glycosylated hemoglobin levels also measure long-term glycemic control (2 to 3 months), and exercise appears to improve HbA1c in the long term (87, 88). There is an acceptable physiological explanation for supporting exercise as a therapeutic supplement to improve glycemic control in women with GDM. Insulin administration does not reduce insulin resistance. In contrast, exercise increases insulin by stimulating glucose uptake into muscle by activating intracellular glucose transporters and increasing the use of intracellular fatty acids (50). Also, the amount of glucose consumed is affected by the duration and intensity of exercise. The more intense the exercise, the stronger the effect of lowering blood sugar (92). On the other hand, women with GDM show a greater inflammatory response. If inflammation promotes these adverse pregnancy outcomes, exercise may protect against the anti-inflammatory effect. Regular exercise has been shown to reduce some of the complications and risks of gestational diabetes, the protective effect of exercise in pregnant women is partly due to the reduction of inflammation (93). Exercise stimulates glucose in insulin-independent skeletal muscle.Therefore, less insulin is needed to maintain glycemia, and this appears to be mediated by muscle-derived cytokines. Both mechanisms could explain the lower first-phase insulin response seen in more active women. Inflammatory cytokines may play aprotective role on the glucose / insulin axis (39), extending this role to overweight and obese pregnant women. Pregnant women are more likely to have a more pronounced proinflammatory condition due to weight, BMI, and metabolic characteristics, which may affect their response to exercise. In general, it seems that changing the exercise version in the experiments prevents identifying the optimal type of exercise to improve metabolic conditions and reduce inflammation in women with GDM. In general, it can be concluded that aerobic and resistance or combined exercise are similarly effective in improving blood glucose control and reducing inflammation in women with GDM, provided they are similar in terms of exercise characteristics. Future studies should evaluate the effects of exercise combined with other interventions (diet) versus control (standard care-recommendation) on metabolic responses and inflammatory and anti-inflammatory factors in women with GDM, separate studies determine the effect of each intervention, and the type and severity of prescribed exercise should be considered. It seems that regular participation in exercise training can improve metabolic conditions and reduce inflammation in women with GDM. However, more studies are needed to investigate the effect of exercise, especially on inflammatory and anti-inflammatory factors in women with GDM.

    Keywords: Gestational Diabetes, Exercise, Insulin Sensitivity, Inflammation
  • Sirous Zeinali, Ahmad Torkfar*, Lila Jamshidain, Seyed MohammadAli Mirhossini Pages 49-57
    Background & Aims

    Undoubtedly, in sports environments, everyone tries to show their best performance. Therefore, in these environments, in order to achieve success and improve the performance of competition in all age groups, it reaches its highest level (2). One of the problems among student-athletes is their incompatibility with sports environments. This issue, in addition to distorting the sports position of students, also causes problems in their education in different situations (4).Compatibility is so important that various researches have been done in this field. For example, Otto et al. (2019) showed that appropriate sports services improve students' athletic performance while improving individual adjustment in sports environments (9). Adaptation is more important in some situations and eras, including crises. One of the crises that human beings face today and has overshadowed all activities is the prevalence of Quid-19 virus (16). The widespread spread of the virus has raised major concerns worldwide (18). Given the importance of adaptation on the one hand and the impact of corona on psychological and social characteristics on the other hand, the need for social adaptation of students in sports environments in the post-corona era is increasingly understood. The lack of research on adaptation among athletes, especially students in times of crisis, especially the outbreak of coronavirus, has caused major problems for this group of people today. These problems are overshadowed by the culture of sports among students, their distance from sports environments and possibly the decrease in their loyalty and interest in sports. On the other hand, in the post-corona era, students will undoubtedly face problems in social adjustment, which can cause major problems for their presence in sports environments. Therefore, it seems necessary to conduct the present study.

    Methods

    The present study is an applied research that was conducted in the field. Also, the present study was mixed in terms of data collection method, which was performed qualitatively and quantitatively. The statistical population of the present study in the qualitative section included people aware of the subject of the study who were selected as a sample in the qualitative section using purposive sampling method until the theoretical saturation was reached. The statistical population of the quantitative section included all male student-athletes of high schools in Shiraz. According to the available selection, 240 student-athletes were identified and after distributing and collecting the questionnaires, 162 completed questionnaires were analyzed.The research instruments included semi-structured interviews and a researcher-made questionnaire derived from the output of the qualitative section. It had 28 questions that were scored based on a 5-point Likert scale. Content validity, Syrian and reliability of the questionnaire were also confirmed. In order to analyze the data of the present study, open, axial and selective coding in the qualitative part and structural equation testing in the quantitative part were used. SPSS software was used using SPSS software.

    Results

    After coding, the characteristics extracted from the interviews were identified and summarized. According to the results, motivational, cultural, economic, personal, health and environmental factors are factors that are important for the psychological adjustment of students in the post-corona period, each of which includes several factors (Figure 1). Also, according to the results of the research model, it was found that according to the T-level of each factor, which is higher than 1.96, it can be said that all factors were significantly present in the research model. On the other hand, the results showed that the research model has a good fit.

    Conclusion

    The present study showed that in order to improve students' social adjustment in sports environments in the post-corona period, motivational factors have the most role. Pakpour and Griffiths (2020) identified that re-emergence in post-corona sports environments requires motivational issues. Motivational factors, by attracting students to sports environments in the post-corona period and improving their social relationships, cause their social adjustment to increase appropriately (22).The results showed that cultural and economic factors had an effect on improving the socio-psychological adjustment of students in sports environments in the post-corona period. It seems that cultural and economic factors cause students to be more motivated to participate in sports environments, which affects their behaviors and attitudes and facilitates their social adjustment (21).Another finding showed that individual factors and health-environmental factors are other factors affecting the improvement of students' socio-psychological adjustment in sports environments in the post-corona period. It seems that paying attention to personal and health factors causes public trust to be formed among students regarding sports environments in the first stage, and then the behavioral and mental problems caused by the outbreak of corona virus in the post-corona period are identified and considered (20).

    Keywords: Corona, The Social-Psychological Adjustment, Sport
  • Sina Falahati, Mina Hakakzadeh*, Mohamad Porranjbar Pages 58-66
    Background & Aims

    Today, physical education and sports have found their true place in the world and its importance in building the human body and soul has been proven. Exercise is the most effective and important program for enriching leisure time and can be a useful tool to deal with various deviations. New research shows that exercise and physical activity in leisure time, even among people in whom athletes increase self-confidence. The benefits of sports activity have been well documented in recent years. Exercise may reduce the risk of cardiovascular disease, help with weight management, improve personal mood, and promote physiological health. In the past, researchers and scientists have conducted population-based or experimental studies to reap the health benefits of physical activity. These facts confirm that common physical activity includes a reduced risk of cardiovascular disease and colon cancer, strong bones, weight management, increased energy, less anxiety, and a sense of well-being. Exercise and physical activity is a valuable tool that today fills most of the leisure time of millions of people around the world. Leisure time is a good and desirable opportunity to engage in sports. Over the past 15 years, people's knowledge of the benefits of physical exercise has increased, and fitness programs have developed at the community level, and recreational and leisure sports have grown unpredictably. In fact, today the people of the world are motivated to participate in sports activities to gain health, well-being, vitality and avoid diseases. Today, on the other hand, sport has become so widespread that experts call it the "small world in society." According to experts, sport shows the values, structure and driving force of society and reflects social characteristics. However, there is insufficient evidence available on the psychological challenges to improving leisure activities. Given the research gap in this area; Conducting the present study can provide valuable evidence for the development of leisure activities. In other words, the present research can be used to develop scientific evidence; Provide a practical path to participate in leisure sports activities. The development of leisure activities such as exercise can provide conditions for improving the mental health of individuals by improving their physical and mental condition. Due to the lack of comprehensive research on improving the mental health of individuals to participate in leisure sports activities, the process of improving the mental health challenges of individuals to participate in leisure sports activities has encountered major problems. In a way, the research gap on the mental health challenges of people to participate in sports activities in leisure time is clear. This gap has led to a lack of operational strategies to address the mental health challenges of individuals to participate in leisure sports activities. This issue has led to the design and implementation of the present study with the aim of challenging the mental health of individuals to participate in leisure sports activities. Therefore, the main question of the present study is what are the psychological health challenges of individuals to participate in leisure sports activities?

    Methods

    The present research is based on an applied purpose and is a hybrid method. To solve the problem of psychological health challenges of individuals to participate in sports activities in leisure, a combined approach is used. This approach was performed in the research using a combination of two sets of qualitative and quantitative approaches. The tools of the present study included a semi-structured interview and a researcher-made questionnaire. In the qualitative part of the research, interviews were used to identify the mental health challenges of individuals to participate in leisure sports activities. The output of the qualitative section led to the formation of a researcher-made questionnaire. In other words, the research questionnaire was the output of the qualitative section, which was designed according to the principles of the qualitative section. The questionnaire consisted of 23 questions that examined the mental health challenges of individuals to participate in leisure sports activities. The validity of this questionnaire was examined by reviewing the opinions of academic experts. Also, its reliability after calculating Cronbach's alpha was 0.88.The statistical population of the research in the field of recognizing factors consisted of experts in the field of sports activity and institutionalization, which includes sports management specialists, executives and managers of cultural and sports departments, managers of sports organizations, sociologists familiar with sports, veteran coaches, veterans, people They were familiar with cultural activities in sports (N = 11). The sampling method was purposeful in the first statistical population. These individuals were identified as a research sample due to theoretical saturation. In other words, sampling in the qualitative section continued until new content was added to the information obtained. This caused theoretical saturation in sample number 11. In the second part, compiling and designing the model and testing it, the statistical population of the study consisted of young people throughout Tehran who went from sports activities to leisure activities to sports activities, which due to their unlimited number throughout Tehran and 384 people were considered using Morgan table. In order to analyze the qualitative part, open, axial and selective coding was used. Also, in a small part, descriptive and inferential statistics were used to analyze the research data. In the descriptive statistics section, frequency and percentage were used. Also, in the inferential statistics section, the structural equation method was used. The whole process of data analysis was performed in SPSS and AMOS software.

    Results

    Ualitative results of the study showed that the mental health challenges of individuals to participate in leisure sports activities included 23 cases. These challenges include not responding to people's tastes, lack of personal support for sports, lack of awareness of sports capabilities, lack of proper quality of life, poor life expectancy, lack of personality fit with sports, lack of perfectionism, irrational beliefs, Inadequate personal styles, poor communication skills, lack of mental stubbornness, low desire to participate in sports, low motivational beliefs about sports, personality disorders, low self-esteem, emotional fatigue, anxiety, lack of environment, lack of environmental attractiveness, lack of environmental attractiveness, Environmental deterrents were in the areas of sports, social phobia, inadequate social support, and inadequate social acceptance. Smirnov clomograph test was used to evaluate the normality of research data. According to the results of these indicators, it was found that the data of the present study had a natural distribution.As the results of the table above show, all the identified challenges have a significant effect on the level of significance with respect to the T level which is higher than 1.96. In general, the mental health challenges of individuals to participate in leisure sports activities were identified in three categories: individual challenge, mental challenge and environmental challenge. Thus, individual challenges include not responding to people's tastes, lack of individual support for sports, lack of awareness of sports capacity, lack of proper quality of life, poor life expectancy, lack of personality fit with sports, lack of perfectionism , Irrational beliefs of individuals, inappropriate individual styles and communication skills were inappropriate. On the other hand, mental challenges included lack of mental stubbornness, low desire to participate in sports, low motivational beliefs about sports, personality disorders, low self-esteem, emotional fatigue and anxiety. Environmental challenges also included environmental incompatibility with individual needs, lack of environmental attractiveness, environmental deterrents in the field of sports, social phobia, inadequate social support and inadequate social acceptance.

    Conclusion

    In general, the mental health challenges of individuals to participate in leisure sports activities were identified in three categories: individual challenge, mental challenge and environmental challenge. This issue has been mentioned in various researches.Lack of attention to these challenges has caused the process of impact of these challenges in mental, personal and environmental dimensions to be still evident. According to the results of the present study, it is suggested that while paying attention to the existing challenges, conditions be created to improve individual education in order to improve sports skills and create mental capacities among individuals. It is also suggested that by improving the environmental situation, conditions be provided to improve environmental issues in attracting people to leisure sports activities.

    Keywords: Mental Health, Leisure Time, Sport
  • Mohsen Karami, Bahram Yosefi*, Saeid Sadeghi Boroujerdi Pages 67-75
    Background & Aims

    The World Health Organization defines health as complete physical, mental, and social health, and not merely the absence of disease. The organization also defines mental health as a state of well-being in which the individual recognizes his or her abilities, can cope with the normal stresses of life, works productively, and is beneficial to his or her community. Paying attention to the concept of health and well-being as an influential aspect on the individual and social performance of individuals is an approach that is considered by many researchers today. Today, paying attention to the signs of emotional well-being such as happiness and well-being, life satisfaction and lack of negative factors such as anxiety and frustration are factors that should be considered in people's lives. Communication between employees and managers does not only come from money, services and information, but also from personal and emotional resources such as approval, respect and support. The amount of support that the organization shows over time and creates a sense of obligation and compensation in employees, which can increase and increase the efficiency and effectiveness and, in fact, the productivity of the organization. Lack of organizational support for individuals leads to lack of emotional growth and adaptation and objectivity of individuals and as a result, dependence on the organization and proper performance is presented at an undesirable level, which ultimately leads to ineffectiveness and efficiency and development of the organization in today's competitive world. It seems that the study of the variables of employee health promotion, perceived organizational support and attention to psychological capital, while clarifying the situation in the study community, can create valuable information about the ability of employees in the study community to create a Provide us with new insights into the physical education officials and administrators of the country and strategies to increase emotional cohesion and engage more of them with the goals of the organization. Another reason for the importance of this research is that it seems that by conducting such research and obtaining more information, sports managers, like managers of other organizations, by correctly and timely identification of how employees are able to work and organizational support and effective consequences on employee productivity. And be aware of the psychological capital of their employees to take significant steps to achieve organizational goals and increase effectiveness. Employees of sports and youth departments due to their important role in increasing the health and well-being of young people in society. They should always have mental health as well as positive behavior that can inject positive spirit into young people and adolescents, encourage them to engage in sports activities and strive to maintain physical and mental health. Therefore, having a positive social capital in this group of employees is necessary and important. Given this, the need for such research is felt more than ever. On the other hand, many researches related to psychological capital, organizational support and health promotion of employees have been done in different organizations, but no research has been found to investigate the effect of perceived organizational support and psychological capital on health promotion in sports and youth employees. Therefore, the concepts of organizational support, psychological capital and its impact on improving the health of employees are of considerable importance, so that increasing attention to these issues increases the commitment and efficiency of the organization; Therefore, considering the importance of the issue and the necessity of doing it, this study intends to investigate the effect of organizational support and psychological capital on improving the health of employees among employees of sports and youth departments in Kurdistan, Kermanshah, Hamedan and Ilam provinces.

    Methods

    This research was descriptive-correlational and applied in terms of purpose. The statistical population of the study consisted of all employees of physical education departments in the western provinces of the country (390 people), data were collected from total sampling; After distributing and collecting the questionnaires, 350 questionnaires were analyzed. Goldberg and Hiller (1970) General Health Questionnaire, Eisenberger et al.'s (1986) Perceived Organizational Support Questionnaire (Lutanz's Psychological Capital Questionnaire) (2007) were used to collect data. The combined method with PLS was approved. To determine the normality of the variables, Kolmogorov-Smirnov and to analyze the data, Pearson correlation matrix test and to test the research hypotheses, the technique of partial least squares and factor load were used. GOF, Tenenhaus et al. (2004) were used to examine the fit of the overall model, which controls both parts of the measurement and structural model.

    Results

    Demographic results show that out of a total of 350 statistical samples included in this study, 208 (59.52%) were male and another 142 (40.48%) were female respondents. Also, 51 people have diplomas (14.62%), 54 people have master's degrees (15.38%), 170 people have bachelors (48.71%), 45 people have master's degrees (12.90%), 30 people have doctorates (8.39%). Findings showed a positive and significant direct effect on the components of psychological capital and its dimensions and perceived organizational support by promoting employee health. The results of regression analysis also showed that psychological capital and perceived organizational support are able to predict the ability to do work.

    Conclusion

    Perceived organizational support as one of the job resources has a positive relationship with health promotion and can as a positive source improve the ability to do work (health promotion) in employees of sports and youth departments because perceived organizational support, wide changes in employees' attitudes toward their jobs. It plays and as a result has positive organizational behavior consequences. Employees will show more enthusiasm for their job if they feel that their commitment and perseverance towards their job is being taken into account and supported. Finally, from the results of this study, it can be concluded that in the employee community, the use of programs to increase the psychological capital of employees can lead to promoting job motivation and improving their health. It also increases the supportive attitude within organizations and, consequently, the employees' perception of being supported, their ability to do work and their enthusiasmIn general, improving the health of employees is very important for organizations and based on the results, increasing organizational support and psychological capital can provide the basis for improving the level of health in employees, and therefore managers and officials of organizations should plan in this regard.

    Keywords: Promote Employee Health, Organizational Support, Psychological Capital
  • Babak Asghari, Ali Fahiminezhad*, Bagher Morsal, Heydar Lotfi Pages 76-90
    Background & Aims

    Although sound waves are considered as an essential factor in human life, but in some cases and in special circumstances, hearing these sound waves is not very pleasant and exposure to annoying sounds too much will cause hearing loss in humans. (1). Noise pollution is defined as the emission of any kind of noise and excessive vibration in open spaces and is one of the examples of damage to the environment (2); So that it will have very clear effects on human health and ecosystems (3). In addition to the negative impact on the auditory system, noise as a stressful source will also affect the human heart and arteries and stimulate the nervous system, cause anxiety and increase mental health problems (7). Environmental conditions have a significant impact on how sound is emitted. However, after a period of exposure to noise, man becomes accustomed to those conditions; But again, noise pollution is a cause of fatigue and reduces the capacity of human work, both in mental jobs and in simple physical jobs. On the other hand, noise pollution affects the mental state of people and causes problems in adapting to their work environment and even the community and family; the result will be a reduction in productivity and productivity (10). Gyms and swimming pools are poorly sounded environments due to the lack of sound-absorbing materials, noisy sports activities, the simultaneous presence of many users, and the heavy use of whistles for communication. As a result, physical education educators not only suffer from prolonged stress and strain, but are also exposed to noise-induced hearing loss. Therefore, it is necessary to carefully analyze all the factors that can affect the noise in these environments, in order to provide guidelines for officials and planners for stress management and hearing protection programs (11). The present research is an applied research that has been done by networking method. The purpose of this study was to measure noise pollution in indoor pools with emphasis on the health of staff and users of indoor pools in Mashhad.

    Methods

    The sound level was measured as an equivalent level by the portable device and software Decibel X version 2020 and was compared with the sound standard (OSHA-90 dBA). Measurements Calculated the parameters of sound pressure level (SPL), average sound level (LP) ̅), continuous sound equivalent level (Leq) and individual daily dose of LAEp, d in 3 shifts.

    Results

    The lowest sound pressure level in the first turn was 76.5 dB and the highest pressure level in the second turn was 97.7 dB. The average sound pressure level increases with the change of time from morning (11 am) tonight (8 pm). The average sound level in indoor pools is equal to 78.4 dB and the level is equal to 85.42 and the individual daily dose of LEp, d personnel and users is 92.45 and 87.15 dB, respectively. The permissible noise exposure time was estimated at 1 hour and 30 minutes for users and 5 hours for personnel, indicating that users were 30 minutes and personnel 3 hours more exposed to noise pollution than allowed.

    Conclusion

    In the indoor pools of Mashhad, staff and users are exposed to high noise pollution and the possibility of physical and psychological injuries is high. Existing sound levels are higher than international and national standards and indicate that the use of engineering management principles is necessary to reduce the sound level in indoor pools. Swimming is one of the most popular sports activities. Diving in water, the whistling of coaches and saviors, moving equipment, the sound of music playing, athletes talking, emotional screams, etc. all provide the ground for raising the sound level. Accordingly, the prolonged or frequent presence of an athlete in an environment with high noise levels, can increase the risk of injuries due to noise pollution and may even reduce his efficiency. The results of the present study showed that the sound level in the shifts in which men were present was not much different from the shifts of women. Also, in the morning sports times (11/15/11), the sound level was significantly lower than in the evening (17-17-17), which is probably due to the smaller number of athletes in the morning compared to the evening.  In general, the absence of the above conditions has caused an increase in the sound level in the selected indoor pools. Of course, there was no significant difference in terms of sound level in different areas of Mashhad and in this regard, there can be no difference in terms of sound level published in indoor pools based on zoning in Mashhad. This research is methodologically consistent with the research conducted by Taheri et al. (1398) (32). But; their results cannot be generalized and compared with each other, because the environment studied in this study was closed space. However, the results are to a large extent consistent with the results of studies of Bahmanpour et al. (2011), Mafi et al. (2009) (28, 11). Comparison of the average sound level in the indoor pools studied with international standards shows that most of the measured pools (except pools 9 and 10) have a lower average sound level than the NIOSH, OSHA and ACGIH standards. However, all the pools studied have a sound level higher than the standard of the Environmental Protection Agency, as well as the standard of leisure centers and parks in the United Kingdom (which is equal to 55 decibels). They also differ from the United Nations Development Program (UNDP) standard of 55-65 decibels. On the other hand, the allowable exposure to the sound level in the studied pools for athletes is 1 hour and 30 minutes, which is basically 30 minutes less than the current time. In other words, at present, athletes are exposed to sound levels for about 30 minutes longer than allowed. Also, for employees (management and employees) the allowable limit of 5 hours was set, which is basically 3 hours less than the current situation. Therefore, due to the sound level in swimming pools, personnel should be present in the pool environment for 3 hours less so as not to be exposed to high sound levels.

    Keywords: Noise Pollution, Equivalent Noise Level, Athletes' Health, Indoor Pools, Mashhad City
  • Mojgan Gheyasvandian, Maryam Akbari*, Mahmood Godarzi, Omid Moradi Pages 91-101
    Background & Aims

    Having an exceptional child in the family often causes irreparable damage. The vulnerability of the family to this injury is sometimes so great that the family is severely damaged in terms of mental health. Quality of life is a broad concept that encompasses all aspects of life, including health. The term, which is also used in a variety of political, social, and economic contexts, is often used in medical research and is considered by most experts to have different dimensions: physiological, social, physical, and even spiritual. Acceptance and practice therapy has six central processes that lead to psychological flexibility. These six processes are: acceptance, failure, self as context, present communication, recognition of values and action, acceptance and practice therapy Its purpose is not to make a direct change in the client, but to help the client to relate to his or her experiences in different ways and to be able to fully engage in meaningful and value-based loss that seems to be able to help mothers of exceptional children. ; However, and in general, according to the presented principles, mothers with mentally retarded children have many challenges in quality of life and mood that these factors may affect the family structure as well as family relationships and marital issues. Cause problems for them in these areas. Therefore, appropriate solutions to improve the perception of quality of life and mood of mothers with mentally retarded children can improve the family environment. However, considering the research gap in the effectiveness of the acceptance and practice approach based on early maladaptive schemas on the quality of women with exceptional children, this study seeks to determine whether the causal model of acceptance and practice based on primary maladaptive schemas with a mediating role Does the difficulty in regulating emotion improve the quality of life of mothers of exceptional children fit the experimental model?

    Methods

    This research is both an experimental-field research that was performed by pre-test and post-test with the control group and also by correlation-modeling method. The statistical population includes all mothers with children with mental and physical disabilities in Kermanshah. 30 sample males were purposefully selected and randomly divided into two groups. Admission-based treatment interventions were performed on the experimental group in one of the exceptional children's schools twice a week in 90-minute sessions for eight sessions. Data collection tools included Weir et al.'s (1996) Quality of Life Questionnaire, the Hertzgertz and Roemer (2004) Difficulty in Emotional Adjustment Questionnaire, the Young (2005) Adaptive Schema Scale (2005), and the Bond et al. (2017) Acceptance and Action Questionnaire. In this study, covariance in SPSS software and structural equations in PLS software were used to analyze the data.

    Results

    The results show that the condition of non-alignment is met. The second criterion for evaluating the internal model is the path coefficients, which in order to examine their significance, the self-management procedure has been used. The results indicate that disconnection and rejection have a positive and significant effect on the difficulty of emotion  regulation; Impaired self-control has a positive and significant effect on the difficulty of emotion regulation; Orientation has a positive and significant effect on the difficulty of emotion regulation; Listening has a positive and significant effect on the difficulty of regulating emotion; Impaired limitation has a positive and significant effect on the difficulty of emotion regulation; Disconnection and rejection have a positive and significant effect on action and acceptance; Impaired self-government has a positive and significant effect on action and acceptance; Orientation has a positive and significant effect on practice and acceptance; Listening has a positive and significant effect on practice and acceptance; Impaired constraints have a positive and significant effect on action and acceptance, and the difficulty of regulating emotion has a positive and significant effect on action and acceptance. Also, based on the obtained results, the indirect effect of disconnection and rejection on action and acceptance is significant with the role of a difficult mediator in emotion regulation; The indirect effect of impaired self-regulation on action and acceptance is significant with a difficult mediating role in emotion regulation; Another indirect effect of direction on action and acceptance is significant with a difficult mediating role in emotion regulation; Another indirect effect of listening is significant on action and acceptance with a difficult mediating role in emotion regulation, and another indirect effect of impaired constraint on action and acceptance with a difficult mediating role in emotion regulation is significant. Also, the interaction between the group and the quality of life test is not significant. In other words, the data support the hypothesis of homogeneity of regression slopes (p = 0.188 and F = 1.830). Also, after adjusting the quality of life test pretest scores, there was no significant difference between the effects of the experimental and control groups (sig = .001 and. Therefore, the null hypothesis that there is no difference between the two groups is rejected and it is concluded that the education program based on the causal model of action and acceptance has been effective on the quality of life of mothers with exceptional children.

    Conclusion

    The goal of acceptance and practice therapy is to create more psychological flexibility. Psychological resilience refers to the ability to change or perpetuate behavioral classes of action that contribute to valuable goals. Because it is not possible to eliminate or displace the language processes that cause human problems, the goal is to bring these processes into contextual control. These processes are related to the change of central language processes that interfere with psychological flexibility. Acceptance and practice treatment interventions can be performed through any of these processes. In acceptance and practice therapy, no action is taken to reduce, change, avoid, suppress or control private experiences (thoughts and feelings). Rather, clients learn to reduce the impact of unwanted thoughts and feelings through the effective use of pervasive consciousness.

    Keywords: acceptance, practice causal model, Emotion regulation difficulties, Quality of life
  • Sanaz Baharestani, Naser Amini*, Moloud Keikhosrovani, Shahdokht Azadi, Kamran Mirzaei Pages 102-112
    Background & Aims

    The family is one of the most important social institutions based on marriage. The issue of marriage is one of the most fundamental issues of human society and the first sprouts of communication between generations appear in the family. Emotional relationships, love, affection, and empathy in the family ensure the mental health of individuals and the upliftment of human beings. But one of the biggest social problems in today's human society is family conflicts; therefore, addressing the issue of marital conflict to achieve prevention strategies is one of the most important necessities of family education. Marital conflict can be defined as the dissatisfaction of at least one couple with the relationship, which increases rapidly. The existence of marital conflicts between couples is inevitable and conflicts in couples' relationships are one of the consequences of harm in the family and a common phenomenon. Although the family gives its members a sense of security and peace, marital conflicts weaken relationships, increase marital problems, and do not meet the natural needs of couples. On the other hand, couples' expectations towards marriage and married life play an important role in marital conflicts, and the problems that arise through marital conflict cause irreparable damage to the family body. As a result, the need to strengthen family life and its stability and durability is the type of attitude and interaction of couples with each other, and communication beliefs are among the factors that affect the relationship between couples. Awareness and knowledge of couples of their role in creating a healthy and fruitful relationship are of particular importance; But sometimes, after a while, a couple or both of them may have doubts about the depth and shape of their relationship; Because they do not see the necessary harmony in the psychological distances between the beliefs of marital relations (their expectations from life) and the realities of their marital life, and they feel frustration and marital exhaustion. However, one of the most damaging factors that threaten marital life and its stability is that irrational and romantic beliefs enter the couple's life after marriage. Research has shown that high levels of irrational communication beliefs are associated with low levels of marital satisfaction. One of the biggest social problems in today's society is family conflicts; therefore, addressing the issue of marital conflict to achieve prevention strategies is one of the most important necessities of family education. This study aimed to investigate the effectiveness of sex enrichment training on marital relationship beliefs, expression, and sexual activity in women with marital conflicts.

    Methods

    In this quasi-experimental study, 50 women with marital conflicts were selected by the purposive sampling method and randomly divided into experimental and control groups. Eight 90-minute sessions were held for the experimental group for 4 weeks and the control group did not receive any intervention during this period. Participants were measured by the Barati and Sanai (1996) Marital Conflict Questionnaire, the Idelson-Epstein (1982) Communication Beliefs, the Halbert Sexual Index (1992), and the Rosen et al. (2000) Sexual Performance Index.

    Results

    The results of analysis of covariance, repeated measures test, and Bonferroni post hoc test showed that the scores of marital relationship beliefs among the experimental group decreased significantly, but in the control group there was no significant decrease and the scores of expression and sexual activity among The experimental group had a significant increase, but in the control group there was no significant increase, so there is a significant difference between the experimental and control groups. The follow-up results also showed that the effect of educational intervention was still stable.

    Conclusion

    The results of this study showed that sex enrichment training has a significant effect on marital beliefs, expression, and sexual activity in the experimental group who received the educational intervention, compared with the control group who did not receive educational intervention Significant changes were experienced in the dependent variables and also the follow-up results showed that the effect of educational intervention in the experimental group was still stable. Therefore, the hypotheses were confirmed. As a result, based on the evidence of the present study, this educational program can be used to improve the beliefs about marital relationships and the sexual expression and sexuality of women with marital conflicts. The Sex Enrichment Training Program helps couples reduce their communication problems by teaching them expressive speaking and listening skills. According to experts, in the approach of enriching sex, change and improvement are the results of the clients' own work, and the clients can overcome problems by acquiring special skills. As a result, in this training program, people are taught skills that can help people to achieve a healthy and happy life. Marital life combined with sexual intimacy requires skills that people in the family may not learn. In this training, conflict resolution skills and conversation skills are taught, and this training causes good couples to learn to listen and establish a good relationship with each other. This good listening skill reduces the couple's misunderstanding. In fact, enriching marital education leads to the growth of the marital relationship in a positive direction. People are also taught the skills to focus on their emotions and the feelings of their husbands, which results in the promotion of sexual intimacy and the ability to express sexual needs and desires by women and ultimately increase their sexual expression. The main limitation of this study is the taboo nature of sexual issues in society, and for this reason, some participants were cautious in their answers. Therefore, it is suggested that other researchers use this type of research with other effective intervention strategies on marital relationship beliefs, expression, and sexual activity in women with marital conflicts.

    Keywords: Sex Enrichment Education, Marital Relationship Beliefs, Sexual Expression, Sexual Functionality, Marital Conflict
  • Farideh Gholami, Hossein Baghooli*, Majid Barzegar, Maryam Kouroshnia Pages 113-124
    Background & Aims

    Patients with borderline personality disorder are known to have a clinically relevant heterogeneity in relation to severity of the disease and specific features, such as rage, rejection sensitivity, personality organization, or depression. There is little information about the importance of pathological narcissism for borderline patients (1). The limited evidence may be due in part to methodological difficulties in identifying Narcissistic clinical manifestations, which reflects disagreement among experts about this structure (2, 3). DSM diagnostic classifications appear as clusters of symptoms rather than being developed by a predetermined theory. The results are familiar but ambiguous. Classification is not effective enough. Among the dimensional models proposed to DSM to describe personality disorders, Kernberg's theory of object relations can be observed. For personality disorders, Kernberg eliminates these problems by shifting attention from borderline personality disorder to borderline personality organization (BPO). He places pathological narcissism on the subgroup of borderline personality organization. This conceptualization is a purely developmental theory, an explanation of the features of interpersonal relationships and defense mechanisms, and even including recommended therapies/treatment methods (4)A review of narcissistic descriptions based on clinical personality theories reveals that two types of vulnerable and grandiose narcissism are two areas of narcissistic personality disorder malfunction(5). Vulnerable narcissism is characterized by low self-esteem, self-criticism and devaluing , shame, social rejection sensitivity and isolation, Entitlement Rage, hiding the Self (6-8). Borderline personality disorder and vulnerable narcissism, although known as distinct structures but different qualitative structures, are interrelated (9). In fact, the characteristics of vulnerable narcissism may indicate a more general personality pathology similar to borderline personality disorder (10, 11).

    Methods

    The present study is descriptive and it has used of structural equation modeling and confirmatory factor analysis. In this study, 102 women and 58 men who had consulted to were client psychiatric clinics in Shiraz participated and received a BPD diagnosis of by a psychiatrist. Patients were selected by convenience sampling and voluntary selection from among those who had consulted to these centers. Explaining the principle of confidentiality of information, patients signed the consent form and then, completed the questionnaire under the supervision of a psychologist present at the center. Enterance requirements were/ to be eligible to apply included having over the age of 18 and at least holding a diploma, no use of psychiatric drugs, no experience of psychosis and mania, no significant medical problems, no mental retardation and no heavy drug use. Two questionnaires of borderline personality disorder and pathological narcissism questionnaire were used to assess the characteristics of psychopathology. Borderline Personality Disorder Questionnaire: The borderline personality disorder questionnaire was developed by Leichsenring in 1999(12) in order to assess borderline personality traits in clinical and non-clinical samples and is answered as yes or no. The questionnaire is essentially a 53-item scale based on the Kernberg concept of borderline personality organization as well as the DSM-IV diagnostic criteria.Pathological narcissism questionnaire: The Pincus’ pathological narcissism scale is a 52-item measurement tool that scores based on the 6-point Likert scale from " Not at all like me " to " Very much like me ". This tool measures the two dimensions of grandiose narcissism and vulnerable narcissism and has 7 dimensions or components including: contingent self-esteem (CSE), Self-Sacrificing Self-Enhancement (SSSE), Exploitativeness (EXP), Hiding the Self (HS), Grandiose Fantasy (GF), Devaluing (DV), and Entitlement Rage (ER).

    Results

    Fit indicators show that all indicators are in the desired range, so the structural model of the research is approved. Findings showed that the variables of vulnerable narcissism have a positive and significant effect on fear of intimacy (0.37), damaged reality testing (0.55), primary defense mechanisms (0.62) and identity difiussion (0.69). Also, the grandiose narcissistic pathway coefficient with fear of intimacy (0.71), damaged reality testing (0.64), primary defense mechanisms (0.38) and identity disorder (0.26) is positive and significant. In other words, vulnerable narcissism and grandiose narcissism predict the dimensions of borderline personality disorder.

    Conclusion

    In this study, pathological narcissism, a recent German version of the scale showing that the vulnerable and grandiose type is associated with borderline disorder was assessed (1, 13). Research shows that great grandiose and vulnerable traits in personality disorders are commonly reported together (14). This research is consistent with the studies of Miller, 2008 and Euler and Stubby, 2018 Kampe et al. 2021(1, 10, 15). In Melanie Klein's theory, the concept of envy and the mechanism of splitting has been used. Envy is one of the most primitive and fundamental emotions. Envy is a two-way relationship that aims to seize the whole goodness that can be pulled out of the object regardless of the consequences. This can lead to the destruction and contamination of its good. Envy wants to be as good as object, but when this is considered impossible, it tries to tarnish the goodness of the object in order to eliminate the source of these envious feelings. Due to the sources of excessive threat to the child's environment, the mechanism of the primary splitting which is vital to the child's development and is associated with the idealization of the good object, destroyed and the very good source on which the baby depends on growth is attacked and lost. As a result, the possibility of obtaining good introspection is eliminated, and what is internalized is only the bad part of the object. The ego will inevitably be damaged. In this case, a gap is created between the person and the object, and this vulnerability may lead to a person turning away from one’s grandiose narcissistic traits from any connection and intimacy.Kernberg, 1976 emphasizes confronting or exposure to the patient's pathological defenses that weaken the ego and reduce its ability to reality testing. Vulnerable narcissism is negatively correlated with the use of mature defenses. From pathological perspective, defense mechanisms in narcissism are perceived as a developmental consequence of early experiences of rejection and devaling by the child's primary caregivers (15, 16).Instability in identity and narcissistic traits are significantly related to eachother (17); The grandiose narcissist has a relatively accurate view of oneself. If failure occurs due to the loss or frustration of the love object, because of the connection between one’s self-image and one's image of the object, Object-focused aggression will also have targeted oneself.Aggressive devaluation of the object leads to self-humiliation and degeneration of self-esteem, and the loss of self-esteem leads to latent narcissistic conflict. Regression to the previous stages of development causes the person's emotional fluctuation in loving parents with absolute power and despair of the love objects and is seen in the form of disturbances in the identification, inability and feeling of emptiness in the borderline or psychotic person.The main essence of narcissistic personality is the existence of a deficit in its structure, which arises from the incompleteness of the process and the coherence and integration of grandiose self and ideal object in ego reality-focused structure. The patient is not fully aware of the pathological nature and state of consciousness and this is due to the feeling of incompleteness and imperfection of his reality and the world around the self. This constant narcissistic structure in borderline disorder suffers from psychological incoherence and resorts to delusions and even illusions to cope with the unbearable feeling of splitting and loss of ideal objects (18).

    Keywords: Grandiose Narcissism, Vulnerable Narcissism, Borderline Personality Disorder
  • Fatemeh Ghanbari, Ghasem Naziri*, Banafsheh Omidvar Pages 125-134
    Background & Aims

    Attention Deficit-Hyperactivity Disorder (ADHD) is one of the developmental neurological disorders, which is associated with significant disorders in developmental, cognitive, emotional, and educational issues. Mentalization-based therapy enhances the ability of ADHD children to empathize by increasing the reflective function of one’s own and others’ mentalizing capacity and improve the ability to see through the perspective-taking and understanding of one’s own and others' feelings under the influence of ego functions reinforcement. From the theory of ego psychology and object-relations approach, Attention-Deficit Hyperactivity Disorder (ADHD) is a disorder in ego functions (executive functions, inability to regulate emotions, problem-solving, etc.) and the development of a coherent senseof self in relation to others. These children have serious problems in interpersonal relationships, and failure and the dyad of frustration and anger are characteristic of their relationships (1). According to Fonagyet al. (1996), mentalization is a psychological process that facilitates explicit and implicit meaningful interpretation of one's own and others' actions, desires, thoughts, and intentions(2, 3). Mentalization is the result of secure attachment and relationship with the early caregivers. Metallization-Based Therapy (MBT) was originally developed by Bateman and Fonagy for adult patients with borderline personality disorder in the 1990s; but in recent years, this treatment has been used for a wide range of disorders, including childhood disorders. Its purpose is to improve the mentalization skills (understanding of the inner world, point of view and feelings, and one's own desiresand others’ intentions or theory of mind) in the child and the parent. The present study aimed to test the effectiveness of this treatment on the empathic function of children with ADHD, considering there are some deficits in empathic functionsduring developmental lines of such children.

    Methods

    The present study is an experimental study of a one-factor design with three groups of Repeated Measures. The study sample consisted of 60 children (30 girls and 30 boys) with school-age ADHD (6- to 12-year-old) who were selected by targeted sampling. These children first received an initial diagnosis by a psychiatrist and then were assessed by psychologists for entry and exit criteria using the K-SADS-PL DSM-5 diagnostic interview form. The participants’ parents completed EQ-SQ questionnaire in three stages (pre-test, post-test, and follow-up), describing their child. Participating children were randomly assigned to three intervention groups including pharmacotherapy with methylphenidate, MBT-C, and combined method. The interventions lasted for 36 sessions and a follow-up session was held again three months after the end of the treatment. To analyze the data, Repeated Measures ANOVA and Bonferroni Post Hoc tests were used. All participants signed an informed consent form for ethical considerations.

    Results

    MANOVA results showed that in the intergroup effect test between the three interventions (pharmacotherapy, MBT-C, combined method), there was a significant difference (P <0.001) in the empathy variable. The result of the intragroup effect test was also significant (P <0.001). In addition, the results of the Post Hoc test in  efficacycomparisons for the two-way between the three interventions showed that mentalization-based therapy and combined method were significantly different from the pharmacotherapy group; And its effectiveness in improving empathy in children with ADHD was confirmed. There was no significant difference in effectiveness between MBT-C group and combined method (P > 0.05).

    Conclusion

    The results confirm that mentalization-based therapy increases the level of empathy in children with ADHD. Mentalization-based therapy is a process-oriented therapy that uses plays to enhance mentalization and introspection, trying to teach and improve the reflective function, thinking, and mentalization capacity of children's mentalization and empathetic companionship and curiosity about the relationship with the child's inner experiences by the parents. Thus, MBT-C can be an effective intervention to improve empathy capacity in children with ADHD by focusing on the interaction of the inner and outer worlds and the regulation of emotions and interpersonal relationships.Data analysis of the present study showed that mentalization-based therapy was effective on empathy in children with ADHD and there was a significant difference between the three interventions of combinedintervention, MBT-C, and pharmacotherapy with methylphenidate in the empathy variable. And combinedintervention and MBT-C were more effective than pharmacotherapy on empathy in children with ADHD. Midgley et al. (2013) stated that the goal of Mentalization-Based Treatment for children (MBT-C) plants the seeds of curiosity and genuine empathy that create an atmosphere full of "emotional oxygen" for both the child and the parents so that they can face the pleasures and experience the challenges of life during the therapy(4). Taylor (2012) also utters that simple mentalization efforts such as support and empathy are effective in treating cases where there is high arousal in children (such as the emotional experiences seen in children with ADHD) (5).Given that mentalization-based treatment seeks to improve children's capacity for reflective functions, thinking, and mentalization, as well as educating reflective functions and practiceempathetic companionship and curiosity about the child's inner experiences to parents, it increases the effectiveness of treatment for ADHD children. Mentalization-based treatmentby use of play builds a powerful medium (for both the child and the parent and therapist) to explore relationships, to learn about the world of feelings, and to discover a psychological voice for oneself as a child. From a mentalization perspective, play is a form of social learning, as all kinds of experiences in daily life are rehearsed, changed, and completed, and integrated into the child's behavioral repertoire through this medium.

    Keywords: Mentalization-based Treatment, Attention Deficit- Hyperactivity Disorder (ADHD), Empathy
  • Mehrab Mafakheri*, Kamyar Mansori, Ali Salehi, Mohsen Akbarian, Narges Saeidi Pages 135-149
    Background & Aims

    Due to the international pain association, pain is usually defined as sensory and emotional experiences associated with actual or potential tissue damage. Chronic pain: pain with unknown etiology that lasts for more than 6 months after the lesion has healed and leads to emotional distress and increased use of resources in health care systems (1). Studies conducted among the Iranian population indicating that pain is a common phenomenon (2). and also, in some groups of patients, especially patients with experience of trauma and patients with post-traumatic stress disorder (3). The literature indicates that the experience of trauma can be considered as a predisposing factor in many diseases with chronic pain (4).in addition people who experienced trauma were more likely to develop physical, psychosomatic, and psychological disorders. And this issue, in the absence of the necessary precautions, leads to huge financial and psychological costs among the affected population for recovery and treatment (9,10). According to researches, in our country, Iran, less attention has been paid to the experience of trauma in the research. Also, there is no proper tools for screening these patients to use it for early assessment and identification of injured patients. In this regard, the Life Events Checklist (LEC) tool was developed and evaluated in accordance with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (LEC). The tool consists of 17 items and is designed to assess exposure to potentially traumatic events based on diagnostic criterion A for PTSD in accordance with the DSM-5 (9). Therefore, the researcher had two options to build a new tool or translate existing tools from the original language into Persian and determine its validity and reliability and cultural adaptation to his country and society.

    Methods

    The method of study is a cross-sectional descriptive and validation research. The statistical population of the study consisted of all patients that suffer from chronic pain. The sample size was determined by considering at least 300 participants for studies based on confirmatory factor analysis (15) and also using Krejcie and Morgan chart (16). The sample size was 350 participants. Three chronic pain clinics (chronic pain clinic, chronic pain clinic of Imam Khomeini, chronic pain clinic of Dr. Shariati hospital) were selected in Tehran. Due to the prevalence of COVID-19 to reduce the risk of transmission of the disease, an online questionnaire was designed to send links to the participant's cellphones, and after the necessary explanations, the individuals completed the questionnaires if they were satisfied. Inclusion criteria include age over 18 years, diagnosis of chronic pain by a chronic pain specialist, literacy and exclusion criteria include disagreement with the research conditions and having any physical disability that prevents participation in the study. Data collection was done with a life events checklist that contains 17 phrases which scored on a 6-point scale. To prepare the tool, first, items of the questionnaire was translated into Persian by two master's degree students in psychology. The validity of the content was then assessed by a faculty member in psychology. In the next step, the items were returned to English by a senior English language expert who had not previously read the original version of the questionnaire, and then the original version and the translated version of the questionnaire were reviewed by psychologists to prevent semantic difference in it. After the final version was prepared, the questionnaire was distributed among 36 participants with chronic pain as a pilot and the desired problems in some items were resolved. All participants were given written letter consent including a brief explanation of the objectives, research method, and principle of confidentiality and anonymity. After obtaining consent, participants were asked to complete a package of self-report questionnaires including a life event checklist scale, a chronic pain catastrophe scale, chronic pain self-efficacy, and life satisfaction.Data were analyzed by SPSS software version 25 and LISREL software version 8/8. In order to analyze the data from descriptive statistics (mean, standard deviation, frequency and percentage) as well as Cronbach's alpha method and retest test to examine internal consistency, the correlation of life events checklist scale with DASS-21 questionnaires and chronic pain catastrophe To assess convergent validity and the correlation of this questionnaire with chronic pain self-efficacy and life satisfaction questionnaires was used to assess divergent validity. Confirmatory factor analysis of LISREL version 8/8 was used for construct validity. Exploratory factor analysis was also used to determine the frequency of factors.

    Results

    The results showed that the phrases had good internal consistency and diagnostic power, except for the seventeenth question, which was excluded from the questionnaire. The correlation of the phrases with the total score varied from 0.27 for phrase 16 to 0.66 for phrase 4 and 14, Cronbach's alpha for the whole scale was equal to 0.86, which indicates the acceptable internal consistency of this instrument. The rate of retesting the questionnaire with a sample of 40 individuals in a period of 3 weeks was equal to 0.85, which is an acceptable score. Also, by considering the KMO value equal to 0/85 and rejecting the null hypothesis in the Bartlett sphericity test (p = 0.000, df = 136, x2 = 1786.27), The results showed that the conditions are ready for factor analysis. Primary analysis indicated four factors. The Scree diagram also supported the four-factor structure. The results related to factor loads show that all expressions have a common variance and a factor load greater than 0.46, in total, the four factors explain 0.56 variance. In the study, RMSEA between 0.8 and 0.10 indicates acceptable model and 0.95 CFI≥ indicates good model fit (27). According to the obtained results and the number of indices after using CFI (comparative fit index) correction indices value 0.95 GFI (goodness of fit index) value 0.90 and (normed fit index) NFI value 0.93 and also index the standardized root error of the mean squares of the RMSEA approximation is 0.7 and the degree of freedom x2 / df is less than 3, all indicating the relative suitability of the model after reformation.

    Conclusion

    Findings of the study indicated that the Persian version of the scale has an acceptable internal consistency in a sample of chronic pain patients. The findings were consistent with the results of Matt Gray et al., In which Cronbach’s alpha was reported in the study (18). The findings consistent with the study of Halip Bae et al., In whose study Cronbach's alpha was reported 0.66 (12). Another study conducted in South Korea were inconsistent with our findings. In explaining this issue, the concept of culturally oriented trauma can be well justified. In other words, the phenomenon of trauma has a cultural aspect and it is the cultural beliefs of a society that determine the traumatic nature of an event (29, 30). In general, according to the results it can be concluded that the checklist of life events in the Iranian sample with chronic pain is valid and the LEC scale has acceptable psychometric properties. Therefore, therapists and specialists in the field of mental health can use this screening tool in research to diagnose and evaluate trauma in order to prevent or reduce consequences and pathological symptoms.

    Keywords: Validity, Reliability, Confirmatory Factor Analysis, Life Events Checklist, Chronic Pain
  • Ainaz Holakouee, Sogand Ghasemzadeh*, AliAkbar Arjmandnia Pages 150-159
    Background & Aims

    Anxiety disorders and depression are the most common emotional disorders in adolescence, which in addition to the direct costs they impose on the community health and care system, also have indirect costs (functional decline) that are higher than other psychological disorders. Allocates the amount to itself (4).One of the most interesting aspects of anxiety disorders is the subtle interaction that exists between hereditary and environmental factors that cause these disorders (5). For this reason, paying attention to the family environment is very important in explaining and treating anxiety disorders. Each family uses special methods for individual and social upbringing of their children, which are called parenting methods. These methods are patterns of child rearing that are formed from the normal interaction of parents and their response to children's behavior (7).Since the mother's communication pattern plays an important role in the child's emotional and social development in the future and can improve children's behaviors, it seems that training sessions for parents to manage emotions in interaction with children can improve parents' skills. Equip them with good upbringing, and in these circumstances, parents can better behave decisively towards their children by setting constructive rules in the family and managing their negative emotions (10).In the meantime, integrated meta-diagnostic therapy in response to the limitations of cognitive-behavioral therapies such as the failure of these therapies to improve a significant portion of patients, the existence of multiple guidelines and treatment plans for each disorder and confusion in choosing the appropriate patient guidelines Has been (14). The main goal of integrated meta-diagnostic therapy is for individuals to acquire skills that can effectively manage their negative emotions (15). Given the above and the impact of anxiety on adolescents' personal, family and social lives and the imposition of heavy costs on the individual and society on the one hand, finding a way to reduce the negative effects of anxiety on the other hand and because reviewed research No research has been found on the subject at home or abroad. The researcher seeks to answer the question of whether an integrated transdiagnostic treatment program affects anxious adolescents and their mothers' parents.

    Methods

    To conduct the present quasi-experimental research, which was conducted as a pre-test-post-test with the experimental and control groups, among all anxious adolescent girls in the age range of 12-15 years in the first grade of high school in Tehran in the 98-99 academic year, 20 Paying attention to the entry and exit criteria from one of the schools in Tehran were selected and randomly assigned to experimental and control groups.Then the therapeutic stages of an integrated meta-diagnostic approach, including five main stages of treatment (emotional awareness based on mood 2. cognitive flexibility 3. emotional avoidance and behaviors caused by emotion 4. awareness and tolerance of bodily feelings and 5. endogenous and situational emotional exposure) ( 16). And 12-16 sessions and ranged approximately 50 to 60 minutes weekly. Also, to collect data, the Spence Anxiety Questionnaire was used to assess the anxiety of children aged 8-15 years old in 1997 and the Arjmandnia Parenting Methods Questionnaire 24 hours before and 48 hours after the intervention. Finally, the collected data were analyzed using univariate analysis of covariance (ANCOVA) and multivariate analysis (MANCOVA).

    Results

    The results of descriptive statistics of children's anxiety showed that the mean obtained for the experimental group in the pretest is 142.70. With a decrease of 16.07 points in the experimental group, the average score in the post-test has reached 126.63.Regarding the effect of intervention on anxiety, the results of analysis of covariance showed that the integrated meta-diagnostic treatment program had a significant effect on reducing adolescent anxiety (F = 59.5). The average score for the experimental group in the pre-test is 27.53. With an increase of 3.96 points in the experimental group, the average score in the post-test has reached 31.49. Also in the component of authoritative behavior: the average achieved for the experimental group in the pre-test is 8.74. With an increase of 4.67 points in the experimental group, the average score in the post-test has reached 13.41. Finally, in the component of parental dependence: the average achieved for the experimental group in the pre-test is 9.53. With a decrease of 3.55 points in the experimental group, the average score in the post-test has reached 6.48.Regarding the effect of intervention on parenting, it was found that the value of Pilay effect is 0.72 and the value of Lambeda Wilkes is 0.28, both of which are significant at the level of P 0.0 0.01. Therefore, the dependent variables (parenting components) of the experimental and control groups are significantly different from each other.Finally, the results of univariate analysis of covariance on the components of parenting show that the value of F obtained in the two components of authoritarian behavior and parental dependence is significant at the level of P 0.0 0.01. Therefore, the difference between the experimental and control groups is significant in these components. Considering that in the component of authoritative behavior, the mean post-test score of the experimental group increased compared to the pre-test and in the component of parental dependence, there was a decrease in the component, so it can be said that integrated meta-diagnostic treatment program increased authoritarian and dependent behavior. reduces; But the effect of the independent variable on democratic parenting was not significant.

    Conclusion

    In general, meta-diagnostic therapies are an emotion-focused meta-diagnostic and cognitive-behavioral therapy that can be used for a wide range of emotional disorders using emotion regulation skills (22). Emotional response management is the core of transdisciplinary practices and seeks to teach individuals to recognize their emotional responses, modify and regulate their emotional habits to reduce the severity of emotional trauma (23). The use of negative cognitive emotion regulation strategies is associated with mental health problems. Among the negative strategies, self-blame, mental rumination and catastrophic captivity, strong correlation with negative emotions such as depression, anxiety, anxiety (24).In summary, to alleviate the problems associated with anxiety, researchers consider the use of cognitive-behavioral and emotional components in therapy necessary (17) and integrated programs have been used to identify multiple problems and benefit from cost-effective multiple therapies; But if these programs are not effective, it is necessary to reduce the anxiety, should consider the cognitive-emotional schemas of individuals and eliminate cognitive distortions, emotional schemas (24).

    Keywords: Adolescent, Anxiety, Parenting Methods, Transdiagnostic Treatment
  • Davood Hemmtian Khayat, Hamid Nejat*, AliAkbar Samari, Ehsan Ormaz Pages 160-168
    Background & Aims

    During an outbreak of a disease such as coronary heart disease, fear of disease and fear of death, along with disruption of daily activities, cause people to become involved with disease anxiety (1). Anxiety about Covid-19 is common, and seems to be due to the fact that it is largely unknown and confusing to people about the virus. Fear of the unknown reduces the perception of safety in humans and has always been anxious for humans. About Covid-19 This lack of scientific information also exacerbates this anxiety (2).Turbulence tolerance, on the other hand, is defined as the capacity to experience and tolerate negative psychological states. Disorder may be the result of cognitive or physical processes, but it manifests as an emotional state that is often characterized by a desire to act to alleviate the emotional experience (3). Therefore, increasing the tolerance of turbulence can help improve the mental health of people, especially the survivors of Quid-19 disease. In addition, it seems that the inability to regulate emotion during threatening and anxious situations can also be an important factor in coronary anxiety. The importance of the subject is such that psychologists define emotion regulation as the process of initiating, maintaining, and modifying one's experience and expression of emotions (4). Due to the above, anxiety control and emotion regulation are very important for survivors of coronary heart disease, so researchers are looking for a way to improve the psychological condition of these people. In this regard, one of the new therapies that treat the third wave. It is well known and has attracted the attention of many psychologists in recent years, it is a dialectical behavior therapy. Which is a cognitive-behavioral method that was first used to treat borderline disease and its core is emotion (6). Also, another new treatment method is compassion therapy. Self-compassion as a way to reduce anxiety associated with mental disorders. Compassionate therapy can play a protective role against depression, anxiety and repressive thinking. This treatment can develop self-compassion and reduce self-critical burden of depression, anxiety and stress, suppress negative thoughts and emotions, and emotional regulation. And be self-controlled. Self-compassion is defined as a three-component construct including kindness to oneself versus self-judgment, human commonalities versus isolation, and mindfulness versus increasing assimilation (8).Considering the above, the effect of corona on anxiety and cognitive regulation of emotion on the one hand, the importance of using a method to control and reduce these symptoms in coronary survivors on the other hand, contradiction in research results and lack of research Research variables Therefore, the researcher seeks to answer the question of whether there is a difference between the effectiveness of dialectical behavior therapy and compassion therapy on anxiety, tolerance of turmoil and emotional regulation in survivors of Covid-19 disease or not?

    Methods

    The present study was quasi-experimental with pre-test and post-test design with  control and test groups. The population of the present study consisted of the survivors of coronary heart disease victims in Mashhad who were members of social networks in the spring and summer of 1399. Inclusion criteria included 3 to 10 months after the death of a family member due to corona, having at least a diploma, not undergoing psychological treatment, not taking psychiatric drugs and no stressful events such as divorce and death of loved ones in three months In the past, being 30 to 60 years old and not having a history of divorce and exclusion criteria included missing more than one session and canceling further cooperation. The questionnaires were designed and provided to the subjects through social networks (Telegram, WhatsApp and Instagram channels) so that people who want to participate in the research can answer the questions. A total of 60 people were selected by available sampling method and randomly replaced in three equal groups (10 pairs in each group). The intervention groups were trained in 10 sessions of 90 minutes separately with dialectical therapy and compassion therapy methods and the control group was placed on a waiting list for training. In this study, data collection tools are: 1. Demographic information questionnaire, 2. Corona anxiety questionnaire (Alipour et al., 1399) (14), 3. Emotional regulation questionnaire (Graz and Roemer, 2004) (15), 4. Turbulence Tolerance Questionnaire (Simmons & Gaher, 2005) (3), 5. Dialectical Behavior Therapy Protocol and 6. Compassion-Based Therapy Protocol. Finally, descriptive statistics (table and graph) and Shapiro-Wilk tests, analysis of covariance and Bonferroni post hoc using SPSS software were used to analyze the data.

    Results

    The results showed that the statistical significance of Wilkes's lambda test was less than 0.05 and was therefore significant. Therefore, it can be found that there is a significant difference between the groups of dialectical therapy, compassion therapy and control in at least one of the variables of coronary anxiety, disturbance tolerance and emotional regulation. Therefore, according to the above results, there are conditions for using multivariate analysis of covariance.On the other hand, it was found that there was a statistically significant difference between the intervention methods in all three variables of coronary anxiety (CS), perturbation tolerance (DT) and emotional regulation (ER).The results of post hoc testshowed that both dialectical and compassionate therapies significantly reduced coronary anxiety, increased turbulence tolerance and increased emotional regulation in comparison with the control group. Also, dialectical therapy was more effective in reducing coronary anxiety, increasing turbulence tolerance and increasing emotional regulation compared to compassion therapy.

    Conclusion

    In general, the results showed that: Dialectical therapy significantly reduced coronary anxiety, increased disturbance tolerance and increased emotional regulation. Compassion therapy significantly reduced coronary anxiety, increased turbulence tolerance, and increased emotional regulation. Dialectical therapy is more effective than compassionate therapy in reducing coronary anxiety, increasing turbulence tolerance, and increasing emotional regulation. The findings of the present study are consistent with some of the results of research by Soler et al. (2009) who concluded that dialectical behavior therapy is effective in improving anxiety and emotional instability (16). Also, the results of the present study confirm some of the findings of the study of Steele et al. (2011) who found that dialectical behavior therapy reduces anxiety symptoms (17). In addition, the findings of the present study, along with some of the results of research by Wang et al. (2020) who found that compassion therapy is effective in conceptualizing emotional responses (18). Is consistent. On the other hand, the results of the present study confirm some of the findings of the study of Richard and Ser (2015) who found that dialectical behavior therapy is effective in improving anxiety (9). Also, the findings of the present study are consistent with some of the results of Modarres Gharavi (2011) that receiving dialectical behavior therapy is effective in significantly increasing anxiety tolerance.

    Keywords: Anxiety, Turbulence Tolerance, Emotional Regulation, Dialectical Behavior Therapy, Compassion Therapy
  • Vahid Sammehr, Farnaz Farshbaf Manisefat*, Ali Khademi, Rahim Shabani Pages 169-178
    Background & Aims

    Coping Disorder is a type of destructive behavior disorder in childhood and adolescence that includes a set of behaviors based on stubbornness, disobedience, inattention, hostility, resentment, arguing, and trying to upset others. One of these important components in these children is interpersonal cognitive distortion. . It is defined as very exaggerated, rigid, irrational and absolute beliefs about the nature of relationships, and the relationship of people with others. People with confrontational disobedience disorder experience individual and interpersonal cognitive distortions and are part of aggressive behaviors. These people are the result of these distortions. There is a strong relationship between cognitive distortions and extrinsic disorders, with high levels of cognitive distortions being associated with high levels of extrinsic problems. Therefore, in the treatment of people with confrontational defiant disorder, this variable also needs clinical attention. . Interventions based on cognitive behavioral therapy have a significant effect on reducing the symptoms of defiant disobedience disorder and is one of the most important components in the field of hypnotherapy. However, although research reports suggest that these two therapies may be effective in reducing adolescent distortion with coping disobedience disorder, it has not yet been addressed. Given these cases, the present study in a quasi-experimental study addresses the question of whether there is a difference between cognitive-behavioral therapy and hypnotherapy in terms of effectiveness in reducing cognitive distortions in adolescents with confrontational defiant disorder?

    Methods

    The study was a quasi-experimental study with a pretest-posttest design with a control group and a one-month follow-up period. The statistical population of this study included all high school students of the first period (seventh, eighth, ninth) in Urmia city who had symptoms of confrontational disobedience disorder who were studying in the educational schools of this city in the academic year 1400-1399. Among them, students suspected of having symptoms of confrontational defiant disorder were purposefully selected using the help of school principals and teachers and examined by a psychologist using a structured clinical interview to accurately diagnose the disease. After identifying these adolescents, their parents were interviewed and asked to respond to Aachenbach's behavioral checklist of their children's behaviors. They were selected from among the 75 people who were interviewed, 51 (17 for the cognitive-behavioral therapy group; 17 for the hypnotherapy and 17 for the control group) and after completing the research tools in the pre-test stage, they were randomly selected. Groups were placed. Then, the cognitive-behavioral therapy group was intervened according to the standard protocol of Houghton et al. However, the members of the control group did not receive any intervention and after one month, a follow-up test was performed. At the end of the sessions, the research scales were used again. SPSS software version 22 and repeated measures analysis of variance were used to analyze the data.

    Results

    In the studies, cognitive distortion in the cognitive-behavioral therapy group had a significant reduction both in the post-test and in the follow-up stage compared to the control group. While in the hypnosis group, there is no significant difference in any of the three stages, because in this study, repeated measures analysis of variance is the basis of the analysis. Mouchley and Looney's value can be said to hold the assumptions of repeated analysis of variance . . Then, the effects of hypnotherapy and cognitive-behavioral therapy on cognitive distortion in adolescents with coping disobedience disorder in the post-test and follow-up stages were discussed. By referring to the significant level values that this value is less than 0.01, which shows a significant difference in the pre-test, post-test and follow-up stages. Also, considering the effect of the group, it was observed that the significance level of this test is less than 0.01, which indicates the difference between the two treatment groups in reducing interpersonal cognitive distortion . Therefore, it can be said that the rate of cognitive distortion in the two groups has changed differently and between the two groups in terms of power to reduce cognitive distortion is different. As can be seen, the course of hypnosis treatment has not had much effect on the rate of cognitive distortion in the post-test and follow-up phase, while this effect is significant through the course of cognitive-behavioral therapy.

    Conclution

    The aim of this study was to compare the effectiveness of cognitive-behavioral therapy and hypnotherapy on reducing interpersonal cognitive distortion in adolescents with confrontational disobedience. has done Because the main philosophy of cognitive and behavioral therapy is to reduce distortions and cognitive errors, and this treatment has been able to be effective in both stages of post-test and follow-up in this area. In the sessions, using direct and indirect questions and interaction with adolescents, a list of problems and types of dysfunctional and distorted cognitions was presented to confirm or disapprove them, and thus the list of the most important cognitive distortions of each client in the form of Separately extracted and with the help of the therapist and by examining these distortions in the context of their own real life, they have a more logical view of the facts around them and evaluate the facts with more analysis. Although in the present study and in the intervention sessions, the cognitions of cognitive distortion were also discussed and these skills were taught, but in general, cognitive distortions seem to be resistant to change through indoctrination and hypnotherapy and to direct treatments. The more they respond the better. One of the limitations of this study is the coronary conditions that caused parents and adolescents to have serious doubts about attending face-to-face meetings. Meetings were held online at the height of the Corona crisis.

    Keywords: Cognitive-Behavioral Therapy, Oppositional Defiant Disorder, Adolescents, Interpersonal Cognitive Distortions, Hypnotherapy
  • Mohsen Pormenati*, Fatholah Havil, Mojtaba Delaram Nasab Pages 179-187
    Background & Aims

    Diabetes is a chronic progressive disease that has physical, metabolic, social and psychological challenges and increases the risk of concomitant mental health problems (1). Accelerated macrovascular complications in type 2 diabetes are due in part to increased metabolic side effects such as elevated cholesterol and LDL (4). In this regard, research has shown that there is a close relationship between fat percentage, body mass index and insulin concentration (5).Because the challenges of diabetes affect many aspects of patients' daily lives and their families, psychosocial assessment and treatment is a vital part of comprehensive diabetes care. The diabetic must accept that he or she may have diabetes-related complications; The patient should consider themselves an important member of the diabetes care team, not the person being cared for by the treatment team. Emotional stress can cause behavior change so that the other person does not follow their own diet, exercise, and treatment (6).For this reason, researchers have long used various methods to reduce the negative effects of diabetes, so that the effect of physical activity in the treatment of type 2 diabetes has long been known (7). Although a lot of research has been done in this field, but there is a big difference between the results of research (8).Regarding the treatment of mental problems of diabetic patients, considering that the use of sedatives and other drugs is always associated with many side effects, and today in the global medical system, more efforts are made to prevent and treat diseases without the use of drugs. It seems that participating in a regular and codified exercise program can play a major role in reducing the effects of diabetes, improving mental health and reducing the negative psychological effects of diabetes.Due to the conflicting results of research, researchers are trying to use different training methods to get the best results, so it seems necessary to design new protocols and study their impact on various factors. Also, considering that there is little research that in addition to examining the effect of aerobic exercise on metabolic side effects has examined the effect of these exercises on psychological factors in diabetic patients, the researcher seeks to answer the question of whether pyramidal aerobic exercise on cholesterol, HbA1c, LDL, affect anxiety and stress in type 2 diabetic patients?

    Methods

    For the present quasi-experimental study, which was performed with a pre-test-post-test design, 30 patients with type 2 diabetes in Zabol city were selected by convenience sampling and randomly divided into two groups. The research method was that 24 hours before and 48 hours after the last training session from the beginning of the research, the research variables in the pre-test were measured using blood sampling and Beck Anxiety and Stress Questionnaires. The training protocol in the present study included 8 weeks, 3 sessions per week and each training session included 45-60 minutes of pyramidal aerobic training in 3 stages. The volume of each training interval based on the intensity of training and the ability of the subjects started from light intensity in the first interval and increased in each interval.Resistance was also calculated using the reserve heart rate of each individual using the caronene formula (20). In order to observe the principle of overload, the training time was started from 15 minutes and reached 35 minutes in the eighth week. To divide the time in each interval, the total training time was divided into 3 parts; In the first 1.2, light exercise was performed (50-35% of the reserve heart rate). In the second interval, the training, which included the remaining 2.3 of the training time, was performed with an intensity of 50-65% of the reserve heart rate. The rest time between each interval was 3 minutes. Finally, descriptive statistics (tables and graphs) and Shapiro-Wilk tests, paired t-test and independent t-test were used for statistical analysis of data.

    Results

    The results showed that after 8 weeks of pyramidal aerobic training, cholesterol, LDL, HbA1c, depression, anxiety and stress in the experimental group were significantly reduced in the post-test compared to the pre-test. However, in the post-test control group, this value increased compared to the pre-test, but was not statistically significant.The results were compared with the control group to ensure that the decrease in research variables was due to the present research protocol. Control can be confidently reported that the changes were due to the training protocol.

    Concluson

    Findings of this study showed that 8 weeks of aerobic exercise significantly reduced total cholesterol, HbA1C, LDL, anxiety, depression and stress in patients with type 2 diabetes. In the above explanation, it can be said that research has shown that muscle contraction has an insulin-like role and sends a large amount of glucose into the cell to be used for energy production. 33 Muscle contraction increases membrane permeability to glucose, possibly due to an increase in the number of glucose transporters in the membrane. Exercise (Glut4) increases plasma in trained muscles, which improves Glut4 levels of insulin on glucose metabolism (28).In the above explanation, it can be said that physical activity in women increases the level of progesterone and this increase reduces psychological symptoms such as anxiety. In general, physical activity seems to improve mood symptoms, including anxiety, by the mechanism of action on cerebral endorphins (34). Physical activity increases the efficiency of the mind, the feeling of freshness and health, and provides a good mental attitude to life, provides mental health. Women are more affected by the psychological factors of physical activity than men and their sense of well-being increases more than men (35). Research has shown that anxiety and stress are caused by a lack of self-confidence in people. As Farad's social interactions increase in team sports, their self-esteem improves and self-confidence increases. On the other hand, team sports reduce stress and anxiety. Although self-confidence was not examined in the present study, it may be one of the mechanisms related to the findings of the present study.

    Keywords: Type 2 diabetes, Exercise, Metabolic complications, Psychological characteristics
  • Gona Fathi, Maryam Akbari *, Omid Moradi, Fardin Abdollahi Pages 188-196
    Background & Aims

     Separation anxiety is known as one of the most fundamental and fundamental fears in human beings that separation anxiety does not disappear with growth and maturity; Rather, it is less visible in adulthood than other psychological problems and often appears alongside other pathologies or some of them. Separation anxiety is predictable in children entering school for the first time, but the diagnosis of this disorder is made when excessive anxiety is disproportionate to the level of development and when separating from the attached person. Separation anxiety disorder is a mental disorder in which a person becomes very anxious due to being away from home or from people with whom they have a lot of emotional attachment. This disorder can cause severe disorders in various aspects of life (such as academic or social performance). Other research has also shown that fostering a healthy parent-child relationship can promote a child's psychological development and prevent psychological damage during his or her lifetime. The type of parental relationship and their interaction with children can have a significant impact on how anxiety disorders develop in children. In most theories of child and adolescent development, the importance of mothers' behavior has been considered. Among mental disorders, anxiety and depression were the most studied disorders in the area of mother-child relationships. Therefore, parental management training is a type of psychological intervention for clinical problems in the field of child and adolescent psychotherapy with the aim of training parental management in reducing the problems of children and adolescents. This program has caused cognitive-emotional change of parents and mutual change of child behavior and has led to increasing parents' awareness of how to deal with children, the skill of controlling emotions against children's behavior and setting appropriate rules and regulations at home. The purpose of this research was to determine the Effectiveness of training differentiation, mother's empathy and child- Parent relationship on separation anxiety disorder students.

    Methods

     The research method was applied research and was a kind of pre-posttest Quasi-experimental design with control group. The statistical population of the study consisted of the Mothers with daughters with separation anxiety disorder syndrome whose child / children in one of the preschool centers in Kermanshah. 60 of them were randomly assigned into two groups of 30 experimental and control groups. Differentiation, empathy, child- Parent relationship was conducted on the experimental group in 8 sessions of 80 minutes. The research data were collected through separation anxiety disorder Hahn, Hajinlian, Eisen, Winder & Pincus (2003) questionnaire. Then the hypotheses were tested using spss software.

    Results

     According to According to the obtained results, it can be said that the training differentiation, mother's empathy and child- Parent relationship can provide the basis for reducing separation anxiety disorder students.

    Conclusion

     Separation anxiety is known as one of the most fundamental and fundamental fears in human beings that separation anxiety does not disappear with growth and maturity; Rather, it is less visible in adulthood than other psychological problems and often appears alongside or part of other pathologies. Separation anxiety is predictable in children entering school for the first time, but the diagnosis of this disorder is made when excessive and disproportionate anxiety occurs when separating from the attached person. Separation anxiety disorder is a mental disorder in which a person becomes very anxious due to being away from home or from people with whom they have a lot of emotional attachment. This disorder can cause severe disorders in various aspects of life (such as academic or social performance). The fourth revised text, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) classifies separation anxiety as a disorder that is first diagnosed in infancy, childhood, or adolescence. Disproportionate anxiety disorder in the DSM-5 is divided into two types: the first type, separation anxiety disorder, starting in the DSM-5, has been reported as disproportionate in dealing with being away from home or being separated from those on whom the child is dependent. Adult (ASAD) and another type starting in childhood (CSAD), researchers have confirmed the importance of parental factors in trying to identify the factors affecting child separation anxiety (Khorshidvand, Rahimian Booger and Talepsan 2015 and Pirzadi 2018). In this regard, Ingelberg and Ssuberg (2005) showed that positive parental behavior reduces child anxiety. Arab, Al-Kashki, and Hadwin (2015) showed that childhood separation anxiety disorder is a definite factor in predicting ADHD in adulthood. And the findings of Kern, Renault, Kendall, Wood, and Stork (2017) suggest that when a parent fails to recognize and respond appropriately to a child's emotions, the child, because of his or her role modeling, is able to recognize and manage his or her emotions. Loses and easily becomes anxious.

    Keywords: Differentiation, Empathy, Child- Parent Relationship, Separation Anxiety Disorder
  • Touran Shahraki, Maryam Nakhaee moghadam * Pages 197-204
    Background & Aims

     Obesity, which is defined as a body mass index above the 95th percentile (according to age and sex), is a chronic disease whose prevalence in adults, adolescents and children is increasing and is currently considered a It is considered a global epidemic. In many societies, the prevalence of overweight and obesity has increased during the last 2 decades. In the United States, the lifetime risk of overweight and obesity in each person is 50% and 25%, respectively. Analysis of the results of studies in 144 countries of the world shows that in 2010, about 43 million preschool children were overweight or obese, of which 35 million are from developing countries and 92 million children are at risk of being overweight. Also, overweight and obesity in preschool children has been increasing rapidly, from 2.4% in 1990 to 6.7% in 2010, and it is expected to reach 9.1% in 2020, i.e. reach 60 million children. Obesity is a multifactorial disease that is caused by various genetic and environmental factors. As the first place where a child grows, the family is important from various dimensions. Several studies that have been conducted in the field of factors related to obesity in children have indicated the important role of parents in the occurrence of obesity in children. Heredity on the one hand and behavioral and nutritional patterns on the other hand justify this relationship. There is strong evidence that shows that the family lifestyle and eating habits formed in the family play an important role in the type of nutrition and the child's weight; In addition, the mother's obesity probably affects how she responds to the child's needs. In many studies, parental obesity, especially maternal obesity, has a direct relationship with child obesity, and in some studies, it is known to be the most important factor related to childhood obesity. Obesity in children is associated with an increase in morbidity in childhood, so that outpatient visits, hospitalizations and the need for treatment are more in obese children than in non-obese children. In addition, childhood obesity is associated with various complications. These obesity complications include metabolic complications (increased risk of type 2 diabetes, hyperlipidemia, hepatic Steatosis, gallstones, increased blood insulin, impaired glucose tolerance test), respiratory and cardiac complications (asthma, sleep apnea, cardiovascular diseases, high blood pressure, cardiac hypertrophy, sudden death), orthopedic diseases (degenerative joint disease, slipped epiphysis of the femoral head) and other complications such as proteinuria, infertility, cancer, obesity in adolescence, depression, anxiety and discrimination in the social and work environment. On the other hand, obese children who remain obese in adolescence may become severely obese in adulthood, such that 80% of adolescents who are obese remain obese in adulthood. Abdominal obesity is more common in adolescent girls than in adolescent boys, which is associated with a higher chance of diabetes. Considering the very high prevalence of obesity and the various complications caused by it, and also considering that the studies conducted in the field of metabolic and endocrine complications of obesity in Iran are few, in this study we intend to further investigate the metabolic and endocrine complications in Let's go to the endocrinology clinic of Ali Asghar Hospital in Zahedan.

    Methods

     The inclusion criteria in the study population include obese children aged 5 to 18 years who were referred to the endocrinology clinic of Ali Asghar Hospital in Zahedan in 2015. Exclusion criteria are unwillingness to participate in the study, mental retardation or having Syndromic diseases, history of chronic disease, or taking medication. Descriptive statistics including mean, standard deviation, and frequency were used to describe the data. Also, to analyze the data, the statistical tests of Student's T, Chi-square, and Pearson's correlation coefficient were used.

    Results

     In this study, 60 children with obesity were investigated, 52% were boys and 48% were girls. The average age of the studied children was 9.9 ± 3.0 years (with a minimum of 5 and a maximum of 17 years). 5.8% of the children had a BMI between the 85-95th percentile for age and sex, and 94.2% of them had a BMI above the percentile. They had 95% for age and sex. In this study, 57% of children had fatty liver in ultrasound (45% grade 1 and 12% grade 2) and 43% were normal.

    Conclusion

     Independent T-test showed that mean FBS, AST, and ALT in boys are significantly higher than in girls. Other parameters were not significantly different in boys and girls. In this study, 57% of the children had a fatty liver ultrasound and 51% of the studied children had precocious puberty. Also, the results showed that 91% of children had normal FBS, 54% normal cholesterol, 33% normal HDL, 73% normal LDL, 40% normal triglyceride, 96% normal AST, 73% normal ALT, 85% normal HbA1C, 30% They had normal insulin, 85% normal TSH, 94% normal T4 and 22% normal vitamin D. The results of the study showed that there are more metabolic complications such as fatty liver and endocrine complications such as Hyperinsulinemia and hyperlipidemia are more common in obese children. Therefore, first of all, it is recommended not to gain a lot of weight in children. If a child is overweight, the endocrine and metabolic effects of obesity should be investigated to be treated faster.

    Keywords: Endocrine, Metabolic, Obese