Razi Journal of Medical Sciences

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Background : The growth of any society depends on its students in the future; accordingly, countries spend significant amounts of their income on their education systems. However, depression reduces the quality of students’ mental health (1). Existing research, such as Mortier et al. (2) and Pillay et al. (3), show that depression is prevalent among students (4). Some students manage to cope with it, while the subjective well-being has troubled others. Therefore, it is crucial to know the effective strategies for alleviating the depression symptoms of students (5).
Mental well-being denotes individuals’ evaluation of life and comprises both reflective cognitive judgments (such as life satisfaction) and emotional responses to life when experiencing positive and pleasant emotions versus unpleasant and negative emotions (7). It includes emotional (Emotional well-being), social (Social Well-being), and psychological (Mental Well-being) categories. The psychological category can be defined as an individual’s ability to express his satisfaction without allowing others to influence the experience of positive feelings (8). The emotional category refers to the presence of positive emotions, the absence of negative emotions, and satisfaction (9). Social category is the evaluation and recognition of an individual on how he functions in society and the quality of his relationships with individuals and social groups (10).
Mindfulness-based interventions are among the efforts aimed at effectively and efficiently reducing depression symptoms in students (12). It enables clients to understand their experiences non-judgmentally and alter their relationships with others by challenging and accepting their beliefs and feelings (15).
Behavioral activation is one of the effective treatment methods (17), which assumes that the life problems of vulnerable individuals take away their ability to receive positive reinforcement from the environment. This is based on emphasizing the major and real factors causing depression, i.e., the reduction of rewarding activities and the increase of avoidance behaviors and ruminative thoughts (19).
Shahsavari (2022) found that mindfulness improved well-being scores (24). Ghamari (2021) reported that mindfulness increased psychological well-being (25). Bahreini (2021) indicated that mindfulness influenced the well-being level (26). Yosep (2023) concluded that mindfulness could help improve psychological well-being (27). Ghodrati and Vaziri Neku (2018) found that behavioral activation therapy affected psychological well-being (28). Mazzucchelli (2010) realized that the effectiveness of behavioral activation intervention was comparable to the integrated effect of positive psychology interventions on well-being (29). A meta-analysis conducted by Stiles-Shields (2014) showed that behavioral activation positively impacted depression. (30).
The review of the literature revealed that no systematic study has yet been conducted on this topic in Iran. Therefore, the purpose of the current research is to answer the question of whether there was a significant difference between the effectiveness of behavioral activation training and mindfulness training on the mental well-being of students with depressive syndrome.
Methods: The research was semi-experimental with a pre-test, post-test, control group, and 60-day follow-up design. The statistical population included all female students studying for both bachelor’s and master’s degrees who were referred to the counseling center of the University of Isfahan, among whom 45 were selected and randomly assigned to two experimental groups and a control group, each comprising 15 students.
The experimental group participants of behavioral activation received this intervention during nine two-hour sessions; the participants of the mindfulness training group underwent eight two-hour sessions, while the control group received no intervention. The participants were retested after 60 days as a follow-up. Finally, they completed the questionnaires in three stages, and the data were analyzed using the mixed analysis of variance and the Bonferroni post-hoc test by SPSS26.
Beck depression scale: This test was developed by Beck (1961) and has 21 items that measure the severity of depression symptoms using a four-point Likert scale, with scores ranging between 0 and 63. Dobson and Mohammad Khani (2006) reported Cronbach’s alpha of 0.93 for students (34).
The mental well-being questionnaire: it was developed by Keyes and Magyarmo (2003). The items are rated on a 5-point Likert scale, ranging from not at all (1) to all the time (5). The internal consistency coefficient of the questionnaire, estimated by Cronbach’s alpha, was 0.80 (36). The description of mindfulness training sessions was taken from Kabat-Zinn (2013) (36), and the description of behavioral activation sessions was provided by Lejuez et al. (2011) (37).
Results: Demographic characteristics were investigated in the descriptive statistics section, and the variables were described using mean and standard deviation. In both experimental groups, the mean score of total well-being increased compared to the pre-test. Levene’s test was used to perform a mixed analysis of variance, which indicates the confirmation of the assumption of homogeneity of variance (P<0.05). Covariance analysis was used to investigate the between-groups effect (F=0.745, p=0.32). Therefore, there was a significant difference between the mean scores of the between subjects’ group in the post-test and the follow-up of the total well-being (P<0.05). Bonferroni post-hoc test was used to examine the difference between the mean of the experimental and control groups in pairs and to determine the effectiveness. The results indicated a significant difference between the mean of the post-test and follow-up well-being of the control group and the experimental group of behavioral activation (P< 0.01), while a significant difference was observed in the mindfulness intervention group only in the follow-up phase (P<0.05); therefore, both methods effectively and equally increased well-being. It is noteworthy that only the behavioral activation treatment effect remained constant over time.
Conclusion: The results showed that both methods effectively and equally increased the mental well-being of students, but only the behavioral activation treatment effect remained constant over time. Although no similar study was found, the findings of Dominguez Rodrigues et al. (23), Shahsavari et al. (24), Ghamari et al. et al. (27), Ghodrati and Vaziri Neku (28), Mazzuchelli (29) and Shields et al. (30) are consistent with those of the present study.
In explaining the findings, it can be stated that behavioral activation is assumed to help individuals engage in different behaviors to feel pleasure and be useful (28). At the same time, mindfulness helps students become more self-aware and allows them to identify negative thought patterns and feelings associated with depression. Therefore, it can be concluded that these two approaches can improve the mental well-being of students.
One of the limitations of the study was that the results were related to female students, and the generalization of the results to the male ones should be done with caution. It is suggested that this research be conducted on other age groups as well. Therefore, it is possible to enhance the mental well-being and reduce mood disorders of students by holding training courses in university counseling centers.

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Background and Aims: Infertility is a complex crisis in married life; Infertile couples, in addition to facing a series of physical problems, also experience psychological problems during treatment (1). The World Health Organization defines infertility as: a disease of the reproductive system defined by failure to achieve clinical pregnancy after 12 months or more of regular unprotected intercourse (2). Infertility has countless negative consequences in marital relationships, and as a result, the possibility of marital conflict, incompatibility, and marital frustration in relationships can increase (5). Disillusionment means the replacement of neutral emotions instead of positive emotions, and for disillusionment to happen, it is assumed that there was a set of positive feelings and emotions at the beginning of the relationship. The disillusioned couple had a feeling of love and affection, but this feeling has died a long time ago (6). People who experience frustration may feel frustration, emotional resentment or anger towards their partner, which leads to a decrease in the overall quality of the relationship (8). Among the problems faced by infertile women is a weakness in emotional balance (9). Emotional balance is a physical and mental ability that a person exhibits to show a natural reaction to environmental factors (10). Most people pay attention to the balance of their positive and negative emotions when judging the level of satisfaction with married life. In general, a person who has a good emotional balance is better able to adapt to the demands of the environment (12). Considering the complex nature of infertility and its disastrous effects on couples' relationships, it is necessary to develop effective interventions to help couples who are facing this problem. Among these treatments is Bowen's couple therapy (14). The main goal of Bueni's treatment is to reduce chronic anxiety in the family, which is done by facilitating family members' awareness of how the emotional system works and increasing their differentiation by focusing on making changes in themselves instead of trying to change others (16). In this regard, Johnson and Smith showed that Bowen couple therapy can positively affect the reduction of negative emotions and relationship dynamics of infertile couples (19). Another treatment method that seems to be effective in improving the conditions of infertile women is the use of couple therapy in the form of reality therapy (20). The goal of reality therapy is to reduce external control and develop internal control in couples; The goal is for couples to reduce the need to control their spouse and to control themselves more; That is, instead of trying to control their spouse, they should try to control their own behavior (23). Brown and Davis found in a study that Glaser's couples therapy sessions helped infertile couples to develop effective coping strategies, improve emotional support, and enhance communication skills (24). The present study seeks to answer the question whether there is a difference between the effectiveness of Glaser's couple therapy and Bowen's couple therapy on emotional balance and frustration in infertile couples.
Methods: The research design was semi-experimental with pre-test-post-test with control group and follow-up stage. The statistical population of the study included all infertile women who referred to the infertility centers of Isfahan city in the spring of 1402, of which 48 people (24 couples) were randomly selected in three groups of 16 people in Glaser couples therapy based on the criteria for entering the study. 90-minute session) and Bowen couple therapy (8 90-minute sessions) and control (no intervention) were replaced. The participants responded to Diener et al.'s (2010) and Niehuis and Bartel's (2006) marital frustration questionnaires in three stages. The research design was semi-experimental with pre-test-post-test with control group and follow-up stage. The statistical population of the study included all infertile women who referred to the infertility centers of Isfahan city in the spring of 1402, of which 48 people (24 couples) were randomly selected in three groups of 16 people in Glaser couples therapy based on the criteria for entering the study. 90-minute session) and Bowen couple therapy (8 90-minute sessions) and control (no intervention) were replaced. The participants responded to Diener et al.'s (2010) and Niehuis and Bartel's (2006) marital frustration questionnaires in three stages. The content of Glasser's couples therapy session was taken from Glasser and Glasser's package in 2010 (37) and the content of Bowen's systemic couple therapy sessions (1998) (38).
 Findings: Analysis of covariance was used to investigate the effect between groups by controlling the effect of pre-test on post-test and follow-up on the scores of emotional balance and marital frustration. The results showed that time was significant within the groups with F calculated for positive emotions (F=10.94), negative emotions (F=14.05) and marital frustration (F=60.97). The significant difference between the measurement steps is confirmed (p<0.01). In addition, with the significance of F obtained in the intergroup source in positive emotions (F=3.65), negative emotions (F=3.42) and marital frustration (F=10.05), it can be said that between groups There is also a significant difference between test and control (p<0.05). The results showed that between the two methods of couple therapy, only Glaser's couple therapy was able to effectively increase the positive emotions of the intervened infertile couples and its effect remained stable over time. Also, the results showed that both Glaser and Bowen couple therapy methods effectively and equally reduced negative emotions and marital frustration in infertile couples, and the effect of both interventions remained stable over time for negative emotions, but the effect of the treatments for frustration Marriage has not remained stable over time and has returned.
Conclusion: In the explanation obtained regarding the effectiveness of Glaser couple therapy on positive and negative emotions and marital frustration of infertile couples, it can be said that the emotional pressure of infertility often leads to misunderstandings, misinterpretations and ineffective communication patterns (41) ). Golsar couples therapy provides a safe and supportive environment for couples to openly express their feelings and concerns. Through guided communication exercises, couples learn empathic active listening skills and effective ways to express their needs and desires, helping couples face individual and social concerns and expectations about their infertility status and jointly make better decisions in get treatment and their family life and this will reduce marital frustration and negative emotions in them. In the explanation obtained regarding the effectiveness of Bowen's couple therapy on negative emotions and marital frustration of infertile couples, it can be said that this approach focuses on understanding the dynamics in couples' relationships and the larger family system (44). Infertility can significantly affect couples' relationships and cause frustration and feelings of inadequacy. In this approach, the therapist helps couples identify and understand the underlying patterns and dynamics that may contribute to marital frustration. The goal of this treatment is to increase the couple's awareness of their emotional reaction and improve their ability to communicate and effectively resolve conflicts.
 One of the limitations of the current research is that the results of this research are related to infertile couples in Isfahan city, and generalization of the results to couples with children and in other cultural contexts should be done with caution. Also, considering the nature of the research topic and the criteria for entering the research; It was not possible to select the sample randomly. Therefore, it is suggested that this research be conducted on couples on the verge of divorce. Finally, according to the obtained results, it is suggested that by holding Glaser couple therapy and Bowen couple therapy, couples can manage stress, improve marital communication, strengthen self-confidence, and train emotion management skills to help infertile couples deal with the challenges of married life.
 

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ABSTRACT In this cross-sectional research, 600 women with unintended pregnancy (U.P) were studied.The incidence of U.P was higher in women with age> 30 years / Level of education lower than intermediate school, and parity of 3. In 35% of cases there was no contraception before current pregnancy and incorrect believes was the most common cause. Coitus interruptus was the most common method of contraception when contraception was used before pregnancy. In cases which oral contraceptive was used before pregnancy, the correct usage was lower when OCP was received from private centers. In 58.3% of cases there was no education about family planning before the current pregnancy. In 16% of cases the pregnancy was due to wish of husband.

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Liver cirrhosis is one of the most essential problems of health care system in our country, because of its high prevalence and its disabling or deathly complications. According to literatures, chronic liver disease substantially reduces HROL which does not differ markedly by the type of the disease. In this regard, designing a self care program according to client’s needs in different aspects of quality of life, can maintain their independence, promote their sense of well-being and improve their quality of life. Using non-probability sampeling(convenience), a number of 44 patients(21 experimental & 23 control) concerning their charactristics(20-65 old, etc) were studied. Patients and their fellows’ demographic questionnaire, chronic liver disease questionnaire(CLDQ), educational needs checklist and self-reported checklist were the data collecting tools. For experimental group and their fellows, a self care program was performed in 4 sessions with 45 minutes. The quality of life in both groups was assessed by CLDQ questionnaire before performance of the self care program and three months after the self care program. The quality of life in both groups was compared and then data were analyzed using SPSS software. Chi-squared test and t-test revealed that the experimental and control group were the same concerning the effective factors on the quality of life, such as age, sex, etc(P>0.05). Mann-whitney test showed that the quality of life total score before intervention did not show a significant difference between the two groups(P=0.75). While after intervention the same test indicated a significant difference between the two groups(P=0.001). Wilcoxon test revealed that the quality of life total score before and after self care program in the experimental group had a significant difference(P=0.001), and the same test showed a significant difference in the control group too (has a decrease)(P=0.001). Consequently, the hypothesis of this study “the quality of life in patients with cirrhosis increases after the performance of self care program compared to the control group” was confirmed.

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    Background & Aim: Viral hepatitis is a significant and worldwide health problem. The main purose of treating and caring of patients with chronic disease is to promote life satisfaction and well being feeling. In most of the patients with chronic hepatitis, especially those treated with interferon, quality of life is less than normal. The aim of this study was to evaluate the effect of education on quality of life of patients with chronic hepatitis treated with P-D Feron who had referred to Hepatitis Center-Tehran. Patients and Methods: The present study was done as a semi experimental research with two separate groups: case and control. The intervention included educating the method of self injection of alpha-2B interferon(P-D feron) and following the continuous treatment with interferon. Sampling method was a non-randomized method and carried out according to the subject characteristics. Sample size was 60 patients, grouped randomly in two 30 patient groups(case and control). Data gathering tool was a demographic characteristics questionnaire and the questionnaire of Quality of Life in Patients with Chronic Liver Disease(CLDQ). Educational program was done in four "45 minute sessions" for case group and their relatives. The follow up period was 12 weeks. Quality of life in patients with chronic hepatitis was measured in two stages, before initiating interferon therapy, and after performing educational program. Finally, the quality of life in two groups was compared by Wilcoxon Signed Rank Test. Results: There wasn't significant difference in demographic characteristics of two groups(P>0.005). The total score of quality of life in two groups, before therapy did not show significant difference(P=0.351) while 12 weeks after performing educational program there was a significant difference between two groups(P<0.001). Wilcoxon statistical test showed that total score of quality of life in case group had a significant difference before and after performing educational program(P<0.001), and had improved after performing educational program. The total score of quality of life in control group didn't have significant difference after 12 weeks(P=0.143). Conclusion: Planning short and simple educational programs has a significant effect on the patient's control on his/her disease and its' side effects and can improve quality of life, life satisfaction feeling, and coping with treatment in patients with viral hepatitis.

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  Background : Toxocariasis is a common worldwide zoonotic parasite infection caused by the larvae of Toxocara catti and Toxocara canis. Allergic rhinitis is the most common chronic diseases in the upper respiratory tract. The main symptoms are sneezing, watery rhinorrhea, itching in the nose, eyes and palate. The purpose of this study was to investigate the association between toxocara seropositivity and allergic rhinitis compared with the control population.

  Methods: This cross-sectional study was carried out from September 2009 to February 2011 on 93 patients with allergic rhinitis and 87 control subjects. Confirmation of the diagnosis of allergic rhinitis was defined by history and positive epicutaneous prick test. Control subjects were healthy based on history and no signs of allergic rhinitis and other allergic diseases were seen. Blood and fecal samples were taken from both groups. Sera were separated, labeled and stored at -20°C until used. Stool samples were examined by a wet mount and formalin-ethyl acetate concentration technique. The diagnosis of toxocariasis was established by IgG anti Toxocara and IgE total by ELISA method.

  Results: In case group (allergic rhinitis) from 93 patients, 50 patients (53.8%) were males and 43 (46.2%) were female. In the control group of 87 individuals studied, 56 (64.4%) were males and 31 (35.6%) were female. In cases and controls, 5 (5.4%) and 3 (3.4%) of sera were positive for IgG Toxocara, respectively. There was no statistical difference in Toxocara seropositivity in both groups (p =0.39).

  Conclusion: It seems to be in contrast to worms and allergies several factors, including phase worm infections (acute and chronic), parasite load, parasite species and resistance genes are involved and this require further studies in different ages and populations.

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Background: Diabetes mellitus is a high prevalent disease among the population, and if not controlled, it causes complications and irreparable damage to the eye and cause blindness. This study goal is to investigate the predictive power of multiple logistic regression model and the Artificial Neural Network Multi-layer Perceptron (MLP) in determining patients with and without diabetic retinopathy. 

 

Methods: Of 16,000 diabetic cases from Kermanshah diabetic center a sample including 150 cases and 150 controls were enrolled. Demographic data, BMI, FBS, Hba1c, blood pressure, cholesterol (TC) and duration of disease, smoking status, and age of patient, and health records were collected into two separate checklists. For identifying risk factors, and artificial neural network models multiple logistic regression was fitted to the data and the Rock charts was used to compare the predictive power of the models. Also sensitivity and specificity were analyzed together with the standards of both models (ROC curve, sensitivity and specificity) and superior model was introduced.

 

Results: The predictive power of logistic regression and MLP were 73.0 and 83.0, respectively. The MLP model features (80%) and sensitivity (85%) were higher. Variables of FBS (p=0.029), BMI (p<0.0001), age (p<0.0001) duration of diabetes (p<0.0001) in the logistic regression model, the variables of age, FBS, duration of diabetes, BMI, smoking status, TC according to the Wrapper, the predictive power of 83% in MLP were significant.

 

Conclusion: In this study, the MLP model showed more power to identify diabetic retinopathy patients from those without retinopathy. Thus, in communities that case and control groups have high affinity (like this study), discovering the difference needs a more powerful method such as artificial neural network MLP. This method is recommended for medical research.

 

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Background: Studies have shown that variation in light-dark cycle influences secretion of many hormones. The aim of this study was to investigate the effects of different periods of darkness on serum level of LH, FSH, testosterone and cortisol in male rats.

Methods: In this laboratory experimental study, 30 male Wistar rats were randomly divided into control (exposed to 12h light - 12h dark), and experimental (exposed to13, 15, 18 or 21h darkness/day) groups,and there were 6 rats in each group. After 8 weeks, blood samples were collected and following serum collection, the levels of LH, FSH, testosterone and cortisol were measured. The data were analyzed using ANOVA.

Results: Serum LH, FSH levels significantly decreased in rats exposed to darkness for 18 and 21 h/day compared with control animals (p<0.05). Serum level of testosterone and cortisol was significantly decreased in all groups exposed to darkness compared to control animals. Serum level of DHEA significantly decreased in groups exposed to darkness for 15, 18 and 21 h/day compared with control animals.

Conclusion: The findings of this study suggest that prolonged periods of darkness results in decreased serum level of testosterone, cortisol and DHEA and leads to increased LH and FSH according to which, darkness can be considered as a factor leading to sexual disorders  and disorders related to cortisol. 

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Background: Umbilical cord blood has been increasingly used as an alternate source of hematopoietic stem cells in the treatment of Hematologic malignancies and life-threatening diseases. The success of engraftment and survival of patients after cord blood transplantation highly depend on either the number of infused total nucleated cells (TNCs) or the number of CD34+ cells per kilogram of recipient body weight. A standardization procedure for cord blood (CB) storage before and during cryopreservation is critical. This work is concerned with the effect of CB storage temperature and storage duration through the stages before cryopreservation on cell recovery, viability, aggregation of cells.

Methods: Total of 30 CB samples were casual collected from Tehran hospitals and remittances to cord blood bank. Total cells and viability were calculated and aggregation was evaluated. Each sample divided to 4 sample and stored at 4ᵒC, 12 ᵒC, 22 ᵒC, and 37 ᵒC for different periods of time after 12, 24, 48 and 72 hours. Total cells and viability were calculated and aggregation was evaluated. Subsequently, these results were evaluated with ANOVA methods.

Results: At the beginning of the experiment, the total number of cells was 5-10 million/ml. All the specimens were investigated after 24 hours. At 4 cº a decrease in the number of viability cells was observed that was statistically significant with a p<0.005. However, the reduction in the number of live cells at 12 degrees Celsius and 24 degrees Celsius was not statistically significant (p>0.005). A significant drop (p<0.005) in the number of live cells was observed at 37 cº.

Conclusion: This study shows that the vulnerability level of cells outside the body from cord blood collection till separation and freezing is directly correlated with storage time and temperature, which is statistically significant with a p<0.005. Nevertheless, changing temperature and storage time did not affect aggregation of cells. These findings suggest that the optimum temperature for storing cord blood is 12-22 cº degrees Celsius for up to 48 hour

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Background: Considering the importance of examining the effects of fluorine and its compounds on aluminum industry workers, this study aimed to compare the signs of dental fluorosis between the workers of one of the aluminum factories and one of the industrial equipment construction companies of Markazi province in Iran.

Methods: This descriptive study was performed on 351 workers of one of the aluminum factories of Markazi province (company A) and 220 workers of one of the industrial equipment construction companies of the same province in Iran (company B). The teeth of all the subjects were examined. Workers in company B were considered as the control group. Data were entered into SPSS software 13 and analyzed by using appropriate method analysis.

Results: We found a significant relationship between the occurrence of dental fluorosis and age and work experience. The rates of dental fluorosis were 34.47% and 17.27% in the company A and company B, respectively. The findings showed that there was a significant difference between the company A and company B regarding the prevalence of dental fluorosis (p>0.05). The most common dental sign in workers of company A was perikymata, while tooth discoloration was most frequently observed in the company B.

Conclusion: Our study revealed that the prevalence of dental fluorosis in aluminum factory was higher than industrial equipment construction company, which exacerbated with increasing age and working history. Oral health training and the use of safety equipment in the workplace are of great significance for workers exposed to fluorine and its compounds.  

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Background: Urinary tract infections (UITs) are the most common hospital-acquired infections and elderly people hospitalized in the intensive care unit (ICU) are highly susceptible to this infection. In this study, according to the hypothesis that probiotic organisms may represent a safe and effective intervention for control purposes infection, the role of a probiotic consists of four strains of Lactobacillus in the prevention of UITs in elderly patients hospitalized in the ICU were studied.
Methods: A randomized, double-blind, placebo-controlled study was conducted on 50 elderly patients admitted to ICUs. Patients in addition to conventional treatment, received randomly either probiotics contained 10⁷ × 5 CFU viable lyophilized bacteria consisting of 4 strains of Lactobacillus (Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus Gasser and Lactobacillus Plantarm) or placebo, twice a day for seven days. At baseline and on the fourteenth day of the study, two groups in terms of the level of CRP, urine culture test results and leukocyturia were compared. Acute Physiology and Chronic Health Evaluation (APACHE II) score and survival status at follow-up one-month also were measured.
Results: Probiotics could significantly reduce the number of leukocyturia (p=0.002) and a positive urine culture (p=0.002) in the probiotic group compared to placebo. The use of probiotics had no significant effect on the levels of CRP. Despite the reduction in APACHE II score and lower mortality rates in the probiotic group compared to the placebo group, these differences were not statistically significant.
Conclusion: Probiotics can significantly prevent UITs in elderly patients hospitalized in the ICU. Administering probiotics led to changes in the urinary tract microflora and reduced the colonization of pathogens. Therefore, probiotics can be considered as an adjunctive therapy in critically ill elderly patients.
 

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Background: The topic (attention) is one of the most complex and important factors affecting training and learning which creates major problems in academic, social, cognitive, emotional, and the family and professional performance in adolescents in overactive children. Therefore, the aim of this study was to evaluate the effectiveness of yoga exercise training in improving visual and auditory attention in boys with attention deficit hyperactivity disorder.
Methods: The research method was semi-experimental. The statistical population of the study included 6 years old pre-school children aged 95-96 in Tehran to do this research, 35 children (all subjects were boys) with attention deficit hyperactivity disorder (ADHD) were selected by random sampling method and multi-stage cluster sampling and randomly divided into experimental and control groups (The experimental group was 18 and the control group was 17). Yoga exercise training (20 sessions per 7 weeks) was performed on the experimental group. The tool used for this study was the Snap grading scale and the NPSIS test. Data were analyzed by covariance analysis.
Results: The results of this study showed that yoga exercise training is effective in improving visual and auditory attention in children with attention deficit hyperactivity disorder (p<0.001).
Conclusion: According to the findings of this study, yoga can be used to improve children's visual and auditory attention or attention-deficit/hyperactivity disorder.
 

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Background: Prediction of spontaneous preterm delivery in Iranian women by comparing the vaginal polymorphonuclear call (PMN) counts on gram-stain preparations and ratios of PMN to epithelial cells (PMN/EPI) at second trimester of gestation.
Methods: In a prospective case-control study, 110 cases with spontaneous preterm delivery at gestational age of less than 37 weeks were compared with control group of 110 women at term. Vaginal gram-stain preparations were collected at the first visit in 23-24 weeks of gestation and the cell counts were performed under oil-immersed microscope. To correct the intra-slide variations in cellular density, PMN/EPI ratios was calculated for each slide field.
Results: Mean delivery gestational ages were 34.5±3.5 and 39.4±1.2 weeks for the cases and the controls, respectively. There was a significant difference in PMN counts between the two groups (p=0.01). The mean PMN/EPI ratio, however, was significantly higher in case group (p=0.01). No significant difference was found in gravidity between the two groups.
Conclusion: Different vaginal PMN count at second trimester were significantly associated with subsequent spontaneous preterm birth. However, the ratio of PMN of EPI count, was significantly higher in women with preterm birth at less than 37 weeks’ gestation.
 

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Background: Fibromyalgia includes a fatigue syndrome with chronic pain that declines the patients’ quality of life. Previous studies confirm these observations, but there is no study on aged-population regarding this issue. Thus we investigated the impacts of anodal stimulation on the life quality in aged-population suffering from fibromyalgia.
Methods: Fifty aged females with fibromyalgia were randomized to receive sham stimulation or real tDCS with the anode centered over the primary motor cortex (M1) and a cathode over the contralateral supraorbital area (2 mA for 20 minutes for 10 sessions). The overall effect of fibromyalgia on the quality of life was assessed using the Fibromyalgia Impact Questionnaire (FIQ) and SF-36 quality of life questionnaire. Also, the mood and anxiety levels were evaluated with Beck depression inventory and Hamilton Anxiety Rating Scale. All assessments were done before, after the last session, and 30 days after the last session of the stimulation.
Results: The quality of life was evaluated for shame stimulation group as well as stimulation group, before the intervention, immediately after the last session, a month later on that were as follows: FIQ: 58.84, 58.4 (p=0.796), 56.17, 49.26 (p=0.020),57.86, 52.32 (p=0.050) and SF-36 score: 38.04, 41.31 (p=0.43), 45.49, 49.84 (p=0.376), 40.40, 45.38 (p=0.138) respectively. In addition, the levels of anxiety and depression for both control and intervention groups were 20.36, 18.84 (p=0.219), 16.68, 15.52 (p=0.106), 18.00, 16.12 (p=0.112), respectively.
Conclusion: Although the quality of life for the intervention group was increased, it was not significant. In this regard, the results were inconsistent with the result of previous literature, investigating this issue. Furthermore, the results of the level of anxiety and depression were not significantly different for both groups.

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Background: Although clinical research and clinical practice are closely related, distinguishing the boundaries between them is an important issue debated by contemporary bioethicists. Some commentators have criticized drawing a sharp line between research and practice (1, 3 & 4), but most experts and policy makers in the field of biomedical ethics, believe that the distinction between the two in clinical settings leads to increased scientific credibility of research and greater protection of patients' rights and safety (2, 18). They argue that blurring the boundaries between clinical practice and clinical research is an ethical mistake (6, 7). Despite significant efforts that have been undertaken in recent years to implement and enforce research ethics in Iran, the need to training in the field of basic concepts of research ethics and ethical justifications for the codes and guidelines of research ethics exists yet.  The purpose of this study is to address this gap in the literature. The first part of this paper deals with a brief history of research ethics that gave rise to the formation of boundaries debates and led to the publication of the Belmont Report. Then, a set of relevant definitions and criteria required to conceptually and practically distinguish between research and clinical practice are presented. Finally, the ethical dimensions of this distinction are reviewed as an argument in favor of the moral requirement to maintain the boundaries between clinical research and clinical practice for the various parties involved in clinical research.
Methods: Relevant publications were selected through a MEDLINE search. The key phrases used were clinical research or clinical practice plus distinction, boundaries or distinguishing. The main textbooks of research ethics and medical ethics, both electronic and paper types, were included in the search. International and national research ethics documents and guidelines were obtained via the organizational websites. 
Results: This study has yielded several results with possible implications for the different parties involved in clinical research. First, through a close look at the nature of unethical human research studies that took place in the 1970s and prompted the U.S. policymakers to rethink research ethics governance and gave rise to creation of the Belmont Report (5, 8), it can be concluded that the mere issuing of research ethics guidelines in the absence of ethical oversight of research leads to a failure in protection of human subjects in clinical research. Recognizing and maintaining a sharp boundary between research and practice is the basic requirement of a thorough research oversight and providing precise definitions for the terms, clinical research and clinical practice, is the prerequisite to distinguish this boundary (14).
Secondly, Activities that are designed initially with the aim of producing or contributing to the production of “generalizable knowledge” and have the form of a research methodology that have been described in an research proposal and have been scientifically (14, 15), methodology and ethically validated can be labeled as research. These research activities are deemed clinical research If they involve a human participant (7, 13). Such interventions that are intended to increase the well-being of a patient without undergoing a peer-review, although considered to generate “new knowledge”, are still considered as clinical practice because the knowledge gained is not generalizable, even though new (7).
Thirdly, the issue of research-practice distinction can be discussed from various ethical aspects. On the practical level there are several issues involving both the physician/researcher and the patient/research participant. The roles and responsibilities of the physician and that of the researcher cannot be a single set of roles and responsibilities, as these two roles each have their own moral implications and duties, which may be in conflict at times (17, 18). Clinicians are committed to make clinical decisions according to the best interests of the patients, while researchers commit themselves to the research protocol (2, 6, and 7). Adopting distinct approaches to clinical research and clinical practice will also help physicians better distinguish their dual role of physician and researcher and manage potential conflicts of interest.
Blurred boundaries between research and practice also leads to therapeutic misconception for Patients /research participants. Therapeutic misconception is a situation in which patients do not recognize that they are participating in a clinical research although being disclosed by the clinician/researcher (19). The therapeutic misconception may also occur to the minds of the clinicians, and the result is their reluctance to disclose to the patients that they are participating in a clinical research, when feeling far from regulatory agencies.  As research interventions are often unapproved, they pose an increased risk to research participants, as well as additional burden and cost. So, failure to understand the research process seriously infringes the patients’ rights to safety, quality care, and autonomy (10).
How research and practice are distinguished also affects the actions taken on the policy level. It is of great importance that research ethics committees and policy making bodies make distinction between research and practice in clinical settings. Historically the most important trigger to acknowledge the issue of separate clinical research and clinical practice was the need to clearly define which activities should undergo oversight in the clinical realm where the professional norms does not require oversight on the practice of licensed clinicians (6). The general rule originally stated in the Belmont report is that whenever there is a research component in an activity, that activity should be monitored for the protection of human subjects (14).
National Research ethics guidelines play an important role in shaping the attitudes of different parties involved in clinical research, toward their roles and responsibilities in research. As research ethics scholars have argued, using the notion of “therapeutic research” in the early versions of the declaration of Helsinki by the World Medical Association led to a "misunderstanding" in clinical research ethics and the violation of patients' rights (1). Although “therapeutic research” was a common concept in the classical research community, but also was reinforced by policy-making institutions; this conceptual error according to Howard Brady, an expert in the field of medical ethics, had prevented a correct and ethical understanding of "research with human subject" for years (11).
A review of national biomedical research ethics guidelines issued by the “National Committee for Ethics in Biomedical Research” at the Iranian Ministry of Health and Medical Education, reveals a lack of basic definitions and clarifications. In some instances, like in the “General ethics guidelines for medical research including human subjects,” some provided definitions increase the ambiguity; however, some criteria for distinguishing between research and practice can implicitly be derived from the text. Codes number 10, 11, 26, and 28, which explain the researcher's ethical responsibilities toward the participants - a responsibility that is not defined for clinicians- implicitly set out the criteria for research-practice distinction (16).
Conclusion: The issue of boundaries between research and practice in clinical settings is ethical in nature.  Although considerable efforts have been made to develop national biomedical research ethics guidelines in Iran, a comprehensive approach to providing the definitions of basic concepts and the underlying theoretical framework in the field of biomedical research ethics still seems lacking.
 

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Background and Aim: Increasing the intensity of physical activity and consequently increasing oxidative stress causes the formation of free radicals in the body and these free radicals cause the destruction of biological cell structures such as proteins, fats, membranes and hereditary structures. Considering that taking supplements can be a good way to control the effects of strenuous physical activity; therefore, it is important to study the mechanism of action of complementary compounds of organic and non-organic (industrial) origin and compare their effects and performance at the biochemical and genetic level. In this regard, the study of the expression of genes related to the inhibition of oxidative stress can be a direct and appropriate solution to evaluate the function of various supplements. Satellite cells below the basal laminal layer of skeletal muscle are located exactly adjacent to myofibrillar sarcolemma and make up 2 to 7% of the nuclei of a muscle fiber. The number of satellite cells depends on the type of muscle fiber, age, and species. The amount of these cells varies at different ages; In infant, adult, and older mice, they make up 30, 4, and 2 percent of the muscle nuclei, respectively, and as they age, the decrease in satellite cells increases the muscle nuclei of glycolytic fibers. Proximity to capillaries, muscle nuclei, and neuromuscular junctions is associated with increased satellite cell density; Therefore, their amount in oxidative fibers is 5 to 6 times higher compared to glycolytic fibers. These adult muscle-specific germ cells are normally dormant and activate and enter the cell cycle in response to induced stress, such as induced mechanical load or muscle damage. The next generation of activated satellite cells are called myogenic precursor cells (mpc), which repair the damaged muscle fibers or hypertrophy after several rounds of cell division and before merging with existing myofibrils or forming new myofibrils, respectively. The ability of satellite cells to migrate and move depends on the integrity and integrity of the cell's basement membrane. After rupture (severe destruction) of the basement membrane due to muscle damage, satellite cells migrate to adjacent damaged myofibrils using tissue connections, but if the tissue damage is limited and rupture of the basal lamina has not occurred. Satellite cells move to the affected area from the beginning of the healthy myofibril section (below the membrane) to participate in the repair of muscle tissue. With the activation of satellite cells (six hours after muscle injury) the expression of MyoD gene increases rapidly, therefore this transcription factor in adult skeletal muscle is activated by markers and proliferation of satellite cells. The amount of MyoD transcription factor mRNA varies at different ages and is higher in rapid-twitch muscles. In animal models, the amount of MyoD gene protein is lower in the rapid and slow-twitch muscles of older rats. This value is lowest in the soleus muscle and therefore the response of the MyoD gene of the soleus muscle (slow-twitch muscle) is also lower than that of the extensor digitorum longus muscle (rapid-twitch muscle). With this description, the aim of this study was to compare the effects of organic and inorganic supplementation on myoD gene expression in twitch muscle after a high-intensity resistance activity to determine whether organic and inorganic supplementation on myoD gene expression.
Method: In this experimental study, 40 Wistar rats with an average weight of 100-200 g were prepared and in the control groups (number = 10), exercise (number = 10), Spirulina + exercise (number = 10), glutamine + exercise (number = 10) were divided. Mice in the exercise group performed a two-week exercise program of 3 days per week of walking on a sloping surface (4 sets, 5 repetitions, 30 seconds rest between repetitions), and the supplement + exercise group performed a supplement program five days before the main protocol. They consumed half a gram/kg of body weight once a day. The obtained data were evaluated by One Way ANOVA.
Results: The results showed that there was a significant difference between the relative expression of MyoD gene in the study groups (P> 0.001). Also, the results of Tukey post hoc test showed that this difference between training and exercise + spirulina group (P> 0.001) and also training and exercise + glutamine group was significant (P> 0.001). While there was no significant difference between the two groups of exercise+ spirulina and exercise+ glutamine (P= 0.055).
Conclusion: In general, it can be concluded that taking organic supplements is a good way to prevent reduced expression and the amount of damage to muscle fibers after high-intensity resistance exercise. The mean variables of MyoD gene expression in soleus muscle tissue (slow-twitch) of adult male Wistar rats were different after taking an organic spirulina supplement and performing a session of intense resistance activity, so that this difference indicates the effect of taking an organic spirulina supplement on alteration and reduction of MyoD gene expression in soleus muscle tissue. The mean variables of MyoD gene expression in extensor digitorum longus muscle tissue (rapid-twitch) of adult male Wistar rats after taking Spirulina organic supplement and performing a session of intense resistance activity were different, so that this difference indicates the effect of taking organic supplement. Finally, one session of intense resistance activity increased the expression of MyoD gene in slow-twitch muscles more than rapid-twitch muscles. These results may be due to more potential damage to the slow-twitch fibers than the rapid-twitch fibers, or it may indicate a response to the development of adaptations related to the performance of resistance exercises in such fibers. In addition, taking an organic spirulina supplement increased the expression of the MyoD gene, so that taking a five-day course of this supplement increased the expression of this gene in rapid-twitch muscles more than slow-twitch muscles. The important point is that in the group of spirulina organic supplementation, before performing a session of intense resistance activity, the expression of MyoD gene is lower than the case of intense resistance activity without supplementation. Therefore, it is recommended that with high resistance activity, appropriate supplements such as organic spirulina supplementation be used to reduce the expression of MyoD gene, which is likely to increase due to damage to muscle fibers. In particular, it has had better and more favorable effects in slow-twitch muscle fibers that have shown a greater increase in MyoD gene expression after intense resistance activity.

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Background & Aims: One of the important goals of development programs in any country is to reduce social harms, and achieving this goal requires recognizing the effective factors that cause it in society. Nowadays, researchers consider social capital as one of the underlying and effective factors in social health and reducing risk in society .Students in a society constitute a large segment of the active population of a country, which various factors such as internal stimuli and external stressors, can endanger their social and mental health and are exposed to various social harms. And put at risk . Many efforts have been made in countries around the world to identify environmental and individual factors that predispose to risk. Among these efforts, attention to the social dimension is possible. Social capital is the result of the "social capital" of health, which is the study of phenomena such as mutual trust, social interaction, social groups, a sense of collective identity, a sense of a shared vision of the future and teamwork with effective interpersonal and group interactions. It can provide risk prevention and many social harms such as violence, drug use, alcohol and high-risk sexual behaviors. Studies have shown that youth and adolescents' access to social capital can reduce social and behavioral problems, so by providing the basis for social interaction, social skills and teamwork can reduce the rate of social harm and risk. They provided opportunities for academic advancement and health promotion. The purpose of this study was to present a model of social capital communication model and high-risk behaviors of social identity in students of Kermanshah University of Medical Sciences.
Methods: The present study is descriptive-correlational in terms of applied purpose and in terms of data collection method. n terms of applied purpose, the present study is descriptive-correlational in terms of data collection method because no manipulation has been done on variables and factors and based on the research approach, it is small. The statistical population of the present study will be selected from all students studying medicine in Kermanshah (2000 people in total) in the academic year 1399-1398 using Morgan table and available sampling method of 322 people to compensate for the possibility of falling sample size. 350 people were considered who will eventually be removed after completing the questionnaires by the volunteers of the distorted questionnaire and the relevant data of 322 people were analyzed. To measure high-risk behaviors, the High-Risk Behaviors Scale (YRBSS) was used. The adaptation of the High Disease Behavior Questionnaire of the US Centers for Disease Control and Prevention (CDC) was designed and developed in 2010 (15). The reliability of the high-risk behaviors questionnaire by Brenner et al. (2002, quoted by Mohammadi, Refahi and Samani, 2013) was evaluated through a test-retest and the results of the items ranged from 14.5 to 91.1 kappa. (1998) has three structural, communication and cognitive dimensions that examine the seven subscales of networks, trust, cooperation, mutual understanding, relationships, values, and commitment, and are arranged in 28 items based on a five-scale scale. Likert (I strongly agree = 5, I agree = 4, I have no opinion = 3, I disagree = 2 and I strongly disagree = 1). The reliability coefficient of this questionnaire in Sardari, Silavio Silavi (2016) research was 0.89 (16) and the Ethical Identity Questionnaire is a self-report scale that was developed and validated by Ako Bino and Reid (2002) and has two subscales of internalization from questions 1 to 5. (The degree to which moral identity is centralized in the individual's self-concept) and symbolism from questions 6 to 10 (the degree to which each subject shows moral identity in their appearance) (17). The answer to this questionnaire is in the range of 1 (strongly agree) to 5 (strongly agree) in each of the questions. The scoring of two items 4 and 7 is done in reverse. First, the person is asked to pay attention to the moral traits written at the top of the questionnaire, and then 10 questions about these traits are asked of the subjects to determine the extent to which these traits are important to the person. Cronbach reported these two dimensions as 0.77 and 0.76, respectively.
Results: In order to analyze the data, descriptive statistics indicators (frequency, mean, standard deviation, graphs) and inferential statistics were used. In order to determine the validity and reliability of the research instrument, Cronbach's alpha statistical methods and confirmatory factor analysis were used to evaluate the normality of data distribution, skewness and elongation indices, and path analysis was used to examine the relationships between variables. SPSS and Smart PLS software were used to perform these tests.The results of the present study showed that moral identity and social capital have a significant effect on high-risk behaviors of students of Kermanshah University of Medical Sciences.
Conclusion: Laying the groundwork for improving and increasing the social capital of young people both at the family level and at the community level by increasing the sense of social trust, social solidarity, social awareness, providing the necessary social support and youth participation in social and cultural affairs. It seems that according to the theories and backgrounds and the results of the present study, the existence of a significant amount of social capital facilitates social actions and paves the way for achieving certain goals and Subsequently, it can act as a shield against social problems and harms, such as the occurrence of risky behaviors of young people.Universities and institutions of higher education should design and implement special training courses or classes in the form of extracurricular activities in order to educate and familiarize students with the field of social identity and social capital and high-risk behaviors with its constituent components.

 

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Background & Aims: Increasing the intensity of physical activity and as a result increasing oxidative stress causes free radicals in the body and these free radicals destroy cell biological structures such as proteins, fats, membranes, and structures. They are inherited. Considering that taking supplements can be a good way to control the effects of strenuous physical activity; therefore, it is important to study the mechanism of action of complementary compounds of organic and non-organic origin and compare their effects and performance at the biochemical and genetic level. In this regard, the study of the expression of genes related to the inhibition of oxidative stress can be a direct and appropriate solution to evaluate the function of various supplements. The satellite cells beneath the skeletal muscle basement membrane are adjacent to Myofibrillar sarcoma and makeup 2 to 7% of the nuclei of a muscle fiber. The number of satellite cells depends on the type of muscle fiber, age, and species. The amount of these cells varies at different ages; in the neonatal, adult, and older mice, they make up 30%, 4%, and 2% of the muscle nuclei, respectively, and as they age, the decrease in satellite cells increases the number of muscle nuclei. It becomes glycolytic fibers. The migration capacity of satellite cells depends on the integrity and integrity of the cell's basement membrane. After rupture (high-intensity destruction) of the basement membrane by muscle damage, satellite cells migrate to adjacent damaged myofibrils using tissue connections, but only if tissue damage is limited. And if there is no rupture in the basal lamina, the satellite cells move to the affected area from the beginning of the healthy myofibril section (below the membrane) to participate in the repair of muscle tissue. Activation of satellite cells (six hours after muscle injury) rapidly increases the expression of the myoD gene, which is why this factor transcribes into adult skeletal muscle, activates and multiplies satellite cells. They take into account. The amount of myoD transcription factor mRNA varies at different ages and is more pronounced in fast-twitch muscles. In animal models, the amount of myoD gene protein is lower in the fast and slow-twitch muscles of older mice. This value is lowest in the horseshoe muscle and therefore the response of the horseshoe myoD gene (slow-twitch muscle) is also lower than that of the Plantaris muscle (fast-twitch muscle). In addition, the effects of supplements on myoD gene expression in muscle have not been studied, but in a study, the protective effect of organic Spirulina supplementation in preventing the destruction of hereditary structures in mice has been shown and appears. Consumption of this supplement is a good way to prevent injuries caused by oxidative stress in muscle, and most of the research done on this gene has paid less attention to slow-twitch and fast-twitch muscle contraction and experimental models (animal and human). While the protocols for this research were either endurance or the measurement times after physical activity was not appropriate. With this description, the aim of this study was to compare the effects of organic and inorganic supplementation on myoD gene expression in slow-twitch muscle after a session of high-intensity resistance activity to determine whether organic and inorganic supplementation on myoD gene expression. In slow muscle, does the contraction of the horseshoe muscle have different effects after a session of high-intensity resistance activity?
Methods: In this experimental study, 40 Wistar rats with an average weight of 100-200 g were prepared and in the control groups (number = 10), exercise (number = 10), Spirulina + exercise (number = 10), glutamine + exercise (number = 10) were divided. Mice in the exercise group performed a two-week exercise program of 3 days per week of walking on a sloping surface (4 sets, 5 repetitions, 30 seconds rest between repetitions), and the supplement + exercise group performed a supplement program five days before the main protocol. They consumed half a gram/kg of body weight once a day. The obtained data were evaluated by t-test.
Results: The results showed that the relative expression of myoD gene in slow-twitch muscle tissue after taking an organic Spirulina supplement was significant after performing a session of high-intensity resistance activity (P ≤0.001). While in slow muscle contraction, the change in expression after glutamine and resistance exercise is no different from the control group (P = 0.245).
Conclusion: In general, it can be concluded that the use of organic supplements is a good way to prevent reduced expression and the amount of damage to muscle fibers after high-intensity resistance exercise. These results may be due to possible injuries after high-intensity resistance exercise in slow-twitch fibers, or they may indicate a response to the development of adaptations related to the performance of resistance training in such fibers. It is important to note that in the Spirulina organic supplement group, prior to a high-intensity resistance activity session, myoD gene expression was lower than in high-intensity resistance activity without supplementation. Taking an organic supplement is a good way to prevent reduced expression and the amount of damage to muscle fibers. So far, the effects of glutamine and Spirulina supplements on the expression of myoD gene in muscle have not been studied, but a study has shown the protective effect of organic Spirulina supplementation in preventing DNA damage in mice. Taking this supplement is a good way to prevent injuries caused by oxidative stress in the muscle. Since in each study, there are limitations that can affect the results of the study, so this study also had such limitations that include not determining some of the basic physiological capacities in resting and training states of mice, lack of Determining the effects of organic and inorganic supplements on the expression of the target gene independently and without performing intense one-session resistance activity, no measurement of morphological changes in adult male Wistar rats, no measurement of protein content by the method Western blot and lack of control over the activity of adult male Wistar rats were in cages. According to the results of the study, it is suggested that in combination with high-intensity resistance activity, it is better to use appropriate supplements such as organic Spirulina supplement to increase the expression of myoD gene, which may be affected by the amount of damage to muscle fibers.

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