مجله علوم پزشکی رازی
سال سی‌ام شماره 2 (پیاپی 228، اردیبهشت 1402)

Aging indicates physiological and biological changes in humans that are associated with a decrease in physical strength and cause changes in the anatomy and physiology of the body. It has been reported that at a rate of one percent per year, muscle mass decreases from the age of 30 to 60 and increases from the age of 60 onwards. The incidence of diseases such as type 2 diabetes, metabolic syndrome and cardiovascular disease, as well as chronic diseases of the musculoskeletal system and cancer are increasing, all of which can be affected by a decrease in muscle mass (1).Autophagic activity has been shown to decrease with age and may contribute to the accumulation of damaged macromolecules and organs during aging. Failure in the autophagy process exacerbates age-related diseases such as nerve damage or cancer (5). p62, a classical autophagy receptor, is a multifunctional protein located throughout the cell and involved in many signal transduction pathways, including the Keap1-Nrf2 pathway (7). p62 is an autophagy substrate used to report autophagic activity. Recently, p62 has been shown to deliver ubiquitinated proteins, including tau, to the proteasome for degradation. In addition, it can be a shuttle between the nucleus and the cytoplasm to facilitate and control the quality of cytosolic proteins (6).It has been well established that regular exercise improves physical function and brings important health benefits that inhibit many pathological diseases such as cancer as well as cardiovascular, metabolic and neurodegenerative diseases (8). Exercise promotes phenotypic adaptation in skeletal muscle, which includes mitochondrial biogenesis, angiogenesis, fiber deformation, and improved insulin sensitivity (9, 10). Regarding the effect of exercise on changes in autophagy, it has been reported that aerobic and resistance training leads to changes in autophagy indices (11, 12). Atroastetin is a type of statin that has a reducing effect on cholesterol production, as well as antioxidant, anti-inflammatory, anti-apoptotic and tissue protective effects in some pathological conditions (15-17). Study of mechanisms affecting the process of autophagy following exercise, including continuous and intermittent exercise with atroastetin supplementation can improve this process (22). Therefore, the aim of this study was to investigate the effect of eight continuous and interval exercises with atroastetin supplementation on mRNA p62 expression in elderly rats with type 2 diabetes.

This is a semi-experimental study. 63 old male Wistar rats (mean weight 300 to 350 g) categorized into eight groups that included; 1) healthy control group, 2) diabetic control group, 3) diabetic group + continuous exercise, 4) diabetic group + interval exercise, 5) diabetic group + supplement, 6) diabetic group + continuous exercise + supplement, 7) diabetic group + interval exercise + supplement, and 8) saline group. Diabetes was induced by injection of 50 mg/kg streptozotocin. continuous and interval exercise program was performed, which included running at a speed of 15 to 29 meters per minute for 5 to 22 minutes for continuous aerobic exercise and six 2.5-minute sets with four minutes of rest between each set for interval exercise. Atherostatin supplementation with dose of 20 mg per kg body weight was injected intraperitoneally daily. One-way ANOVA was used for comparison between groups at the p <0.05.

The results showed that P62 mRNA expression was significantly reduced in all groups compared to the healthy and diabetic control group (p<0.001), but there was no significant difference between the other groups (p<0.05). (fig. 1).

The results of the present study showed that despite the decrease in P62 mRNA expression in the experimental groups compared to the control and patient groups, no significant difference was observed between the other experimental groups. It seems that taking atroastetin supplementation, despite its anti-inflammatory and anti-oxidant effect, has no effect on the process of autophagy, which can be due to the amount used during the training period or the short-term use of atherostatin. Exercise has been reported to induce autophagy in skeletal muscle. Key autophagy proteins, including p62 and LC3-II, change significantly after exercise. These changes are consistent with an increase in autophagy after exercise. Tarawan et al. (2019) reported that exercise significantly reduced P62 in the muscles, which is more pronounced at moderate intensities. The researchers argued that at moderate intensities relative to high and low intensities, autophagic activity decreased after exercise and recommended moderate-intensity exercise (25). Exercise by phosphorylating Akt can inactivate the autophagy pathway through the PI3K-Akt-MTOR mediated pathway. Due to its unique properties, muscle fibers seem to play a significant role in the activity of autophagy and proteins involved in this process (26). Mejías et al. In the study showed that eight weeks of aerobic and resistance training in elderly men and women significantly increased LC3II / I, Atg16-12 and Bcl-2, but p62 expression decreased significantly (11, 12). Therefore, it is thought that exercise play a decisive role in inhibiting autophagy. Jamart et al. (2013) concluded that low-intensity exercise after fasting increases the activity of autophagy in skeletal muscle, which is due to a decrease in Akt pathway activity compared to satiety (27). The results of the present study showed that compared to the control and disease groups, P62 mRNA expression was significantly reduced; However, this decrease was not significant between the training groups and the training groups with supplementation. These results appear to be influenced by research methodology that the duration of the training period was insufficient or that the dose of atroastetin was low. continuous and interval exercise with atroastetin supplementation with anti-inflammatory and anti-oxidant effects on muscle cells is thought to reduce autophagy activity, resulting in a significant decrease in P62 mRNA expression compared with the patient group. In fact, exercise reduces the onset of autophagy in the skeletal muscle of diabetic rats by improving the antioxidant system and reducing the release of cytochrome c. However, the amount of reactive oxygen species has been reported to be high in animal and human species with type 2 diabetes (28). Therefore, continuous and interval exercise with atroastetin supplementation has been able to reduce autophagy markers, including P62 mRNA. There were some limitations in the present study, such as the lack of measurement of other autophagic indices such as LC3-II. It can also be noted that PI3K-Akt-MTOR autophagy pathway indices are not measured. Therefore, a study measuring these indicators in elderly samples with type 2 diabetes is recommended. According to the results, it seems that continuous and interval exercise with atherostatin supplementation can reduce P62 mRNA in elderly type 2 diabetic rats.

Monkeypox is a smallpox-like viral infection caused by a virus of common origin between humans and animals, which belongs to the genus Orthopoxvirus, the Poxviridae family, and sub-family Chordopoxvirinae. The virus was first isolated in 1958 from a group of sick Macaca cynomolgus monkeys. Human infection with the monkeypox virus was first described in Central Africa in 1970 in a 9-month-old child from Zaire (1, 2). The disease is more common in the Congo basin countries of Africa and possibly West Africa, as well as the majority of human cases are reported from Congo basin countries (3, 4). Smallpox is a serious, contagious, and sometimes fatal infectious disease, and its name in Latin means "speckled" and refers to bumps that appear on the skin of the affected person's face and body. Smallpox has been prevalent for thousands of years but has now been eradicated after a successful worldwide vaccination program. The last natural case in the world occurred in Somalia in 1977. After removing the disease from the world, routine vaccination against smallpox was stopped among the public because it was no longer necessary to prevent. In 1970, when an infection with smallpox was close to being eradicated, a previously unknown Orthopox virus called monkeypox was detected in humans. The first known human case in the Équateur province of the Democratic Republic of the Congo occurred when a 9-month-old infant contracted a smallpox-like disease that was eventually confirmed by the World Health Organization as monkeypox in humans (3). Other similar cases occurred in Ivory Coast, Libya, Nigeria, and Sierra Leone between 1970 and 1971, which were attributed to monkeypox infection (2). The monkeypox virus was first isolated in 1958 from vesiculopustular lesions among monkeys kept at the Copenhagen State Serum Institute (5). The close resemblance between smallpox and smallpox in captive monkeys focused attention on the monkeypox virus as a potential threat to smallpox eradication. Before 1970, monkeypox was known only in inhumane hosts. Between 1970 and 1986, 10 cases of monkeypox were reported in humans from West African countries (Sierra Leone, Nigeria, Libya, and Ivory Coast) and 394 cases from the Democratic Republic of the Congo, Cameroon and Central African Republic (2). Monkeypox was limited to rainforests in central and West Africa until 2003 when the first cases were reported in the Western Hemisphere. In late spring 2003, several people in the U.S. Midwest were identified following exposure to meadow dogs (a rodent of the Cynomys species) infected with the monkeypox virus with a fever, rash, respiratory symptoms, and lymphadenopathy (6). Genomic sequencing of monkeypox clades isolated from the United States, West and Central Africa has determined the presence of two distinct clade clades of the virus. U.S. isolates were identical to west African clades. The clinical course of the disease was milder among people infected with the West African clade with minimal transmission from human to human compared to those infected with clades in the Central African region (7). In 2010, using the animal model of the prairie dogs in a re-independent study, it was confirmed that the Congo Basin monkeypox virus clade was more malignant than the monkeypox virus clades in West Africa (8). Therefore, the aim of this study was to provide general information about virology, clinical, diagnostic, virulence, control, and treatment of this viral infection. The Monkeypox virus belongs to the Poxviridae family, which also includes the bovine smallpox virus, vaccinia, and variola (smallpox). Poxviruses are the largest known vertebrate infecting viruses that infect humans and other vertebrates (subfamily Chondropoxvirinae species) as well as arthropods (subfamily Entemopoxvirinae species). There are about 70 known species of Poxviruses, classified in 28 genera and two subfamilies of Chordopoxvirinae and Entomopoxvirinae. The virions of these viruses contain the linear double-stranded deoxyribonucleic acid genome (dsDNA) and enzymes that synthesize messenger ribonucleic acid (mRNA). These viruses multiply in the cytoplasm of host cells (2). The chordopoxvirinae subfamily contains about ten genera that are genetically and antigenic related. The orthopoxvirus genus of the virus includes camelpox, bovine pox, Ectromelia, monkeypox, raccoon pox, Skunkpox, gerbil pox, Uasin Gishu (horsepox virus), vaccinia, variola and Vel pox (a rodent resembling mice). Many smallpox viruses are associated with a particular vertebrate species, suggesting that transmission of these viruses preferably occurs among certain species of vertebrates. Although random transmission to different vertebrate species can occur, no clinical and pathological conditions have been observed in infected hosts leading to the preservation of the virus in these accidentally infected species (9). Orthopoxviruses that can infect humans include variola, vaccinia, bovine smallpox, and monkeypox virus. The variola virus only infects humans, and the Vaccinia virus is a vaccine clade that does not exist in nature and is used to vaccinate smallpox. The Vaccinia virus originated in the 18th century from an unknown vertebrate species. Bovine smallpox can infect cats and cows and transmit the infection to humans as well (2). Monkeypox is also a rodent-infecting virus most seen in West and Central Africa. Unlike smallpox, the monkeypox virus can infect rabbit skin and can be serially transmitted through mouse inoculation. Four viral Orthopoxviruses that can infect humans cause macroscopic lesions on the inoculated chorioallantoic membrane of embryonic eggs (2). These viruses also differ in the ability to replicate in different tissue culture cells. Currently, however, the clearest results for recognizing differences have been obtained by restrictive patterns of viral DNA endonuclease (10). Some genetic differences have been observed between monkeypox viruses isolated from regions in west and central Africa. Genomic studies have shown strong evidence that the monkeypox virus is isolated from the ancestors of the variola virus. This is important because some researchers have been given the possibility that variola may evolve again from the monkeypox virus. Prior to the development of molecular methods, significant efforts were made to detect these four viruses using serological reactions. The results of these studies showed that these viruses share most antigens (11). Results were obtained using absorbed serum in agar diffusion gel test, but were quickly replaced by studies on biological characteristics and DNA limiting patterns. The development of relatively specific antigens has been very efficient for serological studies in humans and animals. For example, this is essential in the possible rapid diagnosis of infection caused by viruses belonging to the orthopox group of viruses, as well as differentiation from chickenpox, as it may cause confusion in adopting clinical measures. For this purpose, it is recommended that the shells of waste be sent to the diagnostic laboratory without a transfer device. Investigation of lesion shells with electron microscopy allows differentiation of orthopox and herpes viruses. Smallpox viruses can be detected in more than 95 percent of lesions, while the varicella-zoster virus can only be detected in half of the material from chickenpox cases. That means negative electron microscopy samples are highly unlikely to be infected with the monkeypox virus (2, 12, 13). Poxviruses are one of the largest and most complex viruses (14). They are brick-shaped particles that vary in width from 220 nm to 450 nm in length and 140 nm to 260 nm in width (15). Therefore, the monkeypox virus is so large that it can be seen by light microscopy and its structure can be solved by electron microscopy. However, a higher-than-limit magnification provided by electron microscopy is required for its ultrastructural separation. The virion consists of four main elements: core, lateral objects, outer membrane, and outer lipoprotein coating. The central core contains double-stranded viral DNA (dsDNA) and core fibers and is surrounded by a solid layer of rod-shaped structures known as the palisade layer. The central nucleus, palisade layer, and lateral objects are enclosed by the outer membrane, which is composed of many surface tubules. Spontaneously released virions often have external lipoprotein coatings, while virions released by cell degradation lack this coating. An adult virion contains at least 80 viral proteins (16).  The monkeypox virus genome is a large linear molecule (197,000 open pairs) of dsDNA, ranked among the largest viral genomes (16). Each end of the genome contains identical but opposite-directional endings with a size of about 6,000 bp (17) with a set of short burst iterations (18) and end-series pin rings (19). The genome consists of about 190 non-overlapping open reading frames (ORF) (more than 180 base pairs in length), containing at least 60 amino acid residues. Of these, there are four in reverse terminal replication (17, 20). The content of guanine and cytosine DNA of the monkeypox virus is low and about 31.1% (21). The two distinct genetic categories of the monkeypox virus include the clades of West Africa and Central Africa (16).

Some drugs used in chemotherapy have destructive effects on hematopoietic tissue.Cyclophosphamide is a commonly used anti-cancer drug which used for some of malignant cancers treatment and causes toxicity by its reactive metabolites such as acrolein and phosphoramide mustard. This drug has oxidant, inflammatory and subversion effects on blood hemopoetic bone marrow tissue. Medicinal plants with antioxidant and anti-inflammatory effects have protective effects on bone marrow tissue. The aim of this experimental study is to investigate  antioxidant and anti-infammatory effects of  Calendula officinalis L. hydroethanolic extract (CHE) on bone marrow in Wistar rats treated with cyclophosphamide.

In this experimental study 35 male Wistar rats (220-250 g) were divided in 5 groups (n=7): control (Normal saline, 0.5 ml), Cyclophosphamide (CP, 15mg/kg), positive control (CHE, 600 mg/kg), treatment 1 (CP, 15mg/kg + CHE, 300 mg/kg) and treatment 2 (CP, 15mg/kg + CHE, 600 mg/kg). All injections were done interaperituneally and the experiments were done for 15 days. At the end of experiments all animals were anesthetized ( ketamine hydrochloride, 50mg/kg + xylasine hydrochloride, 10mg/kg). After splitting the chest with surgical scissor, blood samples were collected directly from the right ventricle of the heart. The collected blood samples were centrifuged at 4000 rpm for 5 minutes and their serums were separated. Serums prepared send to the laboratory for  measuring serum parameters such as: Nitric oxide(NO), Glutamine (GSH), Malondialdehyde (MDA), Glutathione peroxidase (GPx), Tumor Necrosis Factor- alfa(TNF-α) and Inetrlukin-6β (IN-6β). In addition, rat sternum's tissue samples were isolated and fixed with 10% Formaldehyde. Bone marrow tissue samples were studied in the histology laboratory after various steps and preparation of microscopic sections. Data were analyzed using one-way analysis of variance and Tukey's test. The significant difference of the data were considered with p <0.05.

The results of this study showed that cyclophosphamide caused a significant increase in serum TNF-α levels in the group receiving cyclophosphamide compared to the control group (p<0.001). While in the positive control group and treatments 1 and 2 groups, there was no significant difference compared to the control group. Also, there was no significant difference between treatment 1 and treatment 2 groups. Cyclophosphamide significantly increased serum IL-6β levels in the CP group compared to the control group (p<0.001). However, serum levels of IL-6β in the groups treated with CHE were significantly reduced compared to the CP group. There was significant difference of serum levels of IL-6β between treatment 1 and treatment 2 groups (p<0. 01). The use of cyclophosphamide showed that the NO serum level in the CP group was significantly higher than the control group. The groups treated with CHE had a significant decrease in NO serum level compared to the CP group (p<0.001). There was significant difference of serum levels of NO serum level between treatment 1 and treatment 2 groups (p<0. 001). In addition, MDA serum levels in the CP group were significantly increased compared to the control group. There was significant difference of serum levels of MDA serum levels between treatment 1 and treatment 2 groups (p<0. 001). There was significant differences of MDA serum levels in CP group, positive group  and treatment groups 1&2 (p<0. 001). Another result of this study was that cyclophosphamide significantly reduced serum levels of GSH and GPx in the CP group compared with control group (p<0. 001). While serum levels of these parameters in positive control groups and treatments 1 and 2 showed a significant increase compared to the CP group. There were no significant differences of GPx and GSH serum levels between treatment groups 1&2. Histological results in this study showed that CP reduces cell density, loss of cell cohesion and also infiltration of lymphocytes in bone marrow tissue samples in CP group. These results also showed that in treatment group 1 cell density is relatively higher than CP group. In treatment group 2, cell density increased and a significant decrease in inflammatory cells were observed. No significant changes were observed in the positive control group compared to the control group.

The results of this study showed that cyclophosphamide has destructive effects on various tissues of the body, including hematopoietic tissue of bone marrow in test rats. The effects of oxidative stress and cell death of cyclophosphamide have been previously reported. The use of drugs used in the process of chemotherapy is very common and inevitable. Cyclophosphamide, which is used in pediatric oncology as part of standard treatment for leukemia, solid tumors and brain tumors, is one of these drugs. Cyclophosphamide, as a cytotoxic drug, causes inflammation and increases inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α),  IL-1β and IL-6β. Cyclophosphamide has been identified as one of the most important tissue toxicity agents due to its reactive metabolites such as acrolein and phosphoramide mustard and it has been shown that this anticancer drug increases inflammatory serum factors such as TNF-α and nitric oxide (NO) and decreases regenerative glutathione (GSH). In various studies, the antioxidant effects of CHE extract have been proven. Many chemical compounds have been identified in CHE, including carotenoids, flavonoids, terpenoids, coumarins, quinones, amino acids, lipids, and carbohydrates. These compounds can be used for various medicinal and therapeutic purposes as an antioxidant, anti-inflammatory, antibacterial, antifungal, anti-cancer, anti-HIV, for wound healing and more. The main chemical constituents of CHE include steroids, terpenoids, free and esterified terterpene alcohols, phenolic acids, flavonoids (quercetin, rutin, narcissin, isoramentin, campferrol) and other compounds. Research has shown that coumarins have very beneficial effects on cell proliferation and preventing apoptosis. Large amounts of coumarin have been mentioned in the extract of Calendula officinalis's extract. Coumarins have been used to treat prostate cancer, renal cell carcinoma and leukemia. In addition, coumarins play an important role in preventing side effects from radiotherapy. The antioxidant activity of CHE was shown in a study performed on polymorphonuclear leukocytes. Flavonoids and phenolic compounds with iron-binding region have iron chelating properties. By flaking iron, flavonoids both absorb more iron from the intestines and prevent it from being excreted by the kidneys. By doing this, flavonoids store iron in tissues, especially in hematopoietic tissues. Calendula officinalis's flowers contain large amounts of antioxidant compounds (flavonoids and polyphenols), which indicates the antioxidant properties of this plant. The presence of propylene glycol in CHE has been effective in preventing the formation of oxidizing free radicals such as ROS and RNS in isolated leukocytes in the respiratory tract. The protective effects of CHE on inflammatory parameters and serum antioxidants seem to be related to its antioxidant and anti-inflammatory effects. Therefore, it is thought that CHE extract, due to its antioxidant and anti-inflammatory agents, is able to prevent the destructive effects of cyclophosphamide on hematopoietic tissue.

Sepsis is the principal cause of death in the first months of life and leads to 30-50% of infant mortality in developing countries (1). The prevalence of sepsis is reported differently in many countries. In developed countries, the prevalence of sepsis is 1-4 per 1,000 live births, while in poor and developing countries it is almost ten times higher (2). Neonatal sepsis leads to 25.2% of all neonatal deaths in Iran (3). The clinical signs of neonatal sepsis are nonspecific and may be mixed with non-infectious disorders such as aspiration syndrome and respiratory distress syndrome (4,5). The most important factor in reducing infant mortality from sepsis is appropriate and quick treatment (6).On the other hand, the clinical signs of affected infants, including decreased neonatal reflexes, bradycardia, hypo/hyperthermia, respiratory distress, seizures, weakness and lethargy, apnea, and abdominal distension, are not sensitive enough to definitively diagnose sepsis. Blood tests and immunological tests also have less sensitive and specific compared to blood culture (7). Since sepsis is one of the most important causes of mortality and disability in the neonatal stage, with early diagnosis and treatment of the disease and improving the quality of care during delivery, neonatal survival can be increased, the clinical signs, predisposing factors, laboratory findings, treatment and outcome of neonates with the diagnosis of sepsis who admitted to Afzalipour hospital in Kerman were evaluated.

This was a descriptive and cross-sectional study. The statistical population was all infants admitted to Afzalipour Hospital in Kerman from 2015 to 2017.The sample size was determined with the census method (sample size = 200 infants). Infants with Complete Blood Count (CBC), arterial gas measurement, C Reactive Protein (CRP), blood and urine cultures, and Cerebrospinal fluid (CSF) were included in the present study. All neonates with a diagnosis other than sepsis were excluded from the study. Based on clinical and laboratory findings, neonates were classified into three groups:Infants who had positive blood culture sepsis in addition to clinical and laboratory findings. Neonates who had only laboratory and clinical findings of sepsis but their blood culture was negative. Infants who had clinical signs of sepsis but were negative for laboratory findings and blood culture. All infants were treated with antibiotics immediately after the tests. Clinical and laboratory findings as well as the type of antibiotic and maternal and neonatal risk factors were collected using a checklist. Outcomes of treatment were expressed as improvement and discharge, complications, and death. The collected data were analyzed using SPSS software version 25 (version 25, SPSS Inc., Chicago, IL). Quantitative data were presented as Mean ± SD (standard deviation) and frequency and percentage.

The highest age of infants was related to the birth group (91%). 59.5% of infants were male and 40.5% were female. The mean duration of admission was 9.76. 1.05 days. The most common clinical signs were tachypnea (74%), poor nutrition (36%), apnea (32%), and hypo/hyperthermia (25%) respectively. The results showed that 91.5% of participants used ampicillin, 93% of them gentamicin, 84% of them used vancomycin, 52% of them used meropenem, 18.5% of them used metronidazole, 19.5% of them used amikacin, 18 % of them took cefotaxime, 19% of them used fluconazole, 1% of them used clindamycin and 1.5% of them used ceftazidime Regarding the frequency distribution of risk factors, the results showed that 23.5% of participants had PROM (Premature rupture of Membrane), 11 % had maternal urinary tract infection, 12 % had maternal fever and 91.5% had low birth weight. The results showed that the mortality rate for participants was 78% and the rate of discharge and recovery was 22%. The results showed that the mean number of white blood cells was 16.468 ± 0.103 × 103 و and the mean CRP of the participants was 22.6 ± 2.8. The results of this study also showed that 14.5% of participants had positive blood cultures and 85.5% of them had negative blood cultures.

Systemic and local infections are very common in infants. Sepsis is a systemic response to infection and is divided into early, late and nosocomial types  (17). The results showed that 59.5% of the participants who had early sepsis were male and 40.5% of them were female, which is consistent with the results of Khalili et al. (13). While in the textbooks, the incidence of male infants is twice as high as female infants (18). In the study of Arab Mohammadi et al., 60% of patients were boys and 40% were girls. In this study, the most common clinical symptoms were tachypnea (74%), hypo/hyperthermia (25%), and tachycardia (5%), respectively, which is consistent with the results of Hengst et al. (10) while it is not similar to the results of Khalili et al. (13), Santana et al. (9) and Vergnano et al. (14). In other textbooks, the most common clinical symptoms are fever, jaundice, respiratory distress, hepatomegaly, anorexia, vomiting, and cyanosis (19). In the study of Shiva et al. (20), a total of three symptoms of tachycardia, tachypnea, hypothermia had a sensitivity of 53.6% and a specificity of 100% in identifying sepsis with positive blood culture. In the study of Arab Mohammadi et al. (21), hyperthermia, jaundice, respiratory distress, hepatomegaly, anorexia, vomiting, lethargy, and cyanosis were reported as the most common symptoms of sepsis. Investigation of 500 infants suspected of sepsis, temperature instability, and respiratory symptoms were the most common symptoms. The results showed that 14.5% of the participants had positive blood cultures and 85.5% of them had negative blood cultures. This rate (positive blood culture) was 15.4% for the study of Khan et al (22). This rate was 14% in the study of Manucha et al. (23) in India. The reason for the lack of positive blood culture is neonatal SEPSIS is one of the diseases in which the actual number of cases is much less than the number of suspected cases and laboratory-related problems also play an important role in this results (24). The prevalence of sepsis with positive blood culture has been reported in the study of Shiva et al. 25% (20), Samaei et al. 41% (25), and Hosseini et al. The results showed that the mean CRP of the participants in our study was 22.6. 2.8. According to textbooks, if CRP is performed in combination with other tests, it is effective in screening for sepsis, but if used alone as a primary test to look for infection, it helps in less than 10% of definite diagnoses (26, 27). CRP sensitivity has been reported from 46 to 74% in various studies (28). In the meta-analyzes about this subject, the first time CRP sensitivity was 39%, CPR specificity was 92.5%, positive predictive value was 53.2% and negative predictive value was 93.6%. Therefore, it seems that the serum level of CRP for the first time at the time of admission in infants suspected of early neonatal sepsis in the neonatal intensive care unit (NICU) has no value in determining sensitivity (29). In the study by Zecca et al, the negative predictive value of  CRP was 100% (30 %). A study by Cetinkaya et al on 100 infants suspected of having early neonatal sepsis showed that the diagnostic power of CRP increased over time and peaked 24 to 48 hours after the onset of sepsis, which is consistent with our study (31). Therefore, if serum CRP levels remain negative 24 hours after the onset of clinical symptoms, the high negative predictive value is 99%, and antibiotic therapy can be discontinued in the absence of strong clinical suspicion of sepsis (32).

Anxiety is one of the issues that human beings have always been involved with over time (1). One of the characteristics associated with anxiety and quality of life is self-compassion. Compassionate people feel better about themselves and therefore experience more satisfaction in interpersonal relationships. Self-compassion is one of the factors that reduce anxiety (7). Another thing that seems to be related to anxiety due to its special nature is social skills. And is one of the variables that has a significant effect on mental health and can play a major role in mental health and therefore anxiety (12). However, among the disorders that can disrupt social success is anxiety, and the destruction of social relationships is one of the biggest consequences of this disorder, although anxious people are eager to have social relationships (14).One of the methods that affects the cognitive aspects is the reciprocal behavior analysis method, which is an interactive treatment method that emphasizes the cognitive, rational and behavioral aspects of the treatment process and aims to increase people's awareness and power to make new decisions. In doing so, they change the course of their lives. One of the therapies that deals with emotions and its effects on anxiety has been studied is emotion-focused therapy (17). In view of the above, the researcher seeks to answer the question whether there is a significant difference between the effectiveness of group therapy focused on emotion and the analysis of reciprocal behavior in social intimacy, social acceptance and compassion for anxious clients of counseling centers in Isfahan?

The present study is a quasi-experimental with a pretest-posttest design with a control group and a one-month follow-up period. To conduct this study, among the anxious clients of Tohid Counseling Centers in Isfahan in the spring and summer of 1399, whose anxiety disorder was identified through clinical interview and SCL-90 questionnaire, 60 people were selected by convenience sampling method and randomly divided into three groups. 20 people were divided. Before the beginning of the intervention, all individuals had a sample questionnaire of Nef (2003) self-compassion questionnaire with 26 questions and 6 components, Miller and Lefkourt (1982) social intimacy questionnaire with 17 questions and two components and Marlowe and Crown (1960) social acceptance test. They completed 33 questions before, after and one month after the interventions. Also, the experimental group received emotion-focused treatment interventions and interaction behavioral analysis therapy interventions received 12 sessions of 120 minutes of treatment, but the control group did not receive any intervention. Finally, descriptive statistics, Shapiro and Wilk test and repeated measures analysis of variance were used to analyze the data.

The results showed that there is a difference between the effectiveness of the two types of interventions on self-compassion. It was also found that both emotion-focused group therapy and interaction behavioral analysis therapy were effective compared to the control group. However, the mean score of self-compassion in group therapy focused on emotion and interaction behavior analysis is not significantly different.Another finding showed that there is a difference between the effectiveness of two types of interventions on social intimacy. It was also found that the mean scores of social intimacy in the emotion-focused treatment group and interaction behavior analysis and the control group were significantly different. Comparison of means shows that emotion-focused therapy and behavioral analysis are effective. But the effectiveness of emotion-focused therapy is greater than that of reciprocal behavior analysis.Finally, it was found that there is a difference between the effectiveness of two types of interventions on social acceptance. Also, the mean scores of social acceptance in the emotion-focused treatment group and the interaction behavior analysis groupand the control group are significantly different.

Explaining the results, it can be said that reciprocal behavior analysis is one of the most effective psychological theories. It causes a more correct orientation in life, which has a positive effect on people's verbal and non-verbal behaviors and brings peace and people experience more pleasure in life. Also, emotion-focused therapy is that emotion is the foundation and determining factor for self-organization at the beginning of its construction (20).On the other hand, it can be said that the teachings of exchange analysis in the field of caress and strategies for providing caress, intimacy, free expression of feelings and self-disclosure in an atmosphere of psychological security and mutual empathy, can reduce the negative confrontation among anxious people. . Finally, approaching bitter mental and emotional experiences is often a difficult and tedious process for clients. The therapist's mission in this area, in addition to creating an effective relationship, is to teach emotion regulation skills. The creators of emotion-based therapy believe that emotion regulation is a process rather than a training program with a specific protocol, and in this respect the therapist's work is more like a work of the waist than a low-knowledge task (20).

Every organization has an identity that is based on organizational culture. Organizations, like individuals, have personality, which is called the culture of that organization. Accordingly, the purpose of this study is to investigate the components of organizational culture in medical universities and present a conceptual model using the Delphi technique.

To conduct the research, semi-structured interviews with 15 experts, including university professors in the field of organizational culture at Lorestan University of Medical Sciences and the Delphi method were used. In this paper, three basic steps of qualitative methods included; Open coding, axial coding, and selective coding and then the validity of the extracted codes was checked by Delphi method.

The findings showed that in the case of creating and forming friendly groups in universities of medical sciences in order to improve relations and proper cooperation in terms of presenting ideas, opinions and also solving problems, it creates a favorable organizational culture in universities. Medical science will be.in this section, the survey has been conducted in several stages to reach the consensus of the experts for the components. The components identified in the qualitative phase were presented to 15 experts in the form of a closed questionnaire. Then the average answers were calculated using Excel software. The purpose of the Delphi method is to reach the most reliable group agreement of experts on a specific issue, which is done by using questionnaires and asking experts' opinions, repeatedly, according to their feedback. This process continues until the average numbers become stable enough. In this research, the minimum average value of the answers is 3.5 and the difference of opinion for the Delphi averages is 1 (the lowest number in the response spectrum). If the average response is less than 3.5 or the amount of disagreement is greater than 1, the corresponding component will be removed. In the first stage of Delphi, the identified components were presented to the experts in the form of a 5-option Delphi questionnaire, and the average answers were calculated. At this stage, the average answers given for the components of risk acceptance, the importance of work to satisfy personal needs, personal influence, the effort to participate in the public-private sector, and creating an atmosphere without fear and intimidation were less than 3.5, and therefore this component were removed from the process. Kendall's coefficient of agreement in the first stage was equal to 0.569, which shows that the experts' agreement in this stage is average. In the second stage of Delphi, the Delphi questionnaire was again provided to the experts and the average answers and also the average difference with the previous stage were calculated. At this stage, the average difference in all identified components is less than 1, but the average components of voluntary coordination and voluntary presence of people to carry out assigned tasks, sensitivity to the needs, desires and personal problems of organization members, creating a communication network and alliance with Good people, the independence of employees and team members for how to do work and design a happy and stimulating work environment was less than 3.5. Therefore, these components were also removed from the process and the third round of Delphi was conducted. Kendall's coefficient was 0.590 in the second stage, which shows that the experts' agreement in this stage is average. In the third round, the average difference in all components is below 1, and also the average of all identified components is higher than 3.5. Also, Kendall's coefficient was obtained in the third stage equal to 0.690, which shows that the level of agreement of the experts in this stage is almost high. Therefore, all the indicators that entered the third round of Delphi were evaluated according to experts and therefore these indicators were approved. According to the results obtained from the Delphi method, finally 8 main components and 54 secondary components were identified. According to the number of experts, the content validity index of CVR is confirmed. Also, the Cronbach's alpha coefficient in all components is above 0.7, which shows the acceptable reliability of the components questionnaire.

The purpose of the current research was to analyze the components of organizational culture in universities of medical sciences using the Delphi technique. Based on the results, 8 main components and 64 sub-components were identified as organizational culture components in medical sciences universities. First, the questionnaire made by the researcher and the answer package was provided to the experts. Then it was done by Delphi method in three rounds until we reached the agreement of the experts for the components. In the first round, 5 sub-components and in the second round, 5 other sub-components were removed from the study process. Kendall's coefficient in the first and second rounds is 0.569 and 0.590, respectively, which shows that the experts' agreement in these two rounds is average. In the third round, the average difference in all components was below 1 and also the average of all identified components was higher than 3.5. Kendall's coefficient was also obtained at 0.690 in the third stage, which shows that the level of agreement of the experts in this stage was almost high. Therefore, all the indicators that entered the third round of Delphi were evaluated and approved by experts. Therefore, in the end, 8 main components and 54 sub-components were identified.According to the results of this study, the components of organizational culture in Lorestan University of Medical Sciences include shared responsibility; team orientation; The main result; desirable communication pattern; adaptability; governance and leadership; The emphasis is on details and ideation and individual creativity. Based on the results obtained, it can be said that in universities of medical sciences, the factors that define the organizational culture of the university are joint responsibility and cooperation among the members of the organization, attention to teamwork, correct communication. , friendly and favorable among the members of the organization, accuracy in the results and considering it important, adapting the members of the organization to the conditions and problems created, the presence of a competent and capable manager in the university, emphasizing the details of the problems of the university and trying to provide a solution for it. It is a collective and team form, as well as expression of creativity and ideas by all members of the university. If groups are formed in a friendly manner in universities of medical sciences to create cooperation and proper relationships to solve problems and also to present ideas and opinions, a favorable organizational culture will be implemented in universities of medical sciences. Therefore, it is suggested that the universities of medical sciences of the country pay attention to teamwork and cooperation among the members of the organization so that they can use the opinions and ideas of all people. If all employees have a sense of responsibility in the university and adapt themselves to the conditions, it can be said that an organizational culture has been implemented in the university. The requirement for this is to pay attention to the details available in the university as well as the results obtained from the cooperation of the members of the organization.

Chirgwin et al. (1979) were the first authors who proposed the ribonucleic acid (RNA) isolation technique. Without denaturation of the structure of nucleic acid, this method breaks the cell membrane using guanidinium thiocyanate and 2-mercaptoethanol (β-met). The extraction is carried out using ethanol or ultracentrifuge, and cesium chloride gradient. This method is time-consuming, inefficient, and involves toxic and incompatible compounds for the user. Thus, the quality and efficiency of the process of extraction were developed over time and through conducting more studies. Chomczynski and Sacchi (1987) improved the method suggested by Chirgwin et al. and proposed a single-step extraction process called the AGPC method, and it used acid guanidinium, phenol, and chloroform. The advantage of this method is its higher purity and efficiency, plus this process of isolation does not include RNA fragmentation. This method has been developed and using silica columns together with magnetic beads resulted in a revolution in the process of isolating nucleic acids. Extraction of viral nucleic acid includes high-purity DNA and RNA, determining sensitivity, and genome viral load within a short process is quite crucial for the majority of downstream molecular and medical studies such as sequencing, real-time PCR, PCR for research or diagnostic purposes. Efficient protocols for the extraction of nucleic acids are the prerequisite of these methods. As already mentioned the most available protocols are time-consuming and have limitations regarding some samples or disparate types of nucleic acids. An optimal protocol must provide a high sensitivity concerning the extraction of the viral genome from a broad spectrum of samples together with a shorter scientific time and lower price. The majority of methods up to the present time have been using precipitation steps to obtain pure nucleic acids from the extracts. New protocols use the binding capacity of the nucleic acid extract to the silica column. Vogelstein and Gillespie were the first scholars to describe the absorption of nucleic acid to the surface of silica in the presence of great concentrations of chaotropic salts. They used pieces of DNA recovered from agarose gel using silica powder. This technology is developed over time and now selective binding of DNA or RNA through silica gel surfaces is modified and binding and wash buffers have been optimized to provide the maximum separation and isolation capacity in nucleic acids. After the initial lysis of the sample, the respective nucleic acid bound to the membrane is regulated. Polysaccharides and proteins in the extract fail to function properly and lose their ability to bind to the membrane due to the destruction of the molecular structure. Finally, nucleic acid bounded to the column is desalinated by alcohol and washed, and then, separated from the column by elution buffer. One of the limitations of the process of extraction is separating various types of nucleic acids from different viral resources. For instance, Coronavirus contains an RNA genome and on the other hand, the samples are collected from the patient’s nose and throat, which requires an efficient and extremely sensitive procedure for extracting the genome of this virus. Given that, Tehran Cavosh Clon (former Sinaclon), a knowledge-based complex, proposed an optimal method for spearing viral RNA with high efficiency and free from toxic materials in accordance with conducted studies. The present research reported the results of the clinical studies on the basis of European Pharmacopoeia standards.

Viral RNA was extracted from HCV, HIV, and COVID-19 samples. Sensitivity, specificity, verification, and stability tests were carried out according to the European pharmacopeia standard. Furthermore, Tehran Cavosh Clon’s viral extraction kit (SinaPure Viral) was compared with extraction kits of QIA Gen and GeneAll companies, as valid and the most common brands in the market. Finally, the results of PCR and Real-Time tests by these kits were compared. Serums infected with HCV, HIV, and COVID-19 swab nasopharyngeal were provided from Keyvan Laboratory. The reference viral genome extraction kits (QIA Gen:CAT:52904; GeneAll: CAT:128-150), and HCV, HIV, and COVID-19 diagnostic kits (GenproofHIV1/ISEX/050:HCVD/ISEX/050; CMV/ISEX/050; Sansure Biotech: S3104E) Were purchased from the respective agencies.  Chemicals used in the kit structure were purchased from Sigma Company.Kit comprises lysis buffer, precipitation buffer, wash buffer I, wash buffer II, and elution buffer, carrier RNA, and binding columns. First, 400 µl lysis buffer together with 5-6 µl of carrier RNA were added to microtubes containing the samples and they werevortexed for 20 seconds. Then, 300 µl of the precipitation buffer was added to the above solution and vortexed for 5 seconds. The final solution was transferred to the column and centrifuged at 12,100 x g,13,000 rpm, for 1 minute. It must be noted that the transferred solution must be discarded. In the next step, 400 µl of wash buffer I was poured on the column, and centrifuged, at the aforesaid revolutions for 1 minute. The transferred solution was discarded. 400 µl of wash buffer II was transferred to the above column, and centrifuged, at the aforesaid revolutions for 1 minute. The transferred solution was discarded. Finally, without adding any solution, the collector column was centrifuged for 2 minutes. Then, it was transferred to 1.5 ml sterile microtubes and 50 µl elution buffer was added to it. It was placed at 55 degrees centigrade for 3 to 5 minutes. Upon the final centrifuge, the viral RNA was separated from the column with elution buffer. The extracted nucleic acid was collected. This product is used for diagnostic tests. The data were statistically analyzed using SPSS, 18. The diagrams were illustrated using Excel 2010. The One-way ANOVA test was carried out. The means were compared using Duncan's test with a significance level of P<0.05.

Table 1 shows the results of comparing the sensitivity test of SinaPure viral extraction kit with the QIA Gen and GeneAll regarding samples with HIV, HCV, and COVID-19. According to these results, the obtained Ct for LOD of HIV samples indicated no significant difference between GeneAll and SinaPure viral kits. While there was a significant difference between the QIA Gen and the aforesaid kits. The results of the sensitivity test of samples with HCV and COVID-19 manifested a similar pattern. The only significant difference between the QIA Gen and SinaPure viral with respect to the amount of LOD.Table 1 shows the results of the specificity of the SinaPure viral kit on different viral, bacterial, plant, and animal samples. Per the results, except for viruses with RNA such as HCV, HIV, and COVID-19, no positive response was observed in none of the viruses with DNA such as HSV, EPV, HPV, CMV, HBV, plus gram-negative bacteria, (Ecoli), gram-positive bacteria (Staphylococcus aureus), plant samples (wheat), and animal sample (CHO Cell). This confirms SinaPure Viral’s ability in extracting the genome of viruses with RNA.SinaPure Viral confirmation kit was compared to QIA Gen and GeneAll kits in high, medium, and law counts of HCV and HIV serums, plus Swab Nasopharyngeal for COVID-19. The results of disparate counts of HIV-positive samples using all three kits demonstrated no significant difference (Table 2). On the other hand, the same pattern was observed in HCV samples (Table 3). Table 4 shows the results for the COVID-19 samples. Even though kits manifested no significant difference in the high and medium counts, in lower counts of the virus, QIA Gen had a significant difference with SinaPure Viral and GeneAll. It can be due to the difference in the sensitivity of sampling since in the lower loads of virus there is a possibility of making mistakes by the sample collector. On the other hand, the lack of significant difference between the HIV and HCV samples in disparate counts confirms this.Tables 5, 6, and 7 show the results of investigating the stability of the SinaPure Viral kit in the time intervals of 6, 12, and 18 months. Per these results, SinaPure Viral kit manifested no significant difference with QIA Gen and GeneAll in the time intervals of 6 and 12 months. Even after after18 months, the SinaPure Viral kit manifested a significant difference with reference kits in low viral counts in all samples. These high count viruses did not demonstrate this reduction of efficiency. The possible cause of reduction of kit efficiency could be the location of storing carrier RNA after the first time they were used. Taking into account the considerable role of carrier RNA in the viral genome precipitation, after preparing the carriers RNA solution, its storage condition is extremely effective on the stability of RNA.

In accordance with the results, the pharmacopoeia standard of the kit designed by Tehran Cavosh Clon corresponded to reference kits, i.e. QIA Gen and GeneAll. Given that, this kit is comparable to reference kits and it can be considered as a valid replacement for foreign kits in the market.

Emotional resilience can lead to the improvement of the people’s mental health through increasing their mental endurance. Therefore, the present study was conducted with the purpose of investigating the efficacy of training emotional resilience on the interpersonal forgiveness and social adjustmentin assault and battery criminals in the central prison of Isfahan.

It was a quasi-experimental study with pretest, posttest, control group and two-month follow-up period. The statistical population of the present study included all assault and battery criminals in the central prison of Isfahan in 2019 in the quantitative part. 30 assault and attorney criminals were selected through purposive sampling method and they were randomly accommodated into experimental and control groups (each group of 15). The people in the experimental group underwent twelve ninety-minute sessions of training emotional resilience during three months, while the control group didn’t receive these interventions during the study. interpersonal forgiveness questionnaire (Bell, 1961) and social adjustmentquestionnaire (Ehtesham zadeh et al, 2010) were used in the current study. The data taken from the study were analyzed through repeated measurement ANOVA via SPSS23 software.

The results showed that training emotional resilience has had significant effect on the interpersonal forgiveness and social adjustmentin assault and battery criminals (p<0. 001) in a way that this intervention succeeded in increasing interpersonal forgiveness and social adjustment in the assault and battery criminals.

According to the findings of the present study it can be concluded that training emotional resilience can be used as an efficient method to increase interpersonal forgiveness and social adjustment in assault and battery criminals through employing training communicational skills, having intimate communication with others, offering the components of emotional intelligence and training social sufficiency. The psychological health of prisoners and the provision of psychological services to them has attracted much attention from experts. More than 10. 1 million people worldwide and 20,000 people in Iran are in prison, whose mental health is of special importance (Gharibpour, Akbari and Abolghasemi, 1399). However, these prisoners are sometimes imprisoned for crimes such as violence, beatings, and sometimes continue their violent behavior in prison. Trauma from a forensic point of view is damage resulting from the impact of mechanical, physical, chemical and psychological factors on the human body that occur directly or indirectly. These injuries occur due to various factors such as vehicle accidents, firearms and cold steel, during conflicts, work-related injuries, accidents such as electric shocks, earthquakes and other cases (Kiani, Bazmi, Qarahdaghi and Barzegar, 2007). It seems that when people commit a behavior and consider it harmful to themselves or those around them; Feelings of guilt, shame, and guilt manifest themselves (Tangi and Deering, 2003). Self-destructive emotions are seen as a barrier to mental and physical health by reducing a person's sense of self-worth, leading to depression and anxiety, and disrupting relationships with oneself and others (Hall and Fincham, 2005; Ferguson Walter, 2013). ). Here forgiveness, as a variable that stops the process of self-destruction, plays a key role in restoring self-respect and value (Fisher & Axlin, 2010). When experiencing forgiveness, the person who has made a mistake embraces his or her mistake and allows the unpleasant feelings he or she has suppressed to be processed (Yeh, Ma and Yan, Chen, Wang et al., 2019). From a psychological point of view, forgiveness is considered a consequence of transsocial motivations; That is, the forgiving person forbids revenge and experiences positive feelings toward the wrongdoer. This experience is considered the culmination of a socially professional behavior, so that the forgiveness of the wrongdoer by the victim will have positive psychological and physical consequences. In addition, forgiving specific errors in relationships will reduce the other party's hurtful behavior in the future (Griffin, Worthington, Levy Locke, Wade & Identity, 2015). When people are unable to forgive themselves after a mistake or a mistake in a task or a relationship, they avoid similar tasks and in fact show the behavior followed and less follow-up in the long run to succeed in the task (Hull, Saichi and Bennett)., 2010); Here, the person, thinking that he is not able to establish healthy relationships, turns to short-term relationships, or because of guilt and self-destruction caused by not forgiving himself, constantly repeats the same damaging relationships and in the distance. Falsehood is caught up in sin and hatred (Sapmaz, Yildirim, Topkagla, Nalband, & Césir, 2016(. One of the problems that results from aggression in people with injuries is a decrease in social adjustment (Liu and Graves, 2011). Adaptation is defined as the ability of an individual to adapt to the environment and has various dimensions, including social, family, emotional, health, educational, etc. (Bacham and Cassi, 2018). Every human being, consciously or unconsciously, tries to meet his diverse and sometimes conflicting needs in the living environment, and since he has to meet his needs in the form of social construction, his adaptation is inevitably social adaptation (McQuad and Brox, 2017). Social adjustment can have a direct effect on mental health (Namazi and Sohrabi, 1397). Individual health affects not only the individual and the family, but society as a whole (Stein, Coen, Donald, Adenams, Kopowitz et al., 2015). Adapting to new and diverse situations in an age of stress and rapid social change is not an easy task. Research shows that any change in a person's life, whether pleasant or unpleasant, requires some kind of readjustment (Nezu, Nezu Dozorilla, 2013). Considering that adaptation is one of the main symptoms of mental health and its importance in all aspects of life including individual, family, education, occupation and social is clear and can provide an important role in the occurrence of positive behaviors in individuals. Those who are aggressive or beaten are less adaptable and more likely to have behavioral problems (Golestan Jahromi, Shahni Bilaq, Behrozi, and Omidian, 2017). Mikaelimnia, Babaei and Hassani (2014) show that variables such as forgiveness have a positive and significant relationship with social adjustment and can predict and explain social adjustment. Individual health affects not only the individual and the family, but society as a whole (Stein, Coen, Donald, Adenams, Kopowitz et al., 2015). Adapting to new and diverse situations in an age of stress and rapid social change is not an easy task. Research shows that any change in a person's life, whether pleasant or unpleasant, requires some kind of readjustment (Nezu, Nezu Dozorilla, 2013). Considering that adaptation is one of the main symptoms of mental health and its importance in all aspects of life including individual, family, education, occupation and social is clear and can provide an important role in the occurrence of positive behaviors in individuals. Those who are aggressive or beaten are less adaptable and more likely to have behavioral problems (Golestan Jahromi, Shahni Bilaq, Behrozi, and Omidian, 2017). Mikaelimnia, Babaei and Hassani (2014) show that variables such as forgiveness have a positive and significant relationship with social adjustment and can predict and explain social adjustment.

One of the most important factors that have been considered in marital relationships is the sexual relations and sexual functions of couples such as sexual function and sexual self-expression, which if not properly realized can lead to many problems in married life and themselves. Show in the form of various marital problems (1). Among sexual issues, the term sexual fulfillment is defined as a psychosocial feeling defined by a person's personal interpretation of how his or her feelings are expressed in a marital relationship (4,5). In this regard, the study of Zarenejad et al. (1398) showed that there is a positive and significant correlation between low sexual fulfillment and sexual dissatisfaction (7).However, many factors affect sexual fulfillment, including the role of intimacy, violence, and attitudes toward sexuality (11). But one of the most important variables that plays a role in this is sexual self-expression, which is the ability to express feelings, beliefs, thoughts and rights in a logical way (12). In this regard, the results of the study of Westimer and Laporte (2018) indicated that the sexual function of couples is strongly influenced by sexual relations and their sexual expressions; Because sexual expression and dialogue of couples about sexual issues, sexual desires and preferences (14).There are few studies on sexual issues and sex education in men and many men feel ashamed and guilty of raising and talking about their sexual issues and problems, so their problems in the form of anxiety, depression, They show sleep disorders or problems and diseases of the genital tract. In addition, many men are unaware of its effect on marital dissatisfaction as well as dissatisfaction with their lives (15). Therefore, providing sexual interventions and training is very important due to awareness, education and treatment.

The research method of the present study, according to its subject, was a quasi-experimental pre-test-post-test with a control group. The sample of the present study included 40 people from the statistical population (90 people) who were selected based on the available sampling method and taking into account the entry and exit criteria. And were randomly divided into 2 groups of intervention based on sexual intelligence (n = 20) and control group (n = 20). Then, they completed the Halbert Sexual Achievement Index (HISD) and Apt (1992) questionnaires and the Snell et al. (1988) Spouse Sexual Self-Expression Scale before, immediately after, and one month later. Admission criteria were: completing the consent form to participate in the training program, not having psychological problems, minimum diploma literacy to answer the questionnaires and exit criteria were: having psychological problems, taking psychiatric drugs and Refusal to participate in the training program.

The results of statistical analysis in the present study showed that in the variables of sexual fulfillment (P = 0.006, P = 0.001) and sexual self-expression (F = 211.510, P = 0.001) between three different stages of measurement There is a significant difference.The results of Bonferroni test also showed that the difference between the scores of the variables in the pre-test and post-test stages as well as the pre-test and follow-up stages was significant (P <0.01), while the difference between the post-test and follow-up stages was significant. Not significant (P> 0.01). This finding means that sexual intelligence intervention training not only increased male sexual fulfillment and sexual self-expression in the experimental group, but also had a lasting effect in the follow-up phase. As a result, the research hypothesis that sexual intelligence intervention training has an effect on sexual fulfillment and sexual self-expression of couples (men) was confirmed.

The results of the present study showed that education based on sexual intelligence is effective on sexual fulfillment and sexual self-expression of male couples. In this regard, the results of Martha et al. (2011) showed that the provision of sex education had a significant effect on the promotion of healthy sexual behaviors in married students (20). In explaining these findings, it can be said that sexual intelligence is a set of internal resources that allows a person to relax, be present in the moment, communicate, react to arousal in different situations, create a physical and emotional bond with a sexual partner and has a component. Information and awareness are emotional, sensory and verbal skills, body awareness and cognition, and comfort and satisfaction (17). In fact, by training sexual intelligence, people become more assertive in expressing their emotions. In this regard, Reed and Saunders (2020) report that people with self-expression skills are not shy and can express their feelings clearly, directly and without violence, aggression and insults. It is very difficult for some people to express emotions, especially love. This is while self-expression is highly correlated with love, affection, attention, trust and understanding. Thus, lack of sexual arousal causes a sexual problem to persist for a long time; Because it will not be resolved until the issue is discussed and may lead to sexual dissatisfaction (29).Therefore, it can be said that sexual intelligence training by increasing the correct information from reliable sources, increasing awareness about knowing your body, increasing sexual self-awareness of your sexual personality, makes people develop emotional skills and the ability to communicate honestly and effectively. Mind, consciously regulate their emotions and even increase sexual conversations with their sexual partner (5). In these trainings for couples, it was repeatedly emphasized that "increasing communication" and "friendship" are the key aspects of sexual intelligence. Thus, sex education leads people to feel more empowered in their sexual fulfillment and on the other hand to show a lot of sexual self-expression (19).

Urinary incontinence is defined as a complaint of any involuntary leakage of urine. This new definition includes a significant range of women who have rarely experienced accidental leakage events. As a result, some studies have estimated the prevalence of urinary incontinence at 60%. Stress urinary incontinence is the most common type of urinary incontinence and is a term used to describe involuntary urination during physical activity such as coughing, sneezing, laughing, or lifting heavy objects, etc., when the pressure inside the bladder exceeds the pressure. The urethral closure arrives, it is used. Numerous factors, such as sphincter dysfunction, pelvic floor muscles, connective tissues, or nerve structures, may cause or develop urinary stress incontinence. Approximately 4% to 35% of adult women worldwide suffer from stress urinary incontinence. Limited studies have been conducted on the prevalence of urinary incontinence in Iran. In the study of Rashidi., The overall prevalence of urinary incontinence in Iranian women was 46%. In the study of Bakui., Which studied the prevalence of postpartum urinary incontinence in women referring to health centers in Babul, the frequency of postpartum urinary incontinence was reported to be 19.4%. Urinary incontinence is a distressing condition emotionally, physically, socially, and economically. It has been shown to be associated with embarrassment, anxiety and depression and has a significant negative impact on quality of life. Despite the widespread impact of urinary incontinence on quality of life, only a small number of women seek treatment and most of them live in silence, so the disease is never diagnosed or treated. Because most women do not seek treatment in the early stages of urinary incontinence (for example, mild to moderate urinary incontinence), they eventually present with advanced symptoms (severe urinary incontinence), at which time there is an opportunity to prevent or help regress the disease. It is demolished. Given this situation, the need for appropriate prevention and treatment to reduce the negative impact of stress urinary incontinence on women's lives is clear, and most research on current therapies for the management of stress urinary incontinence seeks to improve patients' quality of life. Non-surgical interventions are recommended by the International Association of Incontinence as the first line of treatment for uncomplicated urinary incontinence in women. Pelvic floor muscle training is the basis of non-surgical treatment of urinary stress incontinence. This treatment is based on the hypothesis that training to identify and strengthen the pelvic floor muscles by increasing the support of the urethra and bladder and improving the function of the urethral sphincter muscle neutralizes the weakness of the pelvic floor muscles. The easiest way for women to train their pelvic floor muscles is to insert cone-shaped weights into the vagina and then contract the pelvic floor muscles to prevent the weight from falling out. On the other hand, the timing of pelvic floor muscle contraction, which is transmitted from the brain to the muscle by the nervous system, is an important factor in controlling urination. In other words, when there is a sudden increase in intra-abdominal pressure during sneezing, coughing, etc., the pelvic floor muscles must unconsciously and reflexively activate their rapid contraction fibers to prevent involuntary leakage of urine by neutralizing the increase in pressure, but In people with stress urinary incontinence, the coordination and timing of pelvic floor muscle function is impaired during increased intra-abdominal pressure, and the reflex and subconscious function of the pelvic floor muscles is impaired in response to a sudden increase in intra-abdominal pressure, which means that Although having strong muscles in the pelvis is necessary for proper contraction, a timely contraction is also necessary to prevent involuntary leakage of urine. In other words, a strong muscle that is not activated in time during an increase in intra-abdominal pressure cannot prevent urinary incontinence. Since the negative effect of urinary incontinence on daily activities and quality of life of women is very significant and women with more severe urinary incontinence and weaker pelvic floor muscles have lower quality of life, it is necessary to take measures to increase the contractile strength of pelvic floor muscles and promote health. Think of the urinary tract. Also, according to research, the result of cone therapy is recognizing and strengthening the pelvic floor muscles and does not play a role in the simultaneous action of rapid fibers of contraction of the pelvic floor muscles when increasing intra-abdominal pressure, if, as mentioned, the timing of urethral closure Timely contraction of the pelvic floor muscles is an important factor in controlling urination and should be considered. Therefore, it seems that in addition to strengthening the pelvic floor muscles with the vaginal cone, there is a need to train movement control strategies (control motor) to change the timing of pelvic floor muscle contraction and start their activity while increasing intra-abdominal pressure to the Knack maneuver (speed and coordination). It is said to be necessary to prevent involuntary leakage of urine. Miller et al. In their study justified the effect of the Knack maneuver as an immediate method and early response to pelvic floor exercise regimens that are widely used in women with stress urinary incontinence. Therefore, this study was performed to evaluate the effectiveness of vaginal cone with the Knack maneuver on the severity of incontinence and quality of life in women with stress urinary incontinence compared to the vaginal cone.

In this randomized controlled clinical trial that was performed in the pelvic floor dysfunction clinic of the Faculty of Rehabilitation Sciences, University of Iran, during the years 2021-2022, 76 patients with stress urinary incontinence were present who were randomly assigned to two groups of vaginal cones and were randomly divided into two groups: vaginal cone with the Knack maneuver and vaginal cone. Participants in both groups were finally accepted after an initial evaluation session. The initial evaluation included educating patients in plain language about the anatomy of the pelvic floor muscles, their proper contraction, and the benefits of therapeutic cones for the women participating in the study. Complete urine test (analysis and culture) to rule out participants' urinary tract infections, specific examinations of women in standard lithotomy with an empty bladder, and no vaginal bleeding. Pelvic visceral prolapse was also considered and the degree of each type was determined based on the POP-Q system, which is a standard approved by the International Continent Control Society and recorded in a special sheet. Grade 3 and 4 prolapses removed the sample from the study. Therapeutic interventions were performed for 12 weeks for both groups. The cone treatment protocol was common for both groups, and the intervention group received Knack exercises in addition to the cone treatment protocol. All patients before and after the intervention were evaluated for the severity of urinary stress incontinence due to increased intra-abdominal pressure and the number of involuntary leakage of urine with Urinary Diary, pelvic floor muscle contraction with Dynamometer and quality of life with Incontinence quality of life questionnaire. Paired and Wilcoxon t-tests were used for intragroup analysis and Independent Sample t-test and Mann-Whitney tests were used to compare the differences between the two groups.

There was a significant difference between all values ​​before and after the intervention in each group (P<0.05). Also, comparison between treatment groups showed significant differences in quality of life (P=0.02), pelvic floor muscle contraction strength (P=0.00), urine leakage due to increased intra-abdominal pressure (P=0.01) and the number of leaks (P=0.01).

According to the findings of this study, the treatment of cone protocol with the Knack maneuver can be suggested as a treatment strategy for patients with stress urinary incontinence.

Environmental air pollution is one of the most important environmental problems and the Global Burden of Diseases (GBD) has identified it as the fifth most dangerous human and environmental health hazard in the world. So, they are facing the problem of air pollution on a local, regional and global scale. Toxicity associated with air pollutants can cause a variety of health effects on humans such as respiratory disease, cardiovascular disease, cancer, and even death (1,2). The World Health Organization (WHO) estimates that 800,000 people worldwide die prematurely each year from these diseases caused by air pollution (3). Suspended particles (Including PM2.5) are major air pollutants in terms of public health hazards. PM2.5 particulate matter penetrates deeper into the lungs and causing some of the more dangerous health effects compared to PM10 (2). Ahvaz city with an approximate population of more than 1 million people, an area of 220 square kilometers, and the capital of Khuzestan province is one of the cities in the southwest of Iran. In recent years, due to industrialization, the amount of environmental pollution, including air pollution, has been increasing in this metropolis. This study aimed to estimate the health effects of PM2.5 pollutants on years of lost life (YLL) and expected life remaining (ELR) indicators in the air of Ahvaz city from 2008 to 2017 using AirQ+ software.

The present study was a quasi-experimental study with a statistical population of 10 years for residents of Ahvaz. In this study, the long-term health effects of PM2.5 pollutants on YLL and ELR indicators in the air of Ahvaz city during the period years (2008-2017) were estimated using AirQ+ software. PM2.5 pollutant data were collected from environmental and meteorological organizations in Ahvaz city and the health effects of PM2.5 were estimated. In the next step, this data was processed by Excel software and the data processed by Excel was given to AirQ+ software. Data processing was performed using overlapping Excel sheets in the Excel environment and R and Minitab software. Also, the validation of PM2.5 data for ambient air quality in Ahvaz city was performed based on the methodology of WHO and Aphekom (16,17). PM2.5 averaging data and ELR and YLL data for the entire population in the age range of 0-64 and over 64 years were processed and entered into AirQ+ software. Also, the significant relationship between PM2.5 pollutant concentration and ELR was investigated with the Pearson correlation test at a significance level of 5%.

The average annual variation of PM2.5 concentration was very variable the highest concentration was 70.72 micrograms per cubic meter in 2010 and the lowest was 41.97 micrograms per cubic meter in 2014. In all measurement years, the concentration of PM2.5 was higher than the WHO standard with a range of variations between 4.2 and 7.7 times. The highest number of YLL for ten years in the age group of 0-64 years, was 412.77 years in 2010, and the lowest number of YLL for the age group of 0-64 years, was 135.79 years related to 2014. Also, the maximum and minimum YLL for ten years for the age group over 64 years was 1135.96 years for 2010, and 262.88 years for 2014, respectively. For ELR, the highest value for the total population of Ahvaz city during ten years, at all ages for 2014 was equal to 72.56 years and the lowest in 2010 was equal to 62.17 years.

In all years of measuring PM2.5 (2008-2017), the amount of this pollutant in the air of Ahvaz city has been more than the WHO standard, and its range of changes between 4.2 to 7.7 times more than the standard (10 Micrograms per cubic meter). Therefore, Ahvaz is considered one of the most polluted cities in the world. The polluting factors of this city include the geographical and topographical location, the phenomenon of dust, increased transportation, being close to the Arabian desert and the large deserts of the neighboring countries, and the increase of important production industries such as oil and steel (21,22). The maximum and minimum YLL for all ages in Ahvaz city were 1548.73 years in 2010 and 398.67 years in 2014, respectively, which are linearly related to PM2.5 pollutant concentrations. The highest and lowest PM2.5 concentrations were obtained in 2010 and 2014 in Ahvaz city. From the results of this study, it was estimated that in all the studied years, people over 64 years old had higher of YLL than people aged 0-64 years. The ELR index can be useful in evaluating all the plans made in the field of health and well-being of the population. Prolonged exposure to relatively low concentrations of ambient air pollution results in a significant reduction in the ELR index (30). A comparison of the results with the Iranian standard and EPA showed that in all years the ELR from 2008 to 2017 was lower than the standard. The highest ELR index was 72.56 years (2014) and the lowest was 62.17 years (2010). The values ​​of this index had a significant relationship with the concentration of PM2.5 pollutants. The ELR index decreased and increased with increasing and decreasing the concentration of PM2.5 pollutants, respectively. By examining the significant relationship between PM2.5 pollutant concentration and ELR in Ahvaz city through Pearson's correlation test at a significance level of 5%, the correlation coefficient showed a value of -0.97, indicating a negative correlation between these two parameters.It seems that in the west of the country, the number of days off due to dust has increased significantly in recent years. Therefore, the use of AirQ+ software not only for Ahvaz but also for other cities in the west of the country can be a powerful tool for estimating the lost years of life and reducing life expectancy attributed to PM2.5 pollution. Therefore, estimating the long-term health effects of YLL and ELR exposure to various air pollutants, including PM2.5, can be very useful to evaluate plans for health, population well-being, and the development of general environmental policies.

Autoimmune and chronic diseases cause many psychological problems by directly and indirectly affecting the nervous system. Lupus is one of the autoimmune diseases that, in addition to the problems caused by the nature of the disease itself, the side effects of its drugs also cause emotional and mental disturbances. The prevalence of lupus in women is about 9 times higher than in men, and the patients are usually between 15 and 45 years old. In Iran, according to a study conducted by the Rheumatology Research Center of Tehran University of Medical Sciences, lupus has a prevalence of 40 in 100,000, that is, 1 person per 2,500 Iranians is diagnosed with lupus. People with lupus Erythematosus experience many skin ulcers, joint pains, periodicity of the disease, side effects of medications, and stressful events. In the framework of psychological interventions for people with lupus, in recent years acceptance-based therapy (ACT) and commitment is a non-pharmacological strategy and among the effective treatment lines for patients with physical diseases. This therapeutic approach is part of the third wave of behavioral therapies, which aims to help clients achieve a more valuable and satisfying life by increasing psychological flexibility and not focusing solely on cognitive reconstructions. Research has emphasized the effectiveness of cognitive functions and attention management and executive function by ACT in patients with chronic diseases. For example, Menshi et al showed in their research in 2015 that ACT can improve people's executive function by adjusting incompatible schemas, however, no research was found regarding the effectiveness of this treatment method in people with lupus. In addition to ACT, another psychological approach and non-pharmacological strategies that have been proposed to improve psychological and functional variables such as attention and executive function in people with lupus is short-term intensive dynamic psychotherapy (ISTDP). The goal of ISTDP or psychoanalysis is to help clients achieve a full experience of repressed emotions and the fantasies and memories that are repressed by these emotions. By clarifying defenses and challenging them, ISTDP focuses on experiencing unconscious feelings and emotions to increase awareness. It is a psychological process that can help you change how you react to life's inevitable hardships. The review of the literature showed that even though several studies on the effectiveness of ACT and also the ISTDP approach have been conducted separately on different populations, no study compares these two treatment approaches in patients with lupus Erythematosus. The present study was conducted to compare the effectiveness of ACT and ISTDP on attention and executive function in lupus Erythematosus patients.

The current research was a semi-experimental single-subject type with multiple baseline designs. The participants of this study were 6 people with lupus, members of the Lupus Patients Support Association in Tehran, who were selected as available and randomly assigned to two groups of three. The tools used in the research included the Wisconsin Card Sorting Test and the Stroop Test. The subjects of the first group received ACT and the subjects of the second group (ISTDP) individually in 8 sessions of 90 minutes. To analyze the data, the effect size was used.

Regarding effect size calculations in Stroop dimensions between treatment groups, the results generally showed that the ACT method had a more significant effect than ISTDP in the extent of reaction time. In terms of reducing the number of errors in the error of the first stage, the effect size in the ACT group is medium and in the ISTDP group, slightly too high, in the second and third stages, both are high, but the magnitude of the effect is higher in the second stage in the ISTDP and in the third stage in the ACT group. Regarding the calculation of effect size and index of stable change in Wisconsin dimensions between treatment groups, the results of the study also showed that the average effect size in the residual error of the first and second stages of the Wisconsin test in the ACT group is higher than the average effect of the ISTDP group. In terms of increasing the number of correct answers in the first and second stages, the effect size in the ACT group is lower than in the ISTDP group.

The results of the study showed that despite the effectiveness of ISTDP on the attention and executive function of patients with lupus Erythematosus, ACT had more effectiveness than ISTDP on the attention and executive function of patients with lupus Erythematosus, hence this approach along with other approaches The existing treatment is recommended as a suitable option to improve attention and executive function in people with lupus Erythematosus. It is also suggested that health therapists pay attention to the findings of this research and the discussion of executive functions to enrich their diagnostic formulation, and if they find a symptom in executive functions, they should use cognitive interventions in this direction. Due to the problems in collecting samples from patients with lupus Erythematosus, the available sampling method was used in this research. Therefore, the selected sample group is less representative of the entire society and the results cannot be generalized. Also, this research was considered without a control group and follow-up stage. The same researcher and therapist in ACT may also increase the possibility of bias in the results. Also, in this research, the effect of moderating variables such as gender was not investigated, which may have distorted the results.

Compared to the past, the competition in today's markets is wider and more diverse, and many companies are trying to provide the conditions for their growth and development by developing appropriate competitive strategies. One of these strategies is paying more attention to customers' feelings. (1). Also, in today's competitive market, the most important issue of shopping centers is the different tastes of customers, which is considered one of the important discussions of organizations. Despite the known information about shopping centers, these centers usually have the same products and goods. For example, many shopping centers have placed places as entertainment, reception and conversation centers for friends and customers. Also, some other shopping centers attract customers by placing a variety of products in shop windows and decorating them. In order to bring the best shopping experience to customers, shopping malls must offer unique and different products and services to customers compared to other stores. (2). Nowadays, the good location of shopping centers does not guarantee the success of these centers anymore. The lack of differentiation in providing goods and services to customers is currently a problem in these centers. Shopping centers often offer similar goods and services to customers. However, some of them have added a wide range of amenities to their stores to gain the satisfaction and loyalty of their customers. (3). Today, customer satisfaction is a key factor for the success of organizations. Researchers state that satisfaction is related to the evaluation of products and services and purchase values. These researchers have stated that the evaluation of products in terms of hedonic values leads to a positive effect and the feeling of positive consumption leads to the customer's intention to buy again. (4); Considering that hedonic shopping values affect the mental perceptions and perceptions of customers. (5) Also, due to the reopening of large shopping centers in Iran and stores that offer all the goods needed by the customer in one place, this issue arises that hedonic and materialistic shopping values, according to the different tastes of customers, To what extent can it lead to the intention to repurchase the customers of these shopping centers? Therefore, in this research, based on the background of previous researches and the conceptual model, the effect of hedonism on consumer guilt and consumer shame, the effect of diversification on consumer guilt and consumer shame, the effect of materialism on consumer's feelings Let's examine consumer guilt and consumer shame, consumer guilt and consumer shame on repurchase intention. In the world of shopping and consumption, impulse buying has a lot to do with inappropriate individual behavior and preferences, the negative consequences of which include personal and financial issues, post-purchase satisfaction, social reactions, and above all, individual self-esteem, but sometimes impulse buying is a behavior. It is considered normal and even with positive consequences. Instant shopping is a complex but enjoyable phenomenon. Because a person does not care about the consequences of his actions in the future. Of course, it should be mentioned that just having the feeling of buying a gift does not necessarily lead to action, but various variables can affect the relationship between buying a gift and action. This behavior is an experience, but an experience that happens very quickly. Instant buying can be likened to stealing goods rather than choosing goods, and from an individual point of view, it is more unconscious than conscious. In fact, buyers who experience impulse purchases do not give in to any stimulus or demand. There are various factors that may inform the consumer of his need and at the same time inform him what will be the result of the immediate purchase and the feeling related to it. Factors such as financial situation, time, way of looking at issues and social status and maybe even immediate purchase can be effective in creating the need and evaluating it and speed of purchase. (6) Psychologists believe that people's desire for instant purchases is different and can occur with different notions of hedonism, diversification and materialism. (7,8) Also, shopping for pleasure is always more personal and internal than value based on utility and is often the result of play and entertainment. (9) Consumers can fantasize about owning a product. Also, they may feel arousal after a pleasurable shopping experience. In this case, hedonic shopping consumes emotions such as happiness, jealousy, fear, passion, and pleasure, and these emotions and feelings are phenomena related to motivation and stimuli. (10) In addition, Hirschman and Holbrook state that emotional arousal can be the main motivation of consumers in some product categories such as books, food, games and sportswear and can lead to pleasurable purchases. Just as pleasure-seeking buyers have different motivations, these consumers also have different expectations from their purchases. Babin, Darden, and Griffin state that shopping means more than just having a product, and retailers must focus on the more pleasurable aspects of shopping in order to be successful; Because the pleasant experience of customers plays an important role in gaining a competitive advantage. Despite the fact that retailers try to differentiate themselves from competitors by providing a pleasant experience for the customer; However, limited studies have been done in the academic space on reasons and hedonic motives in the activity of consumer buying activities. (11)

The present study examines the effect of pleasure on consumer guilt and shame, the effect of diversify on consumer guilt and shame, the effect of materialism on consumer guilt and shame, as well as consumer guilt and shame on repurchase intention. The current research is applied in terms of its purpose and is considered a survey in terms of the method of data collection. A questionnaire was used to collect information. For this purpose, among 384 customers of shopping malls in Tehran, the hypotheses were tested by stratified random method according to the volume of distribution and through structural equation modeling. The items are taken from the research of Babin et al. (1994); Lee et al. (2009); Richins and Dawson (1992); Dedeoğlu and Kazançoğlu (2012), Maclnnis and Patrick (2006) and Diallo (2012) were localized with the opinion of professors and experts. To check the validity of the content of the questionnaire, 12 copies of the questionnaire were given to the professors of business administration and the content validity ratio (CVR) was calculated for each of the items, and the value obtained was acceptable for all the items of the questionnaire.

According to the research findings, pleasure, diversify and materialism have a positive effect on consumers' feelings of guilt and shame. Also, pleasure, diversify and materialism are effective on repurchase intention. On the other hand, consumer guilt and shame have a negative effect on repurchase intention.

Considering that the effect of pleasure, diversify and materialism on guilt and shame was confirmed, shopping center managers should try to take measures to manage and reduce the guilt and shame of consumers after shopping, so that they can buy again in the goods. Purchased, because if these centers do not pay psychological attention to consumers, they may lose a significant part of their buyers. Because considering the importance of post-purchase disonance of consumers such as feelings of guilt and shame in repeat purchases, companies should be aware of the importance of post-purchase anomalies in consumers at all stages of service provision and provide solutions. Because training programs and trainings with products will work more consciously.

Throughout history, humans need to have sexual intercourse, at least in order to reproduce and perpetuate their offspring, so sexual activity has become an important aspect of human life(3). One of the most important philosophies in forming a married life is for a couple to come together to have tranquility and comfort. This comfort depends on some factors, one of the most obvious of which is healthy sex. Sex, a four-stage response cycle including sexual desire, arousal, orgasm, and suppression, is a significant aspect of married life. Any disorder in one of these stages may interfere with a person's sexual function and lead to sexual dysfunction (4). In general, the main feature of sexual disorders is a disorder in the processes of the normal stages of sexual intercourse or pain that occurs during sexual intercourse. For each of these disorders, which occurs in the four stages of sexual activity, there are specific diagnostic criteria: the disorder in sexual activity must cause suffering and discomfort, affect the marital relationships, and be continuous and frequent (5). In a study, Froutan et al. (6). examined the sexual dysfunction of divorced couples. The results showed that 77% of women had sexual dysfunction, therefore even people successful in sex may have some problems in their sexual activity. Dosti and Vaziri(2018) (8) reported a high prevalence of the sexual disorder in their study and showed that sexual problems are a widespread health problem in women. Researchers believe that in order to better understand sexual activity and its development in humans, it is necessary to study all aspects of human beings including physical (such as genetics, hormones), mental (such as how one feels about oneself and others), social (the relationship between self and others) and spiritual aspects (such as religion, values, and beliefs) (10). Therefore, beliefs, attitudes, and religion are among the influential factors in the sexual behavior of individuals. In general, religious attitudes can be effective in marital relationships; because religion has guidelines, a system of beliefs and values that can affect marital life (11). Husseni nasab et al. (2018) evaluated the role of religion on marital relations and sexual activity as positive (12). Kamyabi niya et al. (2015) in their study showed that there is a positive and meaningful relationship between sex and religion. In other words, people with desirable sexual activity have a higher religious health score (13).According to Allport and Ross theory, religious orientation which is based on two types; internal and external means the tendency to perform religious practices and thoughts (15). Internal religious orientation has a motivational aspect, organized, and internal principles and does not require other stimuli. External religious orientation is external and is a factor in satisfying personal needs such as status and security. External orientation is considered an immature or less mature religion (16). One of the other variables of the present research is a practical obsession. Studies have shown that obsessive disorder run in families (17). These obsessive-compulsive behaviors lead to considerable confusion and cause severe impairment in psychosocial functioning (18). Obsessive- compulsive behaviors are recurring and persistent thoughts, desires, or perceptions that are experienced as disturbing and unwanted; Practical obsessions, on the other hand, are repetitive behaviors or mental actions that a person feels compelled to perform in response to an obsession or in accordance with rules that must be strictly enforced (18). In societies with high religious beliefs, obsessive thoughts are more prevalent. This indicates the role and relationship of religion with obsessive behaviors confirmed by various studies. Many studies have shown that external religious orientation is both directly and indirectly (through feelings of extreme responsibility and guilt) associated with signs of practical obsessive disorder (21). According to different research, one of the variables related to religious orientation is a practical obsession; therefore, in this study, we will consider the relationship between sexual dysfunction, obsessive behaviors, and religious orientation. A positive point of the present study is that unlike other studies that have dealt more with the relationship between obsessive-compulsive disorder and sexual dysfunction or the relationship between religious orientation and obsessive-compulsive disorder; the present study intends to investigate the relationship among all these three variables. Based on the results of this study, many marital differences and dissatisfaction can be reduced and family stability and continuity can be provided. In general, considering the effective nature of sexual disorders in various aspects of life, especially the importance of this issue on marital relationships, it seems necessary to identify the factors influencing sexual activity. One of these factors is the cultural values of the society e.g. religion. Considering the religious context of Iranian society, conducting research on the role of religious orientation in sexual function and practical obsessive behavior of women is very important; therefore, the main question of the present research is whether there is a meaningful relationship between sexual dysfunction, obsessive behaviors, and religious orientation of married women?

The present study is a descriptive-correlational study. The statistical population of this study included all married female students of North Tehran Azad University in the academic year 2020-2021. According to the statistical sample based on Klein theory, in factor analysis, 10 or 20 samples are required for each variable, but the minimum sample size of 200 is defensible. 250 students of North Tehran Azad University were selected based on the available sampling method.The ethics code of the present study is IR.ALZAHRA.REC.1401.014. Research instruments include the standard female sexual dysfunction questionnaire, the Allport Veras religious orientation questionnaire, and the standard Madzli obsessive-compulsive disorder questionnaire.

The results show that the correlation coefficients between the dimensions of sexual dysfunction with the dimensions and the total score of obsessive behaviors are positive and significant (P≥0.01). Regression coefficients show that in the best predictive model for the dimensions and total score of marital satisfaction of couples, only the psychological dimension can predict the criterion variable. There is also a significant relationship between sexual dysfunction and its subscales with religious orientation (P≥0.01). Regression coefficients also show that both dimensions of religious orientation can predict sexual dysfunction (P <0.01). Religious orientation also has a significant relationship with obsessive behaviors in married women and predicts it (P <0.01).

According to the results, religious orientation is able to predict sexual dysfunction and obsessive behaviors. Other results indicate significant relationships between sexual dysfunction and obsessive-compulsive behaviors and religious orientation. In other words, religion as a coping factor can be associated with many psychological and behavioral disorders, including obsessive-compulsive disorder and sexual dysfunction, and generally predict mental health in individuals. In other words, religion can play a positive role in reducing sexual dysfunction and obsessive behaviors, so it is necessary for psychologists to develop and implement educational programs to solve such kinds of problems, highlight the importance of religious orientation, and pay special attention to preventing and treatment programs.

Autism Spectrum Disorder (ASD) is a neurological developmental disorder characterized by impaired social interactions, stereotypic movements and repetitive and limited behaviors and interests. Given the increasing statistics of autism in children in the world and in Iran, the extent of problems and burdens that this disorder creates for the child, family and society, it is a necessity to identify the causes and factors related to ASD. Moreover, data on this disorder are limited nationally and geographical differences are rarely assessed. To conduct great research on autism spectrum disorders requires a large number of samples to identify the epidemiological trend of the disorder. Registrations are one of the efficient methods that can provide this data in a long time and on a large scale. The purpose of this study is to describe the steps of designing and launching an autism registration system in Tehran, which can be a prelude to creating a system at the national level.

In this study, the aim was to present a protocol to design and launch a registry for patients with autism spectrum disorders in Tehran for clinical and research purposes. The entered population in this system includes individuals (including children over 6 months and adults) with previous diagnosis or new diagnosis referred to the certain centers (Child Psychiatric Clinic of Tehran Psychiatric Institute, Ali Asghar Children's Hospital, Razi Hospital and Roozbeh Hospital) and also, physicians' offices who are members of the program's strategic committee. Patients are admitted to the program if the diagnosis of ASD is confirmed by a pediatrician, child neurologist, psychiatrist, neurologist, psychiatrist, neurologist, child psychologist according to the DSM-5 diagnostic criteria.Then personal and demographics information and clinical and laboratory findings will be recorded by data entry experts in the system. Patients will be followed up by telephone or through coming back of the patients to the certain centers. Data analysis is done in accordance with the objectives of the registration program and is performed based on conventional statistical methods. Also, an annual report of the profiles of registered patients is sent to the beneficiaries of the program at the end of each year, including the Vice Chancellor for Research of the participating universities, the Ministry of Health, and related associations and groups. Initially, stakeholders in the field of autism spectrum disorders from different and related specialties were identified from partner universities of medical sciences in Tehran (Iran, Tehran, Welfare Sciences) and various centers accepting autism spectrum patients and the Strategic Committee for Autism Registration as a subset of the Vice Chancellor for Research was established in 1398 in Iran University of Medical Sciences. The Strategic Committee is responsible for developing guidelines and executive protocols consisting of experts in the fields of general psychology, child psychology, social medicine, epidemiology, information technology, health informatics and health information management, as well as the executive committee and executive groups for follow-up and conducting decisions of Strategic Committee was considered. Data Management and Information Technology (IT) Department was  Responsible for Software Design; Data collection and quality control group was responsible for data collection, quality control, feedback and data correction; The epidemiology and data analysis team was also responsible for designing and conducting the data analysis program.The population entered in this system includes people (including children over 6 months and adults) with previous diagnosis or new diagnosis of the referral centers. A child is considered to have diagnostic criteria for autism spectrum disorders according to the DSM 5 Diagnostic Guide if he or she has serious impairments in communication and social interactions as well as a limited and repetitive pattern of behavior, interests, and activities. Patients enrolled in the program have been diagnosed with ASD by a pediatrician, child psychiatrist, pediatric neurologist, psychiatrist, or neurologist.Child Psychiatric Clinic of Tehran Psychiatric Institute, Ali Asghar Children's Hospital, Razi Hospital and Roozbeh Hospital and also physicians' offices who are members of the program's strategic committee are covered now. Based on the objectives of the Strategic Committee and literature review for the design of registration systems, the following data collection was considered: Personal and socio-demographic characteristics (such as name, age, gender, ethnicity, parents' relatives, place of birth and residence, birth rank, education) Clinical information (such as history of developmental delay, name of the disorder, presence of seizures, presence of mental retardation and other psychiatric diagnoses, personal and family history of the disorder) Laboratory and imaging

Then personal and demographics information and clinical and laboratory findings will be recorded by data entry experts in the system. Patients will be followed up by telephone or through coming back of the patients to the certain centers. Data analysis is done in accordance with the objectives of the registration program and is performed based on conventional statistical methods. Also, an annual report of the profiles of registered patients is sent to the beneficiaries of the program at the end of each year, including the Vice Chancellor for Research of the participating universities, the Ministry of Health, and related associations and groups.In order to validate and evaluate the feasibility and ease of implementation of the data collection form, this form was piloted in several centers and then based on the results of experimental implementation, the questions were reviewed and finalized. After compiling the final version of the data collection form, the software registry system was designed for the web. In order to maintain data security, a separate access and a specific access level for each user is determined and hosted on the servers of Iran University of Medical Sciences. Data analysis is done in accordance with the objectives of the registry and is performed based on the required statistical methods. Also, an annual report on the profile of registered patients of the registry is sent to the beneficiaries of the program at the end of each year, including the Vice Chancellor for Research of the participating universities, the Ministry of Health and related associations and groups.In 2014, the Deputy Minister of Research at the Ministry of Health and Medical Education (MOHME) of Iran decided to establish registration systems for various diseases and health consequences (4). In this regard, the launch of a clinical-research registry in autism in Tehran was considered. Setting up an autism spectrum disorder information registry in Tehran as a preliminary study for its establishment at the national level can help to integrate research activities and create a research network and prevent incoherence, rework and waste of time and energy in related research activities in the country. In addition to the direct use of data for research activities, such systems can also be used to identify patients eligible for clinical trials. In addition, it is possible to study the natural course of this disorder, track individuals and help increase the country's indigenous knowledge based on local and regional information. In addition, launching a program to record the autism spectrum disorders will help policymakers and health planners in the country to decide and plan for it.In addition, is not possible for policy makers to plan in an integrated, comprehensive, accurate and up-to-date way without having access to such online information systems. In the long run, this study aims to record all ASD information across the country in this system to eliminate the huge challenges of patients, physicians and health decision makers and also Smoothing the way for research further.

Establishing registry systems, especially chronic diseases seems to be a need for work so that health policy makers can make the right policies and plans to improve the level of health. One of the most important features of registries is the enrolling of patients in the time period and the possibility of increasing the collection of patients in the country. Due to the relatively high prevalence large number of causes and increasing high financial burden of autism spectrum disorders that it imposes on society, it is a suitable c case to evaluate prevalence, environmental and genetic factors through recording all clinical and epidemiological information

Iron deficiency anemia is the most common anemia worldwide with significant clinical consequences. The disease is caused by not having enough iron to produce hemoglobin for reasons such as dietary iron deficiency, insufficient iron absorption, chronic bleeding, and genetic factors. Hepcidin protein is the main regulator of systemic iron homeostasis hormone ferroportin. The role of hepcidin is to control the expression of iron-releasing ferroportin levels in duodenal cells and macrophages, modulating iron uptake and recycling. Hepcidin inactivation causes severe iron overload, while increased hepcidin causes anemia. Several factors regulate hepcidin synthesis, including matriptase-2, which reduces hepcidin synthesis. Matryptase-2 is a type 2 membrane serum proteinase, encoded by the TMPRSS 6 gene. This gene is located on the long arm of chromosome 22 and is mainly expressed in the liver. In humans, inactivation of this protein leads to a rare autosomal recessive disease called IRIDA. Several genetic polymorphisms related to iron status have been identified using genome-related studies. The aim of this study was to investigate the polymorphism of TMPRSS6rs2111833 in patients with iron deficiency anemia in the west of the country.

The present study is a case-control study. Using the sample size determination method available, sampling was performed at a time interval of 3 months with the cooperation of private laboratories in Sanandaj, Dehgolan and Kermanshah. A total of 91 people were randomly included with respect personal consent. Of these, according to the results of ferritin, hemoglobin, red blood cells, white blood cells and platelets 43(47.25%) with iron deficiency anemia and 48(52.75%) healthy controls were enrolled. Five ml of blood sample was collected from all participants and placed in CBC tubes containing anticoagulant and after inverting several times, it was placed in freezer -20. DNA extraction was performed using the extraction kit of Kwsar Company and according to the kit instructions. The quantity and quality of the extracted DNAs were determined using light absorption in spectrophotometer and electrophoresis on 1% agarose gel. The isolated DNA was stored in separate microtubes at -20 ° C until PCR. Then the genotype of individuals was obtained using ARMS-PCR technique and primer sequences used in previous studies. Amplification of the desired fragment was performed using Sinagene Company PCR kit by Rotor-Gene Q (Corbett Life Science) cyclotron device according to the protocol and the PCR product was loaded on 1.8% agarose gel and the quantity and quality were determined. Finally, a statistical test was performed to compare the frequency of genotypes in all samples using Windows SPSS tool and the value of p <0.05 was statistically described.

The results showed that the frequency of GG, AG and AA in all participants were 45%, 22% and 33%, respectively, and so for sick and healthy individuals were 47 and 44, 23 and 21 and 30 and 35, respectively. Also, out of 200 alleles, 120(56%) and 80(44%) alleles were G and A, respectively. The portion of G allele in patients and controls group was 58 and 54% and the share of A allele was 42 and 46%, respectively. Hardy Weinberg and heterozygosity equilibria were also examined for the two groups. The Hardy-Weinberg test showed that the assessed population was balanced. Heterozygosity for a gene locus is defined as the frequency of heterozygous individuals for that locus relative to the total population. A gene locus is polymorphic if its heterozygosity is greater than 0.1, and if it is greater than 0.7, it is highly polymorphic. Based on the results of this study, it was seen that the difference between observed and expected heterozygosity in the studied polymorphism is less than 0.1, so the gene position is not polymorphic. Also, co-dominant, dominant, recessive and super-dominant models were examined and in all cases, the Pv value was greater than 0.05. On the other hand, Sixty-nine percent of participants had normal hemoglobin, 41% normal iron, 51% normal ferritin, 83% normal red blood cells, 92% normal platelets and 82% normal white blood cells. On the other hand, 22% of participants had abnormal hemoglobin, 65% abnormal iron, 54% abnormal ferritin, 22% abnormal red blood cells, 2% abnormal platelets and 26% abnormal white blood cells. rs 2111833 showed no significant association with decreased serum hemoglobin, serum iron, serum ferritin, platelets, red and white blood cells.

This results showed that the rs2111833 polymorphism were not significantly associated iron deficiency anemia in the studied population. In addition, no significant association was found between rs2111833 and hemoglobin, iron, ferritin, platelets, RBCs and WBCs clinical parameters. Beutler and colleagues investigated the role of TMPRSS6 gene polymorphisms in adults with iron deficiency anemia. Their observations highlighted the role of matriptase-2 in controlling iron metabolism and erythrocyte parameters. Sylvester et al. Reported the association of TMPRSS6 mutations with iron deficiency anemia. Previously, Feinberg et al. reported several mononucleotide polymorphisms associated with iron deficiency anemia, including rs 869320724, rs 767094129, rs 786205059, rs 137853120 and rs 137853119.7 Several studies have shown that the polymorphism rs 2111833 is associated with decreased iron and hemoglobin levels therefore, it related with an increased risk in iron deficiency anemia.  In 2015, Gichohi-Wainaina et al. Identified some changes in the partial frequencies of the rs 2111833 alleles in Asian populations compared to the Caucasian population, which matched our findings. Anemia remains a widespread and significant global health problem that needs to be adequately addressed. Although iron deficiency anemia is the leading cause of anemia in most areas, recent research shows that the cause of anemia is complex and specific to each region. To better understand how to help the underlying causes of anemia, including iron deficiency anemia and other nutritional deficiencies, diseases, and hemoglobin disorders, efforts need to be made to make appropriate interventions work under certain conditions. Further studies on a larger patient scale are also necessary to identify potential haplotypes and polymorphisms responsible for the low response to oral iron therapy and may be useful for planning a proper iron supplementation.There were some limitations to this study, such as an insufficient total number of participants. However, these results could enhance our understanding of the role of genetics, particularly single nucleotide polymorphisms, in increasing susceptibility to a variety of diseases.

The goal of medical science, which is progressing on a daily basis, is not only to avoid diseases but also to increase the quality of life of people (1). Quality of life is an important indicator of health beyond physical health and includes the feeling of healthiness, some degree of satisfaction and the general sense of self-worth (2), namely a mental state of well-being that can be influenced by culture, value system and the stressful environment (3). According to WHO definition, the quality of life is people's understanding of their position in life in terms of culture, value system in which they live, their goals, expectations, standards and priorities (4), which is affected in different ways by social, economic, environmental and individual factors (5). In fact, economic, psychological, social and environmental factors (6), as well as age, health status, occupation (7), gender, culture, education along with general behavioral, job and adaptation elements can influence the quality of life (8). Failure to pay attention to quality of life can lead to disappointment, reduction in social, cultural, economic, and health activities, loss of work motivation, decreased job performance, occupational burnout and early retirement (8, 9). On the other hand, paying attention to quality of life increases efficiency and reduces psychological pressures (10). Quality of life is one of the most important aspects of human health, and improving the health of employees may reduce medical costs, disability and absenteeism, improve job satisfaction and increase productivity (9, 11(.The operating room is a closed environment associated with risks and anomalies, which can be considered a unit with environmental factors of stress causing dissatisfaction with personal responsibilities and professional work of surgical technologists, which may lead to physical and mental disorders adversely affecting a person's health and quality of life (13). Because we need employees who enjoy their high quality of life in order to provide satisfactory health care (14), the physical, mental health and emotional management of staff should not be neglected (15). In the operating room, the common goal of the surgical team is to provide effective, systematic and safe care, and failure of each member to perform their role can have a serious impact on the success of the entire team, and on the other hand, the success of an individual as a member of the team creates personal satisfaction in him/her (16) because surgical technologists are responsible for maintaining safety and comfort for patients in the operating room (17). Any negligence on the part of technologists may endanger the life of patients. According to the search for sources on this issue in Iran and abroad, it was observed that there were limited studies on quality of life of surgical technologists. Therefore, the researcher decided to conduct the present study with the aim of determining the quality of life and its related factors among surgical technologists of the medical training hospitals affiliated with Iran University of Medical Sciences.                                                                                        

In this cross-sectional study that was conducted in hospitals affiliated with Iran University of Medical Sciences hospitals, 125 surgical technologists were recruited. Inclusion criterion was holding an associate or bachelor degree in surgical technology. The cluster sampling method was used, in which each of the centers was considered a separate cluster. According to the number of staff in the center, the personnel IDs of individuals were written on small sheets of paper. Then, the IDs were randomly selected by a person outside the study, the number was matched with that in the staff list, the desired person was chosen and sampling completed. A total of 150 questionnaires was distributed among surgical technologists in hospitals. The data were collected using demographic information questionnaire (age, gender, marital status, work experience, type of shift work, level of education, income, night shift hours per month and employment status) as well as 26-item WHOQOL-BREF. After obtaining permission from Research Vice-Chancellor (ethics code IR.IUMS.REC 1395.9411101009), OR was visited to collect data. The research goal was explained to all the research units, and there was no compulsion to participate in the study. In all stages of the research, the utmost confidentiality was observed for personal information, and anonymous questionnaires were completed as self-reports by the research units themselves in presence of the researcher. The normal distribution of data was confirmed by Kolmogorov-Smirnov test in SPSS-22. The results of descriptive analysis for qualitative variables were reported using frequency (percentage). The values of variables related to different dimensions of quality of life in each level of the studied variables were reported using mean±SD. To examine the relationship between different dimensions of quality of life with the studied variables, independent t-test was used for two-level qualitative variables, and one-way ANOVA was employed for qualitative variables with more than two levels. Bonferroni's post hoc test was used for pairwise comparisons. To investigate the effect of each variable on different dimensions of quality of life by controlling the effect of other variables, we used linear regression analysis, so that the significant variables entered at 0.2 level in univariate analysis. P<0.05 was considered the significance level in the rest of tests.

The participants of this research were 125 surgical technologists. More than half of the research units (52%) were <30 years, 40.8% were 30-40 years and the rest >49 years. The majority of research units (79.2%) were women and the rest were men. The mean and standard deviation of the quality of life was 63.10 ± 18.57; quality-of-life score in dimension of physical health was 54.77 ± 18.87, social health 54.60 ± 18.07, mental health 54.40±14.19, and environmental health 48.27±12.25, which shows that the lowest quality of life score of research units was related to the environmental dimension. By controlling the effect of each of the dependent variables, the variables of marital status and time of night shift had a significant effect on the level of physical health, so that after controlling the effect of night shift variable, the physical health score of married people was on average 13.23 units higher than single people [B=13.23, SE=2.96, P=<0.001, 95%CI= (7.36, 19.09)]. Also, after controlling the effect of the variable of marital status, physical health score of people who had >36 hours of night shift per month was on average 8.73 points lower than those who had <12 hours of night shift per month [B=- 8.73, SE=4.01, P=0.031, 95% CI= (-16.66, -0.790)].

The quality of life of surgical technologists was at an average level, and it was lower than other dimensions in the environmental dimension. Married people had a higher quality of physical health than unmarried people, and physical health was lower in those who had >36 hours of night shift per month relative to people with <12 hours of night shift per month.

In expressing the relationship between servant leadership and knowledge sharing, it should be said that despite the comprehensiveness of the concept of servant leadership style within the organization, there is little research on its relationship with knowledge sharing and social capital in organizations. It doubles the research in this area. In expressing the relationship between servant leadership and social capital, it should be said that servant leadership style can affect all aspects of social capital; In other words, by creating mutual trust and influence in followers and modeling, empowering followers, creating their competence and merit, increase the social capital of the organization. In other words, one of the factors affecting the level of social capital is the type of leadership style adopted by managers. In fact, leaders can grow people by adopting a service-oriented leadership style and investing in people by building trust between themselves and their followers, serving them, and sacrificing personal interests against them in the organization's decisions and missions. Through spiritual nourishment, involvement of followers in organizational affairs, giving responsibility to the followers with authority and being flexible and steadfast, it helps to promote social capital and in this way, in addition to benefiting from people with high human capital, Benefit from the advantage of expanding social capital in your organization. The present study seeks to design a model on the concepts of servant leadership style and knowledge sharing in relation to each other and social capital as a mediating variable in Mazandaran University of Medical Sciences and thus helps to expand the existing knowledge in this area. N. Given the above, it is clear that "servant leadership style" is associated with the variables "social capital" and "knowledge sharing" and can be a source of positive effects on the organization, so the researcher's preoccupation to answer this question. What is the model of the relationship between servant leadership style and knowledge sharing with the mediating role of social capital in Mazandaran University of Medical Sciences?

This research was method-mixed in terms of method. The study population in the qualitative part included the president of the university, managers of the department, the director and managers of the eight vice-chancellors of the university and the director of the nine affiliated faculties) of Mazandaran University of Medical Sciences with an approximate number of 45 people and in the quantitative part included the staff of Mazandaran health services and sub-faculties were in 2016. In the qualitative part, sampling was done by snowball sampling method and 20 people were selected and in the quantitative part, it was done by sampling multi-stage relative classes with Cochran's formula and 323 people. In this study, considering that the data collection method was a researcher-made questionnaire, which consisted of two parts, including general questions and specialized questions (including 95 items). Delphi technique was used to analyze the data in the qualitative part and the structural equation method (SEM) and AMOS software were used in the quantitative part.

The results showed that the direct standard coefficient of the servant leadership style variable on knowledge sharing was 0.57, t value was 5.220 and P-value was less than 0.05. There is a significant relationship between servant leadership style and knowledge sharing. The direct standard coefficient of the servant leadership style variable on social capital is equal to 0.55, the t value is equal to 4.731 and the P-value is less than 0.05, the result is that the relationship between the servant leadership style variable and social capital is meaning. The coefficient of direct standard of the social capital variable on knowledge sharing is equal to 0.39, the value of t is equal to 3.932 and the value of P-value is less than 0.05, therefore, the relationship between social capital and knowledge sharing, the relationship. The results also showed that the value of chi-square in the model 1450/4503, the degree of freedom of the model is equal to 3208, the result of their ratio is equal to 1.404, which is an acceptable value. On the other hand, the fit indices of the main model such as CFI and IFI are all in an acceptable and appropriate level and the SRMR index is 0.061.

In general, the more widespread the service leadership in an organization, the greater the sharing of knowledge and social capital. Social capital also facilitates people's access to other resources inside and outside the organization, increases people's willingness to engage in two-way interaction, and improves the effectiveness of knowledge creation and sharing. The dimensions of social capital, especially trust, networks, relationships and cooperation, with the effective sharing of information, control of information change and reduction of executive and managerial costs, encourage people to participate and cooperate with each other, as well as create and share new knowledge. This, in turn, facilitates knowledge management processes in the organization. To create and share knowledge, there must be a high level of trust and optimism in the relationships of members of the organization with each other. In some organizations, rewards are set or employees are forced to pass on their knowledge to others in order to encourage employees to share knowledge. The danger that may arise is that employees, in order to be rewarded or to satisfy higher authorities, seem to share knowledge and do not transfer their real knowledge and only share some useless information with others. This is usually due to mistrust and lack of social capital among individuals. Indeed, improving an organization's social capital can enhance the acquisition, coding, and transfer of knowledge; Because by facilitating the combination and exchange of resources, it helps the organization's ability to create innovation.

 Education and development are an important part of human resources development. Education is the basis of all learning and one of the most important factors in improving human resources. Education is the most effective tool and the strongest process available to transfer knowledge and skills to human resources and prepare and strengthen them to perform tasks. Training and development play an important role in the advancement of technology, which has led to increased competition, increased customer expectations of quality and service, and subsequently resulted in the subsequent need to reduce costs. Prominent management writer Peter Drucker said that the fastest growing industry is training and development as a result of the replacement of industrial workers with knowledge-based workers. Training and development is one of the main functions of human resources. Many organizations consider training and development as an integral part of human resource development. The new century has also witnessed the focus on this issue in organizations globally. Technical training involves a change in a person's attitude, skill, or knowledge with the resulting improvement in behavior. For training to be effective, a planned activity should be implemented after a complete needs analysis and target specific competencies. Most importantly, education should be done in a learning environment. While designing the training program, both individual and organizational goals should be kept in mind. Although it may not be possible to guarantee a synchronized training program, the competencies are selected in such a way that a win-win relationship is created for the employee and the organization. Training is often confused with development. However, these two concepts are different in some specific dimensions, although they are still parts of the same system. Development means opportunities created to help employees grow. Unlike training that focuses on the current job, development is more of a long-term or forward-looking nature. Development is also not limited to job options in the current organization but may also focus on other aspects of development. Therefore, the main difference between training and development is that training often focuses on current employee needs or competency gaps, while development deals with preparing people for future tasks and responsibilities. Meanwhile, continuous training is an inseparable part of the activities of any organization, which has received significant attention in most countries of the world during the last five decades. Continuous training is a process that prepares employees during their service to improve and increase their efficiency in current and future job positions, to improve their way of thinking and acting, and to provide job information that is relevant and consistent with the need to achieve organizational goals. Places employees. A review of the conducted studies indicates the lack of a comprehensive and appropriate model in this field and the absence of a known and visible model that is effective in improving human resources in medicine according to the conditions and culture of our country. As a result, there is a need to provide an effective model for medical manpower empowerment programs and the possibility of implementing these programs with the conditions and facilities of Iran's hospitals so that it is possible to meet the needs of medical education and then provide care with methods be implemented scientifically. In other words, a model that can be used in applying the taught items improve the quality of medical services and ultimately leads to professional development. Considering that continuing education programs in medical empowerment have positive goals and functions for doctors, paramedics, managers, patients, organizations, and professions, the achievement of which requires the use of the applied model of continuing education in medical improvement. It is effective and efficient, to design a suitable model in continuous education in improving and empowering medicine and to provide a suitable model in this field. To improve the quality of medical services to patients and medical professional development, and in general to achieve greater productivity, which is the effectiveness of continuous education programs in improving medicine.

The present research was an exploratory study in terms of the nature of the research. The statistical population of this research was 90 employees of Ahvaz University of Medical Sciences, and 74 people were selected as a sample using the Cochran sampling method. The data collection tool was a standard 100-item questionnaire. The reliability of the questionnaire was confirmed with Cronbach's alpha of 0.8 and its validity was confirmed by face validity with the opinion of experts. SPSS statistical software was used for data analysis.

As a result of this research, it can be seen that the significance level of the test is less than 0.05 (sig < 0.05), which means that it can be said with 99% confidence that there is a significant difference between the priorities of the continuous education components. You have According to the statistical analysis, the ethical components and technology and design have the highest average and are more influenced by the education of health and medical services than the other factors.

 Compilation of educational content in the education of health and medical services is considered one of the main challenges of learning and the key to the success of this educational system, which is the factors of education management and technical support, technology and design, pedagogical, institutional, ethical, evaluation and feedback and format. Blended learning has a significant impact on the development of medical education. It is suggested that Jundishapur University of Medical Sciences should go through the following steps to implement the personal development program based on learning in the workplace: obtaining the commitment of the executive directors and senior managers to implement and follow up the personal development program based on learning in the workplace; Examining each component in the form of separate studies to investigate and extract sub-components that have an impact on continuous medical education; Compilation of goals and strategies of the organization and formulation of a charter for supporting training plans; Needs assessment and identification of the current situation of organizational education and learning. Human considerations such as respondents' dishonesty and the interference of others' opinions, especially colleagues, could be effective in people's responses to questionnaires. Restrictions in attracting the cooperation of some people with the researcher due to the spread of the coronavirus the distribution of questionnaires and the delay in returning several questionnaires, as well as the restriction in holding group classes due to the spread of the corona disease were limiting factors of the research.

 Education and development are an important part of human resources development. Education is the basis of all learning and one of the most important factors in improving human resources. Education is the most effective tool and the strongest process available to transfer knowledge and skills to human resources and prepare and strengthen them to perform tasks. Training and development play an important role in the advancement of technology, which has led to increased competition, increased customer expectations of quality and service, and subsequently resulted in the subsequent need to reduce costs. Prominent management writer Peter Drucker said that the fastest growing industry is training and development as a result of the replacement of industrial workers with knowledge-based workers. Training and development is one of the main functions of human resources. Many organizations consider training and development as an integral part of human resource development. The new century has also witnessed the focus on this issue in organizations globally. Technical training involves a change in a person's attitude, skill, or knowledge with the resulting improvement in behavior. For training to be effective, a planned activity should be implemented after a complete needs analysis and target specific competencies. Most importantly, education should be done in a learning environment. While designing the training program, both individual and organizational goals should be kept in mind. Although it may not be possible to guarantee a synchronized training program, the competencies are selected in such a way that a win-win relationship is created for the employee and the organization. Training is often confused with development. However, these two concepts are different in some specific dimensions, although they are still parts of the same system. Development means opportunities created to help employees grow. Unlike training that focuses on the current job, development is more of a long-term or forward-looking nature. Development is also not limited to job options in the current organization but may also focus on other aspects of development. Therefore, the main difference between training and development is that training often focuses on current employee needs or competency gaps, while development deals with preparing people for future tasks and responsibilities. Meanwhile, continuous training is an inseparable part of the activities of any organization, which has received significant attention in most countries of the world during the last five decades. Continuous training is a process that prepares employees during their service to improve and increase their efficiency in current and future job positions, to improve their way of thinking and acting, and to provide job information that is relevant and consistent with the need to achieve organizational goals. Places employees. A review of the conducted studies indicates the lack of a comprehensive and appropriate model in this field and the absence of a known and visible model that is effective in improving human resources in medicine according to the conditions and culture of our country. As a result, there is a need to provide an effective model for medical manpower empowerment programs and the possibility of implementing these programs with the conditions and facilities of Iran's hospitals so that it is possible to meet the needs of medical education and then provide care with methods be implemented scientifically. In other words, a model that can be used in applying the taught items improve the quality of medical services and ultimately leads to professional development. Considering that continuing education programs in medical empowerment have positive goals and functions for doctors, paramedics, managers, patients, organizations, and professions, the achievement of which requires the use of the applied model of continuing education in medical improvement. It is effective and efficient, to design a suitable model in continuous education in improving and empowering medicine and to provide a suitable model in this field. To improve the quality of medical services to patients and medical professional development, and in general to achieve greater productivity, which is the effectiveness of continuous education programs in improving medicine.

The present research was an exploratory study in terms of the nature of the research. The statistical population of this research was 90 employees of Ahvaz University of Medical Sciences, and 74 people were selected as a sample using the Cochran sampling method. The data collection tool was a standard 100-item questionnaire. The reliability of the questionnaire was confirmed with Cronbach's alpha of 0.8 and its validity was confirmed by face validity with the opinion of experts. SPSS statistical software was used for data analysis.

As a result of this research, it can be seen that the significance level of the test is less than 0.05 (sig < 0.05), which means that it can be said with 99% confidence that there is a significant difference between the priorities of the continuous education components. You have According to the statistical analysis, the ethical components and technology and design have the highest average and are more influenced by the education of health and medical services than the other factors.

 Compilation of educational content in the education of health and medical services is considered one of the main challenges of learning and the key to the success of this educational system, which is the factors of education management and technical support, technology and design, pedagogical, institutional, ethical, evaluation and feedback and format. Blended learning has a significant impact on the development of medical education. It is suggested that Jundishapur University of Medical Sciences should go through the following steps to implement the personal development program based on learning in the workplace: obtaining the commitment of the executive directors and senior managers to implement and follow up the personal development program based on learning in the workplace; Examining each component in the form of separate studies to investigate and extract sub-components that have an impact on continuous medical education; Compilation of goals and strategies of the organization and formulation of a charter for supporting training plans; Needs assessment and identification of the current situation of organizational education and learning. Human considerations such as respondents' dishonesty and the interference of others' opinions, especially colleagues, could be effective in people's responses to questionnaires. Restrictions in attracting the cooperation of some people with the researcher due to the spread of the coronavirus the distribution of questionnaires and the delay in returning several questionnaires, as well as the restriction in holding group classes due to the spread of the corona disease were limiting factors of the research.

Today, the outbreak of the coronavirus has caused significant changes in the nature and function of higher education, especially in universities, and the digital university is the evolutionary approach of the university and higher education institutions in the face of Corona and post-Corona conditions. The emergence of Covid 19 virus and its epidemic at the beginning of 2020 caused fundamental changes in the higher education programs of the world and Iran. According to the International :union: of Universities, since the global outbreak of the coronavirus, 146 countries have closed their education at all levels (59%) and in some areas education has been limited (30%), 10% of the institutions are facing difficult conditions to operate and only one university in Burundi has continued to operate normally. Accordingly, 67% of the world's universities have used e-learning, 24% did not have adequate infrastructure and the rest have closed their operation. Consequently, today and in the digital age, it is necessary that the maturity of universities and higher education centers be in line with these developments and be able to make the most of the technological potential of the new age to achieve higher education goals. But the digital university has not been examined in the form of a coherent model, and existing research has focused more on the learning aspect and a few components of the digital university. Digital University is an organization that needs to pay attention to its key dimensions in order to be able to use the capacities of the present age and achieve a principled and planned adaptation. This critical situation (conditions of the Corona epidemic and the closure of universities) has raised many concerns, such as the deterioration of the quality of education and concerns about the future of students. Therefore, the need for educational institutions to strengthen more curricula and use teaching innovation techniques and approaches will be of particular importance. Using learning through digital learning makes it possible to learn anytime and anywhere. Creating a digital university and digital learning is an inevitable alternative during the corona disease outbreak. Therefore, in this study, we sought to investigate the impact of digital university on the components of good governance during the corona and post-corona pandemics in the macro medical universities of region one in order to provide a model. The immediate and future benefits of the present study are identifying the dimensions of digital university on the components of good governance of regional medical universities (Mazandaran, Gilan, Golestan, Babol, Semnan and Shahroud universities) and creating relative awareness of the concept and presenting the digital university model which is based on the good governance components of universities. Identifying barriers and facilitators as well as short-term planning in the university, based on research findings to promote the main components of research in medical higher education centers and helping officials and managers of major centers in the higher education organization and the health sector of the country are among the practical consequences of this research for formulating long-term strategies for the promotion of digital universities on the components of good governance in health higher education centers. The question that arises right here is what is the impact of the digital university on the components of good governance during the corona and post-corona pandemics in order to provide a model?

The present study was conducted with a mixed approach (qualitative and quantitative). The statistical population in the qualitative section included the professors of macro medical universities in region one summing up to 25 people among who4 people were selected as a statistical sample  considering the saturation law and the quantitative section comprised the principals and deputies of faculties, department heads and professors of Shahid Beheshti University of Medical Sciences (1851 people) using purposive sampling method 320 of who were selected by stratified random sampling method as a statistical sample based on Cochran's formula.. A researcher-made questionnaire on Digital University was used to collect data.

The results of confirmatory factor analysis showed that at 99% confidence level, t-values ​​for the dimensions of the digital university questionnaire were out of range (2.58, 2-58). Also, the R2 values ​​were higher than strong for all dimensions, so there was a strong positive and significant relationship between the variable of digital university with all its dimensions. The highest standard coefficient (0.939) was related to the component of teaching and learning methods from the content dimensions and the lowest value was related to the educational content component with the standard coefficient of (0.881) in the content dimension. Also, according to the R2 values ​​, the component of teaching and learning methods with an R2 value equal to 0.881 was at a higher than strong level. Considering the two main structural and content dimensions, it should be said that the path coefficient of the structural dimension was equal to 0.996 and the content dimension was equal to 0.911, and the R2 values ​​ were equal to 0.939 for the structural dimension, which was higher than strong.

In general, identifying barriers and facilitators of digital university as well as short-term planning in higher education centers were important to develop long-term strategies for the impact of competency on academic authority in higher health centers. Limitations of the research in this study involved limiting the statistical population to the University of Medical Sciences, the geographical scope of the research, and unfortunately, for a number of articles, the full texts of the articles were not available. The difficulty of communicating with some university professors and determining the time required for the interview were among the problems and limitations of the study. According to the results, it is suggested that the Ministry of Science, Research and Technology provide successful management and strategic experiences of national and international universities and institutions of higher education in the country and abroad as a practical example to universities and institutions. University administrators should form futures research teams to anticipate the issues and problems facing the organization in terms of paying attention to the paradigms of digitalization. Developing international science parks and research centers in universities should be conducted to expand the activities of administrators and professors in the direction of moving towards digitalization.

One of the components of health is mental health and based on the available findings, mental disorders are one of the most important components of the overall burden of illness and it is predicted that by 2020, the share of mental disorders is about 50% of the total burden of illness. Increase. Hospital staff has doubled their responsibility for people's health and lives because they are in direct and close contact with all sections of society. Occupational problems and harsh working conditions are one of the underlying factors of mental disorders (3).On the other hand, it is one of the most important times to reduce the workload of leisure time. Leisure time can be considered a part of organizing daily life. Time Vacancy (6). The importance of leisure activities has made it more important to pay attention to improving the sports leisure of individuals, especially in some sensitive groups, including the middle-aged (7).The importance of physical activity in leisure is so great that a lot of research has been done in this field and contradictory results have been obtained. Lack of research on the impact of physical activity during leisure time on the general health of middle-aged people, providing a promotional model for middle-aged men and women in Iran with an emphasis on sports activities; Therefore, develop a structural model for middle-aged leisure to promote their general health with an emphasis on sports activities.

 Methodology:

The present study was a descriptive-analytical method, including mixed and combined research, and included two parts: quantitative and qualitative. The qualitative method in the present study was the grounded theory method, which was designed according to the Strauss and Corbin method. The statistical population of the present study in the qualitative section included experts in the field of sports management who were identified with the necessary experience and knowledge about the subject of the research. Also, the statistical population in the quantitative part of the study included all middle-aged men and women between the ages of 40 and 65 in Iran. In order to identify the samples of the qualitative part, purposive sampling method was used. This sampling continued until the theoretical saturation was reached and finally 14 people were identified as samples in the qualitative section. In the quantitative part, the Cochran's sample volume formula was used to determine the research samples. And 384 people were selected as a sample. In the qualitative part of the interview and in the quantitative part of the researcher-made questionnaire including 54 questions were used. Finally, in the qualitative part, coding was used to design the pattern and model using structural equation modeling (SEM) and interpretive structural modeling. The whole process of data analysis was performed in SPSS and PLS software.

After the interviews, the initial codes were identified and the researcher reviewed the interviews and concluded about the initial codes. In the axial coding stage, the general dimensions of causal conditions include the categories of physical capacities (lifestyle, psychological condition), underlying conditions (infrastructural aspects, managerial aspects, motivational issues), intervening conditions (weakness). Cultural, individual constraints, social problems), main phenomenon, strategies and consequences (individual consequences and national consequences) were obtained.As can be seen in Table 2, the square root of the AVE of the variables hidden in the study, which are located in the cells in the original diameter of the matrix, is greater than the value of the correlation between them, arranged in the lower and left cells of the original diameter. Have, more. Therefore, it can be stated that in the research, the variables (hidden variables) in the model have more interaction with their indicators than with other variables. In other words, the divergent validity of the model is adequate.
According to Table 3, all relationships are confirmed. On the other hand, the value of R2 for exogenous or independent variables is zero. In this section, there are 3 endogenous variables whose value R2 is more than 0.33 which is equal to the desired value. Finally, it was found that the research model has a good fit.

Discussion:

Undoubtedly, the development of sports leisure activities in each group has its own conditions and characteristics. Although there are some principles and standards for sports leisure activities in general, but for the development of middle-aged sports leisure activities, it is necessary to create the initial bases in this field. It seems that the infrastructural aspects of the existence of specialized spaces for leisure activities, the existence of sports equipment for middle-aged sports leisure and inter-sectoral interaction in promoting middle-aged sports leisure activities cause the provision of basic infrastructure. On the other hand, managerial aspects due to the existence of a sports guide for middle-aged people, recognizing leisure capacities, updating leisure activities, as well as diversity and flexibility in middle-aged sports leisure activities cause managerial efforts in this regard. This will lead to the development of middle-aged sports leisure activities. On the other hand, motivational issues such as creating special material and spiritual rewards for middle-aged people in response to their leisure sports activities, expressing the benefits gained from leisure sports activities among middle-aged people, creating emotional support for the presence of middle-aged people in leisure activities. Sports leisure and assessment and monitoring of the physical and mental condition of middle-aged people causes spiritual support for the development of leisure sports activities among middle-aged people, which can lead to improving the mental state of middle-aged people to participate in leisure sports activities. This issue has led to the development of leisure time in middle-aged men and women in Iran with an emphasis on sports activities need to pay attention to managerial aspects, infrastructure aspects and motivational issues (16).On the other hand, it is undoubtedly a difficult task to implement all the basic needs and requirements in the field of leisure. In this regard, various restrictions have led to overshadow the development of sports leisure activities. Meanwhile, the development of middle-aged sports leisure due to its importance is always affected by some cultural, individual and social problems. Cultural problems such as lack of sports culture at the community level, lack of interest in sports among middle-aged people and lack of positive attitude towards sports at the community level have an influential role in the development of sports leisure activities among middle-aged people. On the other hand, personal limitations such as lack of self-confidence among middle-aged people, lack of sports motivation, livelihoods and insufficient knowledge of middle-aged people about the capacities of sports leisure activities cause the initial interest in sports leisure activities among Do not form middle-aged. Finally, social problems such as the lack of social groups in the field of sports for middle-aged people, lack of interaction between middle-aged people in sports activities and lack of social support for leisure sports activities for middle-aged people have caused social attractions regarding leisure activities in sports. Do not occur among middle-aged people, which has affected the development of middle-aged sports leisure (17).

Background &

Learning disorder is a neurodevelopmental disorder in children that occurs due to genetic and environmental factors and affects brain function in the areas of understanding and processing verbal and non-verbal information; therefore, it is important to identify decisive intervention methods in this field. Learning disability is one of the most controversial topics of exceptional education. One of the goals of educational systems is to raise the level of students' ability to increase the academic efficiency of learners. According to the Statistical Manual of Mental Disorders, a learning disability has been renamed to a specific learning disability, and reading disorder, writing disorder, and math disorder, each of which was once a distinct and independent disorder, are now considered to specify a specific learning disorder. A neurodevelopmental disorder in children that is caused by genetic and environmental factors and affects brain function in the areas of understanding and processing verbal and non-verbal information; in a way that lasts at least 6 months. This disorder leads to problems in learning and using academic skills in the form of carelessness, poor comprehension, slow reading, difficulty in spelling, problems in written expression, problems in mastering the meaning of numbers or calculations, and problems in mathematical reasoning. These problems are not related to mental retardation, developmental delay, uncorrected vision or hearing problems, or movement or neurological disorders, they are specifically meant in this way. In the education and treatment of learning disorders, one of the most important methods introduced is the sensory integration method. Sensory integration refers to processes whose information enters the brain through the eyes, ears, mouth, nose, skin, muscles, joints, and sense of balance. Ayres presented a theory called sensory integration to relate behavior and neural function, especially sensory information, which examines the specific connections of neural function, sensorimotor behavior, and academic learning in a hypothetical framework, and aims to find specific patterns of dysfunction in Children with learning and sensory problems and special treatment methods for these groups. The method of sensory integration is a neurological flow that receives and organizes sensory information from the body and the environment of a person and uses it for more effective and better functioning in the environment. This method leads to the improvement of excellent brain functions and the abstract levels of the brain from which mathematics is applied; increasing and thus improving the educational efficiency of this student. This intervention engages the child's senses with exercises in the form of a game, and this situation helps coordination and precision in the functioning of the child's senses. Agent concentration is important in maintaining integrity and improving learning performance, so it can play an effective role in improving reading and writing disorders. The basic premise of this educational method is that children with learning disorders have problems in these sensory pathways. Much research has been done on the effectiveness of this educational method in children with learning disabilities and its effectiveness has been confirmed. The purpose of this study was to compare the effectiveness of the sensory integration method and the central nervous system reorganization method on the explicit and implicit memory of students with specific learning disabilities.

The present study was a pre-test-post-test experiment with a control group and a follow-up period in terms of its practical purpose and design. The statistical population of the research included all students with specific learning disorders (reading/writing, math, and mixed disorders) who were referred to educational and clinical centers in Rafsanjan city in the academic year of 2020-2021, 90 of them were selected using the purposeful sampling method. Completely randomly, they were replaced in three experimental groups of 30 people, including the sensory integration group, the central nervous reorganization experimental group, and the control group. The research tools included the mental fluid maintenance task of Bogard and Rus (1991) and experimental groups of sensory integration training protocol (for 12 sessions and 90 minutes each session) and central nervous system reorganization protocol (for 8 sessions of 90 minutes each session). Data analysis was also done using repeated measurement with mixed design and multivariate analysis of variance using SPSS-24 software.

The Results showed that the effect of the group (control, sensory integration, and reorganization of the central nerves) was significant in the component of mental maintenance (p<0.01 and F=70.99). Also, the effect of disorder (reading/writing, math, and mixed) in mental maintenance (p>0.05 and F = 0.716) is not significant, so there is no significant difference between the scores of the groups according to learning disorders. Also, in the between-case factor of the interaction of the group and disorders (reading/writing, math, and mixed), the mental maintenance component (p<0.05 and F=2.85) is significant, and there is a significant difference between the effectiveness of educational methods considering learning disorders. The way that effects of the sensory integration group on the students' mental maintenance ability were more than the central nervous system reorganization group.

The present study, like other studies, had limitations, including the uncontrollability of some important psychological factors, such as emotional characteristics and personality traits, along with the biological-neurological foundations involved in specific learning disorders. Considering that the research was carried out in a learning disorder center, generalizing the results to wider groups and different educational levels should be done with caution. Also, the specificity of the research sample only to students with learning disorders in Rafsanjan city limits the generalization of the results to other groups and cultures. Therefore, it is suggested that similar research should be evaluated for other students with special needs with wider samples, students in different educational levels, and different cities and cultures. On the one hand, it is suggested that clinical, educational, and exceptional specialists in the fields of occupational therapy, learning promotion, educational counseling, guidance centers, learning disorders centers, school health centers, and educators use the results of this study to help children with learning disabilities. Based on these findings, it can be concluded that the methods of sensory integration and nerve reorganization are effective in increasing the mental retention of students with specific learning disorders, and this effectiveness in the training of the sensory integration group is more than nerve reorganization. It is higher and more in the ability to keep the mind. Therefore, it is suggested that clinical, educational, and exceptional specialists use the method of integrated sensory interventions and nerve reorganization for students in different educational levels and cultures with learning disabilities.

Background &

On the other hand, research has shown that children's disorders are closely related to parents' psychological problems and their educational methods. The role of the family as the first educational environment in creating or not creating behavioral disorders, and the emergence of diseases and mental disorders is undeniable. Because the family environment is the first environment where a person's physical, emotional, and personality patterns grow and gradually form. Therefore, considering the effect of these children on their parents, as well as the effect of parents' parenting style on the aggravation of symptoms of hyperactivity/attention deficit and the lack of research related to the effect of stress-based mindfulness training on the mothers of these children, designing and implementing various interventions to create and expand skills Social skills and abilities are very important in these children, and on the other hand, having an ADHD child is a source of stress. However, its effect on parents depends to a large extent on their cognitive evaluation of the problem and their skills and training. One of the training methods that can be used for such mothers is stress-based awareness training. This therapy is derived from cognitive behavioral therapy and is considered one of the important components of the third wave of psychological models. Mindfulness-based on stress reduction reduces stress and anxiety, reduces chronic physical pain, increases immunity, ability to deal with problems, ability to face negative emotions, reduces insomnia, and improves focus, happiness, and well-being. Mindfulness means paying attention to specific purposeful ways in the present and free from judgment. The conscious mind focuses on the process of continuous attention, rather than the content that is being paid attention to. Therefore, according to the stated content and the lack of research related to mindfulness interventions based on stress reduction in the community of parents with children with attention deficit hyperactivity disorder, the purpose of this research is to answer the question of whether mindfulness interventions based on stress reduction improve the style of the parenting of ADHD children effective.

The current research method was quasi-experimental with a pre-test and post-test design with a control group, which was approved by the Code of Ethics Commission of the Islamic Azad University, Torbat Jam branch, with the code of ethics IR.IAU.TJ.REC.1399.010. The statistical population of this study was made up of all mothers with children with attention-deficit/hyperactivity disorder who were referred to Mashhad psychotherapy clinics in 2016-2017. From this community, 30 mothers of children with attention-deficit/hyperactivity disorder were selected purposefully and voluntarily and were randomly replaced in the experimental group and the control group (15 people in each group). At first, the subjects responded to Diana Baumrind's parenting styles questionnaire (1972) (pre-test), then the experimental group underwent 9 sessions of mindfulness-based on Kabat and Zain's (2004) stress reduction, and the control group received an intervention. They did not At the end, both groups responded to the research tools. The collected data were analyzed by multivariate analysis of covariance.

The results showed that mindfulness interventions based on stress reduction have an effect on the parenting styles of mothers and have caused an increase in permissive and authoritative styles and a decrease in authoritarian styles.

One of the common and usual challenges of parents with children with attention deficit hyperactivity disorder, especially those who are facing many medical and therapeutic issues, is facing the problems of these children and how to perceive them. In this regard, it can be said that the healthy behavior of parents with hyperactive children is due to their correct perception of this disorder and the correct way to deal with it. Parents have a dynamic and active role in understanding the problems of their children, and with proper educational methods, they can help in reducing the symptoms of these children's problems and their problems. Therefore, it is necessary to provide treatment solutions to deal with this disorder correctly. Parents can help improve the symptoms of these patients and reduce their problems by learning the right methods. Among the treatment methods that can be effective in improving the symptoms of hyperactivity disorder and reducing the stress of their parents, is the stress reduction program based on mindfulness. This treatment is a short-term and structured intervention. Mindfulness-based stress reduction program is defined as a non-judgmental and balanced feeling of awareness that helps to see and accept emotions and physical phenomena as they happen. The stress reduction program based on mind awareness creates a different attitude or relationship with thoughts, feelings, and emotions, which includes maintaining full and moment-to-moment attention and having an attitude of acceptance and away from judgment. Through exercises and techniques based on mindfulness, a person becomes aware of his daily activities and the automatic use of the mind in the past and future world, through moment-to-moment awareness of thoughts, feelings, and states. The physical will gain control over them and be freed from the everyday and automatic mind focused on the past and the future. Mindfulness exercises enable a person to reduce automatic and habitual responses to stressful experiences and activate the response system by cultivating an inner insight and accepting it more than life's unchangeable events. It will reduce stress and this will increase personal control. Treatment control and cognitive therapy help them. Therefore, it can be concluded that mindfulness interventions based on stress reduction are effective in improving the parenting styles of parents of ADHD children. The limitations of this research include the lack of a follow-up period and the special and difficult conditions of children with attention deficit hyperactivity disorder, and it is suggested that the results of this research be used as a basis for future studies in the field of learning effective training programs. Child parenting and parenting styles, parents with attention deficit hyperactivity disorder should be used. Also, it is suggested that the officials and those involved should plan a comprehensive treatment for these patients and their parents.