آقای فرزاد ابراهیم زاده

In numerous studies in the field of medical sciences, researchers use health centers as a frame for stratified sampling. Since socioeconomic variables play a major role in health outcomes, the present study aimed to classify urban health centers of Khorramabad in terms of the socioeconomic status of households using factor and cluster analysis.

In this cross-sectional study, the statistical population included all urban areas of Khorramabad based on the population and housing census conducted by the Statistical Center of Iran. Firstly, the scatter maps of urban areas and health centers were adopted together. Thereafter, socioeconomic indexes of urban areas were calculated in seven fields, and exploratory factor analysis was used to reduce dimensions. Finally, the similar health centers in terms of factor scores were allocated to the same clusters by k-means cluster analysis using SPSS software (version 26) and were displayed on city maps using Arc GIS software.

Three factors identified in factor analysis explained about 73.3% of the total variance of socioeconomic indexes. Based on cluster analysis, 11 health centers were located in cluster 1 (related to lower educational attainment, poorer housing amenities, and higher rate of homelessness and divorce), 16 centers were located in cluster 2 (related to higher studying persons rate, lower marriage rate in women, lower unemployment rate, and higher residence in apartment flats) and 10 health centers were located in cluster 3 (related to higher academic graduates, more profitable jobs, and better housing amenities).

The results of this research can be used in health studies in urban areas of Khorramabad as a basis for performing stratified sampling. Furthermore, it is recommended that authorities adopt more effective planning to improve deprived areas in cluster one.

Cardiopulmonary resuscitation (CPR) is the main treatment for cardiopulmonary arrest, one of the most common causes of death. Training courses must be evaluated to increase CPR quality. This research aims to determine the effectiveness of CPR training on the performance of nurses based on the Kirkpatrick model.

A randomized controlled trial recruited 94 nurses of the CPR team selected with sequential non-probability sampling at Shahid Rahimi teaching hospital in Khorramabad October 2021-2022. They were divided into interventions  n=47 and control groups  n=47. Both groups had a 2-hour theory class, but only the intervention group had a 4-hour basic and advanced defibrillation and CPR practical class. Level 3 of the Kirkpatrick training evaluation model was used. Data was collected in a researcher-made knowledge and reaction questionnaire using Madden's performance observation checklist. The validity and reliability of  these questions were confirmed. Data were analyzed with Fisher's exact test, chi-square test of independence, paired t-test, and ANCOVA (P ˂ 0.05) in SPSS  software version 22.

No statistically significant differences were observed in the demographic variables of the two groups. After the intervention, the average scores of the knowledge and skill level increased in the intervention group and decreased in the control group, but the scores of the reaction level did not change significantly, and no statistically significant difference was observed between the two groups in terms of the average change of the reaction level scores of the nursing staff (P=0.455). However, statistically significant differences were observed in the mean change in scores for defibrillation knowledge (P=0.038), CPR knowledge (P=0.007), defibrillation skills (P˂0.001) and CPR skills (P˂0.001).

Theoretical and practical training increases satisfaction, knowledge, and performance based on kirkpatricks model. The evaluations of effectiveness resuscitation training based on Kirkpatrick's model are recommended.

Early childhood is a critical period for the development of cognitive, linguistic, social, and motor abilities. Due to the importance of early detection of developmental delays in children, this study aims to investigate the effect of preterm birth and birth weight on the developmental skills among children aged 12-36 months.

In this cohort study, 125 children of 12 to 36 months of age from Khorramabad, Iran, were evaluated in three groups, i.e. preterm group (59 children), low birth weight group and term infants group (21 children), and finally children with average birth weight and term infants group (45 children). This evaluation was carried out using the Ages & Stages Questionnaires-Third Edition in five developmental areas. Five models of logistic regression were separately used for modeling the effect of the “age and birth weight of children”. The collected data were analyzed in SPSS v.22 software using logistic regression analysis, where the significance level was 0.05.

According to the findings related to child screening, the percentage of developmental delay in at least one area was 49.6%, where the highest and lowest rates of delay were 15.2% and 6.4% in fine motor and problem-solving skills, respectively. Moreover, 9.6% of the children were abnormal in communication skills, and 9.6% and 8.8% of the children were bnormal in gross motor skills and personal-social skills respectively. Based on the logistic regression method, the relationships between “the age and birth weight of children” and the state of communication skill development (P=0.235), fine motor skills (P=0.125) and personal-social skills (P=0.307) were insignificant but noticeable.

Low birth weight in full-term infants is a risk factor for delayed communication and fine motor skills, while preterm birth is a risk factor for delayed personal-social skills. Preterm birth and low birth weight are risk factors for developmental delays in children, which require early screening to diagnose and prevent their future complications.

One of the most significant indicators of the evaluation of emergency centers is the calculation of waiting time for patients to receive diagnostic and therapeutic services. The aim of the present study was to determine the waiting time for the provision of services in the emergency departments of teaching hospitals in Khorramabad.

This research was a cross-sectional study conducted in 2017. The study population consisted of all the patients referred to the emergency departments of educational hospitals with an emergency department in Khorramabad. Sampling was randomly carried out through multistage stratified sampling. A valid and reliable checklist was used to collect data, and the data were analyzed by SPSS- 19 by related descriptive and analytical statistical tests.

The three investigated hospitals had a total of 166 emergency beds. 70.6% (573 patients) of the patients had attended the emergency departments with one of their companions, and the greatest frequency of consulation was related to internal medicine specialists (44.5%, 361 people). The gaps between the triage and the first visit, the first visit and the first diagnostic action, sending the first diagnostic action and the medical consultation result, and finally the medical consultation and the outcome of the medical consultation were 8.37 minutes, 31.27 minutes, 9.6 hour, and 7.38 hour respectively.

Regarding the results of this study, it is suggested that the number of emergency department staff and related para-clinical sections increase, thereby reducing the waiting time of people to receive emergency services. Moreover, the authorities are recommended to increase the number of the staff of the night shift in the emergency departments.

Spiritual intelligence as a capability of behaving with sympathy and wise along with internal and external peace is the key part in confronting with stressor challenges in critical care units. Indeed, nurses can utilize that in the best way to manage stressful situations related to units and patients. Therefore, this study aimed to assess the effect of training on spiritual intelligence and its' components.

This quasi-experimental was conducted on 82 nurses (40 nurses in experiment group and 42 nurses in control group). Sampling was done in convenience method in critical care units of affiliated hospitals to Lorestan University of Medical Sciences (Shahid Rahimi and Shahid Madani hospitals). King spiritual intelligence scale was used for data gathering which its validity and reliability were confirmed. This scale was fulfilled by participants three times (before study, immediately and one month after study). Eight training sessions was held for experimental group as a workshop. There wasn't any intervention for control group. Data were analyzed by using descriptive and inferential statistics and software SPSS15. (p=0.05)

The covariance analysis (by adjusting the effect of the base values of spiritual intelligence) showed that the main effect of intervention on the mean scores of spiritual intelligence was significant (p<0.05), so that after the study in the experimental group the mean scores of spiritual intelligence reached from  3.37 before the study to 78.50 after the study. Also, the covariance analysis revealed that the main effect of intervention on the mean scores of four dimensions of spiritual intelligence were significant (p<0.05), so that the training results in significant increase of the mean scores of them in the experimental group.

Based on the results that the spiritual intelligence of nurses was at the medium level before training and the training of spiritual intelligence increased their spiritual intelligence, so by using protocols for educating and improving the spiritual intelligence in nurses, their stress in their work places and life would be reduced and finally the quality of care will be progressed.

Computerized concept mapping is a useful tool for providing nursing care. Considering the availability of mobile for learners and the role of it in increasing the skills of nursing students, this paper aimed to investigate the effects of nursing process effectiveness with conceptual mapping via mobile phone on nursing students' self-efficacy in intensive care course. In this randomized clinical trial, 68 fourth grade nursing students from Lorestan University of Medical Sciences in second semester 2015-2016 were selected and by stratified block randomization classified into intervention and control groups. The intervention group received nursing process with concept map and software, and the control group received traditional teaching. The self-efficacy of learners was measured with clinical self-efficacy questionnaire consist of 4 dimensions. Data were analyzed using descriptive statistics, Fisher's exact test, chi square test, and Mann–Whitney through SPSS. The total score of self-efficacy of the subjects before the study did not differ significantly between the two groups, but after the intervention, the relative increase percentage of total self-efficacy score (p<0.001) and its dimensions included an assessment (p=0.005), diagnosis (p=0.002), implementation, (p=0.002) and evaluation (p<0.001) in intervention group were more than control group. The implementation of nursing process with concept map leads to increasing the self-efficacy of learners in clinical practice. Considering easy access to mobile, it is recommended to be used this method with mobile-based application in teaching nursing students.

Patients undergoing hemodialysis report the pain of repeated insertion of vascular needles as the most stressful condition in the treatment process and the greatest concern in their lives. This pain can cause hemodynamic changes before the hemodialysis process. This study was conducted to determine the numbness effect of EMLA cream on hemodynamic changes during fistula cannulation in patients under dialysis. This study is a clinical trial conducted on 50 patients undergoing dialysis in Khorramabad Shohada Hospital in 2013. The patients were randomly divided into two groups (spelling) and (placebo) after entering the study. Hemodynamic changes were measured in two groups before and after fistula cannulation. In order to analyze the data, SPSS version 19 was used. There was no significant difference between two groups in terms of demographic variables and duration of using fistula (P>0.05). The hemodynamic parameters (systolic, diastolic blood pressure and pulse rates) were not significantly different between groups before cannulation (P>0.05). The systolic blood pressure and pulse rate in the placebo group were significantly higher than the EMLA group after fistula cannulation (P<0.001). Application of EMLA cream as an easy method reduces pain during fistula cannulation in patients under hemodialysis and provides hemodynamic stability at the onset of hemodialysis.

The lesson plan is one of effective and key factors in the process of education. The main purpose of the lesson plan design is to facilitate the learning of learners through the establishment of an appropriate communication platform. The purpose of this study was to evaluate the lesson plans offered by faculty members of Lorestan University of Medical Sciences during the academic year 2015-2016. In this descriptive cross-sectional study, 134 lesson plans provided by faculty members of Lorestan University of Medical Sciences during the first and second semesters of 2015-2016. Data collection was done using a checklist that included 13 domains. Descriptive statistics were used to analyze the data. The most common weaknesses related to learning assist tools (85.6%), duties and assignments of students (64.9%), and general goals (39.6%). Also, the most important disadvantages were the planning areas for preparing students before the beginning of the class (62%), training and classification (45.6%), syllabus and behavioral goals (33.6%). The introduction of resources domains (64.9%), general information (43.3%), and policies and rules of the class (43.3%) had the highest score and the best situation in the lesson plans. According to the results, the content and writing of the lesson plans provided by the faculty members of Lorestan University of Medical Sciences were acceptable. Arranging training courses and drafting standard forms is suggested for better designing of the lesson plan among the faculty members

  Academic failure is of paramount importance for medical students because it might lead to a decline in scientific level of the community of physicians in the future. This study was conducted to investigate the predictors of academic failure in medical students of Lorestan University of Medical Sciences using classification tree.

In this cohort study, academic records of all medical students of Lorestan University of Medical Sciences during the academic years of 1999-2008 were selected by census and were followed up until September 2016. Academic failure was defined as having at least one of the components of appropriate grade point average, prolonged graduation, academic probation, dropout, expulsion, and any failure in ccomprehensive exams and the CART classification tree was adopted using the SPSS 22 software to predict it.

The cumulative incidence of academic failure was 26.4% and the most prevalent components were prolonged graduation (21.7%) and academic probation (15.0%). The probability of academic failure was 0.449 in subjects taking guest courses, 0.220 in subjects with no history of guest courses admitted to courses with less than 40 students and admission quotas of zone 1 or 3, and 0.456 in subjects with no history of guest courses admitted to courses with more than 40 students and males.

With respect to identifying the predictors of academic failure, it is suggested that these students be referred to consulting centers of the university or educational supervisors’ moreover, the regulations of taking guest courses in other universities should be revised.

Coronary artery restenosis following angioplasty may lead to major unwanted cardiac events. This is one of the most important concerns of cardiologists. This study was performed to evaluate the predictors of coronary artery restenosis in patients undergoing angioplasty.
In this cohort study, all 2159 patients who referred to Madani Hospital in Khorramabad, Iran for angioplasty between 2004 and 2015 were followed up regarding the incidence of coronary artery restenosis for one or two years (at least 50% stenosis in the place of the previous angioplasty) depending on the type of stent, and clinical variables related to the lesion and procedure were recorded in an information form. Then, agents for predicting coronary artery restenosis were identified based on CART (Classification and Regression Tree).
FINDINGS: Cumulative incidence of coronary artery restenosis was 12.9% (279 patients) in subcategories: non-drug-eluting stent (25.8%, 114 patients), comorbidity of diabetes and hyperlipidemia (under the subcategory of drug-eluting stents, 19%, 32 patients), multiple drug-eluting stents (under the subcategory of non-diabetic patients, 14.6%, 25 patients), comorbidity of hyperlipidemia and drug abuse (under the subcategory of non-diabetic group who use one drug-eluting stent, 12.8%, 16 patients).
According to the results of this study, stent type, history of diabetes, number of stents, hyperlipidemia and drug abuse are among the most important predictors of coronary artery restenosis.

The incidence of atelectasis after coronary artery bypass graft surgery is highly recommended due to the impact of different levels of PEEP to prevent these complications. The aim of this study was to investigate the effects of different levels of PEEP after coronary artery bypass graft surgery.
This study was performed by clinical trial. The sample size in this study was 90 patients. Non-probability sampling was conducted in consecutive patients that using a stratified block randomized to intervention and control groups (each group n = 45). In the control group of patients after surgery, upon arrival in the intensive care unit until tracheal extubation rates PEEP of 5 cm H2O received Patients in the intervention group after entering the intensive care unit for 4 hours average PEEP of 10 cm H2O received. Six hours after tracheal extubation atelectasis of the final diagnosis of chest radiographs, oxygen saturation and body temperature were used. For statistical analysis, chi-square test and t-test used.
The incidence of atelectasis in the intervention group, in 7 patients were about (15.6%) in the control group, and in 16 patients were about (35.6%) which was statistically significant difference (P= 0.03). The mean arterial oxygen saturation was more higher in the intervention group rather than the control group and the difference was statistically significant (P= 0.025).
This study shows that the use of PEEP levels of 10 cm H2O after coronary artery bypass graft surgery can reduce the incidence of postoperative atelectasis. So, it is recommended to use this method in order to reduce the incidence of atelectasis.

Restenosis after stenting constitutes is one of the major concerns among cardiologists’ experts. This may lead to repetition of angioplasty, coronary artery bypass graft surgery, myocardial infarction, and even death. The present study, by using Cox's regression model aims at determine the demographic and clinical factors affecting time to incidence of cardiovascular restenosis in patients’ undergone angioplasty in Zanjan, Iran.
In this descriptive longitudinal study, 421 patients who visited Zanjan's Ayatollah Mousavi hospital for drug eluting stent implantation between April 2009 and June 2011 are scrutinized with respect to the time of the incidence of restenosis. Next, demographic variables and patient's clinical records are entered into “Data Gathering Form of Patients’ Undergone Angioplasty”. Data is analyzed using Cox's regression and SPSS 21.
The mean time of restenosis incidence is 736 days and the rate of restenosis incidence is 30.4%. Hazard ratio of restenosis in unemployed patients is 1.39 times, in drug addicted patients 1.75 times, in patients with a history of hyperlipidemia 1.57 times, and in patients with chronic kidney disease is 1.58 times more than other patients (P This study indicated that the most important factors leading to the incidence of restenosis are unemployment, drug addiction and abuse, suffering from hyperlipidemia, and chronic kidney diseases. Accordingly, it is highly recommended to prevent patients from above-mentioned risk factors and plan a periodic and continuous follow-up for patients with any of these factors.

Obesity and overweight are related to biological factors, individual, social, economic factors, different cultural factors and feeding behavior. Recognizing these factors can be a guidance of interventions relating to prevention and control of obesity in children and teenagers. The present study was aimed to study determinant factors of obesity and overweight in students of Khorramabad city.
In this cross-sectional study, 3387 students from age 6 to 14 were selected by combinative, multistage grouped and clustered sampling. Student's height and weight were measured and also body mass index (BIM) was calculated. In order to determine the prevalence, body mass index was used for age in NCHS table and evidence up 95 was regarded as obese and 85 to 95 was regarded as overweight.
The relation of overweight and obesity in students with kind of school, family size, parental education and family income was very significant (p Overweight and obesity in case study students were related to individual and external factors. Of these factors, we can mention factors such as gender, birth rank, family size and parental education.

Background and Restenosis after percutaneous transluminal angioplasty is a prevalent phenomenon that might lead to repetition of angioplasty, open heart surgery, myocardial infarction, and death. This study, drawing on extended Cox regression model, pursues examining effective factors on the time to incidence of restenosis.
In this historical cohort study, 421 patients attending Ayatollah Moosavi Hospital, Zanjan, Iran (from April 2009 to June 2011) for drug-eluting stent implementation were followed up until June 2015 for time of incidence of restenosis. In next stage, some demographic variables and clinical records were studied. The proportional hazards assumption did not hold, so, to model this survival data, extended Cox regression was applied.
Compared to other patients, the hazard ratio of restenosis in patients with drug abuse and hyperlipidemia was 2.09 times and 1.91 times more, respectively. Also, two years after angioplasty, the hazard ratio of restenosis in patients over 60 years old 2 times, diabetic patients 2.91 times, and in patients suffering from hypertension was 2.49 times more than those of other patients (P In this study, drug abuse and a history of hyperlipidemia constitute effective factors on the incidence of restenosis. Compared to these, being over 60 years of age and suffering from diabetes and hypertension had lower effects. Accordingly, preventing the risk factors mentioned and periodic follow-ups are highly suggested in patients with such conditions.

Handicapped child in the family is a source of stress which can affect physical and mental health of the parents, especially mothers. Increase in resiliency increases ability to manage stressors. The aim of this study was to determine the effect of stress coping skills training on the resiliency of mothers with handicapped children.
Material and This semi experimental study with pre-test, post-test design and control group included 60 mothers with handicapped children who had been referring to the Kermanshah welfare center in 2013. They were selected by using convenient method and then divided randomly into two groups. In this study we used a coping skill training package and Connor and Davidson Resiliency Scale (CD-RISC). SPSS 20 software was used for data analysis.
The results showed that coping skills training resulted in a significant increase in resiliency level in the mothers with disabled children (P In most of the coping skills training programs, handicapped children were the center of attention and their families that take care of them had been ignored. Therefore, training programs for parents with handicapped children is at the forefront of planning policies.

The first step in improving research conduction in society can be conceived as identifying the weak points of research. Given that faculty members of universities carry out most of the research activities, the present study attempts to study the relationship between barriers to research from the viewpoint of the faculty members of Lorestan University of Medical Sciences and the research activities of them.
This cross-sectional study, using census method, assessed all of the faculty members of Lorestan university of medical sciences. A self-administered questionnaire analyzing the faculty members’ demographic variables, knowledge about and attitudes toward barriers to different steps of research was designed and the self-report questionnaires were filled out and their relationship with the annual assessment scores in research criteria were assessed by chi-square, Mann-Whitney and Kruskal-Wallis tests.
Variables such as the faculty members’ department, number of their modules, primary motivation for research conduction, knowledge about variables such as research methodologies, searching strategies in medical databases, putting forward proposals, research article writing and also, attitude towards vaiables such as approved research priorities, putting forward proposals, quality of research advice, approval of proposals in research councils, research facilities, the process of peer review of national scientific articles, presenting papers in conferences and participating in theses were related to the research performance of them (p If seems that giving special privileges to the faculty members of faculty of medicine, those with many modules and those with no optimal knowledge and attitude, we can enhance their motivation to participate in research activities.

Academic failure, conceived of as lack of success in one’s education, is of paramount importance for students of medical sciences and it might lead to more acute problems. The present study set out to investigate the prevalence and underlying reasons of academic failure in Lorestan University of medical sciences. In this cohort study, academic records of all students of Lorestan University of Medical Sciences during the academic years of 2006-2011 were collected from education and student affair center and also, demographic and educational records were entered into a checklist. Inappropriate grade point average, being a provisional student, prolonged graduation, expulsion and dropout were taken into account as academic failure. To model the related effective factors, logistic regression was adopted and significance level was set at 0.05. The cumulative incidence of academic failure was about 25.1%. Factors such as department, being self-funded or government-funded student, academic grade students are pursuing, the elapsed time between academic grades, gender and location of residence were related to academic failure (P<0.05). It is worth mentioning that no relationship was observed between the academic failure and being accepted based on quota system. The most important at risk groups were students of department of medicine and health, associate or medical doctoral students, self-funded students, students with a considerable time elapsed between their academic grades, male students and students living in dormitory. It is suggested that these students refer to consulting centers of university or educational supervisors and receive particular attention.

Height and weight growth failure are among the most important health disorders affecting children less than two in the developing countries. Failure to treat this disorder can lead to the development of serious conditions including increased mortality and types of disability. The aim of the present study is to investigate the factors affecting the height and weight growth of children less than two years old. This historical cohort study was conducted on a sample of 2030 children less than two in Khorramabad who were selected using stratified and cluster sampling methods. Based on household records, data related to the height and weight were recorded as quantitative variables and finally were modeled using a longitudinal marginal model, identity link functions and the R software. Based on the marginal model, the effect of such variables as child's age, child's gender and mother's educational attainment were significantly related to the child's height and weight. Moreover the child's birth order had significant relationship with only the child's height. However, the variable of exclusive breastfeeding during the first six months was no significantly related to weight and height growth of the children. Given the results, it seems that monitoring the growth of the children of the illiterate mothers, specially the girls and the children with first birth orders are the most important approaches to deal with growth disorders among this population.

Disorders of height and weight growth are the most important health disorders affecting children younger than two in developing societies. Failure to treat these disorders can lead to the increased mortality and mental, emotional or physical disability. The objective of this study was to investigate the growth trends of children and the factors affecting it.

This retrospective cohort study was conducted on 2030 children younger than two in Khorramabad, Iran who were selected using stratified and cluster sampling. Based on household records, the weight growth trend was recorded as a four-level variable (decline, stagnation, slowness and desirable) and the the height growth trend was recorded as a three-level variable (stagnation, slowness and desirable); finally, the data were modeled using a longitudinal marginal model and the SAS software version 9.2.

The incidence of at least one decline in the weight growth curve and one stagnation in the height growth curve was 14.2% and 10.4%, respectively. The child’s age and the maternal educational level had a significant effect on the growth trends. However, the sex, parity and the exclusive breastfeeding during the first six months had no significant relationship with the growth trends.

Given the results and the relatively high prevalence of growth disorders among children, it seems that increasing the awareness of low literate women about feeding of the children is the most important approach to manage growth disorders. Additionally, health-care professionals should mostly focus on monitoring the growth of children older than 12 months.

Over the past two decades, this thought that the health system is not safe enough and need to improve, has been studied globally. So, assessing the view's of medical staff would be beneficial for improving health safety programs.
Aim: This study was done to determine patient safety culture from the perspective of the medical staff in Khorramabad teaching hospitals.
Methods and Materials: A cross-sectional study was done in (2015) that (280) medical staff who selected by convenience sampling by using stratified sampling then quota sampling participated. Data were gathered by questionnaires; Hospital Survey on Patient Safety Culture (HSOPSC) that printed in Quality & Research in Health in USA and demographic questionnaire. All data analyzed by SPSS16 and findings with (p findings showed that the safety culture at the university hospitals of Khoramabad in staff view point is not desirable and among twelve patient safety culture dimensions, the most important dimensions need to address includes; organizational learning, continuous improvement, non-punitive response to errors, frequency of adverse event reporting, communication openness, management support for patient safety, feedback and communication about error.
It is suggested to nurse managers that planned change in hospitals for improving safety culture for decreasing errors and increasing reporting them.

One of the challenges of modern society is to provide mental health especially in nurses. This study aimed to investigate the effect of environmental index on mental health in nurses working in emergency and non emergency wards in Khorramabad hospitals. This is a correlational study. The population consisted of all nurses in the hospital, which included 433 patients. The sample included 207 nurses with sampling in Ashayer hospital and census method in Tamin Ejtemaee hospital. Data collection included: Demografic Questionnaire, The General Health Questionnaire (GHQ), Work Environment Scale (WES) validity and reliability are prooven. Data were analysed by test t Independent, one-way ANOVA test and the Spearman correlation. In this study, 119 women and 88 men were studied that 43.30% of nurses were working in the emergency department and 57.69 percent were working in other parts. T tests showed a significant difference between the means of the independent mental health nurses in the emergency department 71.14 ± 19.29 compared to nurses in other sectors 48.13 ± 13.30) (p=0.654). Based on the results, however employees in emergency wards experience more trouma due to their job history, there was no significant meaning between mental health disorders and psychological stress in nurse working in emergency and non-emergency wards.

Unwanted pregnancy is a pregnancy that is considered to be unwanted by at least one member of the couple, and has adverse consequences for the family and community. Using four classification models, this study predicted unwanted pregnancy in the urban population of Khorramabad and compared these classification models. In this cross-sectional study, 467 multiparous pregnant women attending the urban health care centers of Khorramabad in 2011 were selected using stratified and cluster sampling and risk factors were collected. The logistic regression model, discriminant analysis, decision trees, andCART artificial neural networks, along with the SPSS and MATLAB software were applied in data modeling. The indices of sensitivity, specificity, area under the ROC curve, and accuracy rate were applied to compare the models. The prevalence of unwanted pregnancy was 32.3%. Based on the index of area under the ROC curve,ROC the best models were artificial neural networks (0.741), decision tree (0.731), logistic regression (0.712) and discriminant analysis (0.711). The highest. sensitivity was found for decision tree model (73.5%), and the highest specificity was for artificial neural network (62.3%). Given the relatively high prevalence of unwanted pregnancy in Khorramabad, the revision of the family planning programs seems to be inevitable. Moreover, in selecting the best classification method, decision tree and logistic regression are recommended when the researcher is interested in better interpretability of the results, and the model of neural networks is recommended when a higher prediction power is intended.

Patients with end-stage renal failure, consider recurrent fistula cannulation pain as the most severe stress, resulted from the treatment process, and a major concern of their life. Nurses as one of the main targets of their actions, have a duty to relieve the pain. Accordingly, this study was conducted to determine the effectiveness of two topical piroxicam and EMLA on fistula cannulation pain intensity in hemodialysis patients. This clinical trial study was conducted on 75 patients referred to dialysis ward in Khorramabad Shohada hospital in 2013. Patients were randomly divided into three groups: group A (piroxicam), group B (EMLA) and group C (placebo). Data collection tools included demographic information, Visual Analogue Scale (VAS) and a checklist for possible side effects of the drugs. Pain intensity during fistula cannulation was measured in the three groups on two occasions, before and after the intervention. The collected data were then analyzed using Mann-Whitney and Kruskal-Wallis tests and SPSS19 software. The median pain intensity before and after the intervention in the three groups, was significantly different (p <0/001). The highest median pain intensity reduction was in the EMLA, piroxicam and placebo groups respectively. In addition, a short term side effect (blanching) in 16% of the subjects was detected in EMLA group. The results showed that EMLA cream was more effective than piroxicam gel in reducing the pain intensity of fistula cannulation in dialysis patients. Therefore, our study recommends to use EMLA cream as an easy method with ability to work by patients, to reduction pain during fistula cannulation in hemodialysis patients.

Metabolic syndrome is a combination of disorders such as: central obesity, hypertension, increased blood glucose and impaired blood lipids. This study was carried out to determine the prevalence of metabolic syndrome among students of Lorestan University of Medical Sciences during 2011-2012. This study was a cross-sectional survey carried out on 214 students in an age range of 19-27 years. Subjects filled demographic questionnaire and their fasting blood samples were collected to measure their TG, FBS and HDL cholesterol. Then metabolic syndrome was defined having at least three of the ATP III criteria as the following: triglycerides ≥150 mg/dL; high blood pressure (systolic blood pressure≥130 mmHg or diastolic blood pressure ≥ 85 mmHg); fasting glucose≥110 mg/dL; waist circumference ≥102 cm in men and ≥ 88 cm in women and HDL<40 mg/dL in men and<50 in female. Prevalence of metabolic syndrome among students was 1.9%. And 45.8 % of subjects had one component of metabolic syndrome. The most prevalent metabolic syndrome components had high fasting blood sugar (16.8%) and low HDL (39.7%). The results showed that the important metabolic syndrome risk factors among students were high fasting blood sugar and low HDL. Acknowledgment: This is no conflict of interest

One of the most stressful situations is final exams in college courses. Stress and exposure to stressful situations can affect blood sugar levels and weight changes. The aim of this study was to determine the stress making possibility of final exams during the first academic semester (2011-12), the effectiveness exposure of stressful conditions on weight and fasting serum glucose (FBS) two months ago, a month before and at the time of final exams among students studying in Lorestan University of Medical Sciences (LUMS) and to investigate the relationship between these two. The study included 226 students studying in the first semester of the academic year (2011-12) of Lorestan university of medical sciences; sampling method was a combination of class and multistage cluster respectively. Body weight with an accuracy of 0.5 kg and FBS were measured by Glucometer. Stress was examined by Kodron's life health questionnaire. Being in final exam situation can be stressor (P<0.001) while at this stressor condition weight gaining in lower groups for age were significantly higher (P=0.002). FBS changes were associated with degree (P=0.034). Average weight and FBS was higher in men (P<0.001 and P=0.037 respectively). Based on the results of this study, differences of weight changes during the final exams of Lorestan university of medical sciences were not statistically significant, however increasing at FBS levels during the exams can be seen significantly.