فهرست مطالب رضا علی محمدپور

Since 2013, Iran's health system reform has been implemented at the national level with goals such as increasing people's access to health services, reducing direct payments to patients, and improving the quality of services. As this initiative has been associated with significant changes in the financing of hospitals, this study aims to investigate the changes in income and expenses of public hospitals in Mazandaran province, as two important indicators of key hospital financial performance, before and after the implementation of the reform.

This is a retrospective study that was conducted in 2018. Since this study deals with the impact of the intervention carried out by the public sector by comparing the changes before and after the implementation of the intervention, it is therefore considered a type of quasi-experimental study. The statistical population includes all government hospitals in Mazandaran province. The sampling method was census and covered all 24 public hospitals of Mazandaran province. The time frame of the study covers from 2009 to 2016, that is, 4 years before and 4 years after the implementation of the reform. Secondary data that is routinely recorded in the information system of the country's hospital system has been used in this study. To collect the data, a researcher-made checklist was used based on the objectives of the study and the availability of data in the routine information recording system of hospitals, which mainly included the variables of staff cost, non-staff cost, cash income, insurance income, and working year. After collecting the data from the comprehensive and centralized Electronic Information System (HIS), which contains all the financial and functional information of all hospitals in the province, the data were extracted and analyzed using SPSS software and appropriate statistical methods.

In general, after the implementation of the reform, the average costs in the studied hospitals increased from 249,613 to 771,552 million Tomans (2.61 times) and the average incomes increased from 152,738 to 534,804 million Tomans (3.50 times). Therefore, both the average cost and the average income in the 4-year periods before and after the implementation of the initiative have generally increased, but the growth rate of costs and incomes in the period before the implementation of the reform was lower than the period after its implementation, although, in the same period, the gap between expenses and incomes has been widening. In the period after the implementation of reform, due to the rapid increase in income at the beginning of the implementation, the gap between cost and income has decreased relatively, but gradually the rate of income growth has decreased compared to the rate of cost growth, and as a result, the gap between the cost and income of the hospitals studied in the end of the study period has experienced an unprecedented gap. It has also been found that during the years of the study, the staff cost has continued to rise with more or less trends, while the non-staff cost has started to decrease sharply and unprecedentedly since 1995.

Although the implementation of the reform has increased the financial turnover of government hospitals, due to the increase in the average cost compared to the increase in their average income, the implementation of this plan has increased the financial pressure on the hospitals and widened the income deficit compared to their cost. Therefore, the gap between cost and income and the rising trend of this gap in government hospitals can be a challenge for funding hospitals and guaranteeing the relative access of people to these services now and in the future.

Fibromyalgia is a syndrome characterized by chronic musculoskeletal pain, tenderness, and other physical symptoms. We determined the frequency of Fibromyalgia in hypothyroid patients and the relationship between FM symptoms and hypothyroid status.

The current study is a cross-sectional descriptive study investigating the prevalence and demographic characteristics of fibromyalgia in hypothyroid patients referred to University clinic in Sari in 1401-1402. Ninety-one hypothyroid patients were included in the study. The sampling method was convenience sampling. The sociodemographic features and the clinical features of hypothyroid patients were recorded. Thyroid tests included T4, TSH, and Anti Tpo Ab. Patients were examined for Fibromyalgia using American College Rheumatology (ACR) criteria for FM 2010 and 1990. For the patients who were classified as FM, the FIQR questionnaire was completed. To analyze the data, descriptive statistics indicators such as central and dispersion indicators and calculation of ratios were used, and to check the relationship between qualitative variables, chi-square test and quantitative variable comparison in different groups were used by t-tests and ANOVA in SPSS-25 software was used.

The mean age and duration of hypothyroidism were 48.35 ± 13.8 and 9.84± 6.6 years respectively. The frequency of fibromyalgia in hypothyroid patients was 7(8%) patients based on ACR 2010 criteria. In patients with hypothyroidism and fibromyalgia, 6 patients (85.7%) were positive for Anti Tpo Ab, while in patients with hypothyroidism without fibromyalgia, 29 patients (34.5%) had this antibody (P=0.007).

It seems that Anti Tpo Ab is more important than thyroid dysfunction, and it is suggested to check this antibody in fibromyalgia patients in addition to thyroid function tests.

A part of the expenses of every household in all societies of the world is health expenditures, which can sometimes be disastrous for families. This study was conducted to investigate the change in the share of health expenditure from the total Household costs in Mazandaran province and the possible impact of health system reforms on it in Iran during the recent two decades, especially the Health Transformation Plan.

This is a retrospective descriptive-analytical study, based on quantitative and secondary data. The data required for this study was taken from the Statistics Center including household income and expenditure for a period of 18 years from 2001 to 2018. Descriptive statistics indicators and trend charts were used to describe the quantitative data, and to analyze household health expenditures, the t-test was applied in SPSS software.

The results of the study showed that on average, the share of health expenditures in the total household expenses was 12.04% for urban households and 11.36% for rural households that is more than the stated and expected limit of 10%. The trend of changes in the percentage of health expenditures from the total household expenses at the time of the research compared to the base year has been variable and in some years it has decreased and in some years it has increased.

The health system reforms have not ultimately led to the reduction of household health expenditure to less than the expected level and its increasing trend in Mazandaran province.This means the risk of catastrophc health expenditure among households still exist. Even with the implementation of subsequent plans, the achievement of the previous plan has been neutralized. Considering the importance of financial issues in universal health coverage and also the limited resources of the health sector, more detailed policies and plans should be designed and implemented to target vulnerable groups so that families' financial hardship is prevented as well as the possibility of universal coverage is increased to the maximum.

Stress hyperglycemia is a neuroendocrine physiological response to medical stress, hyperglycemic stress increases the risk of mortality and morbidity in ill patients. This study aimed to investigate the frequency of hyperglycemic stress and its related factors, as well as the relationship between hyperglycemia and the severity and clinical outcomes of hospitalized patients with COVID-19.

This cross-sectional study was conducted in Imam Khomeini Hospital in Sari in 2019. The patients were diagnosed based on clinical symptoms, CBC, CRP, ESR tests, RT-PCR test, and CT scan of the lungs and were hospitalized in the Covid ward. Data analysis was performed using SPSS Software.

312 COVID-19 patients were investigated, and 22 (7.1%) suffered from hyperglycemic stress. Hyperglycemic stress patients had more mortality, hospitalization in ICU, respiratory ventilation, and length of hospital stay compared to the normoglycemic subjects, but only in terms of mortality, there was a statistically significant difference between the two groups (P=0.46)

Considering the effect of hyperglycemia on the outcome of the disease and the death rate in ill and hospitalized patients compared to patients with normal blood sugar, it shows the importance of timely diagnosis and proper control of blood sugar in these patients.

The prevalence of Diabetes Mellitus is increasing, and its acute and chronic complications can increase disability and mortality of patients. The present study was conducted to investigate the relationship between attachment styles and blood sugar control in patients with type 2 diabetes.

The present study was cross-sectional (descriptive analytical type) study which 240 people with type 2 diabetes referring to the endocrinology clinics of Mazandaran University of Medical Sciences in 2018 were evaluated in the study using convenience sampling. Subjects with psychiatric disorders based on the SCL90-R, were excluded. Collins's Adult Attachment Scale Revised was used to evaluate attachment styles. Information related to disease control, including fasting blood sugar, 2hpp (postprandial), glycosylated hemoglobin, and the presence of retinopathy, neuropathy, and nephropathy, were extracted from the patients' medical records. The data were analyzed through SPSS version 22 and using the analytical and descriptive tests (mean, standard deviation, frequency) and inferential statistics (Pearson, stepwise regression).

The results of the correlation matrix have shown that neither of the attachment styles had a significant relationship with glycemic control(P>0.05).

Considering that people with psychiatric disorders were excluded from this study, suggested that future researches should investigate this population as well.

 The COVID-19 pandemic has threatened global health and increased the possibility of anxiety symptoms. The present study aims to investigate the frequency of post-traumatic stress disorder (PTSD) symptoms after the outbreak of COVID-19 in patients referred to the Mazandaran Welfare Organization in Mazandaran Province, Iran, in 2020.

In this descriptive-analytical study, 255 people enrolled. All participants were evaluated based on calls or in-person visits to the Mazandaran Welfare Counseling Center in Mazandaran Province, Iran, using the post-traumatic stress disorder checklist (PCL-5) with a cut-off point of 33 to diagnose PTSD. Also, the quality of sleep was measured based on the Pittsburg questionnaire. The P<0.05 was considered significant.

 The prevalence of PTSD in the high-risk population of welfare referees was 40.4% (CI 95%: 34.4 -46.4). The prevalence of PTSD had a significant relationship with the level of education (P=0.03). There was a positive and significant correlation of 30.2% between sleep quality scores and PCL-5 scores (P< 0.001).

 Considering the high prevalence of PTSD in people who are referred to welfare centers, as well as the availability of most of these individuals, it is possible to reduce the damage to this group by identifying factors related to PTSD and health planning.

 The importance of coping strategies and the role of religion as indicators in the face of problems and adversity have been emphasized in numerous studies. Therefore, the present study was conducted to investigate the relationship between religious coping and the resilience of nurses in the emergency department of Mazandaran University of Medical Sciences.

 This is a descriptive-analytical correlational study. All nurses working in the emergency departments of Mazandaran University of Medical Sciences were enrolled in the study by the census. In this study, three questionnaires including a checklist of personal and job characteristics, a resilience questionnaire (Connor and Davidson), and a questionnaire of coping strategies of Aflak Sear and Coleman were used. All data analysis was performed using SPSS software version 25. The significance level was considered p> ​​0.05.

The nurses participating in the study ranged in age from 21 to 59 years with a mean and standard deviation of 4 ± 34 ± 7.9. Job interest (p = 0.021) and work experience (p = 0.007) had statistically significant differences between different levels of religious confrontation. Job interest (p = 0.000) and native status (p = 0.001) have statistically significant differences between different levels of resilience. Resilience and most of its components have a significant correlation with religious confrontation and its components (p <0.05).

 Spirituality and the use of religious coping methods can increase the potential for adaptability and a sense of support from a higher power and ultimately increase nurses' resilience.

Mothers are in the first line of adolescent sexual health education. The aim of this study was to determine the prevalence of sexual health dialogue between mothers and adolescents and related factors in households covered by urban health care centers in Sari, Iran.

This cross-sectional study was conducted in 196 mothers of adolescents (15-19 years) using simple random sampling between August 2020 and January 2021. Data were collected using a Medical Socio-Demographic Questionnaire, a researcher-made questionnaire investigating the barriers to sexual health dialogue between parents and adolescents, and the Sexual Health Dialogue. Data analysis was performed applying logistic regression analysis.

Almost all mothers (99.5%) had a dialogue about at least one of the topics associated with sexual health with their adolescents. However, good-quality dialogue about sexual health was observed in 49%. Embaressment (54.8% of boys and 38% of girls) and encouraging curiosity about sex (49% of boys and 58.7% of girls) were the most frequent barriers to sexual health dialogue between mothers and adolecents of both genders. Logistic regression analysis showed that the odds of good-quality dialogue about sexual health between mothers and sons were 93% less than that between mothers and daughters.

Considering the low frequency of good-quality dialogue about sexual health between mothers and adolescents, attention to the barriers involved in this dialogue and essential appropriate approaches are necessary measures in adolescent health policy.

Stress and socio-economic and psychological consequences of COVID-19 pandemic have affected family and marital relationships. The present study investigated the frequency of marital conflicts and related factors in Mazandaran province, north of Iran during this pandemic.

In this cross-sectional study, 357 married people were selected by convenience sampling via social networks in 2020. Data were electronically collected using demoghraphic and medical checklist and the Marital Conflict Questionnaire- revised form (MCQ-R). Data were analyzed in SPSS V25.

The average age of participants was 38.2±9.9 years. The average duration of marriage was 14.9±10.7 years. The total mean score for marital conflicts was 103.8±28.3 indicating a moderate level of conflict. The respondents reported mild (n=188, 57.7), moderate (n=132, 40.5), and severe (n=6, 1.8) levels of marital conflicts. Significant direct relationships were found between marital conflicts and age, gender, educational level, remarriage, nuclear family or extended family, history of marital conflict before the pandemic, individual or family history of COVID-19, and number of children (P<0.05).

According to current study, social health authorities are suggested to be prepared to predict the family-marital consequences of a pandemic such as COVID-19 and take necessary preventive and treatment actions.

Some patients need emergency dental care and people with low economic status are more likely to go to hospital emergency departments. There is lack of enough knowledge about dental emergencies and no accurate data is available on this issue. This study aimed at investigating clinical and epidemiological characteristics of patients in dental emergency departments.

A cross-sectional descriptive study was performed in patients with dental complaints attending emergency departments affiliated with Mazandaran University of Medical Sciences, 2017-2018. Data were analyzed in SPSS V 16.

A total of 1660 patients (mean age: 36.80±15.50 years) were studied. The most common reasons for attending the emergency department were dental trauma (n=886) and dental infections (n=353). The highest referral times were evenings and nights (n=1130). Compared with women, men were found with more dental trauma and soft tissue injuries (P= 0.0001).

Special training programs should be provided to the staff in hospital emergency departments so that they can obtain sufficient information and skills about triage, diagnosis, treatment, and follow-up of dental emergencies.

Around the world, about one in six older people has experienced some form of abuse. This study aimed at comparing the rate of abuse and related factors in urban and rural senior people attending health centers in Ghaemshahr, 2020.

In this descriptive-analytical study, 250 older people were selected by systematic random sampling. Data were collected using Domestic Elder Abuse Questionnaire, Abbreviated Mental Test (AMT), Geriatric Depression Scale (GDS), Assessment of Daily Activities of Instrumental Activity of Daily Livening (IADL), and Demographic-Medical Questionnare. Data were analyzed in SPSS V22 applying descriptive statistics tests, independent t-test, and one-way analysis of variance.

The mean age of participants was 69.10±8.57 years of whom 58.8% were women. At least one type of abuse was experienced by 60% of elder people in urban areas and 64.8% of the seniors living in rural regions. Psychological abuse was found to be more prevalent in both groups while rejection was the least common form of abuse. Findings revealed significant associations between elder abuse and gender, education, income, disease status, number of drugs used, urinary incontinence, life companions, number of children, and occupation (P<0.05).

High rate of elder abuse calls for alerting aged people and their caregivers. Appropriate interventions can also help in preventing the consequences of this problem.

Treatment of rheumatic diseases depends on proper use of medications. The aim of this study was to evaluate the frequency and reasons for discontinuation of drugs in these patients.

A cross-sectional study was performed in patients with inflammatory rheumatic diseases in Sari, Iran 2020-2021 to investigate the frequency and reasons for discontinuation of drugs. Statistical analysis was performed using SPSS V20 and descriptive statistical methods were used to determine the frequency of drug discontinuation and its causes.

The participants (n=251) included 197 patients with rheumatoid arthritis, 31 with systemic lupus, 16 with ankylosing spondylitis, and 7 patients with psoriatic arthritis. The mean age of patients was 52.36±13.4 and mean duration of illness was 8.35±7.31 years. Drug discontinuation was seen in 73 patients (85 cases). The most common reason for drug discontinuation was drug side effects (55.4%). Drug shortage, transient improvement of symptoms, ineffectiveness of the drug, and fear of developing COVID 19 were some of the reasons for discontinuation of drug.

The most common cause of discontinuation of treatment was drug side effects, but in about one third of cases, there are factors that could be corrected to help preventing drug discontinuation and non-adherence to treatment.

Elder abuse is one of the major challenges in caring and supporting elderly people. Current research aimed to investigate the relationship between loneliness and experiencing abuse in elderly people attending emergency departments in Amol hospitals, Iran 2019.

A descriptive-analytical correlation study was conducted in 220 people aged>60 years selected by convenience sampling. Demographic information of the participants was recorded and Elder abuse questionnaire in the family and the Social and Emotional Loneliness Scale for Adults (SELSA) were used. Data analysis was performed applying descriptive statistics test, Spearman correlation coefficient, multiple regression model and analysis of variance in SPSS V22.

The mean age of the elderly was 66.5±5.45 years and 62.7% were female participants. Among the subjects, 50.9% reported at least one type of abuse. Emotional neglect (29.1%) and physical abuse (0.5%) were the most and least frequent types of abuse, respectively. The current study showed significant relationships between all dimensions of abuse and the sense of loneliness (P=0.001) except for authority deprivation (P=0.5) and physical abuse (P=0.1) and financial neglect (P=0.1(.

Education and increasing awareness of elderly people and their caregivers can reduce elder abuse and improve their relationship, which will consequently improve the sense of loneliness in elderly people.

Almost half of non-specific knee pain can be attributed to patellofemoral pain syndrome (PFPS). There is paucity of information about the effects of different types of combination therapies including exercise and taping and optimizing training variables. The aim of this study was to evaluate the effectiveness of combination of taping and quadriceps strengthening and hamstring stretching exercises on PFPS.

In a randomized clinical trial, 60 male patients (20-50 years old) with PFPS were randomly divided into four groups: 1) Quadriceps strengthening exercise and taping, 2) Hamstring stretching exercise and taping, 3) Quadriceps strengthening and hamstring stretching exercise, and 4) Quadriceps strengthening, hamstring stretching exercise, and taping. Pain and functional outcomes were assessed before and immediately after treatment using VAS scale, KOOS scale, and 6 MWT test. Data were analyzed in SPSS V20.

Compared to beginning of the study, significant decrease in mean VAS scores (P<0.001) and significant increase in mean KOOS scores and 6 MWT test were found in all groups after treatment (P<0.001). However, the increase in 6MWT test score was not significant in group 4.

Combination of quadriceps strength training and hamstring stretching improved PFPS in all four groups. Lack of significant differences between the groups studied suggests that combination of two treatments has a similar effect to the combination of three treatments.
 
(Clinical Trials Registry Number: IRCT20140708018409N2)

Third molar teeth are the most common teeth with agenesis. The absence of this tooth also increases the probability of anomalies in other teeth by several times. Since panoramic radiography is used to diagnose and plan treatment in orthodontic patients, along with routine clinical examination, this study aimed to determine the prevalence of third molar agenesis and incidence of other associated anomalies in comparison to that reported for the non-agenesis group using panoramic radiographs.

In this descriptive-analytical study, the pretreatment records of 562 patients were randomly collected. Out of these subjects, 538 patients were selected based on inclusion and exclusion criteria. The panoramic radiographic images of patients who did not have at least one third molar were assessed with regard to the presence of other dental anomalies, such as dental agenesis, hypodontia, hyperdontia, impacted canine, peg-shaped lateral incisors, ectopic eruption, microdontia, dilaceration, transposition, and transmigration. The prevalence of these anomalies was compared to that of a randomized control group selected from patients with the presence of each four third molars.

Out of 538 studied panoramic radiographs, overall, 13.7%, 13.5%, 13.4%, 5.9%, 2.7%, and 1.4% of them had at least one third molar agenesis, canine impaction, peg-shaped lateral incisors, missing teeth, transposition, and hyperdontia, respectively. The frequency rates of impaction and missing teeth were higher in the agenesis group (30% and 40.5%) than those reported for the control group (16% and 2.7%) (p < /em>>0.001), respectively. The presence or absence of other dental anomalies was not statistically significant between the two groups and two genders. In addition, the present study demonstrated that the probability of the presence of at least one type of other dental anomalies was higher in individuals with third molar agenesis in comparison to that reported for the control group (p < /em>>0.001).

Among different types of dental anomalies in the studied population, the probability of impaction and missing teeth was higher in the third molar agenesis group than that of the control group. Furthermore, the prevalence of third molar agenesis was not different between the two genders.

High prevalence of Type 2 Diabetes Mellitus (T2DM) and its demand for regular care have resulted in a massive amount of electronic health records (EHRs). Hemoglobin A1c (HbA1c) and Fasting Blood Sugar (FBS) levels are two widely-used diagnostic measures for evaluation of diabetes care. This study aimed at assessing Family Medicine Plan (FMP) and exploring the trend of changes in FBS and HbA1c levels in patients attending a referral lab affiliated with Mazandaran University of Medical Sciences. 

This cross-sectional survey was carried out in 12761 EHRs of a registry database containing the results of blood sugar tests and demographic features selected from over 250 thousand EHRs from 2012-2018. The records were categorized according to normal and abnormal levels of HbA1c (cut-off at 7%). The bivariate logistic regression model was performed by R v.3.6.1 and ggplot2 for data visulazation.

Abnormal HbA1c levels were seen in 37.1% of women, 36.7% of men, and 36.7% of the general population. There were significant associations between HbA1c level and age, type of insurance, FMP, kind of care plan, and the year of testing (P<0.001), but, no significant relationship was found between HbA1c level and gender (P>0.05).

Despite the increasing prevalence of T2DM in Iran, the trend of blood sugar changes during these years showed that changes in HbA1c level was lower than 7% in studied citizens. Considerable attention to self-management in recent years indicates improvements in diagnosis and care of citizens at-risk of diabetes.

Contrast-induced nephropathy (CIN) as a common complication of administration of contrast media (CM) is a major source of hospital morbidity and mortality. The aim of this study was to determine the incidence of CIN after contrast-enhanced CT scan and identifying the related risk factors.

A cross-sectional study was carried out in 100 patients attending Sari Imam Khomeini Hospital who underwent contrast-enhanced CT scan in 2016. Predictors of CIN were evaluated in four general categories, including demographic variables, underlying diseases, concomitant medications, and laboratory findings. Data were analyzed in SPSS V20.

In this study, increase in the concentration baseline serum creatinine of more than 25% or 0.5 mg/dl within 48 hours after the injection of contrast material was considered as an indicator of the incidence of CIN. Accordingly, the incidence rate was 7%. The incidence of CIN was significantly different in patients with and without hypertension (P= 0.028) and patients taking angiotensin II receptor blocking drugs (ARBs) (P= 0.019). Compared to creatinine, BUN and eGFR were both observed to be more accurate in predicting the incidence of CIN. BUN was found to have higher sensitivity and lower specificity while eGFR showed higher specificity and lower sensitivity.

In addition to hypertension and the use of ARBs as the major risk factors for the incidence of CIN, BUN was observed to be a better predictor for CIN than eGFR. Higher Efficacy of BUN could have been due to its larger size and therefore fewer laboratory errors.

Heavy metal pollution is among the most serious environmental issues that is caused directly or indirectly through human activities or natural sources. Alagol wetland is one of the most important ecosystems in Iran which is affected by numerous agricultural and industrial development programs.

A descriptive cross-sectional study was performed in summer and autumn 2017. Heavy metal contamination (nickel, cadmium, and lead) was investigated in 50 samples from five different zones of water and sediment of wetland. Zoning was done using GIS and data analysis was performed applying ANOVA, Tukey’s test, and multivariate analysis (CA).

Average concentrations of cadmium, lead, and nickel in water were 0.013±0.02, 0.86±0.44, and 0.164±0.55 in summer and 0.021±0.03, 0.658±0.36, and 0.334±0.65 in autumn, respectively. The average concentrations of cadmium, lead, and nickel in sediment were 0.19±0.005, 2.103±0.011, and 0.489±0.102 in summer and 0.11±0.003, 1.796±0.261, and 0.353±0.2040 μg/kg dry weight in autumn, respectively.

The level of contamination was found to be higher in western zone. The study showed high impact of human resources on lead and cadmium contents but nickel content was more of natural resources. The amount of metals measured were lower than the global standards. Industrialization, increasing rate of international road transportation, and agricultural activities caused high concentrations of metals in Alagol Wetland.

Correction to: Investigation of Electrocoagulation Process Performance with DC Current in Treatment of Poultry Slaughterhouse Wastewater Using Aluminum Electrodes
Zabiholllah Yousefi1,
Hossein Sahebian2,
Abdoliman Amouei3,
Reza Ali Mohammadpour4,
Ebrahim Zarei5
1 Professor, Department of Environmental Health Engineering, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
2 MSc Student in Environmental Health Engineering, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
3 Professor, Department of Environmental Health Engineering, Faculty of Health, Babol University of Medical Sciences, Babol, Iran
4 Associate Professor, Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
5 Assistant Professor, Department of Basic Sciences, Farhangian University, Tehran, IranIn the article published in volume 29, issue 172, 2019, the title was published incorrectly, which is now corrected.

Poultry slaughterhouses produce high rates of polluted effluent. They can contaminate the environment if not treated properly. This study aimed at investigating the performance of electrocoagulation process with direct (DC) current in treatment of poultry slaughterhouse effluent using aluminum electrodes.

This study was performed as an experimental study on a pilot scale on poultry slaughterhouse effluent. In this experiment, direct flow and four aluminum electrodes, which were spaced two centimeters apart, were used as monopole. We investigated the percentage of organic load waste removal (COD, BOD5) and different pH changes, at 6, 12, and 18 V, and pH 3, 5, 7, and 9, and different reaction times (10, 30, 60, 90 min).

The removal efficiency of COD and BOD5 using DC current was optimally at 18 V and pH=7 that occurred in 45 min (84.86%, 88.93%, respectively). Final pH was found to be 8.47.

According to current findings, electrocoagulation process can be used as a combined process with high efficiency in removal of slaughterhouse effluent contaminants, so, using this technique can produce wastewater according to the standards.

Poor sleep quality is one of the most common problems in the elderly with heart failure, and hospitalization exacerbates this problem. In traditional Persian medicine, citrus aurantium has been recognized as a sedative and inducer of sleep. The aim of this study was to determine the effect of citrus aurantium on sleep quality in the elderly with heart failure.

This randomized clinical trial was performed on 80 elderly patients with heart failure admitted in selected teaching hospitals of Mazandaran province in two intervention and control groups. In the intervention group, aromatherapy with two drops of 10% citrus aurantium essential oil was performed on a cotton ball for twenty minutes for three consecutive nights and the control group received routine care. Sleep quality of the elderly was assessed before and after the intervention using the standard St. Mary's Hospital Sleep Questionnaire (SMHSQ) (which assesses the quality of previous night's sleep in hospitalized patients).  

 The mean sleep disorder in the elderly before and after the intervention in the intervention group was 24.70±3.67 and 21.05±3.62, respectively, which was statistically significant (p=0.001). Mean sleep disorder in the elderly before and after the intervention in the control group was 24.37±4.48 and 23.75±4.71, respectively, which was not statistically significant.

The results showed that using aromatherapy with citrus aurantium can improve sleep quality in the elderly with heart failure.

Increasing the age in the elderly is associated with loss of quality of life and loss of self-esteem. Recreation is one of a number of rehabilitation services designed to achievement of social skills in individuals. The aim of this study was to determine the effect of recreational therapy on the level of self-esteem and quality of life of elderly patients referred to Babol's daily care center. In this quasi-experimental study that was carried out in pre-test and post-test in two groups of intervention and control in 2012 in 30 elderly referred to the daily care center and Reziakola Health Center in Babol. In the intervention group, recreational therapy was held in groups with friends for 10 weeks in 40 sessions of 60 minutes. Self-esteem and quality of life were assessed using the standard questionnaire of elderly quality of life CASP and the Rosenberg self-esteem questionnaire before and after intervention. Data were analyzed by SPSS version 20 and descriptive and inferential statistical methods. According to the results of ANOVA, repeated measures, inter-group variations in self-esteem (p = 0.003) and quality of life (p = 0.007) show a significant difference between intervention and control groups. In the subscales of quality of life, intergroup variations in the field of intrusion (p = 0.004) and success (p = 0.006) show a significant difference between intervention and control groups. Regarding improvement of self-esteem, quality of life and its dimensions, this method can be introduced as an enjoyable and useful skill.

Background and purpose: Female reproductive empowerment refers to the ability and rights to make free decisions in reproductive activities such as number of children and birth intervals. This study was designed to investigate the relationship between childbearing motivations and women reproductive empowerment. In this descriptive-correlational study, 810 women living in both urban (n=500) and rural (n= 310) areas participated. They were selected via two stage cluster sampling in Sari healthcare centers, 2017. Data were collected using a demographic-reproductive characteristics checklist, the Childbearing Questionnaire (CBQ), and Women's Empowerment Questionnaire. Data analysis was done applying independent t-test, one-way ANOVA, Pearson correlation coefficient, and linear regression. There was no significant association in the mean score for women reproductive empowerment in urban and rural areas (91.65± 12.86, 91.46±13.14, respectively, P= 0.593). The present study showed that women reproductive empowerment was directly associated with positive dimension of childbearing motivations (β=0.13, P <0.001) while it was inversely associated with negative dimension of childbearing motivations (β= -0.30, P <0.001). Also, women employment status (β=0.11, P= 0.003), husband's educational background (β=0.13, P= 0.029), and age of the last child (β= -0.07, P= 0.021) were amongst the factors affecting women reproductive empowerment. Women reproductive empowerment is associated with diferent socio-economic factors among which husbands' educational level is believed to be highly effective. Therefore, appropriate planning on this issue is of great benefit in improving women reproductive empowerment.

Background and purpose: Consumption of bottled water is increasing in the world and there are many concerns about the migration of phthalate esters into bottled water. These compounds are risky for consumers. This study investigated the concentration of phthalate esters in bottled water in polyethylene terephthalate containers in different storage conditions. Bottled water samples were stored in different conditions and then the phthalate esters were analyzed by gas extraction liquid-liquid-aqueous extraction (ALLME) method and gas chromatography-mass spectrometer (GC-MS). Data analysis was done in SPSS V24. Findings showed that the average concentrations of 5 phthalate esters (DEHP, DBP, DIBP, DEP, and DMP) in different conditions increased by an average of 392.84% compared to the initial levels in control samples. Diethylhexyl phthalate (DEHP) concentrations in bottles of drinking water incubated at 42°c for 15 days and 25°c for 75 days were 10.33 and 9.62 ppb, respectively, which were higher than the limits. Current research showed increased concentration of phthalate esters in water samples in different storage conditions. High temperatures and prolonged storage time were found to influence the migration of phthalate esters. Therefore, PET packaging is not suggested for drinking water to be kept in higher temperatures and longer storage times.

Background and purpose: Thyroid nodules are quite common witch are found in clinical or ultrasound examinations. They are detected in 4-8% of clinical examinations and 7-15% are malignant. TSH is one of the growth factors for nodule growth. Controversial reports are published on the effect of TSH on thyroid nodule malignancy. This study aimed at investigating the effect of TSH in predicting malignancy in thyroid nodules. In this cross sectional research, 500 patients were studied. Serum TSH level was measured prior to fine needle aspiration (FNA). Data analysis was done applying inferential statistics. The patients were 457 (91.4%) females and 43 (8.6%) males and the mean age was 43.43±13.9 years. Among the patients 240 had single nodule and 260 had multiple thyroid nodules (P=0.08). The mean size of nodules in benign and malignant nodules were 26.1±12.2 and 27.3±9.8 mm, respectively (P=0.6). Malignant and benign nodules were observed in 31 (6.2%) and 469 (93.8%) patients. Mean TSH level was 3.3±6.9 and 2.4±2 in patients with benign and malignant nodules, respectively (P= 0.47). To investigate the association between TSH and FNA cytology, TSH levels were divided into <0.5, 4.9-0.5, and ≥5 using person correlation. This study showed no significant difference between the three groups (P= 0.3). TSH alone is not a suitable marker for predicting thyroid malignancy.