ahmad reza sayadi

Chemical and herbal medicines are used to facilitate vaginal delivery and reduce cesarean section. Unripe cervix is associated with many complications. Since chemical drugs may be associated with maternal and fetal complications, the present study was performed with aim to determine the effect of flaxseed on cervical ripening and delivery outcome.

This randomized clinical trial study was conducted in 2018-2021 on 120 primiparous women referred to a midwifery office in Rafsanjan city. The samples were randomly divided into intervention and control groups. Then, 28 packets of 10 gr of flaxseed powder were provided to the intervention group, so that from the 37th week of pregnancy until delivery, they eat one packet in a glass of warm water every morning as fasting. The control group received no intervention. The study tool was a demographic and obstetric information questionnaire, and the two groups were compared in terms of cervical ripening and maternal and neonatal outcomes. Data analysis was done using SPSS software (version 22) and independent t and chi-square statistical tests. P<0.05 was considered statistically significant.

At admission time, the two groups had statistically significant differences in cervical ripening, and it was higher in the intervention group (p=0.01). Also, the first stage duration of labor was shorter in the intervention group (p=0.03). The two groups had no statistically significant difference in terms of other delivery outcomes, including admission cause, induction and strengthening of labor pains, the second stage duration, fetal distress, meconium passing, type of delivery, first and fifth minute Apgar scores, and postpartum hemorrhage (p<0.05).

The use of flaxseed increases the probability of cervical ripening and shortens the first stage and the course of childbirth.

Identification of causes of divorce in any society is the first and most important step in proposing practical solutions to this social problem. This study aimed to investigate certain causes of divorce in a community of divorce applicants in Rafsanjan, Iran.

In this descriptive study, 278 people (139 couples) applying for divorce, referring to counseling centers in Rafsanjan, Iran (2021) were enrolled via convenience sampling method. The causes of divorce were examined from the perspective of the counsellor and subjects. The data were analyzed using SPSS.

The mean age were 34.70±9.85 years. From the perspective of counsellors, psychological- psychiatric and sociocultural issues were the most common reasons for divorce (19.4% and 19.1% respectively). Men stated that the most important causes of divorce were lack of boundaries (parental interference) (21.6%), lack of empathetic dialogue (18%), and lack of conflict resolution skills (17.6%). According to women, the principal causes of divorce were the husband's addiction (17.3%), poor anger control skills (15.1%), and economic problems (15.1%).

The findings of this study indicated that apart from the issue of addiction and economy, other causes of divorce are related to marital skills, which can be reduced with proper pre-marriage education.

Extracorporeal shockwave lithotripsy (ESWL) is mong the the low-risk treatment methods of treating kidney stones. Specialists are looking for ways to remove small stones caused by ESWL in patients as soon as possible. The present study aimed to determine the effect of isosorbide on the duration of renal pelvis excretion after ESWL.

In this clinical trial, 176 patients with renal pelvis < 20 mm, who were referred to the ESWL Department of Moradi Hospital, Rafsanjan, Iran, in 2019, were examined. After lithotripsy, the patients were randomly assigned into two intervention groups of receivers of isosorbide 20 mg tablets every 12 hours for two weeks and placebo control for two weeks. The collected data was analyzed using Mann-Whitney and Kruskal-Wallis statistical tests.

The success of ESWL was 78.2% in the isosorbide group and 77.5% in the placebo group (P=0.919). The average duration of stone excretion in the isosorbide group was 4.21 ± 1.05 days, and the placebo group was 4.79 ± 1.16 (P=0.001). In the isosorbide group, the duration of stone excretion in patients with stone size 16-20 mm was less than 16 mm (P=0.011). The average duration of stone excretion in patients 36-55 years old (P=0.021) and patients with right-sided stones (P=0.008) in the isosorbide group was less than the placebo group.

Isosorbide, accompanied by other treatments, reduced the duration of stone excretion after ESWL. Moreover, although Isosorbide can be used to improve the management of patients with kidney stones, more studies are needed to confirm this finding.

Thyroid disorders have profound effects on body organs. This study was conducted aiming to examine the frequency of skeletal muscle manifestations in patients with thyroid dysfunction. The statistical population of this descriptive study was comprised of 200 patients with thyroid disorders referred to the endocrinology clinic of Rafsanjan University of Medical Sciences from March 21, 2018, to September 23, 2018, who were included in the study by census method. The research checklist included the information obtained from the complete physical evaluation of each patient's organs as well as the demographic characteristics. The Chi-square test and Fisher's exact test were used to analyze the data. The mean age of the examined patients was 39.25±14.43 years. Out of 200 patients, 23 (11.5%) were male and 177 (88.5%) were female. Joint pain was found in 121 people (60.5%), morning stiffness in 45 people (22.5%), limited joint mobility in 44 people (22.0%), adhesive capsulitis in 25 people (12.5%), carpal tunnel syndrome in 24 people (0. 12%), trigger finger disorder in 20 people (10.0%), and 2 patients (1.0%) experienced tarsal tunnel. No musculoskeletal manifestations were reported in 74 individuals (0.37%) suffering from a thyroid disorder. There was a significant relationship between musculoskeletal manifestations accompanying thyroid disorders and gender (p=0.001), level of education (p<0.001), and occupation (p=0.002). The findings of this study indicated the comorbidity of musculoskeletal disorders and thyroid dysfunction. Therefore, patients with thyroid dysfunction should be screened for musculoskeletal complaints and, if necessary, receive appropriate treatment.

Physical activity during retirement is one of the health promotion determinants in this group. This study was conducted to determine the effect of an educational intervention based on the health action process approach (HAPA) on the levels of physical activity among retired female employees.

This quasi-experimental study was conducted among 97 retired women, selected through a simple random sampling technique, and divided into two groups. The primary instruments employed for data collection included the International Standard Physical Activity Behavior Questionnaire (IPAQ) and a researcher-made questionnaire based on the HAPA. Data analysis was performed using SPSS version 20, incorporating a range of statistical tests, namely Spearman's correlation, independent and paired t-tests, the Willcoxon signed-rank test, and the Mann-Whitney U test.

After the educational intervention, the average score of different levels of physical activity has increased significantly (p < 0.05). In addition, three months after the intervention, the score of all the constructs of the HAPA model except for the structure of action planning and coping planning, was significantly increased (p < 0.05).

The implementation of an intervention based on the HAPA can improve the level of physical activity in middle-aged women. Therefore, it is suggested that future studies based on this approach be conducted in other target groups to promote physical activity.

The ABO/Rh blood groups were related to susceptibility to numerous infectious and non-infectious diseases. Here, the association of ABO/Rh groups with susceptibility to COVID-19 and disease severity was investigated in a population from southeast Iran.

 In this descriptive study, information regarding the clinical characteristics and ABO/Rh blood groups was collected from 524 patients with COVID-19 from March to October, 2020. The data of blood groups from patients were compared with those from 7365 healthy individuals during the same period. Data was analyzed using SPSS.

 No significant differences were found between COVID-19 patients and the healthy group regarding the proportions of A, B, and O blood groups. However, the proportion of the AB blood group was significantly higher in COVID-19 patients than that in healthy people (11.8% versus 8.2%, P <0.004). When the A group was considered as a reference, the AB blood group was associated to a greater risk of COVID-19 [OR: 1.45 (1.06-1.98), P<0.02]. No association was found between ABO blood groups and COVID-19 severity. The proportion of the Rh-positive blood group was slightly higher in COVID-19 patients than in the other group. The proportion of Rh-negative patients was greater in severe COVID-19 than in mild and moderate forms (P<0.001). In A, AB, and O blood groups, the proportions of Rh-negative patients were greater in severe COVID-19 than those with mild and moderate disease (P=0.05, P<0.05, and P<0.001, respectively).

 The AB blood group was associated with greater susceptibility to COVID-19, while Rh-negative status was positively associated with disease severity.

Endoscopy is one of the most common diagnostic and therapeutic methods in patients with gastrointestinal diseases. Anxiety and pain are associated with the patients. This procedure is unpleasant and intolerable. The present study was performed to determine the effect of the clinical Orientation Tour on the anxiety, pain, and satisfaction of patients who were candidates for endoscopy referred to Hospital in Rafsanjan in 2019. Hazrat Ali Ibn Abitaleb (AS) Hospital in Rafsanjan in 2019.

In this clinical trial study, 64 patients referred to the hospital were randomly divided into control and intervention groups. Demographic characteristics, Spiel Berger Anxiety Scale, Visual Analogue Pain Scale, and Modified Questionnaire (GHAA-9) were the data collection tools. The intervention was Orientation Tour with endoscopy and direct endoscopic observation. Patient's anxiety before and after the intervention, pain during endoscopy, and satisfaction after endoscopy were measured. Data were analyzed using paired t-test, independent t-test, Chi-square, linear regression, and Mann-Whitney tests. Analysis was done using SPSS software version 16.

The mean score of overt anxiety before the intervention was 56.78±7.32 and after the intervention was 35.19±12.52, latent anxiety ranged from 57.22±9.04 to 32.25±13.67, and total anxiety from 114.00±15.90 decreased to 67.44±25.76, which was statistically significant (P=0.0001). However, in the control group, it was associated with an increase in anxiety scores after the intervention. Pain during endoscopy was also statistically significant between the intervention and control groups (P=0.0001). But the mean satisfaction score after endoscopy was not significantly different between the two groups (P=0.161).

Clinical orientation training is effective in reducing anxiety and pain in patients undergoing esophagogastroduodenoscopy. It can therefore be suggested to reduce anxiety.

The iron and steel industry is one of the most resource-intensive and pollutant industries that creates the highest value across all mining and metal industries. While the recent studies provide recommendations to improve sustainable development in this industry, the complexity of the socio-environmental impacts of activities in this industry due to its multi-tier and multi-supply chain structures has given rise to the problem of sustainable steel supply chain network design. This work proposes a new multi-objective mixed-integer linear programming model to integrate sustainability factors with managerial and technical restrictions. The total economic profitability is maximized, while environmental pollution is minimized. There is also a focus on the social and environmental compliance. Accordingly, a novel sustainability assessment system is proposed. The managerial restrictions are also satisfied by maximizing the demand fulfillment priority using a new method. The augmented ε-constraint method is applied to tackle the mathematical problem under study. Finally, a real case study is used. The results obtained 35% and 41% reductions in CO2 and particulate matter emissions, respectively, while the total profit decreases up to 15%. A sensitivity analysis is also performed. In addition, several managerial insights are discussed based on the results.

Self-efficacy and people's satisfaction with breast self-examination training methods are very important in creating and perpetuating this breast cancer screening behavior. Therefore, choosing the most appropriate educational approach is important. The aim of this study was to Comparing the self-efficacy of breast self-examination and satisfaction with training in both face-to-face and smartphone-based training methods.

In this randomized controlled trial, 70 women referring to the breast clinic in Rafsanjan were selected by available methods and by drawing samples assigned to two groups of face-to-face and smartphone-based training. Training was done in both groups individually. The training in the face-to-face group was through lectures with PowerPoint, and for the smartphone-based group by uploading a training video on WhatsApp. Data were collected before and immediately after the intervention through individual characteristics checklist, satisfaction questionnaire and self-efficacy questionnaire and analyzed by SPSS22 software and independent t-test, paired t-test, chi-square, analysis of covariance and Fisher's exact test.

The mean scores of self-efficacy in the two groups of face-to-face and smartphone-based training, before the intervention were 22/57±4/68 and 20/68±5/08, and immediately after the intervention were 33/57±4/47 and 29/59±6/14, respectively. Satisfaction with training in the two groups of face-to-face and smartphone-based training was 173/78±7/18 and 166/46±17/86, respectively. Covariance analysis results showed a significant difference between the two groups in the degree of self-efficacy score (P = 0.007).

Both face-to-face and smartphone-based training methods provide satisfaction with training and create appropriate self-efficacy for breast self-examination, and face-to-face training has better results in this area.

With recent technological developments in the mining industry, the issue of physical asset management has become more important. Asset management in the mining industry has a key role to achieve production goals and increase competitiveness in the market. Reliability is one of the key indicators of asset management. Reliability is a function of the failures time and various risk factors such as environmental and operational conditions. One of the most widely used methods for investigating the relationship between the risk factors and reliability is the proportional hazard regression model. The regression coefficients can be estimated using two approaches, i.e. parametric and semi-parametric. In this paper, the failure data of a dump truck in the Sungun copper mine is analyzed using both semi-parametric and parametric approaches. The results show that the obtained estimates of both approaches were close to each other, according to Akaike Information Criterion (AIC), the Weibull parametric model is more efficient than the semi-parametric model at describing the reliability and hazard rate. In addition, it is found that road condition; operator skill, ambient temperature, and haulage distance have a significant effect on the hazard rate of the dump truck. This analysis is applied to maintenance management to keep the reliability of the dump truck at an acceptable level.

Reduced quality of life and self-efficacy are among problems of mothers of children with chronic diseases. This study aimed to determine the effect of empowerment based on the Gibson model on self-efficacy and quality of life in the mothers of children with thalassemia.

In this quasi-experimental study, the study population were the mothers of children with thalassemia referred to rare disease clinics in Rafsanjan and Kerman in 2020. The sample size was 25. Mothers were selected by the convenience sampling method and divided into two groups. In the intervention group, mothers participated in five training sessions based on the Gibson model, and in the control group, mothers received routine care. Data collection tools included the Zhang’s self-efficacy questionnaire and the SF-36 which were completed before the intervention and six weeks after the intervention. Data were analyzed using chi-square test, independent and paired t-test via the SPSS software version 18.

Before the intervention, the mean score of self-efficacy (P=0.31) and quality of life (P=0.47) were not statistically significant between the groups, but after the intervention, the mean score of self-efficacy in the intervention group (68.81±9.36) was significantly higher than that of in the control group (44.69±6.87) (P<0.001). But there was no significant difference in the mean score of quality of life between the intervention (60.64±10.08) and control (56.19±11.41) groups after the intervention (P=0.19).

According to the results, empowerment based on the Gibson model is an appropriate method for improving self-efficacy in the mothers of children with thalassemia. However, further studies are recommended about its effect on quality of life.

Since a significant part of mine operating cost belongs to hauling operations, optimizing the allocation and scheduling of trucks in a dynamic system is essential and significantly affects production efficiency. So far, different models and methods have been proposed for optimizing haulage scheduling. In this paper, scheduling models have been reviewed, and a flow-shop model has been developed to optimize truck dispatching systems in open-pit mines. The proposed model has been implemented on a small-scale example, driven by a real-world case study, and results have been discussed. Numerical investigation demonstrates that this model is a powerful tool for optimizing truck scheduling and can result in an enhancement in the productivity of mining operations. The most crucial challenge that must be addressed in future work is the development of fast solution techniques to solve real-scale instances of the developed model.  

The hauling operation is responsible for a significant portion of the operating cost in an open pit mine operation. Therefore, as the main hauling machine, trucks' optimum scheduling is crucial and can dramatically affect mine production productivity. Conventionally, assignment and dispatching of the trucks are defined as two main optimization problems in scheduling hauling operations. Simulation and stepwise mathematical programming have been proposed in the literature to solve these two problems. However, a dynamic and integrated optimization model is required to optimize hauling operations of the state-of-the-art revolution in data collection systems, computational capacity, and the necessity of real-time decision-making. Therefore, this study aims to develop an integrated and single-stage optimization model to optimize truck scheduling problems.

In this study, the truck dispatching problem has been discussed, and a flow-shop scheduling model has been suggested as the best model to be considered for modeling open-pit hauling operations. In a flow shop problem, a set of jobs flow through several stages in the same machine order. The proposed flow shop model has been evaluated using an example from real case study data.  

The results show that job scheduling models for truck optimization can optimize haulage scheduling and truck dispatching in open-pit mines. Using the developed flow shop model, it is possible to incorporate different mining KPI’s such as production time, production productivity, and fuel consumption. This model can also provide a prototype tool for real-time scheduling. Future work is on track to develop fast and reliable metaheuristic solution techniques for this problem's large-scale instances.

Low Back Pain (LBP) is one of the most common complaints during pregnancy, which could cause performance disability. Kinesio tape is a drug‑free elastic therapeutic cotton tape used in treating musculoskeletal problems. This study aims to determine the effects of Kinesio tape on LBP and disability in pregnant women.

A total of 80 pregnant women with LBP who were referred to the comprehensive health service centers were randomly assigned into the two groups of Kinesio tape and adhesive tape. Pain intensity was determined by the visual analog scale before and on the 1st, 2nd, 7th, and 14th day after the intervention and the disability by Roland‑Morris disability questionnaire before and on the 7th and 14th day after the intervention. Data analysis was performed by, Two‑way repeated‑measures ANOVA, Friedman, and Wilcoxon tests.

The intensity of pain decreased in both groups compared to the pre‑intervention period; Kinesio (χ2 = 48.94, df = 4, p </em>< 0.001) control (χ2 = 22.94, df = 4, p </em>< 0.001); however, the comparison results of pain intensity were not different in the two groups at different times (p </em>≥ 0.05). The effects of time was significant (Two‑way repeated‑measures ANOVA, F1,83 = 10.63, p </em>< 0.001), but the effects of time and group were not significant (F1,83 = 0.31, p </em>= 0.722) and indicated a decreasing trend of functional disability in two groups.

The Kinesio tape reduced the disability caused by LBP during pregnancy and had a lasting effect after the tape was removed.

Parturition is one of the most important events in women's lives, and therefore, factors that lead to a reduction in pain and its consequences during childbirth with minimal intervention are important for researchers. Therefore, the aim of this study was to investigate the relationship between midwifery counseling along with type of delivery and the rate of anxiety, stress, and depression in primiparous women in Niknafs Hospital of Rafsanjan in2021.

This was a cross-sectional and descriptive study. The statistical population included all primiparous pregnant women who volunteered for natural childbirth in Niknafs Hospital of Rafsanjanfrom March to August 2021, numbering 199. In this study, a checklist and a questionnaire were used. The checklist included demographic information and clinical characteristics of the patient and a questionnaire (Stress, anxiety, depression questionnaire DASS) for stress, anxiety and depression were assessed. The confidence level was considered as 0.05. Thestatistical software used was SPSS version 20.

The results showed that there were significant relationships between age (p = 0.03) and economic status (p = 0.00) with the type of delivery. Based on statistical analyses, the mean, Chi-square, and Mann-Whitney tests, there was a significant correlation between midwife support with mean stress score and anxiety (p = 0.03) and also between midwife support and depression (p = 0.01). Nevertheless, there was no significant relationship between the mean stress score and type of delivery (p = 0.30), anxiety (p = 0.27) and depression (p = 0.51).

Supporting a trained midwife on a maternity bed reduces her stress, anxiety, and depression in pregnant women, which has a positive effect on mother-infant relationships in midwifery and medical care. Therefore, it should be used to support childbirth and increase positive childbirth experiences in pregnant mothers.

A fundamental duty of the immune system is to defend against infectious agents. Significant abnormalities were reported in immune parameters of hypothyroid and hyperthyroid patients. In this study, we aim to assess various quantities of antibodies against the tetanus toxin (anti-TT) in hypothyroid and hyperthyroid patients. 

Anti-TT levels were measured in serum samples from 50 hypothyroid patients, 50 hyperthyroid patients, and 50 euthyroid individuals, using the ELISA method. Besides, the minimum protective quantity of anti-TT was considered 0.1 IU/mL.

Seroprotective rates against tetanus were 100, 80, and 96.0 % in euthyroid, hypothyroid, and hyperthyroid groups with the means of 3.52 ± 0.31, 1.62 ± 0.21, and 4.07 ± 0.32 IU/ml, respectively. Accordingly, hypothyroid patients exhibited lower anti-TT levels and seroprotective rates than the euthyroid group (P < 0.001 and P<0.004, respectively). Besides, in the hypothyroid group, anti-TT quantities and seroprotective rates were lower than those in hyperthyroid individuals (P < 0.001 and P < 0.03, respectively).

The findings demonstrated lower immunity and higher susceptibility to tetanus in patients with hypothyroidism. However, more studies are needed to be conducted in this field to provide more data to be considered in health programs.

Failure to observe hygienic principles and making minor cuts with scissors and razors while applying makeup may lead to the transmission of diseases of blood origin. The aim of this study was to investigate the knowledge and attitude of female hairdressers in Rafsanjan regarding the prevention of Blood-borne diseases and its relationship with demographic characteristics in 2019-2020.

This cross-sectional study was performed in all hairdressing salons in Rafsanjan that had official activities, by census (201 hairdressers). The tool for measuring knowledge and attitude was a researcher-made questionnaire that was completed as a self-report. The questionnaires were anonymous and coded and included demographic information, awareness and attitude. Data were entered into SPSS software version 18 and reported by indices of Dispersion indices, frequency distribution and Pearson correlation coefficient.

The average knowledge and attitude of hairdressers about Blood-borne diseases were 57.95 ± 5.11 and 57.95 ± 11.35, respectively. There was a statistically significant relationship between the mean score of knowledge and attitude of the research samples with the level of literacy (p value = 0.001). Most of the research samples mentioned that there is a vaccine to prevent hepatitis C disease and it was believed that covering the needle head after use has no effect on Blood-borne diseases.

Considering the average level of knowledge of hairdressers, it is suggested that more effective training courses to increase the knowledge of hairdressers using different training methods in order to make more effectiveness of health programs.

Human brucellosis can be a source of problems that affect public health, social, and economic well‑being of the world’s population. This study was conducted with the aim of determining the effect of Educational Intervention (EI) based on Health Belief Model (HBM) on preventive behaviors against brucellosis in Health Volunteers (HVs) in Rafsanjan.

Randomly, 104 HVs, in the intervention and control group, participated in a quasi‑randomized, controlled experimental study. Variables were evaluated before and 1 month after intervention. In the intervention group, the educational program was conducted with lecture, group discussion, showing movies and related photos, booklets, and pamphlets. The program included five 45‑min sessions that developed regarding the beliefs and constructs of HBM about brucellosis and its prevention methods. Data regarding HBM constructs and preventive behavior were collected using the questionnaire with 100 items by the self‑report method. Finally, the data were entered into the SPSS software version 16.0, and statistical tests such as Chi‑square, independent and paired t‑test, Mann–Whitney, and Wilcoxon test were used for the data analysis at the significant level of 0.05.

Prior to the intervention, the mean score of the HBM constructs and preventive behaviors between the two groups did not differ significantly, but 1 month later, in the intervention group increased significantly compared to the control group (P < 0.05).

We recommend to health authorities and health‑care providers to use HBM in EIs to create susceptibility, increase perceived severity and benefits, promote self‑efficacy, uses cue to action, as well as reduce behavioral barriers, and ultimately adopt health‑promoting behaviors.

Morbidity and mortality due to Coronavirus Disease 2019 (COVID-19) are mainly related to age and comorbidity diseases (hypertension, diabetes, cardiovascular disease, malignancies, etc.). These conditions are associated with poorer clinical outcomes and sometimes lead to long-term hospitalization. The current study aimed to investigate the relationship between COVID-19-induced mortality and various chronic diseases in patients admitted to Ali Ibn Abitaleb Hospital in Rafsanjan City, Iran, in 2020. 

In this retrospective, descriptive, and cross-sectional study, patients with COVID-19 referring to Ali Ibn Abitaleb Hospital in Rafsanjan City, Iran, from March 2020 to September 2020 were assessed. The required data were collected using patients’ records and telephone calls by a researcher-made checklist and analyzed by Independent Samples t-test, Chi-squared test, Fisher’s Exact test, Kaplan-Meier plots, and multivariate regression analysis in SPSS v. 20. 

This study assessed 238 hospitalized patients with COVID-19. The risk of death was significantly higher in patients aged over 75 years; they were 5.5 times more prone to expire, compared to the youngest age group (P<0.001). Chronic diseases, such as hypertension, heart disease, lung disease, and various cancers were more prevalent in patients who expired, compared to those who survived (P≤0.05). Of the patients who died, 73.8% were transferred to the Intensive U (ICU), while only 7.5% of surviving patients were transferred to the ICU (P<0.001). Longer hospitalization was associated with an increased risk of death among patients with underlying diseases and hypertension (P<0.05).

This study identified the role of chronic diseases and other important indicators in the survival of patients with COVID-19 who were admitted to a hospital in Rafsanjan. It is recommended that nurses and healthcare staff consider these findings in the care of patients with COVID-19.

The quality of clinical education requires that studentschr('39') ideas can guide for future program. The aim of this study was to determine the facilitation and inhibiting factors of clinical skills learning from the viewpoint of surgical technology and anesthesia students of Rafsanjan University of Medical Sciences.

In this descriptive study, 104 students of 4th, 6th and 8th semesters of surgical and anesthesiology technology were selected through census sampling. Data gathering tools, demographic information, and a 61-item questionnaire about facilitating and inhibiting factors were effective on learning clinical skills. Data were analyzed using SPSS software and descriptive statistics and inferential statistics using independent t-test and P-Value<0.05 was considered significant.

The results showed that in the area of educator characteristics, good educator-patient relationship with staff and patient is the most important facilitating factor, and in the field of teacher-student communication, providing appropriate feedback from the instructor to the student and the teacher-student confidence are the most important factors, respectively. It was facilitating from the perspective of both groups of students. In terms of the relationship between staff and students, the temperament and anger of the staff were the most important deterrents from the viewpoint of both group.

The most important area of facilitating clinical education from the students chr('39')point of view was good teacherschr('39') characteristics. Therefore, it is recommended to employ experienced teachers and continuous training of inexperienced instructors.

Perineal injury is a common complication of vaginal delivery that can affect women's physical, mental and social health. This study was performed with aim to determine the prevalence of third and fourth degree of perineal laceration during delivery and some related factors.

In this retrospective analytical -descriptive study, information was extracted from the records of mothers who gave birth during 2015-2017. The control group consisted of 129 mothers who did not have severe rupture and were selected by systematic randomization among vaginal deliveries performed during the mentioned years. After collecting information about the factors related to the perineal laceration, data were analyzed by SPSS software (version 18) and Chi-square and Fisher Exact and independent t tests. P<0.05 was considered statistically significant.

Among 8814 vaginal deliveries performed during the relevant years, there were 32 cases of third and fourth degree of perineal laceration (0.363%), of these, 22 cases were noli par (68.8%). In comparison between the case (n=32) and control (n=129) groups, the work experience of the delivery agent (p<0.02), instrumental delivery (p<0.023) and the duration of the second stage of labour (p<0.0001) were more in the case group.

Third and fourth degree of perineal lacerations are associated with the second stage of longer labour and instrumental labour that requires the presence of a labour agent with a longer work experience.

Suicide occurs due to a variety of causes, from heredity and biological factors to environmental factors. The present study aimed to evaluate the serum levels of vitamin D, ferritin, and hemoglobin in patients with attempted suicide referring to hospitals and compare them with the control group.

A comparison was made between the serum levels of vitamin D, ferritin, and hemoglobin of 60 suicidal patients referring to Ali ibn Abitaleb hospital of Rafsanjan from March to september 2020 and those of 60 relatives of selected patients with no history of suicide. The control group completed the Beck Suicide Thought Questionnaire (BSTQ). Chi-square, ANOVA, independent t-test, Mann-Whitney U test, and Kruskal-Wallis statistical tests were used to analyze the data.

The serum level of vitamin D in Patient with attempted suicide was lower, compared to that in controls (P=0.025). Among the age group of 15-35 years, serum levels of vitamin D were lower than those in the control group (P=0.039). Moreover, serum ferritin level in the attempted suicide group was lower than that in the control group (P=0.003). Serum ferritin level was significantly lower among the suidide attempters aged 15-15 years (P= 0.003), men with attempted suicide (P= 0.003) and suicidal women (P= 0.045), as compared to the control group.

As demonstratedd by the results of the present study, vitamin D deficiency and anemia can be two major risk factors for suicide. Therefore, it is necessary to identify and treat these deficiencies in people with psychological disorders, such as depression.

Doing healthy behaviors and having a healthy lifestyle in students is important. This research was conducted to determine the effect of educational intervention based on the theory of planned behavior on the promotion of healthy lifestyle behaviors in first-grade high school students in Rafsanjan city.

The current study was a randomized control trial conducted on 120 first-grade high-school male students in Rafsanjan city. Data were collected before and 3 months after the intervention by a questionnaire based on the theory of planned behavior. the collected data was analyzed by SPSS 16 software and analyzed by paired t-test, independent t-test, and Chi-square test.

After the intervention, the mean score of knowledge, attitude, subjective norms, perceived behavioral control and behavioral intention in the intervention group were significantly higher than the control group and the difference was significant (p<0.001). Also, the rate of addressing healthy lifestyle activities among students in the intervention group significantly increased after the intervention (p<0.001).

Educational intervention based on planned behavior theory of healthy lifestyle behaviors increased in intervention students after educational interventions.

One of the most important duties of a family physician is primary health care. The family doctor plan is one of the developmental measures to provide easy and low-cost access for patients to health care centers. The family doctor and her team are fully responsible for the health of the individuals and families covered. Therefore, this study was conducted to assess the satisfaction of rural areas of Rafsanjan city with the family physician plan.

This study is a descriptive-analytical study that was conducted in rural areas of Rafsanjan from October to December 2018. The study population consisted of twelve randomly selected villages in Rafsanjan. The required sample size was examined according to the size of the statistical population of 480 people. In this study, to collect the required data, a researcher-made checklist was used, which was prepared by reviewing the texts of the questions. The sampling method was cluster random. To check the validity of the checklist, the opinions of 10 health education experts were used. To check the reliability, the checklist was provided to 20 villagers and the reliability was determined using Cronbachchr('39')s alpha method of 82%. The mean was used to describe the data and inferential statistics t-test and ANOVA were used to analyze the data and analyzed by SPSS.

The average satisfaction of villagers with the family physician program was relatively good. The Highest satisfaction is with diploma education and income below 1 million 2.21% and the lowest satisfaction score is 21-30 years old and income over three million 2.16%.

Satisfaction with the implementation of the family physician program in rural areas indicated that the health system reform processes were successful and to increase this satisfaction, we must improve the level of service and improve the quality of family physician services day by day because the health system with effective health care is an important element of family physicians.

In this research, a rule-based expert system, with a graphical user interface, has been designed and implemented to measure, evaluate and provide a policy of improving mining productivity corresponding to the productivity management cycle. The expert system includes a set of rules related to how to calculate and analyze the productivity gap, and the inference engine is based on the analysis of the leading rules. Major policies are being improved based on quantitative and qualitative indicators. In order to evaluate the effective variables and to determine the relative importance of these policies, a fuzzy inference system based on expert opinions has also been implemented. To evaluate system performance, data from a gold mining complex was used for a period of eight years, and various indicators were developed in technical, financial, human resources and markets. For undesirable growth indicators, seven improvement policies were presented, with the highest and lowest share being related to the policy of "improving the production process" and "human resource management." Based on the evaluation of 40 qualitative components, 21 cases were in a rapid recovery situation. Also, after implementing the fuzzy inference system, the policy of "reducing energy consumption" with the importance of 56% was the most important.

Sexually transmitted infections (STIs) are a subject of great concern in public health, particularly in the field of reproductive medicine.

This study aimed to detect the presence of two sexually-transmitted bacteria, C. trachomatis and N. gonorrhoeae, in the semen samples of infertile men referred to a medical diagnostic laboratory in Rafsanjan city by PCR and also to investigate their possible effects on semen parameters.

Semen samples of 309 infertile men who were asymptomatic for genital tract infections were evaluated using the PCR method. In addition, the analysis of semen parameters was performed according to the WHO guidelines.

The average age of the participants was 32.67±17.02 years and 11.65% of cases were positive at least for one of the two tested bacteria; 11.32% for C. trachomatis and only 0.32% for N. gonorrhoeae. Furthermore, there was a direct significant correlation between chlamydia infection and at least two variables of sperm quality; activity, and live ratio (P < 0.05).

The results demonstrated that C. trachomatis are widespread among males, and this infection may lead to an effect on semen parameters such as activity and live ratio.