ramazan fallah

Knee osteoarthritis (OA) is one of the major causes of dysfunction that reduces patients’ quality of life. The aim of current study was to investigate the effectiveness of muscle strengthening exercises on the clinical outcomes of patients with knee OA.

We conducted a single-blind clinical trial on 96 patients with mild to moderate knee osteoarthritis. Patients were randomly assigned to 4 groups with 24 patients and followed-up for 8 weeks. Quadriceps, hamstring and both hamstring and quadriceps strengthening exercises were received by the first (G1), second (G2) and third (G3) groups, respectively. The fourth group (G4) was the control group and did not receive any intervention. The main outcome variables were pain, physical function and morning stiffness. This study was retrospectively registered at irct.ir (Iranian Registry of Clinical Trials) with the code IRCT20220206053950N2, 2022-09-07

Our findings demonstrated a significant impact of interventions on VAS score, pain, and stiffness (All, p < 0.001). Nonetheless, the effect of interventions was not significant for physical function (P = 0.78). After adjusting for the potential confounders, similar results were observed. Besides, the results of Dunnett post hoc test showed that either G1 or G3 had the most decrease in VAS and WOMAC-morning stiffness scores compared to G2 and G4.

Based on the evidence from the present study, we can recommend a combination of quadriceps and hamstring strengthening exercises as the most effective intervention to reduce pain and morning stiffness in patients with OA.

In the presence of competing risks, patients with brain stroke (BS) experience death by various causes, such as diabetes, and heart disease, and other causes in the follow-up. This study aimed to model the survival in patients with BS in the presence of these competing risk of death using cumulative incidence function (CIF) and cause-specific hazard (CSH) models.

In the study, 332 patients with the definitive diagnosis of BS were followed up for 10 years, and their mortality status due to BS or other causes was evaluated. In addition, significance tests and parameters were estimated by using STATA 14 software by considering the CIF and CSH model.

The median follow-up time was 20.68 months for patients who died due to BS and 68.50 months for patients who died due to other causes. In the CIF model, Sex [BS: cumulative incidence hazard ratio (SHR) = 2.35, 90% confidence interval (CI) = (1.76-3.14)], Employment status [BS: 2.04(1.50-2.75)], History of blood pressure[BS: 1.64(1.25-2.14)], Heart disease[BS: 1.47(1.13-1.94)], Cerebrovascular accident type[BS: 0.77(0.69-0.87)]; age [Other case: 59-68 years, 2.61 (1.13-6.06) and ≥76 years: 3.03 (1.32-6.92)] were directly related to hazard of death. The CSH model resulted in similar estimates except for age [BS: 69-75 years; 1.31(1.18-1.45), ≥76 years; 1.37(1.23-1.53); other case: age 59-68 years 1.91 (1.22-2.99) and 69-75 years; 1.89 (1.21-2.96) and ≥76 years: 2.14 (1.36-3.37)], Sex[BS: 1.38(1.07-1.79)], History of blood pressure [BS: 1.57(1.20-2.05)], Heart disease [BS:1.44(1.09-1.91)] were directly related to hazard of death.

The estimation of CIF analysis, along with CSH one for the competing risks, is suggested to provide more precise information about patients’ status in order to support adopted clinical decisions when aiming at assessing health related to a specific cause economically and determining the probability of occurring an intended event among other causes.

The COVID-19 pandemic has caused numerous psychological problems, especially anxiety, in patients with diabetes as a group with increased risk of contracting COVID-19. Patient education in this area can be a good way to reduce the psychological burden of these patients. This study aimed to determine the effect of patient education through social media on the COVID-19-related anxiety in patients with diabetes.

This is a single-blind clinical trial, in which 113 patients with diabetes were recruited using convenience sampling and then divided into two groups of experimental (n = 58) and control (n = 55) using simple random allocation. Data were collected using a demographic questionnaire and Corona Disease Anxiety Scale (CDAS). COVID-19-related patient education was provided for the intervention group at a two-week period, while the control group only received routine care. Data were entered into SPSS software version 26 and then analyzed using descriptive and inferential statistics.

There was no statistically significant difference in terms of demographic characteristics and the mean score of COVID-19-related anxiety between the two groups before the intervention (p > .05). This difference in the mean score of COVID-19-related anxiety was not found to be significant between the two groups after the intervention (p > .05). There was also a statistically significant difference between the mean score of COVID-19-related anxiety at measurement points of before and after the intervention in the experimental group (p < .05).

Educational intervention through social network leads to a slight reduction in COVID-19-related anxiety in diabetic patients. Therefore, social media is suggested as a suitable and accessible method for COVID-19-related patient education.

In today's world, with the advancement of technology, hand tools that required the physical strength of the body have given way to electric and pneumatic tools. Despite all the advantages that these tools have, there are many limitations and problems due to their use for people, including sound and vibration. Most different machines and tools produce vibrations in varying proportions, the forces and effects of which are transmitted to the body through the hands called hand-arm vibration (HAV) 1. These vibrations can cause cardiovascular, neurological, or skeletal disorders in the upper extremities. Hand-transmitted vibration (HTV) 2 can also lead to peripheral neuropathy syndrome, whose symptoms include numbness, impaired sensory perception (tremor, cold, heat, pain), and loss of hand skills. Another complication of hand-arm vibration is blood vessel spasm, which is a clinical manifestation of the white finger phenomenon and varies depending on the intensity and duration of hand contact and the amount of hand-arm vibration. This study was performed in heavy machine puncture workshops. In punctures, workers use an Impact wrench to unscrew and tighten the machine wheel bolts. Using this wrench exposes operators to sound and vibration. The aim of this study was to Evaluation of workers' exposure to hand-arm vibration of impact wrench in heavy vehicles puncture shops and providing control

This study was conducted with the participation of 20 employees of heavy vehicles puncture workshops who worked in different workshops with different Impact wrenches and were randomly selected. At first, the personal Demographic of the employees such as age, work experience, height, weight and level of education and the characteristics of the Impact wrench including weight, power, function life and manufacturer were recorded. Hand-arm vibration measurement GA2003 HARM VIBRATION METER made by CASTEL with a piezo electric T-shaped sensor was used to measure hand-arm vibration. Measurements were performed on the X, Y and Z axes according to ISO 5349-1. The effective vibration acceleration was measured in RMS mode and using a HARM filter. Then the effective total value vibration acceleration was calculated using Equation 1.Equation(1) ahv: total value effective vibration acceleration ( (   ahwx: X-axis effective vibration acceleration ( (  ahwy: Y-axis effective vibration acceleration (  ahwz:  Z -axis effective vibration acceleration ( ( 1. Hand Arm Vibration    2. Hand Transmission Vibration Image (1).  Pneumatic wrench on the left, a worker using it on the right There are about 10 screws in each wheel of heavy machinery, considering that the time required to open and close the screws of a wheel is 3 minutes, and considering the average number of wheels that can be opened and closed by one person during a day ( 20 wheels per day) The average exposure time was calculated as 1 hour, then using Equation No. 2, the effective acceleration equivalent to 8 hours of exposure per person was calculated and the results were compared with the allowable occupational exposure threshold of the country. Equation (2) A (8): the amount of effective vibration acceleration is equivalent to daily exposure  ahv: the total value effective vibration acceleration T: the vibration exposure time T0: the base time which is 8 hours per day.

Mean personal Demographic including age, work experience, weight and height were 36  8.97 years, 10.55  7.52 years, 10.86 kg and 175  4.9 cm, respectively. The mean characteristics of pneumatic wrenches including torque (power), weight and function life were 2750 N/M, 13.7  2.04 Kg and 1.45  1.05 years, respectively. 50% of the wrenches belonged to Genius Company, 25% to TAITIAN Company and 25% to other companies. The maximum effective acceleration measured in the front handle of the Impact wrench was 20.35  on the Z axis. The mean effective acceleration of vibration in the front handle on the X, Y and Z axes was 16.95  8.98 , 18.35  6.93  and 20.35  10.39 , respectively. Also, the total value of the effective vibration acceleration for the front handle was 32.34 14.88 . Measurements performed on the rear handle of the Impact wrench showed that the total value of effective vibration acceleration for the rear handle was 45.22  21.99 and the maximum effective acceleration measured was 28 on the Z axis. The mean effective acceleration of hand-arm vibration in the rear handle of the Impact wrench in the X, Y and Z axes was 22.85  12.79 , 25.2  8.78 and 28 15.9 , respectively.The mean effective vibration acceleration obtained after using felt in the tool handle on X, Y and Z axes was 7.1  1.33 , 8.25  1.69  and 7.2 ± 2.1 , respectively. The Vibration total value of effective acceleration of three-way vibration after using felt was 13.27  2.57 . The maximum vibration reduction was related to the Z axis. The mean effective vibration acceleration obtained after using elastomer in the Impact wrench category in X, Y and Z axes was 14.45  6.06 , 17.15   6.68 , 14.45  6.06 , respectively. The mean Vibration total value of effective three- axes vibration acceleration after elastomer use was 29.21  10.76 .The mean vibration acceleration of the 8-hour exposure of the Impact wrench with the exposure time of 1 hour per day is 16.38  7.58 and is higher than the allowable occupational exposure limit (5 ). The mean effective vibration acceleration of the 8-hour exposure after using felt whit Exposure time of 1 hour per day was 4.67  0.887 which is less than the allowable daily exposure limit and more than the action limit (2.5 ). The mean effective vibration acceleration of exposure 8 hours after elastomer use was 10.18  3.78, which is higher than the occupational exposure limit. effective vibration acceleration is equivalent to 8 hours of exposure  Comparison of the means of the three modes of the total value of effective vibration acceleration of Impact wrench vibration, the total value of effective vibration acceleration after felt application and the total value effective vibration acceleration after elastomer application in Impact wrench handle, showed that the reduction of effective hand-arm vibration acceleration by using felt and elastomer in Impact wrench is significant (P <0.05). Also, according to the obtained results, felt is more efficient than elastomer and reduces the effective acceleration of hand-arm vibration to a greater extent, which is also a significant reduction of vibration (P <0.05). Graph of changes in mean effective vibration acceleration Evaluation of the relationship between Impact wrench vibration total value with power (torque), weight and function life variables showed that there is a significant relationship between power (torque), Impact wrench and hand-arm vibration total value (p <0.05) and As the power increases, the vibration rate increases. But there was no significant relationship between the variables of Impact wrench weight and function life with the total value of effective acceleration of hand-arm vibration caused by Impact wrench.

The aim of this study was to evaluate the exposure of heavy machinery puncture workshop workers to hand-arm vibration caused by Impact wrenches and to provide control strategies. According to the results, the amount of hand-arm vibration caused by the Impact wrench is more than the allowable occupational exposure limit of the country and the highest vibration is in the rear handle of the Impact wrench and in the z axis (28). It is effective and increases the amount of hand-arm vibration by increasing it. The use of felt and elastomer in the Impact wrench category significantly reduced hand-arm vibration.The most effective acceleration of the hand-arm vibration was in the rear and front handles of the Impact wrench in the Z axis. The Z direction is along the length of the hand (from the fingertips to the arm) and when working with an Impact wrench is the maximum force and pressure applied to the back, i.e. in the direction of the hand. Therefore, most of the vibration is in the Z direction and in the same direction as the force generated by the Impact wrench.The maximum reduction in hand-arm vibration was by using felt on the Z axis and the maximum reduction was by using elastomer on the Y axis. Felt reduced by 70% and elastomer reduced by 43% the effective acceleration of hand-arm vibration caused by the Impact wrench. Although the results of repeated measures statistical tests showed that both coatings used in the Impact wrench handle significantly reduce hand-arm vibration caused by the Impact wrench, but the use of felt due to higher efficiency and the greatest reduction in hand - arm vibration in the Z axis (the maximum amount of vibration is caused by the Impact wrench in this axis) Can have a greater effect in reducing hand-arm vibration.According to the obtained results, the power or torque of the Impact wrench affects the vibration of the Impact wrench and with increasing torque, the amount of hand-arm vibration also increases. Statistical analysis by linear regression method also showed a significant relationship between Impact wrench strength and effective vibration acceleration (P <0.05), but there was no significant relationship between vibration and two variables of weight and function life. The amount of use of the Impact wrench during its function life is important and with the increase of the operating time of the Impact wrench, its power decreases so that in some cases it does not have the necessary efficiency to open and close the screws and employees are forced to change their Impact wrench. On the other hand, it is possible to increase the vibration rate by increasing the function life of the Impact wrench and the Depreciation of its parts. It seems that these two issues, i.e. increasing the Depreciation of parts and decreasing the power of the Impact wrench, neutralize the effect of each other on the resulting vibration. As a result, increasing the function life of the Impact wrench does not have a significant effect on hand-arm vibration.

In heavy machine puncture workshops, the level of daily occupational exposure of employees with hand-arm vibration caused by Impact wrenches is higher than the allowable occupational exposure of the country. The use of felt in the handle of the Impact wrench reduced by 70% and the elastomer reduced the vibration of the hand-arm by 43%, so the use of elastomer coatings and especially felt in the tool handle can be a good way to control the effective acceleration of hand-arm vibration.

This study aimed to assess the association between the survival of patients and outcomes in Brain Stroke (BS) in the presence of competing risks utilizing a Weibull parametric model.

In this longitudinal study, 332 patients with BS were attended from Imam Khomeini Hospital in Ardabil, Iran. The stroke was diagnosed according to the medical history, current symptoms, and brain imaging during June 2008 and 2018. The survival of the patients, as the primary outcome, was modeled utilizing the best-chosen Weibull model in the presence of competing risks, including stroke and other factors (heart disease, blood pressure, etc.).

Older age at diagnosis (59-68 years: hazard ratio [HR]=2.27; 90% confidence interval [CI]: 1.65 to 3.12; 69-75 years: HR=4.79; 95% CI: 3.56 to 6.44; ≥76 years: HR, 4.92; 95% CI: 3.55 to 6.80), being a male (HR, 1.39; 95% CI: 1.11 to 1.75), being unemployed (HR, 1.44; 95% CI: 1.39 to 1.82), having heart disease (HR, 1.68; 95% CI: 1.38 to 2.06), and hemorrhagic stroke (HR, 2.21; 95% CI: 1.378to 2.75) were directly related to death from BS. Older age at diagnosis (59-68 years: HR, 18.01; 90% CI, 5.33 to 64.92; 75-69 years: HR, 18.56; 95% CI: 6.97 to 86.57; ≥76 years: HR, 28.90; 95% CI: 15.77 to 218.49), and urban residence (HR, 0.46; 90% CI, 0.28 to 0.77) were directly related to death from other causes.

The recognition of the influential factors on the mortality of BS patients can allow increasing their survival.

Febrile seizure is the most common worrisome neurologic disorder in children in terms of parental point of view. The purpose of this study was to answer distressing parents’ questions about the prevalence and possibility of febrile seizure recurrence.

140 patients who were admitted due to the first febrile seizure in the six months (March up to September) of the year 2015 were enrolled to this study. Exclusion criteria include central nervous system infection, non-confirmed febrile seizure and lack of parental acceptance for long-term inclusion in this study. All children were followed in terms of second febrile seizure during one year follow-up from the time of first febrile seizure. (3 sentences were deleted).

Recurrence of febrile seizure was 25.7 % during one-year follow-up. Significant risk factors for recurrence include: age less than one year old, male gender, seizure with low level of fever, family history of epilepsy, family history of febrile seizure, complex febrile seizure (focal and repeated in 24 hours), seizure duration more than 15 minutes and parental indifference to the onset of fever in their children before seizure occurrence. Although duration of fever before seizure, failure to thrive, positive history of admission in neonatal period, dystocia atbirth delivery and children with day care staying were associated with greater febrile seizure recurrence; but, they did not have significant relationship with recurrence rate. Prophylaxis with benzodiazepine reduced the recurrence rate.

Chance of febrile seizure recurrence in one-year follow-up increased in presence of risk factors expressed in finding part. parental indifference to the onset of fever in their children that is starting before seizure was a considerable risk factor in terms of recurrence prevalence. We recommended to emphasis on parental education about this new finding as a risk factor for febrile seizure in order to prevent its future recurrence.

Background :

  The growth and development of infancy are vital to health and the quality of life throughout a person's life. We aimed to investigate the factors affecting the growth of head circumference in a sample of Iranian children under 18 months.  

This is a retrospective cohort study conducted among 274 children aged under 18 months in Zanjan, Iran. Multi-stage cluster sampling was applied to obtain a representative sample of residents. About eight representative healthcare centers, including four urban health centers and four rural health centers, as clusters, were randomly selected. We used multiple linear regression and marginal models of Generalized Equation Estimators to examine the predictors of head circumference cross-sectionally and longitudinaly, respectively.  

Of the subjects, 49.5% (n=136) were females. The mean head circumference of newborns was 34.5±1.57. The marginal model showed that there is a significant association between sex of newborns, gestational age, high risk pregnancy, height and weight of newborns with head circumference over time (p <0.005). In multiple regression models, mothers' job and educational level also showed a significant association with head circumference in addition to sex of newborns (B=0.33, 95% CI:[0.31, 0.53]), gestational age (B=1.47, 95% CI:[0.99, 1.94]), high risk pregnancy (B=0.37; 95% CI:[0.15, 0.57]), height and weight of newborns (p <0.005).  

Conclusion  :

 In our study the mean of head circumference was similar to standard value of 34.9 cm. The sex, gestational age, high risk pregnancy, height and weight of newborns showed a significant association with head circumference, both in cross-sectional (at birth), and longitudinal models (at birth to 18 months); mothers job and educational level showed a significant association with head circumference only at birth.

The challenges of health systems emphasize the need for more motivated employees to perform better and more effectively. Therefore, pervasive attention to job satisfaction of these employees is a matter of course.

The present study aimed at investigating factors affecting job satisfaction in emergency medical services (EMS) staff of Zanjan Province, Iran, in 2019.

The present descriptive-correlational study was performed on 170 EMS personnel working in the Disaster and Emergency Medical Management Center (DEMMC) of Zanjan Province. The stratified random sampling method was utilized to select the subjects. Job description index and GHQ-12 were administered as data collection instruments. Data were analyzed by SPSS version 16 using descriptive statistics, ANOVA, and Pearson correlation coefficient.

In the present study, the work experience of 46.5% and 26% of the subjects was less than five and more than 10 years, respectively. The highest and lowest scores of job satisfaction belonged to coworkers and pay subscales, respectively (24.4±17 vs. 11.5±18.4). The overall job satisfaction score of the subjects was 19.7±18.2 out of 100. Also, a significant relationship was found between the level of education and overall satisfaction.

Considering the low level of job satisfaction in EMS staff, it seems that modifying the reward mechanisms in the prehospital emergency department and using performance improvement levers can enhance the motivation and improve the performance of staff. Besides, strive to promote social relations among coworkers as an effective element may help to enhance job satisfaction and the overall satisfaction of personnel.

There are not many studies on relationship between teamwork in pre-hospital Emergency Medical Services (EMS) and the relationship between teamwork and its consequences is complicated.

Therefore, the goal of this research is studying the degree of teamwork and its relationship with job and demographic factors of the Emergency Medical Technicians (EMTs) in Zanjan Province.

This cross-sectional study focused on the correlation between inclination to teamwork and the demographic features of the EMTs, using a researcher-made demographic and job features instrument and Patterson’s EMT-Teamwork scale. The data were analyzed through the SPSS. 16 software, and p<0.05 level of significance was adopted. The ethical code of IR.ZUMS.REC.1398.243 for this research was obtained from Zanjan University of Medical Sciences.

This cross-sectional study showed mean score of confrontation with teamwork to be 58.44± 17.25 and the highest score belonged to Interpersonal Conflict (IC). Furthermore, the mean score of inclination to teamwork was 63.71± 11.08 and the highest score in this respect belonged to the partner adaptability and leadership. The linear regression analysis also showed that total teamwork score was statistically significant with respect to the number of missions, workplace and the working environment.

The teamwork score of the Emergency Medical Technicians (EMTs) in Zanjan was acceptable and total teamwork score was statistically significant with respect to number of missions, workplace and working environment of the Emergency Medical Technicians (EMTs) in Zanjan Province.

Respect for patientschr('39') privacy is especially important in the emergency department. The present study was conducted to determine the relationship between the moral intelligence of emergency personnel with the level of respect for patient privacy in the emergency departments of hospitals affiliated to Zanjan University of Medical Sciences, Iran.

In this cross-sectional study, 154 patients and 77 emergency department staff participated by convenience sampling method. Demographic, moral intelligence and patient privacy questionnaires were used to collect data. Data were analyses by SPSS software version 16.

The mean age of employees was 34.04±7.6 years (range 24-54 years old), and the mean age of patients was 38.8±13.4 years (range of 18-76 years old). Employeeschr('39') moral intelligence was 76.96±8.42 and was in a good category. Also, the level of respect for patient privacy in the emergency departments was 85.63±13.88 and was in the moderate category. There was a significant and inverse relationship between employees’ moral intelligence with patientschr('39') physical privacy (r=-0.226) (p=0.048).

Considering the moderate level of respect to patient privacy in the emergency departments in the present study, it seems that in addition to the lack of staff information in this regard, the factors affecting it needs to be studied and paid special attention.

Childhood growth factors play an essential role in the process of child development. Providing an accurate measurement for determining the growth rate predictors longitudinally has an advantage over a growth chart that only measures cumulative growth. This study aimed to determine the trends in growth rate and its effective factors among infants using two different methods.

This longitudinal study was conducted on 181 infants referred to healthcare centers of Zanjan, Iran, from April 2017 to April 2019. The growth rate using 9-time points was estimated for participants via Point Average Weighting (PAW) model and the exponential model. The generalized estimating equation (GEE) method was used to estimate predictors of infant’s growth rate. The coincident and parallelism test was used to compare the growth rate between models.

The mean growth rate of children in the PAW model and the exponential model in the first month were 298.2+109.2 and 299.4+115.6 gr/kg per month. The results showed that the two models' growth rate prediction ability is almost identical over time. The trend of growth rate was decreased significantly (AAPC=22.46% per month, P<0.0001) with a change-point in month ninth. The estimated growth rates based on two models coincided (P=0.885), and parallel (P=0.898) across 24 months. The associations between growth rate with variables mother job (B=9.4, P=0.005), breastfeeding (B=-9.3, P=0.005), and multi-fetal pregnancy (B=-18.9, P=0.005) were significant.

There was no difference between the two models when pediatricians apply them in office or other clinical settings. The multi-fetal pregnancy, job of mother, and exclusion breastfeeding were the most important predictor of growth rate, especially at the first nine months of age.

One of the common complications of renal failure in hemodialysis patients which has a negative impact on quality of life is anemia. Various studies showed that cold hemodialysis could improve hemodialysis complications such as pruritus, sleep disorders and fatigue. The aim of this study was determine the effect of cold hemodialysis on hemoglobin and hematocrit level in hemodialysis patients. This research was a double-blind crossover randomized clinical trial study. 42 hemodialysis patients were divided into two groups (22 in the first group and 20 in the second group). The first group received standard hemodialysis temperature (fluid 37°C) in the first four weeks and simultaneously the second group received cold hemodialysis (fluid 35°C), in the second phase, four weeks later, the type of hemodialysis was changed in two groups. During the study, hemoglobin and hematocrit levels of patients were measured several times. The results showed that in the first and second groups respectively, 55 and 32 percent of patients were in the age range of 50 - 65 years. Hemoglobin and hematocrit levels before the study in the two groups was not statistically significant (P: 0.19). But after the first four weeks, the mean of hemoglobin in the cold and standard hemodialysis were 13.85 vs. 11.9 and hematocrit 43.83 vs. 38.02, respectively and after the second four weeks the average hemoglobin in the cold and standards hemodialysis were 13.57 vs. 11.47, respectively and hematocrit 43.29 vs. 37.18. Crossover outcomes of the groups’ analysis showed that cold hemodialysis significantly increased hemoglobin and hematocrit levels in hemodialysis patients (P < 0.001). The mean of hemoglobin and hematocrit was different between two groups and significantly higher in cold hemodialysis.

Premenstrual syndrome includes physical, mood and behavior symptoms that repeatedly occurring in the luteal of the menstrual cycle and can lead to lack of adaptation against the husband, mistreatment against the children, family conflict and social relations reduction. The current study investigated the effect of group counseling of stress management skills and vitamin B6 on symptoms of premenstrual syndrome (PMS). This randomized clinical trial was conducted on 66 students with PMS in 2016 (Iran). PMS subjects divided into the stress management group, the vitamin B6 group and the control group (n = 22 in each group). The stress managements group trained using a life skill package during 4 sessions (2 hours) per week during the two successive menstrual cycles. The vitamin B6 group received 80 mg of vitamin daily for the last 7 days of the two successive successive cycles. The control group did not receive any interventions. The data were collected using the demographic questionnaire and the premenstrual screening symptoms tools questionnaire (PSST). Two months after the intervention, the intensity of PMS symptoms was significantly reduced in both intervention groups than the control group (P<0.05). No significant difference was found between the stress management and vitamin 6 groups. The present study shows that both the stress management counseling and vitamin B6 can reduce the severity of the PMS symptoms. Given that the non-pharmacological method is free of side effects, the stress management method is recommended for controlling the symptoms of the PMS.

Child growth is an important health indicator in human’s lifespan. Evaluating growth variations in infants and children is highly important. This study was conducted to evaluate the risk factors of child growth retardation and determine childhood growth velocity in Zanjan province, Iran. This longitudinal study was conducted on 7892 children aged 0 to 2 years in Zanjan province in 2013. The sampling method was multi-stage cluster sampling. To determine the growth velocity, 2- pointed model was used. We applied the marginal models of generalized equation estimators (GEE). The related curves were obtained using LOWESS method, and data were analyzed using R Version 2.14.1. In this study, 3879 (49%) of the participants were female, and the mean age of mothers was 27.1±5.4 years. Growth velocity had a significant association with gender, mother’s residency, multiple pregnancies, gestational age, and exclusive breastfeeding (p<0.001). A significant association was observed between gender and weight growth velocity (p<0.001). Moreover, exclusive breastfeeding had a significant association with weight growth velocity (p<0.001). Growth velocity in girls was slightly higher than in boys, however, no considerable difference was found between height growth velocity of girls and boys. The findings of this study also indicated that each month increase in exclusive breastfeeding leads to less growth velocity in children. So, exclusive breastfeeding is strongly recommended to prevent childhood obesity

Cyproheptadine hydrochloride is an antihistaminic drug. Appetite stimulation is one of its secondary effects that can be of advantage in some diseases. In this study we investigated the effect of Cyproheptadine hydrochloride on weight gain in underweight children with anorexia at age group 2 to10 years old.
In this randomized clinical trial, we selected 2-10 year-old underweight children with anorexia who referred to Ayatollah Mousavi Hospital in Zanjan (Iran), during 2015. One hundred and thirty-six children were allocated at random in two groups. The Cyproheptadine - treated children group were given the drug orally; 0.1 mg/kg/dose three times per day for 8 weeks, while patients in placebo group received placebo with the same dose. After two months, weight gain was compared with the previous values in both groups.
In this study, 86 patients (63.2%) were female. The average increase in weight in the cyproheptadine - treated group was significantly higher than in the placebo group (1.08 ± 0.67 kg and 0.22 ± 0.46 kg, respectively) (p=0.005). The average increase height in the Cyproheptadine -treated group was significantly higher than in the placebo group (1.60 ± 0.97 cm, and 0.86 ± 0.85 cm, respectively) (p=0.005). According to the parents of both groups, anorexia in the Cyproheptadine -treated group improved in 100%, and in the placebo group in 52.7%. This difference was statistically significant (p=0.005). No any side effects of Cyproheptadine hydrochloride were observed.
According to the finding of our study, there were no serious side effects of Cyproheptadine hydrochloride. Therefore considering the acceptable safety of Cyproheptadine hydrochloride for inducing growth in underweight children, we propose its administration with the aforementioned dose.

Educating medical students on how to manage emergency patients and how to perform in emergency situations is critical. The aim of this study was to evaluate the effect of emergency department training on promoting clinical preparedness and satisfaction of medical interns in the Emergency Department of Ayatollah Mousavi, teaching hospital of Zanjan University of Medical Sciences in 2015. This is a descriptive-comparative study in which 56 medical interns were studied during one month of emergency medicine course at Ayatollah Mousavi as a teaching hospital. In this one-month course, interns attended the theoretical and internship classes in the emergency department. Clinical preparedness and their satisfaction from internship before and after the course were evaluated with the same tools and the results were compared. Content validity of the questionnaires was reviewed by 3 medical emergency specialists and Cronbach’s alpha method was used to determine the reliability of the questionnaire, which was 82%. Data were analyzed by using descriptive statistics and paired t-test through SPSS software version 16. The results showed that the mean and standard deviation of interns' pre-test scores (9.3 ± 1.84) and the mean and standard deviation of post-test scores (13.73±1.94) were significantly different (P< 0.001). In all cases, post-test scores were significantly higher than pre-test scores. 66.9 percent of the interns had from good to excellent satisfaction from the medical emergency course. Theoretical and practical education in the emergency department affected clinical interns' preparedness and the majority of interns were satisfied with the education of this department.

Low birth weight is one of the key indicators to assess the health of infants, and appropriate birth weight is one of the most important goals of any health system which also reflects the quality of prenatal care.
The present research aimed to study some of the factors associated with low birth weight using quantile regression analysis.
A cross-sectional study was carried out on 621 infants born weighing less than 2500 grams in the period 2012-2013. The data were collected from the medical records of infants in health care centers of Zanjan Province which were selected based on multi-stage cluster sampling. The obtained data were statistically analyzed using quantile and multiple regression analysis in SAS-9.2.
In this study, 320 infants (51.5%) were female, and the mean age of mothers and the mean weight of infants were 27.1±5.8 years and 2236±299 grams, respectively. The results showed that low birth weight is significantly related to age, educational attainment, and the number of children. In addition, there was a significant relationship between infant weight and maternal age only in the tenth percentile (P=0.007), while such a relationship was not found in the higher percentiles (50 and 90) (P=0.0, 953.585).
Some of the demographics of mothers such as educational attainment and gestational age were influential in the low birth weight of infants. Maternal age and birth weight were not statistically significant in all areas.

Growth failure in children less than five years old can lead to the serious complications such as increased mortality, learning difficulties or physical disability. The aim of this study was to investigate the non-organic factors affecting the growth trend in less than two years children living in Zanjan, Iran.
This longitudinal study was conducted on a sample of 3566 children less than two years old in Zanjan. Weight and length growth trends were recorded as ordinal variables and analyzed by longitudinal marginal model.
About 12% (n=289) and 8% (n=212) of children had at least one decline/stagnation in the weight and length growth curve, respectively. Based on the marginal model, the effect of the child’s age and residence area on the weight and length growth trends were statistically significant (p Given the relatively high prevalence of growth failure among studied children less than two years old in rural areas of Zanjan, raising the awareness of parents in rural areas about feeding and nutritional behaviors of children seems an important issue. Additionally, healthcare providers should mostly focus on monitoring the growth of children older than 12 months.

Aspiration is a serious complication that occurs due to delayed gastric emptying in mechanically ventilated patients. Aspiration results in increased rate of pneumonia and death. Acupressure can increase gastric motility and prevent aspiration. This study aimed to determine the effect of acupressure on occurrence of gastric content aspiration in mechanically ventilated patients hospitalized in intensive care units. In this quasi-experimental study، 78 patients hospitalized in the intensive care units of educational hospitals of Zanjan were recruited using convenience sampling method during 2012-2013. Patients were randomly allocated into two intervention and control groups. In the intervention group، acupressure wristbands were placed on the Neiguan point of both hands of the patients for four days. Aspiration was measured and compared using glucose and PH strips on the second and fourth days in both groups. Data were analyzed using the independent T-test، Mann-Whitney، Chi-squared test، Mantel-Haenszel and logistic regression in the SPSS-16. The aspiration، totally and in the fourth day، was lower in the intervention group in compare with the control group; however the difference between the two groups was not statistically significant. Acupressure is an easy-to-use and harmless method to relatively decrease aspiration among the patients. It can be considered as a complementary treatment in decreasing aspiration among patients hospitalized in the intensive care units.

The major problem with mechanically ventilated patients receiving enteral nutrition hospitalized in the intensive care units is delayed gastric emptying. Acupressure can increase gastric motility. This study aimed to determine the effect of acupressure on the amount of gastric emptying in mechanically ventilated patients hospitalized in the intensive care units. Methods & Materials: In this clinical trial، 78 mechanically ventilated patients were recruited using convenience sampling method; and were randomly divided into two control and experimental groups. Acupressure was applied on the Neiguan point for four days in the experimental group. The control group patients received no intervention. Gastric residual volume was measured in the admission time and before the gavages. The mean gastric residual volume of the admission time and the 1-4 days after the admission were compared in the two groups. Data were analyzed using the independent t-test، Chi-squared test، covariance analysis and repeated measured tests in the SPSS-16. The results revealed that there were no differences between the two groups in the admission time and the first day (P>0. 05). There were statistically significant differences between the two groups in the admission time and 2-4 days after the admission (P<0. 05). The difference of mean scores of gastric residual volume were significantly different between the two groups during the four days of post intervention constantly (Repeated measured ANOVA; P=0. 011). The acupressure increased the gastric emptying in mechanically ventilated patients hospitalized in the intensive care units. Since the acupressure wristband was an easy to use، non-expensive، available procedure، it can be used to improve gastric emptying and prevent delayed gastric emptying complications.

Evaluation is one of the important aspects of educational activities that can be performed in different forms and by which the weaknesses and strengths of educational programs can be found identified. Here, the role of continuous evaluation in academic achievement of BS students of Zanjan University of Medical Sciences (ZUMS) was studied. This is a descriptive-analytical study that was performed in cross-sectionally during a four-semester period with four classes. Students in each class were randomly divided into two groups. One group was tested continuously during the semester but no tests were given to the group. At the end of the course, the scores of the two groups of students in each class as well as all the students regardless of the type class were compared under the same conditions. Results demonstrated that in all four classes, mean scores in the students who were asked tested during the semester was significantly higher than the students who were not tested. This result was also true for all students, regardless of their field of study. From total of fifty four students who were questioned, only four students had a lower score toward other fifty four students. The findings of this study reveal that formative evaluation as classroom questioning has powerful impacts on academic achievement. Thus, achieving the educational objectives needs accurate planning and careful implementation.