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  Background and objective : Low blood pressure and Muscle cramps are common complications of Hemodialysis. One approach that has recently been proposed to prevent this complication is the combination of sodium and ultrafiltration. The purpose of this study was to investigate the effect of of sodium and ultrafiltration profile on some of the common complications during Hemodialysis.

  Material and Methods: In this crossover clinical trial study, 22 Hemodialysis patients referred to Panje-­Azar Hospital in 2012 were divided randomly into two groups. For each group, two treatment protocols were conducted, six hemodialysis sessions. The intervention protocol was a linear sodium dialysate and linear ultrafiltration. In routine Protocol, both sodium dialysate and ultrafiltration were considered constant. Using chi-square test and relative risk, the data was analyzed (P<0.05).

  Results: The mean age is 54.73 ± 11.21 year and 59.1% of them are females. The incidence of hypotension and muscle cramps in the experimental protocol procedure is significantly decreased compared with that of control group (P<0.05), but the incidence of headache and vomiting is not significant (P<0.05).

  Conclusion: Because sodium and ultrafiltration profile is simple and cost-free and reduces the incidence of complications during dialysis, we recommend using sodium and UF profile instead of routine one.

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  Background and Objective: Cardiac angiography, which is widely used in Iran, is a diagnostic and therapeutic procedure for cardiac diseases. The patients suffer from back pain due to complete bed rest after angiography. Thus, this study aimed at determining the correlated factors with the severity of back pain after cardiac angiography in Dr. Ganjavian Hospital of Dezful­, 2011.

  Material and Methods: In this correlational study, 140 candidates of cardiac angiography were selected via convenience sampling. We used a checklist to collect the data about age, sex, body mass index(BMI), smoking, high blood pressure, diabetes and duration of angiography, which are the influential factors of the severity of back pain. Then, the severity of back pain was measured at first, second, fourth and sixth hour after angiography, using a numerical scale of pain assessment.­­To analyze the data, we used descriptive statistic, Mann Whitney and Spearman correlation.

  Results: ­The subjects are males (N=67), females (N=64) and smokers (­12%). The mean age is 55.7±7.7, and body mass index is 27.6±3.07. None of them has history of back pain and previous angiography. Based on Spearman, there is no significance correlation between back pain of 1, 2, 4, and 6 hours after angiography and factors such as age, BMI and duration of angiography. Man Whitney test indicates a statistical significance between gender and severity of pain in the first hour (Z=-2.17) and sixth hour (Z=-2.4) after angiography, whereas there is no statistical significance in the second, fourth and fifth hour after angiography.­ As well, there is no significant correlation between back pain and variables such as smoking, diabetes and hypertension.

  Conclusion: The findings showthat the nurses by being aware of related factors to back pain severity can try to reduce the pain and promote the patients’ convenience.

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  Background and Objective: Treatment adherence has an essential role in improving quality of life, survival, decreasing cost and side effects of treatment in patients underwent hemodialysis. This study aimed to determine the effect of individual multi-stage care on the treatment adherence in hemodialysis' patients, ShahrekordHajar hospital.

  

  Material and Methods: This clinical trial was conducted on 66 Hemodialysis patients in 2013. They were randomly allocated into two equal groups of intervention and control. The instrument was the end-stage renal disease adherence questionnaire (ESRD-AQ). The patients in intervention group were participated in 8-session individual care program for one hour in addition to routine treatment. The data was analyzed using Mann–Whitney , Wilcoxon and Spearman (P<0.05). Level.

  

  Results: The study indicated a significant difference between two groups in all dimensions of treatment adherence except dietary and food adherence. Adherence to treatment was better in intervention group (P<0.05). Furthermore, there was a significant correlation between adherence treatment and age of patients (P<0.05, r=0.245).

  

  Conclusion: based on the findings, multi-stage care is effective on different aspects of treatment adherence.

 

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  Background and Objective: Injection of subcutaneous low molecular weight heparin often causes some local reactions such as ­bruising, hematoma­, and pain, directly related to inappropriate injection method­. This study aimed at determining the effect of injection duration of­ Subcutaneous Enoxaparin Sodium on the size of bruising and the severity of injection pain.

  Material and Methods: This experimental study was conducted on 36 patients medicated by subcutaneous Enoxaparin Sodium (60mg). ­­They were randomly divided into two groups.­ The first group received routine method of subcutaneous anoxaparine injection (10 second duration injection technique) and in the second group in addition to routine method, ­“10 second waits” before removing needle was performed. Data collection was carried out by using a researcher-made check-list consisting of a section for demographic data and a section to record the extent o f bruising and pain intensity.­ The Extent of bruising was measured by using a clear flexible ruler within 24, ­ 48 and 72 hours and pain intensity by visual analog scale (VAS) ,immediately after injection­.­­We analyzed the Data by independent T test and Chi square.

  Results: ­ The ­Results indicate ­­that­ the mean ­of pain intensity in second group (­3.05 ± 1.71­)­ is less than first group (­3.86 ± 2.75­)­.­There is no significant difference between two groups for the extent of bruising in 24, ­ 48 and 72 hours (P>0.05).

  Conclusion: with regard to ­pain intensity and the size­ of the bruising, the two groups are not significantly different.

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Background and Objective: Because of high growth of elderly population and the role of life style in their problems, we aimed to investigate the elders’life style in Kashmar. 

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Background and Objective: Fatigue is one of the most common side effect in hemodialysis patients. This study aimed to assess the factors associated with fatigue in hemodialysis patients, such as demographic variables, anxiety, depression and quality of sleep. 

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Background and Objective: Cool temperature dialysate has been recommended to improve hypotension during dialysis. Thus, we aimed to evaluate the effect of lowering the dialysate temperature on intradialytic hypotension (IDH) and some interventions in patients undergoing hemodialysis (HD). Material and Methods: This randomized controlled trial with a cross over design was conducted on 50 patients divided into two equal groups. Each group was dialyzed for two periods of 12 HD sessions, once with standard temperature (37°C) and in the next period with cool dialysate (35.5°C). Blood pressure and the related interventions were noted during each dialysis. The Data was analyzed using Chi-square, McNemar, Independent and Paired T Tests. 

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Background and Objective: The usual method of assessing depth of anesthesia, which is not sensitive and specific enough, is measuring hemodynamic parameters, autonomic changes and subjective symptoms including movement, sweating and lacrimation. This study aimed to determine the relationship between the depth of anesthesia and hemodynamic indices.

Material and Methods: This correlational study was conducted on 57 patients undergoing elective hernia surgery in Shahid Beheshti Hospital ,Sabzevar in summer 2014.  An identical anesthesia technique was used for all patients.  Depth of anesthesia was monitored quantitatively by bispectral index (BIS) at 5-minute intervals, with simultaneous recording of heart rate and blood pressure. We analyzed the data using Anova and correlation coefficient.

Results: The mean age was 45.54±13.46. The patients were males (n=36) and females (n= 21).   Only 59.6 % of the patients experienced a normal depth of anesthesia. Hemodynamic parameters were not significantly correlated with anesthetic depth except for heart rate in the first 5 minutes (P= 0.013).

Conclusion: Given that hemodynamic parameters have some limitations in determining the acceptable depth of anesthesia, we recommend using the monitors based on brain signal processing.

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Background and Objective: Mental health is one of essential needs that has a critical role in sustainable development.  Burnout , a physical and mental fatigue and a sense of reduced capabilities, is a leading factor in lowering mental health efficiency .this study aimed at determining the relationship between burnout and mental health in  Al –E-Jalil hospital`s staff.

Material and Methods: This descriptive - analytical research was conducted on 179 Al–E-Jalil hospital`s staff recruited via Census method in 2014. The data was collected by mental health questionnaire (G.H.Q-28) and Burnout (Maslach) questionnaires, and analyzed by kruskal Wallis, Mann-Whitney and Spearman correlation.

Results: Significant relationship between mental health and burnout (P=0.0001, r=-0.844) showed that mental health enhancement  reduced the level of  burn out. The mean mental health (19.28± 10.77)  was excellent . Two domains of “somatization" and "depression and suicidal tendencies" were better than "social dysfunction" and "anxiety and sleep disorders". The highest mean was related to  "Depersonalization" and "emotional exhaustion"  and the lowest one to " personal accomplishment".

Conclusion: The findings show that there is  a negative significant relationship between mental health and burnout that means by enhancing mental health the staff experiences lower level of  burn out.

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Background and Objective: Patients under hemodialysis are faced with many stressors and psychological problems such as sleep disorder and anxiety. These problems could be a threat to their health and be significant clinically.  Thus, we aimed to determine the relationship between anxiety and sleep quality in hemodialysis patients.

Material and Methods: This descriptive-analytic study was conducted on 74 hemodialysis patients in Hefdahe Shahrivar hospital of Borazjan city, 2014. The data was collected by Pittsburgh Sleep Quality Index (PSQI) and State-Trait Anxiety Inventory (STAI), and analyzed by t-test, ANOVA and correlation Coefficient using SPSS.

Results: Most of the patients (89.2%) had the average anxiety and 63.3% of them had low sleeping quality. The average of patients’ anxiety and sleeping quality were 49±6.5 and 11.7±2/4, respectively. The correlation coefficient between anxiety and sleeping quality was 0.515 (p=0.001), pointing out an acceptable correlation. Along with the increase of anxiety, the dimension of the subjective sleep quality, delay in falling asleep, the sleep disturbances were affected and ended up low sleeping quality. There was no significant correlation between the anxiety and sleeping quality and daily dysfunction.

Conclusion: Given the acceptable correlation between anxiety and sleep quality, there is a direct relation between anxiety and sleep quality of the patients.

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Background and Objective: Nowadays, smoking is a widespread health problem in the world. Hookah smoking is common in many countries, especially in the Middle East and Africa. This study aimed to investigate the causes of hookah smoking in adolescents in Kurdkoy, 2013.

Material and Methods: This cross-sectional study was conducted on 266 teenagers selected via multi stage sampling. The questionnaires were distributed among  the  people who were present at the Coffeehouses and the results were reported by descriptive statistics.

Results: The results showed that 51.5% of the participants said they use Hookah every day. The reasons were pastime (56.4), unemployment (41.7), Pleasant feeling (33.8), being with friends (33.5), fatigue reduction (33.5) and the availability of hookah (32.3).

Conclusion: To minimize the tendency to Hookah smoking, we recommend planning some activities for leisure time, "learning to say no" and training how to reduce anxiety and fatigue.

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Background: Breast milk is the most suitable nutrition for the neonates. Breast milk and breastfeeding duration can contribute to decreased mortality rate, intestinal bleeding, and various neonatal diseases (e.g., digestive and respiratory diseases). It can also reduce the risk of diabetes and obesity in childhood and adulthood. Therefore, the estimation of breastfeeding duration and recognition of the effective factors in this regard can lead to designing and implementing appropriate programs, which can provide the foundations for the modification of breastfeeding behavior.
Methods: This survival study was conducted on 501 mothers with healthy and single birth neonates born within March 21, 2011-September 21, 2012 with active medical records in Aqqala city, Golestan province, Iran, in the second half of 2014. The data were collected from the information registered at the archives of health centers by in-person visiting. In addition, some of the information was collected through phone contacts. The duration of breastfeeding was estimated in month. Data analysis was carried out using the Cox regression in the STATA software, version 11.
 Results: According to the results, the mean and median of breastfeeding were 20.44 and 22 months, respectively. According to the Cox regression, maternal ethnicity, living with family, birth spacing, type of milk consumed along with complementary nutrition, and type of neonatal nutrition during the hospital stay of the infant had a significant relationship with the early cessation of breastfeeding.
Conclusion: Based on the findings of the present study and the identified factors affecting the breastfeeding duration, it seems necessary to provide the essential trainings for the young mothers and pregnant women to avoid of reducing the duration   of breastfeeding. These educations can be included in the programs of the Health centers of the universities and urban and rural medical clinics.
 

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Introduction: Sexual satisfaction is an important indicator of sexual health and is strongly associated with satisfaction of interpersonal relationships. Self-awareness refers to pay attention to the thoughts, feelings, and it is the introduction of interpersonal relationships. Due to this relationship,a study was conducted to determine the impact of individual counseling based on self-awareness skills on sexual satisfaction in women of reproductive age of Gorgan, Iran.
Methods: An interventional study was conducted as a field trial on 76 women of reproductive age referred to Gorgan health centers in the fall of 1395. The samples were availablility selected and randomly divided into intervention and control groups. In the first step, the Hudson Sexual Satisfaction Persian Questionnaire were completed by all women. Then,the women in the intervention group were consulted with six sessions of individual counseling based on self-awareness skills intervention. One month after counseling, both post-tests were performed in both groups.  Variables with T-student and Mann - Whitney using SPSS 16 software were analyzed.
Results: There was no statistically significant difference between mean score of sexual satisfaction before intervention between two controls (103.21 ± 10.15) and intervention groups (102.36 ± 10.00). But, there was a statistically significant difference between mean score of sexual satisfaction after intervention; 103.39 ± 10.04 for the control group and 112.1 ± 7.97 for the intervention group (P-Value<0.0001).
Conclusion: The results show that to increase sexual satisfaction promoting the awareness about sexual issues is not the only solution, but also promoting the self-awareness skills via recognizing their positive and negative characteristics is necessary. Hence, healthcare providers can use individual counseling based on self-awareness skills to increase sexual satisfaction.

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Background: Adolescence is a very troublesome period involving many physical, sexual and psychological changes. Therefore, researchers naintain that adolescents need to make a good relationship with their parents and particually their mothers to adapt to the changes at this age and be compatible with them. Hence, this study aimed to determine the mothers and their teenage daughters'perspectives on the relationship between them.
 
Methods: This cross-sectional study was conducted on 168 mothers and 13-15 year-old daughters who were provided with health services by health centers in Gorgan.  The samples were selected randomly and had the inclusion criteria. Data were collected through a valid and reliable questionnaire of "general discussion between mother and daughter" . Data were also analyzed using Chi-square and independent t-test at a significant level of 0.05 by  SPSS 16.
 
Results: The mean score of general conversation between mother and daughter was 55.95 (74-38) from the mothers’ perspective, and 52.30 (76-25) from the daughters' viewpoint. The difference between the two perspectives was significant (p-value<0.001). In addition, no significant difference was observed between the mothers and daughters’ perspectives on the number of communications with daughters, the feeling of closness to parents, and the responsibility to educate them.
 
Conclusion:The difference in the scores assigned to the general discussion between mother and daughter of their perspectives indicates the need for interventions aiming at increasing their communication skills to maintain and improve the girls’ health.

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Background and objectives: During the postpartum period, mothers may experience physical and emotional changes. Postpartum Depression (PPD) may affect 10-15% of all women after delivery. In some studies, the type of delivery has been considered as a risk factor for postpartum depression. The present study was designed to investigate and compare the frequency of postpartum depression in women with normal and cesarean delivery.
Methods: This descriptive-analytic study was conducted on 300 women referring to the Sayad Shirazi Hospital. First the Women who had Beck depression inventory score>12 were excluded and then the participants were divided into two equal groups of normal (150) and cesarean (150) delivery. Two weeks after delivery, Beck depression inventory was filled out and data analysis was performed by SPSS software V.16 using, chi-square and Mann-Whitney test.
Results: Results showed that 13% of all participants 12.7% of the cases in normal and 13.3% in cesarean groups had postpartum depression. The severity of depression was higher in women with cesarean delivery compared to normal delivery and this difference was significant (mean rank 172.29 vs. 128.71, p<0.0001). There was no significant difference in the level of depression between two groups according to their age, job, parity, baby’s sex, marital satisfaction and wanted/unwanted pregnancy.
Conclusion: The prevalence of postpartum depression was higher in women with caesarian delivery compared to women with normal delivery

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Background and objectives: Fear and anxiety during pregnancy will have a great impact on the mental health of the mother and the fetus, These conditions may be due to fear of childbirth, which can exacerbate sense of pain, severity of pain, anxiety, distress, discomfort and disability. Therefore, we decided to evaluate the factors affecting on fear of child birth.
Methods: This descriptive-analytic study was performed on 211 eligible mothers in health centers of Gorgan, Iran, in the second six months of 1396, by simple sampling. The Data was collected by Wijma Maternity Fear Questionnaire (A) and analyzed by SPSS software version 18, using Fisher and Kruskal Wallis tests at a significance level of 0.05.
Results: The range of maternal fear of childbirth scores was from 14 to 120 with a mean of 61.75 and a standard deviation of 22.99. About 77.2% of mothers had a mild or moderate, 18.5% had clinical and 4.3% had severe fear of childbirth. In this study, the pregnant woman’s and her husband’s job, as well as husband's level of education, were identified as the most important influencing factor on the fear of childbirth.
Conclusion: According to this study, 18.5% of the Nulliparous mothers had clinical and 4.3% had sever fear of Childbirth; therefore, in order to promote the pregnant mother’s mental health, new strategies should be adopted to reduce this fear. In addition, knowing the factors affecting this fear will help us to plan and implement strategies to deal with the fear of childbirth more accurately.

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Background: Health concerns are common issues during adolescence due to the wide range of changes and challenges in this period. As a major population of many countries, including Iran, adolescents need some opportunities to express their thoughts and concerns. Identifying the worrisome subjects among this population group can help us in providing appropriate health education and consultations. Considering that in the majority of studies, adolescent girls express higher concerns compared to boys and since they are more mentally vulnerable than boys, the study aimed to determine health concerns of adolescent’s high school girls from their personal perspectives in Gorgan."
Methods: This study was a quantitative content analysis based on responses of high school female students in private and public schools in Gorgan. The sample size of this study) at least 500 people (was based on the population ratio of high school girls in the public and private schools. As a result, three public and two private schools were randomly chosen. From each grade in the schools, one class was randomly selected. Assenting to take part in the study, adolescents high school girls were asked to fill an anonymous sheet containing demographic information with an open question at the bottom of the sheet in the form of: “Dear adolescent please write down all the concerns you have in your daily lives in the assigned space below”; Finally, 548 sheets were collected and analyzed.
Results: The findings showed that 3 categories including “Self” (%93.8) with 11 subcategories including “education”, “Occupation”, ”Future life”, “Health”, “Marriage”, ”Nutrition”, “Religions”, “Exercise and Recreational activities”, “Appearance“, “Puberty“, and “Risky behavior, “Significant Others“(%44.8) with 3 subcategories including “Family”, “Peers”, and “School staff”, and finally “Peripheral system”(%21.2) with 4 subcategories including “Society“, “School”, “Environment”, and “Cyberspace” as the main adolescents were found as health concern sources.
Conclusions: Based on the findings of the present study, it can be stated that Iranian adolescents experience an atmosphere full of educational, career, family, social, and the future concerns. Thus, modifying the educational system and job creation should be seriously considered by the policy makers to reduce adolescents' health concerns. In this regard, periodical evaluation of health concerns in high schools are recommended. In fact, our findings can give adolescents a stronger voice to increase policy maker’s awareness regarding the adolescents` concerns.

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Background: General self-concept refers to the set of emotions and perceptions of one's self, while sexual self-concept refers to the perception of each individual as a sexual being. General and sexual self-concepts are affected by various life problems including infertility. Infertility can affect people's self-concept by affecting their personal and sexual life. Lack of negative mood management can also affect people's self-concept by creating psychological problems such as anxiety and depression. Mood regulation skill as a protective factor for people experiencing psychological problems in their relationships, will modify emotional responses which in turn leads to improve their physical and psychological health through positive and adapted behaviors. The purpose of this study is to determine the effect of mood regulation education on general and sexual self-concept in infertile women.
Methods: This clinical trial study conducted in 1397, 34 infertile women referred to the only infertility center in Gorgan who were included in the study and were selected by available sampling method, (n=17) in the intervention group and (n=17) in the control group. Education program of mood regulation was performed in four, 90- minute-long sessions of a one-time workshop for individuals in the intervention group. Inclusion criteria were: Iranian nationality, high school education, not having any stepchild, primary infertility, absence of known physical and psychological illnesses (according to their own declaration), not taking psychiatric medication, non-drug addiction of both the woman and the spouse and not having any life skills training. Exclusion criteria were: not attending in educational sessions more than once and unwillingness to continue this study. Both groups completed Rogers' Persian self-concept questionnaire and Snell's self-concept questionnaire before, immediately and one month after the intervention. Data analysis was performed using SPSS software (version 16), repeated measures analysis of variance, and adjusted Bonferroni test (P <0.05).
Results: In this study, the mean age of the samples in the intervention group was 33.18 ± 6.07 and 30.41 ± 4.54 in the control group. Results showed that before intervention, general self-concept in intervention group was 9.41, positive sexual self-concept 123.76, negative 12.17, and situational was 43.17. One month after intervention, general self-concept was 6.21, positive sexual self-concept 139.29, negative 5.70 and situational was 54.23. The results of repeated analysis of variance showed that mood regulation education had a positive effect on promotion of general self-concept and sexual self-concept of infertile women one month after intervention, therefore this effect was statistically significant.
 Conclusions: Mood regulation education improves the general and sexual self-concept of infertile women and can be used in health care, infertility and midwifery centers.