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Abstract Background Pulmonary tuberculosis (TB) is a contagious bacterial infection caused by Mycobacterium tuberculosis that primarily affects the lungs. Despite advances in treatment, TB remains a major public health challenge, particularly in developing countries. This retrospective cohort study aimed to identify factors that influence the time to relapse in patients with pulmonary tuberculosis. Methods All smear-positive pulmonary tuberculosis patients (1548 patients) whose data were recorded in the tuberculosis registration system of Golestan University of Medical Sciences and Health Services from March 2014 to March 2019, and followed up until February 2021. To analyze the data, we applied LASSO, MCP, and SCAD penalized Cox models. Results Based on the AIC and BIC criteria, the MCP penalized model was better than the LASSO and SCAD penalized models. The variables of age at diagnosis (> 35 vs. $$\le$$ ≤ 35, HR = 2.77), marital status (married vs. single, HR = 8.49), chronic renal failure (Yes vs. No, HR = 5.36), and pre-treatment smear test results (+ 1 vs. 1-9Basil, HR = 0.65 and + 2 vs. 1-9Basil, HR = 0.96) influenced time to relapse according to the MCP penalized Cox regression model. Conclusions Health care systems should focus on identification of factors that influence time to relapse and developing interventions to reduce relapse rates.

Abstract Background Predicting mortality and relapse in children with acute lymphoblastic leukemia (ALL) is crucial for effective treatment and follow-up management. ALL is a common and deadly childhood cancer that often relapses after remission. In this study, we aimed to apply and evaluate machine learning-based models for predicting mortality and relapse in pediatric ALL patients. Methods This retrospective cohort study was conducted on 161 children aged less than 16 years with ALL. Survival status (dead/alive) and patient experience of relapse (yes/no) were considered as the outcome variables. Ten machine learning (ML) algorithms were used to predict mortality and relapse. The performance of the algorithms was evaluated by cross-validation and reported as mean sensitivity, specificity, accuracy and area under the curve (AUC). Finally, prognostic factors were identified based on the best algorithms. Results The mean accuracy of the ML algorithms for prediction of patient mortality ranged from 64 to 74% and for prediction of relapse, it varied from 64 to 84% on test data sets. The mean AUC of the ML algorithms for mortality and relapse was above 64%. The most important prognostic factors for predicting both mortality and relapse were identified as age at diagnosis, hemoglobin and platelets. In addition, significant prognostic factors for predicting mortality included clinical side effects such as splenomegaly, hepatomegaly and lymphadenopathy. Conclusions Our results showed that artificial neural networks and bagging algorithms outperformed other algorithms in predicting mortality, while boosting and random forest algorithms excelled in predicting relapse in ALL patients across all criteria. These results offer significant clinical insights into the prognostic factors for children with ALL, which can inform treatment decisions and improve patient outcomes.

Abstract Background Pregnant women experience several changes in their appearance, body shape and body image. In some studies, there has been a relationship between these changes and the type of delivery. This study aimed to investigate the relationship of the prenatal body image and genital image with the mode of delivery preferred by pregnant women in Gorgan in 2020. Methods In this cross-sectional study, 334 pregnant women were selected by stratified sampling. The Prenatal Body Image Questionnaire (PBIQ), Female Genital Self-Image Scale (FGSIS), pregnant women’s preferences for mode of delivery questionnaire (PPMDQ) and DASS-21 were completed on line. The data was analyzed using Spearman test and linear regression. Results The average score of PBIQ, FGSIS, and PPMDQ was 68.24 (standard deviation = 17.71), 19.25 (standard deviation = 3.3), and 63.12 (standard deviation = 3.3) respectively. Vaginal delivery as a preferred mode of delivery was inversely correlated with dissatisfaction with body image (r=-0.32, P

Introduction: According to the population youth regulation, the number of adolescent pregnancies increased in Iran. Considering the importance of knowing the consequences of pregnancy at this age for planning and caring for these people, the present study was conducted with aim to compare the outcomes of pregnancy and childbirth in adolescents and young women. Methods: This desctiptive analytical study was performed in 2021 on 865 hospitalized women in postpartum care unit of two government and semi-government hospitals of Gorgan. Pregnancy outcomes were compared in two groups of adolescent (105 women aged 13-19 years) and young women (760 women aged 20-34 years). The data related to the background information was collected through the data collection form and the outcomes of pregnancy and childbirth by a researcher-made checklist through face-to-face interview, review of hospital records and accompanying documents. Data were analyzed using SPSS statistical software (version 16) and Chi-square, Fisher exact test and logistic regression. P

Background and Objective: Middle age is associated with various biopsychosocial changes. Sexual health is one of the most important aspects of health, which is less addressed in middle age. The study aimed to determine the relationship between sexual self-concept and sexual health in middle-aged women in Gorgan, Iran. Methods: This descriptive-analytical study was carried out on 428 eligible married women (mean age: 46.38±5.46 years) who had electronic records in one of the comprehensive health centers of Gorgan, Iran. Data collection was done in 2019 using a demographic checklist, the Persian version of Snell’s multidimensional sexual self-concept questionnaire, and the sexual health of middle-aged women scale. Results: The mean score of sexual self-concept was 115.10±26.88 in the positive domain, 18.09±11.22 in the negative domain, and 39.92±11.88 in the situational domain. The mean score of sexual health was 129.18±18.71. There was a significant positive correlation between sexual health and the positive (r=0.67, P

Introduction: Regarding to the pandemic of coronavirus and the existence of limited studies on the outcome of this disease in pregnant women, the present study was performed aimed to determine the clinical signs and outcomes of pregnant women with coronavirus. Methods: This descriptive study was performed on 100 pregnant women living in Golestan province who were infected with Covid-19 virus and were admitted to one of the hospitals in the Golestan province in 2020. All pregnant women who were hospitalized due to Covid-19 were followed up for two months after delivery. A researcher-made data collection form was used to evaluate the clinical signs and consequences of coronavirus. Data were analyzed by SPSS software (version 18). Results: The most common clinical sign in pregnant women was fever on the first day, and most women became asymptomatic from 4th day. Among the maternal consequences, 2 cases (2%) of maternal death was observed in the infected mothers. Preterm delivery (16%) and then oligohydramnios (8%) were more common. Most of the pregnant women did not have fetal complications. Among neonatal outcomes, neonatal hospitalization in the intensive care unit (30%) was the most common, and then neonatal jaundice (24%) and preterm infants (11%) were the most common reported cases. Also, 67% of women with Covid-19 had cesarean section delivery and the birth weight of 77% of infants was in the normal range. Conclusion: Covid-19 infection in pregnant women significantly increased adverse maternal and neonatal outcomes; therefore, better planning should be done to prevent this disease in pregnant women so that less pregnant women are affected.

Background: One of the most important causes of marital dissatisfaction is the lack of life skills. This study aimed to compare the effects of training self-awareness and problem-solving skills on marital satisfaction of married women.Methods: This study was a randomized field trial conducted in Gorgan since October 2019 to September 2020. A total of 105 married women were allocated to one of two interventions or a control group based on triplex block randomization. Data collection tools were the Persian version of the self-awareness questionnaire, problem-solving questionnaire and Four ENRICH Couple Scales. The participants completed the questionnaires before (T1), immediately (T2), and one month after the intervention completion (T3). The first intervention group received self-awareness skills training and the second received problem-solving skills training one session per week for four weeks. The control group did not receive any training. Data were analyzed using One-way ANOVA, Kruskal-Wallis, Chi-square, Fishers exact test, exact test, repeated measure ANOVA, and Bonferroni test, using SPSS 16. A P value 0.05). However, in the problem-solving group, the scale of marital satisfaction was significantly different at T2 and T3 (31.40±4.55, 33±5.21, P=0.008). In the self-awareness training group at T1 and T3, the mean of the conflict resolution scale (32.60±63.28, 33.94±5.74, P=0.03) was significantly different.Conclusion: The results showed that problem-solving skills training was more effective in increasing the score of marital satisfaction compared to self-awareness skills training.Trial Registration Number: IRCT20190721044290N1.

Background: Loneliness is a serious issue among the elderly that considerably affects their health. Spiritual health might affect the level of loneliness in these individuals. Therefore, the present study was conducted to determine the relationship between spiritual health and loneliness. Methods: This cross-sectional study was performed on 330 older adults who live in the western areas of the Golestan Province, Iran in 2019. The subjects were selected using stratified random sampling method with proportional to size. Data were collected by the short form of the Social and Emotional Loneliness Scale for Adults (SELSA-S) and the Spiritual Health Questionnaire (SHQ). Data analysis was performed in SPSS software (version 18) using Mann-Whitney U test and Spearman's rank correlation coefficient. Statistical significance level was set to 0.05. Results: The mean of spiritual health and loneliness were 96.57±4.10 and 21.25±9.05, respectively. There was no significant correlation between spiritual health and loneliness (P=0.72), but there was a significant difference between urban and rural residents in this regard (P=0.037 and P=0.003). In addition, there was a significant relationship between spiritual health and loneliness in general (r=-0.139 and P=0.02). There was an inverse correlation between spiritual health and loneliness among urban residents (r=-0.27 and P=0.001) but not among rural residents (r=-0.06 and P=0.41). Conclusion: Based on the findings, there is an inverse correlation between spiritual health and loneliness among the elderly. This could be a useful finding for planners and activists in the field of geriatric mental health in development of educational counseling and support programs.

Aims: Investigators have identified sufficient self-care as an important factor in reducing health-care costs and improving health outcomes in cardiac patients. Therefore, the purpose of the present study was to determine the relationship between perceived social support (PSS) and self-care behaviors (SCBs) in patients with ischemic heart disease. Materials and Methods: The present work was a cross-sectional study. Patients with ischemic heart disease were selected using the convenience sampling method. Data gathering tools used in this study were questionnaires of Zimet multidimensional social support and Miller self-care. The data were analyzed in SPSS 18 software using Spearman's correlation and Mann–Whitney tests by significant coefficient

Background and objectives: Leishmaniasis is a tropical disease caused by protozoan parasites from the genus Leishmania. In this study, we aimed at investigating the in vitro anti-leishmanial effect of essential oils of Rosmarinus officinalis, Mentha pulegium, Foeniculum vulgare, Lippia citriodora and Pelargonium graveolens. Methods: The essential oils were prepared from freshly dried and powdered plants with steam-distilled water. Iranian strain of Leishmania promastigotes was cultured in RPMI medium and the inhibitory effects of different concentrations (25, 32, 62.5, 125, 250, 500 and 1000 μg/ml) of the essential oils were investigated at 24, 48 and 72 hours. The number of live parasites before and after treatment with the essential oils was counted by trypan blue 10% staining and using neobar lam. Results: The essential oils significantly decreased the number of promastigotes in a dose-dependent manner (P

Introduction: Exposure of grain products in polluted soil lead to adverse effects on human health. In this study, concentrations of HM (As-Cr-Hg) were analyzed in wheat grain cultured in Gonbad-e-Kavus City, Golestan province, Iran. Furthermore, its potential health risk was evaluated among residents. Materials and Methods: The sampling sites were located in arable lands. After separating the wheat grains and cleaning them, the seeds were collected in plastic bags for analysis by ICP/MS method. Digestion of samples was performed with Multi wave PRO microwave apparatus. Results: The mean concentrations of Arsenic (As), Chromium (Cr), Mercury (Hg), and Nickel in wheat seeds were 0.186 ± 0.08, 0.9 ± 0.07, 0.021 ± 0.019, and 0.5 ± 0.17, respectively. The results showed that concentrations of HM in wheat were as follow: Cr > Ni > As > Hg. The Hazard Quotient (HQ) was significantly different among various HMs. The largest HQ was related to As ranging from 0.33 to 13.3. The lowest HQ was attributed to Cr, which may be related to its high RfD = 1.5 mg kg−1. Conclusion: Different HMs varied largely in terms of their HQ. Regarding the exposed people, As and Hg had the highest contributions to the aggregate risks of HMs, while Cr had the lowest contribution. Although the findings showed low environmental concentrations of the studied elements and implied no danger to human health, it should be considered that many non-cancerous conditions weaken the immune system and prone the human beings to cancerous diseases.

BACKGROUND: Sexual desire of women is one of the most important factors affecting marital and sexual satisfaction. Regarding the association of life skills level with sexual dissatisfaction and sexual desire, the present study aims to compare the effect of self-awareness and problem-solving skills training on the sexual desire of newly married women. MATERIALS AND METHODS: This was an experimental field trial study conducted since October 2019 to September 2020. The participants included 105 married women with a history of up to 5 years of cohabitation assigned randomly to either of the two intervention or control groups. The data collection tools include a demographic form, Hulbert index of sexual desire (HISD), and ENRICH couple scale that were completed by the participants before (T1), immediately (T2), and one month after the intervention (T3). The first intervention group received self-awareness skills training, whereas the second one received problem-solving skills training (four sessions of 90 min) weekly. On the other hand, the control group received no training. Statistical analyses were performed using SPSS 16 software and descriptive-analytical statistical tests including one-way ANOVA, Kruskal–Wallis, Bonferroni test, tests of within-subjects effects, and analysis test with repeated measures. P value < 0.05 was considered significant. RESULTS: The effect of time (statistic test: 51.24, P-value < 0.001) and the interaction effects of Time and Group on sexual desire (statistic test: 2.87, P-value: 0.03) were statistically significant. The mean score of sexual desire both in interventions and control groups showed statistically significant improvement. The mean score of sexual desire in the self-awareness group was 44.31 ± 9.08 (T1), 51.34 ± 10.92 (T2), and 59.48 ± 13.76 (T3) (P < 0.001); in the problem-solving group was 48.74 ± 10.21 (T1), 52.08 ± 10.59 (T2), and 57.40 ± 12.40 (T3) (P < 0.001); and in the control group was 47.74 ± 11.60 (T1), 50.08 ± 10.04 (T2), and 54.94 ± 12.15 (T3) (P = 0.02). CONCLUSION: The present study showed the effectiveness of both self-awareness and problem-solving skills training on newly married women's sexual desire. Moreover, this study showed simply participating in a study related to sexual desire as a control group could be effective on women's sexual desire.

Background: Preconception care is an opportunity to change unhealthy behaviors which in turn reduces unplanned pregnancy and plays an important role in reducing maternal and infant mortality. The aim of this study was to determine the level of preconception care and its related factors in pregnant women. Methods: This cross-sectional study was conducted on 394 pregnant women referred to Gorgan health centers in 2017. Samples were selected by multi-stage stratified sampling method from Gorgan health centers in Golestan province. Data was gathered using self-report questionnaire. Data analysis was performed using chi-square test, Fisher's exact, and Kruskal-Wallis tests in SPSS-16. The P-value less than 0.05 were considered significant. Results: 32.7% of women were received complete preconception care and 17.8% had no pre-pregnancy care. Only 44.2% of women used folic acid daily since the first trimester of pregnancy. Most of pregnant women (63.7%) performed triple screening laboratory test (FBS, CBC, TSH). Preconception care was more successful in mothers with higher level of education (p

Background and objectives: Promoting and influencing the formation of professional behavior is one of the most challenging issues in education. The purpose of this study was to compare effects of context-based learning (CBL) and cooperative learning on professional behavior and critical thinking of anesthesiology students. Methods: This was a semi-experimental study that was conducted on 42 third and fifth semester anesthesiology students who were divided into a CBL group (n=21) and a collaborative learning group (n=21). Data were collected before the intervention and one week and a month after the intervention using a questionnaire designed by Goze et al. and the Ricketts' Critical Thinking Disposition Inventory. The collected data were analyzed with SPSS (version 16) using the generalized estimation equation method, the Chi-square test, independent T-test and the Mann–Whitney U test. A p-value of less than 0.05 was considered statistically significant. Results: After the intervention, the mean score of professional behavior and critical thinking did not differ significantly between the two groups (P>0.05), but time had a significant impact on the mean score of professional behavior and critical thinking of the students (P

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.

Background: The aim of this study was to evaluate respiratory problems via pulmonary function testing in cement transport workers at Incheh Borun border in northeast of Iran in 2016. Methods: The study was conducted on 358 male workers. All subjects were evaluated for respiratory symptoms via pulmonary function testing and completion of the American Thoracic Society questionnaire. Results: Mean age of workers was 34.8±12.87 yr (age range 16-79 yr). Mean duration of employment was 6.1±4.36 yr. Most workers (75.4%) were illiterate or had elementary education. In addition, 56 (15.6%) subjects were smokers. Only three individuals (0.3%) had obstructive pattern. There was a significant relationship between age of workers and frequency of respiratory problems (P

Background: Leishmaniasis occurs with an incidence of 0.5–1.5 million new cases annually, and is also endemic in 88 countries across the world. Aim: Presently, we aimed to investigate the status of Cutaneous Leishmaniasis (CL) in Golestan Province in North of Iran. Methods: A retrospective survey was conducted on existed data of 6873 patients with CL who attended to Health Centers in Golestan Province during 2010 to 2017 years. Data were collected using patient sheets and online registry form of CL. Descriptive statistical methods such as mean and standard deviation, and Chi-square test were employed to report and analyze results. p-Value

Aims: This study designed to investigate the concentration of some heavy metals (HM) in the soil of agricultural land of Gonbad-e Kavus in Golestan province and relationship of these metals with esophageal cancer disease. Materials and Methods: For the investigation of pollution, especially HM in the soil, 5 points were randomly selected from each village (3 villages). The samples dried and screened by 200 mesh sieve.Then, the samples were analyzed for HM using ICP/MS. Results: The mean of Cadmium (Cd), Zinc, Cobalt, Chromium, Manganese, Nickel, Arsenic, Copper (Cu), Lead (Pb), and Iron (Fe) in soil was 0.5938 ± 1.7, 74.06 ± 18.9, 12.06 ± 1.28, 68.68 ± 5.85, 627.37 ± 53.3, 38.43 ± 4.4, 6.51 ± 1.21, 29.37 ± 4.3, 17.25 ± 3.5, and 27766.06 ± 2200 mg/kg, respectively. Conclusion: The concentration of metals except Cd and iron was less than the global standards. The concentration of some metals in the soil is almost high due to the high consumption of urea, phosphate, and nitrogen fertilizers. Therefore, it is recommended to educate farmers and use less chemical fertilizers.

Background & Objective: Prediction of health status in newborns and also identification of its affecting factors is of the utmost importance. There are different ways of prediction. In this study, effective models and patterns have been studied using decision tree algorithm. Method: This study was conducted on 1,668 childbirths in three hospitals of Shohada, Omidi and Mehr in city of Behshahr. Variables such as baby's gender, birth weight, birth order, maternal age, maternal history of illness, gestational diseases, type of delivery, reason of caesarean section, maternal age, family relationship of father and mother, mother's blood type, mother's occupation and blood pressure and place of residence were chosen as predictive factors of decision tree categorization method. The health status of the baby was used as a dependent dual-mode variable. All variables were used in clustering and correlation rules. Prediction was done and then compared using 4 decision-tree algorithms. Results: In the clustering method, the optimal number of clusters was determined as 8, using the Dunn index measurement. Among all the implemented algorithms of CART, QUEST, CHAID and C5.0, C5.0 algorithm with detection rate of 94.44% was identified as the best algorithm. By implementing the Apriori algorithm, strong correlation rules were extracted with regard to the threshold for Support and Confidence. Among the characteristics, maternal age, birth weight and reason of caesarean section with the highest impacts were found as the most important factors in the prediction. Conclusion: Due to the simple interpretation of the decision tree and understandability of the extracted rules derived from it, this model can be used for (most individuals) professionals and pregnant women at different levels.