The Effect of Chamomile Oil on Pain and Anxiety Intensity of IUD Insertion in Women Referring to Karaj Health Centers: Ridit Analysis

Introduction: Intrauterine device (IUD) is a safe, effective and reversible method of family planning. Unfortunately, IUD insertion causes anxiety and pain. The aim of study was to compare ridit analysis and Kruskal-wallis test in pain and anxiety intensity of IUD insertion in women referring to health centers of Karaj (Iran).Materials and Methods: In this randomized clinical trial study, 150 eligible women candidate intrauterine device insertion entered the study and were randomly divided into three groups: chamomile, placebo and control groups. Data was collected from women who came to health centers in Karaj (Iran) in 2017. Data collection tools included demographic information, Spiel-Berger questionnaire and pain visual analogue scale. The intensity of pain and anxiety were measured afterwards. Finally, ridit analysis and Kruskal-wallis test were used to rank the intensity of pain and anxiety in patients. The R-3.4.3 and Microsoft's Excel software were used for statistical analysis.Results: The results showed that the mean±SD of age in three groups was 29.7±7.01, 28.68±8.15 and 31.6±7.71, respectively. Ridit analysis and Kruskal-wallis test showed considerable decrease of the anxiety and pain intensity, induced by IUD insertion in Chamomile, Placebo and Control groups respectively. Ridit analysis and Kruskal-wallis test statistics are significant. The value of the ridit statistic was 15د‡2=20.23, P<0.001">  and the value of Kruskal-wallis test is 15د‡2=18.67, P<0.005">  in pain intensity. Moreover, the value of the ridit statistic is 15د‡2=3.92, P<0.001">  and the value of Kruskal-wallis test is 15د‡2=21.37, P<0.005">  in anxiety intensity.Conclusions: The results of this study suggested that, there is less significant difference in ridit analysis than Kruskal-wallis test among the three groups in decreasing pain and anxiety intensity. 

The Effect of Strengthening Exercises on Functional Ability in Patients with MS: A Review Study

Introduction: Patients with multiple sclerosis (MS) usually report gait and balance disorders. Exercise therapy, especially strengthening exercise, is a safe and effective treatment approach in these patients. Therefore, the aim of this review study was to determine the effect of strengthening exercises on functional ability in patients with MS. Methods and Materials: A search of databases such as PubMed, science direct, Cochrane library, and Google scholar was reviewed to determine the existing articles on the effect of strengthening exercises on functional ability in patients with MS. Results: According to the evaluation of studies from 2000 to 2020, 8 articles met the inclusion criteria. These articles examined the effect of strengthening exercises on functional ability in patients with MS. The results showed that strengthening exercises improved balance variables, functional ability, strength, and quality of life. Conclusion: Various interventions including stretching, balance, strengthening exercises, and electrical stimulation have been used to treat balance disorders, decreased muscle strength, gait efficiency and quality of life in patients with MS. Among these interventions, strengthening exercises have been shown to play an effective role in improving functional ability, although more studies are needed in this area

Evaluation of the Quality of Clinical Education Based on the Perspective of Medical Students of Shahroud University of Medical Sciences

Background: Improving the quality of clinical education requires a continuous review of the existing situation to identify strengths and weaknesses. The aim of the study was to evaluate the quality of clinical education based on the perspective of medical students of Shahroud university of medical sciences. Methods: This descriptive-analytical study was conducted at1397-98. Participants were 230 medical students and interns in Shahroud university of medical sciences who were enrolled in the study. The data were collected using the clinical education quality assessment questionnaire, with a range of 0-66 points and divided into three levels: weak, moderate and desirable. T-test was used for data analysis. The Significanl level was set at 0.05. Results: The results showed that the mean of the standard deviation of clinical education quality in terms of goals and curriculum (12.95), teacher performance (10.23), and student treatment (4.09) was desirable from medical students' point of view. (Given that the significance level is less than 0.05, these averages are desirable) while in terms of educational environment (4.60) and supervision and evaluation (4.01), it is not desirable. Conclusions: According to the findings, clinical quality status is desirable in most aspects, but it is necessary to eliminate the weaknesses to improve the quality of clinical education in this university in terms of the educational environment, monitoring and evaluation according to the students' viewpoints. Keywords: Quality, Clinical education, Medical students

Evaluation of the Quality of Clinical Education Based on the Perspective of Medical Students of Shahroud University of Medical Sciences

Background: Improving the quality of clinical education requires a continuous review of the existing situation to identify strengths and weaknesses. The aim of the study was to evaluate the quality of clinical education based on the perspective of medical students of Shahroud university of medical sciences. Methods: This descriptive-analytical study was conducted at1397-98. Participants were 230 medical students and interns in Shahroud university of medical sciences who were enrolled in the study. The data were collected using the clinical education quality assessment questionnaire, with a range of 0-66 points and divided into three levels: weak, moderate and desirable. T-test was used for data analysis. The Significanl level was set at 0.05. Results: The results showed that the mean of the standard deviation of clinical education quality in terms of goals and curriculum (12.95), teacher performance (10.23), and student treatment (4.09) was desirable from medical students' point of view. (Given that the significance level is less than 0.05, these averages are desirable) while in terms of educational environment (4.60) and supervision and evaluation (4.01), it is not desirable. Conclusions: According to the findings, clinical quality status is desirable in most aspects, but it is necessary to eliminate the weaknesses to improve the quality of clinical education in this university in terms of the educational environment, monitoring and evaluation according to the students' viewpoints. Keywords: Quality, Clinical education, Medical students

Determination of the Nonlinear Muskingum Model Coefficients Using Genetic Algorithm and Numerical Solution of the Continuity Equation

The optimization method is an appropriate choice for determining optimal parameters in the Muskingum model, in order to increase the speed of computations; coefficients of this model have been computed optimally with assistance of the genetic algorithm. These coefficients were computed from the linear Muskingum and Muskingum-Cunge models using required data and the available relations. In order to evaluate efficiency of the procedure of optimizing coefficients of the nonlinear Muskingum model via the genetic algorithm method compared with the other two methods used for determining these coefficients, outflow hydrographs were computed using the optimal coefficients and solving the continuity equations according to the Runge-Kutta method order 4 and was compared with the two flood routing methods from the Muskingum and Muskingum-Cunge models as well. To study the precision of these three methods, square root of sum of squares of difference of discharges computed from each of the three methods and observational discharges obtained from the HEC-RAS RMSE software was used as the objective function and achieved results indicate more proximity of the computed hydrographs from the optimization coefficients in the Runge-Kutta order 4 to the outflow hydrographs obtained to the HEC-RAS software compared with the two Muskingum and Muskingum-Cunge models

The Role of Voluntary Function in Predicting Addiction Potential: A Survey on Iranian Red Crescent Societies

Background and Aim:Considering Voluntary Function, the purpose of the present study was to predictthe addiction potential among some members of the Iranian Red Crescent Society (IRCS).Materials and Methods:The research method was descriptive-correlational. The statistical population of the present study was all members of the Iranian Red Crescent Society (IRCS). The sampling method was multi-stage cluster sampling, in which 620 active volunteers of the IRCS from 31 province and 175 cities of Iran (48.7% female and 50.1 Male mean age 23.27±3.32, range 14–31 years)were selected for this research.The research data was collected using theIranian Addiction Potential Scale (IAPS) and Voluntary Function Inventory (VFI). Results:Findings proved that there was a negative significant correlation between the AP and all measurements of VF such as protective enhancement, understanding, career, values, and motives; meaning that the more time youth spent on participating in voluntary activities, the less likely they sought to resort to misusing AP. Findings of the multiple regression has proved that volunteerism could predict 15% of changes in the AP as a criterion variable.Conclusion:Voluntary function can increase happiness, mental health, expand interpersonal relationships and social networking, self-esteem and social skills in individuals. These skills can reduce the high-risk behaviors, including addiction. Therefore, it is necessary to pay attention to this valuable factors in preventive programs

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49\ub74% (95% uncertainty interval [UI] 46\ub74–52\ub70). The TFR decreased from 4\ub77 livebirths (4\ub75–4\ub79) to 2\ub74 livebirths (2\ub72–2\ub75), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83\ub78 million people per year since 1985. The global population increased by 197\ub72% (193\ub73–200\ub78) since 1950, from 2\ub76 billion (2\ub75–2\ub76) to 7\ub76 billion (7\ub74–7\ub79) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2\ub70%; this rate then remained nearly constant until 1970 and then decreased to 1\ub71% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2\ub75% in 1963 to 0\ub77% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2\ub77%. The global average age increased from 26\ub76 years in 1950 to 32\ub71 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59\ub79% to 65\ub73%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1\ub70 livebirths (95% UI 0\ub79–1\ub72) in Cyprus to a high of 7\ub71 livebirths (6\ub78–7\ub74) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0\ub708 livebirths (0\ub707–0\ub709) in South Korea to 2\ub74 livebirths (2\ub72–2\ub76) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0\ub73 livebirths (0\ub73–0\ub74) in Puerto Rico to a high of 3\ub71 livebirths (3\ub70–3\ub72) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2\ub70% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODErn), to generate cause fractions and cause specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NC Ds) comprised the greatest fraction of deaths, contributing to 73.4% (95% uncertainty interval [UI] 72.5-74.1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 186% (17.9-19.6), and injuries 8.0% (7.7-8.2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22.7% (21.5-23.9), representing an additional 7.61 million (7. 20-8.01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7.9% (7.08.8). The number of deaths for CMNN causes decreased by 222% (20.0-24.0) and the death rate by 31.8% (30.1-33.3). Total deaths from injuries increased by 2.3% (0-5-4-0) between 2007 and 2017, and the death rate from injuries decreased by 13.7% (12.2-15.1) to 57.9 deaths (55.9-59.2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118.0% (88.8-148.6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36.4% (32.2-40.6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33.6% (31.2-36.1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respirator}, infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990 neonatal disorders, lower respiratory infections, and diarrhoeal diseases were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.Peer reviewe

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning