Relationship Between Assertion and Aggression with Addiction Potential: A Cross-Sectional Study in 2019

ObjectivesThis study aimed to determine the relationship between assertion and aggression with addiction potential among students in Shahroud University of Medical Sciences.MethodsIn this cross-sectional study conducted in 2019, 500 students of Shahroud University of Medical Sciences, were selected by multistage random sampling, for a study using the Addiction Potential Scale, and Assertion and Aggression Questionnaires. Data were analyzed using ANOVA, Chi-square, t test, Pearson’s correlation coefficient, and the linear regression model.ResultsThe mean scores of addiction potential, aggression, and assertion were 32.7 ± 17.2, 41.5 ± 12.9 and 139.4 ± 22.3, respectively. In this study, 38.8% (N = 194) of students had high aggression and 76.8% (N = 384) had high assertion. In the regression model, aggression, history of drug and addictive substances abuse, history of tobacco use, and history of alcohol abuse were significantly related to addiction potential (p ≤ 0.05). There was a negative relationship between assertion and addiction potential so that with one-unit increase in the assertion score, the addiction potential score decreased by −0.11.ConclusionGiven the direct relationship between aggression and addiction potential, and since more than three-quarters of the students had moderate to high aggression, it is necessary to pay more attention to this issue. Interventions may play an important role in improving the current situation.

Sexual Satisfaction and Related Factors among Iranian Married Women, 2017

@#Introduction: Sexual satisfaction is one of the important factors in marital satisfaction that affects couples' health and quality of life. The aim of this study was to determine sexual satisfaction and its related factors among married women in Shahroud, northeast of Iran. Methods: This cross-sectional study was conducted in 2017 and 500 married women were evaluated using Larson Sexual Satisfaction Questionnaire. The data were analyzed using chi-square, one-way ANOVA and a multiple regression model. Results: The mean age of the participants was 32.8 (SD= 8.7) years, and the length of the marriage was 11.05 (SD= 9.1). Among the participants, 4.4% (N=22) had low sexual satisfaction; 37.8% (N=189) had moderate satisfaction. The bivariate analysis showed significant relationships between sexual satisfaction and variables including age, husband's age, length of marriage, number of children, education, husband's education and income (p<0.001). The regression analysis also indicated significant relationships between sexual satisfaction and education (P=0.006), length of the marriage (P<0.001) and income (P=0.005). Conclusion: Socio-economic variables such as education and income are among the main factors related to sexual satisfaction. However, counseling couples on sexual issues after marriage can help improve their sexual satisfaction.

The Relationship Between Health-Promoting Lifestyle and Its Related Factors with Self-Efficacy and Well-Being of Students

OBJECTIVES: Unhealthy lifestyles among young people are seriously related to incapacity and health problems in adulthood. The aim of this study was to determine the importance of a health-promoting lifestyle and its association with self-efficacy and well-being. METHODS: In this cross-sectional study, a sample of 500 students from Shahroud University of Medical Sciences (Shahroud, Iran) were randomly selected in 2017. The Persian versions of Health-Promoting Lifestyle Profile, Self-Efficacy Scale, and WHO-5 Well-Being Index were used. RESULTS: Among the participants, 34% of students had an abnormal imaginable well-being, and 68% of students had high self-efficacy. The mean score of a health-promoting lifestyle was 127.47 ± 19.78, which is interpreted as moderate, and the mean score of physical activity was 14.10 ± 4.95, which is poor. There was a significant relationship between well-being, and self-efficacy with health-promoting lifestyle. Age, gender, educational level, place of residence, student employment, self-efficacy, and well-being were associated with students’ lifestyles. CONCLUSION: A health-promoting lifestyle of students in this study was moderate and they did not have an acceptable level of physical activity. The direct effect of well-being, and self-efficacy on lifestyle, revising students’ curriculums to improve their health behaviors, and general health indicators, can all lead to the enhancement of health-promoting lifestyles.

Study of the Relationship Between Self-Efficacy, General Health and Burnout Among Iranian Health Workers

OBJECTIVES: To evaluate the relationship between self-efficacy, general health and burnout of the staff at Shahroud University of Medical Sciences.METHODS: In 2015, 249 staff at Shahroud University of Medical Sciences (from a total reference population of 520 staff members) were selected through stratified random sampling. To collect the data, Sherer self-efficacy Scale, General Health Questionnaire and Maslach Burnout Inventory were used. The collected data were analyzed through ANOVA, Pearson correlation and Chi-square tests using SPSS 16. The relationship between self-efficacy, general health and burnout (latent factors) were studied using structural equation modeling with Stata 14.RESULTS: The mean age of participants was 36.97 ± 7.60 years, and the mean number of years work experience was 12.29 ± 7.57. The mean scores of general health, self-efficacy and burnout were 28.24 ± 11.14, 62.30 ± 9.21 and 81.67 ± 22.18, respectively. The results of the study showed a statistically significant relationship between self-efficacy and general health which equals −0.32. A statistically significant relationship also existed between burnout scores and general health scores (beta = 0.78).CONCLUSION: The results showed that high self-efficacy improves the general health of employees at the Shahroud University of Medical Sciences and reduces burnout. Special attention should be paid to self-efficacy in the prevention of burnout.

Tioxolone niosomes exert antileishmanial effects on Leishmania tropica by promoting promastigote apoptosis and immunomodulation

Objective: To explore the antileishmanial effect of tioxolone and its niosomal form against Leishmania tropica. Methods: Tioxolone niosomes were prepared by the hydration method and were evaluated for morphology, size, release study, and encapsulation efficiency. The cytotoxicity of tioxolone and its niosomal form was measured by MTT assay, leishmanicidal activity against promastigote and amastigote by MTT assay, apoptosis by flow cytometry, IL-12, IL-10 and metacaspase gene expression levels by q-PCR. Results: Span/Tween 40 and Span/Tween 60 niosomes had good physical stability as depicted in their size distribution curves and high encapsulation efficiency (>99%). The release profile of the entrapped compounds showed Fickian's model of tioxolone delivery based on diffusion through lipid bilayers. With the IC

Pre-hypertension and the risk of diabetes mellitus incidence using a marginal structural model in an Iranian prospective cohort study / 한국역학회지

OBJECTIVES: The aim of this study was to evaluate the effect of pre-hypertension and its sub-classification on the development of diabetes. METHODS: In this cohort study, 2,941 people 40 to 64 years old without hypertension or diabetes were followed from 2009 through 2014. According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)-7 criteria, we classified participants into normal and pre-hypertension groups. The effect of pre-hypertension on the 5-year incidence rate of diabetes was studied using inverse probability of treatment weighting. We modeled the exposure and censored cases given confounding factors such as age, sex, body mass index, smoking, economic status, and education. RESULTS: The 5-year incidence rate of diabetes among people with pre-hypertension and those with normal blood pressure (BP) was 12.7 and 9.7%, respectively. The risk ratio (RR) for people with pre-hypertension was estimated to be 1.13 (95% confidence interval [CI], 0.90 to 1.41). The RRs among people with normal BP and high-normal BP, according to the JNC-6 criteria, compared to those with optimal BP were 0.96 (95% CI, 0.73 to 1.25) and 1.31 (95% CI, 1.01 to 1.72), respectively. CONCLUSIONS: Our results showed that participants who had higher levels of BP (high-normal compared to optimal BP) had a higher risk of diabetes development. With regard to the quantitative nature of BP, using the specifically distinguishing of stage 1 hypertension or high-normal BP may be a more meaningful categorization for diabetes risk assessment than the JNC-7 classification.

Transition in tobacco use stages and its related factors in a longitudinal study

OBJECTIVES@#Considering the increase in the non-communicable diseases associated with tobacco use in recent decades in Iran, it is necessary to have a general view of the current condition. This study aimed to identify factors associated with tobacco use and to estimate the probability of a 5-year transition in the stages of tobacco use in an adult population.@*METHODS@#In this study, 5190 people in the 40-64-year-old population of Shahroud (North East of Iran) were interviewed in 2009 and 2014 on tobacco smoking. The association of independent variables with tobacco smoking was evaluated using the population-averaged logit model. We calculated smoking transition probabilities from non-smoking to current smoking and past-smoking stages during a 5-year span.@*RESULTS@#The prevalence of current tobacco smoking in 40-69-years age group was 11.1% (95% CI 10.3-12.0), 1% among women (95% CI 0.8-1.3) and 25.6% among men (95% CI 23.7-27.6). During this 5-year period, the probability of transition of a non-smoker to an overall current tobacco smoker was 2.3%. Meanwhile, 18.5% of the overall current tobacco smokers had changed into past smokers. Unemployed (OR = 2), male gender (OR = 53.9), widow/widowers (OR = 5.4), divorces (OR = 3.3), and high economic status (OR = 1.2) are associated to tobacco smoking.@*CONCLUSIONS@#Compared with the other studies, the prevalence of tobacco use in this population is low but transition rate of non-smokers into current smokers or past smokers is high. Conducting interventions on determinants of starting and quitting smoking and education and awareness raising on the risk and harms of smoking seems necessary.

Pre-hypertension and the risk of diabetes mellitus incidence using a marginal structural model in an Iranian prospective cohort study / 한국역학회지

OBJECTIVES: The aim of this study was to evaluate the effect of pre-hypertension and its sub-classification on the development of diabetes.METHODS: In this cohort study, 2,941 people 40 to 64 years old without hypertension or diabetes were followed from 2009 through 2014. According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)-7 criteria, we classified participants into normal and pre-hypertension groups. The effect of pre-hypertension on the 5-year incidence rate of diabetes was studied using inverse probability of treatment weighting. We modeled the exposure and censored cases given confounding factors such as age, sex, body mass index, smoking, economic status, and education.RESULTS: The 5-year incidence rate of diabetes among people with pre-hypertension and those with normal blood pressure (BP) was 12.7 and 9.7%, respectively. The risk ratio (RR) for people with pre-hypertension was estimated to be 1.13 (95% confidence interval [CI], 0.90 to 1.41). The RRs among people with normal BP and high-normal BP, according to the JNC-6 criteria, compared to those with optimal BP were 0.96 (95% CI, 0.73 to 1.25) and 1.31 (95% CI, 1.01 to 1.72), respectively.CONCLUSIONS: Our results showed that participants who had higher levels of BP (high-normal compared to optimal BP) had a higher risk of diabetes development. With regard to the quantitative nature of BP, using the specifically distinguishing of stage 1 hypertension or high-normal BP may be a more meaningful categorization for diabetes risk assessment than the JNC-7 classification.

Pre-hypertension and the risk of diabetes mellitus incidence using a marginal structural model in an Iranian prospective cohort study / 한국역학회지

OBJECTIVES@#The aim of this study was to evaluate the effect of pre-hypertension and its sub-classification on the development of diabetes.@*METHODS@#In this cohort study, 2,941 people 40 to 64 years old without hypertension or diabetes were followed from 2009 through 2014. According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)-7 criteria, we classified participants into normal and pre-hypertension groups. The effect of pre-hypertension on the 5-year incidence rate of diabetes was studied using inverse probability of treatment weighting. We modeled the exposure and censored cases given confounding factors such as age, sex, body mass index, smoking, economic status, and education.@*RESULTS@#The 5-year incidence rate of diabetes among people with pre-hypertension and those with normal blood pressure (BP) was 12.7 and 9.7%, respectively. The risk ratio (RR) for people with pre-hypertension was estimated to be 1.13 (95% confidence interval [CI], 0.90 to 1.41). The RRs among people with normal BP and high-normal BP, according to the JNC-6 criteria, compared to those with optimal BP were 0.96 (95% CI, 0.73 to 1.25) and 1.31 (95% CI, 1.01 to 1.72), respectively.@*CONCLUSIONS@#Our results showed that participants who had higher levels of BP (high-normal compared to optimal BP) had a higher risk of diabetes development. With regard to the quantitative nature of BP, using the specifically distinguishing of stage 1 hypertension or high-normal BP may be a more meaningful categorization for diabetes risk assessment than the JNC-7 classification.

Resolution of bile duct adenoma over follow-up period; a case report

Bile duct adenoma [BDA] is a rare neoplasm of bile ducts with various clinical manifestations and imaging appearances. A few cases of BDA and their predisposing factors have been described. We report a 35-year-old woman with right upper quadrant pain who consumed oral contraceptive pills. Ultrasound study revealed three hypoechoic subcapsular liver masses; two of them were hypodense in computed tomography. Fine needle biopsy of the largest mass showed bile duct adenoma. Liver masses disappeared after discontinuing the pills over a 2-year follow-up. BDAs can manifest in imaging. Although previous studies have not reported tumor resolution over a follow-up period, we suggest paying more attention to predisposing factors in order to give an opportunity for tumor resolution by risk factor elimination

Frequency and risk factors of primary sclerosing cholangitis among patients with inflammatory bowel disease in North-East of Iran

To identify primary sclerosing cholangitis [PSC] predisposing factors in order to prevent inflammatory bowel disease [IBD] progression to PSC. IBD is commonly associated with PSC and there is no effective therapy for PSC except for liver transplantation. This retrospective study was conducted on 447 IBD patients from IBD Clinics of Ghaem and Emam Reza Hospitals. Data were collected by interview and through a review of the patients' medical records. Patients were divided into two groups: those with IBD and PSC [IBD-PSC] and those without PSC. Variables were compared between two groups and those with statistically significant differences in IBD-PSC group were considered as predictive factors for the development of PSC. The frequency of PSC in IBDs was 4.3% and all were ulcerative colitis. The mean age of patients with PSC was 39.1 +/- 11.33 years. The male to female proportion in PSCs was 3.8:1 and in IBDs was 0.9:1. There were statistically significant associations between PSC and gender, IBD duration and UC extension, mucocutaneous involvement, oral contraceptive pills [OCP] consumption, history of surgery and history of PSC in the first- degree relatives. PSC frequency among IBD patients in North-East of Iran was 4.3%. It is recommended to limit OCP consumption in IBD patients. Identification and modification of probable predisposing risk factors, as well as early diagnosis of PSC are necessary

Health-related quality of life in polycystic ovary syndrome patients: a systematic review

Increasing attention to the concept of polycystic ovary syndrome [PCOS] health-related quality of life has led to the development of tool that aims to measure this concept. The purpose of this study was to conduct a systematic review of psychometric properties of the PCOS health-related quality of life questionnaire. A search of database [Pubmed, PsychInfo, CINAHL, CENTRAL, Scopus and SID] from January1998 to December 2013 yielded 6152 references of which 27 papers remained after review of the titles and abstracts. The reviewers used structural tools to analyze the articles, critically appraise papers, and extract the data. Finally, eight papers met the full inclusion criteria. A search of database [Pubmed, PsychInfo, CINAHL, CENTRAL, Scopus and SID] from January1998 to December 2013 yielded 6152 references of which 27 papers remained after review of the titles and abstracts. The reviewers used structural tools to analyze the articles, critically appraise papers, and extract the data. Finally, eight papers met the full inclusion criteria. The PCOSQ/MPCOSQ showed acceptable content and construct validity, reliability and internal consistency. However, some other properties, particularly those related to factor and longitudinal validity, absolute error of measurement, minimal clinically important difference and responsiveness still need to be evaluated

impact of polycystic ovary syndrome on the health-related quality of life: a systematic review and meta-analysis

Polycystic ovary syndrome [PCOS] has been shown to cause a reduction in health-related quality of life [HRQOL]. However, the relative degree of impairment in each domain differed among samples, and it was not clear which aspect of disease-specific HRQOL [modified polycystic ovary syndrome health-related quality of life questionnaire] was most negatively affected. To systematically review the effects of PCOS on specific domains of HRQOL. Literature search using search engine of database [PubMed, PsychInfo, CINAHL, CENTRAL, and Scopus] between 1998 to December 2013 yields 6 relevant publications. Pairs of raters used structural tools to analyze these articles, through critical appraisal and data extraction. The scores of each domain of polycystic ovarian syndrome questionnaire [PCOSQ] or modified version [MPCOSQ] of 1140 women with PCOS were used in meta-analysis. The combine mean of emotional [4.40; 95% CI 3.77-5.04], infertility [4.13; 95% CI 3.81-4.45] and weight [3.88; 95% CI 2.33-5.42] dimensions were better, but menstruation [3.84; 95% CI 3.63-4.04] and hirsutism [3.81; 95% CI 3.26-4.35] domains were lower than the mean score of PCOSQ/MPCOSQ in related dimension. The meta-analysis showed that the most affected domains in specific HRQOL were hirsutism and menstruation. Based on these findings, we recommend healthcare providers to be made aware that HRQOL impairment of PCOS is mainly caused by their hirsutism and menstruation, which requires appropriate management

Consanguinity and neonatal death: a nested case-control study

Although numerous studies have found higher rates of abortion and still births following consanguinity [familial marriages], the question of whether consanguinity significantly increases the risk of neonatal death has inadequately been addressed.This study aims to evaluate familial marriage effects on neonatal death in rural areas in Iran. In this nested case-control study, 6900 newbornswho were born in rural areas of Kohgiluyeh and Boyerahmad Province [South-West of Iran] were followed till the end of neonatal period, and neonatal death was the outcome of interest. Subsequently 97 cases and 97 controls were selected in study cohort by using risk set sampling model. Crude and adjusted odds ratios [OR] were estimated by using a conditional logistic regression model. In the final model, prematurity [OR = 5.57], low birthweight [LBW] [OR = 7.68], consanguinity [first cousins] [OR = 5.23], C-section [OR = 7.27], birth rank more than 3 [OR = 6.95] and birthsinterval less than 24 months [OR = 4.65] showed significant statistical association with neonatal mortality [p < 0.05]. According to our findings, after adjusting the effects of other significant risk factors, familial marriage to first cousins is considered as an important risk factor for neonatal death

[Maternal Quality of life in women with wanted and unwanted pregnancy: a longitudinal study]

Introduction: Unwanted pregnancy imposes great psychological pressure on women.The aim of this paper is to compare quality of life of in women withwanted andunwanted pregnancy, from 3rd trimester of pregnancy to postpartum

Methods and materials: This longitudinal study was conducted in 10 urban health centers of Shahroud city, in 2010. There were 43 women with unwanted pregnancy among 358 pregnant women. In order to exclude the selection bias, all pregnant women were included in the study. Inclusion criteria were being in the third trimester of pregnancy and giving birth to a healthy baby. Exclusion criteria were fetal or infant death during the period of the study. WHO-Quality of life questionnaire was filled out in the third trimester of pregnancy and 8 weeks after delivery. Statistical analysis was done by SPSS version 18 using mann witney-u, wilcoxon, chi-square and multiple regression analysis

Results: Although there was no significant difference between the scores of QOL of women with wanted and unwanted pregnancy in third trimester of pregnancy, women with unwanted pregnancy had lower score in perceived overall health [p=0.03] and social domain [p=0.042] than wanted pregnancy group in postpartum periods. Also, means of scores of physical and social domains of QOL in women with wanted pregnancy has improved from pregnancy to postpartum while there was no change in unwanted group and even their perceived overall health declined in the postpartum [p=0.009]. Multiple regression analyses showed that unwanted pregnancy was a predictor of maternal QOL in postpartum.[]

Conclusion: Designing interventions to improve QOL of women with unwanted pregnancy is recommended

Quality of life after cesarean and vaginal delivery

Cesarean rates in recent decades have been increasing and a number of studies have shown that cesarean increases maternal morbidities. The aim of this study is to compare the quality of life after cesarean and vaginal delivery. This prospective study was carried out on 356 pregnant women visiting urban health centers in Shahroud City, Northeast Iran, in 2011. The subjects completed the quality of life questionnaire in the third trimester of pregnancy and at 8 weeks postpartum. In primiparas, the mean global QOL scores for the cesarean and vaginal delivery groups were 67.65 +/- 12.7 and 72.12 +/- 11.8, respectively. Also, the scores for the physical, psychological and social domains of QOL as well as the global score of QOL were higher in the vaginal delivery group than the cesarean group [p<0.05]. In the case of primiparas, multiple regression analysis revealed that after adjusting for education, desirability of pregnancy and the General Health Questionnaire score, the delivery type remained as a predictor of the scores for the physical [R[2]=1.7%; B=-3.826; p=0.031; CI [-7.301, -.350]] and social [R[2]=2.5%; B=-5.708; p=0.017; CI [-10.392, -1.023]] domains of QOL and the global QOL score [R[2]=2.6%; B=-4.065; p=0.006; CI [-6.964, -1.164]]. While multiparas, there was no relationship between QOL and type of delivery. In this sample of low-risk women, cesarean negatively affected the QOL of primiparas. More studies with larger sample sizes should be conducted to examine the effects of cesarean on QOL in both primiparas and multiparas within a shorter period after delivery

[Coincidence symptomatic gall stone and helicobacter pylori: a brief report]

On of the most common gasterointrestinal disease is gallstone disease and it's prevalence is 11%-36%in autopsies. If gallstone leads to symptoms and side effect cholecystectomy will be inevitable. Gastric infection due to H.P will cause several symptoms of which dyspepsia and epigastric pain are outstanding .Gall stones also usually causes epigastric and/or right upper quadrant pain. Pain in other abdominal quadrant is less common. In this study we investigated the coincidence of gall stone and gastro intestinal H.P regarding the common symptom, between these two conditions to prevent unnecessary operation. The cases were adopted from cholecystectomy candidates due to gall stone disease [proved by ultrasonography]. The control group were normal people who proved to be gall stone free ultrasonographicly. Serum IgG anti H.P was checked and compared between the two groups. Seventy percent of patients entered into the study which consisted of 35 case and 35 controls. The two groups were not significantly different in age and gender. There were 22 [68.8%] and 10 [31.2%] H.P positive cases in case and control groups respectively. Thirteen [34.2%] and 25[65.8%] cases were H.P negative in case and control groups respectively. Comparing these results will reveal a statistically significant difference[P=0.004]. The relationship between gastric H.P and gall stone in this study supports the role of H.P in gall stone formation. According to our results and the common symptoms of two conditions specially in atypic biliary colic, it seems that in many cases gastrointestinal H.P causes the pain. Prospective studies are recommended

case report of pegylated interferon and bronchiolitis oblitrans with organizing pneumonia

A 46-year-old woman presented with progressive dyspnea and cough. She was a known case of chronic hepatitis C [HCV] treated with pegylated [PEG]-interferon. Complete pulmonary studies and biopsy were compatible with bronchiolitis oblitrans with organizing pneumonia [BOOP] secondary to PEGinterferon. She discontinued PEG-interferon and was given a short course of steroids, after which the condition completely resolved. This report has shown that particular attention to possible side effects of PEG-interferon is necessary in the clinical practice.

[ case report of primary glomus tumor of stomach in a 59 year old man]

Primary gastric Glomus tumour is rare and much less frequent than gastrointestinal stromal tumors[GIST].at least 150 of them have been reported in articles, but no one had been published in Iran. Patient was a 59 years old man with the chief complains of sense of epigastric fullness after meal. Endosonography showed a hypoechoic mass in muscularis mucosa with 29_14 mm dimentions. patient underwent wedge resection of gastric tumour. In microscopy, sheets and nodules of round to polyhedral uniform cells with bland round to oval nuclei in the background of branched hemangiopericytoma-like vascular stroma with hyalinised wall were seen. Smooth Muscle Actin, desmin, chromogranin and CD117 were determined immunohistochemicaly, the first marker was positive and the reminders were negative. Primary gastric Glomus tumour is essentially a benign neoplasm, in order to prevent unnecessary radical surgery, its differentiation from others malignant lesions is mandatory

Job satisfaction and its influential factors

This study aimed at determining the job satisfaction level of the staff in Shahroud University of Medical Sciences [SUMS], northern Iran, and its influential factors. In this descriptive study, conducted in 2008, the participants were 384 workers in SUMS selected through simple random sampling procedure. The participants received a 33-item questionnaire in a Likert format [8 general items and 25 items related to job satisfaction facets]. The collected data in form of frequencies and percentages were analyzed with SPSS software. 53.4% of interviewees were female and more than 60% had associate or higher degrees. 42.6% had less than 10 yr and 30.9% had 20 to 30 yr of job experience, respectively. The mean of the overall satisfaction was 13.02 out of 20. Regarding the facets of job satisfaction, work, coworkers, supervisor, and promotion had the highest means, respectively. Pearson and Spearman correlation coefficients showed a significant relationship between overall satisfaction and the facets [P=0.001]. Analysis of variance also showed significant difference in overall satisfaction based on organizational units; however, no significant relationship was observed between overall satisfaction and gender, degree, age, job experience and type of employment. Improvement of promotion process, training and qualifying managers, observing meritocracy principles in appointments, using cooperative management, creating convivial and friendly atmosphere and improving work environment conditions, have brought about an increase in overall satisfaction of employees in SUMS