طاهره پاشائی

Health tourism is one of the dimensions of sustainable development to help Mazandarn’s economic dynamic. A strong agreement is doubted in identifying factors influencing the attraction of health tourists. This study was implemented to design a questionnaire to measure the factors influencing the attraction of healthy tourists and investigate its psychometric properties.

This study was done with a combinatorial approach in three steps, including relevant literature and the opinions of experts as long as health tourists' opinions of Mazandaran province were applied to the development of the item pool. Then, content validity, face validity, construct validity, and reliability of the questionnaire were assessed for the psychometric properties of the questionnaire. The final questionnaire was approved after performing 17 interviews and applying professional expertise in the qualitative part. In the first stage of the quantitative part content validity was studied by 10 people from an expert panel, and its face validity, the questionnaire was completed by 10 participants. Finally, the construct validity of the designed instrument was calculated using exploratory factor analysis using SPSS 24 software and confirmatory factor analysis using AMOS 24 software by asking 300 people familiar with health tourism in Mazandaran province. The internal and external validity were determined using Cronbach's alpha and test-retest in 25 people.

The results of the literature review and interviews with experts in the first and second stages of the study led to the design of 76 items. In the next step, the changes in the qualitative stage 15 questions did not receive favorite points in Content validity ratio (CVR) and content validity index (CVI) calculation in the quantitative part of content validity. Then face validity was applied and the item effect index for 8 items was lower than 1.5 in the quantitative stage of face validity. Then the questionnaire with 53 items was entered into construct validity. In the exploratory factor analysis, the value of KMO was equal to 0.778. Furthermore, the value of Bartlett's test of significance was less than 5%. Based on the rotated matrix of components, eight factors with positive values were obtained. The results of exploratory factor analysis showed that 7 items had a factor loading of less than 0.4, which were removed from the questionnaire, and finally, 46 items remained. In the confirmatory factor analysis stage, the factor load of all dimensions was in good condition and the P-value was in the acceptable range. Cronbach alpha rate was calculated as 0.831. The external reliability was lower than 0.05 (ICC= 0.90, P<0.001).

The designed questionnaire, due to the low number of questions, the simplicity of the sentences, as well as the acceptable validity and reliability, can be used to identify and investigate the factors affecting the attraction of health tourists. Normalization of the questionnaire in other cultures is suggested. It is hoped that the findings of this study will be utilized by researchers, healthcare and tourism system managers, and other stakeholders to inform the planning of interventions aimed at increasing medical tourism. Additionally, it is hoped that the results of this study will serve as a springboard for future research in this area.

Cervical cancer is the second most common cancer among females, and one of the influential factors in the course of cervical cancer is the health literacy of patients. This study aimed to determine the relationship between health literacy and determinants of performing Pap smear tests based on the Protection Motivation Model.

A sectional study was conducted on eligible females visiting the health center in the city of Muchesh, Iran in the year 2022. In total, 216 individuals were selected through a census. Data collection was performed using the Population Information Questionnaire, the Health Literacy Assessment Tool for the urban population of Iran (18-65 years old), and the Structured Questionnaire of Motivational Protection Theory. The collected data were entered into SPSS software (version 22), and analysis was carried out using descriptive statistics, the Kolmogorov-Smirnov test, analysis of variance, and Pearson correlation. The significance level was considered at P < 0.05.

The study results showed that the mean scores of health literacy, reading comprehension, access, perception, evaluation, and decision-making were 84.24 ± 9.30, 18.28 ± 6.30, 78.29 ± 4.30, 65.27 ± 9.31, 21.24 ± 6.31, and 29.25 ± 7.30, respectively. Health literacy had a significant relationship with the perceived severity score, perceived susceptibility score, perceived response efficacy score, perceived self-efficacy score, perceived rewards score, and the overall score (P<0.05). However, health literacy had no relationship with the perceived sensitivity score, perceived response cost score, and protection motivation score.

Women's health literacy has a direct and significant impact on some of the determinants of Pap smear test performance. In other words, women with higher levels of health literacy are more inclined to undergo Pap smear tests.

Background and Object: 

Considering the high prevalence of covid-19 in the Iran and generally in Mazandaran province, the most important strategy for managing the crisis is the participation of citizens in different dimensions. Therefore, the present study was conducted with the aim of identifying and analyzing the factors affecting the level of community participation in the management of the Covid-19 crisis, which can be a road map for future planning in managing similar crises.

The present study was performed with a qualitative approach using content analysis by the conventional method in Mazandaran province. The data were collected through in depth semi structured interviews with 34 participants through a purposeful sampling method and analyzed simultaneously.

From data analysis, 3 main themes including 1) beliefs and attitudes with 3 sub-themes of perceived threat, perceived fear and anxiety, and perceived self-efficacy, 2) the main theme of drivers/facilitators with 9 sub-themes of informing, culture building and networking, capacity building/ jihadi and voluntary actions, inter-sectoral coordination, social trust, social responsibility, social resilience, compensatory/financial policies of the government and strategies for changing processes and policies in crisis management, and 3) and the main theme of barriers and challenges of community participation with 5 sub-themes of psychological challenges, social/cultural challenges, economic challenges, health challenges and management challenges is extracted.

The themes discovered based on the viewpoints of the Mazandarani citizens obtained valuable information about the factors affecting the level of community participation in the management of the Covid-19 crisis, which can be taken into account in planning and preventive measures.

Inadequate physical activity is one of the main causes of chronic diseases in adult and elderly individuals. The aim of this study was to evaluate the status of physical activity in middle-aged people (30-59 years) in Iran.

This cross-sectional study was conducted in 2020 on 4112 middle-aged population (30-59 years old) of the country using systematic proportional to size cluster sampling from five universities of medical sciences (Mashhad, Guilan, Alborz, Bushehr and Kermanshah) located in five different geographical areas were selected.The physical activity of individuals was assessed by Global Physical Activity Questionnaire (GPAQ) has been used in WHO STEPS methods. Data analysis was performed in Stata software version 14 using Chi-square test and logistic regression model.

The mean and standard deviation of the age of the subjects was 42.4 ± 7.8 years (men: 42.3±7 7.9 and women: 42.5 ± 7.8 years). According to the results, 61.3% (men:55.1%,women:67.6%) had insufficient physical activity. The percentage of appropriate physical activity was significantly higher in men than women (P <0.001) and in people with higher education (P <0.001) than people with less education.

Based on the findings of the present study, 61.3% of the middle-aged population of Iran do not have enough physical activity. Designing and implemention of interventional programs to increase the physical activity and prevent of main non-communicable diseases in this age group seems to be necessary.
 
 

One of the essential parts of postgraduate education is writing a thesis that has educational and research aspects which is an exclusive experience to students and teachers. The purpose of this study was to explore the teachers chr('39')experiences of Kurdistan University of Medical Sciences on the process of writing a dissertation among postgraduate students.

The present study was carried out with a qualitative approach and a qualitative content analysis method in 2019. By using the purposeful sampling method, 12 professors who worked at the Kurdistan University of Medical Sciences and having experience as a supervisor dissertation of postgraduate students have been selected and the semi-structured interviews conducted with them. The interviews recorded, transcribed, and analyzed by the content analysis method.

From data analysis of experiences of the participants as a supervisor at the dissertation of postgraduate students writing process, four categories of results have been extracted: 1. Student unpreparedness, 2. Not a priority of education, 3. Poor teamwork, and 4. Executive problems.

According to the findings, to prepare and more involving students with the process of writing a dissertation, to plan for coordination between different sections, to strengthen the spirit of teamwork, to improve policies and to upgrade the process of writing a dissertation recommended.

The global prevalence and morbidity of Coronavirus disease 2019 (COVID-19) are high. Preventive behaviors are proven to reduce the damage caused by the disease. There is a paucity of information on determinants of preventive behaviors in response to COVID-19 in Mazandaran province, north of Iran. So, we aimed to evaluate protection motivation theory (PMT) in promoting preventive behaviors of COVID-19 in Mazandaran province.

In this descriptive cross-sectional study, 1220 individuals participated. They were selected via social networks using convenience sampling in 2020. Data were collected online using a demographic questionnaire and a valid and reliable scale based on PMT. Data analysis was done using Pearson correlation coefficient and linear regression in SPSS V24.

Mean age of the participations was 39.34±8.74 years. Regression model showed perceived threat (ß =0.033, P =0.007), perceived costs (ß=0.039, P=0.045), perceived self-efficacy
(ß =0.116, P>0.001), and perceived fear (ß=0.131, P>0.001) as the significant predictors of COVID-19 preventive behaviors. This model accounted for 78% of the variance in these behaviors.

According to constructs of the PMT associated with protection against COVID-19, educational programs and health promotion based on the theory and benefiting from social networks could be helpful in increasing the motivation of people towards protective behaviors of COVID-19.

Breastfeeding has the highest efficacy in promoting health and preventing disorders and diseases. Cessation of breastfeeding, especially in the first six months after delivery (the critical time), has a profound effect on the emotional and physical health of mothers and children. Therefore, the present study was conducted to investigate the exclusive breastfeeding pattern and its related factors in children in Sanandaj 2018.

This descriptive-analytical study enrolled 400 children aged 7-24 months in Sanandaj, Iran. Data were collected with a three-part questionnaire including demographic information, factors affecting the exclusive breastfeeding and child-related factors through interviews. Data were analyzed by chi-square test in SPSS software (version 21). P value <5 was considered significant.

The results showed that the prevalence of exclusive breastfeeding was 71.5%. Significant relationships were found between exclusive breast feeding and the following variables: unwanted pregnancy, mother's perception of the adequacy of milk, baby’s hospitalization after birth, and skin-to-skin contact in the hospital, and breastfeeding within the first hour after birth. (p≤0.05)

Since the main reason for the reduction in exclusive breastfeeding is the fact that mother’s perception of inadequate milk and fear of baby’s hunger, breastfeeding can be promoted by designing appropriate programs for training mothers in healthcare centers in the third trimester of pregnancy.

Spiritual health is one of the factors affecting the quality of life. Although many studies have addressed spiritual health among students, little information is available about their experiences of spiritual vitality. The aim of this study was to explore student's experiences regarding to spiritual vitality in Kurdistan University of Medical Sciences.

This qualitative study was conducted on 36 students of Kurdistan University of Medical Sciences, selected purposefully. Data were collected through semi-structured interview and analyzed using content analysis.

By analyzing the findings, the individual factors and university atmosphere were extracted as the main themes among the extracted ones.

Students’ participation in cultural and charity activities and religious ceremonies makes them feel spiritual vitality. Thus, it is necessary to plan such activities in university to provide appropriate conditions for the development of spiritual skills in students.

Frequency rates of many non communicable diseases can be reduced by changing lifestyle. This study aimed to assess the status of lifestyle indices in relation to nutrition, physical activity and body mass index in middle-aged people referring to health centers in Kurdistan Province. This cross-sectional study included 5022 middle-aged (30-59 years old) in 2016. Sampling method was census. Demographic data about nutritional status, physical activity and body mass index were obtained from the apple system. Using SPSS software, data were analyzed by descriptive statistics, independent T-test and chi-square test. 5022 participants with equal sex ratio and a mean age of 41.8 ± 12.46 years were entered into the study. In our study men had more physical activity during walking and working than women (p <0.001). About 74% of the participants were overweight or obese. The proportion of obesity in the women was higher (p <0.001). The proportion of obesity in people who walked more than 60 minutes/day was less than that in those who walked between 31-60 minutes/day (28% versus 38%) (p <0.001). In spite of optimal consumption of vegetables by both genders, 52% of the participants did not consume enough fruit. Approximately 76.5% of the people had used enough dairy products. The women used dairy productes less frequently compared to the men (70% versus 83%), (p <0.001). Overweight and obesity in the study population were at an alarming level. Obesity prevention programs for, middle-aged people should focus on encouraging physical activity, especially in women.

relapse or retention to pre-treatment is one of the most important challenges in drug treatment program. Cognition of time to relapse in patients with relapse provides an opportunity for performing interventions. The aim of current study was identify the styles of relapse among drug abuser and stimulants.
This study was a cross-sectional study which in from all patients with drug abuse and stimulants referred to MMT, DIC and therapeutic camps centers in Sanandaj city (Iran), 150 patients was recruited multi-stage cluster sampling. The data collected through a Time to Relapse Questionnaire. Data analysis was performed using SPSS version 22.
The mean age was 40. 52 years (SD= 11.30). The most used substance that results in treatment was opium and opium juice (41.3%). The most used therapeutic style was self-avoidance (42.7%).The most purity period of drugs was related to treatment with methadone (78.7%). In terms of relapse styles, more than half (53.4%) participants had a sudden relapse. As well as 11.3% with short delay relapse, 18% with long delay relapse and 17.3% had more than one relapse.
The results of this study showed that the studied group had more sudden relapse that indicates the addiction therapists should seriously considerate teaching the necessary skills to deal with high-risk situations beside pharmacotherapy.

One of the most important factors determining health, are health-promoting lifestyle.The purpose of thisresearch was to Study of the Health-Promoting Lifestyle status of Students that Living in dormitories of Kurdistan University of Medical Sciences in 2016.
In this cross-sectional study, a sample of 152 female and 98 male studentsresiding in the dormitories of Kurdistan University of Medical Sciences were selected bystratified random sampling method in 2016. All the included students completed aquestionnaire with two parts, sociodemographic information and the standard Walker’slifestyle questionnaire. Data were analyzed by the independent samples t-test, Mann-WhitneyU test, Kruskal-Wallis, and Spearman correlation coefficients.
The mean score of health promoting lifestyle was 124.22 ± 17.98 from a maximum scoreof 208, indicating a moderate situation. The highestmean in the subscales was (23/94±4/42) for physical activity and the lowest was (16/40±4/80) for spiritual growth. There were significant associations between health promoting lifestyle (HPL) and marital status and field of study, but no significant associations between health-promoting lifestyle and gender Education and parental occupation.
This study showed that the score of health-promoting lifestyle is average among the students of Kurdistan University of Medical Sciences. Therefore, targeted interventions should be made to promote health-promoting lifestyle among these students.

Smoking is a common health problem which has involved many young people in the society. This study was done to assess the effect of a health education program considered based on the health belief model (HBM) to improve smoking preventive behaviors among 3rd-grade high school students in Nowshahr city, north of Iran.
This study was a quasi-experimental study in was performed on 280 male students of 3rd-grade high schools of Nowshahr city; they were randomly allocated into experimental and control groups. Data was collected through a researcher-made questionnaire including 40 questions based on health belief model (perceived susceptibility, perceived severity, perceived benefits and perceived barriers to smoking, and cues to action) and preventive behaviours of smoking. After data collection in the first phase, health educational intervention was implemented in the second phase. Data was analyzed using SPSS 18 with descriptive and inferential (Chi Square, independent t and pair t) tests.
The mean score of all HBM constructs in experimental group after applying health educational intervention compared with before the implementing the intervention was significantly different (p 0.05). Moreover, the mean score of all parts of HBM constructs after the intervention was significantly increased in the experimental group compared with the control group (p 0.05).
Implementing smoking preventive actions is effective on smoking preventive behaviors among high school students. Therefore, smoking prevention programs should be started before and during the high school period.

Introduction and Aim: personality trait determines the motivation and persons perspective regarding career and the way person responds to career demands. The present study was conducted to predict job performance and resiliency based on personality traits on the employees of Kermanshah Municipality.
the study population consisted of all employees of Kermanshah municipality working at 1st, 2nd, and 3rd districts of Kermanshah in 2014 on 550 people. The sample of this study included 225 who were randomly selected using Morgan table. The instrument condisted of five factor personality questionnaire (NEO) Costa and McCrae (1985), Connor-Davidson resilience Scale questionnaire (2003) and Patersons job performance questionnaire (1989). Data analysis was done using statistical software SPSS16, LIDRL, descriptive statistics and inferential statistics tests including path ananlysis, correlation, regression analysis and independent T.
Findings: The results showed that exogenous and extroversion variables had regression coefficient of 0.15 and 0.19 respectively and a direct significant effect on job performance. Moreover, there was a significant positive correlation between job performance and resiliency and there was no significant difference between male and female job performance.
In order to improve the human resources, more attention should be paid to the role of personaliy factors and resilience in the equations of human resources.

Although self-care is known to affect favorably the control and treatment of osteoporosis، the effective factors from the patients’ viewpoint have not been investigated. The aim of this study was to explore factors affecting self-care from the viewpoint of women suffering from osteoporosis. This was a qualitative study conducted with a content analysis approach in 2014، including 15 women consulting the bone mass densitometry centers in Sanandaj، Iran، selected by purposeful sampling. The inclusion criteria were women aged ≥ 50 years suffering from osteoporosis diagnosed definitively at least 6 months before، a T-score index > -2. 5 (lower back or hip bone)، taking drugs upon a physician’s advice، ability to speak، and willingness to participate in the study. Data were collected through face-to-face and group semi-structured in-depth interviews and analyzed using the content analysis method. The accuracy and rigor of the data were confirmed based on such criteria as credibility، confirmability and transferability. Five main categories were extracted including “background factors of the disease”، “hope and weakness in confrontation with the disease”، “role of the physician”، “role of the family”، and “administrative centers and organizations”. Based on further analysis of the data، 11 subcategories were emerged including “cultural issues”، “lack of knowledge”، “non-priority of health”، “weakness and fear”، “hope for the future”، “positive role of the physician”، “negative role of the physician”، “active role of the family”، “passive role of the family”، “role of the media”، and “information centers”. The finding of the study show that the responsibility of women suffering from osteoporosis towards their health is not a single-factor، but rather a multifactorial، phenomenon. Pre-requisites for empowering women to adopt self-care behaviors include increasing their hope to live longer، physician’s attention to the patient’s needs، increasing health promotion programs in the media، and strengthening role of the family (particularly role of men).

Breast cancer is the most common cancer among women worldwide. Thus, we aimed to determine the effect of stress inoculation group training on the hope and quality of life in women with breast cancer. This experimental study was conducted on 60 randomly selected women in chemotherapy ward of Razi hospital in Rasht, 2011. The instruments were Schneider hope and quality of life (SF-36) questionnaires. Of 60, 30 eligible patients were randomly divided into control group with no training and experimental group with stress inoculation training. Before intervention, the two groups were matched with demographic variables, hope and quality of life score. The results showed that the stress inoculation group training is effective both on hope and quality of life. Furthermore, the effect of this approach on quality of life was more than hope score (P=0.001). Stress inoculation group training is highly effective in improving the hope and quality of life in women with breast cancer. To be sure about its permanent effect, further research with follow-up period is needed.

The objective of this study was to determine factors associated with time to relapse and، thus، retention time، of a cohort of opioid-dependents under methadone maintenance treatment، using survival models، in the Iranian National Center for Addiction Studies (INCAS). A total of 198 opioid-dependent clients participating in the Methadone Maintenance Treatment Program، implemented by INCAS between April 2007 and March 2011، were included in the study. A Cox proportional hazard (PH) model was applied to determine predictors of relapse time among the patients. The data showed that 86 clients relapsed into drug use during the treatment program. The proportional hazard assumption was satisfied according to the goodness of fit test showing that Cox proportional hazard model was appropriate. Estimates of the PH model indicated that an increase of 1mg in the methadone dosage could lead to a decrease of 0. 15 in hazard ratio and an increase in the length of treatment (p<0. 001). Predictors for raising the probability of drug relapse included suffering from mental disorders (compared to mentally healthy: hazard ratio = 2. 29، p<0. 001)، being a poly-substance user (compared to mono-substance users: hazard ratio = 4. 80، p<0. 001)، and having retention experience in the past (compared to those with no previous therapy: hazard ratio = 1. 90، p<0. 001). Other variables entered in the model، including social and demographic variables، had no statistically significant effect on hazard ratio. Although higher methadone dosages are associated with a longer time to relapse، we recommend highly to pay special attention to providing more therapeutic and consultive services to mental health patients، poly-substance users، and individuals with a past therapy record.

Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia for non-medical reasons.The World Health Organization has estimated that 100 to 140 million girls and women worldwide are currently living with the adverse consequences of FGM. Two of the major incentives for FGM are traditions and social pressure, and the practice is mostly carried out by traditional circumcisers. Not only FGM has no health benefits for girls and women, but it has immediate and long-term complications. The objective of this study was to determine the prevalence of female genital mutilation and factors associated with it among women consulting health centers in Ravansar City, Iran

A cross-sectional study was conducted on 348 women consulting 5 health centers in Ravansar City, Iran. Data were collected using a structured questionnaire and SPSS.16 was used for data analysis.

The prevalence of FGM was 55.7% and the mean age of the women undergoing FGM was 9.2±14.2 years. The prevalence increased with age. Almost in all cases the operation had been performed by traditional local circumcisers. The data also showed that 96.2% of the mothers and 87.6% of the sisters of the subjects had also been mutilated. There were statistically significant associations between FGM and several independent variables as follows: the mutilated women's age (0.001) and education level (p<0.001); their mother's education level (p=0.006); and their awareness of, and attitude towards, mutilation (p<0.001).

FGM is prevalent among Ravansar women. Religious leaders and health personnel should attempt to discourage FGM. Promoting public awareness of FGM and its undesirable consequences is essential. Research shows that if a community itself decides to abandon FGM, the practice can be eliminated rapidly.

Unwanted pregnancies are among factors causing maternal mortality that can affect women's quality of life. This study was done to show the incidence of unwanted pregnancy and its relationship with health-related quality of life in pregnant women. This descriptive cross-sectional study enrolled all pregnant women who referred to health centers of Tazehabad urban _ rural health center during for routine prenatal care two month of January and February of 2007. According to the research aim, two questionnaires were completed for every pregnant woman: a questionnaire of pregnancy type and SF36 questionnaire to measure health-related quality of life. Data were analyzed with software of SPSS11. 5 by using descriptive statistics and statistical analysis of T-test. In our study 40. 2٪ women had unwanted pregnancy. In 15. 7٪ pregnancy was unwanted by the couple, 7. 8٪ unwanted pregnancy by husband and 16. 7٪ unwanted pregnancy by the wife. T-test showed the relationship between the average scores of health-related quality of life and type of pregnancy was significant (p = 0. 0001). Average scores of quality of life in mental and physical subscales of unwanted pregnancies were less than mothers with desired pregnancy (p=0. 0001). The decreased incidences of unwanted pregnancies would promote health-related quality of life in pregnant women

Nutrition is an important determinant of health in elderly and nutritional assessment is necessary for development of treatment protocols. The study aimed to evaluate nutritional status using multidimensional assessment in elderly. 140 subjects (76 men and 64 women) from elderly residence house in Kermanshah, Western Iran were studied. Data was collected using Mini-Nutritional Assessment (MNA), FFQ, anthropometry, bioelectric impedance, biochemistry tools. Hematologic and biochemistry markers were assessed in 5 ml fasting blood sample. 46.4% showed normal nutritional status while 38.7% have been classified as mild to moderate malnutrition and 14.9% suffered from severe malnutrition based on MNA scores. Malnutrition using different cut-offs were; body mass index 16.4%, haemoglobin 19%, albumin (with normal CRP level) 9.8%, ferritin 9.4%.