مصطفی فرح بخش

Hypertension is one of the most important public health challenges in the world, and self-care is an essential part of hypertension treatment. The present study aimed to investigate the effectiveness of a blood pressure management protocol based on the transtheoretical model on improving self-care, self-efficacy, and health-related quality of life in patients with hypertension.

This mixed-methods study consisted of two stages that were conducted in Tabriz Health centers in 2022-2023. The first stage was concerned with designing a blood pressure management protocol based on the transtheoretical model. The second stage was centered on a randomized controlled trial (RCT) to evaluate the effectiveness of the designed protocol on increasing self-care, self-efficacy, and health-related quality of life. Thus, 60 people with hypertension were included in the study and were randomly divided into two experimental and control groups. Data was collected via relevant questionnaires in the pre-test stage, immediately after the training (baseline), 2 months after the training in the post-test stage, and 4 months after the training in the follow-up stage. ANCOVA (repeated measures) statistical test was used to evaluate the effect of the intervention at different times.

In the patients of the experimental group, the designed protocol sustainably increased the dimensions of self-care over time (P<0.001). Also, this protocol was effective in increasing self-efficacy and health-related quality of life dimensions in the patients of the experimental group (P<0.001). This increase was not observed for the variables of self-efficacy, self-care, and quality of life in the control group (P>0.05).

The greatest effect of training based on the transtheoretical model was on the patients’ self-care. Furthermore, with the passage of time in the presentation of education, the effect of the intervention decreased. Therefore, it can be concluded that holding short training sessions continuously to stabilize the behavior change of patients with hypertension is necessary.

Energy consumption in Iran is currently very high and the energy efficiency of cities is low. Therefore, it seems necessary to prepare urban rules and regulations at the most executive level of urban policy making to increase energy efficiency in zoning as the main output of detailed plans. This research was conducted with the aim of exploring and measuring energy efficiency in urban rules and regulations with an emphasis on the zoning model. This research tried to see the relationship between the concepts of urban rules and regulations and energy efficiency and determine what parameters impact upon energy efficiency in urban rules and regulations. It also tried to examine the energy efficiency evaluation framework in urban zoning rules and regulations, their criteria, indicators, and final weights and to see how the energy efficiency of the existing urban fabric and the rule-based simulated urban fabric can be evaluated and compared.

This applied, descriptive-analytical research used a mixed method of qualitative and quantitative methods. To carry out this research, library and field studies, including questionnaire and secondary data analysis and Analytical Hierarchy Process (AHP) were used. GIS software and Expert Choice software were also used for this purpose. District 6 of Tehran city was selected as the case to be studied in this study.

The results showed that the energy efficiency evaluation criteria in urban rules and regulations that emphasize on the zoning model are as follow in terms of priority, importance, and weight obtained from the Analytical Hierarchy Process (AHP): Land use zoning, passive urban design for making thermal comfort, compactness, and connected network.

Exploring energy efficiency in both scenarios (the current situation and the simulated context based on the implementation of the zoning rules and regulations of the detailed plan) and comparing them showed that since there is not any rules and regulations pertaining to the main criteria of this study (passive urban design for the creation of thermal comfort and connected network in the zoning of the detailed plan of 2019 of District 6 of Tehran city), the two criteria have been considered to be fixed in both scenarios. So, if we suppose that zoning rules and regulations are fully executed, no change will happen in the status quo of the scenarios. That is, both criteria have similar energy efficiency in both scenarios.
Moreover, the energy efficiency based on the density criterion in the simulated scenario has increased by 39.85% compared to the existing scenario. This means that regarding this criterion, implementing zoning rules and regulations (including employment level and building density) have increased the density of the fabric compared. The zoning rules and regulations of the detailed plan in District 6 of Tehran, based on the density criterion, have played an effective role in increasing the energy efficiency of the simulated scenario. Moreover, comparing the status-quo scenario and the detailed plan zoning scenario regarding the other variable criterion (that is, land use zoning, which is also considered the most significant criterion of this research) showed that energy efficiency decreased when zoning rules and regulations have been implemented. The issue, in turn, clearly shows that the rules and regulations do not guarantee energy efficiency based on land use zoning indicators (such as green and open spaces, mixed areas, and housing type). Comparing the scenarios clearly showed that the energy efficiency based on land use zoning criteria in the zoning scenario of the detailed plan has decreased by 45.55% compared to the existing scenario.
The most significant finding of this study clearly showed that the energy efficiency has decreased by 22.25%, considering the weighted overlap of criteria in District 6 of Tehran in the zoning scenario and assuming the application of the related urban criteria. Considering this decrease, one can conclude that the urban rules and regulations are not effective in terms of energy efficiency. That is, if the rules are executed, they will increase energy consumption in urban areas and make worse the environmental consequences.
Taking account the findings, it is suggested that when establishing zoning laws and regulations, which is a criterion for the implementation of all future constructions, their undeniable role in energy efficiency be considered, and then all decisions be made based on criteria related to energy efficiency. This study evaluated the energy efficiency in urban rules and regulations with an emphasis on zoning in District 6 of Tehran. Considering the results, the following suggestions are made: The establishment of zoning rules and regulations that are compatible with various types of climates in Iran, and considering such applied factors as population density, density of residential units, general pattern of road network, the size of urban blocks, the length of urban blocks, the orientation of main streets, the orientation of buildings, and types of houses. The final aim is to improve energy efficiency.

Bipolar disorder is a chronic condition that necessitates lifelong medication, therapeutic interventions, and self-care. People with bipolar disorder and their families may have varied experiences regarding sleep management, stress, interpersonal relationships, and anger, which are frequently overlooked. In the current study, the knowledge acquired by patients with bipolar disorder and their families was evaluated. Then, an appropriate model for managing self-care knowledge among individuals with bipolar disorder was proposed.

The current mixed-methods study was conducted in four stages. The first stage involved a systematic review and meta-synthesis study in the field of knowledge management in the healthcare system. The second stage involved assessing the self-care experiences of patients with bipolar disorder. In the third stage, the codes obtained from the previous stages were prioritized by experts using Delphi techniques. In the fourth stage, a researcher prepared, validated, and distributed a questionnaire among mental health service providers stages. Finally, the personal knowledge management model of self-care and experience in individuals with bipolar disorder and their families was presented.

Almost half of patients with bipolar disorder do not adhere to their long-term treatment. Also, this disease requires patients to perform self-care activities in addition to drug therapy. So, the design and implementation of a knowledge management model for self-care and experience in people with bipolar disorder can be effective in improving their self-care behaviors and quality of life.

Child abuse is considered a major public health issue worldwide. The knowledge and attitudes of parents and health service providers are of great importance in the prevention and control of child abuse. Therefore, this study was conducted to investigate the knowledge, attitudes, and performance of healthcare providers (HCPs) and healthcare clients (HCCs) regarding child abuse in Tabriz.

This cross-sectional study was performed among 445 HCPs and 390 HCCs in Tabriz in 2021. The samples were selected via random sampling methods, and the information was gathered through a researcher-made questionnaire. In this study, knowledge, attitudes, and performance were considered dependent variables, and demographic variables were regarded as independent variables. Multiple linear regression was used to evaluate the association between dependent and independent variables. The data were analyzed using Stata statistical software (version 17).

The mean score of the knowledge, attitudes, and performance of HCPs was 73.2, 87.89, and 85.12, respectively. The mean score of knowledge, attitudes, and performance of HCCs was 58.81, 64.3, and 48.18, respectively. The knowledge and performance of HCPs had a significant relationship with passing a training course in the field of child abuse, jobs, and education, so that passing the training course increased the knowledge score by 3.33 units. In addition, the knowledge and attitude of HCCs were significantly associated with gender, education, and marital status, so that the knowledge score of people with postgraduate education was 8.03 units higher than that of those having a diploma.

Overall, the knowledge, attitude, and performance of HCPs toward child abuse were favorable. Therefore, they may have a high potential for detecting child abuse and developing preventive initiatives. Additionally, considering the medium level of knowledge and performance of HCCs toward child abuse, it seems necessary to design family education programs for future parents and launch community-based support services in health centers to prevent child abuse.

The findings of this study can be presented to the policymakers of the Ministry of Health to provide an opportunity to improve the knowledge, attitude, and performance of HCPs and HCCs by developing national guidelines for dealing with child abuse.

Hypertension is one of the most common and preventable diseases worldwide. The most effective way to control blood pressure is the patient's adaptation to self-care behaviors. In this regard, teaching the principles of self-care without considering the challenges of behavior change cannot be effective enough. Considering that most previous studies have been limited to self-care education, ignoring effective psychological approaches in behavior change, this study aims to design a blood pressure management protocol based on transtheoretical model and determine its effectiveness in patients with high blood pressure.

This study will be conducted in two stages. In the first stage, the management protocol of blood pressure will be designed based on the transtheoretical model using the literature review and expert panel opinions. Then the content of the educational package will be compiled. The second stage will include the intervention and evaluation of the effectiveness of the self-care protocol, self-efficacy, and health-related quality of life in patients with hypertension, which will be conducted through including two intervention and control groups. The information will be collected using questionnaires related to self-care, stages of change, quality of life, and self-efficacy. Data will be analyzed using SPSS version 22 software.

In Iranian society, adherence to treatment in patients with hypertension is low. Thus, implementing a self-care protocol based on the comprehensive theory of changing behavior such as transtheoretical model can be effective in improving self-efficacy, self-care, and quality of life in patients with hypertension.

Masks play a crucial role in preventing and controlling viral epidemics transmitted predominantly through the air. This study aimed to develop and validate a tool to measure people’s attitudes and behaviors related to mask usage during highly contagious viral epidemics.

In this psychometric study, the initial questionnaire was developed and face validity and content validity were assessed by 17 experts and three lay experts. Reliability was evaluated through internal consistency using Cronbach’s alpha and test-retest reliability using the Intraclass Correlation Coefficient (ICC). Construct validity was measured using exploratory factor analysis (EFA) with the principal component extraction method and Varimax rotation.

Based on a review of previous studies, an initial 27-item questionnaire was crafted. During the face validity stage, two items were excluded. Through calculating the Content Validity Ratio (CVR) and the Content Validity Index (CVI), three and one items respectively removed. The average scale level content validity index (S-CVI/Ave) was 0.95. Cronbach's alpha coefficient was found to be 0.76 for attitude and 0.66 for practice sections; the ICC was equal to 0.873. EFA revealed two factors explaining 63.98% of the total variance.

This questionnaire demonstrated sound reliability and validity in Persian, providing an effective means to assess attitude and behavior related to mask usage during highly contagious viral epidemics. It stands as a valuable tool for use in Iran and other countries.

Drugged driving is a growing traffic safety issue in many countries. Adequate knowledge of physicians concerning the effects of different medicines on driving can help them prescribe safer medications. This study aimed to assess the knowledge and attitudes of family physicians regarding the effect of medicines on driving.

This cross-sectional study was conducted on 91 family physicians in East Azerbaijan Province. A researcher-made questionnaire was used for data collection. This study considered knowledge and attitude as dependent variables and demographic characteristics as independent variables. To investigate the relationship between independent and dependent variables, independent t-test, one-way analysis of variance (ANOVA), chi-square, and multiple linear regression were used. Data were analyzed using Stata version 17.

According to the results, almost 65 (71.43%) of the participants were women and 26 (28.57%) were men with an average age of 31.54 years. The average score of physicians’ attitude about the effect of medicines on driving was 71.70 ± 14.94, and the average score of their knowledge was 37.52 ± 10.23. Therefore, 44 (48.35%) of the physicians had a good level of attitude, whereas 46 (52.87%) of them had a low level of knowledge regarding medications and driving. Receiving education regarding medications and driving was significantly correlated with the level of knowledge and the attitude of physicians (P<0.05). However, no significant relationship was observed between the attitude and knowledge of physicians and other demographic variables.

Considering physicians’ inadequate knowledge regarding the effect of medicines on driving, it is essential to hold training and retraining courses in the field of medicines and driving for physicians and develop a classification system for the drugs affecting driving in Iran.

The findings of this study can be presented to the policy-makers of the Ministry of Health in order to provide an opportunity to boost the knowledge and attitude of physicians regarding medicines and driving with the support of universities of medical sciences. As a result, an important step can be taken to reduce traffic accidents caused by prescription medicines.

Road Traffic Accidents (RTAs) are one of the essential causes of mortality;therefore, it is crucial to investigate the influencing factors. Studies indicate that drivers with attention deficit disorder have weaker driving performance than others. Therefore, it is vital to evaluate their driving performance in various circumstances, given their distinctive driving patterns.

In this methodological study, a total of 62 individuals in both genders, aged 18 to 59, 31 with Attention Deficit Hyperactivity Disorder (ADHD) and 31 in a control group were randomly referred to the Sahand driving simulator or take the tests of Vienna Test System (VTS),after a definitive diagnosis by a psychiatrist . This study protocol aims to compare the driving performance of ADHD drivers with that of control group drivers. In addition, a joint investigation of driving simulator assessments and the Vienna Test System (VTS) including Reaction time (RT) and Adaptive Tachistoscopic Traffic Perception Test (ATAVT) will be performed.

Primary health care system provides appropriate prevention and primary mental care services only for rural population. Therefore, the Community Mental Health Center (CMHC) was developed to provide mental health services in urban areas. The present study aimed to outline the performance, achievements, and challenges of CMHC in Tabriz, Iran.

This was a qualitative pilot study with in-depth interview approach. The outcomes, implications, and challenges of CMHC in Tabriz city were evaluated from 2015 to 2019 using three methods, including conducting in-depth interviews with two executive managers, holding focus group discussion (FGD) with managers and mental healthcare providers, and collecting mental health care indicators from the patients’ health records. After evaluating the challenges, appropriate recommendations to improve mental health services in urban areas were presented.

A total of 17 specialists and general medical doctors collaborated in this study. During the study, 1053 initial visits and/or screenings and 2313 patients with psychological disorders were identified and recorded. Moreover, a total of 988 mental training sessions were held for patients and their families. Five main themes, including the necessity for establishment and objectives, implementation process, achievements, challenges, and recommendations, were identified during in-depth interviews and FGDs.

It seems that CMHC is an appropriate strategy and model for providing basic mental health services, especially in metropolitan cities. Longitudinal studies with a randomized controlled trial design as well as cost-effectiveness evaluation studies are required to confirm CMHC in the Iranian context.

Suicide is recognized as a public health issue in Malekan County through a health community assessment. A community-based suicide prevention program was conducted during 2014-2017.

This health system research was conducted in seven steps, including conducting systematic reviews, gathering expert opinions, improving the coverage of suicide attempt records, conducting research to identify regional risk factors, conducting follow ups and managing the individuals attempting suicide, training health gatekeepers, and launching public awareness campaigns. Our goal was to lower the rates of suicide, and suicide attempt by 15% and 20%, respectively. Multiple logistic regression was calculated to estimate the adjusted odds ratios and the 95% confidence intervals.

821 suicide attempts and 32 suicides had been recorded in the county. 70% of the suicides had been committed by men while the majority of attempters were females (64%). Most of the suicides (18cases-56.25%) had occurred in the spring while the majority of suicide attempts (288cases-35.8%) had been recorded in the summer. The common methods (62%) suiciders used were hanging and poisoning, which increased death risk significantly (OR: 8.5, 95% CI: 2.9–76.99). The incidence rates of suicide and suicide attempts reduced from 11.22, and 203 per 100,000 in 2013 to 2.63, and 157 in 2017, respectively. Suicide re-attempts also diminished from 12% in 2013 to 6.7% in 2017.

Suicide, SA, and re-attempt were lowered by 75%, 22%, and 42%, respectively. Practical Implications. The practical framework that emerged out of the present study can be used for generating future suicide prevention strategies. Furthermore, our study highlights the need to consider a wide range of contextual factors when developing suicide prevention programs.

Surveillance has defined the systematic collection, continuous, analysis and interpretation of health-related information required for the planning, implementation, and assessment of public health performance. This study was aimed to determine the standard structure and components of COVID-19 surveillance and comparison with the Iranian present surveillance system to identify unforeseen components or need to be reviewed, weaknesses, strengths, and providing appropriate solutions.

In this qualitative study, two methods were used: a) reviewing the published guidelines of COVID-19 disease by the Iranian Center for Disease Control, from the beginning of the outbreak to April 19, 2020, and b) The opinion of experts and researchers. The standard structure and components of the COVID-19 surveillance (what standard surveillance must have) were compared with the components of the current surveillance system (what it has).

We found five main structures and 29 components and many various sub-components of the standard surveillance system for COVID-19. According to expert’s comments by comparing the standard surveillance with the current surveillance system, the components related to psychiatric and psychological aspects, epidemiological surveillance, standard precautions, especially for the health workers in close contact with the patient, reporting and social surveillance need to be revised or improved in the current guideline.

Epidemiologic surveillance is the most imperative and effective structure for COVID-19 control. Evaluation indicators are recommended to measure the ability and efficiency of the surveillance system, and also the evidence-based decision-making for appropriate disease control.

This study was aimed to assess Service Quality (SQ) of maternity care from the perception of pregnant women. Methods and materials: A cross-sectional study was conducted using a sample of 185 pregnant women at the 9th month of pregnancy were selected randomly from 40 health posts and urban health centers in Tabriz، Iran. Service Quality was calculated using: SQ = 10 – (Importance × Performance) based on importance and performance of non-health aspects from the customer’ perspective. Data collection used a researcher-developed questionnaire whose validity and reliability was reviewed and confirmed. Data analyzed using SPSS-17 software. Independent sample T-test and ANOVA were used to investigate relationship between service quality dimensions and categorical variables.

From the customers’ perspective the average service quality score was 7. 59 of 10. Service quality aspects of “confidentiality” achieved scores at the level of good quality (≥9); and “support group” (3. 48) reached low service quality scores. Also، result indicate housewife assess SQ better than worker (p=0. 047) and mother who''s have planned pregnancy has had greater SQ score (p=0. 022). Although، in the linear regression analysis، job status and planned pregnancy were significantly and independently related to SQ score.

Findings revealed a significant room for quality improvement in most aspects of provided care، particularly support group and safety from the perception of people who received maternity care.