maryam khazaee-pool

Fertility is a key demographic factor influencing population fluctuations. There is a global trend toward delaying childbearing, and Iran is also undergoing significant changes in this regard. This review study examines the factors influencing childbearing and associated obstacles from 2010 to 2022.

This systematic review utilized PubMed, Scopus, SID, and Web of Science databases to analyze articles published in both Farsi and English from 2010 to 2022. The keywords in both Persian and English included childbearing, attitude, women, reasons, fertility, and obstacles. All studies related to obstacles and factors influencing childbearing published in English between 2010 and 2022 and in Persian up to 2022 were included. In this review, the population (P2) refers to married women, intervention (I3) to the effective factors, comparison (C4) is not applicable given this study's reporting nature, and outcome (O5) refers to childbearing. The search within each database was conducted using title searches, with standardized MeSH terms such as childbearing, attitudes, women, reasons, fertility, and obstacles, combined with operators (e.g., AND, OR) to ensure comprehensive retrieval.

The search yielded 1,254 articles, of which 36 met the inclusion criteria after applying entry conditions, availability of article files, and removing duplicates. Factors such as social and cultural status, urban versus rural residence, educational level, and individuals’ religious and ethnic beliefs significantly impact couples’ decision-making regarding childbearing. Additionally, governmental policies, including support for pregnant mothers, play an influential role.

Analysis of the 1,254 articles showed that economic, social, and cultural factors are significant social determinants of fertility. Ethnic background, education level, family orientation, religiosity, age at marriage, government policies, place of residence, and occupational status were identified as factors influencing childbearing. Religious and traditional values tend to increase fertility rates, especially among families with lower socioeconomic status. Educational programs aimed at improving beliefs and attitudes, promoting positive social norms, and strengthening empowerment skills may significantly enhance Iranian women’s reproductive intentions and behaviors. The findings of this study provide guidance for health policymakers in addressing obstacles to childbearing and supporting population growth in Iran. Additionally, by fostering favorable socio-economic conditions and recognizing diverse fertility behaviors across regions and cultures, reproductive health and pregnancy programs can better align with population growth policies.

In 2023, the incidence of tuberculosis (TB) in Golestan Province was reported to be 26.1 cases per 100,000 people, which is three times higher than the national average in Iran. The contagious nature of tuberculosis has economic repercussions and indirect effects on the quality of life of affected individuals. The stigma associated with tuberculosis often leads to social isolation, which can hinder TB control efforts. On the other hand, social support from family, friends, healthcare workers, and community leaders improves quality of life, promotes self-care behaviors, and enhances patient adherence to medication regimens. This study aimed to determine the correlation between stigma, social support, and self-care behaviors in patients with tuberculosis.

This cross-sectional (descriptive-analytical) study was conducted in 2023, surveying 325 tuberculosis patients undergoing treatment in Golestan Province. Data were collected using a demographic information questionnaire, a 12-question stigma questionnaire (patients' perceptions of tuberculosis), the Sherborn and Stewart Perceived Social Support Questionnaire, and the self-care behaviors questionnaire for tuberculosis patients by Herandi et al. The data were analyzed using SPSS version 24 software. To investigate the relationship between perceived stigma and social support with the dimensions of self-care behaviors in tuberculosis patients, Spearman and chi-square tests were used. Logistic regression was employed to predict factors affecting self-care in the studied patients.

The average age of the participants was 51.97±17.33 years, with an age range of 19 to 84 years. The overall scores for the stigma questionnaire, perceived social support questionnaire, and self-care behaviors questionnaire were 29.03 ± 5.30, 71.14 ± 14.53, and 84.78 ± 10.17, respectively. Based on the univariate logistic regression model, the variables of race, number of family members, addiction, and age were analyzed for their effects on self-care behaviors. Additionally, the effects of marital status and age on stigma were examined. Significant effects of family size, income, and marital status on social support were observed. Spearman correlation tests showed an inverse and significant correlation between stigma and social support (r= -0.19, P= 0.001), stigma and self-care (r= -0.21, P<0.001), and a direct and significant correlation between social support and self-care (r= 0.55, P<0.001).

As stigma increases, levels of social support and self-care behaviors decrease. Stigma has a significant impact on tuberculosis treatment, while higher levels of social support enhance self-care and accelerate the recovery process. To control tuberculosis effectively, comprehensive support from community leaders, the Ministry of Health, welfare organizations, relief committees, municipalities, and other organizations, as well as from patients' families and surrounding communities, is essential. Additionally, health and medical intervention programs aimed at increasing self-care behaviors, raising awareness among patients, and reducing stigma and misconceptions among families, friends, healthcare workers, and society at large are recommended.

Self-care is recognized as a fundamental approach in the field of providing, maintaining, and promoting health in individuals, families, and society. Providing essential training in the field of self-care is one of the important tasks of primary health service systems to the community, including household health ambassadors. On the other hand, determining the educational needs of self-care in each society should be based on the educational needs assessment in the same society. Therefore, the present study was conducted to determine the educational priorities of self-care using the educational needs assessment of health ambassadors.

The current study is a cross-sectional study (descriptive-analytical). The research community included household health ambassadors living in the Golestan and Mazandaran provinces. Entry criteria included being family health ambassadors, being between the ages of 20 and 60, and volunteering to enter the program. Also, the exclusion criteria included the health ambassador's unwillingness to participate in the evaluation. The study tools included a demographic questionnaire and a researcher-made questionnaire on "self-care educational needs" for health ambassadors. The health ambassadors' needs assessment questionnaire was the result of self-care educational priorities based on a general survey of the community, which was scored by the health ambassadors. Data analysis was done using SPSS version 20 software. U-Mann-Whitney and Kruskal-Wallis tests were used to analyze the data.

Results showed that the average age of health ambassadors participating in the study was 38.11±9.64 years. 987 people (57.8 percent) of them were health ambassadors of Golestan province and 721 people (42.2 percent) of them were health ambassadors of Mazandaran province. Also, concerning the participants' gender, 1439 people (84.3%) were women and 269(15.7%) were men. The educational needs assessment showed the top 10 priorities among self-care education topics determined by household health ambassadors, including stress and anxiety, healthy eating, life skills, parenting skills, water hygiene, inactivity, depression, skeletal problems, and lack of vitamins. , and oral and dental health. It was also shown that there is a statistically significant difference between different subgroups of participants such as gender, place of residence, education level, occupation, and ethnicity with self-care educational priorities in household health ambassadors (P<0.05).

The findings of the study showed that mental health issues such as stress, anxiety, and depression, as well as issues related to people's lifestyles, such as healthy eating, inactivity, and skeletal problems, were determined among the needs-based priorities for community education. Due to the limitation in financial and human resources, it is necessary to conduct self-care training based on the needs assessment of the society, because, on the one hand, an important part of the health needs of the society will be answered. On the other hand, the educational subjects that have priority will be the target of educational programs.

Health tourism is a branch of the tourism industry that is of interest to many countries of the world due to its high demand and good income. Therefore, considering the importance of health tourism and the existing potential in Mazandaran province, this study was conducted with the aim of identifying and analyzing the factors affecting the development of the health tourism industry in Mazandaran province.

The present study was conducted using a qualitative method with a content analysis approach. For this purpose, 17 health tourism industry experts and health tourists were selected using the purposeful sampling method. Semi-structured interviews were used to collect data. The interviews were conducted until we reached a point of theoretical data saturation.

The findings showed that the health tourism industry in Mazandaran province is affected by structural, process and contextual factors. The structural factors included issues related to infrastructures, potentials/attractions, institutional factors, and expert human resources for health tourism destination. The process factor included issues related to drivers of health tourism, provision of health services and destination situational factors. The contextual-field factor included issues related to sociocultural contexts, potentials and attractiveness of tourism, and economic capacity.

Despite the importance of services related to health tourism and considering the increasing demand of this industry, travelers who travel to Mazandaran province need a variety of services, and the need to pay attention to quality service development in tourism destinations is evident. Therefore, the provision of other essentials for health tourists such as infrastructure, destination attractions, financial capacities, sociocultural conditions, human resources, situational factors are  the requirements for the development of this industry.

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.

Knowledge translation is the sharing of knowledge obtained from research with knowledge users, including community members, organizations, and policymakers, to use it to improve systems and improve the provision of services and products. The implementation of the knowledge translation process in the health field is facing challenges in our country, which is partly because of insufficient knowledge about the concept of knowledge translation and how to implement the knowledge translation process. In the present study, the definition of knowledge translation, and how the process and tools of knowledge translation were discussed, and then, while reviewing the status of knowledge translation in Iranian universities of medical sciences, solutions for the implementation of knowledge translation were presented. Some of the mentioned knowledge translation tools in this study are podcasts, three-minute thesis presentations, webinars, infographics, research news from research results, press releases, journal clubs, policy briefs, and clinical guidelines. The situation of knowledge translation has been reported as inappropriate and incomplete in medical sciences universities of Iran. In these studies, the evaluation was done using the evaluation tool of knowledge translation, which included the four areas of audience needs assessment, knowledge production, knowledge transfer, and evidence application. According to the current situation of knowledge translation, the implementation solutions of knowledge translation in each field have been presented separately. Appropriate networking between knowledge producers and knowledge users, as well as holding regular meetings with representatives of executive organizations and industry owners to determine research priorities, are among the solutions presented in the audience needs assessment section. Creating the infrastructure to carry out research projects based on the needs of the audience, allocating the necessary resources for the implementation of research projects, active participation of representatives of executive organizations in the process of conducting research, creating an internal network between academic researchers to advance research priorities as much as possible, and also pay attention to the quality of knowledge production to gain the trust of the audience are the solutions provided in the knowledge production sector. Acquainting researchers with the field of knowledge transfer and its importance, allocating resources to implement the knowledge transfer process, using appropriate and up-to-date tools for knowledge transfer by researchers, and creating rules to support researchers who, before publishing their research findings in reputable journals, publish them through other means of knowledge transfer, institutionalizing the mechanisms of benefiting from the research achievements in the general education program, and also considering the incentive plans for the transfer of the produced knowledge are among the solutions presented in the knowledge transfer section. Producing valid and reliable evidence, placing produced evidence at the disposal of policymakers, building trust in the audience by researchers, policymakers, and relevant officials to use produced evidence, informing the audience about the need to use production evidence, creating appropriate communication between knowledge producers and knowledge users through the use of knowledge brokers, the existence of resources and financial support for the use of evidence by policymakers as well as target audiences are some of the solutions provided in the use of evidence section

The purpose of this study was to investigate the state of anxiety as one of the indicators for determining the mental health of Sari dental students during the COVID-19 virus epidemic.

This cross-sectional study was conducted in the year 1400 among all incoming students from 95 to 97, selected by census method, including 143 people in the Faculty of Dentistry of Mazandaran University of Medical Sciences in Sari City. The tools for collecting the required information are a demographic questionnaire and a researcher-made questionnaire on anxiety caused by COVID-19. Based on the score obtained by the participants in this questionnaire, they were divided into three anxiety levels, which included low, medium, and high. Data analysis was done with a chi-square test in SPSS software.

143 people, including 47 (32.9%) people from the 2016 entry, 55 (38.5%) people from the 2017 entry and 41 (28.7%) people from the 2018 entry participated in this study. 73 (51%) of the participants were women. The results of this study showed that 50.3% of students experience a low level of anxiety, 46.9% experience a moderate level of anxiety, and 2.8% experience a high level of anxiety. Also, a significant relationship between the academic year and the level of anxiety was observed so that the students of the newer year showed a higher level of anxiety. There was no significant relationship between gender and place of residence with anxiety level (P>0.05).

There is a significant relationship between the level of anxiety and the academic year of the students. In this way, the stress level is higher in the newer entries. To reduce the anxiety level of students, there is a need to revise the management of infection control, improve the work environment, and learn how to deal with patients to protect everyone, as well as education and support from academic institutions.

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.

The universal nature of science and increasing complexity of technological issues and developments in different sciences led to the growth of interdisciplinary cooperation. Some health issues such as addiction, population aging, emerging and re-emerging diseases, and environmental pollution are beyond the scope and capacity of a single-discipline expertise and require constructive dialogue and cooperation between different specialized fields. Currently in Iran, the development of interdisciplinary cooperation is not of much interest at medical sciences universities. The present policy brief aimed at addressing this issue by reviewing the upstream documents proposed by the Parliament Education/Research Commission, the development roadmap in the 9th and 10th governments, and interviewing elites in interdisciplinary fields.

Considering the global spread of COVID-19, it seems that correct information obtained from reliable sources and training based on the need for self-care behaviors are useful solutions to reduce the harm caused by the disease. This study aimed at assessing the educational needs of people in Mazandaran province about COVID-19.

In a cross-sectional study, 1220 people were recruited via convenience sampling in 2020. A researcher-made questionnaire was administered and information such as demographic characteristics, disease condition, and educational needs for COVID-19 were recorded. Data were analyzed using descriptive statistics and parametric tests, correlation, analysis of variance, and t-test.

The mean age of the participants was 39.34 ± 8.74. Educational level included diploma (42.5%) and university education (38.9%). About 73.3% of the participants were women. According to findings the main sources of information about COVID-19 were social networks (68.4%), satellite programs (20.9%), Ministry of Health notices (8.1%), national media (1.6%), other sources (0.6%), and family members (0.4%). Online methods were the most desirable educational methods (94.6%) reported by the people living in Mazandaran province. The overall mean score for educational needs was 3.89±0.96. The educational need for the disease (3.76±0.84) and self-care needs (4.03±1.07) indicated high needs for educational trainings and significant differences between these areas (P=001).

In this study, social networks and media were the primary sources of information about COVID-19. Designing and implementing self-management and self-care training programs could improve the health of people in Mazandaran province and prevent the spread of COVID-19.

The knowledge, attitude, and practice (KAP) of healthcare workers are important to reduce the transmission and burden of dengue. There is no standard tool to assess KAP of healthcare workers about dengue in Mazandaran Province, Iran, so this study was conducted to design and assess the validity and reliability of a questionnaire in Persian assessing KAP of healthcare workers about these mosquito-borne viral disease.

In this descriptive analytical study, a preliminary questionnaire containing 81 questions was designed after reviewing articles and interviews with experts. To determine the validity of the scale, quantitative-qualitative face and content validity were measured, and Cronbach's alpha coefficient was used to assess the reliability.

In the study of face validity and qualitative content, experts' opinions were applied to the items as minor changes. The Impact Score (IS) of all items were higher than 1.5 (1.5-5) which provided supports for items importance. Content validity, based on the Lawshe table, optimal value of content validity ratio (CVR), and content validity index (CVI) were 0.6 and higher than 0.8, respectively. All items except one that was removed, obtained the desired score and were retained in the scale. Cronbach's alpha coefficient was 0.79 which showed that all items had an acceptable correlation.

This study provided a reliable and valid tool in Persian to assess KAP of healthcare workers about dengue in Mazandaran Province, north of Iran and can be used for measuring dengue KAP by Iranian researchers.

COVID-19’s proliferation worldwide remains a significant threat to public health; therefore, the assessment and measurement of people’s intentions concerning the prevention of this threat can contribute to the development of suitable educational messages that promote preventive behaviors. This study aimed to develop a questionnaire to determine the factors affecting person’ intention of COVID-19 prevention (FAPI-COP).

This descriptive study was conducted on the people living in Mazandaran Province in 2020. The questionnaire was designed via literature review, focus group discussions, and interview with experts. A total of 10 specialists were selected to determine the content validity scores and 10 Mazandarani laypeople used to determine the reliability of the questionnaire. Finally, content validity index (CVI) and content validity ratio (CVR) were calculated by using Cronbach’s alpha and intraclass correlation coefficient (ICC) in SPSS, version 24.00.

The first questionnaire consisted of 51 questions, and after evaluating validity and reliability, 36 questions were obtained. The content validity index of the questionnaire was 0.91, the content validity ratio 0.69, the Cronbach's alpha coefficient 0.78, and the internal correlation coefficient (ICC) 0.95 with the confidence interval of 0.80-0.99.

The results of the study showed that the present questionnaire had acceptable levels of reliability and validity, making it a useful tool in determining the factors affecting intention of COVID-19 prevention by people.

Objective (s):

Due to the rapid growth of the country's elderly population, the need to pay attention to social participation as one of the determinants of health and modifiable in the process of active aging is very important. Thus, the aim of study was to determine the level of social participation, barriers, and related factors in the elderly people of Mazandaran province, Iran.

In this descriptive-study, 421 elderly people over 60 years old in Mazandaran province were selected by stratified and cluster random sampling. The data collection tools were a demographic characteristics questionnaire, a researcher-made questionnaire of social participation, and the Social Participation Barriers. Data were analyzed by SPSS v24 using independent t-test, one-way ANOVA, Pearson correlation coefficient, and linear regression at a significant level of P<0.05.

The mean age of the samples was 72.55 (8.81) years, and the mean score of social participation was 22.87)11.81(. The highest level of participation was related to the cultural-religious dimension 8.43)4.46) and the lowest level was related to the political activity dimension 3.76(2.44).  Being out of reach (86.7%), lack of physical accessibility of activity and facilities (83.6%), impatience (83.1%), costs and financial problems (82.7%), and diseases and health problems (80%) were respectively the most important barriers to social participation. The male elderly with low age, employed, and college-educated had significantly better scores of social participation (P<0.05). According to the regression analysis, 59% of the variance of social participation was explained by age, education, and gender.

The social participation level of the elderly in Mazandaran was low. Therefore, the need for policy-making and the design of comprehensive programs, and developing a proper environment to reduce barriers, seems important to improve social participation in elderly.

The health care environment is changing rapidly, and nurses are exposed to a variety of ethical issues and moral conflicts. Therefore, the present study aimed to explain the experiences of nurses regarding moral conflicts in the educational and medical centers of Mazandaran University of Medical Sciences in 2019.

The present qualitative study was conducted in educational and medical centers of Mazandaran province. Semi-structured interviews were used to collect data. Inclusion criteria include nurses with at least one year of work experience in the hospital who were willing to share their experiences of moral conflicts. Graneheim, U.H., and Lundman, B. Qualitative Content Analysis were used for analyzing the content.

In the present study, in-depth and semi-structured interviews were conducted with 22 participants (16 women and 6 men). In total, 3 main themes and 11 sub-themes were extracted from the data analysis. The subjects include "organization-related factors", "factors related to effective communication", "dilemma of morality versus law".

According to the findings of this study, managers and other members of the healthcare team should support nurses in the face of ethical challenges. Furthermore, continuous in-service training courses should be provided for nursing staff.

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.

Road traffic accidents (RTAs) have always a major concern and human factor has been recognized as their leading cause. Since taxi drivers play a significant role in accidents, the main purpose of this study was to provide a valid and reliable version of the Dula Dangerous Driving Index (3DI) for taxi drivers working in the city of Zanjan, Iran.

Based on the convenience sampling method, 316 taxi (including taxi, internet taxi, etc.) drivers were recruited in this descriptive study. The 3DI contained 28 items within three factors related to dangerous driving behavior. After linguistic validation, qualitative and quantitative face validity was determined for the given questionnaire. Consequently, content validity index (CVI) and content validity ratio (CVR) were assessed by a panel of 10 experts. Internal reliability was further calculated based on Cronbach’s alpha coefficient and test-retest method.

The results revealed that face validity (1.60-3.82.), CVR (0.8-1), and CVI (0.891-1) were acceptable. Cronbach’s alpha coefficient was also 0.896 for the total reliability of the instrument and 0.95, 0.89, and 0.94 for each factor, respectively. In addition, Spearman’s rank correlation coefficient was 0.871 (P-value<0.001).

The results ultimately demonstrated that the Persian version of the 3DI had adequate reliability, as well as, face and content validity. However, construct validity remains.

Coronavirus disease (COVID-19) is an infectious disease caused by the new corona virus. The disease has led to high death toll and extensive damage throughout the world. The aim of this study was to determine the predictors of COVID-19 preventive behaviors in Iranian population based on the Health Belief Model.

A descriptive-analytical cross-sectional study was carried out in 400 individuals older than 18 years of age in Mazandaran Province, Iran 2020. They were selected using convenience sampling in social networks. Data were collected by a researcher-made scale based on Health Belief Model. Data analysis was done applying Pearson correlation coefficient and linear regression.

There were significant positive correlations between preventive behaviors of COVID-19 and perceived susceptibility (r=0.2, P=0.000), perceived benefits (r=0.127, P=0.011), perceived barriers (r=0.189, P=0.000), and perceived self-efficacy (r=0.302, P=0.000). The Health Belief Model constructs predicted 26% of variance for preventive behaviors of COVID-19, among which, perceived self-efficacy (β=0.220) was the most powerful predictor.

This study confirmed the predictive role of self-efficacy in COVID-19 preventive behaviors according to the Health Belief Model. Thus, providing ways to increase self-efficacy such as verbal persuasion, increasing awareness about people abilities, and providing them with suitable models could promote preventive behaviors toward COVID-19.

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.

Food insecurity as a major public health problem has associations with a wide range of adverse consequences on health and quality of life. The aim of this study is to determine the prevalence of food insecurity among Iranian households, its key socio-economic risk factors and population attributable risk via a large-scale cross-sectional study in the capital of Iran.

This cross-sectional study was performed among 30,809 households with complete questionnaires of food security, during 2011. The univariate test was used to investigate the association between economic status and covariates with household food insecurity. Multiple logistic regression model was used to assess the independent effect of economic status on household food insecurity.

Totally, 37.8% (95% CI: 37.25, 38.34%) of the households were food insecure. There were significant associations between economic status and household food insecurity after adjustment for other variables (p-value<0.001). The extent of household food insecurity that could be attributed to the economic status in the 1st and 2nd quintiles (poorest and poor households), compared with the 5th quintile (richest households), was estimated to be 48.43% and 60.12%, respectively.

Food insecurity is relatively prevalent among households in Tehran. Economic status was identified as the most significant determinant of household food security, as 62.7% of poorest households were food insecure. Therefore, there is a crucial need to address food insecurity as a priority in food policies.

Traffic jams and transportation are an important part of the spectrum socioeconomic and environmental factors outside the health system with impacts on health. The aim of this study was to explain the residents’ viewpoints about the impacts of urban traffic on their physical health in Sanandaj.
The study was carried out qualitatively with content analysis method in 2014. Twenty-two residents of the city were selected as participants who were interviewed in a Focus Group Discussions (FGDs) (4 sessions) and in-depth individual interviews (8 sessions), respectively. A purpose-based sampling method was used in this study. The MAXQDA10 software was applied to facilitate the coding and categorizing the data.
Based on the viewpoints of the participants, urban traffic jams has two direct and indirect negative impacts on physical health. The direct effects cause premature aging, excessive fatigue, and mental illness and make some problems in the musculoskeletal system, digestive system, nervous system, respiratory system, cardiovascular system. The indirect influences include pure reliance on the car, accidents, traffic congestion and air pollution.
Healthcare researchers and urban traffic policymakers should design comprehensive studies to assess the impacts of urban traffic jams and transportation on community health. Therefore, they would be able to investigate the impacts on the health of individuals after the enactment of each law and planning and to implement community-based health promoting strategies in the society.

Schools provide an important setting to promote health, especially in Iran with about 12 million children, moreover for school staff, families, and communities. The health-promoting schools approach has been implemented in Iranian schools. This qualitative study aimed to explore the perspectives of school health experts towards the strengths, challenges, and improvement strategy for health promoting schools.
In This qualitative study, data was collected using semi-structured interviews with 14 health schools, professionals and 3 school headmasters in seven provinces of Iran. We recruited interviewers through purposeful sampling. Thematic analysis was conducted to analyze the data by using MAXQDA ver 10.
The results were categorized into eight themes. The main strength, perceived in " based on participatory program "," feedback-driven program"," training- driven program"," a systematic program". The main perceived weakness was ''inefficient executive structural mechanism "and" inefficient property of the program "Improve the supporting infrastructure," and" Reload executive structures were suggested as a corrective mechanism from participants’ view point.
The effectiveness of the health promoting school program, as well as all successful programs in health system requires revision and localization.

Iron deficiency anemia is one of the most common nutritional problems of women in reproductive age, which has a major impact on fetal growth, low birthweight and premature delivery. This study aimed to assess the prevalence of anemia and related factors in pregnant women having referred to health centers of Mazandaran province.
In this descriptive-analytical study, 866 pregnant women were selected through stratified cluster sampling method from 19 cities, affiliated to Mazandaran University of Medical Sciences. Data was collected by using the registration form and information obtained through maternal family documents and a questionnaire. SPSS software version 18 was used and the data were analysed by descriptive and analytical statistics such as mean comparison test, chi-square and logistic regression.
The prevalence of anemia in Mazandaran was 13.4% and it was higher among pregnant women in urban areas than those in rural areas. Logistic regression showed that mother’s age, number of pregnancies, prenatal care, unwanted pregnancy, consumption of red meat, using iron tablets, tea drinking, and mother’s education level had a significant effect on anemia.
Since iron deficiency anemia is a preventable problem and pregnant women are among the vulnerable groups, considering care programs before and during pregnancy, having appropriate dietary patterns, consumption of iron supplements, and having a program to prevent unwanted pregnancies may lead to reducing the risk of catching a disease.

Health-related quality of life (HRQOL) is associated with household food insecurity (HFI). However, the studies examining the relationship between HFI and HRQOL in patients with type 2 diabetes are scarce. Thus, this study was designed to examine the relationship between HFI and HRQOL in rural type 2 diabetic patients.
In this cross-sectional study, we included 1847 rural patients with type 2 diabetes in Neyshabur from April to July 2012. HRQOL and HFI were measured with 36-item HRQOL (SF-36) and 6-item version of Household Food Security questionnaires, respectively. HRQOL was divided into eight dimensions and two summary components. We categorized households as high food secure (HFS), low food secure (LFS), and very low food secure (VLFS). Multiple linear regression model was applied to assess the independent effect of food insecurity on HRQOL.
The mean age of participants was 59.65 ± 12.3 years (range: 30–97) with 69.8% women. The overall prevalence of HFI was 46.1%, and the total mean score of HRQOL was 51.11. Multiple linear regression model showed that HFI was significantly associated with the total mean score of HRQOL and its eight dimensions. One-way ANOVA test also showed that HRQOL (in all dimensions) was significantly different between 3 groups of household food security status (HFS, LFS, and VLFS) (P The results of this study showed that HFI was associated with all dimensions of HRQOL and it is one of the strongest variables, in association with HRQOL among rural patients with type 2 diabetes.

There is mixed evidence about food insecurity and overweight/obesity coexisting, however it is unclear about association between food insecurity and weight status in people with type 2 diabetes. Therefore, the aim of this study was to evaluate the relationship between food insecurity and weight status in individuals with type 2 diabetes in rural areas in Iran.

1847 patients with type 2 diabetes who were residence in rural areas completed Household Food Security Scale (six-item short questionnaire). Logistic regression model was applied to assess the independent effect of food insecurity on weight status.

Mean age of the study population was 62.6±11.8 years, and the majority of them were female (70.4%). Most of the study population (70.4%) had unhealthy weight status. Food insecurity affected more than 46% (n=852) of the households of the study population. According to weight status, more than 40% (n=565) of overweight and obese subjects and 60% (n=18) of underweight subjects lived in households with food insecurity. The results of multiple logistic regression model showed that food insecurity was not an independent significant predictor of overweight or obesity in patients with type 2 diabetes. However, low food security (LFS) was an independent significant predictor for underweight in patients with type 2 diabetes (OR=2.35, P=0.041).

It is concluded that food insecurity was frequent in all levels of weight status of patients with type 2 diabetes in rural regions. However this association observed in underweight individuals but there was no significant overall relationship between household food insecurity and in overweight and obesity in this group of patients.

There are limited documents about HIV patients switched to second-line antiretroviral therapy (ART) in resource-limited countries. We aimed to assess the efficacy of second-line ART for HIV patients following first-line ART failure. This was a cohort study of HIV/AIDS patients with first-line ART treatment failure switched to second-line ART between January 2004 and March 2014, who followed for at least 12 months after switching. Fifty of studied patients (85%) were treated with regimens containing lopinavir/ritonavir (Kaletra) and nine of them (15%) treated with other regimes. Seven patients were experienced opportunistic infections in accordance with stage III and IV WHO classification. In this way, 11.8% of patients had aclinicalfailure, and 37 of them (62%) had immunological responses. Weight gain was evident in these patients, and there was a significant correlation between theincrease in CD4 and weight gain (P=0.007). Only 13 patients achieved HIV viral load testing that 6 of them had avirological response after 12 months on second-line ART. No significant associations were found between virological or immunological response and gender, age, and lopinavir/ritonavir regimens (P>0.05).With counselling and supporting in those failing first-line ART, inessential switching to more costly second-line ART can be prevented in the majority of patients. However, patients'' need to second-line ART drugs has increased, for which national ART programmes and regular follow-up should be organized. The high cost of these drugs and limited access to viral load testing are main barriers to proper management of patients switched to second-line ART regimens.