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Abstract Background Obstetric triage is a new idea, so the design and implementation of it requires identification of its concept and structure. The aim of this qualitative study was to explore the concept and structure of the obstetric triage in Iran. Methods The purposive sampling was done and it continued until reaching the theoretical saturation. Thirty-seven semi-structured interviews were conducted individually and face-to-face. Interviews were audio recorded, transcribed, and analyzed using conventional content analysis. Results Two themes, 8 main categories, and 16 subcategories emerged from the content analysis of the interviews and observations. The themes were the concept and structure of obstetric triage. The concept of obstetric triage consisted of three categories of nature, process, and philosophy of obstetric triage. The structure of obstetric triage included five categories of assessment criteria, emergency grading, determining the appropriate location for patient guidance, initiation of diagnostic and therapeutic measures, and timeframe for initial assessment and reassessment. Conclusion Findings highlighted that obstetric triage is a process with a dual and dynamic nature. This process involves clinical decision making to prioritize the pregnant mother and her fetus based on the severity and acuity of the disease in order to allocate medical resources and care for providing appropriate treatment at the right time and place to the right patient. The results of this study could be used for the design and implementation of the obstetric triage system.

Abstract Background Male reproductive health is a relatively new concept, and most men are neglected in reproductive health discussions. Therefore, it appears that there is insufficient information about the male reproductive health. This study aims to design a psychometric instrument for assessing the male reproductive health-related behavior. Methods/design This is a sequential exploratory mixed-method study with a classical instrument development design. It will be conducted in two qualitative and quantitative phases on the studied units including the men living in Tehran. In the first phase, a qualitative study of a contractual content analysis approach will be conducted in order to perceive the concept of male reproductive health-related behavior, determine the dimensions of the questionnaire, and explore the items. In the second phase, a quantitative study will be carried out to evaluate the psychometric properties as well as (form, content, and construct) validity and reliability of the instrument designed in the first phase. Finally, the instrument will be scored and interpreted. Discussion Discovering men’s perception of concept of reproductive health-related behavior can help design a valid and reliable questionnaire which can be used in studies evaluating the male reproductive health-related behavior. Ethical code IR.TUMS.FNM.REC.1397.157.

Abstract Background Since labor and delivery units often serve as emergency units for pregnant women, the use of obstetric triage systems with poor or inadequate quality can lead to unintended consequences such as over and under-triage and so a waste of humans and financial resources. Therefore, this systematic review was conducted to evaluate the measurement properties of obstetric triage tools. Methods PubMed, EMBASE, and Medline were searched to identify studies in October 2018 and were updated in May 2019. The risk of bias COSMIN checklist was used to evaluate the quality of the studies. The quality of every measurement property was appraised by the update criteria of COSMIN. Evidence quality was judged using the modified GRADE approach. Results A total of 444 studies were retrieved in initial search. Six studies evaluating 4 tools were included in this study. All the included studies reported only content validity and reliability. The quality of evidence varied from very low to moderate. The quality of content validity and reliability of the included tools was sufficient except for the reliability of the maternal-fetal triage index. The obstetric triage acuity scale (OTAS) was found to have higher reliability than other tools. Conclusions Due to insufficient evidence, the conclusions about the quality of measurement properties of each obstetric triage tool may be uncertain. This review emphasizes the necessity for further studies with robust methodological quality on the measurement properties of obstetric triage tools.

Background: Handwriting problems are one of the common problems among students in the early years of education. The current study aimed to determine further validation aspects of the Persian Handwriting Assessment Tool (PHAT) in primary school-aged children.Methods: The current methodological study was conducted on 452 healthy 8-10-year-old students in Tehran, Iran, selected via random cluster sampling method. Inclusion criteria were native Persian-speaking and no documented physical and mental impairments. Construct and structural validities were established by exploratory factor analysis (EFA) using principal axis factoring with Promax rotation and confirmatory factor analysis (CFA), respectively. Criterion validity was examined by expert opinion as the gold standard using Pearson correlation test. Internal consistency, test-retest, and inter-rater reliability were examined using Cronbach’s alpha and intra-class correlation (ICC). Test-retest had a seven-day interval.Results: The EFA results indicated two separate factors in the copying and dictation domains. Speed and orthographic error and size were considered as separate items. The CFA confirmed the factor structure. Criterion validity revealed low to moderate correlation (formation: 0.548, PConclusion: The results indicated that the PHAT was a valid and reliable tool for assessing handwriting in primary school-aged children.

Objectives: The communication is not just being able to verbally pronounce words and sentences, but it includes understanding information through inspiration, inner instinct, or external guidance. To achieve a better quality of life (QoL), there is a need for determining pleasant communication. The current study aimed to explore the women’s perception about different aspects of communication in their life. Materials and Methods: This qualitative content analysis aimed to understand the meaning of communication as a key factor in Iranian women’s QoL, which was conducted on 40 women. The data were gathered through depth interviews from May to November 2016 in Tehran, Iran. The interviews were transcribed verbatim and analyzed using conventional qualitative content analysis in 8 stages recommended by Zhang. Results: Two categories were identified based on the interviews, including constructive spiritual and pleasant peripheral communication and each theme consisted of some categories. Conclusions: Overall, awareness about different aspects of communication in women’s life must be considered by politicians and health care providers in Iran. In addition, efforts would be made to improve nurses’ understanding of different aspects of the QoL, especially pleasant communication in women’s life which could help their health promotion.

Objectives: Facilitating participation is regarded as the primary goal and outcome of rehabilitation. According to the importance of comprehensive assessment of participation in occupational areas (social participation, work, education, instrumental activities of daily living, activities of daily living, rest and sleep, leisure, and play), all available studies on the development or translation of measures, which assess participation in Persian, were systematically reviewed. Methods: A search for Persian versions of measures, which assess participation in at least one occupational area, was carried out. Eight bibliographic databases, including 4 Iranian (IranDoc, Medlib, Magiran, and SID) and 4 international (Cochran, PubMed, Scopus, and ScienceDirect) databases from 1990-2018 were searched by 2 independent researchers based on the predetermined criteria. Any disagreements during the selection processes were resolved in consultation with the third researcher. Results: Through 3 refining steps, by 2 independent researchers, 68 articles exactly related to this study were selected and studied. A total of 50 measures were extracted. The content of the measures and their psychometric properties were reported; 44 were translated into Persian and 6 developed based on the Iranian population. Discussion: This critical review will help Persian-speaking therapists to select an appropriate measure for assessing participation in different occupational areas. Considering the importance of participation in the outcomes of rehabilitation and since it is mostly cultural and familial-based, developing new scales based on Persian-speaking people culture seems necessary.

Background: To provide excellent nursing care services, nursing standards should be considered; one of these standards is being socially responsible. Regarding the lack of appropriate instruments in Iran for measuring social responsibility, the design of an instrument in accordance with Iranian culture seems to be necessary. So, the present study aimed to design a valid and reliable tool for measuring the social responsibility of nurses. Materials and Methods: In this sequential exploratory mixed-method study, designing and psychometric evaluation of nurses' social responsibility instrument were performed in qualitative and quantitative phases. In the qualitative phase, the concept of nurses' social responsibility was explored and its characteristics and dimensions were identified using a hybrid concept analysis model. In the quantitative phase, validity (face, content, and construct), and reliability (Cronbach's α and interclass correlation) were examined a sample of nurses in Tehran, Iran (n = 280). The construct validity of the scale was determined using exploratory factor analysis. Results: The findings supported 23 items in four factors: dedicated to others, efforts to improve social conditions, holistic vision, and favorable relationship. A total of 44.40% of the variance was explained by these four factors. Scale-Content Validity Index/Average (S-CVI/AVE) was calculated 0.91 and it was found that the Cronbach's alpha was 0.88. Conclusions: The researchers focused on designing and psychometric evaluation of nursing social responsibility tools based on nurses' opinions and prepared a native, valid, and reliable tool, which seems to be a good tool for measuring the social responsibility of nurses.

Background: Quality of life drives from the individuals' perceptions of their position in life long and allows holistic assessment of the effects of health conditions beyond the symptoms, signs, and complications. This study aimed to assess the quality of life and recognize females' point of view about the quality of life aspects. Hence, perhaps it could be a step toward improving women's health status. Materials and Methods: This study was an explanatory mixed method research one which was conducted in the two following steps. In the quantitative step, five hundred women aged 15–49 years were selected from varied zone of Tehran Province, using cluster random sampling method. In order to assess the quality of life, Short Form SF-36 instrument was used. In the qualitative step, forty women were selected by purposive sampling in a different range of quality of life based on the result of the first step. Data were collected through semistructured, in-depth individual interviews, which continued up to data saturation point. Data analysis was performed through conventional content analysis. Results: Among different aspects of quality of life, the highest and the lowest means (SD) were related to physical functioning mean (SD) 70.58 (24.52) and general health 67.72 (27.66), and mental health 55.27 (30.22) and social functioning 57.02 (30.62), respectively. From the interviews, three main themes were extracted as the following: (i) financial support, (ii) informational support, and (iii) service-based social support. Conclusions: The present study revealed that Tehranian women do not have high experience related to the quality of life; however, a sense of receiving support from different sources could help them to wrestle with a complicated condition in everyday life.

Background: Patients with heart valve disease need to receive long-term care from their family members after surgical valve replacement. Thus, family caregivers should have adequate self-efficacy for patient care. Objectives: This study examined the effects of the family-centered empowerment model (FCEM) on self-efficacy and self-esteem among the family caregivers of patients with prosthetic heart valve. Methods: In this quasi-experimental study, forty patients together with one of their family caregivers were consecutively recruited and allocated to an intervention or a control group. The FCEM was used in three to five sessions for patients in the intervention group. Besides, we sent their family caregivers educational cards containing the same educations provided to their patients. Finally, an educational session was held for family caregivers in which their questions were answered and each of them was provided with an educational booklet containing the same materials as the educational cards. Patients and their family members in the control group received routine care. Self-efficacy and self-esteem of family caregivers were assessed before, 1 week, and 1.5 months after the intervention. Data analysis was performed through the independent-samples t- test and the repeated measures analysis of variance. Results: Before the intervention, the mean scores of self-efficacy in the control and the intervention groups were 26.68 ± 4.79 and 26.79 ± 5.49, whereas the mean scores of self-esteem in these groups were 33.74 ± 4.55 and 33.84 ± 4.72, respectively. None of the between-group differences were significant. After the intervention, the mean scores of self-efficacy and self-esteem in the intervention group were significantly greater than the control group (37.32 ± 2.68 versus. 29.89 ± 2.20 and 36.26 ± 3.66 versus. 29.26 ± 5.84; P < 0.05). Conclusion: The use of the FCEM promotes self-efficacy and self-esteem among the family caregivers of patients with prosthetic heart valve.

BACKGROUND: The systematic collection, analysis, and interpretation of health data by health surveillance systems provide timely and comprehensive surveillance of public health, identification health priorities, and, consequently, a quick and timely response to reduce damage during natural disasters. Since military forces appear as first responders at the scene of accidents, the present study aimed to identify the components of the military health care system during natural disasters. MATERIALS AND METHOD: Qualitative data collected through semi-structured interviews were analyzed via the conventional content analysis approach to identify the components of the military health care system in natural disasters. The participants consisted of 13 experts who were experienced in providing health services in the military and the civilian health care system during natural disasters in January 2022 to June 2022. RESULT: The identified components were classified into four main categories, namely, pre-requisite components (comprehensive health care, defined position, and providing information), driving components (system efficiency, effective communication), operational components (contingent performance, effective response), and promotional components (purposeful support, pre-disaster preparation). CONCLUSION: In conclusion, the military health surveillance system is a cooperative service for the national health system in which data is essential for making decisions on health and treatment measures during disasters. This study—by identifying four categories of the important components in the design, implementation, and development of the military health surveillance system—provides a comprehensive view of an appropriate and evidence-based military surveillance system in disasters.

BACKGROUND: The promotion of health in adolescents with mental disorders depends on their levels of self-care empowerment. Self-efficacy is a significant prerequisite for successful self-management and behavior change in adolescents with mental disorders. The present study was conducted to explain the concept of care self-efficacy in adolescents with mental disorders. MATERIALS AND METHODS: This qualitative study was carried out using the conventional content analysis approach. Semi-structured interviews (n = 34) were conducted with adolescents having mental disorders, their families, and healthcare providers. The participants were selected from neurology and psychiatry clinics affiliated with University of Medical Sciences using the purposeful sampling method in 2021. Data were analyzed according to Graneheim and Lundman method. RESULTS: According to the findings of content analysis, four main themes were derived from the data: “health information-seeking behavior,” “adaptation of life to the disease and treatment conditions,” “adaptive coping,” and “social self-care.” CONCLUSION: Based on the findings, the promotion of adaptive styles and social support is effective in acquiring social competencies. As a result, policymakers are suggested to design health-oriented educational programs based on care self-efficacy principles to promote health in adolescents with mental disorders.

Objective Self-determination is the ability of recognizing, setting and achieving goals based on knowledge and self-assessment. This ability is essential for the healthy development of adolescents. Self-determination is influenced by knowledge, skills, beliefs, and contextual factors that exist in one's living environment. Since it is an essential element for having a successful life, its assessment and related skills are also important; however, there is no assessment tool for its measurement in Iranian population. The aim of this study was to translate the Self-Determination Student Scale (SSDS) into Persian and determine its psychometric properties including face, content, and construct validity as well as internal consistency and test-retest reliability in adolescents aged 14-18 years. Materials & Methods In this methodological study, the SSDS was translated into Persian to be used on Iranian population and validated according to the International Quality of Life Assessment (IQOLA) protocol. Samples were 498 high school students (mean age = 15.15±0.9; 227 females and 221 males) who were selected using convenience sampling technique with maximum diversity in Tehran. They were divided into two groups of with and without emotional/behavioral symptoms using the Youth Self-Report tool. The face validity of the translated SSDS was determined based on the opinions of samples and experts. The Content Validity Index (CVI) and Content Validity Ratio (CVR) were also calculated for each items of the translated version. The construct validity was tested by comparing known groups (gender groups and groups at risk of emotional/behavioral disorders). Moreover, its internal consistency was estimated by Kuder-Richardson formula, and test-retest reliability was tested using Intraclass Correlation Coefficient (ICC) on 16 students with a time interval of 14 days. Results In the Persian version of SDSS, 4 items were removed from the original version. After confirmation of its face validity after modification, it was found that its items had appropriate content validity based on CVI and CVR scores. The mean of self-determination score under all subscales and most of items was significant between the gender group and the group at risk of emotional/behavioral disorders (P< 0.001). The Kuder-Richardson coefficient was obtained 0.89 and for five subscales, it was in a range of 0.51 to 0.72. The ICC (0.98; 95% CI:0.95 to 0.98) approved the good reliability of the instrument. Conclusion The Persian version of SDSS had good validity (face, content, and construct) and reliability after testing it on the high school students. Therefore, it can be used in clinical and research studies to assess the self-determination of students. Considering the importance of self-definition in adolescence, there is a need for further studies using the SDSS to highlight the potential problems of high school students in self-determination and designing related training programs.

Introduction: Many factors affect desirable quality of life. Regarding the subjective and multivariate nature of the quality of life concept and the need for attention in different cultures and groups of the society, the present study was performed to analyze the concept of quality of life from women's perspectives. Method: To analyze the quality of women's life, Schwartz-Barcott and Kim's hybrid model was used. At theoretical stage, in order to deeply analyze and redefine the concept of women's quality of life, 571 articles from available and reputable databases without a year limit and with keywords of life quality and women were searched in Persian and English. At practical stage, 40 Iranian women living in Tehran were interviewed. Then, the text of interviews was handwritten and analyzed using Zhang's content analysis method. Finally, the similarities and differences of definitions obtained from the previous two stages were evaluated and a general analysis was performed. Results: In the final analysis, women's quality of life was defined as follows: “The quality of life from women's perspectives is a subjective concept and expressed as the sense of happiness that they experience it in their lives by having peace of mind in life, satisfaction with health due to responsibility for health and communicating with themselves, God, environment, and others, sense of security, and understanding of the comprehensive support received to have an ideal life. Conclusion: Based on the findings, paying attention to the status of women in the field of comprehensive support, sense of security, health responsibility, and communication can bring useful and significant results to improve the quality of women's life.

Background: The COVID-19 pandemic and the increased workload and stress associated with the disease prevalence have posed a high risk of burnout to nurses. The effects of the workplace and environmental factors on resilience and burnout among nursing professionals have not been investigated in Iran. Objective: Present study aimed to assess a model linking quality of work-life to the resilience and various dimensions of burnout among Iranian nursing professionals based on the health service workplace environmental resilience model. Methods: This was a cross-sectional study performed on 202 Iranian nurses employed in three educational hospitals. Maslach burnout inventory, Brooks’ quality of nursing work-life survey, and an abbreviated version of the Connor-Davidson resilience scale were used to collect data. The correlation between the study variables was assessed by conducting path analysis in AMOS 22. Results: The final model demonstrated adequate fit. The quality of working life indirectly affected burnout via a direct impact on nursing professionals’ resilience (p

The accumulation of heavy metals in crops irrigated with wastewater is a serious environmental problem. Wastewater irrigation is widespread, particularly for rice due to its high water demands. This can lead to heavy metal accumulation in rice and subsequent entry into the human body, posing detrimental health effects. This study investigated heavy metal accumulation in 12 rice brands (6 imported and 6 domestic) from the Bushehr city market in Iran. The mean values of lead, arsenic, and cadmium in domestic rice brands were 0.246±0.194, 0.074±0.025, and 0.150±0.124 mg kg-1 respectively, while in imported rice brands they were 0.086±0.031, 0.085±0.021, and 0.031±0.007 mg kg-1 respectively. The mean lead and cadmium levels in domestic rice brands slightly exceeded the FAO/WHO limit, while the mean arsenic concentration was below the limit. To protect human health and reduce food contamination with heavy metals, preventive measures such as regular monitoring of heavy metals in food must be taken. [ABSTRACT FROM AUTHOR]

Background & Aim: Efforts to improve self-care in patients with heart failure provide better treatment outcomes and longer life expectancy. The purpose of this study was to determine the effect of a caring program based on Pender model on health-promoting self-care behaviors in patients with heart failure. Methods & Materials: In this single-blind randomized controlled trial, 48 patients with class II or III heart failure, referred to Golestan hospital in Tehran in 2017-2018, were recruited by the purposive sampling method and were randomly assigned to an intervention or a control group. For the intervention group, a caring program based on the Pender Health Promotion Model was conducted in six sessions. Data were collected by the Health Promoting Lifestyle Profile and the Self-Care Heart Failure Index, before and after the intervention. Descriptive and inferential statistical tests were used to analyze the data by the SPSS software version 16. Results: The mean scores of the dimensions (except self-actualization) and the total score of health-promoting behaviors and self-care in the intervention group were higher than in the control group after the intervention (P

Background: Disasters are medically defined as events in which the demands for patients’ care far exceed the available resources. In such situations, triage and rationing of limited resources are inevitable. A decision regarding triage needs not only scientific guidelines but also an ethical framework and supporting policies. This study aims to provide a comprehensive review of the criteria for ethical decision-making in disasters triage. Materials and Methods: Medline (Via pubMed.com), Scopus, Web of Science, and ProQuest databases will be searched from 1990 to July 2017 using a defined search strategy. Other search resources include Google Scholar, World Health Library, Global Ethics Library, Gray Literature Report website, and World Health Organization (WHO), which will be searched using a modified search strategy. The manual search will be conducted in two journals with the highest number of retrieved titles in the Scopus search and the reference list of selected articles. Study selection, quality assessment, and data extraction will be done by the first author, and the second reviewer will check the results, and probable disagreements will be resolved through discussion and review by a third reviewer. Results: This systematic review will identify all factors a triage officer should be considered when he or she would like to make an ethical decision. Conclusion: Transparency and consistency are two main procedural ethical values of disaster triage. The result of this review could be used to make a consistent decision in disaster triage.

BACKGROUND: Heat wave adaptation is a new concept related to experiencing heat. The present study aims at investigating a conceptual definition, that is, the mental framework of heat wave adaptation and its strategies. MATERIALS AND METHODS: A phenomenological study was performed to explain the mental concept. At the same time with the data collection process, data analysis was also performed using Colaizzi method. Semi-structured interview method and purposeful sampling with maximum variety were used. Interviews were conducted with 23 different subjects in the community. The accuracy of the data was guaranteed using Lincoln & Guba scientific accuracy criteria. RESULTS: The two main themes of the adaptation paradigm as well as its strategies were divided into the main categories of theoretical and operational concepts, as well as personal care measures and government measures. Under the category of individual measures, we obtained “clothing, nutrition, building, place of residence and lifestyle,” and under the category of governance actions, the “managerial, research, health, organizational” subcategories were obtained. CONCLUSION: According to the results of the conceptual-operational definition, heat wave adaptation is an active process and an effort to reduce the adverse effects of heat waves on individual and social life, and striking a balance that will not only result in individual awareness and actions that will lead to lifestyle changes, but also mostly requires integrated and comprehensive planning in the community. On the one hand, heat waves could not only be regarded as a threat or danger, but can also become an opportunity for the development of a community through identification and smart measures, and for adaptation, the community must take it as a risk. The community should have a plan in advance, apply the necessary rules and training, and use the new facilities and rules where necessary. This practical concept definition includes the main features of heat wave adaptation.

BACKGROUND AND OBJECTIVE: Digestive diseases are one of the problems of the health system in the world. From the perspective of Persian medicine, the stomach begins the second stage of digestion and its function plays an important role in human health or illness. The written sources of Persian medicine have been widely used to determine the health of the stomach. The purpose of this study is to summarize indices of Mizaj-e-Meda (Temperament of Stomach) identification to help better diagnose the status of health or illness of stomach. METHODS: In this review article, 11 valid Iranian medicine sources and scientific databases of Scopus, PubMed, Science Direct, Google Scholar, Elsevier, and web of science as well as Persian indices of SID, Iran Doc, Magiran were searched and the existing views were summarized. FINDINGS: In the sources of Persian medicine, the indices of different types of Mizaj (temperament) and Su-e-mizaj (abnormal temperament) have been proposed. Seventeen articles on the subject of gastric diseases in Persian medicine were found; one case merely examined gastric symptoms, while others only slightly referred to the indices. Some of the most important indices considered in these sources for identifying the type of Mizaj-e-Meda were the way of digestion, desire for food according to the type of Mizaj (temperament), thirst, appetite, burrow, moisture and taste of the mouth, tongue and mouth condition, flatulence, quality of waste matter, speed of food passage, sour stomach, burning stomach, stomach ache and stomach malmas (touch). CONCLUTIONS: Persian medicine sources have fully cited gastric indices, which can be used for a more effective diagnose and treatment and even prevention of gastric diseases, and can also be used for designing and validating standard scales for Mizaj-e-Meda (Temperament of Stomach) identification.

Background: There are standard guidelines for obesity management, although only few obese people can adhere to these guidelines. This study aimed to assess the effects of Extended Parallel Process Model (EPPM) on obese soldiers' knowledge, attitudes, and practices (KAPs) about obesity management. Materials and Methods: This randomized controlled clinical trial was conducted in Yazd, Iran (2016). Two military centers were chosen through simple random sampling. They were randomly assigned to the experimental or the control group. Then, individuals were randomly selected and either received or did not receive high-risk and efficacy information about obesity. The KAPs of soldiers were measured by researcher made questionnaires before, immediately after, and 1 month after training. Results: Independent t test showed significant differences in perceived severity susceptibility response efficacy self-efficacy knowledge and practices between two groups immediately after training (p < 0.001). Conclusions: It seems that obesity management training according to EPPM is effective to the improvement of soldiers' KAP during military services.

Objectives: Systemic lupus erythematosus (SLE) with a high morbidity rate (7% in general and 325/100.000 in reproductive period) was known as "the mother of autoimmune diseases." But healthcare providers hadn't reliable scales to measure the effectiveness of interventions to improve reproductive health. Women with systemic lupus erythematosus (SLE) express concern about a significant gap in their reproductive and sexual health during medical care due to the lack of a specific scale to measure this concept. This study developed psychometrically specific scale to evaluate this concept in Iranian women. Methods: The study utilized a sequential-exploratory mixed-methods design, wherein the concept of reproductive health was clarified during the qualitative phase using conventional content analysis (inductive-deductive) to create a pool of RHASLE (Reproductive Health Assessment in SLE) items. During the psychometric process, the face, content, and construct validities of the RHASLE were checked with 650 individuals (320 using exploratory factor analysis [EFA] and 330 using confirmatory factor analysis [CFA]) through interviews and completion of the questionnaire. Convergent and divergent validities were then checked, and the reliability was assessed through stability and internal consistency. Finally, the measurement error, responsiveness, and interpretability of the scale were evaluated and confirmed. Results: The study's findings revealed that the RHASLE consisted of 5 factors (33 items): physical-psychological disorder (13 items), relaxing feeling (6 items), spirituality (3 items), high-risk pregnancies (5 items), and sexual satisfaction (6 items). These factors explained a total of 99.97% of the variance in the concept of reproductive health. Confirmatory factor analysis confirmed the good model fit, and its validity and reliability were deemed acceptable. Conclusion: The RHASLE consisted of 27 items with high internal consistency, stability, responsiveness, and interpretability. That was able to get approval of Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Based on the results, RHASLE is a valid and reliable multidimensional scale that encompasses various aspects of reproductive health (physical, sexual, psychological, social, and spiritual). [ABSTRACT FROM AUTHOR]

Background: Estimating the total cost of services is crucial for utilizing available resources more efficiently and effectively. By employing the time-driven activity-based costing (TDABC) method, not only can costs be calculated, but also the efficiency and unused capacity of resources can be assessed. Objectives: This study aimed to calculate the cost of education for each medical student at one of the AJA medical sciences universities in 2022 using the TDABC method. Methods: This quantitative study was conducted cross-sectionally and retrospectively in a descriptive-analytical manner. The data were collected and analyzed through interviews and observations. To analyze and allocate costs, administrative and educational departments were categorized into three levels: Overhead, intermediate, and final activity centers. Then, using the TDABC approach in Microsoft Excel 2013 software costs from the overhead and intermediate activity centers to the final activity center and students. Results: The study estimated the average cost of educating each medical student to be approximately IRR 6 267 568 065. Additionally, the unused capacity of resources in overhead and intermediate centers was observed to be 30% (range: 4-44%) and 33% (range: 26 - 43%), respectively. Conclusions: The findings indicated that the cost per student is somewhat reasonable; however, there is a high level of unused capacity in the university and faculty activity centers. The effective management of human resources and equipment is necessary to enhance service delivery processes, increase productivity, and reduce unused capacity. [ABSTRACT FROM AUTHOR]