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The SARS-CoV-2 COVID-19 pandemic has emerged as an unprecedented emergency state in healthcare system and global challenge. In recent decade, the function of exogenous H

Purpose This study aims to explore the impact of spatial configuration on behavioral patterns of visitors in the ground floor of health-care spaces. Design/methodology/approach In this study, the Space Syntax analysis was used to combine visibility graph analysis and axial line analysis with empirical observation of visitors’ activities. Two types of observation methods on visitors were conducted to discover the behavioral patterns of individuals, respectively, named “gate counts” and “people following.” Findings The outcomes of this research revealed that the spatial arrangements of pathways, public areas, vertical circulations, entrance space, lobby, emergency department, reception desk and pharmacy have a significant influence on the way that visitors perceive the health-care environment. Research limitations/implications The current research is limited to two aspects of effective wayfinding (configuration of health care and geometry). Future work can investigate the other potential factors coupled with the current factor as an integrated research for enhancing wayfinding and sustaining accessibility. Another limitation is that the observation results for this study had been conducted before the COVID-19 pandemic and future studies can compare these results with the current COVID-19 situation within health care environments. Originality/value A large amount of research has focused on the needs of populations in developed countries. This topic has not been investigated thoroughly by professionals in developing countries such as Iran. Accordingly, this study benefits environmental psychologists and architects by revealing the effective characteristics of legible spaces in health-care environments.

This study proposes a simple correlation for approximating hydrogen solubility in biomaterials as a function of pressure and temperature. The pre-exponential term of the proposed model linearly relates to the pressure, whereas the exponential term is merely a function of temperature. The differential evolution (DE) optimization algorithm helps adjust three unknown coefficients of the correlation. The proposed model estimates 134 literature data points for the hydrogen solubility in biomaterials with an excellent absolute average relative deviation (AARD) of 3.02% and a coefficient of determination (R) of 0.99815. Comparing analysis justifies that the developed correlation has higher accuracy than the multilayer perceptron artificial neural network (MLP-ANN) with the same number of adjustable parameters. Comparing analysis justifies that the Arrhenius-type correlation not only needs lower computational effort, it also has higher accuracy than the PR (Peng-Robinson), PC-SAFT (perturbed-chain statistical associating fluid theory), and SRK (Soave-Redlich-Kwong) equations of state. Modeling results show that hydrogen solubility in the studied biomaterials increases with increasing temperature and pressure. Furthermore, furan and furfuryl alcohol show the maximum and minimum hydrogen absorption capacities, respectively. Such a correlation helps in understanding the biochemical–hydrogen phase equilibria which are necessary to design, optimize, and control biofuel production plants.

Purpose The purpose of this study was to assess the self-perceived need, seeking and use of dental care and its main determinants in Kurdistan province, Iran. Design/methodology/approach A total of 1,056 adults in Kurdistan province were included in this cross-sectional study. Multistage sampling approach was used to select the samples. Data on sociodemographic characteristics, economic status, self-perceived need, seeking and use of dental care were collected using a self-administrated questionnaire. Multivariate logistic regression model was used to assess factors affecting the use of dental care. In addition, socioeconomic inequality relating to dental care needs and use of dental care were examined using concentration curve and concentration index. Findings In this study, unmet dental care need was 62.7%. There was a perceived need for dental care among 13.7% (n = 145) of the participants in the past month, with only 39.3% (n = 57) seeking the care. The most important reasons for unmet dental care need were “Could not afford the cost” and “Insurance did not cover the costs.” Multivariate logistic regression showed that supplementary insurance status and household economic status were identified as main determinants affecting dental care-seeking behavior. The result of concentration index revealed that seeking dental care was more concentrated among the rich, whereas the perceived dental care need is more prevalent among the poor. Originality/value This study demonstrated that the prevalence of unmet dental care needs is high in the study setting. Also, financial barrier was identified as the main determinant of unmet dental care needs.

Purpose The purpose of this study is to investigate the status of perceived need, seeking behavior and utilization of health services in the elderly population of Sanandaj (west of Iran). Design/methodology/approach This is a cross-sectional study conducted on 800 elderly people in Sanandaj. Subjects were selected using multistage sampling and data were collected using self-report questionnaires. A multivariate logistic model with odds ratios (ORs) was used to determine the relationship of independent variables with seeking perceived need. Also, the concentration index was used to measure the inequality in using health services. Findings The perceived need for outpatient (during the last 30 days) and inpatient health-care services (during the past 12 months) was 69.7% and 29.7%, respectively. Among them, the unmet need for outpatient and inpatient health-care services was 46.6% and 17%, respectively. Having health insurance (adjusted OR 12.08; 95% confidence interval [CI] 1.04–140.11), middle economic status (adjusted OR 5.18; 95% CI 1.30–20.51) and being in an age group of 65–70 years (adjusted OR 7.60; CI 1.42–40.61) increased the chance of seeking inpatient care. Also, being in an age group of 60–65 years (adjusted OR 0.41; 95% CI 0.18–0.95) reduced the chance of seeking outpatient care. There was also a pro-rich inequality in using outpatient health services. Originality/value The elderly population suffers from unmet health-care needs, especially in outpatient services. The most important reason for not seeking outpatient and inpatient services was financial barriers and self-medication, respectively. So, designing targeted policies and interventions to address barriers in the conversion of need to demand in the elderly population is essential.

We investigate the relationship between the asteroseismic indices and the physical quantities of 438 δ Scuti (DSCT) stars observed by the Transiting Exoplanet Survey Satellite (TESS) mission at 26 sectors. We study the scaling relations of stellar parameters (effective temperature, surface gravity, density, etc.) and asteroseismic indices such as fundamental frequency, large frequency separation (Δν), frequency of the highest peak in the spectrum, and the peak of the envelope of oscillation mode (νmax) for DSCT targets. Using an empirical relation and a 2D autocorrelation method, we determine the large frequency separation for targets. We obtain a highly positive correlation between the fundamental radial pressure mode and the large separation for one-third of targets. We find a scaling relation between the large separation and νmax as $\Delta \nu =0.49\nu _{\rm max}^{0.68}$, which is similar to that of the solar-like and red giant stars. We show a strong positive correlation between the effective temperature and νmax (Pearson correlation R = 0.65). We also obtain a very strong positive correlation (R = 0.86) between the effective temperature multiplying by the surface gravity and νmax.

Background: Health care waste (HCW) management is highly important and has received special attention from the authorities and people. Objectives: This study was conducted to investigate the management of HCW in general and specialized hospitals of Tabriz, Iran. Methods: In this descriptive cross-sectional study, field investigations were conducted on gathering data on HCW management activities using the WHO questionnaire including 100 questions through observation. Results: This study indicated that the total in-use beds in the studied hospitals were 3953 beds. The total amount of generating wastes in the hospitals was 13349.5 kg day-1, of which 10059 kg day-1 (75.4%) was general waste and the remaining 24.6% (3290.5 kg day-1) was categorized as medical waste. The medical waste was categorized further into infectious (3002.50 kg day-1), sharp (171.80 kg day-1), chemical (63.15 kg day-1), and pathological (52.55 kg day-1) wastes. In general and specialized hospitals, 56% and 31% of the waste separation was at a good level, respectively. The results showed that the chemical process (37.5%) was the mostly used method for the treatment of medical waste in the studied hospitals. Conclusions: Generally, the rate of waste generation in general hospitals was more than that in specialized hospitals. Higher waste generation in general hospitals can be due to the fact that in these hospitals the amount and diversity of the health services provided were more than specialized hospitals. Good separation of general wastes from medical ones, proper health waste management, and training of staff for correct segregation of wastes can lead to a reduction of treatment charges.

Background: Short-Form Six-Dimension version 2 (SF-6Dv2) is a multi-attribute utility instrument that can be used in combination with the SF-36v2 (SF-6Dv2SF-36) or as an independent instrument in t...

Background: The aim of this study was to assess unmet needs for health care (UNHC) and its causes during COVID-19 pandemic among pregnant women in Iran. Methods: This cross-sectional study was performed among pregnant women in Kurdistan province in 2020 with a sample size of 800 people who were selected by multi-stage sampling method. Data were collected by a questionnaire. Chi-square test was used to examine the relationship between independent variables including demographic variables with dependent variables of perceived need and benefiting from health services. Also, multiple logistic regression was used to determine the relationship between independent variables and outcome variable. Statistical tests were performed using STATA software package.Results: The highest UNHC were related to dental services with 66%, rehabilitation services with 58.6% and psychological services with 43.2% and the lowest were related to hospital services with 12%, midwifery services with 15.6% and physician visit services with 39.1%. The most important reasons for UNHC were fear of getting COVID-19 and the cost of the service. The variables of age group and spouse education for physician visit services; age group for midwifery services; age group, education and employment status for dental services; age group, supplementary insurance and economic status for rehabilitation services; and age group and economic status for psychological services were significantly associated with UNHC (PConclusion: A significant percentage of health care needs of pregnant women were unmet, for which the fear of getting COVID-19 and financial barriers were the main reasons.

Purpose Health is one of the most basic human rights. This study aims to examine the pattern of unmet health services needs and barriers to use health services among people with disabilities. Design/methodology/approach This cross-sectional study was conducted among people with disabilities in Sanandaj, the capital of a less economically developed province in western Iran in 2020. In total, 548 samples were selected using random sampling, and data were collected using a questionnaire. Chi-square test and Fisher's exact test were used to examine the relationship between independent variables including demographic variables and dependent variables. Statistical tests were performed using STATA software package. Findings About 64% and 23% of participants needed outpatient and inpatient services, respectively. The gap between the perceived need and using health services for outpatient and inpatient services was reported to be 55% and 30%, respectively. The main reasons for not seeking the required health care were “insufficient coverage of costs by insurance” and “lack of physical access.” Having supplementary insurance and better economic status were significantly correlated with using outpatient care and having supplementary insurance and type of disability had a significant relationship with using inpatient care. Originality/value There was a big gap between the perceived need, seeking for and receiving health services in people with disabilities. Designing and implementing appropriate interventions to reduce barriers on the way of transforming, the need for health services into demand in the population of people with disabilities should be on the agenda of policymakers and relevant managers in the country.

Failure Mode and Effects Analysis (FMEA) is one of the most used methods in risk assessment and prioritization. This study was conducted to identify, evaluate, prioritize, and analyze risks associated with the physical processes of Sahand municipal wastewater plant using traditional and fuzzy FMEA methods. The present research was a cross-sectional analytical study that was conducted to prioritize the risks of unit operations of screening and grit removal in Sahand municipal wastewater treatment plant for 6 months. First, a team of five experts was formed and the traditional FMEA worksheet was completed. Then, the fuzzy membership functions were determined according to experts' opinions and using the MATLAB program, and the severity, occurrence, detection, and risk priority number (RPN) became fuzzy and risks were prioritized according to the fuzzy logic outputs. A total of 53 failure modes were identified for screening (26 failures) and grit removal units (27 failures) using the traditional FMEA risk assessment technique. The results of the traditional FMEA method showed that among the 53 identified failure modes, in physical treatment equipment of Sahand municipal wastewater, 51 failures (96.2%) were in the low-risk levels and two failures (3.8%) were in the medium-risk levels. According to the results of the fuzzy FMEA, 5 failures (9.4%) were in the low-risk levels, 43 failures (81.2%) were in the medium-risk levels, and 5 failures (9.4%) were in the high-risk levels. Based on the traditional FMEA, the highest and lowest level of risk belonged to manual screening clogging and conveyor cutting of mechanical screening with RPN of 540 and 12, respectively, whereas in the fuzzy FMEA, the highest and lowest level of risk were related to manual screening clogging and fracture of pump pipes with RPN of 894 and 105, respectively. The finding showed that risk assessment using fuzzy FMEA provides more accurate and better results than traditional FMEA. In the fuzzy FMEA, the involvement of the experts' opinions in risk assessment and fuzzy models leads to more realistic results, as well as corrective action prioritization is better performed.

The amount of fluoride in drinking water sources is very important for public health. This study was conducted to evaluate the fluoride concentration in drinking water and compare the results with ...

Objectives Health-related quality of life (HRQoL) is one of the most important outcome measures for patients. The purpose of this study was to evaluate HRQoL and related factors in Coronavirus disease 2019 (COVID-19) patients. Methods A total of 420 COVID-19 patients who had been discharged from hospital were selected using a systematic sampling. The EuroQol 5-dimensional-5 levels (EQ-5D-5L) questionnaire along with medical records of the patients were used to gather the data. The t test and analysis of variance were employed to test the difference between mean EQ-5D-5L scores, and the BetaMix model was used to investigate factors associated with EQ-5D-5L scores. Results The mean score for the patients who completed the EQ-5D-5L questionnaire (n = 409) was 0.6125. The EQ-5D-5L scores were significantly higher in males, patients with younger age, those with a low level of education, the employed, patients who worked in uncrowded workplaces, patients without diabetes, and those who were not admitted to intensive care unit. The BetaMix model showed that gender, age, education, employment status, having diabetes, heart failure, and admission to the intensive care unit were significant independent predictors of the EQ-5D-5L index values. Conclusion The mean score for EQ-5D-5L in COVID-19 patients was low in this study. Some of the factors, especially aging and having diabetes, should be considered in the aftercare of patients to improve their HRQoL.

Purpose Health is one of the most basic human rights. The mental health of contemporary and future health services providers is of great significance. The purpose of this paper is to investigate the mental health of the faculty members and students of Kurdistan University of medical sciences Design/methodology/approach This was an analytical-descriptive and cross-sectional study, which was conducted using the Census method on 249 faculty members and proportionately by using random sampling on 347 students in 2019. Data were collected using the 28-item General Health Questionnaire. Data analysis was done via SPSS 24 software by using statistical tests such as T-test and one-way ANOVA. Findings The mean values (standard deviation) of the total score of mental health among students and faculty members were 27.43 (14.37) and 20.17 (11.37), respectively. In total, 57.2% of students and 31% of faculty members had symptoms of mental disorder. The highest mean score among faculty members and students was observed on the subscale of “social dysfunction.” There was a significant relationship between the mental health of students and where they study and the mental health of faculty members and type of faculty member with the faculty in which they work (p < 0.05). Originality/value The prevalence of mental disorders’ symptoms among faculty members and students of Kurdistan University of medical sciences was high, and it must be considered by policymakers and managers of the health system to plan appropriate interventions.

This research investigates the impact of the layout of the interior spaces, as an independent variable, on the distribution of daylight factor, uniformity rate, drift magnitude, maximum radial line...

Background: The present study aimed to assess the prevalence and intensity of catastrophic health-care expenditures (CHE) relating to type 2 diabetes mellitus care and inequality in facing such expenditures in Iran. Methods: A total of 1065 type 2 diabetes patients were included in this cross-sectional study. A multistage sampling method was used to select the samples. Data on sociodemographic characteristics, economic status, health and diabetic costs were collected using a selfconstructed questionnaire. We used capacity to pay (CTP) of households to calculate the incidence of CHE due to diabetic care at four different thresholds. The mean positive overshoot (MPO) and overshoot were used to assess the intensity of CHE. The relative concentration index and slope index of inequality (SII) were used to measure socioeconomicrelated inequalities in incidences of CHE. In addition, decomposition methods were used to identify the main factors affecting observed inequality in CHE. Results: The incidence of CHE at the 10, 20, 30, and 40% of CTP thresholds for type 2 diabetes mellitus care was 57.5, 28.9, 16.5, and 11.4%, respectively. The results of CI and SII indices for CHE due to diabetic care indicated that the incidence of CHE was more prevalent among patients with lower socioeconomic groups. The decomposition analysis showed that the socioeconomic status, marital status and gender of patients were the main factors contributing to socioeconomic inequality in incidence of CHE among the poor. Conclusion: Our study demonstrated that the incidence and intensity of CHE due to diabetic care were relatively high, particularly among socioeconomically disadvantaged patients. Modification to the present health care financing strategies is recommended in order to protect lower socioeconomic groups against the financial burden of diabetic care.

The EQ-5D-5L and two versions of the SF-6D version 2 (i.e., SF-6Dv2ind-10 that is derived from 10 items of the SF-36v2, and SF-6Dv2SF-36 that is derived from its combination with the full SF-36v2) are used to drive utilities. The study was prospected to compare the performance of these instruments in breast cancer patients. Data were gathered from 418 patients with breast cancer using three questionnaires including the EQ-5D-5L, SF-36v2, and SF-6Dv2ind-6. The differences between the mean utilities of instruments were tested by t-test. The correlation between the dimensions scores of instruments was estimated by Spearman’s correlation coefficient (ρ). The level of agreement between the instruments score was assessed by ICC and Bland–Altman plot. The correlations between theoretically related pairs of EQ-5D-5L and SF-6Dv2SF-36 were stronger than those of the EQ-5D-5L and SF-6Dv2ind-6. The ICC between EQ-5D-5L and SF-6Dv2ind-6 was 0.64, and between EQ-5D-5L and SF-6Dv2SF-36 was 0.48. The Bland–Altman plot showed that there was a poorer agreement on the lower values. The EQ-5D-5L had more similarity with the SF-6Dv2ind-6 in comparison with the SF-6Dv2SF-36. Nevertheless, there are still significant differences between them.

The health-related quality of life (HRQoL) data extracted from cancer-specific questionnaires are often non-preference based, while patient preference-based utility data are required for health economic evaluation. This study aimed to map Functional Assessment of Cancer Therapy-Breast (FACT-B) subscales onto the Short Form six Dimension as an independent instrument (SF-6Dv2ind-6) using the data gathered from patients with breast cancer. Data for 420 inpatient and outpatient patients with breast cancer were gathered from the largest academic center for cancer patients in Iran. The OLS and Tobit models were used to predict the values of the SF-6Dv2ind-6 with regard to the FACT-B subscales. Prediction accuracy of the models was determined by calculating the root mean square error (RMSE) and mean absolute error (MAE). The relationship between the fitted and observed SF-6Dv2ind-6 values was examined using the Intraclass Correlation Coefficients (ICC). Goodness of fit of models was assessed using the predicted R2 (Pred R2) and adjusted R2 (Adj R2). A tenfold cross-validation method was used for validation of models. Data of 416 patients with breast cancer were entered into final analysis. The model included main effects of FACT-B subscales, and statistically significant clinical and demographic variables were the best predictor for SF-6Dv2ind-6 (Model S3 of OLS with Adj R2 = 61.02%, Pred R2 = 59.25%, MAE = 0.0465, RMSE = 0.0621, ICC = 0.678, AIC = -831.324, BIC = -815.871). The best algorithm developed for SF-6Dv2ind-6 enables researchers to convert cancer-specific instruments scores into preference-based scores when the data are gathered using cancer-specific instruments.

Background Female genital mutilation/cutting (FGM/C) is a clear violation of women’s rights and can have adverse and irreversible health effects as well. Worldwide, more than 200 million women and girls have undergone FGM/C. Utility value of FGM/C has not been estimated yet, so we designed this study to extract the health utility value of FGM/C for the first time in the world. Methods In a cross-sectional study in Iran, 125 girls and women who underwent FGM/C procedure were examined by the trained midwives in order to determine its type. In addition, a questionnaire was completed for identifying the socio-demographic factors and extracting the health utility of these individuals. Health utility was measured using Time Trade-off method and also to determine the effects of the socio-demographic factors on the health utility a two-limit censored regression model was applied. Results The mean and median of the health utility of women with FGM/C were 0.971 (SE: 0.003) and 0.968 (IQR: 1–0.95), respectively. Number of non-traders was 58 (46.4%) who reported perfect health utility. However, the mean of health utility among traders was 0.946 (SE: 0.002). Only type 1 (Clitoridectomy) and type 2 (Excision) FGM/C were seen in this study. Women with Type 1 FGM/C had significantly lower health utility value (Mean: 0.968, Median: 0.957) than their type 2 counterparts (Mean: 0.987, Median: 1.00). Moreover, women in the age group of 31–45 years (Mean: 0.962, Median: 0.956), single (Mean: 0.950, Median: 0.954), divorced (Mean: 0.951, Median: 0.950), employed (Mean: 0.959, Median: 0.956), and with supplementary insurance (Mean: 0.962, Median: 0.950) had significantly lower health utility than their counterparts. Conclusion FGM/C affects physical and psychological well-being of these individuals, resulting in a lack of personal and marital satisfaction, which ultimately leads to a 3% reduction in their health related quality of life. Therefore, preventing from this practice is very important and should be considered by health system policy makers more than before.

Nowadays, in spite of the positive efforts made in recent years, active public libraries are still faced with challenges in attracting and retaining their users through the provision of up-to-date services to meet their scientific, cultural and recreational requirements. Accordingly, the need to create spaces with the approach of sociability in public libraries seems to be necessary. In this way, the Space Syntax method, as a predictor of the social aspects of architectural spaces, has been used in order to evaluate the role of semi-open spaces on the sociability of public libraries in the existing and hypothetical models using Depthmap. Finally, the findings of the two simulated models were examined and compared with each other using SPSS and the independent sample t-test. The findings from the Sunrise Mountain Library analysis indicated that in the existing model, the integration level was 20.49. However, after eliminating the semi-open spaces, the level of integration decreased to 15.48. Also, the findings obtained from the Desert Broom Library indicated that in the existing model, the integration level was 10.10. However, in the hypothetical model, its degree of integration changed to 8.15. Results show that semi-open spaces have a positive effect on the sociability of public libraries.