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Background: Gastric cancer remains a significant global health issue due to its aggressive nature and high heterogeneity, making early detection and prevention critical. Obesity and smoking are established risk factors that significantly contribute to the development of gastric cancer. Despite the clear links between these risk factors and the disease, there is a lack of targeted educational interventions that address these behaviors. This study aims to fill this gap by investigating the impact of an educational intervention based on the Theory of Planned Behavior (TPB) on promoting preventive behaviors for gastric cancer among obese and smoking individuals., Methods: This quasi-experimental study was conducted in 2021-2022 on 150 obese or overweight individuals, more than 25 years old who smoked (cigarettes and hookah) in Fasa city, Iran. From six urban health centers, two centers were randomly selected (one as the experimental group and the other as the control group). Data collection tools included a demographic characteristics questionnaire based on the TPB model (a researcher-made questionnaire). Based on pre-test results, the educational intervention for the experimental group included 12 educational sessions for 50 min, following the TPB model, through lectures, Question and Answers, group discussions, practical demonstrations, video clips, and PowerPoint presentations. The questionnaires were completed by both groups before and six months after the intervention. Data were analyzed using SPSS 22 and descriptive and analytical statistical methods (paired t- test, McNemar test, Chi-square test, and independent t-test) (p < 0.05)., Results: The results showed no significant difference between the two groups before the educational intervention. However, six months after the intervention, the experimental group showed a significant increase in TPB model cues (awareness, attitude, subjective norms, perceived behavioral control, behavioral intention, and behavior) (P < 0.001)., Conclusion: The findings of the present study indicate that the educational intervention based on the TPB model is useful in improving gastric cancer screening and preventive behaviors. It can also be used in planning and implementing appropriate programs to prevent and treat this disease., Competing Interests: Declarations. Human ethics and consent to participate: Ethical approval was obtained from the Human Research Ethics Committee at the Fasa university of medical sciences (IR.FUMS.REC.1397.079). All study participants provided written informed consent. Permission was also obtained to digitally record all interview. For illiterate people, the text of the consent form was read to them and their fingerprints were recorded. Confidentiality and anonymity were ensured. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration. Consent for publication: Not applicable. Conflict of interest: The authors have no conflicts of interest to declare. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Knee osteoarthritis offers significant opportunities for prevention and the mitigation of its severity and associated symptoms through lifestyle modifications. This study aimed to investigate the efficacy of an educational intervention based on the Theory of Planned Behavior (TPB) in promoting preventive behaviors against knee osteoarthritis among women aged over 40 years residing in Fars, Iran. This research utilized a quasi-experimental design. The study population comprised 100 women over the age of 40 who were registered at health centers in Fasa, Iran. Data were collected using a questionnaire based on the Theory of Planned Behavior (TPB). The intervention was implemented through eight educational sessions specifically designed to promote TPB-informed preventive behaviors against knee osteoarthritis. The findings revealed statistically significant differences between the experimental and control groups regarding their scores on attitude, subjective norms, perceived behavioral control, intention, and behavior, both before and after the intervention. At 3 months post-intervention, the experimental group demonstrated significant improvements in all measured constructs, while the control group showed no substantial changes. This study demonstrates that implementing structured educational interventions grounded in behavioral theory, specifically the Theory of Planned Behavior (TPB), can effectively promote preventive behaviors against knee osteoarthritis, thereby potentially reducing its associated morbidity., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval and consent to participate: Ethical approval for this study was obtained from the Human Research Ethics Committee at the Fasa University of Medical Sciences with the ethical code: IR. FUMS. REC. 1396. 302. Informed consent was secured from all participants, and for students involved, additional parental and/or legal guardian consent was obtained. All methodologies employed strictly adhered to the principles outlined in the Declaration of Helsinki. Maintaining participant privacy was paramount, ensuring data was stored and presented accurately without identifying information. Participants were empowered to withdraw from the interview at any time and were promised access to the final study results., (© 2024. The Author(s).)

Background: Classroom behavior is one of the important variables for the curriculum in the learning path of learners. The aim of this study was to explain the classroom behavior process of medical sciences students., Materials and Methods: In a qualitative study using the grounded theory approach, the classroom behavior of 21 students from different medical fields was assessed. Purposeful and theoretical sampling methods were used. Data collection tools were semi-structured interviews. Sampling was continued until saturation, and data analysis was performed according to the Corbin and Strauss 2015 approach. The study was done from 2020 until 2023., Results: The results of the data analysis were divided into three main categories (representation scene, behavioral representation, and representation effect) and nine subcategories. The representation scene consisted of the following subcategories: learner features, teacher and teaching features, classroom environment, and educational content. Behavioral representation was the second category and included groupism, the behavioral continuum, and students' expectations. The representation effect was the third category and included academic progress and positive and negative emotions., Conclusion: Students' classroom behavior is affected by various factors. Professors and policymakers of educational programs can strengthen the positive classroom behaviors of medical students in the shadow of learning theories by recognizing, paying attention, and planning to get closer to educating students with professional behavior and performance., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Background: Regarding the psychosocial aspect of treating those with substance use, it is crucial for them to exhibit a capacity for personal transformation, fully utilize their remaining capabilities, and eradicate societal discrimination. We aimed to assess the efficacy of educational instruction grounded in the theory of planned behavior (TPB) in enhancing adherence to medication regimens, fostering hope, and improving marital quality among people with substance use disorders., Methods: This study was conducted at the Rapid Addiction Closure Center in Fasa city, Iran, involving a sample of 140 patients undergoing addiction treatment with methadone and buprenorphine in 2021-2022. Subjects were randomly allocated to intervention and control groups. The intervention group participated in 15 weekly educational sessions, each lasting 50 to 55 min, covering topics such as quitting strategies, social support, problem solving, communication skills, and coping mechanisms. Data were collected using demographic questionnaires, TPB construct questionnaires, Miller's Hope Survey, and the Revised Dyadic Adjustment Scale., Results: The study included 140 individuals receiving treatment for addiction. No differences were seen among the two groups in education, occupation, marital status, and living conditions before the intervention. However, six months later, the intervention group showed improvements in attitude, subjective norms, perceived behavioral control, behavioral intention, medication regimen adherence, hope, and marital quality compared to controls., Conclusion: The results indicate that family-based educational interventions grounded in TPB are effective in improving medication regimen adherence, hope, and marital quality among patients with substance use disorders. Significant increases in attitude, subjective norms, perceived behavioral control, and behavioral intention positively impacted medication regimen adherence in these patients., Competing Interests: Declarations Ethical approval The study procedures were carried out following the Declaration of Helsinki. The Ethics Committee of Fasa University of Medical Sciences approved this study (IR.FUMS.REC.1398.159). Informed consent was taken from all the participants. Also, for illiterate people, an informed consent form was obtained from their parents or legal guardians. There was an emphasis on maintaining privacy in keeping and delivering the information accurately without mentioning the names of the participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Domestic violence, in addition to the destructive effects it brings to the mother of the family, also has a strong impact on the children. According to the evidence obtained, coping strategies have been successful in tackling this issue. The purpose of this study was to investigate the effect of education on coping skills with domestic violence based on the health belief model (HBM) in women referring to comprehensive rural health service centers in Marvdasht City, Iran., Methods: This semi-experimental study was conducted on 120 women affected by domestic violence who were referred to rural health centers in Marvdasht City in 2022. The multi-stage cluster sampling method was used for assigning people to two experimental and control groups (60 people in each group). The data collection tool was a questionnaire based on the HBM and a coping strategies questionnaire that was completed before and two months after the intervention by both groups. After entering SPSS 24, the data were analyzed by paired t, independent t, and chi-square statistical tests., Results: Before the intervention between the two groups in terms of the constructs of awareness (P = 0.45), attitude (P = 0.23), behavior (P = 0.67), perceived sensitivity (P = 0.10), perceived severity (P = 0.84), perceived barriers (P = 0.31), perceived benefits (P = 0.21), perceived self-efficacy (P = 0.10), and cues to action (P = 0.19), no significant difference was observed, while after the intervention, a significant difference was observed between the two groups in terms of the structures expressed (P < 0.05). Likewise, before the intervention between the two experimental and control groups in terms of the ability to receive and send messages (P = 0.73), emotional control (P = 0.22), listening skills (P = 0.65), insight into the communication process (P = 0.15), communication combined with assertiveness (P = 0.98), and coping skills (P = 0.21), no significant difference was observed, while after the educational intervention, there was a significant difference between the two groups in terms of skill components (P = 0.001)., Conclusion: In the current study, education based on the HBM with a focus on coping skills led to the improvement of the skills of women who have experienced violence, their attitude and awareness, perceived sensitivity and perceived severity, and finally the benefits and barriers they receive from using coping skills., (© 2024. The Author(s).)

Background: Social distancing is a key behavior to minimize and controlling COVID-19 infections. The current study applied an integrated Theory of Planned Behavior to identify the determinants of social distancing behavior, and the processes involved, in the context of the COVID-19 pandemic., Methods: a cross-sectional study was conducted in Southern Iran among 1000 people from Shiraz by employing a convenience sampling technique. Data were collected using a pre-tested and structured questionnaire based on the main constructs of the Theory of Planned Behavior. Statistical analysis was done using IBM SPSS software version 22 and Amos version 24. Level of statistical significance was declared at a P-value of less than 0.05., Results: according to the results, the subjective norms (F = 2.696, effect size = 0.139) and attitude (F = 3.582, effect size = 0.155) play an important role in the samples' PBC (P ≤ 0.05). Final adjusted structural equation model of the effects of independent variables (Gender, subjective norms, attitude) on samples' intention to adherence social distancing for prevention of Covid-19 with the mediating role of one main variable of PBC. The PBC alone can be an important factor in creating intensive behavior in the samples (F = 3.560, effect size = 0.18)., Conclusion: current findings highlight the importance of "attitude, subjective norms and PBC" as determinants of social distancing intention. Future research on long-range predictors of social distancing behavior and reciprocal effects in the integrated model is warranted. This evidence is relevant to public and private organizations in the process of developing strategies to promote and engage the population in adopting the behavior of "Adherence to Social Distancing" in Iran., (© 2024. The Author(s).)

Background: One of the most important causes of cardiovascular disease is hypertension. Lifestyle modification has been emphasized in preventing and controlling blood pressure. This research aimed to determine the effect of educational intervention by application of PRECEDE-PROCEED model on lifestyle change in hypertensive patients in the villages of Fasa City, Fars Province, Iran. Methods: This research is a quasi-experimental study that was conducted on 300 hypertensive patients in 2020-2021. Data gathering tools were a demographic information questionnaire, a questionnaire based on the PRECEDE-PROCEED model, and a lifestyle questionnaire (LSQ). The educational intervention consisted of ten sessions lasting 45 or 50 min. Before and 6 months after the educational intervention, the two groups each completed a questionnaire. The systolic and diastolic blood pressure (DBP) levels, as well as physical exercise and health variables, nutrition and weight control, mental health, and spiritual health were measured before and 6 months after the educational intervention. Results: The results showed that there was no significant difference between the two groups before in cues of PRECEDE-PROCEED model; however, the experimental group had a significant increase in cues of PRECEDE-PROCEED model 6 months after the intervention. The results showed that the experimental group had a significant increase 6 months after the intervention in terms of physical exercise and health variables, nutrition and weight control, mental health, and spiritual health. The mean blood pressure (both diastolic and systolic) in the experimental group was significantly reduced after the intervention. Conclusions: The study's results showed the effectiveness of an educational intervention based on the PRECEDE-PROCEED model on lifestyle change in hypertensive patients. It also highlights the need to pay further attention to the education aimed at controlling hypertension through a healthy lifestyle and correct behavioral habits., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Alireza Ghannadi et al.)

Background: Considering the increasing prevalence of fast food consumption among teenagers, providing the necessary training and self-awareness is the best solution for institutionalizing the prevention of fast food consumption by this group. Therefore, this issue should be taken seriously, as should the implementation of educational interventions to prevent the consumption of fast food. The theory of planned behavior (TPB) is one of the various health education styles and methods that works well. However, given that a number of local data points are crucial in establishing the efficacy of the model employed, this study looks into the impact of TPB-based education in preventing fast food intake among teenagers., Methods: A total of 180 male students, ages 15 to 18, participated in this quasi-experimental study in Shiraz, Iran. Cluster sampling was used in the study, and participants were randomly assigned to two groups: the experimental group (n = 90) and the control group (n = 90). A theory-based questionnaire was used to gather data, and both the control and experimental groups had to complete it before and three months after the intervention. The data were examined using paired t, independent t, and chi-square statistical tests after being entered into SPSS-24., Results: The results of the independent t-test showed that there was no significant difference between the two study groups before the intervention in terms of knowledge (P = 0.14), attitude (P = 0.57), subjective norms (P = 0.94), perceived behavioral control (P = 0.81), behavioral intention (P = 0.42), or behavior (P = 0.25). However, following the intervention, there was a significant difference between the two groups with regard to the noted variables (P = 0.001). Furthermore, the McNemar test results demonstrated that the experimental group's consumption of fast food varied significantly before and after the intervention (P = 0.001), but not in the control group (P = 0.07)., Conclusion: The study's findings demonstrated that TPB-based treatments are successful in helping male students change their habits of consuming fewer amounts of fast food. This study demonstrated that the instructional techniques employed improved the fast food consumption behavior of the intervention group as well as the TPB's structure (attitude, subjective norms, behavioral intention, and perceived behavioral intention)., (© 2024. The Author(s).)

Background: Marital satisfaction is one of the important components of quality of life. Women's marital satisfaction is affected when they enter the middle age period, due to the mental and emotional tensions caused by the physical changes. In this regard, the present study aimed to investigate the association of quality of life with marital satisfaction, stress, and anxiety in middle-aged women referring to health centers of Ahvaz city, Iran., Methods: This cross-sectional descriptive-analytical study was conducted on 1,000 middle-aged married women (30-59 year of age) under the auspices of health centers of Ahvaz city, Iran in 2019. The subjects were selected by simple random sampling method, and were asked to complete demographic characteristics, quality of life questionnaire, Enrich marital satisfaction questionnaire, Holmes-Raheh stress questionnaire, and Spielberger state-trait anxiety inventory. The data were analyzed by using SPSS 0.22 software through mean, standard deviation, frequency, Pearson correlation and regression ( p  = 0.05)., Results: Based on the results, 42.4% of the participants were between 40 and 50 years of age, 35.6% had a high school diploma, and 50% of them were housewives. Also, the results of Pearson's correlation showed a positive and significant relationship between quality of life and marital satisfaction ( r  = 0.178) ( p  < 0.001). However, quality of life had a negative and significant relationship with anxiety ( r  = -0.552) ( r  < 0.001) and stress ( r  = -0.188) ( p  < 0.001)., Conclusion: Given the positive and significant relationship between quality of life and marital satisfaction, appropriate trainings are highly recommended for couples to increase the quality of life and marital satisfaction of middle-aged women and thus strengthen the health of family and society., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Rakhshani, Amirsafavi, Motazedian, Harsini, Kamyab and Jeihooni.)

Background: One of the most crucial and essential methods for the prevention and management of respiratory infections is for healthcare professionals to take precautions for their own safety. Using Protection Motivation Theory (PMT), the current study looked into effective elements influencing the staff at Kazeroon's Valiasr Hospital's preventive actions against respiratory diseases., Methods: One hundred ninety-two male and 108 female employees of the Valiasr Hospital in Kazeroon, Iran, participated in this cross-sectional study, in May 2022. Census data were used as the sample technique. A questionnaire based on the PMT and a questionnaire collecting demographic data served as the data collection method. The study's content validity was confirmed by 10 health education experts, and its reliability was assessed using internal consistency techniques, resulting in a Cronbach's alpha coefficient of 0.87.The statistical program SPSS 24 was used to examine the data using the independent t test, logistic regression, and Pearson correlation., Results: The average age was 34.11 ± 8.91 for men and 32.77 ± 6.09 for women. The majority of participants were married (73.3%), had university education (76.7%), and earned a monthly income between 10 and 15 million Tomans (75%). Notably, 97.7% of participants had received the COVID-19 vaccine, and 77.7% had undergone training related to respiratory infections. The most common preventive practices included avoiding touching the eyes, noses, or mouths, wearing appropriate protective gear, and maintaining a safe distance of 1-2 m from others. Analysis of PMT constructs showed that participants had a generally positive perception toward preventive behaviors. Perceived vulnerability (P = 0.02), perceived cost (P = 0.03), and motivation (P = 0.001) were the three analyzed components that had the greatest impact on respiratory infection preventative behavior. Logistic regression revealed that perceived susceptibility, cost, and motivation significantly predicted the prevention of respiratory infections, with a predictive power of 45%. These findings highlight the importance of understanding the factors influencing preventive behaviors among hospital staff, from respiratory infections like COVID-19., Conclusion: According to the findings, the personnel at Kazeroon's Valiasr Hospital wore gloves, goggles, and other appropriate personal protective equipment. The individuals' decision to wear personal protection equipment was also impacted by perceived susceptibility, cost, and motivation., (© 2024 The Author(s). The Clinical Respiratory Journal published by John Wiley & Sons Ltd.)

Objectives: Research regarding the contribution of specific psychoactive substances to suicidality has yielded equivocal results. The present study examined the prevalence and factors associated with suicidal thoughts and behaviors among a population-based sample of untreated illicit substance users., Methods: A total of 616 illicit substance users who were recruited from high-risk areas of Shiraz using snowball sampling participated in the study. Eligible participants were individuals aged 18 years and older who regularly used one illicit psychoactive substance (e.g., opioids, heroin, cannabinoids, stimulants, hallucinogens) for at least one year and who had received no treatment for their drug use during the past year. Data were collected regarding socio-demographic characteristics, mental history, and substance use habits. Data regarding suicidal thoughts and behaviors were assessed using the Beck Suicidal Ideation Scale (BSIS) and self-reports of previous suicide attempts. Multiple logistic regression analysis was used to identify independent variables associated with suicidality., Results: Among the participants, 23.6% reported having had suicidal thoughts during the past week and 6.7% reported having attempted suicide during the past year. Methamphetamine was reported as the primary substance of use among approximately half of the participants who attempted suicide during past year (49.2%). Multiple logistic regression analysis showed that current suicidal thoughts were independently associated with having no job, a history of mental health condition, previous suicidal attempts, concurrent use of more than one substance, and using methamphetamine and heroin as the primary substances. Suicidal thoughts were not associated with increased odds of regular opium and cannabis use., Conclusion: Both methamphetamine and heroin use are significantly associated with current suicidal thoughts. Evaluation of the risk of suicidality by physicians and mental health care professionals in both community and outpatient settings would be especially appropriate among those individuals using these psychoactive substances., (© 2024. The Author(s).)

Background: One of the most important occupational complications that could occur in nurses is musculoskeletal disorders. In this study, we designed an educational intervention based on the PRECEDE-PROCEED model to investigate its effects on a group of nurses on preventive behaviors of musculoskeletal disorders., Methods: A total of 120 nurses working in Izeh City, Iran, participated in this semi-experimental study. The sampling was performed through a convenient sampling method, and the participants were randomly assigned to the experimental and control groups (60 participants for each group). Both groups filled out a questionnaire based on the PRECEDE-PROCEED model before and 2 months after the educational program as part of the data collection process. The data were examined using a paired t -test, an independent t -test, and a chi-square test after being entered into SPSS version 24., Results: According to the findings, prior to the intervention, there was no difference between the two groups in terms of their knowledge ( p = 0.221), attitude ( p = 0.136), enabling factors ( p = 0.325), reinforcing factors ( p = 0.548), self-efficacy (0.421), and behavior (0.257) levels. However, following the intervention, a substantial rise was witnessed in the experimental group in each of the mentioned variables ( p = 0.001)., Conclusion: In the current study, education based on the PRECEDE-PROCEED model led to the improvement of knowledge, attitude, enabling and reinforcing factors, self-efficacy, and finally preventive behaviors with musculoskeletal disorders in the participants. Considering the importance of the role of health education in promoting behaviors related to musculoskeletal disorders in nurses and the importance of observing related behaviors in preventing long-term complications, the necessity of education in a wider dimension and with different tools is felt more and more in society. Therefore, longer interventions with this aim could be carried out on nurses and other healthcare personnel., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Rakhshani, Limouchi, Daneshmandi, Kamyab and Jeihooni.)

Background: Hospital staff represent a vulnerable population for respiratory diseases. Consequently, the implementation of training programs becomes imperative as a preventive measure against such infections in these populations. The current study was conducted to examine the impact of an educational intervention based on the Protection Motivation Theory (PMT) on preventive behaviors for respiratory infections among a group of hospital staff., Methods: This experimental study involves a sample of 150 hospital staff from Gachsaran City, Iran, in 2021-2022. The sampling technique involved the utilization of a random assignment approach to allocate individuals into two distinct groups: the experimental group, consisting of 75 participants, and the control group, also including 75 individuals. The data collection instrument was a questionnaire designed in accordance with the PMT. This questionnaire was administered to both the experimental and control groups prior to the intervention as well as two months following the intervention. The intervention program consisted of a total of five sessions, each lasting for 60 min, for the experimental group. These sessions were conducted on a weekly basis over a period of two and a half months. Specifically, there were two sessions held every month and one session held every two weeks. Following the completion of the program, the data was entered into SPSS-24 statistical software for analysis using paired t-tests, independent t-tests, and chi-square tests., Results: The results indicated that prior to the intervention, there was no significant difference between the two groups in terms of perceived vulnerability constructs ( p = 0.25), perceived severity ( p = 0.63), perceived response ( p = 0.32), and perceived reward ( p = 0.11). Besides, there was no considerable distinction in perceived self-efficacy ( p = 0.84), perceived response cost ( p = 0.33), fear ( p = 0.45), behavior motivation ( p = 0.51), knowledge ( p = 92), or vaccination behavior ( p = 0.12) before the educational intervention. However, a significant change was noticed in each of the mentioned variables between the two groups after the intervention ( p < 0.05)., Conclusion: The results of this study indicated that the implementation of an educational intervention grounded in the PMT yields positive outcomes in enhancing preventative behaviors pertaining to respiratory infections. Hence, it is recommended to utilize an intervention grounded in this theory among hospital staff as a viable approach to mitigating the occurrence of respiratory infections., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Rakhshani, Nikeghbal, Kashfi, Kamyab, Harsini and Jeihooni.)

Background: Pregnancy is a transient physiological condition that causes adverse oral and dental consequences. The present study aimed to determine the effect of a training intervention based on the theory of planned behavior on oral and dental behaviors in pregnant women., Methods: This quasi-experimental study was conducted on 140 pregnant women (70 in the intervention group and 70 in the control group) supported by comprehensive health centers on the outskirts of Shiraz, Iran, in 2019-2020. The sampling was performed in each center by a simple random method. The tool included a demographic characteristics questionnaire, a questionnaire based on the theory of planned behavior, a self-care behavior questionnaire, and checklists for recording DMFT(Decayed, Missing due to caries, and Filled Teeth(DMFT)) and dental plaque indices. The questionnaires were completed before and 3 months after the intervention by both groups. The intervention group received six 50-min training sessions. The data were analyzed using SPSS 22, the chi-squared test, independent t-test, paired t-test, and descriptive statistics (p < 0.05)., Results: The mean ages of the intervention and control groups were 32.28 ± 6.14 and 31.84 ± 6.71, respectively. The results showed that the average scores of all constructs of the theory of planned behavior, dental plaque indices (PI), and MDFT in the intervention group significantly changed after the intervention (p < 0.001)., Conclusion: According to the results, training based on the theory of planned behavior was effective on dental and oral health behaviors in pregnant women and improved the clinical results of their self-care behaviors. Therefore, training sessions will increase the knowledge of pregnant women, and providing timely consultations and examinations can be helpful and effective in developing oral and dental health behaviors in pregnant women., (© 2023. The Author(s).)

Background: Cancer is a leading cause of death globally and the second cause of death in developed countries. Having a rising incidence, skin cancer is the most prevalent cancer in Iran. Long-term UV radiations, particularly during childhood and adolescence, is a major cause of skin cancers. The Theory of Planned Behavior as the most precise indicator of behavior, contains motivational factors affecting behavior. This theory has been successful in predicting factors related to chronic diseases, especially cancer. As this model was successful in assessing sun-protective behaviors in previous studies, this study was designed to figure out how a theory-based educational intervention can affect the skin cancer prevention practices of Iranian female high school students., Methods: This experimental investigation was carried out 2019-2020 using multistage cluster sampling method on 400 female high school students in Fasa, Fars, Iran. A questionnaire consisting of demographic data and a questionnaire including the components of the Theory of Planned Behavior was used to assess skin cancer preventative behaviors of both the trial and control groups of the study. An educational program based on the Theory of Planned Behavior was held for the experimental group for eight weeks regarding skin cancer preventive behaviors. The two groups completed questionnaires three months following the intervention for a second time., Results: The study's findings revealed that prior to the intervention, there was no considerable distinction between the two study groups with regard to knowledge, attitude, subjective norms, perceived behavioral control, behavioral intentions, and skin cancer prevention behaviors; yet, three months later, the experimental group demonstrated increases in each of the mentioned variables with a significant difference. In contrast, the control group showed no discernible difference., Conclusions: The findings of this investigation highlighted the success of the Theory of Planned Behavior for designing educational interventions aimed at encouraging skin cancer prevention in a population of female high school students., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: The increasing prevalence of needle stick injuries among nurses and the arising risks double the need to pay attention to improve their knowledge and change their behavior using effective educational models. The present study aimed to investigate the effect of educational intervention based on the health belief model on nurses' compliance with standard precautions in preventing needle stick injuries., Methods: This quasi-experimental study was conducted on 110 nurses working in medical training centers in Shiraz and Fasa in 2019. Subjects were selected using a simple sampling method and were randomly divided into two interventions (n = 55) and control (n = 55). The intervention included 7 sessions of 50-55 min. Before and 3 months after the intervention, the health belief model questionnaire was completed by both groups. The data were analyzed using SPSS software version 22 through chi-square, independent, and paired t-tests (P < 0.05)., Results: Based on independent and paired t-tests, there was no significant difference between the control and intervention groups regarding the mean score of health belief model constructs before the intervention. However, there was a significant difference regarding the mentioned scores 3 months after the educational intervention. Based on the paired t-test, the mean score of awareness, perceived sensitivity, perceived severity, perceived benefits, self-efficacy, cues to action, and behavioral performance in the intervention group significantly increased after the educational intervention (P < 0.05). Also, there was a significant decrease in perceived barriers (P < 0.05)., Conclusion: It is recommended to apply the proposed model as an effective and cost-effective method along with other methods in training programs for nurses and other health workers exposed to invasive procedures, contaminated blood, and secretions., (© 2023. The Author(s).)

Background: Oral cancer has created an alarming situation around the world, and being the 16th most common cancer worldwide, it has become a global concern. The present study aimed to investigate the effect of educational intervention based on a theory of planned behavior (TPB) on promoting preventive behaviors of oral cancer in rural women., Methods: This quasi-experimental study was conducted on 120 female hookah users referring to rural health centers in Fasa and Shiraz city, Fars province, Iran. The subjects were divided into experimental and control groups by simple random sampling. The educational intervention for the experimental group consisted of 8 training sessions of 50 min. Both groups completed a questionnaire including demographic characteristics and constructs of TPB before and four months after the educational intervention. Data were analyzed using SPSS 22 software through independent t-test, chi-square, and paired t-test (p = 0.05)., Results: The mean age of the experimental and control group subjects were 41.12 ± 8.86 and 40.63 ± 9.62 years, respectively (p = 0.185). The mean age of onset of hookah use in the experimental and control group was 24.16 ± 9.50 and 23.35 ± 9.44 years, respectively (p = 0.182). Also, before the educational intervention, there was a significant difference between the experimental and control groups in terms of knowledge (p < 0.189), attitude (p < 0.122), perceived behavioral control (p < 0.142), subjective norms (p < 0.236), behavioral intention (p < 0.126), oral cancer prevention behaviors (p < 0.108) and nicotine dependence (p < 0.218); however, four months after the educational intervention, there was a significant increase in the experimental group in all variables except nicotine dependence (p < 0.005)., Conclusion: Due to the alarming situation of oral cancer and the prevalence of hookah use among women, educational programs based on TPB could effectively prevent hookah use and oral cancer., (© 2023. The Author(s).)

Background: Settlement in a village and being native is one of the special conditions for choosing to be a health care worker as they must be accessible day and night and provide people with health services when needed. The aim of this study was to investigate the factors affecting health care workers' intention to remain in villages covered by Jundishapur University, Ahvaz, Iran., Methods: This is a cross-sectional study in 2019. The total number of health workers working at Ahvaz Jundishapur University of Medical Sciences and Health Services, Iran was 1034, amongst whom 280 individuals participated in this study. The data collection tool was a questionnaire consisted of two parts, in the first part of which there were 11 questions on personal information of the participants. In the second part, a total of six measures (physical, social, educational and cultural, occupational, welfare, personal and family) were used to examine the factors affecting the health workers' intention to remain in rural areas., Results: The results of this study showed that the current residence of 55% of the health workers was villages while 45% of them lived in urban areas. The results indicated that there was a significant relationship between physical, social, educational and cultural, occupational, welfare, personal and family factors and the health workers' intention to remain in rural areas. Besides, female HCWs were more affected by personal and family factors compared to the male participants., Conclusion: Increasing the quality and paying more attention to physical, social, educational and cultural, occupational, welfare, personal and family factors can cause health workers to remain longer in rural areas., Competing Interests: The authors declare that they have no competing interests., (© 2023 Published by Elsevier Ltd.)

Background: The relationship between environmental diversity and the health status of older adults has been less considered in studies. This study seeks to investigate the causal relationship among the environment, falling, fear of falling, and the imbalance of older adults in southern Iran in 2021., Objective: The investigation into the relationship between environmental pollution to the imbalance and fear of falling, especially in comparing urban and rural aging societies is the aim of current study., Methods: In a cross-sectional study, 489 older samples from rural and urban areas were chosen randomly and their experience of falling, fear of falling, imbalance, and IADL were examined. The ordinal and nominal logistic regression and ANOVA were performed using IBM-SPSS., Results: With a mean age of 71.8 (SD = 8.3), older participants have long time chronic disease (69.6%) and falling experience twice a year (42.7%). The values of effect size indicated the high effectiveness of settlement in explaining IADL, health situation, experience and fear of falling, and imbalance (Eta squared > 30). The odds ratio for being in the urban settlement was 5.51, indicating the imbalance score increased by approximately 5.52 times., Conclusion: Imbalance in older people leads to the fear and experience of falling. This imbalance is strongly influenced by the environment. Urban pollution can contribute to this problem. Future studies on aging need to focus on environmental pollution and diversity in the experience of falling and imbalance., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Suicide is considered as an important, widespread phenomenon in the world, causing numerous deaths annually. This study is going to investigate how suicidal attempts are affected by several demographic and other underlying factors., Objective: The present study was designed to investigate suicide attempts and its related factors in patients referred to Gachsaran Hospital, Iran., Materials and Methods: This cross-sectional study was conducted on 348 people who had attempted suicide (Please note that 348 was the number of suicidal attempts not the number of suicidal deaths). The data were collected by consent of Shiraz University of Medical Sciences and necessary coordination with the Emergency Management Statistics Center of Shahid Rajaee Hospital in Gachsaran city. The data analysis was performed through the logistic regression test using SPSS software version 19. The significance level was considered 0.05., Results: A total of 348 individuals with a mean age of 23.9 ± 8.1 had attempted suicide in Gachsaran. Of these, 185 were female (53.2%) and 163 were male (46.8%). The results of multivariate regression showed that, after controlling the effect of probable confounding variables, the following variables had a significant relationship with suicide attempts in the individuals who had attempted to suicide: male gender, unemployment, and love problems., Conclusion: Considering the high rate of suicide attempts among unemployed male individuals during one year, counseling centers in Gachsaran city should pay special attention to this group of people. Measures such as creating jobs for young people can help prevent this social dilemma., Competing Interests: The authors declare no conflict of interest., (© 2022 Published by Elsevier Ltd.)

Background: One of the important indices for the efficacy of pre-hospital emergency services is telephone triage. The dispatching team members are faced with many challenges in telephone triage which can adversely affect their performance. This study was conducted in the south of Iran to determine the challenges to telephone triage in pre-hospital emergency services., Method: The present study is qualitative-descriptive where the sample was selected purposefully. Data were collected through 18 semi-structured, in-depth interviews with 18 dispatching team members in pre-hospital emergency care. The collected qualitative data were analyzed using the content analysis approach recommended by Graneheim and Lundman., Results: Analysis of the data resulted in the emergence of three themes and ten sub-themes. The three main themes extracted from the data included inefficient interaction, insufficient and unreal information, and professional challenges., Conclusion: The dispatching unit personnel in pre-hospital emergency care are confronted with various interactional, organizational, and professional issues. Accordingly, the senior managers in emergency departments should take effective measures to remove the existing barriers toward improving the efficacy of telephone triage and, by extension, the quality of pre-hospital emergency care services., (© 2022. The Author(s).)

Background: The parent's and especially the mothers' skills play a major role in the the education of healthy sexual behaviors in children. This study investigates the effect of educational intervention based on the Theory of Planned Behavior (TPB) on mothers' skills in the sexual care of children in Fasa city, Fars province, Iran in 2019., Methods: This study was a quasi-experimental intervention with a control group. 200 mothers of children aged 5 to 6 years in Fasa preschool were selected using a multi-stage random sampling method and were divided into two groups of intervention (100) and control (100). After providing a pre-test to both groups, only the experimental group received training on sexual care of children's abilities based on the Theory of Planned Behavior constructs. The educational intervention consisted of seven 55-60-minute sessions in which the presenter gave a presentation, asked and answered questions, and used posters, brochures, films, animations, and PowerPoints. Both groups completed the questionnaire three months following the intervention. A questionnaire and Theory of planned behavior constructs were used to collect information. The data was analyzed with SPSS22 software using paired t-tests, Chi-square tests, and independent t-tests, with a significance level of 0.05., Results: Before the intervention, there was no significant difference in the constructs of theTheory of planned behavior between the two groups (p>0.05), but after the intervention, knowledge scores from 8.33±2.97 to 20.67±2.84, attitude scores from 29.80±4.27 to 62.22±4.34, subjective norms from 20.12±4.55 to 42.28±4.20, perceived behavioral control from 20.24±4.36 to 42.88±4.52, behavioral intention from 3.24±1.60 to 7.44±1.59 and behavior from 2.98±1.13 to 8.14±1.08 in the intervention group (p< 0.001)., Conclusion: This study showed TPB constructs' Effectiveness in adopting the level of mothers' skills in the sexual care of children. Hence, this model can act as a framework for designing and implementing educational interventions for the sexual care of children., (© 2022. The Author(s).)

Background: Osteoporosis is one of the most prevalent bone diseases which is preventable. Implementing educational programs is an important step in prevention of chronic diseases in the community setting. One of the theories used for predicting behavior and performing educational intervention is theory of planned behavior (TPB) which predicts the intention of an individual toward doing a specific behavior. This study was conducted to assess the effect of educational intervention based on TPB on behavioral responses of premenopausal women in prevention from osteoporosis in Fasa city, Iran., Methods: This study is a quasi-experimental study performed on 200 women aging from 35 and 55 years who referred to health centers in Fasa city; iran in 2019. Simple random sampling was applied to assign participants to control and intervention groups (100 participant for each group). Data were gathered by a "valid" and "reliable" questionnaire arranged based on the constructs of TPB, nutrition performance and physical activity. An educational program on osteoporosis prevention was conducted. educational intervention was performed in six sessions through group discussions and educational films and booklet for experimental group and then the changes in the scores of the two groups were evaluated and compared. Obtained data were analyzed by SPSS-22 software through Chi-square, independent t-test, paired t-test and ANOVA tests., Results: The mean ages of studied participants in experimental and control groups were respectively 43.39 [Formula: see text] 5.20 and 42.94 [Formula: see text] 5.52. In experimental group, the average scores of knowledge [2 weeks (31.12 [Formula: see text] 4.20) and 2 months (39.04 [Formula: see text] 4.10) after educational intervention (p < 0.001)], constructs of theory of planned behavior [attitude construct: 2 weeks (89.32 [Formula: see text] 9.22) and 2 months (98.57 [Formula: see text] 9.13) after educational intervention (p < 0.001), Subjective norms construct: 2 weeks(88.39 [Formula: see text] 8.84) and 2 months (122.57 [Formula: see text] 8.58) after educational intervention (p < 0.001), Perceived behavioral control construct: 2 weeks (88.56 [Formula: see text] 8.38) and 2 months (120.15 [Formula: see text] 8.33) after educational intervention (p < 0.001), Behavioral intention construct: 2 weeks (54.44 ± 4.72) and 2 months (60.26 [Formula: see text] 4.12) after educational intervention (p < 0.001)], nutrition performance [2 weeks (19.88 ± 2.56) and 2 months (24.14 [Formula: see text] 2.36) after educational intervention (p < 0.001)] and physical activity [2 weeks (16.75 [Formula: see text] 1.42) and 2 months (18.94 [Formula: see text] 1.68) after educational intervention (p < 0.001)] had more significant enhancement than control group 2 weeks and 2 months after educational intervention., Discussion: TPB was effected in nutrition performance and physical activity in osteoporosis prevention of subjects. This theory can be used as a framework for designing and performing educational intervention for preventing osteoporosis and promoting women's health., (© 2022. The Author(s).)

Background: Early identification of breast cancer may result in earlier treatment and a lower mortality rate. This fact has resulted in the development of screening programs to detect breast cancer in its early stages; thus, the current study sought to investigate the influence of educational intervention on knowledge, attitude, and practice about breast cancer screening in Izeh, Khozestan Province, Iran., Materials and Methods: This experiment was carried out on the women of Izeh city in 2019. This study included 120 women who were randomized into the experimental and control groups at random (60 in the experimental and 60 in the control groups). Before and two months after the intervention, data were collected using a researcher-created questionnaire by the control and education groups. The intervention program for the intervention group included eight educational sessions over the course of two months. The SPSS 20 statistical program was used to examine the data, as well as the paired t -test, independent t -test, and Chi-square., Results: There was no significant difference between the experimental and control groups' mean scores of knowledge, attitude, and practice prior to the educational intervention, but a significant difference was observed after the intervention, with the experimental group obtaining significantly higher mean scores of knowledge, attitude, and practice ( P = 0.05)., Conclusion: In the present study, the educational intervention on the knowledge, attitude, and practice towards breast cancer screening led to the increased scores of the experimental group compared to control group., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2022 Tayebeh Rakhshani et al.)

Background: The possibility of the emergence of new pandemics necessitates further research into using simple strategies to promote social distancing behaviors in public. Most of the current evidence on effectiveness of physical distancing interventions is based on self-report and measure of intention which will not necessarily predict actual behavior., Methods: A field experimental study was conducted in the subway stations of Shiraz, Southern Iran. The interventions were based on intuitions from protection motivation theory and consisted of using environmental nudges to notify the passengers of the pandemic situation (threat appeal) and a verbal advice on keeping a safe physical distance as an effective method of protection against COVID-19 (coping message). Average physical distancing was estimated as the number of steps between two consecutive passengers and was compared between interventions (n = 1045) and the control (n = 855) groups., Results: A total of 1900 people riding on subway escalators were directly observed during two intervention conditions and the control condition. Under either threat or coping-based interventions, passengers were two times more likely (OR 2.0, 95%CI 1.5-2.7, P <  0.001) to keep a physical distance of at least 1.2 m from the traveler in front compared with those who did receive no intervention. The Kruskal-Wallis test revealed that there was a significant improvement in physical distancing behaviors with coping advice compared with threat appeal and the control conditions (χ2 = 120.84, df = 2, p <  0.001)., Conclusions: Our findings suggest that simple and inexpensive theory-based interventions can be used in crowded public spaces to promote physical distancing within the context of the pandemic., (© 2022. The Author(s).)

Background and Purpose: Recruitment and retention of competent faculty members are important in maintaining and improving the quality of education and research performance of universities. The aim of the present study was to find out the faculty members' views, experiences, and attitudes to identify the reasons for faculty attrition and retention in regional medical schools in Iran., Methods: In this qualitative study, we used a content analysis method. The participants included 12 faculty members who had been transferred to type I universities, four faculty members who had applied for transfer, four with more than 10 years of experience and working in the type 3 universities with no intention to be transferred. Data were collected using semi-structured interviews, which were conducted either face-to-face or via phone calls. The interview was developed for this study (Supplementary file). To measure the trustworthiness of the data, we evaluated four components of credibility, transferability, dependability, and conformability, as proposed by Lincoln and Guba., Results: The findings were classified into three categories and 14 subcategories. The first category was "retention facilitators" including four subcategories of facilitated communication, proximity to major universities, gaining experience, and support by authorities. The second category was "retention threats" including six subcategories of social infrastructure, individual dimension, occupation dimension, economic dimension, sense of respect, and executive management. The third category was "retention strategies" which included four subcategories of recruitment and promotion processes, inter-university collaboration with type I universities, facilitation of the scientific growth, and fulfilment of the safety needs., Conclusion: Several factors play a role in the faculty members' retention in regional medical schools in Iran. Authorities can create a more positive environment by devising a suitable reward system, supporting academic activities, and increasing the level of faculty autonomy practically to develop a sense of belonging among them and reduce the intention to be transferred among their human resources.

Background and Objective: The aim of this study is to determine the effect of educational program based on the extended theory of reasoned action on self-care behaviours in women with type 2 diabetes in Fasa. This quasi-experimental study was performed on 100 women with type 2 diabetes who referred to diabetes clinics in Fasa., Materials and Methods: Samples were randomly divided into experimental and control groups. The data were collected using a questionnaire based on the extended theory of reasoned action and self-care behaviours that were completed by both the control and experimental groups before and 3 months after the educational intervention. Data were analysed by SPSS software version 22, descriptive statistics tests, Chi-square test, independent T-test, and paired T-test., Results: The results of the study showed that after the educational intervention, the mean scores of all constructs of the extended theory of reasoned action in the experimental group were significantly increased compared to the control group ( P <0.05)., Conclusion: Also, the educational intervention had a significant effect on the promotion of patient's self-care behaviours in the experimental group and the HbA1c level decreased in the experimental group compared to the control group ( P <0.05). In addition, it was found that the extended theory of reasoned action could be a suitable framework for designing educational interventions for promoting self-care behaviours in diabetic patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Endocrinology and Metabolism.)

Background: Diabetes is one of the main reasons of the increase of morbidity and mortality around the world. Considering the burden of disease, self-medication can result in irrecoverable consequences. The aim of this study is to investigate the effect of educational intervention based on Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF) model on self-medication behaviors of type 2 diabetic patients in Fasa, Fars province, Iran, in 2017-2018., Materials and Methods: In this quasi-experimental study, 200 type 2 diabetic patients under cover of the diabetes center of Fasa were investigated (100 patients for experimental group and 100 patients for control group). A questionnaire investigating demographic information and BASNEF Model constructs (knowledge, attitude, enabling factors, subjective norms, and behavioral intention) was used for evaluating self-medication behaviors of patients before and 3 months after intervention., Results: The average age of experimental group was 53.25 ± 8.42 and the average age of control group was 54.18 ± 8.13. Three months after intervention, experimental group showed significant enhancement in knowledge, attitude, enabling factors, subjective norms, and behavioral intention and their self-medication behaviors reduced, while control group showed no significant changes in mentioned factors., Conclusion: The present study indicated the efficiency of BASNEF model on reduction of self-medication behaviors of diabetic patients. Hence, this model can act as a framework for designing and implementing educational interventions in this field., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Endocrinology and Metabolism.)

The purpose of the present study is investigating the effect of educational intervention based on health belief model (HBM) on oral cancer prevention in smoker men. This is a quasi-experimental study carried out on 200 smoker men with the age of 40 or older (100 subjects for the experimental group and 100 subjects for control group) resident in Fasa City, Fars Province, Iran, in 2017-2018. The educational intervention for the experimental group included seven educational sessions for 50 or 55 min-based HBM. A questionnaire consisted of items about demographic information, knowledge, HBM constructs (perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action) was used to measure the oral cancer prevention before and 6 months after the intervention. The mean age of the men was 51.35±8.41 years in the experimental group and 52.28±8.09 years in the control group. Based on the obtained results, significant enhancement is observed in average scores of knowledge, perceived susceptibility, severity, benefits, self-efficacy, cues to action, and oral cancer prevention behaviors in experimental group; however, no significant changes are observed in average scores of knowledge, perceived susceptibility, severity, benefits, self-efficacy, cues to action, and oral cancer prevention behaviors of control group. Also, results indicated that, the educational program based on HBM model have positive effect on oral cancer prevention with the improvement of subject's knowledge, perceived susceptibility, severity, benefits, and self-efficacy.

Leishmaniasis is an endemic disease in Iran. Since education to prevent the disease is important, this study aimed to determine the effect of educational intervention based on the PRECEDE-PROCEED model on preventive behaviors of cutaneous leishmaniosis among housewives. In this quasi-experimental study, 240 housewives under the coverage of health centers, who lived in the endemic area of Mianshahr, Fasa city, Fars Province, Iran in 2016, were selected (120 people for the experimental group and 120 for the control group). The educational intervention for the experimental group was based on the PRECEDE model, which consists of seven 50-60-minute sessions of lectures, group discussions, role playing, practical displays, and video and PowerPoint displays. These sessions addressed the familiarity with cutaneous leishmaniasis and its different types and carriers, methods of preventing and fighting against it, personal protection, sanitation of the environment and drinking water, spraying of sites, use of mosquito nets, etc. Data were collected before educational intervention and three months after educational intervention. The mean age of the experimental group was 39.24±9.12 years and that of the control group was 38.84±9.28 years. Three months after the intervention, the experimental group showed a significant increase in knowledge, attitudes, reinforcing factors, enabling factors, and performance compared to the control group. The education based on enabling factors, reinforcing factors, and predisposing factors had a significant effect on the preventive behaviors of cutaneous leishmaniasis among housewives.

Skin cancer is one of the most common cancers in Iran. Farmers are exposed to the sun's ultraviolet radiation due to their job and are susceptible to skin cancer. The aim of this study is to survey the effect of educational intervention based on health belief model and social support on promoting skin cancer preventive behaviors in farmers of Fasa City, Fars province, Iran. In this quasi-experimental study, 200 farmers (100 in experimental group and 100 in control group) in Fasa City, Fars, Iran, were selected in 2017. The educational intervention for the experimental group consisted of eight training sessions (introduction to skin cancer, risk factors, complications, benefits and barriers to proper use of sunscreen, UV sunglasses and physical protection, self-efficacy in applying preventive behaviors, role of social support). A questionnaire consisting of demographic information, knowledge, HBM constructs (perceived susceptibility, severity, benefits, barriers, self-efficacy and cues to action), and social support was used to measure skin cancer preventive behaviors before, 3 months after the intervention, and 6 months later. Data were analyzed using SPSS-22 via chi-squared, independent samples t test, Mann-Whitney, and repeated measures ANOVA at a significance level of 0.5. The mean age of the farmers was 42.21 ± 10.52 years in the experimental group and 44.28 ± 10.16 years in the control group. Three months after the intervention and 6 months after the intervention, the experimental group showed a significant increase in the knowledge, perceived susceptibility, perceived severity, perceived benefits, self-efficacy, cues to action, social support, and skin cancer preventive behaviors compared to the control group. This study showed the effectiveness of the intervention based on the HBM constructs and social support in adoption of skin cancer preventive behaviors in 3 and 6 months post intervention in farmers. Hence, these models can act as a framework for designing and implementing educational interventions for the prevention of skin cancer.

Pharmaceutical compounds which enter the environment are classified as emerging pollutants. Among different drug compounds, anti-cancer drugs like methotrexate are of more concern due to their mutagenic, carcinogenic, and genotoxic properties. Therefore, the main objective of this study was to use catalytic ozonation processes (COPs) as novel advanced oxidation processes to degrade methotrexate from aqueous solutions. The calcination method was used to obtain a nitrate magnesium oxide nano-catalyst. The main variables considering the effect of single ozonation processes (SOPs) and COPs on the target pollutant were initial methotrexate concentration, contact time, solution pH, and MgO dosage. The BET results indicated that the surface area of the MgO nano-catalyst was 140.031 m 2 g -1 . Based on the BJH plot, the size of the MgO nano-catalyst and average pore volume were 44.5 nm and 0.4454 cm 3 g -1 , respectively. The weight percent of Mg and O was 61.09% and 38.91%, respectively. In acidic and alkaline pH, the degradation rate of methotrexate showed a higher increase in SOPs and COPs than at neutral pH. The degradation rate of methotrexate decreased with increasing concentration. By increasing the contact time, the degradation rate of methotrexate of both SOPs and COPs increased. Actually, the methotrexate degradation in COPs was faster than in SOPs. When using tert -butanol as a scavenger, the reduced removal efficiency in SOPs and COPs was 32% and 31%, respectively., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Prostate cancer is one of the most prevalent diseases among men. This study aimed to assess the effect of educational program based on Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation (PRECEDE) model in promoting prostate cancer screening in a sample of Iranian men. This is a quasi-experimental study carried out on 300 men aged 40 to 70 (the subjects 150 experimental and 150 control groups) in Shiraz City, Fars Province, Iran, in 2016. The participants of the intervention group attended training based on the PRECEDE model. The study compared mean scores of knowledge, attitude, enabling factors, perceived social support, quality of life, general health, self-efficacy, and screening behaviors of the subjects before and 6 months after intervention in experimental and control groups. The mean age of experimental group was 56.45 ± 8.65, and the mean age of the control group was 55.64 ± 8.71 years (P = 0.521). The study showed that there was a significant increase in the mean score of knowledge, attitudes, perceived self-efficacy, enabling factors, perceived social support, quality of life, public health and screening behaviors of the experimental group; however, no significant change was observed in the mean score of knowledge, attitudes, self-efficacy, quality of life, general health, perceived social support, enabling factors, and screening behaviors of the control group. Our findings showed that the health education programs designed based on PRECEDE could positively affect prostate cancer screening behaviors of individuals by improving their knowledge level and attitude, enabling factors, perceived social support, quality of life, general health, and self-efficacy.

Background: Family physician (FP) program is a complete health-care system whose most important results are elimination of individuals' confusion when going to the doctor and increase in their satisfaction with health services. This study aimed to evaluate the performance, strengths, and weaknesses of FP program., Materials and Methods: In this cross-sectional study, 52 FPs in Fars province were selected via stratified sampling and their performance was investigated. The data were collected using FPs performance questionnaire that included five domains, namely, management, performance, contract guidelines, community involvement, and outcomes. Then, the data were entered into the SPSS statistical software, version 19, and were analyzed using t -test, ANOVA, and Pearson's correlation coefficient., Results: Among the 52 FPs under study, 56.9% were male and 43.1% were female. The lowest and highest scores were related to community involvement (3.93 ± 0.81) and outcomes (23.52 ± 3.04), respectively. The results showed significant relationships between most domains ( P < 0.05). However, no significant correlation was found between gender and different domains ( P < 0.05)., Conclusion: Considering diverse activities done by FPs, the wide area of our country, and issues related to increasing satisfaction among physicians and individuals covered by the program, further researches are required in this area., Competing Interests: There are no conflicts of interest.

Background: Diabetes is the most common disease related to metabolism disorders. Today, diabetes in the elderly is one of the major epidemics of the century. This study aimed to investigate the effect of nutrition and jogging-based Belief, Attitude, Subjective Norm, and Enabling Factors (BASNEF) model in changes in metabolic parameters that performed in elderly patients with type II diabetes in Fasa city., Methods: This study was a randomized clinical trial on 108 elderly patients with type II diabetes (54 patients in the experimental group and 54 in control group) referred to the diabetes center in Fasa City, Fars Province, Iran, in 2016. Data were collected using a valid self-reported questionnaire including demographic variables and BASNEF Model (knowledge, attitudes, subjective norms, and enabling factors), checklist for patient's practices nutrition and jogging based on self-reporting patients, assess the level of fasting blood sugar (FBS), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and HbAlc patients which was completed by both groups before and 3 months after the intervention. The experimental group received the training in eight sessions; each session lasted for 70 min. Then, the data were entered into the SPSS 22 software (SPSS Inc., IBM, Chicago, IL, USA) and were analyzed using descriptive statistics, Chi-square test, independent t -test, and paired t -test. P <0.05 was considered as statistically significant., Results: The results showed that the mean scores of the BASNEF components (knowledge, attitudes, subjective norms, and enabling factors) in two experimental and control groups after intervention were a significant difference. After training program, nutritional and jogging performance in the experimental group was better than the control group. Furthermore, FBS ( P < 0.001), LDL ( P < 0.001), HDL ( P < 0.001), TG ( P < 0.001), and HbAlc ( P < 0.001) improved significantly in the experimental group compared to the control group., Conclusions: Plan and implement nutrition and jogging education using the BASNEF model to improve metabolic parameters in diabetic patients are very effective and beneficial. Moreover, in the implementation of these programs, control, monitoring, and follow-up educational are recommended., Competing Interests: There are no conflicts of interest.

The ingestion of heavy metals through contaminated seafood can causes significant outcomes on human health. In recent years, consume fishes and shrimps has increased in Iran, and several study about heavy metals content in fishes and shrimps from Persian Gulf were carried out to check their food safety. The aims of these systematic reviews and meta-analysis was to summarize the evidence on the relation of the intakes of Arsenic (As) and lead (Pb) levels, based on the origin and sub-groups of shrimp species consumed, Hence that we can estimate the risk of oral cancer induced by Pb and As in these groups of shrimp from the persian gulf. We carried out a search of all suitable studies published between 1995 and 2017 in Scopus, Science Direct, PubMed and Web of Science databases. Since the heterogeneity among studied was significant, we used the random effect model (REM) to perform meta-analysis of data. Data were obtained from 9 articles (14 studies), with 511 samples, and it was reported that pooled levels of As and Pb in the muscle shrimps were 1.37 (95% CI: 0.66-2.08 mg/kg d.w.) and 0.58 (95% CI: 0.33-0.82 mg/kg d.w.), respectively. This pooled levels in muscle shrimps were higher than safe dose reported on Food and Agriculture Organization/World Health Organization guidelines (FAO/WHO). The rank order of shrimps species based on As was Panulirus homarus > Penaeus semisulcatus and for the Pb levels was Litopenaeus vannamei > Panulirus homarus > Fenneropenaeus indicus > Metapenaeus affinis. The lowest and highest risk levels of oral cancer, divided by consumers age groups, were respectively 45-54 (6.94E-04) and 15-24 (8.42E-04) for the Pb, and 45-54 (2.87E-01) and 15-24 (3.51E-01) for arsenic. Incremental Lifetime Cancer Risk (ILCR) of Pb and As was higher than 10-4 and 10-3, respectively. All groups (age) of consumers are subject to the cancer risk of due to the consumption of shrimps contaminated by Pb and As, therefore, should be started a control plan for the reduction of the heavy metal bioaccumulation levels in shrimps of the Persian Gulf coupled to a capillary food safety communication., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: To determine the effect of educational program based on Health Belief Model (HBM) on promoting preventive behaviors of nosocomial infections in nurses., Methods: In this randomized controlled trial study, 120 nurses working in a hospital in Fasa City, Fars (Iran). Intervention group (n=60) received an educational program based on HBM while control group (n=60) did not received it. A questionnaire consisting of demographic information, HBM constructs (knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, performance and cues to action) was used to measure changes toward the prevention of nosocomial infections before, immediately after intervention and four months later (of the end of the intervention)., Results: Immediately and four months after the intervention, the intervention group showed a significant increase in the knowledge, perceived susceptibility, perceived severity, perceived benefits, Self-efficacy, cues to action and performance compared to the control group., Conclusions: This study in nurses showed that the effectiveness of the Educational program based on HBM on promoting preventive behaviors of nosocomial infections. Hence, this model can act as a framework for designing and implementing educational interventions for the prevention of nosocomial infections., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Universidad de Antioquia.)

The general goal of this study was to measure the concentration of heavy metals on suspended particles and evaluate the health-risk assessment of these metals on human health. In this study, the concentration of heavy metals adsorbed on suspended particles less than 2.5 μm was determined. For determining of health-risk assessment, the developed method of USEPA was used. The health-risk assessment of carcinogen and non- carcinogen of suspended particles were evaluated in three main paths include oral ingestion, inhalation, and dermal contact. The average annual concentrations of Al, Fe, As, Cd, Cr, Cu, Mn, Ni, Pb, V, and Zn were 1.77, 1.14, 0.03, 0.02, 0.07, 0.15, 0.06, 0.03, 0.1, 0.04, and 0.14 μg/m 3 , respectively. Between different stations, the order for the heavy metals was followed as urban>traffic>suburban. The average risk of carcinogenic at urban stations in the spring for As, Cd, and Cr was 2.25*10 -9 , 2.09*10 -12 , and 2.05*10 -11 , respectively.

Aims and Objectives: Pregnant women are at risk of dental caries and periodontal disease. The purpose of this study was to assess the effectiveness of health education program based on health belief model (HBM) on oral and dental hygiene behaviors in pregnant women in Fasa city., Materials and Methods: This is a clinical trial study carried out on 110 pregnant women selected using random sampling method from health centers in Fasa city in 2016 (55 patients in the experimental group and 55 individuals in control group). Data collection with questionnaire was based on construct HBM, as well as their performance about oral health. At first, two groups completed the questionnaires. And then, the intervention was conducted for the experimental group based on HBM. Four months after intervention, two groups completed the questionnaires twice. To analyze the collected data, the researchers used SPSS version 22 and descriptive and analytical statistics tests such as independent t -test and Chi-square and Mann-Whitney test., Results: The age of the pregnant mothers was 28.25 ± 3.02 years in the experimental group and 27.8 ± 4.20 years in the control group. Compared to the control group, the experimental group showed a significant increase in their knowledge, perceived susceptibility, perceived severity, perceived benefits, self-efficacy, cues to action, and performance and decrease in perceived barriers 4 months after the intervention., Conclusion: Applying the HBM is very effective for developing an educational program for oral health in pregnant women. Moreover, in the implementation of these programs, control, monitoring, and follow-up educational are recommended., Competing Interests: There are no conflicts of interest.

Objectives: To explore the attitudes of nursing students and professors towards community-based training and internship in Fasa, Fars, Iran., Methods: This qualitative study was conducted using the content analysis approach. Data from students and professors were collected through five focal groups and data from patients was collected by using field notes. Interviews were conducted with 17 students and three professors responsible for implementing the study plan; in addition, 800 patient-related field notes were analyzed., Results: Community-based training and internship were identified as useful from the point of view of students, professors, and clients. Results were classified into two principal categories: "health preservation and promotion" and "promotion of students' skills"., Conclusions: Attitudes toward the formation and community internship are favorable insofar as it is a highly beneficial experience for students, professors, and patients., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Universidad de Antioquia.)

Objectives: This study sought to determine the effect of education based on the model of health beliefs in self-medication of women in Iran., Methods: Quasi-experimental study in a group of mothers (N = 90, 45 in the intervention group and 45 in the control group) users of health centers from the city of Fasa, province of Fars, southern Iran. Before and after the educational intervention (four training sessions in three months), a questionnaire was applied containing questions based on the model of health beliefs, on the components of knowledge, vulnerability, severity, benefits, and barriers perceived, and practices on self-medication., Results: Prior to the educational intervention, the level of knowledge, sensitivity, intensity, and benefits of self-medication were equal in both groups; however, after the educational intervention, it was observed that the intervention group improved in all components of evaluation and diminished barriers perceived and self-treatment practices., Conclusions: The educational intervention based on the model of health beliefs was effective in reducing self-medication practices in the group of mothers. Hence, this type of training is recommended in health centers to diminish the frequency of this practice., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Universidad de Antioquia.)

Background: Osteoporosis is the most common metabolic bone disease. The purpose of this study is to investigate the health belief model (HBM) and social cognitive theory (SCT) for osteoporosis preventive nutritional behaviors in women., Materials and Methods: In this quasi-experimental study, 120 patients who were women and registered under the health centers in Fasa City, Fars Province, Iran were selected. A questionnaire consisting of HBM constructs and the constructs of self-regulation and social support from SCT was used to measure nutrition performance. Bone mineral density was recorded at the lumbar spine and femur. The intervention for the experimental group included 10 educational sessions of 55-60 min of speech, group discussion, questions and answers, as well as posters and educational pamphlets, film screenings, and PowerPoint displays. Data were analyzed using SPSS 19 via Chi-square test, independent t-test, and repeated measures analysis of variance (ANOVA) at a significance level of 0.05., Results: After intervention, the experimental group showed a significant increase in the HBM constructs, self-regulation, social support, and nutrition performance, compared to the control group. Six months after the intervention, the value of lumbar spine bone mineral density (BMD) T-score increased to 0.127 in the experimental group, while it reduced to -0.043 in the control group. The value of the hip BMD T-score increased to 0.125 in the intervention group, but it decreased to -0.028 in the control group., Conclusions: This study showed the effectiveness of HBM and constructs of self-regulation and social support on adoption of nutrition behaviors and increase in the bone density to prevent osteoporosis.

Background: Osteoporosis is the most common metabolic bone disease. The study's objective is to investigate the effect of an educational program based on Health Belief Model (HBM) on preventing osteoporosis in women., Methods: In this quasi-experimental study, 120 patients (60 experimental and 60 control) who were registered under the health centers in Fasa City, Fars Province, Iran, were selected in 2014. A questionnaire consisting of demographic information, HBM constructs was used to measure nutrition and walking performance for the prevention of osteoporosis before, immediately after intervention, and 6 months later. Bone mineral density (BMD) was recorded at the lumbar spine and femur before and 6 months after intervention., Results: The mean age of women participated in the study was 41.75 ± 5.4 years for the experimental group, and 41.77 ± 5.43 years for the control group. The mean body mass index was 22.44 ± 3.30 for the experimental group and 22.27 ± 3.05 for the control group. The average number of women deliveries for the experimental group was 2.57 ± 1.47 and 2.50 ± 1.19 for the control group. There is no significant difference between the two groups in education level (P = 0.771), marital status (P = 0.880), occupation (P = 0.673), breastfeeding (P = 0.769), smoking (P = 0.315), history of osteoporosis in the family (P = 0.378), history of special diseases (P = 0.769), and records of bone densitometry (P = 0.543). Immediately and 6 months after intervention, the experimental group showed a significant increase in the knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, internal cues to action, nutrition, and walking performance compared to the control group. Six months after intervention, the value of lumbar spine BMD T-score in the experimental group increased to 0.127, while in the control group it reduced to -0.043. The value of the hip BMD T-score in the intervention group increased to 0.125, but it decreased to -0.028 in the control group., Conclusions: This study showed the effectiveness of knowledge, walking, and diet on bone mass by HBM. Hence, these models can act as a framework for designing and implementing educational interventions for the osteoporosis prevention.

Background: Several studies reported the efficacy of osteoporosis prevention interventions in improvement of people's preventive behaviors. However, there are reports that the interventions were not successful in altering osteoporosis health beliefs and preventive behaviors., Objectives: The current study aimed to assess the effect of a program based on health beliefs model (HBM) on females' health beliefs and performances about osteoporosis preventive behaviors., Patients and Methods: This quasi-experimental study was conducted on 120 patients registered in two healthcare centers of Fasa, Fars Province, Iran in 2014. A questionnaire including demographic information and HBM constructs was employed to measure the females' beliefs regarding nutrition and walking performance in prevention of osteoporosis bone mineral density (BMD) measured at the lumbar spine and femur before, immediately after the intervention, and six months after the intervention. Data were analyzed using Chi-square, independent samples t-, Mann-Whitney U tests and repeated measures ANOVA., Results: Immediately and six months after the intervention, a significant increase was found in the intervention group's health beliefs, nutrition, and walking performances to prevent osteoporosis. Six months after the intervention, lumbar spine BMD T-score increased to 0.127 ± 0.061 in the intervention group but reduced to -0.043 ± 0.059 in the control group. Also, hip BMD T-score increased to 0.125 ± 0.088 in the intervention group, but decreased to -0.028 ± 0.052 in control group., Conclusions: The current study showed the effectiveness of HBM in adoption of nutrition and walking behaviors as well as the increase of bone density to prevent osteoporosis.

Background: Prostate cancer is one of the most common and lethal cancers in the world. The incidence of prostate cancer has been increasing in recent years. The purpose of this study was to investigate factors associated with prostate cancer screening behaviors among men over 50 in Fasa, Iran, based on the PRECEDE model., Methods: In this cross-sectional study, 400 men over 50 were studied in Fasa, Iran. Data were collected via a questionnaire on demographic characteristics, such as age, number of children, occupation, education, marital status, smoking, and prostate cancer screening behaviors. Data were analyzed using SPSS software, version 16. Independent samples t-test and the Pearson Product Moment correlation coefficient were used for the statistical analyses., Results: Men in the study had little knowledge (34.11±8.22) and attitude (28.23±7.23) about prostate cancer and screening behavior. Their mean scores about prostate cancer, screening behavior, quality of life, and general health were moderate. The subjects had low self-efficacy and perceived social support. Their mean scores of enabling factors and screening behaviors were at a low level. Pearson correlation scores showed a significant correlation between cancer prostate screening behavior and demographic variables, such as age (p=0.04, r=0.136), occupation (p=0.01, r=0.121), educational level (p=0.02, r=0.211), and marital status of the subjects (p=0.01, r=0.112), but there were not significant correlations with the number of children (p=0.12, r=0.092) and smoking (p=0.09, r=0.002). The T-test results showed significant relationships between age, occupation, and education of the subjects, and the PRECEDE model structures were significant for predisposing factors, enabling factors, and reinforcing factors (p<0.05)., Conclusion: The prostate cancer screening behaviors in men over 50 in Fasa, Iran, were at a low level. Due to predisposing factors, such as the knowledge, attitudes, and beliefs of individuals, reinforcing factors can have an important role in the behaviors related to prostate screening, such as their families and health staffs as well as enabling factors, such as health financing, access to medicines and learning self-care. Educational interventions to improve these behaviors and the quality of life of these people seem essential.