Search

Abstract Background Drought is one of the most destructive and complex natural hazards, with direct and indirect effects, especially economic effects, on society and households. It affects the well-being and life satisfaction of households. It is important to understand the effects of drought at the micro level, such as households, by examining different attitudes, perceptions, and experiences of drought and its impacts. Methods This research aims to investigate the understanding and experiences of the residents of the poor areas of Kerman city regarding drought and its consequences on their well-being and life satisfaction. To that end, the descriptive phenomenology qualitative method was used, selected samples purposefully, and conducted semi-structured and in-depth interviews with households in August and September 2022. MAXQDA2020 software was used to manage and organize the data. Results From the analysis of the results of the interviews with the households, it was shown that the drought, with its impact on the economic, social, family, health, and environmental dimensions, has been identified as five main themes, leading to a decrease in the well-being and life satisfaction of the households. Conclusion The drought has caused the migration of families from the cities and villages around Kerman province to the outskirts of the city. Subsequently, with the increase in the population in the outskirts of the city, the problem of waterlessness has increased. As a result, the welfare and life satisfaction of households have decreased.

Abstract Background Different countries, including Iran, have implemented various policies to address substance use disorder. This study aims to describe the policies related to substance use disorder treatment and identify challenges related to these policies in Iran since the beginning of the Iranian Revolution in 1979. Methods This qualitative study utilized document analysis and interviews with policymakers and implementers. We reviewed a total of 22 documents related to substance use disorder treatment and harm reduction. The results from document analysis complemented and validated the interview data. The research population comprised policymakers and implementers, including individuals directly involved in formulating and implementing substance use disorder treatment policies. Purposive sampling was employed, with a snowball strategy utilized to maximize diversity. Data saturation was achieved after conducting 32 semi-structured interviews. Conventional content analysis was used for data analysis. Results In general, the policy landscape for substance use disorder treatment in the Islamic Republic of Iran can be divided into two periods: the “Moral Model” era (1979–1993) and the “Disease Model” era (1993–present). Challenges within the content of substance use disorder treatment policies in Iran encompass the lack of law revisions, existence of contradictions in laws and nature of disease, the absence of evidence-based policymaking, and an inadequate comprehensive perspective on the phenomenon of substance use disorder. Conclusions The presence of multiple authorities with different perspectives on substance use disorder and its treatment, coupled with the application of personal preferences in policymaking and the absence of evidence-based policymaking, have contributed to weaknesses in decision-making and policy formulation. The true philosophy of Disease Model appears not to have been fully grasped by health policymakers in Iran, as all Disease Model policies have been pursued with an emphasis on abstinence and quitting. Iran and other nations facing similar challenges should place more reliance on evidence-based approaches and shift away from the “Moral Model” paradigm to develop more effective substance use disorder treatment policies.

Abstract This study was designed to investigate the effect of vitamin D and/or synbiotics on the response to treatment, cytokines profile and hormonal biomarkers in breast cancer patients undergoing neoadjuvant therapy. A total of 76 patients were recruited and completed the course of the intervention between 2019 and 2021 in Kerman, Iran. breast cancer patients were randomly enrolled in this study. Patients divided into four groups to receive one of the following regimens: placebo, vitamin D, synbiotics and a combination of vitamin D and synbiotics. clinicopathologic parameters, inflammatory and anti-inflammatory biomarkers and hormonal levels were measured at the baseline and four months after intervention. The study results found no clear link between the interventions and achieving pathological complete response (pCR), and a similar trend was observed in Ki-67 index examination. After neoadjuvant therapy, TNF-α concentrations decreased, with vitamin D supplementation moderating this decline. Vitamin D supplemented groups showed a significant increase in serum IL-6 levels. While IL-10 levels decreased in the placebo group, all intervention groups were protected from this decline. Moreover, there was a notable increase in the anti-inflammatory index, particularly in the group receiving both vitamin D and synbiotic supplementation, suggesting potential synergistic anti-inflammatory effects from their combined administration. The outcomes suggest a potential anti-inflammatory function of this combination. Consequently, more extensive studies with prolonged follow-up periods and substantial sample sizes are warranted to thoroughly evaluate their potential benefits for breast cancer patients.

Drug use during pregnancy is a growing public health problem worldwide. This study determined the prevalence of illicit drug use among pregnant women in Kerman, Sought East Iran. This cross-sectional study was performed in 2020 on the 966 pregnant women referring to the Central Clinical Laboratory of Kerman for routine pregnancy tests. Urine sample of pregnant women was tested anonymously in two stages. At first, a qualitative screening test was done using the rapid immunoassay method. Then for positive specimens, thin layer chromatography was used to confirm the initial positive results. Data were analyzed using Chi-square test and multivariable logistic regression. The mean age of the participants was 27.3±6.6 years. Most of the respondents (93.8%) were urban dwellers. Also, 7.0% (95% CI: 5.4–8.7) of urine samples were positive for illicit drug. Opium was the most frequently used drug (83.8%). No urine sample was positive for marijuana and tramadol. The older the participants, the more likely they used drugs (odds ratio=1.05; CI 95%:1.01-1.09). Women with low socioeconomic status were nearly 2.2 times more likely to use illicit drugs. The prevalence of drug use is alarming among pregnant women in South eEast Iran. Considering this issue is necessary during prenatal care.

Background: Understanding the relationship between religiosity and health behaviors helps us to tailor messages based on cultural beliefs. We conducted an online survey to find any relationship between fatalistic beliefs, religiosity, and mask-wearing in an Islamic context. Methods:The participants consisted of 503 subjects from the adult population of Kerman Province located in the Southeast of Iran. The measurement tool consisted of four sections; (A) demographic characteristics, (B) three items related to mask-wearing, (C) The God Locus of Health Control (G LHC) scale consisting of six items measuring fatalistic beliefs, (D) The Duke University Religion Index (DUREL) consisting of five items measuring religiosity.Results: The mean age of the participants was 36.5 ± 10.9 years, and females consisted 60% (n=302) of the sample. More than one-fifth (n=109) reported a history of COVID-19 infection. Approximately one-third of respondents (n=163) reported full mask adherence. Logistic regression model showed that there was no significant relationship between mask adherence and religiosity (odds ratio: 1.03; 95% confidence interval (CI): 0.99-1.08) and fatalistic beliefs (OR:1.01; 95% CI: 0.98-1.04 ).Conclusion:We found no association of fatalism and religiosity with the mask-wearing during COVID-19 in the Iranian Muslim population. So we can conclude that religious beliefs may have no place in cultural tailoring of health messages for promoting mask adherence.

Introduction: Distal polyneuropathy is a common complication of diabetes mellitus with a considerable negative impact on the quality of life. The aim of this study was to evaluate the effect of dry cupping on distal polyneuropathy in diabetic patients.Methods: This controlled clinical trial was performed on 34 patients with diabetic polyneuropathy (DPN) for eight weeks. The non-invasive dry and fixed cupping therapy was performed on the sole of the right foot in the patients three times a week for 10 min, and the left foot of the same patient was considered as a control. The severity of diabetic neuropathy was measured using the modified Toronto Clinical Neuropathy Score (mTCNS), and the symptom and sensory test scores were determined.Results: 20 patients (40 feet) completed the study. There was a significant difference between the control foot and the treated foot in terms of the mTCNS after four and eight weeks (p-values = 0.004 and 0.001, respectively), in terms of the sensory test scores after four and eight weeks (p-values = 0.007 and 0.005, respectively), and in terms of the symptom scores after eight weeks (p-value = 0.002).Conclusion: For the first time, this study demonstrated that cupping therapy might be effective as a complementary treatment in alleviating the symptoms of DPN, although understanding the underlying mechanism requires further investigation.

Introduction Substance abuse in women has an increasing trend in all socio-economic classes. In addition to the fetal consequences, this problem has many other economic and social consequences as well.This study aimed to determine the prevalence of substance abuse and its related factors in pregnant women. Materials and MethodsThis descriptive cross-sectional study was performed employing a self-administered valid questionnaire on 587 pregnant women in Kerman, Iran who referred to public health centers and private offices to receive prenatal care. Participants were recruited from January to February 2020 using a multistage sampling method.ResultsThe most prevalent substances used during pregnancy (current use) were waterpipe (8.5%), opium (2.6%), and alcohol (1.7%).Substance abuse in first-degree relatives was a very strong correlate of substance abuse in pregnant women (OR = 7.26). The low level of education of pregnant women's husbands was also a strong predictor of substance abuse in pregnant women. (OR = 3.15).ConclusionSince substance abuse by family members was the strongest correlate of drug abuse during pregnancy, family-based interventions should be tailored to address early detection of such vulnerable women and necessary counseling services.

Purpose – One of the priorities of the health system is community health promotion. In this regards, proper development of programs and plans is needed to create a responsive system which leads to health promotion. The aim of this study was to identify the requirements for developing non-communicable disease (NCDs) programs based on CIPP (context, input, process and product) model. Design/methodology/approach – This is a qualitative study. Data were collected through semi-structured interviews with 40 experienced informants in the field of NCDs. The interviewees were selected bases on pre-determined criteria which then were completed by snowball sampling. Analysis was carried out using a content analysis approach that led to identifying program development requirements in four dimensions of context, input, process and product. Findings – Twenty-nine requirements of developing program were categorized in four domains of context, input, process and product. These requirements comprised of pilot studies, the existence of appropriate needs assessment, evidence-based programs, promoting organizational culture, adequacy of resources, identification of stakeholders and comprehensive cooperation and existence of an appropriate evaluation system. Research limitations/implications – Since this study was performed through a qualitative method, it is possible, some prerequisites of program development may not be encountered. But the extreme effort has been made to perceive diversity and different aspects. Originality/value – The first study was in the field of appropriate requirements for program development in the context of a centralized health system in a developing country.

Abstract Earthquake is associated with several health conditions such as posttraumatic stress disorder (PTSD), depression, and cardiovascular disease. However, the association between earthquakes and substance use has been less studied to date. We conducted a historical cohort study 17 years after the Bam earthquake by enrolling 818 households using multi-stage cluster sampling. The sample consisted of earthquake-exposed and non-exposed citizens. The ASSIST screening test was used to determine substance use. Logistic regression analysis was used to evaluate the association of variables of interest with substance use. Nearly 60% of the study subjects were female and the mean ± SD age of the sample was 46.6 ± 11.5 years. The prevalence of tobacco, alcohol, and other drug use in the exposed group was 19.5%, 24.9%, and 21.6%, respectively. The corresponding figures in the non-exposed group were 15.6%, 19.3%, and 20.1%, respectively (P > 0.05). The logistic regression model found no association between the history of earthquake exposure and the risk of any current drug use. Our results showed those 17 years after the Bam earthquake, there was no relationship between earthquake exposure and substance use.

Background and purpose: In today's world, declining fertility rates have led most high- and middle-income countries to pursue pronatalist policies. To plan for fertility desire and intention, it is necessary to examine their determinants in different societies. The purpose of this study was to design and evaluate the validity and reliability of a questionnaire that could measure the components affecting the intention to have children. Materials and methods: First, based on an extensive review of the literature, the most appropriate conceptual framework for explaining the immediate components related to the intention to have children was identified. After that, using the literature and expert opinions, the desired domains were selected and experts approved the content of the domains and items via deductive method. The designed questionnaire was completed through interviewing 500 married women (15- 49 years) selected from visitors of inpatients in public and private hospitals in Kerman, Iran 2021. Then, the construct validity of the items indicating three main constructs affecting fertility intention were evaluated using exploratory factor analysis and known-groups validity. The item reliability of these three constructs were examined by calculating Cronbach's alpha. Results: The theory of planned behavior was selected as the theoretical framework for compiling the constructs of the questionnaire. The three immediate components affecting fertility intention were attitude (8 items), subjective norm (3 items), and perceived control (3 items). All three factors were factorable and the factor loadings of the items in each of the three constructs were above the acceptable minimum level of 0.4. The three factors explained 58% of the variance. Cronbach's alpha values for the three constructs were 0.83, 0.79, and 0.66, respectively. Conclusion: The determinants of childbearing intention questionnaire designed based on the theory of planned behavior had acceptable validity and reliability and can be used in Iranian married women.

Abstract Background Drug use is one of the most common public health problems globally. This study was done to analyze the agenda-setting of policies related to substance use disorder treatment in Iran since 1979. Methods The current qualitative study was done through document review and interviews with policymakers and executives. Purposive sampling with snowball strategy was considered for sampling. Semi-structured interviews were done. A total of 22 documents were examined, and the data were saturated with 32 interviews. Kingdon's Multiple Streams Framework was used to analyze the data. Results The results indicated the intersection of problem stream, policy stream, political stream, and opening the opportunity window. In the problem stream, the rapid growth of AIDS among people who inject drugs (PWID), the decrease in the average age of first drug use, the increase in the prevalence of substance use disorder in women, the ineffectiveness of compulsive treatment, and criminological perspectives played key roles. The policy stream included criminological perspective and war on drugs, and harm reduction. The political stream included announcing general anti-narcotics policies by the Supreme Leader of Iran and understanding the need for treatment, rehabilitation, harm reduction, and social support for substance use disorder by officials and policymakers. Conclusions For a long time in Iran, policies based on the war on drugs were the dominant approach, and then, policies based on harm reduction and patient-centeredness were considered. The ideology and political parties influenced the executive apparatus's policy stream in this area. In countries with an ideological approach, the political stream plays a critical role in setting issues on the agenda. Therefore, policy entrepreneurs can put the points on the agenda by attracting the attention of political forces to the issue.

Abstract Introduction High salt intake has been connected with the increase of many non‐communicable diseases (NCDs) worldwide. Like other middle‐income countries, Iran is experiencing a considerable increase in NCDs, necessitating attempts to reduce dietary salt intake. As in Iran there is uncertainty about the existing rate of salt intake. The present study aimed to estimate mean salt intake of Iranian population by systematically reviewing existing literature. Methods This research is a systematic review and meta‐analysis (PRISMA Protocol) of published article data, with no time constraint until the end of 2020, to estimate mean salt intake of Iranian population. A comprehensive literature search was performed on international databases of Medline, Science Direct, PubMed, Embase, Scopus, Springer, Online Library Wiley, Web of Science, Cochrane, and Google Scholar and domestic data bases of Iranmedex, Magiran, SID, and Medlib. Subgroup analysis was conducted for gender, region, measurement method, and age group. Research homogeneity was evaluated by I2 statistic. We reviewed all studies which met inclusion criteria. STATA Ver.13.1 was used to perform meta‐analysis. Results Meta‐analysis of data from 32 studies showed that the average salt intake in all ages was 9.674 g/day (95% CI, 9.033–10.316 g/day). The lowest estimation of salt intake was 9.33 g/day (95% CI, 7.75–10.91 g/day) which was estimated from studies which used point collection method, and the highest estimate using the food reminder questionnaire was 10.41 g/day (95% CI, 8.49–12.34 g/day). Also, the average weight salt intake for men over 18 years old in different cities was 10.39 g/day (95% CI, 9.01–11.78 g/day), for women over 18 years in different cities 9.52 g/day (95% CI, 8.42–10.62 g/day), and children and adolescents was estimated at 5.664 g/day (95% CI, 2.91–8.41 g/day). Conclusion The intake of salt in the Iranian population is near twice the WHO recommendation. Therefore, it is necessary to consider effective strategies and interventions to reduce dietary salt intake in Iran as a health priority.

Abstract Background Many adulthood illnesses are rooted in childhood, especially in the “first thousand days of life”. Despite parents’ role in children’s development, no study has examined parental awareness concerning this period. This study aimed to examine the awareness of parents concerning the “first thousand days of life” and the relationship between parents’ demographics and their awareness. Methods This study was conducted on 135 parents in Kerman, Iran, using a valid and reliable questionnaire developed by researchers based on the opinion of experts and relevant references. The relationship between participants’ demographics and their awareness was examined by multiple regression. The relationship between homogeneity of couples’ education degree and awareness was analyzed using ANOVA. Chi-square was used to examine the relationship between information sources and parents’ familiarity and to compare parents’ preferred sources. Results The average parental awareness was 41.96 ± 11.90. Eighty-three percent of the parents have not heard about the “first thousand days of life”. The source of information for 57% of the parents was friends and relatives (p

Abstract Background Patients’ non-adherence with medical orders of physicians in outpatient clinics can lead to reduced clinical effectiveness, inadequate treatment, and increased medical care expenses. This study was conducted to develop and validate a questionnaire to determine the reasons for patients’ non-adherence with physicians’ medical orders. Methods A sequential exploratory mixed-method study was conducted in two stages. The first stage comprised a qualitative stage to generate the primary items of the questionnaire. This stage provided findings of two sub-stages comprising a literature review and the findings of a qualitative conventional content analysis of 19 semi-structured interviews held with patients, physicians, and managers of the outpatient clinics in Kerman, an area located in southeastern Iran. The second stage comprised a quantitative study aiming evaluation of the instrument psychometric properties, including the face, content, construct, and reliability assessment of the questionnaire. Construct validity assessment was evaluated using exploratory factor analysis (EFA). The reliability assessment was done using assessing internal consistency (Cronbach’s alpha). To assess the construct validity of the questionnaire, four hundred and forty patients referred to outpatient clinics in Kerman were selected using stratified convenience sampling to fill out the questionnaire. The sample size was calculated using the Cochran formula. Qualitative and quantitative data were analyzed by MAXQDA 10 and Stata version 14, respectively. Results The primary items contained 57 items, of which 42 met the minimum acceptable value of 0.78 for item-level content validity index (I-CVI = 1 for 24 items and I-CVI = 0.8 for 18 items). Item-level content validity ratio (I-CVR) was confirmed for 18 items with a minimum acceptable value of 0.99 for five experts. Finally, 18 items obtained the acceptable value for both I-CVI and I-CVR indicators and were confirmed. Using EFA, four factors (intrapersonal-psychological, intrapersonal-cognitive, provider-related, and socio-economic reasons) with 18 items and Cronbach’s alpha coefficient of 0.70, 0.66, 0.73, and 0.71, respectively, were identified and explained 51% of the variance. The reliability of the questionnaire (r = 0.70) was confirmed. Conclusion The questionnaire with four dimensions is a valid and reliable instrument that can help determine the perceived reasons for non-adherence with medical orders in the outpatient services system.

Introduction: Promoting self-care practice, as a critical strategy for enhancing the quality of life in patients with Multiple Sclerosis (MS) is a challenging issue. This study aimed to propose a model of health-promoting self-care behaviors in MS patients. Methods: In this cross-sectional study, 200 patients with MS, who had referred to the Hospital for Special Diseases in Kerman City, Iran, were chosen. The main data collection instruments were the multiple sclerosis knowledge questionnaire, the Rosenberg self-esteem scale, multiple sclerosis self-efficacy scale, questionnaire of perceived barriers and benefits of self-care behaviors, social support, the health promotion lifestyle profile II, and resilience and sense of coherence scale. Data analysis was conducted in SPSS V. 22 and AMOS18 software. The Structural Equation Modeling (SEM) was also used for further analysis of data Results: The model explained 82% of variance in Health-Promoting self-care Behavior (HPB). The results of the final model obtained from the SEM showed that self-efficacy (β=0.53, SE=0.04, P= 0.007), self-esteem (β=0.39, SE=0.04, P=0.005), social support (β=0.36, SE=0.04, P=0.009), sense of coherence (β=0.34, SE=0.07, P=0.006), resilience (β=0.33, SE=0.07, P=0.018), and perceived benefits (β=0.25, SE=0.05, P=0.009) had a positive and significant relationship with HPB. Conclusion: The self-care empowerment model in patients with MS presented in this study can be used as a framework for designing health promotion interventions to improve the quality of life of patients with MS.

Background: The use of waterpipe tobacco smoking (WTS) is on the rise throughout the world, especiallyamong young people and even athletes. There is a belief among consumers that exercise prevents the harmfuleffects of hookah smoke on the body. We examined this belief by evaluation of lung injury following toconcurrent WTS and swimming endurance training in male Wistar rats.Methods: Animals were randomly divided to sedentary control (CTL) group, exercise training group(Ex group), sedentary WTS (S) group, and exercise plus WTS (S + Ex) group.Findings: 8 weeks of WTS was associated with significant increase in serum level of cotinine, lung damage,reduction in alveolar number AN/SA (mm2) and increase in malondialdehyde (MDA) level of lung tissue.Combination of exercise with WTS significantly decreased these negative effects; however, it could not fullyprotect the lung from smoking damage. Waterpipe smoking (WPS) also significantly increased the proinflammatory cytokines of lung tissue such as tumor necrosis factor alpha (TNF-α) (P < 0.001), interleukin 1beta (IL-1β) (P < 0.010), and IL-6 (P < 0.050) in comparison with CTL group. Exercise training to somedegree reduced the levels of pro-inflammatory cytokines and increased the level of IL-10 as an antiinflammatory IL and glutathione peroxidase (GPX) activity in animals exposed to WTS.Conclusion: It is suggested that combination of mild to moderate exercise with WTS may attenuate thehookah smoking-induced lung damage. This effect partly is mediated through balancing of pro/antiinflammatory and redox systems

Objective: To validate the ultrashort (5-item) Persian version of OHIP by investigating its psychometric properties. Material and Methods: Construct validity was assessed by examining the correlation between OHIP-5 scores and self-reported oral health status, judgment for dental treatment needs and the number of natural teeth. Reliability was calculated using Cronbach’s alpha and corrected item-total correlation. Effect size (ES) and Standardized Response Mean (SRM) were calculated for the responsiveness of the scale and factor analysis was done by measuring Kaiser-Meyer-Olkin (KMO), Bartlett’s sphericity test and scree plot. Results: In 430 subjects (mean age 41.56+/-11.35 years, 56% female) the correlations between OHIP-5 scores and mentioned items were significant (p

In the early decades of the 20th century, discussions regarding alcohol were dominantly directed toward itstherapeutic uses, but authorities now state that any level of alcohol consumption poses negative effects onhealth. Over recent months, increased attention has been devoted to disease burdens attributable to alcoholuse worldwide. As more and more studies are conducted to illuminate the harmful effects of alcohol ondifferent body systems, the mounting evidence generated requires documentation and publication. Thecurrent review was aimed at providing an overview of the recent literature on the adverse consequences ofalcohol consumption.

Abstract Background Non-compliance with prescribed treatment is an important cause of preventable mortality and economic burden. Recognition of the factors for non-compliance with the therapeutic orders of specialists from the perspective of patients and health care providers sheds more light on the issue for policymakers and stakeholders. The current study aimed at determining the factors for non-compliance with therapeutic orders in outpatient clinics in Kerman, Iran. Methods The current qualitative study was conducted using the phenomenological method and semi-structured interviews with 10 patients, five specialists, and four health care managers and treatment officials in outpatient clinics in Kerman. The interviewees were selected by purposive sampling. The codes extracted from the interviews were transcribed using conventional content analysis to identify the viewpoints. The MAXQDA 10 software was used to analyze the data. Results The reasons for non-compliance with specialists’ orders were categorized into five themes including patient-related (patient-centered), disease-related, therapy-related, the healthcare provider related (healthcare system), and socioeconomic factors. Themes were composed of fifteen categories and forty-one sub-categories. The dominant sub-categories extracted from interviews were health literacy and knowledge of the patient, communication and patients’ trust in physicians and direct costs of treatment. Conclusion This study identified a wide range of different individual, disease, treatment, health care provider, and socio-economic factors and the interactions between them which may result into non-compliance with therapeutic orders prescribed by specialists. Therefore, specific attention should be paid to integrate the service provision system into the collaborative approach of the patient and his/her family in order to promote the level of compliance with therapy and care in planning and policy-making to improve the health service provision system.

Background and Objectives: Antibiotics prescribed for infections have diverse effects on microbiota and the pathogen Clostridium difficile (C. difficile) as the most important antibiotic-associated diarrhea. This study aims to determine the gene expression of toxins A and B at the transcription level in the sub-MIC of vancomycin (VAN), clindamycin (CLI), and ceftazidime (CAZ) alone and in combination. Materials and Methods: The MIC and fractional inhibitory concentration (FIC) of two C. difficile samples (a clinical isolate and ATCC 9689) were determined by microdilution and checkerboard microdilution methods, respectively. The total RNA was extracted from the medium inoculated with ~106 CFU/mL of fresh bacteria in the pre-reduced medium containing ½ MIC of antibiotics alone and ½ FIC of antibiotics in combination. Real-time PCR was performed by sybrGreen methods in triplicate, and the data were analyzed by the comparative ∆∆CT method. Results: All antibiotics except CAZ (alone and in combination) decreased the gene expression of toxins A and B within 24 hours. VAN and CLI reduced toxin gene expression within 24 and 48 hours. However, CAZ alone and in combination with VAN as well as CLI increased the gene expression of toxins A and B. Conclusion: The results confirmed toxin gene transcription and toxin production are associated with the type of isolates and antibiotics, as well as the combined form of antibiotics. This could be the reason which can explain the occurrence of C. difficile infection among patients who were treated with the third generation of cephalosporins alone and in combination with another antibiotic in the form of combinational therapy.

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

Evaluation of the Ratio of Human Resources to the Amount of Services Provided in Hospitals of Kerman Province Yazdanpanah Maryam1, Jafarzadeh Shirin1*, Nakhaee Nozar2, Kamyabi Abbas1, Amiresmaili Mohammad Reza3 1. MD, Kerman University of Medical Sciences, Kerman, Iran 2. Professor, Department of Community Medicine, Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran 3. Associate Professor, Department of Health Management, Policy and Economic, Kerman University of Medical Sciences, Kerman, Iran Abstract: Background & Objectives: The combination and distribution of human resources is one of the major factors affecting the quality, quantity, cost, and speed of provision of health services. Today, one of the most important problems of human health systems is the inappropriate distribution of human resources. The aim of this study was to investigate the ratio of human resources to the amount of services provided in hospitals affiliated to Kerman University of Medical Sciences. Methods: This descriptive cross-sectional study was conducted during March 2015 to February 2016, to review the occupational categories of nursing staff, midwife, patient carrier, and unit secretary in 10 teaching and non-teaching hospitals in Kerman province using three methods of Workload Indicators of Staffing Need (WISN), systematic approach, and bed occupancy rate (BOR). Data were collected using a form contains job descriptions, the quantity of services provided per year by the occupational categories studied, the standard of activity time, the work time available to the hospital staff, and bed occupancy rate in the units studied.. Results: The systematic approach showed the highest need for human resources, and then, the bed occupancy ratio and WISN respectively showed the highest need, which however, depended on the hospital unit. So that, in calculating the required number of nurses in the intensive care and burn units, the index proposed by the Ministry of Health in bed occupancy rate was higher than the WISN, and the index obtained in the emergency department, was higher than the WISN. Conclusion: It is suggested to replace traditional methods with modern human resources estimation systems, as WISN. Also, it is recommended to measure the time and activities of hospital units to determine the ratio of staff to bed for each hospital. Key­words: Teaching hospital, Non-teaching hospital, Human resources, Nursing staff ­Citation: Yazdanpanah M, Jafarzadeh S, Nakhaee N, Kamyabi A, Amiresmaili MR. Evaluation of the Ratio of Human Resources to the Amount of Services Provided in Hospitals of Kerman Province. Journal of Health Based Research 2018; 4(1): 95-108. [In Persian]

Background: Cigarette seems to be the least valuable of addictive drugs. It is easily accessible to the public, and its harmful personal and social effects have attracted less attention. Therefore, the present research was carried out with the aim of presenting cost estimations of smoking-related diseases in smokers who aged 35 or higher in Kerman City, Iran, in 2014.Methods: Using the prevalence approach, the direct and indirect costs of smoking-attributable diseases including lung cancer, gastric cancer, myocardial infarction, stroke, and chronic obstructive pulmonary disease (COPD) were estimated. The initial data were obtained from the information in documents of medical document units as well as the 2014 income statements of teaching hospitals of Kerman University of Medical Sciences, Kerman City.Findings: In this research, total economic costs of diseases attributed to smoking were estimated to be 50 million dollars in 2014 in Kerman City, and calculations suggest that this figure accounts for 0.02% of Iran’s gross domestic product (GDP). Total direct cost of diseases caused by smoking in Kerman City adds up to 17 million dollars, whereas the estimated indirect cost of diseases caused by smoking is 33 million dollars. The yearly per capita cost of any of the selected five diseases is 270 dollars.Conclusion: Smoking places a high economic burden on health system and society as a whole. Therefore, stronger intervention measures against smoking should be taken without delay to reduce the health and financial losses caused by smoking.

Background: Adolescence is the age of increased sensation-seeking and risk-taking. To prevent such behaviors, the adolescent tendency to engage in high-risk behaviors must be measureable. This study aimed to develop a questionnaire about risk-taking tendencies among Iranian students.Methods: This study was conducted using cluster sampling of the tenth-grade students in three cities in Kerman province, Iran. The students were assured that the questionnaires would remain anonymous and unlinked. Construct validity was assessed using exploratory factor analysis (EFA) and comparison of known groups. Corrected item-scale correlation and Cronbach's alpha were calculated to evaluate reliability.Findings: A total of 551 high school students participated in this study. Of these, 57 were excluded after checking the “non-existent drug” item (10.3%). Girls accounted for 49.2% of the sample. Of the 33 initial questions, 13 were removed due to factor loading of less than 0.5. Two factors were extracted using the scree plot (“drug abuse tendency" and "other risky behavior tendency"). The tendency toward high-risk behavior was significantly higher in male students than in female ones (P < 0.001). This indicates the known group validity of the questionnaire. The Cronbach's alpha of the above-mentioned factors were 0.93 and 0.83, respectively.Conclusion: The questionnaire measuring the tendency toward high-risk behavior among students showed acceptable validity and reliability.

Background and aim: In social marketing, at the center of the program is consumer perception. The objective of this study was to explore the viewpoints of Iranian women for tailoring interventions so as to increase physical activity. Methods: The social marketing model served as the framework of the study. Qualitative data were collected via six semi-structured focus group discussions (FGDs), in 2014 in Iran. Participants were 51 women, 20 to 60 years old, selected by purposive sampling, with a maximum diversity. Qualitative content analysis of the data was conducted by researchers. Results: After data analysis and extracting initial codes, they were all categorized in four predefined categories of social marketing model (product, price, place and promotion) and related sub-categories. Most of the participants were inactive. Price was addressed by women as the dominant category of this study. The majority of participants emphasized the benefits of prevention of chronic diseases, fitness, staying young, and improving family relations. Most women preferred to do physical activity in a secure and enclosed female environment. And the majority of participants considered radio, television, face to face training, texting, and advertising billboards as promotional strategies. Conclusion: This study provides a unique insight into consumers’ values and motivations that affect consumers’ decisions to adopt physical activity, in Iran. It could also help researchers to design and implement intervention programs to increase physical activity.

Introduction: To follow the progress of technology and increasing domain of nurses’ duties, ethical challenges can be observed more than ever. Therefore, the growing and dynamic system of nursing requires nurses with professional and ethical competence who can provide optimal care. The aim of the present study was to define and explain dimensions of moral competency among the clinical nurses of Iran. Methods: This qualitative content analysis study was carried out in the years 2014 and 2015 in Iran. Data were collected through in-depth semistructured interviews and field notes. The resulting data were analyzed by Graneheim and Lundman’s method of conventional content analysis. The participants were 12 clinical nurses who were selected using purposive convenient sampling and continued interviews until data saturation. Results: Themes obtained in the present study were posited in three main categories of “moral character,” with subcategories of altruism, search for meaning, be pioneering, perfectionism, self-control, honesty, and forgiveness; “moral care” with subcategories of dignified care, safe care, fair care, and holistic care; and “moral decision-making” with subcategories of moral sensitivity, moral thinking, moral reasoning, and moral courage. Conclusions: Findings of the present study suggest that nurses’ moral competency is an adorable character with a wide range that includes moral virtues and character, moral decision-making, and ultimately providing moral care; therefore, moral competency is a meta-competence in the field of nursing. Because there are many competencies in different fields.

BACKGROUND: Traumatic events and psychological damage are common. Identifying different types of traumatic events contributes to the development of psychopathology and can be very helpful in macroeducational and treatment planners. The current study extracted the patterns (overlap) of different traumatic events that Iranian college students commonly experience, with the aim of understanding their association with posttraumatic growth (PTG) and religiosity. MATERIALS AND METHODS: Four hundred and sixty-six students from Kerman universities completed a cross-sectional survey about religion, and questions about PTG and traumatic events have experienced in the past 5 years. The latent class analysis (LCA) was used for extracting patterns of traumatic events, and the one-way ANOVA test was used to compare PTG and religiosity across these classes in Iranian college students. RESULTS: The LCA revealed that a three-class solution had an adequate relative and absolute fit. The three classes were labeled and characterized as multiple-traumatic events (2.9%), intermediate-traumatic events (31.1%), and low-traumatic events (66.0%). In ANOVA results for PTG and Duke University Religion Index (DUREL) domains across classes, individuals in the multiple-traumatic classes had the lowest score of PTG and DUREL domains. CONCLUSION: Although the current study showed the relative frequency of multiple-traumatic events in Iranian students is low, individuals categorized in this class had the lowest PTG, and these findings reveal the necessitation of planning and interventions for PTG.

Background: The use of narcotics such as opium exposes addicts as susceptible targets of different diseases so that they might easily be exposed to different diseases such as fungal infections. The present study aimed to investigate the effects of addiction to opium and fungal infection on plasma levels of certain cytokines including interleukin-4 (IL-4), IL-6, IL-17, Interferon gamma (IFN-γ) and transforming growth factor-β (TGF-β).Methods: Present study included 72 individuals who were divided into 4 groups: 1) opium-addicted with fungal infection; 2) opium-addicted without fungal infection; 3) non-opium-addicted with fungal infection; and 4) normal individuals (non-opium-addicted and non-fungal infection). The fungal samples, after being detected and confirmed by a physician, were prepared based on clinical symptoms and then analyzed by direct smear and culture method. The measurement of the plasma level of cytokines was done by enzyme-linked immunosorbent assay (ELISA) method.Findings: The comparison of the mean of the plasma level of cytokines showed that addiction to opium and fungal infection had significant effect on the plasma levels of IL-17, IFN-γ, TGF-β cytokines in all studied groups. The interaction of addiction to opium and fungal infection was only significant in the case of plasma level of IL-6.Conclusion: Addiction to opium and fungal infection, either separately or simultaneously, poses significant effect on the immune system and causes disorders in the cytokine network and the immune system and also provides a suitable environment for fungal infection.

Background: Disturbances in maternal care have been associated with increased risk for drug abuse later in life. However, there has been little investigation of the effects of maternal separation (MS), a model of early life stress, on nicotine dependence, specifically during adolescence. In the present study, we aimed to investigate the effect of MS on nicotine-conditioned place preference (CPP) in adolescent male rats. We also examined the impact of nicotine on spatial learning and memory impairments induced by MS.Methods: Rat pups were exposed to daily MS for 15 (MS15) or 180 (MS180) minutes during the first 2 weeks of life or reared under normal animal facility rearing (AFR) conditions. In postnatal day (PND) 28-34, they were conditioned with nicotine [0.6 mg/kg, subcutaneously (SC)] or saline and tested for preference over a period of 6 conditioning trials. Morris water maze (MWM) testing was performed to assess spatial cognitive function.Findings: The MS procedure used in our study failed to affect nicotine reward as measured by CPP in the adolescent male rats. Notably, significant spatial learning deficit was seen in the MS180 rats compared to those in the AFR and MS15 groups and nicotine administration modified the MS-induced learning defect in adolescent male rats.Conclusion: In conclusion, although MS revealed no influence on the sensitivity to the nicotine's reinforcing effects in adolescent male rats, the simultaneous effect of MS on learning performance may be altered by nicotine intake.

BACKGROUND AND AIM: Development of patient-based outcome measures has enhanced our ability to assess the oral health-related quality of life (OHRQoL). Present study aimed to compare the performance of the Geriatric Oral Health Assessment Index (GOHAI) and the Oral Health Impact Profile-14 (OHIP-14) as two methods of assessment of oral health-related quality of life. METHODS: In this cross-sectional survey, a sample of 400 healthy participants which were 18-65 years old was recruited in Kerman School of Dentistry, Iran. Main measurement tools were the validated Persian version of GOHAI and OHIP-14 questionnaires. Data were collected by means of personal interview. Internal consistency and discriminant validity were carried out to compare the two measures. RESULTS: The internal consistencies of both tools were acceptable and Pearson’s correlation coefficient between the scores was 0.739. Both measures discriminated between dentate subjects over and under 25 natural teeth and wearing removable dentures or not, both also showed significant associations with dental attendance, self-rated oral health and satisfaction with oral health status. CONCLUSION: Both GOHAI and OHIP-14 are appropriate instruments with equal power for survey of OHRQoL on under-elderly population.

Aspirin is an anti-inflammatory drug, peroxyl radical scavenger, and antioxidant agent that inhibits phospholipases, nitric oxide synthetases, and cyclooxygenase enzymes. The existing literature contains no studies on the effects of various doses of aspirin on spinal cord injury (SCI). Therefore, we sought to investigate the putative effects of aspirin on experimental SCI. The weight-drop injury model was used to produce SCI in 100 albino Wistar rats. The animals were allocated to five groups: a control group, where the rats did not undergo any surgical or medical intervention except for anesthesia; a sham-treated group, where laminectomy was performed without SCI and no further therapy was administered; and three other groups, where the rats with SCI received low-dose aspirin [20 mg/kg], high-dose aspirin [80 mg/kg], and a vehicle, respectively. Half of the rats were sacrificed 24 hours later, and their spinal cords were excised for biochemical studies. The other rats were subjected to Basso, Beattie, and Bresnahan (BBB) locomotor rating scale scoring once a week for 6 consecutive weeks. Aspirin decreased lipid peroxidation following SCI as the mean (± standard error) catalase level was significantly higher in the high-dose aspirin group (46.10±12.01) than in the sham-treated group (16.07±2.42) and the vehicle-treated group (15.31±3.20) (P

Maternal separation (MS) is defined as the termination of the continuity of mother-child relationship after the relationship is established. Although MS and maternal deprivation are different in terms of their definitions, these two terms are usually used interchangeably. This review aims to investigate the effect of MS on drug intake in adulthood. It has been proved that animal models are helpful in evaluating the effects of MS on drug intake risk in adulthood. There are relatively acceptable studies in this field on some drugs such as morphine, ethanol, and cocaine. However, very few animal studies, or even no animal study, have been conducted on some other drugs. The majority of these studies have considered MS as a risk factor for drug intake in adulthood. Different mechanisms are proposed for this phenomenon. Brain reward pathways are one of the main exploratory pathways of this process. Despite the importance of the issue, no human study with a specific concentration on investigating the relationship between MS and drug abuse in later life was found. Causal studies are warranted on humans to investigate the effect of MS on drug intake in later life.

BACKGROUND: Evidence is accumulating that the pattern and nature of marital relationships are very different in different cultures. This nationwide study aimed to determine marital satisfaction and the prevalence of emotional divorce as well as to identify the sociodemographic correlates in a Muslim population. MATERIALS AND METHODS: In this cross-sectional study, one-third of Iran's provinces were selected randomly and a representative sample of inhabitants of their central city was included in the study. The ENRICH marital satisfaction scale was used to determine marital satisfaction levels. A single-item measure with confirmed validity and reliability was used to find out about emotional divorce. The demographic variables included respondent's age, spouse's age, gender, educational level, residency, childbearing, and premarriage familiarity. RESULTS: Of the 2033 participants, 1034 were women (50.9%). Nearly one-third of both men and women had academic degrees. Almost 53% of them were satisfied with their marital life and 9.7% had emotional divorce. Men with academic degrees had a higher probability of marital satisfaction (odds ratio [OR] =1.26, 95% confidence interval [CI]: 1.04–1.53) and a lower prevalence of emotional divorce (OR = 0.37, 95% CI: 0.24–0.58). CONCLUSION: This study showed a relatively high percentage of marital dissatisfaction as well as emotional divorce. Policymakers should strengthen premarriage education programs and postmarriage counseling centers.

BACKGROUND AND AIM: Measuring child abuse and adverse experiences is a critical task with regard to its long-term impact on the health of individuals and communities. The purpose of this study was to validate the Persian version of the International Adverse Childhood Experiences Abuse Short Form (ACE-ASF) in Iranian society. MATERIALS AND METHODS: This cross-sectional study was conducted in Kerman, southeast of Iran, in 2019, on 494 students from Kerman University of Medical Sciences, selected by convenience sampling method. Psychometric properties of the questionnaire were examined after the forward and backward translation processes. The factor structure of the questionnaire was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The concurrent validity of the questionnaire was assessed using the childhood trauma questionnaire (CTQ). Cronbach's alpha and corrected item-total correlation were used to measure reliability. RESULTS: The mean age of participants was 24.3 ± 5.3 years. Based on EFA, two physical–emotional abuse and sexual abuse factors were obtained. The CFA fit indices well supported two extracted factors. The CFA showed acceptable factor loadings. The internal consistency coefficient of Cronbach's alpha was 0.75 for the physical–emotional abuse factor and 0.77 for the sexual abuse factor. The correlation coefficient of ACE-ASF and CTQ was r = 0.56. The reliability index of intraclass correlation coefficient was 0.73 (95% confidence interval: 0.60–0.84). CONCLUSION: The Persian version of the ACE-ASF questionnaire has acceptable psychometric properties.

Background: Substance use is a growing public health problem among adolescents. In the lack of a valid and reliable instrument based on social development model (SDM), this study aimed to develop risk and protective factors of substance use scale based on SDM to determine risk and protective factors influencing substance use among adolescents. Methods: A total of 235 male students from 9th and 10th grade (14-18 years old) of public high schools in Kerman, Iran, selected through multistage cluster sampling. Items pool extracted from the literature and focus groups with male adolescents. Face validity of the questionnaire assessed for readability and clarity of items. Then, an expert panel evaluated the items for content validity. Consequently, construct validity of questionnaire confirmed through exploratory factor analysis (EFA). Known group validity is determined by the degree to which the instrument shows different scores between two groups of those who had an experience in drug use and those who did not have such an experience. In addition, reliability assessed via internal consistency and test-retest. Results: About 10 factor solution (containing 38 items) emerged as a result of EFA entitled adolescent’s “beliefs on hookah and alcohol,” “bonding to parents,” “family rules on substance use,” “drug resistance skills,” “adolescent’s beliefs on hard drugs,” “situational perception on hookah and alcohol,” “rules of school,” “situational perception on hard drugs,” “attachment to school,” and “perceived opportunity at school.” The first four emerged factors explained 46% of the total variance observed. Among these factors, adolescent’s beliefs on hookah and alcohol explained a more than 25.3% of the total variance. Results indicated satisfactory internal consistency (Cronbach¢s alpha ranging from 0.71 to 0.85) and intra-class correlation coefficients (ICC) (ranging from 0.48 to 0.81). Conclusion: The risk and protective factors of substance use questionnaire are the first instrument based on the SDM. The findings showed that this questionnaire is a valid and reliable instrument for assessing determinants of substance use which can be used by researchers and policymakers in preventive initiatives.

Objectives Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. Materials and Methods Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. Results At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. Conclusions There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

Background: Persistent methamphetamine (METH) psychosis is a psychotic state beyond 1-month after abstinence, for which there is no effective treatment. This study aimed to evaluate the effectiveness of electroconvulsive therapy (ECT) in persistent METH psychosis patients hospitalized at Shahid Beheshti Hospital, Kerman, Iran, from 6 September 2012 until 6 September 2013, who were not remitted after treatment with olanzapine. Methods: This research was a pilot study on hospitalized patients. After 4 weeks of treatment with olanzapine, 10 out of 71 studied patients did not show complete remission of psychotic symptoms despite their response to the treatment. The mentioned 10 patients were divided into 2 groups by random digit numbers. 5 patients had continued olanzapine and other 5 received 6 sessions of bilateral ECT every other day in addition to olanzapine. Findings: Remission rate of patients in the initial 4 weeks was 78.7%. Reduction in total brief psychiatric rating scale (BPRS) scale at the end of 1-week compared with the next week demonstrated improvement in the symptoms until the end of the study. There was no significant difference in BPRS scores between weeks 4 and 6 in the two groups. Conclusion: This research demonstrated that few sessions of ECT in persistent METH psychosis will not lead to remission in all patients.

Background: Treatment of drug addicts is one of the main strategies of drug control in Iran. Client satisfaction strongly influences the success of any treatment program. This study aimed to explore the difference between customer expectations and perceptions in drug addiction treatment centers of Kerman, Iran, using SERVQUAL model. Methods: Using a cross-sectional design 260 clients referring to drug addiction treatment centers of Kerman, Iran, were enrolled in 2012. From among 84 clinics, 20 centers were selected randomly. Based on the number of clients registered in each center, a random sample proportional to the size was selected and 290 subjects were invited for interviews. A well validated 22-item questionnaire, which measured the 5 dimensions of service quality (reliability, assurance, tangibility, empathy, and responsiveness), was completed by participants. Each item measured 2 aspects of service quality; expectations and perceptions. Findings: Mean ± SD (Standard deviation) age of the subjects was 37.7 ± 9.4. Most of them were male (87.7%). Less than half of them had an educational level lower than diploma. The total score of clients` expectations was higher than their perceptions (P < 0.001). Considering the 5 dimensions of the SERVQUAL model, only 1 dimension (i.e., assurance) showed no difference between perceptions and expectations of the participants (P = 0.134). Conclusion: There was a gap between the clients’ expectations and what they actually perceived in the clinics. Thus, more attention should be devoted to the clients` views regarding service quality in addiction treatment clinics.

Background: Identifying the status of substance misuse and its psychosocial correlates among residents of juvenile correctional centers, as a high risk group, could potentially illuminate the roadmap to prevention of drug use in this group. Methods: In this cross-sectional study, 93 individuals aged 13 to 18 were enrolled. A self-administered questionnaire was completed and dropped in a sealed box. It consisted of 4 parts of Piers-Harris Children’s Self-Concept Scale, NEO Personality Inventory, drug use questions, and demographic variables. All questionnaires were well adapted in the Persian language. MANOVA was used to compare the subscale scores between the drug users and nonusers. Findings: All respondents were male and 40% were illiterate. More than 40% had drug dependent fathers. Use of cigarette, opium, and alcohol in the previous 30 days was reported by 31.9, 52.2, and 15.9% of respondents, respectively. In this population, the score of 3 of the 5 personality factors (i.e., neuroticism, extraversion, and openness) were higher than in the general population (P < 0.001). More than 88% of subjects had negative self-concept. Both the scores of personality and self-concept showed no significant difference based on the status of drug use. Conclusion: Prevalence of lifetime and last-month drug use was found to be high. Regarding the profiles of personality and self-concept, more comprehensive evidence-based interventions are needed for improvement of their mental health.

Background & Objective: Social accountability medical education in all fields considers health problems priorities in specified countries Health provision (social accountability) encounters many challenges in its delivery due to more reasons and faculty innovations seem essential in promotion of education This study was designed in order to investigate social accountability medical education and innovations of clinical faculty members Methods: In a crosssectional and triangulation study point of view of 72 clinical faculty members in Kerman University of Medical Sciences Iran about social accountability medical education and their innovations was investigated by two separated questionnaires Results: Situation analysis of social accountability medical education in Kerman University of Medical Sciences showed that this form of education is in weaknessthreatened status The score of strengths was significantly difference among men and women and score of weakness was significantly difference among different educational groups and academic degrees (P < 005) There was no significant difference between situation analysis of social accountability medical education innovation and other demographic and educational variables Conclusion: Status of social accountability medical education (weaknessthreatened) is not appropriate in Kerman University of Medical Sciences in order to its promotion there must be an appropriate mechanism In addition potentials of faculty members must be considered about innovation for social accountability medical education

Background: The growing supply and prevalence of waterpipe (WP) smoking among Iranian adolescents have become a concern for both families and policymakers. The aim of this study was to determine the factors underlying WP use and also to design an intervention program based on social cognitive theory (SCT) aimed to reduce the demand for WP smoking among male adolescents. Methods: This quasi-experimental study involved 189 high-school students in Kerman, Iran, who were split into two groups, an intervention group and a control group. A validated questionnaire based on SCT constructs was used to collect data. The intervention was performed over four sessions with a focus on preventing WP smoking. Results: Before intervention, the lifetime and current-use prevalence of WP smoking across both groups was 48.5% and 20.2%, respectively. In the intervention group, the most change was related to knowledge score from 10.70 ± 4.38 to 16.52 ± 3.89 (P < 0.0001) and outcome values score from 12.40 ± 3.81 to 13.53 ± 4.23 (P = 0.007); however, in the control group, no significant changes were seen in posttest scores. The scores for self-efficacy (P = 0.21), outcome expectations (P = 0.09), and environment constructs (P = 0.06) did not show any statistically significant changes after the intervention in both groups. Overall, there was no significant difference in the rate of WP smoking after the intervention. Conclusions: Based on the results of this study, although some construct scores showed significant differences after the intervention, there was no significant change in the prevalence of WP smoking. More effective educational interventions based on this theory but with a greater focus on self-efficacy and environmental influences may be warranted.

Background: The prevalence of substance use among bodybuilding athletes has been poorly studied in Iran. This study was conducted to examine the prevalence of drug use, especially anabolic steroids, among bodybuilding athletes. Methods: This cross-sectional study was conducted in the first half of 2013 among body building athletes referring to gyms located in Kerman, Iran. Five gyms were selected randomly and 380 athletes were invited to complete a self-administered anonymous questionnaire, consecutively. The questionnaire included two parts; baseline characteristics and substance related questions. The prevalence of anabolic steroids was estimated based on three methods; self-report, projective question, and crosswise model. Findings: We enrolled 298 male athletes in the final analysis. Mean ± SD age of subjects was 25.9 ± 8.4. The most frequent recent (past 30 days) drug use was waterpipe smoking (45%). The second most frequently used drug was alcohol (26.5%, recent use). Based on self-reports, the prevalence of lifetime anabolic steroid use was calculated to be 24.5%. The corresponding figure based on crosswise method was obtained to be 56.8%. Participants believed that a median of 40% of athletes had used anabolic steroids in their lifetime. The prevalence of anabolic steroid was higher in single and less educated individuals (P < 0.05). The main reason for using anabolic steroids was to increase muscle size. Conclusion: The prevalence of drug use, especially tobacco, alcohol, and anabolic steroids, was high among bodybuilding athletes. We could not rely on self-reports to examine anabolic steroid use. Keywords: Substance abuse, Anabolic steroids, Athletes, Iran

Reduction in maternal mortality requires an in-depth knowledge of the causes of death. This study was conducted to explore the circumstances and events leading to maternal mortality through a holistic approach. Using narrative text analysis, all documents related to maternal deaths occurred from 2007 to 2011 in Kerman province/Iran were reviewed thoroughly by an expert panel. A 93-item chart abstraction instrument was developed according to the expert panel and literature. The instrument consisted of demographic and pregnancy related variables, underlying and contributing causes of death, and type of delays regarding public health aspects, medical and system performance issues. A total of 64 maternal deaths were examined. One third of deaths occurred in women less than 18 or higher than 35 years. Nearly 95% of them lived in a low or mid socioeconomic status. In half of the cases, inappropriate or nonuse of contraceptives was seen. Delay in the provision of any adequate treatment after arrival at the health facility was seen in 59% of cases. The most common medical causes of death were preeclampsia/eclampsia (15.6%), postpartum hemorrhage (12.5%) and deep phlebothrombosis (10.9%), respectively. Negligence was accounted for 95% of maternal deaths. To overcome the root causes of maternal death, more emphasis should be devoted to system failures and patient safety rather than the underlying causes of death and medical issues solely.

Background: A significant number of opioid-dependent patients in Iran are now being treated by methadone maintenance therapy (MMT). One of the social complications of substance dependency is family disorganization and a decrease in marital satisfaction. This study aimed to determine the effect of group therapy based on the transtheoretical model of change on family functioning of the patients under MMT. Methods: In this open clinical trial, 48 married people who were between the ages of 19 and 40, and under methadone maintenance therapy had been assigned to two random groups of test and control. In the intervention group, group therapy was held based on the transtheoretical model of behavior change, for 29 sessions (two times a week). To assess the overall health and pathology of the family, the two questionnaires Family Assessment Device (FAD) and Marital Conflict Questionnaire (MCQ), both with approved reliability and validity, were used. Findings: A total of 24 patients in the control group and 23 patients in the intervention group (one person withdrew from the study in the early meetings) were evaluated. The mean ± SD of age of the control and intervention groups, respectively, were 33.9 ± 4.8 and 32.8 ± 4.3 (P = 0.40). Before the intervention began the average score of FAD and MCQ questionnaires between the two groups was comparable. After the intervention was over the score of each of the two questionnaires, with the adjustment of the baseline score, was lower in the treatment group than the control group, the difference was marginally significant (P < 0.10). Conclusion: The family functioning of the MMT treated patients showed improvement. Therefore, with the use of stage-of-change and group therapy, steps can be taken for improving family functioning of these patients. Due to the relatively long duration and frequency of treatment sessions the feasibility of this intervention needs further research. Keywords: Behavior change, Marital satisfaction, Drug dependence, Transtheoretical model

Background: In the recent years, advances in medical technologies for end stage cancer patients’ care have affected the end-of-life decision-making in clinical practice and exposed oncologists to serious ethical dilemmas. But little is known about oncologists' viewpoints in our country regarding their ethical problems in this mention. We aimed to clarify the ethical dilemmas which Iranian oncologists may face in our health care setting and to determine factors influencing decision-making process.Methods: In this qualitative study, a phenomenological approach was used. We interviewed 8 cancer specialists in teaching hospitals in Iran and used content analysis to identify codes and categorize themes in the data.Results: During the process of analysis, three main themes emerged about ethical dilemmas in end of life care for advanced cancer patients: illness factors, socio-cultural context and patient-physician relationship. Cancer specialists identified ethical problems on several main issues, the most important of which were telling the truth in Iranian cultural context, uncertainty in end stage definition, multidisciplinary team working and cost consideration in Iranian health care system.Conclusion: Health care and insurance system in Iran face to end of life care challenges; therefore, health care providers and policy makers need to allocate appropriate resources and programs to improve quality of care in terminal stages. Appropriate physicians’ communication skills training, multidisciplinary team working and supplementary insurance services that provide essential health care can improve the quality of care of patients with end stages of cancer. The findings of this study can help us to provide ethical policies for decision-making in end-of-life care.

BackgroundIncomplete hospitalization is the cause of disease relapse, readmission, and increase in medical costs. Discharge Against Medical Advice (DAMA) in emergency department (ED) is critical for hospitals. This paper aims to explore the underlying reasons behind DAMA in ED of four teaching hospitals in Kerman, Iran. MethodsThis was a cross-sectional study in which the samples were drawn from the patients who chose to leave against medical advice from the ED of teaching hospitals in Kerman from February to March 2011. The sampling was based on census. Data were gathered by a self-constructed questionnaire. The reasons for DAMA were divided into three parts: reasons related to patient, medical staff, and hospital environment. The questionnaire was filled out by a face-to-face interview with patient or a reliable companion. ResultsThere were 121 cases (5.6%) of DAMA out of the total admissions. The main reason of AMA discharges was related to patient factors in 43.9% of cases, while two other factors (i.e., hospital environment and medical staff) constituded 41.2% and 35.2% of cases, respectively. The majority of patients 65.9% (80 cases) were either uninformed or less informed of the entailing side effects and outcomes of their decision to DAMA. ConclusionIn comparison to studies conducted in other countries, the rate of DAMA is markedly higher in Iran. The results revealed that patients awareness of the consequences of their decisions is evidently inadequate. The study suggests a number of recommendations. These include, increasing patient awareness of the potential side effects of DAMA and creating the necessary culture for this, improving hospital facilities, and a more careful supervision of medical staff performance.

BackgroundEvaluation of treatment programs in addiction field is a prerequisite to improve the quality of care. This study aimed to investigate the effectiveness of Therapeutic Community (TC) program in Iran. MethodsIndividuals who had voluntarily enrolled in the TC center within a period of seven years, from early 2005 to late 2011, entered the study. Those who successfully completed the 14-week residential course were considered as ‘completers’. They were subsequently called in for urine test and interviews using Maudsley Addiction Profile. Urine test was conducted to determine if they were positive for heroin, opium, methadone, methamphetamine, bupronorphine, hashish, and tramadol. ResultsA number of 378 individuals with mean (± SD) age of 32.5 ± 7.8 enrolled in the TC program during the study period, 240 individuals of whom completed the 14 weeks course (69.0%). At the end of the sixth year, 22% of the participants were in abstinence. Physical and mental health in abstainers proved to be of better conditions than those of non-abstainers (P

Background & Aim: Chronic diseases impact not only on patients but also on their family members’ lives. This study aims to determine dimensions of Family Dermatology Life Quality Index (FDLQI) questionnaire by the use of classic and Bayesian factor analysis (BFA) factor. Methods & Materials: In this study, FDLQI questionnaire distributed among 100 family members of dermatological patients. BFA is exploited to determining dimension and contribution of items of the questionnaire in different sample size. BFA is examined using the Monte Carlo-Markov chain algorithm. All the above analysis is done in sample size 100, 130, 150. Results: In this study, 100 family members of dermatological patient attended to evaluate Persian version of FDLQI questionnaire. A mean age of participants was 37.1 years (± 12.3). A mean score of FDLQI was 15.4 (± 5.5) with maximum and minimum scores of 30 and 6, respectively.Exploratory FA revealed a one-factor solution that accounted for 45.87% of the total variance. The unidimensional model was concordance by confirmatory FA. For more exploration, BFA was performed. Two factors extracted when iteration is done. Conclusion: It appears that when sample size diminished, Cronbach’s alpha and Kaiser–Meyer–Olkin increased. Among 10 items of the questionnaire, item 9 mostly appears differently in results.

Background: Since the number of drug users is increasing, applying a method of detoxification with fewer side effects during withdrawal from opioids and greater reliability seems to be necessary. In addition, without maintenance treatment, there will be limited success of treatment. This study aimed to compare success rates of detoxification with sublingual buprenorphine and clonidine and to evaluate addiction relapse in patients using naltrexone in a six-month follow-up. Methods: This double-blind trial was carried out on opioid dependent patients in a psychiatric hospital in Kerman (Iran) during 2007-09. The subjects were randomly selected from individuals who had referred for detoxification. They were allocated to two groups to receive either clonidine (n = 21) or buprenorphine (n = 14). The success rates of the two methods were assessed at the end of the course and patients were discharged while prescribed with 25 mg daily use of naltrexone. They were followed up for six months and the continuous use of naltrexone and relapse of substance abuse were evaluated. Findings: A total number of 35 patients entered the study. Success of detoxification with naltrexone was confirmed in all cases. One person (8.4%) in the clonidine group and no patient in the buprenorphine group had a Clinical Opiate Withdrawal Scale (COWS) score of more than 12 (P > 0.05). The mean levels of objective signs and subjective symptoms of withdrawal and the desire for drug abuse had significant reductions during detoxification period in both groups (P < 0.001). However, the difference in these variables between the two groups was not statistically significant (P > 0.05). Naltrexone was used for an average of one month in 43% and 64% of subjects in the clonidine and buprenorphine groups, respectively. In addition, 62% of patients in the clonidine group and 92.8% of subjects in the buprenorphine group received maintenance treatment. Nevertheless, the mean number of days staying in treatment was not significantly difference between the two groups (P > 0.05). Conclusion: Buprenorphine is as effective as clonidine in controlling withdrawal symptoms. A greater percentage of patients detoxified by buprenorphine received maintenance treatment, but there was not a significant difference in relapse rates between the two methods.Keywords: Buprenorphine, Clonidine, Naltrexone, Opioid detoxification, Addiction relapse.

Background & Objective: The number of research misconduct cases seems to be increasing so the need for developing a disciplinary charter of research misconduct is felt more than ever This study was aimed to propose and develop a charter to determine types of research misconduct and dealing with them Methods: In this qualitative study three consensus rounds were conducted Each round consisted of five to six qualified experts with related specialties They included one member of academic staff with sufficient experience in research management two experts in professional ethics and two experts in legal affairs Each session lasted for 15 to 2 hours Based on an extensive literature review and personal experiences the different types of research misconduct were extracted in the first two sessions and in the third round agreement on classification of research misconduct was made Results: In general 49 types of research misconduct were explored and defined including 17 mild 22 moderate and 10 severe ones B ased on the severity of each type an appropriate penalty like verbal warnings and summons to early retirement with reduced payment base was determined Finally the expert panel made some comments Conclusion: The results of this study revealed different types of research misconduct and dealing with them Such an understanding can lead to a better design of national charters compatible with Iranian culture and it can also be as a base for preventive interventions