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Indonesia has quality nut commodities. One of them, mung beans, is known to contain 22.75% protein. Kefir grains include lactic acid bacteria (LAB) in symbiosis with acetic acid bacteria and yeast. Its fermentation produced peptide bioactive, functional properties, probiotics, and inhibitory enzymes. This study evaluated kefir’s microbiological and rheological properties in mixed milk and mung bean juice media. The combination treatment (T) of milk (M) and mung bean juice (MB) as the kefir medium was M 90% + MB 10% (T1), M 80% + 20% MB (T2) and M 70% + 30% MB (T3). The results showed that the LAB and yeast no significantly different in each treatment. Rheological properties of kefir were determined by analyzing sample viscosity at different temperatures (5°C, 20°C, and 30°C). The results showed an increase in the percentage of mung bean juice, and temperature reduced the viscosity value. The highest viscosity value regression was T3 (82.75 mPa·s) at 5°C. The research concluded that combinations of milk and mung bean up to 30% do not affect microbiological properties but affect rheological properties.

Background and Objectives: Cervical cancer is one of the most common cancers in women worldwide and although pap smear is considered as an effective screening program, the level of using screening is low. The purpose of this study is pap smear test structures for measuring health belief model and factors affecting women in urban centers covered Zarandieh.Methods: This was a cross-sectional study (descriptive-analytical) which included 265 Urban Women's in Zarandieh. Data collection instrument was a questionnaire included demographic variables and knowledge and health belief model questions. Data was analyzed using chi-square tests, Descriptive statistics, independent samples t-test, at the significance level of p

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Introduction: Despite the fact that cervical cancer is highly preventable, it still continues to occur, even among women who have access to cancer screening and treatment services. This study aimed to determine the effect of health education program based on Health Belief Model on the performance Pap smear test. Material and Methods: This random clinical trial was carried out on 120 women in Zarandieh. Data were collected using a valid and reliable questionnaire based on Health Belief Model which was completed by the participants. After the analysis of pre-test results, the educational program was designed and the experimental group participated in 3 educational sessions during one week. Two months after the intervention, a post-test was performed and analyzed using t-test, t-paired and x². Results: Our findings indicated that mean scores of HBM Model constructs (self-efficacy, susceptibility, severity, benefit and barriers perceived) were significantly increased in the experimental group compared to the controls after the intervention. Also, performance of pap smear test increased significantly among the experimental group as compared to the controls after the intervention(P<0.01) (before intervention 30%, after intervention 53.9% in the experimental group). Conclusion: Health education programs are recommended to use the theories and models of changing of individuals' behavior in organization levels for to Help Plan Effective Programs as the uptake of cervical cancer screening (Pap smear). [ABSTRACT FROM AUTHOR]

Background: Menopause represents a critical stage in middle. Examining menopausal symptoms within healthcare system requires reliable and valid instruments. The Menopause Representations Questionnaire (Menosentations-Q) is a self-report scale grounded in Leventhal's self-regulation model. This study aimed to explore the psychometric properties of this questionnaire among Iranian women., Methods: This study was conducted with women visiting healthcare centers in Saveh, Markazi province, Iran. A total of 320 eligible Iranian women and 354 Portuguese women (aged 45-65) completed the questionnaire. Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was evaluated through Cronbach's alpha and McDonald's omega. Convergent and divergent validity were determined using average shared variance, maximum shared variance, construct reliability, and Fornell and Larcker's method. Cross-cultural validity was performed by multigroup CFA to assess invariance between two culturally distinct samples (Iranian and Portuguese)., Results: The Content Validity Ratio (CVR) and Content Validity Index (CVI) were 0.96 and 0.98, respectively, indicating strong content and face validity. EFA of 22 items revealed four factors-identity, positive and negative consequences, and control/awareness/cause factors, accounting for 61.29% of the total variance. CFA indicated good model fit (CFI = 0.96, TLI = 0.95, χ2/df = 1.74, GFI = 0.91, AGFI = 0.89, RMSEA = 0.04). Cronbach's alpha (0.90) and McDonald's omega (0.92) indicated good internal consistency. Convergent and discriminant validity values of MenoSentations-Q were also acceptable. Also, the instrument showed invariance between the two cultural groups., Conclusions: The Persian adaptation of MenoSentations-Q demonstrated strong validity and reliability. Furthermore, the comparable responses between Portuguese and Iranian participants suggest shared representations of menopause across these cultures. Given the significance of menopause, tailored educational programs and interventions are essential to address potential challenges during this life stage. Employing standardized tools such as the Menopsentations-Q can support the development of effective strategies, including educational initiatives, support programs, and targeted interventions, to empower women and enhance their well-being during this transitional phase., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted following the Declaration of Helsinki and was sponsored by the Deputy of Research and Technology student research committee at Saveh University of Medical Sciences(IR.SAVEHUMS.REC.1401.016). Written informed consent was obtained from all participants before their inclusion in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background and Aim: Caregiver burden encompasses the physical, emotional, financial, and social challenges faced by individuals caring for a sick or disabled person. Spiritual well-being and social support have been identified as protective factors against psychological and physical issues, potentially alleviating caregiver burden. This study aims to explore the relationship between spiritual well-being, perceived social support, and caregiver burden among parents of children with disabilities., Method: A descriptive-analytical study was conducted with 260 family caregivers, selected through systematic random sampling. Data were collected using a demographic questionnaire, the Novak and Gaug Caregiving Burden Scale, the Paloutzian-Ellison Spiritual Well-being Scale, and the Zimet Social Support Questionnaire. Statistical analysis was performed using IBM SPSS version 22, with significance set at p < 0.05., Results: Among the caregivers, 148 (61.4%) reported a high level of caregiving burden, while 81% indicated moderate spiritual well-being and 14.5% reported high spiritual well-being. A significant negative correlation was found between spiritual well-being, social support, and caregiving burden (p < 0.05). Multiple linear regression analysis revealed that spiritual well-being (β = -0.41) and social support (β = -0.33) were the most significant predictors of caregiving burden. Additional significant predictors included social activities, underlying health conditions, age, caregiving duration, insurance coverage, and marital status (p < 0.05)., Conclusion: The high caregiving burden observed in this population, along with the inverse relationship between social support, spiritual well-being, and caregiving burden, underscores the need for strategies to enhance social support and spiritual well-being. These factors may serve as cost-effective, accessible interventions to alleviate caregiving burden., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of Saveh University of Medical Sciences, Ahvaz, Iran (Registration No: IR.SAVEHUMS.REC.1400.010). Written informed consent obtained from participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Rheumatoid arthritis (RA) is a prevalent chronic inflammatory joint disease that might exert significant effects on oral health-related quality of life (OHRQoL). This study aimed to investigate OHRQoL in patients with RA., Methods: This descriptive-analytical study involved 228 RA patients visiting the Jundishapur Dentistry School, Ahvaz, and dental clinics in Ahvaz, south west of Iran, in 2023. Data collection instruments included a demographic and clinical characteristics form, the Oral Health Impact Profile-14 (OHIP-14), the Health Assessment Questionnaire-Disability Index (HAQ-DI), the General Health Questionnaire (GHQ), and clinical oral examinations. The collected data were analyzed using Spearman's correlation test and linear regression analysis in SPSS version 22., Results: The mean age of the participants was 49.23 ± 10.83 years, and the majority were females. The DMFT index was 14.44 ± 6.63, the mean OHRQoL score was 24.72 ± 5.33, the mean general health score was 5.71 ± 2.21, and the mean disability severity score was 11.62 ± 62.11. Of all variables examined, gender, age, duration of RA, Khuzestan nativity status, smoking, anemia, hyperlipidemia, DMFT index, general health, disability, diabetes, acute kidney disease, and hypertension were significantly associated with OHRQoL(p > 0.05)., Conclusion: The findings of this study indicate that OHRQoL is compromised in patients with RA. It is recommended that oral health receive greater attention from healthcare professionals managing RA patients and should be taken into account in daily practice of clinicians. Clinicians should develop multi-faceted care including oral health, dental health, general health and quality of life in addition to medical care for RA., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the ethical committee of the Ahvaz Jundishapur University of Medical Sciences, with a reference number of (IR.AJUMS.REC.1402.207). Informed consent was obtained from all participants prior to their involvement in the study. All experiments were performed in accordance with relevant guidelines and regulations. This is a descriptive study, and ‘Clinical trial number is not applicable’. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Global evidence suggests that natural disasters are on the rise, and that earthquake harm disproportionally impacts developing countries. To mitigate these harms, disaster preparedness is an important behavioral strategy in earthquake risk mitigation. However, there is limited evidence about the levels of preparedness in developing countries, especially Iran. Therefore, this study aimed to investigate earthquake preparedness among the general public, using the Theory of Planned Behavior (TPB) as a theoretical framework., Method: This methodological study was conducted in Iran in 2022, involving 302 participants selected through stratified random sampling. Data was collected using a valid and reliable questionnaire. Structural equation modeling (SEM) was employed to analyze TPB constructs, including attitudes, subjective norms, perceived behavioral control, and intentions, in relation to earthquake preparedness behaviors. The statistical analyses encompassed descriptive statistics, t-tests, ANOVA, correlation coefficients, confirmatory factor analysis, and structural equation modeling., Results: Results show that attitudes toward disaster preparedness, subjective norms, and perceived behavioral control significantly (< 0.05) influenced residents' disaster preparedness intentions. Additionally, there was good model fit of the TPB in explaining earthquake preparedness behavior. For confirmatory factor analysis (CFA) of TPB model the fit indices were CMin/df = 1.35 (< 3), RMSEA = 0.03 (< 0.05); CFI = 0.96 (> 0.95); TLI = 0.95 (= 0.95), and for SEM model they were CMin/df = 1.36 (< 3), RMSEA = 0.03 (< 0.05); CFI = 0.96 (> 0.95); TLI = 0.96 (> 0.95)., Conclusion: The overall fit indexes were acceptable indicating the TPB model is a valid and reliable measurement model for screening population-level readiness for earthquake preparedness, developing and/or implementing health promotion interventions. The findings also suggest that disaster education programs should emphasize the importance of attitudes, subjective norms, and perceived behavioral control in promoting disaster preparedness., Competing Interests: Declarations. Ethics approval and consent to participate: The Ethics Committee of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran approved the study (IR.AJUMS.REC.1400.681). Informed consent from a parent and/or legal guardian for study participation, along with written informed consent was obtained from all participants, and all methods adhered to relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: MA is an editorial board member of BMC Public Health, the remaining 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., (© 2025. The Author(s).)

Background: Fatigue is a prevalent issue among cancer patients. Cognitive behavioral therapy (CBT) is an individualized intervention that empowers patients and caregivers to actively participate in the treatment process. A recent systematic review and meta-analysis examined the impact of CBT on fatigue in cancer patients., Methods: Articles published up to April 2023 were systematically searched in Scopus, PubMed, and the Web of Science using relevant keywords. All randomized clinical trials (RCTs) investigating the effects of CBT on fatigue in cancer patients were included. Statistical analyses were conducted using Stata version 14, with a significance level set at a p -value of <0.05., Results: The current systematic review and meta-analysis encompasses 10 RCTs. CBT demonstrated a significant reduction in fatigue scores among cancer patients [standardized mean difference (WMD): -2.50; 95%CI: -3.43, -1.56; I2 = 95.8%, p  < 0.001]. This effect was consistent across all subgroup analyses., Conclusion: This study underscores the significant impact of CBT on fatigue in cancer patients. Further randomized clinical trials focusing on various cancer types are warranted to validate and build upon these findings., 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 © 2025 Hosseini Koukamari, Karimy, Ghaffari and Milajerdi.)

Background: The evidence indicates a phenomenon of ethical erosion in healthcare students. Variables like empathy and spiritual health might affect moral sensitivity in nursing students. The present study is an attempt to predict the moral sensitivity of nursing students based on empathy and spiritual health., Materials and Methods: A cross-sectional and analytical study was carried out at Saveh University of Medical Sciences, Saveh, Iran, in 2023. In total, 110 nursing students were included in the study by census method. Data gathering was done using Ellison and Paloutzian spiritual health inventory, Jefferson's empathy inventory, and Lutzen's moral sensitivity scale. The collected data was analyzed using Pearson's correlation and multiple regression analysis., Results: The mean scores of empathy, spiritual health, and moral sensitivity in nursing students were equal to 99.8 ± 15.25, 81.32 ± 10.01, and 65.09 ± 12.23 respectively. Empathy and spiritual health were positively and significantly related to moral sensitivity ( P < 0.01). In total, 31% of variation in moral sensitivity was attributed to empathy and spiritual health., Conclusion: Empathy and spiritual health were positively and significantly related to moral sensitivity. Taking into account the role of spiritual health and moral sensitivity in nursing students, enhancing this aspect of health through informing individuals and highlighting the positive aspects and potential effects on physical and mental health and professional performance in return is recommended., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Background: Workforce health is one of the primary and challenging issues, especially in industrialized countries. The purpose of the present study was to evaluate the ability to predict accident-proneness among Saveh Industry workers in Iran, based on an extended Health Belief Model, that included the construct of spiritual health., Method: This descriptive-analytical study was conducted in 2022 on 384 workers in Saveh, Iran. The study aimed to explore relationships between accident proneness behavior, spiritual health, and health beliefs. The accident-proneness questionnaire consisted of two parts: the first part included demographic questions, and the second part comprised 9 sections covering personality traits, workplace harmful factors, miscellaneous factors, musculoskeletal disorders, safety culture, safety attitudes, job stress, organization interest, and degree of risk-taking. The Health Belief Model included 31 questions, while spiritual health was measured with the 20-question Paloutzian and Ellison questionnaire. The collected data were analyzed using SPSS version 26 software., Results: In terms of accident proneness, 229 (59.6%), exhibited high levels, 148 (38.5%) had medium levels, and 7 (1.8%) showed low levels of accident-proneness. Hierarchical multiple regression analysis showed that in the first model, variables of perceived self-efficacy, vulnerability, and severity independently predicted workers accident proneness, explaining a total of 43% of variance in accident proneness behavior. In the second step, perceived self-efficacy (β = 34%), perceived sensitivity (β = 27%), spiritual health (β = 16%), and perceived severity (β = 12%) were included, respectively, which explained a total of 46% of the variance of accident-prone behavior of workers., Conclusion: Given the high rate of accident proneness observed in this study, there is a critical need for policymakers and health planners to design policies aimed at mitigating the risks associated with occupational accidents. Furthermore, the findings highlight the potential of integrating spiritual health into the Health Belief Model, as a conceptual framework for planning effective intervention programs to enhance workplace safety., (© 2024. The Author(s).)

Emergency medical service (EMS) personnel and firefighters (FFs) are first responders in dangerous and stressful situations. They experience high stress due to the nature of their jobs, which can affect their quality of life and various health dimensions. This study aimed to compare quality of life, job stress, and coping strategies in a sample of EMS personnel and FF employees in Iran. This cross-sectional study included 186 FFs and EMS, who were selected using a census sampling method. Our results showed that FFs had a better quality of life, lower perceived stress, and better coping skills than EMS. Individuals living in rural areas, government officials, and staff with regular work shifts also reported less perceived stress. Furthermore, our results indicated a negative and significant correlation between perceived stress and quality of life and a positive and significant correlation between stress management and quality of life in both groups. Given the inevitability of stress in EMS and FF jobs, policymakers need to take interventional measures to reduce anxiety and enhance the quality of life and work for these personnel. Occupational health policies in Iran generally follow the International Labor Organizational recommended standards, however, more attention to managerial interventions that reduce job demands and job stress combined with health promotion programs to improve coping are advised., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

To support milk production and milk quality, ruminant animals like dairy cows are particularly fed using concentrate containing high grain and starch. Nonetheless, this type of regimen feeding could induce subacute rumen acidosis condition. Then, these circumstances cause the lysis of gram-negative bacteria accompanied by endotoxin release in gut. More importantly, gut endotoxin could be translocated to mammary gland, whereby this condition negatively affects to milk safety. The aim of the review is to update and summarize the current knowledge regarding high-grain diet and the occurrence of endotoxin in milk of dairy cows. The data suggest that there is interplay between high-grain feeding for dairy cows to endotoxin contamination in milk., Competing Interests: Declaration of competing interest 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., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Complaints of the arm, neck, and shoulder (CANS) in the workplace are becoming more prevalent among employees. The Maastricht Upper Extremity Questionnaire (MUEQ) validates upper extremity complaints in 7 domains-including workstation, body posture, break time, job control, job demands, work environment, and social support. The aim of the present study was to translate, adapt, and validate the Persian Version of MUEQ among Iranian office workers., Methods: The psychometric evaluation of the Persian version of the MUEQ employed a comprehensive methodological approach comprising face and content validity assessments, confirmatory factor analysis (CFA), and Cronbach's alpha. A panel of 10 experts assessed the face and content validity of the instrument. In the second phase, through a cross-sectional study, the validity and reliability of the questionnaire were measured by CFA and Cronbach's alpha in a sample of 420 people from the target population in Tehran, Iran., Results: The mean age of the participants was 41.40 ± 7.80 years. Examination of upper limb complaints showed that neck pain was the most common complaint among office workers, with a prevalence of 65%. The CFA results confirmed the questionnaire's structure, with 59 items grouped into 7 subscales, and with fit indices-comparative fit index, 0. 87; root mean square error of approximation, 0.08; goodness of fit index, 0.9. The questionnaire demonstrated strong internal consistency, as all items exhibited Cronbach's alpha values of ≥0.9., Conclusion: The psychometric evaluation of the Persian version of the MUEQ showed that it is a valid and reliable tool for evaluating psychosocial factors in the work environment. Identifying psychosocial factors influential in musculoskeletal problems will lead to better planning to change behavior and design constructive interventions to improve behavior. By addressing psychosocial determinants of musculoskeletal issues at both the individual and organizational levels, we can enhance employees' awareness, self-efficacy, and ability to manage their musculoskeletal health and make informed decisions about their well-being., Competing Interests: The authors declare that they have no competing interests., (© 2024 Iran University of Medical Sciences.)

Gastric cancer is a common cause of cancer death in the world. This study examined 120 rural women. The educational program included four sessions for each group based on the health belief model. The mean age of the women was 34.51 ± 9.16. The mean score of the perceived barriers significantly decreased in the experimental group (11.08 ± 0.37) compared to the control group (14.92 ± 0.42) ( P  < .001), and the mean score of knowledge, performance and HBM constructs, increased significantly 2 months after the education ( P  < .001).It is recommended that educational interventions be designed by HBM to improve nutritional behaviors related to GC in the female population.

Competing Interests: The authors declare that they have no competing interests.

Background: Puberty is a sensitive critical stage of human life. As numerous healthy habits and behaviors are created during adolescence, correct health education during puberty is essential to maintain and improve an individual's physical, emotional, and mental health. The present study aimed to determine the impact of educational intervention based on the predictors of the Health Belief Model (HBM) on female nine-grade students' health behaviors in Rasht, Iran., Methods: The present randomized controlled trial study examined 110 female nine-grade students. Multi-stage sampling was performed, and the students were randomly divided into two groups of 55 as intervention and control. The data collection tool included a valid and reliable questionnaire with four sections, namely demographic variables, knowledge, HBM constructs, and health behaviors during puberty. The educational program comprised four 45-60-min sessions per group (4 groups of 13) based on HBM. The data were collected two times, before and 1 month after the educational intervention, and were analyzed using the independent t-test, paired t-test, chi-square test, and SPSS 23., Results: The mean age of menarche was 12.26 ± 1.133 in the intervention group and 12.12 ± 1.263 in the control group. The family was a source of information for students and the main cue to action before the intervention. Before the educational intervention, there was no significant difference between the experimental and control groups in terms of knowledge, HBM constructs, and puberty health behaviors; however, the variables increased significantly in the intervention group after educational intervention (P<0.001)., Conclusions: Given the effectiveness of the HBM in improving the health behavior of adolescent girls, it is recommended that health policymakers should plan and implement educational interventions in this field., (© 2023. The Author(s).)

Background: Report of medical error is one of the effective components in the quality of healthcare services. A significant part of medical errors can be prevented by acting appropriately. The theory of planned behavior offers a framework in which the nurse intention to perform the behavior of error reporting is investigated. This study was conducted to determine the factors related to the behavior of reporting clinical errors in nurses working in educational and medical centers in Rasht based on the theory of planned behavior in 2020., Methods: In this descriptive-analytical study, 326 nurses in all medical centers in Rasht were selected by the multi-stage random sampling method. Data collection tool was a valid and reliable questionnaire based on the theory of planned behavior. Data analysis was conducted using the SPSS software, analysis of variance, correlation, and linear regression., Results: 39% of nurses reported that they had reported a medical error, and the average number of error reports per nurse during the last 3 months was 1.42 errors. The predictive power of the theory of behavioral intention was 47%, and predictive constructs were attitude (B = .43), perceived behavioral control (B = .33), and subjective norm (B = .04) using linear regression. The predictive power of the theory for nurses' behavior was 3.1%. None of the demographic variables played a role in predicting the behavior of nurses' reporting clinical error, and no behavioral intention predicted the behavior of nurses' reporting clinical errors., Conclusion: The theory of planned behavior expresses the factors affecting the behavior intention of nurses' reporting clinical errors satisfactorily. However, it was an inappropriate theory in behavior prediction. It appears that factors, such as fear of consequences of error reporting, social pressures by colleagues and officials, and lack of knowledge and skills required to identify medical errors, are the barriers to conversion of intention to the behavior of reporting clinical errors. It is necessary to provide the ground to increase nurses' report of clinical errors by acting appropriately., (© 2022. The Author(s).)

Background: To significantly reduce the disease and mortality from the novel Coronavirus Disease (COVID-19), a safe and effective vaccine must be widely delivered to the community. However, the availability of a vaccine for COVID-19 does not ensure that individuals will want to be vaccinated. The present study investigated the attitudes, perceived barriers, and benefits of the COVID-19 vaccine, as well as vaccination intentions, among a sample of Iranian adults. Methods: Demographic data were categorized in this study based on whether or not participants received the vaccine. Drawn from a multistage sampling protocol in 2021, a descriptive-analytical study was conducted on 1350 adults in Saveh, Iran. A survey with 5 different sections inquired about eligible participants' sociodemographic information, their attitudes, perceived benefits, and barriers, as well as their intentions to get vaccinated for COVID-19. Multiple logistic regression analysis (enter method) was performed to assess factors related to vaccination intent. Results: The mean age of those who intended to receive the COVID-19 vaccine (57.9±19.2) was significantly higher than those who did not intend to receive the vaccine (43.4±16.8) ( p =0.00). Additionally, married individuals were significantly more likely to receive the vaccine than individuals who were single and/or widowed. Additionally, (n=663) substantially more homemakers and retirees received vaccinations than workers and self-employed individuals (n=481) ( p =0.001). Findings revealed that 78% of participants intended to receive the COVID-19 vaccine. Multiple unconditional logistic regression analyses showed that age and marital status, as well as the behavioral variables (attitude odds ratio [OR]=1.73, benefits OR=1.78, and perceived Barriers OR=0.52), had a significant relationship with vaccination intentions ( p =0.001). Conclusion: This study demonstrated that to increase intentions to receive the COVID-19 vaccine, public health campaigns and interventions should focus on promoting the benefits of the vaccine, improving the attitudes toward the vaccine, as well as reducing the perceived barriers., (© 2022 Iran University of Medical Sciences.)

Background: Incomplete data are often presented for determining the role of vitamin A supplement therapy for improving treatment outcomes in patients with COVID-19., Aims: We compared treatment effects between a group that received vitamin A added to the standard COVID-19 treatment and another group that received the standard drug treatment alone., Methods: Participants in this triple-blind controlled trial comprised 182 COVID-19 outpatients in Saveh City, Markazi Province, Islamic Republic of Iran, in 2020. Patients were randomly divided into experimental (n = 91) and control (n = 91) groups. Patients in the control group received the national standard treatment for COVID-19 (hydroxychloroquine), and those in the intervention group received 25 000 IU/d oral vitamin A for 10 days in addition to the standard treatment recommended by the national protocol. We evaluated the clinical symptoms, paraclinical criteria, and hospitalization status before and after 10 days of interventions., Results: The treatment groups did not differ significantly in clinical and paraclinical symptoms before the intervention. However, clinical symptoms such as fever, body ache, weakness and fatigue, paraclinical symptoms, white blood cell count, and C-reactive protein showed significantly greater decreases in the experimental group 10 days post-intervention compared with the standard treatment alone (P < 0.05)., Conclusion: Vitamin A supplementation demonstrated efficacy in improving some clinical and paraclinical symptoms in patients with COVID-19. Future studies should evaluate vitamin A supplementation with a larger sample size and compare different dosages, especially in hospitalized patients., (Copyright © World Health Organization (WHO) 2022. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: Students of medical sciences are a highly vulnerable group during COVID-19 pandemic who may experience a wide range of challenges and stresses. The aim of this study was to investigate the perceived challenges caused by COVID-19 outbreak in students of medical sciences., Materials and Methods: A qualitative study was carried out based on conventional qualitative content analysis following Graneheim and Lundman from December 2020 to February 2021. The participants were 17 students of medical sciences and data gathering was done through semistructured interviews., Results: Data analyses revealed 5 categories and 12 subcategories. The extracted categories were perceived fear of contracting coronavirus, social limitation, changes in education, neglecting health protocols, and worrying news and information overload., Conclusions: The findings indicated that students of medical sciences had been facing challenges and the COVID-19 had affected the psychological, social, and academic functioning of the health-care students. It is important to take measures to improve their mental health. These measures can prevent medical complications in these students, especially during clinical internship., Competing Interests: Nothing to declare., (Copyright: © 2022 Iranian Journal of Nursing and Midwifery Research.)

Regarding the cost-effective degradation of diazinon (DIZ), the present study was conducted to develop and UV/iodide process in a photo catalyst reactor. CCD modeling applied and the results shows that the highest R-squared value (adjusted R-squared: 0.9987), the lowest P-value (2.842 e - 10), the lowest AIC (14.54), and the most insignificant lack-of-fit (0.73) belonged to the second-order model. Based on second-order model, the stationary points for time, iodide: DIZ (molar ratio %), DIZ concentration, and pH were 6.99 min, 80.15% iodide: DIZ (molar ratio %), 3.34, mg L -1 , and pH 7.34 (- log 10 [H + ]), respectively. The maximum reduction efficiency of 97.22% was obtained at the experimental conditions. The LC-MS analyses from optimal condition implied that all the DIZ molecules and its intermediates breaking to simple compounds during 15 min of processing. The data shown UI process reduced the BOD and COD levels by about 66% and 86.29% within 80 min of photoreaction, respectively. Furthermore, in kinetic investigation, with the increase in DIZ concentration, k obs and r obs increased and secondly, the conventional and PCBR reactor k obs increased by about respectively 17% and 50% with an increase in DIZ concentration from 5 to 15 mgL -1 . Additionally, when the DIZ concentration increase from 5 to 15 mg L -1 , r obs increased in the conventional and PCBR reactors respectively about 4.9 and 6 times. Figure-of-merit E Eo changed from 12.66-17.41 to 7.26-10.15 kWhm 3 for the conventional reactor, and 8.66-13.61 to 5.24-8.12 kWhm 3 in PCBR, when the DIZ concentration increasing from 5 to 15 mg L -1 . Consequently, in the PCBR reactor, the energy consumption reduced by 14% at 5 mg L -1 DIZ concentration and by 60% at 15 mg L -1 DIZ concentration. Also, total cost of the system (TCS) decreases from 4.52 to 1.46 $ in conventional reactor and 1.47 to 0.42 $ in PCBR reactor when the DIZ concentration increase from 5 to 15 mg L -1 ., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: School transportation (ST) crashes are associated with serious adverse consequences, particularly for students in developing countries. High-risk behaviors (HRBs) of ST drivers are a major factor contributing to ST crashes. This study aimed at exploring the facilitators and barriers to HRBs among ST drivers., Methods: This qualitative study was conducted in 2019-2020. Participants were ST drivers, students, parents, and school staff purposively selected from Tehran, Iran. Data were collected through in-depth semi-structured interviews and focus group discussions and were concurrently analyzed through conventional content analysis., Findings: Participants were fifteen ST drivers with a mean age of 45 ± 10.2 years and 24 students, parents, and school staff with a mean age of 28.62 ± 16.08 years. The facilitators and barriers to HRBs came into five main categories, namely previous experiences of HRBs, perceived gains and risks of HRBs, motivating and inhibiting feelings and emotions, positive and negative subjective norms, and perceived mastery in driving., Conclusion: A wide range of facilitators and barriers can affect HRBs among ST drivers. Strategies for preventing HRBs among ST drivers should be multidimensional and individualized and should focus on strengthening the barriers and removing the facilitators to HRBs., (© 2022. The Author(s).)

Background: Transmission routes of COVID-19 have been well identified and documented. Considering the high prevalence of the Covid-19 and its impacts on the population, this study aimed to assess the status of preventive behaviors against coronavirus infection and estimate the odds of its transmission routes among people. Methods: A comparative study was conducted from March to April 2021. A total of 1256 participants were randomly selected, including 262 COVID-19 patients and 994 healthy people from 10 counties in Khuzestan, southwest Iran. A two-part questionnaire was used for data collection that included items on demographic and adherence to preventive behaviors. Statistical analysis was performed using the statistical software SPSS 18.0.0 applying logistic regression. Results: The mean age of participants was 37.60±11.48 years (female: 36.49±11.15 years; male: 38.86±11.74 years). The results showed that having contact with infected patient at home (OR = 4.90, 95%CI = 3.32-7.25), going to the hospital for not-necessary medical reasons (OR = 4.47, 95%CI = 3.05-6.55), leaving home for essential daily services (OR = 2.49, 95% CI = 1.63-3.81), and going to doctors' office (OR = 1.78, 95% CI = 1.20-2.63) could increase the odds of infection. Conclusion: The findings suggest that different factors are responsible for the increased spread of the Covid-19. Indeed, since the intervention for every single factor will have a small contribution to reducing the prevalence of the disease, it seems essential to design comprehensive interventions while emphasizing isolation and contacts tracing. The study provides evidence for multi-level and multi-faceted policy and interventions for promoting adherence to COVID-19 preventive behaviors., Competing Interests: The authors declare that they have no competing interests., (© 2022 Iran University of Medical Sciences.)

High blood pressure is becoming a universal epidemic for both developed and developing countries; it is one of the main public health problems all over the world. This research was conducted to assess blood pressure self-care among hypertensive patients in Iran. This cross-sectional analytic study was conducted on 527 patients with hypertension recruited from Zarandieh, Iran in 2018. Data were gathered using questionnaires assessing socio-demographic information, social support, health belief model (HBM) constructs (perceived benefits to healthy behavior, barriers to healthy behavior, perceived disease threat, self-efficacy to engage in healthy behavior, and cues to action), and self-care activities to address blood pressure. A stepwise multiple linear regression analysis was used to determine factors associated with self-care behaviors. Overall, 512 patients (215 men and 297 women) participated in this study. Participants who were married, and more educated engaged in more self-care behaviors. At least one-half of the patients (47.6%) demonstrated a moderate level of self-care behaviors with a mean score of self-care equal to 9.32 ± 3.6 (out of 18). All the elements of HBM and social support were significant predictors of self-care behaviors and self-efficacy was the strongest predictor, followed (in descending order) by perceived barriers, social support, perceived disease threat, and perceived benefits. Health education based on HBM, enhanced with attention to social support, may help patient enact healthier behaviors to reduce blood pressure., (© 2020. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Coronavirus disease 2019 (COVID-19) is a worldwide public health emergency., Aims: This study aimed to investigate the epidemiological and clinical characteristics of patients with COVID-19 in Saveh city, Islamic Republic of Iran in 2020., Methods: In this descriptive analytical research, 3181 patients suspected of having COVID-19 who visited Saveh medical centres were investigated. Patients were confirmed with COVID-19 using polymerase chain reaction testing. Data on sociodemographic, epidemiological and clinical characteristics of the patients were collected using a validated form through interviews and medical records. The chi-squared, t and Fisher exact tests were used to assess differences in sociodemographic, epidemiological and clinical characteristics between patients with positive and negative polymerase chain reaction results. Logistic regression analysis was used to examine the association between independent variables and death from COVID-19., Results: About half the patients (48.3%) had a history of chronic disease. Diabetes (16.2%), high blood pressure (14.8%) and cardiovascular disease (12.4%) were the most prevalent chronic diseases among patients who were confirmed positive for COVID-19. Risk factors for death among confirmed COVID-19 patients were: intubation (odds ratio (OR) = 8.97; 95% confidence interval (CI): 5.15-15.63), age ≥ 80 years (OR = 5.81; 95% CI: 1.91-17.60), oxygen saturation < 93% (OR = 2.48; 95% CI: 1.51-4.08), diabetes (OR = 1.88; 95% CI: 1.00-3.54) and shortness of breath (OR = 1.70; 95% CI: 1.02-2.82)., Conclusion: Given the greater risks of contracting and dying from COVID-19 in certain groups of patients, health education programmes targeting these groups are recommended., (Copyright © World Health Organization (WHO) 2022. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: The COVID-19 pandemic has become a grave threat to public health. Along with vaccination, preventive behaviors are still an important part in controlling in controlling the COVID-19 pandemic. The present study aimed to investigate health beliefs and sample characteristics associated with COVID-19 preventive health behaviors among an Iranian sample. Preventive behaviors are still an important part in controlling in controlling the COVID-19 pandemic., Methods: This is a cross-sectional study, using a multi-stage randomized sampling method. Participants (N = 250 males and 236 females) were recruited from health centers in Saveh, Iran. Self-administered questionnaires included sociodemographic information, health behaviors, and constructs associated with the Health Beliefs Model (HBM). Data were analyzed using independent t-tests, analysis of variance, and multiple regression with significance level set at α ≤ 0.05., Results: Perceived disease susceptibility (β = 0.44, P< 0.001), self-efficacy to enact preventative behaviors (β = 0.24, P < 0.01), education (β = 0.20, P < 0.001), non-smoking status (β = 0.14, P < 0.01), marital status (β = 0.10, P < 0.03), and perceived barriers to disease preventative behaviors (β = -0.10, P < 0.04) were important predictors of prevention practices for COVID-19, and accounted for 61.4% (adjusted R 2 ) of the variance associated with preventive behavior for COVID-19., Conclusion: As there is accepted therapy for COVID-19, it is especially important to control COVID-19 through behavior change. Results indicate that two behavioral constructs that have the most impact on prevention are perceived disease susceptibility and self-efficacy. Therefore, public health initiatives are needed to enhance perceived susceptibility to the disease and improve self-efficacy to perform preventative behaviors in spite of perceived barriers., Competing Interests: Conflict of interest statement The authors declare that they have no competing interest., (©2022 Pacini Editore SRL, Pisa, Italy.)

Background: Coronavirus disease (COVID-19) pandemic has become one of the biggest challenges to global health and economy. The present study aimed to explore the factors related to preventive health behaviors during the COVID-19 pandemic in Khuzestan Province, South of Iran, using the Health Belief Model (HBM)., Methods: The present cross-sectional study was conducted in the period between July 2020 and September 2020. A total of 1090 people from Khuzestan province participated in the study. The data collection method included a multistage cluster sampling method with a random selection of provincial of health centers. The questionnaire collected socio-demographic information and HBM constructs (e.g., perceived susceptibility, perceived severity, perceived benefits and barriers, cues to action, and COVID-19 preventive behaviors). Data were analyzed using ANOVA, t-test, hierarchical multiple linear regression, and SPSS version 22., Results: The mean age of the participants was 35.53 ± 11.53, more than half of them were female (61.6%) and married (65.3). The results showed that 27% of the variance in the COVID-19 preventive behaviors was explained by HBM constructs. The regression analysis indicated that female gender (β = 0.11), perceived benefits (β = 0.10), perceived barriers (β = - 0.18), external cues to action (β = 0.25), and internal cues to action (β = 0.12) were significantly associated with COVID-19 preventive behaviors (p < 0.05)., Conclusion: Designing an educational intervention on the basis of HBM might be considered as a framework for the correction of beliefs and adherence to COVID-19 behavior. Health information campaigns need to (1) emphasize the benefits of preventive behaviors including avoiding the likelihood of getting a chronic disease and complications of the disease, (2) highlight the tips and advice to overcome the barriers (3) provide cues to action by means of showing various reminders in social media (4) focusing on adoption of COVID-19-related preventive behaviors, especially among men., (© 2021. The Author(s).)

Background: Oral health is an important part of public health and crucial to health promotion and enhancing the quality of life. This research examined childhood oral self-care behavior and their related factors using extended Theory of Planned Behavior (TPB)., Method: This cross-sectional study was conducted on 368 sixth-grade elementary school students in Saveh city, Iran, in 2019. The students were selected using a random multi-stage sampling method. The instrument included the socio-demographic questions, TPB constructs, and action and coping plan items. Data were analyzed by SPSS software (Version 21) at alpha level p ≤ 0.05., Result: Overall, 24 (6.6%) students have never used toothbrushes, 222 (62.7%) have never used dental floss, and 298 (82.7%) students have never used mouthwash. The stepwise multiple linear regression analysis results indicated that the TPB with action and coping planning constructs had better predictive power than the original model. In the final model, coping planning (β = .28), intention (β = .24), action planning (β = .23), and perceived behavior control (β = .15) were the most important predictors of oral self-care behavior., Conclusion: The results indicated that the oral self-care behavior status in Iranian elementary students was not favorable, and the extended model of the TPB with action and coping plan constructs were significant predictors of self-care behavior. Therefore, these findings emphasize the need for expanding educational interventions based on the extended model of the TPB to improve the oral self-care behavior of students., (© 2021. The Author(s).)

Background: Service satisfaction ratings from clients are a good indicator of service quality. The present study aimed to investigate the impact of communication skills and self-efficacy training for healthcare workers on clients' satisfaction., Methods: A quasi-experimental study was conducted in health centers of Saveh University of Medical Science in Iran. Primary Healthcare (PHC; N = 105) workers and service recipients (N = 364) were randomly assigned to intervention and control groups. The intervention group received four 90-min training sessions consisting of lecture, film screening, role-playing, and discussion group. Before and 3 months after the intervention, a multi-part questionnaire (including demographics, self-efficacy and communication skills in PHC workers; and satisfaction questionnaire in service recipients) was completed by participants in both intervention and control groups., Results: PHC worker mean scores of self-efficacy and communication skills after the educational program were increased in the intervention group compared to the control group (p < 0.05). Also, mean satisfaction scores for service recipients of the intervention group (PHC workers) generally significantly increased compared to the control group (p < 0.001)., Conclusions: The educational program improved the self-efficacy, and communication skills in health workers and improved client satisfaction overall. Our results support the application of self-efficacy and communication skills training for other medical groups who wish to improve clients satisfaction as an important health services outcome.