Journal of School of Public Health and

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Measuring of service quality is the basic prerequisite for improving quality. Patients&apos expectations and perceptions of service quality play an important role in the choice of hospital, loyalty to organization and behavioral intention. A first step towards improvement would be to determine areas of quality that are most defective. Studies show that consumers are in close contact with service providers, and they are involved in the service process. Therefore, this group can measure services quality better than any other group. This study was conducted to measure service quality based on patients&apos expectations and perceptions in Zanjan hospitals.
The cross-sectional design was used in this research. For data collection, SERVQUAL questionnaire was employed. To ensure the reliability of the questionnaire, the internal consistency reliability test (Cronbach alpha) was performed.
Findings: Cronbach alpha for service quality was .94. Results show that the assurance (knowledge, experience and ability to maintain patients&apos confidence and trust) was rated as the most important dimension. (SQ mean = -1.3). There were differences between patients&apos expectations and perceptions in all the dimensions.
the assurance dimension constitutes the most serious problem facing hospitals. It is recommended that physicians thoroughly explain the disease condition to patients, and that patients should be treated with dignity and respect.

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Liver flukes-induced pathological changes in liver parenchyma and biliary passages are so severe that, in some cases, may cause total physiologic dysfunction. The human disease is endemic to some parts of the country, and there were two vast epidemics of the human fascioliasis in Gilan province, northern most part of the country. According to WHO reports , the human disease is prevalent in Gilan, Mazandaran, and Isfahan. However , the aim of the present study was to collect more information about the naturally- infected animal hosts, and to extend the Knowledge to prognosticate the pathologic effects occurring in human cases of liver flukes in endemic parts of the human disease. The present study was carried out in slauther houses of Gilan and Khuzestan province, two most endemic areas of human and animal Distomatosis, respectively, from spring 2002 to summer 2003. A total of 30 infected livers were collected, and were examined both for visible gross and microscopic changes. The results of the present study showed that the pathologic changes varied from mild effects to total biliary bstruction. Most of the present knowledge on pathology of the human disease is based on studies in animal models. To have precise and comprehensive information about the tissue changes in naturally –infected animal may help to describe some unanswered concepts about the pathology of the human distomatosis.

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In recent years the patterns of mortality have changed in Iran, and cancers are playing a greater role in this regard in this country. Various reports indicate that gastric cancer is highly prevalent it is the second most common cancer in men, and fourth in the general population. The purpose of this study was to determine the five-year survival rate of gastric cancer patients who had undergone surgical treatment at one of the most important cancer treatment centers, the Iran Cancer Institute, and to assess its associated factors. Three hundred and 30 patients with gastric cancer who had been admitted to and operated on at the Iran Cancer Institute between January 1996 and April 2000 were enrolled in this study. The patients’ life expectancy after surgery was determined, and its relationship with variables of age at the time of surgery, gender, and factors related to the disease such as the cancer site, pathologic type, stage, presence of metastasis, and sites of metastases were assessed. The five-year survival rate and the median life expectancy in the studied patients were 23.6% and 19.90 months, respectively. Univariate analysis showed that gender, cancer site, and pathologic type did not affect life expectancy significantly. But the five-year survival rate significantly decreases with age. As expected, those involved with metastasis had a significantly lower five-year survival rate, and the disease stage significantly affected the patients’ life expectancy (P<0.001). The Cox proportional hazards model was used to assess the effect of different variables simultaneously, and it showed that age, distance metastasis, and disease stage influenced the rate of survival. Gastric cancer patients in Iran have a low five-year survival rate. One of the most important reasons seems to be delayed consultation and diagnosis. Most patients are seen first with the disease in the late stages. At this point, most have lymph node and liver metastasis which makes treatment even more complex. Thus, it is necessary to employ mass media for extensive public education about the early warning signs of the disease and performing periodic examinations.

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Background and Aim: Breast cancer is the leading cause of cancer death among women, both in Iran and worldwide. The wide variation in breast cancer incidence in different geographical areas calls for studies to clarify the role of potential risk factors. In this study we looked at some factors that could be involved in the pathogenesis of breast cancer.
Material and Methods: This matched case-control study was carried out in the summer of 2004, and it drew on data recorded in Babol (Caspian) Cancer Registry. We investigated 250 biopsy-proven cases of breast cancer, together with 500 controls chosen from the neighbors of cases. We matched the subjects with regard to age (with 3 years intervals). Crude and adjusted odds ratios and relevant 95% confidence intervals were calculated through conditional logistic regression, using STATA 8.0.
Results: This study involved 250 incident cases of breast cancer and 500 age-matched controls. The mean age of the cases was 48.7 (±11.37) years with 48, 22 and 80 years as median, min. and max. values, respectively. Mean age in the controls was 48.0 (±11.46) years with 47.5, 19 and 77 years as median, min. and max. values, respectively. In the multivariate analysis, the following variables were found to be risk factors: university education (OR=5.89, 95%CI: 1.73-20.09), menopause (OR=3.98, 95%CI: 2.29-6.91), induced abortion (OR=1.56, 95%CI: 1.02-2.22), BMI (OR=1.02, 95%CI: 1.01-1.03) and longer duration of breast feeding was determined as protective factor against breast cancer (OR=0.995, 95%CI: 0.990-0.999).
Conclusion: Modifiable risk factors should be considered in the community-based preventive interventions. The following areas could serve as topics for community education in Mazandaran: the role of high BMI and induced abortion in increasing the chance of breast cancer and also the protective role of breast feeding on this issue.

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Background and Aim: Limitations of the traditional methods for assessing G*E interaction- including case-control studies- led to development of several non-traditional approaches. This study aims to assess the interaction between the genetic background (history of breast cancer in first degree relatives) and environmental influences (reproductive/menstrual factors) in patients with breast cancer we also compare the statistical efficiency and power of case-control and case-only designs in this setting.
Materials and Methods: In a matched case-control study in Mazandaran province (Iran), 250 incident biopsy-proven cases of breast cancer and 250 age-matched neighbor controls were interviewed. History of breast cancer in mother and/or sister(s) was taken as a surrogate measure of genetic predisposition, while age at first birth, parity, breast feeding, age at menarche and irregular menstruation were considered as relevant environmental factors. For the matched case-control design, we used a conditional logistic regression model to examine main effects and the G*E interaction. In the case-only design, logistic regression analysis was applied to obtain an estimate of G*E interaction, after checking for the independence assumption. We also calculated the power for detecting the interaction by matched case-control and case-only analyses.
Results: Age at first delivery did not meet the assumption of independence (p=0.02), and so was not included in the case-only analysis. No statistically significant interaction effect was seen in the case-control analysis, while case-only analysis showed significant negative interaction between disease in first-degree relatives on the one hand and parity and breast feeding on the other. We also detected a significant positive interaction between genetic predisposition and age at menarche. All the estimated 95% confidence intervals for OR in G*E interactions were narrower in the case-only analysis. For all factors, the power for detecting G*E interaction was greater in the case-only analysis compared to the case-control analysis, with ratios ranging from 1.08 to 2.23.
Conclusion: The case-only design is more efficient and powerful than the case-control design for detecting gene-environment interaction under the assumption of independence. Baseline disease risk, interactions and independent effects should be considered in using the control data for checking the assumption of independence. Considering the existence of another explanatory variable, eg. a mutant gene which may have passed unnoticed, would be the safest approach in a case-only study.

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Background and Aim: Infectious complications after renal transplantation are associated with significant morbidity and mortality. We evaluated post-transplant complications due to infections and their relationship with graft function, immunosuppressive drugs and mortality.
Materials and Methods: Over a 2-year period (2002-2004), 179 renal transplantations were performed in our center. Of these, 142 cases were followed for a period of one year. The immunosuppressive regimen included cyclosporin A, mycophenolate mofetil and prednisolone. Each patient was assessed through regular visits and according to the ward protocol. Results of the investigations (infections and their relationship with age, sex, donor type, creatinine level, acute rejection, immunosuppressive drugs, graft and patient survival) were recorded and analyzed.
Results: The overall incidence of infection was 54%. The most common sites were lower urinary tract (42%) and respiratory tract (6%). The most frequent causes were Klebsiella (24%) and Cytomegalovirus (18%). Wound infection occurred in 5% of the patients. The overall mortality was 7.7%, and almost half of the death cases (3.5%) involved sepsis development. Graft loss occurred in 16 (11%) of the cases: 2 developed Cytomegalovirus infection, 2 experienced urinary tract infection (UTI) and 5 developed sepsis (and expired). Mycobacterial and hepatitis C infections were noticeably low compared to other studies. The hazard rate in occurrence of UTI, CMV, acute rejection and mortality were higher in cadaveric transplant recipients than in others.
Conclusion: This study identifies infections as a major cause of morbidity and mortality in the post-transplant period. Patients having higher creatinine levels and those receiving high doses of drugs at discharge are considered to be at high risk and should be evaluated thoroughly.

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Background and Aim: In breach of all international conventions, Iraq frequently used chemical weapons against both military and civilian targets in its 8-year war with Iran. The most frequently used agent was sulfur mustard. The effects of mustard gas may be divided into early and late categories. Late lesions, due to the agent's mutagenic and carcinogenic potential, are mainly the results of its action on intracellular particles, probably nucleic acids. Although the occurrence of cancer has been proved following long-term exposure, the presence of a carcinogenic effect in acute, short-term contact is still in doubt.
Materials and Methods: To determine the relationship between cancer and acute exposure to mustard gas, a historical cohort study was carried out in Isfahan province, involving 500 chemically-injured soldiers with at least one episode of exposure to mustard gas. The incidence of cancer and the death rates in these subjects were compared with similar rates from i) 500 unexposed soldiers in the same area and ii) nationwide figures.
Results: All the subjects were male. The mean age in the exposed and unexposed groups were 41(±10.8), and 40(±7.6) years respectively. Within the exposed group, the mean age at first exposure was 24.1(±13) years the mean age at first injury in the unexposed group was 23(±11) years. Eighty-one percent of the cases lived in cities and 19% in rural areas. For 395 persons (84.5%) in the exposed group, education was at high school level or below. Within the same group, 481 subjects (96.2%) were married. Sixty-three people (12.6%) were servicemen and 366 (73.2%) had civilian jobs. Three cases of cancer were observed in those exposed to mustard gas. No cases occurred in the unexposed group. Ten people in exposed group and 7 in the unexposed group were dead at the time of the study. Relative risks for cancer and death were estimated at 4.02 (CI 95% = 0.45-36.1) and 1.44 (CI 95% = 0.54-3.81) respectively.
Conclusion: The results failed to show a statistically significant relationship between cancer incidence and acute exposure to sulfur mustard.

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Background and Aim: The purpose of this study was the assessment of inappropriate admissions and hospital stays and reasons for this in the hospitals affiliated to Tehran university of Medical Sciences.
Materials and Methods: We used the Appropriateness Evaluation Protocol (AEP) to evaluate the appropriateness of 258 admissions to Dr. Shariati and Imam Khomeini hospitals and 1732 days of hospital stay for the same patients. Findings indicate that on the whole, 22.8% of admissions were inappropriate and the length of stay for patients who were inappropriately admitted was significantly shorter than for those whose admission was judged to be appropriate.
Results: Results show that 8.6% of the total number of patient stay days were unnecessary the figures differ significantly between the two hospitals. The most frequent reason for inappropriate hospital stay was the delay in the discharge process .Consultations and delay in surgical operations were other causes of inappropriate patient stay.
Conclusion: A substantial proportion of hospital admissions and stays were found to be inappropriate due to hospital procedures and inadequacies in the lower levels of healthcare. Efficient use of hospital resources should be promoted by modifying procedures, improving the performance of the healthcare system and revising insurance policies.

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Background and Aim: Iran managed to eradicate the wild poliovirus in 2000. However, a large number of AFP cases are still detected each year because of close surveillance: there were 450 reported AFP cases in 1382. The expected number of cases for the year 1382 in the province of West Azarbayjan (with an under-15 population of 1100000) was 11, while the observed number was more than 6 times greater (70 cases). In this study we investigated the non-polio enteroviral agent which could cause the AFP cases especially in Azarbayjan Province. Hence, the main purpose of the study was to identify circulating non-polio enteroviruses, using cell lines RD, Hep2, L20 and RT-PCR.

Material and Methods: All stool specimens of AFP cases were treated with chloroform and then injected into the above-mentioned cell lines. The isolated viruses were identified by the NT method. In cases where polioviruses were isolated, intratypic differentiation (wild vs. vaccine strains) using hybridization and ELISA tests. Finally, we performed RT-PCR with pan-EV primers on all samples.

Results: Using cell cultures, we were able to isolate 10 viruses, 9 of which were isolated by the RD cell line and this is regarded as the most sensitive cell line. The RT-PCR also identified 16 different viruses, 7 of which were not isolated on the RD line. Thus, RT-PCR could increase viral detection by 10%, indicating a high degree of high sensitivity.

Conclusion: Although the combination of cell culture and RT-PCR for detection and identification of non-polio enteroviruses causing AFP is invaluable, more than 75% of AFP patients were enterovirus negative. Therefore, they must be checked for other agents such as flavivirus (viral) and Campylobacter jejuni (bacterial).

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Background and Aim: Leishmaniasis is a parasitic disease transmitted by sand-flies. Seventeen out of the 30 Iranian provinces are contaminated. Although many therapeutic modalities have been suggested, no definite treatment for this widespread infection is available. Many drugs currently used for cutaneous leishmaniasis have their side effects and create complications-drug resistance, etc. This has prompted researchers to get interested in drugs of a natural origin. The aim of this study was to investigate and compare the efficacies of an extract of propolis and systemic glucantime against cutaneous leishmaniasis in Balb/c mice.

Materials and Methods: Groups of inbred, female Balb/c mice, aged 4-6 weeks, were inoculated with 1.6 × 10 6 viable stationary-phase promastigotes in the base of tail. The mice were provided by Iran Pasteur Institute, Tehran and were randomized into three groups of 9 mice each. Groups 1 to 3 were treated with pure 70% ethanol, systemic glucantime, or the propolis hydroalcoholic extract for a 6-week period the 4th group served as control. The statistical tests including student t-test were used for data analysis.

Results: Overall, 27 mice were studied. We did not observe any statistically significant difference among the groups with regard to the size of the ulcer at the beginning (P>0.01). At the end f the period, there was a significant difference with regard to reduction of ulcer size between the propolis extract and glucantime groups in favor of the propolis extract (P= 0.001). Further analysis of the data showed that the largest reduction in the ulcer size was caused by the propolis extract, as compared with the control, glucantime and alcohol groups.

Conclusion: Our results suggest that the propolis extract is more effective in the treatment of cutaneous leishmaniasis in mice. We suggest that the efficacy of this extract alone or in combination with drugs be assessed against human cutaneous leishmaniasis, using randomized clinical trials.

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Background and Aim: Like other cancers, gastric cancer is due to uncontrolled growth of tissues. Although there are different therapy methods to treat it, such as surgery, radiation therapy, chemotherapy, and multimodality therapy, relapse and death may occur. Reports show that in Iran gastric cancer is the first cause of death among deaths due to cancers. The purpose of this study was to determine the two-year survival rate after relapsing and its associated factors among gastric cancer patients who had undergone surgical treatment in Iran Cancer Institute, one of the most important cancer treatment centers in Iran.

Methods and Materials: A total of 330 patients with gastric cancer who had been admitted to and operated on at the Iran Cancer Institute between January 1996 and April 2000 were enrolled in this study. The patients' life expectancy after relapse was determined. Survival was defined as the elapsed time between the two successive events, relapse and death, neither of which can be determined exactly therefore the data are doubly censored failure time data. Thus, the relationships between life expectancy at relapse and such variables as age, gender, and factors related to the disease, such as the cancer site, pathologic type, stage, and sites of metastases were determined using the Cox proportional hazards model.

Results: The two-year survival rate after relapsing and the median life expectancy after relapsing were 15% and 10.15 months, respectively. Univariate analysis showed that except disease stage, no other variable (age, gender, cancer site, pathologic type and sites of metastases) affected life expectancy after relapsing significantly. The Cox proportional hazards model for doubly censored failure time data showed that age, gender, and pathologic type had the highest influence, in a decreasing order, on the rate of survival after relapsing.

Conclusion: Two-year survival rate after relapsing is very low in gastric cancer patients. One of the most important reasons seems to be delayed consultation and diagnosis. Most patients seek medical advice first with the disease in the late stages, when most have lymph node, liver or even distant metastasis which makes treatment even more complex, and when the risk of relapse and death would be increased. Thus, early diagnosis and therapy for a common stomach illness could help prevent a potential gastric cancer.

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Background and Aim: Cervical cancer is the second most common cancer in women with incidence of more than 500000 cases per year. It is preventable because of its long pre-cancerous period, suitable screening programs and effective treatments. Since the social and cultural barriers alongside the lack of knowledge are deterrents to participation in screening programs, the current study was performed to assess the effect of educational intervention through the Health Belief Model on knowledge and attitude of teachers about pap smear, considering their role in making people aware. Materials and Methods: This was a controlled before-after interventional study conducted on 72 individuals selected through simple sampling, assigned to two groups. Data collection tool was a questionnaire used and compared before training and one month after that. Training methods (intervention) included lectures with questions and answers. Data were analyzed with SPSS, version 11.5. Results: 47.2% of intervention and 45.8% of control group were 40 to 50 years old and majority of them (47.2% and 50% respectively) had undergraduate educational level and 86.1% were married. Respectively, 67.2% and 74.2% have experience of being examined via Pap smear, while the knowledge of women in both groups was moderate about the disease. Study results revealed significant differences in knowledge, attitude and Health Belief Model constructs within intervention group (before and after training) as well as between groups (p<0.05). Conclusion: Using Pap smear test among the participants was lower compared with healthy people aims targeted by 2010. Therefore, necessity of education and knowledge promotions are obvious.

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Background and Aim: Overcoming barriers of living with type-2 diabetes mellitus is a challenge in line with empowering patients for a well-managed life. This study was conducted to determine the effect of an educational intervention based on the BASNEF model on the living barriers among type-2 diabetes patients and factors affecting it.

Materials and Methods: This study, conducted in 2014, was a quasi-experimental intervention including a total of  90 type-2 diabetes patients under coverage of South of Tehran Health Centers, randomly divided, after a pre-test, into 2 groups ─ an experimental and a control (comparison) group. Based on the information obtained through the pre-test, a one-month education was imparted at the experimental group in 6 sessions the control group received no education. The educational contents included, based on the BASNEF model constructs, diabetes as a disease and its cardiovascular complications, healthy nutrition, physical activity, methods of self-monitoring blood glucose control, and ways of communication with the health personnel and physicians.

Results: The findings showed significant differences between the mean scores of constructs of the BASNEF model (beliefs, attitudes, subjective norm, enabling factors) and constructs of barriers of living with diabetes (diagnosis, treatment, self-monitoring, communication with health professionals) in both the experimental and control groups before and after the intervention (p<0.0001).

Conclusion: The findings of this study show the necessity of educating type-2 diabetes patients aiming at reducing barriers to living with the disease. The BASNEF model is one of the applicable theories that can be used to this end.

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Background and Aim: Breast cancer is one of the most prevalent cancers in women and is the second cause of mortality due to cancer in women, with lung cancer being the first.

Materials and Methods: In this study we followed all the cases for 5 years, patients from West-Azerbaijan and East-Azerbaijan Provinces that diagnosed with breast cancer in 2009 and 2010 that attended to health cares. Using multivariate cure cox model for the influence of variables in this study.

Results: In this study 171 cases which suffering from breast cancer had the mean age of 55.9 ± 12.9 and the range of 23 to 89 years, in time of cancer diagnosis. Mean of patients follow-up was 51.7± 23.4 months with range of 11 days to 78 months. Overalls 52 death occurred and patient survival rate of 5 years was estimated 60. 6 percent. Eventually the two variables which are economic status and emergency hospitalization were found the two factors of pre-warning in long term survival of patient suffering from breast cancer.

Conclusion: Due to the findings, it seems using cure model in patients suffering from breast cancer was better than classical survival models.

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Background and Aim: Nowadays, the need for informing children and teens in different ages, about sexual problems, is felt more than ever before. Sexual training and education; such as every other original training, must be done at the right place and time. On the other hand, this training should be based on a systematic program and educational models to achieve the desire results. The aim of this study is to determine the effect of educational intervention on the BAZNEF Model on mother's skill about sexual care of their children, Tehran 2017.
Materials and Methods: This study was a quasi-experimental intervention with control group. Ninety six mothers of children aged 5-6 were selected in Tehran pre-schools. They were randomly divided into two groups; intervention and control. Data were collected by a researcher made questionnaire based on BAZNEF Model whose the validity and reliability were confirmed. After pre-test, according to educational needs, educational content and program were based on BAZNEF Model and that were conducted in the intervention group. Data were analyzed by SPSS23, independent t, Mann-Whitney and Chi- squar statistic tests. 
Results: The mean scores of attitude, subjective norms, behavioral intention and behavior showed no significant difference before the education in both intervention and control group. However, the result showed compelling difference in mean scores of attitude, subjective norms, behavioral intention and behavior after the education (p<0/001).Enabling factors showed no important variation among intervention and control groups before and after the experiment. 
Conclusion: The finding of current study confirmed the educational intervention, based on BAZNEF Model, was effective on mother's attitude, subjective norms, behavioral intention and behavior about sexual care of their children.                           

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Background and Aim: “Active ageing” is the process of optimizing opportunities for health, participation and security of the elderly in order to enhance their quality of life. This study aimed to measure the Active Ageing Index (AAI) in Tehran at the individual level and determine its determinants.    
Materials and Methods: This quantitative cross-sectional study included 590 old people 55 years old and above, selected by randomized cluster sampling and interviewed at their homes in various areas of Tehran. The AAI tool, which includes 4 domains ─ employment, participation, secure/safe life and an empowering environment ─ and 22 indicators was used to measure active ageing. The association between individual characteristics of older people and their AAI scores was determined using the mixed-effect linear regression analysis method, with the STATA software.
Results: The overall AAI score in Tehran was found to be 26.8 out of 100, it being 33.9 and 20.6 for men and women, respectively. Being a women, older, poorer, and living alone or in a large family resulted in significantly lower AAI scores as compared to being a man, younger, richer, living with others, and living in a smaller family.
Conclusion: Iranian older people, particularly women, are experiencing relatively inactive lives. Their AAI scores are particularly low in the third and fourth domains. Considering the high rate of population aging in Iran, providing a safe environment for an active life for the elderly, particularly for the groups found to have a less active life, is a top priority.

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Background and Aim: The pandemic of coronavirus can be considered as one of the most important issues in the world in the last two years. Undoubtedly, reducing the outbreak of coronavirus requires preventive behaviors. The purpose of this study was to investigate the status of preventive behaviors of people and its relationship with demographic and socio-economic variables.
Materials and Methods: A total of 385 residents aged 18 to 65 years in Shiraz City were surveyed using the cluster sampling method and a structured questionnaire. The SPSS.20 software was used to analyse the data.
Results: The findings showed that with increasing age and level of education preventive behaviors increased, while increasing income led to a decrease in such behaviors. Preventive behaviors were more common among women than men, and less common among employed people and housewives than students.
Conclusion: Preventive behaviors in connection the coronavirus are relatively acceptable but far from ideal. Men, young people and people with lower literacy levels should be given more attention in health-related teaching programs.
 

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Background and Aim: Domestic violence against women as a social characteristic can affect women's reproductive behaviors. The present study investigated the relationship between domestic violence against women and their childbearing intention.
Materials and Methods: This study was a survey conducted using a questionnaire in 2022. The statistical population was married women aged 15-49 years living in Sadra city, Iran, out of whom a sample of 379 was selected by the multi-stage cluster technic. Domestic violence against women was measured using a form with 26 items with a Likert scale, the domestic violence score being obtained by the sum of scores of the items. The SPSS software version 20 was used to analyze the data, the statistical tests being descriptive statistics and two-dimensional logistic regression.
Results: The most common types of domestic violence against women were found to be, in descending order, psychological, physical, economic and sexual violence. The duration of marriage and education of women had a statistically significant effect on their childbearing intention. Increasing domestic violence against women was found to reduce their childbearing intention.
Conclusion: Reducing domestic violence can increase the women’s intention to have children. Therefore, reducing domestic violence against women should be on the policy agenda of the relevant decision makers.
 

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Background and Aim: During the COVID-19 pandemic public health measures and protocols such as regular hand washing and wearing a face mask were recommended at the national level. The implementation of these health protocols reduced the prevalence of respiratory diseases, but no study has been conducted to investigate the impact of the implementation of these protocols on the spread of viruses that are transmitted through fecal-oral route. Considering that non-polio enteroviruses (NPEVs) are mainly transmitted through fecal-oral route, this study was conducted to determine the prevalence of non-polio enteroviruses in patients with acute flaccid paralysis (AFP) in Iran before and during the COVID-19 pandemic.
Materials and Methods: To detect non-polio enteroviruses stool samples of AFP cases received by Iran National Polio Laboratory in 2019 (before the COVID-19 pandemic) and 2021 (during the COVID-19 pandemic) were tested. To isolate NPEVs by cell culture, the WHO standard protocol was used, and the TaqMan One-Step Real Time PCR was used for molecular testing.
Results: In 2019, a sample of 21 out of 1070 patients and a sample of 12 out of 100 patients were found to be positive for non-polio enterovirus by cell culture and the molecular method, respectively; these ratios decreased to10 out of 678 and 3 out of 100 in 2021.
Conclusion: Based on the findings of this study, it can be concluded that the observance of personal hygiene and public health protocols during the COVID-19 epidemic  have, in addition to the general reduction of respiratory transmission of viruses, also affected the faecal-oral transmission of viruses.
 

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Background and Aim: Healthy eating habits are undeniably one of the most crucial determinants of people's health in today's world. Undoubtedly food literacy and its components are key variables influencing food habits. This study aimed to investigate the relationship between food knowledge, food skills, resilience and healthy eating habits in the adult population of Shiraz City, Iran.
Materials and Method: A sample of 384 adults in Shiraz City was selected by cluster sampling and completed a questionnaire in 2023. Food literacy included 3 components, namely, knowledge, skill and resilience, determined using a standard 14-item questionnaire. The scale used to measure healthy eating habits included 6 items. Data analysis was conducted using SPSS version 27 software.
Results: The majority of the sample demonstrated average levels of food knowledge, food skills, resilience and healthy eating habits. Multivariate analysis revealed a significant positive correlation between age and healthy eating habits, while individuals with university education exhibited significantly healthier eating habits compared to illiterate individuals. Furthermore, it was found that food knowledge and resilience had the most significant effect on healthy eating habits, respectively.
Conclusion: The purpose of this research was to investigate the relationship between the components of food literacy and healthy eating habits in the adult population of Shiraz City, Iran. Food knowledge and resilience had significant effects on healthy eating habits. In general, it can be concluded that the implementation of targeted training courses with a special emphasis on improving food knowledge and skills should be prioritized by relevant authorities. Promoting food literacy has the potential to promote healthy eating habits and ultimately elevate the overall level of community health.