Journal of School of Public Health and

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  Background and aim: In Iran, HIV prevalence in sex workers is reaching to an epidemic, but still consistent use of condoms is low. This qualitative study aimed to assess barriers to condom use in female sex workers (FSWs).

  Materials and Methods: We conducted individual in-depth interviews with 40 FSWs and 12 partners in the year 2010 in Tehran. The FSWs were purposefully selected from four different groups based on the level of socioeconomic status and history of using substance. Findings were extracted and coded manually and the responses of the groups were categorized and compared.

  Results: Almost all FSWs had not used condoms regularly in the past six months. The main barriers of condom use were: lack of awareness of the modes of transmission of HIV and prognosis of the disease, doubt on the role of condoms in preventing sexually transmitted diseases and HIV, fear of violence or rejection by male customers, reluctance of sexual partners to use condoms due to diminution of sexual pleasure, and believing in health of some customers.

  Conclusions: Increasing awareness of the FSWs through education about HIV, ways to prevent the disease and empowering them on negotiating skills to use condoms as part of harm reduction programs are recommended .

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  Background and Aim: The aim of this study was to assess exposure of workers in a metal industry to nickel and lead.

  Materials and Methods: Extraction was done using the solid-phase extraction on Chromosorb-102 resin to prepare, concentrate and purify biological samples of urine, hair and nails of workers working in metal industries. The variables influencing response (pH, loading flow rate, elution solvent, and amount of resins, elution volume, and sample volume) were examined and the procedure was optimized. The optimized procedure was, then, validated based on the “within-day” and “day-to-day” reproducibility experiments, using low, medium and high concentrations, leading to a satisfactory accuracy and precision. Finally, lead and nickel samples were taken from the workers and their concentrations determined voltammetrically.

  Results: The optimum values for the examined parameters were as follows: pH = 9, ligand concentration = 0.05%, loading flow rate = 5 ml/min, elution solvent = 2M HNO₃, amount of resins = 500 mg, elution volume = 15 ml, and sample volume up to 500 ml. A good reproducibility and repeatability was obtained for the optimized method under the existing conditions. Lead and nickel could be extracted with recoveries in the range of 94-100%. On the whole, the concentrations of nickel and lead in the workers’ biological samples were above the respective maximum permitted levels.

  Conclusion: Solid-phase extraction procedure is a fast and simple method for preconcentrating and isolating analytes from biological samples. Considering the low concentrations of the analytes and presence of confounding factors in such samples, the procedure can be very effective for their preparation. The application of the developed method indicates that trace metal ions can be effectively purified and preconcentrated from different matrices like urine, hair and nail samples to assess occupational exposures.

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Background and Aim: A New Health Reform Plan consisting of seven programs was initiated in Iran in mid-May 2015 aiming to reduce the out-of-pocket payments, improve the public’s health, and promote the public health indicators. This study was conducted to determine the effect of the Plan on the performance indicators of Hamedan university hospitals.

Materials and Methods: In this longitudinal descriptive-analytical study, based on the interrupted time series design, data related to hospital performance indicators were collected from all (15) Hamedan University hospitals for a period of 15 months (7 months before, and 7 months after, the implementation of the Plan, with a one-month interval in between). The SPSS software was used for data analysis.

Results: The data indicated changes in all the performance indicators after the implementation of the Plan. The largest changes were in the number of emergency and selective surgeries and the smallest in the ratio of active to total beds. Further analysis of the data showed that, as compared to the same months in the previous year, only a small number of these changes (number of emergency surgical operations and the ratio of active to total beds) were statistically significant.

Conclusion: Based on the findings it can be concluded that changes have occurred in all the selected indicators as a result of implementation of the New Reform Plan, indicating that the Plan has affected favorably performance of the hospitals. However, the effects observed should be judged cautiously, considering the possible negative consequences such as induced demand and hospital workload increase in the long run.

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Background and Aim: Human resources in any organization are its main capital. They are the only unique asset that are not liable to depreciation over time, but they even create more added value. The Social Security Organization (SCO) as a social insurer organization needs urgent assessment of its human resource management. In this regard, it appears that such an essential assessment can be done using the European Foundation for Quality Management (EFQM) model.

Materials and Methods: This project was an applied descriptive study conducted at the Social Security General Department in Tehran, Iran. The data collection tool was a standard questionnaire for performance assessment based on the EFQM model, the reliability of which (0.989) was determined by using the Cronbach's alpha coefficient. A total of 388 questionnaires were distributed, of which 311 were completed and returned to the researcher; the response rate was 81%. Analysis of the data was done using the SPSS-16 software.

Results: The human resource managers in the SCO achieved a score of 495.72. The empowerment and results dimensions rated 261.34 and 198.38, respectively. In the empowerment dimension, policy and strategy criteria had the highest score (56.12) and process the lowest (51.28), while in the results dimension, community criteria had the highest (50.27) and the customers criteria the lowest (51.18) score.

Conclusion: Based on the findings it can be concluded that the European Foundation for Quality Management (EFQM) model is suitable for assessing both the performance, strengths and weaknesses of the Tehran Security General Department human resources and improving its performance. Certainly better implementation of programs and achieving excellence will be possible through sustainable collaboration.

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Background and Aim: Sexuality education is one of the most important educational needs of adolescents, and mothers can have a key role in sex education of their daughters. This study aimed at developing, implementing and evaluating a skill-based training program for mothers for sexuality education of adolescent girls in Mahshahr, Iran.
Materials and Methods: This was a field trial conducted on 140 mothers having 12- to18-year-old girls between September and March 2012. Data were collected using two reliable questionnaires developed by the investigators ─ a "Parent-Child Relationship: Mother" questionnaire for assessing the mothers’ communication skills completed by the adolescent girls, and a "Knowledge and attitude about sexuality education of adolescents" questionnaire for assessing the mothers’ knowledge and attitude about sex matters and communication, skills completed by the mothers themselves. Based on the results, an educational intervention for mothers was designed consisting of three training sessions and implemented. The mothers’ knowledge, attitude and communication scores after a period of three months were compared with the respective baseline scores.  
Results: Three months after the intervention, the mean scores of mothers’ knowledge and attitude about sexuality matters increased significantly (in both cases p <0.01). However, there was no statistically significant difference between the initial and final scores of mothers’ communication skills (p = 0.37).
Conclusion: Based on the findings it can be concluded that the designed educational program was effective in improving the knowledge and attitudes of the mother about sexuality matters although it did not affect their communication skills. Promoting communication skills of mothers as an important factor for sexuality education of their daughters requires regular, continuous educational sessions, as well as practice and experiences.
 

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Background and Aim: Hospital accreditation is a systematic external evaluation of a hospital’s structures, processes and results (outputs/ outcome) by an independent professional accreditation body using pre-established optimum standards. This study aimed to examine the relationship between accreditation and hospital performance. In addition, the most important accreditation constructs affecting hospital performance were identified and ranked.
Materials and Methods: This descriptive, correlational and cross-sectional study was conducted using the data related to accreditation scores and nine performance indicators of 121 hospitals in 2014 and 123 hospitals in 2015 in Tehran province, Iran. Shannon entropy method was used for calculating the weights of the hospital indicators. Then, Feature Selection method in data mining was used to explore the relationship between accreditation scores and hospital indicators. Data were analyzed using IBM SPSS Modeler software. Analyses were carried out at the 0.05 significance level
Results: The mean of hospitals’ accreditation scores were 61.98% and 69.56% in 2014 and 2015 respectively. All performance indicators except the number of outpatients were increased in 2015 compared to 2014. There was no significant difference in the scores between 2014 and 2015 data. Hospitals’ accreditation scores were not associated with their performances. However, accreditation scores of leadership and management; accident and emergency; and procurement departments had the most effect on hospitals’ performance.
Conclusion: Accreditation was not correlated with hospital performance. Thus, improving accreditation system including standards, methods and surveyors and using quality management strategies in hospitals are necessary for improving hospital’ performance.
 

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Background and Aim: The Internet is a strong and multimedia technology that meets the most basic needs of human beings; however, this new technology can have great negative effects on people's lives. This study aimed to determine the prevalence of Internet addiction and its relationship with quality of sleep and quality of life among students of Zahedan University of Medical Sciences.          
Materials and Methods: This descriptive-analytical cross-sectional study was conducted in Zahedan in 2017.The study population included all the students of Zahedan University of Medical Sciences. A sample of 340 students were selected through stratified random sampling. Data were collected using three World Health Organization questionnaires, namely, quality of sleep, Internet addiction and quality of life questionnaires, and analyzed using SPSS (v22), the statistical tests being ANOVA and linear regression test and T-test.
Results:  Data analysis showed that Internet addiction and the quality of life among the students were mild (43 ± 15) and desirable (78.4± 1.6), respectively. However, the sleep Quality Index for 282 students (82.9%) was not desirable. There were statistically significant associations (p<0.05) between the place of residence on the one hand and Internet addiction, quality of sleep and quality of life on the other.
Conclusion: Based on the findings it can be concluded that Internet addiction has a negative effect on the quality of sleep and quality of life of the students. The students need to pay more attention to the use of the Internet. It is also recommended that behavioral and cognitive intervention be designed and implemented aiming at teaching the students proper use of the computer and the Internet.

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Background and Aim: The aim of the present study was to investigate the relationship of hope and life satisfaction with students bullying and bullying victimization with the mediating role of school connectedness.                                    
Materials and Methods: This was a cross-sectional study, the statistical population being high school students of Tehran city in the school year 2015-16. A sample of 300 students was selected using the stratified random sampling method. The data collection tools were the Snyder’s hope scale, Diener et al. life satisfaction scale, Waters and Cross School Connectedness scale and the Espelage and Holt Bullying scale. The hypothetical model was analyzed using path analysis with the LISREL8.57 software.  
Results: Analysis of the data showed the following: 1. Hope and life satisfaction had a structural positive direct effect on school connectedness; 2. Life satisfaction had a direct negative effect on bullying; 3. Bullying had a direct effect on bullying victimization; 4. School connectedness had no direct effect on students bullying and bullying victimization. 5. Life satisfaction had an indirect effect on bullying victimization through bullying; 6. Finally, the indirect effects of hope and life satisfaction on bullying and bullying victimization through school connectedness were not confirmed.
Conclusion: In can be concluded that life satisfaction is a facilitating factor for the school connectedness, serving as a protective factor against bullying. Hope and school connectedness may act as protecting factors in the prevention of bullying.

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Background and Aim: In recent years bullying behaviors among school adolescent have risen and have raised concerns for psychologists, teachers and their families around the world. The use of bullying control methods in schools is important. Therefore, the purpose of this study was to evaluate the effectiveness of bullying control training program on health promotion behaviors in bullying adolescents in Tehran.
Materials and Methods: The statistical population consisted of students aged 12 to 17 years old in public schools in Tehran. A total of 40 subjects (20 controls and 20 experimental groups) were randomly assigned into two groups of experimental and control groups. Using a pilot, pre-test, post-test and one month follow up with the control group, Hartler's bullying questionnaire and health promotion behaviors were implemented on both groups. Then, experimental testing of bullying control training was performed in 8 sessions on the experimental group and after the completion of the sessions the post-test was presented to both groups. After that, a month's follow-up was carried out. For data analysis, multivariate analysis of repeated measurements was performed using SPSSV22 software.
Results: The results showed that the cognitive-behavioral bullying control training program on health promotion behaviors between the two groups was significantly different in three stages (p<0.05).
Conclusion: According to the results of this study, bullying control education can be effective on health promotion behaviors of adolescents aged 12 to 17 years and can be used to improve their health. Parents, teachers, managers and other professionals can learn from these trainings.

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Safe food and proper nutrition play a vital role in the health of populations. Food-borne diseases are a serious public health problem. Food handlers working in the kitchen play an important role in the transmission of foodborne diseases. Food-borne diseases, especially those caused by bacteria, viruses, parasites and fungi, are preventable. Proper manpower training is a key factor in provision of safe food and prevention of malnutrition.
Materials and Methods: A descriptive, cross-sectional and applied study was conducted in 10 hospitals affiliated with Tehran University of Medical Sciences in 2017. The knowledge, attitude and practice of 136 food handlers working in the kitchens of the hospitals was assessed using questionnaires.
Results: Analysis of the data showed that 8.08% of the participants had a good knowledge about food hygiene and safety (a score above 75%), while 16.7% of them achieved the full score as regards attitude. The hospitals’ performance was at a desirable level. The level of food hygiene and safety knowledge of the food handlers was significantly associated with their refresher trainings (p <0.05).
Conclusion: It can be concluded that the awareness of food handlers in most of the hospitals about food hygiene and safety is not sufficiently high. It is suggested to design and implement proper refresher training crash courses, as well as sensitize the personnel.

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Background and Aims: Nocardia asteroides complex is the most common cause of infectious diseases due to nocardiosis. Interspecies differentiation of Nocardia genera is essential for prognosis and timely proper treatment, as well as for epidemiological studies. Since each genus has its own antibiotic resistance, precise careful diagnosis is of prime importance. As compared to biochemical and phenotypic methods, the efficacy of molecular methods for fast and accurate identification of Nocardia species has been proven. The aim of this study was to detect for the first time Nocardia asteroides complex in clinical isolates using real time polymerase chain reaction (Real-Time PCR).
Materials and Methods: Out of the 25 clinical isolates suspected to be Nocardia asteroides genus 10 were identified as Nocardia asteroids complex by biochemical and phenotypic methods, followed by genomic DNA extraction of the suspicious isolates. Nocardia asteroides complex positive controls were prepared using standard strains. Real-time PCR was conducted on all the 10 suspicious isolates. The final real-time PCR samples were sent for sequencing to verify the identified species.
Results: Based on sequencing results 3 of 10 clinical isolates suspected to be identified as Nocardia asteroides complex were confirmed as belonging to the Nocardia asteroids complex genera ─ Nocardia asteroids, Nocardia farcinica, and Nocardia nova.
Conclusion: This study shows that, as compared to biochemical and phenotypic methods, real-time polymerase chain reaction is faster and more specific, and is considered as an efficient method, for Nocardia interspecies identification and differentiation.

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Background and Aim: Good governance results in better health outcomes for the society thorugh improving health system performance. The governance of Iran health stsyem faces some challenges. Hence, this study aimed to propose and verify a model for strengthening Iranian health system governance.
Materials and Methods: This descriptive study was conducted in 2016 using the Delphi method. A health governance model with six dimentions including sturucture, communication, regulation, policy making and planning, stewardship and evaluation and accreditation has been proposed. Then, the proposed model verified using 25 Iranian healthcare experts’ opinions in two rounds.
Results: Developing an integrated health system model comprising health system enablers and results, downsizing and reducing the number of directorates in ministry of health,determining basic principles for regulation, enhancing communication with other external organizations affecting people health, using more evidence in policy making and planning, developing a strategic plan and national health policy, enhancing leadership, management and stewardship; and developing comprehensive systemic standards for evaluation and accreditation of healthcare organizations are recommended to enhance the effectiveness and efficiency of Iran health system governance.
Conclusion: Iran health system governance faces numerous challenges. Using successful countries’ experience and internal health care experts’ opinions help to reduce the current challenges and achieve health system goals.
 

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Background and Aim: The family relationships of parents suffering from cancer change following the onset of physical problems, the experience of depression and the lack of emotional access. This study aimed to compare the negative orientation of adolescent girls with mothers with and without breast cancer toward the problem, hopelessness and perceived stress.
Materials and Methods: This was a cross-sectional study. The statistical population was all the adolescent girls 13-18 years old referring to the oncology ward of Golestan Teaching Hospital in Ahvaz, Iran during a 6-month period accompanying their mothers suffering from breast cancer. The girls for the group with mothers with cancer (n=57, mean age 16.31 ±4.65 years) and the group with mothers without cancer (n=57, mean age 16.02  ±3.27 years) were selected using convenient and multistage sampling, respectively. Both groups completed the Robichuad and Dogus negative orientation to problem questionnaire, Beck Hopelessness Scale and Chohen Pecieved Stress Scale.  Data were analyzed using the one-way and multivariate analysis of variance (with a p<0.05 to show statistical significance) with the software SPSS-22.
Results: There were significant differences between the two groups as regards the variables of negative orientation toward the problem and hopelessness (F= 4.21; p<0.05), while no significant difference was found between them as regards perceived stress (F= 0.015 P= 0.90).
Conclusion: The children of cancer patients have psychological problems and, therefore, need guidance and support. Improvements in the psychological conditions of children will improve their relationship with their mothers, who will then feel more relieved.

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Background and Aim: Insects associated with dead bodies are very diverse and very important in decomposition and recycling of the carcasses.  The present study was conducted in the Margoon region of Kohgiluyeh and Boyer Ahmad province (Iran) to determine the species diversity of carrion insects associated with decomposing remains of different animals.
Materials and Methods: Different cadavers of domestic goat, rat and chicken were collected and carrion insects were sampled from them in different seasons during one year.
Results: In total, 21 species of carrion insects including 13 necrophages, 3 predators, 3 omnivores and 2 casual species were collected and identified.
Conclusion: Based on the data, the order Coleoptera (beetles) was the most diverse group as regards species among the orders collected, and the highest diversity was observed during spring. Two species, namely, Thanatophilus rugosus and Saprinus maculatus were reported to be new in the south west of Iran. Furthermore, our results show that the species diversity of carrion insects in the region studied was rather high.

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Background and Aim: The aim of this study was to investigate the effectiveness of emotional working memory education on the ability to control emotions and cognitive emotion regulation in women hurt by infidelity.
Materials and Methods: This was a pre-test, post-test and follow-up single-blind intervention study. From among the women hurt by infidelity referring to the Social Emergency Department of Sabzevar City, Iran between September and January 2021, a sample of 42 were randomly selected and assigned to either an experimental (n = 21) or a control group (n = 21). They completed 2 questionnaires, namely, an Inhibition of Emotions Questionnaire (27) and a Cognitive Emotion Regulation Questionnaire (29), initially and after the intervention. The education was carried out in 20 sessions using emotional working memory education software (32). The data were analyzed using the repeated measures multivariate analysis of variance.

• : Analysis of the data showed that emotional working memory education can affect the ability to control emotions and regulate cognitive emotion in women hurt by infidelity.
• : A complementary treatment strategy for controlling emotions and cognitive emotion regulation in women hurt by infidelity is emotional work-based education. Practical implications of the findings of this study were discussed.

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Background and Aim: Cardiovascular diseases (CVD) are the leading cause of death globally, causing annually 17.3 million deaths, more than 75% of these deaths occurring in the low- and middle-income countries. Although extensive studies have been conducted to determine the risk factors for these diseases, limited studies have been performed to investigate these factors using a multilevel analysis method. The aim of this study was to determine the CVD risk factors in the staff of Mashhad University of Medical Sciences using a multilevel analysis approach, as well as compare the application of the conventional and multilevel logistic regressions in doing this according to the hierarchical structure of the data.
Materials and Methods: This was a case-control study including a total of 1091 randomly selected individuals from among the people in a prospective cohort study, namely, the “PERSIAN Cohort Study in Mashhad University of Medical Sciences” in 2018.  The case group included 152 patients with a definite diagnosis of CVD and the control group 939 staff members not suffering at the time from CVD. Data analysis was done using the STATA software. Data analysis (based on frequencies and percentages) was done using one-way and two-level logistic regression analysis at α = 0.05.
Results: Multivariate analysis showed that hypertension, smoking, fasting blood sugar and cholesterol were among the cardiovascular risk factors with a significant relationship with the disease. Based on the two-tier logistic regression model, the odds ratio for CVD in the hypertensive patients was 3.93 times that in individuals with a normal blood pressure with a confidence interval of 2.64-6.28. The risk in smokers was 1.85 (1.11-3.09) times that in nonsmokers. The CVD odds ratio in individuals with a high fasting blood glucose level (undiagnosed/uncontrolled diabetes) was 2.7 (1.18-6.18) times that in those with a normal blood pressure. There were no statistically differences between the case and control groups as regards the other variables ─ body mass index, diabetes (controlled or uncontrolled), or blood triglyceride level.
Conclusion: The findings show that statistical model selection can influence the results of data analysis in a dataset. It should be noted that the results of this study indicate a high prevalence of some cardiovascular risk factors among the staff. Another crucial point in this study is that the level of physical activity of the staff was found to be low, which would result in increased risk of overweight and obesity.
 

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Background and Aim: Food preferences and health literacy ─ key determinants of food choices in childhood and adolescence ─ are determinants of chronic diseases in adulthood. This study aimed to determine associations between food preferences, health literacy and body mass index (BMI) among elementary school students in Malekan city, east Azarbayejan Province, Iran in 2021-2022.
Materials and Methods: This cross-sectional descriptive-analytical study included 582 male and female primary-schoolers in the fourth, fifth and sixth grades in both the public and private  schools in Malekan County (Malekan, Lilan, and Mubarakshahr) selected by the two-stage randomized cluster method. A questionnaire including background questions and questions about health literacy and a researcher-made checklist of food preferences was used to collect data online using the Pros-Online Platform. The content validity ratio and index were used to determine validity and Cronbach's alpha index to check for the reliability of the questionnaire (CVI=0.98, CVR=0.91, Cronbach's alpha > 0.7). Data were analyzed using Mann-Whitney, t-test, one-way analysis of variance, Kruskal-Wallis and Chi-square tests at a significance level of 0.05 using SPSS 26.
Results: The average health literacy score of all the students was rather low (52.9±00.33), that of the female students (55.7±36.49) being slightly higher than that of the boys (49. 9±29.79). Further analysis of the data showed that there was a statistically significant relationship between the students' food preferences and health literacy variables (p<0.001). Furthermore, statistically significant relationships were observed between the students' BMI and their food preferences (p˂0.001) and health literacy (p˂0.001).
Conclusion: Considering the low level of health literacy of the adolescents and a positive relationship between health literacy, food preferences and BMI in adolescents, it can be concluded that increasing their health literacy will improve their healthy food choices. Therefore, it seems that interventions based on a theoretical framework aiming at increasing the students’ health literacy and improving their food preferences can be beneficial to them as a potential strategy for improving their healthy eating patterns resulting in preventing overweight and obesity.                
 

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Background and Aim: Considering the quality of prenatal care services, indentification of the avoidable and inevitable maternal factors and proper promotion of the knowledge and skills of health care service providers is vital for providing suitable preventive and interventional services with the aim of ensuring a successful pregnancy and proper management in the health care system.  This study was conducted to compare the adverse pregnancy outcomes among women with or without a history of Covid-19 in the pregnancy and postpartum stages covered by the Babol University of Medical Sciences, Babol, Iran.
Materials and Methods: This was a descriptive-analytical cross-sectional study including 4124 women, either pregnant or after a recent childbirth (with or without Covid-19) between 20.2.2020  and  29.3.2022, registered in the Sib electronic system (hereinafter Sib) of Babol University of Medical Sciences, Babol, Iran. Using a checklist developed and validated by an expert panel data were collected on the prevalence of maternal and neonatal outcomes in mothers with or without a history of Covid-19 and compared. The data collected were analyzed with SPSS 24 using descriptive tests such as chi-square and Fisher's exact test and STATA version 22, and the adverse outcomes with high frequencies following Covid-19 were determined.
Results: Analysis of the data showed the following to be the most common outcomes among mothers with a history of Covid-19: 1. obstetric complications and maternal disorders/diseases (hypertension, type-2 diabetes mellitus, at least one case of bleeding during pregnancy, premature/delayed birth and premature rupture of the amniotic sac, n= 457, 27.8%); 2. medical and surgical problems (unhealthy pregnancy weight gain and thromboembolic events, n=206, 12.5%). In addition, there was a statistically significant difference between the two groups of pregnant mothers with and without a Covid-19 infection as regards medical and surgical problems (P=0.001) and obstetric complications and maternal diseases (p=0.002). As regards the adverse neonatal outcomes in pregnant mothers with and without a history of Covid-19, there was a statistically significant difference between the two groups in terms of Apgar score at minutes 1 and 5 (p≥0.001) and exclusive breastfeeding (P=0.001) and the presence of Covid-19 symptoms in the baby (p<0.001).
Conclusion: Based on the findings of this study it seems that Covid-19 infection during pregnancy is associated with a higher risk of some of the undesirable maternal and neonatal outcomes.  Therefore, it is essential to plan and implement programs for health education, creation of a sound attitude towards better management, enhancement of the skills and capabilities of the health-care providers and, finally, promotion of the knowledge of service recipients. 
 

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Background and Aim: Despite all the current diabetes prevention programs, only a limited number of patients are identified and receive care.
Materials and Methods: This was a cross-sectional descriptive-analytical study including individuals over 30 years old in Buin Zahra city, Iran selected using the multi-stage sampling method (sample size = 1154). Data were collected using a questionnaire for the general public and the health team, the validity and reliability of which had been determined based on the CVR and CVI indexes and the correlation coefficient, respectively.
Results: The average age of the sample and the prevalence of diabetes were 48.42 ± 14.45 years and 9.9%, respectively. Further analysis of the data showed the following:
1. the prevalence of diabetes in at-risk people: women with a history of abortion and large children, 12.8% and 31.7%, respectively; gestational diabetes 36.5%;
2. obesity during pregnancy: 19.7%; a family history of diabetes: 22.4%;
3. waist circumference>90 cm: 14.08%, BMI>25: 13.95%; and
4. triglyceride<200: 22%, hypertension: 32.97%.
Further analysis of the data showed statistically significant associations between diabetes and blood sugar level above 100 mg/dl (OR = 2.73), waist circumference >90 cm (OR = 3.02) and gestational diabetes (OR =12.22); no other significant associations were found.
Only 55% of the health team personnel had received diabetes prevention training.
Conclusion: It can be concluded that patient care and education are not of a proper quality. The considerable prevalence of diabetes among people at risk shows that more follow-up and care are needed for them. The training of health team personnel should be very efficient and the number of trainings related to the diabetes program should increase.
 

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Background and Aim: Vaccination, as one of the most cost-effective medical interventions, has significantly reduced the incidence of many infectious diseases. This study aimed to examine the moderating effect of mandatory vaccination policies on the relationship between corona anxiety and vaccine hesitancy among the employees of medical universities.
Materials and Methods: A descriptive-correlational study was conducted using convenience sampling on a sample of 152 employees selected from a medical university in North Khorasan Province, Iran. Data were collected using a researcher-made questionnaire on mandatory vaccination policies and vaccine hesitancy and Corona anxiety questionnaires. Pearson correlation coefficient and hierarchical regression were employed to test the research hypotheses, and data analysis was performed using the SPSS and AMOS software.
Results: The findings showed that 77% of the employees supported mandatory vaccination policies in the workplace. In addition, the correlation coefficients between Corona anxiety and mandatory vaccination policies with vaccine hesitancy were significant (p<0.001). Furthermore, the interaction of Corona anxiety and mandatory vaccination policies accounted for an additional 2% unique variance in the model (R²Δ=0.02, FΔ=4.02, p=0.05).
Conclusion: Based on the findings of this study it can be said that mandatory vaccination policies can moderate the relationship between Corona anxiety and vaccine hesitancy among employees of medical universities. It is, thus, recommended to use appropriate and cost-effective policies and executive guarantees to improve vaccination attitudes in employees with anxiety.