Journal of School of Public Health and

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Background and Aim: One of the dimensions of health is mental health that could be affected by the quality of occupational life. The purpose of this study was to determine the effect of job satisfaction on teachers' mental health with due consideration of the moderating role of gender and the subjects taught.
Materials and Methods: This was a quantitative survey using a questionnaire including a sample of 373 teachers, selected by multistage random sampling, from among all (n = 1500) the secondary school first- and second-grade teachers in Najafabad city, Isfahan Province, Iran. Data analysis was done using the software AMOS and SPSS.
Results: The confirmatory factor analysis of the items showed that these items could explain 63.25% of the variance of the mental health construct. In addition, the standard effect of job satisfaction on mental health was found to be 0.37 (p <0.001), explaining 13% of the mental health construct variance. Further analysis of the data showed that the teachers’ mean mental health construct (66.64) and their mean of job satisfaction (73.90) were lower and higher than the means of the respective spectra (p <0.001), respectively.
Conclusion: Job satisfaction, which has been proven to affect the teachers’ mental health, can improve their personal and social life and make them more efficient in education. In this regard, gender and the type of subject taught can have moderating effects on the relationship between job satisfaction and mental health of the teachers. Based on the beta-values (0.55 for the women group and 0.68 for the experimental science teachers group), the gender female and teaching experimental science can have a stronger effect on the teachers’ mental health than gender male and teaching subjects other than experimental science.

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Background and Aim: High concentrations of particulate matter-25 (PM_2.5) have been the cause of the unhealthiest days in Tehran, Iran in recent years. This study was conducted with the aim of the spatio-temporal analysis of traffic volume and its relationship with PM_2.5 pollutant concentrations in Tehran metropolis, Tehran during 2015-2018, using the Geographic Information System (GIS).
Materials and Methods: In this study in different regions of Tehran, the Inverse Distance Weighting (IDW) model was used for prediction and zoning of the PM_2.5 concentrations and traffic volume during the period 2015-2018. In addition, the association between the PM_2.5 concentrations and traffic volume was determined based on the Geographically Weighted Regression (GWR) model.
Results: The findings showed that the southern and southwestern regions of Tehran had the highest PM_2.5 pollutant concentration (annual average more than 40 μg/m³), while the eastern and northern regions had the highest traffic volume. In addition, based on the GWR model, the eastern regions were found to have the highest local R² values (between 0.36 and 0.70).
Conclusion: In most regions of Tehran, no strong association can be found between high concentrations of PM_2.5 and traffic volume. However, based on the findings of this study we cannot reject the relationship between traffic volume and PM_2.5 pollutant but postulate other sources to be the main reason for the high concentrations of PM_2.5. Thus, in the first step, these sources should be identified, followed by adopting strategies for traffic volume control and reduction aiming at having a cleaner air in Tehran.

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Background and Aim: This study was performed to investigate the effect of mental wellbeing on flow at work with the mediator variable of perceived organizational support in Payam Noor University in Khuzestan Province, Iran.
Matrials and Methods: This was an applied research project. The research population was the personnel of Payam Noor University in Khuzestan Province, Iran. The sample size was, based on the Cochran formula, 228 subjects selected by stratified random sampling. Data were collected using a standard questionnaire (on a 5-point Likert scale), the validity of which was determined based on experts’ confirmation and confirmatory factorial analysis and the reliability by Cronbach alpha (in both cases over 0.7). Data analysis was done using the SPSS-21 and Amos software.
Results: The effects of mental wellbeing on flow at work and perceived organizational support were found to be 0.76, 0.48, respectively, the effect of perceived organizational support on flow at work being 0.23.
Conclusion: Based on the findings, it is concluded that mental wellbeing has a significant positive impact on flow at work and perceived organizational support. In addition, the mediating effect of perceived organizational support is confirmed.

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Background and Aim:  The health financing system is the process of collecting, pooling and managing financial resources to purchase health services. Sustainable financing of the Iranian health system is crucial for achieving universal health coverage. The purpose of this study was to identify strategies for sustainable financing of the Iranian health system.
Materials and Methods:  This study was conducted using the scoping review in 2020. The following databases and search engines were searched systematically between 21.03.2002 and 21.09.2020 to find studies related to sustainable financing strategies for the Iranian health system: PubMed, Web of Science, Scopus and Embase, Magiran, Iranmedex and SID databases, and two search engines; i.e., "Google" and "Google scholar”. Finally, 47 studies were selected and analyzed using the MAXQDA software and the framework analysis method.
Results: A total of 40 strategies were identified for strengthening the sustainability of Iran's health financing system, which were grouped into three categories: collecting funds, pooling funds and purchasing health services. The most frequently cited strategies for sustainable financing of the Iranian health system were the following: increasing the health share of gross domestics product, expanding tax revenues, pre-payment methods of health financing, strengthening public-private partnership, increasing the efficiency of the health system, reducing health system costs, consolidating insurance funds, eliminating insurance overlaps, value-based health service tariffs, optimizing health services support packages, and fixed payment methods based on  the performance of the health service providers.
Conclusion: The Iran's health financing system must be strengthened in such a way as to make it possible to collect, pool and manage sufficient financial resources to be used to purchase health services for the people to ultimately ensure universal health coverage leading to the promotion of the public’s health.

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Background and Aim: Fertility declining to a level too low for replacement and preventing its negative consequences have led to changes in the country's population policies. Understanding the causes of declining fertility and proper policymaking to increase it requires prompt action on the part of researchers and policymakers in different social and health fields. The purpose of this study was to investigate the effect of different components of perceived social support  ̶  instrumental support, material support and emotional support  ̶  on women's fertility intention. 
Materials and Methods: This was a survey conducted in the suburban areas of Bushehr Province, Iran. Using multi-stage cluster sampling a total of 600 eligible women aged 18-44 years old were selected. The questions used to measure fertility intention and social support dimensions of the women were extracted from the standard questionnaire used in international research.
Results: The data showed thaBackground and Aim: Fertility declining to a level too low for replacement and preventing its negative consequences have led to changes in the country's population policies. Understanding the causes of declining fertility and proper policymaking to increase it requires prompt action on the part of researchers and policymakers in different social and health fields. The purpose of this study was to investigate the effect of different components of perceived social support  ̶  instrumental support, material support and emotional support  ̶  on women's fertility intention. 
Materials and Methods: This was a survey conducted in the suburban areas of Bushehr Province, Iran. Using multi-stage cluster sampling a total of 600 eligible women aged 18-44 years old were selected. The questions used to measure fertility intention and social support dimensions of the women were extracted from the standard questionnaire used in international research.
Results: The data showed that about 89% of those women who had had one child declared their intention to have a second child, while only 38% of those with 2 children had the intention to have a third child. Multivariate analysis using logistic regression indicated that increased instrumental support will, through controlling the number of currently living children, their education and employment status, increase the likelihood of women's fertility intentions to 1.445.
Conclusion: The instrumental support and the relevant support that can be obtained from social network members can facilitate the transition to higher fertility sequences.
t about 89% of those women who had had one child declared their intention to have a second child, while only 38% of those with 2 children had the intention to have a third child. Multivariate analysis using logistic regression indicated that increased instrumental support will, through controlling the number of currently living children, their education and employment status, increase the likelihood of women's fertility intentions to 1.445.
Conclusion: The instrumental support and the relevant support that can be obtained from social network members can facilitate the transition to higher fertility sequences.
 

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Background and Aim: With the rapid spread of Covid-19 around the world, the exposure of health care workers to the disease has increased. The study aimed to investigate the personal and professional experiences of health care workers during the outbreak of coronavirus in hospitals in Tehran, Iran.
Materials and Methods: This qualitative study included health care workers in the main Covid-19 units in Shahid-Beheshti University of Medical Sciences hospitals in Tehran, Iran conducted using the content analysis method in 2021. The sample was selected by purposeful sampling, using the snowball method. Data were collected through semi-structured interviews and, after extracting the items, analyzed using the MAXQDA 10 software.
Results: After coding a total of 236 main codes were extracted and divided into 10 main categories and 30 subcategories. Four main themes were identified: "Personal experience of health care workers", "Professional experience of health care workers", "Challenges of working in the field of Covid-19" and "Strategies to deal with Covid-19".
Conclusion: Due to the increasing psychological pressure on health care workers, it seems that planning psychological counseling and providing welfare facilities for them can be useful in reducing their mental stress. In addition, it is recommended to hold training and maneuvering courses at times of crisis and provide the necessary equipment, as well as take action for continuous supervision and monitoring to improve the working conditions of health workers.
 

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Background and Aim: The health financing system is "the process of collecting, pooling and managing financial resources and purchasing healthcare services”. Iran's health financing system is facing challenges. The aim of this study was to evaluate the Iranian health financing system.        
Materials and Methods: This descriptive study retrospectively evaluated the health financing system of Iran between 2000 and 2019 using archival data. Data were collected from the World Bank website and analyzed using the Excel software.
Results: Iran's health expenditure per capita increased by 3.7% annually between 2000 and 2019 and reached $868 (purchasing power parity) in 2019. Iran's total health expenditure increased from $32 billion in 2000 to $72 billion (purchasing power parity) in 2019 (5.9% annual increase). Iran accounted for about 0.6% of the world total health expenditure in 2019. In that year about 6.7% of the country's gross domestic product was spent on health, the global average being 9.8%, while the general government health expenditure (% of the then current health expenditure) in Iran and the world were 49.5% and 59.8%, respectively. Out-of-pocket expenditure (% of the then current health expenditure) decreased in the last decade in Iran, reaching 39.5% in 2019, compared to 18% worldwide.
Conclusion: Iran’s health system costs are increasing at a faster rate than the growth of its Gross Domestic Product (GDP). The country’s health expenditure (% of GDP) and, as a result, the general government health expenditure (% of general government expenditures) has decreased and out-of-pocket expenditure (% of current health expenditures) has increased. Therefore, reforms should be implemented to strengthen the country's health financing system.
 

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Background and Aim: Clinical Practice Guidelines (CPGs), are "recommendations intended to optimize patient care based on systematic reviews of available evidence and assessment of the benefits and harms of alternative care options". CPGs play an important role in improving the quality of care, reducing the diversity of treatment methods, reducing medical errors, managing health costs and increasing patient safety. This study was conducted with the aim of analyzing the decisions, consequences and policy trends of using CPGs in Iran during the period 2001-2021.
Materials and Methods: This study was a type of health policy analysis, carried out using analysis of the policy process approach. Data were collected through reviewing policy documents (n=79) and qualitative interviews (n=27). Analysis of policy documents was done using the content analysis method, the software used being Excel software, while for analysis of the interviews the framework analysis method was used, the software being the MAXQDA10 software.
Results: The policy of using CPGs in Iran started in 2001 and has improved over the past two decades. During the period 2016-2021 a total of 836 CPGs (knowledge products) were published, but according to the participants, many of these CPGs or knowledge products did not have the necessary quality and were not used by physicians. The findings of this study also showed that in Iran there is a suitable atmosphere for implementing CPGs and the policies of using them are sound policies; however, there is a huge gap between the development and implementation of CPGs.
Conclusion: Although the process of applying CPGs has improved in Iran, their implementation faces challenges and, thus, they have not been fully implemented. Therefore, there is a need to adopt new standard methods and approaches to improve the quality and reliability of CPGs. Certainly, the support of the government, Ministry of Health and Medical Education, the medical community, insurance organizations and other stakeholders, along with proper collaboration and appropriate policy formulations, are essential to achieve success.
 

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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: Diabetes is a disease in which blood sugar level is high due to hormonal disturbances. Monitoring and evaluation certainly helps to prevent, manage and control this widespread disease. The aim of this study was to study the epidemiology of diabetes in the Diabetes Clinic in Bu-Ali Hospital, Zahedan in South East Iran.
Materials and Methods: This was a cross-sectional descriptive-analytical study conducted in 2020 including all the 1164 patients referring to the Diabetes Clinic in Bu-Ali Hospital.  Data were collected using a standard check list and analyzed using the Stata-v14 software.
Results: Information on 1164 patients with diabetes was recorded and analyzed. Most (97.7%) of the patients had type-2 diabetes. The average fasting blood sugar in patients with type-1 and type-2 diabetesd was 236 and 201 mg/dL respectively, the corresponding A1C levels being abnormally high ─ 9.6% and 8.4%. Fasting blood sugar was associated with diabetic foot complications and nephropathy (p<0.05).
Conclusion: Based on the findings of this study the level of care of diabetic patients in terms of quantity and quality is not quite acceptable, not conforming to the respective national standards. This issue indicates the unfavorable performance of the Diabetes Center, which can be attributed to the poor conditions of the geographic region, insufficient equipment and specialized manpower and low health literacy of the people. Therefore, increasing the awareness of overweight and obese people, especially those with a family history of diabetes, about prevention can help to reduce the incidence of the disease or minimize its complications.
 

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Background and Aim: Considering the destructive consequences of corruption in Iran’s healthcare system, the present study aimed to explain the roots and causes of corruption prevalence in this system.
Materials and Methods: This was a qualitative study with quantitative content analysis conducted in Iran’s Ministry of Health and Medical Education (MHME). Data were collected based on in-depth interviews with 13 experts in the MHME headquarters selected by theoretical and snowball sampling. The unit of analysis of the interviews was the sentence and the conducted interviews were analyzed through thematic analysis using the Shannon Entropy index.
Results: Data analysis showed that legislative fields with an importance coefficients (IC) of 0.293 ranked first, followed by social and cultural fields (IC 0.26), economic fields (IC 0.175), decision-making fields and organizational factors (IC 0.174), and, finally, individual factors and micro-level fields (IC 0.102).
Conclusion: Considering the importance coefficient of individual factors and micro-level fields,
it can be concluded that the personality and individual characteristics of the experts/relevant persons are less important in the corruption occurrence, while the legal, social and cultural variables paly crucial roles in explaining corruption in the Iran’s healthcare system.
 

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Background and Aim: The social health of people is a phenomennon that can play an essential role in the development of the society. A question is: to what extent has the Imam Khomeini Relief Committee (IKRC), an organization established at the beginning of the Iranian Islamic revolution to deliver services and help and empower the poor people to get them out of poverty, been successful in affecting the social health of the household female heads?  This study aimed to answer this question.
Materials and Methods: This research was conducted with a quantitative and survey approach, including 221 female heads of households under coverage of IKRC in Shiraz, Iran selected by the multi-stage cluster sampling method. The data collection tool was a questionnaire.    
Results: The findings showed that the social health of the household female heads under coverage of IKRC and all its components were higher than the average level.
Conclusion: Based on the findings it can be concluded that the educational, health and financial    
services provided by the Imam Khomeini Relief Committee could not have influenced significantly the social health of the service-seekers, although they could have affected some aspects of their lives. It is, thus, essential that the Committee revise the contents and the form of services delivered to female heads of households to promote their social health.
 

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Background and Aim: Performance evaluation is a useful way to obtain information for decision-making and management of healthcare organizations. The purpose of this study was to assess the performance of health houses in rural areas in Kerman City, Iran during the outbreak of Covid-19.
Materials and Methods: This cross-sectional study was conducted in 2021-22 using descriptive and analytical methods. The research population included all the health houses in Kerman City (n=57), Iran. The tool for data collection was the Health House Performance Evaluation Checklist of the Ministry of Health and Medical Education developed to supervise the performance of health houses during the outbreak of Covid-19. Data analysis was done using SPSS 26 software, the statistical tests being descriptive statistics (mean and standard deviation) and analytical statistics including independent t-test, one-way analysis of variance and Pearson and Spearman correlations.
Results: The average performance score of the health houses (n =55) in managing Covid-19 was 96.37 out of 136. Installation of the village map on the wall of the health house  (92.3%), screening and following up the positive-test individuals and informing the health care team to track and isolate individuals in close contact (84.6%) were found to have the highest, and injecting the third dose (78.8%) and the second dose (75%) of the Covid vaccine the lowest,  scores. From among the characteristics investigated the variable of native Behvarzes (the personnel of health houses) had a statistically significant positive relationship with the performance score (p=0.01). In addition, the health houses with more than one Behvarz were found to perform better than those with only one Behvarz (p=0.05).
Conclusion: Assessing the performance of health care units at times of crisis, including communicable diseases epidemics, will make it possible to identify the bottlenecks that need improvement for better preparedness in the future. Based on the findings of this  research, the expansion of the coverage of the covid-19 vaccination, updating the disease incidence, the performance of health care teams at home visits, and the progress of the operational plan were the variables that needed improvement most.
 

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Background and Aim: Assessment of disease risk with the ultimatevaim of implementing preventive strategies in the workplace is a necessity. This study was conducted to assess the risk of COVID-19 in hospital occupational groups in Saghez city, Iran.
Materials and Methods: This cross-sectional study was conducted in 2021 among three hospital occupational groups (total sample size = 300) in Saghez city, Iran, including physicians and nurses, as well as laboratory, administrative, financial, radiology and general service personnel, using the COVID-19 rapid risk analysis technique. Data were collected using a valid questionnaire based on the Likert scale and analysed (to determine acceptable, tolerable and intolerable risks) using the descriptive and inferential methods, the software used being SPSS-26.
Results: As regards the probability variable, the highest probability of occurrence of COVID-19 was related to the general service and administrative-financial occupational groups with an average of 1.6 and 1.5, respectively. The level of attitude was generally good and excellent. The analysis of the severity of the outcome variable was at a critical level in the physicians group (42.5) and at a catastrophic level in the other groups. In total, all occupations were rated at an unacceptable risk level (H), the general service and administrative-financial occupational groups being at a higher risk than other groups. There were statistically significant differences between the types of occupation on the one hand and the variables studied, as well as the individual characteristics and COVID-19 morbidity on the other hand.
Conclusion: Considering the high risk of occurrence of COVID-19 among the hospital professionals it is essential to develop and implement plans aiming at preventing and reducing the disease risk in them.
 

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Prevalence and Distribution of Common Rotavirus Genotypes in Iran and Comparing them with Vaccine Strains Before the Start of the National Vaccination Program

Somayeh Jalilvan¹, Atefeh Kachooei², Tayebeh Latifi³, Mahdieh Motamedi‐Rad⁴, Mohammad Farahmand³, Nasir Mohajel⁵, Zabihollah Shoja^6*
1- Ph.D. Associate Professor, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2- Ph.D. Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
3- Ph.D. Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
4- MSc. Department of Virology, Pasteur Institute of Iran, Tehran, Iran
5- Ph.D. Assistant Professor, Department of Virology, Pasteur Institute of Iran, Tehran, Iran
6- Ph.D. Associate Professor, Department of Virology, Pasteur Institute of Iran, Tehran, Iran
* Corresponding author: zabihollahshoja@gmail.com, zshoja@alumnus.tums.ac.ir
Received: May 25, 2023                                                Accepted: Oct 11, 2023

ABSTRACT
Background and Aim: Since the discovery of rotaviruses in 1973, these viruses have been identified as one of the most important and common causes of diarrhea in infants and children all over the world. Before the introduction of rotavirus vaccination, this virus led to the death of more than 500,000 children in the world annually, which mainly occurs in developing countries. With the introduction of Rotarix and RotaTeq vaccines as well as ROTAVAC and ROTASIIL in the world, the death rate has decreased by 50%. Iran, like many countries, is in the period before rotavirus vaccination, and considering putting the rotavirus vaccine in the vaccination program is one of the priorities of the country's health system. Therefore, knowing the genotypes circulating in Iran in the past and recent years and their comparison with vaccine strains is very important. Our aim in the current study is to review the prevalence of rotavirus and its genotypes circulating in Iran and whether the existing vaccines based on the circulating strains in Iran can be effective.
Materials and Methods: Studies regard to the prevalence and genotypes of rotavirus in Iran were reviewed.
Results:  G1P[8] genotype includes more than 50% of circulating genotypes. Non-G1P[8] genotypes, including G4P[8], G3P[8] and G9P[8], have also had a high frequency in some studies. In addition, in a recent study, it has been shown that the rare and uncommon genotype G9P[4] has been introduced as a common genotype.
Conclusion: Studies in Iran have shown that the country may face a change in the rotavirus genotype pattern in the future. This study can provide useful information to recommend appropriate policies for rotavirus vaccination before the start of the national vaccination program and may even change policies for the use of existing vaccines.
 

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Background and Aim: The health system is trying to prevent unnecessary referrals to higher levels by providing tiered services and thus reduce the cost of health care. Therefore, this study was conducted in Zahedan City, Iran with the aim of finding the causes of referrals from level 1 to higher tiers in rural areas.
Materials and methods: This cross-sectional study was conducted on 458 rural patients referred to the second level in the rural areas of Zahedan City, Iran. Data were collected from the family health files available in the Sib system and analyzed using the SPSS-16 statistical software, the statistical tests being descriptive statistics (percentage, frequency) and Chi-square test.
Results: The highest (57.6%) and lowest (4.1%) proportions of referrals to the second level of service provision were found to have been in 2018 and 2016, respectively. From among the referred patients nearly 50% had been referred due to the need for a higher expertise, thus most referrals (67.2%) were to specialists. Further analysis of the data showed that only in 23.6% of the cases there was a feedback from the higher level to the first level.
Conclusion: The findings show that referrals from family physicians to higher levels in the health system requires higher medical expertise and patient insistence. In addition, feedback to the first level of service provision has not received proper attention. Establishing interactions between physicians and other health service levels, refresher training of physicians, emphasizing the importance of providing feedback and promoting the awareness of patients can reduce to a large extent inappropriate referrals.
 

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Background and Aim: As a crisis, the Covid-19 disease affected all aspects of people's lives, especially the occupational aspect.  Bank employees were more under pressure due to the type of service they provided to the public. The aim of this study was to analyze the challenges affecting the job efficiency of some of the Bank Melli Iran personnel during the Covid-19 pandemic.
Materials and Methods: This was a qualitative research project with a phenomenological approach. The research population was the employees of Melli Bank branches in the 10th district of Mashhad City, Iran in 2021, from among whom a sample of 10 people was selected by purposeful sampling, the sampling process continuing until saturation. Data were collected through semi-structured interviews and analyzed using the inductive thematic analysis method.
Results: Data analysis showed 12 sub-themes, 3 main themes including challenges at the individual, interpersonal and organizational levels, and a core theme.
Conclusion: The findings of this study show that the Bank employees’ concept of the Corona pandemic can affect their work efficiency.  These findings can be used for planning to solve the problems and challenges of this group of people after the Corona pandemic.
 

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Background and Aim: Considering the growing trend of cosmetic surgery it is essential to adapt a different approach to provide the relevant services in response to the community needs. In this study we aimed to assess the current state of cosmetic surgery services in Iran in terms of frequency distribution according to the type of surgery and other features.
Materials and Methods: This was a descriptive study using the information in the Statistics and Information Technology Management Center (SITMC) of the Ministry of Health and Medical Education. The data in the SITMC medical records of the information system of the reference hospitals for cosmetic surgery, including admission type, status at the time of discharge, average cost, average length of stay, type of center (ownership) and demographic characteristics of the patients undergoing cosmetic surgery were extracted between January 2017 and June 2021. Data analysis was done using Excel software and descriptive statistics (frequency, percentage and mean).
Results: During the study period a total of 62,387 surgeries had been performed for 56 cosmetic surgery codes. The majority of cosmetic surgery centers (79.7%) were governmental. The demands for cosmetic surgery by different groups were as follows: women 73.9%, Iranian nationals 97.7%, married individuals 40.6%, and the aged individuals 16-45 years 82.7%. Rhinoplasty accounted for approximately 60% of the cosmetic surgeries, while septorhinoplasty and lower eyelid blepharoplasty had the highest and lowest average costs and lengths of stay, respectively.
Conclusion: Considering the average cost of surgical operations, financing arrangements and the framework of providing the relevant services should be specified with more precision and transparency. In addition, prior to making decisions in this area policies should be checked in terms of efficiency, effectiveness and cultural compatibility.
 

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Background and Aim: This study aimed to investigate whether cultural intelligence, a construct measure of individuals' capacity to adjust to new surroundings and different cultures, has an effect on their social functioning and effective communication with others, ultimately influencing their overall social health.
Materials and Methods: This research was a quantitative survey conducted on a sample of 380 individuals aged 15 years and above selected by multi-stage sampling in Yasouj city, Iran using a questionnaire.
Results: Data analysis showed that the research population possessed higher levels of cultural intelligence and social health compared to the average levels, there being no difference between men and women. Married individuals were found to have higher averages of cultural intelligence and social health compared to single individuals. While there was no correlation between age and social health, there was a positive correlation between age and cultural intelligence.
Testing the hypotheses revealed that various dimensions of cultural intelligence had direct and positive associations with social health. Cultural intelligence with a standard regression coefficient of 0.372 accounted for approximately 14% of the changes in social health; age did not have an intervening effect on the relationship between these two variables.
Conclusion: Overall, the findings of this study indicate that individuals with higher levels of cultural intelligence possess a greater ability to understand and accept other individuals’ perspectives, this leading ultimately to enhanced societal engagement and interpersonal interactions. Consequently, this heightened cultural intelligence positively impacts their overall social health.
 

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Background and Aim: Accreditation as an external assessment model is considered a key program for evaluating health care organizations. The new health service accreditation system in Iran seems to lack the necessary standards for evaluating outpatient services and general clinics. The objective of this study was to design, based on the experiences of other countries, a model for accreditation of general clinics in Iran
Materials and Methods: This research was a qualitative review study conducted in two phases First, the methods and standards of accreditation of general clinics of selected countries were identified through a comparative review. In the second phase, the conceptual framework of the accreditation of these clinics was developed by an expert panel.
Results: The proposed framework for the accreditation of clinics starts with registering the application in the system and updating the information. After the clinic's self-evaluation and external evaluation, amendments will be made.
The key areas proposed for the accreditation of clinics included management and leadership, information management, process management, human resource management, salaries,  and operational results. The country's clinics can be ranked in five levels, namely, excellent, good, average, poor, and substandard.
Conclusion: Considering the processes and areas determined in this study and the lack of a systematic approach, the proposed accreditation model could provide a scientific and practical method for the internal and external evaluating bodies to provide a relevant and valid evaluation of the general outpatient clinics in Iran.