Journal of Health Research in Community

1-13

Authors: Sara Karimi Zeverdegani , Amir Hossein Molla Agha Babaei , Fatemeh Paridokht *

Introduction and purpose: Following respiratory problems, musculoskeletal disorders are the second leading health concern in the world. The present study aimed to explore ergonomic posture and the prevalence of musculoskeletal disorders in workshop employees in the west of Isfahan province. Methods: This descriptive analytical study was conducted on 74025 people working in 9 different industrial group in the workshops of the West of Isfahan province in 2019. The samples were selected by census sampling method. In order to investigate the ergonomic condition and muscular-skeletal disorders of the workers, after taking photos of different tasks, RULA, REBA and QEC, WISHA, and OWAS methods were used to evaluate the posture of the workers. Finally, the collected data were analyzed in SPSS software (version 26) using descriptive statistics and Spearman's rank correlation coefficient. Results: This study indicated the high prevalence of musculoskeletal disorders in back pain (2,806 people). Moreover, there was a statically significant relationship between people with back pain and those who push and lower the load (P<0.05). Furthermore, improper posture and repetitive work were the most frequent risk factors. Conclusion: Determining the incidence of musculoskeletal disorders and evaluating the ergonomic status of employees using posture assessment tools in western industries of Isfahan province revealed that ergonomic problems are high in employees' working environment. To reduce the prevalence of musculoskeletal disorders and minimize their effects in the studied community, it is necessary to reduce the risk level of ergonomic factors from risk level 4 to risk level 1. Therefore, ergonomic training and intervention programs should be considered for the employees of these industries to prevent possible and serious injuries in the future.

26-37

Authors: Jamshid Bahmaei , Bagher Pahlavanzadeh , Zahra Abdolahi Arpanahi , Ebrahim Kharazinejad * , Maryam Jafarpourian

Introduction and purpose: Goal orientation is one of the determining variables in the quality of the learning process and academic progress of people. Therefore, this study was designed and implemented to investigate the relationship between goal orientation and academic achievement among the students of Abadan University of Medical Sciences, Abadan, Iran. Methods: The present study was a descriptive-analytical correlational research that was conducted cross-sectionally in 2022-2023. The sampling method was stratified and clustered. The study sample consisted of 259 students from Abadan University of Medical Sciences. The data collection tool was the Academic Goal Orientation Questionnaire of Buffard et al. (1998), and the students' grade point average (GPA) in the last semester was used as the measure of their academic status. Data were analyzed using SPSS 26 and AMOS 24 software. Results: The average age of the students was 24.3 (±2.4) years and their average last semester GPA was 16.57 (±1.25). The average score of the failure avoidance component was 20.32 (± 4.11), performance 14.08 (± 5.58), and goal-mastery 9.43 (± 3.82). The correlation coefficient showed that although there was a positive relationship between goal orientation components and academic achievement, it was not significant. The correlation coefficient also showed that the academic semester had a positive and significant relationship with the components of performance orientation and mastery orientation; however, it had a negative relationship with failure avoidance. Conclusion: According to the results of this study, no significant relationship was found between the three components of goal orientation and academic achievement. It can be suggested that educational planners provide and improve educational conditions in such a way that students move towards mastery and performance goals and move away from avoidance orientation.

48-61

Authors: Fatemeh Zanjanchi Neko , Isa Mohammadi Zeidi * , Hadi Morshedi , Banafsheh Mohammadi Zeidi

Introduction and purpose: Providing mobile-based cognitive-behavioral interventions reduces physical complications and enhances the quality of life in diabetic patients by improving physical activities. The present study aimed to determine the effect of a model-based intervention based on the health action process approach model (HAPA) on physical activity in the elderly with type 2 diabetes in Qazvin. Methods: The current study was a randomized controlled trial, and using a simple random sampling method, 120 elderly people with type 2 diabetes participated in experimental and control groups. The educational intervention consisted of six virtual training sessions with the aim of promoting the psychological constructs affecting physical activity through short lectures, group discussions, and individual counseling associated with educational pamphlets, audio files, and educational SMS. The scales related to the HAPA model and international physical activity questionnaire (IPAQs) were completed by two groups before and three months after the educational intervention. The data were analyzed in SPSS software (version 25.0), and a significance level of less than 0.05 was considered. Results: The mean age of the participants was 60.7 ± 9.23 years, and 64.17% of cases were female. The results of covariance analysis demonstrated that by controlling the effect of the pre-test, the mean of HAPA constructs as perceived risk, outcome expectancy, social support, action self-efficacy, maintenance self-efficacy, recovery self-efficacy, action planning, coping planning, behavioral intention, and the level of physical activity improved in the experimental group (P<0.001). Conclusion: As evidenced by the obtained results, the provision of mobile-based cognitive-behavioral interventions led to an increase in the level of physical activity in diabetic patients by improving the psychological variables related to the HAPA model.

75-87

Authors: Azadeh Edalat , Zahra DashtBozorgi * , Marzieh Talebzadeh Shoshtari

Introduction and purpose: Patients with diabetes face many problems, especially in the field of health hardiness, self-compassion, and behavioral emotion regulation. As a result, the present research aimed to investigate the effectiveness of health-promoting lifestyle training in health hardiness, self-compassion, and behavioral emotion regulation in patients with type 2 diabetes. Methods: This study was conducted based on a semi-experimental pretest and posttest design with a control group. The statistical research population was patients with type 2 diabetes who were members of Ahvaz Diabetes Association in the winter of 2021. After reviewing the inclusion criteria, 50 people were selected as a sample with the available sampling method and randomly assigned to two equal groups (n=25 in each group). The experimental group underwent eight 90 minutes sessions of Alijani et al. health-promoting lifestyle training (2015), and the control group remained on the waiting list for training. Data were collected with the demographic information form, revised health hardiness inventory (Gebhardt et al., 2001), self-compassion scale (Neff, 2016), and behavioral emotion regulation questionnaire (Kraaij and Garnefski, 2019) and analyzed in SPSS software (version 19) using chi-square, independent t-test, and multivariate analysis of covariance. Results: The results demonstrated that the experimental and control groups did not significantly differ in terms of gender, education level, and age (P>0.05). The other findings pointed out that health-promoting lifestyle training led to increased health hardiness (F=575.597, P<0.001), self-compassion (F=283.882, P<0.001) and behavioral emotion regulation (F=633.967, P<0.001) in patients with type 2 diabetes (P<0.001). Conclusion: As evidenced by the results of the present study, health professionals and therapists can use the health-promoting lifestyle training method along with other training methods to improve the psychological characteristics of patients with type 2 diabetes, especially increasing health hardiness, self-compassion, and behavioral emotion regulation.

99-107

Authors: Alireza Heidari * , Shamim Imani Gorgi , Farideh Koochak , Zahra Khatirnamani

Introduction and purpose: Nurses' fatigue is defined as a mental and multidimensional feeling of fatigue that is physically and mentally penetrating and may even remain despite periods of rest. In addition to fatigue, nurses suffer from lack of sleep and its poor quality more than other occupational groups. This study was conducted to determine the relationship between occupational fatigue and sleep quality in nurses. Methods: This was a correlational and cross-sectional descriptive study that was conducted at Golestan University of Medical Sciences, Golestan, in 2021. A total of 277 nurses were included in the study after random stratified sampling and obtaining the code of ethics. The required data were collected by Swedish Occupational Fatigue Inventory and Pittsburgh Sleep Quality Index, and analyzed in SPSS-23 software using descriptive statistics and Spearman correlation, Mann-Whitney, and Kruskal-Wallis tests. Results: The mean scores of the nurses' age and work experience were obtained at 28.75 ± 4.8 years and 5.66 ± 4.6 years, respectively. In total, 68.6% of the nurses were women. The mean of the total occupational fatigue score was 53.18 ± 22.5, which was evaluated at a lower-than-average level. The mean of nurses' sleep quality was 18.14 ± 1.77, which indicated poor sleep quality in nurses. There was an inverse and significant relationship between the score of occupational fatigue and all its dimensions and sleep quality. Conclusion: The level of occupational fatigue in nurses was lower than the average and their sleep quality was poor, and with the increase in occupational fatigue, the quality of sleep decreased. It is suggested to implement individual and organizational solutions to reduce and eliminate occupational fatigue and improve sleep quality.

1-12

Authors: Wirya Nawrozi * , Behnam Talebi , Faranak Asadi Sharif , Khadijeh Mansoori , Fatemeh Abasiraki

Introduction and purpose: Covid-19 is an infectious disease caused by the novel Coronavirus, and its pandemic has resulted in numerous deaths and losses worldwide. This study aimed to predict Corona-preventive behaviors in adults aged 30 to 50 admitted to Ardabil health centers based on their health literacy. Methods: The present study was a correlational descriptive-analytical study. The statistical population consisted of 30 to 50-year-old patients admitted to Ardabil health centers (Iran) in 2019, from which 232 were randomly selected using cluster sampling. Data were collected through administering a health literacy and preventative behavior questionnaire online. The data were then analyzed using inferential (Pearson correlation and linear regression) statistics by the SPSS software (version 26) with a significance threshold of 0.05. Results: The results of this investigation revealed a statistically significant relationship (P<0.0001) between health literacy and anti-Covid-19 preventative behavior. In addition, there was a direct but moderate correlation between the stated factors (r=0.526). According to the findings of linear regression analysis, decision-making (P<0.0001, B=0.980) and knowledge (P=0.008, B=0.588) were the strongest predictors of preventive behavior. Overall, the variables included in the regression analysis predicted 65.6% of the Covid-19 disease-preventive behaviors. Conclusion: This study demonstrated that health literacy plays a crucial role in enhancing citizens’ preventative behaviors against Covid-19. Therefore, it is possible to strengthen people’s preventive behavior against Covid-19 by enhancing their health literacy.

28-38

Authors: Ehsan Zarei, Mohammad Rafiei, Habibollah Rahimi , Mohsen Hosami Arani , Mehrnoush Abtahi Mohasel *

Introduction and purpose: One of the dangers that environmental health experts face at work is violence, the incidents of which are observed every year. The type and extent of this violence depend on the ethics of the operator. This s tudy aimed to determine the s tate of violence among environmental health experts in Kashan and Aran va Bidgol, Isfahan, Iran. Methods: In this descriptive s tudy, 53 environmental health inspectors working in the centers affiliated with Kashan University of Medical Sciences, Kashan, Iran, were selected. The data collection tool was a 58-item reliability-validated ques tionnaire consis ting of four parts, including physical violence (18 items), psychological violence (12 items), sexual violence (12 items), and racial violence (12 items), and there were three open ques tions at the end of the ques tionnaire. After the ques tionnaire was completed, information was recorded in SPSS software, and analysis was performed using independent t, Chi-square, and Fisher s tatis tical tes ts. Results: According to the results, 30% of the subjects experienced a physical attack, 90% verbal violence, and 7% racial violence in the pas t three years. No cases of sexual violence were reported. Moreover, the curator's insult to the inspectors had no relationship with the inspectors' behavior and was influenced by factors related to the curator himself and cultural and social factors. Conclusion: Based on the results, a combination of personnel training and improving their communication skills, as well as behavioral training for attendants, would be effective in reducing cases of violence.

51-59

Authors: Alireza Heidari , Mohammad Javad Kabir , Zahra Khatirnamani * , Reza Hosseinpour

Introduction and purpose: The assessment of the length of hospital s tay until recovery of patients with Covid-19 and its related factors in different areas can help manage the treatment process and prepare for the epidemic. This s tudy aimed to model the survival time until the recovery of COVID-19 definite patients. Methods: This descriptive-analytical s tudy was retrospective. The s tatis tical population included all COVID-19 definite hospitalized in the educational and medical hospitals of Goles tan University of Medical Sciences from 20 February to 20 July 2020. The outcome variable was discharging confirmed cases of Covid-19. All analytical tes ts and charting were performed in R3.6.2 software. Results: From a total of 3480 confirmed patients, 77.5% recovered, and 22.5% experienced death at the end of the s tudy or were undergoing treatment. The median length of hospitalization in patients was 6 (IQR: 3-10) days. The mean age of all patients was 52.93±19.20 years; 58.2% of patients were over 49 years old, and half of the population were male. Women infected with Covid-19 survived and recovered 1.16 times more than men. Patients with an age group above 49 years of age had more recovery than their counterparts aged under 49 years. Conclusion: As evidenced by the obtained results, apart from older adults, the prevalence of the disease needs to be evaluated more closely in young people and men, and these people should be monitored and screened frequently.

77-90

Authors: Majid Yousefi Afrashteh * , Sogand Heydari Viyari

Introduction and purpose: This s tudy aimed to inves tigate the relationship of ambiguity tolerance, trus t, religious attitude, and quality of life with the attitudes toward COVID-19 vaccination by analyzing the mediating role of health anxiety among citizens in Zanjan, Iran. Methods: This descriptive-correlational s tudy was conducted on 597 citizens of Zanjan who were selected using the convenience sampling method. The data were collected utilizing the COVID-19 Vaccination Attitude Ques tionnaire, Uncertainty Intolerance Ques tionnaire by Carleton et al. (2007), NEO Revised Five Personality Factors Ques tionnaire by McCree and Cos ta (1985), Religious Commitment Inventory-10 by Worthington et al. (2003), World Health Organization Quality of Life Ques tionnaire (1996), and Health Anxiety Ques tionnaire by Salkowski and Warwick (2002). The obtained data were then analyzed using the Pearson correlation coefficient tes t and path analysis in SPSS software (version 26) and LISREL software (version 10.20). Results: The s tandard pathway coefficients indicated a significant correlation of the attitude towards the COVID-19 vaccination with ambiguity tolerance (β=-0.09, P˂0.05), trus t (β=-0.10, P˂0.05), and quality of life (β=-0.28, P˂0.001). Moreover, health anxiety was directly correlated with ambiguity tolerance (β=-0.11, P˂0.05), trus t (β=-0.11, P˂0.05), religious attitude (β=-0.12, P˂0.01), and quality of life (β=-0.09, P˂0.05). In addition, the results revealed the indirect association of tolerance of ambiguity, trus t, religious attitude, and quality of life with health anxiety (β=-0.16, P˂0.001). Conclusion: According to the results, health anxiety can play a mediating role in the relationship of the attitude towards COVID-19 with ambiguity tolerance, trus t, religious attitude, and quality of life.

1-10

Authors: Alireza Heidari , Mohammad Javad Kabir , Sajad Khodabandelu , Nahid Jafari , Zahra Khatirnamani * , Masoumeh Gholami

Introduction and purpose: Accidents are one of the main causes of death that impose a great socioeconomic burden on society. This study aimed to model and predict the trend of mortality due to accidents in Golestan province, Iran, from 2011 to 2020. Methods: The study was a secondary analysis based on the available data. The required information was obtained from the statistics unit of the Health Department of Golestan University of Medical Sciences (Gorgan, Iran) and was cleaned after being entered into the Microsoft Office Excel software (2016). Afterward, all the steps of analysis and fitting of the Lee-Carter model were performed using the Demography (version 18/1) and StMoMo packages in the R/3/62 software. Results: The death rate due to accidents in 2011 was 0.51 in the total population, 0.23 in women, and 0.78 in men per 1,000 population. It is predicted that in 2028, the age group of over 80 will reach 2.17 in the total population, 2.12 in men, and 1.77 in women (per 1,000 population). Both men and women over 50 years of age had the highest increase in deaths from accidents. Conclusion: Based on the findings of the study, the trend of deaths due to accidents in Golestan province is upward. Therefore, it is necessary to plan to reduce accidents, and in this regard, specific strategies should be formulated and implemented by explaining the role of all stakeholders.

25-38

Authors: Vahid Mirzaei Majarshin , Tahereh Ramezani , Farzaneh Saadat Talab , Vahideh Rezapour , Sepideh Harzand jadidi , Shahab Papi *

Introduction and purpose: Investigation and recognition of the factors affecting the quality of life are essential to start the behavior, and continuing the behavior can be a key factor in improving the living conditions of the elderly in Tabriz. Methods: This descriptive-analytical study was conducted on a random sample of older adults living in the city and villages of Tabriz in 2021. Data were collected through standardized questionnaires of healthy lifestyle and cognitive impairment, psychological well-being, and depression from 422 old people. The collected information was analyzed using descriptive and analytical statistical methods in the SPSS software (version 22). The significance level of the tests was less than 0.05 in this study. Results: The results of the data analysis showed that the lifestyle of the rural elderly had a significant and positive relationship with cognition (P=0.001, r=0.29). On the other hand, there was a significant and negative relationship between lifestyle and depression (P=0.001, r=-0.24) and a significant and positive relationship with psychological well-being (P=0.001, r=0.71). Among urban older adults, there was no statistically significant association between lifestyle and cognition (P=0.077, r=0.12), in addition to lifestyle and depression (P=0.9, r=0.009). However, a health-promoting lifestyle showed a significant positive relationship with psychological well-being (P<0.001, r=0.37). Conclusion: According to the results of this study, the significant influence of lifestyle on cognition and memory, psychological well-being, and depression indicates the need for appropriate measures to improve the lifestyle of older adults.

49-55

Authors: Elham Ghazanchaei , Mojgan Palizdar , Mohammad Varahram , Beheshteh Jebelli *

Introduction and purpose: Vaccine skepticism and refusal to vaccinate against infectious diseases have been recognized by the World Health Organization as one of the ten global health threats in 2019. Therefore, it is necessary to understand the knowledge and attitude of medical staff towards vaccination in order to advance immunization coverage. Methods: This analytical cross-sectional study was conducted to evaluate the knowledge and attitudes toward the Covid-19 Vaccination using a researcher-made questionnaire. In this research, 455 cases were selected via the convenience sampling method from among all the physicians and staff of Dr. Masih Deneshvari Hospital from February 2019 until the end of vaccination for four months. The obtained data were analyzed in SPSS software (version 22). Results: A total of 455 people participated in this study. The mean age of subjects was 36.2±8.99 years. Regarding gender, 50.6% of the participants were female. It was found that 44.8% of cases believed in vaccination, 28.6% of them considered Vaccination to be safe, and 29.9% of them considered Vaccination to be effective. The participants' knowledge of the benefits and side effects of the vaccine was reported as 24.2%. In examining the mean scores of the questionnaire questions, the highest score was related to recommending family members to get vaccinated (2.54±0.58), and the lowest score was related to the role of the media in deciding on Vaccination (1.80±0.72). Conclusion: As evidenced by the results of this study, the treatment staff's attitude towards Vaccination was average, and they often did not have any attitude toward the safety and effectiveness of the vaccine. Furthermore, participants' knowledge about the benefits and side effects of the vaccine was reported to be weak, highlighting a need to increase the level of awareness among the treatment staff regarding the injection of Vaccination in emerging diseases.

68-77

Authors: Shahin Shahidi , Ramezan Hasanzadeh * , Bahram Mirzaian

Introduction and purpose: The impact of psoriasis is very high on the quality of patients’ life even when a very small area of the body is involved. Psoriasis patients have a lower quality of life than the general population. This study aimed to compare the effectiveness of acceptance and commitment therapy (ACT) on mental pain and life engagement in patients with psoriasis. Methods: This study was a semi-experimental type with a pretest-posttest design and a one-month follow-up with the control group. The statistical population consisted of all patients referred to skin and hair clinics in Boroujerd, Iran, in 2021, who received a definite diagnosis of psoriasis. Among these, 54 patients whose depression rate was higher than the cut-off point were selected through non-random sampling and were replaced in an experimental group (receiving ACT) and a simple random control group (18 in each group). Afterward, eight 90-min sessions of ACT were performed in the experimental group. Data were collected using mental pain (OMMP; Orbach et al., 2003) and life engagement (Hasanzadeh, 2014) questionnaires, as well as the Beck depression inventory (Beck, 1996). Data were analyzed using the SPSS software (version 22) and through repeated measures analysis of variance (ANOVA) test. Results: The results showed that ACT was effective on mental pain (P<0.01, F=31.53) and life engagement (P<0.01, F= 54.08) of patients with psoriasis, which continued until the follow-up stage. Conclusion: It can be concluded that ACT was effective in reducing mental pain and increasing life engagement in patients with psoriasis. It is suggested to use this treatment to reduce the psychological problems of patients with psoriasis.

89-95

Authors: Zari Sheykhoshagi , Zahra Imani Goghary , Sakineh Sabzevari *

Introduction and purpose: The health of food products is one of the indicators of community health, and health workers provide numerous services in this regard. Therefore, it seems necessary to provide education based on the current situation and existing educational needs. The present study was conducted to investigate the knowledge, attitude, and educational needs of health workers in the field of food health, in the villages of Sirjan, Iran, in 2020. Methods: This cross-sectional descriptive study was conducted on 77 health workers in the villages of Sirjan in 2020 by census method. Two questionnaires were used to collect the required data, including a questionnaire to measure knowledge and attitude and a researcher-made questionnaire to assess educational needs. Data were analyzed in SPSS version 24 using descriptive statistics. Results: The mean age of the participants was 23.9±84.37 years. Most of the subjects (67.5%) were female, and 87% of them were married. The mean scores of knowledge and attitude were 7.33±1.03 and 28.23±5.33, respectively, which indicated the average level of knowledge and attitude of health workers in this field. The total mean score of educational needs was estimated at 134.33±3.42. The mean scores of subscales were obtained as follows: personal hygiene (19.29±3.18), kitchenware hygiene (18.75±3.42), building hygiene (45.70±8.99), and food hygiene (51.10±9.15). Conclusion: The knowledge and attitude of rural health workers of Sirjan in the field of food health were moderate and their educational needs were high. Therefore, it is essential to provide necessary training in the field of food hygiene to improve their knowledge and attitude and meet their educational needs.

1-11

Authors: Majid Babaei * , Shila Hasanzadeh , Habibollah Pirnejad , Rana Hoseini , Zahra Niazkhani , Iraj Mohebbi

Introduction and purpose: The severity of accidents and mortality rate varies between countries with different socio-economic statuses. This study aimed to model the socio-economic factors affecting the severity of injuries in traffic accidents of drivers referred to Imam Khomeini Hospital in Urmia using logistic regression. Methods: This cross-sectional-analytical study included 250 drivers who had a traffic accident in 2020 and were referred to Imam Khomeini Medical Center in Urmia, Iran. For evaluating the relationship between socio-economic factors and the severity of injuries, the Injury Severity Score (ISS) scale was used to determine the severity of the injury, and logistic regression was used to model and study the relationship. The collected data were analyzed in SPSS software (version 16), and a p-value less than 0.05 was considered statistically significant. Results: The results showed a significant relationship between the high severity of the injury with, marital status (OR=0.43, P=0.029), level of education (OR=4.45, P=0.005), monthly household income (OR=5.40, P=0.037), car monetary value (OR=3.22, P=0.011), and the share of health care costs (OR=0.31, P=0.004). In contrast, there was no significant relationship between job and the high injury severity. Conclusion: The results showed a significant relationship between most of the socio-economic factors and the severity of the injury. It seems that paying attention to welfare and public health strategies, material and spiritual support for the recovery of patients, increasing the purchasing power of families, improving cultural views, specialized training, and upgrading the automotive industry may reduce accidents and the severity of injuries.

25-38

Authors: Malihe Mobarakian , Homamodin Javadzade , Marzieh Mahmoodi , Mahnoush Reisi *

Introduction and purpose: The World Health Organization considers preventive behaviors, which are influenced by several factors, the most important factor in breaking the COVID-19 transmission chain. Therefore, the present study aimed to determine the predictors of COVID-19 preventive behaviors based on an extended pattern of health beliefs in adults. Methods: The present study is a descriptive-analytical cross-sectional study performed on 900 adults. The sample was selected through convenience sampling from the statistical population of Salamooz website users. In this study, information was collected using a researcher-made questionnaire consisting of four sections (demographic characteristics, health belief model constructs, perceived social support, and COVID-19 preventive behaviors) and statistically analyzed using the SPSS software (version 24). Results: Among the studied variables, age (P<0.001, B=0.04), sex (P<0.001, B=1.33), history of COVID-19 (P=0.001, B=-0.75), perceived sensitivity (P=0.007, B=0.13), perceived barriers (P<0.001, B=-0.24), perceived self-efficacy (P< 0.001, B=0.16), family social support (P<0.001, B=0.13), and friends social support (P=0.021, B=0.06) were predictors of COVID-19 preventive behaviors. These constructs were able to predict 29% of changes in COVID-19 preventive behaviors. Among them, perceived barriers were the strongest predictor of preventive behaviors. Conclusion: Based on the predictors of COVID-19 preventive behaviors, it is suggested that policymakers, officials, and planners in the process of implementing behavioral change to improve COVID-19 preventive behaviors form strategies to increase mental sensitivity. In particular, they can use the risk of illness and inform families, as well as individuals, to improve their supportive role and self-efficacy to reduce barriers to performing preventive behavior.

50-62

Authors: Mahdi Shahraki * , Mojtaba Abbasian , Mehdi Safdari

Introduction and purpose: Gender equality and good governance are the most important social indicators affecting health status and well-being. Therefore, the present study aimed to investigate the impact of gender inequality and good governance on health status in upper-middle-income countries. Methods: The present ecological and applied study was conducted on upper-middle-income countries using the cross-sectional data method and the Common Correlated Effect Means Group estimator by STATA software (version 16). A total of 33 upper-middle-income countries were selected non-randomly. Data for 2000-2019 were extracted from the databases of the World Bank and the United Nations. Results: The mean of life expectancy index, under-five mortality rate, gender inequality index and good governance were 71.25, 25.28, 0.42 and -1.26. The impact of gender inequality index, good governance index, health expenditures and women's participation rate on life expectancy were equal to -1.15, 0.031, 0.040 and 0.009, respectively, and impact of gender inequality index and per capita GDP on the infant mortality rate were 12.062 and -5.183, respectively. Conclusion: Gender inequality index had a negative effect and good governance, health expenditures and women's participation rate in the labor market had a positive effect on life expectancy; Gender inequality index also had a positive effect and per capita GDP had a negative effect on child mortality rate. Therefore, policies to reduce gender inequality, such as improving women's education, increasing women's participation in parliament, and increasing women's employment are proposed.

76-85

Authors: Hadi Eslami * , Najmeh Hassan Shahi , Zahra Ebrahimi , Ameneh Marzban

Introduction and purpose: Water scarcity is a daunting challenge in most areas of the world, with at least one in six people in the world does not have access to safe drinking water. The present study aimed to investigate the relationship between religious attitudes and water saving in students of Rafsanjan University of Medical Sciences in 2021. Methods: This descriptive study was conducted on 299 students who were selected by the convenience sampling method. Data collection tools were the water conservation tendency and the religious attitude standard questionnaires (Marzban et al., 2019). Data were analyzed in SPSS software (version 24) using an independent t-test, analysis of variance, and Pearson correlation coefficient statistics tests. Results: The mean scores of religious attitude and tendency towards water saving were 4.19±0.5 and 4.25±0.36, respectively. Moreover, 92.3% and 100% of students were in favarouble conditions in terms of religious attitude and water saving, respectively. The tendency to save water consumption had a significant relationship with the university of students (P <0.05). The correlation between religious attitude and the tendency towards water saving was statistically significant (R= 0.483; P ≤0.001). Conclusion: According to the positive relationship between religious attitude and tendency towards water saving consumption, as well as the religious context of our society, we can use this potential in the field of environmental protection and water saving.

1-15

Authors: Samaneh Dehghan , Yousef Dadban Shahamat * , Fariba Ziarati

Introduction and purpose: Today, chlorine and its compounds are the most popular elements employed for disinfecting water and wastewater due to their flexibility, cost-efficiency, and ease of use. This research aimed to optimally produce active chlorine by the electrochlorination method using titanium and platinum/titanium electrodes. Methods: This experimental study was conducted in a batch flow of an electro-chlorination cell. The experimental design was performed using the Box Behnken method with a sample size of 34 experiments. The production of active chlorine was evaluated and compared on various operating factors, including current density (10-60 A/dm2), sodium chloride concentration (50-250 g/L), reaction time (5-120 min), and two types of anode electrodes of titanium and platinum/titanium and 316 cathode steel. Results: The results showed all four operating parameters had a significant effect on the active chlorine production and the highest effectiveness was related to electrolysis time, followed by current density, sodium chloride concentration, and anode electrode in descending order. The optimal operating conditions provided by the model for chlorine production included the electrolysis time of 120 min, current density of 60 A/dm2, concentration of sodium chloride of 187 g/L, and type of platinum/titanium anode electrode and 316 cathode steel electrode, which resulted in active chlorine of 65.95 g/L. Conclusion: This method can be used as an effective method to produce chlorine to disinfect water and wastewater in treatment plants, and if replaced with gas chlorination systems, the safety problems of chlorine gas capsules will be solved.

27-38

Authors: Hossein Masoumbeigi , Foad Gholami , Seid ali Yahyapor , Ghader Ghanizafeh

Introduction and purpose: Nitrate is one of the most important pollutants in surface and groundwater. The present study aimed to evaluate the effect of different parameters on the performance of the electrical coagulation process in the removal of nitrate from contaminated water. Methods: This study was conducted based on an experimental design and the statistical community was urban water. A cylindrical batch reactor with aluminum and zinc electrodes (monopolar arrangement) was used to remove 100 mg/L nitrates. The experiments were performed three times in direct and alternating currents using standard methods. Factors of pH, contact time, and weight of electrodes were evaluated, and the results were reported in tables and graphs. Results: Nitrate removal efficiency (87.4%) was higher in direct current, as compared to that in alternating current (39.1%). The highest nitrate removal efficiency of 87.4% was obtained in direct current, in comparison with 61% for alternating current. As the contact time increased, the pH of the solution increased in two currents, from 7 to 11.21 and 8.47, respectively. Total dissolved solids (TDS) at optimal conditions in alternating and direct current were 79 and 126 mg/L, respectively. After 30 min of settling, the produced sludge was measured as 17.66 and 280 mL/L in direct and alternating current, respectively. The weight of the anode electrode had the greatest decrease in direct current. Conclusion: The results of this study pointed out that the process of electrical coagulation could reduce the concentration of nitrate to less than the standard. Nitrate removal with the direct current was performed with less energy consumption and cost than alternating current. As a result, the use of optimal conditions increases the process efficiency in the electrochemical removal of nitrate.

50-59

Authors: Parisa Khoraminejad , Javad Khalatbari * , Mohammad Reza Seyrafi

Introduction and purpose: Gestational diabetes mellitus is the most common metabolic complication during pregnancy that affects 10-15% of all pregnancies depending on the diagnostic criteria. This study aimed to determine the effectiveness of compassion-focused therapy on the quality of life of mothers with gestational diabetes. Methods: This semi-experimental study was conducted based on a pretest-posttest design with a control group and follow-up. The statistical population of the study included all pregnant women referring to Milad Hospital in Tehran, Iran, in 2019, diagnosed with gestational diabetes. The samples (n=30) were selected using a purposeful sampling method (considering inclusion and exclusion criteria) and then randomly assigned to two groups of compassion-focused therapy and control (n=15 each). The experimental group received self-compassion training, while no intervention was administered to the control group. Both groups were followed up for 3 months. The research tool was the quality of life of the World Health Organization. The collected data were analyzed in SPSS.22 software using a repeated measure test. Results: The results showed that compassion-focused therapy had a significant effect on improving the quality of life (P<0.01) of women with gestational diabetes. Moreover, the effect of compassion-focused therapy remained constant until the follow-up phase. Conclusion: It can be concluded that compassion-focused therapy had an effect on improving the quality of life of mothers with gestational diabetes, and this method can be used to reduce the problems of such mothers.

69-80

Authors: Arash Farvahari , Saber Amirzadeh Googhari , Vadidreza Borhaninejad * , Ali Bahramnejad , Mozhgan Negarestani

Introduction and purpose: With the outbreak of COVID-19 and subsequent changes, such as the closure of high-risk jobs, creation of emergency levels of public health, and home quarantine, the mental health of people, was severely affected. In this regard, the present study aimed to assess the effects of the COVID-19 pandemic on mental health. Methods: This descriptive-analytical cross-sectional study was conducted in 2020 in Kerman. The study sample consisted of 500 cases who were selected via the available sampling method. Due to the conditions of the COVID-19 pandemic, data was collected through online questionnaires shared on WhatsApp and Telegram (including the general population living in different parts of Kerman. To assess mental health, the 12-Item General Health Questionnaire (GHQ-12) was used, the validity and reliability of which have been confirmed in various studies (Cronbach's alpha of 0.8). Factors affecting mental health status included demographic information (including age, gender, education, occupation, marital status, and income) and questions about media use status. The collected data were analyzed in SPSS software (Version 23) using independent t-test, analysis of variance (ANOVA), and logistic regression. Results: The mean age of the subjects was reported as 34.94 years, and 58.6% of the subjects did not have good mental health status. Moreover, 88.8 % of participants followed COVID-19 news through social media. The results of one-way ANOVA indicated that mental health scores were different in different groups of age, education, occupation, and income (P<0.05). Furthermore, in logistic regression analysis, the factors affecting mental health, education, and life satisfaction were significant, indicating a better mental health chance in people with higher-level education and higher life satisfaction (P<0.05). Conclusion: As evidenced by the obtained results, the COVID-19 pandemic is associated with an increased risk of mental health problems. Therefore, it is suggested to develop mental health support programs and psychological interventions.

93-109

Authors: Erfan Pourshahri , Meisam Dastani , Matineh Khoshkhoo , Amirhosein Sharghi , Saeed Yaghoubi , Leila Sadeghmoghadam *

Introduction and purpose: The identification of barriers and concerns regarding the acceptance of the Covid-19 vaccine is of paramount importance. Accordingly, this systematic review was conducted to determine the factors affecting the acceptance and non-acceptance of the Covid-19 vaccine. Methods: This systematic review was performed in accordance with the principles of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The data were retrieved from PubMed, WOS, and Scopus in May 2021. The inclusion criteria entailed: 1- All original articles published on the reasons for acceptance or non-acceptance of the Covid-19 vaccine and 2- English language articles. On the other hand, the exclusion criteria were as follows: 1- Overlap of some articles in several databases, 2- The non-original articles, such as review articles or letters to editors, 3- unrelatedness to the objectives of the study, and 4- Lack of access to the full text of the articles. Results: The query yielded a total of 442 articles. After removing duplicates, as well as screening and qualitative evaluation of articles, 75 articles were finally selected for review in this study. Based on the obtained results, gender in individual factors, trust in governments, hospitals in social factors, and concerns about vaccine side effects among vaccine-related factors played the most important roles in accepting and rejecting the vaccination. Conclusion: Removing barriers to vaccination based on individual, social, and vaccine factors, as well as informing people about its benefits should be a priority for health organizations and institutions. Consequently, education and information campaigns on vaccination outcomes should be established at the community level to address individual and social concerns, as well as vaccine-related concerns.