marzieh nojomi

General practitioners (GPs) play a crucial role in providing primary healthcare services. However, there is limited understanding of the specific roles and responsibilities of GPs in Iran's healthcare system. The objective of this qualitative study is to explore the various roles and responsibilities of GPs in Iran's healthcare system by gathering insights from different stakeholders.

Semi-structured interviews were conducted with 32 health policymakers and GPs in Iran between April and December 2021. Participants were selected using a purposive sampling method. The interviews, conducted in Persian, were transcribed verbatim. Data analysis was performed using both deductive and inductive content analysis. Initially, deductive coding was applied based on the research questions, followed by inductive coding to allow new concepts to emerge from the interview data. Qualitative analysis was conducted using MAXQDA 22.

The study included a diverse group of participants in terms of age, gender, experience, and workplace. During data analysis, 173 primary codes were identified, which were categorized into four themes: "The evolving role of GPs," "rhe skills and competencies of GPs," "GPs' perspectives on their role," and "requirements for general practitioner reinforcement."

Recognizing GPs as gatekeepers within Iran's healthcare system requires significant measures in both health policy and public attitudes. It is crucial to shift public perception so that individuals rely more on GPs as their first point of contact in the healthcare system, using secondary services only through referrals. This shift should be accompanied by a greater emphasis on strengthening primary care and the role of family physicians in service delivery.

Social health is more important and sensitive than the physical and mental health. Women's health, as half of the society's population, affects the dimensions of family and society's health.Therefore, upper-level documents and laws can have positive effects on the health of all members of the society. The present study was conducted with the aim of determining the approach of upper-level documents in order to improve the social health of women, family and society.

The current research is a qualitative study. In order to review, a list of relevant upstream documents was prepared (18 related documents) and conducted by the researchers.

The analysis of the upstream documents of the country showed that all aspects of women's social health have been paid attention to in the country's constitution. The third, fourth and sixth development programs have also covered social health. In the general policies of creating transformation in the education system, charter of women's rights and responsibilities, women's employment policies, the national document on women's health, the approach of women's social health and social health promotion of society has been seen. In other upstream documents, some dimensions of women's social health are less clear.

The upstream documents of the country are related to the social health of women. It is possible to take a step towards improving the social health of the society with appropriate executive tools, internal and inter-sectoral cooperation, reforming the culture of officials and women's self-confidence.

During the pandemic of COVID-19, the function and performance of hospitals have been affected by various economic-financial and management aspects. The aim of the current study was to assess the process of therapeutic care delivery and also the economic-financial functions of the selected hospitals before and after COVID-19.  

This research is a descriptive-analytical study and a cross-sectional-comparative study in terms of time, and it was conducted in several selected teaching hospitals of Iran University of Medical Sciences. A purposeful and convenient sampling method was used. The data has been collected using the standard research tool (standard checklist of the Ministry of Health) in the two areas of financial-economic  and healthcare performance (such as Data of financial and economic indicators such as direct and indirect costs, liquidity ratio and profitability index as well as key performance indicators of hospitals such as bed occupancy ratio (BOR; %), average length of stay (ALOS), bed turnover rate (BTR), bed turnover distance rate (BTIR) and hospital mortality rate (HMR), physician-to-bed ratio and nurse-to-bed ratio) of hospitals in two times before and after the outbreak of COVID-19 (time period 2018 to 2021). The data was collected from 2018 to 2021. Pearson/Spearman regression was used for the evaluation of the relationship between variables using SPSS 22.  

This research showed the admission of COVID-19 patients caused a change in the indicators we evaluated. ALOS (-6.6%), BTIR (-40.7%), and discharge against medical advice (-7.0%) decreased from 2018 to 2021. BOR; % (+5.0%), occupy bed days (+6.6%), BTR (+27.5%, HMR (+50%), number of inpatients (+18.8%), number of discharges (+13.1%), number of surgeries (+27.4%), nurse-per-bed ratio (+35.9%), doctor-per-bed ratio (+31.0%) increased in the same period of time. The profitability index was correlated to all of the performance indicators except for the net death rate. Higher length of stay and turnover interval had a negative effect on the profitability index while higher bed turnover rate, bed occupancy ratio, bed day, number of inpatient admission, and number of surgery had a positive effect on the profitability index.  

It has been shown from the beginning of the COVID-19 pandemic, the performance indicators of the studied hospitals were negatively affected. As a consequence of the COVID-19 epidemic, many hospitals were not able to deal with the negative financial and medical outcomes of this crisis due to a significant decrease in income and a double increase in expenses.

Cardiovascular disease, the first leading cause of death worldwide, is associated with different consequences, including rehospitalization. Health literacy (HL) is a factor with potential effects on rehospitalization. This study aimed to examine the relationship between HL and rehospitalization among patients with myocardial infarction (MI). This prospective cohort study was conducted in 2015–2017. Participants were 366 hospitalized patients with MI who were conveniently recruited from four teaching hospitals in Tehran, Iran. A demographic questionnaire and the Health Literacy for Iranian Adults instrument were completed for participants at the time of their hospital discharge. One month after hospital discharge, thirty-day rehospitalization was assessed over telephone. The SPSS program (v. 16.0) was used to analyze the data through the Chi-square test, independent-sample t test, one-way analysis of variance, Pearson’s correlation analysis, and logistic regression analysis. T he t otal m ean s core o f H L w as 5 3.08±16.64 ( in the possible range of 0–100). Most participants (78.6%) had inadequate or barely adequate HL. At the time of rehospitalization assessment, fifteen participants were inaccessible. Among the remaining 351 participants, 28 (8%) reported thirty-day rehospitalization. The mean scores of HL among the participants with and without rehospitalization were 55.36±19.06 and 53.08±16.53, respectively. Logistic regression analysis showed that after adjusting the effects of potential confounders, HL had a significant relationship with rehospitalization (odds ratio=1.05; 95% confidence interval: 1.007–1.1; P=0.024). Most hospitalized patients with MI have limited HL, and their HL has a significant relationship with rehospitalization.

Sir, Within the past 18 months, the prevalence of the COVID-19 (Coronavirus Disease 19) pandemic in the world  (as well as in Iran) has fluctuated widely, but its trend has spread rapidly around the world. Despite the efforts of governments, this trend has been even greater in recent months in some less developed and developing countries. The prevalence of COVID‑19 depends on various factors, such as health infrastructure, health, and economic, social, and cultural policies of countries and differs from country to country. The fluctuations in the spread of this disease in the form of different waves  (first, second, third, fourth, etc.) have appeared in many countries, including Iran  (battling the fifth wave of the disease).[1,2]

Multiple-choice questions (MCQs) are a common assessment method, and it is crucial to design them carefully. Therefore, this study aimed to determine the item analysis of MCQ exams in clerkship tests for general medicine students.

Following a cross-sectional study, a total of 1202 MCQs designed for fourth-year clerkship medical students in the second semester of 2019 were analyzed. Difficulty and discrimination indices of student scores and taxonomy levels were then computed. Furthermore, the prepared standard structural Millman checklist was utilized.

Of the 1202 MCQs, according to difficulty indices, most questions (666) were considered acceptable (55.39%). In terms of the discrimination index (DI), 530 (44.09%) questions had an average discrimination coefficient. Additionally, 215 (17.88%) had a negative or poor DI and required revision or elimination from the tests bank. Of the 1202 MCQs, 669 (50.7 %) were designed at a lower cognitive level (taxonomy I), 174 (14.5 %) belonged to taxonomy II, and 419 (34.8%) of the questions had taxonomy III. Moreover, according to the structural flaws of the Millman checklist, the most common structural flaw was a lack of negative choices for Stems 1127 (93.8 %), while vertical options 376 (31.3%) were the least common.

Based on the results, it is recommended that easy questions and negative/poor DI of items, a high level of Bloom’s taxonomy type I, and questions with unstructured flaws be reviewed and reconstructed to improve the quality of the question banks. Holding training courses on designing test questions could effectively improve the quality of the questions.

The multi-state models help more closely study of the factors affecting the survival of patients with breast cancer.

We conducted the present retrospective cohort study on 2030 Iranian patients with breast cancer in 2020. The patients’ follow-up period ranged from 1 month to 15 years. Accordingly, the initial treatment, metastasis, and death were considered as the first, second, and absorbing states, respectively. The multi-state model was utilized for modeling and analyzing the data at a 95% significance level using the MSM package in R software.

The mean age (± standard deviation) of the patients included at diagnosis time was 55.3 (±12.07) years old. The first one year and 5 years adjusted transition probabilities for transitions from the treatment to metastasis estimated as 0.85 (0.15 – 0.89) and 0.45 (0.21 – 0.61), and for metastasis to death transitions, they were estimated as 0.15 (0.1 – 0.21) and 0.55 (0.41 - 0.69), respectively. Moreover, the average sojourn times were estimated as 0.27 and 74.85 months for the treatment and metastasis states, respectively.

The obtained results revealed that over time, the transition probabilities of patients from surgery to metastasis state decreased, whereas the transition probabilities from metastasis to death state increased using the multi-state model.

Dietary patterns and diet quality index (DQI) are widely discussed in relation with different health conditions and have recently been taken into consideration for all cancer types. Since chronic inflammation has been recognized as an important biologic risk factor for cancer occurrence, especially in epithelial tissues, proinflammatory or anti-inflammatory characteristics of diet has become the center of attention. In the present study, we aimed to identify whether a specific dietary pattern, Mediterranean dietary score (MDs), and dietary inflammatory index (DII) were associated with overall cancer risk in Iranian population.

This study was performed in the context of the Golestan cohort study. Participants with extreme daily energy intake or those who did not answer more than 30 question of the Food Frequency questionnaire (FFQ) were excluded. Dietary patterns, MDs, and DII were measured from FFQ. Age, sex, total energy, place of residence, smoking, wealth score, ethnicity, opiate use, BMI, education, marital status, and physical activity score were considered as confounding variables. Using Cox proportional hazards regression models, hazard ratios (HRs) and 95% confidence interval of cancer were estimated.

HRs (95% CIs) of all cancers by quartiles of Western dietary pattern, DII, and MDs showed that the forth quartile of the Western dietary pattern is attributed to 23% higher cancer risk (HRs: 1.23, CI: 1.09-1.40, P< 0.001, adjusted for age and sex) compared to the first quartile. It also remained significant after further adjustments (HRs = 1.20, CI: 1.06-1.36, P< 0.001).  There was a higher cancer risk in the fourth quartile of DII in comparison with the first quartile (HRs = 1.16, CI: 1.01-1.32, P trend < 0.001, adjusted for age and sex). The lower adherence to the Mediterranean dietary pattern also largely contributes to 27% higher cancer risk (HRs: 1.27, CI: 1.12-1.44), P trend < 0.001, adjusted for age and sex), which also remained remarkable after further adjustments ((HRs =1.19, CI: 1.05-1.35, P trend < 0.001).

Cancer is highly correlated to dietary intake and dietary patterns, such as the Western dietary pattern, while the Mediterranean diet score was inversely associated with cancer risk. Further investigations are required to get a broader insight into cancer determinants in population.

The current COVID-19 pandemic started in Wuhan, China, in December 2019. The World health Organization (WHO) declared the COVID-19 as a public health emergency of international concern on January 30, 2020, and recognized the situation as a pandemic on March 11, 2020.  Around 135 million confirmed cases and around 2.9 million deaths until the first week of April 2021 have been among its direct impacts on human health.All countries have been affected in different degrees, and each of them has used different strategies to protect themselves against health and nonhealth consequences of this epidemic. Although all approaches are full of mistakes with fatal and painful results, some of them were successful in limiting the epidemic. One of the astonishing improvements is development of several vaccines in a relatively short period of time, which has increased hopes for epidemic control. This review aims to critically appraise the strategies for COVID-19 epidemic control in Iran since the beginning of the disease until the fourth peak of disease in March 2021.

Risk factors of noncommunicable diseases (NCD) are increasingly contributing to morbidity and mortality in Iran. Health care providers’ competencies and motivation are essential factors for the success and efficiency of primary health care.  This field trial aims to evaluate the impact of a results-based motivating system on population level of the NCD risk factors field trial (IRPONT) in Iran.

Population groups of 24 rural or urban catchment areas from 3 provinces were randomized to 1 of the 4 types of study groups. The groups were defined based on a set of 4 intervention packages. Extra 8 rural or urban catchment areas in a separate city were considered as independent nonintervention (control) group.  Population levels of major NCD risk factors in all 32 population groups were measured at the beginning of the trial, at the end of the first year, and will be measured in the second year through standardized population surveys. As the outcome measure, the difference in population levels of the risk factors will be compared among the study groups. Study group IV will be compared with combined control groups (study groups I, II, and III). Also, we will conduct subgroup analysis to determine the effects of interventions 2, 3, and 4.

Ethics: 

This trial has received ethical approval from National Institute for Medical Research Development in Iran (IR.NIMAD.REC.1396.084) in 2017.

Trial Registration Number: 

This trial has been registered on the Iranian Registry of Clinical Trials (identifier: IRCT20081205001488N2). Registered on 3 June 2018 and updated on 12 April 2020.

 Down syndrome (DS) screening has been integrated into prenatal care programs in Iran.

 Using cost-benefit analysis (CBA) method, this study aimed to evaluate the economic aspects of combined first trimester screening in Iran.

 The population of this descriptive cross-sectional study included all pregnant women in Tehran, Iran. A decision tree model was used to determine the costs and benefits of diagnosing and averting a DS fetus through screening. Direct and indirect costs of diagnosis and the incremental living costs of DS children in 2019 were calculated from societal perspective and compared with each other.

 The cost of identifying a fetus with DS in Iran is approximately equal to 611 million Tomans (about 25,000 USD), and the incremental living cost of DS children (benefits) was about 34 million Tomans (about 2,270 USD). The net monetary benefit was negative due to the lower incremental living cost of a DS child than the cost of finding the affected fetus.

 The result of this study showed the screening tests for DS needs revision and consideration in Iran, and due to the high cost of screening, coverage with insurance organization is necessary.

School violence as a health issue is a global concern. One of the problems that affect the health and well-being of children at school is bullying.

In this study, we aimed to examine the association of depression and anxiety with bullying among 6 - 19-year-old students in Iran.

This study was conducted in Tehran, Iran, in 2020. A multistage cluster sampling method was used, and 54,550 students aged six to 19 years of both sexes, from urban and rural areas, were selected. Standard questionnaires, according to the WHO recommendations, were used for data collection. Involvement in bullying in the past 12 months and anxiety and depression status in both bully and bullied students were investigated by standard questionnaires. To compare the psychiatric problems and violent behavior, the Wald chi-square test was applied. The multilevel fixed-effect model and logistic multivariate regression were used to adjust the multilevel effects and estimate the odds of anxiety and depression in both bully and bullied students. All statistical analyses were performed at a 95% significance level.

Of the total students, 50.9% were males, 29.45% were in the 6 - 10 age group, and 70.55% in the 11 - 19 age group. There was a significant difference in depression and anxiety between boys and girls in both age groups (P < 0.001). Amongst males, 11.7% of the students aged 6 - 10 and 11% of the students aged 11 - 19 and in females, 7.7% aged 6 - 10 and 10.4% aged 11 - 19 had at least four experiences of bullying to others in the last year. The odds ratios for depression in male bullies were 1.3 and 1.5 in 6 - 10 and 11 - 19 age groups, respectively. The odds ratios for depression in bullied males and females were 4.2 and 3.9 in 6 - 10 and 2.9 and 4.3 in 11 - 19 age groups, respectively. Bulling others increased the odds of anxiety to 1.7 and 1.9 in males and 2.1 and 1.9 in females in 6 - 10 and 11 - 19 age groups, respectively. In bullied students, the odds of anxiety were estimated at 2.9 and 2.2 in males and 3.4 and 2.2 in female students respectively, in 6 - 10 and 11 - 19 age groups.

There was a significant positive association between psychological disorders (anxiety and depression) and bullying among 6 - 19-year-old students. Victims of bullying were more at risk of depression and anxiety. This health-threatening phenomenon should not be ignored.

The purpose of this study was to perform a narrative review and documentary research in the history of community medicine specialty formation and the needs for its existence in health systems. We searched and reviewed related literature and documents in English and or Farsi (printed or online). Data was extracted and findings were categorized, summarized, and reported. About a century ago community medicine specialty was formed to respond to major health challenges of that time such as neglecting the effects of social determinants on populations’ health and total separation between clinical care and public health. Community medicine professionals are able to address many of the current health problems such as inequalities in health, fair financing problems, increasing demands and costs and disease-based health system approaches. They can be the leading advocates to emphasize the importance of social determinants in health of populations. They can promote communications with influencing institutions outside the health system to improve the health of the communities. This discipline can pave the way for the health systems to tackle the most important contemporary health challenges. Lack of attention to this discipline may hinder the achievement of sustainable development goals and health promotion of the communities. More support from officials and utilizing the skills of community medicine specialists can help health systems not only to better respond to the health needs of the society but also to facilitate the achievement of their main goals.

In this systematic review, we aimed to evaluate the existing strategies and interventions in domestic violence prevention to assess their effectiveness.

To select studies, Pubmed, ISI, CINAHL, PsycINFO, Cochrane, Scopus, Embase, Ovid, Science Direct, ProQuest, and Elsevier databases were searched. Two authors reviewed all papers using established inclusion/ exclusion criteria. Finally, 18 articles were selected and met the inclusion criteria for assessment. Following the Cochrane quality assessment tool and AHRQ Standards, the studies were classified for quality rating based on design and performance quality. Two authors separately reviewed the studies and categorized them as good, fair, and poor quality.

Most of the selected papers had fair- or poor-quality rating in terms of methodology quality. Different intervention methods had been used in these studies. Four studies focused on empowering women; 3, 4, and 2 studies were internet-based interventions, financial interventions, and relatively social interventions, respectively. Four interventions were also implemented in specific groups. All authors stated that interventions were effective.

Intervention methods should be fully in line with the characteristics of the participants. Environmental and cultural conditions and the role of the cause of violence are important elements in choosing the type of intervention. Interventions are not superior to each other because of their different applications.

Chronic diseases such as diabetes have an adverse effect on the quality of life (QOL) of patients. It has been shown physical activity can improve the quality of life.

The aim of current study was to determine the effectiveness of Physical activity package (PAP) on the quality of life (QOL) of individuals with type 2 diabetes.

Using a randomized controlled trial, 100 individuals with type 2 diabetes were studied. The patients were selected from endocrine clinic of a teaching hospital of Iran University of Medical Sciences. Subjects were randomly assigned to intervention (PAP and routine care), and control (just education and routine care) groups. The WHO Quality of Life‑ brief (WHOQOL ‑ BREF) Questionnaire was completed by all patients at the beginning and after three months. The IPAQ (long form) physical activity questionnaire was completed at the beginning, 1.5 and 3 months follow‑up for all subjects. The Mann‑Whitney U, Chi‑square and repeated measure of analysis of variance (ANOVA) tests were used to analysis of data. The significant level was considered as 0.05.

Average of age was 46.22 ± 6.10 years. The scores of physical, psychological and environmental domains of WHOQOL ‑ BREF were 27.42 ± 3.34, 21.44 ± 3.24 and 27.02 ± 4.68 in intervention group versus 22.58 ± 3.71, 17.29 ± 3.46, and 24.41 ± 3.92, in control group respectively. These differences were statistically significant (P < 0.0001). There was not any significant difference for social relations domain across two groups.

Physical activity package had a significant effect on all aspects of QOL just social relations of individuals with type 2 diabetes. It seems social relations activities needs more time to change

Depression and anxiety are the most common mental disorders and currently, they constitute one of the main causes of disability and death. The high prevalence of psychiatric disorders and their increasing burden are noteworthy. The aim of this study is to investigate the effectiveness of community-based preventive interventions for depression and anxiety in women.

We systematically searched for articles published up to the beginning of 2018, which addressed community-based preventive interventions for depression and anxiety in women. The studies were searched in PubMed, Scopus, Cochrane Library, Web of Science, PsycInfo, IranMedex, SID and EMBASE electronic databases. Articles that complied with our inclusion criteria (preventive interventions involving healthy adult women aged 18 to 65 years) were reviewed. Quality assessment of the articles was performed using standard tools. We extracted the required data and reported the results in a narrative form.

Twenty-three articles were identified and entered into the final review. Depression and anxiety symptoms were decreased in more than 70% of interventions. Cognitive behavioral therapy (CBT) and exercise were the most effective interventions. In addition, computer and internet-based programs had positive outcomes in both categories of depression and anxiety.

Community-based preventive programs for depression and anxiety in women had promising and positive results. CBT and exercise were the most effortless, yet the most effective interventions to apply. Computer and internet-based programs had the benefit of covering many people simultaneously. These interventions are cost-effective and feasible among Iranian women.

According to the expansion of suicide prevention applications in recent years, the aim of this study was to review randomized controlled trials (RCTs) and pretest-posttest studies that evaluated the effectiveness of suicide prevention applications.

In this systematic review, we searched online databases including Pubmed, SCOPUS, Web of Science, Chocrane Database, and Google Scholar to find randomized controlled trials and pretest-posttest studies published up to Jul 18, 2019. Randomized controlled trials and pretest-posttest of efficacy self-guided telephone applications that reported any primary and secondary outcome of suicidal thoughts and behaviors were included in the review. We evaluated the articles using the CONSORT 2010 checklist.

After screening articles, 7 studies were included in this review. Four studies focused on the effectiveness of applications on suicide thoughts and attempt, 2 on effectiveness of applications on self-injury, 4 on depression and anxiety, 1 on impulsivity, and 2 on adaptive strategies. Overall, mobile phone applications were associated with reductions in suicidal ideation scores at post intervention, and enhancement of adaptive skills; however, no evidence of reduction was reported in impulsivity after use of applications.

Despite the differences in studies, this review showed that the use of mobile applications had an overall positive effect on reducing the risk of suicide and improving performance and health of patients.

The present study aimed to examine the association between ADHD and suicide attempts among adolescents with bipolar disorder. Participants were 168 adolescents who fulfilled DSM-IV-TR criteria for bipolar disorder. They were divided into 2 groups: The first group of patients with bipolar disorder with a history of suicide attempts (n = 84) and the second group without a history of suicide attempts (n = 84). ADHD and other variables were analyzed using a chi-squared test and logistic regression model. No significant difference was observed between the 2 groups in comorbidity of ADHD and other psychiatric disorders (P value > 0/05). In the logistic regression model, and after controlling for other factors, gender (OR = 3.9, CI 95%: 1.5-9.6) and history of sexual abuse (OR = 3.4; CI 95%: 1.06-11.3) were the only 2 factors associated with a history of suicide attempts. No significant association was found between ADHD and suicide attempts in adolescents with bipolar disorder.

Cardiovascular disease (CVD) is the leading cause of death globally and has enormous costs for healthcare systems. This disease has a strong association with lifestyle behaviors. Therefore, applying reliable and effective strategies for prevention and treatment of CVD is important. In this study, we aimed to evaluate the adherence of cardiologist physicians to the American Heart Association (AHA) guideline for prevention of CVD. Using a cross-sectional study, data were gathered for 208 patients using their medical records in the cardiology ward of a general teaching hospital. A physician systematically reviewed the medical records and completed the checklist in each domain. Adherence to the AHA guideline was evaluated in treating physician's choices and recommendations regarding these eight variables: hypertension (HTN), dietary intake, weight management, diabetes management, physical activity, blood lipid management, smoking, and aspirin prescription. Medical records of 208 patients (109 men and 99 women) with the mean age of 62 ± 14 years were reviewed. The frequency of CVDs was 5.3% for coronary heart failure (HF) and 67.8% for the acute coronary syndrome (ACS). Cardiovascular risk factors of patients were HTN (53.8%), diabetes (34.6%), hyperlipidemia (17.3%), smoking (17.8%), and obesity (31.7%). We found a proportion of 59%, 15%, and 26% for high, moderate, and low adherence to AHA guideline, respectively. Our study showed almost 60% high adherence to the AHA guideline by physicians in a teaching hospital. The most and the least adherence to the AHA guideline were for obesity and diabetes recommendations, respectively. More studies are needed to evaluate preventive guideline adherence in Iran. Establishing national preventive and therapeutic guidelines may increase the physicians' adherence to them.

Numerous studies have been conducted to evaluate the frequency of hypovitaminosis D in patients with fibromyalgia syndrome (FMS) and its association with FMS symptoms. This study aimed at assessing the effect of hypovitaminosis D on the symptoms and quality of life of patients with fibromyalgia.
A total of 74 FMS patients with hypovitaminosis D were randomly assigned into group A (Trazodone 25 mg at bedtime vitamin D 50 000 IU weekly) and group B (Trazodone 25 mg at bedtime placebo). Serum vitamin D level, Widespread Pain Index (WPI), Fibromyalgia Impact Questionnaire (FIQ), Pittsburgh Sleep Quality Index (PSQI), and Short Form Health Survey (SF-36) were used at the beginning of the treatment and 4 and 8 weeks post treatment.
Significant improvements were observed in WPI, FIQ, and PSQI scores in both groups. Moreover, combination of vitamin D and Trazodone resulted in significant improvement of SF-36 scores compared to Trazodone therapy. Improvement in pain-related indices including the WPI and the physical component score (PCS) fraction of SF-36 was more noticeable in vitamin D/Trazodone combination therapy.

This study suggests that vitamin D supplementation has significant therapeutic benefits in the management of FMS, especially in pain reduction of patients with fibromyalgia. According to our results, a combination of vitamin D supplements and a conventional antidepressant, when given to vitamin D-deficient fibromyalgia patients, could significantly improve both physical and psychological symptoms.

Screening and behavior consultation are considered to be limited, dispersed and expensive services across the country. To deliver efficient and equitable services current disordered practices need to be consolidated. An analysis of current situation, learned lessons and future scopes of country’s preventive care delivery, along with a review of international experience and generous participation of various stakeholders, led to proposing a model for screening and behavior consultation practices in IR. Iran. Upon the results of the previous steps, the desired model was based on the network system and family physician. Comprehensive health centers and other centers affiliated to the network are the most appropriate service positions. However, private and academic preventive centers are playing their rules. The proposed model matches the overall pattern of service delivery in the health system (network system with the private sector and the educational sector).

Policy-makers in the Ministry of Health Care and Medical Education need to have knowledge concerning high-risk behaviors among medical students in order to have positive changes in the educational system of universities of medical sciences.
To enquire into the prevalence of high risk behaviors among medical students.
A cross-sectional study was conducted on medical students in one of the largest medical universities in Tehran, Iran. A total of 275 medical students participated in the study. They filled out a self-developed questionnaire that covered both demographic characteristics and items on eight main risk domains including safety, violence, depressed mood, physical activity, nutrition, smoking, alcohol consumption, and substance abuse.
A total of 275 students (55.3% male, mean age: 23.7 ± 4.3 years) took part in the study. Approximately, 38% of the subjects reported less than 30 minutes of low intensity physical activity during the preceding week. Obesity and overweight were seen in 24.4% of the participants. Around 8% of the students had body mass index (BMI) values below 18 kg/m2. Daily smoking during the past month was reported by 10.5%. A total of 29 students (10.2%) mentioned drinking alcohol during the past month. Sense of depression and hopelessness were reported by 26.6% of students. A total of 5.5% had seriously considered committing suicide, with 3.6% who had actually attempted, with some doing it more than once.
In this study, physical inactivity, obesity/overweight, and depressed mood were more frequent. Smoking, alcohol consumption, and drug abuse were more prevalent among male students

Spiritual well-being is an important issue in health sciences, hence the need for validated instruments to assess this aspect of health in the Iranian population. The aim of the current study was to determine the validity of the Persian versions of 2 most common measures of spiritual health (Spiritual Well-Being Questionnaire [SWBQ] or Spiritual Health and Life-Orientation Measure [SHALOM] and Spiritual Well-Being Scale [SWBS]).
This was a cross-sectional study via a convenience sampling method in Iran University of Medical Sciences with 170 participants aged above 18 years comprising students, teachers, and administrative staff and managers. The study was conducted from September 7, 2014 to September 20, 2015 in Tehran. Four questionnaires, namely the SWBQ, SWBS, General Health Questionnaire (GHQ-12), and Oxford Happiness Questionnaire (OHQ), were used. Statistical analysis was done using SPSS 18 and LISREL (version 8.2). Cronbach’s alpha, intra-class correlation coefficient, Pearson correlation, and confirmatory factor analysis were employed to assess the validity and reliability of the questionnaires.
Cronbach’s alpha for the SWBQ and the SWBS was greater than 0.85. The repeatability of both questionnaires was between 0.88 and 0.98. The Pearson correlation for the SWBQ and the SWBS ranged from 0.33 to 0.53; and all the correlations were significant. The respondents who indicated a higher spiritual well-being also reported better general health and happiness.
The Persian versions of the SWBS and the SWBQ have good reliability, repeatability, and validity to assess spiritual health in the Iranian population.

Satisfaction of physicians could effect on their quality of life and quality of care of their patients.

The aim of current study was to determine the job satisfaction and lifestyle of specialist physicians in Tehran.

Using a cross-sectional survey between October 2014 and April 2015, convenience samples of 645 specialist physicians were evaluated. We used a self-administered questionnaire included items about demographic variables, lifestyle, overall health status, happiness, and job satisfaction. Physicians based on specialty type are categorized to two groups included surgical and non-surgical.

Mean age was 44.22 (±8.23) years old. The body mass index (BMI) had a mean of 25.07 (±2.98). Overall, 413 (64.5%) of participants were rated their happiness as “extremely happy” and happy. Four hundred and eight (69.5%) physicians were in an excellent or good status of health. Almost 70% (453) of studied specialist physicians were satisfied with their job. Orthopedic surgeons and obstetricians had the bests and worst general health respectively. The neurologists were happiest physicians. The general surgeons had the highest BMI.

Majority of studies physicians were in a good status of health and almost two third were happy. More than two third of physicians were satisfied with their job. About 40% had less than once physical activity per year and more than 45% were overweight and obese.

Viral hepatitis B is a common community infection. It damages the liver tissue and can be a risk factor for cirrhosis or also liver cancer. In this study, we investigated the major risk factors for hepatitis B in Hamedan blood donors.
119 HBs Ag positive patients and 452 HBs Ag negative blood donors were evaluated by filling a questionnaire. Logistic Regression was used to calculate Odds Ratios (OR) of risk factors.
Of a total 571 subjects, 27.6% were female with the same distribution in both groups. Of all subjects, 88.6% were living in cities and the rest were villagers. 65.7% were married. Among the risk factors studied “History of Surgery” ranked first (OR=3.11), and “Familial History of Liver Disease” was the second (OR=2.90). In contrast with our expectation, human bite, dental filling, and needle stick had odds ratios less than one.
Of all risk factors investigated in our study, “History of Surgery” had the highest odds ratio, which suggests a probability of transmission by surgical team members, which suggests further study. The major risk factors in our study were consistent with other studies but further investigations are essential.