Journal of Community Health Research
Volume:14 Issue: 1, Jan 2025

Tuberculosis (TB) remains a major public health challenge in India. Efforts outlined in the National Strategic Plan (2017-2025) are committed to achieve targets towards eliminating TB. Early identification of recurrence among cured TB cases is a crucial strategy towards this goal.  However, there are limited data on the implementation of long-term follow-up for cured cases.

A prospective mixed-method study was conducted to evaluate the implementation of long-term follow-up strategy among 180 cured TB patients. Quantitative assessment involved tracking follow-up visits at 6, 12, 18, and 24 months post-treatment success. Moreover, Focus Group Discussions (FGDs) with 46 TB Health Visitors (TB HVs) were conducted to identify barriers to the implementation of long-term follow-up strategies for cured TB cases.

Quantitative analysis revealed a decline in follow-up visits over time, and only 16.89% of patients were followed up by TB HVs during fourth visit at 24 months post-treatment. Recurrent TB was identified in 22 cases, 13.7% of which were not followed up by health workers. Qualitative analysis highlighted patient-related factors like loss to follow-up due to migration and denial of sputum testing. Health workers cited workload issues and inadequate financial incentives as barriers to implementation.

The study underscores challenges in implementing long-term follow-up strategies for cured TB patients in India. Addressing barriers such as loss to follow-up and workload issues among health workers is crucial for improving recurrence detection and management. Efforts to enhance program effectiveness must prioritize overcoming these barriers to achieve the goal of TB elimination by 2025.

Health is one of the most fundamental rights of individuals from birth and is guaranteed by national and international texts. This study aims to evaluate individuals' healthcare demand procrastination behaviors from a societal perspective.

This descriptive cross-sectional study was conducted in the province of Kocaeli, located in the Marmara region of Türkiye. The population of the study consisted of literate individuals aged 18-65 residing in Kocaeli. The sample included 438 individuals who volunteered to participate in the study. Data were collected using a sociodemographic information form and the Healthcare Demand Procrastination Scale (HDPS) through face-to-face interviews employing the convenience sampling method. Descriptive statistics and SPSS 27 software were used for data analysis.

Women were found to have statistically significantly higher total scores on the HDPS compared to men (p = 0.016; p < 0.05). Married individuals had significantly lower total scores for procrastination behaviors than single individuals (p = 0.015; p < 0.05). Participants with low income and no social security exhibited more healthcare demand procrastination behaviors (p = 0.015; p = 0.042; p < 0.05). A weak but significant negative relationship was found between age and procrastination behavior (r = -0.133; p = 0.005; p < 0.01).

To achieve a healthy society, it would be beneficial to implement policy regulations aimed at protecting disadvantaged groups who cannot seek healthcare services when needed due to various reasons.

This article explores the distinction between education and literacy, emphasizing their close yet separate meanings. Education typically refers to formal schooling and academic qualifications, while literacy now includes a wider range of skills beyond basic reading and writing, such as digital, financial, and health literacy. Education is achieved through structured learning environments and results in certifications, whereas literacy involves the application of knowledge to effect significant changes in one’s life. Effective learning brings about stable changes in behavior, unlike temporary shifts due to external factors. The article argues that true literacy depends on various societal factors, including supportive families, well-equipped schools, and community resources. Despite this, many individuals receive degrees without attaining comprehensive literacy. In epidemiological research, addressing bias and confounding variables is crucial. Bias, such as misclassification bias, can skew results by misrepresenting data. Confounding occurs when an external variable influences both exposure and outcome, potentially distorting the observed relationships. Residual confounding may persist despite adjustments, highlighting the need for accurate indicators. The article questions the validity of using educational level as a proxy for literacy, suggesting it may not fully capture literacy’s complexity and introduce residual confounding.

Dental students have experienced changes in their learning format due to the SARS-CoV-2 pandemic. This study aimed to evaluate their perspectives on E-learning during this time.

A cross-sectional study utilizing a validated and reliable questionnaire and an online self-report was conducted with dental students in 2022 in Yazd. The study included 120 dental students from the last three years of their program. Socio-demographic and academic data were collected, and certain questions explored students' perspectives on E-learning and its impact on dental education during the COVID-19 pandemic. Responses were rated using a four-point Likert-like scale. Data analysis was performed using SPSS (v. 24) with paired T-tests, one-way ANOVA, Tukey tests, and Pearson correlation (P < 0.05).

There was an insignificant difference between the two genders across all dimensions. Overall, 39 students (32.5%) believed that online courses are more appealing than in-person classes, whereas 72 students (60%) found dental professional courses with a laboratory format more engaging than online courses. A significant difference in the fear of COVID-19 was noted among 5thyear students compared to 4thyear and 6thyear students (P-value = 0.0001). Endodontics (39.2%) and prosthodontics (30.8%) were the two fields that were most negatively affected.

The results of this study indicated that online activity could serve as a beneficial substitute for dental students during the quarantine. Overall, students expressed positive views about the impact of E-learning during the COVID-19 pandemic. Additionally, a significant correlation was found between the fear of COVID-19 infection and the positive experiences associated with online activity.

Cutaneous Leishmaniasis (CL) remains a significant health concern in Iran, particularly in specific areas of Yazd province in central Iran. This investigation was conducted with the aim of presenting the spatial and temporal modeling of CL in Yazd province.

This was an ecological study, using data from the health department of Yazd province. The data for the cases of CL during 2004-2013 were extracted and merged into Arc Geographic Information System (GIS) 9.3 software. Cochran-Armitage test, Choropleth Map, Hot-Spot Analysis, and High/Low Clustering analysis were used to determine time trend, distribution of disease, hot-spots, and possible abnormal clustering, respectively.

The results indicated a decreasing trend of incidence of CL from 199 to 29.2 cases (per 100,000 populations) during 2004-2013. The findings of the choropleth map showed that cities of Khatam and Abarkuh had a high incidence of CL. The results of the analysis of hot spots showed that during 2004-2008, cities of Yazd and Saduq were classified as cold spots of disease and the difference with neighboring cities was statistically significant (p = 0.031). No hot spots were obtained. In the cluster analysis, no results were obtained to separate high or low level.

Maps of spatial distribution of CL were generated to facilitate the decision-making capacity at provincial health department. These results showed that in regions of Yazd province neighboring Fars, Isfahan and Kerman provinces, there was a high risk of disease. Hence, in these areas, preventive strategies can be focused and pursued more purposefully.

Domestic violence is a social and behavioral problem affecting almost half of females. This study aimed to compare the effectiveness of behavioral activation and metacognitive therapy on depression, emotion regulation strategies, and assertiveness in women victims of domestic violence.

The quasi-experimental design of the study was pretest-posttest with a control group. The statistical population included all female victims of domestic violence who referred to family counseling clinics under the supervision of Shiraz Welfare in 2019. This study was conducted on 45 people, who were selected using random sampling method and assigned to experimental and control groups. The measurement tools included the Beck Depression Inventory, Assertiveness Inventory, Cognitive Emotion Regulation Questionnaire, and Domestic Violence Against Women Questionnaire. The data were analyzed using multivariate analysis of covariance (MANOVA) and Kolmogorov-Smirnov test to check the normality of data distribution and the Levene test was applied to test the homogeneity hypothesis of group variances.

The mean age of participants was 36.58 ± 11.31 in behavioral activation group and was 35.17 ± 7.54 in metacognitive therapy group, and their marriage duration was 6.23 ± 2.89. The results demonstrated that behavioral activation therapy improved components of self-blame, blame others, repetition and positive concentration, assertiveness and depression, and metacognitive therapy components of self-blame, acceptance, cognitive emotion regulation strategies, positive focus, assertiveness, and improved depression (P < 0.05). However, there was no significant difference between the effectiveness of behavioral activation and metacognitive therapy (P < 0.05).

Behavioral and metacognitive activation therapies can be used to improve mental health and teach coping skills to women victims of domestic violence, educational and therapeutic planning.

Today's changes in health systems and the importance of health can be a basis for self-care, increasing the quality of services, patient satisfaction, achieving optimal levels of health in people, and finally using innovation to improve the quality of health services. Electronic measures in the health sector also include many benefits such as improving the quality of health services, reducing costs, and increasing efficiency. Therefore, this study aimed to design an ecosystem model of innovation with an emphasis on the role of e-government in Yazd hospitals.

This was a qualitative-quantitative study conducted in Yazd in 2023. In the qualitative phase, 7 people and in the quantitative phase, 70 senior and middle managers of government and non-government hospitals were selected and interviewed through convenience sampling. In this study, SMSRT-PLS 3.2.4 software was used to measure the reliability and validity of the questionnaire, considering the number of available samples (70 people) and the insensitivity to the normality of the data. Cronbach's alpha coefficient and composite reliability coefficient (CR) were used to examine reliability, and convergent validity was used to examine validity.

Most of the participants were female (81/43%), between the ages of 36-54 (34/29%), and had a master's degree (30%). After using factor analysis, the questionnaire was designed into 4 dimensions: 1- Activation of policies and regulations, 2- Access to data and infrastructure, 3- Funding and validation opportunities, 4- Ease of adoption and dissemination of innovations The results showed that the reliability of these dimensions was 89% , 91%, 76% and 88%, respectively. Also, the validity results of Wager showed that its value for the studied dimensions was 51%, 71%, 63% and 79%, respectively.

According to the accepted validity and reliability, this questionnaire can be a valid, reliable and easy-to-use tool to improve the field of technology. Although the questionnaire is in Persian, it can be used in other languages as a basis to check the validity and reliability through the scientific process.

This article has been updated due to an error in the names of the authors: https://jhr.ssu.ac.ir/article-1-1151-en.html

The mistake in Article 7 is that the order of the authors is  "Azita Khanjani 1, Ashraf Beirami 2*, Moosa Javdan 3", while the correct order is "Azita Khanjani 1 , Ashraf Beirami 2 *, Moosa Javdan 3, Aboubakr Jafarnezhad4". On behalf of the author, the publisher wishes to apologize for this error. The online version of the article was updated on May 12, 2025, and the previous version can be found at: https://jhr.ssu.ac.ir/article-1-1102-en.html

The mistake in Article 7 is that the order of the authors is " Zahra Mirjalili1, Saeed Sayadi2, Hamidreza Melai2, Abbas Babai Nejad *2 ", while the correct order is " Zahra Mirjalili 1 , Abbas Babai Nejad 2 *, Saeed Sayadi 2 , Hamidreza Mollaei 2 ". On behalf of the author, the publisher wishes to apologize for this error. The online version of the article was updated on March 20, 2025, and the previous version can be found at: https://jhr.ssu.ac.ir/article-1-1104-en.html

This study explores the complex phenomenon of glue-sniffing among the street children in Bangladesh, focusing on the complex interplay between hunger and addiction. Street children, often marginalized and forgotten, face numerous challenges including lack of shelter and limited access to education. In the midst of these hardships, many turn to glue-sniffing as a means of escape from hunger and harsh realities of their life. This paper explores the socio-economic factors that drive street children towards glue-sniffing. It examines how poverty and food insecurity push these children into the streets, where they are exposed to the lure of cheap and accessible inhalants. Moreover, the study explores the physiological effects of glue-sniffing on these vulnerable individuals. The findings of this study underscore the urgent need for holistic interventions that address both the immediate needs of street children, such as food and shelter, as well as the underlying factors driving their substance abuse. Ultimately, this paper will contribute to a deeper understanding of the complex dynamics at play within the lives of street children in Bangladesh.

Previous studies indicated the risk factors for COVID-19. Malnutrition is one of the main causes of immune system failure. This study aims to investigate the effect of nutritional status on the outcomes of COVID-19 in participants of Yazd Health Study (YaHS).

279 people who had taken a blood test before contracting COVID-19 were included in this study in 2022. Data of PO2 level, rate of hospitalization, "supplementation with oxygen" rate, BUN, and creatinine were extracted. Malnutrition status was evaluated using hemoglobin levels and body mass index (BMI). The authors applied analysis of variance (ANOVA) and independent sample t-test to show differences between levels of BMI and hemoglobin. All statistical analyses were conducted using IBM SPSS version 22.0 software.

The results showed a significant difference between hemoglobin levels and different BMI levels (P = 0.03). However, there was no significant relationship between different BMI levels and BUN (P = 0.34), creatinine (P = 0.42), BUN/Cr (P = 0.14), PO2 (P = 0.34), supplementation with oxygen (P = 0.26), and hospitalization rates (P = 0.97). The results according to the normal and abnormal hemoglobin levels were not significant.

According to the criteria used in this study to assess nutritional status (BMI and hemoglobin levels), there was no significant relationship between nutritional status (different levels of BMI and hemoglobin) and COVID-19 outcomes, including hospitalization rate, “supplementation with oxygen” rate, and low PO2 levels. Further studies in different countries using other nutritional status assessment tools are needed to confirm these findings.

Research indicates that individuals with autism spectrum disorder (ASD) often struggle with prosodic skills, which include the rhythm, stress, and intonation of speech. While most studies focus on children, some findings suggest these challenges persist into adulthood.

This comparative cross-sectional study used a quantitative approach to assess prosodic impairments in Persian-speaking adults with ASD. Thirteen Persian-speaking men with autism, aged 25 to 44 (mean = 32.84, SD = 4.17), participated. Their educational backgrounds ranged from third grade to 20 years of formal education. A control group of 26 healthy Persian-speaking men matched in age and education was also included. Prosodic skills were evaluated using five subtests from the Persian version of the Montreal Protocol for the Evaluation of Communication (P.M.E.C.): linguistic prosody comprehension, linguistic prosody repetition, emotional prosody comprehension, emotional prosody repetition, and emotional prosody production. Data were analyzed using descriptive statistics, independent samples t-tests, and the Kolmogorov-Smirnov test.

Participants with ASD performed significantly worse than the control group across all five subtests. Significant differences were found in linguistic prosody comprehension (p = 0.002), linguistic prosody repetition (p = 0.0001), emotional prosody comprehension (p = 0.004), emotional prosody repetition (p = 0.015), and emotional prosody production (p = 0.0001). These results highlight substantial deficits in both linguistic and emotional prosody among adults with ASD.

This study emphasizes the need for targeted assessment and intervention strategies for prosodic impairments in adults with autism. The findings have practical implications for clinical, educational, and research settings.

 Hypertension, known as a silent killer, leads to various complications and may influence serum liver enzymes, potentially resulting in liver diseases. This study aims to investigate the relationship between hypertension and serum liver enzymes in Yazd, Iran.

 This cross-sectional study analyzed data from the first phase of Shahedieh Yazd Cohort Study (2015–2016), including 9,550 individuals aged 35–70. Statistical analyses were performed using Chi-square tests and multivariable logistic regression in STATA 17, with a significance level of P < 0.05.

Among 9,550 participants (mean age 49.68 ± 9.54, 50.02% male), hypertension prevalence was 7.53%. Hypertensive individuals showed significant differences in age, sex, education, smoking, diabetes, cardiac diseases, and cholesterol levels compared to normotensive individuals. However, no significant associations were found with fatty liver history, alcohol consumption, low-density lipoprotein (LDL), high-density lipoprotein (HDL), serum glutamic-oxaloacetic transaminase (SGOT, also known as aspartate aminotransferase [AST]), or serum glutamic-pyruvic transaminase (SGPT, also known as alanine aminotransferase [ALT]) levels. Liver enzymes, including AST, ALT, gamma-glutamyl transferase (GGT), and alkaline phosphatase (ALP), were significantly associated with hypertension, particularly in younger age groups. GGT was related to hypertension in individuals aged 30–39 and ≥50, while ALP showed an association only in those aged ≥ 60 (P < 0.05).

A significant association between liver enzymes (ALT, AST, GGT) and hypertension was observed, especially in younger individuals. These findings suggest liver enzymes as potential hypertension indicators, emphasizing the need for early screening. Public health policies should incorporate liver function tests alongside hypertension management, particularly for younger populations.

Confounders can distort the actual connection between exposure and outcome, resulting in skewed results. In research, it is essential to account for confounding variables to preserve the validity of causal inferences.

In this narrative review study, all statistical methods for adjusting confounding variable such as standardization, propensity score, stratification, restriction, statistical model for control, matching, randomization were reviewed. 

The five most important methods were reviewed.

Adequate adjustment improves the internal validity of findings and elucidates the relationships among variables, underscoring the importance of a comprehensive analysis of confounding for trustworthy research results.

The purpose of this research is to determine the dimensionality and reliability assessment of the questionnaire of Adult Responses to Symptoms (ARCS) of Iranian children suffering from chronic diseases. When adults respond appropriately to the physical symptoms of sick children, they can manage chronic diseases more effectively and prevent the worsening of symptoms associated with psychological factors.

In this psychometric and validation study, 290 parents of children aged 4 to 16 with chronic diseases were selected through consecutive sampling. They were recruited from a children's educational and therapeutic center in Rasht city (north of Iran) and participated by answering the ARCS questionnaire between December 2021 and June 2022. Confirmatory factor analysis (CFA) was used to determine the construct validity. Pearson correlation coefficient and intraclass correlation coefficient (ICC) were employed to assess the test-retest reliability over a 4-week interval.

In the CFA, the factor loadings of all the items were above 0.3, and the fit indices of the modified Iranian model (PCFI = 0.69, PNFI = 0.62, CMIN/DF = 2.80, RMSEA = 0.07, IFI = 0.90, CFI = 0.90 and GFI = 0.92) were obtained, which shows the confirmation of the three-factor model of the ARCS questionnaire (i.e. protective, encouraging and minimizing dimensions). The test-retest reliability of the ARCS questionnaire scores for the dimensions of protective, encouraging/monitoring and minimizing responses were equal to 0.85, 0.94 and 0.87 (p = 0.001). Furthermore, ICC for the dimensions of protective, encouraging/monitoring and minimizing responses was obtained as 0.90, 0.97, and 0.93, respectively. The Cronbach's alpha coefficients were also calculated for the three above-mentioned subscales as 0.83, 0.70, and 0.60, respectively.

The ARCS questionnaire has desirable reliability coefficients and construct validity. It can be used for clinical monitoring, educating families of children with chronic illnesses, and evaluating improvements in treatment outcomes.

Promoting the health of society members, especially the workforce, is a top priority for any society. Hence, this study was conducted with the aim of determining the relationship between health literacy with public health in employees of Highway and Road Transportation Department of Razavi Khorasan province in 2023.

This cross-sectional study was conducted on 121 employees of Highway and Road Transportation Department of Razavi Khorasan province in Iran in 2023. Data collection tools included demographic information questionnaire of employees, health literacy questionnaire, and public health questionnaire. The data were analyzed using SPSS26.00 with a significance level of 0.05.

The mean (SD) health literacy of participants was 111.2 (22.01). The study found that 55.4% of people had medium health literacy, and there was a statistically significant relationship between health literacy and public health (p < 0.05). Additionally, there was a statistically significant relationship between education level and health literacy (p < 0.05).

The results of the study showed that health literacy is related to public health, so, to improve the public health of employees, their health literacy should be improved, and it is necessary to design interventions to improve the health literacy of employees.

The present study aims to evaluate the level of awareness of workers with the Globally Harmonized System (GHS) among workers exposed to chemicals.

The current study was cross-sectional which was conducted on 80 industrial workers in Zahedan (Iran). Therefore, the Multiple-Choice Question (MCQ) questionnaire according to the GHS international system was used to evaluate general knowledge and the labelling status of chemical substances by designing integrated visual and theoretical questions. Descriptive statistics, and correlation coefficients were also used in data analysis.

The highest awareness of workers was related to explosive (100%) and flammable (96.3%) pictograms. About 72.5% of the participants claimed to have encountered unlabeled chemical packages in their work experience. 86.3% of the workers considered the label on the package "useful to prevent accidents"; about 32% reported that they had never seen "health hazard" pictogram; and about 98.8%, received the necessary training about the dangers of chemicals. Also, the results showed that there was no significant correlation between the age and work history of the participants and their level of awareness (P>0.05), but a statistically significant correlation was observed between education and gender and the level of awareness (P<0.05).

Analysis of the current state of chemical safety labeling showed that pictograms such as GHS "health hazard" are not familiar to workers. Despite the high level of education, workers could analyse English labels at an average level. Moreover, increasing work records did not have much effect on improving people's awareness.

Comorbidity indices, such as Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Measure (ECM), are essential tools for assessing the influence of comorbid health conditions on patient outcomes. This study aims to review comorbidity indices by assigning weighted scores to a spectrum of comorbidities; these instruments play a critical role in predicting mortality rates and evaluating healthcare resource utilization.

In this narrative review study, we reviewed all comorbidity indices and important points were mentioned.

CCIand ECIhave proven to be highly effective tools for predicting mortality and healthcare outcomes across a wide range of patient populations. This review examines four comorbidity indices: CCI, ECI, Acute Myeloid Leukemia (AML), and the Chronic Disease Index (CDI).

Among four types, CCI and ECM were the most applied, and the researcher should know different types of comorbidity indices to use in research.

Breast cancer, one of the most prevalent cancers among women, not only affects physical health but also significantly impacts psychological well-being and self-care practices. This study aimed to evaluate the impact of Quality-of-Life Therapy (QoLT) on self-care and mental health in women with breast cancer.

A quasi-experimental design with pre-test, post-test, and two-month follow-up was employed, involving a control group. The study population included breast cancer patients admitted to Shohadaye Kargar Hospital in Yazd from September 2023 to February 2024. Participants were selected based on inclusion criteria such as female gender, age 30–60, breast cancer diagnosis, and undergoing hormone therapy, while exclusion criteria included smoking, severe illness, or psychiatric treatment. Thirty-one patients were purposively sampled and randomly assigned to an intervention group (N = 15) receiving 10 QoLT sessions over two months, or a control group (N = 16) receiving routine care only. Data were collected using the General Health Questionnaire (GHQ-28), Individualized Self-Care Scale (ICS), and a demographic form, and analyzed using SPSS-21 and repeated measures ANOVA.

Findings showed that QoLT significantly improved self-care (F = 11.06, effect size = 61%) and mental health (F = 255.2, effect size = 80%) (p < 0.001). These effects persisted at the two-month follow-up.

The results demonstrated the effective impact of QoLT on self-care behavior and improvement in mental health among breast cancer patients. It is therefore recommended that QoLT be used as an adjunctive treatment alongside routine care for breast cancer patients.

According to WHO, for every 100 hospitalized patients at least 7 in developed and 10 in developing countries acquire healthcare associated infection. Important factors that put the patients at the risk of infections are inadequate environmental hygiene, waste disposal, and poor knowledge, and application of basic infection control measures. To assess the knowledge, attitude and practice regarding biomedical waste management (BMWM) among health care providers (HCP) and support staffs in a secondary level Hospital with the goal of identifying gaps and informing strategies for improved compliance and waste management practices.
A cross-sectional study was done in government hospital, Mayiladuthurai, Nagapattinam district, during September 2018 to November 2018. Among the 32 districts in Tamilnadu, Nagapattinam district was randomly selected and Mayiladuthurai government hospital was randomly selected among 9 secondary level care hospitals. All the categories of staff in the hospital like doctors, pharmacists, staff nurses, lab and x ray technicians, sanitary workers who handle the biomedical waste in the study area were included in the study. After getting informed consent, data was collected using pre-tested semi structured questionnaire. Data entry was made in the Microsoft Excel software and analysis was done with SPSS version 21 software package.  
Out of 109 participants, 24.8% were males and 75.2% were females. Age group of the participants ranges from 20-60 with the mean age of 35.34 and standard deviation of 7.51. Majority of them belong to 31-40 age group (44%). In this study, based on the work experience 72.5% participants belong to 0-8 -years' experience group, 22.9% participants belong to 9- 16years experience and about 4.6% belongs to 17-24 years of experience group. It was observed that those having adequate knowledge and good attitude about BMW management were found to have less adequate practices which also varies among different categories of health workers (p < 0.001).
The results of the present study showed that knowledge, attitude and practices of participants were not adequate among different categories of health care providers. Safe and effective management of waste is not only a legal necessity but also a social responsibility. The government should take the responsibility to train effectively the healthcare providers working in secondary healthcare settings. Compulsory continuous intensive training programs should be conducted at regular time interval for all the paramedical personnel with special importance to the newcomers, and they should have access to BMWM guidelines in their department/healthcare delivery section. The authors recommend similar studies in different settings and further research to provide accurate data for future decision-making.

 The global elderly population is growing rapidly, and India is home to the world's second-largest elderly population. Understanding the activities of daily living (ADL) among the elderly is essential for providing effective healthcare and support. This study aimed to assess the prevalence of dependency with respect to ADL and its association with socio-demographic and comorbidities variables among elderly individuals residing in three wards of urban Bengaluru.
 This community-based cross-sectional study was conducted between January and March 2023. A total of 132 elderly were selected using simple random sampling. Data were collected through semi-structured interviews. Data analysis was performed using EpiData 3.1 software, with the chi-square test and binary logistic regression used to study associations.
 The study found that 43% of the elderly population experienced activity limitations in ADL where 75(57%) showed full function, 47(36%) showed moderate impairment, and 10 (7%) showed severe functional impairment. Activity limitations were more prevalent among females, those over 80 years of age, illiterate individuals, homemakers, and those with hypertension and economic dependency. The adjusted odds ratio analysis showed a significant association between activity limitations and those aged above 80.
 The study highlights the need for targeted healthcare interventions, regular health check-ups, and literacy programs for elderly population, particularly elderly feamles and those over 80 years of age. Policies should focus on addressing the determinants of activity limitations to improve the functional status and overall quality of life for the elderly.

Prehospital emergency preparedness in radiological and nuclear incidents is significant to the health system's first responders. This study aims to conduct a scoping literature review to identify and explain the components affecting prehospital emergency preparedness in radiological and nuclear incidents.
This study is a scoping review protocol. A search will be conducted in PubMed, Scopus, Web of Science, ProQuest, and Google Scholar databases using main keywords, including nuclear, radiation, radiological, and Prehospital Emergency Care, preparedness, and relevant MeSH terms defined in the PubMed database from 1970 to 2024. Articles related to prehospital emergency preparedness and nuclear and radiation incidents are the inclusion criteria for the study. The documents used will include a variety of original, systematic, and scoping review articles. The basis for defining search strategies will be the guide for each database. Database management, removing duplicate and irrelevant articles, and extracting appropriate articles will be done using EndNote software version X7. Two team members will perform all screening and selection steps based on the inclusion and exclusion Criteria. The PRISMA 2020 flowchart will be used to show the article selection process.
The results of this study will identify the effective components for prehospital emergency preparedness in radiological and nuclear incidents, categorized into subcategories and codes.
Knowing the effective components of prehospital emergency preparedness will improve the response. In this way, various groups, including decision-makers, researchers, and executive areas, including the Ministry of Health and Medical Education and the Non-Active Defense Organization, can take a more effective step in managing the risk of emergencies and disasters.

Tobacco use in India is a significant public health challenge, contributing to high morbidity and mortality. Despite strict regulations, widespread cultural acceptance and accessibility continue to drive its prevalence across diverse population groups. The objective is to estimate prevalence of tobacco, its usage patterns, and their socio-demographic associations among adults in Manikeshwari, Kalaburagi.”
A cross-sectional study was conducted for 2 months among adults residing in Manikeshwari using a pre-tested questionnaire administered through face-to-face interviews. The sample size of 350 was calculated based on a 33.5% prevalence in Kalaburagi, with participants selected through cluster sampling. Data from 310 participants were analyzed for completeness using Jamovi software.
  Among 310 participants, 41.9% had used tobacco at least once, with 29.7% currently using it. Most smokers (54.9%) commenced between 20 and 30, whereas 23.6% started earlier. 47.6% of users had been consuming tobacco for less than 10 years. Smokeless tobacco was utilized by 63% of the participants. With addiction as the main hurdle (48.9%), only 13.9% of current users are willing to quit. Smoking was found to be associated with gender (p-value: <0.001), religion (p-value: 0.02), marital status(p-value:<0.03), education(p-value:<0.001), and occupation(p-value:<0.001).
The study shows high tobacco use, mainly smokeless forms, starting in early adulthood, influenced by demographic and socio-cultural factors. Targeted interventions and stricter enforcement of sales bans and no-tobacco zone regulations are recommended.

This study investigated the prevalence of injuries among Taekwondo athletes, with specific emphasis on psychological attributes, namely competitive anger and aggression, as well as sleep quality. Although these factors are recognized contributors to sports-related injury risk, their association with Taekwondo-specific injuries remains insufficiently explored. The research aimed to identify injury patterns and evaluate the relationships between these psychological constructs, sleep quality, and injury incidence to guide targeted prevention and management approaches.

A cross-sectional survey was administered in Tehran between November and December 2023 to 201 Iranian Taekwondo practitioners. Participants completed a validated Farsi-language online questionnaire capturing demographic information, training characteristics, scores on the 12‑item Competitive Aggressiveness and Anger Scale (CAAS), the 19‑item Pittsburgh Sleep Quality Index (PSQI), and self-reported musculoskeletal injuries over the preceding six months. Data analyses employed descriptive statistics and multivariable logistic regression to determine independent predictors of injury.

Among respondents, 118 athletes (58.7%) reported at least one injury, most commonly involving the ankle (20.6%) and foot/toe (17.6%). Adjusted regression analyses revealed that each one‑point increase in CAAS score was associated with greater injury risk (OR = 1.23; 95% CI 1.11–1.36; p < 0.001), as was each one‑point increase in PSQI score (OR = 1.12; 95% CI 1.05–1.38; p = 0.006). Training more than three sessions per week (OR = 4.01; 95% CI 1.93–8.33; p < 0.001) and session durations exceeding 60 minutes (OR = 2.27; 95% CI 1.07–4.84; p = 0.032) were also independent predictors.

The findings underscore the need to systematically assess competitive aggressiveness, anger, sleep quality, and training load when formulating injury prevention and management strategies for Taekwondo athletes.

Social health is a crucial yet underexplored dimension of human well-being, particularly in architecture and environmental design. While the links between design and physical or mental health have been widely studied, the social dimension remains insufficiently addressed. This review examines how architectural and urban design influence social health outcomes globally from 2002 to 2024.
This systematic review followed the PRISMA protocol. Peer-reviewed articles were retrieved from Scopus, Web of Science, PubMed, and Google Scholar using Boolean keywords (e.g., “design*” AND “social health”). After screening 16,402 initial records, 44 studies from 14 countries and 31 journals met the inclusion criteria. Eligible studies empirically assessed environmental design factors in relation to social health indicators in real-world settings.
Key design features positively linked to social health include access to green and blue spaces, walkability, aesthetics, public safety, mixed land use, spatial layout, and third places. Common social outcomes were enhanced interaction, cohesion, trust, and sense of belonging. The majority of studies focused on outdoor spaces, with fewer addressing interior environments.
The built environment significantly shapes social well-being. However, notable research gaps persist, especially in non-Western and indoor contexts. Future studies should apply mixed methods, include diverse cultural settings, and develop standardized frameworks to evaluate the social impacts of design.

Prehospital emergency preparedness in radiological and nuclear incidents is significant to the health system's first responders. This study aims to conduct a scoping literature review to identify and explain the components affecting prehospital emergency preparedness in radiological and nuclear incidents.

This study is a scoping review protocol. A search will be conducted in PubMed, Scopus, Web of Science, ProQuest, and Google Scholar databases using main keywords, including nuclear, radiation, radiological, and Prehospital Emergency Care, preparedness, and relevant MeSH terms defined in the PubMed database from 1970 to 2024. Articles related to prehospital emergency preparedness and nuclear and radiation incidents are the inclusion criteria for the study. The documents used will include a variety of original, systematic, and scoping review articles. The basis for defining search strategies will be the guide for each database. Database management, removing duplicate and irrelevant articles, and extracting appropriate articles will be done using EndNote software version X7. Two team members will perform all screening and selection steps based on the inclusion and exclusion Criteria. The PRISMA 2020 flowchart will be used to show the article selection process.

The results of this study will identify the effective components for prehospital emergency preparedness in radiological and nuclear incidents, categorized into subcategories and codes.

Knowing the effective components of prehospital emergency preparedness will improve the response. In this way, various groups, including decision-makers, researchers, and executive areas, including the Ministry of Health and Medical Education and the Non-Active Defense Organization, can take a more effective step in managing the risk of emergencies and disasters.

Fire is a significant disaster that poses a threat to people's lives, properties, and overall well-being. The level of awareness within a community plays a crucial role in effective handling of fire incidents. This research aims to assess knowledge, attitude, and practice of students at Kurdistan University of Medical Sciences concerning fire safety.

This was a cross-sectional descriptive study conducted in 2023 among the students studying medical sciences in Kurdistan. The sample size consisted of 250 participants, and data were collected using a researcher-made questionnaire consisting of four parts: demographic information, knowledge, attitude, and practice. Data analysis was performed using SPSS24, employing descriptive statistics, independent t-tests, and ANOVA.

The mean and standard deviation of knowledge, attitude, and performance scores were 23.28 ± 4.31, 21.53 ± 8.36, and 23.04 ± 4.94, respectively, and the average scores of knowledge, attitude, and performance were reported in 24.56%, 32.59%, and 41.05% of the participants. The results indicated a statistically significant relationship between the average knowledge score and gender and educational level (p < 0.05). The primary sourceof information about fire for students was the Internet, followed by professors and academic units’ views.

The findings of this study reveal an average level of knowledge, attitude, and performance among students regarding fire safety, and the obtained scores are considered inadequate for educated and young individuals in the country. It is recommended to develop suitable educational programs that encompass both theoretical knowledge and practical exercises (maneuvers) to enhance awareness, foster the right attitude, and improve practice. These educational programs should be conducted regularly to minimize forgetfulness in this context.

Health centers play an important role in improving the health of society in the structure of the health system in Iran. This study was conducted to evaluate the quality of health services based on SERVQUAL Model (Service Quality Model) in Birjand Comprehensive Health Centers based on the perspective of the clients in 2021.

In this cross-sectional (descriptive-analytical) study, 257 health service users referring to Birjand Comprehensive Health Centers participated. The sampling method was a quota from 8 Comprehensive Health Centers in Brijand. Demographic characteristics and SERVQUAL questionnaire were completed by the participants. Furthermore, data were analyzed using Mann-Whitney U, Wilcoxon, and Kruskal-Wallis tests at a significant level of 0.05 in SPPS (16) software.

The average scores of health service users’ perceptions and expectations were 5.80 ± 0.56 and 6.14 ± 0.37, respectively. The average score of the gap between perceptions and expectations was also -0.34 ± 0.64. There was a significant difference between the average score of perceptions and expectation of service quality.

Due to the gap between perceptions and expectations of service quality, it seems that the health system policymakers should plan a program in order to improve the quality of services based on the factors affecting the quality of services.

Tendency to smoke is one of the most important social problems and harms. The aim of this study was to determine the prevalence and causes of smoking in high school students in Yazd province and to study some of the factors affecting it.
This was descriptive-analytical cross-sectional study with a statistical population of 455 high school students in Yazd who were selected by cluster-random sampling. Research data were collected using a researcher-made questionnaire.
In this study, 34.7% of students had a history of smoking, and the age of the first experience of smoking was 15-20. 20.7% smoked cigarettes through others, and 14% smoked their first cigarette. 13.8% believed that the reason for smoking their first cigarette was imitation of others, and 8.8% believed in becoming more mature and beautiful. 15.8% of the students were currently smoking, of whom 9.7% was for hoby and occasionally, and 12.7% was through friends. 23.7% of students had a history of alcohol consumption. The most sources of information about smoking were family, cyberspace, and friends, respectively. 55.6% of students found smoking cessation difficult, and 89.2% of students believed that smoking was harmful. 62.4% did not believe that smoking was a risk factor for coronary heart disease, and 37.6% did not believe that smoking was a risk factor for coronary heart disease.
Due to the relatively high frequency of smoking (about one sixth) among high school students, educational programs should be done since adolescence, and because family, cyberspace, and friends were the most important source of information about smoking, so appropriate education can be very effective.

The COVID-19 pandemic underscored the critical need for advanced modeling approaches to elucidate transmission dynamics and inform public health strategy. This study employed a Time-Series Susceptible-Infected-Recovered (TSIR) model to quantitatively analyze the pandemic trajectory in Iran and estimate the time-varying basic reproduction number (R₀) from February 2020 to December 2023.
In an analytical cross-sectional study, comprehensive national COVID-19 data were obtained from the Iranian Ministry of Health and validated international repositories. The TSIR framework was implemented using R software (v4.0.0) to estimate transmission parameters (β, γ) and reconstruct epidemic dynamics. Vaccination impact was assessed through comparative analysis of compartmental populations pre- and post-vaccination deployment.
Analysis of 1,373 surveillance days revealed 7,625,160 confirmed cases with 146,741 fatalities (CFR: 2%). The TSIR model demonstrated superior tracking of seven distinct epidemic waves, with R₀ estimates declining to 0.2 during 2022-2023. Statistical analysis confirmed significant compartmental shifts post-vaccination (p<0.001), indicating substantial intervention impact. Moreover, model validation showed robust performance across multiple epidemic phases.
The TSIR model provides a validated framework for epidemic monitoring and evaluation of public health interventions in Iran. The sub-critical R₀ values observed during the study's conclusion reflect successful containment through combined vaccination and control measures. Therefore, integration of time-series epidemiological modeling into national surveillance systems is recommended for enhanced preparedness against future infectious disease threats.