Background: Benzene, toluene, ethylbenzene, and xylenes (BTEX) are key volatile organic compounds (VOCs) that pose substantial environmental and public health risks in urban environments. Objectives: This study presents a methodologically transparent assessment of BTEX concentrations, spatial and seasonal variations, emission sources, and associated human health risks across distinct land-use microenvironments in Tehran, Iran. Methods: Ambient BTEX concentrations were monitored biweekly over 12-hour sampling periods (08:00 - 20:00) from January to December 2025 at five strategic stations (traffic, industrial, residential, urban background, and suburban). Active sampling was conducted using charcoal tubes (NIOSH 1501) and analysis was performed by GC-FID. Seasonal variations were evaluated using an independent-samples t-test, whereas spatial differences among the five monitoring sites were assessed using one-way analysis of variance (ANOVA). Source attribution was evaluated using empirical diagnostic ratios (T/B, X/B) and Pearson correlation (n = 120). Carcinogenic and noncarcinogenic inhalation risks were modeled using the updated United States Environmental Protection Agency (USEPA) Human Health Risk Assessment framework. Results: Toluene was the most abundant species (47.3 ± 19.8 μg/m3), followed by xylenes (34.1 ± 15.2 μg/m3), ethylbenzene (17.4 ± 7.4 μg/m3), and benzene (11.6 ± 5.1 μg/m3). All target species exhibited statistically significant winter accumulation (P < 0.001). BTEX concentrations were significantly higher during the cold season than during the warm season for all target compounds (P < 0.001), with benzene and toluene showing the greatest seasonal increases. Uniformly high diagnostic ratios (T/B = 4.12 - 4.29, X/B ≈ 3.0, and T/X = 1.38 - 1.46), together with strong positive correlations among BTEX compounds (r = 0.90 - 0.95), were consistent with the influence of common traffic-related emission sources, including vehicle exhaust and evaporative fuel losses. Although individual noncarcinogenic hazard quotients were below 1.0, the cumulative Hazard Index (HI) reached 0.84 at the traffic site. The deterministic Incremental Lifetime Cancer Risk (ILCR) for benzene ranged from 2.1 × 10-5 to 6.8 × 10-5, exceeding the strict USEPA de minimis benchmark (1.0 × 10-6). Conclusions: BTEX pollution in Tehran is a critical environmental health concern driven by high mobile fleet intensity and winter meteorological stagnation. Given the pronounced cold-season accumulation, emergency seasonal traffic zoning restrictions and stage II vapor recovery systems at fuel stations should be dynamically prioritized during winter months to mitigate inhalation exposure and protect public respiratory health.
Background: Healthcare entrepreneurship is increasingly relevant to the transformation of the Saudi healthcare system, private-sector participation, digital health, and innovation. However, evidence regarding healthcare providers’ entrepreneurial intentions, awareness, and perceived facilitators and barriers in Saudi Arabia remains limited. Objectives: This study assessed entrepreneurial intention, awareness, perceived facilitators, motivators, and barriers among healthcare providers in Saudi Arabia and examined factors associated with entrepreneurial readiness and willingness. Methods: A cross-sectional online survey was conducted in November 2023 among 435 healthcare providers working in Saudi Arabia. Participants were recruited through convenience sampling, and the bilingual questionnaire was distributed electronically via professional networks and social media platforms, including LinkedIn and X/Twitter. Descriptive statistics were used to summarize the findings, and Mann-Whitney U and Kruskal–Wallis tests were used to examine factors associated with entrepreneurial readiness and willingness scores. Results: Among 435 participants, 82.8% reported interest in entrepreneurship, 76.3% believed that healthcare providers could become entrepreneurs, and 72.2% had considered starting a healthcare-related business. However, only 32.9% were familiar with entrepreneurship concepts, 35.6% had completed entrepreneurship courses, and 6.2% had started a healthcare-related business. The mean entrepreneurial readiness and willingness score was 3.94 ± 0.72 out of 5. Entrepreneurial readiness and willingness scores were significantly higher among female participants than among male participants (4.05 ± 0.64 vs. 3.85 ± 0.77; P = 0.004) and differed significantly across professional groups (P < 0.001). Higher scores were also associated with interest in entrepreneurship, prior entrepreneurship education, institutional support, and previous healthcare-related business experience (all P < 0.001). Conclusions: Among surveyed healthcare providers in Saudi Arabia, entrepreneurial interest was high; however, the establishment of healthcare-related businesses remained uncommon. This intention–implementation gap underscores the need for structured entrepreneurship education, institutional support for innovation, mentorship, regulatory guidance, and access to funding or incubation pathways within the Saudi healthcare system.
Context: In patients with diabetes, oral health problems, such as periodontal disease, pose a significant risk and may worsen glycemic control and quality of life. However, the effectiveness of self-management interventions for improving oral health outcomes remains unclear. This systematic review aimed to evaluate evidence from randomized controlled trials (RCTs) on the effects of self-management interventions on oral health outcomes. Evidence Acquisition: PubMed, Scopus, Web of Science, and ScienceDirect were systematically searched through December 17, 2025, using terms related to diabetes, self-management, oral health, and RCTs. Of 419 retrieved records, four RCTs met the PICOTS criteria: patients with diabetes; oral health self-management versus usual care; and outcomes, including oral health measures, self-efficacy, and quality of life. Screening was conducted in two stages by independent reviewers. Data extraction included study characteristics, interventions, outcomes, and quality assessed using the Jadad scale. Thematic analysis was used for synthesis. Results: Self-management interventions, comprising 6 to 16 sessions of education, coaching, follow-up, and peer support, significantly improved self-efficacy, oral hygiene, periodontal status, quality of life, and glycemic control in 1219 patients with predominantly type 2 diabetes. Discussion: Structured oral health self-management, delivered through education, follow-up, and coaching, should be integrated into diabetes care to improve outcomes, self-efficacy, and quality of life. Healthcare providers play a key role in health promotion.
Context: The increasing complexity of global disasters requires doctoral-level leadership in Disaster Health Management (DHM). DHM curricula are increasingly important for strengthening workforce preparedness and ensuring coordinated, evidence-informed responses to disasters. However, variability in curriculum structures and competencies may hinder standardization and implementation across settings. Evidence Acquisition: This scoping review followed the Joanna Briggs Institute framework and PRISMA-ScR guidelines. PubMed, Scopus, Web of Science, ERIC, and ProQuest were systematically searched, along with grey literature, for English-language, doctoral-level DHM curricula published between 2000 and February 2026. Studies focusing on non-doctoral training were excluded. The search strategy combined controlled vocabulary and keywords related to disaster health management, doctoral education, public health competencies, and curriculum development. Curricular components were extracted using a standardized data extraction form and thematically synthesized in relation to the World Health Organization Essential Public Health Functions. Results: The search retrieved 832 records; after removal of 140 duplicates and full screening, 16 documents were included in the final synthesis. Few programs were specifically designed for DHM, and most training was offered at the master’s or certificate level. Content analysis showed low alignment with WHO competencies: 13% of curricula addressed intersectoral skills, whereas 81.6% focused on clinical aspects. Curricula also disproportionately emphasized disaster response and recovery over mitigation and preparedness. Conclusions: These findings underscore substantial structural and thematic gaps. The predominance of a specialized clinical model, rather than a systemic leadership-focused model, limits the capacity to achieve WHO and UNDRR macro-level disaster risk reduction goals. Targeted doctoral programs should be developed, and postgraduate curricula should be updated to prioritize prevention, preparedness, and systemic competencies.
Background: This study investigates the effects of specialised Thai Yoga facial massage (STYFM) on visual, musculoskeletal, cardiovascular, and autonomic functions in young adults with computer vision syndrome (CVS). Methods: A randomized controlled trial was conducted with 30 participants with visual fatigue. Participants were randomly assigned to either an STYFM group (FMG, n = 15) or a control group (CTG, n = 15). The FMG received 10 - 15 minutes of STYFM, while the CTG rested with eyes closed for 15 minutes to control for time and removal of visual load. The primary outcome was visual fatigue assessed by the Computer Vision Syndrome Questionnaire (CVS-Q). Secondary outcomes included near point of convergence (NPC), amplitude of accommodation (AMP), visual acuity (VA), spherical equivalent refraction (SE), handgrip strength (HS), cervical range of motion (CROM), and cardiovascular/autonomic indicators (heart rate, heart rate variability [HRV], and peripheral oxygen saturation [SpO₂]). Outcomes were assessed at baseline and immediately post-intervention. Results: The FMG demonstrated significant improvements in CVS-Q, NPC, AMP, VA (P < 0.001), HS (P < 0.05), CROM (P < 0.001), SpO₂, HRV, high-frequency power (HF), RMSSD, and PNN50 (P < 0.05). The CTG showed modest improvements in CVS-Q and NPC (P < 0.05), a decline in HS (P < 0.05), and increases in HRV, HR, RMSSD, and PNN50 (P < 0.05). Significant between-group differences were found in CVS-Q, NPC, AMP, VA, HS, CROM subcomponents (P < 0.001), SpO₂, and HR (P < 0.05). Conclusions: STYFM, as a noninvasive and easily self-implementable yoga-based mind–body intervention, appears to reduce visual fatigue and improve musculoskeletal and autonomic-related indicators in young adults. Given yoga’s role in stress regulation, STYFM may also help mitigate stress-related and extraocular symptoms associated with prolonged screen use, including headache. Larger, adequately powered trials are warranted. No intervention-related adverse events were reported.
Background: Despite increasing investment in telemedicine, many health systems -particularly in developing contexts -lack a prioritized, context-specific implementation model that integrates governance, resource allocation, and digital infrastructure. In Iran, existing telemedicine initiatives remain fragmented, with no empirically grounded framework for identifying which strategic dimensions exert the greatest leverage on healthcare access. Objectives: This study aims to develop and prioritize a native telemedicine implementation model to improve access to health services in Iran by identifying causal relationships and the relative importance among key dimensions and indicators. Methods: A mixed-methods exploratory design was employed. In the qualitative phase, semi-structured interviews with 10 experts (each with >= 10 years of experience in health services management, e-health, or health policy) were analyzed using thematic analysis in MAXQDA (v2018). Theoretical saturation was achieved when no new codes or dimensions emerged across consecutive interviews, and the extracted themes were validated through member checking and iterative expert review In the quantitative phase, the finalized indicators were prioritized using the DEMATEL-based analytic network process (DANP) via an expert influence assessment questionnaire. Results: The DANP results showed that service planning (D = 0.2189) was the most influential dimension, followed closely by service coordination (E = 0.2093) and the proper allocation of financial and human resources (B = 0.1985). This pattern suggests that planning-related functions retain a slight systemic dominance, whereas coordination and resource allocation exert comparably strong influences within the telemedicine system. At the indicator level, the highest priorities were reducing telemedicine technology costs (El = 0.0612), providing services based on existing standards (E4 = 0.0570), identifying legal gaps and removing barriers (E2 = 0.0508), and gaining patients' trust (A3 = 0.0496). Notably, the leading role of cost reduction reflects its function as a structural enabler that supports standard compliance, legal readiness, and user trust, thereby shaping coordination efficiency and the overall sustainability of the telemedicine network. Conclusions: The proposed model provides an evidence-based, prioritized decision-support tool for telemedicine implementation in Iran by identifying high-leverage intervention points rather than merely describing success factors. Although the framework is grounded in Iran's institutional context, its methodological logic and prioritization structure may inform similar analyses in other developing health systems with comparable governance and infrastructure constraints, subject to contextual recalibration.
Background: Honey is a valuable natural food with important nutritional and medicinal properties. However, because its composition is influenced by environmental conditions, geography, plant sources, and beekeeping practices, it may be exposed to heavy metal contamination. Objectives: This study investigated the concentrations of lead (Pb), cadmium (Cd), and tin (Sn) in honey samples collected from different regions of Sistan and Baluchistan Province in southeastern Iran. Methods: A total of 33 honey samples were collected from three geographical regions of Sistan and Baluchistan Province (the northern, central, and southern areas). The samples were analyzed using graphite furnace atomic absorption spectroscopy (GF-AAS) after acid digestion and dry ashing. Results: All 33 samples contained Pb, confirming its ubiquitous presence. Sn was detected in 32 of 33 samples (97%), with concentrations ranging from 21.63 to 71.65 ppb. Cd was detected in only 16 of 33 samples (48.5%), indicating that it was a localized rather than ubiquitous contaminant. Pb concentrations were significantly higher in some northern samples than in those from other regions (P < 0.05). Conclusions: These findings indicate that honey from certain areas may be influenced by environmental contamination. All measured concentrations were below the maximum permissible limits established by European Union Regulation 2023/915 and ISIRI 12968. Therefore, honey from this region is currently considered safe for human consumption; however, continued monitoring is recommended to safeguard public health.
Background: This study investigates the efficiency of the advanced oxidation process VUV/H2O2 for removing the antibioticfrom tetracycline (TC) aqueous solutions. Methods: The process uses a low-pressure vacuum ultraviolet (VUV) lamp emitting at 185 nm and 254 nm to degrade TC. Theaddition of hydrogen peroxide (H2O2) enhances the generation of hydroxyl radicals (OH center dot), which are the main agentsresponsible for the degradation. Various operational parameters were evaluated, including pH (5-7-9), initial TC concentrations(5, 10, and 20 mg/L), H2O2 concentrations (1 - 10 mg/L), as well as the presence of anions and organic compounds. Results: Results showed that the highest removal efficiency of TC (100%) was achieved at pH 7 with 2 mg/L of H2O2 after 90minutes of treatment. Increasing the H2O2 concentration beyond the level of 10 mg/L reduced the efficiency slightly to around90.55% due to scavenging effects. In the absence of H2O2, the VUV process alone removed about 60% of TC. The presence of anionssuch as phosphate, chloride, and sulfate led to decreases in removal efficiency by 29.4%, 13.4%, and 15.6%, respectively. Among thetested organic compounds, phenol and humic acid exhibited the most pronounced inhibitory effects. The degradation kineticsfollowed a pseudo-first-order model (R & sup2; = 0.9942), indicating a consistent and predictable reaction behavior. Under optimalconditions, the removal efficiencies of chemical oxygen demand (COD) and total organic carbon (TOC) were 78% and 40%,respectively. Conclusions: In conclusion, the study demonstrated that the VUV/H2O2 process is an effective and tunable method for thedegradation and mineralization of TC in contaminated water.
Context: Financial incentives represent a key policy lever shaping workforce motivation and behavior in health systems. Objectives: This systematic review examines physician and nurse compensation systems across countries to identify prevailing payment modelsand their policy implications, thereby providing evidence to inform provider payment system reforms in Iran. Data Sources: A systematic literature search was conducted across major English-language databases (Web of Knowledge, ProQuest, PubMed,Emerald, and Scopus) and Persian databases (SID, MagIran, Google Scholar) for the period 2000-January 2026. Search terms focused on physicianand nurse payment models. Study Selection: Study quality was appraised using the Critical Appraisal Skills Program (CASP) checklist for qualitative studies and theStrengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for quantitative research. Data Extraction: Extracted data were synthesized and organized in comparative tables by provider type (physician or nurse) and level of servicedelivery within the health system. Results: The search identified 2,205 studies, of which 29 articles and 4 policy reports from 17 countries met the inclusion criteria. Paymentsystems were classified into three levels: (1) Core stand-single payment models, (2) incentive-linked payment systems, (3) bundled paymentmodels, which will be elaborated on in the following sections. In addition, systems were classified as retrospective (rewarding past activity) orprospective (linked to predefined targets). Although fixed salary, capitation, and fee-for-service (FFS) remain the most common models, there is agrowing shift toward blended approaches that emphasize outcomes, accountability, and flexibility. Conclusions: No single provider payment model is universally optimal. In Iran, evidence supports gradual, context-sensitive reform throughhybrid payment arrangements aligned with service type, institutional capacity, and digital readiness, rather than premature large-scale adoptionof fully value-based or performance-based models.
Background: Childhood cancers, particularly leukemia and solid tumors, are leading causes of morbidity and mortality globally. Objectives: This study examines environmental and sociodemographic risk factors associated with these cancers in children under 18 years in Tehran, Iran. Methods: A hospital-based case-control study was conducted at Ali-Asghar Children's Hospital from 2013 to 2023. The study included 114 children diagnosed with leukemia or solid tumors and 114 controls admitted for non-oncologic reasons. Data on environmental exposures, parental characteristics, and lifestyle factors were collected through medical records and structured interviews. Multinomial logistic regression was used to identify significant risk factors. Results: In the adjusted model, maternal age >= 35 years (AOR = 3.45, 95% CI: 1.30-9.09; reference: <35 years) was associated with significantly higher odds of leukemia, while a higher maternal education level (> diploma) was a protective factor [AOR = 0.35, 95% CI: 0.15-0.80]. Low birth weight showed a strong but non-significant association with leukemia after adjustment [AOR = 3.18, 95% CI: 0.97-10.44]. For solid tumors, no factors reached statistical significance in the adjusted model, though point estimates suggested potential associations with maternal age >= 35 [AOR = 1.54, 95% CI: 037-6.68] and higher maternal education [AOR = 0.54, 95% CI: 0.18-1.63]. Conclusions: Maternal age and education are important independent risk factors for childhood leukemia. For solid tumors, no significant associations were identified, a finding that is likely limited by the small sample size. Prenatal environmental factors may also contribute, highlighting the need for targeted public health interventions focused on maternal health and education to reduce childhood cancer risk.
Background: The effectiveness of particulate air scrubbers in industrial settings is closely linked to an accurate understanding of particle size distribution (PSD). Isokinetic sampling is the standard approach for PSD measurement, though it presents operational challenges such as complex instrumentation and flow disturbances during sampling. Objectives: This study aimed to evaluate the correlation between PSD in the workplace environment and the airflow inside the local ventilation duct of an iron manufacturing facility. It also assessed the efficiency of the existing scrubber system in controlling particle pollutants. Methods: A cross-sectional descriptive study was conducted at an iron manufacturing unit, where PSD was measured three times at 17 pollutant-emitting sources connected to a single ventilation system. A four-stage cascade impactor was used to categorize particles into four size ranges: <1 mu m, 1- 4 mu m, 4 -15 mu m, and >15 mu m. Isokinetic sampling based on BS 3405 standards was performed inside the main duct leading to the scrubber. Data were analyzed using SPSS v16. Results: The results showed that there was no statistically significant correlation between the PSD of airborne pollutants in the duct before and after the scrubber (r = 0.476, P-value > 0.05), nor between the PSD after the scrubber and in the workplace air when the system was ON (r = 0362, P-value > 0.05). In contrast, strong and statistically significant correlations were observed between the PSD in the duct before the scrubber and the workplace air when the system was ON (r = 0.958, P-value <= 0.05) and OFF (r = 0.763, P-value <= 0.05), as well as between the PSD in the workplace air when the system was OFF and at the chimney outlet (r = 0.876, P-value <= 0.05). Conclusions: Ambient air PSD measurements can serve as a reliable alternative to internal duct measurements for evaluating and redesigning scrubber systems. It is recommended that this approach be tested across various pollutants to enhance its applicability and reliability.
Background: Air pollutants may harm the nervous system and act as environmental risk factors for increased hospitalizations and relapses in multiple sclerosis (MS). Objectives: This study aimed to assess the potential association between MS hospitalizations and ambient air pollutants, including CO, O3, SO2, NO2, PM10, and PM2.5, in Kerman, Iran. Methods: This ecological study used air pollution and meteorological data obtained from the Kerman Environmental Protection Agency and the Kerman Meteorology Organization, respectively. Multiple sclerosis hospitalization data were obtained from the Shafa Hospital MS Registry in Kerman. Generalized additive models (GAMs) were used to estimate rate ratios (RRs) for air pollutants in predicting MS hospitalization after adjusting for temperature, relative humidity, seasonality, weekdays, and long-term trends, using lags of up to 7 days. Results: During 2008 - 2020, 4,913 MS hospitalizations occurred among patients with MS in Kerman, of which 3,739 were in females. Significant associations were observed between MS hospitalization and CO in individuals aged < 30 years (RR = 1.5647 at lag 0), O3 in individuals aged > 50 years (RR = 1.0161 at lag 5), SO2 in individuals aged > 50 years (RR = 1.0253 at lag 5), NO2 in females (RR = 1.0121 at lag 0), PM10 in individuals aged > 50 years (RR = 0.9828 at lag 3), and PM2.5 in individuals aged > 50 years (RR = 0.9832 at lag 5). Conclusions: Ambient O3 and NO2, and more consistently, CO and SO2, were associated with increased MS hospitalizations in Kerman.
Background: Globally, vaccination has substantially reduced invasive Haemophilus influenzae type b (Hib) disease. However, limited information is available on the persistence of protective antibodies after Iran incorporated the Hib-containing pentavalent vaccine into the national immunization program in 2014. Micronutrients, including iron, zinc, and copper, may influence immune responses. Objectives: This study aimed to assess Hib-specific antibody levels and their association with trace element status in vaccine-eligible children in Jahrom, Iran. Methods: This cross-sectional study was conducted in Jahrom, southwestern Iran, from October 2024 to May 2025. Serum samples were collected from 450 children who had received the Hib-containing pentavalent vaccine after its introduction in Iran in 2014, with doses administered at 2, 4, and 6 months of age. Anti-Hib immunoglobulin G (IgG) antibody concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). Results: Among 450 children, 246 (54.7%) were male, and the mean age was 78.4 +/- 33.2 months. Overall, 75.6% had short-term Hib protection, and 18.7% had long-term protection. The mean serum anti-Hib antibody concentration was 0.547 +/- 0.446 mu g/mL. Linear regression (adjusted R-2 = 0.883) showed that serum concentrations of iron (B = 0.009, P < 0.001), zinc (B = 0.001, P = 0.010), and copper (B = 0.012, P < 0.001) were positively associated with anti-Hib antibody levels. Conclusions: Following the introduction of the Hib-containing pentavalent vaccine, only 18.7% of participants had antibody titers indicating sustained protection. Micronutrients may influence vaccine-induced immunity. These findings underscore the need for rigorous surveillance and reporting of invasive Hib disease to assess the disease burden despite vaccination. The low proportion of children with long-term protective antibody levels suggests that supplemental Hib vaccination may be needed to ensure durable protection.
Background: Iran's total fertility rate (TFR) has experienced a steep decline, from approximately 7.0 in 1960 to an estimated 1.6 in recent years (2024 - 2025), which is significantly below the replacement level, necessitating research on fertility determinants. Objectives: This study examined factors influencing childbearing reluctance among married women in Kashan. Methods: A cross-sectional study was conducted with 578 married women (aged 18 - 49 years) selected through a two-stage cluster random sampling method from five comprehensive health centers (2023). The sample size was calculated using the Cochran formula, yielding a minimum of 578 participants. Data were collected via a structured questionnaire comprising socio-demographics, a validated 15-item fertility attitude scale, and a 24-item barrier inventory. Analyses included descriptive statistics and multivariable logistic regression (SPSS v26). Results: Of the participants, the mean age was 32.5 +/- 6.8 years. In total, 68.2% (n = 394) reported no fertility desire. Key deterrents were: Financial constraints (76.1%, OR = 3.2, 95% CI: 2.1 - 4.9), career conflicts [65.3%, adjusted odds ratio (aOR) = 2.7, 95% CI: 1.8 - 4.0], and marital dissatisfaction (58.9%, OR = 2.1, 95% CI: 1.4 - 3.2). Higher education (aOR = 1.9, 95% CI: 1.3 - 2.8) and employment (OR = 2.4, 95% CI: 1.6 - 3.6) significantly predicted reluctance (P < 0.001). Conclusions: Economic pressures primarily drive fertility decline. Policy interventions addressing childcare costs and workplace flexibility are urgently needed. Future policies must move beyond short-term financial incentives to address the fundamental structural and normative barriers shaping reproductive decisions.
Background: Due to the sensitivity and complexity of healthcare environments, the emergence of phenomena such asorganizational silence and organizational envy among staff can negatively affect professional interactions, teamwork, andultimately the quality of healthcare services. Objectives: This study aimed to investigate the explanation of the relationship between organizational envy andorganizational silence among staff in educational hospitals of Yazd in 2024. Methods: This cross-sectional study was conducted on 297 employees in four educational hospitals, using stratified randomand simple random sampling. Data were collected through two standardized questionnaires measuring organizational silenceand organizational envy. Descriptive statistics (mean and standard deviation), independent t-test, one-way ANOVA, Pearsoncorrelation coefficient, and linear regression were used. Results: The findings indicated that only a significant relationship was observed with work experience (P = 0.012).Organizational envy showed a significant relationship only with gender (P = 0.039). The Pearson correlation coefficient betweenorganizational silence and organizational envy was 0.217, which was statistically significant and weak (P = 0.001). Furthermore,regression analysis showed that organizational envy was a significant positive predictor of organizational silence (beta = 0.216, P =0.000). Conclusions: Considering the positive, significant, yet weak relationship between the two main variables under investigation,an increase in organizational silence leads to a slight increase in organizational envy. It is recommended that managers reducesilence and envy among employees by enhancing communication skills, providing equal educational opportunities, andfostering a transparent and trustworthy work environment.
Background: Suicide is a major public health challenge, with Ilam province in Iran exhibiting a concerning upward trend and one of the highest rates in the country. Objectives: This study aimed to determine the prevalence of fatal suicide in Ilam province and to develop and validate a multivariable predictive model to identify individuals at high risk. Methods: This retrospective case-control study included all fatal suicide cases recorded by the Legal Medicine Organization from May 2024 to June 2025. Age- and gender-matched controls were selected from the primary health care registry. A multivariable logistic regression model was constructed, and its performance was evaluated using the Area Under the Curve Results: The incidence rate of fatal suicide was 18.1 per 100,000 population (95% CI: 14.7 - 21.4). The final model identified a history of psychiatric disorder (OR = 2.7), unemployment (OR = 1.9), and a family history of suicide (OR = 2.1) as significant predictors. The model demonstrated excellent discrimination (AUC = 0.81) and good calibration (Ho smer-Lemeshow P = 0.48). Conclusions: The high incidence of suicide in Ilam necessitates targeted interventions. The validated model provides a robust, evidence-based tool for the early identification of high-risk individuals, which can guide preventive strategies and optimize resource allocation.
Background: Iran has experienced a sustained decline in fertility. Understanding how newly married couples navigate childbearing decisions is critical for policy and counseling. Objectives: To explore factors shaping childbearing intentions among couples attending premarital counseling in Zahedan, Iran. Methods: We conducted a qualitative study using conventional content analysis (CCA) in 2024. Maximum-variation purposive sampling recruited 18 couples (36 individuals) from a university-affiliated premarital counseling center. Data were generated through in-depth, semi-structured individual interviews until information saturation. Verbatim transcripts were anonymized. Analysis proceeded inductively: Familiarization, line-by-line open coding, grouping codes into sub-categories, abstraction into main categories, and identification of an overarching (central) category. Trustworthiness was ensured via member checking, independent co-coding, an audit trail, reflexivity, and peer debriefing. This report was developed in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results: One central category - "Deliberate childbearing: Decision-making contingent on readiness and capability" - organized five main categories: Economic-livelihood, bio-psychological, work-education, cultural-family, and personal preferences. Conclusions: Multilevel strategies that improve economic security, support education-work-family balance, and enhance premarital counseling content may better align couples' goals with fertility policies.
Background: Communication problems and relational distress are among the primary predictors of marital dissatisfaction and instability. Marital satisfaction is a key component of mental health and family stability and is influenced by various psychological factors. Objectives: The present study aimed to investigate the mediating role of social cognition in the relationship between marital satisfaction and attachment styles. Methods: In this descriptive-correlational study based on structural equation modeling, a total of 220 individuals (153 women and 67 men) were selected from among married people in Zahedan, Iran. The ENRICH Marital Satisfaction (EMS) Questionnaire, Attachment Styles Questionnaire (ASQ), and the "Reading the Mind in the Eyes" and "Recognition of Emotional Facial Expressions" tests were used for data collection. Data analysis was conducted using SPSS version 25 software, and mediation analysis was performed with the Hayes PROCESS tool. Results: Secure attachment style and social cognition demonstrated a positive and significant relationship with marital satisfaction, while insecure preoccupied, fearful, and dismissing attachment styles showed a significant negative relationship with marital satisfaction (P < 0.001). Additionally, according to the results from hierarchical multiple linear regression analysis, the research variables explained more than 45% of the variance in marital satisfaction (R-2 = 0.453). Conclusions: The mediation path analysis suggested a significant indirect effect of secure and insecure attachment styles on marital satisfaction. Furthermore, the social cognition model of marital satisfaction, with emphasis on attachment styles, was found to be a good fit for the studied sample. Therefore, it is recommended to address the importance of social cognition and parent-child relationships in the early years of life.
