Understanding the prevalence of mental distress in hospitalized patients and identifying associated factors can help reduce the burden of mental disorders on their medical management and improve their quality of life. This study aimed to examine the prevalence of mental distress among hospitalized patients in general hospitals and assess its associated factors. In this cross-sectional study, we evaluated the mental health status of inpatients in seven cities in Iran, using the General Health Questionnaire-12 (GHQ-12), with a total GHQ-12 score ≥ 4 or higher categorized as “mentally distressed.” Statistical analyses were conducted using independent t-tests, one-way analysis of variance, and cross-tabulations. A total of 524 patients (347 females) were assessed, with 208 (38.7

Background: Considering the challenges of the referral system in the family physician program and the impact of Covid-19 pandemic on the performance of the relevant ministry's programs, it is necessary to assess the performance of the referral system. This study was conducted with the aim of investigating the performance of the family physician referral system before and after Covid-19 in Golestan province. Objective: The present descriptive-analytical study was conducted on secondary data (including information on physicians' and midwives' visits, percentage of prescriptions and other information) in Golestan province from 2017 to 2022 in a census and retrospective manner. Data were collected using the reference ratio checklist and analyzed with SPSS 23 software at a significance level of less than 0.05. Results: The highest and lowest percentages of referrals by family physicians were belonged to the surgical and infectious specialists before Covid-19, and internal medicine and urology specialists after Covid-19, respectively. Referral due to physician's diagnosis and target group increased compared to before Covid-19 and care and reverse referral decreased compared to before Covid-19. The amount of changes in the population covered by rural insurance, the amount of referrals to midwives, the percentage of electronic appointments after Covid-19 were significant compared to before it (P-Value<0.05). Conclusion: The present study showed that the Covid-19 pandemic had a significant impact on family physician referral indicators, such as the process of referral to specialists, drug prescriptions, insurance coverage, one-time service population, and patient care.

Background and Purpose: Considering that the treatment of cancer and psychosomatic diseases puts a high medical cost burden on the health system, it is necessary to use suitable services to improve the effectiveness of the treatment and thus reduce the costs. This study presents a protocol for developing a spiritual care program for patients with cancer and psychosomatic diseases in Iran. Materials and Methods: This is a mixed-method protocol study. To prepare the content of the program, a systematic review of the literature on spiritual care for patients with cancer and psychosomatic disorders will be carried out after searching databases such as PubMed, Web of Sciences, Scopus, MagIran, SID, and Google Scholar for articles published in Persian or English from 2015 to June 1, 2023, using the keywords such as spiritual health, spirituality, spiritual care, cancer, psychosomatic, depression, and anxiety. Then, the opinions of a panel of experts will be used to finalize the content and assess the quality of the designed program using the appraisal of guidelines for research and evaluation instrument II (AGREE II) tool. The designed service package will then be implemented in the target population. They will be assessed before and after the intervention by using the hospital anxiety and depression scale, distress tolerance scale, hospital service satisfaction questionnaire, and spiritual well-being questionnaire. Conclusion: The developed cost-effective, non-pharmacological program for spiritual care can be used for patients with psychosomatic disorders and cancers in Iran.

Background One of the clinical responsibilities and goals of hospitals is to provide patients with comfort and security. The present study aims to assess patients’ sense of security among patients in Iranian hospitals. Methods The present research employed a cross-sectional design. The sample consisted of 830 patients visiting public, private, and social security hospitals in Mazandaran in the North of Iran. The required data were collected using a questionnaire developed by the researcher of this study.This questionnaire consisted of 4 dimensions:nursing, medical, advanced facilities and patient rights. The participants were selected using a proportional stratified random sampling method. Exploratory factor analysis, confirmatory factor analysis, descriptive statistics, and ANOVA were used for data analysis using SPSS version 22. Results The mean scores of patients’ sense of security in social security, private, and public hospitals were 4.16 ± 0.89, 3.78 ± 0.67, and 3.60 ± 0.89, respectively. Medical factors with a mean and standard deviation of 3.92 ± 0.76, advanced facilities and equipment with 3.89 ± 0.89, nursing factors with 3.87 ± 0.73, and patient rights with 3.71 ± 0.90 were the highest to the lowest scores, respectively. The results showed that the type of hospital significantly affected the mean dimensions of security ( p < 0.05). Conclusions The study revealed variations in the sense of securityacross the sampled hospitals. Particularly, the sense of security attributed to the patient rights factors was lower than other factors. Therefore, to enhance the sense of security for patients, it is recommended to focus on staff training and fostering a culturethat emphasizes obtaining informed consent, demonstrating respect for the patient, and introducing the medical team to the patient before initiating any treatment.

Background and Objective Nursing is a stressful occupation. The quality of nursing care plays an important role in improving patients’ conditions. This study aims to evaluate the relationship between occupational stress and sleep disorders in nurses working in a hospital in Sari, Iran. Materials & Methods This descriptive-analytical study was conducted on 196 nurses of Imam Khomeini Hospital in Sari, who were selected by random sampling method method. Data were analyzed in SPSS software version 20. The significance level was set at 0.05. Results The results showed a significant relationship between sleep disorders and occupational stress (R=0.43; P<0.05). Occupational stressors had a significant role in predicting the sleep disorders (P<0.05). Sleep disorders of nurses were significantly different in terms of work shifts (P<0.05), where nurses working the night shift had higher sleep disorders than those with other work shifts. Conclusion There is a significant relationship between occupational stress and sleep disorders of nurses in the study hospital in Sari. Sleep disorders of nurses are significantly different based on the work shifts. The role of occupational stressors in predicting the sleep disorders of nurses are significantly different.

Objectives: Specificity impairment is a memory alteration that occurs in people with major depressive disorder (MDD). In this investigation, we intended to shine a light on obscure aspects of executive resource and capture and rumination frameworks to determine whether these theories are reliable in predicting underlying mechanisms for specificity impairment. Methods: In this correlational research, we used the convenience sampling method over two months, between January and February 2021. We administrated the digit span working memory test, ruminative response scale (RRS), and autobiographical memory interview to indicate whether working memory capacity and subtypes of rumination can predict memory specificity in people with MDD. Using RRS enabled us to determine the correlation between subtypes of rumination and memory specificity. Results: Our samples consisted of 105 adults (53 males (50.5%) and 52 females (49.5%)) with MDD. The participants’ mean age was 33.38 years with a range of 22-43 years. The results no significant difference between gender, marriage, and age groups in terms of memory specificity (P>0.05). The results of the Spearman correlation coefficient and multiple regression analysis showed that only working memory capacity can predict memory specificity (r=0.216, p<0.05). There was no significant correlation between brooding and reflection, as two subtypes of rumination and memory specificity. Discussion: In line with our results, it should be stated that depression is accompanied by executive deficits, which result in memory impairments. These impairments are due to the structural and functional alterations in the brain in the depressed group. As the Carfax model emphasized, working memory capacity is not only required to maintain, define, and hold the optimal retrieval model but it is also crucial to inhibit interfering autobiographical information. Nonetheless, neither brooding nor reflection rumination can predict memory specificity. Therefore, memory capacity is probably occupied due to ineffective search strategies, not rumination.

The Pabon Lasso Model is often used to assess the efficiency of hospitals as the most important component of the health care system. The present study sought to evaluate and compare the efficiency of hospitals in northern Iran before and after the COVID-19 pandemic using the Pabon Lasso Model. This descriptive study was conducted in 36 public, private, and social security hospitals in northern Iran from 2019 to 2020. The hospitals were selected using the census method. The data were collected using the forms approved by the Ministry of Health and Education. The three indices of bed occupancy rate, bed turnover frequency, and the average length of stay were calculated and plotted using the Pabon Lasso graphs. The collected data were analysed using the paired samples t-test. The average bed occupancy rates in 2019 and 2020 were equal to 67.72% and 52.28%, lower than the national standard rate. Moreover, the average lengths of stay were 2.58 and 2.83 days and the bed turnover rates were 96.7 and 77.94, higher than the national standard rate. Of the total 36 hospitals in 2019, 33.3% of hospitals were in the first quarter (low efficiency), and 16.6% in the third quarter (high efficiency). Furthermore, the data for 2020 indicated that 38.8% of hospitals were in the first quarter (low efficiency), showing an increase compared to 2019 and 19.4% of hospitals were in the third quarter, indicating a decrease compared to 2019. The paired samples t-test indicated that the bed occupancy rate and bed turnover showed significant differences in 2019 and 2020 (P-value<0.05). The data confirmed that the average length of stay and bed turnover in the studied hospitals were favourable. In addition, unlike private hospitals, the number of efficient units in public hospitals decreased during the COVID-19 pandemic. Thus, hospital managers need to pay more attention to improving performance indicators and increasing productivity in these hospitals.

Determining the reliability and validity of the Mental Health Knowledge Schedule (MAKS-P) in Iran was the purpose of this study. We translated the MAKS into Persian and back into English. The validation process included linguistic validation, face validity, internal consistency, test-retest reliability, and construct validity. We perform multiple linear regressions to test the association between mental health knowledge and independent variables. A total of 384 people completed the Persian version of the questionnaire. In total, 64.6% of the respondents were women. The majority of respondents (51.6%) were married and did not have a full-time job (67.7%). The linguistic validation was confirmed. All the items of the questionnaire had acceptable face validity, except question number one, which was deleted due to incompatibility with the Iranian culture. Good internal consistency and reliability were shown by an overall Cronbach's alpha coefficient of 0.77. The test-retest approach was performed and the Cronbach's alpha was 0.845. Eigenvalues and the scree plot supported a 2-factorial nature of the translated survey form. The first and the second factors explained 33.14 and 14.92% of the variance, respectively. Age, education, and working status can be considered possible predictors of the MAKS-P score. The MAKS-P is a trustworthy questionnaire to assess stigma-related mental health knowledge in Persian-speaking societies.

BACKGROUND: Receiving safe health care services is among the first rights of patients. Ethical predictability is influential to identify the patient safety concerns in hospitals. OBJECTIVE: This study aimed to ascertain and compare ethical predictability of patient safety in selected hospitals in Mazandaran Province in Iran. METHODS: A cross-sectional design was applied in the current study. By applying the multistage method for sampling, the statistical population consisted of clinical units of selected public, social security, and private hospitals. Out of the 18 public hospitals, five teaching hospitals, nine private and five social security hospitals, one hospital was randomly selected in Mazandaran Province from each cluster. In total, 938 patients participated in the study. Data entry and analysis was carried out by SPSS version 22 software. RESULTS: The results showed that ethical predictability in social security hospitals was higher than the results in private and public hospitals (p < 0.001). In addition, among the selected dimensions of ethical predictability of patient safety in the selected hospitals, blood management was the highest dimension. Safe drug management, error management, infection control, and safe clinical services were the middle priorities and management and leadership of patient safety had the lowest mean in the ethical predictability of patient safety in the selected hospitals in the province. CONCLUSION: Identifying the factors causing ethical predictability in order to improve patient safety and service quality, is of great help to managers and authorities in the field of health services. Such awareness helps managers to consider these factors in all decision making processes.

Background: Ethical predictability in hospitals and other healthcare centers is a predisposition of good delivery of medical care accompanies respectful interaction with stakeholders, especially patients. The importance of healthcare delivery makes the topic of ethical predictability much more sensitive.Aim: To prioritize the ethical predictability dimensions effective on patients tendency to the hospital by using the analytic hierarchy process (AHP).Methods: This study was descriptive and applied. The required data collected by paired comparison questionnaire. 12 experts in health services field were chosen purposively and their view points analyzed by AHP with Expert Choice 11 software.Results: The prioritization of the main factors from experts viewpoints showed that quality of healthcare services (w= 0.336), observance of patients' rights (w= 0.278), patient management (w= 0.275), observance of staff's rights (w= 0.215), observance of family members' rights (w= 0.195), transparency (w= 0.130), and adherence to law (w= 0.087) placed in grades first to seventh, respectively.Conclusion: Considering the key role of ethical predictability in patients tendency to hospitals, experts`viewpointswere assessed carefully and the main dimensions of ethical predictability and their parameters, ranked base on their importance.

Background and purpose: Adherence to the principles of professional ethics in medical groups, in addition to influence patient satisfaction, plays a key role in improving and restoring their health. The aim of this study was to evaluate professional ethics from the perspective of recipients and service providers in hospitals affiliated with Mazandaran University of Medical Sciences. Materials and methods: This descriptive analytic study was performed in employees (n= 241), patients (n= 309), and managers (n= 25) in Mazandaran province hospitals, Iran, 2019. The sampling methods for patients, staff, and managers were simple random, systematic, and census random, respectively. Data were collected using a researcher-made questionnaire. The content and face validity of the questionnaire were determined by experts. The construct validity was confirmed by confirming factor analysis and its reliability was assessed by Cronbach's alpha coefficient and compound reliability. Data analysis was performed applying descriptive statistics and one-way analysis of variance (ANOVA). Results: The mean score for medical ethics was higher from the perspective of staff (4.17±0.64) compared to managers (4.15±0.52) and patients (3.95±0.71) (P <0.05). Communication with colleagues and respecting patient rights were found with the highest and lowest scores (4.34 ± 0.55 and 4.09 ± 0.68, respectively). Conclusion: Medical ethics was favorable in hospitals of Mazandaran province. But, continuous evaluation of different dimensions of medical ethics is needed to identify weaknesses and strengths, thereby making appropriate decisions to provide enhanced services.

Purpose Respect for human rights is one of the most important criteria for the delivery of medical care in hospitals. Ethical predictability is useful to identify human rights concerns in health-care organizations. The hospital environment and the flow of its processes make the topic of predictability much more sensitive and, at the same time, more difficult than other organizations. The purpose of this paper is to determine and compare the ethical predictive factors in selected hospitals in Mazandaran province. Design/methodology/approach This cross-sectional survey using multilevel sampling (four hospitals, 938 patients, 186 staff) was conducted in the first half of 2017. The measurement instrument was a researcher-made questionnaire consisting of seven areas of service recipients' rights, patient safety, patient satisfaction, human resources, governance, organizational and financial commitments. The analysis of the collected data was performed through SPSS V. 22 and one-way ANOVA and post hoc Tukey's tests. Findings Ethical predictability was higher in social security hospitals compared to private and public hospitals, and patient safety and patient rights showed higher magnitudes compared to other dimensions. Financial domain, patient satisfaction, governance and organizational commitment formed the middle priorities in ethical predictability, and human resources had the least average in ethical predictability in the selected hospitals in the province. Originality/value Identifying the factors which influence ethical predictability, in addition to promoting service recipients' rights and patient satisfaction, is of great help to the managers and health service authorities, so that they can have a better understanding of these factors and, consequently, make appropriate micro and macro-decisions to provide better services.

OBJECTIVES:Investigating the survival of patients with cancer is vitally necessary for controlling the disease and for assessing treatment methods. This study aimed to compare various statistical models of survival and to determine the survival rate and its related factors among patients suffering from lung cancer.METHODS:In this retrospective cohort, the cumulative survival rate, median survival time, and factors associated with the survival of lung cancer patients were estimated using Cox, Weibull, exponential, and Gompertz regression models. Kaplan-Meier tables and the log-rank test were also used to analyze the survival of patients in different subgroups.RESULTS:Of 102 patients with lung cancer, 74.5% were male. During the follow-up period, 80.4% died. The incidence rate of death among patients was estimated as 3.9 (95% confidence [CI], 3.1 to 4.8) per 100 person-months. The 5-year survival rate for all patients, males, females, patients with non-small cell lung carcinoma (NSCLC), and patients with small cell lung carcinoma (SCLC) was 17%, 13%, 29%, 21%, and 0%, respectively. The median survival time for all patients, males, females, those with NSCLC, and those with SCLC was 12.7 months, 12.0 months, 16.0 months, 16.0 months, and 6.0 months, respectively. Multivariate analyses indicated that the hazard ratios (95% CIs) for male sex, age, and SCLC were 0.56 (0.33 to 0.93), 1.03 (1.01 to 1.05), and 2.91 (1.71 to 4.95), respectively.CONCLUSIONS:Our results showed that the exponential model was the most precise. This model identified age, sex, and type of cancer as factors that predicted survival in patients with lung cancer.

Context: Burns and associated injuries are considered as the most severe types of trauma leading to multiple disabilities. Hence, obtaining information from the burn-related demographic variables is also of particular importance. The consequences of the burn include mortality, high hospital costs, and mental and emotional health problems. Aims: The current study was conducted to determine the demographic information affecting the mortality rate among burn patients in Burn Center of Mazandaran University of Medical Sciences (Sari, Iran). Settings and Design: This is a cross-sectional analytical study done in 2016. Materials and Methods: This retrospective study was conducted using the medical records of 629 patients hospitalized in the Burn Departments and BICU of the Burn center of Mazandaran University of Medical Sciences (Sari, Iran) in 2015. All participants were included through the headcount technique. Settings and Design: This is a cross-sectional analytical study done in 2016. Statistical Analysis Used: Mean, standard deviation (SD), and Probit regression and logistic regression were used for statistical analysis. The data were analyzed using the Spearman correlation coefficient and Chi-square test through the SPSS version 16. Results: The mean age of participants was 32.95 (SD = 22.17) years old. There were 93 patients (18.4%) aged below 5 years. The mean length of hospital stay was 13.69 ± 12.78 days. The majority of fatal burn injuries (77%) occurred at home. In this study, the lethal area 50 was obtained as 66.7%. A significant correlation was observed between demographic variables (age and educational attainment) and consequences of burn injuries. Conclusion: Considering the relationship between the effects of burns on age and educational level, investment in promoting awareness among people at different levels is recommended to prevent relevant incidents as an effective and necessary measure.

Background and purpose: Job stress is one of the main factors that reduce productivity in organizations and leads to physical and psychological complications in personnel. This study aimed to investigate the relationship between job stressors and quality of life in nurses. Materials and methods: A descriptive cross-sectional study was performed in all nurses (n=394) working in Sari Imam Khomini Hospital. In this study, 196 individuals (155 females and 41 males) were selected by stratified random sampling. Expanded Nursing Stress Scale (ENSS) and World Health Organization Quality of Life questionnaire were used to collect the data. Statistical analysis was done in SPSS V20. Results: According to findings, 79% of changes in quality of life were predicted by occupational stressors. There was a significant relationship between quality of life variables and job stressors (P =0.001). Also, the total mean score for quality of life was more favourable in morning shifts (37.77, P<0.001). The results showed that high levels of work-related stress would decrease quality of life and its reduction improves quality of life. Conclusion: Job stress in respondents had negative effects on some aspects of their quality of life. Therefore, nurse managers should build appropriate relationships with nurses and support them to reduce their physical needs and psychological pressures. Staff participation in making decisions could also be of great benefit in reducing job stress and improve the quality of life of nurses.

Purpose: This study aimed to investigate the relationship between the patients’ sense of security and the gap in the quality of services in the selected hospitals in the year 2015.Materials and Methods: The present study, as applied research, followed a descriptive-analytical approach. The sample used in this study comprised 600 patients, hospitalized in Imam and Shafa Hospitals in Sari, in addition to ValiAsr Hospital in Ghaemshahr, with at least 24 hours in internal, surgery, women, and children wards. The data were initially collected through the standard SERVQUAL questionnaire with two sections of demographic and specific questions including 22 five-point Likert scale questions, and one other 76 five-point liker scale questions regarding the sense of security among the patients. Results: The results of the study showed that the mean, median, and mode values of the gap (the distance between perceptions and expectations) equaled -0.61, 0.59, -0.55, respectively, with the Standard Deviation of 0.46. Through examining the relationship between gap and sense of security, it was observed that Spearman correlation coefficient was 0.289, which showed a significant relationship between the two elements.Conclusion: Given the direct relationship between the gap in services and the patients’ sense of security, it is essential that specific opportunities to be provided for the hospitals to improve their service quality.

Purpose: Visual impairment is responsible for medical, mental, and socio-economic problems. Several studies have investigated the prevalence of blindness and low vision in different parts of Iran. This study aims to estimate the pooled results of these studies to estimate the total prevalence of this problem in Iran. Methods: National and international databases were searched using specific keywords. The selected primary studies were quality assessed using STROBE checklist. According to the results of the heterogeneity tests (Cochrane and I-squared indices), fixed- or random-effect models were applied to estimate the pooled results. The factors responsible for the heterogeneity were investigated using meta-regression models. The point and pooled estimates were presented by forest plots, and the presence of publication bias was assessed based on Egger test. Results: Considering the results of 10 eligible studies showed that the prevalence (95% confidence intervals) of blindness among men, women, urban, and rural population as well as total population was 0.96% (0.60-1.31), 1.00% (0.70-1.31), 0.81% (0.19-1.44), 0.89% (0.45-1.32), and 1.02% (0.71-1.34), respectively. Prevalence (95% confidence intervals) of low vision among men, women, urban, and rural populations and also total populations was estimated at 2.19% (1.60-2.79), 2.60% (2.08-3.12), 2.81% (1.26-4.36), 3.67% (2.17-5.17), and 2.85% (2.12-3.58), respectively. Conclusion: Our meta-analyses showed that more than 3% of Iranian people are suffering from visual problems. In addition, we found that prevalence of blindness and low vision among Iranian women was more common than that of Iranian men and also was higher in rural areas than urban areas.

Background and purpose: Today, health is one of the main priorities of human life. Nowadays, the viewpoints about health are different and more attention is paid to nonmedical expectations. So, this study aimed to analyze the Health Reform Plan in healthcare sector using SWOT approach from the stakeholder perspective. Materials and methods: This qualitative study was conducted in 37 people using semi-structured in-depth interviews in 2017. The participants included individuals who were informed about the Health Reform Plan, executive managers, health administrators, family physicians, and patients in comprehensive healthcare centers. They were selected by purposive sampling. The interviews were transcribed and analyzed by framework method. Results: The main strengths included empowering the managers, developing and facilitating the health network, electronic health records, increasing the accessibility of services, and promoting self care. The weak points were as follows: management of human resources, choosing the managers, financial management, poor infrastructures, treatment-based system, low efficacy of recording system, and payment system. The opportunities included authorities’ supports, legal backing, and public-private sector cooperation. The threats were lack of sustainable financing, aging phenomenon, and non-communicable diseases. Conclusion: This study showed the strengths and weaknesses of Health Reform Plan in healthcare sector, and its opportunities and threats. Therefore, efficient interventions are needed to ensure appropriate and precise planning and implementation of this project.

Background and purpose: Increase in cesarean section (C-Section) is a health system problem around the world. The aim of this study was to compare the rate of C-Section and indications for that before and after implementation of Health System Reform in the hospitals of Mazandaran province, Iran. Materials and methods: This descriptive cross-sectional study was conducted analytically. The indications for C-Section were recorded based on curative treatment checklist before implementation of the Health System Reform (2013) and after that (2016). Data were analyzed in SPSS V21 applying t-test and Chi-square. Results: The rate of C-Section was significantly lower only in governmental hospitals after implementation of the Health System Reform (P< 0.05). Among the indications of C-Section, only the previous C-Section had a significant difference before and after the Health System Reform in total hospitals in the province (P<0.002). Significant differences were found between previous C-Section (P<0.025) and its increasing trend, and post-term pregnancy (P<0.027) and decreasing trend before and after the Health System Reform in governmental hospitals. Other indices were not significantly different between public, private, and Social Security Organization hospitals (P<0.05). Conclusion: Implementation of Health System Reform was effective in decreasing the rate of C-section in governmental hospitals. It is hoped that with appropriate implementation of the program, along with cultural and social programs, we could get closer to Iran’s scientific goals and decrease the rate of C-Section according to global standards.