Substance use disorders (SUDs) present persistent challenges for effective treatment and relapse prevention. Understanding the factors that support sustained recovery is therefore critical. Recovery capital, encompassing the internal and external resources that facilitate the initiation and maintenance of recovery, is recognized as a key determinant of long-term recovery outcomes. This study examines factors associated with recovery capital among individuals with SUDs across different treatment modalities in Iran. In this cross-sectional study, 332 individuals in recovery from SUDs were recruited in 2024 through cluster sampling from outpatient and community-based treatment settings. Guided by a socioecological framework, individual, social, and treatment-related factors were assessed. Data were collected using validated questionnaires measuring recovery capital, perceived social support, and perceived quality of life and satisfaction, along with demographic and substance use-related variables. Multiple linear regression analyses were conducted using SPSS. Recovery capital was significantly associated with gender (p = 0.005), marital status (p < 0.001), employment status (p < 0.001), predominant substance type (p < 0.001), stage of recovery (p = 0.004), relapse history (p = 0.034), and treatment modality (p < 0.001). Higher recovery capital was also strongly correlated with greater perceived social support (p < 0.001), perceived quality of life and satisfaction (p < 0.001), and engagement in meaningful activities (p < 0.001). In multivariable analysis, perceived social support, perceived quality of life and satisfaction, living arrangements, and treatment modality jointly explained 44% of the variance in recovery capital. Recovery capital appears to be shaped by modifiable social and contextual resources, in addition to demographic and treatment-related factors. The strong associations with social support and perceived well-being highlight the importance of integrating psychosocial and quality-of-life-focused strategies into routine SUD services to strengthen recovery resources across treatment settings.

Background: Online training for the rehabilitation of people with spinal cord injuries (SCI) is essential. Various environmental barriers can make it challenging for individuals to attend face-to-face interventions. This study aimed to investigate the effectiveness of online group wheelchair mobility and transfer training on occupational performance and satisfaction in people with SCI. Methods: In this single-blind randomized controlled trial, individuals with SCI were recruited from SCI association hospitals and clinics, and randomly assigned to an online training group (OTG) or a control group (CG) using blocked randomization. The OTG participated in five online training sessions over five weeks, while the CG received routine guidance via an individual online booklet. Outcomes were assessed post-intervention and at one-month follow-up immediately to evaluate changes in occupational performance and satisfaction. Treatment efficacy and between-group comparisons were analyzed using repeated measures analysis of variance (ANOVA). Results: A total of 37 participants (CG = 18; OTG = 19) completed the 5-week intervention and follow-up assessments out of 49 enrolled. The mean age of participants was 35.0 years in the CG and 33.7 years in the OTG. Significant performance improvements (p < 0.001) and satisfaction (p < 0.001) were observed within the OTG during pre-post assessments. Additionally, significant differences between groups were found in both performance (p = 0.026) and satisfaction (p = 0.015). Conclusion: The findings indicate that online wheelchair mobility and transfer training is an effective and feasible method for telerehabilitation in people with SCI.

Social network-based HIV testing (SNHT) is an evidence-informed strategy for expanding HIV testing coverage. This systematic review evaluated the effectiveness of SNHT strategies in improving HIV testing uptake, diagnosis of new HIV cases, and linkage to care among women and their at-risk social networks and examined key strategies for effective implementation. We systematically reviewed studies assessing social network-based approaches for HIV testing uptake, HIV diagnosis, linkage to HIV care and treatment after diagnosis, and related barriers and adverse effects among women. We searched PubMed, Web of Science, Scopus, Embase, and Google Scholar for English-language articles published up to February 2023, following PRISMA guidelines. Due to heterogeneity in study designs and incomplete data, with some studies lacking either the numerator or the denominator, we conducted a qualitative synthesis to summarize patterns in HIV testing uptake, diagnosis, linkage to HIV care and treatment after diagnosis, and adverse events. In addition, where data were available, we extracted and presented reported effect sizes for HIV testing uptake and HIV test results. Out of 1,282 screened publications, 19 met the inclusion criteria. Findings were categorized based on HIV testing uptake, diagnosis, linkage to care, the types of social network members, recruitment strategies, and adverse event. Our review found a high acceptance rate of HIV testing regardless of the type of network members. Evidence regarding new HIV case diagnoses and linkage to HIV care after diagnosis was mixed. Implementation strategies varied across studies, including differences in the types of social network members targeted, recruitment approaches, and use of incentives. Adverse events, including intimate partner violence, were infrequently reported. This review highlights that SNHT strategies can effectively increase HIV testing uptake among women and their at-risk network members. Women, through roles such as peer educators or recruiters, can actively engage peers, sexual partners, and other network members to promote HIV testing. Effective SNHT programs require robust monitoring systems to track how many network members are approached, tested, and successfully linked to confirmatory testing and treatment.

Mental health disorders significantly contribute to the global burden of disease, both as non-communicable diseases (NCDs) and as risk factors for other health conditions. They represent a major public health concern in low- and middle-income countries (LMICs). This study aims to investigate associations between psychological distress, socioeconomic factors, and corruption-related factors among Iranian adults in urban settings using multilevel analysis. This cross-sectional analysis uses data from a survey conducted in 2025 among urban adults across all 31 provinces of Iran, employing a proportional, stratified cluster sampling design with probability proportional to size (PPS). Psychological distress among adults aged 18 years and above was assessed using the 12-item General Health Questionnaire (GHQ-12), with a binary threshold of ≥ 4. Multilevel logistic regression models were used to examine associations between psychological distress and socioeconomic factors, perceived corruption, and experience of paying bribes. Models adjusted for health status and included random effects at the province and county levels. Sensitivity analyses were conducted using alternative GHQ-12 thresholds (≥ 3 and ≥ 5) to assess the robustness of findings to the choice of cut-off. The proportion of participants scoring above the GHQ-12 threshold of ≥ 4 for psychological distress was 41.2

Background: The COVID-19 pandemic has caused a threat to global public health. The sexual function and satisfaction of couples during the COVID-19 pandemic have received comparatively less attention. This study aimed to assess sexual satisfaction and sexual function and their related factors among married women in the west of Iran during the COVID-19 pandemic.Methods: A cross-sectional study was conducted among 390 married women in Kermanshah province in 2021. For data collection, a checklist consisting of demographic variables along with Larson’s sexual satisfaction questionnaire and the 6-item Female Sexual Function Index were utilized. To investigate the relationship between function and sexual satisfaction, we used a hierarchical linear regression.Results: The means (SD) of sexual satisfaction and sexual function scores were 83.25 (40.59) and 19.33 (9.82), respectively. A significant relationship was observed between sexual satisfaction and the women’s occupation status, traditional marriage status, tubal ligation, a history of chronic diseases, alcohol use, the history of sexual violence, changes in sexual behavior during COVID-19, and total sexual function score. Also, the women’s age, male condom use, oral contraceptive pill use, changes in sexual behavior during COVID-19, and total sexual satisfaction score associated with the sexual function of women.Conclusion: These findings showed that during the COVID-19 pandemic, married women reported moderate sexual satisfaction and sexual dysfunction. Additionally, the results of this study could help to develop a plan to improve the sexual lives and health of women in sudden events.

Background: Medical errors are considered inevitable events in healthcare systems and represent a major challenge in global health, particularly in developing countries. This study aimed to investigate the types of medical errors and their associated factors in Kermanshah Province, western Iran, in 2020.Methods: A cross-sectional study was conducted using data from all patients referred to public and private healthcare centers with complaints related to clinical or medical errors. Complaints were filed with the Kermanshah Medical System Organization in 2020. Data were collected using a checklist and medical error registry software.Results: The operating room ward accounted for the highest proportion of reported errors (44.09%), followed by the delivery ward (20.43%) and the emergency ward (6.45%). Poisson regression analysis revealed that age group, type of service center, and the interaction between medical negligence and type of shift were significantly associated with the number of errors.Conclusion: Greater attention should be paid to hospital performance, and medical protocols should be revised to prevent errors and their associated financial and human consequences. Our findings suggest that healthcare organizations should prioritize conditions during night shifts, particularly when additional medical staff are involved. Implementing enhanced safety protocols or support systems during these periods may mitigate the elevated risk of errors and improve overall patient safety.

There is limited understanding of socioeconomic inequality in multimorbidity in Iran. This study aims to investigate socioeconomic inequality in multimorbidity among adults in western Iran. Data from the Ravansar Non-Communicable Disease (RaNCD) cohort study were used in this cross-sectional study. A sample of 10,047 adults aged 35–65 years was analyzed. Principal component analysis was utilized to determine socioeconomic status (SES). The normalized concentration index (NCI) was used to assess the extent of socioeconomic disparities in multimorbidity. Decomposition analysis was conducted to identify and calculate the factors contributing to multimorbidity inequality. In this study, the prevalence of having at least two NCDs was 9.07%, while the prevalence of having at least three NCDs was 2.87%, and four or more NCDs was 1.25%. The NCI for multimorbidity was -0.061 (P < 0.001), indicating a higher concentration of multimorbidity among individuals with low SES. Age (52.5%), body mass index (BMI) (29.4%), gender (27.5%), physical activity (25.1%), and SES (15%) were identified as significant factors contributing to the increased inequality in multimorbidity. The study findings identified age, gender, BMI, physical activity, and SES as key factors driving multimorbidity disparities. It is recommended that health policymakers prioritize health interventions aimed at reducing socioeconomic inequalities in multimorbidity, particularly for low-SES groups, women, obese individuals, and older adults.

PurposeSelf-care is recognized as an important element in the comprehensive management of patients with heart failure. The study aimed to explore the correlations of self-care behaviors in chronic heart failure patients in Kermanshah, West Iran.DesignDescriptive and analytical cross-sectional.SettingHospital.SampleThe research population included 597 (246 female and 351 male) patients with chronic heart failure visiting Imam Ali Cardiovascular Hospital in Kermanshah in 2022.MeasuresDemographic information, European Heart Failure Self-care Behavior Scale.AnalysisIndependent-sample t test, ANOVA, and Kruskal-Wallis in SPSS-24. The significance level was set at 5%.ResultsThe participants' age was 63.04 ± 14.1 years. The mean and standard deviation of the participants' self-care behaviors was 2.91 ± 31.00, and only 20.60% of the patients reported engaging in satisfactory self-care behaviors. Self-care behaviors were significantly related to Income level, ethnicity, family history of background disease, history of co-morbidity, history of addiction, access to medical centers, and not with any other variables.ConclusionBased on the study's results, most participants exhibited moderate self-care behaviors, suggesting that these patients may need preventive educational interventions to acquire the knowledge, skills, and attitudes necessary for effective self-care behaviors. Therefore, it is essential to design and implement a health promotion educational intervention aimed at convincing these patients to make lifestyle changes and adhere to their dietary and medication regimens to improve self-care behaviors.

Background:Cybervictimization among adolescents is a growing concern, particularly in non-Western contexts where empirical evidence remains limited. Guided by socioecological theory, this study aimed to examine how individual (i.e., gender, negative mood, loneliness), family (i.e., parental supervision, home belonging, parental education), peer (i.e., peer acceptance, peer rejection), and school-related factors (i.e., school victimization, school climate, educational level) are associated with cybervictimization among Iranian adolescents. Methods:A cross-sectional survey was carried out among 592 students aged 13-18 from 36 classrooms across public and private secondary and high schools in Tabriz, Iran. Participants completed an online self-report questionnaire assessing cybervictimization and associated predictors. Binary logistic regression analyses were performed to examine both bivariate and multiple associations. Results:Nearly half of the students reported experiencing cybervictimization (46.8%). High school students (P = 0.002), those exposed to school victimization (P < 0.001), and those reporting negative mood symptoms (P < 0.001) were significantly more likely to be targeted. In contrast, students with a stronger sense of home belonging (P = 0.016) and greater parental supervision (P = 0.036) were significantly less likely to experience cybervictimization. Conclusion:These results highlight the importance of addressing both school and home environments, as well as emotional well-being, in cybervictimization prevention efforts. Culturally responsive strategies involving schools, families, and mental health systems are recommended.

Women with diabetes are at an elevated risk for cardiovascular disease (CVD), and insomnia exacerbates these risks, highlighting the urgent need for effective interventions that improve cardiometabolic health and reduce mortality in this population. This study aimed to evaluate the effects of the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet on cardiometabolic health and novel anthropometric indices in 44 women, aged 30 to 65, with type 2 diabetes and insomnia. In this randomized controlled trial, participants were assigned to either the MIND low-calorie diet (MLCD) or a standard low-calorie diet (LCD) for 12 weeks. Outcomes assessed at baseline and after 12 weeks included lipid profiles, markers of glycemic control, blood pressure, and anthropometric measures. The results revealed that the MIND diet significantly improved fasting blood sugar (FBS) (-19.31, 95

Earthquakes increase disease incidence and mortality due to overcrowding, poor housing and nutrition, stress, treatment discontinuation, and poor patient management. This study examined the impact of an earthquake on pulmonary tuberculosis (TB) incidence in three earthquake-stricken areas and 11 other districts of Kermanshah Province to better inform disease control planning. Monthly pulmonary TB case counts and population data for 14 districts of Kermanshah Province were obtained from the TB Registration Office and the Kermanshah Deputy of Medical Sciences Statistics Center, covering 2009–2018. The total cohort comprised 2,622 TB cases: 207 from three earthquake-affected districts (Sar-e-Pul-e-Zahab, Qasr-e Shirin, Salas-e Babajani) and 2,415 from eleven non-affected districts (e.g., Kermanshah, Islamabad, Paveh). The study period included 8 years pre-earthquake (2009–2016) and 2 years post-earthquake (2017–2018). The earthquake’s impact on monthly TB incidence trends was assessed using segmented regression, single-group Interrupted Time Series (ITS) analysis, and multiple-group ITS models comparing affected and control regions. The impact of the earthquake on TB incidence varied across districts. While earthquake-affected areas showed a significant increase in TB cases (ß2= 0.059, P < 0.011) following the event, the TB incidence trend showed a pronounced decline (ß3= -0.0042, P < 0.001) with 207 observations (184 before, 23 after). Similar patterns were observed in other districts, with some experiencing significant increases (e.g., Islamabad, ß2= 0.00028, P < 0.001) and others decreases (e.g., Paveh, ß2=-0.00049, P < 0.001) in TB levels following the earthquake. The earthquake did not result in a sustained increase in TB incidence in affected regions. The findings may reflect effective TB control efforts, post-disaster public health interventions, or underreporting. Strengthening TB surveillance and long-term monitoring in disaster zones is essential for informed response planning.

Background: Numerous studies have demonstrated that a significant number of individuals experience weight regain following bariatric surgery. To sustain long-term weight loss outcomes, it is imperative to assist patients in adopting and maintaining healthy lifestyle changes. Implementing cognitive interventions aimed at enhancing self-management behaviors is crucial in supporting patients' efforts to sustain weight loss post-surgery. Materials and methods: This paper outlines a protocol for a randomized controlled trial with two arms. The sample will consist of 100 patients who have undergone bariatric surgery and are part of the Tehran Obesity Treatment Study. The participants will be randomly assigned to either the intervention group or the control group. The intervention group will receive an educational intervention based on the health action process approach for a duration of eight weeks. The inclusion criteria for this study are patients who have undergone bariatric surgery at least one year prior to the study. All primary and secondary outcomes will be measured at two different time points: baseline and four months after the completion of the intervention, for each participant. Conclusion: The results of this study offer valuable insights into the advantages of theory-based educational interventions in improving outcomes of bariatric surgery. These findings present an opportunity for health planners, practitioners, nurses specializing in bariatric surgery care, policy makers, and patients to utilize an effective intervention in the field.

Insomnia is common in type 2 diabetes mellitus (T2DM) and affects mental health and quality of life. The present study aimed to examine the efficacy of MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet on the anthropometric measurements, sleep quality, depression, anxiety, and serum levels of cortisol and brain derived neurotrophic factor (BDNF) in type 2 diabetic women with insomnia. This randomized controlled trial (RCT) involved 44 type 2 diabetic women with insomnia, aged 30 to 65 years, who were randomly assigned to be under the MIND low-calorie diet (n = 22) or a low-calorie diet (LCD) as the control group (n = 22) for 12 weeks. The above-mentioned variables were assessed at the beginning and the end of intervention. Following the MIND diet for 12 weeks accompanied by the significant decrease of waist circumference and significant improvement of sleep quality, depression, and anxiety compared to the control group. In addition, the MIND diet vs. LCD group exhibited a significant reduction in the cortisol levels and a significant increase in BDNF. This study provides promising evidence of the effectiveness of the MIND diet in improving the sleep quality, mental health, and some related biochemical parameters in diabetic women with insomnia. Trial registration: IRCT20181111041611N8.

BackgroundBariatric surgery is effective in treating severe obesity. However, surgery alone, without additional behavior change management, may not lead to optimal long-term weight loss and maintenance. This study aimed to evaluate an intervention designed based on the Health Action Process Approach to improve outcomes of obesity surgery in patients who underwent bariatric surgery in Tehran, Iran.MethodsIn this randomized controlled trial, a total of 100 patients who had undergone bariatric surgery after the past year were randomly assigned to two intervention (n = 50) and control (n = 50) groups. The intervention group received educational intervention for two months. Health action process approach (HAPA) constructs, the Bariatric Surgery Self-Management Behaviors Questionnaire (BSSQ), dietary recall, blood chemistry parameters, BMI, percentage of body weight loss, and the International Physical Activity Questionnaire (IPAC) were measured at baseline and four months after the intervention. To compare the changes between the two groups before and four months after the educational intervention, the interaction of group and time was analyzed using the generalized estimating equation (GEE). A p-value of less than 0.05 was considered statistically significant.ResultsThe educational intervention resulted in improvements in various aspects of self-efficacy, including task and coping self-efficacy constructs (P = 0.02), action planning (P < 0.01) and behavioral intention (P < 0.01) related to diet self-management. There were also statistically significant improvements in action planning (P = 0.02), risk perception (P = 0.01) and Recovery self- efficacy (P = 0.01) related to the self-management of physical activity. There were significant improvements in the iron blood test results (P = 0.01) among the patients.ConclusionOur intervention, designed based on the Health Action Process Approach, led to improvements in dietary and physical activity outcomes among patients who underwent bariatric surgery. Trial Registration: Iran Randomized Clinical Trials IRCT20230722058887N1.

Health literacy may play an important role in the attainment of the United Nations Sustainable Development Goals. The aim of this study was to assess the psychometric properties of the Persian version of Health Literacy for School-Aged Children (P-HLSAC) employing data that covered the entire school path. This cross-sectional study was conducted in 2023-24 among 605 school-aged students in Isfahan, Iran. Reliability indices as well as content, predictive and concurrent validity were evaluated. The factor structure of P-HLSAC was assessed and confirmed employing exploratory and confirmatory factor analysis, respectively. The scale content validity indices, Cronbach α and intraclass correlation coefficient were acceptable. A significant correlation was found between quality of life and health literacy (Pearson's r = 0.28, p < 0.001) demonstrating a good predictive validity. The mean of health literacy in those with daily self-health learning behavior was significantly higher than those without it (33.60 vs. 31.9, p < 0.001) highlighting the concurrent validity of P-HLSAC. Confirmatory factor analysis approved both one- and two-factor structure of P-HLSAC. The model indices verified an adequate model fit for both one- and two-factor structure of P-HLSAC. This study confirmed the reliability and validity of the P-HLSAC for estimating health literacy in an Iranian cultural context among primary to upper secondary school students. Considering its briefness, the psychometric characteristics of P-HLSAC were approved for its utilization in large-scale studies among entire school-path Iranian school-age children.

Abstract Background Metabolic syndrome (MetS) is associated to sleep duration. It is crucial to identify factors that disrupt sleep regulation. The study aimed to assess the indirect effect of risk factors related to MetS severity through sleep duration by utilizing a structural equation model (SEM). Methods The study involving 3,935 adults from the baseline data of the Ravansar Non-Communicable Disease (RaNCD) cohort study. MetS severity scores were the outcome variables. SEM was employed to explore the relationships, utilizing IBM SPSS and AMOS version 23. Results The mean MetS severity score was higher in women compared to men (0.25 vs. 0.16, P = 0.003). In men, socioeconomic status (SES) has a positive direct effect (β = 0.048) and a negative indirect effect (β=-0.006) on MetS severity. Increased physical activity is directly (β=-0.036) and indirectly (β=-0.093) associated with reducing MetS severity. Nap duration is directly linked to an increase (β = 0.072) but has an indirect effect (β=-0.008) in decreasing MetS severity. In women, SES has a direct (β=-0.020) and indirect (β=-0.001) inverse relationship with MetS severity. Increased physical activity is directly (β=-0.048) and indirectly (β=-0.036) associated with decreasing MetS severity in women. Nap duration is directly associated with an increase in MetS severity (β=-0.018) but indirectly contributes to its reduction (β=-0.002). Sleep duration not only directly affects MetS severity but is also influenced by age, SES, physical activity, obesity and nap duration. Conclusion Physical activity, SES, and nap duration directly and indirectly effect the MetS severity. Sleep duration was recognized as a mediating variable that supports the indirect effects.

Objective Mitral valve failure is one of the most common valvular heart diseases worldwide. Valve replacement and repair have an impact on the quality of life of patients. Therefore, the present study was conducted to compare the quality of life in patients with mitral valve replacement and those who underwent mitral valve repair.Methods In this cross-sectional study, we considered all cardiac patients with ischemic mitral insufficiency who underwent mitral valve repair and patients with a history of valve replacement in Imam Ali Hospital of Kermanshah between 2014 and 2020. Two Minnesota and general quality of life questionnaires along with a checklist for demographic variables were used for data collection. Data analysis was performed using SPSS version 21 software.Results The mean quality of life score based on the general quality of life scale in the valve repair group was 32.33 (SD = 2.29) and in the valve replacement group 32.89(SD = 2.60), (p = 0.917). Also, mean quality of life, as measured by the Minnesota MLHFQ was 60.89(SD = 17.67) in the valve repair group and 63.42 (SD = 12.13) in the valve replacement group (p = 0.308). The results showed that the average general quality of life was different in study groups regarding education. Tukey's post hoc test showed that the average general quality of life in illiterate people is significantly lower than in people with academic degrees (P-value = 0.001).Conclusion The quality of life of the patients in both the valve repair and replacement groups was at an average level. There was no significant difference between the general quality of life and the Minnesota scales, suggesting that both tools can be effectively used to measure patients' quality of life. The study's findings can be valuable for monitoring patients, screening for conditions, and enhancing communication between doctors and patients.

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders in reproductive-age women caused by hyperinsulinemia. The portfolio Moderate-carbohydrate diet (PMCD) is a plant-based diet with a carbohydrate content of 40 https://www.irct.ir/trial/67548

Background: Sleep is a vital physiological process that plays a crucial role in various aspects of human health and well-being. Regarding the important role of diet on the sleep quality, the present study aimed to assess the association of dietary inflammatory index (DII) with the sleep outcomes and also to provide the potential mechanisms of action. Methods: PubMed, Web of Science and Scopus databases and Google Scholar search engine were systematically searched for relevant studies related to DII and sleep outcomes using appropriate search terms until February 2024. Results: From the initial systematic search of databases, 197 studies were retrieved. However, only 14 of them met the criteria for evaluation. Out of these, eleven studies indicated a significant correlation between higher DII scores and poor overall sleep quality and/or short/long sleep duration or its subscales. On the contrary, four studies did not find any proof of this association. Conclusion: This systematic review indicated that following an anti-inflammatory diet could potentially lead to an improvement in the sleep outcomes. Well-designed clinical trials in the future will be necessary to provide a better understanding and quantification of this association.

Background The purpose of this study was to develop and evaluate the validity and reliability of a healthy diet and physical activity assessment tool among patients one year after bariatric surgery based on Health Action Process Approach. Methods We compiled 53 items based on healthy diet and physical activity behaviors among patients undergone bariatric surgery through reviewing the literature. Using quantitative and qualitative methods, and a panel of experts, we evaluated the face and content validities of the tool. The reliability was evaluated by Intra-class correlation coefficient and Cronbach’s alpha. Results The content validity ratio and the content validity index were 0.62 and 0.79, respectively. Exploratory factor analysis showed seven factors, including risk perception, outcome expectations, task self-efficacy, coping, recovery self-efficacy, action planning, coping planning, and behavioral intentions. The Intra-class correlation coefficient was between 0.8 and 0.91; and Cronbach’s alpha for different constructs was between 0.8 and 0.95. Conclusion The findings showed that the constructs of the Health Action Process Approach tool regarding healthy diet and physical activity had adequate validity and reliability in bariatric surgery patients.