Validation of the Short Version (TLS-15) of the Triangular Love Scale (TLS-45) across 37 Languages.

Love is a phenomenon that occurs across the world and affects many aspects of human life, including the choice of, and process of bonding with, a romantic partner. Thus, developing a reliable and valid measure of love experiences is crucial. One of the most popular tools to quantify love is Sternberg's 45-item Triangular Love Scale (TLS-45), which measures three love components: intimacy, passion, and commitment. However, our literature review reveals that most studies (64%) use a broad variety of shortened versions of the TLS-45. Here, aiming to achieve scientific consensus and improve the reliability, comparability, and generalizability of results across studies, we developed a short version of the scale-the TLS-15-comprised of 15 items with 5-point, rather than 9-point, response scales. In Study 1 (N = 7,332), we re-analyzed secondary data from a large-scale multinational study that validated the original TLS-45 to establish whether the scale could be truncated. In Study 2 (N = 307), we provided evidence for the three-factor structure of the TLS-15 and its reliability. Study 3 (N = 413) confirmed convergent validity and test-retest stability of the TLS-15. Study 4 (N = 60,311) presented a large-scale validation across 37 linguistic versions of the TLS-15 on a cross-cultural sample spanning every continent of the globe. The overall results provide support for the reliability, validity, and cross-cultural invariance of the TLS-15, which can be used as a measure of love components-either separately or jointly as a three-factor measure.

Exploring Attitudes Toward "Sugar Relationships" Across 87 Countries: A Global Perspective on Exchanges of Resources for Sex and Companionship.

The current study investigates attitudes toward one form of sex for resources: the so-called sugar relationships, which often involve exchanges of resources for sex and/or companionship. The present study examined associations among attitudes toward sugar relationships and relevant variables (e.g., sex, sociosexuality, gender inequality, parasitic exposure) in 69,924 participants across 87 countries. Two self-report measures of Acceptance of Sugar Relationships (ASR) developed for younger companion providers (ASR-YWMS) and older resource providers (ASR-OMWS) were translated into 37 languages. We tested cross-sex and cross-linguistic construct equivalence, cross-cultural invariance in sex differences, and the importance of the hypothetical predictors of ASR. Both measures showed adequate psychometric properties in all languages (except the Persian version of ASR-YWMS). Results partially supported our hypotheses and were consistent with previous theoretical considerations and empirical evidence on human mating. For example, at the individual level, sociosexual orientation, traditional gender roles, and pathogen prevalence were significant predictors of both ASR-YWMS and ASR-OMWS. At the country level, gender inequality and parasite stress positively predicted the ASR-YWMS. However, being a woman negatively predicted the ASR-OMWS, but positively predicted the ASR-YWMS. At country-level, ingroup favoritism and parasite stress positively predicted the ASR-OMWS. Furthermore, significant cross-subregional differences were found in the openness to sugar relationships (both ASR-YWMS and ASR-OMWS scores) across subregions. Finally, significant differences were found between ASR-YWMS and ASR-OMWS when compared in each subregion. The ASR-YWMS was significantly higher than the ASR-OMWS in all subregions, except for Northern Africa and Western Asia.

Hesitancy among Iranian nursing students regarding future career trajectory: a qualitative analysis.

BACKGROUND: The shortage of skilled nurses is a major concern for health systems worldwide. This may be partly due to the hesitancy of some nurses to enter or remain in the nursing career. This shortage consequently reduces the quality of standard patient care, increases patients' length of stay in a hospital, increases medical costs, and results in patients' dissatisfaction. This study aimed to explore hesitancy among senior undergraduate nursing students to pursue a career in nursing. METHODS: This qualitative study adopted a thematic analysis approach. The population comprised senior undergraduate nursing students at Isfahan University of Medical Sciences, Iran, who indicated that they were hesitant to pursue a career in nursing. The study sampling was performed from May 2021 till February 2022 and continued until data saturation. Twenty-four interviews were conducted with the selected students. The attributes related to hesitancy among senior undergraduate nursing students to pursue a career in nursing were extracted as themes and sub-themes. RESULTS: Four themes were identified: academic idiosyncrasies, individual characteristics, poor nursing market regulations (sub-themes: nursing as a tough and intense career, and unfavorable employment contracts), and the peculiarities of the workplace (sub-themes: conflict within work environment, and barriers to professional nursing practice). CONCLUSIONS: The findings of this study showed that senior undergraduate nursing students weigh their future career options from various academic, personal, professional, and work environment dimensions. The findings provide new insights for decision makers to design and implement innovative strategies to promote retention in nursing careers. We recommend to provide academic counseling for all students and applicants of nursing before they enter the nursing education. Furthermore, we suggest to improve study and work environments, and to implement incentive programs to enhance enthusiasm of nursing students for pursuing a nursing career.

Lifestyle patterns, nutritional, and metabolic syndrome determinants in a sample of the older Iranian population.

BACKGROUND: Chronic diseases and metabolic disorders are prevalent health concerns that often escalate with increasing age and thus affect older individuals. The proportion of the elderly population in Iran increased from 7.22% in 2006 to 12.0% in 2023. The current study aimed to evaluate lifestyle patterns and lifestyle risk factors among patients with metabolic syndrome (MetS) based on dietary, physical activity, and smoking, as well as MetS components. METHODS: This cross-sectional study included 582 older people with MetS living in Yazd, Iran. Latent class analysis (LCA) was used to determine the lifestyle behaviors of diet patterns, smoking, and physical activity. Dietary intake was measured using a validated food frequency questionnaire, and dietary patterns were identified using principal component analysis (PCA). Clinical measurements of MetS components were examined using relevant guidelines. RESULTS: The mean age of the participants was 72.71 years (SD = 5.57). Using PCA, two dietary patterns were identified: traditional patterns (e.g., fruits, fish, poultry, vegetables, meats, salt, and sugar sweetened beverages) and high-fat patterns (e.g., high-fat dairy). Applying LCA identified two classes of lifestyle patterns. About 35% (n = 204) of the participants were categorized in a low-risk class (I) and characterized by physical activity (0.93%, n = 190), a traditional pattern for diet (61%, n = 122), and zero probability of smoking. About 65% (n = 378) of the patients were categorized in high-risk class (II) and characterized by low physical activity levels (69%, n = 261), cigarette smoking (71.6%, n = 271), and a high-fat dietary pattern (56.9%, n = 215). CONCLUSION: The results of our study indicated two distinct classes within the patients. In class I, aging patients with MetS exhibited characteristics such as engagement in physical activity and having a traditional pattern for diet. Class II, with a higher prevalence of lifestyle risk factors, included individuals who engaged in cigarette smoking, displayed low physical activity (69%), and having a high-fat diet. The combination of these lifestyle factors exposed them to a heightened risk of developing MetS. The findings could guide healthcare professionals to be aware of the associations between different lifestyle risk factors and to focus on multiple behaviors at the same time.

The study of acceptability HIV self-testing among Iranian injecting drug users: a qualitative study.

BACKGROUND: In 2016, The World Health Organization introduced HIV self-testing (HIVST) as an alternative to traditional HIV testing (1), the present study aims to study the acceptability of HIV self-testing among Iranian women injecting drug users (WIDUs). The results of this study are expected to provide valuable evidence for the proper implementation of this program in Iran. METHODS: This study employed a content analysis approach to gather qualitative data. The investigation was conducted from April to July 2023. We have chosen the following five provinces, namely Mashhad, Tehran, Kurdistan, Mazandaran, and Kerman, as the designated areas for our study. A sample of Iranians (17-62 years) was selected by purposeful and snowball sampling methods to participate in the study, and 31 semi-structured interviews were conducted. The data collection tool was an interview guide, which was designed based on a review of the literature. The data were analyzed using conventional content analysis. The interviews continued until data saturation was reached. RESULTS: Based on our findings, we distilled 2 main themes and 9 categories including Inhibiting factors (Access and Affordability, Accuracy Concerns, Low knowledge, linkage to HIV treatment, the window period, Ignoring the danger) and Focalizing factors (Empowerment and autonomy, Stigma and privacy. CONCLUSION: Iran's HIV stigma may discourage regular testing, but self-testing can help overcome challenges. Support for counseling, care links, and accurate information dissemination are crucial.

A comprehensive perspective on local drivers in community-based health tourism industry development: a qualitative study of Mazandaran Province, Iran.

BACKGROUND: Health tourism is an important component that may influence the direction of development in a region. Mazandarn, Iran, is recognized as a highly sustainable market in the region because of its abundant natural resources, temperate temperature, and strategic geographical location. Therefore, considering the importance of health tourism and its existing potential in Mazandaran, Iran, this study was conducted with the aim of exploring a comprehensive perspective on local drivers in community-based health tourism industry development and factors affecting the attraction of health tourism. METHODS: We conducted this study in Mazandarn, Iran, using a qualitative approach. Participants included a sample of Iranian people, aged 34-54 years, with previous history of health tourism or expert in it. Participants were selected from three different categories of the community: academic professionals in health tourism, managers in health tourism, and health tourists. Data were obtained via semi-structured in-depth interviews and focus group discussions. Inductive qualitative content analysis was used to converge and compare themes through participant data. The interviews kept going until data saturation was achieved. RESULTS: Based on our findings, we distilled local drivers in community-based health tourism industry development into five main categories and 30 subcategories: (Sharifabadi AM, Ardakani FA. A model for health tourism development using fuzzy TOPSIS and interpretive structural modeling in Yazd province. J Health Adm (JHA). 2014;17:55.) infrastructure and resources; (Hemmati F, Dabbaghi F, Mahmoudi G. Investigating the impact of Information Technology on the status of Health Tourism in Mashhad, Iran. Revista Publicando. 2018;5(15):54-65.) tourist attractions; (Sarabi Asiabar A, Rezapour A, Raei B, Tahernezhad A, Alipour V, Behzadifar M. Economic, Cultural, and Political Requirements for Medical Tourism Development in Iran: Insights from a Fuzzy Analytical Hierarchy Process Method. Med J Islamic Repub Iran. 2022;35:199.) socio-cultural contexts; (Mosadeghrad AM, Sadeghi M. Medical tourism: Reasons for choosing Iran. Payesh (Health Monitor). 2021;20(2):145-66.) economic-financial factors; and (Manna R, Cavallone M, Ciasullo MV, Palumbo R. Beyond the rhetoric of health tourism: shedding light on the reality of health tourism in Italy. Curr Issues Tourism. 2020;23(14):1805-19.) political-communicative factors. The findings of the study showed that, from the participants' point of view, although there are several strategies, such as the development of public service and tourism infrastructure, increasing tourist attractions, and formulating appropriate policies and procedures for the development of health tourism, they are also faced with many challenges, especially political, economic, and cultural challenges. CONCLUSION: This study showed that improving infrastructure and resources, promoting tourist attractions, informing socio-cultural contexts, improving economic and financial capacity, and developing political and communicative contexts might increase the attraction of health tourists. The suggested components are not contextually driven, although empirical outcomes may differ based on the level of service offerings in health tourism locations.

Adolescents' mental health in the social-media era: The role of offline and online need-based experiences.

INTRODUCTION: Debate about the precise role of social media use (SMU) in the mental health of today's adolescents is still ongoing. The present study adds to the literature by focusing on adolescents' experiences during SMU and in their offline activities through the lens of basic psychological needs, which are central to self-determination theory. METHODS: To examine the joint and supplementary effects of need-experiences in the offline and SMU domain (i.e., SMU satisfaction, offline satisfaction, SMU frustration, offline frustration) on several indicators of adolescents' mental health (i.e., vitality, life satisfaction, sleep quality, anxiety, and depression), polynomial regression analyses were used. Three cross-sectional samples were collected in Belgium, including early to mid-adolescents during the COVID-pandemic (Sample 1; N = 447; Mage = 14.26; 54.4% female) as well as postpandemic (Sample 2; N = 179, Mage = 15.25; 54.2% female), and among college students in postpandemic times (Sample 3; N = 4977; Mage = 20.72; 69.1% female). RESULTS: The results showed that need-experiences common to both domains were a robust factor associated with mental health. This finding was obtained across all samples and outcomes, with need satisfaction playing a beneficial and need frustration a harmful role. We further found that offline need-experiences serve as a more crucial predictor of adolescents' mental health than need experiences on social media. CONCLUSIONS: Adolescents' experiences of need satisfaction and need frustration on social media and in offline activities are central to their mental health. However, only relying on SMU as a single source of need satisfaction may not be recommended, given that offline experiences seem to be more decisive.

Exploring the Decision-Making Process behind Illicit Drug Use at Music Festivals.

Background: Illicit substance use is common at music festivals. One could question whether festival attendees deliberately plan to take drugs at such events or whether their illicit (poly)drug use is provoked by specific circumstances, such as the presence of peers or a general belief that others are using drugs at the festival. Objectives: The present study implemented the prototype willingness model, which is a model that assesses whether illicit drug use at music festivals is rather a rational or a more spontaneous decision-making process. Results: A three-wave panel survey was conducted, questioning festival attendees before (n = 304, 60.86% males), during, and after music festival visits. In total, 186 people (59.68% males) between 18 and 55 years (M = 27.80 years; SD = 8.19) completed all three surveys, of which 62.9% had taken one or more different illicit substances at the festival. Positive attitudes toward illicit drug consumption were most firmly related to attendees' intentions to take drugs at festivals. Additionally, the more festival visitors identified themselves with the prototype of an attendee using drugs, the more likely they were to be willing to use them. The perceived presence of illicit substances at such events was also strongly related to the actual behavior. Conclusion: The findings suggest that illicit drug use at music festivals relates to both a rational choice and an unplanned one.

Spiritually Based Interventions for High Blood Pressure: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis aimed to evaluate the effectiveness of spiritually based interventions on blood pressure (BP) among adults. A systematic search was performed using the PubMed, Scopus, and Cochrane databases to identify studies evaluating spiritual interventions, including meditation, transcendental meditation, mindfulness meditation, and yoga, for high BP among adults up to January 1, 2022. The inclusion criteria were (a) randomized controlled trials (RCTs), (b) studies in English or Persian, (c) studies conducted among adults (≥ 18 years), and (d) studies reporting systolic or diastolic BP. Given the high heterogeneity of these studies, a random effect model was used to calculate the effect sizes for the RCTs. In total, the systematic review included 24 studies and the meta-analysis included 23 studies. As some of studies reported two or more outcome measurements, separate estimates of each outcome were extracted for that study (24 datasets). Fifteen trials reported the mean (SD) systolic blood pressure (SBP), and 13 trials reported the mean (SD) diastolic blood pressure (DBP). In addition, 13 studies reported means (SDs) and six trials reported mean changes in DBP. A significant decrease was found in systolic BP following intervention ((WMD (weighted mean difference) = - 7.63 [- 9.61 to - 5.65; P < 0.001]). We observed significant heterogeneity among the studies (I2 = 96.9; P < 0.001). A significant decrease was observed in DBP following the interventions (WMD = - 4.75 [- 6.45 to - 3.05; P < 0.001]). Spiritually based interventions including meditation and yoga had beneficial effects in reducing both SBP and DBP. Reducing BP can be expected to reduce the risk of cardiovascular diseases.

To what extent has the Iranian Health Transformation Plan addressed inequality in healthcare financing in Iran?

BACKGROUND: One of the major goals of health systems is providing a financing strategy without inequality; this has a significant impact on people's access to healthcare. The present study aimed to investigate the inequality in households' financial contribution (HFC) to health expenditure both before and after the implementation of the Iranian Health Transformation Plan (HTP) in 2014. METHODS: This study is a secondary analysis of two waves of a national survey conducted in Iran. The data were collected from the Households Income and Expenditure Survey in 2013 and 2015. The research sample included 76,195 Iranian households. The inequality in households' financial contributions to the health system was assessed using the Gini coefficient, and the concentration index (CI). In addition, by using econometric modeling, the relationship between the implementation of the HTP and inequality in HFC was studied. The households' financial contribution included healthcare and health insurance prepayments. RESULTS: The Gini coefficient values were 0.67 and 0.65 in 2013 and 2015, respectively, indicating a medium degree of inequality in HFC in both years. The CI values were 0.54 and 0.56 in 2013 and 2015, respectively, suggesting that inequalities in HFC were in favor of higher income quintiles in the years before and after the implementation of the HTP. Regression analysis showed that households with a female head, with an unemployed head, or with a head having income without a job were contributing more to financing health expenditure. The presence of a household member over the age of 65 was associated with a higher level of HFC. The implementation of the HTP had a negative relationship with the HFC. CONCLUSION: The HTP, aiming to address inequality in the financing system, did not achieve the intended goal as expected. The implementation of the HTP neglected certain factors at the household level, such as the presence of family members older than the age of 65, a female household head, and unemployment. This resulted in a failure to reduce the inequality of the HFC. We suggest that, in the future, policymakers take into account factors at the household level to reduce inequality in the HFC.

Male patients' preferences for opioid use treatment programs.

BACKGROUND: A patient-centered approach to the treatment of substance use is helpful in achieving positive treatment outcomes. This study aimed to explore male patients' preferences for opioid use treatments. METHODS: A qualitative study was conducted in Isfahan, a city in the center of Iran. The study sample included 64 male participants who had started treatment for opioid use disorder (OUD). Using a purposive maximum variation sampling procedure, seven treatment centers were selected as interview venues. The semi-structured face-to-face interviews were conducted in a private room in the selected centers. A hybrid inductive/deductive approach was used to thematize the interview transcripts. RESULTS: A total of three themes and 13 subthemes on opioid treatment preferences were identified: treatment concerns (anonymity, social stigma, fear of treatment distress, and family concerns), treatment attributes (treatment cost, location of the treatment center, treatment period, frequency of attendance, informed treatment, and treatment personnel), and treatment type (maintenance or abstinence and residential and community treatments). The study showed that all treatment programs were perceived to have their own strengths and weaknesses. CONCLUSIONS: The results showed that patients with OUD carefully compare the positive and negative aspects of existing treatment programs, and they consider a treatment program to be a package of favorable and non-favorable qualities. The identified themes could inform policymakers about the treatment preferences of male patients and provide an opportunity to promote better treatment options for OUD.

Psychosocial status and risk perception among Iranian healthcare workers during the fifth wave of the COVID-19 pandemic.

BACKGROUND: Healthcare workers (HCWs) are essential resources, and their health and wellbeing are key not only for offering constant and useful care facilities to clients, but also for maintaining the safety of the workforce and patients. The risk of severe mental health problems among HCWs may have increased during large outbreaks of COVID-19. To evaluate the psychosocial status and risk perception of HCWs who participated in treating COVID-19 patients in Northern Iran, we performed a web-based cross-sectional study. METHODS: The web-based cross-sectional design was applied between June 27 and September 2, 2021. Using convenience sampling, 637 HCWs were recruited from hospitals in Northern Iran (Mazandaran). The HCWs completed self-report questionnaires that included a sociodemographic information form, the 12-item General Health Questionnaire, Impact of the Event Scale-Revised, Risk Perception Questionnaire, and Anxiety Stress Scale-21. The data were analyzed via descriptive and inferential statistics and univariate/multivariate logistic regression to assess the risk factors linked to each psychosocial consequence. RESULTS: The results reveal that the COVID-19 pandemic had an adverse psychosocial influence on HCWs, which was already apparent 1.5 years after the crisis began. Based on the results, 71.6%, 55.6%, and 32.3% of HCWs reported having anxiety, depression, and stress symptoms, respectively, since the outbreak of this disease. The logistic regression models displayed that marital status, having children, and working hours with patients were all risk factors of psychosocial impairment. CONCLUSIONS: The outbreak of COVID-19 can be considered an important experience of a bio-disaster resulting in a significant rate of psychiatric problems in HCWs. There is a need for designing and promoting supportive programs to help HCWs cope and to improve their psychosocial state, and the present study has detected for whom psychosocial support may be effective and practical 1.5 years after the primary outbreak. Moreover, detecting and managing concerns and reducing infection-related embarrassment/stigma are essential for improving HCWs' mental health.

Parents' knowledge and socio-demographic determinants toward child's restraint system use.

BACKGROUND: Lack of protection or improper protection, is one of the most important reasons of child passenger's death and injury in traffic crashes. Based on what we see on the roads, Iranian children are unrestrained inside the car. The aim of this study was to investigate children restrained system (CRS) use rate, its socio-demographic determinants and parents' knowledge toward CRS use among Iranian parents. METHODS: Using multi-stage cluster sampling and direct in filed method of observation, the behavior of 700 children in cars was observed in the current cross-sectional study. Socio-demographic determinants and parents' knowledge, toward using the CRS were evaluated using questionnaires. The study was performed from July to August 2019 in Tabriz city, northwestern Iran. RESULTS: The rate of child safety seat (CSS) use was 15.1% CI 95%:(12.5%,18.0%), and the rate of booster use was 0.6%; CI 95%:(4.3%,8.0%). The majority of parents [e.g. 64.3%; CI 95%: (60.7%,67.9%)], had low knowledge about the use of CRS. The most important reasons for not using CRS was lack of laws and policies [e.g. 59.7%; CI 95%:(12.5%,18.0%)], lack of knowledge [e.g.59.6%; CI 95%:(57.9%, 63.3%)] and the high cost of CRS [e.g. 57.6%; CI 95%:(53.81%,61.2%)]. The most important predictors of not using CRS were the child's age, parental knowledge, and the socioeconomic status of the household (p < 0.05). CONCLUSIONS: Most children did not have CRS. The parents with higher education and those with higher socioeconomic status had higher rate of CRS use. Based on the low rate of CRS use and poor parental knowledge about it, education of parents toward boosters use and benefits of using CRS, enforcing mandatory laws and ploicies for CRS use in Iran, and allocation of government subsidies to low-income families for purchasing CRS are suggeted as essential strategies to increase CRS use.

Personal, Social and Cultural Predictors of Intention to Misuse Prescription Stimulants among Medical Students: A Test of the Theory of Triadic Influence.

OBJECTIVE: The misuse of prescription stimulants among students has been identified as a public health problem. To date, most research has focused on individual-level determinants of stimulant misuse, making research on the socio-cultural context of students' misuse a priority. This study aims to test the applicability of the Theory of Triadic Influence, capturing three influence streams (personal, social and cultural) and three causational levels (ultimate, distal and proximal). METHOD: A questionnaire on stimulant misuse was distributed among all bachelor's and master's students from the five Flemish medical faculties. In total, 3159 students participated (48.99% response rate). Data were analyzed using structural equation modeling. RESULTS: Multiple personal (i.e., fear of failure, procrastination, self-perceived ADHD, sensation-seeking, academic stress, controllability), social (i.e., living situation, peer endorsement, social norm) and cultural (i.e., competitive study-environment, financial worries, positive and negative expectancies, attitude) factors were identified as risk factors of misuse intention. The strongest ultimate to distal pathway was found between self-perceived ADHD and positive expectancies, meaning that students who believed they have ADHD, although not diagnosed, were more likely to have positive expectancies about stimulants. Moreover, the strongest distal to proximal pathways were found between expectancies and attitudes toward stimulant misuse (i.e., more positive and fewer negative expectancies were associated with more favorable attitudes). Finally, attitudes were most strongly related to misuse intention. CONCLUSIONS: The current study shows that the TTI is an important framework to understand the risk factors of stimulant misuse among medical students. This study offers a strong basis for prevention initiatives.

Disentangling social support mobilization via online neighborhood networks.

This paper proposes and tests a theoretical model to investigate the mechanism underpinning local social support exchange via online neighborhood networks (ONNs). We drew on community psychology, social support, and social media literature and used a survey conducted in the Dutch-speaking part of Belgium among 561 ONN users (nfemales = 409; 72.9%) between 18 and 82 years old (Mage = 43.73; SDage = 15.37). We found that engaging in online neighboring behaviors was associated to both online and offline neighborhood sense of community. Subsequently, these provide access to perceived local social support and the intention to mobilize local social support online. The latter was predominantly explained via the path along online sense of community. ONNs facilitate local bridging behavior, connecting otherwise distinct local networks and ties. At the same time, online neighboring behaviors provide the normative context that supports the exchange process.

Unpacking the dynamics of double stigma: how the HIV-TB co-epidemic alters TB stigma and its management among healthcare workers.

BACKGROUND: HIV and tuberculosis (TB) are intricably interlinked in South Africa. The social aspects of this co-epidemic remain relatively unexplored. More specifically, no research has quantitatively explored the double stigma associated with HIV and TB in this context, and more specifically the impact of the co-epidemic on [1] the stigmatisation of TB and [2] the TB stigma mangement strategy of covering (i.e. the use of TB as a cover for having HIV). The current study aims to address this research gap by disentangling the complex mechanisms related to HIV-TB stigma. METHODS: Using Structural Equation Modelling (SEM), data of 882 health care workers (HCWs) in the Free State province, South Africa, are analysed to investigate the link between the stigmatization of HIV and TB and the stigma management by those affected. The current study focuses on health care workers (HCWs), as both TB and HIV have a severe impact on this professional group. RESULTS: The results demonstrate that the perceived link between the epidemics is significantly associated with double HIV-TB stigmatization. Furthermore, the link between the illnesses and the double stigma are driving the stigmatization of TB. Finally, the link between HIV and TB as well as the stigmatization of both diseases by colleagues are associated with an increased use of covering as a stigma management strategy. CONCLUSIONS: This is the first quantitative study disentagling the mediating role of double stigma in the context of the co-epidemic as well as the impact of the co-epidemic on the social connotations of TB. The results stress the need for an integrated approach in the fight against HIV and TB recognizing the intertwined nature of the co-epidemic, not only in medical-clinical terms, but also in its social consequences. TRIAL REGISTRATION: South African National Clinical Trials Register, registration ID: DOH-27-1115-5204. Prospectively registered on 26 August 2015.

The psychometric properties of the Persian menopause rating scale.

BACKGROUND: To measure the severity of menopausal complaints and determine the pattern of menopausal symptoms, a valid and reliable instrument is needed in women's healthcare. The Menopause Rating Scale (MRS) is one of the best-known tools in response to the lack of standardized scales. The purpose of this study was to examine the psychometric properties of the MRS in an Iranian example. METHODS: Participants were randomly selected from women referred to healthcare centers in Miandoab, West Azerbaijan, Iran. A total of 330 questionnaires were completed (response rate of 96.9%). Two samples were considered for analysis in the validation process. An exploratory factor analysis (EFA) was conducted on the first sample (n1 = 165), and a confirmatory factor analysis (CFA) was done using a second study sample (n2 = 165). The psychometric properties process was concluded with assessment of internal consistency and test-retest reliability. RESULTS: The EFA with Principal Component Analysis extracted three factors explaining 75.47% cumulative variance. The CFA confirmed a three-factor structure of the 11-items MRS. All fit indices proved to be satisfactory. The relative chi-square (χ2/df) was 3.686 (p < .001). The Root Mean Square Error of Approximation (RMSEA) of the model was .04 (90% CI = .105-.150). All comparative indices of the model, including the Comparative Fit Index, Normed Fit Index, and Relative Fit Index, were more than .80 (.90, .87, and .80, respectively). For the overall scale, Cronbach's alpha was .931, whereas the alpha for the subscales ranged from 0.705-0.950. The intraclass correlation was .91 (95% CI = .89-.93), p < 0.001. CONCLUSION: The results of the study indicate that the Persian model of the MRS is a valid and reliable scale. As a screening tool, the Persian MRS could be used to identify the pattern of symptoms among menopausal, premenopausal, and postmenopausal women to care for and educate them on how to identify and treat the symptoms.

Risk perception related to COVID-19 among the Iranian general population: an application of the extended parallel process model.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) has emerged as a major global public health challenge. This study aimed to investigate on how people perceive the COVID-19 outbreak using the components of the Extended Parallel Process Model (EPPM) and to find out how this might contribute to possible behavioral responses to the prevention and control of the disease. METHODS: This cross-sectional study was conducted in Iran during March and April 2020. Participants were recruited via online applications using a number of platforms such as Telegram, WhatsApp, and Instagram asking people to take part in the study. To collect data an electronic self-designed questionnaire based on the EPPM was used in order to measure the risk perception (efficacy, defensive responses, perceived treat) related to the COVID-19. Descriptive statistics, chi-square, t-test and analysis of variance (ANOVA), were used to explore the data. RESULTS: A total of 3727 individuals with a mean age (SD) of 37.0 (11.1) years participated in the study. The results revealed significant differences in efficacy, defensive responses and perceived treat among different population groups particularly among those aged 60 and over. Women had significantly higher scores than men on some aspects such as self-efficacy, reactance, and avoidance but men had higher perceived susceptibility scores compared to women. Overall 56.4% of participants were engaged in danger control (preventive behavior) while the remaining 43.6% were engaged in fear control (non-preventive behavior) process. CONCLUSION: More than half of all participants motivated by danger control. This indicated that more than half of participants had high perceived efficacy (i.e., self-efficacy and response efficacy). Self-efficacy scores were significantly higher among participants who were older, female, single, lived in rural areas, and had good economic status. The results suggest that socioeconomic and demographic factors are the main determinants of the COVID-19 risk perception. Indeed, targeted interventions are essential for controlling the pandemic.

Determining factors in the retention of physicians in rural and underdeveloped areas: a systematic review.

BACKGROUND: Imbalance in distribution of Health Care Workers (HCWs) in a country is a global challenge. Almost all of the rural and underdeveloped areas are struggling with the shortage of HCWs, especially physicians. Therefore, this study aimed to identify factors governing the retention of physicians in rural and underdeveloped areas. METHODS: International databases including Scopus, PubMed, Web of Science, Proquest, and Embase were searched using Mesh terms in order to find peer-reviewed journal articles addressing physicians' retention factors in rural and underdeveloped areas. The records were screened, and any duplicate results were removed. The quality of the studies was assessed according to the Critical Appraisal Skills Program developed for different types of studies. Then, through content analysis, the related factors were identified from finally selected papers, coded, and categorized. RESULTS: The initial search resulted in 2312 relevant articles. On the basis of specific selection criteria, 35 full-text articles were finally reviewed.. The major affecting factors in physicians' retention in rural and underdeveloped regions were classified into the following six categories: 1) financial; 2) career and professional; 3) working conditions; 4) personal; 5) cultural; and 6) living conditions factors. CONCLUSION: There is a complex interplay of factors governing physicians' retention in rural and underdeveloped areas. If health organizations are concerned with physicians' retention in deprived areas, they should take into account these main factors. Moreover, they should develop policies and strategies to attract and retain physicians in rural and underdeveloped areas.

Off-label prescribing of stimulant medication to students: a qualitative study on the general practitioner perspective.

Students' use of prescription stimulants to enhance study performance is increasingly under the spotlight. Medical guidelines discourage general practitioners (GPs) from prescribing stimulants to students without a diagnosis; yet a considerable proportion of students acquire them from GPs. Building on Eisenberg's theoretical framework on clinical decision-making and Conrad's sociological concept of biomedical enhancement, this study examined the social context of GPs' off-label prescribing decisions for stimulants, using data from 21 semi-structured interviews, including vignettes, undertaken with Flemish GPs. Results identified two groups of GPs: (1) hard-liners who strictly follow medical guidelines and who would only prescribe in case of an appropriate diagnosis and (2) context-dependent GPs who would prescribe stimulants depending on the patients' symptoms and extent of need. GPs' decisions depend on one-on-one doctor-patient interactions (i.e. the extent of empathy from the doctor and the extent of assertiveness from the patient); the extent to which GPs define concentration problems as medical problems; GPs' interactions with fellow health care workers; as well as GPs' interaction with the wider community. By disentangling these influences, this paper advances both theoretical and practical understanding of the sociological context in which GPs' off-label prescribing behaviour occurs.