Trauma and its consequences in Iran: cross-cultural adaption and validation of the Global Psychotrauma Screen in a representative sample.

BACKGROUND: Potentially traumatic events may lead to the development of a wide range of adverse psychological responses, including symptoms of anxiety, depression, and (complex) posttraumatic stress disorder (PTSD). Despite the high prevalence of potentially traumatic events in Iran, there is no population data nor evidence-based instrument to screen for cross-diagnostic psychological responses to trauma. The Global Psychotrauma Screen (GPS) is a transdiagnostic self-report instrument for the detection of trauma-related symptoms, as well as risk and protective factors related to the impact of potentially traumatic events. OBJECTIVE: The present study seeks to 1) translate and cross-culturally adapt the GPS in the Persian (Farsi) language and 2) examine the psychometric properties of the Persian GPS. METHOD: The translation and adaptation were performed using the Sousa and Rojjanasrirat (2011) method. A pilot study (n = 30) was carried out to test the content validity and test-retest reliability of the GPS. Next, in a representative sample (n = 800) of residents of Kermanshah City, the GPS, the General Health Questionnaire (GHQ) and the PTSD Checklist for DSM-5 (PCL-5) were administered. Construct validity of the Persian GPS was assessed using exploratory and confirmatory factor analysis. Additionally, we evaluated the convergent validity and internal consistency of the GPS. RESULTS: Exploratory and confirmatory factor analyses indicated a three-factor model as the best solution with factors representing 1) Negative Affect, 2) Core PTSD symptoms and 3) Dissociative symptoms. The GPS total symptom score had high internal consistency and high convergent validity with related measures. A GPS total symptom cut-off score of nine was optimal for indicating a probable PTSD diagnosis based on the PCL-5. About half (52%) of the current sample met criteria for probable PTSD. CONCLUSIONS: The current findings suggest that the GPS can be effectively adapted for use in a non-Western society and, specifically, that the Persian GPS represents a useful, reliable and valid tool for screening of trauma-related symptoms in Iran.

The effect of self-rated health, subjective socioeconomic status, social capital, and physical activity on life satisfaction: a cross-sectional study in urban western Iran.

BACKGROUND: Life satisfaction is an important component in designing strategies to improve health outcomes in different groups of society. This study aimed to investigate the effect of subjective socioeconomic status (SSS), social capital (SC), self-rated health (SRH), and physical activity (PA) on life satisfaction (LS) in Iran. METHODS: This cross-sectional study was conducted on 1187 people (643 men and 544 women) lived in five western cities in Iran. The sampling method was multistage clustering. Data collection tool was a five part questionnaire including demographic characteristics, socioeconomic status ladder, social capital scale, a question to measure physical activity, and the life satisfaction scale. Data were analyzed using independent t-test, one way ANOVA, and Ordinal Logistic Regression. RESULT: Life satisfaction was higher in married men and women compared to single and widows (p < 0.05). Among the variables included in the main model, the significant predictors were college education (- 0.500), marriage (coefficient = 0.422), age 25-34 years (coefficient = - 0.384), SRH (coefficient = 0.477), male sex (coefficient = 0.425), SSS (coefficient = 0.373), trust (coefficient = 0.115), and belonging and empathy (coefficient = 0.064). CONCLUSION: SRH and SSS were significant predictors of life satisfaction in west Iranian society. Being married was associated with higher LS, but college education affects LS adversely.

Health system responsiveness after health sector evolution plan (HSEP): An inpatient survey in Kermanshah in 2015.

BACKGROUND: Responsiveness is one of the three main goals of the health system introduced by World Health Organization. This study aimed at examining health system responsiveness after Health Sector Evolution Plan in Kermanshah, Western Iran. METHODS: A sample of 335 hospitalized patients was selected using proportionate allocation to population size method in the city of Kermanshah (Iran) in 2015. World Health Survey (WHS) questionnaire was used to collect data. Data were analyzed using descriptive statistics and principal component analysis by STATA 12. RESULTS: The overall health system responsiveness score was 72.6. The best and worst performance for domains of dignity and autonomy were 82.2 and 62.5, respectively. Socio-demographic variables of the patients had no significant effect on the total health system responsiveness score. The principal component analysis findings indicated that 68% of the variance of the overall responsiveness score was explained by four components. CONCLUSION: The overall responsiveness score of each of the domains was higher than that of other similar previous studies in Iran. Although it is difficult to reach a conclusion, our findings may show better responsiveness of the health system compared to the previous reports.

Socioeconomic Status and Domostic Violence Interact in Perdict of Quality of Life in Married Women: A Population-Based Study in Westeren Iran.

Objective: Women's quality of life is essential both for women's and their family's health. The aim of this study was to examine the quality of life status and interaction of subjective socioeconomic status and violence, on quality of life of married women in west of Iran. Materials and methods: This was a cross-sectional study that recruited 1533 married women using multi-stages sampling method. Multiple linear regression was employed for estimating adjusted association and 95% confidence intervals. Results: The mean (SD) age of the participants was 33.67(11). The majority of participants (92%) experienced some degree of domestic violence. Less than half of women (46.70%) perceived medium socioeconomic status. Mean (SD) score of quality of life was 3.57 (0.94). There was a significant statistical interaction between socioeconomic status and domestic violence on quality of life. Conclusion: These findings suggest that considering the interaction of subjective socioeconomic status with domestic violence in prevention program, especially in poor categories of family, appears to be one of the important ways in improving married-females' quality of life.

Social Determinants of Adherence to COVID-19 Preventive Guidelines in Iran: A Qualitative Study.

INTRODUCTION: Adherence to COVID-19 preventative guidelines may be influenced by a variety of factors at the individual, societal, and institutional levels. The current study sought to investigate the social factors of adherence to those preventive measures from the perspective of health professionals. METHODS: In October 2020, we performed qualitative research in Tehran, Iran, using the directed content analysis method. For the preparation of our interview guide and data analysis, we employed the WHO conceptual framework of socioeconomic determinants of health. Semi-structured interviews were conducted with 15 health professionals and policymakers who were chosen using a purposive sampling approach. MAXQDA-18 software was used to analyze the data. The Goba and Lincoln criteria were used to assess the quality of the results. RESULTS: There are 23 subcategories and 9 categories, which include socio-economic and political context (unstable macroeconomic environment, poor management of the pandemic, media and knowledge transfer), cultural and social values (fatalism, cultural norms, value conflicts, social customs), socio-economic positions (livelihood conditions), social capital (social cohesion, low trust), living conditions (housing conditions), occupational conditions (precarious employment), individual characteristics (demographic characteristics, personality traits, COVID-19 knowledge, and attitude), psycho-social factors (normalization of the disease, social pressure, and stigma), and health system leadership (health system problems, not taking evidence-based decisions, non-comprehensive preventive guidelines, non-operational guidelines, inadequate executive committee) were obtained. CONCLUSION: To limit the new COVID-19 transmission, people must be encouraged to follow COVID-19 prevention instructions. Improving adherence to COVID-19 preventive guidelines necessitates dealing with the complexities of responding to social determinants of those guidelines. Increasing public health literacy and knowledge of COVID-19, informing people about the consequences of social interactions and cultural customs in the spread of COVID-19, strengthening regulatory lockdown laws, improving guarantees for adhering to preventive guidelines, providing easy access to preventive supplies, and strengthening financial support for households with precarious employment are all important.

Investigating Global Spatial Patterns of Diarrhea-Related Mortality in Children Under Five.

Objective: Investigating the trends of child diarrhea-related mortality (DRM) is crucial to tracking and monitoring the progress of its prevention and control efforts worldwide. This study explores the spatial patterns of diarrhea-related mortality in children under five for monitoring and designing effective intervention programs. Methods: The data used in this study was obtained from the World Health Organization (WHO) public dataset that contained data from 195 countries from the year 2000 to 2017. This dataset contained 13,541,989 DRM cases. The worldwide spatial pattern of DRM was analyzed at the country level utilizing geographic information system (GIS) software. Moran's I, Getis-Ord Gi, Mean center, and Standard Deviational Ellipse (SDE) techniques were used to conduct the spatial analysis. Results: The spatial pattern of DRM was clustered all across the world during the study period from 2000 to 2017. The results revealed that Asian and African countries had the highest incidence of DRM worldwide. The findings from the spatial modeling also revealed that the focal point of death from diarrhea was mainly in Asian countries until 2010, and this focus shifted to Africa in 2011. Conclusion: DRM is common among children who live in Asia and Africa. These concentrations may also be due to differences in knowledge, attitude, and practices regarding diarrhea. Through GIS analysis, the study was able to map the distribution of DRM in temporal and spatial dimensions and identify the hotspots of DRM across the globe.

Investigating geographical accessibility and site suitability of medical laboratories in Kermanshah-Iran.

Introduction: One of the major challenges in developing countries is the inappropriate spatial distribution of medical laboratory centers (MLCs) which can lead to injustice in access to health services. This study aimed to investigate the accessibility to and site suitability of MLCs in Kermanshah Metropolis by GIS. Materials and methods: In this cross-sectional study, data were collected from the Iran Statistical Center and Deputy of Treatment of Kermanshah University of Medical Sciences. We used Arc/GIS 10.6 software, AHP technique, and network analysis tools to determine the access status of Kermanshah citizens to MLCs in 2019 and site selection for MLCs. The layers used in this study included population density, city development trends, compatible and incompatible land uses, pathways, land slope, river area, and access radius. Results: About 70% of households had inappropriate access to all MLCs in walking scenario. This ratio was 31.26% for 5 min, 9.58% for 10 min, and 6.09% for 15 min driving. Comparisons between public and private MLCs showed that in walking scenario, 88% of households had improper access to public and 80% to private MLCs. Based on 5 and 10 min of driving, 57 and 19% of households had inappropriate access to public MLCs, and 45 and 17% to private MLCs, respectively. Also, with 15 min of driving, 8% of households had improper access to public and 18% to private MLCs. Findings showed that scores provided for population density criteria were (0.298), distance from existing laboratories (0.213), proximity to pathways (0.175), consistent land use (0.129), city development trend (0.087), distance from riverfront (0.053), distance from incompatible land uses (0.015), and land slope (0.03). The final model was obtained by overlaying the layers. The model showed a 9-degree range from very bad to very good in Kermanshah city for the construction of laboratory centers (CR<0.01). Conclusion: The site selection model showed that the location of the proposed centers can be in the north and outskirts of the city to facilitate citizens' access to the MLCs. These results emphasize the justice in the spatial distribution of MLCs for the benefit of deprived populations as a global value.

Social determinants of adherence to COVID-19 preventive guidelines: a comprehensive review.

Adherence to coronavirus disease 2019 (COVID-19) preventive guidelines (ACPG) is an important strategy to control the COVID-19 pandemic effectively. The present study aimed to identify and summarize the social determinants of ACPG among the general population. A comprehensive review was performed from December 2019 to February 2021 through searching electronic databases. Two independent reviewers assessed and selected relevant studies. Next, the characteristics and main findings of the included studies were summarized. Finally, the World Health Organization's conceptual framework of social determinants of health was used to synthesize the identified social determinants of ACPG. Forty-one of 453 retrieved articles met the inclusion criteria. The study results showed different patterns of ACPG among various communities. Furthermore, 84 social determinants were identified and categorized into structural and intermediary determinants. ACPG is a set of complex behaviors associated with different individual sociodemographic and behavioral characteristics; living and working conditions; COVID-19 knowledge, attitudes, and risk perceptions; exposure to sources and information level; leisure activities; social support; trust; social norms; psychosocial well-being; socio-economic position; and the socio-economic and political context. Interventions to promote ACPG among the general population should consider the identified social determinants of ACPG.

Sleep Quality and Health-Related Quality of Life in Workers of Kermanshah Industrial Town: A Correlation Study.

BACKGROUND: Sleep Quality (SQ) is one of the most important predictors of quality of life in individuals. This study was conducted to evaluate the quality of life and SQ of industrial male workers in Kermanshah. MATERIALS AND METHODS: In this cross-sectional study, 404 male workers selected by stratified sampling in the Kermanshah Industrial Town participated. The research questionnaires included demographic information checklist, the 36-Item Short-Form Health Survey (SF-36), and the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed by SPSS18 software, using descriptive statistics, Pearson's correlation, and partial correlation tests. RESULTS: The mean age of respondents was 35.33 ± 7.31; ranged from 20 to 62 years old. The mean score of mental health and physical health were 55.01 ± 21.62 and 54.96 ± 21.93, respectively. Out of all participants, 58.6% of participants had a score of 50 or less in terms of health-related quality of life (HRQL). Two dimensions of subjective SQ (1.48 ± 0.97) and sleep duration (1.48 ± 0.97) had the worst mean score, and sleep efficiency (0.05 ± 0.3) had the most favorable mean score. The results of the Pearson's correlation test showed that the total score of SQ had a negative and significant correlation with the main dimensions of quality of life (P < 0.001). The highest correlation was found between physical pain (r = 0.350) and mental health (r = 0.332) with SQ. CONCLUSION: This study showed that more than half of the workers reported poor HRQL. Besides, a considerable number of workers had some degree of sleep disorders. The results of the study showed that there is a moderate correlation between SQ and HRQL.

Inequalities in access to hospitals: a case study in the Islamic Republic of Iran 1997-2012.

BACKGROUND: Nowadays, the significance of applying Geographic information system (GIS) to survey accessibility to hospitals and understanding disparities in this regard has increased. AIMS: The main aim of this descriptive-analytical research was to study the spatial accessibility of the population of Kermanshah for 3 years 1997 (n=693157), 2007 (n=794863), and 2012 (n=851 405) to hospitals based on age and gender groups through GIS. METHODS: The study was conducted based on network analysis models, mean centre, and standard distance in the environment of Arc/GIS. A standard radius of 1500 metres was set for the medical centres, and a 25-minute walking span was set for the distance of each person from home to the nearest hospital. RESULTS: The results of the network analysis demonstrated that the hospitals were inaccessible to the populations according to our criteria, and their geographical access to hospitals measured 68.80%, 64.23% and 66.20% in 1997, 2007, and 2012, respectively. Women aged 65 years and above were more at risk in this regard. CONCLUSIONS: Over the total period under study, the results revealed that hospitals were concentrated in the central and southern areas of Kermanshah.

Health-related quality of life in informal settlements in Kermanshah, Islamic Republic of Iran: role of poverty and perception of family socioeconomic status.

BACKGROUND: Quality of life is an important indicator for measuring health status, and information on quality of life of different groups in society can be used to assess the effect of interventions on health. AIMS: This study aimed to assess the relationship between urban poverty and perception of family socioeconomic status, and health-related quality of life in residents of informal settlements. METHODS: A cross-sectional study was conducted among 432 residents of two neighbourhoods of informal settlements in Kermanshah in 2015. To measure poverty, the 16 indicators of 2011 Iranian census were used. The neighbourhoods were classified into three groups: high poverty (9.3%), middle poverty (49.2%) and low poverty (41.5%) levels. Health-related quality of life was assessed with the SF-36 questionnaire. The Pearson correlation coefficient was calculated and regression and ANOVA analyses were done. RESULTS: There were no statistically significant differences between the SF-36 scores for the three poverty levels, and no relationship between poverty and the health-related quality of life subscales (P > 0.05). A significant positive correlation was found between perception of family socioeconomic status and health-related quality of life (P < 0.05). In regression analysis, having a chronic illness, perception of family socioeconomic status, age and sex predicted the physical health domain of the SF-36, whereas perception of family socioeconomic status and having a chronic illness predicted the mental health domain. CONCLUSIONS: Subjective perception of family socioeconomic status can explain differences in health-related quality of life of low-income people.

Municipal leachate treatment by Fenton process: effect of some variable and kinetics.

Due to complex composition of leachate, the comprehensive leachate treatment methods have been not demonstrated. Moreover, the improper management of leachate can lead to many environmental problems. The aim of this study was application of Fenton process for decreasing the major pollutants of landfill leachate on Kermanshah city. The leachate was collected from Kermanshah landfill site and treated by Fenton process. The effect of various parameters including solution pH, Fe(2+) and H2O2 dosage, Fe(2+)/H2O2 molar ratio, and reaction time was investigated. The result showed that with increasing Fe(2+) and H2O2 dosage, Fe(2+)/H2O2 molar ratio, and reaction time, the COD, TOC, TSS, and color removal increased. The maximum COD, TOC, TSS, and color removal were obtained at low pH (pH: 3). The kinetic data were analyzed in term of zero-order, first-order, and second-order expressions. First-order kinetic model described the removal of COD, TOC, TSS, and color from leachate better than two other kinetic models. In spite of extremely difficulty of leachate treatment, the previous results seem rather encouraging on the application of Fenton's oxidation.