A Community-Based Safety Reporting System; Development, Implementation, and Evaluation: An Experience of Safe Communities in Iran.

Background: Online reporting systems can establish and maintain the community-authority connection for safety promotion initiatives and their sustainability. The aim of this study was to report the development, implementation, and evaluation of an online community safety reporting system in safe communities in Iran. Methods: In the first place, the life cycle approach and software systems development were used for design and implementation, which included 7 steps. In the following, an online Community Safety Reporting System (CSRS) was developed with two main interfaces, including a web-based and phone application. The software was developed using suitable programming languages for the web and as a mobile application for Android and iOS systems. Results: During the six months of implementation, we received 80 reports in different safety areas, which were managed by the administrators and provided feedback for reporters. System user-friendliness and easy to use were the main strengths declared by users. The CSRS program is implemented at two levels of usage: public users to report safety issues and city admin functional evaluation of the system through a short interview with users. Moreover, city authorities believed that the system facilitates community participation in decision-making processes. The address of the web page is www.payamiran.ir. Conclusion: CSRS provides a way for community voices to be heard and facilitates mutual interaction between the community and authorities. CSRS could be used as a community participation tool to ensure safety promotion initiatives sustainability.

Predictors of receiving COVID-19 vaccine among adult population in Iran: an observational study.

BACKGROUND: Vaccination is one of the best ways to stop the transmission of coronavirus disease 2019 (COVID-19). In this regard, uunderstanding the features related to the intention of different populations to receive the COVID-19 vaccine is essential for an effective vaccination program. This study aimed to investigate the vaccination intention predictors in the general adult population of Iran. METHODS: A cross-sectional, web-based survey was conducted on social networks, including Telegram, WhatsApp, LinkedIn, Instagram, and Facebook. Multinomial logistic regression models were used to investigate predictors associated with the intention to receive COVID-19 vaccines, including sociodemographic characteristics, trust, worry, sources of information, and conspiracy beliefs. The main outcomes included unwillingness, undecidedness, and intention to receive the COVID-19 vaccine. RESULTS: Out of 780 respondents, 481 (61.6%) reported an intention to be vaccinated, 214 (27.4%) expressed their undecided status, and 85 (10.9%) reported unwillingness to receive any type of COVID-19 vaccine. A higher age (OR undecided = 0.97, 95% CI (0.96-0.99)), (OR unwilling = 0.97, 95% CI (0.95-0.99)); exposure with COVID-19 (OR unwilling = 0.82, 95% CI (0.76-0.89)), (OR undecided = 0.87, 95% CI (0.83-0.93)) were positively associated with vaccination intentions. No/low trust in vaccines, institutions, concerns about the future of the pandemic, and conspiracy beliefs were strongly and negatively associated with COVID-19 vaccination intentions. CONCLUSION: Most Iranians intended to get a COVID-19 vaccine. Higher vaccine acceptance needs to consider demographic features, exposure history, confidence in vaccines, trust in institutions, concerns, and conspiracy beliefs of people.

Road safety lead agency challenges of three decades of intervention for road safety in Iran: implications for policy-makers.

BACKGROUND: Road traffic crashes and associated injuries and mortalities are one of the big public health challenges, especially in low/middle-income countries. Road safety lead agency (RSLA) is a vital factor in the sustainable prevention and promotes road safety. In the recent decades, various policy interventions have been conducted for road safety in Iran. This study aimed at exploring the challenges of RSLA from the perspectives of stakeholders at various levels. METHODS: A qualitative study was conducted. In-depth interviews and document reviews were used for data collection. To conduct interviews, different stakeholders at various levels such as policy-makers, senior national authorities, researchers and faculty members were selected. Data collection was conducted between November 2019 and June 2020. Thematic content analysis approach was used for data analysis. RESULTS: The experts' perspectives were analysed and then categorised under five main themes including the role and position of the lead agency, the role and duties of the actors and players, translating policy into practice, intrasectoral and intersectoral cooperation and coordination and evidence production and application and a total of 22 subthemes were identified. The current structure of the RSLA is one of the main challenges emphasised by the research participants. CONCLUSION: To achieve significant improvements in road safety at the national level, a strong management system and leadership body is a critical issue. Organisational reform to establish an effective unique lead agency is proposed to cope with RSLA challenges.

Assessing and Improving Fitness to Drive in the Elderly People: A Scoping Review of Policies and Guidelines.

Background: This study has been conducted to analyze the processes, models, and policies to assess fitness to drive and improving driving in the elderly in the world. Methods: The Arkesy and O'Malley frameworks were employed. Articles with at least one aspect of driving eligibility in the elderly were included. Expected data were collected using appropriate keywords from PubMed, Web of Science, Scopus, Embase, IranDoc, SID, and MagIran. Data were analyzed using the Content Analysis method. Results: Out of 675 records, 24 papers and reports were included in the study that all of them were High-Income Countries (HICs). Among the studies that referred to the baseline age, the highest frequency was 70 yr old (4 studies). Vision assessment was the main item to judge driving fitness (mentioned in 75% of the studies). The in-person (5 studies) was the most common method of renewal. General practitioners were the principal performers to measure driving fitness (7 studies). Thirteen studies referred to the road tests as part of the driver's license renewal process. In most all reports and papers, there were policies on empowering the elderly driver, including providing safe driving tips, optional driving skills tests, holding retraining courses, etc. The most frequently supporting policies included introducing alternative transportation. Conclusion: Most HICs have worthwhile experience in measuring and improving the fitness to drive in the elderly and enforce different laws according to social and political conditions. Utilizing these experiences by considering economic and social differences can be useful and practical for middle and low-income countries.

Psychometric properties of public trust in Covid-19 control and prevention policies questionnaire.

BACKGROUND: Public trust is a crucial concept in the COVID-19 pandemic, which determines public adherence with preventive rules as a success factor for disease management. This study aimed to develop and validate a tool to measure public trust in COVID-19 control and prevention policies (COV-Trust tool). METHODS: This is a psychometric study that was conducted in 2020 (March-August). A primary tool was developed through literature review, in-depth interviews with experts and expert panel meetings. Content and construct validity was evaluated using content validity index (CVI) and content validity ratio (CVR) indexes and exploratory and confirmatory factor analysis, respectively. Cronbach α coefficient was calculated to determine the internal consistency. RESULTS: A 28-item questionnaire with seven factors was developed. Factors included macro policy-making and management of pandemic, pandemic control policies implementing at all levels and their effectiveness, providing protective equipment and medicine for hospitals and public, prevention of negative socio-economic consequences of the pandemic, public participation, informing and public education and public behavior. The questionnaire reliability was calculated to be α = 0.959. Based on the experts' opinion, tool content validity was estimated to be CVR = 0.73, CVI = 0.89. RMSEA = 0.07 revealed a good model fit as the confirmatory factor analysis results for the tool. CONCLUSION: COV-Trust tool is a well-fit tool to be used during this pandemic for improving policies effectiveness and could be used in similar situations as it determines the success of public health interventions.

Comparison of the Effect of Forced-air Warming and Warmed Intravenous Fluid on the Comfort and Prevention of Shivering After Spinal Anesthesia in Patients Undergoing Orthopedic Surgery.

PURPOSE: This study aimed to compare the effect of forced-air warming and warmed intravenous fluid on the comfort and prevention of shivering after spinal anesthesia in patients undergoing orthopaedic surgery. DESIGN: Randomized controlled clinical trial. METHODS: A total of 120 patients were randomly divided into three groups: forced-air warming (38°C), warmed intravenous fluid (37°C), and the control group. Patients' comfort and severity of shivering were measured and recorded five times (immediately and 15 minutes after spinal anesthesia, end of the surgery, time of entrance to the recovery room, and 15 minutes after entering the recovery room), and compared with each other. FINDINGS: There was a significant difference between the three groups in terms of comfort at all points of evaluation times (P < .001). The comfort score in the control group was significantly higher than the two intervention groups (P < .001). Moreover, the comfort score in the warmed intravenous fluid group was significantly higher than the forced-air warming group (P < .001). In addition, there was a significant difference in shivering severity between the three groups at the end of the surgery, entrance to the recovery room, and 15 minutes after surgery (P < .001). The majority of patients in the forced-air warming group (90%) had no shivering at all three times, while the warmed IV fluid and control groups was 65% and 30% respectively. CONCLUSIONS: Non-pharmacological methods such as forced-air warming and warmed intravenous fluid can provide comfort and prevent shivering in orthopaedic patients undergoing spinal anesthesia. However, the use of forced-air warming is more effective than warmed intravenous fluid in providing comfort and preventing shivering in these patients. It is recommended that these methods be used in the operating room to provide comfort and prevent shivering in these patients.

Prediction of PTSD related to COVID-19 in emergency staff based on the components of self-compassion and perceived social support.

BACKGROUND: On March 11th, 2020, the World Health Organization (WHO) proclaimed Coronavirus Disease of 2019 (COVID-19) a pandemic. In addition to severe health problems, the disease has had a major psychological impact on the public. The aim of this research was to examine the association between Post-Traumatic Stress Disorder (PTSD) related to COVID-19 in emergency staff and self-compassion and perceived social support. METHODS: Data were collected from 222 emergency staff working in two referral educational and health centers for COVID-19 affiliated to Tabriz University of Medical Sciences. The participants were recruited six months following the first case of hospitalization for COVID-19 in these two hospitals in Tabriz, Iran. Four questionnaires were used to measure the variables, including a researcher-made demographic checklist, PTSD Checklist for DSM-5 (PCL-5), the Multidimensional Perceived Social Support Scale (MSPSS) and the Self-Compassion Scale. RESULTS: The findings showed that age (r = 0.17, P = 0.034), self-judgment (r = 0. 36, P < 0.001), isolation (r = 0.44, P < 0.001) and over-identification (r = 0.15, P = 0.031) were associated with PTSD score, and there was also a statistically significant inverse relationship between the score of the self-kindness (r = - 0.19, P = 0.006) subscale and the overall score of PTSD in the emergency staff. CONCLUSION: During the COVID-19 pandemic, emergency staff have persistently faced potentially traumatic situations as first-line healthcare workers, suggesting the direness of this group's mental health. By identifying the predisposing factors of the psychological pathology under study, this research can be applied in clinical practice and provide useful information for designing special interventions and protocols for emergency staff.

Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in critically ill COVID-19 patients: A systematic review.

Objectives: COVID-19 patients develop Life-threatening complications like pneumomediastinum/pneumothorax and emphysema which might experience prolonged hospital stays and additional costs might be imposed on the patient and the health system. The clinical features and outcomes of mechanically ventilated patients with COVID-19 infection who develop a pneumothorax, pneumomediastinum and subcutaneous emphysema has not been rigorously described or compared to those who do not develop these complications. So a systematic review of studies conducted on this subject was carried out to better manage these complications by investigating the underlying factors in COVID-19 patients. Methods: The search was conducted between early January and late December 2020 in databases including PubMed, Scopus, ProQuest, Embase, Cochrane Library, and Web of Science, using the following keywords and their combinations: COVID-19 Complication, Pneumothorax, Pneumomediastinum, Pneumopericardium, and Subcutaneous Emphysema. The extracted studies were screened separately by two researchers based on the PRISMA statement. After eliminating the duplicate studies, the title, abstract, and full text of the remaining studies were reviewed. Disagreements in the screening and selection of the studies were resolved by consensus or through a third-party opinion. Results: A total of 793 articles were retrieved through the literature search, and 99 studies conducted on a total of 139 patients were finally included The patient mortality was found to have a significant relationship with positive pressure ventilation (P=0.0001). There was no significant relationship between the patients' death and chest tube insertion (P=0.2) or between the interval of time from the onset of symptoms to the diagnosis of pneumothorax (P=0.7). The mean age was higher in the deceased cases, and the mean difference observed was statistically significant (P=0.001). Conclusion: With the expansion of our clinical understanding of COVID-19, recognition of the uncommon complications of COVID-19 especially pneumothorax is crucial. Although in our review we couldn't find a causal relationship between COVID-19 and pneumothorax or association between pneumothorax and death, as it is limited by many variables such as included studies' design, or incomplete outcome data especially more information about the associated risk factors, we recommend performing more well-designed studies to describe the pneumothoraxes' incidence, risk factors, and outcomes in COVID-19 patients.

Setting research priorities to achieve long-term national road safety goals in Iran.

Background: Road traffic crashes (RTCs) and its associated injuries are one of the most important public health problems in the world. In Iran, RTCs rank second in terms of mortality. To address this issue, there is a need for research-based interventions. Prioritizing researches using a variety of approaches and frameworks to determine the most effective interventions is a key nodal point in the RTCs' research policy planning cycle. Thus, this study aims to generate and prioritize research questions in the field of RTCs in Iran. Methods: By adapting the Child Health and Nutrition Research Initiative (CHNRI) method, this study engaged 25 prominent Iranian academic leaders having role in setting Iran's long-term road safety goals, a group of research funders, and policymakers. The experts' proposed research questions were independently scored on a set of criteria: feasibility, impact on health, impact on the economy, capacity building, and equity. Following the prioritization of Research Questions (RQs), they were all classified using the 5 Pillar frameworks. Results: In total, 145 Research Questions were systematically scored by experts against five criteria. Iran's top 20 road traffic safety priorities were established. The RQs related to "road safety management" and "road and infrastructure" achieved a high frequency. Conclusions: The top 20 research questions in the area of RTCs in Iran were determined by experts. The majority of these RQs were related to "road safety management". The results of this study may contribute to the optimal use of resources in achieving long-term goals in the prevention and control of road traffic crashes and its related injuries. Considering these RQs as research investment options will improve the current status of Road Traffic Injuries (RTIs) at a national level and further advance toward compliance with international goals. If these research priorities are addressed, and their findings are implemented, we can anticipate a significant reduction in the number of crashes, injuries, and deaths.

Psychological pathways between type D personality and COVID-19.

BACKGROUND: Patients with a type D personality have worse social functioning and mental health and more affective constraints than non-type D personalities. They have a negative outlook on life and health-related issues. The aim of this study was to examine the mediating role of stress and anxiety in the relationship between type D personality and COVID-19 by adjustment of the effect of demographic characteristics and perceived symptoms as confounder variables. PARTICIPANTS AND PROCEDURE: A total of 196 patients out of those suspected of having COVID-19 and visiting the reference hospitals were selected. They had completed the type D personality and the anxiety and stress scales along with their hospital admission form before undergoing COVID-19 testing. After their COVID-19 test, the participants were divided into two groups based on their disease, an infected group (n = 90) and a non-infected group (n = 106). RESULTS: Type D personality has no significant direct effect on infection with the disease, but taking into account the mediating variable of stress, the odds of an event in those with type D personality is 2.21 times higher than those without this personality (p = .027) and, taking into account the mediating variable of anxiety, having a type D personality increases the odds of an event by 2.62 times (p = .011), holding demographic characteristics and perceived symptoms constant. CONCLUSIONS: Given the indirect relationship between COVID-19 and type D personality, the mediating variables of stress and anxiety can be considered full mediating variables.

Lifestyle Risk Factor Assessment Through WHO STEP Approach in Tabriz, Iran.

BACKGROUND: The aim of this study was to assess the lifestyle behaviour and risk factors for lifestyle-related diseases in East Azerbaijan province, Iran. METHODS: A household study using a two-stage cluster sampling method was performed. Tabriz city was randomly selected for data collection among five geographic regions in the East-Azerbaijan province. Short WHO-STEP and Ultra-short version of Socio-Economic Status assessment questionnaire were used. Six hundred households were asked to respond to the STEP questionnaire. RESULTS: A total of 1196 people have participated in the study. People with higher socioeconomic status consumed more fruits, vegetables and fish than the people with lower socioeconomic status. People with academic education less likely to be hypertensive compared to people with non-academic education. People with a medium socioeconomic status are less likely to be hypertensive than people with high socioeconomic status. The majority of participants had poor dietary habits. In this study, 17.22%, 7.53% and 4.35% of respondents had hypertension, diabetes and depression, respectively. CONCLUSION: Considering that lifestyle-related risk factors are common among people. Due to the direct link between lifestyle and the occurrence of many chronic diseases, campaigns for and training programs to implement healthy lifestyle habits are recommended.

A robust polyfunctional Pd(II)-based magnetic amphiphilic nanocatalyst for the Suzuki-Miyaura coupling reaction.

Herein, a robust Pd(II)-based polyfunctional magnetic amphiphilic artificial metalloenzyme was prepared by anchoring a Pd(2,2'-dipyridylamine)Cl2 bearing hydrophilic monomethyl ether poly(ethylene glycol) (mPEG) chains on the surface of amino-functionalized silica-coated magnetic nanoparticles. The 2,2'-dipyridylamine (dpa) has shown excellent complexation properties for Pd(II) and it could be easily anchored onto functionalized magnetic support by the bridging nitrogen atom. Moreover, the bridging nitrogen atom at the proximity of Pd(II) catalytic center could play an important role in dynamic suppramolecular interactions with substrates. The leaching, air and moisture resistant [Pd(dpa)Cl2] complex endow the dynamic and robust structure to the designed artificial enzyme. Moreover, the water dispersibility of designed artificial metalloenzyme raised from mPEG chains and the magnetic nanoparticles core which could function as protein mimics endow it other necessary characters of artificial enzymes. The prepared artificial metalloenzyme displayed remarkable activity in Suzuki-Miyaura cross-coupling reaction employing low-palladium loading under mild conditions, with the exceptionally high turnover frequency, clean reaction profile, easy work-up procedure, good to excellent products yields and short reaction times. The designed air- and moisture-stable artificial metalloenzyme could recycle more than fifteen times with easy separation procedure in aqueous solution under aerobic conditions without any noticeable loss in activity.

Effect of homogenization and solution treatments time on the elevated-temperature mechanical behavior of Inconel 718 fabricated by laser powder bed fusion.

In the present study, the effect of homogenization and solution treatment times on the elevated-temperature (650 °C) mechanical properties and the fracture mechanisms of Inconel 718 (IN718) superalloy fabricated by laser powder bed fusion (LPBF) was investigated. Homogenization times between 1 and 7 h at 1080 °C were used, while solution treatments at 980 °C were performed in the range from 15 to 60 min. The as-printed condition showed the lowest strength but the highest elongation to failure at 650 °C, compared to the heat-treated conditions. After heat treatments, the strength of the IN718 alloy increased by 20.3-31% in relation to the as-printed condition, depending on the treatment time, whereas the ductility decreased significantly, by 67.4-80%. Among the heat treatment conditions, the 1 h homogenized conditions at 1080 °C (HSA1 and HSA2) exhibited the highest strength and ductility due to the combined effects of the precipitation hardening and sub-structural changes. Further increases in the homogenization time to 4 and 7 h led to a decrease in the strength and significant ductility loss of the LPBF IN718 due to the considerable annihilation of the dislocation tangles and a greater precipitation of coarse MC carbide particles. Furthermore, it was found that the solution treatment duration had a crucial influence on the mechanical properties at 650 °C due to the increase in the grain boundary strength through the pinning effect of the intergranular δ-phase. In addition, the fracture mechanism of the LPBF IN718 was found to be dependent on the heat treatment time. Finally, this investigation provides a map that summarizes the effect of homogenization and solution treatment times on the high-temperature mechanical behavior of LPBF IN718 by relating it to the corresponding microstructural evolution. This effort strives to assist in tailoring the mechanical properties of LPBF IN718 based on the design requirements for some specific applications.

Psychometric properties of the Iranian version of self-care ability scale for the elderly.

BACKGROUND: Measuring self-care ability in elderly people needs specific instruments. The Self-care Ability Scale for Elderly (SASE) is one of the common instruments used for assessing self-care ability. The aim of this study was to assess the psychometric properties of the SASE among Iranian elderly population. METHODS: This cross-cultural adaptation study was carried out at Shahid Chamran and Shadpour Health Complex in Tabriz, Iran. The forward-backward procedure was applied to translate the SASE from English into Persian. Then, it was completed to 220 elderly people. A systematic random sampling method was used for sampling. Content validity was calculated through modified Kappa coefficient (modified CVI) based on clarity and relevance criteria. Reliability was measured by internal consistency and test-retest analysis. The construct validity also was assessed using Exploratory Factor Analysis (EFA). All the statistical analyses were performed using SPSS 21 statistical software package. RESULTS: The mean of self-care ability was 61.14 ± 21.08. The CVI and modified kappa were 0.91 and 0.92 for relevance and clarity, respectively. The Cronbach's alpha coefficient was 0.73 and Intra-class correlation coefficient was 0.97. The results of EFA revealed a three-factor solution ('ability to take care of personal responsibility', 'ability to take care for the goals', and 'ability to take care of the health') that jointly explained for 64.61% of the total variance. CONCLUSION: Results of the study showed that the Iranian version of the SASE has good psychometric properties and can be used in assessing the self-care ability of elderly people.

Developing safe community and healthy city joint model.

BACKGROUND: Healthy city and safe community programs are the most common initiatives gaining increasing appeal in various communities to improve safety and health, independently. The aim of this study was to develop a joint application model of safe community and healthy city. METHODS: A comprehensive literature review was conducted on healthy city and safe community programs using PubMed, Web of Science, Scopus and Science Direct and also related websites such as WHO regional offices in 2018. The preliminary list of joint model dimensions and topics were extracted and then assessed by the expert through two rounds of decision Delphi and four expert panel sessions. Eventually, the visual model was developed and approved by the experts. RESULTS: Literature review resulted in the identification of 11 programs on safety and health promotion in the community of which 35 topics were extracted. After investigating the topics accordance, they were judged (correction, merging or eliminating) by experts through Delphi rounds and panel sessions. Eventually a joint model comprising 14 dimensions, 3 core principles and 4 values called "Safe and Health Promoting Community, SHPC_ model" was developed. CONCLUSIONS: SHPC model provides a parallel and comprehensive view on safety and health topics in a community. The implementation of an integrated model could be one possible way to enhance the commitments on behalf of state and local government, and health system leaders to prioritize injuries and non-communicable disease prevention to address promotion, prevention, treatment and social consequences of mutual community-based interventions.

Home injury prevention attitude and performance: a community-based study in a designated safe community.

BACKGROUND: Unintentional injuries in the home are one of the threats to childhood quality of life which is considered as a social determinant of health. Regarding mother's leading role in taking care of the children in Iranian families, the present study was conducted to investigate mothers' home-injury prevention attitude and performance and its contributing factors in Sahand safe community, East-Azerbaijan, Iran. METHODS: This was a cross-sectional study conducted in 2017. Sampling was done using "Random Sampling method" among all mothers having at least one U-5 child and attended the health centers to receive childcare services. A valid attitude questionnaire and safety performance checklist were used for data collection. Data were analyzed by SPSS-24, using descriptive (frequency, mean, etc.) and inferential statistics (chi-square, Kruskal-Wallis). RESULTS: The mean age of mothers was 30.58 (±5.01). About 65% of the mothers had primary or secondary school education. The mean score of mothers' attitude was 72.12(±6.79). More than 58% of the mothers had an appropriate level of attitude. The mothers' injury prevention performance mean score was 66.59 (±12.85). Family's socioeconomic status, mother's age, educational level, and job, father's job, age, and gender of the child were the contributing factors (p less than 0.05). CONCLUSIONS: Most of the mothers have an appropriate level of home-injury prevention attitude but a low level of performance. Strengthening Primary Health Care system in safe communities would have a leading role in child safety promotion through increasing the mother's knowledge, attitude and performance level.

Influence of Homogenization and Solution Treatments Time on the Microstructure and Hardness of Inconel 718 Fabricated by Laser Powder Bed Fusion Process.

In the present study, Inconel 718 (IN718) superalloy fabricated by laser powder bed fusion (LPBF) has been characterized focusing on the effect of both homogenization and solution treatment time on grains structure, crystallographic texture, precipitates formation/dissolution and material hardness. For this purpose, a heat-treatment time window with a wide range of soaking times for both treatments was established aiming to develop the optimal post-treatment conditions for laser powder bed fused IN718. It was found that the as-printed IN718 is characterized by very fine columnar/cellular dendrites with Laves phase precipitating at the grain boundaries as well as inter-dendritic regions, which differs from the microstructure of wrought and cast materials and requires special heat-treatment conditions different from the standard treatments. The results reveal that the relatively short homogenization treatment at 1080 °C for 1 h was not enough to significantly change the as-printed grain structure and completely dissolve the segregates and Laves phase. However, a completely recrystallized IN718 material and more Laves phase dissolution were obtained after homogenization treatment for 4 h. A further increase in time of the homogenization treatment (7 h) resulted in grain growth and coarsening of carbides precipitates. The solution treatment time at 980 °C did not cause noticeable changes in the crystallographic texture and grain structure. Nevertheless, the amount of δ-phase precipitation was significantly affected by the solution treatment time. After applying the heat-treatment time window, the hardness increased by 51%-72% of the as-printed condition depending on the treatment time due to the formation of γ' and γ″ in the γ-matrix. The highest material hardness was obtained after 1 h homogenization, whereas the prolonged time treatments reduced the hardness. This study provides a comprehensive investigation of the post heat-treatments of the laser powder bed fused IN718 that can result in an optimized microstructure and mechanical behavior for particular applications.

Forty years after Alma-Ata: how people trust primary health care?

BACKGROUND: Primary Health Care (PHC) was introduced as the first level of health services delivery after Alma-Ata declaration. However, after forty years, it needs to be more trustful to achieve its predefined objectives. Public trust in PHC is one of the neglected issues in the context. The aim of this study is to evaluate public trust in PHC in Iran. METHODS: The present investigation is a household survey conducted in East Azerbaijan Province, Iran. Two-stage cluster sampling method with Probability Proportional to Size (PPS) approach was used. Totally, 1178 households were enrolled in the study. PHC trust questionnaire and Ultra-short version of Socio-Economic Status assessment questionnaire (SES-Iran) was used for data collection. Data were analyzed using STATA software (version 15) through descriptive statistics and linear regression. RESULTS: The mean ± SD age of the participants was 41.2 ± 15.1 and most (53.7%) were female. Mean score of PHC trust was 56.9 ± 24.7 (out of 100). It was significantly different between residents of Tabriz (the capital of province) and other cities in the province (p < 0.001). Linear regression showed that younger age, gender, insurance type, being married, and households higher socio-economic status had a significant positive effect on PHC trust level with R2 = 0.14383. CONCLUSIONS: Public trust in PHC system in Iran needs to be improved. Individual variables had a small but key role in trust level. PHC trust cannot be only affected by individual's variables and experiences but also by health system and health providers' characteristics and public context in which PHC system exists. PHC trust level could be used as a public indicator in health systems especially in Low and Middle Income Countries (LMIC) to contribute in system strengthening policies at the national and international levels.