Demanded interdisciplinary subjects for integration in medical education program from the point of view of graduated medical physicians and senior medical students: a nationwide mixed qualitative-quantitative study from Iran.

INTRODUCTION: This study aimed to detect interdisciplinary subjects for integration into the medical education program of Iran. METHODS: A qualitative-quantitative method was used. Firstly, interdisciplinary subjects demanded by medical graduates and senior medical students were defined by qualitative study. In the second stage, questionnaire was developed which based on the findings of qualitative stage, experts' opinion and reviewing of the national general guide of professional ethics for medical practitioners. Questionnaire consisted of demographic, occupational and thirteen interdisciplinary items. These items consisted of social determinants of health, social and economic consequences of disease, social prescribing, physicians' social responsibility, role of gender, racial, ethnic, social and economic issues in approach to patients, role of logic and mathematics in clinical decision-making, philosophy of medicine, maintaining work-life balance, self-anger management, national laws of medicine, religious law in medical practice, health system structure, and teamwork principles. Level and importance of knowledge and self-assessed educational needs were asked about each item. In the third stage, a national online survey was conducted. SPSS 25 was used for statistics. RESULTS: By content analysis of data in qualitative stage, 36 sub-themes and 7 themes were extracted. In the quantitative part, 3580 subjects from 41 medical universities across Iran participated in this study. 2896 (80.9%) were medical graduates and 684 (19.1%) were senior medical students. Overall, knowledge about interdisciplinary items was low to intermediate, while high to very high knowledge ranged from maximally 38.7% about socioeconomic consequences of disease to minimally 17.2% about social prescribing. Participants gave the most importance to the having knowledge about self-anger management (88.3%), maintaining work-life balance (87.2%) and social determinants of health (85.8%), respectively. However, national laws of medicine (77.6%), maintaining work-life balance (75.4%) and self-anger management (74%) were the first top three educational demands by participants. CONCLUSION: This study revealed a low to moderate level of knowledge about interdisciplinary topics among both graduated medical physicians and senior medical students. These groups showed a strong demand and tendency to know and to be educated about these topics. These findings underscore the urgency for educational reforms to meet the interdisciplinary needs of medical professionals in Iran.

A demographic study of death caused by unintentional injuries in Iran during 2011-2018.

INTRODUCTION: The rate of deaths and injuries caused by unintentional injuries, especially driving accidents, in Iran is globally high. This study aims to explore the rate of the death due to unintentional injuries. MATERIAL AND METHODS: This quantitative research used the secondary analysis of the data on death caused by unintentional injuries obtained from the civil registration statistics based on ICD10 from 2011 to 2018. Excel 2016 software was used for the analysis, and indices of rate, percentage, sex ratio, and years of life lost (YLL) were taken into consideration. RESULTS: The rate of death caused by unintentional injuries in Iran during the years 2011-2018 was almost constant but slightly decreased. The main decrease was for women and older people. In 2016, the rate of death due to unintentional injuries in men was 3.3 times that of women, and the highest rate of years of life lost (YLL) due to premature mortality was for men aged 14 to 49. The results also show that the death rate is high in less developed provinces with poor road conditions. CONCLUSION: Despite the policies adapted about the deaths caused by accidents and the reduction of them, the results of the study show that one of the main groups and the target of these policies, namely young men, has not been affected much yet, and the death caused by accidents in young men is still high. Focusing on this population group, policies should be made to reduce the death of young men caused by accidents.

A Qualitative Study on Stigmatization Associated With COVID-19.

Objective: To survey and analyze the experience of stigma among patients with coronavirus disease 2019 (COVID-19) in Iran.Methods: This qualitative study was conducted from September to December 2020 in the Fars, Khorasan Razavi, and Yazd provinces of Iran. Sampling was done via the snowball method. Based on data saturation criteria, 24 adults aged > 18 years who had been diagnosed with COVID-19 were recruited. Semi-structured telephone interviews were conducted with each patient. Data were analyzed following the conventional content analysis method.Results: The results showed that during their illness with COVID-19, the participants experienced a difficult and anxious course, with rejection and alienation from their first-degree relatives taking them by surprise. The 3 main themes extracted from this study were (1) fear and rejection, (2) discrimination, and (3) loneliness. These experiences changed the attitudes of the participants toward life and themselves.Conclusions: The results show the importance of being aware of social stigma among patients and that primary care physicians play an integral role in addressing this issue, especially during pandemics. Psychological counseling sessions for those afflicted is recommended, and education and training should be provided to the public regarding the proper treatment of patients with COVID-19. Quantitative studies in this field are highly recommended.

Public sphere attitudes towards the rumor sources of the COVID-19 pandemic: evidence from community perceptions in Iran.

BACKGROUND: In the COVID-19 pandemic, rumors travel far faster than the outbreak itself. The current study aimed to evaluate the factors affecting the attitudes of individuals towards the rumors-producing media in Iran. METHODS: An online cross-sectional survey was conducted in Iran in March 2020 on the source of information and rumors, along with the perception of individuals regarding the reasons for rumors propagation during the COVID-19 pandemic. RESULTS: Results showed that the majority of the participants (59.3%) believed that social media were the main source of rumors. The lack of a reliable and formal news resource was also considered the most common cause of rumoring by the participants (63.6%). An evaluation was carried out to identify the main source of misinformation and rumors. Results showed that Retired participants considered foreign media (P < 0.001) as the main resource. The middle-income level participants believed that social media (P < 0.001) were the main source. In this regard, the highly educated participants (P < 0.001), government employees, and middle-income individuals (P = 0.008) believed that national media produced rumors. CONCLUSION: Although findings were achieved during the first peak of the COVID-19 pandemic, the authorities immediately introduced the national media as a reliable news resource, which allowed both media and its journalists to reduce the gap between themselves and the public sphere. It was suggested that social networks and foreign media be more accountable in pandemics.

Challenges for food security and safety: a qualitative study in an agriculture supply chain company in Iran.

BACKGROUND: Food supply chain companies are major link for safe food production and distribution. Food safety ensures reduced food losses and, therefore, contributes to food security. Although there have been extensive studies on the food industry with different perspectives, no study has so far been conducted on the challenges in terms of the food security. The present study is a qualitative one conducted in 2019 in one of the largest agricultural production chain companies in Khorasan Razavi province, Iran. RESULTS: The research method was based on the conventional content analysis. Triangulation method was used for the data collection being a combination of the participant observations, focus group discussions (17 managers) and semi-structured interviews with the president of the company. Participants believed that their company plays an important role and has a prestigious position in the food security of Iran. However, the main challenges of the company are regulatory system, food safety risks, market unpredictability, traditional management and sanctions. CONCLUSIONS: The company is highly resilient to all these challenges; however, the traditional management is still a serious disadvantage. This leads to the managers' burnout along with the company survival problem, removing unfair sanctions and protecting agricultural development in developing countries is a necessity. In general, paying attention to the modern organizational management of these companies and their survival is an essential policy. For this reason, it is suggested that trust must be established between policymakers and companies on one hand and relationship between the academia and such companies to promote the organizational management on the other hand.

Expectations of citizens from the government in response to COVID-19 pandemic: a cross-sectional study in Iran.

BACKGROUND: The government is the main body in charge of controlling epidemics; hence, expectations from the intention and capacities of the government would affect the flexibility and behaviors of citizens. Given the severity of COVID-19 pandemic and the urgent need for cooperation of people in the prevention and combat processes, understanding the public perspectives would be crucial and instructive. This study aimed to explore such perspectives towards the current pandemic among the Iranian. Indeed, we sought to provide a favorable platform for effective policies in the face of the COVID-19 pandemic through recognizing public expectations. METHODS: This cross-sectional survey used an open-ended online questionnaire to investigate the common perspectives of the Iranian towards the response of government to COVID-19 pandemic. The participants were selected using snowball and convenient sampling techniques across the country. The collected data were analyzed and described using a thematic analysis. RESULTS: In general, 2547 participants agreed to participate in this study and completed the online questionnaire. According to the findings, the Iranian exhibited several expectations regarding the response of the government to COVID-19 pandemic. Three main themes were extracted based on these expectations: (1) health-related expectations, (2) policy-related expectations, and (3) Information-related expectations. In this study, a majority of participants highlighted the need to consider and follow-up the patients and their families, providing the financial and hygiene support during the pandemic, applying strict restrictions, and using close monitoring and controlling procedures. Furthermore, they mentioned that authorities and news agencies should observe the principals honesty and transparency. CONCLUSIONS: Our findings revealed that people expect the government and other responsible institutions to minimize the burden of this pandemic through adopting effective policies. Also, they could help policy-makers become aware of the expectations of people and develop better strategies.

The effect of risk communication on preventive and protective Behaviours during the COVID-19 outbreak: mediating role of risk perception.

BACKGROUND: The COVID-19 outbreak is a global pandemic, during which the community preventive and protective behaviors play a crucial role in the containment and control of infection. This study was designed to contribute to the existing knowledge on how risk communication (RC) and risk perception (RP) affect protective and preventive behaviors (PPB) during the COVID-19 outbreak. METHODS: The required data were extracted from a national online survey of Iranian adults aged 15 and older during March 15-19, 2020 (n=3213). Data analysis was performed using structural equation modeling. RESULTS: The study findings reveal that RC has direct and indirect positive effects on PB. Furthermore, this study also provides new evidence indicating that RP mediates the relationship between RC and PB and there is a two-way relationship between RC and RP. These interactions may have impact on risk communication strategies which should be adopted during this pandemic. CONCLUSION: The study findings have remarkable implications for informing future communications as well as interventions during this ongoing outbreak and subsequent national risk events.

A Qualitative Study on the Importance and Value of Doctor-Patient Relationship in Iran: Physicians' Views.

BACKGROUND: Doctor-patient relationship [DPR] refers to verbal and non-verbal communication between doctor and patient, which is of great importance in consultation sessions. AIM: Therefore, the present study attempts to explore the importance and value of DPR in Iran. MATERIAL AND METHODS: The method used in the study was conventional content analysis. The data were collected from 21 faculty members (FMs) of Shiraz University of Medical Sciences (SUMS), Shiraz, Iran, who participated in three focus group discussions (FGDs). Transcribed data were analysed using Conventional Content Analysis (CCA) which identified condensed meaning units, subthemes, and themes. RESULTS: Four themes were extracted from 198 meaning units, 87 condensed meaning units, and 17 subthemes. These included gateway [the role of DPR]; nonlinearity [the nature of DPR]; distortion (quality of DPR in the context); and dysfunctional system (weakness in health system). Generally, results showed DPR to be the gateway to consultations based on non-verbal communication and doctor empathy. The study showed distorted DPR which was due to the dysfunctionality of the health care system. CONCLUSION: As indicated DPR plays an important role in medical contexts, but if distorted it leads to an unsuccessful outcome. Therefore, to promote DPR, it is necessary to reinforce its structure. Thus, the infrastructure has to be modified and developed at all levels.

The impact of environmental and demographic factors on nursing job satisfaction.

OBJECTIVE: This study aims to evaluate all aspects of job satisfaction in registered nurses working in different hospitals in Shiraz, Iran. METHODS: This cross-sectional study was performed during February to August 2015 in Shiraz, Iran. It comprised of 371 registered nurses working in government and private hospitals using multi-stage cluster sampling. Job satisfaction was evaluated using 5 items of the Job Descriptive Index (JDI) consisting of 63 questions developed by Smith, Kendall, and Hulin (1969). Statistical tests including independent sample t test and one-way analysis of variance (ANOVA) were used in order to identify the relation between job satisfaction, and demographic features and work environment. Data were analyzed by SPSS version 15.0, using descriptive statistics, independent-samples t-test, and ANOVA. RESULTS: Our findings showed no relationship between demographic variables and job satisfaction. However, a significant association was observed between environmental aspects such as work rotation (fixed versus rotating) nurse's status (staff vs. supervisors), type of hospitals (governmental vs. private) and work (p<0.01), promotion (p<0.02) and pay (p<0.01) items respectively; however, type of hospital was deemed exempt regarding promotion. Also regarding the number of shifts per week, nurses with more than eight shifts present a lower mean score of satisfaction about pay significantly (p=0.03). CONCLUSION: The results concerning younger nurses have different types of satisfaction based on several environmental factors. Nurses' policy makers must pay more attention to nurses' satisfaction and focus on reducing the various inequalities.

Health Sector Reform, Emotional Exhaustion, and Nursing Burnout: A Retrospective Panel Study in Iran.

BACKGROUND: Nursing burnout is affected by various factors, including work overload. Since the inauguration of the Health Sector Evolution Plan (HSEP) in Iran in 2014, government hospitals have been required to provide health services to the public at all levels. This decision, however, has increased the volume of patients admitted to government hospitals. Because nurses are on the front line of health services, they are faced with a greater load of care provision. PURPOSE: This study aimed to evaluate nursing burnout before and after HSEP in Iran, with an emphasis on the differences between government and private hospitals. METHOD: This retrospective panel study used Maslach's burnout inventory to evaluate nursing burnout in 371 nurses working in government and private hospitals in Shiraz, Iran, before and 7 months after the health sector reform. Chi-square test and paired t test were used to compare burnout scores. RESULTS: The results showed that nursing burnout had changed significantly after HSEP was launched (p = .030). A more detailed assessment found that burnout and emotional exhaustion had both increased significantly in the government-hospital group (ps = .014 and .001, respectively). However, no significant change in burnout was found in the private-hospital group over the same period. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study indicate an increase in nursing burnout in government hospitals. An important issue in every health sector reform is nursing resource management, with a focus on burnout. Accordingly, policymakers should consider the work overload situation of nurses and work to prevent increased burnout, especially emotional exhaustion.

Burden of traffic accidents among pedestrians of Fars province, southern Iran; estimate of years of life lost in a sample of Iranian population from 2009 to 2013.

PURPOSE: Traffic injuries are among the leading causes of mortality and morbidity worldwide. Pedestrians have been considered as a high-risk group among road users, especially in middle- or low-income communities. This study attempted to determine the burden of pedestrians' fatalities in Fars, the southern province of Iran using years of life lost (YLL) approach. METHODS: The data used in this study were retrieved from Fars Forensic Medicine Organization database on pedestrian traffic accidents. The YLL from 2009 to 2013 was estimated using the method presented by World Health organization. Some epidemiological characteristics of pedestrians' fatalities were analyzed by SPSS. RESULTS: Although YLL among 1000 male pedestrians decreased from 2.5 in 2009 to 1.5 in 2013, it increased from 0.9 to 2.1 among 1000 females during the same period. Higher proportion of death was found in female, illiterate, and married pedestrians (p < 0.001). In addition, mortality was higher in pedestrians living the cities, during daytime, at home, and in hospitals (p < 0.001). CONCLUSION: Consistent with the global trends, burden of pedestrian accidents in Fars was also exceptionally high. Considering the national and cultural aspects of different countries, improving the safety of pedestrians demands a multi-dimensional approach with interventional factors concerning policies, rules, pedestrians, motor vehicles and environmental conditions taken into consideration.

Relationship between religion and school students' road behavior in southern Iran.

PURPOSE: Unsafe behaviors are an important cause of accidents in adolescent age groups. This study was designed to examine the behaviors of adolescent pedestrians in southern Iran. METHODS: This is a descriptive analytical cross-sectional study. The study population consisted of high school students in Shiraz, capital city of Fars Province, Iran. Five hundred and sixteen students were selected by multi-stage sampling. Data were collected by the use of three questionnaires, which included Persian copies of adolescent road user behavior questionnaire (ARBQ), Duke University Religious Index (DUREL), as well as the context and independent variables questionnaire. RESULTS: The results showed that a decrease in dangerous behaviors on the road resulted in an increase in respondents' intrinsic religiosity. Also, engagement in unsafe crossing behavior in the road decreased with increasing respondents' intrinsic religiosity. Another finding showed that female students were less involved in dangerous play and planned protective behaviors on the road. CONCLUSION: Findings clearly indicate that intrinsic religiosity has a significant role in reducing the risky road behaviors of students. Hence, religion may improve road safety in school students' road behavior in Iran.

A critical ethnography of doctor-patient interaction in southern Iran.

Doctor-patient interaction is a subject with ethical ramifications, besides being an important issue in medical sociology. The main goal of this critical study is to explore the interactional experience of hospital admitted patients. For this reason, the study, carried out in an educational hospital in southern Iran, entailed 156 recorded clinical consultations, 920 hours of participant observation, and six focus groups consisting of patients and their families. The research method used is Critical Ethnography, which was introduced by PF Carspecken. The results showed that negative interactional experience was common among the participants. Six related themes were: doctors' inattentiveness; weak interaction; violation of patients' privacy; unjustified pain; long waiting period and ambiguity; and faceless physicians. According to the participants' observations, poor interaction with doctors has led to these negative experiences. The findings showed that doctors were inconsiderate about patients' concerns and due to this, patients were dissatisfied. Theoretically, this form of fragmented collaboration has deep roots in the framework of modern medicine, but in the context of this study, the intensity of the fragmentation between doctors and patients was observed to be intolerable. To solve this problem, models of patient-centredness and narrative medicine are recommended. In addition, the health system should monitor and evaluate the observance of ethics by physicians.

The Causal Factors Associated with the Loving Care of the Mothers of Children with Multiple Disabilities.

BACKGROUND: Families with disabled children need more psycho-social considerations. Motherhood care of the children with multiple disabilities is difficult. Due to its importance, the aim of this study was to investigate the causal factors affecting loving care of mothers of children with multiple disabilities. METHODS: The study used a cross-sectional method in which 75 mothers of exceptional children with multiple disabilities (physical and mental) in elementary schools in Shiraz, Iran. The data were collected through questionnaires which, besides demographical factors, evaluated the relationship between mothers' loving care of children with multiple disabilities and four other variables including purpose in life, life satisfaction, religious attitude, and sense of coherence. Mann-Whitney U was used for comparison between mothers' loving care and other variables. RESULTS: Results revealed that demographic variables did not have a significant relationship with loving care. In the case of social variables, there was a significant relationship between mothers' loving care and purpose in life (P<0.001), religious attitude (P<0.001), and life satisfaction (P=0.01). CONCLUSION: Motherhood care of disabled children is a unique phenomenon which is due to attachment of mother-child situation. Nevertheless, these mothers are vulnerable and marginalized people who need more attention and social supports provided by related governmental institutions and also NGOs actors.

Religion as an empowerment context in the narrative of women with breast cancer.

This paper aims at exploring women's meaningful perception, semantic understanding, and their experiences of breast cancer in a religion context. Accordingly, eight women who had one of their breasts completely removed by surgery (mastectomy) were studied by narrative interviews. In this narrative interview, participants told their life stories since the beginning of disease. Findings showed that religious concepts have a heightened role in the interpretation and understanding of disease, coping strategies, and gaining new concepts for life and death. Two main themes discovered in this research were fatalism on the one hand, and the hope and empowerment on the other. Despite the intrinsic conflict between these two concepts, religion, as a specific cultural and epistemological context, reconciles them; in a way, these polar concepts form a unitary structure of meaning and activity. In this structure, semantic coherence and concrete experience leads women with breast cancer to a new meaningful system, which shapes a new path for living well.