The assessment of risk factors and risk perception status of breast cancer in Northern Iran.

BACKGROUND: Breast cancer (BC) is the most common malignancy in women. Identifying and avoiding the preventable risk factors of BC reduces its occurrence effectively. So, this study aimed to assess BC's risk factors and risk perception status in Babol, Northern Iran. METHODS: This cross-sectional study was conducted on 400 women aged 18 to 70 in Babol, Northern Iran. According to the eligibility criteria, the selected participants completed the demographic characteristics and researcher-made valid and reliable questionnaires. The statistical software was SPSS20. RESULTS: The significant risk factors related to BC were old age (60 years old and more) (30.2%), obesity (25.8%), history of radiation (10%), and familial history of BC (9.5%), respectively (P < 0.05). Suspected symptoms of BC were observed in 78 (19.5%) women, including indentations in 27 (6.75%), redness in 15 (3.75%), pain in 16 (4%), and enlargement of lymph nodes in 20 (5%). The BC risk perception score was 107.72±13.22. CONCLUSION: Most participants had at least one risk factor for BC. It is essential to implement intervention programs to control obesity and BC screening programs in obese and overweight women to prevent BC and its complications. Further studies are needed.

Communication competence, self-efficacy, and spiritual intelligence: evidence from nurses.

INTRODUCTION: Communication skills and acceptable levels of spiritual intelligence (SI) are the prerequisites of the nursing profession, which can significantly impact the individual and organizational performance of nurses. This study aimed to investigate the competency and self-efficacy of communication and its relationship with the SI of nurses. METHODS: This cross-sectional study was conducted in 2021 and included 312 nurses working in a COVID-19 hospital in the south of Iran. The data collection instruments were the Standard Communication Competence Scale, Communication Self-Efficacy, and SI Questionnaires. Data were analyzed with SPSS software version 23 using descriptive and inferential statistics, and t-test, ANOVA, Pearson's correlation coefficient, and multiple linear regression were performed at 5% significance level. RESULTS: The mean scores of nurses' communication competence, communication self-efficacy, and SI were 89.11 ± 7.32 out of 180, 64.45 ± 5.61 out of 120, and 147.13 ± 11.26 out of 210, respectively. A direct and significant correlation was observed between competence (r = 0.527, p<0.001) and communication self-efficacy (r = 0.556, p<0.001) with spiritual intelligence. The dimensions of spiritual intelligence, including the ability to deal with and interact with problems, self-awareness, love and affection, general thinking and doctrinal dimension, and dealing with moral issues, were identified as predictors of nurses' communicative competence and self-efficacy (p<0.05). There was a positive and significant correlation between nurses' competence and self-efficacy with their age (p<0.05). The nurses' mean communication competence and self-efficacy score were different regarding their level of education and the number of shifts (p<0.05). The mean scores of self-efficacy revealed a statistically significant difference between the participants' gender and the number of patients under observation (p<0.05). Moreover, the nurses' SI significantly correlated with age, and the mean scores of this intelligence had statistically significant differences regarding gender (p<0.05). CONCLUSION: The nurses' communication competence and self-efficacy were at a moderate level. Considering the correlation and predictive role of SI and its dimensions, it is recommended to promote problem-solving skills, improve self-awareness, and pay attention to moral standards to nurture communication competence and self-efficacy among nurses.

Examining the relationship between health literacy and quality of life: evidence from older people admitted to the hospital.

INTRODUCTION: Literacy has become an increasingly serious problem, especially as it relates to health care. In this regard, health literacy (HL), as a cognitive skill, has proven to be an influential factor to improve of the quality of life (QOL). This study aimed to examine the level of HL and its relationship with the QOL of older people at the time of discharge from the hospital in the south of Iran. METHODS: This descriptive-analytical cross-sectional study included 300 older people admitted and treated in 10 teaching-therapeutic hospitals affiliated with the Shiraz University of Medical Sciences in 2021. The standard Health Literacy for Iranian Adults (HELIA) questionnaire and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) were used to collect the required data. Data were analyzed with SPSS software version 23 software using descriptive and inferential statistics, Pearson's correlation coefficient, T-test, ANOVA, and multiple linear regression at p = 0.05. RESULTS: The mean scores of Hl and QOL for older people were 48.22 ± 9.63 (out of 100) and 61.59 ± 12.43 (out of 120), respectively. Moreover, there was a significant direct correlation between the participants' HL and their QOL (r=0.388, p<0.001). All dimensions of HL, including comprehension (ß=0.461, p<0.001), decision-making and behavior (ß=0.434, p<0.001), access (ß=0.397, p<0.001), reading skill (ß=0.362, p=0.002), and assessment (ß=0.278, p=0.004), were significant relationship with QOL. A statistically significant difference was revealed between the mean scores of HL regarding the participants' gender (p=0.04) and level of education (p=0.001). Furthermore, the mean scores of QOL were significantly different with regard to older people's gender (p=0.02), marital status (p=0.03), level of education (p=0.002), and income (p=0.01). CONCLUSION: The findings revealed the participants' inadequate HL and average QOL. Considering the relationship of HL with QOL, it is recommended to develop comprehensive programs and effective interventions to develop HL skills and subsequently improve QOL among older people.

Responsiveness level and its effect on services quality from the viewpoints of the older adults hospitalized during COVID-19 pandemic.

BACKGROUND: Aging is a sensitive period of life. Attention to the needs of this stage is considered a social necessity. This study is conducted to investigate the responsiveness level and its effect on service quality from the hospitalized older adults' viewpoints during the COVID-19 pandemic in the south of Iran. METHODS: It was a cross-sectional descriptive-analytic study that was conducted on 386 old patients. The study instrument was a standard questionnaire that includes three sections of demographic information, World Health Organization Responsiveness, and SERVQUAL. Data were analyzed applying descriptive and inferential statistics the same as Independent T-test, ANOVA, Pearson correlation, and multiple linear regression. RESULTS: The mean levels of responsiveness and service quality were 90.72 ± 9.38 (from 160) and 68.01 ± 8.51 (from 110) respectively. This indicates the average level of these variables from the old patients' viewpoints. There was a significant positive correlation between responsiveness and service quality (r = 0.585). According to the results of multiple linear regression, the dimensions of communication, dignity, prompt attention, primary facilities, social support, information confidentiality, right to choose, and autonomy were identified as the predictors of service quality. CONCLUSION: The average level of responsiveness and service quality perceived from the old patients' viewpoints during the COVID-19 pandemic can be considered a necessity for supportive planning among the older adults. Meanwhile, according to the impacts of responsiveness on service quality, educational programs are recommended to promote the level of healthcare providers' responsiveness.

Patients' perceptions of the quality of nursing services.

INTRODUCTION: The quality of nursing services is one of the main factors accelerating patients' recovery. The present study aimed to examine patients' perceptions of the quality of nursing services in the teaching hospitals of Iran. METHODS: This cross-sectional research was a descriptive-analytical study conducted in 2021, in which 1067 patients were selected as the research sample. The Qualipak nursing quality questionnaire (QUALPAC) was used to collect the required data. Data were analyzed using t-test, ANOVA, and Pearson correlation coefficient using SPSS software version 23. RESULTS: From the patients' perspective, the mean and standard deviation of the quality of nursing services was 191.47 ± 19.51. Among the quality dimensions, all services quality: psychosocial (91.34 ± 9.34), physical (65.72 ± 10.18), and communication (34.41 ± 6.21) were placed at the moderate level. A significant association was found between patients' age and nursing service quality. The perceived nursing service quality was subject to sex (P = 0.01, t = 1.921) and place of residence (P = 0.02, t = 1.873). CONCLUSION: According to the findings, the quality of nurses 'care was "moderate" from the patients' perspectives. Planning is recommended to reinforce and promote the quality of nursing services.

Out-of-pocket payments for treatment of COVID-19 in Iran.

INTRODUCTION: Out-of-pocket (OOP) is among the payment methods in Iran's health system. The present study aimed to examine the OOP treatment costs for patients with COVID-19 in Iran. METHODS: A descriptive-analytical, cross-sectional study was conducted in 2021. In this study, the cost records of 550 patients with COVID-19 hospitalized in a referral center of COVID-19 were selected using the stratified random sampling method. The required data were collected using a researcher-made questionnaire. Data were analyzed by t-test, ANOVA, and Pearson's correlation coefficient in SPSS software version 23 at p = 0.05. RESULTS: The total direct costs were 1,037,992.15 US $. Moreover, the shares of patients (OOP), basic insurance, government subsidy, supplementary insurance, discounts, and out-of-government subsidy in the total direct costs were US $ 92,231.21, 746,932.99 US $, 155,127.08 US $, 39,690.25 US $ and 4010.61 US $, respectively. In addition, the results confirmed that there was a positive and significant relationship between the patients' OOP payments and the length of stay. It also found that the patients' OOP payments are subject to the type of insurance program and discharge method. CONCLUSION: According to the results, 8.89% of the total direct costs were directly paid out of the patients' pockets. The research findings confirm the urgent need to make decisions and implement effective interventions for COVID-19 disease by controlling risk factors and exploiting other countries' successful experiences and international organizations' recommendations to decrease the prevalence of the infected and consequently reduce the financial pressure of the disease on patients by approving the expansion of the insurance organizations' role.

Health literacy and health promoting behaviors among inpatient women during COVID-19 pandemic.

BACKGROUND: One of the leading health indicators during the COVID-19 crisis is health literacy and health-promoting behaviors. The present study aimed to investigate health literacy and health-promoting behaviors among women hospitalized during the COVID-19 pandemic in the southern part of Iran in 2020. METHODS: This descriptive-analytical study encompassed 465 women hospitalized and treated in none teaching hospitals affiliated with the Shiraz University of Medical Sciences. Data collection tools were the Health Literacy for Iranian Adults (HELIA) and Health Promoting Lifestyle Profile II (HPLP-II). The collected data were analyzed using descriptive and inferential statistical methods. RESULTS: The mean scores of the participants' "health literacy" and "health-promoting behaviors" were 64.41 ± 11.31 and 112.23 ± 16.09, respectively, indicating the poor level of health literacy and the average level of health-promoting behaviors. Moreover, there was a significant direct correlation between health literacy and health-promoting behaviors (P < 0.001, r = 0.471). Furthermore, all health literacy dimensions of comprehension (P < 0.001), accessibility (P < 0.001), reading skills (P < 0.001), evaluation (P = 0.002), and decision making and behavior (P = 0.003) were detected as the predictors of health-promoting behaviors. Further, statistically significant relationships were noticed between the mean score of health literacy with age (r = - 0.327, P = 0.007), level of education (F = 3.119, P = 0.002), and place of residence (t = 2.416, P = 0.004) and between health-promoting behaviors with level of education (F = 3.341, P = 0.001) and marital status (F = 2.868, P = 0.02). CONCLUSION: According to the findings, health policymakers should adopt national measures for educational planning to promote health literacy and support health-promoting behaviors to encourage women to adopt a healthy lifestyle.

Health human resources challenges during COVID-19 pandemic; evidence of a qualitative study in a developing country.

BACKGROUND: One of the main forthcoming challenges of healthcare systems against preparedness and management of the pandemic is the challenge of procurement and recruitment of the human resources. This study is aimed to explore the health human resources challenges during COVID-19 pandemic in Iran. METHODS: This qualitative content analysis study was conducted in 2020. The study population includes all the Iranian human resources managers affiliated in Universities of Medical Sciences, hospitals and health centers managers and the health networks managers all over the country. 23 participants were included via purposeful sampling considering the inclusion criteria and were interviewed individually. After 23 semi-structured interviews, data were saturated. Then the data were analyzed through content analysis approach applying MAXQDA10. RESULTS: Three main themes of "organizational challenges", "legal challenges", and "personal challenges" were explored as the main challenges of health human resources management during COVID-19. On the one hand, organizational challenges include restricted financial resources, compensation discrimination, staffing distinction points, imbalance in the workload, weak organizational coordination, inefficient inter-sectoral relationships, parallel decisions, inefficient distribution of the human resources, lack of applied education, lack of integrated health protocols, lack of appropriate evaluation of performance, employee turnover, lack of clear approaches for staffing, and shortage of specialized manpower, and on the other hand, the personal challenges include insufficient knowledge of the employees, psychological disorders, reduction of self-confidence, burnout, workload increase, reduced level of job satisfaction, effects of colleague and patients bereavement and unsafety sense against the work place. Finally, the legal challenges that mostly related to the governments laws and regulations include lack of protocols for continuous supportive services, inappropriate approaches and instructions for teleworking, and lack of alternative plans and regulations for the human resources. CONCLUSION: Organizational, legal and personal challenges are among three main challenges of health human resources management during COVID-19 pandemic. Serious attention to these challenges should be considered by health policymakers in order to be prepared for facing new probable outbreaks and managing the present condition. The integrated comprehensive planning of human resources management for COVID-19 along with supportive packages for the personnel can be helpful.

Resilience level and its relationship with hypochondriasis in nurses working in COVID-19 reference hospitals.

INTRODUCTION: A new coronavirus, called COVID-19, is an acute respiratory disease, which may arouse many psychological disorders since there is no specialized knowledge about it. The present study aimed to investigate the level of resilience and its relationship with hypochondriasis in nurses working in a COVID-19 reference hospital in south of Iran. METHODS: This cross-sectional study was conducted in 2020, in which 312 nurses participated using the census method. Data collection tools were the Conker-Davidson standard resilience scale (CD-RISC) and the Evans Hypoglycaemia Awareness Questionnaire. Data were analyzed using t-test, ANOVA, Pearson correlation coefficient, and multiple linear regression using SPSS software version 23. RESULTS: The mean scores of resilience and hypochondriasis were 72.38 ± 7.11 and 49.75 ± 8.13, respectively, indicating the moderate level of these two variables among nurses. Hypochondriasis in 18.91, 61.22, and 1.28% of the nurses was mild, moderate, and severe, respectively. There was a significant negative correlation between resilience and hypochondriasis (r = - 0.214 and P < 0.001). In this regard, control (P < 0.001), positive acceptance of change (P < 0.001), spiritual effects (P = 0.001), trust in individual instincts (P = 0.001), and perception of competence (P = 0.002) were detected as the predictors of nurses' hypochondriasis. CONCLUSION: The nurses had moderate levels of resilience and hypochondriasis. Promoting knowledge about COVID-19and increasing information on how to protect oneself and others against the disease along with supportive packages from their managers are thus recommended.

Outsourcing in Shiraz University of Medical Sciences; a before and after study.

BACKGROUND: Outsourcing is a kind of participation between public and private sector. This should be monitored and supervised to enhance the quality of outsourced services and to prevent new problems in this area. Shiraz University of Medical Sciences (SUMS) hospitals increasingly use outsourcing in recent years. OBJECTIVES: The present research aimed at comparing outsourced departments of SUMS from economic view, accessibility of services, and service quality during the years 2010-2012. METHODS: A before and after descriptive and analytical design was applied in outsourced departments of SUMS in 2014. First, 17 indicators were extracted by Delphi technique. Then, all outsourced units were assessed using economic, access to services, and quality indicators during 2010 to 2012. RESULTS: After outsourcing, in all pharmacies and dentistry units, except one, loss decreased and benefit increased from public sector viewpoint. The number of personnel for one pharmacy and two laboratories was decreased, while it remained unchanged for dentistry units. The total number of clients was increased for all pharmacies and laboratories and decreased for one dentistry unit. Patient satisfaction for pharmacies, laboratories, and dentistry units was 73.4%, 80.3%, and 78.5%, respectively. Also, employer's satisfaction from contraction was 60%, 68%, and 93.3% for pharmacies, laboratories, and dentistry units, respectively. CONCLUSION: Outsourcing as an effective strategy resulted in increase in the personnel, client, and stakeholder satisfaction. Also, it increased benefit and decreased cost for public sector. It is recommended that rules for the implementation of this strategy and monitoring the private sector should be defined.

Risk Factors for Gastric Cancer: A Systematic Review

Objective: Gastric cancer is one of the leading causes of death worldwide, with many influences contributing to the disease. The aim of this study was to identify the most important risk factors. Methods: This study was conducted in 2017 with a structured overview in the Science Directe, Scopus, PubMed, Cochrane, Web of Science (ISI) databases. In the first step, articles were extracted based on their titles and abstracts; the quality of 43 articles was evaluated using the STORBE tool. Inclusion criteria were studies carried out on human, English language (first step), year of the study and the study type (second step). Results: Finally, 1,381 articles were found, of which 1,269 were excluded in primary and secondary screening. In reviewing the references of the remaining 44 papers, 4 studies were added. Finally, 43 articles were selected for the quality assessment process. A total of 52 risk factors for gastric cancer were identified and classified into nine important categories: diet, lifestyle, genetic predisposition, family history, treatment and medical conditions, infections, demographic characteristics, occupational exposures and ionizing radiation'. Conclusion: Several environmental and genetic factors are involved in the development of gastric cancer. Regarding the role of changes in 'diet and lifestyle', considering appropriate nutrition and improving the level of education and awareness of people is vital for early diagnosis and timely treatment of this disease, especially in people with a family history and genetic predisposition.