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Physical Activity for the Elderly and Different Ways of Their Participation 2 2 Physical activity levels have declined in recent decades due to technological advances and the increased use of electronic devices and robots that handle many physical tasks for us. This decrease in physical activity poses health risks for individuals of all ages. For the elderly, engaging in physical activities is important(VaezMousavi et al., 2025), but they often face challenges such as a lack of motivation and insufficient strength to participate in these activities(Izquierdo et al., 2025). It is essential to tailor physical activities to their specific conditions to help improve their overall well-being. Encouraging the elderly to engage in more physical activities presents a significant health challenge, particularly in developing countries(Kohl III et al., 2025). Various solutions have been explored to motivate older individuals to participate in suitable physical activities. Numerous articles have been published on the importance of seeking support and fostering relationships between humans and animals to promote both physical and mental well-being(Kim & Lee, 2025; Martins et al., 2023; Northrope et al., 2025). The relationship between humans and pets varies significantly across cultures and has existed since the dawn of human social life, whether in small or large communities. Coexisting with pets—such as dogs, cats, and birds—is a common practice worldwide. In recent decades, there has been a surge in research focused on using companion animals, particularly dogs, to assist in the physical and mental treatment of the elderly(Friedmann et al., 2025). However, in Iran, cultural beliefs and policies pose challenges to implementing these health-promoting and therapeutic methods for seniors. Despite this, several suggestions can be made to enhance physical activity and overall health for the elderly within this context. Many elderly people may not have the conditions to keep dogs at home, but some solutions can be suggested. For example, we have animal care camps such as dogs in different cities of Iran, which are especially active with the voluntary cooperation of people. By observing cultural and legal issues, it is possible to take the elderly, especially the lonely elderly living in nursing homes, to suitable spaces outside the city and establish contact with dogs that are very social and establish deep and appropriate relationships with humans, and to do attractive walking and physical activity, of course under the supervision and cooperation of family members or volunteers serving in animal protection camps. This activity is a step towards promoting the physical and mental health of the elderly and helping stray dogs by going out and walking in nature, utilizing the effective connection between humans and nature. The current issue features an article discussing the impact of dog walking on the physical activity and health of volunteers at stray dog camps in the United States. Authors interested in this topic are invited to collaborate with us in publishing scientific articles from various perspectives that align with the journal’s mission to promote the health of older adults.   1607 1608 2025/09/23 1404/7/1 2025/11/18 1404/8/27 Mojtaba Yassini Mojtaba Yassini Department of Psychiatry, Addiction and Behavioral Sciences Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Iran yassini@ssu.ac.ir Exercises Aged Health Friedmann, E., Gee, N. R., Simonsick, E. M., Kitner-Triolo, M. H., Resnick, B., Gurlu, M., . . . Adesanya, I. (2025). Pet Attachment and Maintenance of Physical and Cognitive Function in Community-Residing Older Adults: Evidence From the Baltimore Longitudinal Study of Aging (BLSA). Anthrozoös, 38(1), 153-169. ##Izquierdo, M., de Souto Barreto, P., Arai, H., Bischoff-Ferrari, H. A., Cadore, E. L., Cesari, M., . . . Duque, G. (2025). Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR). The Journal of nutrition, health and aging, 100401. ##Kim, G.-M., & Lee, D.-Y. (2025). Physical Activity and Health Benefits of Human-Pet Interaction: A Focus on Dog Ownership. The Journal of Korean Physical Therapy, 37(3), 143-149. ##Kohl III, H. W., Murray, T. D., & Salvo, D. (2025). Foundations of physical activity and public health. Human Kinetics. ##Martins, C. F., Soares, J. P., Cortinhas, A., Silva, L., Cardoso, L., Pires, M. A., & Mota, M. P. (2023). Pet’s influence on humans’ daily physical activity and mental health: a meta-analysis. Frontiers in public health, 11, 1196199. ##Northrope, K., Shnookal, J., Ruby, M. B., & Howell, T. J. (2025). The Relationship Between Attachment to Pets and Mental Health and Wellbeing: A Systematic Review. Animals, 15(8), 1143. ##VaezMousavi, M., Nobari, H., Shams, A., Abbasi, H., Shamsipour-Dehkordi, P., Mohamadi, F., . . . Carneiro, L. (2025). Assessing physical activity, mental health, and quality of life among older adults in Tehran, Iran: A cross-sectional study. PloS one, 20(4), e0317337.## ##

Proximity to Fast Food Restaurants and Its Association with Obesity: A Public Health Concern 2 2 Dear Editor Obesity has emerged as one of the most pressing public health challenges of the 21st century. Its prevalence has escalated globally, affecting both high-income and low- to middle-income countries (Jiwani et al., 2019; Sanchez-Vaznaugh et al., 2019). The consequences of obesity extend beyond individual health, contributing to increased rates of cardiovascular disease, type 2 diabetes, respiratory complications, and certain cancers (Hamano et al., 2018). Moreover, the economic burden is staggering, with obesity-related healthcare costs accounting for a significant portion of national health expenditures estimated at 1.2% of GDP in the United States alone (Van Hulst et al., 2025). While genetic and behavioral factors are often cited in discussions of obesity, growing evidence points to the critical role of environmental determinants (Hamano et al., 2018). Among these, the spatial distribution of fast food restaurants has garnered increasing attention (Jiwani et al., 2019). Studies have consistently shown that individuals residing in close proximity to fast food outlets are more likely to exhibit unhealthy dietary patterns, including higher consumption of energy-dense, nutrient-poor foods and lower intake of fruits and vegetables (Gallego & López-Gil, 2024; Hamano et al., 2018; Van Hulst et al., 2025). This trend is particularly alarming among children and adolescents, whose exposure to fast food near schools and recreational areas correlates with increased intake of sugary beverages and processed snacks (Jia et al., 2021). The proliferation of fast food establishments reflects broader socioeconomic and cultural dynamics (Jia et al., 2021). In many urban settings—particularly in countries such as the United States and the United Kingdom—fast food restaurants are disproportionately concentrated in low-income neighborhoods, where access to fresh produce and healthy food options is limited. For example, in the UK, 29% of people living in the most deprived areas reside in neighborhoods with the highest concentration of fast food outlets, compared to only 11% in the least deprived areas (Sanchez-Vaznaugh et al., 2019). Similarly, a multi-country study across 68 nations found that food insecurity was significantly associated with increased fast-food consumption, especially in low- and middle-income countries (Smith et al., 2022). This imbalance in the food environment exacerbates health disparities and perpetuates cycles of poor nutrition and obesity (Gallego & López-Gil, 2024).Despite public health campaigns which aims at promoting healthier eating habits, the nutritional profile of fast food offerings has remained largely unchanged, and aggressive marketing strategies continue to target vulnerable populations (Gallego & López-Gil, 2024). To address this multifaceted issue, The authors recommend a comprehensive public health approach that includes both regulatory and educational interventions (Jiwani et al., 2019). Zoning policies should be implemented to restrict the establishment of fast food outlets near schools, parks, and residential zones (Van Hulst et al., 2025). Simultaneously, incentives should be provided to encourage the development of supermarkets and grocery stores offering affordable, nutritious food options. Community-based programs that promote food literacy and empower individuals to make healthier choices are also essential (Jiwani et al., 2019). Furthermore, longitudinal research is needed to examine the causal relationship between food environments and obesity outcomes. Such studies should account for confounding variables such as socioeconomic status, physical activity levels, and cultural dietary preferences. By deepening the understanding of these dynamics, policymakers can design targeted interventions that are both effective and equitable. In conclusion, the spatial accessibility of fast food is not merely a convenience; it is a determinant of public health. Tackling obesity requires a shift in how we conceptualize and regulate our food environments. Through coordinated efforts across urban planning, education, and health sectors, we can create communities that support healthier lifestyles and reduce the burden of obesity.   1609 1610 2025/09/232025/05/2 1404/2/12 2025/11/182025/10/8 1404/7/16 Ameneh Marzban Ameneh Marzban Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. Iran amenemarzban@yahoo.com payam emami payam emami Department of Emergency Medical Sciences, School of Paramedical Sciences, Kurdistan University of Medical Sciences, Sanandaj, Iran. Iran payamemami115@gmail.com Obesity Fast Foods Public Health Schools Food Environment Gallego, A., & López-Gil, J. F. (2024). The role of individual and contextual economic factors in obesity among adolescents: A cross-sectional study including 143 160 participants from 41 countries. Journal of Global Health, 14, 04035. ##Hamano, T., Li, X., Sundquist, J., & Sundquist, K. (2018). Association between childhood obesity and neighbourhood accessibility to fast-food outlets: a nationwide 6-year follow-up study of 944,487 children. Obesity Facts, 10(6), 559-568. ##Jia, P., Luo, M., Li, Y., Zheng, J. S., Xiao, Q., & Luo, J. (2021). Fast‐food restaurant, unhealthy eating, and childhood obesity: a systematic review and meta‐analysis. Obesity Reviews, 22, e12944. ##Jiwani, S. S., Carrillo-Larco, R. M., Hernández-Vásquez, A., Barrientos-Gutiérrez, T., Basto-Abreu, A., Gutierrez, L., . . . Parra, D. C. (2019). The shift of obesity burden by socioeconomic status between 1998 and 2017 in Latin America and the Caribbean: a cross-sectional series study. The Lancet Global Health, 7(12), e1644-e1654. ##Sanchez-Vaznaugh, E. V., Weverka, A., Matsuzaki, M., & Sánchez, B. N. (2019). Changes in fast food outlet availability near schools: unequal patterns by income, race/ethnicity, and urbanicity. American journal of preventive medicine, 57(3), 338-345. ##Smith, L., Barnett, Y., López-Sánchez, G. F., Shin, J. I., Jacob, L., Butler, L., . . . Tully, M. (2022). Food insecurity (hunger) and fast-food consumption among 180 164 adolescents aged 12–15 years from sixty-eight countries. British Journal of Nutrition, 127(3), 470-477. ##Van Hulst, A., Zheng, S., Argiropoulos, N., Ybarra, M., Ball, G. D., & Kakinami, L. (2025). Overweight and obesity in early childhood and obesity at 10 years of age: a comparison of World Health Organization definitions. European Journal of Pediatrics, 184(4), 270.## ##

How Effective Is Tele-Nursing in Overcoming Psychological Barriers to Colonoscopy Screening? 2 2 Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related deaths worldwide. According to global statistics, over 1.9 million new cases of this cancer are diagnosed annually, resulting in approximately 935,000 deaths(Miller et al., 2019). The rate of colorectal cancer in Iran over the past years has been reported to be 7 cases per 100,000 people, making it the fourth most common cancer in Iran(Vakili et al., 2014). Colonoscopy remains the gold standard for CRC screening and diagnosis, capable of reducing mortality rates by 40–60% (Miller et al., 2019). Despite its proven efficacy, acceptance rates for colonoscopy, particularly in developing countries and rural areas, remain suboptimal(Wang et al., 2019). Colonoscopy screening represents a powerful tool in the fight against colorectal cancer, offering both early detection and preventive capabilities. While many high-income countries achieve screening coverage of 50–80%, low- and middle-income countries typically report rates below 10% (Dare et al., 2021, Gravitt et al., 2021, Petersen et al., 2022). This disparity reflects significant structural, financial, cultural, and educational barriers that disproportionately affect vulnerable populations(Petersen et al., 2022). In developed countries, psychological factors such as fear of pain, embarrassment, and anxiety about findings represent primary barriers(Miller et al., 2019, Yue et al., 2025). In developing countries, systemic challenges, including limited healthcare infrastructure, financial constraints, and low awareness, play a more significant role(Wang et al., 2019, Travis et al., 2024, Lim et al., 2021, Paudel et al., 2025). Numerous studies have identified fear and anxiety as major barriers to colonoscopy acceptance (Wang et al., 2019, Travis et al., 2024, Lim et al., 2021, Paudel et al., 2025). Accordingly, patients commonly report concerns about pain during the procedure (68% of cases), anxiety about potential complications such as bleeding or perforation (54%), embarrassment due to the invasive nature of the procedure (62%), and worry about possible findings (45%)(Miller et al., 2019, Yue et al., 2025). These psychological factors, combined with insufficient knowledge about the benefits of early detection and health literacy limitations, lead many individuals to avoid this critical screening method(Miller et al., 2019, Wang et al., 2019). Various educational interventions have been proposed to alleviate patient anxiety. Studies such as Shahrbabaki et al. (2022) have demonstrated that structured education programs can reduce patient anxiety by up to 35% (Shahrbabaki et al., 2022). In addition to requiring physical presence, these interventions are costly and time-consuming. Although digital interventions are available, they usually lack personal interaction and ongoing support(Evans et al., 2025). Tele-nursing—structured telephone counseling and education delivered by trained nurses—offers a promising solution to these challenges. Research indicates that tele-nursing interventions can significantly increase colonoscopy acceptance rates by addressing psychological barriers remotely(De Leo et al., 2022, Hsueh et al., 2016, Tsagkaris et al., 2023). This approach has been shown to reduce patient anxiety by providing personalized education and emotional support(Coughtrey and Pistrang, 2018). The method is particularly valuable in contexts with limited healthcare access, such as rural areas and during public health emergencies(Peng et al., 2024). The effectiveness of tele-nursing can be explained through self-efficacy theory. When patients receive targeted education and emotional support through telehealth platforms, their confidence in managing the procedure increases, thereby enhancing their willingness to undergo colonoscopy(Shahrbabaki et al., 2022). This method effectively addresses health literacy gaps and provides continuous support throughout the screening process(Cevheroğlu and Büyükyılmaz, 2024). Despite promising evidence, challenges remain in implementing tele-nursing. Variations in telehealth infrastructure and digital literacy may affect effectiveness across different populations (Shahrbabaki et al., 2022). Additionally, standardizing educational content and training specialized personnel require more attention(Evans et al., 2025). Future research should focus on developing culturally adapted interventions and measuring long-term outcomes in diverse populations(Chen et al., 2023). The study by Mashhadi et al. showed that face-to-face education and educational videos were able to reduce the anxiety of patients who were candidates for colonoscopy, and also emphasized that the implementation of such interventions should be planned according to the time constraints of medical personnel and the conditions of the patients, including cultural differences; their literacy level should also be taken into account(Mashhadi et al., 2020). This point can indicate the importance of distance education and tele-nursing.   1611 1614 2025/09/232025/05/22025/08/19 1404/5/28 2025/11/182025/10/82025/09/27 1404/7/5 Zohreh Karimiankakolaki Zohreh Karimiankakolaki Social Determinants of Health Research Center, Shk.C., Islamic Azad University, Shahrekord, Iran Iran zohrehkarimian68@gmail.com CEVHEROĞLU, S. & BÜYÜKYıLMAZ, F. (2024). Anxiety and health literacy levels of patients undergoing colonoscopy. Gastroenterolog Nursing, 47, 11-18.##CHEN, J., JIA, L., LI, Y., SHI, Y., DONG, X., YAO, J., ZHU, M., ZHANG, X. & YUAN, H.( 2023). Factors influencing adherence to healthy eating behaviors among adult colorectal cancer survivors: a systematic mixed method review. Supportive Care in Cancer, 31(1), 88.##COUGHTREY, A. E. & PISTRANG, N. (2018). The effectiveness of telephone-delivered psychological therapies for depression and anxiety: a systematic review. Journal of telemedicine and telecare, 24, 65-74.##DARE, A. J., KNAPP, G. C., ROMANOFF, A., OLASEHINDE, O., FAMUREWA, O. C., KOMOLAFE, A. O., OLATOKE, S., KATUNG, A., ALATISE, O. I. & KINGHAM, T. P. (2021). High-burden cancers in Middle-income countries: a review of Prevention and early detection strategies targeting At-risk populations. Cancer Prevention Research, 14, 1061-1074.##DE LEO, A., LIQUORI, G., IEMULO, C., DIONISI, S., GIANNETTA, N., SPANO, A., RAGNOLI, V., PETRONE, F., DI MUZIO, M. & DI SIMONE, E. (2022). Cancer patients and telenursing interventions in Italy. a systematic review. World Cancer Research Journal, 9, 1-13.##EVANS, C., CLANCY, G., EVANS, K., BOOTH, A., NAZMEEN, B., SUNNEY, C., CLOWES, M., JONES, N. W., JONES, N. & TIMMONS, S. (2025). How to implement digital clinical consultations in UK maternity care: the ARM@ DA realist review. Health and Social Care Delivery Research,22, 1-77.##GRAVITT, P. E., SILVER, M. I., HUSSEY, H. M., ARROSSI, S., HUCHKO, M., JERONIMO, J., KAPAMBWE, S., KUMAR, S., MEZA, G. & NERVI, L. (2021). Achieving equity in cervical cancer screening in low-and middle-income countries (LMICs): Strengthening health systems using a systems thinking approach. Preventive medicine, 144, 106322.##HSUEH, F.-C., CHEN, C.-M., SUN, C.-A., CHOU, Y.-C., HSIAO, S.-M. & YANG, T.( 2016). A study on the effects of a health education intervention on anxiety and pain during colonoscopy procedures. Journal of Nursing Research, 24, 181-189.##LIM, K. T., NG, C. H., DECRUZ, G. M., LIM, T. Z., DEVI, K., TAN, K.-K. & CHONG, C. S. (2021). Barriers and facilitators towards colonoscopy: a qualitative systematic review. European Journal of Cancer Prevention, 30, 232-238.##MASHHADI, M., MOHAMMADI, P. A. & SHARIFIAN, P.( 2020). Comparison of effect of two methods of face-to-face training and educational video on anxiety and physiological parameters in candidate patients for colonoscopy: A quasi-experimental study. Journal of Health and Care,22(3),267-276.[persian]##MILLER, K. D., NOGUEIRA, L., MARIOTTO, A. B., ROWLAND, J. H., YABROFF, K. R., ALFANO, C. M., JEMAL, A., KRAMER, J. L. & SIEGEL, R. L.( 2019). Cancer treatment and survivorship statistics, 2019. CA: a cancer journal for clinicians, 69, 363-385.##PAUDEL, Y. R., MAH, S., ABOYEJI, A. & ADHIKARI, K.( 2025). Barriers and facilitators to colonoscopy participation for colorectal cancer screening: a rapid review. Journal of Public Health, 1-39.##PENG, W., HUANG, Q. & MAO, B. (2024). Evaluating variations in the barriers to colorectal cancer screening associated with telehealth use in rural US Pacific Northwest. Cancer Causes & Control, 35(4), 635-645.##PETERSEN, Z., JACA, A., GININDZA, T., MASEKO, G., TAKATSHANA, S., NDLOVU, P., ZONDI, N., ZUNGU, N., VARGHESE, C. & HUNTING, G. (2022). Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review. BMC women's health, 22(1), 486.##SHAHRBABAKI, P. M., ASADI, N. B., DEHESH, T. & NOUHI, E. (2022). The effect of a pre-colonoscopy education program on fear and anxiety of patients: a randomized clinical trial study. Iranian Journal of Nursing and Midwifery Research, 27(6), 554-559.[persian]##TRAVIS, E., KERRISON, R. S., O’CONNOR, D. B. & ASHLEY, L. (2024). Barriers and facilitators to colonoscopy for cancer detection: patient and practitioner perspectives. Psychology & health, 39(9), 1263-1283.##TSAGKARIS, C., TRYGONIS, N., SPYROU, V. & KOULOURIS, A. (2023). Telemedicine in care of sarcoma patients beyond the COVID-19 pandemic: challenges and opportunities. Cancers, 15(4), 3700.##VAKILI, M., AGHAKOOCHAK, A., PIRDEHGHAN, A., SHIRYAZDY, M. & SAFFARMOGHADAM, A. (2014). The Survival Rate of Patients with Colorectal Cancer in Yazd during 2001-2011. The Journal of Shahid Sadoughi University of Medical Sciences, 22(3), 1187-1195.##Wang, H., Roy, S., Kim, J., Farazi, P. A., Siahpush, M., & Su, D. (2019). Barriers of colorectal cancer screening in rural USA: a systematic review. Rural and remote health, 19(3), 1-10.‌##YUE, Q.-Q., FENG, G.-H., PENG, T., TANG, T., SUN, Y.-X., MENG, X.-R., HUANG, L.-L., ZHAO, K.-H., HUANG, H.-L. & ZENG, Y. (2025). What is the current state of anxiety and its related factors in Chinese patients undergoing colonoscopy? A cross-sectional study. BMC psychology, 13(1), 169.## ##

Relationship between Emotional Exhaustion and Chronic Fatigue in Nurses: The Moderating Role of Health-Promoting Lifestyles 2 2 Background: The present study aims to investigate the moderating role of health-promoting lifestyle in the relationship between emotional exhaustion and chronic fatigue in nurses. Methods: This was a descriptive correlational study and the statistical population of this study included nurses at Sinai Hospital and Heart Center in Isfahan who were working in the winter of 2022. Based on the Krejci and Morgan’s table, 280 questionnaires were distributed among the sample members, of which 266 questionnaires could be analyzed statistically. The data collection tools included the Maslach Emotional Exhaustion Questionnaire, the Chalder Chronic Fatigue Questionnaire, and the Walker Health-Promoting Lifestyle. Data analysis was conducted using two software programs: SPSS and Smart PLS. Results: The results demonstrated that nurses' chronic fatigue was significantly improved by emotional exhaustion (β = 0.146, p < 0.05). Furthermore, it was discovered that a healthier lifestyle had a greater impact on lowering chronic fatigue (β = -0.393, p < 0.001). An acceptable fit was shown by the model fit indices (SRMR = 0.080, NFI = 0.928, R2 = 0.42). Furthermore, the moderating effect of a healthy lifestyle was validated, showing that increased participation in healthy behaviors lessened the effect of emotional exhaustion on chronic fatigue. Conclusion: The results showed that a health-promoting lifestyle can play a moderating role in the relationship between emotional exhaustion and chronic fatigue in nurses; therefore, paying attention to factors affecting the increase in a health-promoting lifestyle can be considered in improving the conditions of nurses who are exposed to burnout and chronic fatigue and improve their performance.   1615 1624 2025/09/232025/05/22025/08/192025/01/8 1403/10/19 2025/11/182025/10/82025/09/272025/10/1 1404/7/9 Amin Barazandeh Amin Barazandeh Department of Psychology, Faculty of Educational Sciences and Psychology, Islamic Azad University, Isfahan Branch (Khorasgan), Isfahan, Iran Iran aminbar.psy@gmail.com Maedeh khorasani Maedeh khorasani Department of Psychology, Faculty of Educational Sciences and Psychology, Islamic Azad University, Isfahan Branch (Khorasgan), Isfahan, Iran Iran khorasani766@gmail.com Molouk Tahmasebi Molouk Tahmasebi Department of Human Resources, Faculty of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran Iran tahmasebi.molouk@yahoo.com Mohammadhadi Farahzadi Mohammadhadi Farahzadi Department of psychiatry, Research center of addiction and behavioral sciences, Shahid Sadoughi, University of medical sciences, Yazd, Iran Iran h.farahzadi@ssu.ac.ir Sara Fazeli Sara Fazeli Faculty of Educational Sciences and Psychology, Department of Clinical Psychology, Alzahra University, Tehran, Iran Iran Emotional exhaustion Chronic fatigue Health-promoting lifestyle Nurses. 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Nurses’ Well-Being, Health-Promoting Lifestyle and Work Environment Satisfaction Correlation: A Psychometric Study for Development of Nursing Health and Job Satisfaction Model and Scale. International Journal of Environmental Research and Public Health, 17(10), 3582. ##Dugger, J. (2024). Predictive and Associated Factors of Burnout in Nursing Faculty: ##An Integrative Review. Nurse Educ, 49(3), ##E142–e146. https://doi.org/10.1097/nne. 0000000000001533 ##Ebrahemzadih, M., Jam barsang, S., Soltani gerdfaramarzi, r., Ashrafzadeh, H., Halvani, G., & Ebrahimzadeh, M. (2020). The relation between shift work and chronic fatigue among educational hospital nurses in Yazd [Research]. Occupational Medicine Quarterly Journal, 12(2), 1–7. [persian]https://doi.org/10.18502/ tkj. v12i2.4368 ##El-Ashry, A. M., Elsayed, S. M., Ghoneam, M. A., & Atta, M. H. R. (2023). Compassion fatigue and stress related to cardiopulmonary resuscitation: a study of critical care nurses’ experiences. BMC Nursing, 22(1), 482. https://doi.org/10.1186/s12912-023-01640-y ##Elham, B., Abbas, A., Mohamad Taghi, Y., Ali, K., Soosan, S., Soheila, K., & Hamid, S. (2019). Job Burnout and Related Factors among Health Sector Employees. Iranian Journal of Psychiatry, 14(4). [persian]https://doi.org/ 10. 18502/ijps.v14i4.1982 ##Fang, S., & Mushtaque, I. (2024). The Moderating Role of Health Literacy and Health Promoting Behavior in the Relationship Among Health Anxiety, Emotional Regulation, and Cyberchondria. Psychol Res Behav Manag, 17, 51–62. https://doi.org/10.2147/prbm.S446448 ##firouzkouhi berenj abadi, m., & pourhossein, m. (2022). The Effect of Job Stress on Resilience: The moderating Role of Job Engagement in Nurses [Research]. Faslname-i mudiriyyat-e parastari, 11(3), 26–37. [persian]##Golparvar M, M. A., Nairi S. . (2008). 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Analysis of Factors Affecting Psychological Resilience of Emergency Room Nurses Under Public Health Emergencies. Inquiry, 60, 469580231155296. https://doi.org/ 10.1177/00469580231155296 ##Marczak, P., & Milecka, D. (2024). Professional burnout of nurses and the level of rationing of nursing care: an observational preliminary study. BMC Nurs, 23(1), 269. https://doi.org/10.1186/ s12912-024-01940-x ##Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99–113. https:// doi.org/https://doi.org/10.1002/job.4030020205 ##Moghimi, A., Saberi Isfeedvajani, M., Javanbakht, M., & Khedmat, L. (2024). Health-promoting lifestyle behaviors and its association with sociodemographic characteristics in hospital clinical staff [Original Research]. Frontiers in Public Health, Volume 12 - 2024. https:// doi.org/10.3389/fpubh.2024.1391094 ##Mohaisen, A., & Mohammed, Q. (2024). Relationship Between Emotional Exhaustion and Job Satisfaction among Nurses. South Eastern European Journal of Public Health, 743–751. https://doi.org/10.70135/seejph.vi.1556 ##Mohammadi Zeidi, I., Pakpour Hajiagha, A., & Mohammadi Zeidi, B. (2011). Reliability and Validity of Persian Version of the Health-Promoting Lifestyle Profile [Research(Original)]. Journal of Mazandaran University of Medical Sciences, 20(1), 102–113. [persian]##mohammadyari, z., poortaghi, s., pashaepoor, s., & haghani, s. (2022). The relationship between health promotion behaviors of nurses and quality nursing of care [Community Health Nursing]. Iranian Journal of Nursing Research, 17(3), 16–26. [persian]https://doi.org/https:// doi.org/ 10. 22034/IJNR.17.3.16 ##Poku, C. A., Donkor, E., & Naab, F. (2020). Determinants of emotional exhaustion among nursing workforce in urban Ghana: a cross-sectional study. 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Physical Activity, Well-Being, and Community Engagement: A Socioecological Examination of Volunteers Walking Shelter Dogs 2 2 Background: The purpose of this work is to examine physical activity levels of volunteers who walk shelter dogs at an open-admission animal shelter in the southern United States.  In doing so, shelter dog walking is presented as an activity of relational community engagement that can enhance well-being at all levels.   Methods: For this quasi-experimental study, a purposive sample of volunteer dog walkers in rural North Carolina was asked to record daily activity for a twelve-week period, with a total of 336 days submitted. Descriptive statistics and a paired-samples t-test were analyze the data. Results:  Data from a total of 336 days was collected.  Paired-samples t-test was performed to compare outcomes assessed on days shelter dogs were not walked and days they were walked by volunteers.  Significant differences were demonstrated for the steps taken (t(154) = 9.5, p < .001), the distance walked (t(154) = 9.0, p < .001), and the calories expended (t(154) = 5.2, p < .001).  Conclusion:  The implications of these findings are multi-level and suggest walking shelter dogs can be a beneficial activity for all parties involved.  At the micro-level, volunteers walked further, burned more calories, and accumulated more steps on days they walked shelter dogs.  In turn, shelter staff and the local community benefited at the meso- and macro-levels, respectively. 1625 1633 2025/09/232025/05/22025/08/192025/01/82025/05/30 1404/3/9 2025/11/182025/10/82025/09/272025/10/12025/08/25 1404/6/3 Melanie Sartore-Baldwin Melanie Sartore-Baldwin Department of Recreation Sciences, College of Health and Human Performance East Carolina University Greenville, NC 27858, United States United States sartorem@ecu.edu Bhibha Das Bhibha Das Department of Recreation Sciences, College of Health and Human Performance East Carolina University Greenville, NC 27858, United States United States dasb@ecu.edu Exercise Community engagement Volunteers Dogs Walking Health ShelterAnimalsCount,(2024)Statistics.(n.d.).[online]Availble: https://www.shelteranimalscount.org/ explore-the-data/statistics-2024/ (April 2, 2025)##Carver, L. F. (2022). One Health, the Human-Animal Bond and Well-Being During the Covid 19 Pandemic. One Health Innovation, 1(1). https://doi.org/10.24908/ohi.v1i1.16190##Delobelle, J., Lebuf, E., Dyck, D. V., Compernolle, S., Janek, M., Backere, F. D., & Vetrovsky, T. (2024). Fitbit’s accuracy to measure short bouts of stepping and sedentary behaviour: Validation, sensitivity and specificity study. Digital Health, 10, 20552076241262710. https://doi.org/10. 1177/20552076241262710##Figley.ch. (1995). Compassion fatigue as secondary traumatic stress disorder-An overview. Compassion Fatigue.‌##Friedmann, E., Krause-Parello, C. A., Payton, M., Blanchard, K., Storm, A., Barr, E., & Gee, N. R. (2021). A Leash on Life: An Exploratory Study on the Effects of a Shelter-Dog Walking Program for Veterans on Dogs’ Stress. Anthrozoös, 35(1), 23-36. https://doi.org/10. 1080/08927936.2021.1944559##Guenther, K. M. (2017). Volunteers’ Power and Resistance in the Struggle for Shelter Animal Survival. Sociological Forum, 32(4), 770–792. https://doi.org/10.1111/socf.12376##Harvey, L. P., Lane, K. R., Johnson, R. A., & Silveira, B. A. (2024). Walk a hound: Dog walking and the wellbeing of older adults. Educational Gerontology, 50(7), 594–608. https://doi.org/10.1080/03601277.2024.2321065##Jacobs, J., & Reese, L. A. (2021). Compassion Fatigue Among Animal Shelter Volunteers: Examining Personal and Organizational Risk Factors. Anthrozoös, 34(6), 803–821. https://doi.org/10.1080/08927936.2021.1926719##Kilanowski PhD, R., APRN, CPNP, FAAN,Jill F. (2017). Breadth of the Socio-Ecological Model. Journal of Agromedicine, 22(4), 295–297. https://doi.org/10.1080/1059924X.2017.1358971##Krause-Parello, C. A., Gulick, E. E., & Basin, B. (2019). Loneliness, Depression, and Physical Activity in Older Adults: The Therapeutic Role of Human–Animal Interactions. Anthrozoös, 32(2), 239–254. https://doi.org/10.1080/ 08927936. 2019.1569906##Lindenmayer, J. M., & Kaufman, G. E. (2021). One Health and One Welfare. In T. Stephens, One Welfare in Practice (1st ed(.CRC Press. https://doi.org/10.1201/9781003218333-1##McNamee, L. G., & Peterson, B. L. (2016). High-Stakes Volunteer Commitment: A Qualitative Analysis. Nonprofit and Voluntary Sector Quarterly, 45(2), 275–294. https://doi.org/10. 1177/0899764015581055##Mellor, D. J., Beausoleil, N. J., Littlewood, K. E., McLean, A. N., McGreevy, P. D., Jones, B., & Wilkins, C. (2020). The 2020 Five Domains Model: Including Human–Animal Interactions in Assessments of Animal Welfare. Animals, 10(10), 1870. https://doi.org/10.3390/ ani10101870##Newbury, S., Blinn, M. K., Bushby, P. A., Cox, C. B., Dinnage, J. D., Griffin, B., Hurley, K. F., Isaza, N., Jones, W., Miller, L., O’Quin, J., Patronek, G. J., Smith-Blackmore, M., & Spindel, M. (2010). Guidelines for standard of care in animal shelters. Association of Shelter Veterinarians [Online] Available: https://oacu.oir.nih.gov/system/files/media/file/2021-02/shelterguide.pdf##North Carolina. (n.d.).(2025). Best Friends Animal Society - Save Them All. [Online] Available: https://bestfriends.org/no-kill-2025/animal-shelter-statistics/north-carolina##Paluch, A. E., Bajpai, S., Bassett, D. R., Carnethon, M. R., Ekelund, U., Evenson, K. R., Galuska, D. A., Jefferis, B. J., Kraus, W. E., Lee, I.-M., Matthews, C. E., Omura, J. D., Patel, A. V., Pieper, C. F., Rees-Punia, E., Dallmeier, D., Klenk, J., Whincup, P. H., Dooley, E. E., … Fulton, J. E. (2022). Daily steps and all-cause mortality: A meta-analysis of 15 international cohorts. The Lancet Public Health, 7(3), e219–e228. https://doi.org/10.1016/S2468-2667(21) 00302-9##Potter, K., Marcotte, R. T., Petrucci, G. J., Rajala, C., Linder, D. E., & Balzer, L. B. (2021). Examining the Contribution of Dog Walking to Total Daily Physical Activity Among Dogs and Their Owners. Journal for the Measurement of Physical Behaviour, 4(2), 97–101. https://doi. org/10.1123/jmpb.2020-0059##Rank, M. G., Zaparanick, T. L., & Gentry, J. E. (2009). Nonhuman-animal care compassion fatigue: Training as treatment. Best Practices in Mental Health: An International Journal, 5(2), 40–61.##Redvers, N., Odugleh-Kolev, A., Cordero, J. P., Zerwas, F., Zitoun, N. M., Kamalabadi, Y. M., Stevens, A., Nagasivam, A., Cheh, P., Callon, E., Aparicio-Reyes, K., & Kubota, S. (2024). Relational community engagement within health interventions at varied outcome scales. PLOS Global Public Health, 4(6), e0003193. https://doi.org/10.1371/journal.pgph.0003193##Reese, L. A. (2023). “Don’t Harass the Staff": Volunteer Satisfaction and Organizational Interpersonal Culture in Animal Shelters. The Journal of Nonprofit Education and Leadership, 13(1). https://doi.org/10.18666/JNEL-10771##Reese, L. A. (2024). Community factors and animal shelter outcomes. Journal of Applied Animal Welfare Science, 27(1), 105–123. https://doi.org/10.1080/10888705.2022.2063021##Sartore-Baldwin, M. L., Baker, J., Schwab, L., Mahar, M. T., & Das, B. (2019). Shelter dogs, university employees, and lunchtime walks: A pilot study. Work, , 64(3), 487–493. https://doi.org/10.3233/WOR-193010##Sartore-Baldwin, M. L., Das, B. M., & Schwab, L. M. (2021). Undergraduate students’ physical activity levels and experiences in a service-learning dog walking class: An exploratory pilot study. Journal of American College Health, 69(6), 617-624.https://doi.org/10. 1080/ 07448481. 2019.1705833##Tallberg, L., & Jor dan, P. J. (2022). Killing Them ‘Softly’ (!): Exploring Work Experiences in Care-Based Animal Dirty Work. Work, Employment and Society, 36(5), 858–874. https://doi.org/10.1177/09500170211008715##Veterinarians, T. A. of S. (2022). The Guidelines for Standards of Care in Animal Shelters: Second Edition. Journal of Shelter Medicine and Community Animal Health, 1(S1), Article S1. https://doi.org/10.56771/ASVguidelines.2022##Westgarth, C., Christley, R. M., & Christian, H. E. (2014). How might we increase physical activity through dog walking?: A comprehensive review of dog walking correlates. International Journal of Behavioral Nutrition and Physical Activity, 11(1), 83. https://doi.org/10.1186/1479-5868-11-83##Westgarth, C., Christley, R. M., Jewell, C., German, A. J., Boddy, L. M., & Christian, H. E. (2019). Dog owners are more likely to meet physical activity guidelines than people without a dog: An investigation of the association between dog ownership and physical activity levels in a UK community. Scientific Reports, 9(1), 1–10. https://doi.org/10.1038/s41598-019-41254-6##Westgarth, C., Christley, R. M., Marvin, G., & Perkins, E. (2017). I Walk My Dog Because It Makes Me Happy: A Qualitative Study to Understand Why Dogs Motivate Walking and Improved Health. International Journal of Environmental Research and Public Health, 14(8), 936. https://doi.org/10.3390/ ijerph14080936##Westgarth, C., Christley, R. M., Marvin, G., & Perkins, E. (2021). Functional and recreational dog walking practices in the UK. Health Promotion International, 36(1), 109–119. https://doi.org/10.1093/heapro/daaa051##Wünderlich, N. V., Mosteller, J., Beverland, M. B., Downey, H., Kraus, K., Lin, M.-H. (Jenny), & Syrjälä, H. (2021). Animals in our Lives: An Interactive Well-Being Perspective. Journal of Macromarketing, 41(4), 646–662. https:// doi.org/10.1177/0276146720984815## ##

Profile of Unintentional Injuries at the Household Level among Under-Five Children in Faridkot, India: An Urban-Rural Comparison 2 2 Background: Unintentional injuries, caused by energy transfers, cause over 2 lakh deaths annually, with drowning and falls being top causes in India. In impoverished neighborhoods, inadequate preventive measures, unstable living, and poor educational conditions contribute to the risk. Hence, this study was conducted to estimate the proportion of under-five children having unintentional injuries along with injury profile at household level in urban and rural areas. Methods: A cross-sectional study was conducted in an institution's field practice area from May 2019 to April 2020, focusing on households with under-five children. A total of 280 mother-child duos were included, with a 1:1.7 ratio for representation of both urban and rural populations. The study used a self-designed household survey questionnaire to assess injury profiles among under-five children. Chi-square analysis was used to assess the variation of variables across urban and rural areas. Results: Out of 280 households, injury was present in 115 (100%) urban and          155 (93.9%) rural houses. Overall, 270 (96.43%) of households reported at least one child injury event. Majority i.e. 254 (90.71%) households reported falls with a 907.14 injury rate/1000/year. Conclusions: Falls were the most common type of injury reported, with a high injury rate per 1000 children per year. Health education among adolescents, parents, school teachers, and district health authorities must address causes, severity, complications, and prevention of unintentional injury. Child injuries can be prevented through public health initiatives, requiring collaboration between international communities, governments, and civil society to create safer societies.   1634 1641 2025/09/232025/05/22025/08/192025/01/82025/05/302025/07/4 1404/4/13 2025/11/182025/10/82025/09/272025/10/12025/08/252025/09/29 1404/7/7 Priyanka Singla Priyanka Singla Dept. of Community Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana (Ambala), Haryana Haryana priyankasingla0201@gmail.com Saras Sanchaya Saras Sanchaya b Dept. of Community Medicine, Gouridevi Institute of Medical Sciences and Hospital, Durgapur, West Bengal West Bengal sarasgmch@gmail.com Shalini Devgan Shalini Devgan Dept. of Community Medicine, Guru Gobind Singh Medical College, Faridkot, Punjab Punjab uniqueshalu2009@gmail.com Rupali Bhatia Rupali Bhatia Dept. of Community Medicine, Guru Gobind Singh Medical College, Faridkot, Punjab Punjab drrupali137@gmail.com Ramnika Aggarwal Ramnika Aggarwal Department of Community and Family Medicine, AIIMS Bathinda, Punjab Punjab publichealth937@gmail.com Accidental injury Child Cross-sectional study Household Bhatta, S. (2017). Community-Based Home Injury Risk Assessment in RuralNepal. University of the West of England. ##Eric Ho Man Tang, & Laura Elizabeth Bedford, E. Y. T. Y., *, Emily Tsui Yee Tse, Weinan Dong,Tingting Wu, Bernard Man Yung Cheung,Carlos King HoWong and Cindy Lo Kuen Lam. (2021). Unintentional Injury Burden in Hong Kong: Results from a Representative Population-Based Survey. International Journal of Environmental Research and Public Health, 18(16), 8826. ##India, G. o. ,(2011), Census Info India2011(Punjab Profile) Ministry of Home Affairs. Available: https://www.censusindia.co.in/states/punjab##Ma, Y., Song, J., Hu, M., Yang, R., & Yang, P. (2022). Risk factors of in-home unintentional injuries among 0-6-year-old children in Changsha city of China: a cross-sectional survey based on Bronfenbrenner’s ecological system theory. BMC pediatrics, 22(1), 598. ##McKenzie, L. B., Roberts, K. J., Collins, C. L., Clark, R. M., Smith, K. C., & Manganello, J. (2019). Maternal knowledge, attitudes, and behavioral intention after exposure to injury prevention recommendations in the news media. Journal of health communication, 24(7-8), 625-632.‌##Indrayan, A., Mittal, B. N., Sengupta, R. K., & Bagchi, S. C. (1975). Epidemiological trial in domestic accidents. Indian Journal of Medical Research, 63, 1344-1352.‌##Bhuvaneswari, N., Prasuna, J. G., Goel, M. K., & Rasania, S. K. (2018). An epidemiological study on home injuries among children of 0–14 years in South Delhi. Indian journal of public health, 62(1), 4-9.‌##Atak, N., Karaoğlu, L., Korkmaz, Y., & Usubütün, S. (2010). A household survey: unintentional injury frequency and related factors among children under five years in Malatya. The Turkish journal of pediatrics, 52(3), 285-293.‌##W.H.o, (2008), Preventing Child Injuries. Available: https://www.who.int/europe/activities/ preventing-child-injuries##W.H.o, (2020a),Global Health Estimates 2020: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2019. World Health Organization. Available: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death##W.H.o, (2020b), Global Health Estimates 2020: Disease burden by Cause, Age, Sex, by Country and by Region, 2000-2019. Available: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death##W.H.o,(2022), Preventing injuries and violence: an overview. World Health Organization. Available: https://iris.who.int/bitstream/handle/10665/361331/9789240047136-eng.pdf ##Shriyan, P., Prabhu, V., Aithal, K. S., Yadav, U. N., & Orgochukwu, M. J. (2014). Profile of unintentional injury among under-five children in coastal Karnataka, India: a cross-sectional study. Int J Med Sci Public Health, 3(11), 1317-19.‌##Parmeswaran, G. G., Kalaivani, M., Gupta, S. K., Goswami, A. K., & Nongkynrih, B. (2017). Unintentional childhood injuries in urban Delhi: a community-based study. Indian journal of community medicine, 42(1), 8-12.‌##Scheidt, P. C., Harel, Y., Trumble, A. C., Jones, D. H., Overpeck, M. D., & Bijur, P. E. (1995). The epidemiology of nonfatal injuries among US children and youth. American Journal of Public Health, 85(7), 932-938.‌##Poorolajal, J., Cheraghi, P., Hazavehei, S. M., & REZAPUR, S. F. (2013). Factors associated with mothers’ beliefs and practices concerning injury prevention in under five-year children, based on health belief model. J Res Health Sci., 13(1), 63-68. ##Ramnika, A., GPI, S., RK, S., K, A., & RK, S. (2009). Pattern Of Domestic Accidents In Children In A Rural Area Of Punjab. Indian Journal ofMaternal and Child Health, 11, 2-9. ##Nouhjah, S., Kalhori, S. R. N., & Saki, A. (2017). Risk factors of non-fatal unintentional home injuries among children under 5 years old; a population-based study. Emergency, 5(1), e6.‌##Sheriff, A., Rahim, A., Lailabi, M. P., & Gopi, J. (2011). Unintentional injuries among children admitted in a tertiary care hospital in North Kerala. Indian journal of public health, 55(2), 125-127.‌##Yu, X., Wang, Y., He, C., Kang, L., Miao, L., Wu, Y., ... & Tao, J. (2023). The trend of unintentional injury-related mortality among children aged under-five years in China, 2010–2020: a retrospective analysis from a national surveillance system. BMC public health, 23(1), 673.‌##Jin, Z., Han, B., He, J., Huang, X., Chen, K., Wang, J., & Liu, Z. (2023). Unintentional injury and its associated factors among left-behind children: a cross-sectional study. BMC psychiatry, 23(1), 478.‌## ##

Fourth-Generation Multi-Theory Model (MTM) of Health Behavior Change as a Novel Strategy for Sustainable Health Promotion: A Systematic Review 2 2 Background: Health promotion has evolved significantly since its conceptualization, emphasizing the need for sustainable interventions to address population health challenges. This systematic review explored the effectiveness of the multi-theory model (MTM) of health behavior change in promoting sustainable health behavior. Methods: Following PRISMA guidelines, a comprehensive search was conducted across MEDLINE, CINAHL, APA PsycINFO, and Academic Search Premier databases. From 883 records sourced after removal of duplicates, abstracts were screened and followed by complete article reading and screening. Eight experimental studies (four randomized controlled trials and four quasi-experimental studies) published between 2016 and 2024 were included. Data extraction focused on study design, population, interventions, and outcomes, with risk of bias assessed using Cochrane tools (RoB 2 and ROBINS-I). Results: The findings revealed significant improvements in health behaviors, including reduced water pipe smoking, increased physical activity, healthier diets, and enhanced quality of life. MTM constructs—particularly participatory dialogue, behavioral confidence, emotional transformation, and practice for change—showed strong, statistically significant effects (p < 0.001). Process evaluations confirmed high intervention fidelity, strong engagement, and feasibility for community implementation. Despite small sample sizes, biases, and heterogeneous designs, the interventions effectively promoted sustainable, equitable behavior change across diverse populations. Overall, the results demonstrate the MTM’s potential for long-term health promotion through integrated behavioral and environmental strategies that align with public health sustainability goals. Conclusion The review underscores MTM's potential as a robust framework for sustainable health promotion. By integrating environmental sustainability principles and fostering community engagement, MTM-based interventions can address social determinants of health and promote long-term behavior change. Future research should focus on scaling MTM interventions, addressing methodological limitations, and exploring its integration with other sustainability frameworks to enhance public health outcomes.   1642 1662 2025/09/232025/05/22025/08/192025/01/82025/05/302025/07/42025/08/2 1404/5/11 2025/11/182025/10/82025/09/272025/10/12025/08/252025/09/292025/10/15 1404/7/23 Manoj Sharma Manoj Sharma Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, USA USA manoj.sharma@unlv.edu Asma Awan Asma Awan Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, USA USA asma.awan@unlv.edu Ana Gonzalez Ana Gonzalez Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, USA USA gonza152@unlv.nevada.edu Sidath Kapukotuwa Sidath Kapukotuwa Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, USA USA kapukotu@unlv.nevada.edu MdSohail Akhter MdSohail Akhter Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, USA USA akhtem1@unlv.nevada.edu Health Promotion Multi-Theory Model (MTM) Health Behavior Sustainable Health Interventions Behavior Health Care Public Health Sustainable Growth Abbasi Shavazi, M., Sharma, M., & Mokhtari Sorkhani, T. 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The Effectiveness of Visual-Auditory Perception Training on Working Memory and Attention in Children with Dyslexia 2 2 Background: Attention and working memory are impaired as reading correlates in children with dyslexia. This study was conducted with the aim of determining the effectiveness of auditory-visual perception training on attention and working memory in these children. Methods: The present research was a quasi-experimental study using a pretest-posttest design. The statistical population consisted of students referred to the learning disorders centers of Afagh, Shahid Hosseinzadeh, and Arvandroud in Birjand during the academic year 2024–2025. A total of 30 dyslexic students were selected through convenience sampling and randomly assigned into experimental group (n=15) and a control group (n=15). The experimental group participated in 16 sessions of auditory-visual perception training, while the control group received no intervention. To collect data, the Diagnostic Questionnaire for Specific Learning Disorders, the abbreviated form of the Stanford-Binet Intelligence Scale (ABIQ), the N-Back test, and the Continuous Performance Test (CPT) were used. Finally, data were analyzed using multivariate analysis of covariance (MANCOVA). Results: The results indicated a significant improvement in working memory (F =73.97, p<.001) and attention scores (F=43.61, p< .001) in the experimental group compared to the control group in posttest. Conclusions: These findings suggest that auditory-visual perception training can be effectively used as an intervention method to enhance attention and working memory in children with dyslexia.   1663 1673 2025/09/232025/05/22025/08/192025/01/82025/05/302025/07/42025/08/22025/10/6 1404/7/14 2025/11/182025/10/82025/09/272025/10/12025/08/252025/09/292025/10/152025/11/2 1404/8/11 Najmeh Sadat Najmeh Sadat Department of Psychology, Faculty of Educational Sciences and Psychology, University of Birjand, Birjand, Iran Iran najme.sadat91@gmail.com Mehdi Rezaei Mehdi Rezaei Department of Psychology, Faculty of Educational Sciences and Psychology, University of Birjand, Birjand, Iran Iran mehdi.rezaei15@birjand.ac.ir Mohammad Hosien Salarifar Mohammad Hosien Salarifar Department of Psychology, Faculty of Educational Sciences and Psychology, University of Birjand, Birjand, Iran Iran Mehdi.rezaei15@birjand.ac.ir Attention Auditory-Visual Perception Dyslexia Working Memory Afruzeh, E., Amraei, K., Hasanzadeh, S., & Azizi, M. (2022). Effectiveness of Visual and Auditory Perception Program on Fluency and Reading Perception in Students with Dyslexia Disorder. Psychology of Exceptional Individuals, 12(45), 171-191.[persian] ##Alizadeh, H., Delavar, A., Sadeghian, Z., & Sharifi, A. (2023). Development and psychometric properties of DSM-5 based diagnostic questionnaire for specific learning disorder with specifiers: Reading, writing and mathematics (Teacher Form). Journal of Learning Disabilities, 12(2), 63-79. [persian]##Baddeley, A. (2000). The episodic buffer: a new component of working memory? Trends in cognitive sciences, 4(11), 417-423. ##Bagheri Nia, H., Zareian, G. R., Mohammadi Hoseini, S. A., & Ejadi, Z. (2022). The effect of visual and auditory accuracy training strategies on improving the reading performance of second-year elementary students with dyslexia in Sabzevar. Iranian Journal of Learning and Memory, 4(16), 55-62. [persian]##Bouchacourt, F., & Buschman, T. J. (2019). A flexible model of working memory. Neuron, 103(1), 147-160. ##Breadmore, H. L., Halliday, L. F., & Carroll, J. M. (2024). Variability in auditory processing performance is associated with reading difficulties rather than with history of otitis media. Dyslexia, 30(1), e1760. ##Bucci, M. P. (2021). Visual training could be useful for improving reading capabilities in dyslexia. Applied Neuropsychology: Child, 10(3), 199-208. ##Bundesen, C. (1990). A theory of visual attention. Psychological review, 97(4), 523. ##Daneman, M., & Carpenter, P. A. (1980). Individual differences in working memory and reading. Journal of verbal learning and verbal behavior, 19(4), 450-466. ##Dawes, P., & Bishop, D. (2009). Auditory processing disorder in relation to developmental disorders of language, communication and attention: a review and critique. International journal of language & communication disorders, 44(4), 440-465. ##dos Santos, J. S. d. A., & Carvalho, R. M. (2024). Working memory as a predictor of reading comprehension skills in children with dyslexia. International Journal of Professional Business Review: Int. J. Prof. Bus. Rev., 9(11), 8. ##Farah, R., Ionta, S., & Horowitz-Kraus, T. (2021). Neuro-behavioral correlates of executive dysfunctions in dyslexia over development from childhood to adulthood. Frontiers in Psychology, 12, 708863. ##Gibbons, A., & Warne, R. T. (2019). First publication of subtests in the Stanford-Binet 5, WAIS-IV, WISC-V, and WPPSI-IV. Intelligence, 75, 9-18. ##Hadianfard, H., Najarian, B., Shokrkon, H., & MEHRABIZADEH, H. M. (2001). Construction and validation of the Farsi version of The Continuous Performance Test. Journal of Psychology,4(4),388- 404.[persian]##Hitch, G. J., Allen, R. J., & Baddeley, A. D. (2025). The multicomponent model of working memory fifty years on. Quarterly Journal of Experimental Psychology, 78(2), 222-239. ##Kane, M. J., Conway, A. R., Miura, T. K., & Colflesh, G. J. (2007). 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A critical review of recent studies. Brain Sciences, 12(1), 87. ##Peters, J. L., De Losa, L., Bavin, E. L., & Crewther, S. G. (2019). Efficacy of dynamic visuo-attentional interventions for reading in dyslexic and neurotypical children: A systematic review. Neuroscience & Biobehavioral Reviews, 100, 58-76. ##Ren, X., Li, J., Liu, J., Liu, D., & Zhao, J. (2023). Intervention targeting different visual attention span components in Chinese children with developmental dyslexia: a study based on Bundesen’s theory of visual attention. Annals of Dyslexia, 73(3), 487-509. ##Roitsch, J., & Watson, S. M. (2019). An overview of dyslexia: definition, characteristics, assessment, identification, and intervention. Science Journal of Education, 7(4). ##Sakhai, F., Mazaheri, S., Golmohammadi, G., & Asadollahpour, F. (2025). Prevalence of developmental dyslexia among primary school children in iran: a systematic review and meta-analysis. Iranian Journal of Psychiatry, 20(2), 223.[persian]##Same, S. K. 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Improving sentence reading performance in Chinese children with developmental dyslexia by training based on visual attention span. Scientific reports, 9(1), 18964. ## ##Afruzeh, E., Amraei, K., Hasanzadeh, S., & Azizi, M. (2022). Effectiveness of Visual and Auditory Perception Program on Fluency and Reading Perception in Students with Dyslexia Disorder. Psychology of Exceptional Individuals, 12(45), 171-191.[persian] ##Alizadeh, H., Delavar, A., Sadeghian, Z., & Sharifi, A. (2023). Development and psychometric properties of DSM-5 based diagnostic questionnaire for specific learning disorder with specifiers: Reading, writing and mathematics (Teacher Form). Journal of Learning Disabilities, 12(2), 63-79. [persian]##Baddeley, A. (2000). The episodic buffer: a new component of working memory? Trends in cognitive sciences, 4(11), 417-423. ##Bagheri Nia, H., Zareian, G. R., Mohammadi Hoseini, S. A., & Ejadi, Z. (2022). The effect of visual and auditory accuracy training strategies on improving the reading performance of second-year elementary students with dyslexia in Sabzevar. Iranian Journal of Learning and Memory, 4(16), 55-62. [persian]##Bouchacourt, F., & Buschman, T. J. (2019). A flexible model of working memory. Neuron, 103(1), 147-160. ##Breadmore, H. L., Halliday, L. F., & Carroll, J. M. (2024). Variability in auditory processing performance is associated with reading difficulties rather than with history of otitis media. Dyslexia, 30(1), e1760. ##Bucci, M. P. (2021). Visual training could be useful for improving reading capabilities in dyslexia. Applied Neuropsychology: Child, 10(3), 199-208. ##Bundesen, C. (1990). A theory of visual attention. Psychological review, 97(4), 523. ##Daneman, M., & Carpenter, P. A. (1980). Individual differences in working memory and reading. Journal of verbal learning and verbal behavior, 19(4), 450-466. ##Dawes, P., & Bishop, D. (2009). Auditory processing disorder in relation to developmental disorders of language, communication and attention: a review and critique. International journal of language & communication disorders, 44(4), 440-465. ##dos Santos, J. S. d. A., & Carvalho, R. M. (2024). Working memory as a predictor of reading comprehension skills in children with dyslexia. International Journal of Professional Business Review: Int. J. Prof. Bus. Rev., 9(11), 8. ##Farah, R., Ionta, S., & Horowitz-Kraus, T. (2021). Neuro-behavioral correlates of executive dysfunctions in dyslexia over development from childhood to adulthood. Frontiers in Psychology, 12, 708863. ##Gibbons, A., & Warne, R. T. (2019). First publication of subtests in the Stanford-Binet 5, WAIS-IV, WISC-V, and WPPSI-IV. Intelligence, 75, 9-18. ##Hadianfard, H., Najarian, B., Shokrkon, H., & MEHRABIZADEH, H. M. (2001). Construction and validation of the Farsi version of The Continuous Performance Test. Journal of Psychology,4(4),388- 404.[persian]##Hitch, G. J., Allen, R. J., & Baddeley, A. D. (2025). The multicomponent model of working memory fifty years on. Quarterly Journal of Experimental Psychology, 78(2), 222-239. ##Kane, M. J., Conway, A. R., Miura, T. K., & Colflesh, G. J. (2007). Working memory, attention control, and the N-back task: a question of construct validity. Journal of Experimental psychology: learning, memory, and cognition, 33(3), 615. ##Kim, S. K. (2021). Recent update on reading disability (dyslexia) focused on neurobiology. Clinical and experimental pediatrics, 64(10), 497. ##Magnan, A., & Ecalle, J. (2006). Audio-visual training in children with reading disabilities. Computers & Education, 46(4), 407-425. ##Nahravanian, P., Asgari, P., Dortaj, F., Naderi, F., & Bakhtiarpoor, S. (2018). The effect of cognitive training on working memory and focused attention of anxious children. Journal of Research in Educational Systems, 12(40), 7-26. ##Patel, A., Gajre, M., Bhandarkar, P., & Parlikar, V. (2020). Visual perception skill profile pattern in children with learning disorder. Internationa l Journal of Contemporary Pediatrics, 7(9), 1860-1863. ##Perry, C., & Long, H. (2022). What is going on with visual attention in reading and dyslexia? A critical review of recent studies. Brain Sciences, 12(1), 87. ##Peters, J. L., De Losa, L., Bavin, E. L., & Crewther, S. G. (2019). Efficacy of dynamic visuo-attentional interventions for reading in dyslexic and neurotypical children: A systematic review. Neuroscience & Biobehavioral Reviews, 100, 58-76. ##Ren, X., Li, J., Liu, J., Liu, D., & Zhao, J. (2023). Intervention targeting different visual attention span components in Chinese children with developmental dyslexia: a study based on Bundesen’s theory of visual attention. Annals of Dyslexia, 73(3), 487-509. ##Roitsch, J., & Watson, S. M. (2019). An overview of dyslexia: definition, characteristics, assessment, identification, and intervention. Science Journal of Education, 7(4). ##Sakhai, F., Mazaheri, S., Golmohammadi, G., & Asadollahpour, F. (2025). Prevalence of developmental dyslexia among primary school children in iran: a systematic review and meta-analysis. Iranian Journal of Psychiatry, 20(2), 223.[persian]##Same, S. K. L., Alizadeh, H., & KOUSHESH, M. (2009). The impact of visual perception skills training on reading performance in students with dyslexia. Advances in Cognitive Sciences, 11(2),63-72.##Sinha, N., Arrington, C. N., Malins, J. G., Pugh, K. R., Frijters, J. C., & Morris, R. (2024). The reading-attention relationship: Variations in working memory network activity during single word decoding in children with and without dyslexia. Neuropsychologia, 195, 108821. ##Twomey, C., O'Connell, H., Lillis, M., Tarpey, S. L., & O'Reilly, G. (2018). Utility of an abbreviated version of the stanford‐binet intelligence scales in estimating ‘full scale’IQ for young children with autism spectrum disorder. Autism Research, 11(3), 503-508. ##Valdois, S. (2022). The visual‐attention span deficit in developmental dyslexia: Review of evidence for a visual‐attention‐based deficit. Dyslexia, 28(4), 397-415.‌##Zhao, J., Liu, H., Li, J., Sun, H., Liu, Z., Gao, J., Liu, Y., & Huang, C. (2019). Improving sentence reading performance in Chinese children with developmental dyslexia by training based on visual attention span. Scientific reports, 9(1), 18964.## ##

Navigating the Care Landscape for Spinal Cord Injury: A Sociological Insight 2 2 Background: Spinal Cord Injury (SCI) is a major global public health concern, with a disproportionate burden in low- and middle-income countries (LMICs), particularly in Africa. In Nigeria, most research has emphasized clinical and rehabilitative outcomes, with limited attention to sociocultural aspects of SCI care. This study examined how people living with SCI and their caregivers navigate the healthcare landscape, and the sociocultural factors shaping their choices and experiences. Methods: This hospital-based, cross-sectional study was conducted between February 2018 and February 2019 at the University College Hospital, Ibadan, using a mixed-methods design. Data were collected through surveys with 108 informal caregivers, in-depth interviews with 30 SCI patients and caregivers, and 6 key informant interviews with traditional healers. Quantitative data were analyzed using univariate and bivariate statistics, while qualitative data was analyzed thematically. Results: Biomedical care was the most common initial response to SCI, driven by its acute presentation and availability of specialized services. Many participants later concurrently or sequentially utilized alternative care, including traditional bone setting (25.9%) and spiritual healing (71.3%). Medical tourism was reported in a few cases, and decision-making was heavily influenced by family, friends, and spiritual advisors. Despite skepticism, some caregivers reported psychological and cultural value in alternative therapies. No significant associations were found between caregivers’ socio-demographic characteristics and alternative care use. Conclusion: Healthcare-seeking for SCI in Nigeria reflects a complex blend of biomedical, traditional, and spiritual practices. Integrating culturally sensitive, community-based rehabilitation strategies with evidence-based care is critical for improving outcomes and ensuring continuity of care in LMICs.   1674 1689 2025/09/232025/05/22025/08/192025/01/82025/05/302025/07/42025/08/22025/10/62025/08/3 1404/5/12 2025/11/182025/10/82025/09/272025/10/12025/08/252025/09/292025/10/152025/11/22025/10/4 1404/7/12 Kafayat Aminu Kafayat Aminu Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria Nigeria aminukafayat@gmail.com Spinal Cord Injury Healthcare Seeking Behaviour Traditional Medicine Patient Experience Developing Countries Nigeria Adamu, A., & Ango, U. M. (2024). Health-seeking Behavior among Mothers of Under-five Children in Sokoto Metropolis, Sokoto, Nigeria. Annals of African Medicine, 23(3), 335 -342. https:// doi.org/10.4103/aam.aam_112_23##Aminu, K., & Jegede, A. S. (2015). Perception and attitude towards Ebola Virus Disease among traditional healers in Ibadan, Nigeria. African Research Journal of Medical Sciences,44(3). http://adhlui.com.ui.edu.ng/handle/123456789/2736##Aminu, K., & Jegede, A. S. (2017). Traditional Healers’ Knowledge of Ebola Virus Disease. Annals of Public Health Research, 4(1), 1–6.##Anand, A., Ajayi, A. O., Ansari, A., Mustapha, M. J., Verma, A., Adinoyi, S. A., Uthman, U., Usman, A., Mofatteh, M., Khatib, M. N., Zahiruddin, Q. S., Gaidhane, S., Sharma, R. K., Rustagi, S., Satapathy, P., Ajibade, A. A., Oluwamayowa, O., Obanife, H. O., Ahmad, K. I., & Ogunleye, O. O. (2024). Academic Neurosurgery in Nigeria- Past, Present, and Future: A Review. World Neurosurgery, 189, 108–117. https://doi.org/10.1016/j.wneu. 2024. 05.168##Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 1–10.##Baer, H. A. (2022). Medical pluralism: An evolving and contested concept in medical anthropology. A companion to medical anthropology, 342-357.‌##Baffour-Awuah, D., Acheampong, K., & Francis, Y. (2018). Health-Seeking Behaviour of Orthopedic Trauma Patients Attending Saint Joseph Hospital in Koforidua, Ghana. IOSR Journal of Nursing and Health Science, 7(1), 43–50. https://doi.org/10.9790/1959-0701064350##Bernhörster, L., & and Reifegerste, D. (2025). More Help from Friends and Family? Trends in Determinants of Surrogate Health Information-Seeking. Health Communication, 1–12. https://doi.org/10.1080/10410236.2025.2502195##Braun, V., & Clarke, V. (2014). What can “thematic analysis” offer health and wellbeing researchers? International Journal of Qualitative Studies on Health and Well-Being, 9(1), 23088.##Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. https://doi.org/10.1080/2159676X.2019.1628806##Budd, M. A., Gater, D. R., & Channell, I. (2022). Psychosocial Consequences of Spinal Cord Injury: A Narrative Review. Journal of Personalized Medicine, 12(7), 1178. https:// doi.org/10.3390/jpm12071178##Budu, E., Seidu, A.-A., Armah-Ansah, E. K., Sambah, F., Baatiema, L., & Ahinkorah, B. O. (2020). Women’s autonomy in healthcare decision-making and healthcare seeking behaviour for childhood illness in Ghana: Analysis of data from the 2014 Ghana Demographic and Health Survey. PLOS ONE, 15(11), e0241488. ##Chowdhuri, P. D., Kundu, K., & Meyur, S. (2022). Dynamics of Decision-Making in Medical Pluralism: A Systematic Review of Conceptual Models. Alternative Therapies in Health and Medicine, 28(7). https://pubmed.ncbi.nlm.nih. gov/ 34331756/##Creswell, J. W., & Clark, V. L. P. (2017). Designing and conducting mixed methods research. Sage publications. United Kingdom##Ekechukwu, E. N. D., Ikrechero, J. O., Ezeukwu, A. O., Egwuonwu, A. V., Umar, L., & Badaru, U. M. (2017). Determinants of quality of life among community-dwelling persons with spinal cord injury: A path analysis. Nigerian Journal of Clinical Practice, 20(2), 163 -169. https:// doi.org/ 10.4103/1119-3077.187328##Envuladu, E. A., Massar, K., & de Wit, J. (2022). Adolescents’ sexual and reproductive healthcare-seeking behaviour and service utilisation in plateau state, Nigeria. Healthcare, 10(2), 301. https://www.mdpi.com/2227-9032/10/2/301##Fasasi, L., Kafayat, A., & Jegede, A. S. (2020). Seeking healthcare in Purdah: A qualitative study of Muslim women in Ibadan Metropolis, Nigeria. Gender and Behaviour, 18(3), 16085-16092.##Ihegihu, C., Ugezu, A., Ndukwu, C., Chukwuka, N., Ofiaeli, R., & Ihegihu, E. (2014). A review of traumatic spinal cord injuries at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Tropical Journal of Medical Research, 17(1), 31. https://doi.org/10.4103/1119-0388.130180##Ikhioya, G. O., & Akerele, S. S. (2021). GLOBAL TREND IN TECHNOLOGY: ITS IMPACT IN HEALTHCARE-SEEKING BEHAVIOUR AND HEALTHY LIFE STYLES FOR BETTER PRODUCTIVITY. UNIZIK Journal of Educational Research and Policy Studies, 5, 16–32.##James, P. B., Wardle, J., Steel, A., & Adams, J. (2018). Traditional, complementary and alternative medicine use in Sub-Saharan Africa: A systematic review. BMJ Global Health, 3(5). https://doi.org/10.1136/bmjgh-2018-000895##Jazayeri, S. B., Maroufi, S. F., Mohammadi, E., Dabbagh Ohadi, M. A., Hagen, E.-M., Chalangari, M., Jazayeri, S. B., Safdarian, M., Zadegan, S. A., Ghodsi, Z., & Rahimi-Movaghar, V. (2023). Incidence of traumatic spinal cord injury worldwide: A systematic review, data integration, and update. World Neurosurgery: X, 18, 100171. https://doi.org/10.1016/j.wnsx.2023.100171##Jesuyajolu, D., Ayantayo, T., Oyesiji, E., Bakare, S., Madeleine, O., Adewale, O., Zubair, A., Ekennia-Ebeh, J., & Morgan, E. (2023). Burden of Traumatic Spinal Cord Injury in Sub-Saharan Africa: A Scoping Review. World Neurosurgery, 179, 216-221.e2. https://doi.org/10.1016/ j.wneu.2023.08.096##Kleinman, A. (1980). Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry (Vol. 3). Univ of California Press. ##Kukoyi, O., Orok, E., Oluwafemi, F., Oluwadare, T., Oni, O., Bamitale, T., Jaiyesimi, B., Ojo, T., & Eze, H. (2022). Factors affecting the utilization of mental health services among undergraduate students in a Nigerian University. Heliyon, 8(11). https://doi.org/10.1016/ j.heliyon. 2022.e11476##Latunji, O. O., & Akinyemi, O. O. (2018). FACTORS INFLUENCING HEALTH-SEEKING BEHAVIOUR AMONG CIVIL SERVANTS IN IBADAN, NIGERIA. Annals of Ibadan Postgraduate Medicine, 16(1), 52-60.##Liu, Y., Yang, X., He, Z., Li, J., Li, Y., Wu, Y., ... & Xiang, H. (2023). Spinal cord injury: global burden from 1990 to 2019 and projections up to 2030 using Bayesian age-period-cohort analysis. Frontiers in neurology, 14, 1304153.‌##Lu, Y., Shang, Z., Zhang, W., Pang, M., Hu, X., Dai, Y., Shen, R., Wu, Y., Liu, C., Luo, T., Wang, X., Liu, B., Zhang, L., & Rong, L. (2024). Global incidence and characteristics of spinal cord injury since 2000-2021: A systematic review and meta-analysis. BMC Medicine, 22(1), 285. https://doi.org/10.1186/s12916-024-03514-9##Malomo, A. O., Aminu, K., Adeolu, A. A., Adeleye, A. O., Balogun, J. A., Badejo, O. A., Shokunbi, M. T., & Jegede, A. S. (2020). Subjective Evaluation of Life Satisfaction by community-dwelling Spinal Cord Injury Patients Managed at the University College Hospital, Ibadan. Journal of Community Medicine and Primary Health Care, 32(2), 1–16.##Mbada, C. E., Ojoawo, A. O., Owoola, S. O., Okonji, A. M., Odetunde, M. O., Adigwe, K. C., Makinde, M. O., Adegbemigun, O. D., Fasuyi, F. O., & Idowu, O. A. (2020). Knowledge and attitude about the practice of traditional bone setters and its use for musculoskeletal disorders in rural areas in Nigeria. Middle East Journal of Rehabilitation and Health Studies, 7(2). https://www.academia.edu/ download/107827024/8a95ab46-7276-11ea-9383-a35291c765df.pdf##Mohammed, O. A., Popoola, T. O., Bognet, A. C., & Dahunsi, O. E. (2023). Determinants of Healthcare Seeking Behaviour Amongst Households in Nigeria. Abuja Journal of Economics and Allied Fields, 12(5), 129–143.##Nasidi, M. A., Akindele, M. O., Ibrahim, A. A., Ahmad Ahmad, A., & Musa, A. (2019). Health-related quality of life and related characteristics of persons with spinal cord injury in Nigeria. Iranian Journal of Neurology, 18(2), 50–56.##Nonye, A. P., & Oseloka, E. C. (2009). Health-seeking behaviour of mentally ill patients in Enugu, Nigeria. South African Journal of Psychiatry, 15(1), Article 1. https://www. ajol.info/index.php/sajpsyc/article/view/50422##Obalum, D. C., Giwa, S. O., Adekoya-Cole, T. O., & Enweluzo, G. O. (2009). Profile of spinal injuries in Lagos, Nigeria. Spinal Cord, 47(2), 134–137. https://doi.org/10.1038/sc.2008.93##Okyere Asante, P. G., Tuck, C. Z., & Atobrah, D. (2023). Medical pluralism, healthcare utilization and patient wellbeing: The case of Akan cancer patients in Ghana. International Journal of Qualitative Studies on Health and Well-Being, 18(1), 2238994. https://doi.org/10.1080/ 17482631. 2023.2238994##Olasehinde, N. (2018). Healthcare seeking behavior in Nigeria. Journal of Population and Social Studies [JPSS], 26(3), 207–218.##Oña, A., Strøm, V., Lee, B.-S., Le Fort, M., Middleton, J., Gutenbrunner, C., & Pacheco Barzallo, D. (2021). Health inequalities and income for people with spinal cord injury. A ## ##comparison between and within countries. SSM - Population Health, 15, 100854. ##Oyediran, O. O., Ayandiran, E. O., Olanrewaju, T. D., Ojo, I. O., Ogunlade, A. A., & Fajemilehin, B. R. (2022). 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Beliefs and Behaviors toward Breast Cancer Screening among Women in Rural Southern Iran: A Health Belief Model Approach 2 2 Background: Early detection of breast cancer through screening significantly improves survival rates; however, there is limited understanding of rural Iranian women’s beliefs and behaviors related to breast cancer screening. This study explores these beliefs and behaviors among women in the Khonj region of Iran, using the Health Belief Model (HBM) as a framework. Methods: A cross-sectional survey was conducted with 394 women aged 20–68 using a structured questionnaire assessing demographics, HBM constructs (perceived susceptibility, severity, benefits, barriers, self-efficacy, cues to action), and screening behaviors (BSE, CBE, mammography). Pearson correlations and logistic regression analyzed relationships between beliefs, risk factors, and screening behaviors. Results: The HBM focuses on the beliefs of the individual about health conditions to predict health-related behaviors. The model predicts that the higher the perceived susceptibility, severity, and benefit of a desired health behavior, the higher the likelihood of engagement in health-promoting behavior. This study revealed that participants had a low perceived susceptibility towards breast cancer (mean=2.34± 2.48) and a low confidence in doing a breast self-examination (mean=5.47± 4.68). However, they had a relatively high perceived benefit towards clinical breast examination (mean=15.15± 5.85) and mammography (mean=17.21± 7.91). Overall, participants perceiving the severity of breast cancer positively affected their perception of the benefits of getting breast self-examination (r =.119, p <.05), clinical breast examination (r =.276, p <.05), and mammogram (r =.238, p <.05). Conclusions: Women recognized the seriousness of breast cancer and the benefits of screening, but low perceived susceptibility and limited self-efficacy restricted participation in preventive behaviors. Accordingly, interventions targeting self-efficacy, BSE skills training, and provider-led CBE programs were recommended. Since early detection is the key to survival rate, raising awareness of breast cancer can positively affect the quality of life for women 1690 1699 2025/09/232025/05/22025/08/192025/01/82025/05/302025/07/42025/08/22025/10/62025/08/32025/09/8 1404/6/17 2025/11/182025/10/82025/09/272025/10/12025/08/252025/09/292025/10/152025/11/22025/10/42025/11/16 1404/8/25 Shahrzad Aseel Shahrzad Aseel Department of Behavioral and Environmental Health, School of Public Health, Jackson State University (JSU), Jackson, Mississippi, USA. Graduated USA shahrzad_aseel@bellsouth.net Mahkameh Moradimehrabadi Mahkameh Moradimehrabadi Technical Manager, Darugostar Medicine Distribution Center, Shiraz, Iran Iran Mahkameh.moradi21@gmail.com Masoumeh Karimi Masoumeh Karimi School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA USA m.karimi1751@gmail.com Adnan Ahmadiazad Adnan Ahmadiazad Faculty Member and Clinical Lecturer of Psychiatric, Clinical Science Department, Gulf Medical University, Ajman, UAE UAE dr.adnan@gmu.ac.ae Mohammad Shahbazi Mohammad Shahbazi Department of Behavioral and Environmental Health, Jackson State University, Jackson,MS,USA USA shahbazimohammad4@gmail.com Breast cancer screening behavior Health Belief Model rural women Iran Bashirian, S., Heidarimoghadam, R., Jenabi, E., & Soltanian, A. R. (2019). Breast self-examination performance and its determinants among Iranian women. Journal of Education and Health Promotion, 8, 170. https://doi.org/10.4103/jehp.jehp_305_18##Bloom, D. E., Cafiero, E. T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L. R., Fathima, S., ... & Weiss, J. (2017). The global economic burden of noncommunicable diseases. Geneva: World Economic Forum.##Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide. CA: A Cancer Journal for Clinicians, 68(6), 394–424. https://doi.org/10.3322/caac.21492##CDC. (2016). What are the risk factors for breast cancer? Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm##Champion, V. L. (1999). Revised susceptibility, benefits, and barriers scale for mammography screening. Nursing Research, 48(6), 337–343. https://doi.org/10.1097/00006199-199911000-00008##Champion, V. L., Skinner, C. S., Menon, U., Sriram, P. S., & Rawl, S. M. (2008). The effects of personal susceptibility and perceived benefits on breast cancer screening. Health Psychology, 27(1), 77–87. https://doi.org/10.1037/0278-6133.27.1.77##Charkazi, A., Shahnazi, H., Kouchaki, G. M., Moodi, M., & Sharifirad, G. (2013). Breast cancer screening behaviors among Iranian women: Application of the Health Belief Model. Journal of Education and Health Promotion, 2, 46. https://doi.org/10.4103/2277-9531.119037##El-Masry, R., Mansour, A., & Kamel, M. I. (2022). Health Belief Model constructs and breast cancer screening among Middle Eastern women: A systematic review. BMC Women&#039;s Health, 22(1), 342. https://doi.org/10.1186/s12905-022-02045-7##Fingeret, M. C., Nipomnick, S. W., Crosby, M. A., & Reece, G. P. (2014). Body image after breast cancer: A comparison of breast-conserving surgery and mastectomy. Psycho-Oncology, 23(10), 1005–1013. https://doi.org/10.1002/pon.3534##Gaemi, S., Moghadam, S. A., & Khazaee-Pool, M. (2019). The impact of breast cancer on quality of life in Iranian women: A systematic review. Asian Pacific Journal of Cancer Prevention, 20(8), 2391–2399. https://doi.org/10.31557/APJCP.2019.20.8.2391##Gautam, A., & Jain, A. (2016). Non-communicable diseases: The silent epidemic. International Journal of Community Medicine and Public Health, 3(2), 345–350. https://doi.org/10.18203/2394-6040.ijcmph20160448##Ghasemi, H., Karami, M., & Rafiei, H. (2025). Barriers to implementing breast cancer screening services in Iran: A qualitative study. Iranian Journal of Public Health, 54(1), 112–125.##Global Burden of Disease Study (GBD). (2010). Global burden of disease results tool. Institute for Health Metrics and Evaluation. http://ghdx.healthdata.org/gbd-results-tool##Heer, E., Harper, A., Escandor, N., Sung, H., McCormack, V., Fidler-Benaoudia, M., ... & Bray, F. (2020). Global burden and trends in breast cancer: A population-based study. The Lancet Global Health, 8(8), e1027–e1037. https://doi.org/10.1016/S2214-109X(20)30292-9##Jafari, A., Najafi, M., & Moghaddam, S. S. (2018). Breast cancer epidemiology and mortality in Iran: Trends and projections. Iranian Journal of Cancer Prevention, 11(3), 155–162. https://doi.org/10.5812/ijcp.6631##Keshavarzi, F., Tavakoli, R., & Najmabadi, S. (2022). Predictors of mammography uptake among rural women in southern Iran: Application of the Theory of Planned Behavior. BMC Public Health, 22, 2153. https://doi.org/10.1186/s12889-022-14593-4##Lee, C. H., Dershaw, D. D., Kopans, D., Evans, P., Monsees, B., Monticciolo, D., ... & Berg, W. A. (2010). Breast cancer screening with imaging: Recommendations from the Society of Breast Imaging. Journal of the American College of Radiology, 7(1), 18–27. https://doi.org/10.1016/j.jacr.2009.09.022##McKenzie, J. F., Pinger, R. R., & Kotecki, J. E. (2008). An introduction to community health (6th ed.). Jones & Bartlett Publishers.##Moradi, F., Nasrabadi, A., & Karimlou, M. (2022). Health Belief Model predictors of breast cancer screening behavior in Iranian women: A meta-analysis. Journal of Cancer Education, 37(5), 1295–1308. https://doi.org/10.1007/s13187-021-01975-y##Özkan, S., & Taylan, S. (2020). Sociocultural barriers to breast cancer screening: A qualitative study among Middle Eastern women. BMC Women&#039;s Health, 20, 238. https://doi.org/10.1186/s12905-020-01085-1##Raeissi Dehkordi, M., Shamsi, M., & Rezaei, N. (2025). Breast cancer screening in Iran: A systematic review of infrastructure challenges and policy gaps. Iranian Journal of Public Health, 54(2), 201–220.##Shahbazi, M. (2017). Iranian and American Health Professionals worked together to Address Health Disparities in Mississippi Delta. Presented at Department of Behavioral and Environmental Health’s Annual meeting. Jackson Medical Mall, Jackson, Mississippi. ##Stewart, B. W., & Wild, C. P. (2014). World cancer report 2014. Lyon: International Agency for Research on Cancer.##Tavakoli, R., Keshavarzi, F., & Najmabadi, S. (2023). Breast cancer screening behaviors and their predictors among Iranian women aged 40+: A cross-sectional study. BMC Women&#039;s Health, 23, 510. https://doi.org/10.1186/s12905-023-02359-1##WHO. (2014). Breast cancer country profiles: Iran. World Health Organization. https://www.who.int/cancer/country-profiles/IRN_2014.pdf##WHO. (2020). Noncommunicable diseases. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases##YJC. (2018). Breast cancer prevalence in Iran reaches 33 percent. Young Journalists Club. http://www.yjc.ir/en/news/6623089## ##

The Relationship between Loneliness and Emotion Regulation in Predicting Internet Addiction among Men and Women in Yazd, Iran 2 2 Background: Cyberspace is a new form of social interaction that, despite its relatively short history, has successfully become integrated into people’s daily lives. Maladaptive patterns of Internet use and excessive engagement can lead to behavioral addiction and ultimately to internet addiction. The present study aimed to investigate the relationship between loneliness and emotion regulation and the tendency toward Internet addiction among men and women in the city of Yazd,Iran. Methods: The research method was a survey. The population included all men and women in Yazd in 1403, from which 300 people (150 men and 150 women) from different age groups were selected by random sampling. In this way, the link to the online questionnaire (Porsline) was placed on local social networks and popular groups in Yazd and in public places such as parks, universities and cultural centers, for optional completion by individuals. The quality of entry included participating, residing in Yazd, and having a minimum level of literacy. The output included incomplete or invalid responses in the questionnaires. Young's Internet Usefulness, Russell's Loneliness, and Gross's Emotion Regulation questionnaires were administered to the subjects. Then, the data were analyzed using SPSS26 software. Results: The results of the present study showed that there was a positive and significant relationship between loneliness and relationship (r=0.407, p<0.001). Also, a negative relationship was observed between emotion regulation and Internet use (r=-0.211, p<0.001). These results were felt in both sexes, with the difference that the correlation coefficient was stronger in men (men: r=0.503, p<0.001; women: r=0.307, p<0.001). F=35.802, p<0.001). In this model, loneliness was a positive and significant predictor of Internet use (β=0.389, p<0.001) and emotion regulation was a significant predictor (β=-0.171, p<0.001). In other words, increasing loneliness significantly increased the likelihood of using the Internet, and increasing pressure on other regulation significantly reduced Internet use. Conclusion: In summary, it can be concluded that loneliness and dysfunctional emotion regulation are good predictors of Internet use tendencies.   1700 1708 2025/09/232025/05/22025/08/192025/01/82025/05/302025/07/42025/08/22025/10/62025/08/32025/09/82025/09/15 1404/6/24 2025/11/182025/10/82025/09/272025/10/12025/08/252025/09/292025/10/152025/11/22025/10/42025/11/162025/11/19 1404/8/28 Hasan Zareei mahmoodabadi Hasan Zareei mahmoodabadi Department of Psychology and Educational Sciences, Yazd University,Yazd, Iran Iran h.zareei@yazd.ac.ir Arezoo Jabin pour Arezoo Jabin pour Department of Psychology and Educational Sciences, Yazd University,Yazd, Iran Iran arezoojabinpour@gmail.com Zahra Esfahani Zahra Esfahani Department of Psychology and Educational Sciences, Yazd University,Yazd, Iran Iran zahraesfahani83@gmail.com Internet addiction Emotion regulation Loneliness Cyberspace Alavi, S. (2010). Psychometric properties of Young internet addiction test. International Journal of Behavioral Sciences, 4(3), 183-189. [persian]##Alavi, S. S., Jannatifard, F., Eslami, M., & Rezapour, H. (2011). Survey on validity and reliability of diagnostic questionnaire of internet addiction disorder in students users. Zahedan Journal of Research in Medical Sciences, 13(7). [persian]##Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical psychology review, 30(2), 217-237. ##BEYRAMI, M., Movahedi, Y., & Movahedi, M. (2015). The relationship between perceived social support and the feeling of social-emotional loneliness with internet addiction in university students. SOCIAL COGNITION,3(2),109-122##Bozoglan, B., Demirer, V., & Sahin, I. (2013). Loneliness, self‐esteem, and life satisfaction as predictors of Internet addiction: A cross‐sectional study among Turkish university students. Scandinavian journal of psychology, 54(4), 313-319. ##Chen, I.-H., Chen, C.-Y., Liu, C.-H., Ahorsu, D. K., Griffiths, M. D., Chen, Y.-P., . . . Wang, S.-M. (2021). Internet addiction and psychological distress among Chinese schoolchildren before and during the COVID-19 outbreak: A latent class analysis. Journal of behavioral addictions, 10(3), 731-746. ##Gioia, F., Rega, V., & Boursier, V. (2021). Problematic Internet Use and Emotional Dysregulation Among Young People: A Literature Review. Clin Neuropsychiatry, 18(1), 41-54. https://doi.org/10.36131/ cnfioritieditore 20210104 ##Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of personality and social psychology, 85(2), 348. ##Hormes, J. M., Kearns, B., & Timko, C. A. (2014). Craving F acebook? Behavioral addiction to online social networking and its association with emotion regulation deficits. Addiction, 109(12), 2079-2088. ##Josephs, R. A., Markus, H. R., & Tafarodi, R. W. (1992). Gender and self-esteem. Journal of personality and social psychology, 63(3), 391.‌##Kim, K., Ryu, E., Chon, M.-Y., Yeun, E.-J., Choi, S.-Y., Seo, J.-S., & Nam, B.-W. (2006). Internet addiction in Korean adolescents and its relation to depression and suicidal ideation: a questionnaire survey. International journal of nursing studies, 43(2), 185-192. ##Kuss, D. J., & Lopez-Fernandez, O. (2016). Internet addiction and problematic Internet use: A systematic review of clinical research. World journal of psychiatry, 6(1), 143. ##Mahmoodabadi, H. Z., Shamrizi, Z. S., & Mohammadi, M. R. (2025). Exploring the Challenges and Consequences of Maternal Parenting in the Age of Digital Children (Digital Baby Syndrome): A Grounded Theory Study. Iranian Journal of Psychiatry, 1-8. ##Maitland, D. W. (2020). Experiential avoidance and fear of intimacy: a contextual behavioral account of loneliness and resulting psychopathology symptoms. Journal of Contextual Behavioral Science. 18,193-200##Mann, S., & Yung, R.,. (2008). Internet addiction in the workplace: Causes and effects. Journal of Workplace Behavioral Health, 23(1), 77-94. ##Mazloomzadeh G, G. C. A., Bagherzadeh. . (2021). The mediating role of emotion regulation difficulty in the relationship between executive dysfunction and internet addiction. Scientific Journal of Psychology Growth., 10(6), 139-150. ##Mitchell, M. E., Lebow, J., Uribe, R., Grathouse, H., & Shoger, W. (2011). Internet use, happiness, social support and introversion: A more fine grained analysis of person variables and internet activity. Computers in Human Behavior, 27(5), 1857-1861. ##Mo, P. K. H., Lau, J. T. F., Yu, X., & Gu, J. (2014). The role of social support on resilience, posttraumatic growth, hopelessness, and depression among children of HIV-infected parents in mainland China. Aids Care, 26(12), 1526-1533. ##Naderi M, H. H. (2009). Psychometric properties of the UCLA Loneliness Scale in Iranian students. Journal of Clinical Psychology, 1(2), 33-45. ##Oguz, E., & Cakir, O. (2014). Relationship between the levels of loneliness and internet addiction. The Anthropologist, 18(1), 183-189. ##Ozawa, H., & Toda, T. (2013). Internet addiction and loneliness among Japanese university student. Psychiatry and Clinical Neurosciences, 67(3), 120–126. https://doi.org/ https://doi.org/ 10.1111/pcn.12034 ##Piri, Z., Amiri Majd, M., Bazzazian, S., & Ghamari, M. (2019). The mediating role of coping strategies in the relationship of difficulties in emotion regulation with internet addiction among college students. Internal Medicine Today, 26(1), 38-53. ##Pontes, H., Griffiths, M. D., & Martins Patrão, I. (2014). Internet addiction and loneliness among children and adolescents in the education setting: An empirical pilot study. Aloma: Revista de Psicologia, Ciències de l'Educació i de l'Esport, 32(1), 91-98. ##Romano, M., Osborne, L. A., Truzoli, R., & Reed, P. (2013). Differential psychological impact of internet exposure on internet addicts. PloS one, 8(2), e55162. ##Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. Journal of personality and social psychology, 39(3), 472. ##Yildiz, M. A. (2017). Emotion regulation strategies as predictors of internet addiction and smartphone addiction in adolescents. Journal of Educational Sciences and Psychology, 7(1). ##Young, K. S. (1998). Caught in the net: How to recognize the signs of internet addiction and a winning strategy for recovery. John Wiley& Sons. ##ZAREEI, M. H., Yektafar, M., & Asadi, S. (2022). 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Quality of Care, Physician–Patient Communication, and Patient Satisfaction: A Cross-Sectional Study in Selected Hospitals of Dhaka City, Bangladesh 2 2 Background: Physician-patient relationships play an important role in the delivery of high-quality medical care. There are many concerns reported by patients about service quality, communication with healthcare providers, and overall hospital experiences in Bangladesh. Despite government efforts to improve public hospital management in Bangladesh, patient-centered care remains overlooked. This study assesses care quality, physician–patient communication, and factors influencing patient satisfaction. Methods: This study used a quantitative approach. Data were collected from 125 outdoor patients from two public hospitals. Survey interviews were conducted using a structured questionnaire based on convenience sampling. Chi-square test was used to determine the association of patient satisfaction in relation to care quality and physician–patient communication. Statistical significance is determined by P > 0.05. Results: A total of 125 patients (45.6% male, 54.4% female) were analyzed (mean age = 26.62 years; SD = 5.95 years). The mean score of patients' satisfaction with quality of care and physician-patient communication were 2.56 and 2.49, respectively, indicating lower satisfaction. The majority (60%) of patients reported that doctors did not attentively listen, with 64.8% had consultations lasting less than five minutes. A significant association was found between the number of patients seen together and satisfaction (𝜒2 = 8.82; p = 0.03). Additionally, consultation time had a strong effect (𝜒2 =21.199; p=0.000), where patients with consultations under five minutes (81.63%) were more likely to express dissatisfaction than those who had consultations lasting over 15 minutes (1.02%). Conclusion: The findings call for policies that foster patient-centered care by improving staff attitudes, consultation time, ethical oversight, and access to essential medicines to enhance trust and satisfaction in public healthcare.   1709 1722 2025/09/232025/05/22025/08/192025/01/82025/05/302025/07/42025/08/22025/10/62025/08/32025/09/82025/09/152025/09/6 1404/6/15 2025/11/182025/10/82025/09/272025/10/12025/08/252025/09/292025/10/152025/11/22025/10/42025/11/162025/11/192025/11/10 1404/8/19 Labony Khatun Labony Khatun Department of Sociology and Anthropology, Shanto-Mariam University of Creative Technology, Uttara, Dhaka 1230, Bangladesh Bangladesh labonysoa@smuct.ac.bd Shah Ehsan Habib Shah Ehsan Habib bAustralian College of Community and Health Services, Parramatta, NSW 2150, Australia Australia se_habib@hotmail.com Care Quality Patient’s Satisfaction Physician-Patient Communication Public Hospital Bangladesh Adhikary, G., Shawon, M. S. R., Ali, M. W., Shamsuzzaman, M., Ahmed, S., Shackelford, K. A., & Uddin, M. J. (2018). Factors influencing patients’ satisfaction at different levels of health facilities in Bangladesh: Results from patient exit interviews. PloS ONE, 13(5), e0196643.##Akthar, N., Nayak, S., & Pai, Y. P. (2023). Determinants of patient satisfaction in Asia: Evidence from systematic review of literature. Clinical Epidemiology and Global Health, 23, 101393, https://doi.org/10.1016/j.cegh.2023.101393.##Almomani, R. Z. Q., Al-Ghdabi, R. R., & Hamdan, K. M. (2020). Patients’ satisfaction of health service quality in public hospitals: A PubHosQual analysis. Management Science Letters, 10(8), 1803-1812.##Andaleeb, S. S. (2000). Public and private hospitals in Bangladesh: service quality and predictors of hospital choice. Health Policy and Planning, 15(1), 95–102, https://doi.org/10.1093/heapol/15.1.95##Andaleeb, S. S., Siddiqui, N., & Khandakar, S. (2007). Patient satisfaction with health services in Bangladesh. Health Policy and Planning, 22(4), 263-273.##Agha, Z., Schapira, R. M., Laud, P. W., McNutt, G., & Roter, D. L. (2009). Patient satisfaction with physician–patient communication during telemedicine. Telemedicine and e-Health, 15(9), 830-839.##Bangladesh Medical University (2025). Super Specialized Hospital. [Online]. Available: https:// bmu.ac.bd##Begum, F., Said, J., Hossain, S. Z., & Ali, M.A. (2022). Patient satisfaction level and its determinants after admission in public and private tertiary care hospitals in Bangladesh. Front Health Serv, 2,952221. https://doi: 10.3389/frhs.2022.952221.##Campbell, S. M., Roland, M. O., & Buetow, S. A. (2000). Defining quality of care. Social Science & Medicine, 51(11), 1611-1625.##Das, M. C., Zakaria, M., Cheng, F., & Xu, J. (2021, September). Appointment length with patients in medical consultations in Bangladesh: A hospital-based cross-sectional study. In Healthcare, 9(9), 1164.##Dulewicz, V., & Assem, B. V. D. (2013). The GP-patient relationship and patient satisfaction. British Journal of Healthcare Mangement, 19(12), 596-600. DOI:10.12968/bjhc.2013. 19.12.596##Dhaka Medical College (2021). History of Dhaka Medical College. [Online]. Available: https:// dmc.gov.bd/site/page/ 1cb15259-e127-4705-bb31- 116f5dd48052/-##Eveleigh, R. M., Muskens, E., Ravesteijin, H. V., Dijik, I. V., Rijswijk, E. V., & Lucassen, P. (2012). An overview of 19 instruments assessing the doctor-patient relationship: different models or concepts are used. Journal of Clinical Epidemiology, 65(1), 10 - 15##Gautam, A., Bhandari, B., Hassan, C., Hassan, F., Mehjabeen, S., Ahmed, S. M., & Haque, R. (2022). The responsiveness of health service provider and quality of services when provided at three selected urban primary health care sites in Dhaka city, Bangladesh: A cross–sectional study. MedRxiv, 2022-03.##Gessesse, A. G., Mohammed Haile, J., & Woldearegay, A. G. (2022). The nexus between physician-patient communication and health outcomes: level of patient communication satisfaction and its impact on adherence in Ethiopian comprehensive specialized hospitals. Patient Preference and Adherence, 2509-2519.##Gupta, N., & Carr, N. T. (2008). Understanding the patient-physician interaction: potential for reducing health disparities. Journal of Applied Social Science, 2(2), 54–65. ##Hamid, S. A., Begum, A., Azim, M. R., & Islam, M. S. (2021). Doctor‐patient relationship: Evidence from Bangladesh. Health Science Reports, 4(4), e394.##Hasan, M. Z., Rabbani, M. G., Akter, O., Mehdi, G. G., Ahmed, M. W, Ahmed, S., & Chowdhury, M. E. (2024). Patient Satisfaction with the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study. JMIR Form Res, 8:e49815. https://doi: 10.2196/49815. ##Islam, A., & Biswas, T. (2014). Health system in Bangladesh: challenges and opportunities. American Journal of Health Research, 2(6), 366-374.##Jha, A. K., Orav, E. J., Zheng, J., & Epstein, A. M. (2008). Patients' perception of hospital care in the United States. New England Journal of Medicine, 359(18), 1921-1931.##Kandu, R., Jain, P. J., & Ghosal, I. (2023). Service Quality of Public Hospitals in Nepal: A Systematic Review and Meta-analysis. Indian Journal of Science and Technology, 16(28), 2102-2112.##Kanwal, K., Rafi, Y., & Sarwar, M. Z. (2019). Quality of Medical Care: Patient experiences and satisfaction at tertiary care setting in Public Hospital in Pakistan. Age, 18(29), 52.##Karim, M. R., Akhter, S., Zannat, T., & Sajid, T. (2025). Determinants of Patient Satisfaction in a Bangladeshi Public Hospital Outpatient Department: A Cross-Sectional Study. medRxiv, 2025-08 https://doi.org/10.1101/2025.08.01.25332704##Khandakar, M. S. A. (2014). Rural health care system and patients’ satisfaction towards medical care in Bangladesh: an empirical Study. Journal of Business Studies, 35(2), 83-102.##Kumar, K. N., & Anand, B. (2024). Comparing Patients' Satisfaction: Quality of Service in Public vs. Private Hospitals in Puducherry, India. In S. S. Sengupta, P. J. S. Kalagnanam, & B. Charumathi (Eds.), Organization, Purpose, and Values: Integrating Diversity, Equity and Inclusion (pp. 193-204). Routledge.##Madhuwanthi, R. M., & Marasinghe, R. B. (2021). Evaluation of Patient Satisfaction and Patient-physician Relationship in an Out-Patient Department Re-engineered through a Health Information Management System: A Descriptive Study Done at a Major Women’s Hospital in Sri Lanka. Journal of Health Sciences and Innovative Research, 2(01), 12-31##Malathi, M., Olickal, J. J., Stanley, A., Anish, T. S., Chellappan, V. (2025). Perceived healthcare quality as the predictor of patient satisfaction: Findings from a public sector tertiary care hospital in Kerala, South India. Clinical Epidemiology and Global Health, 35, 102163, https://doi.org/10.1016/j.cegh.2025.102163.##Maseko, L., & Harris, B. (2018). People-centeredness in health system reform. Public perceptions of private and public hospitals in South Africa. South African Journal of Occupational Therapy, 48(1), 22-27.##Ministry of Health and Family Welfare. (2023). Bangladesh Digital Health Strategy 2023 - 2027. Dhaka: Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh.##Mohamed, B., & Azizan, N. A. (2015). Perceived service quality’s effect on patient satisfaction and behavioural compliance. International Journal of Health Care Quality Assurance, 28(3), 300-314.##Mohiuddin, A. K. (2020). An extensive review of patient satisfaction with healthcare services in Bangladesh. Patient Experience Journal, 7(2):59-71. https://doi: 10.35680/2372-0247.1415.##Nessa, M., Sultana, S., & Hossain, S. (2025). Assessment of relationship between doctor and patient in a selected Hospital: Patient’s perspective. Journal of Current Health Sciences, 5(1), 51-58.##Pavel, M. S., Chakrabarty, S., & Gow, J. (2015). Assessing willingness to pay for healthcare quality improvements. BMC Health Services Research, 15, 43.##Rahman, M.S., & Islam, M.A. (2024). Assessing citizen perception of health service quality of general hospitals in Bangladesh. Discover Health Systems, 3, 108. https://doi.org/10.1007/s44250-024-00172-9##Siddique, A. B., Nath, S. D., Rasel, S. M., Roy, C., Monim, M. M., & Amin, M. Z. (2024). Unraveling patient satisfaction, associated factors, and dissatisfaction reasons in the provision of health care services for rural communities in Bangladesh: A cross-sectional investigation. Clinical Epidemiology and Global Health, 29, 101724.##Singh, S., Kaur, P., & Rochwani, R. (2013). Patient satisfaction levels in a tertiary care medical college hospital in Punjab, North India. Int J Res Dev Health, 1(4), 172-82.##Subedi, D., & Uprety, K. (2014). Patients' satisfaction with hospital services in Kathmandu. Journal of Chitwan Medical College, 4(3), 25-31.##Singhal, S., Shah, R. B., Bansal, S., & Dutta, S. (2024). Doctor–patient communication practices: A cross-sectional survey on Indian physicians. Journal of Family Medicine and Primary Care, 13(11), 5198-5206.##Uddin, M. J., Ashrafun, L., & Kubra, T. J. (2017). Patient satisfaction with doctors’ care in Bangladesh: a case of government hospital. J Fam Med, 4(6), 1132.##Van den Brink-Muinen, A., Verhaak, P. F. M., Bensing, J. M., Bahrs, O., Deveugele, M., Gask, L., & Perez, A. (2000). Doctor–patient communication in different European health care systems: Relevance and performance from the patients’ perspective. Patient Education and Counseling, 39(1), 115-127.##Wang, Y. F., Lee, Y. H., Lee, C. W., Lu, J. Y., Shih, Y. Z., & Lee, Y. K. (2024). The physician-patient communication behaviors among medical specialists in a hospital setting. Health Communication, 39(6), 1235-1245.##Zakaria, M., Mazumder, S., Faisal, H. M., Zannat, R., Haque, M. R., Afrin, T, & Xu, J. (2024). Physician communication behaviors on patient satisfaction in primary care medical settings in Bangladesh. Journal of Primary Care & Community Health, 15, 21501319241277396.## ##

Challenges of Educating Single-Child Students: Perspectives of First-Grade Elementary Teachers in Yazd, Iran 2 2 Background: The aim of the current research is to study the views of first grade elementary school teachers in Yazd about the challenges of working with single-child students. Methods: In this qualitative descriptive study, 15 primary school teachers were selected through theoretical sampling. The criteria for determining sample size were achieving the theoretical saturation in extracted categories. The inclusion criteria were willingness to participate and at least one academic year of teaching experience with single-child students in the classroom. Data were collected through semi-structured face-to-face interviews conducted over a period of 3 months. Data were analyzed using qualitative content analysis with a conventional (inductive) approach. To ensure research rigor, the authors addressed trustworthiness through four criteria: (1) credibility (via member checking and peer debriefing), (2) transferability (thick description of context), (3) dependability (audit trail of research process), and (4) confirmability (researcher reflexivity journals). Triangulation was achieved through multiple data sources and analyst cross-checking. Results: Three core themes emerged from the analysis, with twenty distinct subthemes illuminating the challenges faced by single-child students in classroom settings:Social Competency Deficits (Social isolation, peer incompatibility, egocentric behaviors, conflict resolution difficulties, rule-compliance challenges, friendship formation barriers), Developmental Vulnerability Traits (Depressive tendencies, obsessive behaviors, low self-efficacy, poor resilience, indecisiveness, digital overreliance, self-regulation gaps, delayed social acceptance, passive listening, accountability deficits),Emotional Regulation Difficulties (Separation anxiety, perceived deviance distress, emotional dysregulation, excessive validation-seeking).    Conclusion: The study reveals that single-child students' developmental trajectories are significantly shaped by their limited peer socialization opportunities, which  are manifested in three interrelated domains: underdeveloped social competencies, heightened vulnerability in personality development, and impaired emotional regulation capacities. These findings suggest that the absence of sibling relationships may create distinct socialization challenges that classroom environments must intentionally address through targeted pedagogical interventions.   1723 1734 2025/09/232025/05/22025/08/192025/01/82025/05/302025/07/42025/08/22025/10/62025/08/32025/09/82025/09/152025/09/62025/05/11 1404/2/21 2025/11/182025/10/82025/09/272025/10/12025/08/252025/09/292025/10/152025/11/22025/10/42025/11/162025/11/192025/11/102025/08/25 1404/6/3 Delaram Darvishpour Delaram Darvishpour Department of Psychology and Educational Sciences, Yazd University, Yazd, Iran Iran darvishpourdelaram@gmail.com Hossain Hassani Hossain Hassani Department of Educational Sciences, Faculty of Psychology and Educational Sciences, Yazd University, Yazd, Iran Iran hassani.hossain@yazd.ac.ir Veronese Guido Veronese Guido Department of Human Sciences and Education Italy guido.veronese@unimib.it Family Single child Students Teachers.  Hoghabrkhah, O., Ghahari, S., Memaryan ,N., Lotfi, M. (2023). Comparison of Parent-Child Relationship, Identity Styles, Self-Compassion of Adolescents in Single-Child and Multi-Child Families. Rooyesh. 12(1), 1-10. [Persian]. http://dorl.net/dor/20.1001.1.2383353.1402.12.1.1.5## Jalili, F., Zafarnejad, M., Khosravi, F. (2022). the Only-Child Adolescents’ Lived Experience of Interaction: Narrative Research. Rooyesh. 11(6), 153-164. [Persian]. http://dorl.net/dor/20.1001.1.2383353.1401.11.6.6.3## Karimyan, Z., Sahbazi Rad, A., & Hagigh Kermanshahi, M. (2016). A Comparison of the Social Cognition of 5 to 7 Years Old Girls&#039; of Families with one Child vs. Families with more than one Child in Isfahan City. Social Cognition, 4(2), 22-34. [Persian]. https://dorl.net/dor/20.1001.1.23223782.1394.4.2.2.7## Lee, J., Allen, J., Lim, H. (2024). The effect of single mothers’ employment on their children’s mental health in young adulthood: Random effects model for longitudinal data. Children and youth services review. V(160), 107585. https://doi.org/10.1016/j.childyouth.2024.107585## Mehdizadeh Hasanabadi, F., Salehi, I. (2022). Comparison between the Sense of Psychiatric Integrity, Self-regulatory and Obstinacy of the Students in the Last Grade of High School Course of Studies, in the single-child and several-children’s families of Rasht City. Journal of New Strategies in Psychology and Educational Sciences. 5(13), 200-213. [Persian].## Mohammadi kashka, S., Abolghasemi, A., & Kafi Masooleh, S. M. (2023). The Effect of Painting-Based Group Play Therapy on Emotional Skills of Children with Separation Anxiety Disorder. Psychology of Exceptional Individuals, 13(49), 233-259. [Persian]. http://doi.org/10.22054/jpe.2022.64578.2391## Mojoudi, M., Yousefi, Z., Torkan, H. (2018). Predicting the Adolescence Depression Based on Adolescence Stress, Resiliency, Attachment Style, and Family Relations among Two Groups of One-Child and Multi-Child. Journal of research in behavioral sciences, 16(2), 221-228. [Persian]. http://dorl.net/dor/20.1001.1.17352029.1397.16.2.14.2## Mortazavi, M., Hosseinian, S., Rasooli, R., & Zareei, H. (2018). Lived experience of single children of their interaction with parents &quot;A Phenomenological study&quot;. Journal of Family Research, 15(2), 251-266. [Persian]. https://jfr.sbu.ac.ir/article_97751.html?lang=fa## Naeimi, E., Saeidi, M., & Kazemian, S. (2019). Comparison of quality of life of single-parent couples with couples with more than two children in families living in Tehran. Family Counseling and Psychotherapy, 9(1), 161-172. [Persian]. http://doi.org/10.34785/J015.2019.021## Satooriyan, A., Tahmasiyan, K., Ahmadi, M. (2014). A Comparative Study of the Behavioral Problems of Children from Single-Child Families and Two-Child Families, Ravanshenasi Va Din, 7(3), 65. [Persian].## Taheri A, Pyadeh -Kohsar A, Hassan A (2023). The effectiveness of play therapy on behavioral problems, loneliness and depression of deaf children. 21(3), 563-574. [Persian]. http://rbs.mui.ac.ir/article-1-1646-fa.html.## Tian, Y., Qin, N., Cao, S., Gao, F. (2024). Reciprocal associations between shyness, self-esteem, loneliness, depression and Internet addiction in Chinese adolescents. Addiction Res, 29(2), 98-110. https://doi.org/10.1080/16066359.2020.1755657## Yang, X., Hong, X., Li, V. (2023). Only children” and entrepreneurship in China: Spillover effects and mechanisms. Pacific-basin finance journal. V (79), 101994. https://doi.org/10.1016/j.pacfin.2023.101994## Zhu, J., Zou, S., Li, Y. (2024). Relations between maternal parenting styles and callous-unemotional behavior in Chinese children: A longitudinal study. Child abuse & neglect. V(154), 106865 https://doi.org/10.1016/j.chiabu.2024.106865## ##

The Critical Role of Programming Languages among Healthcare Data Scientists: A Systematic Review of Trends, Applications, and Future Directions 2 2 Background: Artificial intelligence (AI) and data science have transformed healthcare by enabling advanced analytical techniques. AI-driven solutions rely on sophisticated algorithms that require specialized programming languages. Understanding the most commonly used programming languages is essential for healthcare data scientists in order to navigate this domain effectively. This study explores the trends and applications of programming languages in healthcare data science, highlighting their roles in machine learning (ML) and related methodologies. Methods: A systematic search was conducted in PubMed/MEDLINE, Scopus, and Web of Science (WoS) covering the period 2010–2023. Keyword combinations included artificial intelligence, machine learning, programming languages, healthcare, and medical informatics. After screening, 174 studies that explicitly mentioned programming languages in their abstracts were included for analysis. Results: Public health accounted for 50.6% (n=88/174) of the reviewed studies, followed by medicine at 25.9% (n=45/174) and genomics at 14.4% (n=25/174). Python emerged as the most widely used programming language, appearing in 37.47% (n=65) of the articles, followed by R at 29.6% (n=51) and MATLAB at 17.8% (n=31). Machine learning methods were predominant in genomics and epidemiology. The temporal trend showed an increasing preference for Python, while MATLAB use declined in recent years. Conclusion: The selection of programming languages in healthcare data science is influenced by technical needs, application-specific requirements, and collaboration dynamics. Python’s versatility has made it a dominant choice, while R’s statistical focus and MATLAB’s specialized toolkits remain significant in specific domains. The findings provide a framework for educational strategies, guiding data scientists in making informed decisions about language proficiency. Future research should evaluate the long-term implications of programming language adoption on healthcare analytics.   1735 1747 2025/09/232025/05/22025/08/192025/01/82025/05/302025/07/42025/08/22025/10/62025/08/32025/09/82025/09/152025/09/62025/05/112025/07/26 1404/5/4 2025/11/182025/10/82025/09/272025/10/12025/08/252025/09/292025/10/152025/11/22025/10/42025/11/162025/11/192025/11/102025/08/252025/10/1 1404/7/9 Seyedeh Nahid Seyedhasani Seyedeh Nahid Seyedhasani Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Iran n.syedhasani@gmail.com Afrooz Arzehgar Afrooz Arzehgar Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Iran afroozarzehgar@gmail.com Mohamad Amin Bakhshali Mohamad Amin Bakhshali Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Iran bakhshalima2@mums.ac.ir Mostafa Sohrabifar Mostafa Sohrabifar Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Iran sohrabifar372@gmail.com Seyyed Mohammad Tabatabaei Seyyed Mohammad Tabatabaei Applied biomedical Research Center, Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran. 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