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ZusammenfassungOsteoidosteome und Osteoblastome sind gutartige knochenbildende Tumore, die in den ersten beiden Lebensdekaden nicht selten die Ursache von schmerzhaften Läsionen der Wirbelsäule mit schmerzbedingter skoliotischer Deformierung sind. Beide Entitäten sind sich histologisch sehr ähnlich, lassen sich jedoch durch Röntgen bzw. computertomographische Darstellung anhand ihrer Größe und morphologischen Merkmale gut differenzieren. Die Osteoblastome können durch ihre Größenzunahme und osteodestruktives Verhalten die Wirbelsäule destabilisieren oder zu neurologischen Ausfälle führen. Die Schmerzen sprechen häufig gut auf die Nicht Steroidale AntiRheumatika (NSAR), insbesondere auf Azetylsalezylsäure, an. Schmerzpersistenz und Nebenwirkungen von NSAR sowie mögliche Instabilitäten erfordern aber häufig eine interventionelle Therapie mit chirurgisch vollständiger Resektion selten in Kombination mit Stabilisierung oder perkutane Radiofrequenzablation, die je nach morphologischen Gesichtspunkten angewendet werden können.

Background Phenylketonuria (PKU) screening is a public health measure taken to diagnose and treat the patients with PKU to prevent severe neurological disorders in them. The present study was aimed at analyzing the policies of the national PKU screening (NaPS) program in Iran. Methods PKU screening program policies were analyzed in compliance with the policy triangle model. Document review and 38 semi-structured interviews were used for data collection. Document review data were analyzed using content analysis, and interview data were analyzed using framework analysis. Results The national PKU screening (NaPS) program was a decision made at the genetics department of Ministry of Health and Medical Education (MOHME) in Iran. Many internal and external stakeholders were involved in it and valid evidence was used to formulate the policies. Despite some opposition and insufficient support, the program was implemented due to the continuous persistence of parents, interested executives, formulated valid content and a top-down approach. The main barriers included rapid substitution of managers, shortage of Phe-free milk, little awareness of patients’ families, social stigma, and inadequate co-operation of some hospital administrators. Conclusions The policy triangle framework contributed to explaining the different components of the PKU screening program. A successful PKU screening program requires more stability of senior managers in MOHME, enough human resources and Phe-free milk, educating patients’ families, and commitment of hospitals administrators. Meanwhile, all the stakeholders need to be involved in the program effectively.

Objectives: Investigating the elderlychr('39')s lifestyle conditions is a challenging issue, due to various factors influencing lifestyle. The current study was developed to explore the construct and validity of the Healthy Lifestyle Questionnaire (HLQ) among the Iranian elderly who receive home care services. Methods & Materials: This combinatory, sequential exploratory study was conducted for creating a lifestyle measuring tool among the elderly in Tehran City, Iran, in 2018. The research was performed in 4 steps including the following: studying semi-structured texts and interviews (the elderly & specialists); extracting fields and factors related to lifestyle; validity examination, and the final assessment on the target community (reliability). To check the validity, ratio tests were implemented by the expertchr('39')s panel (n=20 in 8 different specialty fields related to the elderlychr('39')s treatment). Besides, Cronbachchr('39')s alpha coefficient was implemented to check the scale’s reliability (n=40). SPSS was also used for the statistical analysis of the collected data. Results: The agreed limit for the Content Validity Ratio (CVR) was selected as 42% according to the specialistchr('39')s number. Accordingly, out of 130 extracted questions, only 69 questions, CVR point was more than the agreed limit (CVR≥0.42). Thus, the remained questionchr('39')s CVR point equaled 52.5, by dividing it by the number of remained questions. CVI was calculated to be 0.76 for the whole questionnaire. Moreover, CVI was more than the agreed limit for all the questions in 11 fields (CVI≥0.76). Lifestyle’s Cronbachchr('39')s alpha coefficient (0.979) was >0.7. Conclusion: The Elderlychr('39')s Healthy Lifestyle Questionnaire (EHLSQ) has appropriate reliability and validity for assessing lifestyle in the elderly. It can be used to evaluate lifestyle among the elderly in various studies.

Background: Informal payments are one of the major obstacles to health system reform in many developing countries, and its elimination is on the agenda of health system policymakers in many countries, including Iran. This study was conducted to identify the causes of informal payments in the Iranian health system.Methods: This was a qualitative and exploratory study. The study population included health care providers and health care recipients. Data were collected using open-ended questions and semi-structured interviews. Convenience and snowball sampling methods were used to select the providers. Content analysis method was used to analyze the data.Results: In the present study, 6 participants were physicians, 4 were hospital managers or CEOs, 4 were treatment or technical managers, 2 were nurses and 12 were patients or their companions. Reasons for informal payments divided in 4 themes include Economic factors, Socio-cultural factors, Service delivery challenges and Legal-political factors.Conclusions: In the Iranian health system, there is a great effort in order to reduce and eliminate the informal payments phenomenon, especially with the implementation of the health system transformation plan. Knowing the causes of this phenomenon can help reduce or eliminate it.

Background: Phenylketonuria (PKU) is an autosomal recessive disorder that screening and timely control of this disorder can prevent the adverse effects. Regarding the high prevalence of PKU in Iran, the PKU screening program was started in Iran in 2006. This study was conducted to determine the cost-effectiveness of PKU screening in Iran. Methods: An economic evaluation was performed among screened and treated individuals compared to no screening in 2013. The study population included 1356132 newborns that screened for PKU diagnosis. Lifetime costs, quality-adjusted life year (QALY) gains and incremental cost-effectiveness ratio (ICER) were calculated from the perspective of government. A discount rate of 3% was considered for both QALYs and costs. A one-way sensitivity analysis was used for assessing the robustness of the results. Results: The discounted lifetime cost of intervention and non-intervention were $59528953.8 and $85295501.6 respectively. Therefore, the total estimated cost saving was $25766547.84. PKU screening produces an ICER of $1844420 per QALY gained. Conclusion: Screening and early treatment for PKU is highly cost-effective. Therefore, the screening can improve quality of life of the patients and increase financial saving in health system.

Herein, intrinsic p-type conductivity of NiO films were enhanced by high power impulse magnetron sputtering (HiPIMS) technology, where more charged Ni3+ ions are created during the deposition process. The formation of Ni3+ ions are advantageous for strengthening the p-type conductivity of NiO films. As the pulse off-time increases from 0 μs to 3000 μs, Ni3+ concentration improves greatly, indicating the amount of Ni vacancies as well as the hole concentration significantly enhances. It confirms that HiPIMS is a preferential technology for preparing NiO films with high p-type conductivity. Especially, when pulse off-time reaches 3000 μs, a high carrier concentration of 2.86 × 1021 cm−3 and a relatively low electrical resistivity about 0.07 Ω·cm are achieved.

Patient-level utility data are needed for cost-utility analysis; in oncology, however, the data are commonly gathered using disease-specific questionnaires that are often not appropriate. Present study aimed to derive an algorithm which can map the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) scales and the Colorectal Cancer-Specific Quality Of Life Questionnaire (QLQ-CR29) scales onto the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) values in patients with colorectal cancer (CRC). Using the Ordinary Least Square (OLS) model, a cross-sectional dataset of 252 patients with CRC were gathered from three academic centers of cancer treatment in Tehran in 2017. The predicted R2 (Pred R2) and adjusted R2 (Adj R2) are used to evaluate model goodness of fit. Additionally, mean absolute error (MAE), root mean square error (RMSE), Spearman’s correlation coefficients (ρ), and intraclass correlation (ICC) are applied to assess predictive ability of models. The tenfold cross-validation procedure was applied for validation models. According to the results of our study, the model C4 from EORTC QLQ-C30 was the best predictive model (Pred R2 = 66.57%, Adj R2 = 67.67%, RMSE = 0.10173, MAE = 0.07840). Also, the model R4 from QLQ-CR29 performed the best for EQ-5D-5L (Adj R2 = 48.42%, Pred R2 = 45.54%, MAE = 0.10051, RMSE = 0.12997). The mapping algorithm successfully mapped the EORTC QLQ-C30 and QLQ-CR29 scales onto the EQ-5D-5L values; therefore, it enables policymakers to convert cancer-specific questionnaires scores to the preference-based scores.

Bituminous binders have significant effect on the overall performance of the asphalt mixtures, although binders are not the main component of the asphalt mixture (4–6% by weight). This paper presents an overview of research efforts undertaken to evaluate the sensitivity of asphalt mixture performance to the change of the binder suppliers in the State of Arizona. The binders used in the asphalt mixture have identical Performance Grade (PG). However, the binders were from different suppliers. The laboratory testing program included the dynamic modulus and the repeated load/flow number tests. Asphalt mixtures were collected from four sections on a project constructed in northern Arizona. This project was unique in that all four asphalt concrete mixtures had the same aggregate structure and source but used PG 76-16 binders obtained from four different suppliers. Based on the test results, the tests were sensitive to variations in the properties of the same PG binders obtained from different suppliers. This was also confirmed through statistical analysis and comparison with the binder test data. In order to assess the sensitivity of the four asphalt binders on the pavement performance, the binder and mixture data were input into the Mechanistic-Empirical Pavement Design Guide (MEPDG) and design simulations were run to compare rutting and fatigue cracking associated with each of the four PG76-16 binders included in this study. Significant statistical differences in both distress mechanisms were also observed for the different mixtures with changing only the binder supplier.

Background Patient falls are considered a challenge to the patient’s safety in hospitals, which, in addition to increasing the length of stay and costs, may also result in severe injuries or even the death of the patient. This study aims to investigate the associations between risk factors among fallers in comparison with the control group. Methods A prospective nested case control study was performed on 185 patients who fell and 1141 controls were matched with the patients at risk of fall in the same ward and during the same time. This study was conducted in a university educational hospital in Tehran with 800 beds during a 9-month period. The data included demographics, comorbidities, admission details, types of medication, clinical conditions, and activities before or during the fall. The data was collected from clinical records, hospital information system, error reporting system and observations, and the interviews with the fallers, their families and care givers (physicians, nurses, etc). Data analysis was conducted through time-based matching using a multi-level analysis. Results In a multilevel model including patient-related, medication, and care-related variables, the factors that were significantly associated with an increased risk of patient falls included: longer length of stay (odds ratio [OR] = 1.01; CI = 0.32 to 0.73), using chemotherapy drugs, sedatives, anticonvulsants, benzodiazepines, and angiotensin-converting enzyme (ACE) inhibitors, visual acuity (OR = 6.93; CI = 4.22 to 11.38), balance condition (OR = 6.41; CI = 4.51 to 9.11), manual transfer aid (OR = 8.47; CI = 5.65 to 12.69), urinary incontinence (OR = 8.47, CI = 5.65 to 12.69), and cancer (OR = 2.86, CI = 1.84-4.44). These factors were found to be associating with more odds for a falling accident among patients. Several characteristics such as fall history (OR = 0.48; CI = 1.003 to 1.02), poly-pharmacy (OR = 1.37, CI = 00.85 to 2.2), stroke (OR = 0.94, CI = 0.44 to 2.02), and nurse to patient ratio (incidence rate ratio = 1.01, CI = 0.01 to 0.03) were not significantly associated with falling in hospitals. Conclusion It seems that a combination of both patient-related factors and history of medication should be considered. Moreover, modifiable clinical characteristics of patients such as vision improvement, provision of manual transfer aid, diabetes control, regular toilet program, and drug modification should be considered during the formulation of interventions.

The role of slope stability in design, implementation and prediction of risk is very significant. From an economic point of view, higher slope angles would result in reduction of stripping ratio, return time of investment, and increase of the minable mineral reserves. The presence of natural disasters such as earthquakes is very important for the sustainability of open and underground structures. Earthquake is one of the major factors affecting the instability of natural and artificial slopes. Often, instabilities occurred in slopes due to earthquake cause large amounts of material collapse into open pit mines, and thus halt the mine production. Sarcheshmeh Copper Mine is one of the most important and biggest active mines of Iran which has an important contribution to copper production in the world. Presence of many faults and extreme weathering accompanied by the fact that the mine is located in a seismically active zone, confirms the requirement of slope dynamic stability analysis in addition to static analysis. In this paper, the finite difference method is used for the stability analysis of rock mass under static and earthquake loadings. The static analysis is performed and modelling results are presented in terms of safety factor and displacement history of important locations of the wall. Slope dynamic stability analysis under seismic loads is implemented based on time response method. In order to apply earthquake loading, the 2003 Bam earthquake record is utilized. The conclusions obtained by the time response analysis are displayed in the form of vertical and horizontal displacements histories of criticed locations within the slope. The results of analysis confirm the overall stability of slope. The displacements obtained by the time response analysis method are convergent and within the permitted range, such that there is no oscillation after the earthquake load is applied over the time. Finally, a sensitivity analysis for some input parameters including wall slope angle, underground water table, cohesion and internal friction angle of the rock mass is performed to examine and assess the impact of these parameters on the wall displacements field.

The importance of maintaining and restoring health has always made human beings seek health care. Lack of proper access to health care, price and quality differences, as well as other factors among different countries have led to the formation of a long-standing industry called health tourism. Outbreak of coronavirus throughout the world has shocked and affected most countries. In this regard, the health tourism market of Islamic Republic of Iran was no an exception and was affected by this crisis. To meet this challenge, stakeholders of the health tourism market should determine their recession during this period, strengthen their weaknesses, and use the available opportunities. In this study, we intended to investigate effect of the coronavirus prevalence on the health tourism market of the Islamic Republic of Iran.

Background: Global surgeries include ninety operations in the common surgical procedures, with the annual fixed fees; which the insurance companies pay hospitals accordingly. The aim of this study was to compare the global fees to these surgeries’ real costs and to investigate the affecting factors in two teaching hospitals affiliated to Tehran University of Medical Sciences. Methods: This longitudinal retrospective descriptive-analytic study was conducted on all hospital records with global surgeries in three months in 2012 to 2013in two educational hospitals affiliated to Tehran University of Medical Sciences.Data were collected using the researcher’s –made checklist and extracted from the HIS (Hospital Information System). SPSS, EXCEL, and STATA software were used to analyze the data and to obtain the difference between the recorded costs and global fees. Results: The global fees were less than the recorded costs in both hospitals. The recorded costs in hospital B were much less than hospital A for the same surgeries. In hospital B, costs have been reduced for some surgeries in 2013comparedto 2012 by reducing the patients’ length of stay and time management. Conclusion: Fees in the referral hospitals of Tehran University, which usually involve complicated patients, should be determined more accurately. However, this study suggested that hospitals can greatly reduce the cost of global surgeries throughclinical and cost management. Keywords: Global surgery, Hospital, Fee

Introduction: Economic evaluation of healthcare interventions usually needs accurate data on utility and health-related quality-of-life scores. The aim of this study is to map QLQ-C30 scale score onto EQ-5D-5L and SF-6D utility values in colorectal cancer (CRC) patients. Methods: EQ-5D-5L, SF-6D, and QLQ-C30 were completed by 252 patients with CRC who were referred to three cancer centers in Tehran between May and September 2017. Moreover, OLS, Tobit, and CLAD models were used to predict EQ-5D-5L and SF-6D values. The goodness of fit of models was evaluated using Pred R2 and Adj R2. In addition, their predictive performance was assessed by MAE, RMSE, ICC, MID, and Spearman’s correlation coefficients between observed and predicted EQ-5D-5L and SF-6D values. Models were validated using a 10-fold cross-validation method. Results: Considering the goodness of fit and predictive ability of models, the OLS Model 2 performed best for EQ-5D-5L (Adj R2 = 58.09%, Pred R2 = 58.93%, MAE = 0.0932, RMSE = 0.129) and the OLS Model 3 performed best for SF-6D (Adj R2 = 54.90%, Pred R2 = 55.62%, MAE = 0.0485, RMSE = 0.0634). Conclusion: Our results demonstrated that algorithms developed based on OLS Models 1 and 2 are the best for predicted EQ-5D-5L and SF-6D values, respectively.

Background: Global payment system is a first example of per-case payment system that contains 60 commonly used surgical operations for which payment is based on the average cost per case in Iran. Objective: The aim of the study was to determine the amount of reduction, increase or no change in the trend of global operations. Methods: In this retrospective longitudinal study, data on the 60 primary global surgery codes was gathered from Tehran Health Insurance Organization within the ten-year period of 2005-2015 separately, for each month. Out of 60 surgery codes, only acceptable data for 46 codes were available based on the insurance documents sent by medical centers. A quantitative analysis of time series through Regression Analysis Model using STATA software v.11 was performed. Results: Some global surgery codes had an upward trend and some were downwards. Of N Codes, N83, N20, N28, N63, and N93 had an upward trend (p

Background: Informal payments can cause delayed access to health care services, forcing people to sell their properties for cost of treatment; and as a result, they lose trust in the health system. Considering the importance of this issue, this study was conducted in 2016 to identify solutions to reduce and eliminate informal payments in Iran’s health system. Methods: Initially, solutions to reduce informal payments were extracted by reviewing resources and searching Persian and Englishlanguage databases including Science direct, PubMed, Scopus, Medline, ISC, Magiran, SID using the following keywords: informal payments, under the table payment, bribes, gratitude payment, and informal payments/fees. Then, Iranian context specific solutions were obtained by performing semi-structured interviews with 19 individuals, who were aware of the problem. Next, the identified strategies were confirmed using Delphi technique and with the participation of 50 experts. Results: Various solutions were identified and confirmed to reduce or eliminate informal payments in Iran’s health system, which are divisible in different economical fields, such as payments to providers based on performance, religious leaders’ fatwa (sociocultural), disclosing the offenders’ names (legal-political), and using family doctor system (structural). Conclusion: The proposed solutions can be used by policymakers and managers in the health sector to manage informal payments. Careful identification of health care providers and recipients’ motivations and needs can be effective in recognizing and eliminating this phenomenon.

Background: Smoking is recognized as one of the main public health problems worldwide and is accounted for a high financial burden to healthcare systems and the society as a whole. This study was aimed at examining the effect of smoking status on cost of hospitalization among patients with lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischemic heart diseases (IHD) in Iran in 2014. Methods: A total of 1,271 patients (consisting of 415 LC, 427 COPD and 429 IHD patients) were included in the study. Data on age, sex, and insurance status, length of hospital stay and cost of hospitalization were extracted from the medical records of the patients. The smoking status of the patients was obtained through a telephone survey. A generalized linear model (GLM) was used to compare the costs of hospitalization of current, former and never smokers. The analysis was done using Stata v.12. Results: The mean±SD cost of hospitalization per patient was 45.6 ± 41.8 million IR for current smokers, 34.8±23 million IR for former smokers and 27.6±24.6 million IR for never smokers, respectively. The findings indicated that the cost of hospitalization for current and former smokers was 65% and 26% in the unadjusted model and 35% and 24% in the adjusted model higher than for never smokers. Conclusion: The findings revealed that smoking drains a large hospital resource and imposes a high financial burden on the health system and the society. Therefore, efforts should focus on reducing the prevalence of smoking and the negative economic consequences of smoking.

Background: Awareness about the process of law making and the factors that affect the legislative process have an important role in improving legislations that are approved by parliaments. Objective: This study aimed to explore and analyze the process of development and enactment of law in Iran’s parliament, and factors that might affect the enactment of laws that are related to the allocation and distribution of health sector resources in Iran. Methods: In this case study, data were collected through review of literature and national documents, and experts’ interviews. Interviews were performed with selected members of parliament (MPs), ex members of parliament and professionals from the Ministry of Health and Medical Education (MOHME) (15 persons). MAX QDA 10 was used for coding and constructing themes. Data were analyzed in five steps (familiarization, developing a conceptual framework, coding, indexing, and interpretation) using a content analysis with inductive and deductive approaches. Results: The main factors that could affect the approval and enactment of legislations related to allocation of healthcare resources in the Iranian parliament were categorized in seven themes including: Importance of issue, resource availability, legislator’s awareness about the topic, lobbying and unofficial relations with influential officials, mentioning strong reasons by MOHME, weakness of previous laws, and positive feedback related to the same laws. Conclusion: Although the process of law making in parliament, and implementation of them in health organizations have legal stages, the study showed that several key factors affect this trend. In fact, it is suggested the health policy makers and MPs consider extending a range of factors to improve the process of law making and the efficiency of legislation related to allocation of healthcare resources

Background: According to the Global tuberculosis (TB) Report 2014, released by World Health Organization (WHO), difference between estimated number of TB patients and the number of patients who are registered by the National Tuberculosis Programs (NTBP) is about 3 million annually in the world. In the current study, we investigated the level of under-reporting of TB cases between labs with poor collaboration background with NTBP in Tehran. Methods: In the context of TB, this is an inventory study that evaluating the level of under-reporting of TB cases. To do inventory study, first, after selecting laboratories based on poor collaboration background with NTBP and developing patient’s list we matched the patient’s list with the MoHME’s database then, patients that were not recorded in NTBP’s list were identified, and those with available telephone numbers were called. Results: Out of 23 selected labs, 10 (5 private, 5 public (other than PHC)) had individuals with positive results. 71.6% of all samples are tested in public labs. Out of 23633 performed tests, 1396 individuals were positive. The under-reporting was, 62.5% and 39% in public and private laboratories, respectively. Conclusion: Public and private sector laboratories will be able to significantly reduce their failure to report if they comply with the recommended requirements and standards of the NTBP in their Processes and software for registering patient information.

Context: Esophageal cancer is considered as a malignant disease with fatal consequences worldwide. In cancers, it is the sixth most common cause of mortality in the world. Objectives: The aim of the current study was to assess the cost-effectiveness of esophageal cancer treatments by performing a systematic review. Data Sources: We conducted systematic searches in Medline through PubMed, Scopus, Cochran Library, EMBASE, and Web of Science databases. The search was limited to English language publications and studies published before July 17, 2018. Results: Of 2487 records, 14 articles met our inclusion criteria. Most were conducted in The United States of America (USA) and The United Kingdom (UK). The majority of the evaluations (8) followed a healthcare system perspective. Of 14 included studies, 4 compared esophagectomy with endoscopy treatment (ET), 2 compared esophagectomy with chemotherapy regimens, 2 contrasted chemotherapy regimens, and 5 studied compared palliative cares. Conclusions: Among all the assessed studies, the ET was more cost-effective than esophagectomy, but there were contradictory results in palliative care for the treatment of esophageal cancer.

Health insurance provides financial support for health care expenditures. There are two types of health insurance: compulsory and voluntary. Voluntary health insurance can be divided into two categories: self-employed and supplementary. In this study, the main factors that affect the demand for self-employed health insurance in Iran were determined.In this cross-sectional study, data were derived from the 2013 Household Income and Expenditure Survey from the Statistical Center of Iran. Then, a logistic regression model was designed to determine the factors influencing health insurance demand.The age, income, and education level of the head of the household directly correlated with the demand for self-employed health insurance. There was no significant relationship between the demand for health insurance and the gender or marital status of the head of the household. In addition, there were no significant relationships between occupation or house ownership and the demand for health insurance in rural households.To promote voluntary health insurance, it is helpful to identify effective factors that stimulate the health insurance demand.Sağlık sigortası sağlık bakımı harcamaları için maddi destek sağlar. İki tip sağlık sigortası vardır: zorunlu ve isteğe bağlı sağlık sigortası. İsteğe bağlı sigorta iki kategoriye ayrılabilir: serbest meslek ve tamamlayıcı sigorta. Bu çalışmada, İran’da serbest meslek çalışanları için sağlık sigortası talebini etkileyen temel faktörler belirlenmiştir.Bu çalışmadaki veriler, İran İstatistik Merkezi’nin 2013 Hane Halkı Gelir ve Gider Anketinden elde edildi. Daha sonra Stata12 programı kullanılarak lojistik regresyon modeli oluşturuldu.Aile reisinin yaşı, geliri ve eğitim seviyesinin serbest meslek sağlık sigortası talebi ile doğrudan ilişkili olduğu bulundu. Sağlık sigortası talebi ile aile reisinin cinsiyeti veya medeni durumu arasında anlamlı bir ilişki yoktu. Ayrıca, kırsal bölgelerde meslek veya ev sahipliği ile sağlık sigortası talebi arasında da anlamlı bir ilişki bulunmadı.İsteğe bağlı sağlık sigortasını teşvik etmek için, sağlık sigortası talebini artıran faktörleri belirlemek faydalıdır.

OBJECTIVES General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. METHODS A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran's health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. RESULTS Iran's medical education is faced with several challenges that were categorized in four main themes including student selection, medical students' perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. CONCLUSIONS Challenges that were found could have negative effects on retention. Modification in student's perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas.

Introduction: Newborn screening (NBS) is a public health measure aimed at identification of early cases, management of afflicted infants, and making efforts to reduce the morbidity and mortality among newborns. All countries may face challenges in implementation of screening programs. The present study aimed to determine the challenges of implementation of the National Phenylketonuria (PKU) Screening Program in Iran. Methods: In this qualitative study, 38 health policymakers, managers, and PKU experts in Iran were purposively selected as the respondents in 2015. The semi-structured interview was used for collecting the required data and information. After transcription of interviews, their content was analyzed using framework analysis. Results: The results were categorized into five main themes and 22 subthemes. The main themes extracted from data were management challenges, diagnosis challenges, treatment challenges, care challenges, and patients’ family problems. Each category consisted of several subthemes. Conclusion: Considering the challenges of implementing this program, some measures such as increased stability of managers in the health system, greater interaction of the Ministry of Health and Medical Education with the heath stakeholders, improving the level of parents’ awareness, the use of efficient information systems, support and legal backing for requiring parents who refuse newborn screening for various reasons, and appropriate insurance coverage seem necessary to be taken.

Introduction: Considering the scarcity of skilled workers in the health sector, the appropriate distribution of human resources in this sector is very important for improving people’s health. Having information about the degree of equality in the distribution of health human resources and their time trends is necessary for better planning and efficient use of these resources. The aim of this study was to determine the trend of inequality in the allocation of human resources in the health sector in Tehran between 2007 and 2013. Methods: This cross-sectional study was conducted in Tehran Province in Iran. The inequality in the distribution of human resources (specialists, general practitioners, pharmacists, paramedics, dentists, nurses and community health workers (Behvarz)) in 10 cities in Tehran Province was investigated using the Gini coefficient and the dissimilarity index. The time trend of inequality was examined by regression analysis. The required data were collected from the statistical yearbook of the Iran Statistics Center (ISC). Results: The highest value of the Gini coefficient (GC) was related to nurses (GC = 0.291) in 2007. The highest value of the Gini coefficient was related to nurses and Behvarzs in 2008 and 2009, respectively. The distribution of specialists had the highest inequality in 2010 (GC = 0.298), 2011 (GC = 0.300) and 2013 (GC = 0.316). General practitioners had the lowest Gini coefficient for 2007, 2008 and 2012. Nurses for 2009 and Behvarzs for 2010, 2011 and 2013 had the lowest value of Gini coefficient. The dissimilarity indexes for specialists and general practitioners were 26.64 and 8.72 in 2013, respectively. The means of this index for included resources were 31.35, 18.27, 16.91, 22.32, 15.82, 26.74, and 24.33, respectively. The time trend analysis showed that the coefficient of time was positive for all of the human resources, except Behvarzes, and only the coefficient of general practitioners was statistically significant ( p

Hospital waste management is imperative due to its impending health hazards. This study was meant to evaluate the strong safety awareness of cleaning workers at the time of hospital waste collection. Additionally, determining the correlation between demographic variables with average score of the strong safety awareness as well as the correlation between provision of training for workers with score of strong safety awareness were among the main goals of the present study. This descriptive-analytic and cross-sectional study was carried out in 2014. Data were collected using a questionnaire. 150 subjects were selected using simple random sampling, and finally 135 questionnaires were analysable. Findings indicated that 33.3 % of the studied hospitals showed good situation (score >30), 55.5 % with moderate (scored 26–30), and 11.2 % had weak situation concerning the practice of safety features in waste collection. Furthermore, there has been statistically a significant correlation between education, age, work experience, and workers training with strong safety awareness. In general, executing standards, removing shortages, establishing monitoring and observation systems, using young workers beside experienced ones, and paying attention to their needs will help them consider safety points for hospital waste collection.

Objective Information systems are "computer systems that collect, store, process, retrieve, show, and provide timely information required in practice, education, management, and research". The purpose of these systems is to support hospital activities in practical, tactical, and strategic levels in order to provide better service to patients. This study aimed to evaluate the communication and information system (MCI) in public hospitals in Sabzevar city in 2014 from the perspective of human resources according to international standards of the Joint Commission Accreditation Hospital (JCAH). Methods This study was a practical, descriptive, cross-sectional study. The study population consisted of Sabzevar nurses who used hospital information system. Sampling was done by classification method and in proportion to the number of nurses in each health care units in hospitals in 2014. The sample size was 200 and after referring to hospitals, 200 questionnaires were completed. Sample size was calculated by the formula n=Z(2)P (1-P)/d(2) with P=0.5, α=0.05, d=0.05, and Z=1.96. Data collection tool was the questionnaire of assessment of hospital information systems of JCAH, which has 124 specific questions, including 6 areas. To assess the effect of demographic variables with MCI standards of two questionnaires (feasibility and implementation), the following steps were taken. 1. Kolmogorov-Smirnov test was used to determine whether responses were normal or not. 2. In case of normal data, t-test was used for dual groups and one-way ANOVA test for groups of three or more. 3. If not normal, Mann-Whitney test was used for dual groups and Kruskal-Wallis test for groups of three or more. Results Research findings show the mean results of feasibility and implementation of all 6 areas of international standards MCI have feasibility in three hospitals in Sabzevar in 20 sections (H1=105.01±10.468), (H1=196.31±4.662), (H2=104.26±9.099), (H2=195.33±3.778) (H3=106.48±11.545) and (H3=197.57±4.943), respectively. Conclusion The results showed that the mean feasibility and implementation of all six areas of MCI international standards is practical in three hospitals in Sabzevar in 20 wards. Also, 50% of users in clinical departments, physicians, and nurses agreed to appropriateness of the hospital information and communication systems for doing their duties.

International audience; Tungsten oxide thin films exhibiting an oriented columnar architecture were prepared by reactive co-sputtering. Two opposite W and WO3 targets focused on the center of the substrate were simultaneously sputtered using opposite and oblique angles of 80° from the substrate normal. The reactive gas pulsing process was used to adjust the films electrical resistivity. Different inclined columnar structures were produced and applied as gas sensors for dodecane detection. Morphology, structure and resistivity of the films were investigated and connected to the sensing performances measured from 373 to 773 K.

Background: Patients’ fall is considered as a challenge to patient safety, which entails not only prolonged hospital stays and higher costs, however, it may also result in injuries and even death. Objectives: This study aimed to identify attributed root causes and to develop preventive strategies. Methods: The present study is a multiphase qualitative study in which all fall incidents were studied deploying a root cause analysis process in accordance with the modified NPSA protocol in an educational hospital within a 9-month period. The contribution and association of risk factors attributed to each fall incident were analyzed using descriptive and analytical statistics. Finally, a nominal group technique was used, with specialist and holding three separate rounds, for determining preventive strategies of falling in health care facilities. Results: Out of a total of 110 fall incidents, 657 root causes were identified. Three groups of attributed causes, including patient, task, and education factors were found to have a greater share in the patient falling. Based on the identified root causes, fall prevention interventions were selected by members as specialized panels, who rated the solutions in several sessions. Ultimately, interventions agreed less than 70% were removed, and other potential preventive interventions were implemented in the form of a hospital-based trial. Conclusions: We found that a fall is the result of intrinsic and extrinsic risk factors. The first step in preventing falls is proper assessment of the patient in terms of clinical condition. Evaluation of the environment of the hospital is also essential to identify problems as well as developing amendment programs. Due to missing data on falls reported by nurses, it seems unwise to solely rely on the submitted reports.

ZnO with dense, porous, nano-wire and nano-tree morphologies was successfully synthesized via reactive magnetron sputtering at high pressure (10 Pa) and with different deposition temperatures (RT → 1273 K). The morphological properties of prepared ZnO coatings were revealed using scanning electron microscopy (SEM) and X-ray diffraction (XRD) analysis was performed to determine crystalline structure of the films in relation with their deposition temperature. Hall effect measurements were used to investigate the electrical resistivity, free carrier concentration and mobility in the coatings as a function of their morphology in a temperature range from 293 K to 473 K. Finally, C12H26 dodecane gas sensing properties of ZnO nano-trees were investigated at different temperatures (from 323 K to 566 K) and the results were discussed depending on dodecane concentration. A remarkable response of 39% was observed at 415 K for a low concentration of dodecane in air [1 ppm(v)]. High response to low concentrations of C12H26 as well as good chemical stability of ZnO nano-trees make this kind of structure a potential candidate as sensing layer for practical sensor applications.

Background We aimed to identify the indicators of healthcare fraud and abuse in general physicians’ drug prescription claims, and to identify a subset of general physicians that were more likely to have committed fraud and abuse. Methods We applied data mining approach to a major health insurance organization dataset of private sector general physicians’ prescription claims. It involved 5 steps: clarifying the nature of the problem and objectives, data preparation, indicator identification and selection, cluster analysis to identify suspect physicians, and discriminant analysis to assess the validity of the clustering approach. Results Thirteen indicators were developed in total. Over half of the general physicians (54%) were ‘suspects’ of conducting abusive behavior. The results also identified 2% of physicians as suspects of fraud. Discriminant analysis suggested that the indicators demonstrated adequate performance in the detection of physicians who were suspect of perpetrating fraud (98%) and abuse (85%) in a new sample of data. Conclusion Our data mining approach will help health insurance organizations in low-and middle-income countries (LMICs) in streamlining auditing approaches towards the suspect groups rather than routine auditing of all physicians.

The purpose of the present study is to model the hydrocarbon resources potential mapping using geographic information systems (GIS). The presented method is based on petroleum system concepts; therefore, petroleum system elements were used to define criteria for petroleum potential mapping. Several statistical methods can be used to effectively predict potential areas for hydrocarbon resources. In this study, two statistical methods were used (frequency ratio and evidential belief functions) to predict the potential distribution of petroleum resources in the study area. A case study in the Red River – Red River petroleum system of the Canadian Williston Basin in southeastern Saskatchewan in Canada is proposed to assess the feasibility of this new modelling technique. The accuracy of the hydrocarbon potential maps was evaluated by success rate and prediction rate efficiency curves. The resultant petroleum potential maps resulted in delineation of high-potential zones occupying about 15% of the study area. The validation results showed that the prediction rate for the best model is 88.14%. This study was carried out at a regional scale; therefore, the results can be used to guide exploration works at early stages.

Today, various methods are used in order to assess the health care system which is one of the Governance Leadership Direction (GLD) standards of the Joint Commission International (JCI) of America. This study aimed to evaluate the performance of managers of Tehran University of Medical Sciences’ Obstetrics and Gynecology Hospitals from the viewpoint of personnel, based on the JCI Accreditation Model. This study is a descriptive-analytical research and a cross-sectional study in 2014 which has been conducted among the 311 personnel of two hospitals of obstetrics and gynecology of Tehran University of Medical Sciences. Tools for data collection included two questionnaires. The first questionnaire had 27 questions to evaluate the ability to implement the Governance, Leadership, and Direction (GLD) aspects of JCI standards. The second questionnaire was designed to evaluate the performance of managers. The data were analyzed using the SPSS Software version 18 and Mann-Whitney and Kruskal-Wallis statistical tests. The results show that in the studied hospitals, the functional performance standards of GLD have a relatively high level (average = 0.50 ± 2.30 from 3) and among its dimensions, the highest score related to monitoring (average of 0.57 ± 2.23) and the least related to leadership (average of 0.530 ± 2.26). There was a significant relationship among age, education and employment type of personnel and GLD standards and aspects. Given the relatively good rating of various aspects of management performance in the studied hospitals, it can be upgraded and get closer to the JCI international standards. Meanwhile, emphasizing on leadership seems more urgent.

The general goal of the management of communication and information technology (MCIT) in the health sector, is to accelerate collecting, achieving and supporting the health system processes, and effective decision-making for managing this system; because preparing and providing health care services for society is very complex, and highly dependent on the information system. The aim of this investigation is to determine the mean scores of the possibility of implementing the MCIT standards in Khorasan Razavi hospitals, from the perspective of managers. This was a cross sectional descriptive-analytic study conducted in two steps in all hospitals. In the first step, the applicability of the standards in hospitals was studied. In the second step, the current status of hospitals was compared with international standards MCIT. In order to determine the validity of the questionnaires, opinions of professors and experts were acquired. Regarding the reliability, the SPSS V. 12 calculated the value of Cronbach’s to be 0.95 for the first questionnaire and 0.86 for the second questionnaire. Data were analyzed using statistic tests of one way ANOVA and t-test. The level of significance was fixed at 0.5. In the 16 hospitals studied, the mean and standard deviation of MCIT were (57.25 ± 13.74). The MCIT standards are applicable in hospitals of Khorasan Razavi according to half (49.4%) of managers; nonetheless, their application requires greater efforts by the hospitals.

CuCr 0.93 Mg 0.07 O 2 thin films were successfully deposited by DC reactive magnetron sputtering at 1123 K from metallic targets. The influence of film thickness on the structural and optoelectronic properties of the films was investigated. X-ray diffraction (XRD) results revealed that all the films had a delafossite structure with no other phases. The optical and electrical properties were investigated by UV–VIS spectrophotometer and Hall measurement, respectively. It was found that the optoelectronic properties exhibited a thickness-dependent behavior. The optical band gap and the average transmittance of the films showed a monotonous decrease with respect to the increase in thickness. The average transmittance in the visible region decreased from 67% to 47% as the thickness increased from ~70 nm to ~280 nm. Simultaneously, the conductivity of the films fell from 1.40 S∙cm −1 to 0.27 S∙cm −1 . According to Haacke's figure of merit (FOM), a film with a maximum FOM value of about 1.72×10 −7 Ω −1 can be achieved when the thickness is about 70 nm (σ≈ 1.40 S·cm −1 and T av. ≈67%).

Background Priority-setting is a complicated and time-consuming process; however, if appropriately conducted, it could efficiently divert resources to the most important studies. A considerable body of evidence indicates that priority-setting measures in health research taken so far in Iran have not satisfied decision-makers, policy-makers, funders, communities, or even researchers. This study was designed to explore the flaws of these measures and their deciding factors. Methods We conducted semi-structured interviews with 23 key participants and used a thematic data-analysis approach to analyse verbatim transcripts and documents. Our interviewees, who were skilful at conducting health research and worked as managers at different levels of the health system, were selected using a purposeful sampling. We asked about their experiences of priority-setting in health and relevant challenges and asked for recommendations. These semi-structured interviews were taped, transcribed and analysed in terms of content and themes using the MAXQDA10 qualitative data-analysis software. Results With regard to priority-setting facilitators and barriers, four themes were extracted, namely managerial factors, structural factors, motivational factors, and process factors. Managers’ commitment, consideration of intellectual property, compliance with superordinate rules, and provision of a definition of reliable criteria were among the facilitators. The rapid turnover of managers, inefficiency of criteria for faculty promotion, and disregard of appeal mechanisms were examples of the barriers. Conclusion It is important to consider appropriate regulations and motivations to provide research priorities and divert scarce resources to them. In addition, it is necessary to improve the knowledge and skills of researchers and research administration offices on priority-setting methods, thereby enhancing priority-oriented research projects.

Background: Rational prescription is a considerable issue which must be paid more attention to assess the behavior of prescribers. The aim of this study was to examine factors affecting family physicians’ drug prescribing. Methods: We carried out a retrospective cross-sectional study in Khuzestan province, Iran in 2011. Nine hundred eighty-six prescriptions of 421 family physicians (including 324 urban and 97 rural family physicians) were selected randomly. A multivariate Poisson regression was used to investigate potential determinants of the number of prescribed drug per patient. Results: The mean of medication per patient was 2.6 ± 1.2 items. In the majority (91.9%) of visits a drugs was prescribed. The most frequent dosage forms were tablets, syrups and injection in 30.1%, 26.9%, and 18.7% of cases respectively. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and antibiotics were 29.7% and 17.1% of prescribed drugs respectively. The tablets were the most frequent dosage forms (38.6% of cases) in adult’s patients and syrups were the most frequent dosage forms (49% of cases) in less than 18 years old. Paracetamols were popular form of NSAIDs in two patients groups. The most common prescribed medications were oral form. Conclusion: In Khuzestan, the mean of medication per patient was fewer than national average. Approximately, pattern of prescribed drug by family physicians (including dosage form and type of drugs) was similar to other provinces of Iran.

BACKGROUND: Road Traffic Injuries (RTIs) as a result of road traffic crashes (RTCs) rank as the leading cause of death, disability and property loss worldwide, especially in low- and middle-income countries. This study aims to analyze the costs of RTCs in Iran. METHODS: A standard human capital approach was used to estimate the costs. Costs included medical, administrative and funeral costs, property damage, production lost and intangible costs. Data about the number of deaths and injuries resulting from RTIs between 20 March 2009 and 20 March 2010 was obtained from two national databases designed at the Center for Disaster Management and Medical Emergencies (CDMME) and the Legal Medicine Organization (LMO), respectively. The severity and medical costs of injuries were identified by reviewing 400 medical records that were selected randomly from patients who were admitted to two large trauma centers in Shariati and Sina hospitals in Tehran province. Moreover, information about production lost, property damage, rehabilitation cost, intangible costs and administration costs were collected by review of current evidence and consulting with expert opinion. RESULTS: In total 806,922 RTIs and 22,974 deaths resulted from the RTCs in the study period. The total cost of RTCs was about 72,465 billion Rials (7.2 billion US Dollars), which amounts to 2.19% of Iran’s Gross Domestic Production (GDP). Direct costs were 3,516 billion Rials (around 48.6 % of the total costs), following by 24,785 billion Rials (around 34.2 % of the total costs) for production lost and 12,513 billion Rials (around 17.2 % of the total costs) for intangible costs. CONCLUSIONS: This study indicated that the burden of both RTCs and RTIs in Iran is substantial. Moreover, RTCs have significant economic consequences and are a large drain on healthcare resources. © 2013 KUMS, All rights reserved

The purpose of this study is to model hydrocarbon resources potential mapping using geographic information systems (GIS). A case study in Ahvaz/Khuzestan Province, southwest Iran, is proposed to assess the feasibility of this modeling technique. Several statistical methods can be used to effectively predict potential areas for petroleum reserve occurrences. In this research, evidential belief functions approach was used to predict the potential distribution of the petroleum reserves in the study area. The accuracy of the petroleum potential map was evaluated by success rate and prediction rate efficiency curves. The results were validated using area under curve (AUC) analysis. The AUC of training and testing subsets showed 73.84 and 67.32 %, respectively. The final favorability map shows different zones of petroleum prospective potential, viz., high favorable (27.09 %), moderate favorable (37.39 %), and low favorable (35.52 %). The validation of results showed that there is a relatively good adaption between the optimum potential map and petroleum fields. The present study was carried out at a regional scale, so the results can be used to guide exploration work at early stages.

Increasing the production of energy in line with industry development, transportation, and life quality improvement is an interesting topic needs to be addressed. Energy policymakers and researchers have aimed at energy management, particularly by improving energy systems performance. This review paper explains the rising interest of thermoelectric technology and applications. Nowadays, thermoelectric technology such as thermoelectric generators (TEGs) and thermoelectric cooling systems (TECs) provide heat loss recovery of thermodynamic units for power production of remote areas. Unlimited solar energy can also be employed for thermoelectric power production. This paper describes the principles of thermoelectricity and presents an explanation of current and upcoming materials. Developed models and various performed optimization of thermoelectric applications by using non-equilibrium thermodynamics and finite time thermodynamics are discussed as well. Additionally, a number of topical applications and energy resources are introduced. The main goal of this study is to give a clear overview of thermoelectric technology and applications.

Background: The nurses as the largest group among different groups of hospital workforce play a crucial role in success of the hospital activities and promotion of community health. Objectives: This study aimed to obtain an estimation of the necessary nursing workforce status in educational hospitals affiliated to Ilam and Ahvaz University of Medical Sciences based on the scientific formula. Materials and Methods: This research was a cross sectional-descriptive study, which was done in hospitals affiliated to Ilam and Ahvaz University of Medical Sciences during 2010. Using three researcher-made forms, data was collected from all clinical, para-clinical, financial, administrative and support departments of hospitals. Data was analyzed in accordance to the standards of Iran's Ministry of Health and Medical Education using the Excel software. Results: The results showed that the nursing staffs in the 42 wards (89.5 %) were lower than the standards, only one ward (2 %) matched the standards and the rest of the wards (8.5%) were higher than the standards. The organizational dislocation (utilization of nurses in non-related jobs) of nursing staffs obtained for Imam Khomeini of Ilam, Mostafa Khomeini, Taleghani, Razi and Imam Khomeini of Ahvaz Hospitals were 8, 5, 3, 8 and 21, respectively. Conclusion: Generally, the studied hospitals were faced with a lack of nursing manpower and distribution of manpower was not appropriate. Proper planning and management of manpower in accordance with the lack of personnel, compensates and achieves the standards required for hospital’s nursing manpower and this would lead to an increase in the efficiency of hospitals activities and can provide satisfaction for the nursing staff.

Cu x O thin films were deposited on glass and silicon substrates by High Power Impulse Magnetron Sputtering (HiPIMS) at room temperature from a metallic copper target. The influence of pulse off-time on the films’ structural, morphological and optoelectronic properties was investigated. It was found that the power intensity applied on the Cu target was strongly affected by pulse off-time, which had an important impact on the films’ composition. Upon increasing the pulse off-time from 500 μs to 3500 μs (pulse on-time fixed at 50 μs), the films’ crystallinity as well as transmittance in the visible region both ameliorate. Meanwhile, the conductivity type changed from n-type to p-type as the films’ composition changed. When the pulse off-time was fixed at 2000 μs, the optimal p-type conductivity of about 3 S × cm −1 was achieved, which is the highest p-type conductivity reported for Cu 2 O films in the last few years. The transition of the films’ conductivity type can be utilized for the fabrication of Cu 2 O-based p-n homojunction, and may also prove useful in developing other oxide films by using HiPIMS technology.

International audience; The optoelectronic properties of Mg-doped CuCrO2 with delafossite structurewere enhanced by stacking CuCr0.93Mg0.07O2/Ag/CuCr0.93Mg0.07O2 multilayers.The influences of the deposition time of the Ag and the thickness of theCuCr0.93Mg0.07O2 layers on the film’s performance were investigated. When thestacks were deposited under our deposition conditions, no continuous Ag layerwas observed. The diffusion of Ag atoms into the neighboring CuCr0.93Mg0.07O2layers caused a composition gradient of Ag in the films and caused Cr3? cationsto be replaced by Ag? cations, which is beneficial for improving the conductivityof the films. When the Ag deposition time was increased, Schottky barriersoccurred between Ag nanocrystallites and CuCr0.93Mg0.07O2 grains, loweringthe films’ optoelectronic performances. The multilayers’ optoelectronic performanceswere enhanced when the thickness of the CuCr0.93Mg0.07O2 layers wasdecreased. Optimal films with a relatively high figure of merit of2.37 9 10-7 X-1 can be achieved when the deposition time of Ag and thethickness of CuCrO2:Mg layers are optimized.

Titanium films were DC sputtered with a particle flux incidence angle of 80 degrees, using the Glancing Angle Deposition (GLAD) technique with increasing sputtering pressures from 0.2 to 1.5 Pa. This range of pressures is typically implemented for the deposition of thin films by the magnetron sputtering process. The main objective of this work was to study the anisotropic electrical resistivity behaviour of the different thin film nanostructures that were obtained. It is shown that low sputtering pressures (0.2-0.5 Pa) promote higher column angles beta with respect to the substrate normal (15 degrees, This work was supported by the Region of Franche-Comte, the French RENATECH network and performed in cooperation with the Labex ACTION program (contract ANR-11-LABX-0101). Funding was also provided by the Portuguese Foundation for Science and Technology (FCT) in the framework of the Strategic Funding UID/FIS/04650/2013 and project PTDC/EEI-SII/5582/2014. Armando Ferreira acknowledges the FCT for the SFRH/BPD/102402/2014 grant. The authors thank financial support from the Basque Government Industry Department under the ELKARTEK Program., info:eu-repo/semantics/publishedVersion

Background: Standards of Joint Commission International emphasize on the organizational performance level in basic functional domains including patient right, patient care, medical safety and infection control. These standards are focused on two principles: expectations of the actual organizational performance and assessment of organizational capabilities to provide high quality and safe health care services. The aim of this study is to evaluate the possibility of improvement in Access to Care and Continuity of Care for patients (ACC) in teaching hospitals of Tehran University of Medical Sciences. Methods: This cross-sectional study was conducted in hospitals affiliated to Tehran University of Medical Sciences during 2012. Data collection was performed using author-designed questionnaire of “Access to Care and Continuity of Care patients” based on JCI standards (2013). A total of 171 questionnaires were sent to 26 hospitals and 154 (90%) questionnaires were successfully completed and used for data analysis. The questionnaire was reviewed by experts and the Cronbach’s alpha was calculated to be 0.967. The effects of the two variables of hospital type (general, specialty) and the number of beds on mean scores of ACC standards and each of its domains were analyzed using T-test or Mann-Whitney test depending on the distribution due to Kolmogorov-Smirnov test result. Results: In general, the mean of ACC standards was found comprehendible and applicable by 82.3 (SD = 11) of the respondents. The highest and lowest mean scores of ACC questions belonged to hospitals H21 (90 ± 6) and H14 (67 ± 12), respectively. There were not any significant effects of hospital type and the number of beds on the ACC scores. Conclusion: There was not any important effect of hospital type and bed numbers on ACC, although there was a 9%-15% possibility of improvement in accreditation scores of ACC standards in hospitals of Tehran University of Medical Sciences. A complete accreditation score in this domain didn’t seem achievable in these hospitals. However, it is proposed that future managerial planning of the studied hospitals lead to a complete accreditation score.

Herein, a novel method of high-power impulse magnetron sputtering (HiPIMS) was used to prepare Cu2O thin films, which were deposited at ambient temperature without further thermal treatment. The films with varying optoelectronic properties as a function of oxygen flow ratio ( f O 2 ) were investigated. The results demonstrate that the film's performances are dependent on the film's composition and their crystallinity, which is influenced by the oxygen flow ratio. Cu2O-dominated films were fabricated in the oxygen flow range between 12.5% and 35%, whose values were used to determine their optoelectronic properties. Consequently, the films optoelectronic properties can be controlled by adjusting oxygen flow ratio. At low oxygen flow ratio ( f O 2 ≤ 10%), Cu-dominated films present n-type conductivity. With oxygen flow ratio increasing to above 15%, the films conductivity type changes from n-type to p-type due to the majority phase in the films changing from Cu to Cu2O. Meanwhile, the film's transmittance improves significantly from 0.28% for f O 2 of 2.5% to the maximum value of 58.77% for f O 2 of 30% resulting from the phase's transition upon increasing the oxygen flow ratio. When the oxygen flow ratio is at about 20%, a Cu2O film with optimal p-type conductivity of approximately 0.4 S × cm−1 is achieved at room temperature, which is the highest p-type conductivity reported in Cu2O film for the last few years.

Smoking is recognized as one of the main preventable causes of mortality and morbidity that imposes a high financial burden on healthcare systems and society. This study aimed to examine the association between smoking status and hospital length of stay (LOS) among patients with lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischemic heart diseases (IHD) in Iran in 2014.A total of 1271 patients (415 LC patients, 427 COPD patients and 429 IHD patients) were included in the study. Data on age, sex, insurance status and LOS was extracted from the patients' medical records and smoking status was obtained from the patients using telephone survey. The LOS among current smokers, former smokers, and nonsmokers was compared using a zero-truncated poisson regression. Analysis was done using STATA v.12.The mean LOS for current smokers, former smokers and nonsmokers was 9.4±8.4, 7.3 ±5.3 and 6.02±5.05 days, respectively. The unadjusted and adjusted probabilities of LOS for current smokers and former smokers were 56% and 21% and 48% and 15% higher, respectively, than when compared with the nonsmoker category.The study demonstrated longer LOS for the current and former smokers, contributing to the drain on large hospital resources in Iran. The results of the study provide useful information for health-policy makers that contribute to the planning and designing of smoking cessation interventions in this area.

Background: Given the rapid pace of changes in community health needs and the mission of healthcare organizations to provide and promote the community’s health, the growing need to increase health system responsiveness to people as a key element of observance and fulfillment of justice is felt more than ever. Objectives: This study was aimed at designing the native model of responsiveness for Iran and to validate the aspects of the proposed model. Materials and Methods: Our study had a cross-sectional design and was a validation study performed in 2014. In order to define and identify responsiveness model aspects, the first phase recorded the views of 200 key informants from 19 provinces of Iran. Snowball sampling was used to select experts (based on WHO guideline). Then, the opinions of 18 comments were received from service recipients in the form of three focus group discussions and were analyzed by the frame framework analysis (interviewed recipients were selected using the purposive sampling method). Finally, in order to confirm the model’s efficacy, a responsiveness questionnaire with 7 aspects (domains) and 52 indicators (items) obtained from the initial proposed model was answered by 600 members of the selected families in the two provinces of Fars and Yazd. A multi-stage cluster sampling approach was used for the household survey. The results were analyzed by the Confirmatory Factor Analysis (CFA) test and through the use of Lisrel software. Results: Confirmatory Factor Analysis, based on the results of the key informant survey and group discussions, showed that according to quantities of GFI = 0.91, CFI = 0.93, NFI = 0.91, RMSEA = 0.074, SRMR = 0.061 and Hoelter (CN) = 178.54 in outpatient services and where GFI = 0.89, CFI = 0.91, NFI = 0.86, RMSEA = 0.064, SRMR = 0.053 and Hoelter (CN) = 158.93 for inpatient services, seven factors (F) (dignity, informed choice, confidentiality, patient training and informing, access to services, quality of basic amenities, and access to social support) are the main determinants of the responsiveness model and proposed model validity. Conclusions: Given the comprehensiveness of presented aspects and indicators in this proposed model and its validity test, the aforementioned responsiveness model can be considered a suitable model to use when assessing the levels of health system responsiveness in Iran.

Purpose: Objective of this research is to find out weaknesses of undergraduate programs in terms of personnel and financial, organizational management and facilities in view of faculty and library staff, and determining factors that may facilitate program quality–improvement. Methods: This is a descriptive analytical survey research and from purpose aspect is an application evaluation study that undergraduate groups of selected faculties (Public Health, Nursing and Midwifery, Allied Medical Sciences and Rehabilitation) at Tehran University of Medical Sciences (TUMS) have been surveyed using context input process product model in 2014. Statistical population were consist of three subgroups including department head (n=10), faculty members (n=61), and library staff (n=10) with total population of 81 people. Data collected through three researcher-made questionnaires which were based on Likert scale. The data were then analyzed using descriptive and inferential statistics. Results: Results showed desirable and relatively desirable situation for factors in context, input, process, and product fields except for factors of administration and financial; and research and educational spaces and equipment which were in undesirable situation. Conclusion: Based on results, researcher highlighted weaknesses in the undergraduate programs of TUMS in terms of research and educational spaces and facilities, educational curriculum, administration and financial; and recommended some steps in terms of financial, organizational management and communication with graduates in order to improve the quality of this system.