Search

Abstract The internationalization of medical universities is confronted with various uncertainties due to environmental trends. Therefore, obtaining insight into potential future scenarios is essential for adopting exclusive and effective strategies. Accordingly, this study aims to identify future scenarios for the internationalization of Medical Sciences Universities in Iran (MSUI) in the 2040 horizon. A scenario-based strategic planning approach was employed to create and develop possible scenarios for the internationalization of Iran’s medical universities. This approach followed a four-step framework consisting of scoping, exploring, synthesizing, and scenario building. To develop the scenarios, a combination of futures study methods was employed, including a literature review, expert opinions, cross-impact analysis, morphological analysis, and balance impact analysis. Qualitative data were analyzed using framework analysis and MAXQDA software, while quantitative data were analyzed using EXCEL, MICMAC, and Scenario Wizard software. A total of 61 drivers related to the future of internationalization of medical sciences universities in Iran were identified. Key drivers such as political relations and diplomatic influence, economic sanctions, scientific supremacy, and the knowledge economy were recognized. By configuring the states of these key drivers in the 2040 horizon, a total of 81 possible scenarios were generated. Among these scenarios, 16 were assessed as plausible, with 5 of them being highly probable. These scenarios include evergreen universities, lush universities, blooming season, frost gardens, and dried-up gardens. The analysis of probable future scenarios reveals that the optimistic conditions of the driving forces outweigh those of their pessimistic counterparts, indicating that, at worst, the current situation will persist. Each university could select a probable scenario aligned with its preferred vision to implement within the study timeframe.

Abstract Background The advertising of unhealthy products, including unhealthy foods, drugs with abuse potential, certain cosmetic products and services, and tobacco, has raised significant public health concerns due to its role in increasing consumption and contributing to the rise of non-communicable diseases. Policy development and enforcement in this area necessitate an in-depth analysis of the relevant stakeholders. This study aims to examine the stakeholders involved in regulating the advertisement of unhealthy products in Iran, providing critical evidence for shaping advertising regulations and reducing the societal consumption of such products. Methods This qualitative study, conducted in 2022, involved 18 experts experienced in the area of unhealthy product advertisement in Iran. Participants were selected through purposive and snowball sampling methods. The stakeholders' roles, power, positions, and interests were analyzed using Schmeer's guidelines. Results 17 stakeholders were identified as relevant to the ban on unhealthy product advertisements, of whom 14 were classified as active and three as inactive. Key stakeholders included radio and television broadcasters, the Ministries of Health, Culture, and Industry, as well as political institutions. The Ministry of Health (MOHME) emerged as a leading advocate for the ban, while the Ministries of Culture and Industry, along with political institutions, were identified as possessing significant power with moderate support for the policy. In contrast, broadcasters and social media platforms were powerful opponents of the ban. Conclusions The study underscores the pivotal role of stakeholders with high power and medium interest in the success of policies aimed at banning unhealthy product advertisements. Key challenges included conflicts of interest, insufficient penalties for organizations violating advertising regulations, organizational disputes, limited human and financial resources, lack of clear implementation guidelines, weak community engagement, and inadequate oversight. Engaging key stakeholders effectively could mitigate these obstacles and facilitate more effective health policy interventions in the future.

Abstract Unhealthy products (food, alcohol, tobacco) are among the main risk factors of non-communicable diseases. To discourage the consumption of these products, Iran has passed a law banning the advertisement of unhealthy products in all media and for all age groups. The purpose of the present study was to identify the challenges of this approach and provide evidence to facilitate the enforcement process and the participation of stakeholders. In this qualitative study participants were selected from the policymakers and experts involved in the banning of advertisements on unhealthy products in Iran. Semi-structured interviews were conducted with 24 specialists and experts. The participants were selected through purposive and snowball sampling. Identified challenges and solutions were divided into three categories and nine themes: external (political, social, and economic); interorganizational (mission and communication); and internal (planning, organization, leadership, and control). Banning the advertisement of unhealthy products involves many challenges due to the existence of key players with different roles and missions. If these challenges are not managed effectively, they will hinder the enforcement and success of this law. Therefore, it is necessary for policymakers and health system managers to take the necessary measures to remove these obstacles.

Background: Accreditation and ISO 9001 programs in hospitals are widely adopted for quality control and quality improvement in healthcare. Objectives: The objective of this study is to identify stakeholders’ perspectives and experiences regarding the implementation of accreditation and ISO 9001 programs in hospitals affiliated with the Social Security Organization in Alborz Province, Iran. Methods: In this qualitative study, participants were selected based on purposive sampling. For data collection, semi-structured one-to-one interviews were conducted with hospital staff in different positions (n = 30). All interviews were digitally recorded, transcribed verbatim, and analyzed using thematic analysis. Results:Based on the analysis, 10 primary themes and 88 subthemes were identified. The 10 primary themes were categorized as experiences, strengths, weaknesses, effective factors, and recommendations for the implementation of accreditation and ISO 9001 programs in hospitals. Proper planning, benchmarking, physician involvement, increased resources, and more training are suggested for the successful implementation of accreditation in hospitals. Additionally, fostering a positive culture, focusing on the executive dimension, changing managerial attitudes, training, and supporting and motivating staff are the most important recommendations for the implementation of the ISO 9001 program. Conclusions: The results provide important insights into the dimensions of implementing accreditation and ISO programs in hospitals, which can be used by health policymakers and managers to improve the implementation of these programs in Iranian hospitals.

This paper is concerned with a Legendre Ritz-Least squares technique for the non-singular and singular delay differential equations (DDEs) of multi-pantograph type. This tech-nique is based on Legendre polynomials and Least squares. The Legendre Ritz-Least squarestechnique (LRLS) is used to decrease the problem to a set of the algebraic equation system.The efficiency and reliability of the proposed method are shown by some numerical results. Allof the numerical implementations have been performed on a PC using some programs written inMATHEMATICA.

Background: The COVID-19 pandemic has posed many challenges on the health system and hospitals to provide services. This study investigated the difference between factors affecting hospital management which considered in preparing a disaster management plan for hospital in the face of a pandemic based on the experiences of hospital managers. Methods: This qualitative research was conducted on selected hospitals affiliated in Alborz University of Medical Sciences in 2021. Data were gathered with purposive sampling and semi-structured interviews with 16 hospital managers. MAXQDA 10 and framework analysis were used to analyze the data. Results: The results were categorized in four categories: 1) Mitigation including staffing, bed capacity, enough space for quarantines, protective equipment, diagnosis and treatment equipment, funding, medicines, patient follow-up, management and leadership; 2) Preparedness such as crisis committee, preparedness and response plan, measures, action plan; 3) Response including motivating health workers, cooperation and coordination; 4) Recovery and lessons learned including providing facilities, expediting patient processes, control, economic conditions, and planning better, passive defense, regular crisis committee meetings, human resources, documentation and use of information systems in planning. Conclusion: In addition to providing the necessary infrastructure, it is important to plan for fair distribution of resources and effective supply chain management. A mechanism should also be developed at the national level to anticipate future health crises and to prevent and control diseases in the most effective way.

Social monotheism, which is a new term and one of the topics of social discourse, is based on Quranic research and is inspired by the key sentence La Allah Ilallah and many monotheistic verses. It has two main components of negation of worshiping other than God and proving the oneness and Lordship of God, which is according to the Quranic verses. Each has sub-components. Considering that the dimensions and social identity of monotheism have not been clearly explained in the existing works from the perspective of Muslim thinkers, this research seeks to answer the question of how the components of social monotheism are analyzed from the point of view of commentators and traditions. Considering that worship is the basic meaning of social monotheism, what is the meaning of worship in Quranic culture?This research, which is organized by relying on the appearances of the verses indicating monotheistic topics and with an analytical-inferential approach, shows that some commentators have paid attention to the duality of the truth of monotheism in the Qur'an, and by adhering to interpretive traditions, they have compared "worship" to "obedience" They have made meaning. The proof of the truth of this interpretation is the words of some lexicographers in the meaning of the word worship.

Abstract Background Evidence-informed policymaking on human resources for health (HRH) has been directly linked with health system productivity, accessibility, equity, quality, and efficiency. The lack of reliable HRH data has made the task of planning the HRH more difficult in all settings. Aim This study aimed to develop a conceptual model to integrate HRH data and evidence. Methods The current study is a mixed-method study conducted in three phases: a rapid literature review, a qualitative phase, and an expert panel. Firstly, the electronic databases were searched up to 2018. Then, in the qualitative phase, semi-structured interviews with 50 experts were conducted. Data analysis was performed using the content analysis approach. After several expert panels, the draft of the model was validated with 15 key informants via two Delphi rounds. Results Our proposed model embraces all dominant elements on the demand and supply side of the HRH in Iran. The conceptual model consists of several components, including input (regulatory system, structure, functions), educational system (pre-service and in-service education), health labor market structure, process (technical infrastructure), and output (productions, policymaking process). We considered networking toward sustainable interaction among stakeholders, and also the existence of capacity to integrate HRH information and produce evidence for actions. Conclusion The proposed model can be considered a platform for developing a harmonized system based on the HRH data flow to evidence-informed decision-making via networking. We proposed a step-by-step approach for the sustainability of establishing a national human resources for health observatory (HRHO). The proposed HRHO model can be replicable and flexible enough to be used in different context domains.

Objectives: Corruption means abusing the position and power delegated for personal gain, which undermines the performance of the organization and the quality of services provided to patients. The aim of this study was to identify and extract internal and external anti-corruption strategies in healthcare organizations. Information sources and selected methods for study: This scoping review was performed on the published documents (57 items) until September 5, 2020. Search was conducted in English databases including PubMed, Web of Sciences and Scopus and also in Persian ones including SID and Magiran. There was also a manual search for anti-corruption strategies in relevant international organizations. Qualitative data were analyzed thematically using MaxQDA 10 software. Results: 57 studies and reports were selected to find strategies to fight corruption. The three main areas of solutions were identified as executive, legislative and judiciary powers. 16 strategies were extracted in the fields of executive (7 cases), legislative (5 cases) and judiciary (4 cases). Solutions regarding the Ministry of Health were categorized into 6 building blocks of health systems, including leadership / governance, service delivery, financing, health workforce, medical products, vaccines, technology, and the health information system. Conclusion: Fighting corruption in healthcare organizations requires using a set of intra-sectoral and extra-sectoral solutions, and in this regard, policy-makers need to design and implement practical strategies based on the evidence presented in areas prone to corruption.

Background and Aim: Home care is an alternative method of hospitalization, especially for chronic patients and is an innovative approach to improve care and reduce the costs of hospital readmissions. The present study was conducted with the aim of investigating the benefits and challenges of implementing the home care plan after being discharged from the hospital considering the perspective of health service recipients and providers at Tehran University of Medical Sciences in 2021. Material and Methods: The present study is an applied research that was conducted qualitatively using structured and semi-structured interviews. The research sample was those responsible for the implementation of this project at the ministry and university level, the implementers of this project in 4 hospitals, 5 institutions providing home care services, and family of patients. Twenty-eight people from the research community were included in the study using the purposeful and snowball sampling method. Content analysis method was used to analyze the interview data. MAXQDA2020 software was used for data classification. Results: The results were classified into two categories: benefits and challenges of the home care plan after discharge. A total of 61 open codes were extracted from the analysis of research interviews, so that 27 codes led to the identification of 5 themes (Including improving service delivery, reducing costs, achieving health goals, cultural and social benefits, providing the necessary infrastructure) in the benefits and 34 codes led to the identification of 7 themes (including policy-making, legal and ethical, economic, manpower, cultural-social-communication, service provision limitations and time and place limitations) in the challenges. Conclusion: The result of this research showed that home care services after being discharged from the hospital play an important role in completing the provision of healthcare services. Home care services after being discharged from the hospital improves service delivery, reduces costs, and helps in achieving health goals. It also benefits patients, society and the government in various cultural and social fields. On the other hand, it seems that there are challenges in the political, legal, economic and cultural fields in the way of the optimal implementation of this plan. Therefore, planning to evaluate and solve the problems facing these services is essential.

Background. The aim of periodontal treatment is to remove bacterial plaque and dental calculus by hand and power-driven instruments. However, the comparison of the effectiveness of these instruments has always been controversial. Therefore, this in vivo study investigated and compared the effects of hand and ultrasonic piezoelectric instruments on the roughness of dental surfaces under an atomic force microscope (AFM). Methods. In this study, 35 periodontally hopeless teeth were selected and randomly divided into four groups (n=7). The control group consisted of teeth that had to be extracted for orthodontic or prosthetic treatment (n=7). In group one, scaling and root planing were performed using hand instruments. In other groups, scaling and root planing were performed using piezoelectric ultrasonic instruments with low to high power, respectively. Then the scaled teeth were extracted for analysis under an atomic force microscope. Results. This study showed that root roughness significantly differed between different experimental groups (P

Background and Aim: Reforming the structure of medical universities and its continuous adaptation to the mission of the organization and new functions is an undeniable necessity. The purpose of this article was to explain how to implement this policy. Materials and Methods: The current qualitative study was conducted in 2020 retrospectively based on Kingdon’s multiple streams model. Data collection was done using two methods: individual interviews and document review. Sampling of the managers and experts of the administrative development and transformation centers of the Ministry of Health and 12 universities of Medical Sciences as well as vice-chancellors of the universities was done in a purposeful and snowball method until data saturation was reached by conducting 19 individual interviews. Data analysis were done with framework and content analysis methods, and using MAXQDA 2020 software. Results: The low of structural problems included quantitative and qualitative changes in new tasks in the environmental units of universities, interference and parallel work in the tasks of university units, and bargainings for restructuring by universities. The policy low included the obligation to make structural changes in the upstream laws and documents, including the Fifth Development Plan, and the cooperation of all stakeholders. The political process included the implementation of the Health Transformation and the Family Physician Plan, and the support of relevant policymakers and the approval of the law of becoming a university trustee in the law of the fifth plan of economic development and also gaining the all-round support of the stakeholders. Conclusion: The medical sciences universities, as the headquarters arm of the Ministry of Health at the provincial level, need to have flexible structure in line with the needs of their surrounding units. In luential context factors in policy-making the reform of the structure of the headquarters of universities/colleges, in addition to the stream of structural problems, the main of which was the change in the duties of the units, along with the political determination created in the Ministry of Health, led to the simultaneous occurrence of three streams of problems, Politics and politics and finally opening the window of opportunity and changing the structure and organization of the headquarters of medical sciences universities.

Abstract 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 environment included the Ministry of Health, physicians' offices, medical universities, and hospitals and health centers. The study population included health care providers (physicians and hospital staff, managers, supervisors, and nurses) and health care recipients (patients or patients who had a history of dealing with informal payments). Data were collected using open-ended questions and semi-structured interviews. Snowball sampling method was used to select managers, chief executive officers (CEOs) and nurses. Convenience sampling was used to select physicians due to their lack of participation and cooperation. Content analysis method was used to analyze the data. Results Reasons for informal payments were divided into 4 themes including: Economic factors (improper tariff valuation of services; failure to increase tariffs proportionate to inflation; lack of comprehensive participation of stakeholders in determining tariffs; tariff inconsistency in the public, private and charity sectors; etc.); socio-cultural factors (decreased social capital of the medical community among the people; improving the quality of life; incorrect comparison of providers' income levels with the income of doctors in other countries; existence of a culture of gratitude and appreciation; health as a priority for society; pride of service recipients; pride of service providers; etc.); service delivery challenges (high professional skills of the doctor; use of modern medical equipment; the monopoly of some doctors, etc.) and legal-political factors (inadequate monitoring by upstream organizations; lack of strict rules; difficulty of proving informal payments; presence of stakeholders in management and policy making processes). Conclusions Knowing the causes of informal payments can help reduce or eliminate it. The results of this study identified the causes of informal payments in the Iranian health system. Accurate knowledge of the needs and motivations of both health care providers and recipients can be effective in accurately identifying and eliminating this phenomenon.

Lanthanum manganite (LMO) thin films were deposited by co-sputtering La and Mn targets in an Ar and O2 gas mixture. The films were synthesized on silicon and fused silica substrates. The influences of thermal annealing on the structure, optical and electrical properties of LMO films were investigated. The results exhibited a correlation between these properties. In the amorphous state, an increase in annealing temperature improved the optical transmission and decreased the electrical capacitance. The beginning of crystallization at 600 °C was manifested by a strong increase in the capacitance and a decrease in the optical transmission. At higher annealing temperature, polycrystalline films were obtained with different optical and electrical characteristics. On the other hand, the annealed LMO films showed a photocurrent effect during exposure to a weak LED light.

Abstract Background Esophageal cancer causes considerable costs for health systems. Appropriate treatment options for patients with esophageal squamous cell carcinoma (ESCC) can reduce medical costs and provide more improved outcomes for health systems and patients. This study evaluates the cost-effectiveness of treatment interventions for patients with ESCC according to the Iranian health system. Material and methods A five-state Markov model with a 15-year time horizon was performed to evaluate the cost-effectiveness of treatment interventions based on stage for ESCC patients. Costs ($US 2021) and outcomes were calculated from the Iranian health system, with a discount rate of 3%. One-way sensitivity analyses were performed to assess the potential effects of uncertain variables on the model results. Results In stage I, the Endoscopic Mucosal Resection (EMR) treatment yielded the lowest total costs and highest total QALY for a total of $1473 per QALY, making it the dominant strategy compared with esophagectomy and EMR followed by ablation. In stages II and III, chemoradiotherapy (CRT) followed by surgery dominated esophagectomy. CRT followed by surgery was also cost-effective with an incremental cost-effectiveness ratio (ICER) of $2172.8 per QALY compared to CRT. Conclusion From the Iranian health system’s perspective, EMR was the dominant strategy versus esophagectomy and EMR followed by ablation for ESCC patients in stage I. The CRT followed by surgery was a cost-effective intervention compared to CRT and esophagectomy in stages II and III.

Background: Measuring the efficiency of hospitals due to the high proportion of budget allocated to them on the one hand, and the need to ensure the best practices regarding the use of scarce resources on the other hand, is of particular importance. The purpose of this study is to evaluate the technical efficiency of the affiliated hospitals of Shahrekord University of Medical Sciences by using a combination of Principal Component Analysis and (PCA) & Data Envelopment Analysis (DEA). Methods: This was an analytical and cross-sectional study measuring the technical efficiency of all 8 hospitals affiliated to Shahrekord University of Medical Sciences. The required information was collected from the medical records unit of each hospital. For better differentiation between efficient and inefficient units, and the increase of research accuracy and further differentiation between hospitals in terms of efficiency, at first, 17 indicators were selected to assess and adjust these parameters to 3 components proportional to the number of the hospitals by using PCA and SPSS 16 software. After doing the PCA, 7 studied input variables became 7 principal components among which the first input component reflecting the 83 % of scattering data was selected as principal input component, and for being more influenced by human resource variables, it was named as a human resource index. Furthermore, among the output variables, the first 2 output components, which represented 76% of the variance of the data, were selected as the 2 principal components of the output for the study, which were mostly affected by these variables, respectively, the number of admissions and length of stay. Then, the modified input and output components were entered into the software Windeap 2.1 and the technical efficiency of hospitals and their rank were calculated by assuming constant and variable efficiency with respect to the scale. In order to evaluate the effect of using the combined method instead of the conventional method of efficiency measurement, the results of the PCA - DEA method were compared with the results of the conventional DEA method. Results: The result of DEA on the selected components showed the capacity to upgrade the Technical Efficiency (TE) of hospitals is 15 % (TE: 0.852). Moreover, out of 8 hospitals, 1 hospital was increasing return to scale, 3 decreasing returns to scale and 4 constant returns to scale. The technical efficiency of 3 hospitals was 1 (TE = 1), 2 hospitals had the technical efficiency between 0.80 to 1 (1 > TE > 0.80) and that in 3 hospitals was less than 0.80 (TE < 0.80). The scale efficiency for 50 % of hospitals and the management efficiency for 62/5 % of them were equal 1. Conclusion: The average of total technical efficiency, management efficiency and scale efficiency were calculated to be 0.999, 1 and 0.999, respectively based on the usual comprehensive analysis method; while using the combined method, the average total technical efficiency, management efficiency and scale efficiency were 0.852, 0.947 and 0.902 respectively. The results confirm that the use of PCA method, due to its important role in reducing alignments, increases research accuracy and better differentiates between hospitals in terms of efficiency.

Background: Access to and utilization of eye care services may improve vision-related quality of life (VRQoL) of older people. This study aimed to evaluate the VRQoL of older adults and its associations with access to and utilization of eye care services. Methods: This is a community-based cross-sectional survey conducted in Tehran, Iran, on 566 older people in 2018. The NEI-25 VFQ was used to measure the VRQoL. Multilevel Linear Regression analysis used to test the study hypotheses. Results: The average score of the VRQoL was 80 out of 100. About 61% of the participants did not utilize the annual routine eye examination and the mean score of overall access to eye care was 85 out of 115. Having a higher physical, socio-cultural and overall access were significantly associated with higher VRQoL, but those with regular utilization had no better VRQoL status compared to non-users. Conclusion: Access to eye care services showed to be very important in improvement of the VRQoL, whereas higher utilization was not found to be associated with better VRQoL statue of older people, as there might have a reverse causality with using more eye services with higher Visual impairment.

Background: Medical tourism has been considered in our country for many years. The arrival of international patients in the country will boost the medical tourism sector; however, the necessary infrastructure must be created for this. The guidelines for the establishment of the International Hospital Unit are one of the legal infrastructures for standardization in this field. Therefore, this study was conducted with the aim of strategic analysis of the establishment of an international patient unit in hospitals of Tehran University of Medical Sciences. Materials & Methods: This combined study was performed in 2019 in three hospitals of Tehran University of Medical Sciences that had a license to operate this unit. In-depth interviews were conducted in each hospital with experts in this field. The data were then categorized into four categories of strengths, weaknesses, opportunities and threats, and according to the results of the SWOT technique, the necessary strategies were presented. Results: There are opportunities including low cost of medical services in Iran, low value of Iranian Rial and political and religious ties with countries in the region. Significant threats also included the existence of professional competitors, the widespread activity of brokers, and the large number of trustees for the industry within the country. Finally, appropriate strategies were presented for each hospital. Conclusion: This market in our country faces many threats and needs policies appropriate to the current situation with an immediate action. The results also showed that two hospitals are in a competitive state and one hospital is in a defensive state.

This study examines the effect of a fit between regulatory focus and goal orientation on performance in a cognitive task. According to regulatory fit theory, a fit between regulatory focus and goal orientation can have positive effects on performance. However, previous studies in this area have produced conflicting results regarding the effect of regulatory fit on performance. This study is quantitative and uses a lab experiment to address these conflicting results. In total, 53 individuals participated in a 2x2 factorial design with two variables: regulatory focus (2 levels: promotion, prevention) and goal orientation (two levels: eagerness, vigilant). Research hypotheses were tested using a two-way analysis of variance. Results showed that regulatory fit harms performance. This result is consistent with previous studies which examined the effect of regulatory fit on performance in cognitive tasks such as brain storming task and reducing decision making biases such as escalation of commitment and sunk cost fallacy.

Objective: This study is designed to investigate the effect of auditing firm’s size and the organizational level of auditors on the ethical reasoning at different stages of Kohlberg's theory of cognitive moral development. Methods: This study is a descriptive survey. A questionnaire containing a scenario was used to collect research data. 355 questionnaires were collected at 2020 from auditors working in private audit firms and the Audit Organization. Data were analyzed using descriptive statistics and regression analysis. Results: The present study has three main findings: The first shows that the ethical reasoning of Iranian auditors is at the post-contractual level of Kohlberg’s theory. The second indicates a negative relationship between the levels of ethical reasoning and the size of audit firms, and finally the last finding shows that with improving auditors' position in audit firms, their levels of ethical reasoning decreases. Conclusion: The results indicate that the size of the auditing firms and the organizational level of auditors affect on their ethical reasoning. The findings of this study can help policy makers and legislators to avoid the potential risk of negligence by auditors.

Abstract 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.

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 and Objectives: organizational justice is employees’ perceptions of fairness and equity in their behaviors and relationships so this perception can be effective in responding to patients. Accordingly, this study aimed to decide the correlation between the dimensions of organizational justice and responsibility at affiliated hospitals of Tehran University of Medical Sciences in 2015. Material and Methods: This cross-sectional and descriptive-analytical study performed on 342 patients and staff with direct relation to patients. Niehoff and Moorman’s questionnaire and WHO standard questionnaire used to measure justice and responsibility. Data analyzed using descriptive and analytical statistics (t-test, ANOVA and Pearson) with SPSS software. Results: The mean and standard deviation of justice and responsibility was obtained 62.70±15.23 and 105.16 ± 18.75. Correlation analysis showed that there was a significant relationship between justice dimensions and responsibility so that the weakest and strongest relationship was obtained between "distributive justice and Quality of Basic Amenities" and "interactional justice and dignity". In addition, there was no significant relationship between demographic variables and justice, and only type of insurance and academic degree had a significant relationship with responsibility. Conclusion: The results showed that the level of responsibility could be improved by improving employees' perceptions of justice. This will lead to a better vision of the hospital in the minds of patients, which will increase the ability to attract customers. Therefore, it is recommended to managers to enhance the responsibility by organizational justice, especially equity in resource distribution.

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: equality in access of health care services is one of the most important goals of Health system .In this study, we provided a description of the distribution of Otorhinolaryngology Head & neck surgery specialists in the Provinces of Iran in 2017. Materials & Methods: This descriptive-analytical study was conducted in 2017 to describe the distribution of Otorhinolaryngology Head & neck surgery specialists in the Provinces of Iran in 2017. Data were gathered through Ministry of Health and Statistical Center of Iran. Gini Coefficient, Concentration Curve ,Multiple Regression and Geographic Maps used by Microsoft R Version 3-6-0 for data analysis. Results: The highest and lowest ratio of Otorhinolaryngology Head & neck surgery specialists per population in the year 2017 was reported in Tehran (2.31 per 100,000 populations) and Hormozgan (0.39 per 100,000 populations). Conclusion: There was a considerable disparity between different regions of the country in terms of access to Otorhinolaryngology specialists.

Background and Aim: Nowadays, medical tourism market is considered as one of the most profitable and competitive industries in the world and is one of the new areas of advanced tourism. The aim of this study was to investigate the marketing status of medical tourism in private and public hospitals affiliated to Tehran University of Medical Sciences (TUMS) in 2018. Materials and Methods: This is a cross-sectional descriptive-analytic study that investigated the marketing status of medical tourism in 6 private and 14 public hospitals affiliated to TUMS in 2018. A valid checklist was used for data collection; besides, SPSS software, descriptive statistics, Mann-Whitney test and Kruskal-Wallis test were applied for data analysis. Results: Product factor has a satisfactory status in state-owned hospitals and an average status in private hospitals. Place factor, people factor, process factor, and physician factor are satisfactory in public and private hospitals. Promotion factor in public hospitals is unacceptable and in private hospitals is average. Besides, price and place factors in public and private hospitals are average. Moreover, there is no significant relationship between any of the above factors and the type of hospitals (public, private). Conclusion: Due to marketing mix, hospitals and medical institutions can increase the confidence of tourists by adopting international standards in addition to enhancing international reputation. Also, paying more attention to media advertising and providing more facilities can improve the condition of hospitals, thereby attracting more medical tourists and expanding the industry in Tehran.

The policies of health systems are inspired by ethical priorities. A critical review of policies can reveal the ethical theories/justice schools behind them. This study aimed to identify the ethical theory(ies) underpinning the Iranian health system governance over the past 50 years. This was a qualitative study conducted in two stages during 2019. First, we identified and constructed the key concepts and distinctive notions of prominent ethical theories/justice schools. Then, we spotted and selected 24 strategic laws and policy documents in the Iranian health system governance during the past 50 years and analyzed their content to surmise their underlying ethical theory. The results showed that the dominant theory affecting the policies of the Iranian health system governance over the past 50 years was egalitarian liberalism and then objective utilitarianism and relativist communitarianism. Retrospective empirical application of ethical theories to health system governance is methodologically doable, and this application reveals the mood or priorities of the politics. Also, highlighting the underpinning ethical theories of health system governance as well as the gap between ambitions versus realization are insightful and may prospectively empower and strengthen egalitarianism

BACKGROUND: The World Health Organization (WHO) considers a safe operating room as one of the necessities of hospitals that support patients. Achieving safety in surgical operations in all countries of the world is the basic goal of healthcare centers and organizations; hence, the present study investigated the challenges and prerequisites for the implementation of an active risk management program in the operating rooms of Iranian hospitals. MATERIALS AND METHODS: This qualitative-phenomenological study was conducted in 2022. Data were collected using semi-structured interviews, targeted sampling, and the participation of 20 experts (health policy and management experts and academic officials and faculty members of universities) and executive staff (nurses and operating room technicians, doctors and surgical specialists, and officials of surgical departments) and were analyzed using the framework analysis method. RESULTS: In the resulting qualitative study, the challenges and prerequisites for active risk management in the operating room from the point of view of experts and executive staff were divided into three sub-themes. These three themes include managerial challenges and prerequisites, organizational resources (financial resources, human resources, equipment, and facilities), and cultural issues. CONCLUSION: Considering managerial prerequisites, organizational resources (financial, human, equipment, and facilities), cultural issues, and removing challenges, an active risk management program in the operating room can be implemented correctly. With the correct implementation of this program, injuries in the operating room for personnel and patients will be greatly reduced, and the satisfaction of beneficiaries and the productivity of the hospital will be greatly increased.

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.

Background: A set of experiences that leads to the destruction of individual’s self-esteem are the main causes of suicide. Socioeconomic factors can be reasons for this event. Therefore, we aimed to investigate the impact of socioeconomic variables on suicide. Methods: A panel data model was used to investigate the impact of socioeconomic indexes on the number of suicides in each province of Iran from 2001-2016. The data of socioeconomic variables were obtained from the statistical center of Iran, and data for the number of suicides in each province were obtained from the forensic science department. The analysis was conducted using estimated generalized least squares method by EViews version 8. Results: The lowest and highest number of suicides was in 2001 (4.97 per 100,000 populations) and 2004 (5.97 per 100,000 populations), respectively and the average rate of suicide from 2001 to 2013 was 1.01 also unemployment, divorce, and industrialization rates have high impact on suicides for both sexes in P

The aim of this study was to develop a student engagement scale in school)SES)Viga 2016 and determine its validity and reliability. This research was acorrelation type of factor analysis (exploratory factor analysis and confirmatory factor analysis). Factor analysis and reliability studies were conducted using data on 420(230 girls, 190 boys) tenth, eleventh, and twelfth graders of Semnan(academic year 2016- 2017) that were selected by Multistage Cluster Random Sampling and completed Students´ Engagement in School Scale(Viga, 2016) and Student engagement to school scale(Wang, Willett & Eccles, 2011 . Result of Confirmatory factor analysis through varimax rotation and Exploratory factor analysis, the axplored factors were behavioural, agency, self-regulation, affective and cognitive. The Cronbach's alpha were 0/78, 0/80, 0/67, 0/60, 0/42 for behavioural, agency, self-regulation, affective , cognitive and %78 for Student engagement in school. Also Confirmatory factor analysis confirmed these factors.To test the validity of instrument, Student engagement to school scale(Wang, Willett & Eccles, 2011) was used and correlation of 0/44 was concluded. The results permitted to find this scale presents psychometric qualities and can be used in research and psychoeducational practice, to assess the multidimensional students’ engagement in school. The future use of the SES is considered and proposed. This scale may be a useful opportunity for psychologists and teachers. and researcher can use to a valid instrument for Measuring engagement in school.

Background: Due to the presence of valuable and expensive equipments in hospitals’ warehouses, scientific management and continuous evaluation plays an important role to improve the performance of warehouses and whereby the performance of hospitals’ wards. This study aimed to evaluate the performance of the central stores of hospitals affiliated to Tehran University of Medical Sciences (TUMS). Materials and Methods: In order to conduct this cross-sectional study, a checklist was designed and validated to examine the warehouses’ status considering structural, process and outcome dimensions of 39 depots in 14 hospitals. The status of hospitals’ warehouses were assessed using descriptive analysis and in order to assess association between performance evaluation score and charchetristics of warehouses and its staff Pearson Correlation Coefficient was utilized. Results: Although, warehouses’ performance of studied hospitals in general was satisfactory, there were some items in unsuitable condition particularly in structural and process dimensions which should be addressed quickly. Also, performance of warehouses revealed a positive and significant correlation with number of beds, area and size of warehouse and number of staff (p

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.

Background: Visual disorders in old age is one of the most important factors in decreasing quality of life of older people. This study aimed to access the vision-related quality of life of older people in Tehran and to examine some of the underlying factors. Materials and Methods: This was a population-based cross-sectional study among 566 older people aged 60 years and over, living in Tehran. A multistage cluster randomized sampling method was used to select study population, data was gathered using interviewing them at their home. NEI-25 VFQ (Visual-Functioning Questionnaire) was used to measure the vision-related quality of life of the participants. Multi-level linear regression analysis was used to data analysis. Results: The average score of the vision-related quality of life was 80 out of 100. Among 12 dimensions of Visual-Functioning Questionnaire, the dimensions of color vision (CV), vision specificsocial functioning (VSSF) and peripheral vision with the scores of 96.8, 96.7 and 95 gained the highest and the dimensions of driving and vision specific dependency (VSD) with the scores of 42.6 and 50.3 had the lowest scores, respectively. Significant associations were observed between being a women, older, and having a lower education with poorer vision-related quality of life. Conclusion: This study results provides an evidence for policymakers in prioritizing visual health services based on more impaired visual function and also at risk older people.

A Survey of Clinical Governance Success in University Hospitals in Tehran Mosadeghrad Ali Mohammad1, Arab Mohammad2, Shahidi Sadeghi Niusha3* 1. Associate Professor, Department of Health Management and Economics, Health Information Management Research Centre, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2. Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 3. PhD Student in Health Services Management, Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran *Correspondence: Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Valiasr street, Vanak Square, Tehran, Iran Tel: 00982188883334 Email: sadeghi.niusha@gmail.com Abstract: Background & Objectives: Clinical Governance (CG) is an organizational strategy for maintaining and improving the quality and safety of patient care and increasing employees’ and managers’ responsiveness and accountability through developing an appropriate organizational structure and culture as well as developing, implementing and monitoring clinical guidelines, pathways and standards. This study aimed to examine the success of CG implementation in university hospitals, in Tehran, Iran. Methods: In this descriptive analytic study, a researcher-made questionnaire was filled out by managers and CG executive managers of 39 university hospitals in Tehran/ Iran. Data analysis was done through SPSS software and using Pearson, Spearman and logistic regression. Results: Clinical Governance was moderately successful in Tehran university hospitals (58%). The most success was achieved in patient involvement and risk management dimensions and the least success was observed in clinical effectiveness and clinical audit dimensions. Management and leadership and clinical audit had the most effect on CG success. The involvement and commitment of managers and employees in implementing CG were moderate and physicians’ involvement and commitment was poor. The length of CG implementation time had significant relationship with managers’ and employees’ commitment and CG success. Conclusion: Clinical governance was not successful in Tehran university hospitals. Active involvement and commitment of top managers, staff empowering, patient centeredness, evidence-based practice, and clinical audit are necessary for successful CG implementation. Key­words: Quality management, Clinical governance, Hospital, Critical success factors ­Citation: Mosadeghrad AM, Arab M, Shahidi Sadeghi N. A Survey of Clinical Governance Success in University Hospitals in Tehran. Journal of Health Based Research 2019; 5(1): 101-16. [In Persian]

Background: Management style is one of the factors that could cause staff unwillingness for sharing information and ideas that ultimately leads to dominance silence culture in organizations. This study aimed at determining the relationship between management style and organizational silence in hospitals affiliated by Tehran University of Medical Sciences. Methods: This study was an analytical, descriptive cross-sectional study conducted in 2016. The study population included all employees of General Hospitals of Tehran University of Medical Sciences with 4251 employees that 354 among this population were selected as samples with stratified random sampling method. Organizational silence questionnaire by Vakola and Bouradas was used for data collection. The reliability of the questionnaire was α = 0.83 assessed by Cronbach’s alpha method. Data were analyzed using a t-test, ANOVA and Pearson correlation coefficient and also post-test experience if necessary. SPSS19 software was used for analyzing the data. Results: The results showed that there was a positive and meaningful relationship between exploitative-authoritative and benevolent-authoritative styles and organizational silence (P

Background: Three big medical universities were merged in Iran in 2010, but they separated again after 2.5 years. The purpose of this study was to identify the most important challenges of this merger. Methods: This qualitative study was conducted using semi-structured interviews with 63 participants from April to September 2015. The data were analyzed via conventional content analysis method using MAXQDA10 software. Results: The merger of universities faced strategic, procedural, structural, contextual, and human resources' challenges. Factors such as the merger’s vision, goals, and motives, the stakeholders’ involvement, the merger announcement and time, interruption in service delivery, information systems, power balance, organizational structure, geographical distance, organizational culture, employees’ reaction, and education influenced the failure of this merger. Conclusion: Merger and acquisition require a well-designed plan for the effective and efficient use of resources to achieve the desired outcomes. Therefore, policymakers should involve universities’ managers and employees in decision-making process to achieve the best results.

SnO2 thin films were prepared by conventional and Glancing Angle Deposition reactive sputtering, and their gas sensing properties were investigated. The porosity of the as-prepared films was widely assessed using optical methods, and the sensing performances of these active layers were correlated with the evolution of surface and film porosity as a function of deposition conditions and annealing treatment. The sensor made of inclined columns grown at high sputtering pressure (6 × 10−3 mbar) and annealed at 500 °C in air exhibited the best response to benzene, with a limit of detection of 30 ppb. In addition, successful BTEX (i.e., benzene, toluene, ethylbenzene, and xylenes) discrimination was achieved by combining the sensing signals of four nanostructured tin-oxide-based gas sensors.

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 2013 in 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). SPSS20, 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.

BACKGROUND: By the epidemiological transition, most of the developing countries still have malnutrition problem as well as different levels of obesity and overweight as most important risk factors of non-communicable and chronic diseases. Body mass index (BMI) is a suitable index for studying them. Thus, the aim of this study was to investigate the relationship between children’s BMI and household socioeconomic status in West-Azerbaijan province, Iran, in 2015. METHODS: This cross-sectional study was conducted on 1024 children aged 6-7 years who were assessed in Sanjesh Plan conducted by Organization of Exceptional Education and Training. To determine BMI, world health organization (WHO) Growth Reference (2007) was used. Then, to estimate the risk factors affecting BMI, chi-square test and categorical (multinomial) logistic regression were used. RESULTS: The results showed that obesity, overweight, and thinness were 2.5%, 12.7%, 5.2% in girls, and 4.4%, 12.3%, and 1.8% in boys, respectively, which were statistically significant. Of all the variables studied, insurance, occupation and education level of parents, birth order, and number of household members were not statistically significant. The rest of indicators such as gender, location of residence (city or village), ethnicity, and development degree were statistically significant. CONCLUSION: Since analysis showed that BMI had relation with development degree and location of residence, it can be said that West-Azerbaijan is at the median of transition. Therefore, health policy makers should pay enough attention to prevention of obesity and overweight as well as elimination of thinness and malnutrition.

Background and Aim: The quality of healthcare services is determinant in patients’ improvement process, upgrading their satisfaction, ranking healthcare centers, and preventing patients’ repeated referrals leading to more costs for healthcare centers and insurance companies. The purpose of this study was to evaluate the quality of services -- from the perspective of patients -- given by the laboratories having contract with Iran Health Insurance Organization (IHIO). Materials and Methods: In this cross-sectional study, the opinions of 302 patients having referred to the laboratories in contract with IHIO in Tehran were surveyed with a researcher-developed questionnaire. Descriptive and inferential statistical tests were used to analyze and report the results. Results: The sample included 43.5% males and 56.5% females. Most of the participants were married (71/3%). Based on the results, the patientschr('39') perception of the quality of laboratory services was 78%. Their expectation of services was 85%. The gap between perception and expectation of clients in all dimensions was statistically significant (p

Abstract 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: 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: Necessity of development, quantity and quality improvement needs of medical tourists had been unavoidable based on medical tourism growth with its competitive function. This study aimed to determine satisfaction rate of medical tourists referee to Tabriz hospitals to get treatment services. Materials and Methods: This descriptive and analytical study was conducted on 82 medical tourists referee to all wards of selected hospitals using convenient sampling method in Tabriz city. Data was collected using a-28 items valid and reliable researcher made questionnaire. Cronbach’s Alpha was calculated 0.708. In order to data analysis, SPSS Software version 23 was utilized. Also, Spearman’s correlation coefficient was used to assess the association between different aspects of patients’ satisfaction. Results: Satisfaction rate was obtained in five main aspects including cultural problems (51.88%), structural issue (57.50%), insurance payment system (16.04%), information system and communication channels (41.34%) the economic challenges (50.35%). The information system and communication channels had high effect on economic aspects (p

New advanced fuel cell technologies are moving towards high-temperature proton conductors (HTPCs) to meet environmental issues. Their elaboration remains a challenge and micro-computed tomography (µCT) is an innovative way to control their quality. NiO-BZY anodic supports of a protonic ceramic electrochemical cell (PCEC), elaborated by co-tape casting and co-sintered at 1350 °C, were coated with a BZY20 electrolyte layer by DC magnetron sputtering. The µCT allowed to observe defects inside the volume of these PCEC half-cells and to show their evolution after an annealing treatment at 1000 °C and reduction under hydrogen. This technique consists in obtaining a 3D reconstruction of all the cross-sectional images of the whole sample, slice by slice. This allows seeing inside the sample at any desired depth. The resolution of 0.35 µm is perfectly adapted to this type of problem considering the thickness of the different layers of the sample and the size of the defects. Defects were detected, and their interpretation was possible thanks to the 3D view, such as the phenomenon of NiO grain enlargement explaining defects in the electrolyte, the effect of NiO reduction, and finally, some anomalies due to the shaping process. Ways to anticipate these defects were then proposed.

Objective (s): People are the major recipients of health services, they deserve their selves to have the choice right and equitable access to healthcare services. Health system is responsible for providing the fair services and choice right to the public. Hence, this study aims to explore the current position of freedom and equity in providing the healthcare services. Methods: This qualitative study was conducted through literature and national documents review and face to face interview with key experts of the health system. All interviews are recorded and transcribed. MAX QDA10 was applied for organizing the concepts. Framework analysis was used for analyzing the concepts. Results: Findings were categorized in two main themes of freedom of choice (with 3 categories including freedom of choice for treatment services, freedom of choice for preventive and hygienic services and freedom of choice for choosing the insurer) and equity(with 2 categories including equity in financial access and equity in physical access). Equity in physical access includes two sub categories: equity in access to preventive and hygiene services and equity in access to specialty and subspecialty services. Conclusion: The freedom of choice and equity are considered in different ways in the health system however, there is a significant gap with the ideal position. It seems that the commitment of health system managers to national documents and learning from the experiences of other countries is essential for proper implementation of freedom of choice and equity at different levels of the health system.

Background: Health of hospital staff has a determinant role in increased productivity and since the main mission of hospitals is community health promotion, in order to achieve this important issue, monitoring, maintaining and improving general health is essential; this study developed to assess general health of staff affiliated to Tehran University of Medical Sciences and identify its related factors. Materials and Methods: This Cross-Sectional, Descriptive-analytical study was conducted among 320 staff members of the Tehran University of Medical Sciences who selected using random sampling. In order to data collection, the General Health questionnaire was used. Collected data were analyzed using SPSS software through t-test and ANOVA tests. Results: Study findings revealed that 47.5% of participants had psychological disorders suspiciously; prevalence of physical symptoms, anxiety, social dysfunction and depression were 53.9%, 49.3%, 79.5% and 14.6% respectively. There was a significant relation between general health and demographic features such as gender, marital status, major, job department, housing situation and type of employment (p

Background: This study was conducted to validate the "staff attitude toward the use of coercion in the treatment of mentally ill patients" questionnaire and assessed their attitude in selected public psychiatric hospitals in Tehran city. Materials and Methods: This is a descriptive and analytical study which was carried out on three hospitals of Tehran University of Medical Sciences, Iran University of Medical Sciences and social welfare and Rehabilitation University in 2015. The questionnaires were distributed to the participants and finally 273 questionnaires were used. Data were analyzed using confirmatory factor analysis test. Moreover, ANOVA and independent t-test were applied to evaluate the participantschr('39') attitude on using coercion for treatment of mentally ill patients. Results: Study findings revealed that 61% of participants were nurse and 11% were physicians. According to the study results, three final obtained factors explained 61.93% of the total variance; this variance reflects the proper and appropriate selection of the questions. In addition, there were statistically significant differences between marital status and offending attitude domain; between job and education and offending attitude; and security and treatment domains. Conclusion: The current questionnaire has a high validity and reliability and is also appropriate for the context of Iran. The attitude of the studied participants was a bit towards using coercion in treatment of mentally ill patients. Therefore, it is recommended that authorities take some steps toward changing health services providerschr('39') attitude of using coercion.

Forecasting earnings per share (EPS) are among the most important and crucial tasks for both outside investors and internal managers. The focus of most articles in literature is forecasting EPS with linear methods. Researchers rarely employ nonlinear models to forecast EPS. However some researchers show that nonlinearities exist in the relation between EPS and its determinants. This finding of nonlinearities provides support for the use of non-linear models in the field of earnings per share.In this paper, the model based on an Artificial Neural Network (ANN) to predict EPS is proposed. After that, ANN model was optimized by Genetic Algorithm and particle swarm optimization. The Genetic Algorithm and particle swarm optimizations used to select the most relevant input variables because selection of input variables is a key stage in building predictive models, In this paper, The Genetic Algorithm and particle swarm optimizations used to select the effective variables on the EPS using a sample of 131 companies listed in the Tehran Stock Exchange through for the years 1389_1391.The results reveals that the genetic algorithm and swarm optimization is able to extract the effective variables on the EPS amongst the factors affecting EPS, and also have been caused improve power capabilities and expansion of neural network structure.

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