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Abstract Introduction and objective Road Traffic Injuries (RTIs) represent the predominant cause of morbidity and mortality globally. Thus, impactful interventions and trustworthy authorities are imperative to mitigate traffic accidents. The present study seeks to assess public trust in traffic accident diminution policies and measures within the country of Iran. Method This cross-sectional study utilized a questionnaire comprising 31 questions distributed across eight dimensions. The questionnaire’s design was informed by a literature review and semi-structured interviews with experts specializing in traffic accidents. The target population consisted of Tabriz city residents, who were selected via convenience sampling. The collected data were then analyzed using SPSS-16 software, employing the T-test, One-way ANOVA, and Pearson correlation coefficient to present the study’s results. structural equation modeling (SEM) was conducted using R 4-4-2 programming language. Results A total of 681 participants completed the questionnaire, yielding a commendable response rate of 88.6%. The majority of participants were male (60.8%), and 86.2% identified as drivers, with 61.8% having experienced driving accidents. The overall score for public trust in RTIs policies was calculated to be 46.9%. The individual scores for specific domains of trust in traffic safety were as follows: safer roads (43.1%), safe vehicle (43.3%), safety laws (48.8%), safe user (51.1%), safe technology (51.5%), road safety management (46.8%). All the latent variables except education are significantly effective on public trust. Conclusion The study findings indicate relatively low levels of public trust in RTIs policies among the Iranian population. These results emphasize the need for targeted interventions to enhance public confidence in specific aspects of traffic safety. Policymakers can use these insights to implement effective measures, thus contributing to the RTIs and the promotion of road safety in the country.

Background. The coronavirus disease 19 (COVID-19) is one of the most important public health issues, and the evaluation and improvement of COVID-19 health literacy and self-care can be effective in preventing its spread. This study was conducted to investigate the health literacy of COVID-19 and its relationship with self-care among the health ambassadors of Urmia in 2021. Methods. In this descriptive-analytical study, 400 health ambassadors of Urmia were selected using the cluster random sampling method. The data-gathering tool was a questionnaire, including questions about self-care, COVID-19 health literacy, and demographic information. The data were analyzed by SPSS 19 using analysis of variance and regression tests. Results. COVID-19-related health literacy was reported to be at a good level (63.5%) in most health ambassadors. In addition, it had a statistically significant relationship with the level of education and economic status. Similarly, there was a significant relationship between self-care and demographic characteristics such as age, gender, level of education, occupation, and economic status (P>0.05). On the other hand, according to data analysis results, with an increase in health literacy related to COVID-19, regression modeling could predict 22% of self-care behaviors in the participants of the present study. Conclusion. Overall, there is a need for interventions by healthcare professionals for training to increase health literacy related to COVID-19 that results in self-care and adoption of health behaviors in health ambassadors, given the significance of COVID-19-related health literacy and its effects on self-care in these ambassadors. Practical Implications. The findings of this study can be presented to the Deputy of Health and healthcare providers so that actions can be taken to promote health literacy and self-care and prevent similar epidemics.

Abstract Background and Aim Taxi drivers play a significant role in urban mobility and safety as professional drivers. They typically have poor incomes, long work hours, lack of sleep, and high levels of stress, which increase the risk of physical and mental illnesses. The goal of this study was to explore the relationship between sleep disorders and depression among Tabriz metropolis taxi drivers. Methods Using the street intercept technique, a cross‐sectional study was conducted with the participation of 402 taxi drivers in Tabriz during January and March 2020. Data collection tools included the Pittsburgh Sleep Quality Index (PSQI) and Patient Health Questionnaire as well as demographic information. Twenty taxi stops were used as sampling sites, and the method used was random sampling based on the number of drivers at each stop. Statistical analysis was performed using Stata 13. Results The majority of drivers worked an average of 6 days each week, with a mean tenure of 13.3 years. The sleep quality mean score for drivers was 5 (SD = 2.3). Approximately, 21% of them had sleep disorder (PSQI >6). Moderate depression was recognized in 13% of drivers and moderately severe depression has been found in 5% of them. Drivers were more likely to experience sleep disorders if they had mild (odds ratio [OR] = 3.9), moderate (OR = 16.4), or fairly severe depression symptoms (OR = 35.3). A seven times higher risk of depression was identified among drivers with sleep disorders. Conclusion It might be contended that a mutual relationship has been found between sleep disorders and depression, and disregarding this will deteriorate sleep turbulences. Considering the pivotal role of taxi drivers in urban mobility, accommodating initiatives that give a break time for drivers and improve their mental health is recommended.

Background. Risky driving behaviors increase the risk of injury and death due to crash. Vast strata of behaviors are considered as risky behavior in the literature. The aim of this scoping review was to extract and determine various behaviors tagged as risky driving behavior. Methods. Based on Arkesy and OMalley framework, a scoping review study was conducted. Literature search was done through PubMed, Embase, Scopus and Web of Science databases. Snowballing of references and hand search of related journals were also used. Time limitation for search was defined from 1st January 2000 to 30th December 2019. Screening process was done independently by two researchers. Data was systematically extracted from the included articles using a predetermined extraction table. Results. Literature review resulted in 3761 articles. After the screening process, 45 articles were included in the study. Majority of included articles were from United States (n=13), followed by Iran (n=5), Australia (n=4) and China (n=4). Speeding (reported in 70% of included studies), drunk driving (52%), aggressive driving (44%), tailgating (41%) and not-using seat belt (37%) were the most frequent behaviors tagged as risky driving behaviors in the included studies. Conclusion. Regarding the discrepancies in understanding, definition, and categories of risky driving behaviors, it is of great importance to develop a unified standard definition and categorize risky behaviors which would facilitate global movements to reduce risky driving behaviors through effective interventions. Practical Implications. The results will guide the policymakers to clearly develop suitable policies in national, regional or local levels to prevent and reduce the negative results of risky driving behaviours.

Abstract Background Vaccination is one of the best ways to stop the transmission of coronavirus disease 2019 (COVID-19). In this regard, uunderstanding the features related to the intention of different populations to receive the COVID-19 vaccine is essential for an effective vaccination program. This study aimed to investigate the vaccination intention predictors in the general adult population of Iran. Methods A cross-sectional, web-based survey was conducted on social networks, including Telegram, WhatsApp, LinkedIn, Instagram, and Facebook. Multinomial logistic regression models were used to investigate predictors associated with the intention to receive COVID-19 vaccines, including sociodemographic characteristics, trust, worry, sources of information, and conspiracy beliefs. The main outcomes included unwillingness, undecidedness, and intention to receive the COVID-19 vaccine. Results Out of 780 respondents, 481 (61.6%) reported an intention to be vaccinated, 214 (27.4%) expressed their undecided status, and 85 (10.9%) reported unwillingness to receive any type of COVID-19 vaccine. A higher age (OR undecided = 0.97, 95% CI (0.96–0.99)), (OR unwilling = 0.97, 95% CI (0.95–0.99)); exposure with COVID-19 (OR unwilling = 0.82, 95% CI (0.76–0.89)), (OR undecided = 0.87, 95% CI (0.83–0.93)) were positively associated with vaccination intentions. No/low trust in vaccines, institutions, concerns about the future of the pandemic, and conspiracy beliefs were strongly and negatively associated with COVID-19 vaccination intentions. Conclusion Most Iranians intended to get a COVID-19 vaccine. Higher vaccine acceptance needs to consider demographic features, exposure history, confidence in vaccines, trust in institutions, concerns, and conspiracy beliefs of people.

Background and Aim: In recent years, public trust in health system has been considered one of the performance evaluation indicators of health systems. However, most of the research on public trust in health system is related to developed countries, and research in this regard is limited in Iran. A better understanding of trust in health system and some influential factors helps to develop targeted interventions to increase trust. The present study was conducted to investigate the level of public trust in health system in Rasht County. Materials and Methods: In this cross-sectional study, 680 households (510 urban and 170 rural) were included. The data collection tool was a questionnaire to measure public trust in health system with 30 items and six dimensions, whose validity and reliability were confirmed. Mann-Whitney and Kruskal-Wallis tests were used to compare and analyze the difference in public trust in health system between groups. Results: The overall score of trust in health system was 66.7 out of 112. The highest score for the quality-of-care dimension was 16.38 out of 28, and the lowest for the cooperation quality of providers dimension was 7.47 out of 12. Among service providers, the highest trust was in nurses and specialist doctors, and the least was in traditional medicine service providers. Women, government employees, people without health insurance, people with excellent and good health status, those who had used hospital services, and those who were satisfied with the last service received had a high level of trust in the health system (P

Highlights: Investigating public trust during the outbreak of Covid-19 is of utmost important for both research and policy making perspectives. COV-Trust tool (Seven factors and 31 items) was developed and validated. COV-Trust tool comprehensively assesses public trust in various aspects of policies and their determinants and can provide valuable information for promoting the effectiveness of policies.

Background. This systematic review evaluated the studies conducted on Guillain-Barré syndrome (GBS) due to COVID-19 vaccination to clarify any possible connections and the type of vaccines causing GBS. Methods. A comprehensive search was performed on July 2021 through MEDLINE (via PubMed), Scopus, Cochrane, and Web of Science databases to detect published and unpublished papers. Our PICO was all COVID-19 vaccinated individuals as the population, COVID-19 vaccines as the intervention, and patients experiencing GBS following COVID-19 vaccination as the outcome. Critical appraisal instruments from the Joanna Briggs Institute case series or case report were used to evaluate the quality of included studies. Results. In the present systematic review, 12 case reports and case series including 21 patients were assessed. More than half of the patients were male, and the mean age of male patients was lower than females. In terms of vaccine type, the most common kind of vaccine injected was Oxford/AstraZeneca, and all the cases except one patient had received only one dose of the vaccine. Regarding the interval between receiving the vaccine and the onset of GBS symptoms, the mean duration was 14 days. The lowest mean time interval between receiving the vaccine and the onset of symptoms of GBS was related to the unnamed vector-based COVID-19 vaccine, and the highest was associated with Oxford/AstraZeneca. Conclusion. Through this systematic review of case reports, we neither attempt to establish nor rule out a causal link between the COVID-19 vaccine and GBS, because such a link requires extensive case-control studies. However, we must highlight any events that may occur following the injection of existing vaccines. Practical Implications. The most common symptoms seen in patients experiencing GBS after vaccination included progressive bilateral lower limb weakness, paresthesia, numbness of limbs, generalized body aches, and back pain.

Background and Purpose: Emergency Department (ED) staff are frequently faced with road traffic injury victims and also play role as various road users. This study was conducted to investigate the knowledge, attitude, and practices of ED staff towards road safety at referral trauma hospitals of Tabriz. Materials and Methods: This cross-sectional study was conducted in 2020 in the referral trauma hospitals of Tabriz. Data were collected using a standard questionnaire. Census sampling was used to select the participants. Descriptive statistics, Pearson’s correlation test and logistic regression model were used for the data analysis using SPSS Software. Results: The mean score of the ED staff in traffic safety knowledge, attitude and practices was 9.73 ± 2.28 out of 15, 95.3±11.4 out of 118, and 61.3±8 out of 76, respectively. The staff’s traffic safety knowledge was associated with their attitude and practices. Moreover, the univariate logistic regression modeling results revealed that participants' traffic safety attitude (OR= 0.96 (95% CI= 0.93-0.99)) and practices (OR= 0.95 (95% CI= 0.91-0.99)) were, independently, correlated with a reduction in road traffic accidents. Conclusions: The ED staff’s attitudes towards traffic safety had a positive correlation with their practices and also accident experience. Nonetheless, after adjusting the data in terms of knowledge and attitude, road traffic safety practice was not associated with participants' accident experience. It is crucial to consider road safety education in colleges to promote safety knowledge of graduate individuals which will have conspicuous results in risk reduction.

Abstract Background On March 11th, 2020, the World Health Organization (WHO) proclaimed Coronavirus Disease of 2019 (COVID-19) a pandemic. In addition to severe health problems, the disease has had a major psychological impact on the public. The aim of this research was to examine the association between Post-Traumatic Stress Disorder (PTSD) related to COVID-19 in emergency staff and self-compassion and perceived social support. Methods Data were collected from 222 emergency staff working in two referral educational and health centers for COVID-19 affiliated to Tabriz University of Medical Sciences. The participants were recruited six months following the first case of hospitalization for COVID-19 in these two hospitals in Tabriz, Iran. Four questionnaires were used to measure the variables, including a researcher-made demographic checklist, PTSD Checklist for DSM-5 (PCL-5), the Multidimensional Perceived Social Support Scale (MSPSS) and the Self-Compassion Scale. Results The findings showed that age (r = 0.17, P = 0.034), self-judgment (r = 0. 36, P

The existence of bacterial proteins was proved in the gut of animals. Many proteins with bacterial origin were reported from the alimentary canal in the invertebrate animals. Insects, as the largest group of animals, have known serious pests in agricultural ecosystems. Feeding and nutrition are the main ways that caused damages to economic crops. Identification of digestive proteins in the gut of insects is the first step in the clearance of biochemical degradation of food particles. Proteomics is a powerful tool to identify effective proteins in the physiological systems in animal and plants. Digestive proteins in the gut of insects have originated from innate cells and microorganisms like bacteria. In this research, for the first time, gut proteins of Nezara viridula were extracted. These proteins were visualized and identified with two-dimensional polyacrylamide gel electrophoresis and mass spectrometry, respectively. Eight proteins with bacteria origins were accumulated in the gut of adults. Identified proteins were phospho pyruvate dehydratase, amino acid –N-acetyl transferase, hypothetical protein, glycerol-3 phosphate dehydrogenases, ribulose-phosphate 3-epimerase, pyruvate kinase, chitinase, and catalase. Results suggest that the interaction of bacteria and lumen of Hemiptera has a high level of efficacy; hence, the nutrition process can be used as a new target for selecting proper inhibitors to use in the integrated pest management.

Introduction Patients with a type D personality have worse social functioning and mental health and more affective constraints than non-type D personalities. They have a negative outlook on life and health-related issues. The aim of this study was to examine the mediating role of stress and anxiety in the relationship between type D personality and COVID-19 by adjustment of the effect of demographic characteristics and perceived symptoms as confounder variables. Material and methods A total of 196 patients out of those suspected of having COVID-19 and visiting the reference hospitals were selected. They had completed the type D personality and the anxiety and stress scales along with their hospital admission form before undergoing COVID-19 testing. After their COVID-19 test, the participants were divided into two groups based on their disease, an infected group (n = 90) and a non-infected group (n = 106). Results Type D personality has no significant direct effect on infection with the disease, but taking into account the mediating variable of stress, the odds of an event in those with type D personality is 2.21 times higher than those without this personality (p = .027) and, taking into account the mediating variable of anxiety, having a type D personality increases the odds of an event by 2.62 times (p = .011), holding demographic characteristics and perceived symptoms constant. Conclusions Given the indirect relationship between COVID-19 and type D personality, the mediating variables of stress and anxiety can be considered full mediating variables.

Background: This study has been conducted to analyze the processes, models, and policies to assess fitness to drive and improving driving in the elderly in the world. Methods: The Arkesy and O’Malley frameworks were employed. Articles with at least one aspect of driving eligibility in the elderly were included. Expected data were collected using appropriate keywords from PubMed, Web of Science, Scopus, Embase, IranDoc, SID, and MagIran. Data were analyzed using the Content Analysis method. Results: Out of 675 records, 24 papers and reports were included in the study that all of them were High-Income Countries (HICs). Among the studies that referred to the baseline age, the highest frequency was 70 yr old (4 studies). Vision assessment was the main item to judge driving fitness (mentioned in 75% of the studies). The in-person (5 studies) was the most common method of renewal. General practitioners were the principal performers to measure driving fitness (7 studies). Thirteen studies referred to the road tests as part of the driver's license renewal process. In most all reports and papers, there were policies on empowering the elderly driver, including providing safe driving tips, optional driving skills tests, holding retraining courses, etc. The most frequently supporting policies included introducing alternative transportation. Conclusion: Most HICs have worthwhile experience in measuring and improving the fitness to drive in the elderly and enforce different laws according to social and political conditions. Utilizing these experiences by considering economic and social differences can be useful and practical for middle and low-income countries.

Background and Objectives Burns is one of the most common and potentially dangerous public health problems. Burn patients' hospitalization facilitates the provision of medical services. However, prolonging the length of hospital stay can not only impose an economic cost, but also cause various infections in patients. Various factors affect patients’ hospitalization length including patients age and gender, burn cause, anatomic place and its severity. Identifying and considering these factors will reduce burn patient’s hospitalization and its consequences. The aim of this study was to evaluate the factors affecting hospitalization length in burn patients admitted to Sina Hospital as burn referral hospital in Northwest of Iran. Material and Methods In this cross-sectional study, the medical records of burn patients who were admitted to Sina Hospital in Tabriz during 2018, were included. Data collection was performed using a goal-based researcher data collection form. The form included patient’s demographics (age, gende, marital status, education level, occupation, comorbidity) and Status of vital signs at admission including respiratory rate, heart rate, body temperature, Glasgow Coma Scale score (less than 12 moderate injuries, 13 and 14 mild injuries, 15 or more normal) and systolic and diastolic blood pressure, burn place, date, cause, TBSA, burn severity, length of stay and outcome. Data were analyzed using Stata 16 software and through quantile regression modeling. Data normality was evaluated using Kolmogorov-Smirnov test, skewness and kurtosis. Due to the skewness of the hospitalization variable distribution (hospitalization length was a non-negative variable with right skew and skewness coefficient of 4.72 and kurtosis coefficient equal to 6.53), to obtain a complete picture of how the conditioned distribution of the response variable changes from variables Independently, Quantile regression was used for modeling with a significance level of P

Purpose: Insect-insecticide interaction, as a dynamic system, increases our knowledge to improve chemical application. Although modes of action in the most insecticides is obvious (direct action) but the other targets which may be affected after treatment are not determined (indirect action). In this study digestive enzymes were considered as potential targets for insecticides. Research method: Some of (three sample) adults that were exposed to the different insecticide concentrations were selected for in vivo analysis. In this part, internal organs (midgut) were homogenates and enzyme activity was determined. On the other hand, in the in vitro assays, nontoxic adults were selected and after dissection of the guts, incubated to the different insecticide manually. Fifty microliters enzyme solution with 450 μl toxic solutions incubated 30 min in the room temperature before enzyme assay. Findings: Twenty hours after exposure to the insecticides, gut of adults were dissected and used for in vivo experiment. Our data showed that there was a significant difference in the enzyme activity among different concentrations of chlorpyriphos. The highest and lowest level of enzyme inhibitory was occurred in the 2000 and 0 ppm (control). There was no significant difference between control (0 ppm) and 300 ppm. Data in the in vitro experiment showed that enzyme activity was reduced in the toxic concentrations. Trend of enzyme inhibiting that occurred with chlorpyriphos was regular as the highest and lowest inhibiting were observed in the maximum (99.2 %) and minimum concentrations (7.4 %), respectively. Limitations: There is a problem in which how to correlate in vivo and in vitro results to practical toxicology. Originality/Value: Using of new insecticides with new and widespread mode of action can be recommended against postharvest pest in the practical entomology.

Proteomics is a powerful tool to identify effective proteins in the biochemical reactions of the insect body. Many proteins were reported in the gut lumen and tissues which are essential to complete the physiological role of the alimentary canal of Sunn pest. The gut microbiome of insects has a key role in the digestive process. In this study, for the first time, gut proteins of adult Sunn pest were extracted. These proteins were visualized and identified with two-dimensional polyacrylamide gel electrophoresis and mass spectrometry, respectively. Newly identified proteins include pyruvate dehydrogenase, oxidoreductase FAD-binding protein, hypothetical proteins, glycerol-3 phosphate dehydrogenase, conserved hypothetical proteins, ABC excinucleases, ABC-type transport systems and molecular chaperones. The accumulation of these metabolism proteins in the gut of Sunn pest indicates the importance of symbiotic proteins in the improvement of digestive activities and insect-bacteria interactions. Results suggest that the identified bacterial proteins can be considered as effective proteins in the process of nutrition and provide more gut-derived targets for enzyme engineering and development of biopesticides.

Abstract In the present study, the effect of homogenization and solution treatment times on the elevated-temperature (650 °C) mechanical properties and the fracture mechanisms of Inconel 718 (IN718) superalloy fabricated by laser powder bed fusion (LPBF) was investigated. Homogenization times between 1 and 7 h at 1080 °C were used, while solution treatments at 980 °C were performed in the range from 15 to 60 min. The as-printed condition showed the lowest strength but the highest elongation to failure at 650 °C, compared to the heat-treated conditions. After heat treatments, the strength of the IN718 alloy increased by 20.3–31% in relation to the as-printed condition, depending on the treatment time, whereas the ductility decreased significantly, by 67.4–80%. Among the heat treatment conditions, the 1 h homogenized conditions at 1080 °C (HSA1 and HSA2) exhibited the highest strength and ductility due to the combined effects of the precipitation hardening and sub-structural changes. Further increases in the homogenization time to 4 and 7 h led to a decrease in the strength and significant ductility loss of the LPBF IN718 due to the considerable annihilation of the dislocation tangles and a greater precipitation of coarse MC carbide particles. Furthermore, it was found that the solution treatment duration had a crucial influence on the mechanical properties at 650 °C due to the increase in the grain boundary strength through the pinning effect of the intergranular δ-phase. In addition, the fracture mechanism of the LPBF IN718 was found to be dependent on the heat treatment time. Finally, this investigation provides a map that summarizes the effect of homogenization and solution treatment times on the high-temperature mechanical behavior of LPBF IN718 by relating it to the corresponding microstructural evolution. This effort strives to assist in tailoring the mechanical properties of LPBF IN718 based on the design requirements for some specific applications.

Abstract Background Measuring self-care ability in elderly people needs specific instruments. The Self-care Ability Scale for Elderly (SASE) is one of the common instruments used for assessing self-care ability. The aim of this study was to assess the psychometric properties of the SASE among Iranian elderly population. Methods This cross-cultural adaptation study was carried out at Shahid Chamran and Shadpour Health Complex in Tabriz, Iran. The forward-backward procedure was applied to translate the SASE from English into Persian. Then, it was completed to 220 elderly people. A systematic random sampling method was used for sampling. Content validity was calculated through modified Kappa coefficient (modified CVI) based on clarity and relevance criteria. Reliability was measured by internal consistency and test-retest analysis. The construct validity also was assessed using Exploratory Factor Analysis (EFA). All the statistical analyses were performed using SPSS 21 statistical software package. Results The mean of self-care ability was 61.14 ± 21.08. The CVI and modified kappa were 0.91 and 0.92 for relevance and clarity, respectively. The Cronbach’s alpha coefficient was 0.73 and Intra-class correlation coefficient was 0.97. The results of EFA revealed a three-factor solution (‘ability to take care of personal responsibility’, ‘ability to take care for the goals’, and ‘ability to take care of the health’) that jointly explained for 64.61% of the total variance. Conclusion Results of the study showed that the Iranian version of the SASE has good psychometric properties and can be used in assessing the self-care ability of elderly people.

Abstract Background Primary Health Care (PHC) was introduced as the first level of health services delivery after Alma-Ata declaration. However, after forty years, it needs to be more trustful to achieve its predefined objectives. Public trust in PHC is one of the neglected issues in the context. The aim of this study is to evaluate public trust in PHC in Iran. Methods The present investigation is a household survey conducted in East Azerbaijan Province, Iran. Two-stage cluster sampling method with Probability Proportional to Size (PPS) approach was used. Totally, 1178 households were enrolled in the study. PHC trust questionnaire and Ultra-short version of Socio-Economic Status assessment questionnaire (SES-Iran) was used for data collection. Data were analyzed using STATA software (version 15) through descriptive statistics and linear regression. Results The mean ± SD age of the participants was 41.2 ± 15.1 and most (53.7%) were female. Mean score of PHC trust was 56.9 ± 24.7 (out of 100). It was significantly different between residents of Tabriz (the capital of province) and other cities in the province (p

Purpose: Successful application experiences on public-private partnership (PPP) in different countries, suggest that PPP could be an option in road traffic injury (RTI) prevention. The present study aims at investigating the applicability of PPP policy in RTI prevention in Iran based on the experts’ perspectives. Methods: This is a qualitative study with grounded theory approach which has been conducted in Tabriz University of Medical Sciences, Iran in 2018. The participants were 22 experts in the field of RTIs selected using purposive sampling method. Data were collected by semi-structured interviews and analyzed with content-analysis method. Results: The results were classified under 5 main themes (applicability, scopes and services, challenges, advantages, and strategies) for applying PPP policy and 37 sub-themes. Due to the prevalence of RTIs, the present challenges in public sector, existence of qualified private sector, and successful experiences in other areas, there are opportunities for private sector partnership in prevention of RTIs. Private sector could participate in different scopes and services regarding RTI prevention, including road construction and maintenance, maintenance and provision of vehicles safety and public education. The main challenges including legislation issues, ambiguities in collaboration, political and organizational unsustainability, government's financial hardship and lack of experienced experts in the field of RTI. However, there are significant advantages including high efficiency in program implementation, covering the weaknesses of public sector, effective and efficient management on application of PPP in RTI prevention. The strategies include identifying and prioritizing the assignable activities, identifying the qualified private sector, developing PPP policies and legal frameworks, creating a common language between public and private parties, trying to meet the expectations of the private sector by public sector, developing a comprehensive and sound contract, and cultivating public culture to accept private sector in the field of RTI prevention. Conclusion: This study sought to determine whether PPP could be used as strategy to reduce the burden of RTIs in Iran. But it requires a lot of preliminary studies to provide the context and conditions for applying this policy.

Introduction: A national road safety strategic plan (NRSSP) is considered as one of the main road safety management issues in different countries. Such a plan not only determines the vision and relevant strategies but also causes the implementation of appropriate interventions to be coordinated and strengthened to achieve the goals set by partner organizations. The present study mainly aims to report Iran's NRSSP 2021–2031 development protocol. Methods: According to a schedule, the study protocol consists of ten sections: (1) Determining a core planning center, (2) Establishment of a steering committee, (3) Stakeholder identification, (4) Identification and development of Goals and Strategies, (5) Vision development, (6) Establishment of committees, (7) Integration of Goals and Strategies, (8) Goals and Strategies assessment, (9) Action plans development, (10) Monitoring and evaluation. An appropriate study method is performed for each of the concerned steps. Conclusion: The road safety strategy plan is a critical component to promote the effectiveness of activities and achieve the goals determined for road safety purposes. The Decade of Action for Road Safety is just being closed to its end; hence, reviewing and drawing up a road safety document concerning authentic scientific models and evidence is of paramount importance in Iran. The present study takes over the mission to address this gap.

Abstract Background Scientometric studies are one of the most important and useful tools to assess the research performance and knowledge impact of researchers. The aim of this study was to map out the scientific performance of the Iranian medical academics with respect to a detailed range of scientometric indicators. Methods Using scientometric approach, individual and scientific performance data of medical academic staff were extracted from the Iranian Scientometric Information Database (ISID). Total number of publications, total number of citations, citation per paper, h-index, international collaboration, self-citation, SJR decile, i10-Index, Quartile distribution were the studied scientometric variables. Out of the registered 19,023 academic staff, 746 were included in the study through simple random sampling method using random sample extraction function in STATA. Data were analyzed using STATA 14 statistical software package. Results Most of the included academicians were men (60%). A total of 13,682 articles were published by them until 2018, being cited 114,928 times with a mean of 5.77 citation per paper. H-index median was three and about 90% of the staff had an H-index below 10. Number of published papers, cite per paper and H-index metrics were significantly different with respect to gender, academic position/degree, and general field of study (p

Abstract Background Trust has been introduced as the cornerstone of the public and health providers’ relation. Public trust in primary health care (PHC) is crucial and must be measured. The aim of this study was to develop and validate PHC trust measurement tool. Methods This was a psychometric study to develop PHC trust measuring tool done in Tabriz, East-Azerbaijan with participation of 600 households in 2016. Item generation was done through literature review and experts opinions. The content validity, reliability and construct validity of the PHC trust tool were assessed using several statistical methods including modified Kappa, Kendall’s Tau and intra-class correlation coefficient (ICC) as well as exploratory factor analysis (EFA). Data were analyzed using STATA 14 statistical software package. Results A 30-item questionnaire was developed. The Modified Kappa coefficient as an indicator of content validity assessment was 0.94. With respect to reliability assessment, a high internal consistency was observed with 0.98 Cronbach-Alpha score and the test–retest reliability for overall scale (assessed by ICC) was 0.94 (CI: 0.87–0.97). Exploratory factor analysis emerged 2 factors. Factor 1 consisted of 25 items accounting for 74.1% of the variance (eigenvalue = 22.47) followed by Factor 2 consisting of 5 items accounting for 19.2% of the variance (eigenvalue = 1.6). Conclusion PHC trust measuring tool could be used as a valid and reliable tool by health systems in Iran and similar contexts to investigate how they are trustful from the public viewpoint.

Abstract Background Providing comprehensive and high-quality services is one of the most important goals of the health systems and a basic principle for Universal Health Coverage (UHC). Fulfilling this important task would be feasible through continuous evaluation and improvement of the health services quality. The aim of this study was to develop a framework for quality assessment of Primary Health Care (PHC) in Iran’s health system. Methods This study is a literature review which continued by a qualitative research. The extracted quality dimensions and indicators for initial screening were reviewed and discussed in two panel meetings attended by the experts with regard to the current package of health system in Iran. Using Delphi method, the dimensions and Quality Indicators(QIs) were evaluated and approved by 39 national health professionals in two rounds. Finally, after 4 panel sessions at ministerial level, the selected QIs were categorized in form of the final dimensions of the quality of care. Results The literature review emerged 13 Primary Health Care Quality Assessment Frameworks (PHCQAF) including 20 and 698 QIs. Delphi study resulted in developing Iranian PHCQAF comprising 7 dimensions and 40 QIs. Among these, 8 QIs of the dimension of access and equity, 5 QIs of safety dimension, 2 QIs of efficiency dimension, 13 QIs of effectiveness dimension, 2 QIs of patient-centeredness dimension, 3 QIs of governance dimension and 7 QIs of appropriateness dimension were presented. Conclusions The presented PHCQAF can be used as a comprehensive and practical tool for continuous improvement of the quality of PHC services at local, national and regional levels. Moreover, it can give some useful information to the health managers and policy makers on how the services are provided.

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Objective: To perform a systematic review and meta-analysis of self-immolation epidemiology and characteristics in Iran.Methods: This was a systematic review and meta-analysis study. PubMed, Scopus, Web of science and Science Direct were searched for English literature and SID and Magiran for Persian in the time period of 2000 to 2016. The retrieved studies were screened and reviewed then quality assessed. Random Effect model was applied for meta-analysis. The qualitative data were analyzed by content analysis method.Results: After literature screening, 39 studies included in the analysis. Women were subject to self-immolation more than men. The rate of self-immolation estimated to be 4.5 cases in every 100,000 populations and it was the reason of 16% of hospitalized burns. The average length of hospital stay calculated to be 12.24 (95% CI: 8.85-15.59) days. The total burnt surface area was 65.3% (95% CI: 56.71-73.89). Death due to self-immolation was 62.1%. The major risk factors of self-immolation were having mental health issues, family problems and characteristics and problems in relation/communication with spouses.Conclusion: Despite the low rate of self-immolation in Iran, it comprises one sixth of the hospitalized burns. The mortality rate of self-immolation also is high and this highlights the importance of providing special care. Psychological consultations and mental health screening in the primary health care would help to prevent the self-immolation.

Abstract Background Delivering interventions is the main task of health systems whose accurate measurement is an essential input into tracking performance. Recently, the concept of effective coverage was introduced by World Health Organization to incorporate into health system performance assessment. The aim of present scoping review was mapping the key elements and steps of effective coverage assessment in practical efforts including kinds of interventions, criteria for selecting them and the need, use and quality estimation approaches and strategies of each intervention. Methods We conducted a scoping review of health system/program assessments which assessed effective coverage till May 2017. Seven databases were systematically searched with no time and language restriction through applying combined keyword of “effective coverage”. Results Eighteen studies contributed findings on monitoring effective coverage of health interventions and they all were included in the review. Only 4 contributed findings on health system and the others were related to specific intervention(s) assessment. The interventions monitored by effective coverage were mainly in child health, prenatal and antenatal care and delivery, and chronic conditions areas. Potential impact on the burden of disease, leading causes of mortality and morbidity, and high occurrence and prevalence rate were among the main intervention selection criteria. Availability of data was the critical prerequisite, especially, in all of the studies applied ex post approach in estimating effective coverage. Estimation based on a norm, self- reporting from surveys and biomarkers were the main strategies and methods of need, utilization and quality measurement, respectively. Conclusions More studies are needed to contribute to the ongoing improvement in the development of effective coverage concept and increasing practical efforts, especially through defining prospective approaches and strategies into estimation of composite measures based on the effective coverage framework. Also, further attention needs to be paid to quality measures of effective coverage in a manner that better conceptualizes and measures the connection between coverage rates and interventions’ effectiveness. At the administrative system level, more innovation is needed to develop data systems in order to enhance capacity of routine health service information.

Dear Editor, Education is a complex issue and there is a need to consider a several factors to provide an effective training program. Regarding the issue of road traffic crashes, there are some contradictory findings about the efficacy of education, which may cause mistrust among professional circles and experts. Some scientists believe that most of the training programs do not necessarily cover all aspects of crashes and only address some of the concerns. Road traffic crashes are a multidimensional issue and can be influenced by various political, economic, social and cultural factors, and thus the efficacy of an education program can be reduced. The low efficiency of educational programs can have several reasons, which are mentioned below: 1.Non-use of Specific Educational Theory The efficacy of some educational interventions poses a serious challenge for researchers. A simple search in scientific databases will result in various studies aiming to offer educational programs for different road users about the road traffic safety. These educational programs are sometimes designed and implemented without sufficient scientific evidence or without relying on specific educational theory. Some researchers believe that designing an educational intervention without considering the guiding theory in education is like prescribing a medication to a patient regardless of his/her physiology. The use of educational theories entails identifying the audience properly, presenting the educational content in an appropriate manner, and evaluating its feedback. It also helps audiences to gain a better understanding about the safety in relation to their own behavior as road users. 2.Non-use of Various Methods for Providing the Educational Content Some educational interventions are based on learning context-dependent methods. However, learning context-dependent methods is not easily generalized among the target group. This type of educational delivery method is not adequately effective for some age groups, including children. Adopting various training methods tailored to the content and target groups such as role-playing, as well as using animation, cartoons, computer games, simulators, virtual reality technologies and augmented reality in training of traffic safety can increase the efficacy of such educational methods. 3.Insufficient Attention to the Causation Network of Traffic Crashes Some believe that educational programs only emphasize on one topic, and generally fail to take into account the effect of other interventions. On the other hand, the designed educational intervention may focus on the wrong variable (as a factor influencing the occurrence of traffic crashes or the resulting injuries). For example, some drug abuse resistance education interventions focus on peer pressure as a variable with a direct causal effect, while the effect of the peer pressure in some studies is pale and other factors have a stronger causal effect. As for the road safety issue, some educational interventions focus on a number of factors, such as vehicle control skills, while these factors may or may not be the main factors responsible for some of the road traffic crashes. The road safety educational programs may focus only on traffic behaviors such as driving speed and may neglect other behavioral aspects such as smoking, alcohol, and drug consumption. In such cases, and even if the trainees demonstrate the positive aspects of driving speed in their behavior, the impact of the negative aspects of other behaviors such as alcohol consumption causes the risk of road traffic crashes to remain in the target group. 4.Insufficient Knowledge of Audience Gaining sufficient knowledge about the target group, as well as paying due attention to the characteristics of individual receiving an education are important factors for deepening learning in the audience. Recognition of the audience usually takes place over a long period of time. However, it has been shown that educational activities are often short-lived, and short-term interventions may be less effective for the audience. Some educational interventions only provide safety information without giving the drivers an accurate understanding of their behavior as road users. On the other hand, some educational interventions focus on high-risk behaviors of the drivers without considering the underlying reasons for these behaviors. Many drivers who display an unsafe behavior are aware of the fact that their behavior is not safe; however, they keep displaying the unsafe behavior. The issue of education has conflicting aspects that should be addressed. For example, raising risk awareness may strongly discourage some people to follow educational topics; while it may be attractive for others and may even encourage them to include their acquired education in their behavior. For instance, education providers focus on quitting high-risk health behaviors such as smoking, alcohol consumption, and speeding that culminate in adolescence, while some training recipients may be curious and think about following these behaviors. It is argued that sometimes extensive financial resources to run inefficient educational program may deviate the resources from more effective community-based initiatives. Therefore, it is recommended that the researchers and policymakers in this field consider the theoretical and scientific principles when designing and implementing the educational interventions in order to increase their efficacy. Ethical Approval Not applicable. Conflict of Interest Disclosures None.

Background: Hospitals are the largest and most costly operating units of health systems, and their share of current government expenditures in the healthcare sector is between 50 and 80 percent. The hospital efficiency is more indicative of the proper function of the resources devoted to it. The aim of this study was to evaluate the efficiency of hospitals in Tabriz by using the Pabon Lasso model. Methods: This is a descriptive study that investigated the efficiency of Tabriz hospitals during 2009-2013. All hospitals of Tabriz were entered by census. Data (bed occupancy rate, bed turnover and patient length of stay) were collected in summer 2014 and charts were plotted using SPSS19 software. Results: The mean of Pabon Lasso's three indices of efficiency in 5 years (excluding psychiatric beds) was 67.6% for bed occupancy rate, 104.3 times bed turnover, and 2.48 days average patient length of stay. The coefficient of bed occupancy increased by 3% over 5 years, the bed turnover index increased by 8 times and the average length of stay decreased by 0.17 day. On average, 25.2% of hospitals were in Region 1, 23.5% in Region 2, 26.1% in Region 3 and 25.2% in Region 4 of Pabon Lasso Diagram. Conclusion: The presence of 26% of hospitals in the region of Pabon Lasso Diagram shows the effective efficiency of hospitals which is not an acceptable statistics for hospitals and requires the intervention of health practitioners and policymakers.

Sunn pest, Eurygaster integriceps, is a serious pest of wheat and barley in Iran. The gut and salivary glands are main parts of digestive system in sunn pest. The performance of these organs in digestion is related to its’ expressed proteins. The use of proteomics technique to study plant protein behaviors in gut of insects is new method in insect–plant interaction experiments. In this study, some of plant protein spots were traced in adult gut of sunn pest using 2 DE, mass spectrometry and NCBI database. Six proteins contain serpin, β-amylase, α-amylase inhibitor, dehydrosacorbate reducyase, triticin and α-l arabinofuranidose were identified using plant database. The study of sunn pest–wheat interaction and identification of effective proteins in stability of this relation can be helpful for finding of new target proteins in pest control.

Background: Concepts such as organizational commitment and employees’ and managers’ ethics provide decision-makers and policy makers with potentially useful information which can result in increasing organizational efficiency and effectiveness. This study aimed to explore the relationship between professional ethics and organizational commitment among the staff working in the education departments of Tabriz University of Medical Sciences. Methods: This cross-sectional study was conducted in 2015. The study population consisted of all staff working as educational experts in the education departments of Tabriz University of Medical Sciences (N = 65). Data collection instruments used in this study were two standard questionnaires on professional ethics and organizational commitment. SPSS software version 21 was used to analyze the data. Results: According to the results, mean scores obtained for professional ethics and organizational commitment were (91.57± 9.13) (95% CI, 89.23-93.91) and (64.89 ± 10.37) (95% CI, 62.2367.54), respectively. A significant relationship was observed between professional ethics and organizational commitment among the educational experts working in Tabriz University of Medical Sciences (correlation coefficient = 0.405) (P = 0.001) (at 95% confidence level). Furthermore, there was a significant relationship between professional ethics and work experience (P = 0.043). The highest level of professional ethics observed was associated with those participants having a work experience of ranging from 6 to 10 years. Individuals with fulltime employment scored the highest in organizational commitment. Conclusion: Educational experts possessed a high level of professional ethics. The finding provides the grounds for promoting organizational commitment, which will lead to higher levels of organizational effectiveness.

Background and purpose: Improved life standards, over the past few decades, had led to an increase in health expenditures. The aim of this article was to compare the trend of health expenditure per capita and its association with health indicators in selected countries. Materials and Methods: The health indices of World Health Organization and World Bank health statistics for 10 years (2003 to 2013) were employed. Countries includes Denmark, the Netherlands, Saudi Arabia, Turkey, Iran, Nigeria and Liberia. Six indices were compared with the global average in 5 income groups. Results: Denmark with health expenditure per capita more than the Netherlands had higher life expectancy at birth and more deaths as a result of alcohol abuse and tobacco smoking. Nigeria’s health spending per capita was 2.5 times more than that of Liberia, because it had worse results in all health indicators with high mortality rate due to lower vaccination coverage for malaria, AIDS, and tuberculosis, and at the same time, high costs for the labor force and corruption in health system. Iran with health expenditure per capita less than Turkey had lower total mortality rate of infants and children under 5 years and lower total fertility. Well-organized PHC system and highly qualified professionals in the field of healthcare are among the strengths of the healthcare system in Iran. Conclusion: Increasing trend of health expenditures in selected countries did not have a significant impact on the health indicators trend. Countries must identify and invest on their health priorities to improve population health status.

Objective The aim of this study was to describe health services utilisation and responsiveness in East Azerbaijan province, Iran.Design A cross-sectional household study as part of a larger research on primary healthcare system.Setting We carried out the study in East Azerbaijan Province, northwest Iran from July to September 2015.Participants A total of 1318 households were included.Results Most of the participating households had social security health insurance. Heart failure or hypertension care, general outpatient care and arthritis care were the most used services. High services cost and inadequate medicine and medical equipment were introduced to be the main barriers to health services utilisation in Tabriz and province representative sample (PRS), respectively. Health system responsiveness mean score (the maximum is 100) was 33.71±16.15 (95% CI 32.45 to 34.97) in Tabriz and 32.02±14.3 (95% CI 30.9 to 33.13) in PRS, which showed significant difference (p≤0.02).Conclusions Differences in the utilisation and responsiveness of health services and distribution of health resources were observed between Tabriz and PRS. Evidently, health system responsiveness in both Tabriz and PRS was at low level. The results demonstrate the need for changing resource distribution policies and employing reactive health policies to response the public health.

Objective: To systematically identify the various methods of speed management and their effects. Methods: A systematic search was performed in Science Direct, Ovid Medline, Scopus, PubMed and ProQuest databases from April to June 2015. Hand searching and reference of selected articles were used to improve article identification. Articles published after 1990 which had reported on efficacy/effectiveness of speed management strategies were included. Data were extracted using pre-defined extraction table.Results: Of the 803 retrieved articles, 22 articles were included in this review. Most of the included articles (63%) had before-after design and were done in European countries. Speed cameras, engineering schemes, intelligent speed adaption (ISA), speed limits and zones, vehicle activated sign and integrated strategies were the most common strategies reported in the literature. Various strategies had different effects on mean speed of the vehicles ranging from 1.6 to 10 km/h. Moreover, 8-65% and 11-71% reduction was reported in person injured accidents and fatal accidents, respectively as a result of employing various strategies.Conclusion: Literature revealed positive effects of various speed management strategies. Using various strategies was mostly dependent on road characteristics, driver’s attitude about the strategy as well as economic and technological capabilities of the country. Political support is considered as a main determinant in selecting speed management strategies.

​Background and objectives : Health promoting lifestyle is one of the major determinants of one’s physical and psychological health. A great proportion of population in our country belongs to university students which their lifestyle could affect the community health. The aim of this study was to determine health promoting lifestyle among Shahed students in Tabriz University of Medical Sciences. Material and Methods: This is a cross-sectional study conducted by using health promoting lifestyle standard questionnaire. Convenience sampling method was used to select 150 participants in October 2014. Data were analyzed using Kolmogorov-Smirnov, Independent t and one way ANOVA tests. Results: The mean score of health promoting lifestyle was 53.09± 13.31. Spiritual growth subscale obtained the highest mean score (Mean= 65.76± 17.04). There was a significant difference between male and female in stress management and health responsibility subscales (P-value Conclusion: Results demonstrated that health promoting lifestyle was not in an acceptable level among Shahed students. So, it is necessary to employ proper strategies, especially in physical activity to promote students’ life quality.

​ Background and Objectives : Improving socioeconomic situation and health status in communities had led to quality of life improvement and aging. Health systems must pay attention to the emotional needs of elderly people besides their health needs. This study aimed to study the elderly friendly center experience in Zafarenieh health center of Tabriz. Material and Methods : This is a case study. Data were gathered using Focus Group Discussions (3 sessions) by the participation of elderly people and the elderly friendly center personnel in 2015. Also, center documents were reviewed. Thematic analysis was done to extract the meaningful themes. Results: Providing elderly care had increased their sense of quality of life. Being a member in peer groups and participating in social activities (like group exercise, poem and so on) had positive effects on their mentality. Conclusion : Concurrent attention to the health and emotional needs of elderly would lead to improved quality of life of elderly people and their families.

In the present study, multi-objective optimization is employed to develop the optimum heat treatments that can achieve both high-mechanical performance and non-distinctive crystallographic texture of 3D printed Inconel 718 (IN718) fabricated by laser powder bed fusion (LPBF). Heat treatments including homogenization at different soaking times (2, 2.5, 3, 3.5 and 4 h) at 1080 °C, followed by a 1 h solution treatment at 980 °C and the standard aging have been employed. 2.5 h is found to be the homogenization treatment threshold after which there is a depletion of hardening precipitate constituents (Nb and Ti) from the γ-matrix. However, a significant number of columnar grains with a high fraction (37.8%) of low-angle grain boundaries (LAGBs) have still been retained after the 2.5 h homogenization treatment. After a 4 h homogenization treatment, a fully recrystallized IN718 with a high fraction of annealing twins (87.1%) is obtained. 2.5 and 4 h homogenization treatments result in tensile properties exceeding those of the wrought IN718 at both RT and 650 °C. However, considering the texture requirements, it is found that the 4 h homogenization treatment offers the optimum treatment, which can be used to produce IN718 components offering a balanced combination of high mechanical properties and adequate microstructural isotropy.

Background: Self-care ability was considered as a mechanism to improve the quality of life and reducing the high costs of medical services for elder people. Iran is experiencing increased elder people and healthy aging is one of the challenges. This study aimed to investigate self-care ability of elder people in Shahid Chamran and Dr. Shadpour health complexes, Tabriz- Iran. Methods: This was a cross-sectional study done in 2015."The Self-care Ability Scale for the Elderly (SASE)" valid and reliable questionnaire (Persian version) was used for data collection. Totally, 220 samples were selected using G-Power 3.1.5 software. Sampling was conducted through systematic random method. Data were analyzed using SPSS 21 software. Descriptive statistics and independent t-test, one-way ANOVA, Mann-Whitney, Kruskal-Wallis test and Kolmogorov-Smirnov test were used. Results: The mean of self-care ability in elder people was calculated as 56.69± 15.07 (out of 100). 96.8% of participating elderlies, had poor self-care ability. Significant relations were found between elder people self-care ability and their educational level, life status, employment status, and marital status (P0.05). Conclusion: Self-care ability of elder people in Tabriz was at weak level. Regarding, health providers must employ the programs to promote older people self-care ability including improving self-esteem, receiving family help, improved nutrition and mental health improving elderly's quality of life.

Background: Non-standard management of medical waste leads to irreparable side effects. This issue is of double importance in health care centers in a city which are the most extensive system for providing Primary Health Care (PHC) across Iran cities. This study investigated the medical waste management standards observation in Tabriz community health care centers, northwestern Iran. Methods: In this triangulated cross-sectional study (qualitative-quantitative), data collecting tool was a valid checklist of waste management process developed based on Iranian medical waste management standards. The data were collected in 2015 through process observation and interviews with the health center’s staff. Results: The average rate of waste management standards observance in Tabriz community health centers, Tabriz, Iran was 29.8%. This case was 22.8% in dimension of management and training, 27.3% in separating and collecting, 31.2% in transport and temporary storage, and 42.9% in sterilization and disposal. Lack of principal separation of wastes, inappropriate collecting and disposal cycle of waste and disregarding safety tips (fertilizer device performance monitoring, microbial cultures and so on) were among the observed defects in health care centers supported by quantitative data. Conclusion: Medical waste management was not in a desirable situation in Tabriz community health centers. The expansion of community health centers in different regions and non-observance of standards could predispose to incidence the risks resulted from medical wastes. So it is necessary to adopt appropriate policies to promote waste management situation.

Background and Objectives : Medical error reporting is a common way in identifying and preventing their occurrence. A proper reporting system will lead to patient safety improvement. The aim of this study was to investigate medical errors and the reporting barriers from the perspectives of nurses and managers in Tabriz Shahid Madani hospital. Material and Methods : A cross-sectional study was conducted in 2013 using standard questionnaire. Medical error reporting forms were reviewed during 2012. 157 nurses were selected by easy sampling method and 30 managers were enrolled in the study (census method). Results : Most of the reported medical errors (55.7%) were adverse event. Patient falls from bed were the most reported error (21%). Lack of knowledge and awareness about medical errors was the main reporting barrier from the perspectives of managers and nurses. Conclusion : To improve patients and staff safety, hospital managers should employ appropriate policies to enhance the nurses’ knowledge about medical errors and create a proper reporting culture. ​

Introduction: Clinical Governance (CG) is an overarching concept, using organizational capacity, safeguards high standards of the health services and provides a safe care for patients. The aim of this research was to study nurses’ perception about Clinical Governance. Materials and Methods: A qualitative study was done with Focus Group Discussions (FGD). Purposeful Sampling was used to select the objectives including 65 participants. Actually 7 FGD’s were held. Content analysis was used to extract the meaningful themes. Results:Nurses believed that patient centeredness and evidence based practice is the core of the CG concept. Also they mentioned that cultural change, staffs training, adequate financial and human resources are required to successfully implementation of CG in hospitals. Conclusion: Spreading up a shared vision about CG and providing the required infrastructures in hospitals would be facilitate CG initiatives. Proper commitment of the managers and staff participation could lead an effective CG implementation.

Background and objectives : Patient safety leadership walk-rounds are proper techniques to the contribution of executive managers and other staffs to improve the safety in hospitals. The aim of this study was to evaluate the patient safety leadership walk-rounds that were held in ShahidMahallati hospital. Material and Methods : This is a descriptive, triangulated (qualitative and quantitative) study. All the records of patient safety leadership walk-rounds in 2013 were analyzed by content and the usefulness of taken actions were assessed with research-made form. Results : During 1 year period, 31 patient safety leadership walk-rounds were held in 19 different areas of the hospital and 236 safety issues were identified, of which 75% were completely resolved. Conclusion : Patient safety leadership walk-rounds are useful methods to express the executive managers' commitment to safety and to attract other staffs contribution to improve the safety.

​ Background and objectives : Health care organizations require clinical accreditation standards for improving high quality, assured and safe services. Considering importance of clinics in hospitals’ quality improvement and lack of accreditation measures in adapted model for clinics, this study is aimed at developing accreditation measures for the adapted model and accredited the clinic of Tabriz Aali Nasab hospital using this model. Material and Methods : This is a descriptive study which was conducted at autumn 1391. Measures were developed for the standards of the adapted model. Accreditation team used these measures for accrediting the clinic of Tabriz Aali Nasab hospital. Data were collected by interviews, observation and surveying documents. Results : Findings showed that the clinic of Tabriz Aali Nasab hospital got the 65% of the scores. This clinic in 6 standards in the fields of clinical effectiveness, referral, transfer, discharge and registration of patients achieved less than 25% score, full score in 9 standards, and in 21 standards got upper than 75% score in respect, authority, safety, accessibility, complaint system and prevention of hazards. Conclusion : The Study results showed that the clinic of Tabriz Aali Nasab hospital is in a mediocre condition in observing standards which can be improved with a proper planning.

Background and Objectives : Tracer methodology is a novel evaluation method which its purpose is to provide an accurate assessment of systems and processes for the delivery of care, treatment, and services at a health care organization. This study aimed to assess student care process in Tabriz using Tracer methodology. Material and Methods : This cross-sectional study was conducted in autumn 1391. Population study consisted of all the students who were covered by Tabriz health care center and study sample included an urban health care center, a rural health care center, a health house, and two schools in urban and rural areas which were selected by simple sampling method. Also, all the complicated and problematic processes were chosen to be assessed. Data were collected by interviewing, observing, and surveying documents and were compared with current standards. Results : The results of this study declared the percentage of points that each target group gained from tracer evaluation in student care process was 77% in health house, 90% in rural health care center and 83% in urban health care center. Findings indicated that documentation was the main weak point. Conclusion : According to the results of this study, student care process is sufficient; despite the fact that there are some deficiencies in caring process, as it may be improved through appropriate strategies. Furthermore, tracer methodology seems to be a proper method to evaluate various levels of health care system. ​

​ Background and Objectives : For a successful accreditation program, it is necessary to have adequate resources and infrastructures. The aim of this study was to evaluate existing resources and infrastructures to implement the accreditation system. Material and Methods : This descriptive study was conducted in the universities of East Azerbaijan and Ardabil in 2011. A total number of 150 individuals were selected using census sampling. The data were collected by a structured questionnaire whose validity was confirmed by library validity method and its reliability was measured using split-half method (α=89.4). Data analysis was performed using SPSS 16. Results: The participation rate was 82% (123 individuals out of 150). Average work experience was 16.88 years. The bachelor degree was the highest frequency among participants (66%). 80% of the participants stated that the organizational culture and financial resources are inadequate, 54% expressed there is a lack of top management support and 77% stated that the expected information does not exist in the hospitals. Yet, 55% of the participants declared that the probability of a successful implementation of accreditation is higher than average. Conclusion: In a successful implementation of accreditation system, it is important to mobilize adequate resources and develop suitable cultural statuses. Also, it is needed to provide sufficient education about accreditation and how to implement and benefit the manpower’s potential capabilities.

Background and objectives : Medical Errors reporting system is an initiative that provides staffs’ awareness through learning and sharing. This system improves the patient safety culture in hospitals. The aim of this study was to investigate the status of medical error reporting and sharing system in a military hospital. Material and Methods : This is a cross-sectional study. Data were gathered by medical error reporting sheets that were reported in the first semi-annual of 2011 and 2012. Data were analyzed and suggested interventions were distributed among the hospital units and educational trainings were applied to avoid errors. Results : Most of the errors were medication errors. The comparison of reported errors showed that the number of reports was increased from 14 cases in the first semi-annual of 2011 to 38cases in the first semi-annual of 2012. Interventions indicated a positive effect on avoid these errors and an improved reporting culture among staff. Conclusion : Establishment of medical error reporting and sharing system and management’s support of correct reaction unto medical errors provides a good context to improve patient safety culture, quality and safety assurance. ​

Background and Objectives : Since one of the effective ways to prevent infections is the proper sterilization of instruments, CSR is one of the most important units in hospitals. Thus, risk management has a high priority in CSR. The aim of this study was to identify and prevent potential risks in CSR unit in Shams Hospital using FMEA technique. Material and Methods : This is a descriptive and interventional study. Using FMEA technique, potential risks were identified. Risks were prioritized and corrective interventions were implemented to reduce risks. Results : The current study identified 69 risks that 10 risks were marked as high priority. Corrective activities were suggested by risk management teams which were applied. Conclusion : The results showed that flaws in safety policies, equipment and physical conditions were the most important risk factors. Implementing risk management plan and clear safety policies could be useful. ​

Background and Objectives : Hospitals are of high importance in the society. Therefore, evaluation of health care provided by hospitals is in high priority. Performance indicators are used as a tool for evaluation of effectiveness and efficiency of services. The aim of this study was to investigate the relationship between performance indicators and Neonatal Intensive Care Units (NICU) evaluating score in East Azerbaijan. Material and Methods : This cross-sectional study was conducted in 2011 in all East Azerbaijan hospitals with active NICU wards. Data regarding performance indicators and evaluating score of NICU units were collected from Deputy of Treatment of Tabriz University of Medical Sciences and were analyzed using SPSS 16 and t-test was applied. Results : The mean of bed occupancy, bed turnover and length of stay in studied NICU units were 96.31%, 4.88% and 6.39%, prospectively. There was no significant relationship between performance indicators and NICU units evaluating score. Conclusion : The lack of significant relationship between performance indicators and evaluating score indicates that evaluation tools and procedure must be reconsidered to assess the effectiveness and efficiency of services properly.