Search

Abstract Occupational stress is a complex concept resulting from interaction among personnel, work environment, and cultural contexts. It can cause mental health issues, including clinical mental disorders, as well as emotional challenges like depression, anxiety, cognitive difficulties, and feeling sad. As a vulnerable group, healthcare professionals, especially nurses, experience a high rate of occupational stress. Therefore, we aimed to study the relationship between occupational stress, mental health problems, and self-efficacy among the nursing population. A cross-sectional study was conducted among 365 nurses selected through a two-stage sampling process from tertiary hospitals in Qazvin, Iran, between July and September 2022. Study variables included occupational stress measured by the persian version of the health and safety executive management standards revised indicator tool (MS-RIT), the general health questionnaire containing 28 questions measuring psychological distress in four primary areas of somatic and anxiety symptoms, sleep disorders, social dysfunction, and depression [GHQ–28], and general self-efficacy [GSE–10]. The mentioned variables and some of the nurses’ demographic characteristics, including age, gender, education, and work experience, were analyzed using moderated multiple regression, descriptive statistics, and the Pearson correlation coefficient.The Pearson correlation analysis revealed a statistically significant association between self-efficacy and occupational stress (r = 0.62, P = 0.000) and self-efficacy and mental health (r = 0.67, P = 0.01). Regression analysis demonstrated that occupational stress accounted for 42% of the variation in mental health (R2 = 0.42, P

Abstract Background Responsiveness to the population’s non-clinical needs encompasses various dimensions, including responsive research and an educational outreach plan at the community level. This study aims to develop a community-responsive research model in the healthcare system to ensure the connection between community-identified health priorities and research funds, as well as capacity-building efforts. Methods A mixed-methods research study was conducted in three main phases, including a comprehensive literature review, a qualitative analysis of an expert panel’s points of view, and the developing of a model using the Equation Modeling (SEM) technique. R software version 3.2.4 was used to conduct statistical analysis, considering a significance level of 0.05. Results Based on the literature review, 41 responsiveness components were identified from sixteen relevant studies conducted between 2000 and 2022. Ten sub-themes in four major themes, including planning, implementation, monitoring and evaluation, and action, were identified through qualitative content analysis. Standardized coefficients revealed that components such as dissemination of results to all stakeholders, research prioritization aligned with community needs, commitment to implement research findings, and collaborative learning had statistically significant effects on the community-responsive research model. Conclusion It is essential to identify community health priorities by following a community-focused, priority-setting process based on the principles of community engagement to develop a community-responsive research model. Afterward, dissemination of research findings to all stakeholders, commitment to apply the obtained results in the real world, and promotion of shared learning among research partners have been proven to facilitate collaborative investigation and mutual understanding between the community and academic partners.

Abstract Background Responsiveness is relevant in the context of treatment and the provision of medical services. However, if we delve deeper into the subject, we must establish and develop responsiveness within the medical sciences education system. This study aims to identify the dimensions that significantly impact responsiveness in the medical education system based on a comprehensive review and expert opinions in healthcare. Methods The present research is descriptive-analytical in terms of its objective and follows a mixed-method approach. This study was conducted in three stages. Initially, we utilized relevant keywords related to education in databases, such as Web of Science, Scopus, ScienceDirect, OVID, CINHAL, EBSCO, Google Scholar, Iranmedex, SID, and Irandoc. Subsequently, in the expert panel session stage, the factors influencing responsiveness were identified in the comprehensive review stage, and with this thematic background, they were conceptualized. Finally, the Confirmatory Factor Analysis (CFA) technique was employed to coherently examine the relationships between variables and present the final model. Results We obtained 32 articles from the comprehensive review of studies. Four components in planning, implementation, monitoring and evaluation, and intersectoral cooperation were identified based on expert panel opinions. Based on the standardized coefficients, the components of research-based educational planning, community-oriented education evaluation indicators, and utilization of modern educational methods are statistically significant. Conclusion The establishment and development of responsiveness in the medical sciences education system involve training specialized and responsive human resources through innovative educational methods that have sufficient familiarity with the multidimensional concepts of health and how to achieve them. This approach allows for practical and responsible steps toward training competent and committed physicians in line with the needs of society. On the other hand, responsiveness in the medical sciences education system can be improved by enhancing research-based educational planning and developing community-oriented evaluation indicators that can assess the number of revised educational programs based on societal needs. Therefore, understanding the critical elements in revising medical education programs, which play the most significant role in addressing societal needs and responding to changing disease patterns and new health priorities, is both a necessity and an important priority.

Background: Ensuring equal utilization of health services has always been a priority in health systems globally. Iran implemented reforms such as the Health Transformation Plan (HTP), in which one objective was to reduce inequity in access to inpatient and outpatient services. These studies aimed to measure inequality in health services utilization in Qazvin, Iran, and clarify inpatient and outpatient utilization patterns among socioeconomic subgroups of the population.Methods: This cross-sectional study recruited 442 households living in Qazvin, Iran, in 2019. We collected data using a tool that included demographic characteristics, socioeconomic status, and health services utilization. We applied the concentration index to measure inequality and performed data analysis using STATA 15.Results: Based on our estimates, the utilization rates of outpatient and inpatient services in the study sample were 0.89±1.39 and 0.45±0.94, respectively. There was no statistically significant difference in the use of outpatient healthcare services in terms of gender and insurance coverage of the households, while literacy, age, and health condition had statistically significant effects on inpatient healthcare utilization (P

Background: Acquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV) is known as one of the most chronic conditions, having significant effects on physical and mental health status in infected individuals, and thus reducing their quality of life (QoL).Methods: I n t his s ystematic r eview, t he d ata w ere i nitially collected from the databases of Scopus, PubMed, Embase, Web of Science, and Google Scholar from January 2000 to September 2020 based on the inclusion and exclusion criteria of the study. The data were then analyzed by using the R software.Results: A total number of 25 research articles addressing the QoL in 5,952 HIV/AIDS patients were evaluated using three valid questionnaires, including the Medical Outcomes Study HIV Health Survey (MOS-HIV), the 36-Item Short Form Health Survey (SF-36), and the World Health Organization Quality of Life in HIV-Infected Persons (WHOQoL-HIV). Based on the MOS-HIV, the SF-36, and the WHOQoL-HIV questionnaires, the QoL mean scores in HIV/AIDS patients were 51.80 (49.4- 54.57), 54.81 (52.68-56.93), and 13.62 (11.97-15.26), respectively. In addition, the physical items gained a higher mean score than the mental ones in all the questionnaires. The QoL showed higher mean scores in the SF-36 and the WHOQoL-HIV questionnaires in Africa, except for the MOS-HIV questionnaire, which had the highest mean score in North America.Conclusion: Overall, the QoL in HIV/AIDS patients in this study was acceptable, even though further changes and studies are still required to support the findings.

Abstract Background Diabetes is widely recognized as one of the most pressing public health concerns globally. To manage blood glucose levels and reduce subsequent complications and mortality rates, self-management mechanisms have been found to be effective in controlling diabetes. This study aimed to investigate the association between spiritual intelligence and diabetes self-management in patients with type 1 diabetes in Qazvin, Iran. Methods This cross-sectional study included 220 adults with type 1 diabetes aged 18–35 years who referred to an outpatient diabetes clinic of a tertiary hospital in Qazvin province, and were selected through a convenience sampling method in 2022. Two valid and reliable questionnaires were used for data collection, including the 24-item questionnaire of spiritual intelligence and self-management of type 1 diabetes for adolescents (SMOD-A). To analyze the data, correlation coefficients and multiple linear regression analysis were used. Results The total score of spiritual intelligence was 57.24 ± 10.77, and self-management was 77.14 ± 8.92. Among different subscales of spiritual intelligence, critical thinking obtained the highest score. In self-management, the highest score was achieved for communication.Findings also revealed that spiritual intelligence could predict 7.2% of changes in self-management among diabetes patients, and its relationship with diabetes self-management was estimated at 0.27. Conclusion The growing prevalence of diabetes worldwide underscores the significance of self-management of the disease in the well-being of patients. This study demonstrated that spiritual intelligence played a crucial role among young adults with diabetes and assisted them in coping with stressful situations. As such, placing greater emphasis on the spiritual aspects of care is necessary, especially in the healthcare of young adults who are dealing with diabetes and its complex conditions.

Abstract Background Breast self-examination is a simple, painless, confidential and inexpensive screening method for early diagnosis that does not require specialized tools and equipment. In this study, we have estimated the pooled percentage of breast self-examination (BSE) in Iranian women. Methods All the published literatures between 2012 and 2022 have been reviewed. Searches were performed in PubMed, Web of Science, ProQuest, Science Direct, Google Scholar, Scientific Information and Magiran databases. The effect size was the pooled percentage of breast self-examination (BSE). In order to check the heterogeneity, the estimation of the I2 index and extraction of the Galbraith plot were used, and the drivers of heterogeneity have been identified through meta-regression and estimates were made based on subgroups. All the analysis was done in STATA 15. Results From the initial 294 records, 38 were included in the final analysis in which 9960 women have been studied. The heterogeneity of the studies was high based on the variation in OR (I2 = 98.4%, heterogeneity X2 = 2278.21 (d.f. = 37), p

BackgroundNurses as the largest group of health workers have a very stressful job which can cause number of diseases specially increase cardiovascular risk factors. This study aims to investigate the overall epidemiology of cardiovascular disease (CVD) risk factors among nurses.MethodWe searched all four main databases such as Scopus, PubMed, Embase and Web of Sciences from the beginning of 2000 to March 2022 with appropriate Mesh Terms. We also searched Google scholar. Then we applied inclusion and exclusion criteria and after selection the studies the Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of included studies. Comprehensive Meta-analysis and R software was used for analysis.ResultsFinally, 22 articles with a total number of 117922 nurses were included. Among all risk factors, sedentary lifestyle and lack of regular physical activity with a prevalence of 46.3% (CI 95%, 26.6-67.2) was regarded as the main prevalent risk factor among nurses. The mean systolic blood pressure (SBP) measured in the study population was 121.31 (CI 95%, 114.73-127.90) and the mean diastolic blood pressure (DBP) was 78.08 (CI 95%, 74.90-81.25). Also family history of cardiovascular disease (41.9%; 95% IC: 29.8-55.1%), being overweight (33.3%; 95% IC: 24.7-43.2%), and alcohol consumption (24.6%; 95% IC: 16.4-35.2%) was found among the participants.ConclusionStudy results revealed that sedentary lifestyle was the main prevalent CVD risk factor among nurses followed by family history of cardiovascular disease, being overweight and alcohol consumption. Furthermore, among nurses with shift works almost all risk factors got higher score representing the worse condition in comparison with day workers' nurses. This study enables learning the associated risk factors of CVD among nurses to facilitate interventional programs with a view to reduce the exposure of nursing staff particularly those who work in shifts to cardiovascular risk factors.1. what was already known?In general, many studies have emphasized the impact of the nursing profession on the incidence of some cardiovascular patients. Also, different shifts of nurses can have a double effect.2. what are the new findings?In this study, the mean for sedentary lifestyle was reported to be 46.3% which represented the most prevalent risk factor for cardiovascular risk factors among study population.3. what is their significance?This study enables learning the associated risk factors of CVD among nurses to facilitate interventional programs with a view to reduce the exposure of nursing staff particularly those who work in shifts to cardiovascular risk factors. This information can comprise essential tools for health human resource management contributing to advance nursing.

Background: Strict adherence to safety precautions and, most importantly, social distancing and isolation of people infected with the Coronavirus disease-19 (COVID-19) virus have considerably affected the daily life activities of individuals and overshadowed their routine lifestyle. We conducted a systematic review to provide evidence-based information for clinicians, health policymakers, and social workers in developing useful interventions to effectively mitigate the adverse impacts of the pandemic on people’s life and health condition.Methods: In this systematic review and meta-analysis, studies assessing quality of life (QOL) among the population during the COVID-19 pandemic were searched in four main databases and Google Scholar from the onset of the epidemic to May 2021 with Mesh terms of quality of life and Covid-19.Results: We included 23058 people who participated in 33 studies; the total quality of life score was estimated at 59.45 (95% CI, 56.33-62.58). Based on the analysis, for each year added to participants’ age, their quality of life score was reduced by -0.3%. Furthermore, a significant association between gender and QOL was affirmed, indicating a more favorable condition among men. The highest score of QOL was reported in AMRO at 66.77 (95% CI, 60.55-73) and WPRO at 64.79 (95% CI, 59.30-70.28), respectively, while SEARO with 47.95 (95% CI, 47.67-48.23) got the lowest score.Conclusion: Our review robustly recommends the necessity for community health promotion programs to be implemented in vulnerable community segments and adds corresponding knowledge to the existing literature about the status of quality of life in people with different socio-demographic characteristics living in different regions worldwide.

Background: The pandemic of COVID-19 affect all healthcare systems globally, and its effect on different hospital performance indicators has been debated. The study aimed to compare the impacts of COVID-19 on hospital performance indicators using pre-and post-pandemic data from training hospitals.Methods: We conducted an observational cohort study of hospital performance indicators from two healthcare facilities affiliated with Qazvin University of Medical Sciences in the north-west of Iran. The R statistical software was used to analyze monthly data on three basic performance indicators, including bed turnover, average length of stay (LOS), and bed occupancy rate before and during the outbreak of Coronavirus disease-19 (COVID-19).Results: The pandemic had a remarkable effect on the level of bed turnover, the average length of stay (LOS), and the bed occupancy rate after one month from the COVID-19 outbreak (P

Introduction and purpose: In order to have more effective programs and social interventions controlling the burden of diseases, it is necessary for policy makers to have valid evidence about the role of socioeconomic determinants. The present study aimed to provide empirical evidence about the relationship of socioeconomic inequalities and the availability of resources with the burden of diseases among the provinces of the country in 2019. Methods: This descriptive and analytical research was carried out using the provincial data of 2019. The required provincial data were extracted from the Statistical Yearbook Report and the Household Income Expenditure Report of the Statistics Center and the data related to adjusted years with disability and early death (DALI) from the 2019 disease burden estimates. DALY's inequality was investigated by estimating the concentration index and extracting the concentration curve at a 95% confidence interval. The analyses were carried out in the Stata software (version 15). Results: In 2019, the average per capita DALY was 18.33±3.98. The average socio-economic index and resource availability index for 31 provinces were obtained at 0.37±0.21 and 0.64±0.20, respectively. Considering the difference in the available resources (covariate), there was a statistically significant difference between the socio-economic quartiles in terms of the distribution of per capita DALY (P

Abstract Background The hospital environment is very dynamic and faces many internal and external changes. Healthcare knowledge and technology are developing at a swift pace. This study investigated the relationship between succession and intellectual capital with entrepreneurship at the Qazvin University of Medical Sciences hospital, Iran. Methods The number of employees working in six hospitals was 2256, and according to Morgan’s table, the required number of samples was 331. We distributed three hundred sixty-five questionnaires considering 10% of sample loss. We used a multi-stage stratified sampling method. In the first stage, each hospital was considered a stratum. After that, occupational groups were considered the next stratum within each hospital, and based on the ratio, the required number of samples for each occupational group was randomly selected. We used the Sobel test to investigate the mediating role of intellectual capital and the structural equation model to fit the research model. Results Succession aspects, including culturalization, meritocracy, job promotion path, and the role of senior managers, have a positive and significant effect on intellectual capital. Succession is only effective on intellectual capital and does not affect the personnel’s entrepreneurship directly or through intellectual capital. Conclusion Conducting training classes and intervention programs and using localized succession models can create a suitable platform for increasing organizational creativity and entrepreneurship, motivating the hospitals’ personnel, and increasing intellectual capital.

Background: Depression and anxiety are the psychological problems that have intensified during Covid-19 and have affected the psychological well being of people. The purpose of this study was to systematically review the prevalence of anxiety and depression in Middle East countries.Methods: In this review, we searched for studies aiming to estimate the prevalence of depression and anxiety during the Covid-19 pandemic among the general population in databases including Scopus, PubMed, Web of Science, EMBASE, and Google Scholar from January 2020 to February 2021. We used the Comprehensive Meta-Analysis-2 software for data analyses and generated forest plots of the summary pooled prevalence.Results: In this systematic review, 55 articles with a total sample size of 28128 people were included. The pooled analysis of depression and anxiety amid the pandemic was estimated at 41% and 39%, respectively. Based on the study results, Iraq and Egypt had the highest prevalence rates of depression at 88% and 82%, respectively. Regarding anxiety, the highest and lowest prevalence rates were reported for Egypt with 91% and Qatar with 17%.Conclusion: To effectively provide mental health services for people, particularly the ones who are suspected of higher risk of depression and anxiety, it is necessary to identify individuals who are more likely to be suffered from psychological problems.

Introduction: Health workers, especially nurses, are facing a high risk of contracting the COVID-19 and consequent mental disorders such as stress, anxiety and depression. We aimed to study the relationship between anxiety, stress and the protective behavior of nurses during the Covid-19 pandemic. Material and Methods: This cross-sectional study was conducted on nurses working in COVID -19 referral hospitals in Qazvin, Iran, in 2020. Out of 645 nurses working in two hospitals, 260 of them were selected randomly. Three questionnaires including demographic and contextual information, COVID-19 anxiety, stress and precautionary behaviors against COVID-19 were used. Descriptive statistical methods, Pearson correlation, t-test and one-way analysis of variance and binary logistic regression analysis were applied at 95% confidence interval. Results: The prevalence of anxiety symptoms in nurses was 32.08%, the mean score of protective behavior was 18.45+5.66 and the maximum score was 22.06+4.7. The negative relationship between anxiety and nurses precautionary behavior) β=-0.36, P

Summary: Background: The objective of this study is to investigate the trends of exposure and burden attributable to the four main metabolic risk factors, including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body-mass index (BMI), and high low-density lipoproteins cholesterol (LDL) in North Africa and the Middle East from 1990 to 2019. Methods: The data were retrieved from Global Burden of Disease Study 2019. Summary exposure value (SEV) was used for risk factor exposure. Burden attributable to each risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life-years (DALYs). Findings: While age-standardized death rate (ASDR) attributable to high-LDL and high-SBP decreased by 26.5% (18.6–35.2) and 23.4% (15.9–31.5) over 1990–2019, respectively, high-BMI with 5.1% (−9.0–25.9) and high-FPG with 21.4% (7.0–37.4) change, grew in ASDR. Moreover, age-standardized DALY rate attributed to high-LDL and high-SBP declined by 30.2% (20.9–39.0) and 25.2% (16.8–33.9), respectively. The attributable age-standardized DALY rate of high-BMI with 8.3% (−6.5–28.8) and high-FPG with 27.0% (14.3–40.8) increase, had a growing trend. Age-standardized SEVs of high-FPG, high-BMI, high-SBP, and high-LDL increased by 92.4% (82.8–103.3), 76.0% (58.9–99.3), 10.4% (3.8–18.0), and 5.5% (4.3–7.1), respectively. Interpretation: The burden attributed to high-SBP and high-LDL decreased during the 1990–2019 period in the region, while the attributable burden of high-FPG and high-BMI increased. Alarmingly, exposure to all four risk factors increased in the past three decades. There has been significant heterogeneity among the countries in the region regarding the trends of exposure and attributable burden. Urgent action is required at the individual, community, and national levels in terms of introducing effective strategies for prevention and treatment that account for local and socioeconomic factors. Funding: Bill & Melinda Gates Foundation.

Background: Behcet’s disease is a chronic fatal illness with a relapsing remitting nature and significant organ-threatening morbidity and mortality. The aim of this research was to examine studies which were conducted on investigation of prevalence of quality of life among patients with Behcet’s disease. Methods: A total of 13 articles were extracted from four main databases including PubMed, EMBASE, Scopus, and Web of Science from the onset of 2000 to January 2021. All studies published in English with the purpose of examining quality of life (QOL) among patients with BD or investigating its main determinants were included. Results: Totally, 1137 BD patients participated in 13 studies. Based on random effect analysis, the total score of physical health-related QOL was 46.7 (95% CI=41.26 to 52.13) and the total score of mental health-related QOL was 49.01 (95% CI=43.83 to 54.18) representing a moderate level of QOL among BD patients. Furthermore, weighted effect size analyses showed a significant correlation between QOL and variables such as patients’ age, gender, disease duration and depression (pvalue: 0.00). Conclusion: As the symptoms of BD worsen over time, patients confront with more severe body pain, mobility restrictions, and difficulties in chewing, eating, speaking and swallowing which negatively affect social interactions of patients and reduce their QOL. Furthermore, depression was proved to act as a deteriorating factor for HRQOL among BD patients. Thus, patients need to be psychologically supported by a specialized team and be informed during the course of treatment to gain useful information about the disease, treatment approaches and coping strategies.

Summary: Background: The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods: In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings: In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95% uncertainty interval [UI] 9·1–9·3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95% UI 24·3–25·3) spent by low-income countries in 2019. That same year, $43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and $37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation: There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained. Funding: Bill & Melinda Gates Foundation.

ObjectivesHospital-acquired infections (HAIs) are significant problems as public health issues which need attention. Such infections are significant problems for society and healthcare organizations. This study aimed to carry out a systematic review and a meta-analysis to analyze the prevalence of HAIs globally.MethodsWe conducted a comprehensive search of electronic databases including EMBASE, Scopus, PubMed and Web of Science between 2000 and June 2021. We found 7031 articles. After removing the duplicates, 5430 studies were screened based on the titles/ abstracts. Then, we systematically evaluated the full texts of the 1909 remaining studies and selected 400 records with 29,159,630 participants for meta-analysis. Random-effects model was used for the analysis, and heterogeneity analysis and publication bias test were conducted.ResultsThe rate of universal HAIs was 0.14 percent. The rate of HAIs is increasing by 0.06 percent annually. The highest rate of HAIs was in the AFR, while the lowest prevalence were in AMR and WPR. Besides, AFR prevalence in central Africa is higher than in other parts of the world by 0.27 (95% CI, 0.22-0.34). Besides, E. coli infected patients more than other micro-organisms such as Coagulase-negative staphylococci, Staphylococcus spp. and Pseudomonas aeruginosa. In hospital wards, Transplant, and Neonatal wards and ICU had the highest rates. The prevalence of HAIs was higher in men than in women.ConclusionWe identified several essential details about the rate of HAIs in various parts of the world. The HAIs rate and the most common micro-organism were different in various contexts. However, several essential gaps were also identified. The study findings can help hospital managers and health policy makers identify the reason for HAIs and apply effective control programs to implement different plans to reduce the HAIs rate and the financial costs of such infections and save resources.

Background: Organizational culture can affect the levels of entrepreneurship and innovation through identifying the social capital dimensions and enhance the ability of staff to accept challenges. This study aimed to examine the impact of organizational culture on entrepreneurial behavior with the mediating role of social capital among the staff working in Qazvin University of Medical Sciences. Methods: This was an cross-sectional analytical study conducted among the staff of Qazvin University of Medical Sciences in 2020. Sample size was calculated by Cochran formula considering type I error and the accuracy of 5 % and was equal to 122 individuals. Addressing sample attrition, the final size considered to be 143 people by calculating 15 % increase. The standard questionnaires of entrepreneurial behavior were applied to collect the data. Descriptive statistical tests were used in order to analyze the data; moreover, correlation coefficients were applied to examine the relationship between the main variables of the study. Furthermore, the Structural Equation Analysis (SEM) test was used by LISREL and SPSS software to test the research hypotheses. Results: The estimated coefficient reported for the relationship between organizational culture and entrepreneurial behavior was 23 %; while it was reported to be 12 % for the relationship between social capital and behavior. Furthermore, the hypothesis that social capital mediates the relationship between organizational culture and entrepreneurial behavior was confirmed (T statistic = 3.310, Std. Error = 0.110, P-value < 0.001 ). Conclusion: The results of the present study necessitate further attention to university environments and higher education institutions for creating an entrepreneurship culture by establishing a flexible structure with participatory and supportive management in order to empower human resources and encourage them to promote social capital. Holding discussion sessions with staff and using their pure ideas and avoiding the implementation of strict regulations in addition to creating a participatory atmosphere can play important role in this regard.

Introduction: Recognizing the personality traits of employees and examining the role of these traits in motivating people’s safety can greatly lead to the formation of safe behavior of employees. Considering the significant importance of reducing adverse events and developing safe behaviors, the present study aimed to investigate the role of nurses’ personality traits in their safety behaviors with the mediating role of safety motivation during 2019-2020. Material and Methods: This is a descriptive-analytical study conducted among nurses working in educational hospitals affiliated by Qazvin University of Medical Sciences, from which 435 individuals were selected by multi-stage proportional sampling method. Data were collected using McCray and Costa Five-Factor Personality Questionnaire, Saleh Motivation Questionnaire (2010) and Safe Behavior Questionnaire (2016) and analyzed by SPSS software version 26 and AMOS software version 23. Results: The path coefficients between nurses’ personality traits and their safety motivation (0.557) and safety motivation with safe behavior of individuals (0.267) were statistically significant (p

Background: Cost of Quality is an approach that helps organizations evaluate the extent to which their resources are used to prevent poor quality activities, assess the quality of provided services, or evaluate the number of resources that are wasted due to the internal and external failures occurring in a system. The research objective was to measure the Cost of Quality(CoQ) in a medical device division of a hospital in Qazvin, Iran. Methods: We performed a qualitative study in the medical device division in a public hospital affiliated with Qazvin University of Medical Sciences, Iran in 2020. To measure and report the (CoQ) in the division, the Prevention-Appraisal-Failure (PAF) model was used. Data were collected through document review, semi-structured interview, and group discussion, which were entered into the Excel software to calculate their distribution and frequencies using the descriptive statistics method. Results: Among different cost categories, the highest amount of expenditures belonged to internal and external failure costs. Results also revealed that several factors were responsible for the failures, including lack of knowledge of personnel about the proper use of medical devices; failure to periodically perform calibration on due dates; lack of adequate supervision; stress and work pressure among employees; and lack of managerial commitment toward the importance of preventive maintenance. Conclusion: In order to decrease the number of failures occurring in a working system, it is required to increase personnelchr('39')s knowledge about the proper use of medical devices, perform calibration of devices on due dates, increase managerial commitment toward preventive and quality appraisal activities and apply systematic supervision.

Background: Nowadays, most organizations, including universities, are subject to significant changes. Thus, in order to adapt themselves successfully with such variations, they need skillful, innovative, self-confident, and entrepreneurial individuals. Accordingly, this study was conducted to predict medical university students' educational performance based on the existing social capital and their entrepreneurial behavior. Methods: A cross-sectional study was done in 2019 based on Structural Equation Modeling (SEM) among 260 students of Qazvin Medical University. To collect information, three standard questionnaires, including Nahapiet and Ghoshal (1998) social capital questionnaire, the entrepreneurial behavior questionnaire of Leon Dice, and the entrepreneurial performance questionnaire of Zamptakis and Vasilis Mustakis (2007), were used. After entering data in AMOS software, the associations between variables were analyzed by structural equation modeling. Results: Findings revealed that social capital and entrepreneurial behavior were influencing factors on the educational performance of students. The direct and indirect effects of social capital on educational performance (path coefficients: 0.798 and 0.44 respectively) were affirmed (P-value < 0.05). Conclusion: Promoting social capital, innovation, and entrepreneurial behavior among university students can improve the educational performance of students. Thus, applying effective strategies to create trust in the education system and designing new approaches to use motivational methods in strengthening students' sense of creativity and innovative capabilities can effectively contribute to the improvement of their educational performance.

BackgroundThyroid cancer is the leading cause of mortality and morbidity among cancers of the endocrine system. We aimed to describe the trends of thyroid cancer burden in North Africa and Middle East for 1990–2019.MethodsData on burden of thyroid cancer in North Africa and Middle East from 1990 to 2019 were obtained from the Global Burden of Disease (GBD) Study 2019. Decomposition analysis was used to estimate the effects of population growth, aging, and change in incident numbers on overall change of thyroid cancer incidence. Also, we used the comparative risk assessment framework of GBD to determine the burden of thyroid cancer attributable to a high body mass index (BMI).ResultsIn 2019, the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of thyroid cancer were 3.5 (2.9–4) and 0.5 (0.5–0.7) per 100,000, respectively. The highest age-standardized incidence, deaths, and disability-adjusted life year (DALY) rate were in Lebanon, Afghanistan, and United Arab Emirates, respectively. The ASIR of thyroid cancer in region was about 2.5 times higher among women, which had a positive association with increasing age. In 2019, the age-standardized deaths attributable to a high BMI was 16.7% of all deaths due to thyroid cancer. In 1990–2019, the overall change in thyroid cancer incident cases was a 396% increase which was mostly driven by the increase in disease-specific incidence rate (256.8%).ConclusionsWomen, the elderly above about 60 years old, and countries with a higher sociodemographic index showed higher incidence rates of thyroid cancer. Regarding our findings, it is recommended to establish preventive plans by modification in life style like weight reduction programs.

Background: A few studies have reviewed and revised ICU admission criteria based on specific circumstances and local conditions. The aim was to develop ICU admission criteria and compare the cost, mortality, and length of stay among identified admission priorities. Methods: This was a cross-sectional study conducted in an intensive care unit of a training hospital in Qazvin, Iran. The study was conducted among 127 patients admitted to ICU from July to September 2019. The data collection tool was a self-designed checklist, which included items regarding patientschr('39') clinical data and their billing, type of diagnosis, level of consciousness at the time of hospitalization based on GCS scale or Glasgow Coma Scale, length of stay, and patient status at the time of discharge. Descriptive statistical tests were used to describe study variables, and in order to determine the relationship between study variables, ANOVA and Chi-square test were used. Results: A set of criteria were designed to prioritize patient admissions in ICU. Based on the defined criteria, patients were categorized into four groups based on patientchr('39')s stability, hemodynamic, and respiration. Study findings revealed that a significant percentage of patients were admitted to the ward while in the second and third priorities of hospitalization (26.8 % and 32.3 %, respectively). There was a statistically significant difference in the four groups in terms of patientschr('39') age, total cost, and insurance share of the total cost (P-value < 0.05). Conclusion: Study results emphasize the necessity to classify patients based on defined criteria to efficiently use available resources.

Background: This study was designed to conduct a systematic review and meta-analysis of existing literature examining the prevalence of depression among hospital staff and the impact of various factors with a view to organize related programs for reducing the complications of this mental disorder. Method: A total of 24 studies were extracted from a literature search conducted through electronic databases including PubMed, EMBASE, Scopus, and Web of Science from January 2019 to February 2021. Findings: Following the extraction of data, the total number of hospital staff was reported to be 42,010. Based on the results, depression prevalence among them was 26% (95% Cl, 0.18–0.35). Furthermore correlation coefficients revealed a significant relationship between the rate of depression and variables including type of career, age, and gender (P-value

Background Centers for Disease Control and Prevention data showed that about 40% of coronavirus disease 2019 (COVID-19) patients had been suffering from at least one underlying medical condition were hospitalized; in which nearly 33% of them needed to be admitted to the intensive care unit (ICU) to receive specialized medical services. Our study aimed to find a proper machine learning algorithm that can predict confirmed COVID-19 hospital admissions with high accuracy. Methods We obtained data on daily COVID-19 cases in regular medical inpatient units, emergency department, and ICU in the time window between 21 July 2020 and 21 November 2021. Data for the first 183 days (training data set) were used for long short-term memory (LSTM) network, adaptive neuro-fuzzy inference system (ANFIS), support vector regression (SVR) and decision tree model training, whilst the remaining data for the last 60 days (test data set) were used for model validation. To predict the number of ICU and non-ICU patients, we used these models. Finally, a user-friendly graphical user interface unit was designed to load any time series data (here the trend of population of COVID-19 patients) and train LSTM, ANFIS, SVR or tree models for the prediction of COVID-19 cases for one week ahead. Results All models predicted the dynamics of COVID-19 cases in ICU and non- wards. The values of root-mean-square error and R 2 as model assessment metrics showed that ANFIS model had better predictive power among all models. Conclusion Artificial intelligence-based forecasting models such as ANFIS system or deep learning approach based on LSTM or regression models including SVR or tree regression play a key role in forecasting the required number of beds or other types of medical facilities during the coronavirus pandemic. Thus, the designed graphical user interface of the present study can be used for optimum management of resources by health care systems amid COVID-19 pandemic.

Background:The process of the patient discharge from the hospital is one of the most important processes that has been taken into consideration by managers in recent years. An efficient health system can only accomplish its duty to provide the health of the community by providing the right services and this system can be evaluated through its services. Therefore, the necessity of performing this research is to improve the quality of hospital services for patients and increasing patient satisfaction. This study has been aimed to identify the factors affecting the process of patient discharge. Methods: This was a cross-sectional study conducted in a general hospital located in Takestan, Qazvin in 2019. The study population in the qualitative section of the study included those who were aware of the discharge process and had managerial positions in the hospital. The sampling process was continued until achieving data saturation. The required information was gathered through reviewing relevant literature, observing the discharge process, and conducting semi-structured interviews with managerial members and study experts. Results:In the present study, the most important factors affecting the discharge process were lack of timely physician visit and issuance of the discharge order, delay in the approval of medication used by pharmacy officer, sending discharge files to hospital discharge unit, the patients' needs, diagnostic services (discharging with doctor's opinion), delays in registering nursing records, and undue secretarial performance in reviewing and recording reports in the hospital information system. Conclusion: The results of the present study, in line with other researches, have shown that the importance of the discharge process on hospital performance is undeniable and this process needs continuous investigation, monitoring, and intervention.

Background: Nursing profession has a key role in providing health services. Objective for the study: The present study is an attempt to survey the relationship between organizational commitment and occupational burnout in nurses working in Shahid Sadoughi Hospital-Yazd in 2017. Methods: This descriptive-correlative study was conducted on 195 nurses working in Shahid Sadoughi Hospital. Based on the sample size, the participants were selected through stratified sampling. Data gathering tool included Maslach’s standard occupational burnout questionnaire and Allen Meyer’s organizational commitment questionnaire. The collected data were analyzed through SPSS using statistical tests like Pearson’s correlation. results: The mean score of organizational commitment was 75.42 and that of occupational burnout was 81.70; both of them were at moderate level. Organizational commitment, emotional sub-aspect, and continuous sub-aspect were directly and significantly related to occupational burnout (p≤0.01). In addition, there was a significant relationship between occupational burnout and gender so that it was higher in women compared with men (p ≤0.01). Conclusion: Managers can create proper and effective relationship with nurses and avoid the serious qualitative and quantitative outcomes of occupation burnout in nurses through introducing official and unofficial support strategies.

Background: The uneven distribution of human resources in the health sector, especially in the medical profession, is a global phenomenon that poses a significant challenge to the population's access to quality health services. The aim of this study was to investigate the influencing factors on the retention of specialists and subspecialists working in training hospitals of Qazvin University of Medical Sciences in order to provide appropriate suggestions and practical solutions to increase their chances of survival in these areas. Methods: This research is a descriptive-analytical study using conjoint analysis technique conducted between 2017 and 2018 among physicians. The study was conducted among 109 physicians who met the inclusion criteria of the study. DCE questionnaire was used to collect the research data. The collected data were entered into STATA software version 13 for statistical analysis and were statistically analyzed by Probit and Logistic regression models. Results:The results show that the probability of physicians' retention in the city of work is 1.2 times higher if they were allowed to work in the private sector (β = 1.2). Providing proximity to the family also doubles the chances of physicians' retention (β = 2.2). Provision of adequate educational facilities (β = 1.07), moderate clinical facilities (β = 1.18) and favorable accommodations (β = 1.12) also increase the likelihood of physicians' retention in the workplace. Conclusion: Considering all factors identified as the preferences of physicians due to the limitations of resources and the existing legal requirements cannot be applied in planning and policy making in the field of health care. However, being aware of these factors and then considering legal considerations that are considered mandatory by the Ministry of Health and Medical Education can greatly help in making effective policies in the area of physician retention.

Background & Aim: Regarding the chronic course of obstructive pulmonary disease and multiple problems which it brings to individuals and the community in terms of physical, mental, and economic aspects; this study aimed to investigate the role of life-style factors in disease exacerbation and hospitalization among COPD patients. Methods & Materials: This is a descriptive, prospective study of outpatients with COPD in a tertiary care clinic. To collect data, a demographic questionnaire (including age, gender, marital status, occupation, and educational level), an international physical activity questionnaire (IPAQ), and a mini-nutritional assessment (MNA) tool were used. Disease severity was also determined by Initiative for Chronic Obstructive Lung Disease (GOLD) index. Results: A total of 128 patients (78.1% male) were recruited with a mean age of 65.3+11.9 years. Findings revealed significant correlations among physical activity level of patients and their nutrition, smoking behavior, BMI, and disease exacerbation. In fact patients with older age, lower BMI, smoking habit for a long time, and limited physical activity were more probable to face with disease exacerbation and hospitalization. Conclusion: Evidence suggests that adoption of health promotion strategies and emphasis on health based approaches can be helpful in reducing hospitalization among COPD patients. Due to their effectiveness and low cost, such policies are regarded as cost effective strategies in dealing with chronic diseases.

Background: The provision of manpower is one of the effective factors on the improvement in the coverage of health services and the realization of the highest community health level and a considerable part of the health budget is devoted to the production and update on human resources. Therefore, the current study aimed to estimate the number of nurses required in the Emergency Department (ED) of Imam Ali hospital based on the proposed method of the World Health Organization, in which the manpower is calculated based on the workload Workload Indicators of Staffing Need (WISN). Methods: This was a cross-sectional descriptive study. The study population was all the nurses working in the emergency department of Imam Ali hospital affiliated by Alborz University of Medical Sciences and their duties in the hospital which was performed using the proposed method of the World Health Organization i.e. WISN in 2018. Determination of their duties and the time and number of times for performing them were carried out during the group discussion session through Delphi method. Results: Based on the research findings, 40 standard nurses were calculated. The studied hospital had 4 nursing staff shortages. The working pressure ratio is 0.91in this study. Conclusion: In the current study, the nursing staff shortage is observed and this shortage caused a high working pressure on the nurses working in the study area. Considering the vital role of nurses in the emergency department, it is recommended to employ and distribute the manpower based on the requirement and workload in the department.

Educational interventions are helpful strategies to empower communities encountering the threat of pandemics like Covid-19. This study was carried out to examine the effect of educational intervention on anxiety control and improvement in public quality of life. A quasi-experimental study. The study was conducted among individuals referred to healthcare centers of Qazvin province, Iran, in 2020. Given that Qazvin consists of nine urban healthcare centers, two centers were selected by a simple random selection method. After considering inclusion and exclusion mentioned criteria, 240 individuals were selected to participate in the research and were randomly assigned into two groups of experimental and control. Following the educational intervention, all study variables, including knowledge score, anxiety level, and quality of life, improved significantly in the experimental group compared to the pre-intervention phase (P

It is necessary for managers in all types of organizations to take an appropriate training approach in order to maintain and promote health, achieve safety, and prevent environmental damages. We aimed to evaluate the effectiveness of Health Safety and Environment training workshops from the students’ point of view to inform the relevant officials about the participants’ opinions and make efficient decisions in order to improve the quality of training courses in the field of health, safety, and environment. A qualitative study was conducted using face-to-face or telephone interviews with a purposeful number of 37 students studying at the faculty of the health of Qazvin University of Medical Sciences. To analyze data, thematic analysis using a framework approach was applied. Findings related to the students’ viewpoint about the effectiveness of the HSE workshop were presented in six main themes including satisfaction with the educational content, awareness about HSE concepts before the workshop, the importance of HSE subject in the participants’ field of study, important topics presented in the workshop, experience from HSE workshop, major workshop problems, and solutions. Based on the study results, one of the key objectives of all medical universities should be training their students about health and safety matters to potentially prepare them for future job positions with maximum safe behaviors in workplaces. In fact, medical universities play a key role in developing the health and safety knowledge of students helping them in protecting themselves while working in hazardous working conditions.

Socio-economic and life style factors are regarded as important influencing issues regarding to a wide range of chronic diseases including chronic obstructive pulmonary disease. This study aimed to explore the role of such factors as determinants of the disease exacerbation among COPD patients. A cross-sectional study was conducted among 150 COPD patients who referred to an outpatient respiratory care center in Qazvin, Iran to undertake respiratory function tests from December 2017 to June 2018. Disease severity was determined by Initiative for Chronic Obstructive Lung Disease (GOLD) index. Odds ratios were applied to find out factors associated with exacerbation. Study findings affirmed that within COPD severity groups, there were significant differences among patients in terms of educational level, smoking status, income and occupation. Factors associated with severe COPD were found to be smoking (OR 3.6, 2.6-4.2), lower education (OR 1.4, 0.9-2.6), insufficient income (OR 2.3, 0.6-3.1), and unsupportive family (2.7, 1.5-3.6).Due to the obtained evidence about the effect of socio-economic status on the prognosis of the disease, it is suggested that clinicians should also consider the nonclinical and social aspects associated with the disease in advancing patients' therapeutic procedures and management algorithms.

Background: One of the most important methods for improving the fair access of people to health services is the family physician program, which is facing many challenges. One of these challenges is the lack of policymakers' understanding of physicians' preferences regarding the provisions of the family physician contract. Therefore, this study was aimed to investigate general practitioners' preferences regarding the type of family doctor contract in one of the underprivileged regions of Iran. Methods: An analytical-cross-sectional study was conducted among 150 general practitioners (GPs) who registered in Ministry of Health and Medical Education (MoHME) family physician plan and were working in the health network of deprived regions in Iran. A discrete choice experiment (DCE) questionnaire was developed by the researchers and then distributed to GPs. Results were analyzed using Ordered Logistic Regression. Data were collected using a questionnaire designed by orthogonal method in SPSS 20. Data analysis was performed using logistic regression model in Stata 13 software. Results: Findings revealed that “type of employer” had the most significant effect on GPs’ preferences (OR = 2.5), followed by “allocating quota for admission to medical specialty courses after 5 years” (OR = 2.25), being allowed to give medical services to population without geographical restriction (OR = 2.8), being allowed to provide services out of the defined service packet (OR = 1.4), and “decreased length of contract” (OR = 0.93). Conclusion: The amendment of the provisions of the family physician contract in accordance with physicians' preferences increases the probability of their participation in and compliance with the family physician program. However, the compliance of the provisions of this contract with relevant international standards and upstream laws of the country should be maintained as much as possible.

Background: Measurement of the organizational performance would be effective and helpful for improvement, in the case that it is based on an appropriate and principled system. Such a system uses specific indicators to measure the productivity and performance of the organizations. In fact, these indicators act as useful tools for strategic planning in managerial levels. Given the importance of the issue, this study aimed to develop the key productivity indicators for hospitals affiliated to Isfahan University of Medical Sciences. These indicators are designed to be applied in evaluation, implementation, and improvement processes of the organizations under study. Methods: This was a qualitative study conducted among the hospitals affiliated to Isfahan University of Medical Sciences in 2015. Purposive sampling method was applied and the study participants were selected through snowballing. Then, the participants were organized in a focus group consisting of 16 experts in the field of hospital performance and efficiency indicators to achieve the research objectives by using indexing matrix method. Finally, validity of the developed indices was confirmed using Delphi method. Results: A total of 42 productivity indicators were formulated. Of these, nine indices were input (structural), which included financial, human resources, and energy consumption indicators. The next 29 indices were output and mainly belonged to the financial, efficiency, and quality area. The final four indices included process indicators and consisted of length of stay in emergency department, waiting time for out of hospital counseling, and waiting time for the presence of resuscitation team at the patient bedside during the cardiopulmonary resuscitation. Conclusion: Development of the indicators in three areas of input, process, and output helped managers and policy makers to access reliable and valid instrument for measuring organizational productivity.

Background: One of the main important principles of human health is spirituality which its promotion could lead to an effective control of work related stress; can be considered in nurses’ job performance and assurance of their physical and mental health as a crucial factor. This study aimed to explore the effect of spiritual health on job stress among nurses employed in a training hospital affiliated to Qazvin University of Medical Sciences in 2017. Materials and Methods: This was a descriptive-cross sectional one conducted on 220 nurses at Velayat hospital in Qazvin city. Data gathering was performed using two standard questionnaires including spiritual health and nurseschr('39') job stress. Data analysis was carried out with SPSS22 using descriptive statistical methods, Pearson Correlation Coefficient and multivariate regression analysis at a significance level of P < 0.05. Results: The mean score of spiritual health and job stress assessed at a moderate level 70.5±5.2 and77.5±2.3, respectively. Spiritual health in both religious and intrinsic dimensions, gender, job history and type of employment were statistically related to job stress (p

Abstract Introduction: In every country, educational systems are regarded as the axes of development. Therefore, evaluating different academic departments as the main parts of educational systems is one of the most important responsibilities for university managers and authorities This study aimed at evaluating educational performance of all departments at the School of Health, a University of Medical Sciences using Data Envelopment Analysis technique in a time period of 2012-2015. Methods: This descriptive, cross-sectional study evaluated the performance of the School of Health departments from 2012 to 2015 using Data Envelopment Analysis technique and Deap version 2.1. Results: The study findings revealed that 57% of the academic departments were efficient and had constant returns to scale (CRS) while others (43%) had decreasing returns to scale (DRS). The Departments of Health Care Management, Nutrition, and Environmental Health were mentioned as reference groups for those inefficient ones. Conclusion: Improving the quality of universities' performance depends greatly on competent and well-organized academic departments. Thus inefficient departments should benchmark reference groups to increase their output and promote the performance. Keywords: Performance evaluation, DEA, Academic department, Efficiency.

Background: Recent trends have led many organizations to use strategic planning for designing and implementing Total Quality Management (TQM) as a fundamental necessity. This study investigated the role of TQM in the quality maturity of hospitals from the employees’ point of view. Methods: A cross-sectional study was conducted among the senior managers and officials of three Zanjan University of Medical Sciences (ZUMS) training hospital wards, including supervisors, matrons, and all hospital committee members. All the managers who were willing to participate and met the inclusion criteria were recruited. Two questionnaires, including TQM Assessment and Quality Maturity of Hospital Services were used. Statistical analyses were conducted by SPSS through multivariable regression modeling. Results: The obtained results affirmed a significant effect of TQM on the quality improvement of hospital services; a unit of increase in the mentioned variable resulted in 0.63 unit of change in quality maturity (P

Background: Considering the role of general practitioners in the family physician plan, policymakers and planners are required to be aware of the factors influencing the practitioners' decision to enter this plan. The aim of this study was to identify the effective factors on the decision of general practitioners to participate in the family physician plan. Furthermore, the interaction among these factors and the demographic characteristics of physicians working in Yazd University of Medical Sciences were identified. Methods: This descriptive study was conducted on 137 general practitioners, who were selected using the census method and discrete choice test in 2018. Data were collected using a questionnaire designed by orthogonal method and analyzed by SPSS 24. Data analysis was conducted using the Logit regression model in Stata 13 software. Results: The findings showed that the "higher salary" construct was more favorable among the male married general practitioners who had higher incomes. Furthermore, married physicians were significantly more willing to provide out-of-pack services and use facilities of housing and transportations. On the other hand, these physicians have little desire to continue their education and use their quota for admission in the specialization course. Moreover, a reverse and significant relationship was observed between the place of service and the marital status. Conclusion: The family physician plan should be designed by taking into account the demographic characteristics of general practitioners. Therefore, more general practitioners would participate in and cooperate with the plan. The upstream laws of Iran emphasize the necessity of implementing family physician program and general practitioners have an important role in the formation and successful implementation of this program. Consequently, policy making in this area should take into account the demographic variables of physicians, so that more physicians are attracted to it.

Influencing Factors on Patients’ Length of Stay in an Emergency Department of a Training Hospital Bagheri Zahra1, Rafiei Sima*2, Mohebbifar Rafat3 1. MSc Student in Healthcare Management, Student Research Center, Qazvin University of Medical Sciences, Qazvin, Iran 2. Assistant Professor, Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran 3. Associate Professor, Department of Healthcare Management, School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran *Correspondence: School of Public Health Qazvin University of Medical Sciences, Bahonar Blvd., Qazvin, Iran. Tel: 00982833369581 Email: sima.rafie@gmail.com Abstract: Background & Objectives: Patients’ length of stay in emergency departments is one of the key criterion which has been focused by hospital managers recently. This study aimed to assess the influencing factors on patients’ length of stay in an emergency department of a training hospital affiliated by Alborz Medical University of Medical Sciences. Methods: This was a descriptive-analytical study with a cross-sectional design in 2017. Study population consisted of all inpatients in a six month time period from the beginning of the study year. Through the use of Cochrane sample size calculation formula 555 numbers of samples were selected which their related data were obtained from the review of patients’ medical records. To test study hypotheses data were entered to a SPSS version 20 and analyzed through descriptive statistical analysis method, Pearson correlation test, t-test, and ANOVA. Results: Mean of patients’ length of stay was 11.31 hours. Evidence showed that this mean time was correlated with some of the factors including internal or external medical counseling, the necessity to have a medical laboratory test, a medical imaging test or the time interval between triage and the first physician’s visit. Conclusion: Modifying hospital processes and performance procedures in an emergency department with an aim to improve service quality and effective interactions among different hospital units can play a helpful role in solving existing problems. Key­words: Length of Stay, Emergency Department, Training Hospital, Inpatients ­Citation: Bagheri Z, Rafiei S, Mohebbifar R. Influencing Factors on Patients’ Length of Stay in an Emergency Department of a Training Hospital. Journal of Health Based Research 2019; 4(4): 371-81. [In Persian]

Background: One of the main important factors which affects nurseschr('39') job performance and potentially influences their capability in accomplishing their tasks and responsibilities is job burnout (JB). This study aimed to investigate the moderating role of JB on the relationship between QWL and job performance among nurseschr('39') employees in emergency departments of five training hospitals affiliated to Qazvin University of Medical Sciences in 2017. Materials and Methods: This descriptive, cross-sectional study was conducted among 178 nurseschr('39') employees in emergency departments of five teaching hospitals affiliated to Qazvin University of Medical Sciences in 2017. In order to assess main variables of present study, three standard questionnaires consisted of Walton QWL, Maslach and Jackson job burnout and Paterson job performance were used. Descriptive statistics, Pearson correlation coefficient and moderated multiple regression analysis were used to analyze data. The level of significance was set less than 0.05. Results: Study results revealed that most of the nursing staff had a low level of QWL, experienced a considerable JB with a moderate to high level of performance. Furthermore, QWL predicted 21% of variances regarding to job performance (R2=0.21, p=0.04). The moderated multiple regression results supported the hypothesis that JB had a significant effect on the relationship between QWL and nurseschr('39') job performance (β≠0, p=0.02). Conclusion: Considering the importance of QWL and efforts to develop an appropriate condition to promote different aspects of QWL would play an important role in nurseschr('39') productivity and accomplishment of their performance goals.

Background: Social capital has an important role in empowering entrepreneurship activities and performance improvement inhuman resources. This study aimed to examine the relationship between social capital and entrepreneurship behavior of academic members of Qazvin University of Medical Sciences in 2018. Methods: The present study is a descriptive cross-sectional method conducted among all faculty members working in Qazvin University of Medical Sciences in 2018. In order to collect study data, two standard questionnaires including social capital scale (Nahapiet & Goshal 1998) and entrepreneurial behavior (Leon Daes Zamptakis and Vasiliss Mustakis 2007) were used. Data were analyzed using descriptive and analytical statistical methods in SPSS 20. Results: The results of the study showed that social capital and entrepreneurial behavior had a desirable condition. Furthermore, these two variables were statistically correlated (P-value < 0.05). Conclusion: Promoting the level of social capital in academic environments has significant benefits and a positive impact on entrepreneurial behaviors of academic members of the university. Therefore, managers should strengthen this key element in their organizations to upgrade their professional job performance.

Background: Human resources are the key component of health systems. It is critical to have the right number of human resources at anytime and anywhere in the health system. This article aims to help local health decision makers to identify potential gaps between the future supply and demand of human resources and to make necessary changes in medical training processes to fill the gap. Methods: An eight-stage process was applied to project the supply and demand of health workers in Ilam province in 2025 for the following fields: public health, environmental health, general medicine, dentistry, pharmacy, nursing and midwifery. To estimate the demand for human resources, a mainly population-based model (manpower-to-population ratio) was applied. A modified version of the Australian dynamic stock and flow model was used to predict the supply of new recruits in 2025. The potential surplus or shortfall in the health workforce was calculated by comparing the supply and demand in 2025. Results: The demand and supply projections for the chosen fields were estimated respectively as: general medicine 457, 709; pharmacy 131, 86; dentistry 86, 251; nursing 949, 1657; midwifery 24, 247; public health 182, 211; and environmental health 92, 225. Conclusions: The current trend of medical graduates will meet the need for human resources in 2025, and there is no need to increase medical student admission. The Education Deputy of Ilam Medical University should take into account the health needs of its catchment area in medical educational processes and training new health-care staff.

Background: The study aimed to assess affecting structural factors on the entrepreneurship behavior of the academic members of healthcare in Qazvin University of Medical Sciences, Central Iran. Methods: This was a descriptive, cross-sectional study conducted among faculty members working in five faculties of Qazvin University of Medical Sciences, Iran in 2018. Data were collected using a three-part standard questionnaire including demographic characteristics, entrepreneurial behavior and structural factors questions. ANOVA and linear regression modeling were used in STATA software version 14. Results: Of 270 academic staff who participated in the study, 204 (73%) completed the questionnaire. The mean score reported for entrepreneurial behavior was 3.76±0.55 considered high tendency toward entrepreneurship. Moreover, the average conditions of the structural elements have been 2.51±0.89 considered average. Linear regression analysis showed that along with increasing age, entrepreneurship behavior increased (P=0.018, β=0.52), while an increase in educational level led to a decrease in entrepreneurship behaviour (P=0.001, β=-0.74). In a final model, organizational structure revealed a significant effect on entrepreneurship behavior (P0.05). Conclusion: Universities must also pay attention to acquiring and developing the science and technology gained from academic research and transferring them through entrepreneurship channels. Considering the effect of structural elements on entrepreneurial behavior of the academic members, the need for such substructure in the universities and the country’s higher education organizations to assist development of entrepreneurial behavior among the academicians is greatly felt.

Background: In order to develop entrepreneurship, we need to study and recognize the present entrepreneurship situation precisely. The aim of this study was to determine the entrepreneurship behavior of the faculty members in Qazvin University of Medical Sciences and its effective structural factors. Methods: This analytical cross-sectional study was conducted among 270 faculty members working in 5 schools of Qazvin University of Medical Sciences in 2018. A three-part standard questionnaire including demographic characteristics, entrepreneurial behavior, and structural factors questions was used for data collection. Furthermore, ANOVA and linear regression modeling were applied using Stata 13 software. Results: The mean scores reported for the entrepreneurial behavior and structural elements of participants were 3.76 ± 0.55 and 2.51 ± 0.89, respectively. These rates show high tendency of the faculty members toward the entrepreneurship and average conditions for the structural elements. With increase of age, entrepreneurship behavior increased; whereas, an increase in the educational level led to a decrease in entrepreneurship behavior (p < 0.05). Finally, in the last model, the organizational structure revealed a significant effect on entrepreneurship behavior (p < 0.05). Conclusion: Considering the effect of structural elements on entrepreneurial behavior of the faculty members, we need such substructure in the universities and the higher education organizations of Iran to assist development of entrepreneurial behavior among the faculty members.

Background: Literature has focused that oxidative damage is a common factor in the aging process and the formation and development of major diseases. Such a finding encouraged the use of antioxidants to prevent and treat mentioned problems. Several research endeavors have done on the issue to find out any relevant relationship between antioxidant use and human being health especially in the case of preventing premature aging and many kinds of diseases. This study outlines results of representative research studies conducted worldwide to clarify the necessity of antioxidant use in health promotion of human life. Methods: For the purpose a literature review was done through defining an appropriate search strategy to identify existing evidence and key publications on the issue. Results: Study findings revealed that existing literature is not enough to prove the antioxidant usefulness for improving human health outcomes and it seems that other factors including life style should also be considered instead of focusing on isolated antioxidants as single leading factors. Conclusions: It is necessary to obtain comprehensive information from the influencing factors including disease origins, diet and different environmental, individual factors to determine possible effects on health condition or survival.

Background and Objectives: The work-family conflict has many negative consequences, such as absenteeism, employee turnover, and reduced performance. This study aimed to investigate and compare perceived work-family conflict among clinical and non-clinical employees working in hospitals affiliated to Shahid Sadoughi University of Medical Sciences. Methods: This descriptive analytical cross-sectional study, was conducted on 210 employees working in Shahid Sadoughi educational hospital in Yazd city, 2016. Data collection was performed using Carlson work-family conflict questionnaire. Data analysis was carried out by t -test, Spearman correlation coefficient, and one-way analysis of variance. Results: The mean perceived work-family conflict among the study population in terms of three dimensions of time, pressure, and behavior, were 18.11+4.23, 7.91+5.09, and 18.16+4.71, respectively, which showed a significant difference between clinical and non-clinical employees (p