What makes inequality in the area of dental and oral health in developing countries? A scoping review.

BACKGROUND: Equity in health is an important consideration for policy makers particularly in low and middle income developing country. The area of oral and dental health is not an exception. This study is conducted to explore the main determinants that make inequality in oral and dental health area in developing countries. METHODS: This was a scoping review applying the framework enhanced by Levac et al. Four databases of Scopus, PubMed, WOS and ProQuest were systematically searched applying to related keywords up to 27.11.2020. There restriction was placed in the English language but not on the study design. All the related studies conducted in the low or middle income developing countries were included. A qualitative thematic analysis was applied for data analysis and a thematic map was presented. RESULTS: Among 436 articles after excluding duplications, 73 articles were included that the number of publications from Brazil was greater than other developing countries (33.33%). Thematic analysis of the evidence has led to 11 determinants that may result in inequality in oral and dental health services in developing countries including personal characteristics, health status, health needs and health behaviours, social, economic, cultural and environmental factors, as well as insurance, policies and practices and provided related factors. CONCLUSION: The policymakers in the low and middle income developing countries should be both aware of the role of inequality determinants and also try to shift the resources to the policies and practises that can improve the condition of population access to oral and dental services the same as comprehensive insurance packages, national surveillance system and fair distribution of dentistry facilities. It is also important to improve the population's health literacy and health behaviour through social media and other suitable mechanisms according to the countries' local contexts.

Provision of dental services for vulnerable groups: a scoping review on children with special health care needs.

BACKGROUND: The provision of dental services for children with special health care needs (CSHCN) needs to be considered by policymakers. This study is aimed to explore the determinant factors affecting dental and oral services provision for this vulnerable group. METHODS: A review was conducted applying the 9-steps approach. Five scientific databases of PUBMED, SCOPUS, Web of Science and PROQUEST and EMBASE were searched up to 10.07.2021, applying appropriate keywords. Thematic analysis was used to analyse the extracted data, and a conceptual map was developed according to JBI manual for evidence synthesis. RESULTS: From the abstracts of the 136 articles that fulfilled the inclusion criteria, 56 articles were included. Five main themes were identified as determinants affecting the provision of dentistry services for CSHCN, including needs assessment, policy advice, oral health interventions, providers' perception and access barriers. According to the developed conceptual map, assessing the needs of CSHCN can lead to particular policy advice. Regarding the policies, appropriate oral health interventions can be presented. These interventions, along with providers' perception about service delivery to CSHCN and the barriers to access them, determine the provision of dentistry services for CSHCN. CONCLUSIONS: An effective needs assessment of CSHCN and their parents/carers can lead to evidence-informed policymaking and applicable policy advice according to the needs. Then policymakers should develop interventions to improve the community's health literacy, as well as support the seeking behaviours for appropriate services. Policymakers should also consider how to limit the barriers to accessing oral and dental health by CSHCN to decrease disparities.

Main Factors Affecting the Readiness and Responsiveness of Healthcare Systems during Epidemic Crises: A Scoping Review on Cases of SARS, MERS, and COVID-19.

Background: Given the significance of the preparedness and responsiveness of healthcare systems in relation to epidemics, this study aimed to determine their influencing factors during epidemic crises with a view to utilizing the findings in the battle against the coronavirus disease 2019 (COVID-19) outbreak. Methods: This scoping study was conducted in 2020 via the Arksey and O'Malley approach. A systematic search was conducted on five online databases from January 2000 to June 15, 2020. Initially, 1926 English articles were retrieved based on their abstracts. After the screening process, 60 articles were considered for the final analysis. Data were charted by applying Microsoft Office Excel 2013 and were synthesized via thematic analysis. Results: Five main factors have affected the responsiveness and preparedness of countries during the epidemics of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19: community-related interventions, managerial interventions, socioeconomic factors, the readiness of hospitals and health centers, and environmental factors. These themes are associated with 38 related sub-themes. The thematic framework shows that interactions between these five determinantes can affect the preparedness and responsiveness of healthcare systems during pandemics/epidemics. Conclusion: According to the results, healthcare systems need to pay attention to their internal capacities, managerial interventions, and health centers to overcome the current pandemic. They should also consider such external factors as socioeconomic and environmental determinants that can affect their potential preparedness against pandemic/epidemic crises. Community-related interventions such as improvement of the community health literacy, teamwork, and social responsibility can enhance the readiness of healthcare systems against the COVID-19 outbreak.

Iranian's healthcare system challenges during natural disasters: the qualitative case study of Kermanshah earthquake.

BACKGROUND: In order to the significance of lessons learned from the natural disasters for health care systems particularly in developing and under-developed countries, the main purpose of this study was to identify challenges and limitations in light of the earthquake experience in Kermanshah Province. METHODS: The present study was conducted in 2019 as a qualitative research using content analysis method. In this regard, 19 key informants were selected using snowball sampling. To enhance the accuracy of the study, the four validation criteria for qualitative studies in data coding developed by Guba and Lincoln including credibility, transferability, dependability and confirmability were used. Data was analyzed applying Graneheim and Lundman (2004) approach for analyzing the qualitative content of an interview text. RESULTS: Analysis of the data led to the identification of 2 main themes, 5 sub- themes and 17 main categories. The first main theme was health system oriented challenges containing challenges of medication supply and preparation, structural challenges, challenges in crisis-scene management and challenges of service delivery and the second main theme was non-health system oriented challenges including social and psychosocial challenges. CONCLUSION: According to the results, along with health system oriented challenges with the inter-sectoral or intra-sectoral nature, the non-health system oriented challenges the same as social, cultural and psychological factors can be considered as the major challenges of Iran's healthcare system in the face of crises. This complicated context can shed the light to policy makers that not only attention to the medicine and medical equipment supply chain, manpower preparation and service delivery system can be considered as an emergency, but also careful attention to the structural challenges and crisis-scene management should be planned and considered as a priority. Besides, the policy makers and the local managers should try to plan and act in a contingent situation according to the social and cultural characteristics of the region and the psychological condition and the mental needs of the people.

Oral health policymaking challenges in Iran: a qualitative approach.

BACKGROUND: As the strategies proposed for oral health improvement in developed countries are not adapted for developing ones, this study aimed to identify the challenges of oral health policy implementation in Iran as a low-income developing country. METHODS: This qualitative study was conducted in 2019 in Iran as a middle-eastern developing country. The study population consisted of experts who had experience in oral health and were willing to participate in the study. Snowball sampling was used to select 12 participants for semi-structured interviews and saturation was achieved after 16 interviews. Guba and Lincoln criteria including credibility, transferability, confirmability and dependability were used to determine reliability and transparency, and finally a five-step framework analysis method was used to analyze the data. RESULTS: The analysis of the interviews resulted in identification of 7 main themes that were categorized into 5 problems of policy implementation as proposed by the Matus framework. The main themes of executive and preventive challenges to implement oral health policies were categorized as organizational problems, the main themes of educational and resource challenges were situated as material problems, and the main themes of insurance, policy making and trusteeship challenges were considered as legal, policymaking and perspective. CONCLUSION: The implementation of oral health policies has faced some challenges. It seems that the national coverage of oral health and integration of these services in prevention and serious attention to the private sector can be considered as the most important strategies for achieving improved oral health in Iran.

The necessity revealed by COVID-19 pandemic: Paradigm shift of Iran's healthcare system.

Background: COVID-19 pandemic has resulted in drastic changes around the world, revealing vulnerable aspects of healthcare systems. This study aimed to explore how Iranian healthcare system experienced the paradigm shift during the pandemic and determine the aspects that need improvement during the pandemic era. Method: This qualitative study was conducted in 2021. A framework analysis approach was used to analyze the content of the 19 semi-structured interviews with the healthcare system experts from Shiraz University of Medical Sciences (SUMS). The interviews' audio files changed into transcript after each session and data was saturated at the 19 interview. To increase the trustworthiness of the study, Guba and Lincoln's criteria including credibility, transferability, dependability, and confirmability were used. Goldsmith's five-step framework analysis was used applying MAX QDA version 10 software. Result: Eight main themes and 20 subthemes were explored. The main themes included "strengthening the electronic health infrastructure," "research for evidence-based decision making," "dedicated financing to the pandemic," "prevention of disruption in the effective provision of services and medicines," "enriching the authority of the Ministry of Health by focusing on interactions," "recruiting, managing and empowering health human resources with attention to financial and non-financial incentives," "reforming educational approaches in training students in medical universities," as well as "lessons learned from neglected aspects." Conclusion: To be ready to respond to a possible future pandemic and for a paradigm shift, bold steps must be taken to make fundamental changes in various aspects of the healthcare system including e-health development, evidence-based decision making, dedicated budgets for pandemics, reinforcement of interactions at the national and international level, as well as sufficient attention to healthcare workers from all financial, non-financial and educational aspects.

Hospital management by health services management graduates: the change paradigm in Iran.

BACKGROUND: The hospital management and its functions can be very important in improving the quality of hospital care, and their managers need several competencies to perform these functions efficiently and effectively. Today, more attention should be paid to the use of professional hospital managers, especially those educated in the field of Health Services Management. The present study aimed to study the change paradigm of hospital management by graduates of Health Services Management in a hospital in Iran as a developing country. MATERIALS AND METHODS: This study was a qualitative case study conducted in the Hazrate Ali Asghar Hospital in Shiraz, Iran in 2018 in order to determine the "why", "how" and "what" aspects of applying hospital managers educated in the field of Health Services Management instead of other traditional managers, as a change paradigm. The samples were selected purposefully and semi-structured in-depth interviews with 12 people were used to explain the experiences of management style by graduates of Health Services Management. Data were collected and analyzed simultaneously using the thematic analysis method and with the inductive approach. RESULTS: Results of the interviews led to the identification of 6 main themes and 26 sub-themes. The main themes were structural reforms, process reforms, organizational culture reforms, performance reforms, resource reforms, and consequences and results. CONCLUSION: According to the results, shifting from the use of traditional managers to the use of graduates of Health Services Management in the hospital proposed as a change paradigm in the hospital management is accompanied by some reforms in the hospital structures, processes, resources, culture, and performance. Such reforms may lead to some valuable final consequences and results such as increasing patient and staff satisfaction and effectiveness of actions and activities. This hypothesis is recommended to be tested in other similar settings.

Oral health practitioners' knowledge, attitude, and awareness about coronavirus: A systematic review and meta-analysis.

BACKGROUND: Oral health practitioners are at the frontline of infection, particularly with respiratory viruses such as the novel coronavirus. Knowledge, awareness, and attitude of these workers are considered important in preventing and controlling the outbreak. This study aims to review the literature to provide a better understanding of the status of dentists and other oral health practitioners' knowledge, attitude, and awareness about COVID-19. METHODS: A systematic review was conducted through Web of Science, PubMed, Scopus, and ProQuest up to May 6, 2020. All the knowledge, attitude, and practice studies on oral health workers about respiratory contagious outbreak the same as severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID-19 were included in the meta-analysis. RESULTS: A total of eleven studies were included in the meta-analysis. 85.5% of the dentists and oral health practitioners had a high level of awareness about virus transmission modes (95% confidence interval [CI]: 78.6%-92.4%; P < 0.001). 80.7% of the oral health practitioners gave right answers to the questions related to virus transmission modes (95% CI: 69.9%-91.4%; P < 0.001), and 79.9% of the dentists had a positive attitude about virus transmission modes (95% CI: 66.4%-93.4%; P < 0.001). CONCLUSION: This meta-analysis shows that the level of dentists and oral health practitioners' knowledge, awareness, and attitude was relatively high about the respiratory contagious diseases as well as COVID-19. The present results can shed further light for policymakers to support the best evidence medical education for all health-care workers the same as oral health practitioners. Preventing the dissemination of misinformation along with preparing comprehensive guidelines can be considered by the oral health policymakers, particularly in the more infected regions.

Global concerns of dental and oral health workers during COVID-19 outbreak: a scope study on the concerns and the coping strategies.

BACKGROUND: Dental and oral health workers have direct contact with respiratory aerosols of patients during procedures. This study aimed to determine the main concerns of dental and oral health workers globally during COVID-19 outbreaks and the coping strategies that help the resilience of dental and oral healthcare system. METHODS: This scoping study was conducted in August 2020. After adjusting the search strategy, a systematic search of five databases (PubMed, ISI Web of Science, Scopus, ProQuest and EMBASE) was conducted. Data was extracted using Microsoft Excel and the contents of retrieved articles were analysed through a qualitative thematic analysis applying MAX QDA10. RESULTS: Most articles were either editorial/letters to the editor/commentary formats (34%), or literature reviews (26%). About half of the articles belonged to three countries of Italy, China and the USA (each 16% and totally 48%). Thematic analysis of included papers led to the identification of four main global concerns and 19 sub-concerns. Economic, ethical, social and professional concerns are among dental and oral health concerns. Other results indicate on three main themes and 13 sub-themes as the coping strategies including patient management, infection control and virtual strategies. CONCLUSION: Dental and oral health care workers have many concerns relating to COVID-19 including economic, ethical, social and professional factors. Resolution of concerns may involve enhancing coping strategies relating to patient management and infection control strategies as well as using new technologies for virtual contact with the patient without any risk of infection.

Factors influencing access and utilization of health services among older people during the COVID - 19 pandemic: a scoping review.

BACKGROUND: Access to healthcare and service utilization are both considered essential factors for improving the general health and wellbeing of older people, especially at the time of COVID-19 pandemic. The aim of the study is to explore factors affecting healthcare access and health service utilization for older people during the pandemic. METHODS: PubMed, Web of Science, Scopus and Embase were systematically searched for relevant articles. Access, utilization, health, elderly and COVID-19 were used as keywords in the search strategy. A total of 4308 articles were identified through the initial database search; 50 articles were included in the review as passing the eligibility criteria. The searches were conducted up to August 2021. Data extraction was performed, and evidence was descriptively illustrated. Thematic analysis was used to explore factors influencing the elderly's access and utilization of healthcare services, using Max QDA10, a qualitative analysis software. RESULTS: Among articles included in the review (n = 50), a majority of the studies were from the United States (36%), followed by India (8%). According to the main healthcare services, a large number of articles (18%) were related to mental health services, followed by digital health services (16%). Factors were identified at an individual, provider and systems level. Seven main themes emerged from the thematic analysis, as determinants of elderly's access and utilization of healthcare services during COVID-19 pandemic. These included: access to non-COVID related services, access to COVID-related services, literacy and education, accommodation challenges, perceived attitudes of aging, and policies and structures, and social determinants. CONCLUSION: Mental health and digital health services were identified as major issues influencing or contributing to or influencing older people's health during the COVID-19 pandemic. We also argue on the importance of a rounded view, as attention to a range of factors is vital for policy decisions towards sustainable care and equitable interventions for improving the health of older people.

Strategies to improve pharmaceutical supply chain resilience under politico-economic sanctions: the case of Iran.

BACKGROUND: Given the impact of politico-economic sanctions on the pharmaceutical supply chain, this study aims to identify practical strategies to improve the resilience of the Iranian supply chain in pharmaceutical procurement under politico-economic sanctions. METHODS: This is a qualitative content analysis study conducted in 2018. Semi-structured interviews were conducted using snowball sampling, and saturation was achieved after 18 interviews. Guba and Lincoln's criteria, namely credibility, confirmability, transferability, and dependability, were considered to ensure the validity and transparency of the study. A five-step framework analysis was applied to analyze the data using MAX QDA10. RESULTS: The results led to the identification of nine main themes and 26 subthemes as strategies to improve the resilience of the pharmaceutical chain. According to the thematic map, some of these strategies have an extra-sectoral character: 'insurance organizations', 'strengthening relations with other countries', 'mechanization of the distribution system', and 'suppliers and manufacturers'. At the same time, some inter-sectoral strategies can help the pharmaceutical chain maintain its resilience: 'healthcare management and policy', 'exploiting local potential', 'pricing', and 'integrated health information systems.' As a strategy, 'Medical community and consumers' also plays a crucial role in this regard. According to the subthemes, revisions of health management, more supervision, privatization, clinical policies, strategic purchasing, improvement of the referral system, inter-sectoral cooperation, support of indigenous medicines, rational pricing, insurance system, improvement of medical coverage, and development of electronic prescription should be considered by health systems. Sufficient support for indigenous medication and supervision of the distribution system should be considered by the pharmaceutical industry, taking into account the cooperation between consumers and patients. CONCLUSIONS: Integration of the pharmaceutical supply chain and modern technologies, more attention to business complexity, economic development, intense competition, rapid changes in customer needs, and appropriate relationship between manufacturers, distributors, prescribers, and insurance organizations as purchasers should be considered by policymakers to improve supply chain resilience.

The effect of garlic on lipid profile and glucose parameters in diabetic patients: A systematic review and meta-analysis.

PURPOSE: Several studies have been published about the effect of garlic on lipid profile and blood glucose in diabetic patients. Which, the results mostly contradict with each other. This study aimed to investigate the effect of garlic on lipid profile and serum glucose levels in diabetic patients using a systematic review and meta-analysis. METHODS: This study was a systematic review and meta-analysis of articles published between 1988 and 2016. For this purpose, two independent researchers searched SID medical information databases including MagIran, Irandoc, Medlib, Iran Medex, Science Direct, Scopus, Google and PubMed using keywords. Data were analyzed using STATA software. RESULTS: After the initial search, 23,000 articles were found, of which 33 had the required criteria for the meta-analysis. In the present study, the total sample under review was 1273 individuals, with a mean of 39 samples per study. Overall, the garlic was more influential than placebo in reducing the levels of lipid parameters including triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), and fasting blood sugar (FBS) and HbA1C. In the meta-analysis, the concentration of serum TC, LDL, TG, and HDL in the group receiving garlic compared with the placebo showed a significant decreased for 16.87mg/dl (95% CI, -21.01, -12.73) (P=0.001), 9.65mg/dl (95% CI, -15.07, -4.23) (P=0.001), 12.44mg/dl (95% CI, -18.19, -6.69) (P=0.001), and increased for 3.19mg/dl (95% CI, 1.85, 4.53) (P=0.001), respectively. Also, the concentration of serum FBS and HbA1C serum showed a significant decreased for 10.90mg/dl (95% CI, -16.40, -5.40) (P=0.001) and 0.60mg/dl (95% CI, -0.98, -0.22) (P=0.001), respectively. CONCLUSION: Garlic can reduce lipid profile as well as glucose parameters and be therapeutically effective in patients suffering from cardiovascular diseases and diabetes.