Non-falciparum malaria infections in Uganda, does it matter? A review of the published literature.

BACKGROUND: Plasmodium falciparum is the dominant malaria species in the sub-Saharan Africa and the main cause of severe disease and death. Notwithstanding, severe malaria and death due to non-falciparum infections have been reported, but at much lower rates than P. falciparum infections. Following increasing use of molecular detection techniques in epidemiological studies, a higher prevalence of non-falciparum species has been reported in the region than previously thought. This article reviews the literature on the prevalence of non-falciparum malaria species in Uganda and the clinical figures of their severe diseases. It aims to elucidate the extent to which mono non-falciparum malaria infections in a highly malaria-endemic country contribute to malaria mortality and outline its policy implications on malaria case management. METHODS: The available English-language published peer-reviewed literature up to March 2024 was sought via PubMed and Google Scholar. The keywords used were severe malaria, AND P. falciparum, P. malariae, P. vivax, P. ovale spp., mixed infections AND Uganda. The review encompassed 53 articles. Articles using molecular diagnosis methods were accounted for analysis. RESULTS: The literature reported a substantial prevalence of non-falciparum infections in Uganda. Plasmodium malariae and Plasmodium ovale spp. were the second and third most prevalent reported malaria species respectively after P. falciparum as dominant species. Non-falciparum malaria infections often occur as mixed infections rather than mono-infections. Besides, molecular diagnostics revealed that 21% of initially reported mono-infections of P. falciparum were, in fact, mixed infections. No article was found on the prevalence of severe malaria or case fatality rate due to mixed or non-falciparum infections. CONCLUSION: A critical knowledge gap exists regarding the impact of mixed and non-falciparum species on severe malaria and death in Uganda. Robust evidence on prevalence, recurrent parasitaemia, and severe clinical manifestations of mixed and non-falciparum malaria infections is crucial for evidence-based and effective policymaking regarding malaria case management.

Access, utilization, and barriers to using malaria protection tools in migrants to Iran.

BACKGROUND: Imported malaria cases could be considered one of the threats to malaria elimination. Therefore, increasing migrants' access to malaria preventive measures can play an essential role in maintaining appropriate conditions and preventing malaria outbreaks. This study aimed to provide detailed information about access, utilization, and barriers to using malaria protection tools in migrants to Iran. METHODS: This study was conducted in a vast region consisting of 4 provinces and 38 cities located in the south and southeast of the country. Study participants were migrants who moved to the study area in the past three months. A sample of 4163 migrants participated in the study. They were selected through a multi-stage sampling method to obtain a representative community sample. Data were collected through interviewer-administered questionnaires about participants' socio-demographic specification, commuting characteristics, travel aim, access, ways of preparing, and reasons to use or not to use malaria protection tools. Quantitative and qualitative variables were described and analyzed finally. RESULTS: The mean age of individuals was 28.6 ± 10.8, with a range of 3-88 years old. Migrants' country of origin was Afghanistan (56.6%), Pakistan (38.4%), and Iran (5%). Most migrants (69.2%) did not have malaria protection tools while staying in Iran. Among those who procured the protection tools, 74% used long-lasting insecticidal nets (LLINs), 13.4% used mosquito repellent sticks and coil, and 12.7% did not use any tools. Respectively, lack of knowledge about where they can get LLINs, followed by being expensive, unavailability in the market, not cooperation of health officer, and no need to use were expressed as the causes for having no access. The main reasons for non-using the tools were lack of knowledge about their application, followed by a defect in protection tools, ineffectiveness, and being harmful, respectively. Migrants who were supported by an employer accessed more to LLINs. CONCLUSIONS: This study reveals significant shortcomings in knowledge, access, and utilization of malaria protection tools among migrants in Iran. Inequitable access to public health services is predictable during migration; however, access to sustainable protection tools is recommended.

Prevention and control of non-communicable diseases in iran: the case for Investment.

BACKGROUND: Non-communicable diseases are imposing a considerable burden on Iran. This study aims to assess the Return on Investment (ROI) for implementation of Non-communicable diseases (NCDs) prevention program in Iran. METHODS: Four disease groups including cardiovascular diseases, diabetes, cancer, and respiratory diseases were included in our ROI analysis. The study followed four steps: 1) Estimating the total economic burden of NCDs using the Cost-of-Illness approach. 2) Estimating the total costs of implementing clinical and preventive interventions using an ingredient based costing at delivering level and a program costing method at central level.3) Calculating health impacts and economic benefits of interventions using the impact measures of avoided incidence, avoided mortality, healthy life years (HLYs) gained, and avoided direct treatment costs. 4) Calculating the ROI for each intervention in 5- and 15- year time horizons. RESULTS: The total economic burden of NCDs to the Iranian economy was IRR 838.49 trillion per year (2018), which was equivalent to 5% of the country's annual Gross Domestic Product (GDP). The package of NCD will lead to 549 000 deaths averted and 2 370 000 healthy life years gained over 15 years, and, financially, Iranian economy will gain IRR 542.22 trillion over 15 years. The highest ROI was observed for the package of physical activity interventions, followed by the interventions addressing salt, tobacco package and clinical interventions. Conclusions NCDs in Iran are causing a surge in health care costs and are contributing to reduced productivity. Those actions to prevent NCDs in Iran, as well as yielding to a notable health impact, are giving a good economic return to the society. This study underscores an essential need for establishment of a national multi-sectorial NCD coordination mechanism to bring together and strengthen existing cross-agency initiatives on NCDs.

Primary Health Care Model for Non-Communicable Diseases Management during COVID-19 Pandemic in the Islamic Republic of Iran.

Background: Given the importance of appropriate response to prevent and manage Non-Communicable Diseases (NCDs), this study aimed to analyze the state of NCDs services at the level of the PHC system during the COVID-19 pandemic and to determine the main strategies. Methods: In this qualitative study, first, the circulars and guides in Iran's PHC system from the beginning of the pandemic to the end of September 2020 were retrieved manually and by searching the internal websites of the Ministry of Health. All documents about decision-making or governance and coordination mechanisms for the provision of NCDs services were enrolled and analyzed. In the second phase, the status of service delivery for major NCDs was presented in a model, and finally, SWOT analysis was used to analyze the situation and determine the main strategies. Results: 25 out of 199 circulars and guides were eligible and analyzed. In the crisis phase, most risk assessment, screening, and diagnosis services for NCDs have been suspended, and follow-up and care of patients with major NCDs were done by telephone. In the reopening phase, the general strategies and strategies to increase capacity and provide delayed care were adopted, and the PHC model of the provision of essential services for the major NCDs was developed in low-risk, intermediate and high-risk pandemic conditions. Finally, 16 main strategies were determined with the approach of integrating and focusing on essential services, considering vulnerable groups and the use of E-health technologies. Conclusion: The results indicate on interruption of NCDs services in the crisis phase while adopting strategies for responding to the pandemic. Revision of the COVID-19 guides with a particular focus on NCDs is recommended.

The Effect of the COVID-19 Pandemic on Non-Communicable Disease Prevention and Management Services in the Primary Health Care System of Iran.

Background: The COVID-19 pandemic has caused significant disruptions in the provision of non-communicable disease (NCDs) prevention and control services in many countries, and there is a concern that it would lead to long-term complications of the diseases. The aim of this study is to assess the changes in the provisions of selected NCD services before and after the COVID-19 epidemic in Iran's primary healthcare system. Methods: In this descriptive-analytical retrospective study, the number of eight NCD services provided during the first 10 months of the COVID-19 pandemic from Feb 2020 to Dec 2020 were compared with the same period in the previous year using the data from the Iranian integrated electronic health record system (SIB) and also the association between the number of deaths due to COVID-19 and a sample of NCD services were assessed using cross-correlation analysis. The statistical analysis was performed in Stata Software v.14. Results: The NCD services have decreased by an average of 18.89% compared to the same period in the previous year; this decline was much more severe at the beginning of the epidemic period (up to 75% in some services) and was greater in physician-provided services than in non-physician services. Also, examining the course of the selected services during this period, a gradual compensation was evident after the initial reduction. Conclusion: The general trend of the selected services of prevention and control of NCDs in the PHC system of Iran within 10 months after the onset of COVID-19 showed a sharp decline and subsequent gradual compensation. Although the process of compensation in some services may be considered somewhat reassuring, in the case of some essential services, more effort and attention to the implementation of programs or compensatory policies seem necessary.

Predicting factors for malaria re-introduction: an applied model in an elimination setting to prevent malaria outbreaks.

BACKGROUND: Malaria re-introduction is a challenge in elimination settings. To prevent re-introduction, receptivity, vulnerability, and health system capacity of foci should be monitored using appropriate tools. This study aimed to design an applicable model to monitor predicting factors of re-introduction of malaria in highly prone areas. METHODS: This exploratory, descriptive study was conducted in a pre-elimination setting with a high-risk of malaria transmission re-introduction. By using nominal group technique and literature review, a list of predicting indicators for malaria re-introduction and outbreak was defined. Accordingly, a checklist was developed and completed in the field for foci affected by re-introduction and for cleared-up foci as a control group, for a period of 12 weeks before re-introduction and for the same period in the previous year. Using field data and analytic hierarchical process (AHP), each variable and its sub-categories were weighted, and by calculating geometric means for each sub-category, score of corresponding cells of interaction matrices, lower and upper threshold of different risks strata, including low and mild risk of re-introduction and moderate and high risk of malaria outbreaks, were determined. The developed predictive model was calibrated through resampling with different sets of explanatory variables using R software. Sensitivity and specificity of the model were calculated based on new samples. RESULTS: Twenty explanatory predictive variables of malaria re-introduction were identified and a predictive model was developed. Unpermitted immigrants from endemic neighbouring countries were determined as a pivotal factor (AHP score: 0.181). Moreover, quality of population movement (0.114), following malaria transmission season (0.088), average daily minimum temperature in the previous 8 weeks (0.062), an outdoor resting shelter for vectors (0.045), and rainfall (0.042) were determined. Positive and negative predictive values of the model were 81.8 and 100 %, respectively. CONCLUSIONS: This study introduced a new, simple, yet reliable model to forecast malaria re-introduction and outbreaks eight weeks in advance in pre-elimination and elimination settings. The model incorporates comprehensive deterministic factors that can easily be measured in the field, thereby facilitating preventive measures.

The Iranian blood pressure measurement campaign, 2019: study protocol and preliminary results.

Purpose: Hypertension is one of the most important risk factors for premature mortality and morbidity in Iran. The objective of the Iranian blood pressure (BP) measurement campaign was to identify individuals with raised blood pressure and providing appropriate care and increase the awareness among the public and policymakers of the importance of tackling hypertension. Methods: The campaign was conducted in two phases. The first (communication) phase started on May 17th (International Hypertension Day). The second phase started on June 8th, 2019, and lasted up to July 7th during which, blood pressures were measured. The target population was Iranians aged ≥ 30 years. Participants voluntarily referred to health houses in rural and health posts and comprehensive health centers in urban areas in the setting of the Primary Health Care network. Additionally, over 13,700 temporary stations were set up in highly visited places in urban areas. Volunteer healthcare staff interviewed the participants, measured their BP, and provided them with lifestyle advice and knowledge of the risks and consequences of high blood pressure. They referred participants to physicians in case their BP was high. Participants immediately received a text message containing the relevant advice based on their measured BP and their past history. Results: Blood pressure was measured for a total of 26,678,394 participants in the campaign. A total of 13,722,148 participants (51.4%) were female. The mean age was 46 ± 14.1 years. Among total participants, 15,012,693 adults (56.3%) with no past history of hypertension had normal BP, 7,959,288 participants had BP in the prehypertension range (29.8%), and finally, 3,706,413 participants (13.9%) had either past medical history of hypertension, used medications, or had high BP measured in the campaign. Conclusion: The campaign was feasible with the objective to increase the awareness among the public and policymakers of the importance of tackling hypertension in Iran.

Efficacy of applying self-assessment of larviciding operation, Chabahar, Iran.

BACKGROUND: Appropriate supervision, along with availability of an effective system for monitoring and evaluation, is a crucial requirement to guarantee sufficient coverage and quality of malaria vector control procedures. This study evaluated the efficacy of self-assessment practice as a possible innovative method towards achieving high coverage and excellent quality of larviciding operation in Iran. METHODS: The research was conducted on the randomly selected rural health centre of Kanmbel Soliman with 10 staff and 30 villages, in three main steps: (i) assessment of effectiveness of larviciding operations in the study areas before intervention through external assessment by a research team; (ii) self-assessment of larviciding operations (intervention) by staff every quarter for three rounds; and, (iii) determining the effectiveness of applying self-assessment of larviciding operations in the study areas. Two toolkits were used for self-assessment and external evaluation. The impact of self-assessment of larviciding operations was measured by two indicators: percentage of missed breeding habitats and cleaned breeding habitats among randomly selected breeding sites. Moreover, the correlation coefficients were measured between self-assessment measures and scores from external evaluation. The correlation coefficient and Mann Whitney test were used to analyse data. RESULTS: Following the utilization of self-assessment, the percentage of missed breeding habitats decreased significantly from 14.23% to 1.91% (P <0.001). Additionally, the percentage of cleaned breeding habitats among randomly selected breeding sites increased from 66.89% to 95.28% (P <0.001). The external evaluation also showed significant effects of self-assessment in performance of vector control; the maximum effect of intervention were seen in an action plan for monitoring and evaluation of larviciding operations at field level, geographical reconnaissance for the registration of breeding habitats and worker skills related to larviciding.Before intervention, the results of self-assessment practice were compatible with external evaluation in 76.3% of 139 reviewed reports of self-assessment. After intervention, the findings of self-assessment and external evaluation were similar in the vast majority of reviewed reports (95%). CONCLUSION: The self-assessment tool seems to be valid and reliable in improving effectiveness of larviciding operations. Furthermore, the result of self-assessment is more compatible with external evaluation results if it would be applied frequently. Therefore, it can be used as an alternative assessment technique in the evaluation of larviciding operations in addition to traditional assessment methods.

The effect of hookah use on COVID-19 related adverse outcomes: Lessons learned from integrating STEPs 2016 and national COVID-19 registration databases.

INTRODUCTION: Amidst the COVID-19 pandemic, an international effort has been concerted to identify the factors associated with more adverse outcomes to better allocate resources and perform more effective targeted preventive measures. This study aims to describe the risk of COVID-19 adverse outcomes among individuals with a history of being ever cigarette smokers and being ever hookah users. METHODS: We combined two databases, including the Iran national registry of COVID-19 patients, including 2020 with 656258 hospitalized patients and STEPs survey 2016 with 30541 participants. After merging the two databases using the national ID, the association was investigated between being ever smoker or hookah user and the adverse outcomes of COVID-19 including death, need for a ventilation therapy, and admission in the intensive care unit (ICU), among 474 severe acute respiratory infections (SARI) cases and 211 PCR-positive patients. RESULTS: Among 211 PCR-positive patients, 40 (19%) patients were ever hookah users and 28 (13.3%) were ever cigarette smokers. Death occurred in 27 (12.8%) patients and severe COVID-19 in 17 (11.6%). Among 211 PCR-positive patients, ever cigarette smokers had 4.2 times (95% CI: 1.1-15.4, p=0.03) higher odds of ICU admission and 4.2 times (95% CI: 1.1-15.4, p=0.03) increased odds for need of ventilation, compared with non-smokers. Besides, ever hookah users had 3.9 times (95% CI: 1.1-13.6, p=0.03) higher odds for need of ventilation therapy, compared with non-hookah users. CONCLUSIONS: Tobacco use and hookah smoking were associated with adverse outcomes among COVID-19 patients in Iran.

Insights for speed management among Iranian drivers: a social marketing formative research study.

BACKGROUND: Road traffic crashes are among the leading causes of death and disability in the world, particularly in low and middle-income countries. This study aimed at to conduct a social marketing formative research to inform the development of a campaign to manage driving speed on the intercity roads of Iran. METHODS: To carry out the social marketing formative research, a qualitative and quantitative study were conducted. Also, a literature review of the speed management strategies was carried out and an analysis of traffic accident data and speeding violations was performed in selected provinces during 2019 and 2020. RESULTS: Based on the findings of the qualitative study, perceived sense of lack of speed control, poor monitoring system, and law enforcement are the main reasons drivers exceed the speed limit. They mostly suggest using punitive levers and more stringent law enforcement practices for speed management. Literature reviews also confirm that to successfully develop an effective speed management plan a set of measures should be implemented together, including road safety engineering, raising awareness, social marketing strategies, and finally strict law enforcement. The overriding findings of the formative research revealed that to persuade Iranian drivers to respect the speed limit, the messages of the campaign should focus on strict law enforcement in the selected corridors. CONCLUSIONS: In the minds of the Iranian audience, strict law enforcement is of paramount importance for a speed management strategy to work; hence it should be taken into consideration when tailoring the campaign messages. From the findings of the present study, it can be concluded that to manage speed on intercity routes in Iran, a social marketing campaign is needed to encourage compliance with speed limits.

Routine COVID-19 testing may not be necessary for most cancer patients.

Cancer patients are at risk for severe complications or death from COVID-19 infection. Therefore, the need for routine COVID-19 testing in this population was evaluated. Between 1st August and 30th October 2020, 150 cancer patients were included. Symptoms of COVID-19 infection were evaluated. All eligible individuals went through RT-PCR and serological tests for COVID-19. At the same time, 920 non-cancer patients were recruited from a random sample of individuals who were subject to routine molecular and anti-body screening tests. Of 150 cancer patients, 7 (4.7%) were RT-PCR positive. Comorbidity made a significant difference in the RT-PCR positivity of cancer patients, 71.4% positive versus 25.8% negative (P-value = 0.02). The average age for negative and positive groups was 53.3 and 58.2 respectively (P-value = 0.01). No significant difference was observed between cancer and non-cancer patients regarding COVID-19 antibody tests. However, cancer patients were 3 times less likely to have a positive RT-PCR test result OR = 0.33 (CI: 0.15-0.73). The probability of cancer patients having a positive routine test was significantly lower than non-cancer patients, and the concept that all cancer patients should be routinely tested for COVID-19 may be incorrect. Nevertheless, there may be a subgroup of patients with comorbidities or older age who may benefit from routine COVID-19 testing. Importantly, these results could not be subjected to multivariate analysis.

Exploring the Human Factors Affecting Health Service Managers: A Qualitative Study.

BACKGROUND: In recent decades, managing health-service systems has faced multiple challenges. Identifying and resolving these challenges promote the efficiency and effectiveness of hospital activities. AIM: The present study aimed to explore the human factors affecting health service managers. MATERIAL AND METHODS: In this qualitative study, in-depth unstructured interviews were conducted with 29 employees who were in close contact with the health service managers. All the interviews were transcribed verbatim. Data were collected using purposeful sampling and were analysed using conventional content analysis via MAXQDA software. RESULTS: A group of 29 participants were interviewed (male 65.5%, female 34.4%). "Managing managers" has been identified as the primary theme with four supporting secondary themes including the inappropriate appointment of managers, the impact of human and social needs of managers, influential employees, and disrupting organisational communications. These are the challenges faced by managers in managing human resources in health-service organisations. CONCLUSION: Results showed that employees manage their managers within the organisation so that they can prevent managers from concentrating on their management affairs and tasks resulting in the distortion of management practices. The results of this study can help the key policy makers and planners in health-service organisations to guide the organisation to pursue its goals through appointing appropriate managers and identifying influential employees.

Study on the Quality of Life Among the Cancer Patients at the Sari Comprehensive Cancer Center in 2017.

BACKGROUND: Cancer is a disease caused by abnormal cells shape change and loss of cell variation. Cancer patients suffer from mental and physical problems, which affect their social quality of life (QOL). A cancer diagnosis and its treatment can be expensive. METHODS: In this descriptive-analytical and cross-sectional study, 183 patients referring to the Sari Comprehensive Cancer Center were enrolled. The data on QOL of patients and the cost of diagnosis and treatment were collected in QLQ questionnaire-C30. The obtained Data were analyzed using the Kruskal-Wallis test of the correlation coefficient, the Mann-Whitney U-test, ANOVA and T-test. RESULTS: The average cost of treating patients in a comprehensive cancer center was $20161801 and the average QOL was 2.43 (5 points). Therefore, the patients achieved, 2.41% of the QOL per one million rails. CONCLUSIONS: Considering the average QOL for cancer patients at Sari Comprehensive Cancer Center and the hospital cost, the evaluation of the patients from the view point of the hospital equipment was positive.

The study of the relationship between value creation and customer loyalty with the role of trust moderation and customer satisfaction in Sari hospitals.

BACKGROUND: Healthcare providers are competitive, owing to heightened customers' awareness and expectations of health care services. OBJECTIVE: The aim of this study was to determine the relationship between customer value creation and loyalty with mediator trust and customer satisfaction. METHODS: This is a cross sectional survey study. Participants were 196 patients referred to private hospitals in Sari city, Iran from May to June 2014 which were selected by convenience sampling method. Data were collected using questionnaires. Data were analyzed using the structural equation modeling software Smart PLS. RESULTS: The results revealed a relationship between customer value creation and customer loyalty in a Sari city private hospital, and customer satisfaction and trust, mediate the relationship between customer value creation and customer loyalty. The results also revealed significant positive relationship between customer satisfaction and trust (p=0.000 r=0.585). CONCLUSION: customer satisfaction and trust mediate the relationship between customer value creation and customer loyalty.

Prophylactic efficacy of primaquine for preventing Plasmodium falciparum and Plasmodium vivax parasitaemia in travelers: A meta-analysis and systematic review.

BACKGROUND: With increased international travel over the world the need for safe and effective chemoprophylaxis for malaria is as great as ever. The choice of regimen is difficult, as effectiveness should be weighted against potential adverse effects. Although, some studies have reported high prophylactic efficacy of primaquine, there is no comprehensive evidence comparing its prophylactic effectiveness as well as toxicity. To fill the gap, this systematic review and meta-analysis study was carried out. METHODS: Using MeSH terms, 756 records were detected through searching "Pubmed", "Embase","Web of Science"and "Cochrane" databases. From these,7 relevant full-text articles with 14 comparisons for final quantitative meta-analysis were included in our review. In order to make a comparison between the studies, Risk Ratios(RRs) and their 95% confidence intervals(CIs) were estimated. RESULTS: Overall,74% reduction in the incidence of parasitaemia by primaquine versus other prophylactic regimens was estimated(RRoverall = 0.26, CI 95%:0.16-0.41--RRvivax = 0.16, CI 95%:0.07-0.36--RRfalciparum = 0.31, CI 95%:0.18-0.55). The incidence rate ratios for adverse effects showed no statistically significant difference between primaquine and control groups (p > 0.05). CONCLUSIONS: For persons without G6PD deficiency, who are not pregnant, primaquine is the most effective presently available prophylactic for P. vivax malaria and comparable to such regimens as doxycycline, mefloquine and atovaquone-proguanil for the prevention of P. falciparum malaria.

Evaluation of Deltamethrin in Combination of Piperonyl Butoxide (PBO) against Pyrethroid Resistant, Malaria Vector, Anopheles stephensi in IRS Implementation: an Experimental Semi-Filed Trial in Iran.

BACKGROUND: The aim of this study was to evaluate different concentrations of deltamethrin combined with formulated piperonyl butoxide (PBO) synergist on various surfaces against the wild strain of Anopheles stephensi, the main malaria vector in Southern Iran under semi-field condition. METHODS: Four concentrations of deltamethrin WG 25% (Tagros) and PBO 800EC-UV (Endura) were prepared and sprayed on the pre-designed surfaces in accordance with WHO alliance line of the IRS Micronair®. The WHO's recommended bioassay kit and method was used during this study. RESULTS: Comparing the mortality rate of mosquitoes, the results showed a significant difference between months after treatment of IRS (Indoor Residual Spraying) (P< 0.05) but didn't show any significant differences between days during the first and second months (P> 0.05).Statistical test revealed a significance difference between mortality rate of mosquitoes in exposing to concentrations of 1 and 4 (P< 0.05) which demonstrated effect of synergizing PBO on mortality rate. CONCLUSION: This research as the first semi-field trial on deltamethrin added to different concentrations of formulated PBO for IRS, indicates that deltamethrin+10X PBO is more effective than other concentrations. Therefore, using synergists can be suggested as a new tool for prevention of pyrethriod resistance, although more studies are recommended.

Burnout and its Influencing Factors among Primary Health Care Providers in the North East of Iran.

INTRODUCTION: Burnout is a popular research topics in service providing jobs, including the health care field. This study aimed at assessing the level of job burnout and to consider the important antecedents which might be related to job burnout among primary health care providers in Iran. METHODS: The participants in this applied cross-sectional study which was conducted in 2013 were 548 primary health care providers who were randomly selected from among those working in Shahroud, Sabzevar, Neishabour, Bojnord (provinces located in the north east of Iran). Maslach Burnout Inventory (MBI) was administered to the participants and the collected data were analyzed using SPSS through chi-square test and ordinal logistic regression model. RESULTS: The burnout mean score among the participants was 54.1 ± 27.2 and the mean scores of burnout components i.e., emotional exhaustion, depersonalization and personal accomplishment were 15.5 ± 13.6, 3.7 ± 5.4 and 35.5 ± 13.5 respectively. In terms of levels of burnout, 64.2% of the participants showed low levels (n = 352), 18.4% average levels (n = 101) and 17.3% high levels (n = 95). A significant relationship was observed between burnout, job resources and interest in job (p ≤ 0.05). However, no significant relationship was observed between burnout and the place (university) of working, age, satisfaction with income, experience, gender, level of education, marital status, housing status, having a second job and place of residence (p ≥0.05). CONCLUSION: Lack of personal accomplishment was highly prevalent among the participating primary health care providers. Lack of career advancement and job transfer opportunities may play a role in the burnout of primary health care providers. Therefore, paying attention to this aspect may help to reduce burnout and even increase job engagement.

Rate of medical errors in affiliated hospitals of mazandaran university of medical sciences.

INTRODUCTION: Health care organizations are highly specialized and complex. Thus we may expect the adverse events will inevitably occur. Building a medical error reporting system to analyze the reported preventable adverse events and learn from their results can help to prevent the repeat of these events. The medical errors which were reported to the Clinical Governance's office of Mazandaran University of Medical Sciences (MazUMS) in years 2011-2012 were analyzed. METHODS AND MATERIALS: This is a descriptive retrospective study in which 18 public hospitals were participated. The instrument of data collection was checklist that was designed by the Ministry of Health of Iran. Variables were type of hospital, unit of hospital, season, severity of event and type of error. The data were analyzed with SPSS software. RESULTS: Of 317966 admissions 182 cases, about 0.06%, medical error reported of which most of the reports (%51.6) were from non- teaching hospitals. Among various units of hospital, the highest frequency of medical error was related to surgical unit (%42.3). The frequency of medical error according to the type of error was also evaluated of which the highest frequency was related to inappropriate and no care (totally 37%) and medication error 28%. We also analyzed the data with respect to the effect of the error on a patient of which the highest frequency was related to minor effect (44.5%). CONCLUSION: The results showed that a wide variety of errors. Encourage and revision of the reporting process will be result to know more data for prevention of them.

Social problem solving ability predicts mental health among undergraduate students.

BACKGROUND: The main objective of this study was predicting student's mental health using social problem solving- ability. METHODS: In this correlational. descriptive study, 369 (208 female and 161 male) from, Mazandaran University of Medical Science were selected through stratified random sampling method. In order to collect the data, the social problem solving inventory-revised and general health questionnaire were used. Data were analyzed through SPSS-19, Pearson's correlation, t test, and stepwise regression analysis. RESULTS: Data analysis showed significant relationship between social problem solving ability and mental health (P < 0.01). Social problem solving ability was significantly associated with the somatic symptoms, anxiety and insomnia, social dysfunction and severe depression (P < 0.01). CONCLUSIONS: The results of our study demonstrated that there is a significant correlation between social problem solving ability and mental health.

Determination of Malaria Epidemiological Status in Iran's Malarious Areas as Baseline Information for Implementation of Malaria Elimination Program in Iran.

BACKGROUND: According to willingness of the Ministry of Health, Iran and presence of appropriate conditions for disease elimination, national malaria control program decided to conduct a research to clarify malaria status in 2007 and to provide required information to perform the elimination program. This review is comprised of the basis of national malaria elimination program in vision of 2025, which was started in 2010. METHODS: In this descriptive study, data were analyzed by applications of different variables at district level. All districts in the three south eastern provinces, in which malaria has local transmission, were considered. Malaria cases has been determined and studied based on the national malaria surveillance system. RESULTS: Since vivax malaria is predominant in Sistan & Baluchestan Province, number of vivax cases is equal to malaria positive cases approximately. The important point is that Nikshahr contains the maximum number of local vivax cases in this province and the maximum number of falciparum cases is reported from Sarbaz district. Among all districts of Hormozgan Province, no case of autochthonous falciparum was detected except in Bandar Jask and one case in Minab. There was no case of autochthonous falciparum in Kerman Province, except in Kahnoj and Ghale Ganj that each of them had one case in 2007. CONCLUSION: It appears that the report of locally transmitted cases in Iran is increasing over the past few years, before starting malaria elimination plan. Since the Afghan refugees started to return to their own country so the main source of reporting of imported malaria cases reduced and local cases would be demonstrated more clearly.