Neural stem cell therapies for spinal cord injury repair: an update on recent preclinical and clinical advances.

Traumatic spinal cord injury (SCI) is a leading cause of lifelong disabilities. Permanent sensory, motor and autonomic impairments after SCI are substantially attributed to degeneration of spinal cord neurons and axons, and disintegration of neural network. To date, minimal regenerative treatments are available for SCI with an unmet need for new therapies to reconstruct the damaged spinal cord neuron-glia network and restore connectivity with the supraspinal pathways. Multipotent neural precursor cells (NPCs) have a unique capacity to generate neurons, oligodendrocytes and astrocytes. Due to this capacity, NPCs have been an attractive cell source for cellular therapies for SCI. Transplantation of NPCs has been extensively tested in preclinical models of SCI in the past two decades. These studies have identified opportunities and challenges associated with NPC therapies. While NPCs have the potential to promote neuroregeneration through various mechanisms, their low long-term survival and integration within the host injured spinal cord limit the functional benefits of NPC-based therapies for SCI. To address this challenge, combinatorial strategies have been developed to optimize the outcomes of NPC therapies by enriching SCI microenvironment through biomaterials, genetic and pharmacological therapies. In this review, we will provide an in-depth discussion on recent advances in preclinical NPC-based therapies for SCI. We will discuss modes of actions and mechanism by which engrafted NPCs contribute to the repair process and functional recovery. We will also provide an update on current clinical trials and new technologies that have facilitated preparation of medical-grade human NPCs suitable for transplantation in clinical studies.

Challenges and solutions for implementing telemedicine in Iran from health policymakers' perspective.

BACKGROUND: Despite significant progress in health technology and growing interest among countries in incorporating telemedicine into healthcare delivery, its usage remains limited in Iran. The aim of this study is to investigate the challenges related to telemedicine in Iran and pinpoint potential solutions from the viewpoint of health policymakers, marking the first such endeavor. METHODS: This qualitative study was conducted in Iran in 2022. Data were gathered from 19 health policymakers who were selected using purposeful and snowball sampling techniques via in-depth and semi-structured interviews. The research findings were analyzed using the content analysis technique, with coding performed using MAXQDA software. The content analysis approach developed by Erlingsson was utilized to analyze the data. RESULTS: The study revealed eight main challenges that inhibit the widespread use of telemedicine in Iran. These challenges include policy weaknesses, uncertainty around operating mechanisms, inadequate communication and telecommunication infrastructure, insufficient cultural infrastructure, lack of electronic requirements, redundant bureaucracies, legal gaps, and economic factors. Furthermore, four key solutions to these challenges were identified. These include a national commitment to the development of telemedicine, the establishment of a telemedicine roadmap, the enhancement of e-health requirements and infrastructure, and the preparation of the community to accept telemedicine as a viable option for healthcare delivery. CONCLUSION: The implementation of telemedicine in Iran faces significant challenges, some of which are related to the national healthcare system, while others stem from various policy-related institutions and organizations. Addressing these challenges will require extensive inter-organizational cooperation and strong leadership at the governance level. However, it should be noted that fully resolving these issues is a time-consuming process.

Suppressing CSPG/LAR/PTPσ Axis Facilitates Neuronal Replacement and Synaptogenesis by Human Neural Precursor Grafts and Improves Recovery after Spinal Cord Injury.

Traumatic spinal cord injury (SCI) is a leading cause of permanent neurologic disabilities in young adults. Functional impairments after SCI are substantially attributed to the progressive neurodegeneration. However, regeneration of spinal-specific neurons and circuit re-assembly remain challenging in the dysregulated milieu of SCI because of impaired neurogenesis and neuronal maturation by neural precursor cells (NPCs) spontaneously or in cell-based strategies. The extrinsic mechanisms that regulate neuronal differentiation and synaptogenesis in SCI are poorly understood. Here, we perform extensive in vitro and in vivo studies to unravel that SCI-induced upregulation of matrix chondroitin sulfate proteoglycans (CSPGs) impedes neurogenesis of NPCs through co-activation of two receptor protein tyrosine phosphatases, LAR and PTPσ. In adult female rats with SCI, systemic co-inhibition of LAR and PTPσ promotes regeneration of motoneurons and spinal interneurons by engrafted human directly reprogramed caudalized NPCs (drNPC-O2) and fosters their morphologic maturity and synaptic connectivity within the host neural network that culminate in improved recovery of locomotion and sensorimotor integration. Our transcriptomic analysis of engrafted human NPCs in the injured spinal cord confirmed that inhibition of CSPG receptors activates a comprehensive program of gene expression in NPCs that can support neuronal differentiation, maturation, morphologic complexity, signal transmission, synaptic plasticity, and behavioral improvement after SCI. We uncovered that CSPG/LAR/PTPσ axis suppresses neuronal differentiation in part by blocking Wnt/ß-Catenin pathway. Taken together, we provide the first evidence that CSPGs/LAR/PTPσ axis restricts neurogenesis and synaptic integration of new neurons in NPC cellular therapies for SCI. We propose targeting LAR and PTPσ receptors offers a promising clinically-feasible adjunct treatment to optimize the efficacy and neurologic benefits of ongoing NPC-based clinical trials for SCI.SIGNIFICANCE STATEMENT Transplantation of neural precursor cells (NPCs) is a promising approach for replacing damaged neurons after spinal cord injury (SCI). However, survival, neuronal differentiation, and synaptic connectivity of transplanted NPCs within remain challenging in SCI. Here, we unravel that activation of chondroitin sulfate proteoglycan (CSPG)/LAR/PTPσ axis after SCI impedes the capacity of transplanted human NPCs for replacing functionally integrated neurons. Co-blockade of LAR and PTPσ is sufficient to promote re-generation of motoneurons and spinal V1 and V3 interneurons by engrafted human caudalized directly reprogramed NPCs (drNPC-O2) and facilitate their synaptic integration within the injured spinal cord. CSPG/LAR/PTPσ axis appears to suppress neuronal differentiation of NPCs by inhibiting Wnt/ß-Catenin pathway. These findings identify targeting CSPG/LAR/PTPσ axis as a promising strategy for optimizing neuronal replacement, synaptic re-connectivity, and neurologic recovery in NPC-based strategies.

Oxidized Phosphatidylcholines Trigger TRPA1 and Ryanodine Receptor-dependent Airway Smooth Muscle Contraction.

Asthma pathobiology includes oxidative stress that modifies cell membranes and extracellular phospholipids. Oxidized phosphatidylcholines (OxPCs) in lung lavage from allergen-challenged human participants correlate with airway hyperresponsiveness and induce bronchial narrowing in murine thin-cut lung slices. OxPCs activate many signaling pathways, but mechanisms for these responses are unclear. We hypothesize that OxPCs stimulate intracellular free Ca2+ flux to trigger airway smooth muscle contraction. Intracellular Ca2+ flux was assessed in Fura-2-loaded, cultured human airway smooth muscle cells. Oxidized 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphocholine (OxPAPC) induced an approximately threefold increase in 20 kD myosin light chain phosphorylation. This correlated with a rapid peak in intracellular cytoplasmic Ca2+ concentration ([Ca2+]i) (143 nM) and a sustained plateau that included slow oscillations in [Ca2+]i. Sustained [Ca2+]i elevation was ablated in Ca2+-free buffer and by TRPA1 inhibition. Conversely, OxPAPC-induced peak [Ca2+]i was unaffected in Ca2+-free buffer, by TRPA1 inhibition, or by inositol 1,4,5-triphosphate receptor inhibition. Peak [Ca2+]i was ablated by pharmacologic inhibition of ryanodine receptor (RyR) Ca2+ release from the sarcoplasmic reticulum. Inhibiting the upstream RyR activator cyclic adenosine diphosphate ribose with 8-bromo-cyclic adenosine diphosphate ribose was sufficient to abolish OxPAPC-induced cytoplasmic Ca2+ flux. OxPAPC induced ∼15% bronchial narrowing in thin-cut lung slices that could be prevented by pharmacologic inhibition of either TRPA1 or RyR, which similarly inhibited OxPC-induced myosin light chain phosphorylation in cultured human airway smooth muscle cells. In summary, OxPC mediates airway narrowing by triggering TRPA1 and RyR-mediated mobilization of intracellular and extracellular Ca2+ in airway smooth muscle. These data suggest that OxPC in the airways of allergen-challenged subjects and subjects with asthma may contribute to airway hyperresponsiveness.

Proposed Model of Management for Patients with Multi-Morbidity in Iranian Hospitals.

Background: Today, multi-morbidity (MM), the presence of more than one disease in the same person at the same time, has been prevalent. This is while the healthcare delivery systems are formed based on a single-disease-oriented approach. Hence, this study intended to address presenting a model for the management of patients with multi-morbidity in Iranian hospitals. Methods: This was a mixed-method study. The data was gathered from 54 semi-structured interviews with the participation of experts in inpatient care management who were purposefully selected. The qualitative data were analyzed using content analysis. The Interpretive Structural Modeling (ISM) via STATA and Excel software was exploited in the quantitative phase. Results: The factors affecting the management of patients with multi-morbidity were identified in 26 main themes and 142 sub-themes, and ultimately, a model for improving the management of patients with multi-morbidity in Iranian hospitals at six different levels was offered. The "Comprehensive Health Care Information System (CHIS) and Electronic Health Record (EHR)" had the greatest influence and the lowest dependency. "Efforts to remove patients' confusion" had the highest dependency and the lowest influence. The results of employing the Cross Impact Matrix Multiplication Applied to Classification (MICMAC) analysis demonstrated that most of the variables are placed in the third group of linkage variables that have high driving power and dependence power. Conclusion: Concerning the sophisticated needs of patients with multi-morbidity for the management of their clinical conditions, the presented model could be provided to policymakers and health care managers as a beneficial performance guideline for improving the quality of care.

International Sanctions and the Procurement of Medical Equipment in Iran: A Qualitative Study.

Background: Despite regulations to facilitate the purchase of medical equipment, the process is now faced with severe challenges due to the sanctions. This study focuses on the effects of the international sanctions on the process of procuring capital medical equipment in the Iranian health system. Methods: A qualitative study using a content analysis approach was designed to investigate the effects of the international sanctions on capital medical equipment from January 2018 to June 2019. The data were gathered through 32 face-to-face, semi-structured interviews according to an interview guide. All the interviews were transcribed verbatim and analyzed accordingly. Thematic analysis with an inductive approach was employed for analyzing the data. Results: After a comprehensive analysis of open codes, two themes and 9 sub-themes were formulated. Based on our findings, the challenges facing the Iranian health sector during international sanctions included: "procurement of capital medical equipment" (with 6 sub-themes: Capital medical equipment suppliers, Monetary and interbank transactions, Suppliers and importers of the capital medical equipment, The process of procurement of capital medical equipment, Healthcare providers and Service receivers) and "repairing and after-sales services of capital medical equipment," (with 3 sub-themes: Software and spare parts dependent repair, Specialized human resources dependent repairing and after-sales services). Conclusion: Even though the sanction has made Iranian scientists and technicians capable of re-engineering and producing some of the medical equipment and accessories, the study confirms the adverse effects of sanctions on the quality and quantity of medical equipment procurement, hence, delivering adequate and on-time medical services. In many cases, for money transfer issues, international companies were not sure they could have their money back if they sold the facilities to Iran. Fear of losing the US market was the other main consideration for the international companies.

Confirmatory factor analysis model of factors affecting the implementation of clinical guidelines in Iran.

Background: Clinical guidelines refer to a developed scientific statement to help physicians and patients for decision-making about the best care for special clinical conditions, which can be an important document to shape evidence-based medicine. This study aimed to identify factors affecting the implementation of clinical guidelines in Iran to enhance the quality of services. Methods: This descriptive analytical study was performed with combined quantitative-qualitative method in the first half of 2019. The statistical population consisted of 400 health managers and experts who were selected through multistage sampling method in 5 regions of Iran (north, south, center, east, and west). Overall, 20 academic experts were selected from each university. For data collection, a researcher-made questionnaire (n = 400) was used. To measure face and content validity, content validity ratio (CVR) and content validity index (CVI) were used. Also, to determine reliability, test-retest method, with Cronbach's alpha coefficient of 0.934 was used. For data analysis, Lisrel 8.8 and SPSS 24 were used. Finally, fitness indices were used to determine the fitness of the model. Results: Six factors, including organizational (9 components), organizational culture (8 components), the clinical guidelines feature (8 components), insurance (7 components), and trusteeship of the health care system (8 components) were identified as the main dimensions. The economic dimension had the maximum effect on implementing clinical guidelines (0.90), while the clinical guidelines feature (0.63) and organizational culture (0.63) showed the minimum extent of effect on implementing clinical guidelines. Conclusion: Evidently, imposing the mentioned interventions with the ultimate goal of sustainable behavior change in providing health care services requires contribution of all practitioners, presentation of suitable facilities for implementing clinical guidelines based on evidence, time and personnel management, training methodology and planning, developing the necessary infrastructure, supervision, and developing professional and legal motivation.

Targeted Mutation Analysis of the SLC26A4, MYO6, PJVK and CDH23 Genes in Iranian Patients with AR Nonsyndromic Hearing Loss.

BACKGROUND: Hearing loss (HL) is the most prevalent sensory disorder. The over 100 genes implicated in autosomal recessive nonsyndromic hearing loss (ARNSHL) makes it difficult to analyze and determine the accurate genetic causes of hearing loss. We sought to de?ne the frequency of seven hearing loss-Causing causing genetic Variants in four genes in an Iranian population with hearing loss. MATERIALS AND METHODS: One hundred ARNSHL patients with normal GJB2/GJB6 genes were included, and targeted mutations in SLC26A4, MYO6, PJVK and CDH23 genes were analyzed by ARMS-PCR. The negative and positive results were confirmed by the Sanger sequencing. RESULTS: We found only two mutations, one in MYO6 (c.554-1 G > A) gene and another in PJVK (c.547C > T). CONCLUSION: c.554-1G > A and c.547C > T mutations are responsible for 1% each of the Iranian ARNSHL patients. These genes are not a frequent cause of ARNSHL in an Iranian population.

Inequality in distribution of burn facilities in Iran.

Background: Inequality in the distribution of medical equipment and facilities has mainly been observed in health centers and, particularly, in governmental hospitals in each country. This study aimed to assess inequality in the distribution of burn facilities in Iran, including burn beds and specialist physicians needed for burn patients in 2017. Methods: This was a descriptive-analytic study, in which statistical records of the Ministry of Health and Medical Education for 2017 and the Population and Housing Report of 2016 of the Statistical Centre of Iran were used. The main variables studied were number of burn beds and number of general surgeons and plastic surgeons in medical universities in the provinces of Iran. Inequality in the distribution of these variables was evaluated using the Gini coefficient and the Lorenz curve. Excel 2010 software was used for data analysis. Results: In 55% of the provinces, the number of beds per capita for 100 000 population was lower than the average of Iran (1.26 beds of burn ward), and in 45% of the provinces, it was higher than the average of Iran in terms of this index. The results showed that burn beds were distributed unevenly in medical universities (G=0.42). However, the provincial distribution of these beds had a favorable condition (G=0.21). Also, the numerical value of the Gini coefficient showed the alert status in the distribution of specialist physicians based on the university distribution (G=0.51). Conclusion: Although solving the problems related to equality in the distribution of health resources is not an easy task, assessing this issue has a great impact on improving the policymaking procedures and allocating the health system resources. For the first time, this study presented some policies to avoid centralization and prevent some metropolitan cities from turning into cities with limited burn facilities through a comprehensive reviewing of the distribution of the main sources needed by the Iranian burn patients.

Designing and validating a measuring tool for the factors affecting the distribution of hospitals' intensive care beds in Iran.

Background: Hospital services are the most expensive medical service in modern health care systems. Intense care beds, in particular, are more important. The present study was conducted to design and validate a measuring tool for the factors affecting the distribution of hospitals' intensive care beds in Iran. Methods: In this mixed method study, first, all known factors affecting the distribution of hospitals' intensive care beds were extracted by reviewing related literature. Then, all 60 confirmed items were categorized into different dimensions. Face validity and content validity of the questionnaire was done by 20 medical experts through qualitative and quantitative methods. Validity and reliability indices, content validity index (CVI), content validity ratio (CVR), and Cronbach's alpha were measured. SPSS software were used for data analysis and significance level was set at less than .05. Results: From the 60 suggested items, 34 were confirmed by the expert panels and all items had CVR and CVI scores higher than 0.83 and 0.81, respectively. CVR and CVI for all 34 items were 0.88 and 0.89, respectively. Also, Cronbach's alpha coefficient (0.75) indicated a suitable internal consistency. The value of S-CVI / Ave was also calculated to be 0.92. Conclusion: In this study, a valid tool was designed to identify the factors affecting the distribution of hospitals' intensive care beds. This tool consists of 6 dimensions: demographic, geographic, economic, sociopolitical, organizational, and constructional.

Preconditioned neurons with NaB and nicorandil, a favorable source for stroke cell therapy.

Poor survival of stem cells in the harsh microenvironment at the site of stroke, especially during acute phase of injury, remains a serious obstacle to achieve the desired prognosis. We hypothesized that combined treatment of neural stem cells (NSCs) with small molecules would precondition them to become robust and survive better as compared with the native nonpreconditioned cells. Mouse ganglionic NSCs were isolated, cultured, and characterized. The cells were preconditioned by treatment with sodium butyrate (NaB) and nicorandil (Nico) and transplanted in an experimentally induced stroke model. Sham-operated animals without treatment or animals with experimental stroke treated with basal medium, native NSCs, NSCs preconditioned with NaB or Nico alone were used as controls. The tissue samples and cells with different treatments were used to measure brain-tissue-derived neurotrophic factor (BDNF) level and the activity of phosphatidylinositol-3 kinase (PI3K), apurinic/apyrimidinic endonuclease 1 (APE1), and nuclear factor-κB (NF-κB) p50 both in vitro and in vivo, respectively. Additionally, survival of the cells and recovery indices for stroke were studied. The combined treatment with NaB + Nico resulted in increased BDNF level and higher PI3K, APE1, and the downstream NF-κB activation, which were blocked by pretreatment with their respective inhibitors. Donor cell survival increased postengraftment as assessed by 5-bromo-2'-deoxyuridine immunostaining and reduced Terminal deoxynucleotide transferase dUTP Nick End Labeling positivity at the site of engraftment. There was reduction in proinflammatory cytokines and infiltration of both GFAP + and CD68 + at the injury site. There was reduction in the infarct size and neurological function was preserved in the preconditioned cell treatment group. Our preconditioning approach with small molecules effectively improved the survival as well as functionality of NSCs.

Factors affecting strategic plan implementation using interpretive structural modeling (ISM).

Purpose Strategic planning is the best tool for managers seeking an informed presence and participation in the market without surrendering to changes. Strategic planning enables managers to achieve their organizational goals and objectives. Hospital goals, such as improving service quality and increasing patient satisfaction cannot be achieved if agreed strategies are not implemented. The purpose of this paper is to investigate the factors affecting strategic plan implementation in one teaching hospital using interpretive structural modeling (ISM). Design/methodology/approach The authors used a descriptive study involving experts and senior managers; 16 were selected as the study sample using a purposive sampling method. Data were collected using a questionnaire designed and prepared based on previous studies. Data were analyzed using ISM. Findings Five main factors affected strategic plan implementation. Although all five variables and factors are top level, "senior manager awareness and participation in the strategic planning process" and "creating and maintaining team participation in the strategic planning process" had maximum drive power. "Organizational structure effects on the strategic planning process" and "Organizational culture effects on the strategic planning process" had maximum dependence power. Practical implications Identifying factors affecting strategic plan implementation is a basis for healthcare quality improvement by analyzing the relationship among factors and overcoming the barriers. Originality/value The authors used ISM to analyze the relationship between factors affecting strategic plan implementation.

The Effects of Implementing an Accreditation Process on Health Care Quality Using Structural Equation Modeling.

This study was undertaken to investigate nurses' perceptions of and attitudes toward the effects of hospital accreditation on their service quality in an eye hospital in Tehran in 2016. This was a cross-sectional and descriptive-analytic study conducted in the second half of 2016. Data of 200 nurses who were selected using a census method were studied. For collecting the required data, a standard questionnaire was used. Data were analyzed using SPSS 21.0 through descriptive statistics, as well as AMOS 18.0 software through the measurement and structural models of structural equation modeling method. The results showed that the independent variables of nurses' participation and the benefits of accreditation had predicted 63% of the variations in the dependent variable of "quality." Also, the results of structural equation modeling showed that the benefits of accreditation (regression weight = 0.22) had a significant effect on quality outcomes (P = .02). Moreover, the participation of nurses (regression weight = 0.61) had an important effect on quality outcomes (P < .001). Finally, the benefits of accreditation had a significant association with the nurses' participation (regression weight = 0.50) (P < .001). According to the results of the present study, the hospital accreditation program had positive effects on the quality of care from the studied nurses' perspective.

Origins of the breast milk-derived cells; an endeavor to find the cell sources.

Fresh human breast milk consists of a heterogeneous population of cells that may offer a non-invasive source of cells for therapeutic proposes. The aims of this study were to characterize the breast milk-derived cells cultured in vitro. To do this, the cells from human breast milk were cultured and the expression of the CD markers along with the embryonic stem cell markers, endothelial and luminal mammary epithelial cell markers was evaluated by flow cytometry and immunofluorescence. The presence of fetal microchimerism among the isolated cells was also determined by the presence of SRY gene. They were also differentiated into adipocytes and osteoblasts. The results showed that a remarkable number of cells expressed the mesenchymal stem cell (MSC) markers such as CD90, CD44, CD271, and CD146. A subpopulation of the human breast milk-derived cells (HBMDC) also expressed the embryonic stem cell markers, such as TRA 60-1, Oct4, Nanog and Sox2 but not SSEA1 or 4. The frequencies of the cells which expressed the endothelial, hematopoietic cell markers were negligible. SRY gene was not detected in the breast milk isolated cells. A subpopulation of the cells also expressed cytokeratin 18, the marker of luminal mammary epithelial cells. These cells showed the capability to differentiate into adipocytes and osteoblasts. In conclusion, these finding highlighted the presence of cells with various sources in the breast milk. Different stem cells including MSCs or embryonic stem cell-like cell along with the exfoliated cells from luminal epithelial cells were found among the isolated cells. The breast milk-derived stem cells might be considered as a non-invasive source of the stem cells for therapeutic purpose.

Analysis and optimization of a dual-core dispersion compensation fiber based on a 12-fold photonic quasicrystal structure.

In this paper, a dual-concentric-core photonic quasicrystal fiber (DCC-PQF) with a 12-fold symmetric structure has been designed to compensate for dispersion effects. To this end, a new design based on modifying the positions of the nearest air holes to the central core has been proposed for dispersion compensation, in which ultra-high negative dispersion of about -44,000 ps/(nm·km) at 1.55 µm can be estimated. In addition, by optimizing structural parameters, high negative dispersion for the proposed DCC-PQF has been predicted, approximately -12,000 ps/(nm·km) at around 1.55 µm, with an FWHM about 42 nm in the wavelength ranges between 1529 and 1571 nm, which entirely covers the C telecommunication band. Furthermore, a dispersion relation dependency on hole-to-hole spacing, first ring air hole diameters, as well as diameter of the air holes in the outer core and its position, has been investigated and discussed in detail.

Identification of the factors affecting the referral system of veterans' health services: A scoping review.

Referral in the health system is a systematic process for the optimal allocation of resources and improves the access of people in need of treatment services. Considering the vulnerability of the veterans and more medical needs in this group, this study aims to identify the components that affect veterans' health services referral system. MEDLINE, Scopus, Web of Science, and ProQuest databases, the international military studies website, and key journals in the field of veterans' health services were searched with related keywords including "veteran," "referral system," and "health services" for the period from January 2000 to July 2022. Studies were screened and selected in accordance with the phases of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) flow diagram 2020. Data extraction was done by two researchers independently and a thematic content analysis method was used to analyze the findings. Among 40,608 studies searched electronically and 16 studies searched manually, 19 studies that met the inclusion criteria were selected. The research method applied here is a combination of quantitative, qualitative, and mixed methods. The most important findings were extracted from the included studies and analyzed in three general categories: components related to the patient, service provider, and the structural-operational mechanisms of the referral system. The effective performance of the referral system for providing health services to veterans is influenced by the factors affecting components related to the patient, the service provider, and the structural-operational mechanisms of the referral system. Evaluating and improving each of these factors improve the performance of the referral system and provision of health services to veterans.

Identifying the preparedness components in COVID-19: Systematic literature review.

In 2019, the COVID-19 pandemic posed a major challenge to the world. Since the world is constantly exposed to communicable diseases, comprehensive preparedness of countries is required. Therefore, the present systematic review is aimed at identifying the preparedness components in COVID-19. In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Science Direct, Iran Medex, Magiran, and Scientific Information Database were searched from 2019 to 2021 to identify preparedness components in COVID-19. Thematic content analysis method was employed for data analysis. Out of 11,126 journals retrieved from searches, 45 studies were included for data analysis. Based on the findings, the components of COVID-19 preparedness were identified and discussed in three categories: governance with three subcategories of characteristics, responsibilities, and rules and regulations; society with two subcategories of culture and resilience; and services with three subcategories of managed services, advanced technology, and prepared health services. Among these, the governance and its subcategories had the highest frequency in studies. Considering the need to prepare for the next pandemic, countries should create clear and coherent structures and responsibilities for crisis preparedness through legal mechanisms, strengthening the infrastructure of the health system, coordination between organizations through analysis and identification of stakeholders, culture building and attracting social participation, and service management for an effective response.

A review study of the providing elderly care services in different countries.

Background: Population aging leads to change of population structure and increase care needs. Lack of proper planning in this field will lead to occur increasing problems. In this paper, the review of the elderly care plans at various levels in some European and Asian countries, comparing these countries with Iran with the goal of using their experiences to enhance elderly plans have been done. Methods: This research was a review study of library documents and resources and systematic search. Data were collected using the resources, databases, scientific databases and websites of the Ministry of Health and Welfare of the studied countries. Results: Based on this research in the studied countries, the care services of the elderly is based on the important principle of coordination between different organs of the country, followed by the creation of LTC insurance and provision of health and social services for the elderly and mainly the type of home care. In Iran country, providing appropriate services and cares for the elderly with existing plans and policies is not possible and the need to provide appropriate service packages based on the different systems of successful countries and applying the experiences of these countries is essential. Conclusion: Given the current status of the Iranian elderly population in terms of policies and plans and the types and methods of providing services, quality, access and financial resources allocated to this age group, compared to the studied countries, there is a well and integrated plan is essential.

Health needs assessment of the residents of the informal settlements in South-Eastern Iran: A case study of Bam city.

BACKGROUND: Informal settlements are considered as one of the social problems in societies. As the residents do not have adequate access to basic services, including health services, their health is at risk. This study was conducted to evaluate the access to health services and determine the health needs of informal settlements in Bam city. MATERIALS AND METHODS: This cross-sectional study was carried out in the spring of 2020 in Bam. The sample size was 400 residents of informal settlements in Bam, and the multi-stage random cluster sampling was used. A researcher-made questionnaire was used to collect the required data. The validity of the questionnaire was confirmed using the content validity, and its reliability was 85% by Cronbach's alpha. The data were analyzed using the SPSS version 23 software and descriptive statistics (frequency, mean, standard deviation, and percentage) as well as analytical statistics (Mann-Whitney and Kruskal-Wallis tests). RESULTS: More than 50% of the individuals had good access to general practitioners and health centers. However, over 50% had poor access to dental, para-clinical, specialist, and hospital services. Furthermore, 49.3% of the people assessed their health status as poor in the previous year. A total of 46 items in the areas of communicable and non-communicable diseases, women's health, mental and social health and addiction, environmental health, etc., were identified as the most important health needs of the informal settlement residents. CONCLUSION: Informal settlements are facing various health problems including environmental health, mental and social health, and addiction, meeting which requires collaboration of all stakeholders as well as provision of a comprehensive program and appropriate service packages.

Impact of comorbidities on mortality in hospitalized patients with COVID-19: An experience from Iran.

BACKGROUND: COVID-19 pandemic has spread all over the world. However, information regarding clinical characteristics and prognostic factors is scarce. The aim of this study was to explore the impact of preexistent chronic comorbid conditions and multimorbidity on risk of mortality in patients with COVID-19. MATERIALS AND METHODS: We designed a retrospective, cross-sectional, observational, single-center study. Data were analyzed from all consecutive patients diagnosed with COVID-19 who admitted in a pandemic hospital affiliated with Tabriz University of Medical Sciences, Tabriz, Iran, from February 20, 2020, to September 25, 2020. The independent effects of preexistent conditions were evaluated using multivariate logistic regression model. RESULTS: A total of 2597 hospitalized patients with COVID-19 were included. At least one preexistent condition was observed in 36.5% of study population. Multivariate logistic regression analysis showed that older age, male sex, diabetes, cardiovascular disease, hypertension, cancer, chronic kidney diseases, liver diseases, and chronic obstructive pulmonary disease were associated with increased risk of mortality. In addition, the number of comorbidities was significantly associated with increased odds of mortality compared to no-comorbidity. CONCLUSION: The results of this study suggest that patients with comorbidities have an increased risk of in-hospital mortality following COVID-19 infection.