Analyzing the Factors Affecting Neonatal Mortality Control in Iran by Providing a Model.

INTRODUCTION: Despite Iran's success in reducing neonatal mortality rate, it is still far behind some developing countries and some Asian countries. The aim of this study was to summarize the measures taken and proposed solutions to design a model to control neonatal mortality. METHODS: This applied cross-sectional analytical study was performed using a factor analysis method derived from 4 models of neonatal mortality reduction. After reviewing different texts and patterns, the common and non-common dimensions of these patterns were set in a comparative table. The results of the comparative studies were designed in the form of a questionnaire and sent to 30 experts for reliability and validity. CVI and CVR validity and Cronbach's α reliability were confirmed and in order to validate the model, the final questionnaire was completed and summarized by interviewing 311 people from 7 provinces in a multi-stage interview method using multi-stage random sampling. Data analysis was performed using SPSS25 and AMOS-18 software. RESULTS: 6 factors were found to be effective in controlling neonatal mortality, including access to health care, health policy, health services, health information systems, family involvement, and evaluation. Access to health care services had the most significant effect with 23.19% of explained variance, and participation and evaluation with 1.19% of explained variance had the least effect. CONCLUSION: The proposed model has the greatest impact on the access to health care services and the least impact on the evaluation component.

Adapted fairness benchmarks for the evaluation of Iran health system reform.

INTRODUCTION: This study has been designed to localize fairness benchmarks for the evaluation of health system reform with an ethical approach. METHODS: A descriptive-analytic study was applied in which a questionnaire with selected indicators and based on main fairness benchmarks was validated. Besides, the final indicators were chosen for surveys of 255 health equity experts from 31 provinces of Iran to localize fairness benchmarks using the exploratory factor analysis through the SPSS software. RESULTS: Seven fairness benchmarks were adopted: (1) Efficacy, Efficiency, and Quality of Health Care; (2) Impact of Information Infrastructure on Health Reform; (3) Responsiveness; (4) Equitable Access, and Universal Health Coverage; (5) Equitable Financing; (6) Social Determinant of Health; and (7) Financial Barriers to Equitable Access. CONCLUSION: The priorities of fairness benchmarking through localization included focusing on the quantity and quality of primary health care, allocating resources based on the need; for equitable efficiency, and paying attention to community-based information infrastructure, and social determinants for fair reform. Moreover, respecting patient rights as a part of democratic accountability was more close to equity. Elimination of financial and nonfinancial barriers for health access and coverage based on vulnerability, through fair financing, was also confirmed.

Developing a Shared Decision-Making Model for Diabetic Patients: A Qualitative Study.

Background: Patient participation in healthcare leads to increased satisfaction and trust, reduction of anxiety, and a better understanding of patients' needs. The components of shared decision-making (SDM) are well documented in the literature. The purpose of this study was to design an SDM model for diabetic patients. Materials and Methods: This qualitative content analysis study was performed in three steps. First, a descriptive comparative study was conducted using the widely-used George Brady method. Next, the perceptions of participants (both physicians and patients) were collected via interview and in focus group discussions (FGDs). Content analysis was used to categorize the comments made by participants. In the final step, the model of SDM for diabetic patients was designed based on expert panel discussions. Results: Twelve components were extracted from the comparative study. Two themes and six sub-themes were extracted from data resulting from physicians' interviews, and two themes and ten sub-themes were extracted from data resulting from the FGDs involving patients. The model of SDM for diabetic patients was designed in light of three concepts; practitioners' behavior, participatory decision-making process, and patients' autonomy. Conclusion: This model was valuable because it recognizes the process of SDM in the context of Iran. The model's main purpose was to help choose optimum strategies for the care of diabetic patients within the health sector.

Population and mortality profile in the Islamic Republic of Iran, 2006-2035.

BACKGROUND: The Islamic Republic of Iran has encountered demographic and epidemiological changes as a result of the transformation of health measures. AIMS: This study aimed to calculate the population and mortality in the Islamic Republic of Iran during the years 2006 to 2035. METHODS: We carried out a cross-sectional analytical-descriptive account. We calculated the age and sex structure of the Iranian population using census data as well as mathematical methods. The crude and causal death rates were calculated and their 20-year trend was predicted using the Lee-Carter model. RESULTS: In 2035, the age group 60 years and over will reach 17.6% of the total population. Endocrine, nutritional and metabolic diseases will be the biggest causes of an increase in the rate of death in the general population. The largest decline in cause of death is for unintentional injuries. CONCLUSIONS: Noncommunicable diseases will increase as the aging population grows. Identification of their primary causal and risk factors can, therefore, contribute to prevention and control.

Comparing performance of Tabriz obstetrics and gynaecology hospitals managed as autonomous and budgetary units using Pabon Lasso method.

BACKGROUND: Considering governmental scrutiny and financial constraints in medicine, the need for improved performance, which can provide acceptable care for medical consumers, leads to the conduct of new managerial methods to improve effectiveness. AIMS: This study aimed to compare performance indicators of obstetrics and gynaecology teaching hospitals in Tabriz. METHOD: A longitudinal, retrospective study was conducted to compare performance indexes of Tabriz obstetrics and gynaecology teaching hospitals during 2010-2012. Al-Zahra is Tabriz's central teaching hospital in obstetrics and gynaecology that is authorised under a board of trustees as an autonomous hospital and Taleghani hospital is managed under centralised administration. Study variables included: Average Length of Stay (ALOS), Bed Occupancy Rate (BOR), and Bed Turnover Ratio (BTR). The data was extracted via the Hospital Information Systems (HIS) within the hospitals' admission and discharge units. Pabon Lasso model was used to assess hospital performance. Data was analysed and graphs were plotted using the SPSS-17 software package. RESULTS: According to study findings, overall ALOS in Al-Zahra hospital is 3.15 (2.15) days (1.88 (0.97) days for prenatal wards and 6.13 (0.97) days for neonatal wards) and ALOS in Taleghani Hospital is 3.37 (3.09) days (1.74 (0.14) days for perinatal wards and 5.96 (3.55) days for neonatal wards). In this regard, Al-Zahra hospital holds the maximum BOR with 86.92 per cent and the minimum BOR was attributed to Taleghani hospital at 68.44 per cent (P<0.001). Study findings indicate that BOR in neonatal wards is greater than prenatal wards. On the other hand, BOR in Al-Zahra is greater than Taleghani (P<0.001), whereas BOR trend shows an increasing pattern in both hospitals. CONCLUSION: Results of this study showed that the performance of Al- Zahra Hospital is better than Taleghani Hospital. These two hospitals are similar in different aspects except Al-Zahra is under a board of trustees and Taleghani is not. We should also consider that Al-Zahra Hospital has more facilities than Taleghani.