The PERSIAN Cohort: Prevalence of Psychiatric Disorders Among Employees.

BACKGROUND: Considering the impact of psychiatric disorders on the productivity of individuals and society's economy, we aimed to determine the prevalence of psychiatric disorders among the employees of Tabriz University of Medical Sciences. METHODS: This cross-sectional study was conducted on 1282 employees of Tabriz University of Medical Sciences in 2019. The required data were collected by trained psychologists using Composite International Diagnostic Interview (CIDI). In this process, psychiatric disorders were considered dependent variables, and demographic variables as independent variables. The relationship between independent and dependent variables was assessed using the chi-square test and Binary logistic regression in Stata version 17. RESULTS: The prevalence of generalized anxiety disorder (GAD), major depressive disorder (MDD), and obsessive-compulsive disorder (OCD) among employees was 14.12%, 12.48%, and 3.9%, respectively. The prevalence of GAD in women was significantly higher than men (17.06% vs. 10.02%, P<0.001). The prevalence of GAD was 42.86%, 15.97%, 13.49%, and 16.67 in widowed, single, married, and divorced employees, respectively (P=0.016). The prevalence of MDD in women was significantly higher than men (16.59% vs. 7.64%, P<0.001). The prevalence of MDD was 16.3%, 11.2%, 9.6%, and 8.56% in employees with Bachelor's, Associate, Master's degree, and High school diploma, respectively (P=0.009). CONCLUSION: Considering the relatively high prevalence of GAD and MDD among the employees of Tabriz University of Medical Sciences, strengthening counseling centers in the university and encouraging employees to participate in these centers, and examining them in terms of mental health help identify people at risk of mental disorders in time and provide counseling services to these people.

Efficacy of Rivastigmine Augmentation on Positive and Negative Symptoms, General Psychopathology, and Quality of Life in Patients with Chronic Schizophrenia: A Randomized Controlled Trial.

The study aimed to assess Rivastigmine augmentation on positive and negative symptoms (PNSs), general psychopathology, and quality of life in patients with chronic Schizophrenia. A double-blind, parallel-design, randomized, placebo-controlled trial of 60 schizophrenia patients was conducted. Intervention group received rivastigmine 3 mg/day + Treatment as Usual (TAU) and the control group: TAU + placebo. Negative and positive symptoms, general psychopathology; and quality of life were measured using Positive and Negative Symptom Scale (PANSS) and Manchester Short Assessment of Quality of Life (MANSA). T-test, ANOVA, and the general univariate linear model tests were used for the analyses. Out of 60 participants, 52 (86.6%) were male. At baseline, no significant relationship was found for demographic and clinical characteristics between intervention and control groups. Between-group analysis indicated that all outcome measures PNSs, general psychopathology symptoms, and QoL score in rivastigmine group was significantly improved (p = 0.001). According to within-group analysis, a significant association was found between Rivastigmine and placebo groups in PNSs (p < 0.05). Rivastigmine augmentation improved PNSs and psychopathology in schizophrenia patients. However, no significant association found for improving the life quality after 8 weeks treatment.

PERSIAN traffic safety and health cohort: a population-based precrash cohort study.

PURPOSE: Despite to high burden of road traffic injuries (RTIs), the RTI epidemiology has received less attention with rare investments on robust population cohorts. The PERSIAN Traffic Safety and Health Cohort (PTSHC) was designed to assess the potential causal relationships between human factors and RTI mortality, injuries, severity of the injury, hospitalised injury, violation of traffic law as well as offer the strongest scientific evidence. PARTICIPANTS: The precrash cohort study is carried out in four cities of Tabriz, Jolfa, Shabestar and Osku in East Azerbaijan province located in northwest Iran. The participants were people who sampled among the general population. The cluster sampling method was used to enrol the households in this study. The PTSHC encompasses a wide and comprehensive range and types of data. These include not only the common cohort data collections such as medical examination measures, previous medical history, bio assays and behavioural assessments but also includes data obtained using advanced novel technologies, for example, electronic travel monitoring, driving simulation and neuro-psycho-physiologic laboratory assessments specifically developed for traffic health field. FINDINGS TO DATE: A total of 7200 participants aged 14 years and above were enrolled at baseline, nearly half of them being men. The mean age of participants was 39.2 (SD=19.9) years. The majority of participants (55.4%) belonged to the age group of 30-56 years. Currently, approximately 1 200 000 person-measurements have been collected. FUTURE PLANS: PSTHC will be used to determine the human-related risk factors by adjusting for the vehicle and land-use-related factors. Therefore, a lot of crashes can be prevented using effective interventions. Although this cohort provides valuable data, it is planned to increase its size to achieve the highest level of evidence with higher generalisability. Also, according to the national agreement this cohort is going to be extended to several geographical regions in second decade.

Mental Health Services Integration in Primary Health Care in Iran: A Policy Analysis.

Objective: The National Mental Health Services (N-MHSs) in Iran was integrated with Primary Health Care (PHC) in 1988. This study aimeds to analyze the policy of integrating N-MHSs in PHC, focusing on the analysis of the current situation, pathology, and the existing challenge. Method : This qualitative research was conducted in 2020 using a case study approach. This study used the policy triangle model to analyze the policy. The required data were collected via interviews, literature review, and document analysis. The interviews were conducted with 23 experts, stakeholders across the country who were selected through purposive sampling, and the data were analyzed using the content-analysis method. Results: The main goals of this policy were to raise mental health literacy among the people and eliminate its stigma in the society, while implementing the referral system for N-MHSs. Twenty weaknesses were extracted in eight areas, including negative views of mental health, weaknesses in human resource training, compensation for the service of psychologists, unfavorable working conditions of the workforce, inappropriate service delivery facilities, lack of meaningful communication between different levels of service delivery, poor inter-sectorial communication, and the challenging nature of mental health care. De-stigmatizing psychological disorders in the society and identifying hidden patients are some of the most significant achievements of this policy. Conclusion: Despite the successful implementation and significant achievements in integrating N-MHSs in PHC, the results of the present study indicate that there are many challenges in this field that require serious planning and attention from relevant authorities.

Prevention of Re-attempt Suicide Through Brief Contact Interventions: A Systematic Review, Meta-analysis, and Meta-regression of Randomized Controlled Trials.

Brief contact intervention (BCI) is a low-cost intervention to prevent re-attempt suicide. This meta-analysis and meta-regression study aimed to evaluate the effect of BCI on re-attempt prevention following suicide attempts (SAs). We systematically searched using defined keywords in MEDLINE, Embase, and Scopus up to April, 2023. All randomized controlled trials (RCTs) were eligible for inclusion after quality assessment. Random-effects model and subgroup analysis were used to estimate pooled risk difference (RD) and risk ratio (RR) between BCI and re-attempt prevention with 95% confidence intervals (CIs). Meta-regression analysis was carried out to explore the potential sources of heterogeneity. The pooled estimates were (RD = 4%; 95% CI 2-6%); and (RR = 0.62; 95% CI 0.48-0.77). Subgroup analysis demonstrated that more than 12 months intervention (RR = 0.46; 95% CI 0.10-0.82) versus 12 months or less (RR = 0.67; 95% CI 0.54-0.80) increased the effectiveness of BCI on re-attempt suicide reduction. Meta-regression analysis explored that BCI time (more than 12 months), BCI type, age, and female sex were the potential sources of the heterogeneity. The meta-analysis indicated that BCI could be a valuable strategy to prevent suicide re-attempts. BCI could be utilized within suicide prevention strategies as a surveillance component of mental health since BCI requires low-cost and low-educated healthcare providers.

Psychometric properties of trust in trauma care in an emergency department tool.

BACKGROUND: In emergency cases, lack of other treatment alternatives may affect a person's decision, but it does not render that decision involuntary. Being able to make choices is a crucial (but not necessary) element of trust. We aimed to develop a tool to evaluate the Trust in Trauma Care in an Emergency Department (TTC-ED) among traumatic patients. METHODS: This psychometric study was carried out on 498 trauma patients who referred to the Imam Reza hospital in Tabriz, Iran, 2022. Patient-focused interviews, expert/key informants' opinions, and literature reviews were used to generate the items. Several statistical techniques were used to evaluate the TTC-ED trust tool's content validity, reliability, and construct validity, including the modified Kappa (k*), the Intra-Class Correlation (ICC) coefficient, and Exploratory Factor Analysis (EFA). Data were analyzed using SPSS version 26.0 and STATA 14 statistical software packages. RESULTS: A tool with 22 items was developed. As a measure of content validity assessment, the k* coefficient was 0.97. Regarding the evaluation of reliability, a good level of internal consistency was noted with a Cronbach's α 0.93, and the scale's test-retest reliability (as measured by ICC) was 0.96. The results of exploratory factor analysis indicated that the TTC-ED had a two-component tool fitted the data. Factor 1 includes 13 items covered 43.0% of the variance (eigenvalue = 9.47) and factor 2 consisted of nine items which accounted for 5.64% of the variance (eigenvalue: 1.24). CONCLUSION: The Trust in TTC-ED has been shown to be a valid and reliable test for assessing patients' trust in emergency room settings delivering trauma care. Future research may examine the validity in other contexts and create a TTC-ED instrument with a shorter version.

Developing Iranian sub-national primary health care measurement framework: a mixed-method study.

BACKGROUND: Desired health outcomes are more achievable through strong Primary Health Care (PHC). Using comprehensive and scientific tools, decision-makers are guided to formulate better PHC reforms and policies. This study introduces a sub-national framework based on the World Health Organization (WHO) proposed frameworks for the PHC performance measurement. METHOD: By a mixed-method and qualitative approach, the Iranian sub-national PHC Measurement Framework (PHCMF) was developed through a review of the WHO's PHC measurement conceptual framework (for selecting Key Performance Indicators (KPIs)), literature review (academic database), PHC-related national documents, consultations with an advisory committee of national experts (6-meetings), and the Delphi technique for finalizing the framework. RESULTS: The Iranian sub-national PHCMF was finalized with 100 KPIs in three components including Health systems determinants, Service Delivery, and Health system objectives. Based on the result chain domain, most KPIs were related to the output (24 KPIs) and the least were related to the input and the process (9 KPIs). CONCLUSION: Regarding the comprehensiveness of the developed measurement framework due to its focus on all PHC operational levers and key aspects of PHC systems' performance, it can be used as a practical tool for assessing and improving the Iranian sub-national PHC system.

Adaptation of a European categorization system for driving-impairing medicines in Iran.

OBJECTIVE: Road traffic crashes due to impaired driving are a leading cause of preventable injuries and deaths. The purpose of this study was adaptation of a European categorization system for driving-impairing medicines in Iran. METHODS: DRUID categorization system was used as a leading model to classify medicines. Medicines that were compatible with DRUID categorization system were identified and classified accordingly. Medicines that were not compatible with DRUID categorization system were assessed in an expert panel in terms of possiblity of classification. Instructions for health care providers and advice for patients were prepared based on the medicine's influence on fitness to drive. RESULTS: Of the 1255 medicines in Iranian pharmacopeia, 488 medicines were classified in four categories. Among classified medicines 43.85% and 25.41% belonged to Category 0 and Category 1. About 13.94%, 10.04%, and 6.76% pertained to Category 2, Category 3, and Multiple categories respectively. Majority of the medicines with moderate and severe adverse influences on driving fitness belonged to the nervous system medicines (72.65%). Most of the medicines with non-existing or minor adverse influences on driving fitness pertained to cardiovascular medicines (16.56%). Majority of uncategorized medicines belonged to Iranian herbal medicines. CONCLUSION: The current study disclosed that DRUID categorization system was implementable for most of the commonly prescribed medicines. Experimental studies are needed to determine the influence of uncategorized medicines of Iranian pharmacopeia. Other countries with similar settings can adapt DRUID categorization system until they develop their own model using original studies.

Categorization and labeling systems concerning driving-impairing medicines: A scoping review.

OBJECTIVE: Classification systems concerning driving-impairing medicines can help healthcare providers identify medicinal drugs with no or the least impairing effects and inform patients of the potential risks of certain medicines to safe driving. This study aimed to comprehensively assess the characteristics of classifications and labeling systems regarding driving-impairing medicines. METHODS: Google Scholar and several databases, including PubMed, Scopus, Web of Science, EMBASE, safetylit.org, and TRID were searched to identify the relevant published material. The retrieved material was assessed for eligibility. Data extraction was done to compare the categorization/labeling systems concerning driving-impairing medicines in terms of characteristics such as the number of categories, description of each category, and description of pictograms. RESULTS: After screening 5,852 records, 20 studies were selected for inclusion in the review. This review identified 22 categorization/labeling systems regarding medicines and driving. Classification systems had different characteristics, but most of them were designed based on the graded categorization system described by Wolschrijn. Initially, categorization systems had seven levels, but later the medicine impacts were summarized into 3 or 4 levels. CONCLUSIONS: Although different categorization/labeling systems regarding driving-impairing medicines are available, the most effective systems in changing driver's behavior are the simple and understandable ones. Besides, health care providers should consider patient's socio-demographic features when informing them about driving under the influence.

Validity and reliability of short-form travel behavior questionnaire during COVID-19 pandemic (TBQ-Cov19).

Introduction: Avoiding unnecessary travel and reducing the number of essential travels are among the effective strategies for preventing the spread of COVID-19 during the pandemic. Given that it is impossible to avoid essential travel, health protocols should be observed to prevent disease transmission. The extent to which health protocols are observed during the trip should be accurately assessed by a valid questionnaire. Therefore, this study aims to develop and validate a questionnaire to assess compliance with COVID-19 prevention protocols during travel. Methods: In this cross-sectional study, 285 individuals were selected from six provinces using the cluster sampling method in May and June 2021. The Content Validity Ratio (CVR) and Content Validity Index (CVI) were calculated using the comments of 12 external experts. The exploratory factor analysis (EFA), with principal component factor in the extraction method and Varimax rotation, were applied to determine construct validity. Cronbach's alpha was employed to assess internal consistency and the Spearman-Brown correlation coefficient was computed for test-retest reliability. Results: In the content validity phase, the I-CVIs for all items were acceptable, but due to a low CVR value (below 0.56), one question was eliminated. As a result of EFA for construct validity, two factors were extracted that justified 61.8% of the variance. Cronbach's alpha coefficient of the questionnaire, with 10 items, was 0.83. The Spearman-Brown correlation coefficient was 0.911 which confirmed the stability of the questionnaire at an excellent level. Conclusions: This questionnaire is a valid tool with good validity and reliability for assessing compliance with health protocols in travel during the COVID-19 pandemic.

Public-private partnership in primary health care: an experience from Iran.

AIM: The aim of this paper is to introduce the experience of applying public-private partnership (PPP) in providing primary health care (PHC) in East Azerbaijan Province (EAP), Iran. BACKGROUND: Moving toward the Universal Health Coverage (UHC) involves using of all health-related resources. Certainly, one of the key strategies for achieving UHC is PPP. Since 2015, a PPP in PHC policy has begun in EAP as a major strategy for strengthening the health system and achieving UHC. METHODS: In this case study, data were collected through interviews with stakeholders, document analysis, reviewing of health indexes and published studies. The data were analyzed using content analysis. FINDING: PPP in PHC policy was designed and implemented in EAP with the aim of social justice, strengthening the health system and achieving UHC in the framework of health complexes (HCs). HCs provide a defined service package according to the contract. The reimbursement method is a combination of per capita, fee for services and bonus methods. Part of the payments is fixed and the other part is based on the pay for quality system and paid according to the results of monitoring and evaluation. According to the study results, the most important strength of the plan is to improve access to services, especially in marginalized areas. The main weakness is not providing infrastructures before the implementation of the plan, and the most important challenges are financial, political and organizational unsustainability and, sometimes, poor cooperation by the other organizations. The findings show that PPP in PHC in EAP is an effective strategy to provide social justice, implement family practice and achieve UHC.

Psychometric Properties of EQ-5D-3L Applied through Phone Follow-Ups: An Experience in PERSIAN Traffic Cohort.

Objective: To assess psychometric properties of the European Quality of Life 5-Dimension 3-Level Version (EQ-5D-3L) commonly used tool for measuring road traffic injury (RTI) patients' quality of life. Methods: The psychometric study assessed the reliability and applicability of EQ-5D-3L through phone surveys, based on a national cohort platform. Data of 150 RTI patients recruited from the cohort study were included as 50 patients per each follow-up phase (one, six, and twelve months after discharge). A 12- day-time span was between test and retest. We measured psychometric properties (internal consistency reliability and stability reliability) and agreement using Kappa coefficients and percentages of agreement and Bland-Altman method. Data were analysed using software STATA statistical package. Results: The majority of patients were men (80%) with mean age (SD) of 41(14.7%), employed (78%) and educated (86%). The Persian version represented high internal consistency reliability at total level (Cronbach's α=0.81) and moderate to good reliability at phase levels (0.62-0.87). The stability reliability was excellent at total (ICC=0.98, 95% CI: 0.97, 0.98) and phase levels (0.97-0.98. The kappa agreement coefficients were valued moderate to perfect (0.6-0.8, p>0.0001). The Bland-altman plot illustrated high agreement between test and retest scores. No floor and ceiling effects were found. Conclusion: The study revealed that EQ-5D-3L was highly reliable and responsive to be applied through phone interviews at three different times post injury and discharge, as no previous study considered its psychometric properties at various phone follow-ups after RTIs.

The challenges facing programs for the prevention and control of non-communicable diseases in Iran: a qualitative study of senior managers' viewpoints.

BACKGROUND: Despite significant achievements in the prevention and control of NCDs in Iran, these conditions are still the biggest challenges to Iran's healthcare system and are estimated to account for 78.1 percent of all deaths. Therefore, this study aimed to reflect on the potential challenges standing in the way to implement the relevant policies, empower the dimensions of governance, and react in an effective and timely manner by Iran's healthcare system to NCDs. METHODS: This study was conducted with a qualitative approach using the conventional content analysis method. A total of 46 senior managers involved in the prevention and control of NCDs at the medical sciences universities across Iran were recruited through the purposive sampling method and were interviewed via semi-structured interviews. Graneheim and Lundman's approach was utilized to analyze the data. RESULTS: According to the analysis of the senior managers' viewpoints, current challenges to implement the program for the prevention and control of NCDs in Iran could be placed into six main categories, including financing, human resources, infrastructure and inputs, legal, executive, administrative, as well as inter-sectoral collaboration, and management and policy-making challenges with their own sub-categories. CONCLUSION: The results revealed that financing was the biggest challenge to successfully implementing the program for the prevention and control of NCDs in Iran. However, strengthening Iran's healthcare system in the field of the prevention of NCDs demanded more innovative measures and strategies, such as the empowerment of human resources, the effective use of intra- and inter-sectoral collaboration, and non-governmental organizations and charities, along with the exploitation of evidence-based studies during policy-making and decision-making processes, with no need for financial resources.

Developing inpatient suicide prevention strategies in medical settings: Integrating literature review with expert testimony.

OBJECTIVE: According to some recent evidence, suicide rate is higher in inpatients than in the general population around the world. However, suicide prevention strategies (SPS) are poorly focused and understood in medical settings. This study aimed to develop effective SPS and interventions in medical settings of Iran and provide evaluation checklists/procedures for them. METHODS: The study was performed in two steps, including literature review and expert opinions panel. In the first stage, we conducted a comprehensive literature review to find relevant suicide prevention programs, strategies, interventions, or any efforts to prevent suicide in the medical settings. In the second stage, an expert panel was arranged for developing effective and feasible SPS in medical settings. Data were analyzed through content analysis approach. RESULTS: Overall, 11 records were included in the literature review. SPS varied from staff training, safety plan and quality improvements, and prevention programs to therapy methods. Finally, in the second stage, the following seven major SPS were recommended by the expert panel: 1) Integration and application of obtained suicidal behavior data through evaluating medical records, 2) Screening and suicide risk assessment, 3) Staff training, 4) Quality improvement, 5) Follow-up of inpatients with high-risk behaviors, 6) Reducing stigma and improving public awareness, and 7) Follow-up of discharged high-risk inpatients. Also, 23 interventions within the strategies were presented. CONCLUSION: Given that SPS are poorly focused in medical settings, the practical framework that emerged in this study could be used to develop or advance SPS in various medical settings.

Developing Iranian sub-national Primary Health Care Measurement Framework: a study protocol.

BACKGROUND: Developing an effective system for measurement and improvement of primary health care (PHC) based on the conditions and characteristics of the countries' health systems is one of the World Health Organization (WHO) recommendations. AIMS: This study will aim to develop a framework to assess the Iranian sub-national PHC system performance using the WHO measurement framework for PHC. METHODS/DESIGNS: This is a mix-method study with a triangulation design. The Iranian sub-national PHC Measurement Framework (PHCMF) will be developed through a review of the WHO's PHC measurement conceptual framework (for selecting key performance indicators (KPIs)), literature review (academic database), PHC-related national documents, consultations with national experts, and the Delphi technique for finalizing the framework. The required data for calculating selected KPIs is expected to encompass qualitative and quantitative data. Discussion: Iranian PHC system performance is not measured based on the holistic and scientific framework and international standards. The information obtained from this project will guide managers and policymakers to be aware of the current situation and the success rate of the PHC system in achieving the desired goals, as well as identify strengths and weaknesses of the PHC system and provide the solution to better policy formulation.

Psychometric properties of the 12-item WHODAS applied through phone survey: an experience in PERSIAN Traffic Cohort.

BACKGROUND: Due to limited capability to function in post-injury daily life injury, survivors need to be reliably assessed without need to commute more than necessary. The key action is to determine the level of functioning difficulties. Having the opportunity of conducting a national post-crash traffic safety and health cohort study, we aimed to translate into Persian and assess the psychometric properties of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) through phone surveys six month post injury. METHODS: First, having World Health Organization permission, we tested the translation validity by forward translation, expert panel evaluation, back-translation, pre-testing and cognitive interviewing, and finalizing the Persian WHODAS. Then, through a psychometric study within a national cohort platform, the validity, reliability and applicability of the 12-item WHODAS was assessed through phone surveys. We included data of 255 road traffic injury patients enrolled from the cohort at six-month follow-up. The psychometric assessment (internal consistency reliability and stability reliability) was conducted on test-retest data of 50 patients with an average 7-day time span. An exploratory factor analysis tested the construct validity using extraction method of principal component factor and oblique rotation on data from 255 patients. Regarding the multiple criteria including an eigenvalue > 0.9, Cattell's scree test, cumulative variance, and the theoretical basis, the minimum number of factors were retained. Data were analyzed using STATA statistical software package. RESULTS: The respondents were mostly male (81%), employed (71%), educated (87%), and with a mean age of 37.7(14.9). The Persian version had high internal consistency reliability (Cronbach's α = 0.93) and excellent stability reliability (ICC = 0.97, 95% CI: 0.92-0.98). An exploratory factor analysis retained four factors defining 86% of all the variance. Factors of Self-care, Mobility, and Cognition were completely retained. CONCLUSIONS: The brief Pesrian WHODAS 2.0 was highly reliable and valid to be applied through phone interviews post injury.

Effective Programs on Suicide Prevention: Combination of Review of Systematic Reviews with Expert Opinions.

Background: Health managers often do not have adequate information for decision making on what strategy makes an effective impact on suicide prevention. Despite the availability of global Suicide Prevention Programs (SPP), no previous investigation has developed combinations of a review study with expert opinions. This study was aimed to identify effective programs for suicide prevention. Methods: We used two methods for selecting the effective SPP. (1) review of systematic reviews: we systematically searched to find relevant review studies through Medline, Cochrane Library, PsycINFO, and gray literatures. (2) Expert panel opinions: effective programs identified from the previous step were combined with expert views via the Hanlon method. Results: A total of 27 since some of them were reports met the inclusion criteria. After full-text screening 9 records included. We found the following 12 SPP for prioritizing and rating the most effective interventions by an expert panel: (1) case management of Suicide Attempters (SAs), (2) identification and treatment of depression, (3) registry for suicide, (4) identifying local determinants of Suicidal behavior (SB), (5) public awareness campaigns, (6) gatekeepers' training, (7) conducting research, (8) school-based training, (9) improving knowledge and attitudes, (10) restricting access to means, (11) at-risk people screening, (12) mass media. Conclusions: Seven effective SPP identified after combined 12 included interventions with expert panel opinion: (1) Case management of SAs, (2) Identification and treatment of depression, (3) Improving a registry for suicide, (4) Identifying local determinants of SB, (5) Public awareness campaigns, (6) Training gatekeepers, and (7) Conducting research.

Telehealth in Primary Health Care: A Scoping Review of the Literature.

Background: The use of telehealth as a viable mobility to deliver quality services steadily increases in various levels of the health system. Despite the increasing use of telemedicine in secondary and tertiary health care services, there is a long way to go in the use of this technology in public health and primary health care (PHC). This study aimed to explore the features, approaches, and various dimensions of telehealth in PHC. Methods: A scoping review was conducted using the Arksey and O'Malley framework. A search was conducted in three bibliographic databases including PubMed, Web of Sciences, and Scopus and in Google Scholar to collect papers published in November 2018 to 2000. Data were extracted according to a predefined form and check for completeness and accuracy by a second reviewer. Results: Through reviewing papers, the authors extracted information on the general characteristics and features of telehealth services, kinds of PHC services delivered via telehealth, hardware and software facilities used for providing health care through telehealth services packages, as well as their benefits, outcomes and obstacles. Conclusion: Telehealth can be used for different purposes of PHC through deploying a full range of communication channels available to the public. Due to the opportunistic use of existing devices and platforms, telehealth can provide scalable PHC services nationwide and worldwide. However, implementing telehealth in PHC faces challenges from technical, organizational, and human perspectives. Digital equity (in terms of technology access and e-health literacy) is required to expand telehealth services to the populations in underserved areas.

Setting research priorities to achieve long-term national road safety goals in Iran.

Background: Road traffic crashes (RTCs) and its associated injuries are one of the most important public health problems in the world. In Iran, RTCs rank second in terms of mortality. To address this issue, there is a need for research-based interventions. Prioritizing researches using a variety of approaches and frameworks to determine the most effective interventions is a key nodal point in the RTCs' research policy planning cycle. Thus, this study aims to generate and prioritize research questions in the field of RTCs in Iran. Methods: By adapting the Child Health and Nutrition Research Initiative (CHNRI) method, this study engaged 25 prominent Iranian academic leaders having role in setting Iran's long-term road safety goals, a group of research funders, and policymakers. The experts' proposed research questions were independently scored on a set of criteria: feasibility, impact on health, impact on the economy, capacity building, and equity. Following the prioritization of Research Questions (RQs), they were all classified using the 5 Pillar frameworks. Results: In total, 145 Research Questions were systematically scored by experts against five criteria. Iran's top 20 road traffic safety priorities were established. The RQs related to "road safety management" and "road and infrastructure" achieved a high frequency. Conclusions: The top 20 research questions in the area of RTCs in Iran were determined by experts. The majority of these RQs were related to "road safety management". The results of this study may contribute to the optimal use of resources in achieving long-term goals in the prevention and control of road traffic crashes and its related injuries. Considering these RQs as research investment options will improve the current status of Road Traffic Injuries (RTIs) at a national level and further advance toward compliance with international goals. If these research priorities are addressed, and their findings are implemented, we can anticipate a significant reduction in the number of crashes, injuries, and deaths.

The impact of the Covid-19 pandemic on primary health care utilization: an experience from Iran.

BACKGROUND: The Covid-19 pandemic affected the performance of Primary Health Care (PHC) worldwide. This study was performed to investigate the impact of the Covid-19 pandemic on the utilization of PHC in Iran. METHOD: A before and after study conducted between 2019 and 2021. 56 medical science universities across the country were studied. The data extracted from Electronic Health Record (EHR) is entitled "SIB". Three major indicators included a weighted average of essential services provided by (physician, dentist, mental health expert, midwife, nutritionist), percentage of actual delivered service, and percentage of customer satisfaction was selected as a criterion for assessing the PHC. Descriptive statistics and analytical statistics (Wilcoxon test) using SPSS 16 software were used for the data analyzing and reporting. RESULTS: There was a significant difference among the examined dimensions before and after Covid-19 separation in all studied indicators except the level of percentage of customer satisfaction (P < 0.05). So that the percentage of actually delivered services decreased about 1% and the weighted average of essential services provided by a physician, dentist, midwife, mental health experts, and nutritionist decreased 627.95, 718.81, 460.85, 2914.66, 2410.65 numbers, respectively. CONCLUSION: Covid-19 Pandemic has affected the performance of Iranian PHC at the beginning and overall, has a negative consequence on utilization of services. Preparedness to respond to pandemics and develop programs and interventions is necessary to cover the weaknesses of the PHC.