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.

Applying the Delphi Approach to Prioritize Social Factors Affecting the Development of Children Under Six Years.

BACKGROUND: Social determinants of health have a key role in the growth and development of children, particularly in early childhood which is mentioned from infancy to the age of six years old. These factors might cause disparities in living conditions and consequently bring about inequities regarding different aspects of development such as emotional, psychological, social, psychological, and intellectual. This research aimed to provide a model for prioritizing social factors affecting the development of children under six years. METHODS: We used quantitative-qualitative (mixed) method to perform data analysis. The statistical population included 12 medical experts and professionals in the field of children's development and social determinants of health that were selected using the snowball method. In the quantitative section, a Delphi technique was applied to screen the extracted indicators. Then through applying a decision-making trial and evaluation laboratory (DEMATEL) method, the cause-and-effect interactions among main social determinants were identified. To analyze data, super decision software was used. RESULTS: According to literature review and the results obtained from focus group discussions, five dimensions including individual factors, family factors, environmental factors, governance, and global factors were identified. Based on the study findings, the criterion of "family factors" was mentioned as the most important priority affecting childhood development. Furthermore, the sub-criterion of "International Programs and Policies" received the greatest priority among other sub-criteria with a profound impact on children's healthy growth and development. CONCLUSION: Despite the current knowledge about social determinants of health, it is required to identify the most influential socioeconomic factors on childhood development. In such a manner, political strategies for improving the health condition of children can be implemented based on scientific evidence. Due to the crucial role of family factors, environmental factors and other socio-economic conditions, health policy makers and public health practitioners should be informed of the importance of these factors in shaping the health condition of children.

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.

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.

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.

Phagocyte-mediated synapse removal in cortical neuroinflammation is promoted by local calcium accumulation.

Cortical pathology contributes to chronic cognitive impairment of patients suffering from the neuroinflammatory disease multiple sclerosis (MS). How such gray matter inflammation affects neuronal structure and function is not well understood. In the present study, we use functional and structural in vivo imaging in a mouse model of cortical MS to demonstrate that bouts of cortical inflammation disrupt cortical circuit activity coincident with a widespread, but transient, loss of dendritic spines. Spines destined for removal show local calcium accumulations and are subsequently removed by invading macrophages or activated microglia. Targeting phagocyte activation with a new antagonist of the colony-stimulating factor 1 receptor prevents cortical synapse loss. Overall, our study identifies synapse loss as a key pathological feature of inflammatory gray matter lesions that is amenable to immunomodulatory therapy.

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.

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.

Altered Glutamate Receptor Ionotropic Delta Subunit 2 Expression in Stau2-Deficient Cerebellar Purkinje Cells in the Adult Brain.

Staufen2 (Stau2) is an RNA-binding protein that is involved in dendritic spine morphogenesis and function. Several studies have recently investigated the role of Stau2 in the regulation of its neuronal target mRNAs, with particular focus on the hippocampus. Here, we provide evidence for Stau2 expression and function in cerebellar Purkinje cells. We show that Stau2 downregulation (Stau2GT) led to an increase of glutamate receptor ionotropic delta subunit 2 (GluD2) in Purkinje cells when animals performed physical activity by voluntary wheel running compared with the age-matched wildtype (WT) mice (C57Bl/6J). Furthermore, Stau2GT mice showed lower performance in motor coordination assays but enhanced motor learning abilities than did WT mice, concomitantly with an increase in dendritic GluD2 expression. Together, our results suggest the novel role of Stau2 in Purkinje cell synaptogenesis in the mouse cerebellum.

IDENTIFYING ELEVEN FACTORS OF SERVICE MARKETING MIX (4PS) EFFECTIVE ON TENDENCY OF PATIENTS TOWARD PRIVATE HOSPITAL.

INTRODUCTION: One of the important factors of correct management is to identify the reasons for patient tendency toward private hospitals. This study measures these factors based on service marketing mixes. PATIENTS AND METHODS: This study used a cross sectional descriptive methodology. The study was conducted during 6 months in 2015. The studied population included patients of private hospitals in Tehran. Random sampling was used (n = 200). Data was collected by an author-made questionnaire for service marketing factors. Reliability and validity of the questionnaire were confirmed. Data analysis was done using factor analysis test in SPSS 20. RESULTS: The results showed that constant attendance of physicians and nurses has the highest effect (0.707%) on patient tendency toward private hospitals.

Reconstruction of single cortical projection neurons reveals primary spine loss in multiple sclerosis.

Grey matter pathology has emerged as an important contributor to long-term disability in multiple sclerosis. To better understand where and how neuronal damage in the grey matter is initiated, we used high resolution confocal microscopy of Golgi-Cox impregnated tissue sections and reconstructed single cortical projection neurons in autopsies from eight patients with long-standing relapsing-remitting or secondary progressive multiple sclerosis and eight control patients without neurological disease. Analysis of several hundred individual neurons located in the insular, frontotemporal and occipital lobe revealed a widespread and pronounced loss of dendritic spines in multiple sclerosis cortex that occurs independent of cortical demyelination and axon loss. The presence of a primary synaptic pathology in the normal-appearing cortex of multiple sclerosis patients challenges current disease concepts and has important implications for our understanding of disease progression.

Synergistic interaction between caloric restriction and amphetamine in food-unrelated approach behavior of rats.

RATIONALE: Approach behavior is regulated by the brain integrating information about environment and body state. Psychoactive drugs interact with this process. OBJECTIVES: We examined the extent to which caloric (i.e., food) restriction, amphetamine (AMPH) and lithium interact in potentiating locomotor activity and responding reinforced by visual stimulus (VS), a reward unrelated to energy homeostasis. METHODS: Rats either had ad libitum access to food or received daily rations that maintained 85-90 % of their original body weights. Leverpressing turned on a cue light for 1 s and turned off house light for 5 s. AMPH and lithium were administered through intraperitoneal injections and diet, respectively. RESULTS: Food restriction or AMPH (1 mg/kg) alone had little effect on VS-reinforced responding; however, the combination of the two conditions markedly potentiated VS-reinforced responding (fourfold). Food restriction lasting 7 days or longer was needed to augment AMPH's effect on VS-reinforced responding. AMPH (0.3-3 mg/kg) potentiated locomotor activity similarly between food-restricted and ad libitum groups. Repeated injections of AMPH-sensitized locomotor activity, but not VS-reinforced responding. In addition, while chronic lithium treatments (0.2 % lithium carbonate chow) reduced VS-reinforced responding, chronic lithium further augmented AMPH-potentiated VS-reinforced responding. CONCLUSIONS: Food restriction interacts with psychoactive drugs to potentiate goal-directed responding unrelated to food seeking in a much more powerful manner than previously thought. The novel finding that lithium can augment a psychostimulant effect of AMPH suggests caution when combining lithium and psychostimulant drugs in clinical settings.

Long-term genetic fate mapping of adult generated neurons in a mouse temporal lobe epilepsy model.

In the epileptic brain, seizures can increase hippocampal neurogenesis, while opposingly seizure-associated brain pathology has been shown to detrimentally affect neurogenesis. The long-term impact of recurrent seizures on the number of new neurons as well as their relative contribution to the granule cell layer remains an open question. Therefore we analyzed neuron addition based on genetic fate mapping in a chronic model of epilepsy comparing non-kindled animals and kindled animals having at least one generalized seizure with and without further seizures. The number of all new granule cells added to the dentate gyrus following the onset of kindling was significantly increased (7.0-8.9 fold) in kindled groups. The hyperexcitable kindled state and a prior seizure history proved to be sufficient to cause a pronounced long-term net effect on neuron addition. An ongoing continuous occurrence of seizures did not further increase the number of new granule cells in the long-term. In contrast, a correlation was found between the cumulative duration of seizures and neuron addition following a kindled state. In addition, the overall number of seizures influenced the relative portion of new cells among all granule cells. Non-kindled animals showed 1.6% of new granule cells among all granular cells by the end of the experiment. This portion reached 5.7% in the animals which experienced either 10 or 22 seizures. A percentage of 8.4% new cells were determined in the group receiving 46 seizures which is a significant increase in comparison to the control group. In conclusion, permanent genetic fate mapping analysis demonstrated that recurrent seizures result in a lasting change in the makeup of the granule cell layer with alterations in the relative contribution of newborn neurons to the granule cell network. Interestingly, the formation of a hyperexcitable kindled network even without recent seizure activity can result in pronounced long-term alterations in the absolute number of new granule cells. However, seizure density also seems to play a critical role with more frequent seizures resulting in increased fractions of new neurons.