Maternal macronutrient and energy intake during pregnancy: a systematic review and meta-analysis.

BACKGROUND: Nutritional status during pregnancy can have a significant impact on infant and maternal health outcomes. To maintain maternal homeostasis and support fetal growth, adequate macronutrient and energy intake during pregnancy is essential. Therefore, this study sought to systematically review and meta-analyze macronutrient and energy intakes during pregnancy. METHODS: A systematic review and meta-analysis was carried out based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The required data were collected from four databases including: Web of Sciences, ProQuest, Scopus, and PubMed, from 1 January 1980 to 30 May 2023, by using a combination of search terms (dietary pattern" OR "diet quality" OR "food habits" OR "nutrition surveys" OR "diet surveys" OR "food-frequency questionnaire" OR "diet record" OR "dietary recall") AND ( "pregnancy" OR "reproduction" OR "maternal health" OR "neonatal outcomes") among interventional and observational studies. Excel and STATA version 11 were used for data analysis. RESULTS: Among 7081 published articles, 54 studies were included in the review. Most of the 33 (61%) studies were cohort studies and a total of 135,566 pregnant women were included. The overall average of energy, carbohydrate, fat, and protein intake was 2036.10 kcal/day, 262.17 gr/day, 74.17 gr/day, and 78.21 gr/day, respectively. Also, energy intake during pregnancy was higher in American (2228.31 kcal/day, CI95%: 2135.06-2325.63) and Eastern Mediterranean regions (2226.70 kcal/day, CI95%: 2077.23-2386.92) than other regions (P < 0.001). Energy intake was higher in the third trimester than others (2115.64 kcal/day, CI95%: 1974.15-2267.27). Furthermore, based on the findings, there was a significant difference between energy intake in different World Health Organization (WHO) regions (P < 0.05). CONCLUSIONS: According to the results of meta-analysis, the average total energy was below than average total energy required during pregnancy. More efforts are needed to encourage women to adopt healthy eating habits during pregnancy to support healthy fetal and infant development.

Length of Hospital Stay and Its Related Factors in Iran: A Systematic Review and Meta-Analysis.

Background: One of the effective indicators used to determine the efficiency and optimal use of hospital resources is the length of stay (LOS). Then, we aimed to determine LOS and its related factors in Iran. Methods: A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, PubMed, SID, MagIran, and Medlib from 1995 to 2022 using a combination of medical subject. STATA version 11 used for data analysis. Results: Overall, 75 (cross-sectional, cohort, and case-control) reports were identified. The average length of stay in Iranian hospitals was 6.7 (95% CI: 5.32 -7.74) d. There was a significant relationship between the length of stay in the hospital and different wards of hospital (P=0.001). The average of men' LOS was longer than women were [6.9 (95% CI: 5.32 -7.74) vs. 3.9 (95% CI: 1.67-9.41)]. Moreover, the average LOS before and after the Health Transformation Plan (HTP) in Iran has changed, so that it has increased from 5.8 (95% CI: 4.39 -7.86) to 7.1 (95% CI: 5.59 -9.25) d after HTP (P=0.30). Conclusion: The average length of stay of patients in Iranian hospitals is more than the expected index of the Ministry of Health and Medical Education and is in the unfavorable range (> four days). Moreover, considering the direct effect of the type of departments on LOS; therefore, hospital managers should pay more attention to hospital processes using new process-oriented and customer-oriented management approaches.

Systematic review and meta-analysis of hospital acquired infections rate in a middle east country (1995-2020).

Background: Hospital-acquired infections (HAIs) are a global problem in hospitals and significant causes of mortality and morbidity regardless of advances in supportive care, antimicrobial therapy and prevention. The study aimed to determine a comprehensive estimate of the HAIs prevalence, influential factors, and types of these infections in Iran. Methods: A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, Cochrane, SID, Magiran, and Medlib from January 1995 to September 2020 using a combination of medical subject heading terms ('Nosocomial infection [Mesh] OR '' Hospital infection [Mesh] OR Hospital Acquired Infection[Mesh] OR Healthcare-associated infection ''AND ('Iran' [Mesh]) among observational and interventional studies. SPSS version 25 and STATA version 11 were used for data analysis. Results: A total of 66 (cross-sectional, cohort, and case-control) observational studies were identified. More of the studies had been done before 2014(43 papers or 65%). Based on the random-effects model, the overall prevalence of HAIs in Iran was 0.111 [95% CI: 0.105 - 0.116] with a high, statistically significant heterogeneity (I2= 99.9%). The infection rate was 0.157 and 0.089 before and after the Iranian Health Transformation Plan (HTP), respectively. HAIs rates reported more in the South and West of Iran rather than other regions (0.231 and 0.164) (p= 0.001). Escherichia coli and klebsiella infections were reported in 53 and 52 papers (0.239 and 0.180, respectively). In addition, respiratory and urinary infections were reported 0.296 and 0.286 in 51 and 38 papers, respectively. Conclusion: The prevalence of HAIs in Iran is relatively high. Preventing and decreasing hospital nosocomial infections can considerably affect reducing mortality and health-related costs. This should be taken into consideration by health policymakers for pathology and revision of some previous programs and standards as well as the development of appropriate and evidence-based control and education programs to reduce this health problem.

Burden of Transport-Related Injuries in the Eastern Mediterranean Region: A Systematic Analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age. METHODS: TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs). RESULTS: In 2017, there were 5.5 million (UI 4.9-6.2) transport-related incident cases in the EMR - a substantial increase from 1990 (2.8 million; UI 2.5-3.1). The age-standardized incidence rate for the EMR in 2017 was 787 (UI 705.5-876.2) per 100000, which has not changed significantly since 1990 (-0.9%; UI -4.7 to 3). These rates differed remarkably between countries, such that Oman (1303.9; UI 1167.3-1441.5) and Palestine (486.5; UI 434.5-545.9) had the highest and lowest age-standardized incidence rates per 100000, respectively. In 2017, there were 185.3 thousand (UI 170.8-200.6) transport-related fatalities in the EMR - a substantial increase since 1990 (140.4 thousand; UI 118.7-156.9). The age-standardized death rate for the EMR in 2017 was 29.5 (UI 27.1-31.9) per 100000, which was 30.5% lower than that found in 1990 (42.5; UI 36.8-47.3). In 2017, Somalia (54; UI 30-77.4) and Lebanon (7.1; UI 4.8-8.6) had the highest and lowest age-standardized death rates per 100,000, respectively. The age-standardised DALY rate for the EMR in 2017 was 1,528.8 (UI 1412.5-1651.3) per 100000, which was 34.4% lower than that found in 1990 (2,331.3; UI 1,993.1-2,589.9). In 2017, the highest DALY rate was found in Pakistan (3454121; UI 2297890- 4342908) and the lowest was found in Bahrain (8616; UI 7670-9751). CONCLUSION: The present study shows that while road traffic has become relatively safer (measured by deaths and DALYs per 100000 population), the number of transport-related fatalities in the EMR is growing and needs to be addressed urgently.

The role of mass media communication in public health: The impact of Islamic Republic of Iran broadcasting health channel on health literacy and health behaviors.

Background: By informing and educating, the Media play a main role in increasing the health literacy of the community. Broadcasting health channels (BHCs) are established to improve health literacy and public health worldwide. This study was aimed to evaluate the role of Islamic Republic of Iran the broadcasting health channel (IRIB HC) on public health. Methods: A cross-sectional, comparative study was performed on 500 participants throughout 6 urban areas in Tehran, the capital of Iran in 2019. About 250 of the samples were included in viewing the health channel group. A standard questionnaire was used to measure the levels of public health in the 2 groups. Data were analyzed and compared using SPSS software version 25. Results: According to the results, health literacy was higher in the group that used the health channel rather than the other group. Also, with regard to physical and psychological health levels, a significant difference was observed between audiences and nonaudiences (p= 0.013, p= 0.001, respectively). Conclusion: The IRIB HC has positive effects on increasing the level of health literacy, Physical and psychological health, and consequently improving public health. Therefore, these channels have a great role in the implementation of health polices to improve health status.

Sources of news as a necessity for improving community health literacy about COVID-19.

Background: In the 21st century, the world has become a global village and a disease outbreak in one part of the world can spread rapidly to other countries far away. Methods: The emergence of the new Coronavirus (COVID-19) in China in January 2020 and its growing level of spread and severity between and within other countries as well as different continents has become a global emergency. Moreover, low health literacy results in more problems and continuation of the outbreak. Consequently, COVID-19 pandemic may produce new debates, discussions, and disturbing developments every day. In the meantime, cyberspace plays an important role in this case. Results: Improving people's health literacy can lead to increased potential of patients to make informed decisions, reduce health risks, increase disease prevention, and improve quality of life. Conclusion: The experience during COVID-19 pandemic has shown that health literacy plays an important role in preventing and controlling diseases and pandemic.

Economic cost of diabetes in the Eastern Mediterranean region countries: A meta-analysis.

BACKGROUND AND AIMS: Non communicable diseases including diabetes imposes substantial financial burden on households, societies and nations in both developed and developing countries. However, there is no information on the extent of diabetes expenditure in the Eastern Mediterranean Region (EMRO). Therefore, this study aimed to identify the treatment costs of diabetes in this area. To our knowledge, this is the first systematic review on treatment expenditures of diabetes in EMRO countries. METHODS: A comprehensive literature search was conducted in PUBMED, MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCES databases to find out published manuscripts on treatment cost of diabetes. Information was extracted using data extraction sheets and then the data were imported into STATA software version.11. Mean annual treatment cost of diabetes per patient, annual treatment costs of diabetes per patient by Diabetes Mellitus (DM) complications and finally, cost of chronic diabetes complications per patient were pooled and reported. RESULTS: After reviewing title, abstract and the full text of identified articles; a total of seven studies were reported appropriate data for this meta-analysis. The pooled annual treatment cost per diabetes patient for EMRO countries was 1150 US$ (95% CI: 595-2221) which was 3358 US$ (95% CI: 2200-5124) in EMRO countries except of Iran compared to 255 US$ (92-708) in Iran. The treatment cost of diabetes was higher in males, insulin-used and in the patient with family history of diabetes. The cost of diabetes was significantly increased with the duration of diabetes (P = 0.001) as well. According to the results, the largest share of costs is related to medication costs. Finally, the pooled average annual treatment cost per patient by diabetes mellitus complications was varied from 2828 US$ in the patients that have cerebrovascular disease complication to 7261 US$ in the patients with Stroke complication. CONCLUSIONS: This study demonstrated that the annual treatment cost of diabetes is varied within EMRO countries. Qatar and Iran have spent the highest and lowest cost for diabetes, respectively. This may be due to the large socioeconomic differences between countries and special conditions of them such as currency value in the region.

Household financial contribution to the health system after Iran's Health Transformation Plan.

INTRODUCTION: Iran's Health Transformation Plan (HTP) was implemented in 2014 to decrease household expenditures. The present study seeks to measure the household financial contribution to healthcare expenditures in Sistan-Baluchistan Province after the implementation of HTP. METHODS: A household survey was conducted in 2017 in Sistan-Baluchistan Province. The province is the most remote and poorest in the country and this poverty has extended to most of its main health indicators as well. About 2400 households were selected as the study samples using multistage sampling. Data were collected using the World Health Survey questionnaire. The questionnaire was designed by WHO in 2003 for assessing health system performance. Two main indicators of equity in health were measured: the percentage of households facing catastrophic health expenditure (CHE) and the Fair Financial Contribution Index (FFCI). The multiple adjusted logistic regression model was used to study the likelihood of facing CHE and to calculate the adjusted odds ratios (OR) using the model coefficients. Data were then analyzed the Statistical Package for the Social Sciences. RESULTS: The results showed that 484 (20.2%) of the households faced CHE after implementation of the HTP. The FFCI was approximately 0.7 across the province. Statistically significant relationships were observed between the chances of facing CHE and variables including place of residence (p=0.010), having members aged more than 65 years (p=0.005) and having members with disabilities and in need of care (p=0.001). There were statistically significant relationships between the chance of facing CHE and variables related to the use of health services, including the use of dental (OR=5.212), rehabilitation (OR=2.471), diagnostic and laboratory (OR=3.637), and inpatient (OR=2.511) services. CONCLUSION: Despite the implementation of HTP, a high percentage of the households faced CHE. The authorities should pay more attention to low-income and remote regions of the country; in addition, the HTP should financially cover outpatient healthcare services in an adequate manner.

The prevalence of metabolic syndrome among Iranian bakers.

BACKGROUND: Metabolic syndrome (MetS) is a group of risk factors that are associated with increased risk for atherosclerotic cardiovascular disease. OBJECTIVE: The objective of this study was to determine the prevalence of metabolic syndrome and its individual components among Iranian bakery workers. METHODS: A cross-sectional study enrolling 163 randomly selected bakery workers from Semnan province (Northeast Iran), was conducted in 2017. A standard questionnaire was used for data collection. Analyses were performed using t-test, one-way ANOVA and Latent Class Analysis (LCA) in R software. RESULTS: The prevalence of MetS was 19.8% among bakery workers. More bakery workers with MetS had no regular exercise (p = 0.001) and worked more than eight hours a day (p = 0.001). In this study, the International Diabetes Federation (IDF) diagnostic criteria had more agreement with the American Heart Association (AHA) (49.1%) than the World Health Organization (WHO) and Adult Treatment Panel (ATP) criteria. Also, the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) had the highest sensitivity for diagnosing MetS. The sensitivity of the four diagnostic methods, WHO, IDF, ATP and AHA, were 45.2%, 61.7%, 67.9% and 64.8%; and their specificity were 98.2%, 100%, 100% and 100%, respectively. CONCLUSION: The prevalence of MetS is high among bakery workers in Iran. Increased physical activity and intake of fruit and vegetables are recommended for the prevention of MetS.

Impact of the Health Transformation Plan on the Number of Surgical Operations and Their Cancelation.

Operation cancelations are a serious problem with undesirable consequences. The Health Transformation Plan was launched in the health system of Iran on May 5, 2014, to enhance the efficiency and quality of services in public hospitals. Comprehensive coverage of patients' basic treatment needs and reduction of patients' out-of-pocket expenditures through insurance for all are other objectives of Health Transformation Plan as well. Then, the present study aimed to determine the impact of the Health Transformation Plan on the number of surgical operations and the cancelation of elective surgeries within public hospitals of Iran. This retrospective comparative study was conducted in 2017 within 2 tertiary public hospitals in the South-East of Iran. Using systematic random sampling method and census, 8138 scheduled surgical files and all canceled operations files were reviewed from April 2012 to March 2017, respectively. A standard checklist was used for data collection. The data were analyzed using χ2 test and a logistic regression model in SPSS, version 21. The study population was 8138 patients with mean age of 33 ± 19 years. Female patients comprised about 51% of the study population (n = 4115), and nearly two-third of them were married (n = 5192 [63.79%]). Coverage by Iranian health insurance was reported in more than half of patients (n = 4415 [54.79%]). The common reason for surgeries was injury and poisoning (n = 2814 [34.52%]) followed by delivery (n = 1747 [21.46%]). The number of operations increased from 26 677 before Health Transformation Plan (cancelation rate = 1.5%) to 33 190 after Health Transformation Plan (cancelation rate = 2.0%). The cancelation rate had a significant relationship with age (odds ratio = 1.009; confidence interval: 1.00-1.01), health insurance status (odds ratio = 2.12; confidence interval: 1.33-3.38), outpatient service referrals (odds ratio = 0.5; confidence interval: 0.43-0.62), inpatient service referrals (odds ratio = 1.5; confidence interval: 1.36-1.77), and surgical types (P < .05). In general, the Health Transformation Plan was markedly associated with a rise in the number of surgeries and cancelation rate in the public hospitals. The information obtained in the present study concerning the causes of operation cancelations can be used to decrease the number of future cancelations.

Factors affecting mortality in burn patients in the poorest region of Iran; a case control study.

BACKGROUND: Burns is one of the most important health issues as well as the most expensive injuries that take place at all ages. It also considers a disaster for society, family, and person. The aim of the study was to examining fatal burns and associated factors' in burn unit patients in Iran. METHODS: a case-control study was carried out in the poorest region of Iran. The research population consisted of all patients in a burn unit in Zahedan public hospital during 2013-2018. Using systematic random sampling method, 430 persons (215 dead persons, 215 released persons) were entered into the study. The data form and SPSS software were used for data gathering and the data analyzing, respectively. RESULTS: about 41.4% of dead patients were at the age of 25-44 and 60.5% of dead patients were women. Also, 96.3% of expired patients were on level 3 burns. The cause of the burns in 46% of death was flame, oil, and gasoline. Moreover, there is a significant relationship between burns and the age, gender, residence place, history of the previous disease, the cause of burns, burns percentage and the burn level in both case and control group. CONCLUSION: in the poorest region of Iran, younger (as the labor force) and women were at high risk of death due to burn. Developing gas infrastructures in this region could decrease the incidence and severity of burns.

Risk factors associated with congenital hypothyroidism: a case-control study in southeast Iran.

BACKGROUND AND AIM: Congenital hypothyroidism (CH) is known as one of the most common preventable cause of mental retardation. This study aimed to determine factors associated with CH in Iran. METHODS: This case-control study was conducted on 160 children under one year old in Zahedan in southeast Iran in 2016. The neonates who were born from March 1, 2015 to March 19, 2016 and had undergone a screening program for CH were the study population. The neonates with serum TSH > 10mIu/L and T4 < 6.5 or TSH > 30 mIu/L were considered as a case group. Each case was individually matched for sex, age at birth and place of residence with three neonates with normal TSH and T4 titers as a control group. Data was gathered using a standard checklist and analyzed using SPSS 20 and statistical tests, such as Chi-square and Fisher's exact tests. Multivariable logistic regression analysis was also used to identify independent predictors of CH. RESULTS: About 25 of the 40 patients with CH (62.5%) were male who, in the univariate analysis, the following explanatory factors had no significant association with CH: history of parental consanguinity, type of delivery, weight at birth, height at birth, age of mother, sampling time, nationality, and birth season (p>0.05). Although, multivariate analysis showed no significant association between the studied factors and risk of CH (p>0.05), the likelihood of CH was greater among neonates born to consanguineous parents (AOR: 1.78, 95% CI: 0.82-3.89), those who were born to lower height at birth (AOR: 1.82, 95% CI: 0.85-3.91), neonates born to mothers younger than 18 years (AOR: 2.43, 95% CI: 0.57-10.29) and those who were born in the summer (AOR: 1.76, 95% CI: 0.57-5.44). CONCLUSION: None of the studied factors were predictors for CH. Since consanguineous marriages are frequent in the province, and it may be a major contributory factor, future studies should be conducted on the genetic causes.

Identification determinant factors on willingness to pay for health services in Iran.

BACKGROUND: A common method used to examine the relationship between internal preferences and caring externalities is willingness to pay (WTP) approach. We aimed to estimate WTP for health status with different severity level and identify determinant factors on WTP. METHODS: For determining main factors in WTP, a cross-sectional study was conducted in Shiraz in the southeast of Iran, in March to April 2015. The open-ended method was used to estimate monthly WTP in private and altruistic section. Multivariate regression analyses using ordinary least squares were applied to examine the effect of Scio-demographic factors on WTP using SPSS software 21. RESULTS: Participants were willing to pay an average amount of $ 295 in health status 1 and an average amount of $ 596 in health status 6 (worst status) for internal preferences. Altruistic WTP for health status 1 was $ 294 and participants were willing to pay an average amount of $ 416 in health status 6. Multiple regression analysis identified monthly income as the key determinant of WTP for internal preferences and caring externalities (P < 0.01). With an increase of 1% in income, private WTP increase 1.38% in health status 1. CONCLUSIONS: The finding indicates that the mean of WTP increases at severe health status; therefore, health policy maker should allocate resources toward severe health status.

Comparison of the effect of educational methods on students' knowledge, attitude and behavior about hookah smoking.

INTRODUCTION: Smoking tobacco by hookah may seriously affect the health of smokers and those exposed to smoke. This study aimed to compare the effect of educational digital media versus pamphlets on the reduction of hookah use among male high school students in Zahedan, Iran. METHODS: A semi-experimental study was conducted on 200 male high school students of Zahedan using multi-stage random sampling for three months in 2014. The samples were divided into two groups - the test (educated using digital films) and the control (educated using pamphlets) groups, and measurement was performed before and after intervention. The data collection instrument was a 53-item questionnaire consisting of demographic, knowledge, attitude, behavior and self-efficacy questions. Its validity and reliability were confirmed. The results before and after the intervention were analyzed using SPSS version 18, Mann-Whitney U test, Pearson-product moment correlation coefficient and Chi square test as well as one directional variance analysis. RESULTS: There was no significant relation between demographic and basic variables before intervention (p>0.05); however, the mean scores of knowledge, attitude, self-efficacy, and hookah using preventive behavior were significantly different between the two groups after the intervention (p<0.05). Moreover, there was a meaningful relation among the demographic characteristics including age and attitude- the previous educational year's GPA and self-efficacy; and there was a significant relation between father education and self-efficacy. Moreover, there was a significant relation between the main variables of the study, concerning the relation of knowledge and attitude- knowledge and self-efficacy, and attitude and self-efficacy. CONCLUSION: Educational digital media is more efficient than the pamphlet in the reduction of hookah use among the students; and that the media may be applied to prevent of hookah use among students.

The impact of computerized physician order entry on prescription orders: A quasi-experimental study in Iran.

Background: One way to reduce medical errors associated with physician orders is computerized physician order entry (CPOE) software. This study was conducted to compare prescription orders between 2 groups before and after CPOE implementation in a hospital. Methods: We conducted a before-after prospective study in 2 intensive care unit (ICU) wards (as intervention and control wards) in the largest tertiary public hospital in South of Iran during 2014 and 2016. All prescription orders were validated by a clinical pharmacist and an ICU physician. The rates of ordering the errors in medical orders were compared before (manual ordering) and after implementation of the CPOE. A standard checklist was used for data collection. For the data analysis, SPSS Version 21, descriptive statistics, and analytical tests such as McNemar, chi-square, and logistic regression were used. Results: The CPOE significantly decreased 2 types of errors, illegible orders and lack of writing the drug form, in the intervention ward compared to the control ward (p< 0.05); however, the 2 errors increased due to the defect in the CPOE (p< 0.001). The use of CPOE decreased the prescription errors from 19% to 3% (p= 0.001), However, no differences were observed in the control ward (p<0.05). In addition, more errors occurred in the morning shift (p< 0.001). Conclusion: In general, the use of CPOE significantly reduced the prescription errors. Nonetheless, more caution should be exercised in the use of this system, and its deficiencies should be resolved. Furthermore, it is recommended that CPOE be used to improve the quality of delivered services in hospitals.

A Survey of Iron Supplementation Consumption and its Related Factors in High School Students in Southeast Iran, 2015.

BACKGROUND: This study aimed to estimate the prevalence of iron supplement consumption and its associated factors among high school students in Iran. METHODS: A mixed-methods (quantitative-qualitative) study was conducted in Zahedan, southeast Iran, in 2015. The sample comprised 400 high school students from different areas of Zahedan who were randomly selected. A standard questionnaire and semi-structured interview were used to collect data in the quantitative and qualitative phases, respectively. The data were analysed using SPSS software with one-way ANOVA and Pearson's chi square. Additionally, content analysis was used for the qualitative analysis. RESULTS: In total, 38.2% of the students had not consumed iron supplements in the past 16 weeks, and students in third grade had the highest non-consumption rate (P=0.006). There was a significant positive relationship between iron tablet consumption and grade point average in the last year (P = 0.003). Digestive problems, influence of family and friends, students' reluctance, and poor environmental situations were the most important factors related to students' refusal to take tablets. CONCLUSIONS: Most students did not take or irregularly consumed iron supplements. Based on the digestive problems of the students, improving the taste and quality of iron tablets is recommended.

A Qualitative Study to Identify Skills and Competency Required for Hospital Managers.

INTRODUCTION: Hospital managers aim to improve the efficiency and effectiveness of their institutions through leadership and guidance of medical personnel. Fulfilling these objectives requires a holistic approach to both the management of people and institutional prioritization. The aim of this study was to identify the skills and competencies that hospital managers must demonstrate in order to achieve their objectives. METHODS: In 2015, a regional, multi-center qualitative study was undertaken in Shiraz, Iran. Interviews and focus group discussions were conducted with university hospital managers, senior managers, faculty members, and post-graduate students, and the results were analyzed using the content analysis method by MAXQDA software. RESULTS: Eight key skill themes (communication, experience, appreciation of institution logistics/infrastructure, management skills, motivation, systematic problem solving, ethics, and financial/legal awareness) were identified among the hospital managers. The common challenges that face hospital institutions include problems with hierarchical and organizational structure, excessive rules and regulations, lack of resources, poor post-graduate education, and overall management. Recurring themes with respect to how these could be addressed included changing the culture and belief structure of the hospital, restructuring the organizational hierarchy, and empowering the people. CONCLUSION: In our cohort, practical skills, such as communication and experience, were considered more important than theoretical skills for the effective management and administration of hospitals. Therefore, we suggest that practical, skill-based training should be emphasized for students of these disciplines so they will be better suited to deal with real world challenges. Further organizational improvements also can be attained by the active and constructive involvement of senior university managers.

Designing Computerized Provider Order Entry Software in Iran: The Nurses' and Physicians' Viewpoints.

This study aimed to identify the functional requirements of computerized provider order entry software and design this software in Iran. This study was conducted using review documentation, interview, and focus group discussions in Shiraz University of Medical Sciences, as the medical pole in Iran, in 2013-2015. The study sample consisted of physicians (n = 12) and nurses (n = 2) in the largest hospital in the southern part of Iran and information technology experts (n = 5) in Shiraz University of Medical Sciences. Functional requirements of the computerized provider order entry system were examined in three phases. Finally, the functional requirements were distributed in four levels, and accordingly, the computerized provider order entry software was designed. The software had seven main dimensions: (1) data entry, (2) drug interaction management system, (3) warning system, (4) treatment services, (5) ability to write in software, (6) reporting from all sections of the software, and (7) technical capabilities of the software. The nurses and physicians emphasized quick access to the computerized provider order entry software, order prescription section, and applicability of the software. The software had some items that had not been mentioned in other studies. Ultimately, the software was designed by a company specializing in hospital information systems in Iran. This study was the first specific investigation of computerized provider order entry software design in Iran. Based on the results, it is suggested that this software be implemented in hospitals.

The decision-making matrix of propensity to outsourcing hospital services in Bandar Abbas, Iran.

OBJECTIVE: To determine the level of managers' propensity for outsourcing the services in hospitals using decision-making matrix. METHODS: The applied, cross-sectional study was conducted at three hospitals affiliated to Bandar Abbas University of Medical Sciences, Iran, in 2013, and comprised managers and employees of four service units: radiology, laboratory, nursing, and nutrition services. Data was collected using two questionnaires and face-to-face interviews. Data was analysed using SPSS 16 and by using decision-making matrix. RESULTS: Of the 122 subjects in the study, 12(9.8%) were managers and 110(90.2%) were other employees. The highest and lowest propensities for outsourcing were related to nutrition (66.6%) and nursing services one (8.33%). The decision-making matrix showed low outsourcing of the nursing, radiology, and laboratory services based on the services' features. However, there were difference between the results obtained from laboratory service decision-making matrix and the propensity for laboratory service outsourcing. CONCLUSIONS: The difference between the results obtained from the matrix and managers' viewpoint can be due to the lack of managers' sufficient attention to the features of hospital services when making decisions on outsourcing them.

A Comparison of Mothers' Quality of Life after Normal Vaginal, Cesarean, and Water Birth Deliveries.

BACKGROUND: Assessment of quality of life (QOL) is of paramount importance for improving postpartum QOL which will in turn enhance QOL of mothers, children, individuals, and the community. The present study aimed to evaluate and compare postpartum QOL after Cesarean Section (CS), Normal Vaginal Delivery (NVD), and water birth delivery. METHODS: This descriptive analytical, cross-sectional study was conducted on postpartum women referred to urban health centers and two public hospitals in 2012-13 in Shiraz, Iran. Overall, 59 women with NVD, 39 with CS, and 39 with water birth, all at 2 months postpartum, were recruited into the study through multi-stage sampling. Postpartum QOL was measured using Short Form Health Survey (SF-36) which hadbeen adapted previously in Iran. Then, the data were analyzed using descriptive statistics and one-way analysis of variance (ANOVA) in SPSS, version 18. RESULTS: The results showed that the NVD group had the highest mean score in physical health domains; the women with water birth had the highest mean score in mental health domains and total QOL. Regarding postpartum QOL the results of one-way ANOVA showed no statistically significant differences between the three modes of delivery. CONCLUSION: Women with water birth and NVD had the highest and second highest total QOL mean scores, respectively; women with NVD and water birth experienced better physical health. Thus, providing more information to pregnant women to encourage them to use NVD and water birth is suggested.