Status of Crimean-Congo haemorrhagic fever virus in ticks in Iran: A systematic review with meta-analysis.

Crimean-Congo haemorrhagic fever (CCHF) is a re-emerging viral haemorrhagic fever causing outbreaks in Iran in the last 15 years. In this systematic review and meta-analysis, the status of Crimean-Congo haemorrhagic fever virus (CCHFV) in ticks would be evaluated. PubMed, Google Scholar and Web of Science were searched for peer-reviewed original papers published between 2000 and 1 July 2022. We included papers that evaluated the prevalence of CCHFV in individual ticks using reverse transcription polymerase chain reaction (RT-PCR). The pooled prevalence of CCHFV was 6.0% (95% confidence interval [CI]: 4.5-7.9%), with heterogeneity (I2 = 82.706; P < 0.0001). The prevalence of CCHFV was higher related to regions with above sea level of 1001-1500m (6.4%; 95% CI: 4.3-9.5%), an average temperature of ≤15 °C (8.3%; 95% CI: 5.6-12.0%), latitude of ≥36° (8.1%; 95% CI: 5.2-12.3%), an annual rainfall of 101-300 mm (9.8%; 95% CI: 6.1-15.4%) and humidity of ≥61% (10.2%; 95% CI: 5.1-19.3%). Due to the importance of CCHF, it is better to do new epidemiologic studies on ticks by related organizations and adjacent regions of some provinces in which human cases have been previously reported.

An estimation of global Aeromonas infection prevalence in children with diarrhoea: a systematic review and meta-analysis.

OBJECTIVES: Diarrhoea is the most commonly related disease caused by Aeromonas. To improve knowledge on prevalence, this systematic review and meta-analysis was performed to evaluate the global prevalence of Aeromonas in children with diarrhoea worldwide. METHODS: We systematically searched PubMed, Google scholar, Wiley Online Library, ScienceDirect, and Web of sciences to identify all cross-sectional published papers between 2000 and 10 July 2022. After initial scrutinizing, 31 papers reporting the prevalence of Aeromonas in children with diarrhoea were found to be adequate for meta-analysis. The statistical study was accompanied by using random effects models. RESULTS: A total of 5660 identified papers, 31 cross-sectional studies encompassing 38,663 participants were included in the meta-analysis. The pooled prevalence of Aeromonas in children with diarrhoea worldwide was 4.2% (95% CI 3.1-5.6%). In the subgroup analysis, the highest prevalence was seen among children in Upper middle-income countries with pooled prevalence of 5.1% (95% CI 2.8-9.2%). The prevalence of Aeromonas in children with diarrhoea was higher in countries with populations of over 100 million people (9.4%; 95% CI 5.6-15.3%), and water and sanitation quality score of less than 25% (8.8%; 95% CI 5.2-14.4%). Additionally, Cumulative Forest Plot showed a decreasing trend in the prevalence of Aeromonas infection in children with diarrhoea over time (P = 0.0001). CONCLUSION: The results of this study showed a better comprehension of Aeromonas prevalence in children with diarrhoea on a global scale. As well as our findings showed that much work is still required to decline the burden of bacterial diarrhoea in countries with high populations, low-level income, and unsanitary water.

Content Analysis of Entrepreneurship and Employment Development Policies in Iran's Health Sector: Is It a Health Wealth Promoter?

Context: Growing needs mandates economic growth. Entrepreneurship policies play a significant role in achieving productive employment and sustainable development for the health and wealth of society. Aims: This study is conducted to find the accordance of this document with the basic theory of the global alphabet model of entrepreneurship on the one hand and a comparison to the real entrepreneurial and economic achievements as social determinants of health (SDOH) on the other hand. Methods and Material: This research is a quantitative and qualitative content analysis of entrepreneurship documents in the health sector of Iran, using the basic theory of the global alphabet model as our target. We reviewed the Work Bank and Global Entrepreneurship Monitor (GEM) reports as world indicators to compare whether our entrepreneurship policies have been successful. Statistical Analysis: MAXQDA is a software program designed for computer-assisted qualitative and mixed methods data, text and multimedia analysis in academic, scientific, and business institutions. Results: The findings showed that the retelling of the word employment is more dominant than entrepreneurship. Imbalanced attention is paid to the components of the standard global alphabet model, and a downhill regression is seen in almost all aspects of entrepreneurial results. Conclusions: The written health policies have not been effective in promoting the development of health by wealth.

Educational leadership in education development centers: A qualitative study.

BACKGROUND: Education development centers (EDCs) have a vital role in improving the quality of medical education. This study was conducted with the aim of discovering educational leadership characteristics in EDCs. MATERIALS AND METHODS: This study was carried out with a qualitative approach and using a conventional content analysis method. The sampling was purposive. Twenty-four faculty members, managers, and experts of EDCs in the universities of medical sciences included 13 males and 11 females participated in this study. Semi-structured interviews were utilized for data collection. The conventional content analysis approach was utilized to analyze the data. RESULTS: From the data analysis, two categories included "personality characteristics" and "job characteristics" and six subcategories included reliabilism, humanness and altruism, accountability, decisiveness, dynamism and perfectionism, and knowledge, experience, and expertise and 24 codes were extracted. CONCLUSION: Results obtained in the present study will help to increase the awareness of the educational leaders of the EDCs in improving their personality and job skills and this will lead to the qualitative development of educational leadership.

Quality of Life of People with HIV/AIDS in Iran: A Systematic Review and Meta-Analysis.

BACKGROUND: Assessing the quality of life in HIV/AIDS patients is of great importance not only for evaluating the effect of the disease, but also to measure the impact of the interventions in order to improve their quality of life in clinical researches. Therefore, this study aimed to systematically review the quality of life of HIV/AIDS patients in Iran. METHODS: In this systematic review and meta-analysis, the literature search using the related chain of keywords was conducted from 1 Jan 1987 to 30 Apr 2019 in PubMed, Scopus, Web of Science, Embase, Iranian Scientific Information Database (SID), and Magiran. Moreover, hand search of the key journals and the gray literature was performed. The meta-analysis was performed by CMA2 software. RESULTS: Out of the 1576 retrieved records, eight studies met the inclusion criteria. The average age of the patients was 37.15 ± 9.46 years. The average score of quality of life before and after sensitivity analysis was (39.13 [28.36-49.901 95% CI P>0.000] vs. 49.05 [46.31-51.79 95% CI P>0.000]). Moreover, the average score of quality of life was respectively 38.86±3.83 vs. 40±6.37 among married compared with single patients, 56.33±4.67 vs. 43.64±1.94 for employment vs. unemployment status. While quality of life was measured in terms of education level, the score was 29.59±9.34 vs. 41.65±4.45 in the individuals with primary school versus academic education. CONCLUSION: The QOL score of the HIV/AIDS patients in Iran was significantly low. Therefore, the study highlights the importance of strengthening efforts to undertake necessary investigations in order to provide adequate health insurance, extensive and affordable welfare services, and more appropriate social and mental supports in order to improve the quality of life of the individuals with HIV/AIDS in Iran.

Discovering the performance criteria of education development centers of medical sciences universities: A qualitative study.

CONTEXT: Performance is a significant objective of any organization. To grow and develop and to improve the performance of the education development centers (EDCs) of medical sciences universities at Iran, the recognition of the performance criteria of these centers is important. This study was conducted with the aim of discovering the performance criteria of EDCs of medical science universities. SUBJECTS AND METHODS: This study was conducted using qualitative research and a semi-structured interview. Participants were selected using an expert sampling method is a sub-type of purposive sampling. Twenty-three faculty members and expert staff (11 males and 12 women) participated in the interview. Data were collected using the participant's perception. The data analysis was performed based on the interpretative analysis steps of Gillham and Rubin. RESULTS: From the analysis of data, seven categories including leadership, strategy, stakeholders, workforce, knowledge management, processes management, and results were obtained. CONCLUSIONS: The obtained criteria in this study assist managers to design and to develop self-assessment questionnaires and a performance measurement program for EDCs of medical sciences universities. This will facilitate performance evaluation of EDCs.

Future Research in Health Information Technology: A Review.

INTRODUCTION: Currently, information technology is considered an important tool to improve healthcare services. To adopt the right technologies, policy makers should have adequate information about present and future advances. This study aimed to review and compare studies with a focus on the future of health information technology. METHOD: This review study was completed in 2015. The databases used were Scopus, Web of Science, ProQuest, Ovid Medline, and PubMed. Keyword searches were used to identify papers and materials published between 2000 and 2015. Initially, 407 papers were obtained, and they were reduced to 11 papers at the final stage. The selected papers were described and compared in terms of the country of origin, objective, methodology, and time horizon. RESULTS: The papers were divided into two groups: those forecasting the future of health information technology (seven papers) and those providing health information technology foresight (four papers). The results showed that papers related to forecasting the future of health information technology were mostly a literature review, and the time horizon was up to 10 years in most of these studies. In the health information technology foresight group, most of the studies used a combination of techniques, such as scenario building and Delphi methods, and had long-term objectives. CONCLUSION: To make the most of an investment and to improve planning and successful implementation of health information technology, a strategic plan for the future needs to be set. To achieve this aim, methods such as forecasting the future of health information technology and offering health information technology foresight can be applied. The forecasting method is used when the objectives are not very large, and the foresight approach is recommended when large-scale objectives are set to be achieved. In the field of health information technology, the results of foresight studies can help to establish realistic long-term expectations of the future of health information technology.

Efficacy of Traditional Medicine Product Henna and Hydrocortisone on Diaper Dermatitis in Infants.

BACKGROUND: Diaper dermatitis (DD) is a common inflammatory disorder in infants, including newborns. OBJECTIVES: This study aimed to compare the effects of a traditional medicine product (containing natural henna oil 25%) and hydrocortisone 1% cream on DD in infants. PATIENTS AND METHODS: In a triple-blind, randomized trial, 82 children aged two years or less were randomly divided into two groups of 41 children each to receive either hydrocortisone ointment or henna medicinal product. Infants were treated 3 times a day for 5 days. The severity of dermatitis was assessed on the first, third, and fifth days using a six-point scale. The study was conducted in 2013 in a children teaching hospital in Qazvin, Iran. RESULTS: Both groups showed an improvement in the severity of DD (mean DD severity on the first, third and fifth days, respectively, was 3.20, 1.39, and 1.20 in the henna group versus 3.20, 2.05, and 1.90 in the hydrocortisone group; P < 0.001). The henna group showed a better response when compared with the hydrocortisone group: the rate of improvement on the fifth day of treatment was 90.2% (37 of 41 children without erythema) in the former versus 61% (25 of 41 patients) in the latter (P = 0.042). No significant side effects were observed in both the groups. CONCLUSIONS: Henna, a traditional medicine product, can be considered an effective and appropriate treatment for DD in infants and children.

Vitamin D-Fortified Bread Is as Effective as Supplement in Improving Vitamin D Status: A Randomized Clinical Trial.

CONTEXT: Bread can potentially be a suitable vehicle for fortification with vitamin D. OBJECTIVE: This study was undertaken to evaluate the following: 1) the bioavailability of vitamin D from the fortified Iranian bread and 2) the possible effects of daily consumption of the fortified bread on certain health aspects. DESIGN, SETTING, AND PARTICIPANTS: This was a randomized, double-blind, placebo-controlled trial conducted over 8 weeks in 90 healthy subjects aged 20-60 years. INTERVENTION: Subjects were randomly allocated to one of three groups: 1) fortified bread (FP; 50 g bread fortified with 25 µg vitamin D3 plus placebo daily; n = 30); 2) supplement (SP; 50 g plain bread plus 25 µg vitamin D supplement daily; n = 30); and 3) control (CP; 50 g plain bread plus placebo daily; n = 30). OUTCOME MEASURES: Initial and final anthropometric and biochemical assessments were performed. RESULTS: The within-group changes of serum 25-hydroxyvitamin D concentrations were 39.0 ± 22.6 (P < .001), 28.9 ± 31.2 (P < .001), and -9.2 ± 12.3 nmol/L in the FP, SP, and CP groups, respectively. Only in FP and SP groups, serum intact PTH concentrations decreased approximately 13.5% and 14.5%, respectively. Visceral fat also showed a significant decrement in FP (-1.05% ± 1.4%; P ≤ .001) and SP (-0.96% ± 1.7%; P = .006). Serum low-density lipoprotein cholesterol concentration showed a within-group reduction in FP (-10.4 ± 11.2 mg/dL; P < .001) and an insignificant decrement in SP (-6.6 ± 20.2 mg/dL; P = .083). Serum high-density lipoprotein increased in both vitamin D-supplemented groups (FP: 9.7 ± 7.6 vs SP: 5.7 ± 6.7 mg/dL; P < .001). CONCLUSION: Vitamin D-fortified bread could be potentially effective in raising circulating 25-hydroxyvitamin D levels of the population to nearly adequate levels.

Quality Management Systems Implementation Compared With Organizational Maturity in Hospital.

BACKGROUND: A quality management system can provide a framework for continuous improvement in order to increase the probability of customers and other stakeholders' satisfaction. The test maturity model helps organizations to assess the degree of maturity in implementing effective and sustained quality management systems; plan based on the current realities of the organization and prioritize their improvement programs. OBJECTIVES: We aim to investigate and compare the level of organizational maturity in hospitals with the status of quality management systems implementation. MATERIALS & METHODS: This analytical cross sectional study was conducted among hospital administrators and quality experts working in hospitals with over 200 beds located in Tehran. In the first step, 32 hospitals were selected and then 96 employees working in the selected hospitals were studied. The data were gathered using the implementation checklist of quality management systems and the organization maturity questionnaire derived from ISO 10014. The content validity was calculated using Lawshe method and the reliability was estimated using test - retest method and calculation of Cronbach's alpha coefficient. The descriptive and inferential statistics were used to analyze the data using SPSS 18 software. RESULTS: According to the table, the mean score of organizational maturity among hospitals in the first stage of quality management systems implementation was equal to those in the third stage and hypothesis was rejected (p-value = 0.093). In general, there is no significant difference in the organizational maturity between the first and third level hospitals (in terms of implementation of quality management systems). CONCLUSIONS: Overall, the findings of the study show that there is no significant difference in the organizational maturity between the hospitals in different levels of the quality management systems implementation and in fact, the maturity of the organizations cannot be attributed to the implementation of such systems. As a result, hospitals should make changes in the quantity and quality of quality management systems in an effort to increase organizational maturity, whereby they improve the hospital efficiency and productivity.

An Exploration of the Role of Hospital Committees to Enhance Productivity.

Productivity is the main concern of hospitals as organizations providing health services. As the role of hospital committees is increasing and their productivity and performance improvement is very important, the present study was performed to identify weaknesses and strengths of committee sessions. This analytical-descriptive study was conducted cross- sectional from January to April in 2012. Summary of 405 committee session's agendas related to 11 kinds of committees in 8 hospitals (out of 23 hospitals) of capital cities in 3 provinces of Sistan and Balouchestan, South Khorasan and Khorasan Razavi in Iran were extracted. Data was collected through a form and was analyzed by SPSS16 software using descriptive statistics and variance analysis and content analysis technique. This study showed that the number of hospital committee's sessions holding in 2012 was more than 2011.The differences between public and private hospitals in terms of the following subjects were significant (P-Value < 0.001). In terms of the number of selected policies, participants of the committees, and the duration of the sessions the public hospitals had better conditions. And regarding documentation process, feedback of decisions to personnel and the implementation of the formulated policies in the committees, private hospitals performed better. According to the results of this study, to improve the productivity of hospital committees, it is suggested to motivate senior, tactical and operational managers to appropriately participate in the committees and necessary planning for the committees in advance is mandatory.

Strategic planning, implementation, and evaluation processes in hospital systems: a survey from Iran.

BACKGROUND & AIM: Strategic planning has been presented as an important management practice. However, evidence of its deployment in healthcare systems in low-income and middle-income countries (LMICs) is limited. This study investigated the strategic management process in Iranian hospitals. METHODS: The present study was accomplished in 24 teaching hospitals in Tehran, Iran from September 2012 to March 2013. The data collection instrument was a questionnaire including 130 items. This questionnaire measured the situation of formulation, implementation, and evaluation of strategic plan as well as the requirements, facilitators, and its benefits in the studied hospitals. RESULTS: All the investigated hospitals had a strategic plan. The obtained percentages for the items "the rate of the compliance to requirements" and "the quantity of planning facilitators" (68.75%), attention to the stakeholder participation in the planning (55.74%), attention to the planning components (62.22%), the status of evaluating strategic plan (59.94%) and the benefits of strategic planning for hospitals (65.15%) were in the medium limit. However, the status of implementation of the strategic plan (53.71%) was found to be weak. Significant statistical correlations were observed between the incentive for developing strategic plan and status of evaluating phase (P=0.04), and between status of implementation phase and having a documented strategic plan (P=0.03). CONCLUSION: According to the results, it seems that absence of appropriate internal incentive for formulating and implementing strategies led more hospitals to start formulation strategic planning in accordance with the legal requirements of Ministry of Health. Consequently, even though all the investigated hospital had the documented strategic plan, the plan has not been implemented efficiently and valid evaluation of results is yet to be achieved.

Investigating the Financial Performance of Universities of Medical Science and Health Services in Iran, Using Data Envelopment Analysis.

BACKGROUND: Universities of Medical Science and Health Services (UMSHSs) are among the main organizations in Iran's health-care section. Improving their efficiency in financial resource management through creating an appropri-ate coordination between consumption and resources is strategically vital. Investigating the financial performance as well as ranking the Iranian UMSHSs is the research objective. METHODS: The study is of descriptive and applied type. The study population includes the UMSHSs of Iran (n=42) among which 24 UMSHSs are selected. DEA is used with the aim to model and assess the financial performance in-cluding 4 inputs and 3 outputs. Also, linear regression is applied to determine the effectiveness of the applied indices as well as the level of the financial performance. Data are obtained from the Budgeting Center in the Ministry of Health and Medical Education, during 2010 mainly through forms designed based on the available balance sheets. RESULTS: The average score of financial performance assessment for UMSHSs based on the DEA of input-oriented data is 0.74, assuming a constant scale of DEA-CRS. Thus, approximately 25% of the studied UMSHSs have maxi-mum relative performance and totally, there is about a 30% capacity to increase the financial performance in these UMSHSs. CONCLUSION: Most Iranian UMSHSs do not have high financial performance. This can be due to problems in financial resource management especially in asset combining. Therefore, compilation and execution of a comprehensive pro-gram for organizational change and agility with the aim to create a kind of optimized combination of resources and assets is strongly recommended.

Serum levels of interleukin-6 and interleukin-8 as diagnostic markers of acute pyelonephritis in children.

PURPOSE: Early diagnosis and treatment of acute pyelonephritis in children is of special importance in order to prevent serious complications. This study was conducted to determine the diagnostic value of serum interleukin (IL)-6 and IL-8 in children with acute pyelonephritis. METHODS: Eighty-seven patients between 1 month to 12 years old with urinary tract infection (UTI) were divided into 2 groups based on the result of 99m-technetium dimercapto-succinic acid renal scan: acute pyelonephritis (n=37) and lower UTI (n=50) groups. White blood cell (WBC) count, neutrophil (Neutl) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, platelet count, and serum IL-6 and IL-8 concentrations of both groups were measured and compared. RESULTS: There was a significant difference between two groups regarding WBC count, Neutl count, ESR, and CRP concentration (P<0.05). In addition, the difference between the two groups regarding serum IL-6 and IL-8 concentrations was not significant (IL-6, 60 and 35.4 pg/mL and IL-8, 404 and 617 pg/mL, respectively). The sensitivity and specificity of serum IL-6 and IL-8 for diagnosis of acute pyelonephritis were 73%, 42% and 78%, 32%, respectively. Sensitivity, specificity, negative and positive predictive values of serum IL-6 and IL-8 were less than those of acute phase serum reactants such as CRP. CONCLUSION: This study showed that there was no significant difference between acute pyelonephritis and lower UTI groups regarding serum IL-6 and IL-8 levels. Therefore, despite confirming results of previous studies, it seems that IL-6 and IL-8 are not suitable markers for differentiating between acute pyelonephritis and lower UTI.

National health information infrastructure model: a milestone for health information management education realignment.

OBJECTIVE: Challenges and drawbacks of the health information management (HIM) curriculum at the Master's degree were examined, including lack of well-established computing sciences and inadequacy to give rise to specific competencies. Information management was condensed to the hospital setting to intensify the indispensability of a well-organized educational campaign. The healthcare information dimensions of a national health information infrastructure (NHII) model present novel requirements for HIM education. MATERIALS AND METHODS: Articles related to challenges and barriers to adoption of the personal health record (PHR), the core component of personal health dimension of an NHII, were searched through sources including Science Direct, ProQuest, and PubMed. Through a literature review, concerns about the PHR that are associated with HIM functions and responsibilities were extracted. In the community/public health dimension of the NHII the main components have been specified, and the targeted information was gathered through literature review, e-mail, and navigation of international and national organizations. Again, topics related to HIM were evoked. RESULTS: Using an information system (decision support system, artificial neural network, etc.) to support PHR media and content, patient education, patient-HIM communication skills, consumer health information, conducting a surveillance system in other areas of healthcare such as a risk factor surveillance system, occupational health, using an information system to analyze aggregated data including a geographic information system, data mining, online analytical processing, public health vocabulary and classification system, and emerging automated coding systems pose major knowledge gaps in HIM education. CONCLUSIONS: Combining all required skills and expertise to handle personal and public dimensions of healthcare information in a single curriculum is simply impractical. Role expansion and role extension for HIM professionals should be defined based on the essence of HIM roles and responsibilities. Forming a curriculum development team consisting of various professional profiles brings divergent views regarding the HIM curriculum and paves the way for HIM to branch out at the Master's and Ph.D. levels based on advanced information technology.

Designing a model for trauma system management using public health approach: the case of Iran.

Trauma is a leading cause of death and disability around the world. Injuries are responsible for about six million deaths annually, of which ninety percent occur in developing countries. In Iran, injuries are the most common cause of death among age groups below fifty. Trauma system development is a systematic and comprehensive approach to injury prevention and treatment whose effectiveness has been proved. The present study aims at designing a trauma system management model as the first step toward trauma system establishment in Iran. In this qualitative research, a conceptual framework was developed based on the public health approach and three well-known trauma system models. We used Benchmarks, Indicators and Scoring (BIS) to analyze the current situation of Iran trauma care system. Then the trauma system management was designed using the policy development phase of public health approach The trauma system management model, validated by a panel of experts, describes lead agency, trauma system plan, policy-making councils, and data-based control according to the four main functions of management: leading, planning, organizing and controlling. This model may be implemented in two phases: the exclusive phase, focusing on resource integration and the inclusive phase, which concentrates on system development. The model could facilitate the development of trauma system in Iran through pilot studies as the assurance phase of public health approach. Furthermore, the model can provide a practical framework for trauma system management at the international level.

Organization's quality maturity as a vehicle for EHR success.

In health care industry, EHR has been advocated to improve care quality. The journey toward the development and adaptation of EHR should be holistic and integrate all the EHR's building blocks-health record management, business process improvement (BPI), collaboration and innovation, change management, user governance, etc.-that are intertwined together as like the links of a chain to improve quality of health care services. These cornerstones that shares common features with quality principles will pave the way for implementing EHR. To go along with quality features and take advantage of quality principles namely "quality maturity" builds a solid foundation for adaptation of EHR. Therefore, the recent theories of EHR success go far beyond technical rationales and focus on organizational and managerial factors in quality improvement. The milestone of quality concept in information system success is revealed in Delone and Mclean's model which launches system quality, information quality, service quality, as distinct elements of the IS success. EHR is a means to an end -to improve quality within enterprises- based on quality approaches. In this regards, more research should be conducted to investigate the relationship between of organization's quality maturity and EHR development success.

A qualitative study of the difficulties in reaching sustainable universal health insurance coverage in Iran.

OBJECTIVE To understand the Iranian health financing system and provide lessons for policy makers about achieving universal coverage. METHODS Twenty-five interviewees from seven major health insurance companies were selected for a qualitative study in 2007. Using a semi-structured interview, three main tasks of the health financing system (revenue collection, risk pooling and purchasing) were investigated. A framework method was applied for the data analysis. RESULTS The results of the study show the following seven major obstacles to universal coverage: unknown insured rate; regressive financing and non-transparent financial flow; fragmented and non-compulsory system; non-scientifically designed benefit package; non-health-oriented and expensive payment system; uncontrolled demands; and administrative deficiency. A long-term systematic plan is required to address the above problems.