From Public Health Policy to Impact for COVID-19: A Multi-Country Case Study in Switzerland, Spain, Iran and Pakistan.

Objectives: With the application of a systems thinking lens, we aimed to assess the national COVID-19 response across health systems components in Switzerland, Spain, Iran, and Pakistan. Methods: We conducted four case studies on the policy response of national health systems to the early phase of the COVID-19 pandemic. Selected countries include different health system typologies. We collected data prospectively for the period of January-July 2020 on 17 measures of the COVID-19 response recommended by the WHO that encompassed all health systems domains (governance, financing, health workforce, information, medicine and technology and service delivery). We further monitored contextual factors influencing their adoption or deployment. Results: The policies enacted coincided with a decrease in the COVID-19 transmission. However, there was inadequate communication and a perception that the measures were adverse to the economy, weakening political support for their continuation and leading to a rapid resurgence in transmission. Conclusion: Social pressure, religious beliefs, governance structure and level of administrative decentralization or global economic sanctions played a major role in how countries' health systems could respond to the pandemic.

The Slums in the Mirror of Health: A Systematic Review Analysis from Iran.

Background: One billion worldwide population is living in slum areas that mostly accompanied with high rates of poverty, illiteracy, unemployment, unhealthy situation, and inappropriate health-care services. The prediction of enormous growth of slums by 2030 led to a raise to address the "plight of slums" in Sustainable Development Goals (SDGs). Methods: To address evidence-based health-related priorities, we conducted a systematic review to summarizing evidences on health situations of slums population in Iran. Six electronic databases were systematically searched for published studies without any restriction on age, sex, and language to assess health situations of slums in Iran reported by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. All identified articles were screened, quality assessed, and data extracted by two authors independently. Results: The finding of this systematic review in addition to overall view categorized in five categories: health system, reproductive health, infectious diseases, noncommunicable diseases and their risk factors, social issues besides overall situation of Slums. Conclusions: Community-based participatory interventions with socioeconomic approach on modifiable risk factors; active response of health system; establishment new health care centers in slum areas; augmenting the quality of care; active case finding; and elevating health knowledge, attitude, and practice is crucial to achieve SDG's in Slum area.

COVID-19 and Comparative Health Policy Learning; the Experience of 10 Countries.

BACKGROUND: Since December 2019, the world has been facing one of the most critical health threats of the last decades. In March 2021, the official number of deaths passed 2.6 million worldwide. Most countries have developed policies to control the disease. Nevertheless, countries have experienced different outcomes related to their various adapted policies. Complementing our first report, in this article, we report our findings of comparing the policies adopted to combat coronavirus disease 2019 (COVID-19) in Iran, with those from nine selected countries, including China, Japan, South Korea, Singapore, Germany, the United States, the United Kingdom, Spain, and Italy, to draw evidence-informed policy lessons. METHODS: This is a qualitative study conducted based on document analysis related to COVID-19 policies in Iran and nine selected countries. Using a deductive approach, data were extracted and analyzed based on the components of the WHO Building Blocks Framework. Finally, we compared the Iranian policies with the nine selected countries. RESULTS: Documents analysis revealed a spectrum of policies, which have led to a variety of outcomes. Based on our findings, three main strategies (widespread testing, comprehensive contact tracing, and timely measures) were the most effective directions to combat COVID-19. CONCLUSION: The experience of the first and second waves of COVID-19 showed that the risk of coronavirus is serious and will continue until a vaccine or decisive treatment is achieved. Therefore, countries are required to adopt appropriate and tailored policies to deal with this crisis effectively. Applying the experiences from the previous waves is essential for more efficient performance in the likely upcoming waves.

Developing "Code of Ethics for Medical Professionals, Medical Council of Islamic Republic of Iran".

BACKGROUND: The medical profession has always been an inspiration for human societies throughout its diverse history. This position and historical authority in the field of ethics has had a different and higher status, in such a way that many of the norms of general ethics and professional ethics, especially principles, such as trust, confidentiality and respect for human dignity, have been developed by medical professionals. Developing guidelines of general and professional ethics is one of the inherent duties of the Medical Council of the Islamic Republic of Iran (IRIMC) as a professional organization. In this regard, the Supreme Council of IRIMC has approved the "Code of Ethics for Medical Professionals" and, in accordance with its legal authority, has annexed it to the disciplinary regulations of IRIMC. METHODS: A draft document, the result of extensive literature review, was discussed in 27 expert panel meetings and after receiving and endorsing the stakeholders' point of view, was approved by the IRIMC Supreme Council. RESULTS: The first edition of "Code of Ethics for Medical Professionals, Medical Council of Islamic Republic of Iran" was developed on July 6, 2017 by the Supreme Council of IRIMC. The guideline was set to take effect one year after its enactment. The first edition was revised and completed and final edition was adopted on August 9, 2018 by IRIMC in 13 chapters and 140 articles (original full text is available in the Supplementary file 1). CONCLUSION: According to the approved decision by the Supreme Council of IRIMC on May 10, 2018, the final edition takes effect as of October 7, 2018.

Iranian Society of Asthma and Allergy Codes of Professional Ethics.

The advances in science and technology in recent decades, especially in medical sciences, have raised new ethical challenges. Hence, professional organizations in the field of medical science are trying to develop regulations in the field of medical ethics to help medical science professionals in making the best decisions in different circumstances and moral dilemmas. The organizations also try to monitor their performance using those regulations. On the other hand, due to the specialization of medical science as well as the complexity of communication between these disciplines, there is a growing need for regulations to answer questions and resolve the challenges of each discipline. Certainly, scientific societies, due to benefit from relevant specialists, are the best reference for the development of specialized guidelines, one of which is the Iranian Society of Asthma and Allergy (ISAA). The aim of the current study was to develop codes of ethics for ISAA members, using a qualitative study. Generally, the ISAA codes of professional ethics consists of general and specific sections. In order to compile the general section, the upstream medical documents, including the patients' rights charter in Iran, the research ethics guidelines approved by the Ministry of Health and Medical Education (MOHME), ethical codes from the international societies of asthma and allergy, the general codes of professional ethics of the Iran Medical Council and the Islamic jurisprudential rules and the statute law of the country were used. To develop specific sections, we interviewed the experts in the field of Asthma and Allergy about the ethical challenges they had ever faced with. The ISAA codes of professional ethics developed in five chapters, entitled "Ethical Guidelines for the Mangers and Director of the Society, General Guidelines, Specific Guidelines, Ethical Guidelines for Research and Education, and Procedure for Supervision on the Professional Behavior of the ISAA Members", and approved by the board of directors of ISAA.

COVID-19 Pandemic and Comparative Health Policy Learning in Iran.

BACKGROUND: On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus disease (COVID-19) a global pandemic. Starting in December 2019 from China, the first cases were officially announced on February 19 in Qom city, Iran. As of April 3, 2020, 206 countries have reported a total of 932166 cases with 46764 deaths. Along with China, USA, Italy, Spain, and Germany, Iran has been suffering the hardest burden of COVID-19 outbreak. Worse still, countries like Iran are struggling with the double burden of political sanctions to provide lifesaving medical equipment and medicines to combat the emergency. METHODS: Using systematic document content analysis and through the lenses of health policy triangle, this article aims to compare the policies and strategies that Iran is adopting, with the experience and recommendations of China and WHO to combat COVID-19. RESULTS: Iran has formulated contextual-based policies to combat COVID-19 outbreak before and after virus entrance. Insufficient whole-government, whole-society approach in managing the outbreak, inadequate lifesaving and protective equipment, and delayed decisive governance are the biggest challenges in policy making to combat COVID-19. COVID-19 policies are a public health concern and require professional advocacy attempts through appropriate inter-sectoral collaboration and whole-government coalitions. CONCLUSION: COVID-19 is an unfolding outbreak; hence, policy learning is crucial to formulate appropriate policies and implement them accordingly. Iran has made many efforts to defeat the outbreak, but more coherent, timely and efficient action is required, now, more than ever, to save lives and slow the spread of this pandemic.

A study of lifestyle factors associated with breast cancer patients in Iran

Background: Several environmental and lifestyle factors have a significant role in the incidence of various types of cancer. Lifestyle factors are important elements in the development of cancer, and correction of them can lead to prevention. Given that the underlying cause of cancer is unclear, comparing the lifestyle of two groups of women can explain some of the breast cancer risk factors. Objective: The present study was conducted to compare the lifestyle dimensions in women with and without breast cancer. Methods: This cross-sectional study was carried out to compare two groups of 546 women (273 healthy individuals and 273 cancer patients). The lifestyle sub-scales were collected using a lifestyle questionnaire (LSQ). The differences between the scores of the eight sub-scales in the two groups were analyzed using independent ttest and Mann-Whitney test. Results: The mean age of the participants in both groups of this study was 44.51 ± 11.28. Although the lifestyle scores of the healthy individuals were higher than the patient group, in terms of all eight dimensions of lifestyle, a significant difference was found between the two groups in terms of four dimensions (P<0.05). Also, there was a positive and significant correlation between the socioeconomic status and the lifestyle of women with breast cancer (P=0.49). Conclusions: Regarding the difference between the lifestyle score of the two groups, it seems to be necessary for authorities and healthcare providers to plan for educational programs of lifestyle practices, and healthy behaviors. Besides, conducting longitudinal studies are recommended to find the causal relationship between the two variables

Helping to prevent hepatitis B in family setting, by educating women to vaccinate before marriage.

Hepatitis B (HB) is one of the major public health problems and a major cause of liver cirrhosis and hepatocellular carcinoma (HCC). The aim of this study was to evaluate the effect of a model-based educational intervention on preventive health behavior of hepatitis B vaccination among women who were going to get married (pending marriage women). Seventy pending marriage women were selected from martial counseling centers. The participants' knowledge, health beliefs model (HBM) constructs, and intention to receive HB vaccination were collected using a questionnaire based on HBM. The questionnaire was based on the Likert-type scale with the score range of 1 to 5. An educational intervention was carried out based on pretest results. The baseline and follow-up level of the variables was statistically significant within the case group. The mean score of the variables in the two groups showed a statistically significant difference in favor of the case group. Our study showed a positive effect of educational intervention on the participants' knowledge, HBM constructs, and intention to receive HB vaccination, indicating that educational intervention based on HBM could be used as an appropriate tool to improve preventive behavior of HB vaccination.

The Impact of Demographic Factors and Blood Sugar Control on the Incidence of Urinary Tract Infections in Khorramabad in 2013.

BACKGROUND: Diabetes is one of the most serious metabolic disorders to affect different organs in the body. Patients with diabetes are hence at risk of developing other problems. Urinary tract infections (UTI) are one of the problems that occur more commonly in diabetic patients than in others. There are several risk factors that lead to the incidence of UTI in diabetic patients. OBJECTIVES: We conducted this study to determine the effect of different factors on the incidence of UTI in diabetic patients in order to decrease the incidence of this problem. PATIENTS AND METHODS: In this cross-sectional study, data concerning 233 patients who were referred to the largest diabetes center in Khorramabad, Lorestan province, Iran, were recorded. The relationships between various factors and the incidence of UTI in these patients were evaluated using SPSS version 16. We used chi-square and logistic regression to analyze the data. A P < 0.05 was considered to be statistically significant. RESULTS: The incidence of UTI increased significantly with increasing age (P = 0.009). The incidence of UTI was higher among females than among males, and it was higher among unemployed people than among those in other occupations. The prevalence of UTI among patients who control their diabetes through diet and exercise was lower than that among those undergoing other types of treatment; however, no significant relationship was found between the different types of oral medication and the incidence of UTI. We did not find any relationship between the incidence of UTI in diabetic patients and other factors such as literacy, marital status, BMI, addiction, history of hospitalization, and level of HbA1c. CONCLUSIONS: We found that age, gender, occupation, and the type of medication used are all risk factors for the incidence of UTI in diabetic patients. Other factors such as literacy, marital status, addiction, and history of hospitalization did not have any significant association with the incidence of UTI in diabetic patients.

Impact of maternal hemoglobin concentration on fetal outcomes in adolescent pregnant women.

BACKGROUND: Studies on the association between maternal hemoglobin (Hb) concentration and adverse pregnancy outcome have been inconsistent. Many studies have shown the impact of Hb concentration on pregnancy outcomes in adult women; however, it is not revealed in adolescent pregnant women. OBJECTIVES: The aim of this study was to examine the effect of Hb concentration on birth outcomes in pregnant adolescents as a high-risk group. PATIENTS AND METHODS: In this cross-sectional study, 312 healthy and nonsmoker adolescent pregnant women with gestational age (GA) of 37-40 weeks were chosen by random sampling, and were followed until delivery. A complete history was obtained from women. In addition, clinical examination and Hb test were performed. After birth, the associations between Hb concentration during pregnancy and birth outcomes were investigated. Statistical analyses were performed using SPSS software by t-test, chi-square and ANOVA. RESULTS: In total, about 23.2 % were anemic, 58% had normal level of Hb (11-13.2 g/dL) and 18.8% had Hb > 13.2 g/dL. The mean birth weight was 3197.8 ± 398.25 grams and it was more in mothers with Hb = 10.5-12.5 g/dL than others (Hb < 10.5 or Hb > 12.5 g/dL) (P < 0.001). The lowest mean birth weight was found in mothers with Hb < 10.5 (3033.33 ± 422). Moreover, the mean birth weight of male newborns was more than females (P = 0.001). Eight percent of neonates had Apgar score less than eight. Low Apgar score in anemic group and mothers with high Hb concentration (Hb > 12.5 g/dL) was more than others. CONCLUSIONS: Abnormal Hb concentrations increase the risk of adverse birth outcomes such as low birth weight (LBW) and low Apgar scores in pregnant adolescents, so intensive care is recommended for this group of pregnant women.

Citation Analysis of Hepatitis Monthly by Journal Citation Report (ISI), Google Scholar, and Scopus.

BACKGROUND: Citation analysis as one of the most widely used methods of bibliometrics can be used for computing the various impact measures for scholars based on data from citation databases. Journal Citation Reports (JCR) from Thomson Reuters provides annual report in the form of impact factor (IF) for each journal. OBJECTIVES: We aimed to evaluate the citation parameters of Hepatitis Monthly by JCR in 2010 and compare them with GS and Sc. MATERIALS AND METHODS: All articles of Hepat Mon published in 2009 and 2008 which had been cited in 2010 in three databases including WoS, Sc and GS gathered in a spreadsheet. The IFs were manually calculated. RESULTS: Among the 104 total published articles the accuracy rates of GS and Sc in recording the total number of articles was 96% and 87.5%. There was a difference between IFs among the three databases (0.793 in ISI [Institute for Scientific Information], 0.945 in Sc and 0.85 GS). The missing rate of citations in ISI was 4% totally. Original articles were the main cited types, whereas, guidelines and clinical challenges were the least ones. CONCLUSIONS: None of the three databases succeed to record all articles published in the journal. Despite high sensitivity of GS comparing to Sc, it cannot be a reliable source for indexing since GS has lack of screening in the data collection and low specificity. Using an average of three IFs is suggested to find the correct IF. Editors should be more aware on the role of original articles in increasing IF and the potential efficacy of review articles in long term impact factor.

The more publication, the higher impact factor: citation analysis of top nine gastroenterology and hepatology journals.

BACKGROUND: The impact factor (IF), as the most important criterion for journal's quality measurement, is affected by the self-citation and number of publications in each journal. OBJECTIVES: To find out the relationship between the number of publications and self-citations in a journal, and their correlations with IF. MATERIALS AND METHODS: Self-citations and impact factors of nine top gastroenterology and hepatology journals were assessed during the seven recent years (2005-2011) through Journal Citation Reports (JCR, ISI Thomson Reuters). RESULTS: Although impact factors of all journals increased during the study, five out of nine journals increased the number of publications from 2005 to 2011. There was an increase in self-citation only in the journal of HEPATOLOGY (499 in 2005 vs. 707 in 2011). Impact factors of journals (6.5 ± 3.5) were positively correlated with total number of publications (248.6 ± 91.7) (R: 0.688, P < 0.001). Besides, the self-citation rate (238.73 ± 195.317) was highly correlated with total number of publications in each journal (248.6 ± 91.7) (R: 0.861, P < 0.001). On the other hand, impact factor without self-citation (6.08 ± 3.3) had a correlation (R: 0.672, P < 0.001) with the number of published items (248.6 ± 91.7). CONCLUSIONS: The number of articles and self-citation have definite effects on IF of a journal and because IF is the most prominent criterion for journal's quality measurement, it would be a good idea to consider factors affecting on IF such as self-citation.