Modeling Medical Data by Flexible Integer-Valued AR(1) Process with Zero-and-One-Inflated Geometric Innovations.

In this paper, we introduce a new stationary first-order integer-valued autoregressive process (INAR) with zero-and-one-inflated geometric innovations that is useful for modeling medical practical data. Basic probabilistic and statistical properties of the model are discussed. Conditional least squares and maximum likelihood estimators are proposed to estimate the model parameters. The performance of the estimation methods is assessed by some Monte Carlo simulation experiments. The zero-and-one-inflated INAR process is subsequently applied to analyze two medical series that include the number of new COVID-19-infected series from Barbados and Poliomyelitis data. The proposed model is compared with other popular competing zero-inflated and zero-and-one-inflated INAR models on the basis of some goodness-of-fit statistics and selection criteria, where it shows to provide better fitting and hence can be considered as another important commendable model in the class of INAR models.

Comparison of the Effects of Using Physiological Methods and Accompanying a Doula in Deliveries on Nulliparous Women's Anxiety and Pain: A Case Study in Iran.

Childbirth is a great moment in a woman's life and is inevitably influenced by emotional, social, and psychological stress. This study aimed to assess the anxiety and pain level of nulliparous women giving birth using physiological methods (without doula support) during labor and those women supported by a doula at Towhid Hospital of Jam, Bushehr, Iran in 2015. In this interventional study, 150 women were randomly assigned to either an intervention (with doula support) or a control group (with no doula support). The intrapartum, postpartum, and hidden anxiety levels were measured using Spielberger standard questionnaire used for assessing anxiety. The labor pain rate was evaluated using McGill questionnaire. Results showed that the average rate of obvious anxiety during labor was 57.76 ± 9.57 in physiological delivery (without doula) and 48.04 ± 9.61 in doula-supported delivery. The difference between mean scores of obvious anxiety during labor was significant. The mean anxiety of the control group (who did not receive doula support) was higher (P = .000). Also, the difference between the mean labor pain scores of the 2 groups was statistically significant. The results of the study showed that doula's presence has positive significant effects on labor pain and anxiety reduction; also, doula-supported mothers reported considerably lower pain and anxiety compared with those experiencing physiological delivery (without doula). Thus, the increased use of doula in hospitals all over the country is recommended.

Assessing the Quality of Services Provided in the Teaching Hospitals: A Case Study of Iran.

Service quality is the most important factor in the success of health care organizations; because of their vital and important services, even very small errors can be followed by great and irreparable harm and damage. This study aimed to assess the quality of services provided in the teaching hospitals affiliated to Shiraz University of Medical Sciences in 2015. This is an applied, cross-sectional, and descriptive-analytical study conducted in 2015 in the teaching hospitals affiliated to Shiraz University of Medical Sciences. A sample of 290 inpatients with at least 2 days of admission to hospital was selected using stratified sampling proportional to size and simple random sampling methods. The results showed that there were significant negative gaps in all dimensions (P > .001), and the highest and lowest means and SD of negative gaps were related to empathy (-1.35 ± 1.4) and assurance (-0.52 ± 0.95). Moreover, the results showed that there was a significant negative correlation between the patients' age and the total mean of the patients' expectations. According to the results, the studied hospitals had not been able to meet the expectations of their patients in any of the service quality dimensions. Therefore, to improve the service quality dimensions, the authors recommend holding training courses on how to interact with patients and meet their needs, providing adequate and proper information about the diseases and their treatment for the patients, having adequate medical staff, and so on.

The Effects of Transformational Leadership and Mediating Factors on the Organizational Success Using Structural Equation Modeling: A Case Study.

This study was undertaken to determine the effects of transformational leadership (TL) and mediating factors on organizational success (OS) from the administrative, financial, and support employees' perspective in teaching hospitals affiliated with Shiraz University of Medical Sciences using structural equation modeling. Three hundred administrative and financial employees were selected, using stratified sampling proportional to size and simple random sampling. Data were collected using 5 questionnaires and analyzed using SPSS 21.0 and Lisrel 8.5 through Pearson correlation coefficient and path analysis and confirmatory factor analysis methods. Results showed that TL had significant positive effects on the 3 mediating factors, including organizational culture (t = 15.31), organizational citizenship behavior (OCB) (t = 10.06), and social capital (t = 10.25). Also, the organizational culture (t = 2.26), OCB (t = 3.48), and social capital (t = 7.41) had significant positive effects on OS. According to the results, TL had an indirect effect on OS. Therefore, organizations can achieve more success by strengthening organizational culture, OCB, and social capital through using transformational leadership style. Therefore, in order to increase OS, the following recommendations are made: supporting and encouraging new ideas in the organization, promoting teamwork, strengthening intergroup and intragroup relationships, planning to strengthen and enrich the social and organizational culture, considering the promotion of social capital in the employee training, establishing a system to give rewards to the employees performing extra-role activities, providing a suitable environment for creative employees, and so on.

Demand for Dental Services in Shiraz, Iran, 2013.

This cross-sectional and descriptive-analytic study aimed to estimate the demands for the use of dental services by Shirazi inhabitants in Iran from June 2013 to October 2013. Six hundred eighty subjects older than 18 years were selected from among the people living in Shiraz, using a multistage sampling method. The collected data were analyzed using SPSS 16.0 and Stata 11.0. The results showed that the factors affecting the number of referrals to the dental services centers and the use of these services included the age groups of 28 to 37 and 38 to 47 years, household expenses per month, and having supplementary health insurance coverage (P < .05). According to the results, in order to improve access to dental services and increase the probability of utilizing such services by people in need, the researchers recommend that the authorities should design and develop basic and supplementary health insurance plans to cover different types of dental services, allocate subsidies to dental health services, and increase the knowledge of all the people in different age groups about adherence to dental health principles and prevention of oral and dental diseases.

The Effects of Supervisors' Support and Mediating Factors on the Nurses' Job Performance Using Structural Equation Modeling: A Case Study.

Nurses are the largest group and an important part of the providers in the health care systems that who a key role in hospitals. Any defect and deficiency in their work can result in irreversible outcomes. This study aimed to determine the effect of supervisors' support and mediating factors on the job performance (JOBPER) of 400 nurses working in the teaching hospitals affiliated to Shiraz University of Medical Sciences, using structural equation modeling. The results showed that the supervisor's support had a significant negative effect on work-family conflict (t = -2.57) and a positive effect on organizational commitment (t = 4.03); Work-family conflict had a significant positive effect on job stress (t = 11.24) and a negative effect on organizational commitment (t = -3.35) and JOBPER (t = -2.29). Family-work conflict had a positive effect on job stress (t = 4.48) and a negative effect on organizational commitment (t = -2.54). Finally, job stress had a negative effect (t = -3.30), and organizational commitment showed a positive effect (t = 5.96) on the studied nurses' JOBPER. According to the results, supervisor's support could influence JOBPER through reducing work-family conflict and increasing organizational commitment. Therefore, to improve the nurses' JOBPER in the hospitals, some strategies are recommended.

The association between work ethics and attitudes towards organizational changes among the administrative, financial and support employees of general teaching hospitals.

In order to achieve success in today's competitive world, organizations should adapt to environmental changes. On the other hand, managers should have a set of values and ethical guidelines for their administrative and organizational functions. This study aimed to investigate the association between work ethics and attitudes towards organizational changes among the administrative, financial and support employees of general teaching hospitals affiliated to Shiraz University of Medical Sciences. This was an applied, cross-sectional and descriptive-analytic study conducted in 2013. A sample of 124 employees was selected using stratified sampling proportional to size and simple random sampling methods. Data were collected using 2 questionnaires measuring the dimensions of employees' work ethics (four dimensions) and attitudes towards organizational changes (three dimensions). The collected data were analyzed using SPSS 18.0 and statistical tests, including ANOVA, independent samples t-test, and Pearson's correlation coefficient. A P < 0.05 was considered statistically significant. The maximum and minimum score of work ethic dimensions were related to being cooperative (4.60 ± 0.38) and dependable (4.29 ± 0.39) respectively. On the other hand, the maximum and minimum score of attitudes towards the various dimensions of organizational changes were related to the behavioral (3.83 ± 0.70) and the affective (3.55 ± 0.88) dimensions respectively. Furthermore, there was a significant relationship between the work ethics and education levels of the employees in this study (P = 0.003). Also, among work s dimensions, only being considerate had a significant association with attitudes towards organizational changes (P = 0.014) and their cognitive dimension (P = 0.005). To improve employees' work ethics and attitudes towards organizational changes, the following suggestions can be offered: training hospitals managers in participative management style and its application, as well as the importance of meeting the employees' needs and expectations based on their characteristics; familiarizing employees with the Islamic work ethic; educating employees on the importance of being considerate towards their colleagues and subordinates in the workplace, and reinforcing this desirable quality; and finally, clarifying the need for changes in the organization for all employees.

Comparison of the patients' satisfaction after inpatient and outpatient operations for haemorrhoidal disease.

OBJECTIVE: To compare the patients' satisfaction between outpatient and inpatient haemorrhoidectomy. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran, from January to July 2011. METHODOLOGY: A total of 208 patients were involved in this cross-sectional study. All patients were examined by their specialists and after definite diagnosis of haemorrhoid, they were randomly allocated to two groups: outpatient and inpatient. Data for this study was collected by a satisfaction questionnaire. RESULTS: There was no statistical significant difference between the two groups' satisfaction. Both groups were quite satisfied. Also, there was no statistical significance regarding the variable of time of visit. In addition, there was no association between the patients' satisfaction and with, occupation, and level of education. CONCLUSION: Based on the results of the study, minor operations such as haemorrhoidectomy are better to be done in clinics since they do not differ from the operating room regarding the patients' satisfaction.