Developing a responsive model to societal needs in medical education.

BACKGROUND: Responsiveness is relevant in the context of treatment and the provision of medical services. However, if we delve deeper into the subject, we must establish and develop responsiveness within the medical sciences education system. This study aims to identify the dimensions that significantly impact responsiveness in the medical education system based on a comprehensive review and expert opinions in healthcare. METHODS: The present research is descriptive-analytical in terms of its objective and follows a mixed-method approach. This study was conducted in three stages. Initially, we utilized relevant keywords related to education in databases, such as Web of Science, Scopus, ScienceDirect, OVID, CINHAL, EBSCO, Google Scholar, Iranmedex, SID, and Irandoc. Subsequently, in the expert panel session stage, the factors influencing responsiveness were identified in the comprehensive review stage, and with this thematic background, they were conceptualized. Finally, the Confirmatory Factor Analysis (CFA) technique was employed to coherently examine the relationships between variables and present the final model. RESULTS: We obtained 32 articles from the comprehensive review of studies. Four components in planning, implementation, monitoring and evaluation, and intersectoral cooperation were identified based on expert panel opinions. Based on the standardized coefficients, the components of research-based educational planning, community-oriented education evaluation indicators, and utilization of modern educational methods are statistically significant. CONCLUSION: The establishment and development of responsiveness in the medical sciences education system involve training specialized and responsive human resources through innovative educational methods that have sufficient familiarity with the multidimensional concepts of health and how to achieve them. This approach allows for practical and responsible steps toward training competent and committed physicians in line with the needs of society. On the other hand, responsiveness in the medical sciences education system can be improved by enhancing research-based educational planning and developing community-oriented evaluation indicators that can assess the number of revised educational programs based on societal needs. Therefore, understanding the critical elements in revising medical education programs, which play the most significant role in addressing societal needs and responding to changing disease patterns and new health priorities, is both a necessity and an important priority.

Relationship between perceived social support and disability with the mediating role of perceived stress among older adults.

BACKGROUND: Social support is essential for individuals to cope with difficult circumstances. Older adults with disabilities face significant challenges in engaging with everyday activities. The current study examines the mediating role of perceived stress in the association between perceived social support and disability among Iranian community-dwelling older adults. METHODS: In this descriptive and cross-sectional study, 300 older adults were selected using cluster sampling from January to June 2022. The data were collected using the Multidimensional Scale of Perceived Social Support (MSPSS), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2), and the Cohen Perceived Stress Scale-14 (PSS-14). The collected data was analyzed using structural equation modeling (SEM) in Mplus. RESULTS: The mean age of older adults was 68.71 ± 6.13 years, ranging from 60 to 85 years old. The results of this study revealed a significant relationship between perceived social support and disability (ß=-0.20, SE = 0.06, p < 0.001) and perceived stress and disability (ß = 0.50, SE = 0.05, p < 0.001). The results also confirmed the mediating role of perceived stress in the relationship between perceived social support and disability (ß=-0.17, SE = 0.03, p < 0.001). CONCLUSION: The results indicated that increasing social support could reduce disability by decreasing perceived stress. These results have important implications for policymakers and healthcare professionals in promoting healthy aging.

The moderating role of social support in the relationship between death anxiety and resilience among dialysis patients.

BACKGROUND: Chronic Kidney Disease (CKD) who receive social support can cope with the challenges. Therefore, this study determined the moderating role of social support in the relationship between death anxiety and resilience among dialysis patients in Qazvin City. METHODS: This cross-sectional study used a descriptive-analytical approach on 347 dialysis patients in Qazvin City. The data collection tools included several questionnaires. The convenience sampling method was employed. The data were analyzed using SPSS software version 22 and mplus software version 7.2, employing descriptive statistics, such as mean and standard deviation for continuous variables and using counts and percentages for categorical/nominal variables. Regression analysis and tests were used to examine the relationships between variables. Structural Equation Modeling (SEM) analysis was employed to determine direct and indirect relationships between independent and dependent variables. RESULTS: The prevalence of death anxiety was high (48.3%) among the patients. The mean resilience score was 62.59 ± 15.69, and the mean social support score was 52.23 ± 10.21. There was a significant association between resilience and social support (P < 0.001), as well as between resilience and death anxiety (P < 0.001). Furthermore, a significant relationship was observed between social support and death anxiety (p = 0.015). In the analysis of SEM, both the direct and indirect relationships between resilience and death anxiety were significant through the mediating variable of social support. CONCLUSION: This study demonstrates that there is a relationship between death anxiety and resilience, and social support significantly moderates the relationship between death anxiety and resilience.

The effect of circadian on the productivity of nurses with the mediating role of quality of work life.

BACKGROUND: Circadian rhythms, as an integral part of daily life, govern the scheduling, management, and coordination of living organisms. Given the irregular nature of shift patterns in nurses' work schedules, investigating their implications is paramount to increasing Quality of Work Life (QWL) and productivity. The study aimed to investigate the impact of circadian rhythm on the efficiency of nurses working in hospitals in Qazvin, Iran, with QWL serving as a mediating variable. METHODS: This study employed a descriptive-analytical research design, utilizing cross-sectional data collected in 2022-2023 based on the implementation of Structural Equation Modeling (SEM). The number of participants was 378 nurses. The data were obtained by administering a questionnaire and various tools, organized into four sections: demographic information, the Circadian Questionnaire, the Quality of Work Life Questionnaire, and the Nurses' Efficiency Questionnaire. The collected data were subsequently analyzed using SEM techniques within the R software. RESULTS: The findings demonstrated statistically significant variations in mean scores about gender and efficiency (p = 0.008), marital status and efficiency (p = 0.000), and employment type and efficiency (p = 0.002) among the study participants. There was a significant association between shift patterns and QWL (p = 0.004). Expressly, the confirmed results indicated a direct impact of circadian on QWL (with a path coefficient of 0.013), as well as an indirect impact on efficiency mediated by the variable QWL (with a path coefficient of 0.037) (p < 0.05). CONCLUSION: Due to the critical role of nurses in the healthcare system, implementing strategies that promote their efficiency is paramount. Therefore, managers can create an environment that enhances nurses' productivity by improving methods that positively impact their QWL.

Fear of hypoglycemia and illness perception in type II diabetes patients.

BACKGROUND: Hypoglycemia, a prevalent acute complication among individuals with type 2 diabetes (T2D), manifests with varied symptoms. Those with diabetes who have previously encountered hypoglycemic episodes commonly develop a Fear of Hyperglycemia (FOH). Illness perception (IP) significantly affects self-care behaviors and health outcomes in individuals diagnosed with T2D. OBJECTIVE: This study examined the correlation between IP and FOH among T2D patients and predictors of FOH. METHODS: The present study employed a descriptive-analytical design. The target population for this investigation comprised patients diagnosed T2D who sought medical care at the clinic and endocrinology departments of a hospital affiliated with Alborz University of Medical Sciences. The data collection period spanned from August 2019 to March 2021. A total of 300 individuals were included in the sample. Questionnaires were administered to measure both IP and FOH. Statistical analysis was conducted to examine the association between IP and FOH, as well as to identify the predictors of FOH. RESULTS: The results of the study indicated a statistically significant relationship between FOH and the mean score of IP among patients with diabetes (p = 0.001, r = 0.393), suggesting a moderate positive correlation between these variables. Additionally, the duration of illness, IP, and level of education were identified as variables that predicted FOH (p < 0.05). CONCLUSION: The numerous factors that influence FOH in individuals diagnosed with T2D highlight the necessity for strategic planning and training initiatives aimed at enhancing IP and reducing FOH within this specific population. Healthcare providers should prioritize interventions that not only address patients' concerns but also contribute to the improvement of their overall well-being. By implementing such interventions, healthcare providers can optimize diabetes management strategies and ultimately enhance patient outcomes.

What rate of Iranian women perform Pap smear test? Results from a meta-analysis.

In this study, an attempt was made to estimate the aggregated proportion of Pap smear test uptake among women in Iran from 2012 to 2022 using meta-analysis. The data collection process involved reviewing records registered in databases between January 1, 2012, and September 11, 2022. The final data was analyzed using random effects models, and potential heterogeneity was assessed using the I2 index. To examine publication bias, Egger's test and Funnel Plot were employed. Sensitivity analysis, specifically single study exclusion Meta-analysis, was conducted to assess the influence of each individual study on the aggregated percentage of Pap smear test uptake. A total of 28,754 women were included across the 33 articles analyzed. The pooled percentage of Pap smear test uptake for both one-time and regular screenings was found to be 46.52% (95% CI: 40.91 to 52.14) and 17.80% (95% CI: 12.42 to 23.18), respectively. No significant evidence of publication bias was detected, although the influence of smaller studies was confirmed. Sensitivity analysis indicated that the overall rate of Pap smear test uptake was not highly sensitive to the results of individual studies. The findings emphasize the low rate of regular Pap smear testing among Iranian women and suggest that tailored interventions considering cultural and geographical factors specific to different provinces in Iran could help increase the utilization of this screening service.

Inequality in the distribution of resources in the health sector before and after the Health Transformation Plan in Qazvin, Iran.

BACKGROUND: The equitable distribution of healthcare resources represents a paramount objective in the realm of global health systems. Thus, the present study sought to assess the fairness in the allocation of health resources at Qazvin University of Medical Sciences (QUMS), both prior to and subsequent to the implementation of the Health Transformation Plan (HTP) using the Gini coefficient and the Hirschman-Herfindahl index (HHI). METHODS: This descriptive-analytical study aimed to investigate the distribution of healthcare resources among general practitioners (GPs), specialists, and subspecialists employed at QUMS between 2011 and 2017. Demographic data pertaining to the cities were obtained from the statistical yearbooks of the Statistical Center of Iran, while information regarding the healthcare workforce was extracted from QUMS records. The analysis utilized two key measures, namely the Gini coefficient and the HHI, to assess the fairness of resource distribution. Data analysis was performed using Microsoft Excel 2016 and the Stata statistical software. RESULTS: The highest number of GPs, specialists, and subspecialists was observed in 2014, 2017, and 2017, respectively, while the lowest number was recorded in 2016, 2011, and 2015, respectively. From 2011 to 2017, the Gini coefficient for GPs ranged between 0.61 and 0.63. Among specialists, the lowest Gini coefficient value was observed in 2015 (0.57), while the highest was recorded in 2017 (0.60). The Gini coefficient for subspecialists remained constant at 0.52 from 2011 to 2017. The HHI revealed a high concentration of GPs in the cities of Qazvin province. Although the disparity gradually decreased in the specialties of eye, ear, nose, and throat, and pediatrics, the concentration still persists in Qazvin. In general surgery, the index value is low, indicating some level of inequality. In anesthesia and neurology, the index value decreased after the HTP and reached 5700; however, achieving equality (below 1000) still requires further efforts. No significant change in the index was observed after the HTP in specialties such as neurosurgery, rehabilitation, and nuclear medicine. Subspecialists also exhibited a concentration in the city of Qazvin. CONCLUSION: Based on the analysis of the Gini and HHI, it is evident that the distribution of GPs has not undergone significant changes following the implementation of the HTP. The Gini coefficient, which ranges from 0.4 to 0.6, indicates a high to complete level of inequality in the distribution of specialists and subspecialists. Moreover, the HHI exceeds 1000, reflecting a concentration of resources in specific areas. As a result, the HTP has not yet achieved its goal of ensuring a fair distribution of human resources. To address this issue, it is recommended to redesign distribution policies, including the allocation of physical health resources, such as specialized hospitals, beds, and medical equipment. Additionally, increasing student admissions in specialized and subspecialized fields and implementing tariff incentives can contribute to a more equitable distribution of resources. By aligning distribution policies with the principle of fairness, the healthcare system can better address the issue of resource distribution.

Investigating the Rate and Affecting Factors of Unnecessary Cervical Collar Use in Trauma Patients.

Objective: This study aimed to investigate the necessity of cervical collars in patients with neck problems. Methods: This cross-sectional study was conducted on 114 patients who were admitted to the Haft Tir and Rasoul Akram Hospitals (Tehran, Iran) from August to September 2022. The Nexus protocol was used to select the patients with cervical collars. According to the protocol, a cervical collar was required for individuals who had at least one symptom. If none of these symptoms existed, the cervical collar was deemed unnecessary. The data were analyzed using the Chi-square test and Fisher's exact test. Results: Of the 114 trauma patients, the cervical collar was used unnecessarily by 49 (43%) patients. Tenderness was the most common complication in 62 patients (54.4%). The prevalence of unnecessary cervical collar use was 37.5% in female trauma patients and 43.88% in male trauma patients, which was not statistically significant (p=0.63). The prevalence of unnecessary cervical collar use in trauma patients with multiple trauma was 39.42% and 80% in patients without multiple trauma, which was statistically significant (p=0.018). Patients with a medical history had a higher rate of unnecessary use of the cervical collar (47.96%) than those without a history (12.5%), and this difference was statistically significant (p=0.008). Conclusion: The guidelines for using cervical collars need to be updated by the EMS. Due to the large number of trauma patients in Iran, cervical collars for necessary conditions can help to reduce the healthcare expenses and injuries caused by unnecessary cervical collars.

The relationship between spiritual intelligence and self-management in patients with diabetes type 1.

BACKGROUND: Diabetes is widely recognized as one of the most pressing public health concerns globally. To manage blood glucose levels and reduce subsequent complications and mortality rates, self-management mechanisms have been found to be effective in controlling diabetes. This study aimed to investigate the association between spiritual intelligence and diabetes self-management in patients with type 1 diabetes in Qazvin, Iran. METHODS: This cross-sectional study included 220 adults with type 1 diabetes aged 18-35 years who referred to an outpatient diabetes clinic of a tertiary hospital in Qazvin province, and were selected through a convenience sampling method in 2022. Two valid and reliable questionnaires were used for data collection, including the 24-item questionnaire of spiritual intelligence and self-management of type 1 diabetes for adolescents (SMOD-A). To analyze the data, correlation coefficients and multiple linear regression analysis were used. RESULTS: The total score of spiritual intelligence was 57.24 ± 10.77, and self-management was 77.14 ± 8.92. Among different subscales of spiritual intelligence, critical thinking obtained the highest score. In self-management, the highest score was achieved for communication.Findings also revealed that spiritual intelligence could predict 7.2% of changes in self-management among diabetes patients, and its relationship with diabetes self-management was estimated at 0.27. CONCLUSION: The growing prevalence of diabetes worldwide underscores the significance of self-management of the disease in the well-being of patients. This study demonstrated that spiritual intelligence played a crucial role among young adults with diabetes and assisted them in coping with stressful situations. As such, placing greater emphasis on the spiritual aspects of care is necessary, especially in the healthcare of young adults who are dealing with diabetes and its complex conditions.

Socioeconomic Inequalities in Cancer Incidence: A Comparative Investigation Based on Population of Iranian Provinces.

Cancer is the second important cause of death worldwide. Cancer is one of the top health priorities in Iran. We aimed to study the socio-economic inequality of cancer incidence in Iran provinces. We conducted this cross-sectional study using provincial data. We obtained the required data from the statistical yearbook report, the Statistics Center Report and the National Cancer Registration Program Report of Iran's Ministry of Health and Medical Education (MoHME) for 2018. Socio-economic inequality of cancer incidence was analyzed by estimating the concentration index and extracting the concentration curve. Statistical analyzes were performed using STATA 14. Our findings revealed that cancer incidence was unequally distributed in terms of the socio-economic status in Iranian provinces. Cancer incidence is slightly concentrated in the provinces with higher than average literacy, per capita income and insurance coverage and household size below average. The concentration of cancer incidence has been to the detriment of the provinces that have a slightly better ranking in terms of the socio-economic index. The employment rate did not significantly affect cancer's distribution burden. We recommend policymakers facilitate early cancer detection by providing insurance coverage for screening services, payment exemptions, and public awareness.

A framework for elderly participation in Primary Health Care in Tabriz Health complexes.

BACKGROUND: A framework for increasing elderly participation in Primary Health Care (PHC) is a vital issue considering the growing population. After examining the situation and elderly participation in the provision of PHC in the health complexes of Tabriz City, the present study presents the framework of elderly participation in PHC. METHODS: This is a mixed-method study. First, we reviewed the models of elderly participation in PHC worldwide using a comprehensive search of literature. Then, we extracted the service providers' and the elderly's views regarding the obstacles and solutions for the elderly participation in PHC in Iran using the interviews and focus group discussions (FGD). We conducted three FGDs (8-10 people) and seven individual interviews. Data were analyzed using the content analysis method. We developed the proposed framework for the participation of the elderly in PHC using a panel of experts and checked and confirmed the framework's validity using the Delphi technique with 11 experts from the content validity index and modified kappa coefficient. RESULTS: Based on the result of included studies in the systematic review, the characteristics of the participation models were classified into five areas: the characteristics of the service user, the main facilitator of the intervention, the type of ownership of the center, the subject and the method of participation. The solutions and obstacles, and problems presented by the service providers and users in different areas include 12 themes (elderly participation, home care, and self-care, respect for the elderly, cooperation of different organizations, service package for the elderly, referral system, planning for the elderly, considering insurance for the elderly, the role of informing the elderly, mental health of the elderly, physical space of centers and training of elderly caregivers) and 46 sub-themes. The final framework also includes five themes (approaches and strategies to attract participation, indicators, and consequences of participation of the elderly, implementation strategies of elderly care, implementation infrastructure and goals and areas of participation of the elderly) and sub-themes. CONCLUSION: The results of the study indicate that the final framework obtained should be used based on a systematic model for elderly participation in PHC and should be implemented and followed up based on local strategies and specific indicators, considering all capacities.

The relationship between patient safety culture and adverse events in Iranian hospitals: a survey among 360 nurses.

BACKGROUND: Adverse events have become a global problem and are an important indicator of patient safety. Patient safety culture is essential in efforts to reduce adverse events in the hospital. This study aimed to investigate the status of the patient safety culture, the frequency of adverse events, and the relationship between them in Qazvin's hospitals in Iran. METHODS: The present study is a descriptive-analytical study conducted in six hospitals in Qazvin, Iran, in 2020. The study population was nurses working in Qazvin hospitals. We collected data via a patient safety culture questionnaire and an adverse event checklist. Three hundred sixty nurses completed questionnaires. Multiple logistic regression was used to investigate the relationship between variables. RESULTS: The highest mean of patient safety culture was related to the organizational learning dimension (3.5, SD = .074) and feedback and communication about errors (3.4, SD = 0.82). The participants gave the lowest score to dimensions of exchanges and transfer of information (2.45,=0.86) and management support for patient safety (2.62,Sd = 0.65). Management's support for patient safety, general understanding of patient safety culture, teamwork within organizational units, communication and feedback on errors, staff issues, and information exchange and transfer were significant predictors of adverse events. CONCLUSION: This study confirms patient safety culture as a predictor of adverse events. Healthcare managers should provide the basis for improving the patient safety culture and reducing adverse events through methods such as encouraging the reporting of adverse events and also holding training courses for nurses.

The relationship between succession and intellectual capital with entrepreneurship in hospitals.

BACKGROUND: The hospital environment is very dynamic and faces many internal and external changes. Healthcare knowledge and technology are developing at a swift pace. This study investigated the relationship between succession and intellectual capital with entrepreneurship at the Qazvin University of Medical Sciences hospital, Iran. METHODS: The number of employees working in six hospitals was 2256, and according to Morgan's table, the required number of samples was 331. We distributed three hundred sixty-five questionnaires considering 10% of sample loss. We used a multi-stage stratified sampling method. In the first stage, each hospital was considered a stratum. After that, occupational groups were considered the next stratum within each hospital, and based on the ratio, the required number of samples for each occupational group was randomly selected. We used the Sobel test to investigate the mediating role of intellectual capital and the structural equation model to fit the research model. RESULTS: Succession aspects, including culturalization, meritocracy, job promotion path, and the role of senior managers, have a positive and significant effect on intellectual capital. Succession is only effective on intellectual capital and does not affect the personnel's entrepreneurship directly or through intellectual capital. CONCLUSION: Conducting training classes and intervention programs and using localized succession models can create a suitable platform for increasing organizational creativity and entrepreneurship, motivating the hospitals' personnel, and increasing intellectual capital.

Evaluation of errors related to surgical pathology specimens of different hospital departments with a patient safety approach: a case study in Iran.

BACKGROUND: Most surgical specimen errors occur in the pre-analysis stage, which can be prevented. This study aims to identify errors related to surgical pathology specimens in one of the most comprehensive healthcare centers in Northeast Iran. METHODS: The present study is descriptive and analytical research conducted cross-sectionally in 2021 at Ghaem healthcare center in the Mashhad University of Medical Sciences on the basis of a census sampling. We used a standard checklist to collect information. Professors and pathologists evaluated the validity and reliability of the checklist using Cronbach's alpha calculation method of 0.89. We analyzed the results using statistical indices, SPSS 21 software, and the chi-square test. RESULTS: Out of 5617 pathology specimens studied, we detected 646 errors. The highest number of errors is the mismatch of the specimen with the label (219 cases; 3.9%) and the non-compliance of the patient's profile in the specimen sent with the label (129 cases; 2.3%), and the lowest errors are the inappropriate volume of the fixator(24 cases; 0.4%), and they accounted for insufficient sample size (25 cases; 0.4%). Based on Fisher's exact test results, there was a significant difference between the proportion of errors in different departments and months. CONCLUSION: Considering the frequency of labeling errors in the stage before the analysis in the pathology department, the use of barcode imprinted in specimen containers, the removal of the paper request for pathology, the use of radio frequency chip technology, the use of the rechecking system and improving communication in different departments can be effective in reducing these errors.

Prevalence and the affecting factors on depression, anxiety and stress (DASS) among elders in Qazvin City, in the Northwest of Iran.

BACKGROUND: Depression, anxiety, and stress are among the most common mental health disorders of the elderly that affect the health of individuals and society. Considering the growing trend of the elderly population in Iran, this study aimed to determine the prevalence of these disorders and to identify the factors affecting them in the elderly. METHODS: We conducted this cross-sectional study using cluster random sampling on 301 elderly people referred to Qazvin health centers. Data was collected using the Depression, Anxiety, Stress Scale 21 (DASS-21) questionnaire and analyzed through univariate and multivariate linear regression tests with the interaction between variables in STATA Version 14 software. A P-value of less than 0.05 was significant. RESULTS: The prevalence of depression was 45.5%, anxiety 35.5%, and stress 40.2%. Our findings showed that 22.9%, 7.9%, and 14.3% of people had severe and very severe levels of depression, anxiety, and stress. The variables of age, comorbidity, living status and job status had a significant relationship with the DASS score (p < 0.05). There was an interaction between the variables of comorbidity and income status influencing the DASS score (ß = 0.68, 95% CI 0.15, 1.22). CONCLUSION: The prevalence of depression, anxiety and stress in the elderly was high, indicating the inappropriate status of their mental health. Therefore, it is necessary to take operational steps to reduce some problems in the elderly, prioritize the elderly suffering from concurrent diseases, the unemployed elderly, those who do not have a certain income, and the elderly who live alone.

Healthcare workers exposure risk assessment in the context of the COVID-19: a survey among frontline workers in Qazvin, Iran.

BACKGROUND: Healthcare workers perform various clinical procedures for COVID-19 patients facing an elevated risk of exposure to SARS-COV-2.This study aimed to assess the healthcare workers' exposure to COVID-19 in Qazvin, Iran in 2020. METHODS: We conducted this descriptive-analytical study among all healthcare workers on the frontline of exposure to COVID-19 in Qazvin province. We entered the participants into the study using a multi-stage stratified random sampling method. We utilized a questionnaire, "Health workers exposure risk assessment and management in the context of COVID-19 disease", designed by the World Health Organization (WHO) to collect data. We analyzed data using descriptive and analytical methods with SPSS software version 24. RESULTS: The results showed that all participants in the study had occupational exposure to the COVID-19 virus. So of 243 healthcare workers, 186 (76.5%) were at low risk and 57 (23.5%) at high risk of COVID-19 virus infection. Also, from the six domains mentioned in the questionnaire, health workers exposure risk assessment and management in the context of COVID-19 disease, the mean score of the domain of the type of healthcare worker interaction with a confirmed COVID-19 patient, the domain of health worker activities performed on a confirmed COVID-19 patient, the domain of the adherence to infection prevention and control (IPC) during health care interactions, and the domain of the adherence to IPC when performing aerosol-generating procedures in the high-risk group were more than the low-risk group. CONCLUSION: Despite strict WHO guidelines, many healthcare workers are exposed at contracting COVID-19. Therefore, healthcare managers, planners, and policymakers can revise the policies, provide appropriate and timely personal protective equipment, and plan for ongoing training for staff on the principles of infection prevention and control.

Policy analysis of nutrition stewardship for prevention and control of Non-communicable diseases in Iran.

BACKGROUND: Non- communicable diseases (NCDs) are the main cause of death, which lead to over 73% of death and 62% of DALYs globally. As an unhealthy diet is the leading behavioral risk factor of NCDs, in line with the national action plan for the prevention and control of NCD, this study explored the nutrition-related stewardship problems to reduce the burden of NCDs in Iran. METHODS: This is a qualitative study. We interviewed 30 purposefully identified key informants, i.e., stakeholders, policymakers, and academics, from December 2018 to August 2019. All interviews were recorded and transcribed verbatim. We analyzed data using qualitative content analysis facilitated by MAXQDA 11 software. RESULTS: Ample policies and laws were identified, most of which were not or partially implemented. Despite some plausible efforts, NCDs do not seem to be a top priority for high-level managers and decision-makers. Besides, the role of non-state actors, i.e., the private sector, is marginal in NCD's planning and management. Whereas the government, e.g., the Food and Drug Organization (FDO), is the biggest player. Worse still, many harmful products are advertised and easily distributed across the country. CONCLUSION: Iran's government has created a noticeable roadmap to battle NCDs despite imposing many sanctions and related socioeconomic problems. Nevertheless, more interventions are needed to strengthen the stewardship of NCDs by various stakeholders. We recommend the government to monitor the implementation of policies and advertisement of harmful products to prioritize prevention and control of NCDs. In addition, we advocate employing the capacity of non-state actors to reduce the consumption of unhealthy food and the burden of NCDs across the country, ultimately.

The health system barriers to a healthy diet in Iran.

BACKGROUND: Decreasing calories, salt, sugar and fat intake is considered the golden solution to reduce obesity and cardiovascular diseases (CVDs) related to unhealthy diet. This study aimed to investigate the health system induced barriers to a healthy diet in Iran. METHODS: This is a qualitative health policy analysis. We collected data through 30 semi-structured, face-to-face interviews with purposefully identified experts, including policy-makers, top-level managers and related stakeholders. All interviews were transcribed verbatim, and analyzed with qualitative content analysis, facilitated by MAXQDA 11 software. RESULTS: We identified six categories of barriers: structural problems within the Ministry of Health and Medical Education (MoHME), i.e. Supreme Council of Health and Food Security (SCHFS); the MoHME's inadequate stewardship of public health, the short life of the deputy of social affairs within the MoHME and its possible impact on the National Health Assembly; inefficient traffic lights labelling for foods; lack of adequate policies and guidelines for monitoring restaurants and fast foods and insufficient incentive policies for the food industry. CONCLUSION: In line with the World Health Organization (WHO) Global Action Plan, in 2015, Iran defined its roadmap for prevention and control of NCDs, i.e. some nutritional interventions. However, different stakeholders including MoHME and other sectors need to provide series of interventions to change people's approach about food choice so that they might reduce the consumption of foods with excessive salt, fat and sugar.

Economic barriers and gaps to reach the desirable consumption of salt, sugar, and fat in Iran: a qualitative study.

BACKGROUND: Non-communicable diseases (NCDs), also known as chronic diseases, specifically cardiovascular diseases (CVD), cancers, respiratory diseases, and diabetes are the main reason for more than two-thirds of global deaths, in which the unhealthy diet is one of the primary risk factors. The golden solution to reducing obesity and CVD linked to an unhealthy diet is to reduce calories, salt, sugar, and fat intake. Besides, activities highlighting lifestyles that contain healthy diets usually focus on reducing salt, sugar, and saturated fat consumption. As a result, the researchers aimed to study the gaps and economic barriers to recommended consumption of salt, sugar, and fat in Iran, based on WHO recommendations. METHODS: This is a qualitative study. We conducted semi-structured and in-depth interviews with 30 stakeholders, including academics, experts, and key informants in different sectors from December 2018 until August 2019 in Tehran, Iran. We used a purposeful and snowball sampling method to select participants. All interviews were transcribed verbatim and thematically analyzed using MAXQDA 11. RESULTS: Economic problems and inflation in Iran caused people to eat more unhealthy foods, while a healthy diet consumption was reduced due to higher prices. Unfair political sanctions imposed on the country caused economic pressure and adversely affected family nutrition. Worse still, despite legal bans, advertising unhealthy foods via media, mainly to generate revenue, encouraged more consumption of unhealthy food. The lack of targeted subsidies and failure in tax legislation and implementation related to the unhealthy products deteriorated the conditions. CONCLUSION: Some economic barriers have hampered plans to reduce salt, fat, and sugar consumption in Iran. Fundamental reforms in the tax and subsidy system are required to improve people's eating habits. In particular, citizens' income that has been continuously shrinking due to economic conditions, imposed sanctions, and the inevitably high inflation needs to be addressed urgently. Unless the government of Iran deals with the economic barriers to healthy nutrition, the pathway for implementing the national action plan for prevention and control of NCDs toward a 30% mortality reduction due to NCDs by 2030 looks unlikely to reach.

Global prevalence of nosocomial infection: A systematic review and meta-analysis.

OBJECTIVES: Hospital-acquired infections (HAIs) are significant problems as public health issues which need attention. Such infections are significant problems for society and healthcare organizations. This study aimed to carry out a systematic review and a meta-analysis to analyze the prevalence of HAIs globally. METHODS: We conducted a comprehensive search of electronic databases including EMBASE, Scopus, PubMed and Web of Science between 2000 and June 2021. We found 7031 articles. After removing the duplicates, 5430 studies were screened based on the titles/ abstracts. Then, we systematically evaluated the full texts of the 1909 remaining studies and selected 400 records with 29,159,630 participants for meta-analysis. Random-effects model was used for the analysis, and heterogeneity analysis and publication bias test were conducted. RESULTS: The rate of universal HAIs was 0.14 percent. The rate of HAIs is increasing by 0.06 percent annually. The highest rate of HAIs was in the AFR, while the lowest prevalence were in AMR and WPR. Besides, AFR prevalence in central Africa is higher than in other parts of the world by 0.27 (95% CI, 0.22-0.34). Besides, E. coli infected patients more than other micro-organisms such as Coagulase-negative staphylococci, Staphylococcus spp. and Pseudomonas aeruginosa. In hospital wards, Transplant, and Neonatal wards and ICU had the highest rates. The prevalence of HAIs was higher in men than in women. CONCLUSION: We identified several essential details about the rate of HAIs in various parts of the world. The HAIs rate and the most common micro-organism were different in various contexts. However, several essential gaps were also identified. The study findings can help hospital managers and health policy makers identify the reason for HAIs and apply effective control programs to implement different plans to reduce the HAIs rate and the financial costs of such infections and save resources.