The Effect of Iran Health Transformation Plan on Equity in Health Financing: A Systematic Review.

Background: Achieving financial goals is one of the health systems goals, especially for those in low- and middle-income countries. Since financing equity, is an objective of Health Transformation Plan (HTP) implementation in Iran, this study examined this plan toward improving equity in healthcare Financing, using four payment indices: Out-of-Pocket Payment (OOP), Catastrophic Health Expenditure (CHE), Fair financial Contribution Index (FFCI) and Impoverishing Health Expenditure (IHE). Methods: Articles published in English on equity in financing related to HTP were searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between Jan 2014 and Dec 2020, following PRISMA guidelines. Overall, 1319 papers were retrieved initially, and 31 were selected for analysis. Results: After implementation of HTP, OOP index has decreased between patients and households. No consistent trend was evident for CHE. HTP reforms have a limited effect on the FFCI. The one study on IHE has shown an upward trend for this index. In general, in the early years of HTP, there was a higher downward trend in equity in financing indicators than in subsequent years. Conclusion: HTP has made significant accomplishments in equity, such as the financial protection of patients in healthcare centers, but fail to achieve this plan goals, significantly reduced its value. Therefore, it is necessary for managers and health policy makers around the world, with scientific and principled solutions, to prevent loss of their reform plans positive achievements.

COVID-19 Reinfection Rate and Related Risk Factors in Fars Province, Iran: A Retrospective Cohort Study.

Background: Reinfection with Coronavirus Diseases 2019 (COVID-19) has raised remarkable public health concerns globally. Therefore, the present retrospective cohort study intended to investigate COVID-19 reinfection in registered patients of Fars province in Iran from February 2020 to April 2021. Methods: The patients' data, including the COVID-19 infection, symptoms, comorbidities, and demographics, were collected using the Health Information Systems (HISs). The patients were divided into three groups in terms of the duration between the initial infection and reinfection, including 28-44, 45-89, and more than 90 days. Following the univariate analysis, logistic regression was used to investigate the factors effective on COVID-19 reinfection. Results: A total of 213768 patients had a positive Polymerase Chain Reaction (PCR) test. The reinfection rate was 0.97% (2079 patients). Of these re-infected individuals, 14.9%, 18.5%, and 66.6% had their second positive test 28-45, 45-89, and ≥90 days later, respectively. The mean duration between the initial infection and reinfection was 130.56 days (29-370 days). The chance of reinfection was significantly higher in the youths (Odds Ratio (OR)=2.055; P<0.001), men (OR=1.283; P<0.001), urban population (OR=1.313; P<0.001), and healthcare providers (OR=4.453; P<0.001). The patients with chronic pulmonary diseases, chronic kidney diseases, and malignancy were 1.421 (P=0.036), 2.239 (P<0.001), and 3.437 (P<0.001) times, respectively, more likely prone to reinfection. Conclusion: The results of this study showed that there is a higher risk of reinfection in several vulnerable groups including healthcare providers, young individuals, residents of urban areas, men, and individuals with underlying diseases.

What is the role of institutional quality in health outcomes? A panel data analysis on 158 countries from 2001-2020.

Our study investigated the impact of institutional quality on health system outcomes, utilizing worldwide governance indicators and analyzing data from 158 countries between 2001 and 2020. We employed Principal Component Analysis (PCA) to create a composite index of institutional quality and conducted various tests to select the appropriate econometric model. The role of institutional quality, along with other variables, in health outcomes was estimated using fixed effects and generalized method of moments (GMM) models. High-income and low-income countries were analyzed separately. The results of our study revealed that institutional quality, as measured by Control of Corruption, Voice and Accountability, Political Stability, Rule of Law, Regulatory Quality, and Government Effectiveness, had a negative impact on infant mortality rates and a positive impact on life expectancy. Similarly, variables such as GDP, mean years of schooling, total health expenditure, and urbanization rate showed a negative association with infant mortality rates and a positive association with life expectancy. Conversely, the logarithm of CO2 emissions exhibited a positive effect on infant mortality rates and a negative effect on life expectancy. These findings highlight the crucial role of institutional quality in determining health outcomes. Improving institutional quality contributes to the development of democratic and meritocratic systems, infrastructure enhancement, efficient tax and subsidy systems, optimal budget allocation, improved public education, and enhanced access to primary healthcare services. The influence of institutional quality is particularly significant in high-income countries compared to low-income countries. In conclusion, our study emphasizes the importance of institutional quality in shaping health system outcomes. Enhancing institutional quality is essential for the overall advancement of healthcare systems, encompassing governance, infrastructure, education, and access to healthcare services. It is crucial to prioritize efforts to improve institutional quality, especially in high-income countries, to achieve better health outcomes for populations worldwide.

Factors affecting oral and dental services` utilization among Elderly: a scoping review.

BACKGROUND: Regular use of oral and dental services by the elderly is one of the important factors in reducing oral and dental diseases. This study aimed to identify the factors affecting oral and dental services` utilization among elderly. METHODS: The published articles on the factors affecting oral and dental services` utilization among elderly were found through a scoping search and using related keywords in PubMed, Scopus, Embase, and Web of Science databases within January 2000 - December 2022 according to the PRISMA guidelines. The data were analyzed using the thematic analysis method. RESULTS: Among the 2381 articles retrieved from the databases, forty-two were extracted. The factors affecting oral and dental services` utilization among elderly were classified into five main components as follows: access, demographic factors, social factors, health level, and mental factors. The results showed that income, education level, living area, number of teeth, and importance of care were the most frequent in the main components of access, demographic factors, social factors, health level, and mental factors, respectively. CONCLUSION: Equitable utilization of oral and dental services is the right of all members of the society, especially the elderly. Therefore, it is necessary to provide the elderly with suitable conditions to utilize such services, which are mostly luxury items. Furthermore, increasing the elderly's awareness and encouraging them to use oral and dental services regularly can help reduce the burden of oral and dental diseases.

Strategies for maintaining and strengthening the health care workers during epidemics: a scoping review.

INTRODUCTION: During epidemics such as COVID-19, healthcare workers (HCWs) face several challenges, leading to a shortage and weakening of human resources. To address this issue, employing effective strategies is essential in maintaining and strengthening human resources during outbreaks. This study aimed to gather and classify strategies that could retain and strengthen human health resources during epidemics. METHODS: In this scoping review, all studies published about strategies for maintaining and strengthening HCWs in epidemics were collected from 4 international databases, including PubMed, Embase, Scopus, and Web of Science. The English language articles published after 2000 up until June 2022 recommended specific strategies regarding the research question. Then, they were analyzed and classified according to thematic analysis based on Braun and Clarke 6 phases protocols. RESULTS: In total, 9405 records were screened, of which 59 articles were included, and their full texts were reviewed. Fifty factors were identified and classified into five themes: Instruction, Protection, Supporting, Caring, and Communication. Most of the suggestions were conducted in high-income countries and related to the Supporting theme. DISCUSSION: The majority of strategies discussed in the literature addressed only one or two aspects of human resources. This study provides a holistic perspective on these issues by providing a thematic map of different strategies for strengthening and maintaining HCWs during epidemics. Considering the multidimensionality of human nature, it is suggested that policymakers and managers of health systems provide facilities that simultaneously address a wide range of needs.

Factors affecting the acceptance of tele-psychiatry: a scoping study.

BACKGROUND: In today's digital world, providing services through telemedicine has become an essential issue in health systems, and the Covid-19 pandemic has made this necessity even more apparent. On the other hand, mental health services are needed more than ever, and their nature makes their delivery via telemedicine more feasible than other specialized services. This study aimed to determine the factors affecting the acceptance of telemedicine among users of this technology in the field of mental health. METHODS: This article is a scoping review based on the PRISMA guidelines and without any time limit until June 20, 2022. The search was performed in PubMed, Scopus, Web of Science, and PsycINFO databases using keywords related to the three fields of telemedicine, acceptance, and mental disorders. Two authors independently selected the studies based on inclusion and exclusion criteria. Then the data were collected using a data extraction form, and finally, the results were determined using the content analysis method. RESULTS: Five main factors affect the acceptance of telemedicine among users of this technology in the field of mental health: perceived effectiveness, users' understanding of the effects of telemedicine on the quality and outcomes of care delivery, technological aspects, organizational change capacity, the nature of the disease and psychological and psychosocial factors. These main factors are associated with 21 related sub-factors. CONCLUSIONS: Revealing the factors affecting the acceptance of telemedicine among recipients and providers of services, as key actors in health systems, can help managers and policymakers to successfully implement telemedicine in the less-regarded field of mental health, especially in the early stages.

Factors facilitating and inhibiting the social participation of the elderly in health-oriented activities in Shiraz, Southern Iran.

BACKGROUND: The social participation (SP) of the elderly is one of the factors that contribute to the improvement of their well-being. SP, one of the most important factors of active ageing, is mainly influenced by a number of facilitating or inhibiting factors. AIMS: This study aimed to identify the factors that prevent and facilitate the SP of the elderly population in Iran. METHODS: A cross-sectional study carried out in Shiraz, southern Iran in 2021. Participants were selected using a convenience sampling method. Shiraz is divided into 11 districts and the largest park in each district is selected for data gathering. The questionnaires were completed by 612 people aged over 60. Data were collected using the Canadian Elderly Survey Project scale and a health-related lifestyle questionnaire and were analyzed using t-test, ANOVA, Pearson's correlation, and ANCOVA. RESULTS: The mean SP score of the elderly in Shiraz was 24.2 out of 60, which is below the midpoint. The results of the covariance analysis revealed that the SP had a significant relationship with the experience of physician consultation, cost barriers, age, marital status, income level, and education level (P < 0.001). Moreover, the results of Pearson correlation revealed a significant correlation between SP and different dimensions of health-oriented activities (< 0.001). CONCLUSIONS: This study revealed that the main barriers to older people's participation in health-related activities are cost and access barriers, such as transportation issues. Moreover, higher income level and higher educational attainment have been recognized as the main facilitators of SP in the elderly. In this regard, it can be suggested to apply a combination of health promotion strategies, financial support programs, and development of optimal transportation infrastructure to increase the SP of the elderly.

The necessity revealed by COVID-19 pandemic: Paradigm shift of Iran's healthcare system.

Background: COVID-19 pandemic has resulted in drastic changes around the world, revealing vulnerable aspects of healthcare systems. This study aimed to explore how Iranian healthcare system experienced the paradigm shift during the pandemic and determine the aspects that need improvement during the pandemic era. Method: This qualitative study was conducted in 2021. A framework analysis approach was used to analyze the content of the 19 semi-structured interviews with the healthcare system experts from Shiraz University of Medical Sciences (SUMS). The interviews' audio files changed into transcript after each session and data was saturated at the 19 interview. To increase the trustworthiness of the study, Guba and Lincoln's criteria including credibility, transferability, dependability, and confirmability were used. Goldsmith's five-step framework analysis was used applying MAX QDA version 10 software. Result: Eight main themes and 20 subthemes were explored. The main themes included "strengthening the electronic health infrastructure," "research for evidence-based decision making," "dedicated financing to the pandemic," "prevention of disruption in the effective provision of services and medicines," "enriching the authority of the Ministry of Health by focusing on interactions," "recruiting, managing and empowering health human resources with attention to financial and non-financial incentives," "reforming educational approaches in training students in medical universities," as well as "lessons learned from neglected aspects." Conclusion: To be ready to respond to a possible future pandemic and for a paradigm shift, bold steps must be taken to make fundamental changes in various aspects of the healthcare system including e-health development, evidence-based decision making, dedicated budgets for pandemics, reinforcement of interactions at the national and international level, as well as sufficient attention to healthcare workers from all financial, non-financial and educational aspects.

Development of a model for predicting hospital beds shortage and optimal policies using system dynamics approach.

BACKGROUND: Policymakers use simulation-based models to improve system feedback and model the reality of the problems in the system. This study uses the system dynamics approach to provide a model for predicting hospital bed shortages and determine the optimal policy in Shiraz, Southern Iran. METHODS: This study was designed based on Sterman's system dynamic modeling (SDM) process. Firstly, we determined the main variables affecting bed distribution using a mixed qualitative and quantitative study which includes scoping review, expert panel, Delphi, and DANP. Then, dynamic hypotheses were designed. Subsequently, we held several expert panels for designing the causal and stock-flow models, formulating and testing a simulation model, as well as developing various scenarios and policies. RESULTS: Dynamic modeling process resulted in four scenarios. All of the scenarios predicted a shortage of national hospital beds over a 20-year time horizon. Then, four policies were developed based on the changes in the number of beds and capacity of home care services; finally, the optimal policy was determined. CONCLUSIONS: Due to the high cost of setting up hospital beds, developing and supporting cost-effective home care services, strengthening the insurance coverage of these services, and improving the quantity and quality of community care, considering the real needs of the community could be considered as an optimal option for the future of the city.

The Relationship between Experiences Level and Clinical Decision-Making Skill in Midwifery Students: A Cross-Sectional Study.

Background: Development and assessment of clinical decision-making skills are essential in midwifery education because of their role in mothers' and infants' safety. Therefore, the present study's primary objective was to evaluate the relationship between experience levels and clinical decision-making skills using the key features (KFs) examination. Methods: One hundred and two midwifery students in five different education levels participated in this cross-sectional study through convenient sampling. Twenty KFs questions were designed based on the principles of the KFs examination. The participants' information, including grade point average (GPA), theoretical and practical scores of the obstetrics course, were collected. KFs scores were compared according to students' training semester by one-way analysis of variance (ANOVA). Pearson correlation was conducted to explore the correlation between KFs scores and GPA as well as theoretical and practical scores. All statistical analyses were performed at a significance level of 0.05 (p≤0.05). We used five kinds of effect size calculators, which include mean difference (MD), standardized mean difference (cohend), partial Eta-squared, Cohenf, and partial omega-squared. Results: There was no correlation between KFs scores and the grade point average, theoretical exam scores, and practical exam scores. KFs scores linearly rose as the learners' level increased with a mean± SD score of 7.61±1.09 during the third semester compared to 11.55 ± 1.89 during the eighth semester (p=0.001). The effect size of this result was large (partial omega square=0.35, partial eta square=0.38 & cohen's f=0.73). The largest SMD was related to the comparison of KFs scores between the eighth and third semester (MD=3.58, SMD=2.554 [CI 95%: 1.719-3.389], p-value═ 0.001), and the lowest was related to the comparison between the third and fourth semesters (MD=0.354, SMD= 0.2 [CI 95%: -0.421-0.821], p=0.987). Conclusion: Establishing proficiency in clinical decision-making skills is a linear process greatly enhanced by experience, clearly shown by the present study results. Using KFs examination and obtaining extensive evidence to its benefit can allow us to renegotiate proficiency evaluation methods for students in clinical fields. the education curriculum should focus more on identifying clinical KFs skills than merely teaching knowledge about disease processes.

Influencing factors on the tendency of general practitioners to join in urban family physician program: a cross-sectional survey on Iranian physicians.

BACKGROUND: Urban family physician program (UFPP) is initiated as pilot by policy makers as a main reform in future of primary health care in Iran. Despite an ongoing pilot implementation of this program from 2012, it remains a main question about providing sufficient number of general practitioners (GPs). This study aimed to investigate the factors which affect GPs' decision to join in the UFPP. METHODS: In this national cross-sectional study a sample of 666 GPs, using convenience sampling, filled a self-report questionnaire. The multivariate logistic regression was applied to explore the demographic, practice and views determinants of the tendency of GPs to join in the UFPP. RESULTS: More than half of GPs (58.6%) participated in the study had a positive tendency to join in the UFPP. Older GPs (adjusted OR = 3.72; 95%CI 1.05-13.09), working in public sector (adjusted OR = 2.26; 95%CI 1.43-3.58), lower income level (adjusted OR = 6.69; 95%CI 2.95-15.16), higher economic expectations (adjusted OR = 2.08; 95%CI 1.19-3.63), and higher satisfaction from medicine profession (adjusted OR = 2.00; 95%CI 1.14-3.51) were the main factors which increased the GPs tendency to enter in UFPP. CONCLUSIONS: Decision for joining in the program is mainly affected by GPs' economic status. This clarifies that if the program can make them closer to their target income, they would be more likely to decide for joining in the program.

The length of stay and cost of burn patients and the affecting factors.

BACKGROUND: Burn trauma is a significant health problem that has physical, psychological, and economic reaction on affected patients. Burn patients have different length-of-stay (LOS) due to the complexity of the injury itself. This study aimed to find factors affecting the LOS and cost of burn patients (2017-2018) in Guilan province, north of Iran. MATERIALS AND METHODS: This cross-sectional study includes all 899 hospitalized burn patients who were admitted for the first time (first visit). Data about cost, LOS, and demographic variables were extracted from the hospital registry system. Data were analyzed using t-test, ANOVA, and Linear regression by SPSS 22 software. RESULTS: Nearly 62% of the burn patients were male, and 38% were female. Hot liquid or vapor were the leading causes for burns hospitalization (n = 345; 39.07%). The majority of patients (n = 465; 52.31%) were at level three of burn (total thickness). The upper limb that included head, neck, shoulder, back, hand (45.44%), lower limb (38.25%), multiple or total body (11.36%) were the most organs that were affected by burning. Direct medical costs for patients varied from 0 to 18,550 US$, which was 1489 US$ on average. Patients' length of stay ranged from 1 to 47 days, which was 3.22 days on average. CONCLUSION: The result showed Adverse consequences burned hot liquid and hot steam burns most common reason that it is important to take preventative methods for this type of patient. Improved patients with the third level cost more and stay longer. Other factors such as underlying disease, urbanity, used antibiotics, sex, and insurance coverage can also be decisive. The burnt percentage also has a direct and significant relationship with medical costs and length of stay. Insurance organization has a direct and significant relationship with the length of stay. Also there was a direct relationship between multiple burns and the patients' length of stay and hospitalization costs.

Global socioeconomic inequality in the burden of communicable and non-communicable diseases and injuries: an analysis on global burden of disease study 2019.

BACKGROUND: Examining the distribution of the burden of different communicable and non-communicable diseases and injuries worldwide can present proper evidence to global policymakers to deal with health inequality. The present study aimed to determine socioeconomic inequality in the burden of 25 groups of diseases between countries around the world in 2019. METHODS: In the current study data according to 204 countries in the world was gathered from the Human Development Report and the Global Burden of Diseases study. Variables referring to incidence, prevalence, years of life lost (YLL), years lived with disability (YLD) and disability adjusted life years (DALY) resulting by 25 groups of diseases and injuries also human development index was applied for the analysis. For measurement of socioeconomic inequality, concentration index (CI) and curve was applied. CI is considered as one of the popular measures for inequality measurement. It ranges from - 1 to + 1. A positive value implies that a variable is concentrated among the higher socioeconomic status population and vice versa. RESULTS: The findings showed that CI of the incidence, prevalence, YLL, YLD and DALY for all causes were - 0.0255, - 0.0035, - 0.1773, 0.0718 and - 0.0973, respectively. CI for total Communicable, Maternal, Neonatal, and Nutritional Diseases (CMNNDs) incidence, prevalence, YLL, YLD and DALY were estimated as - 0.0495, - 0.1355, - 0.5585, - 0.2801 and - 0.5203, respectively. Moreover, estimates indicated that CIs of incidence, prevalence, YLL, YLD and DALY for Non-Communicable Diseases (NCDs) were 0.1488, 0.1218, 0.1552, 0.1847 and 0.1669, respectively. Regarding injuries, the CIs of incidence, prevalence, YLL, YLD and DALY were determined as 0.0212, 0.1364, - 0.1605, 0.1146 and 0.3316, respectively. In the CMNNDs group, highest and lowest CI of DALY were related to the respiratory infections and tuberculosis (- 0.4291) and neglected tropical diseases and malaria (- 0.6872). Regarding NCDs, the highest and lowest CI for DALY is determined for neoplasms (0.3192) and other NCDs (- 0.0784). Moreover, the maximum and minimum of CI of DALY for injuries group were related to the transport injuries (0.0421) and unintentional injuries (- 0.0297). CONCLUSIONS: The distribution of all-causes and CMNNDs burden were more concentrated in low-HDI countries and there are pro-poor inequality. However, there is a pro-rich inequality for NCDs' burden i.e. it was concentrated in high-HDI countries. On the other hand, the concentration of DALY, YLD, prevalence, and incidence in injuries was observed in the countries with higher HDI, while YLL was concentrated in low-HDI countries.

What makes inequality in the area of dental and oral health in developing countries? A scoping review.

BACKGROUND: Equity in health is an important consideration for policy makers particularly in low and middle income developing country. The area of oral and dental health is not an exception. This study is conducted to explore the main determinants that make inequality in oral and dental health area in developing countries. METHODS: This was a scoping review applying the framework enhanced by Levac et al. Four databases of Scopus, PubMed, WOS and ProQuest were systematically searched applying to related keywords up to 27.11.2020. There restriction was placed in the English language but not on the study design. All the related studies conducted in the low or middle income developing countries were included. A qualitative thematic analysis was applied for data analysis and a thematic map was presented. RESULTS: Among 436 articles after excluding duplications, 73 articles were included that the number of publications from Brazil was greater than other developing countries (33.33%). Thematic analysis of the evidence has led to 11 determinants that may result in inequality in oral and dental health services in developing countries including personal characteristics, health status, health needs and health behaviours, social, economic, cultural and environmental factors, as well as insurance, policies and practices and provided related factors. CONCLUSION: The policymakers in the low and middle income developing countries should be both aware of the role of inequality determinants and also try to shift the resources to the policies and practises that can improve the condition of population access to oral and dental services the same as comprehensive insurance packages, national surveillance system and fair distribution of dentistry facilities. It is also important to improve the population's health literacy and health behaviour through social media and other suitable mechanisms according to the countries' local contexts.

Strategies for reducing out of pocket payments in the health system: a scoping review.

BACKGROUND: Direct out-of-pocket payments (OOP) are among the most important financing mechanisms in many health systems, especially in developing countries, adversely affecting equality and leading vulnerable groups to poverty. Therefore, this scoping review study was conducted to identify the strategies involving OOP reduction in health systems. METHODS: Articles published in English on strategies related to out-of-pocket payments were Searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between January 2000 and November 2020, following PRISMA guidelines. As a result, 3710 papers were retrieved initially, and 40 were selected for full-text assessment. RESULTS: Out of 40 papers included, 22 (55%) and 18 (45%) of the study were conducted in developing and developed countries, respectively. The strategies were divided into four categories based on health system functions: health system stewardship, creating resources, health financing mechanisms, and delivering health services.As well, developing and developed countries applied different types of strategies to reduce OOP. CONCLUSION: The present review identified some strategies that affect the OOP payments According to the health system functions framework. Considering the importance of stewardship, creating resources, the health financing mechanisms, and delivering health services in reducing OOP, this study could help policymakers make better decisions for reducing OOP expenditures.

Predictors of Self-medication in Iran: A Notional Survey Study.

While logical use of medicine is a priority in all health systems, people do self-medication- mainly using Nonprescription Drugs or Over the Counter (OTC) drugs- for different reasons. Self-medication is rising in many developing countries that could increase healthcare expenditure. The present study aimed to find the self-medication rate and predisposing, enabling, and need factors affecting it based on the Anderson behavioral model in the Iranian population. The present study uses 22470 households' data acquired from Iranian utilization of healthcare survey at the national level (2016). Due to the study objective, the data of 13005 people who were over 15 years old and had outpatient healthcare needs two weeks before the survey. The survey included a binary question about self-medication, which is considered a dependent variable. Age, gender, marital status, literacy, job status, socio-economic status, location, basic health insurance, complementary health insurance, and need for health services were considered as independent variables. Data were analyzed using logistic regression. The self-medication rate was calculated at 26.3% that was different among different subgroups of the population. According to the model estimates, married (OR = 0.80, CI = 0.71-0.91) and housekeepers (OR = 0.79, CI = 0.67-0.93) had significantly lower self-medication. Moreover, the urban population (OR = 1.29, CI = 1.17-1.43), people without basic (OR = 1.32, CI = 1.10-1.58), and supplementary (OR = 1.18, CI = 1.04-1.35) health insurance and also people who had two or higher number of outpatient healthcare needs had significantly more self-medication (OR = 2.96, CI = 2.67-3.29). It can be concluded that need, enabling, and predisposing factors are respectively the main determinants of self-medication behavior. From a policy point of view, increasing effective health insurance coverage with a focus on people who have more health care needs can be helpful.

Lockdown Effect on COVID-19 Incidence and Death: Iran Experience.

OBJECTIVE: Countries are trying several policy options for decreasing the incidence and burden of the coronavirus disease 2019 (COVID-19). One of these strategies is a lockdown, complete closure, to reduce the risk of distributing disease by means of social interactions. This study aimed to analyze the effect of a 3-week lockdown on the mortality and morbidity of COVID-19 in Iran. METHODS: Official daily data on COVID-19 incidence and death reported by the World Health Organization (WHO) were extracted from September 1, 2020, to January 14, 2021. Data were analyzed using interrupted time series analysis by means of STATA 14 software. RESULTS: Lockdown resulted in a significant reduction in the daily death from COVID-19 in the short-term (ß = -139; P < 0.01) and in the long-term (ß = -12; P < 0.01). Moreover, lockdown in the short-term insignificantly (ß = -21.58; P = 0.969), and in the long-term significantly (ß = -317.31; P < 0.01) reduced the COVID-19 daily incidence. CONCLUSIONS: The results showed that the lockdown has a significant effect on incidence and death numbers. Therefore, it could be a suitable short-term strategy for controlling the COVID-19 outbreak. On the other hand, its negative effects on households and businesses should be considered.

Modeling organizational intelligence, learning, forgetting and agility using structural equation model approaches in Shiraz University of Medical Sciences Hospitals.

OBJECTIVES: Strengthening the organizational agility of the hospital can lead to decreased production costs and increased market share, better serving to patients' needs, introduction of new services and increased competitiveness; therefore, this study aimed to investigate the agility of Shiraz public teaching hospitals. RESULTS: The results showed that organizational intelligence had a positive and significant effect on organizational agility with a path coefficient of 0.172. Organizational forgetting and organizational learning also played a mediating role between organizational intelligence and organizational agility. This means that organizational intelligence had positive effect on organizational forgetting with path coefficient of 0.482, organizational forgetting on organizational learning with path coefficient of 0.40 and subsequently organizational learning on organizational agility with path factor of 0.07. Organizational forgetting also played a mediating role between organizational intelligence and organizational learning.

How Much Money Should be Paid for a Patient to Isolate During the COVID-19 Outbreak? A Discrete Choice Experiment in Iran.

INTRODUCTION: Isolation of COVID-19 patients is a vital strategy for preventing the spread of the virus. Isolation without any incentive or compensation for the patients cannot be effective. We sought to find the monetary value of the willingness to accept (WTA) being isolated for COVID-19 in Iran. METHODS: In this discrete choice experiment, scenarios were designed by reviewing the literature and semi-structural interviews. Fourteen choice sets with two scenarios were included in an internet-based questionnaire that was sent to the Telegram Social Network. A total of 617 individuals completed the questionnaire. A random-effects logistic regression model was used for the main analysis. RESULTS: The average monetary value of a WTA 7 days of isolation was US$51.71 (95% confidence interval [CI] 43.09-60.33). The WTA for one day of isolation was US$1.48 (95% CI 1.11-1.85) for unemployed groups, US$1.49 (95% CI 1.18-1.79) for office employees and US$1.36 (95% CI 0.73-2.01) for manual workers. The WTA was 0.44 (95% CI 0.35-0.53) US$ for low-income groups, US$0.68 (95% CI 0.52-0.84) for middle-income groups and US$0.77 (95% CI 0.35-1.18) for high-income groups. CONCLUSIONS: Our findings suggested that financial preferences for being isolated vary widely across individuals within different socioeconomic groups. Policymakers should consider these differences when designing effective intervention to increase compliance with the isolation protocols during infectious disease outbreaks.