The Analysis of the Content of Tobacco Control Policymaking and Legislation in Iran and Providing Policy Solutions

Background. Tobacco use is the fifth risk factor for non-communicable diseases in Iran. This study aimed to analyze the policies and measures of tobacco control in Iran in the last four decades (1983-2021). Methods. The present study is a retrospective policy analysis that used a case study plan based on the Walt and Gilson triangle policy analysis framework to examine the content of tobacco control policies in Iran. Data were collected using tobacco use policies and legal documents and analyzed using documentary analysis. MAXQDA 11 software was used to categorize and analyze the findings. Results. The policies include setting prices and taxes on tobacco to reduce demand; protecting the public from second-hand smoke; controlling the composition of tobacco products; setting regulations on the disclosure of information about tobacco packaging and labeling; educating the public about the dangers of tobacco use; advertising, promotion, and financial support of tobacco; setting measures to encourage smoking cessation and reduce the demand and dependence on tobacco; banning illegal tobacco product trading; banning youngsters from tobacco trading; financially supporting the practical alternatives such as economic activities and research; setting monitoring and evaluation systems; and enhancing the exchange of information. Conclusion. Strengthening the government's tobacco control capacity and formulating a clear and coherent national tobacco control strategy and roadmap, including a mechanism for practical cross-sectoral cooperation between different actors, can reduce conflicts of interest between the actors involved and determine the country's current and future tobacco control policies

Clinical governance; How been understood, what is needed? Nurses' perspective

Introduction: Clinical Governance (CG) is an overarching concept, using organizational capacity, safeguards high standards of the health services and provides a safe care for patients.  The aim of this research was to study nurses’ perception about Clinical Governance. Materials and Methods: A qualitative study was done with Focus Group Discussions (FGD). Purposeful Sampling was used to select the objectives including 65 participants. Actually 7 FGD’s were held. Content analysis was used to extract the meaningful themes. Results:Nurses believed that patient centeredness and evidence based practice is the core of the CG concept. Also they mentioned that cultural change, staffs training, adequate financial and human resources are required to successfully implementation of CG in hospitals.  Conclusion: Spreading up a shared vision about CG and providing the required infrastructures in hospitals would be facilitate CG initiatives. Proper commitment of the managers and staff participation could lead an effective CG implementation

Direct and Indirect Costs Associated with Coronary Artery (Heart) Disease in Tabriz, Iran

PURPOSE: Cardiovascular diseases (CVDs) are the major causes of mortalities worldwide. This study was conducted to evaluate the direct and indirect costs of coronary artery disease (CAD) in Iran.PATIENTS AND METHODS: This is a prevalence-based cost-of-illness (COI) study that estimates the direct and indirect costs of CAD. The study conducted over a six-month period from April to September in 2017. Patients were recruited from Madani hospital in Tabriz, Iran. A total of 379 patients were investigated from societal perspective. Direct costs were estimated using the bottom-up costing approach and indirect costs were estimated using the Human Capital (HC) approach. A generalized linear model of regression was used to explore the relation between total cost and socio-demographic variables. The total annual mean cost was compared to Gross Domestic Product (GDP) per capita which was reported in the form of Purchasing Power Parity (PPP) index. To deal with uncertainty, one-way sensitivity analysis was performed.RESULTS: Total costs per patient in one year were estimated to be IRR 63452290.17 ($PPP 7736.19) at a 95$PPP 4131.18) (54%). Direct non-medical costs were estimated IRR 1655936.68 ($PPP 201.89) per patient (2$PPP 3403.11) (44%), which 62% of indirect costs is related to patients' work absenteeism.CONCLUSION: This study estimates the direct (56%) and indirect (44%) costs associated with CAD. The study explores the essential drivers of the costs and provides the magnitude of the burden in terms of the share of GDP. The outcomes can be used in priority setting, in particular for cost benefit analysis, and adopting new policies regarding insurance coverage and equity issues.</p