The role of health integrated system in health transformation plan in Iran

E-health encompasses a wide extent and has excellent possible to grow in the future. Growing numbers of specialist believe that e-health will fuel the next breakthroughs in health system improvements throughout the world . There is frequent evidence that largely indicates failures or unsustainable e-health implementations in different countries for different reasons. Iran is also a developing country that is presently applying this promising technology for its traditional healthcare delivery . the Iranian Ministry of Health and Medical Education (MoHME) has launched a series of ambitious reforms, known as the Health Transformation Plan (HTP) in 2014. Nine main packages of healthcare services and provisions were considered as the core of the plan, including: i) reducing out-of-pocket expenditure, ii) increasing healthcare coverage, especially in remote, rural areas and recruiting physicians, healthcare workers and personnel in underserved areas, iii) e-health serves and... . These services should be provided free of charge to all rural and urban residents

Factors Affecting Medical Tourism Destination Selection: A Mix Methods Study in a Developing Country

Background: Health tourism is an important and growing industry in the world. Iran has long been one of the active centers of health tourism in the Middle East region. Due to the important role of the medical tourism industry in the global economy, this study aimed to determine factors affecting and challenges on medical tourism. Methods: A mixed methods (quantitative and qualitative) study was carried out in the southeast of Iran, where has a border with Afghanistan and Pakistan countries. All patients who were referred to Sistan and Baluchistan province hospitals (six hospitals) between 2010 - 2018 were selected with the census method. In the qualitative phase, a semi-structured interview had done on 17 experts specialized in health tourism in 2019. All interviews were recorded and written daily. Finally, the data were analyzed by the content analysis method. Results: About 349 health tourists had referred to the selected hospitals from 2010 to 2018, of which 213 (61%) patients were male and 234 persons (39%) were married. The majority of the patients belonged to Afghanistan (190 patients, 54.4%). Four main themes affect the development of the medical tourism industry included human resource, specialized services, facilities, and infrastructure services and security conditions. Conclusion: Despite the high capacity of health tourism in the southeast of Iran, a few health tourists used the hospital services. Planning and policy-making must be done correctly in the field of infrastructure, medical equipment, marketing, and advertising. Also, attention should be paid to transportation infrastructure for easy access to these centers, as well as training capable and specialized medical staff in various medical centers. Keywords: Evaluation, Development Barriers, Health Tourism

Factors Affecting Medical Tourism Destination Selection: A Mix Methods Study in a Developing Country

Background: Health tourism is an important and growing industry in the world. Iran has long been one of the active centers of health tourism in the Middle East region. Due to the important role of the medical tourism industry in the global economy, this study aimed to determine factors affecting and challenges on medical tourism. Methods: A mixed methods (quantitative and qualitative) study was carried out in the southeast of Iran, where has a border with Afghanistan and Pakistan countries. All patients who were referred to Sistan and Baluchistan province hospitals (six hospitals) between 2010 - 2018 were selected with the census method. In the qualitative phase, a semi-structured interview had done on 17 experts specialized in health tourism in 2019. All interviews were recorded and written daily. Finally, the data were analyzed by the content analysis method. Results: About 349 health tourists had referred to the selected hospitals from 2010 to 2018, of which 213 (61%) patients were male and 234 persons (39%) were married. The majority of the patients belonged to Afghanistan (190 patients, 54.4%). Four main themes affect the development of the medical tourism industry included human resource, specialized services, facilities, and infrastructure services and security conditions. Conclusion: Despite the high capacity of health tourism in the southeast of Iran, a few health tourists used the hospital services. Planning and policy-making must be done correctly in the field of infrastructure, medical equipment, marketing, and advertising. Also, attention should be paid to transportation infrastructure for easy access to these centers, as well as training capable and specialized medical staff in various medical centers. Keywords: Evaluation, Development Barriers, Health Tourism

Study of patients absconding behavior in a general hospital at southern region of Iran

Background: Patients’ escape from hospital imposes a significant cost to patients as well as the health system. Besides, for these patients, exposure to adverse events (such as suicide, self-harm, violence and harm to hospital reputation) are more likely to occur compared to others. The present study aimed to determine the characteristics of the absconding patients in a general hospital through a case-control design in Shiraz, Iran. Methods: This case-control study was conducted on 413 absconded patients as case and 413 patients as control in a large general hospital in Shiraz, southern Iran. In this study, data on the case and control patients was collected from the medical records using a standard checklist in the period of 2011–3. Then, the data were analyzed using descriptive and analytical statistics, through SPSS 16. Results: The finding showed that 413 patients absconded (0.50%) and mean of age in case group was 40.98 ± 16.31 years. In univariate analysis, variables of gender [Odds Ratio (OR)= 2], ward (OR= 1.22), insurance status (OR= 0.41), job status (OR= 0.34) and residence expenditure were significant. However, in multivariate analysis significant variables were age (OR adj = 0.13), gender (OR adj = 2.15), self-employment/unemployed (OR adj = 0.47), emergency/admission (OR adj = 2.14), internal/admission (OR adj = 3.16), insurance status (OR adj = 4.49) and residence expenditure (OR adj = 1.15). Conclusion: Characteristics such as middle age, male gender, no insurance coverage, inability to afford hospital expenditures and admission in emergency department make patients more likely abscond from the hospital. Therefore, it may be necessary to focus efforts on high-risk groups and increase insurance coverage in the country to prevent absconding from hospital

Maternal macronutrient and energy intake during pregnancy: a systematic review and meta-analysis

Background: Nutritional status during pregnancy can have a significant impact on infant and maternal health outcomes. To maintain maternal homeostasis and support fetal growth, adequate macronutrient and energy intake during pregnancy is essential. Therefore, this study sought to systematically review and meta-analyze macronutrient and energy intakes during pregnancy. Methods: A systematic review and meta-analysis was carried out based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The required data were collected from four databases including: Web of Sciences, ProQuest, Scopus, and PubMed, from 1 January 1980 to 30 May 2023, by using a combination of search terms (dietary pattern" OR "diet quality" OR "food habits" OR "nutrition surveys" OR "diet surveys" OR "food-frequency questionnaire" OR "diet record" OR "dietary recall") AND ( "pregnancy" OR "reproduction" OR "maternal health" OR "neonatal outcomes") among interventional and observational studies. Excel and STATA version 11 were used for data analysis. Results: Among 7081 published articles, 54 studies were included in the review. Most of the 33 (61%) studies were cohort studies and a total of 135,566 pregnant women were included. The overall average of energy, carbohydrate, fat, and protein intake was 2036.10 kcal/day, 262.17 gr/day, 74.17 gr/day, and 78.21 gr/day, respectively. Also, energy intake during pregnancy was higher in American (2228.31 kcal/day, CI95%: 2135.06–2325.63) and Eastern Mediterranean regions (2226.70 kcal/day, CI95%: 2077.23–2386.92) than other regions (P < 0.001). Energy intake was higher in the third trimester than others (2115.64 kcal/day, CI95%: 1974.15–2267.27). Furthermore, based on the findings, there was a significant difference between energy intake in different World Health Organization (WHO) regions (P < 0.05). Conclusions: According to the results of meta-analysis, the average total energy was below than average total energy required during pregnancy. More efforts are needed to encourage women to adopt healthy eating habits during pregnancy to support healthy fetal and infant development

Participation rate of cancer patients in treatment decisions: a cross sectional study

Background and objective: Cancer is one of the most common diseases and the second reason of death in Iran. Giving decision making authority to patients is one of the fundamental principles of the protection of patients. Patients have rights as consumers of health care services that nurses, physician and other health professionals are responsible for maintaining and protecting it. This study aimed to determine cancer patients’ involvement in treatment decisions making. Methods:This cross-sectional study was carried out as descriptive-analytic with practical purpose in 2017 in Zahedan University of Medical Sciences. The study population included 1,000 patients who had cancer that whom 450 patients were selected by simple random sampling. To measure patient participation in treatment decisions, was used of Levente Kristona standard questionnaire. Reliability and validity of the questionnaire was confirmed (coefficient = 0.82). For data analysis used of software spss21 with descriptive statistics and chi-square tests Results: among the patients, 197 men (53%) and 177 women (47%) with a mean age of 31 years were examined. The results of this study showed that the score of mean participation in treatment decisions among the cancer patients was 30 ± 12 and it was in low level. The patients’ participation in treatment decisions had a significant relationship with education level (P = 0.027), however, it was not statistical significant with gender, age, income, occupation and type of cancer and other demographic variables (P> 0.05). Conclusion: In general, that patients' participation in clinical decision making is weak and low. Since patients’ participation in clinical decisions could affect the quality of treatment decisions, therefore, health care providers should attention more to this fact. Also, culturalizating and education according to patients’ knowledge and use of treatment techniques are recommended for clinical decision making promotion. Paper Type:Research Article

Household financial contribution to the health System in Shiraz, Iran in 2012

Background: One common challenge to social systems is achieving equity in financial contributions and preventing financial loss. Because of the large and unpredictable nature of some costs, achieving this goal in the health system presents important and unique problems. The present study investigated the Household Financial Contributions (HFCs) to the health system. Methods: The study investigated 800 households in Shiraz. The study sample size was selected using stratified sampling and cluster sampling in the urban and rural regions, respectively. The data was collected using the household section of the World Health Survey (WHS) questionnaire. Catastrophic health expenditures were calculated based on the ability of the household to pay and the reasons for the catastrophic health expenditures by a household were specified using logistic regression. Results: The results showed that the fairness financial contribution index was 0.6 and that 14.2% of households were faced with catastrophic health expenditures. Logistic regression analysis revealed that household economic status, the basic and supplementary insurance status of the head of the household, existence of individuals in the household who require chronic medical care, use of dental and hospital care, rural location of residences, frequency of use of outpatient services, and Out-of-Pocket (OOP) payment for physician visits were effective factors for determining the likelihood of experiencing catastrophic health expenditure. Conclusion: It appears that the current method of health financing in Iran does not adequately protect households against catastrophic health expenditure. Consequently, it is essential to reform healthcare financing

Comparison of the Rate and Causes of Surgery Cancellations before and after the Implementation of the Health Sector Evolution Plan: a case study in selected public hospitals

Background: Operating room efficiency is one of the main factors in determining hospital costs. Since Health Sector Evolution Plan (HSEP) was implemented with the idea of increasing people's access to hospital services, this study aimed to compare the rate and causes of cancellation of surgical procedures in public hospitals before and after HSEP. Methods: This descriptive-analytic study was carried out in two public hospitals in Zahedan in 2017. A total of 8138 of registered profiles were selected randomly and reviewed. A standard checklist containing 9 questions were used for data gathering. Data were analyzed using descriptive statistics and chi-square tests and through SPSS software version 21. Results: The number of surgies has increased after HSEP. Befor HSEP, most of the surgeries had been canceled for organizational and managerial reasons (58%) while after HSEP, patient issues were the main cause of cancellation of surgeries (66%). Surgery cancellation related to the surgery team, patient, anesthesia, medical, equipment and organisation had a significant relation with the marital status of patients (P=0.011) and their type of health insurance (P= 0.021). Conclusion: Performing detailed planning for operating rooms, providing necessary training programs for patients, patients' visit by anesthesiologists, as well as quantitative and qualitative improvement of operating room conditions can increase the efficiency of oprtaing rooms and hospitals

The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019

BACKGROUND: Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. METHODS: In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. FINDINGS: In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. INTERPRETATION: Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. FUNDING: The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation