Sustainable health promotion and resilience in urban environment

A part of resilience and sustainability in any urban environment is establishing and maintaining health. Sustainability in health is a dynamic process in which growth of physical, mental, and social health is guaranteed. A city is sustainable when all aspects of life, such as economy, environment, health, and infrastructure, are well defined and very often subjected to optimization. © 2016 Sharif University of Technology. All rights reserved

Patient Satisfaction With the Family Physician Program in Sabzevar, Iran

BACKGROUND AND OBJECTIVES: Patient satisfaction with the family physician program is an important factor for more favorable treatment results. Evaluation of patient satisfaction improves the services and approximates them to patient's preferences. The family physician program has been executed since late March, 2005 in Iran. This study aimed to measure patient satisfaction with family physician services and determines factors affecting the level of satisfaction in order to propose appropriate suggestions for providing medical services based on patients' expectations. METHODS: Forty-one centers provide healthcare services in rural and urban areas. The participants in this study comprised 1263 people. The data were collected by an inventory with 11 items about demographic specifications, waiting time and the importance of physician's sex and 40 items for assessing the level of patient satisfaction. RESULTS: A total of 1199 patients participated in the current study, 72.1 of them were female and 19.6 waited 10-20 minutes for receiving services. About 55.72 of the participants chose high and very high for the items of the inventory. Total satisfaction with the family physician program decreased with age (p-value=0.029).Moreover, total satisfaction did not show any significant differences in different groups in terms of sex, place of residence, education level and marital status. Also family physicians' sex did not affect patient satisfaction significantly. Based on results of regression model, an increase in patients' age by one year decreased their satisfaction by 0.12 and level of satisfaction in rural patients was lower than that in urban patients by 7.93. CONCLUSIONS: The level of patient satisfaction with family physician services was moderate, which mostly arose from the components of the family physician program and services such as the waiting time, costs, welfare facilities, accessibility and the service-providing team rather than patients' personal characteristics

Identifying factors affecting destination choice of medical tourists: a systematic review of literature

Objective: Overseas travels in which improved health is the main component, “medical tourism”, has emerged as a new source of competitive advantage all over the world. The present study seeks to identify the factors that affect destination choice of medical tourists.Methods: We systematically searched relevant databases including Pub Med, Embase, Science Direct, Web of Science and Medline databases using terms “medical tourism” OR “health tourism”.Studies were identified and screened in accordance with the preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) published in English or Farsi, determining factors that develop  country’s ability to become a preferred destination for outbound patients seeking healthcare services in foreign countries.Results: The search retrieved (1374) citation of which 18 studies were eligible.Across the eligible articles, 13 overarching themes including 75 that encourage medical tourists to choose a specific destination sub-themesemerged.Conclusions: Results of this study offer evidence for a comprehensive approach to strategic outreach and market expansion for medical tourism decision makers for attracting more medical tourists to their countries.Keywords: Medical tourism, health tourism, attractive factors, destination choic

Challenges of implementation of hospital accreditation in Iran: an exploratory factor analysis

Background: Today, accreditation is considered as the most commonly used health assessment approach. Considering the importance and application of the process of this approach in the hospital, this study aimed to investigate the challenges of implementation of hospital accreditation in Iran using exploratory factor analysis. Methods: A cross-sectional study design was carried out from July to December 2017, consisting of 200 managers in the seven hospitals accredited by the MOH in Tehran, Iran. Samples were selected through the purposive sampling method, and data were collected using a structured questionnaire in which validity and reliability were confirmed. Likert�s five-choice range was used for the rating of items. Exploratory factor analysis was used to categorize the identified challenges and extract the mathematical model on them. Results: Exploratory factor analysis identified six dimensions (implementation, evaluation, content, structural, psychological, and managerial) with 40 items using a 5-point Likert scale. Each dimension accounted for greater than 63.20 of the total variance. The scale had strong content validity (indices = 0.84). Each dimension of Cronbach�s alpha ranged from 0.74 to 0.94. Implementation, evaluation, content, structural, psychological, and managerial components also formed the final identified areas. Conclusion: The present study showed that there were major challenges in the path to successful deployment of Iranian hospital accreditation, requiring serious action by managers and policymakers in this field. © 2020, The Author(s)

Designing the maternal and child health services package based on comparative study of developed countries models

Introduction: Community women�s health is more vulnerable than men due to various reasons, in addition to biological characteristics; it is influenced by cultural, social, economic and political factors. Nowadays,managing maternal health development is one of the World Health Organization priorities.This study was performed with aim to improve maternal and child health service package in Iran by providing variables derived from a comparative study conducted in selected developed countries. Methods: In thiscomparative study, the studied countries(Singapore, Australia, England and Japan) wereselectedby comparingmaternal-child healthindicators from different continentsusing cluster sampling and with studying of their maternal and child health service package through referring to valid health documents, important variablesanddimensions were identified, and based on itand designed comparative tables, the conclusion was made. Results: Free sportsandtraining classeswiththe husbands� presence, extensive maternal network emergency as specialized and boarding, varietyof vehicles fortransportto emergency centers,emotional supportpackages, home visit and delivery, newbornsfreesurgical facilitiesandcare, pregnant womenscreeningfacilitiesfor free, guideline booklet and unifiedrecording of servicesin allcountrycenters are the factorsidentified in successfulmaternal-child health servicespackage. Conclusion: The role ofsome identified factors such as home visit and deliveryis loworabsent in Iran health service package. Implementation ofthesuggested factors canplay an important rolein promotingmaternal-child healthindicators inIran. � 2016, Mashhad University of Medical Sciences. All rights reserved

Unusual sites of bone involvement in Langerhans cell histiocytosis: a systematic review of the literature

Background: Langerhans cell histiocytosis (LCH) is a rare disease that originates from the uncontrolled proliferation and accumulation of bone marrow-derived immature myeloid dendritic cells. Dendritic cells are a type of histiocyte that play an important role in the human immune system and are found in the bone, skin, stomach, eyes, intestines, and lungs. Objective: This systematic review aimed to collect and report published case reports of rare bone disease caused by LCH to avoid misdiagnoses or delays in diagnosis. Methods: We systematically searched Scopus, PubMed, Embase, and Web of Sciences from August 1, 2000 to December 31, 2019. Studies reporting cases of LCH with rare bone involvement were included. Results: We identified 60 articles including 64 cases. Of the identified cases, 31 (48.4) involved children, and 33 (51.6) involved adults. Additionally, 46.9 (30 individuals) were from Asian countries. The mean age of the children was 7.6 ± 4.3 years and that of the adults was 36 ± 12 years. The findings indicated that unifocal bone involvements were the most prevalent form of the disease (68.7), and, overall, the skull and chest wall were the most commonly affected bones in both adults and children. The spine and long bones were the second most commonly affected bones in children, and the spine and jaw were the second most commonly affected bones in adults. Pain and swelling were the most frequent presenting signs among the investigated cases, and loss of consciousness, myelopathy, nerve palsy, visual loss, torticollis and clicking sounds were rare signs. Osteolytic lesions were the most frequent radiologic feature (62.5), and intracranial hemorrhage, fluid�fluid level, dura and intracranial extension and pathologic fractures were rare radiological features. Total excision, curettage and observation in the unifocal group of patients and systemic chemotherapy in the other groups (i.e., multifocal and multisystem) were the most frequent management approaches. The recovery rates of the unifocal and multifocal groups were 77.3 and 81.8, respectively, while that of the multisystem group was 55.5. The rates of recurrence and mortality in the multisystem group were 11 and were higher than those in the other groups. Conclusions: LCH is a rare disease that can affect any organ in the human body. However, bone is the most commonly involved organ, and rare bone involvements may be the first or only symptom of the disease due to the rarity of such lesions; a lack of familiarity with them may result in misdiagnosis or delayed diagnosis. © 2021, The Author(s)

A model for priority setting of health technology assessment: The experience of AHP-TOPSIS combination approach

Background: In recent times, the use of health technologies in the diagnosis and treatment of diseases experienced considerable and accelerated growth. The goal of the present study was to describe the designated pilot MCDM (Multiple Criteria Decision Making) model for priority setting of health technology assessment in Iran. Methods: Relevant articles were sought and retrieved from the most appropriate medical databases, including the Cochrane Library, PubMed and Scopus via three separate search strategies, using MESH and free text until March, 2015. Retrieved criteria were questioned from health technology assessment experts in two rounds and the relative weight for valid criteria was finally obtained from paired wise comparison method. After extraction of relative weights based on the aforementioned procedure, TOPSIS (The Technique for Order of Preference by Similarity to Ideal Solution) priority setting model was designed. The stated model was applied for assessing three technologies (adenosine, tissue plasminogen activator and mechanical thrombectomy) which were available for projects call of Iranian health technology assessment department in order to determine applicability of the model for practical purpose. Results: Nine criteria, including efficiency/effectiveness, safety, population size, vulnerable population size, availability of alternative technologies, cost effectiveness in other countries, budget impact, financial protection, quality of evidence, were extracted by the Iranian health technology assessment experts. The relative weights of these criteria were as follows 0.12, 0.2, 0.06, 0.08, 0.08, 0.13, 0.08, 0.09, and 0.15, respectively. Finally TOPSIS pilot model was designed by three health technologies and nine criteria relative weights. Results showed that, the applicability of the stated model was suitable and as the pilot testing, tissue plasminogen activator was the first priority, adenosine was second and mechanical thrombectomy was third for performing health technology assessment by the Iranian ministry of health and medical education. Conclusion: According to the results of this study, this model with nine effective criteria and their relative weights and in combination with TOPSIS approach could be used with suitable applicability by health technology assessment department in deputy of curative affairs and food and drug organization for determination of research priorities in health technology assessment. © 2016 Mobinizadeh et al

Effects of air pollution on public and private health expenditures in Iran: A time series study (1972-2014)

Objectives: Environmental pollution is a negative consequence of the development process, and many countries are grappling with this phenomenon. As a developing country, Iran is not exempt from this rule, and Iran pays huge expenditures for the consequences of pollution. The aim of this study was to analyze the long- and short-run impact of air pollution, along with other health indicators, on private and public health expenditures. Methods: This study was an applied and developmental study. Autoregressive distributed lag estimating models were used for the period of 1972 to 2014. In order to determine the co-integration between health expenditures and the infant mortality rate, fertility rate, per capita income, and pollution, we used the Wald test in Microfit version 4.1. We then used Eviews version 8 to evaluate the stationarity of the variables and to estimate the long- and short-run relationships. Results: Long-run air pollution had a positive and significant effect on health expenditures, so that a 1.00 increase in the index of carbon dioxide led to an increase of 3.32 and 1.16 in public and private health expenditures, respectively. Air pollution also had a greater impact on health expenditures in the long term than in the short term. Conclusions: The findings of this study indicate that among the factors affecting health expenditures, environmental quality and contaminants played the most important role. Therefore, in order to reduce the financial burden of health expenditures in Iran, it is essential to reduce air pollution by enacting and implementing laws that protect the environment. Copyright © 2018 The Korean Society for Preventive Medicine

Nurses� perception of patient safety culture and its relationship with adverse events: a national questionnaire survey in Iran

Background: Patient safety culture is an important factor in determining hospitals� ability to address and reduce the occurrence of adverse events (AEs). However, few studies have reported on the impact of nurses� perceptions of patient safety culture on the occurrence of AEs. Our study aimed to assess the association between nurses� perception of patient safety culture and their perceived proportion of adverse events. Methods: A cross-sectional survey was carried out among 2295 nurses employed in thirty-two teaching hospitals in Iran. Nurses completed the Persian version of the hospital survey of patients� safety culture between October 2018 and September 2019. Results: Positive Response Rates of overall patient safety culture was 34.1 and dimensions of patient safety culture varied from 20.9 to 43.8. Also, nurses estimated that the occurrence of six adverse events varied from 51.2�63.0 in the past year. The higher nurses� perceptions of �Staffing�, �Hospital handoffs and transitions�, �Frequency of event reporting�, �Non-punitive response to error�, �Supervisor expectation and actions promoting safety�, �Communication openness�, �Organizational learning continuous improvement�, �Teamwork within units�, and �Hospital management support patient safety� were significantly related to lower the perceived occurrence at least two out of six AEs (OR = 0.69 to 1.46). Conclusions: Our findings demonstrated that nurses� perception regarding patient safety culture was low and the perceived occurrence of adverse events was high. The research has also shown that the higher level of nurses� perception of patient safety culture was associated with lowered occurrence of AEs. Hence, managers could provide prerequisites to improve patient safety culture and reduce adverse events through different strategies, such as encouraging adverse events� reporting and holding training courses for nurses. However, further research is needed to assess how interventions addressing patient safety culture might reduce the occurrence of adverse events. © 2021, The Author(s)