Socioeconomic status and self-reported oral health in Iranian adolescents: the role of selected oral health behaviours and psychological factors

PhDHealth inequality according to socioeconomic status has been established. There is evidence for inequality for self-reported oral health outcomes. There has been interest in exploring the factors that explain general health inequality such as health behaviours and psychological factors. However, few studies have examined whether oral health behaviours and psychological factors explain oral health inequality among adults from industrialised countries. The aim of this thesis is to investigate whether oral health behaviours and psychological factors explain inequality in self-reported oral health among Iranian adolescents. This study tested four conditions according to the hypothesis of mediation; the final condition is that adjusting for the mediating factors attenuates the relationship between socioeconomic status and oral health. A questionnaire was used to collect data on four sets of variables from 639 males and females aged 15-17 studying at secondary schools in Sanandaj, Iran: socioeconomic status, oral health behaviours, psychological factors, and self-reported oral health outcomes. Indicators of socioeconomic status were subjective socioeconomic status, wealth index, mother‟s education and father‟s education. Oral health behaviours were toothbrushing, dental flossing, and visiting dentist. Psychological factors were selfesteem, depression, and anxiety. Self-reported oral health outcomes were single item self-rated oral health, and the experience of dental pain. Several regression models were conducted to examine the four conditions of the hypothesis of mediation. This study found a graded relationship between indicators of socioeconomic status and self-reported oral health outcomes, but no strong evidence to support the hypothesis that oral health behaviours and psychological factors mediate oral health inequality for self-reported oral health outcomes. Adjustment for oral health behaviours and psychological factors led to only small changes in the associations between socioeconomic status and self-reported oral health outcomes. In conclusion, oral health behaviours and psychological factors explained a little extent of oral health inequality for self-reported oral health outcomes

Futures of elderly care in Iran : A protocol with scenario approach

This study is the first author’s PhD Thesis, which has been supported by Iran University of Medical Sciences (IUMS_SHMIS: 65/2014). The authors would like to make special thanks to all participants for their kind contributions to this project and are also grateful to Dr. Mohammad Azmal and Dr. Hesam Seyedin for their insightful comments on the earlier manuscript.Peer reviewedPublisher PD

Senior Managers’ Viewpoints Toward Challenges of Implementing Clinical Governance: A National Study in Iran

Background: Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government’s intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. Methods: A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Results: Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers’ viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Conclusion: Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers’ attitude toward CG and ultimately affected the success of quality improvement activities

A qualitative study of the current situation of elderly care in Iran : what can we do for the future?

This study is part of the first author's PhD dissertation (17 Goharinezhad S. Foresight of elderly care in Iran: a scenario approach. PhD dissertation. 2016; Tehran, Iran: Iran University of Medical Sciences. [Google Scholar]) in Iran University of Medical Sciences, School of Health Management and Information Sciences (IUMS_ SHMIS: 65/2014). The authors would like to make special thanks to all participants for their cooperation to this study. The authors would also like to thank all reviewers who helped improve the manuscript.Peer reviewedPublisher PD

Policies and Programs for Prevention and Control of Diabetes in Iran: A Document Analysis

Trend analysis in 2005 to 2011 showed high growth in diabetes prevalence in Iran. Considering the high prevalence of diabetes in the country and likely to increase its prevalence in the future, the analysis of diabetes-related policies and programs is very important and effective in the prevention and control of diabetes. Therefore, the aim of the study was an analysis of policies and programs related to prevention and control of diabetes in Iran in 2014. This study was a policy analysis using deductive thematic content analysis of key documents. The health policy triangle framework was used in the data analysis. PubMed and ScienceDirect databases were searched to find relevant studies and documents. Also, hand searching was conducted among references of the identified studies. MAXQDA 10 software was used to organize and analyze data. The main reasons to take into consideration diabetes in Iran can be World Health Organization (WHO) report in 1989, and high prevalence of diabetes in the country. The major challenges in implementing the diabetes program include difficulty in referral levels of the program, lack of coordination between the private sector and the public sector and the limitations of reporting system in the specialized levels of the program. Besides strengthening referral system, the government should allocate more funds to the program and more importance to the educational programs for the public. Also, Non-Governmental Organizations (NGOs) and the private sector should involve in the formulation and implementation of the prevention and control programs of diabetes in the future

Transcatheter Mitral Valve Replacement: Structural and Hemodynamic Analysis

Transcatheter mitral valve replacement (TMVR) is being developed to become a substitute therapy for surgery in prohibitive or high surgical risk patients to treat severe mitral regurgitation. A limited number of TMVR systems are under clinical evaluation. However, transcatheter mitral valve (TMV) long-term durability and hemodynamic performance is not known. TMV durability and hemodynamics must match with that of surgical bioprostheses for potential commercialization of TMVR. Experimental and computational approaches were used to find the leaflets’ three-dimensional anisotropic mechanical properties in a transcatheter Edwards SAPIEN 3 valve and a surgical Carpentier-Edwards PERIMOUNT Magna mitral valve and finite element (FE) simulations were conducted to obtain the stress distribution on both valves. Moreover, to visualize the flow field within the left heart, steady-state computational fluid dynamics (CFD) simulations were run. The FE simulations demonstrated that in a cardiac cycle, at peak systole, the highest stress value in the two bioprostheses was 4.75 and 16 MPa for the surgical and transcatheter heart valve, respectively. After studying the leaflet stress distributions and flow field, long-term durability may potentially be different between the two models. The results of CFD simulations could potentially show that TMVs with supra-annular positioning have a higher risk of leaflet thrombosis as opposed to the intra-annular position

Organisational failure and turnaround process in NHS hospital trusts.

Since 1997, public services improvement has been at the centre of the national policy agenda in the UK. The greater visibility of poor quality and performance has led to an increasing interest among policy makers, health care managers and clinicians in understanding the processes by which underperforming organisations can 'turnaround' their situation. The aim of this thesis is to contribute to a wider understanding of organisational failure and turnaround processes in the public sector, particularly health care organisations. A conceptualisation was carried out concerning organisational failure and the turnaround process in the for-profit sector in relation to a range of theoretical frameworks and models. As a result, the 'stages' theory was selected as a conceptual framework with which to organise and interpret the findings of the empirical part of the study. A comprehensive review was conducted to examine the findings of empirical studies regarding the processes of organisational failure and turnaround across a range of public services. The review showed insufficient empirical studies in this field in the health sector. The review concluded that a range of both external and internal factors contributed to organisational failure and various triggers were identified, which initiated the process of change. A range of turnaround interventions were identified including reorganisation, retrenchment and repositioning strategies. A qualitative case study of a purposefully sampled hospital Trust, involving semistructured interviews (57 interviewees from different organisations) and a review of background documents were carried out to explore the symptoms and causes of organisational failure, factors that triggered the process of change, and the perceived effectiveness of a variety of turnaround interventions. Symptoms of organisational performance failure were identified, including financial deficit, lack of good external relationships, inability to meet core targets, lack of clear management systems and low staff morale. These markers had not been taken seriously by the previous senior management team. Symptoms of failure reflected the presence of secondary and primary causes of failure. Poor managerial leadership, poor financial control and performance management, lack of an open culture, distraction by two large projects and the lack of clinician engagement were perceived as internal causes of failure and the high level of policy changes within the NHS as the key external cause. The level of 11 _ ._~ ~ .'Â?Â? _ Â? .......... Â? .. , ... -...t:.- Â? deprivation in the area was also thought to have had a negative impact on performance. The replacement of the Chief Executive Officer and executive members of the Board and the public reporting of poor performance and external investigation reports were perceived as the main triggers for change. The Trust's managers were able to develop and implement their action plan and turnaround performance without receiving direct intervention from external organisations. The interventions deployed within the Trust may be classified under three key categories: i) Reorganisation (replacement of the Chief Executive Officer and executive members of the board, internal restructuring and increased involvement of clinical staff in the management of the organisation, and an increased focus on performance management); ii) Retrenchment which aimed to stabilise the crisis situation using tight financial control and focus on main performance targets); iii) Repositioning strategies which aimed to sustain performance improvement by attempting to change organisational culture, better stakeholder management and external relationship and developing new vision. Several unintended consequences of turnaround interventions (e.g. distortions of clinical priorities and presence of stress and anxiety among staff) were identified. The findings of this study make a significant contribution to our understanding of organisational failure and the turnaround processes and reinforce and expand those of recent studies in the public sector, particularly in health care

Developing of the appropriateness evaluation protocol for public hospitals in Iran

Background: Employment of utilization review instruments is a method for managing costs and efficiency in the healthcare systems. Objectives: This study developed an instrument for measuring the level of inappropriate acute hospital admissions and days of care in Iran. Patients and Methods: The American version of the Appropriateness Evaluation Protocol (AEP) was modified, using the agreement method, by a multidisciplinary group of physicians. We conducted a retrospective descriptive study of 273 randomly selected patients admitted to Imam Khomeini Hospital of Tehran University of Medical Sciences in Tehran, Iran. For the reliability study, two nurses were asked to review patients� medical records using the instrument. Validity was appraised by pairs of clinicians, including two general surgeons, two internists and two gynecologists. The degree of consensus between the three pairs of clinicians was compared with that of the nurses. Results: Inter-rater and intra-rater reliability testing revealed an excellent level of consensus between the two nurses employing the AEP in all the studied departments. Overall agreement was > 92, while the specific appropriate agreement and specific inappropriate agreement were > 88 and > 83, respectively. External validity testing of the instrument yielded a sensitivity > 0.785, specificity > 0.55, and positive and negative predictive values > 0.775 and > 0.555, respectively. The kappa statistic for the nurses who applied the AEP and clinicians using personal judgment were perfect (k > 0.85) and substantial (k > 0.68), respectively. Conclusions: The results illustrate that the Iranian version of the AEP (IR-AEP) could be a reliable and valid instrument for assessing the level of inappropriate acute hospital admissions and days of care in the Iranian context. © 2015, Iranian Red Crescent Medical Journal