Hospital Managers’ Perception of Recent Health Care Reform in Teaching Hospitals of Qazvin, Iran

Abstract Background: The main purpose of any government from a healthcare reform is to improve the service quality and raised public satisfaction. Objectives: As the important role of managerial human resources in any organizational changes, this paper tried to examine the point of view of this group about the recent reform in governmental hospitals of Qazvin. Patients and Methods: This cross-sectional study was conducted in January 2015. The statistical population consisted of 50 executive managers of Qazvin teaching hospitals. The data gathering instrument was a research-made questionnaire with approved reliability and validity (α = 0.84). Data analyse was performed in SPSS version 20 using descriptive and analytic statistics (analysis of variance (ANOVA), Pearson correlation test and one sample t-test). Results: A total of 43.2% of managers believed that this reform was a good restrictor for malpractices in healthcare and 31.8% believed that it will not be so useful to improve the society health status. The average score of resource preparation, insurance companies coordination, changing the routine workflows, and finally achieving the goals, had a meaningful difference (P ˂ 0.05) and the average score of these fields were upper than average. Conclusions: The findings showed that based on the managers’ point of view, the reform plan was able to achieve its primary goals; however, it could not meet their exceptions in improving the society health status. Therefore, it is necessary to design some interventions for changing this perception. Keywords: Healthcare Reform, Managers, Teaching Hospital

Crimean-Congo Hemorrhagic Fever, Afghanistan, 2009

In response to an outbreak of Crimean-Congo hemorrhagic fever in western Afghanistan, we measured immunoglobulin G seroprevalence among household members and their animals. Seroprevalence was 11.2% and 75.0% in humans (n = 330) and livestock (n = 132), respectively. Persons with frequent exposure to cattle had an elevated risk of being immunoglobulin G positive

Individual and institutional capacity-building for evidence-informed health policy-making in Iran: a mix of local and global evidence

BACKGROUND: Providing valid evidence to policy-makers is a key factor in the development of evidence-informed policy-making (EIPM). This study aims to review interventions used to promote researchers' and knowledge-producing organizations' knowledge and skills in the production and translation of evidence to policy-making and explore the interventions at the individual and institutional level in the Iranian health system to strengthen EIPM. METHODS: The study was conducted in two main phases: a systematic review and a qualitative study. First, to conduct the systematic review, the PubMed and Scopus databases were searched. Quality appraisal was done using the Joanna Briggs Institute checklists. Second, semi-structured interviews and document review were used to collect local data. Purposive sampling was used and continued until data saturation. A qualitative content analysis approach was used for data analysis. RESULTS: From a total of 11,514 retrieved articles, 18 papers were eligible for the analysis. Based on the global evidence, face-to-face training workshops for researchers was the most widely used intervention for strengthening researchers' capacity regarding EIPM. Target audiences in almost all of the training programmes were researchers. Setting up joint training sessions that helped empower researchers in understanding the needs of health policy-makers had a considerable effect on strengthening EIPM. Based on the local collected evidence, the main interventions for individual and institutional capacity-building were educational and training programmes or courses related to the health system, policy-making and policy analysis, and research cycle management. To implement the individual and institutional interventions, health system planners and authorities and the community were found to have a key role as facilitating factors. CONCLUSION: The use of evidence-based interventions for strengthening research centres, such as training health researchers on knowledge translation and tackling institutional barriers that can prevent well-trained researchers from translating their knowledge, as well as the use of mechanisms and networks for effective interactions among policy-makers at the macro and meso (organizational) level and the research centre, will be constructive for individual and institutional capacity-building. The health system needs to strengthen its strategic capacity to facilitate an educational and training culture in order to motivate researchers in producing appropriate evidence for policy-makers

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

The Role of Using Social Networking Sites to Achieve Competitive Advantage in the Tourism Companies in Afghanistan Botswana

 The internet has revolutionised the tourism destinations´ business both as a source of information and as a sales channel. Visitors’ reviews, photographs, videos, stories and recommendations, and online marketing bring destinations closer to potential visitors regardless of geographical location. The purpose of this study is to identify and assess the role of social networking sites in creating a competitive advantage for tourism companies in Afghanistan. Since social networking sites are used widely by all age groups in Afghanistan, assessing the role played by the said sites leaves vast room for future growth and development in the tourism sector of Afghanistan. The major focus will be on how social networking sites have successfully created a competitive advantage for tourism companies in Afghanistan. This research is based on secondary data collected from sources like; journals, magazines, company websites, annual reports, the internet, reports published by the ministry of tourism, books and journals related to the topic. The data analysis is conducted through content analysis as a qualitative technique. This research investigates the role of social network sites in placing tourism companies in giving tourism companies a competitive edge in the tourism industry. </p

The Legal Implications of Disruptive Financial Technologies

Financial technology (FinTech) has rapidly transformed the traditional financial services industry, offering new ways of accessing, managing and investing money. However, with these advancements come various legal challenges that require attention. This paper examines the intersection of FinTech and law, discussing the regulatory challenges and legal implications of disruptive financial technologies. The paper also explores the role of law in shaping the future of FinTech and ensuring compliance in a FinTech-driven economy. Additionally, the paper analyzes the legal frameworks and best practices regarding data privacy and security in FinTech and the emerging legal issues in the use of cryptocurrencies and digital assets. The study concludes that while FinTech provides numerous opportunities for the financial industry, legal considerations must be carefully evaluated to manage the associated risks and ensure sustainable growth. , , A

Fluoride release and bioactivity evaluation of glass ionomer: Forsterite nanocomposite

Background: The most important limitation of glass ionomer cements (GICs) is the weak mechanical properties. Our previous research showed that higher mechanical properties could be achieved by addition of forsterite (Mg 2 SiO 4 ) nanoparticles to ceramic part of GIC. The objective of the present study was to fabricate a glass ionomer- Mg 2 SiO 4 nanocomposite and to evaluate the effect of addition of Mg 2 SiO 4 nanoparticles on bioactivity and fluoride release behavior of prepared nanocomposite. Materials and Methods: Forsterite nanoparticles were made by sol-gel process. X-ray diffraction (XRD) technique was used in order to phase structure characterization and determination of grain size of Mg 2 SiO 4 nanopowder. Nanocomposite was fabricated via adding 3wt.% of Mg 2 SiO 4 nanoparticles to ceramic part of commercial GIC (Fuji II GC). Fluoride ion release and bioactivity of nanocomposite were measured using the artificial saliva and simulated body fluid (SBF), respectively. Bioactivity of specimens was investigated by Fourier transitioned-infrared spectroscopy (FTIR), scanning electronmicroscopy (SEM), Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES) and registration of the changes in pH of soaking solution at the soaking period. Statistical analysis was carried out by one Way analysis of variance and differences were considered significant if P < 0.05. Results: The results of XRD analysis confirmed that nanocrystalline and pure Mg 2 SiO 4 powder was obtained. Fluoride ion release evaluation showed that the values of released fluoride ions from nanocomposite are somewhat less than Fuji II GC. SEM images, pH changes of the SBF and results of the ICP-OES and FTIR tests confirmed the bioactivity of the nanocomposite. Statistical analysis showed that the differences between the results of all groups were significant (P < 0.05). Conclusion: Glass ionomer- Mg 2 SiO 4 nanocomposite could be a good candidate for dentistry and orthopedic applications, through of desirable fluoride ion release and bioactivity