A policy analysis of agenda-setting of Brucellosis in Iran using multiple streams framework: health policy and historical implications

Background: Brucellosis, a major zoonotic disease, is highly present in Iran, especially in Lorestan province. The aim of this study was to understand the issues related to Brucellosis utilizing the multiple streams framework. Methods: A two-step method was adopted: i) assessment of brucellosis-related documents and ii) interviews with stakeholders. Results: The problem stream was characterized by: 1) high prevalence of the disease, 2) traditional livestock production, 3) unsafe animal slaughtering, 4) centers for the sale and distribution of non-authorized dairy products, 5) raw milk and 6) traditional unsafe dairy products consumption, 7) incomplete livestock vaccination, 8) lack of knowledge of Brucellosis, 9) neighboring countries with high prevalence of Brucellosis, 10) lack of livestock quarantine, and 10) nomadic immigration. The policy stream was characterized by 1) primary healthcare networks, 2) guidelines, 3) medicines, insurance, and 4) diagnostic services. Finally, the political stream was characterized by: 1) support of the University of Medical Sciences, 2) sponsorship by the Ministry of Health and Medical Education, 3) Health transformation plan, and 4) Working Group on Health and Food Security in Lorestan. Conclusion: This study examined the brucellosis-related agenda setting: if different issues are taken into consideration, it can be perceived as a health priority

Integrating rehabilitation services into primary health care:policy options for Iran

BACKGROUND: Providing rehabilitation services in primary health care (PHC) is associated with numerous health, social, and economic benefits. Therefore, low and middle-income countries, such as Iran, should benefit from the advantages of integrating rehabilitation services into PHC. We conducted a qualitative study to determine policy solutions that could facilitate the integration of rehabilitation services into Iran’s PHC network. METHODS: Semi-structured interviews were conducted with 38 participants, including health policymakers, rehabilitation managers, faculty members, and rehabilitation practitioners. Purposive and snowball sampling strategies were adopted to recruit participants. The WHO Health System building blocks framework analysis was applied to analyze the collected data. RESULTS: Participants’ perspectives and experiences outlined potential policy options including: (1) stewardship: increasing political support, strengthening the leadership of the rehabilitation sector, and promoting inter-sectoral collaborations; (2) service delivery: increasing the knowledge of healthcare professionals, using local volunteers, deploying mobile rehabilitation teams, using telerehabilitation, and improving referral pathways; (3) financing: increasing government funding, preparing a package of rehabilitation services, and using appropriate payment mechanisms; (4) human resources: expanding rehabilitation workforce, training rehabilitation assistants, and enhancing employment and social opportunities; (5) information systems: establishing a comprehensive information system and an effective surveillance system; and (6) technologies: facilitating access to a range of rehabilitation equipment and raw materials, especially for prosthetics and orthotics services. CONCLUSION: Based on the WHO six building blocks framework, this study identified several policy options for integrating rehabilitation services into the Iranian PHC Network. Some of the policy options include increasing political support, promoting inter-sectoral collaborations, increasing the skills and knowledge of healthcare workers, establishing effective referral pathways, strengthening team-working, and increasing government funding

Prostorna analiza električne vodljivosti podzemnih voda pomoću običnoga kriginga i metoda umjetne inteligencije (slučaj ravnice Tabriz, Iran)

rtificial intelligence (AI) systems have opened a new horizon to analyze water engineering and environmental problems in recent decades. In this study performances of ordinary kriging (OK) as a linear geostatistical estimator and two intelligent methods including artificial neural networks (ANN) and adaptive neuro-fuzzy inference system (ANFIS) are investigated. For this purpose, geographical coordinates of 120 observation wells that located in Tabriz plain, north-west of Iran, were defined as inputs and groundwater electrical conductivities (EC) were set as output of models. Eighty percent of data were randomly selected to train and develop mentioned models and twenty percent of data used for testing and validating. Finally, the outputs of models were compared with the corresponding measured values in observation wells. Results indicated that ANFIS model provided the best accuracy among models with the root mean squared error (RMSE) value of 1.69 dS.m–1 and correlation coefficient (R) of 0.84. The RMSE values in ANN and OK were calculated 1.97 and 2.14 dS.m–1 and the R values were determined 0.79 and 0.76, respectively. According to the results, the ANFIS method predicted EC precisely and can be advised for modeling groundwater salinity.u posljednjih nekoliko desetljeća sustavi umjetne inteligencije (AI) su otvorili nove horizonte u analizi problema vodnog inženjeringa te ekoloških problema. U ovoj studiji istražene su performanse običnog kriginga (OK) kao geostatističkog procjenitelja te performanse dvaju naprednih metoda, prva od kojih je umjetna neuronska mreža (ANN), a druga je hibridni sustav ANFIS (Adaptive Neuro-Fuzzy Inference System) koji uz neuronsku mrežu uključuje i neizravnu (fuzzy) logiku. U tu svrhu, zemljopisne koordinate 120 mjernih bunara lociranih u ravnici Tabriz u sjeverozapadnom Iranu definirane su kao ulazi, a električne vodljivosti (EC) podzemnih voda postavljeni su kao izlazi modela. Osamdeset posto podataka nasumce je izabrano za razvoj i obuku (učenje) navedenih modela, a dvadeset posto podataka iskorišteno je za testiranje i provjeru. Na kraju, izlazi modela su uspoređeni s odgovarajućim mjerenim vrijednostima u mjernim bunarima. Rezultati su pokazali da model ANFIS među svim promatranim modelima daje najbolju točnost s korijenom srednje kvadratne pogreške (RMSE) od 1,69 dS.m–1 i koeficijentom korelacije (R) od 0,84. Izračunate vrijednosti RMSE u modelima ANN i OK iznose 1.97, odnosno 2.14 dS.m–1, a koeficijenata korelacije 0,79, odnosno 0,76, respektivno. Prema dobivenim rezultatima ANFIS metoda je precizno predvidjela električnu vodljivost te se stoga može preporučiti za modeliranje saliniteta podzemnih voda

How Iranian people perceived the COVID-19 crisis? Explored findings from a qualitative study: current concerns, ethics and global solidarity

Abstract Objectives: This nation-wide project aimed to investigate the common perceptions and concerns regarding COVID-19 outbreak in Iran.        Methods: This qualitative study was conducted in Iran from February to March 2020 via an online open-ended questionnaire. The participants were also selected using convenience and snowball sampling methods. As well, the data collection process continued until data saturation was achieved. Thematic content analysis was utilized to analysis the transcribed texts.   Results: The statements retrieved also represented the most challenging psychological stress experienced by the participants. Four themes were accordingly recognized based on the content analysis including stressful conditions, health concerns, social and political concerns, and economic concerns. Throughout the study, a major proportion of the participants commented that psychological disorders such as fear, anxiety, stress, and ennui were their main challenges regarding this pandemic. Furthermore, lack of social responsibility, worries about high-risk and susceptible groups, decreased economic power of the public, financial hardships for low-income groups, shortage of healthcare facilities, and adverse effects of disinfectants were expressed as the main concerns.    Conclusions: As a whole, it is evident that people have confronted with several challenges and need help together with effective policies and strategies during and after this pandemic to reduce their current concerns. The study findings provided a favorable ground to develop and adopt the required policies in Iran and other countries. It was concluded that creating local, national, and global solidarity in such epidemics is an inevitable necessity.&nbsp

Assessing Iran’s health system according to the COVID-19 strategic preparedness and response plan of the World Health Organization: health policy and historical implications

Background: The role of health systems in the management of disasters including natural hazards like outbreaks and pandemics, is crucial and vital. Healthcare systems which are unprepared to properly deal with crises are much more likely to expose their public health workers and health personnel to harm and will not be able to deliver healthcare provisions in critical situations. This can lead to a drammatic toll of deaths, even in developed countries. The possible occurrence of global crises has prompted the WHO to devise instruments, guidelines and tools to assess the capacity of countries to deal with disasters. Iran’s health system has been hit hardly by the COVID-19 pandemic. In this study, we aimed to assess its preparedness and response to the outbreak. Methods: The present investigation was designed as a qualitative study. We utilized the “COVID-19 Strategic Preparedness and Response Plan” devised by WHO as a conceptual framework. Results: The dimension/pillars which scored the highest was national laboratories, followed by surveillance, rapid response teams and case investigations. Risk communication and community engagement was another pillar receiving a high score, followed by infection prevention and control and by country-level coordination, planning and monitoring. The pillar/dimensions receiving the lowest scores were operational support and logistics; case management; and points of entry. Discussion: The COVID-19 pandemic has represented an unprecedent event that has challenged healthcare systems and facilities worldwide, highlighting their weaknesses and the need for inter-sectoral cooperation and collaboration during the crisis. Analyzing these experiences and capitalizing on them, by strengthening them,will help countries to be more prepared to face opossible future crises

The challenges of urban family physician program over the past decade in Iran: a scoping review and qualitative study with policy-makers

Introduction: Despite all the advantages of urban family physician program (UFPP), there is still a gap between UFPP and what is actually achieved by the community after its implementation in Iran. In response, this study attempted to review published studies related to the barriers to the implementation of the UFPP in Iran as well as potential solutions to improve it. Further, a qualitative study was conducted to learn the perspectives of experts at the national level and in the Fars province in order to better understand the program's challenges. Methods: This study was conducted in two phases. First, a scoping review was done, aiming to identify the common barriers and potential solutions to implementing UFPP in Iran. Second, a qualitative study using semi-structured interviews was conducted to investigate the views of decision- and policy-makers regarding barriers to and solutions for implementing the UFPP in the Fars province over the last decade. The findings were classified using the five control knobs framework (Organization, financing, payment, regulation, and behavior).  Results: The most common barriers to UFPP were: 1) organization (ununited stewardship function of the Ministry of Health, weak management and planning, inadequate training of human resources, and a weak referral system); 2) financing (fragmented insurance funds, insufficient financial resources, and instability of financial resources); 3) payment (inappropriate payment mechanisms and delay in payments); 4) regulation (cumbersome laws and unclear laws); and 5) behavior (cultural problems and conflict of interests). On the other hand, several solutions were identified to improve the implementation of UFPP, including: enhancing the role of government; improving the referral system; providing comprehensive training for UFPP providers; considering sustainable financial resources; moving towards mixed-payment mechanisms; employing appropriate legal and regulatory frameworks; enhancing community awareness; and elevating incentive mechanisms. Conclusion: Our research found that, despite the UFPP having been in place for a decade in Iran, there are still significant challenges in all five components. Therefore, the promotion of this program requires solving the existing implementation challenges in order to achieve the predetermined goals. The ideas in this study can be used to improve the current program in Fars Province and bring it to other cities in Iran

Analysis and evolution of health policies in Iran through policy triangle framework during the last thirty years: a systematic review of the historical period from 1994 to 2021

Background: Health policy analysis as a multi-disciplinary approach to public policy illustrates the need for interventions that highlight and address important policy issues, improve the policy formulation and implementation process and lead to better health outcomes. Various theories and frameworks have been contributed as the foundation for the analysis of policy in various studies. This study aimed to analyze health policies during the historical period of the almost last 30 years in Iran using policy triangle framework. Method: To conduct the systematic review international databases (PubMed / Medline, Scopus, Web of Sciences, CINAHL, PsycINFO, Embase, The Cochran Library) and Iranian databases from January 1994 to January 2021 using relevant keywords. A thematic qualitative analysis approach was used for the synthesis and analysis of data. Results: Out of 731 articles, 25 articles were selected and analyzed. Studies used health policy triangle framework to analyze policies in the Iranian health sector has been published since 2014. All the included studies were retrospective. The main focus of most of studies for the analysis was on the context and process of polices as the elements of the policy triangle. Conclusion: The main focus of health policy analysis studies in Iran over the last thirty years was on the context and process of polices. Although range of actors within and outside the Iran government influence health policies but in many policy processes the power and the role of all actors or players involved in the policy are not recognized carefully. Also, Iran's health sector suffers from lack of a proper framework for evaluating various implemented policies

Exploring the landscape of health technology assessment in Iran: Perspectives from stakeholders on needs, demand and supply

Background: The evaluation of health technologies plays a crucial role in the allocation of resources and the promotion of equitable healthcare access, known as health technology assessment (HTA). This study focuses on Iran’s efforts to integrate HTA and aims to gain insights into stakeholder perspectives regarding capacity needs, demand and implementation. Methods: In this study, we employed the HTA introduction status analysis questionnaire developed by the International Decision Support Initiative (iDSI), which has been utilized in various countries. The questionnaire consisted of 12 questions divided into three sections: HTA need, demand and supply. To identify key informants, we conducted a literature review and consulted with the Ministry of Health and Medical Education (MOHME), as well we experts in policy-making, health service provision and HTA. We selected stakeholders who held decision-making positions in the healthcare domain. A modified Persian version of the questionnaire was administered online from September 2022 to January 2023 and was pretested for clarity. The analysis of the collected data involved quantitative methods for descriptive analysis and qualitative methods for thematic analysis. Results: In this study, a total of 103 questionnaires were distributed, resulting in a favourable response rate of 61% from 63 participants, of whom 68% identified as male. The participants, when assessing the needs of HTA, rated allocative efficiency as the highest priority, with a mean rating of 8.53, thereby highlighting its crucial role in optimizing resource allocation. Furthermore, healthcare quality, with a mean rating of 8.17, and transparent decision-making, with a mean rating of 7.92, were highly valued for their impact on treatment outcomes and accountability. The importance of budget control (mean rating 7.58) and equity (mean rating 7.25) were also acknowledged, as they contribute to maintaining sustainability and promoting social justice. In terms of HTA demand, safety concerns were identified as the top priority, closely followed by effectiveness and cost-effectiveness, with an expanded perspective on the economy. However, limited access to local data was reported, which arose from various factors including data collection practices, system fragmentation and privacy concerns. The priorities of HTA users encompassed coverage, payment reform, benefits design, guidelines, service delivery and technology registration. Evidence generation involved the participation of medical universities, research centres and government bodies, albeit with ongoing challenges in research quality, data access and funding. The study highlights government support and medical education as notable strengths in this context. Conclusions: This study provides a comprehensive evaluation of Iran’s HTA landscape, considering its capacity, demand and implementation aspects. It underlines the vital role of HTA in optimizing resources, improving healthcare quality and promoting equity. The study also sheds light on the strengths of evidence generation in the country, while simultaneously identifying challenges related to data access and system fragmentation. In terms of policy priorities, evidence-based decision-making emerges as crucial for enhancing healthcare access and integrating technology. The study stresses the need for evidence-based practices, a robust HTA infrastructure and collaboration among stakeholders to achieve better healthcare outcomes in Iran

Adolescent transport and unintentional injuries : a systematic analysis using the Global Burden of Disease Study 2019

Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades.Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019.Findings In 2019, 369 061 deaths (of which 214337 [58%] were transport related) and 31.1 million DALYs (of which 16.2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34.4% (from 17.5 to 11.5 per 100 000) for transport injuries, and by 47.7% (from 15.9 to 8.3 per 100000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80.5% to 42 774 for transport injuries and by 39.4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16.7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48.5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0.2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19.Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Peer reviewe

Continuous monitoring of suspended sediment concentrations using image analytics and deriving inherent correlations by machine learning

The barriers for the development of continuous monitoring of Suspended Sediment Concentration (SSC) in channels/rivers include costs and technological gaps but this paper shows that a solution is feasible by: (i) using readily available high-resolution images; (ii) transforming the images into image analytics to form a modelling dataset; and (iii) constructing predictive models by learning inherent correlation between observed SSC values and their image analytics. High-resolution images were taken of water containing a series of SSC values using an exploratory flume. Machine learning is processed by dividing the dataset into training and testing sets and the paper uses the following models: Generalized Linear Machine (GLM) and Distributed Random Forest (DRF). Results show that each model is capable of reliable predictions but the errors at higher SSC are not fully explained by modelling alone. Here we offer sufficient evidence for the feasibility of a continuous SSC monitoring capability in channels before the next phase of the study with the goal of producing practice guidelines