Patient Safety Behavior in Physicians: How is it Predicted?

Background: Patient safety is a serious global public health issue. Estimates show that every day many patients are harmed while receiving hospital care. Health care staff plays a key role in providing quality and safe patient care, especially physicians who are main members of the medical team and a critical element in patient safety efforts. Objective: The current study used a Theory of Planned Behavior (TPB) framework to investigate predictors of patient safety intentions and behavior of physicians. Methods: This descriptive analytical study was conducted in 8 hospitals with 52 physicians participating. A researcher-designed questionnaire was prepared to investigate patient safety behaviors and behavior constructs of physicians based on the guidelines of constructing a TPB Questionnaire: Conceptual and Methodological Considerations. The content validity and reliability of the questionnaire were confirmed. Binary logistic regression analysis was performed using SPSS18. Results: The total mean score of physician safety behavior indicated that 3.8±0.92. 42% of physicians reported their safety behavior at a good level. There was no significant difference between the patient safety function of physicians in public and private hospitals (P=0.8) and working in medical or surgical wards (P=0.4). Among TPB constructs, “normative beliefs” had the greatest influence on physician intention for safety behaviors (wald=3.828, P=0.05). Conclusion: The results showed that “normative beliefs” had the greatest influence on physician intention for safety behaviors; therefore, it seems that patient safety must be the most important concern of all health care staff, specifically managers and executives throughout health care centers

First draft genome sequence of the Acidovorax caeni sp. nov. type strain R-24608 (DSM 19327)

We report the draft genome sequence of the Acidovorax caeni type strain R-24608 that was isolated from activated sludge of an aerobic-anaerobic wastewater treatment plant. The closest strain to Acidovorax caeni strain R-24608 is Acidovorax sp. strain MR-S7 with a 55.4% (amino-acid sequence) open reading frames (ORFs) average similarity

The human cost of economic sanctions and strategies for building health system resilience: A scoping review of studies in Iran

Objectives This review aimed to analyse the impacts of international economic sanctions on the overall health status of Iranians and the health system performance of Iran, in addition to identifying effective strategies for making the health system resilient to sanctions. Study design A scoping review. Methods Three databases and grey literature were reviewed, and additional papers were identified in the lists of references. Two authors reviewed papers to check duplications and screen through inclusion/exclusion criteria. Furthermore, a narrative approach was employed to synthesise the findings. Results Given overall health impacts, economic sanctions are believed to have adverse effects on Iranian's health and cause significant financial hardships in accessing healthcare services. These hardships mostly affect those in marginalised and vulnerable groups. Economic sanctions degrade Iran's health system by negatively impacting health services' availability. The detrimental effects of sanctions on economic and social circumstances were also documented. Economic sanctions could also adversely affect health research and education. Most strategies identified for health system resilience to sanctions are related to the health system governance. Conclusions Even if essential medicines and supplies are exempted from the sanction regime, the impact of economic sanctions on public health is unavoidable. The quantification of the effect economic sanctions on different health-related areas needs by further research. The measures identified for dealing with sanction can be considered in other countries but more work is needed to explore how health of people can be resilient against negative consequences of sanctions

Analysis of Physicians' Retention Policies in Deprived Areas of the Islamic Republic of Iran

Introduction: The concentration of physicians in urban areas and the lack of specialist physicians in deprived ‎areas is a global challenge. It is necessary to adopt specific, scientific and evidence-based policies ‎to increase the health sector’s resources and reduce inequality in the distribution and allocation of ‎these resources in different regions of the‏ ‏country. The Ministry of Health and Medical ‎Education, as the most important custodian of planning and policy-making for distribution of ‎specialized manpower in Iran, has designed policies.Methods: This study aimed to analyze the incentive ‎policies for the retaining physicians in deprived areas of the country. This study has a qualitative ‎‎– retrospective design to analyze the most effective policies using the Walt and Gilson policy ‎model. Various methods were used to analyze the policies, including reviewing texts and ‎documents.Results: Findings of the study were classified based on the policy context, policy content, ‎policy-making process and role makers in the four law (policies or plan) of service of physicians ‎and paramedics, family physician plan, health transformation plan, and instructions on how to ‎distribute the Specialized medical graduates. Five legal, political-economic, socio-cultural, ‎international and structural factors were identified as policy making factors‏. ‏‎ In addition, ‎attention to upstream documents and the use of evidence in policy-making were identified as ‎strong points, and stakeholder ignorance and a top-down approach to planning were identified as ‎common weak points of policies.Conclusion: Considering the priority of needs, provision of resources and ‎requirements, constructive interaction of planners, and continuous evaluation of programs are ‎required to formulate and implement policies and interventions

Antimicrobial activity of three different endodontic sealers on the enterococcus faecalis and lactobacillus (in vitro)

Introduction: Growth and proliferation of the remaining microorganisms within the root canals may destroy the surrounding tissue of the root and leads to periapical lesion. Consequently, the complete elimination of microorganisms from the root canal is an important goal of endodontic therapy. Endodontic sealers do not provide complete seal in root canal system, and micro spaces have always remained between the material and canal walls that lead to penetration of these spaces, so, an antibacterial activity is essential for sealers. The aim of the present study was the in vitro evaluation of antimicrobial activity of the three endodontic sealers on two microorganisms. Methods: To study the effect of each sealer; AH26, MTA Fillapex and ADseal on Enterococcus Faecalis and Lactobacillus bacteria 10 samples were considered. In this experimental study, 60 plates were exposed to bacteria and 10 plates were considered for control group. Sealer antibacterial effect on bacterial growth was studied after 48 hours. Firstly, the freshly prepared sealers were poured inside the micro tube and diffused in the wall of the micro tube. Then solution of nutrient broth was poured into a micro tube and the determined volume of solution of bacterial suspension was added into a microtube and was kept 24 hours in the incubator to grow the bacteria. Then, it was poured in the plates of blood agar and cultured after 24 hours and then the colonies grown on the plates were counted in sufficient light. The data were analyzed with MANOVA statistical test and SPSS Version 18. Results: Most bacteria grew in the plates of ADseal sealer and MTA fillapex sealer with means of 5113.00CFU and 3077.00CFU respectively, while the lowest number of bacteria grew in the plates of AH26 sealer with a mean of 1345.15CFU. Conclusions: Most antibacterial activities of each enterococcus faecalis and lactobacillus bacteria sample was for AH26 sealer and MTA fillapex sealer. The lowest antibacterial activity was for ADseal sealer

Willingness to Pay in Choosing Pre-hospital Emergency Services in Iran: A Population-Based Discrete Choice Experiment

Providing pre-hospital emergency services is accessible in Iran but costly for the country’s health system. This study calculated the willingness to pay (WTP) for pre-hospital emergency services in Iran. Discrete choice experiment (DCE) was used to measure the population’s WTP for ambulance services focusing on time, price, and quality of services. Four hundred and sixty people in Rasht city, Iran, participated in this online survey. Participants preferred lower transfer fees (β = -0.7, P˂ 0.05), lower time of reaching to the scene (β = -0.061, P˂ 0.05), lower time to arrive to the hospitals (β = -0.038, P ˂ 0.05), Private ambulance (β = -0.151, P ˂ 0.05), and emergency medical services (EMS) technicians (β = 0.209, P ˂ 0.05). Patients’ WTP in selecting EMS services can help policymakers to provide the best services

Developing Framework and Strategies for Capacity Building to Apply Evidence-Informed Health Policy-Making in Iran: Mixed Methods Study of SAHSHA Project

BACKGROUND: SASHA, which stands for "evidence-informed health policy-making (EIHP)" in Persian, is a national project to draw a roadmap for strengthening EIHP in Iran. As a part of SASHA, this research aimed to develop evidence-based and context-aware policy options for increasing the capacity of decision-makers to apply EIHP in Iran. METHODS: This was a qualitative study, which was informed by a literature review of pull efforts' capacity building programs. Based on the review, we developed policy options and validated them through an expert panel that involved twelve experts. Data were analyzed using a content analysis method. RESULTS: We extracted data from 11 articles. The objectives of capacity building programs were: single-skill development, personal/professional development, and organizational development. According to these objectives, the contents and training methods of the programs vary. Capacity building programs have shown positive impacts on individual knowledge/attitudes to use EIHP. However, the impacts of programs at the organizational or the health system level remain under-researched. We followed several threads from the literature review through to the expert panel that included training the management team, instead of training managers, training for problem-solving skills, and designing tailored programs. Barriers of capacity building for EIHP regard the context of the health system (weak accountability and the widespread conflict of interest) and healthcare organizational structures (decision support systems, knowledge management infrastructures, and lack of management team). Experts suggested interventions on the barriers, particularly on resolving the conflict of interests before launching new programs. A proposed framework to increase the capacity of health policy-makers incorporates strategies at three levels: capacity building program, organizational structure, and health system context. CONCLUSION: To prepare the context of Iranian healthcare organizations for capacity building programs, the conflict of interests needs to be resolved, decision-makers should be made more accountable, and healthcare organizations need to provide more knowledge management infrastructures and decision support systems

Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Human resources for health (HRH) include a range of occupations that aim to promote or improve human health. The UN Sustainable Development Goals (SDGs) and the WHO Health Workforce 2030 strategy have drawn attention to the importance of HRH for achieving policy priorities such as universal health coverage (UHC). Although previous research has found substantial global disparities in HRH, the absence of comparable cross-national estimates of existing workforces has hindered efforts to quantify workforce requirements to meet health system goals. We aimed to use comparable and standardised data sources to estimate HRH densities globally, and to examine the relationship between a subset of HRH cadres and UHC effective coverage performance. Methods: Through the International Labour Organization and Global Health Data Exchange databases, we identified 1404 country-years of data from labour force surveys and 69 country-years of census data, with detailed microdata on health-related employment. From the WHO National Health Workforce Accounts, we identified 2950 country-years of data. We mapped data from all occupational coding systems to the International Standard Classification of Occupations 1988 (ISCO-88), allowing for standardised estimation of densities for 16 categories of health workers across the full time series. Using data from 1990 to 2019 for 196 of 204 countries and territories, covering seven Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) super-regions and 21 regions, we applied spatiotemporal Gaussian process regression (ST-GPR) to model HRH densities from 1990 to 2019 for all countries and territories. We used stochastic frontier meta-regression to model the relationship between the UHC effective coverage index and densities for the four categories of health workers enumerated in SDG indicator 3.c.1 pertaining to HRH: physicians, nurses and midwives, dentistry personnel, and pharmaceutical personnel. We identified minimum workforce density thresholds required to meet a specified target of 80 out of 100 on the UHC effective coverage index, and quantified national shortages with respect to those minimum thresholds. Findings: We estimated that, in 2019, the world had 104·0 million (95% uncertainty interval 83·5–128·0) health workers, including 12·8 million (9·7–16·6) physicians, 29·8 million (23·3–37·7) nurses and midwives, 4·6 million (3·6–6·0) dentistry personnel, and 5·2 million (4·0–6·7) pharmaceutical personnel. We calculated a global physician density of 16·7 (12·6–21·6) per 10 000 population, and a nurse and midwife density of 38·6 (30·1–48·8) per 10 000 population. We found the GBD super-regions of sub-Saharan Africa, south Asia, and north Africa and the Middle East had the lowest HRH densities. To reach 80 out of 100 on the UHC effective coverage index, we estimated that, per 10 000 population, at least 20·7 physicians, 70·6 nurses and midwives, 8·2 dentistry personnel, and 9·4 pharmaceutical personnel would be needed. In total, the 2019 national health workforces fell short of these minimum thresholds by 6·4 million physicians, 30·6 million nurses and midwives, 3·3 million dentistry personnel, and 2·9 million pharmaceutical personnel. Interpretation: Considerable expansion of the world's health workforce is needed to achieve high levels of UHC effective coverage. The largest shortages are in low-income settings, highlighting the need for increased financing and coordination to train, employ, and retain human resources in the health sector. Actual HRH shortages might be larger than estimated because minimum thresholds for each cadre of health workers are benchmarked on health systems that most efficiently translate human resources into UHC attainment

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

Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

Background: Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. Methods: We distinguished the overall HAQ Index (ages 0–74 years) from scores for select age groups: the young (ages 0–14 years), working (ages 15–64 years), and post-working (ages 65–74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. Findings: Between 1990 and 2019, the HAQ Index increased overall (by 19·6 points, 95% uncertainty interval 17·9–21·3), as well as among the young (22·5, 19·9–24·7), working (17·2, 15·2–19·1), and post-working (15·1, 13·2–17·0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30·7 (28·6–33·0) on average in low-SDI countries to 83·4 (82·4–84·3) on average in high-SDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40·4–89·0), working (33·8–82·8), and post-working (30·4–79·1) groups. Absolute convergence in HAQ Index was estimated in the young group only. In contrast, divergence was estimated among the working and post-working groups, driven by slow progress in low-SDI countries. Interpretation: Although major gaps remain across levels of social and economic development, convergence in the young group is an encouraging sign of reduced disparities in health-care access and quality. However, divergence in the working and post-working groups indicates that health-care access and quality is lagging at lower levels of social and economic development. To meet the needs of ageing populations, health systems need to improve health-care access and quality for working-age adults and older populations while continuing to realise gains among the young. Funding: Bill & Melinda Gates Foundation