فصلنامه پژوهش های سلامت محور
پیاپی 1 (تابستان 1394)

One of the most important improvement and health indexes is under 5-year children’s mortality. Recently under 5-year children decreased but it is still more than developing countries. This research aimed to study accidents and injuries of under 5-year children in province of Kerman. This was a descriptive analytical prospective study in2013. This project included 1303 under 5 years children who could refer to three training hospitals 'emergencies which data on accidents for a period of 1 year (2013) were collected from record accident and mortality of health military forms of Kerman Medical University (‌. The study was conducted in 1303 under 5-year children. Data were analyzed by spss19 software and using t-test, ANOVA, 2χtests. Among 1303 under 5-year children were studied, 159 people died. 69% were girls and 31% were boys. The most accidents that occurred for them were injury, poisoning and falling. Accidents range were higher among girls and most of them occurred in 3-4 years old children. Age, Sex and season of death did not have correlation with kind of accident however there was a significant correlation between accidents occurred in under 5-year children and season of death. Three main causes of accidents occurring were injury, poisoning and falling so we must choose proportional trainings with age group and accidents that happened for them, and in addition we should try more to train all society particularly parents that care children.

Outsourcing of hospital care was widely used after the implementation of the Third Socio-economic Development Plan in 2000. A return in policy occurred since 2006. Contracts between private sector and hospitals were cancelled, and the Ministry of Health employed the private sector staff. Outsourcing did not achieveits primary goals of downsizing health sector and improving efficiency. This study aimed to describe the lessons learned from the experience. We conducted a qualitative study. Data were gathered by documents analysis and observations of the hospitals of medical university in Tehran and ten interviews with stakeholders and key informed persons. These people include hospital managers; headquarter experts, contractors, and hospital staff. " Framework Analysis " is used to understand and analyze data. We classified the factors related to unsuccessfulness of outsourcing into four categories (themes) and eight subcategories (sub-themes): 1- Factors related to employers (hospitals) including weakness in designing and monitoring contracts and hospital manager's interference with the activities of the other side of the contracts (private administration) 2- Factors related to private firms including low management knowledge and skills and pursuing short time benefits 3- Factor related to workers including workers protests 4- Factors related to policy space (upper level than hospital) including the gap between work status of formal employees and private sector workers and problems related to management. Unsuccessfulness of outsourcing was related to factors resulted from weak governmental hospital management system. In fact, private sector abilities and efficiency were restricted by weak hospital management potentials in public hospitals. Performing reforms in public management system is essential for successfulness of outsourcing.

Justice and its realization has always been a goal of utopian reformers and leaders in various governments throughout the history. Achieving this goal is the most basic principle of social systems during different periods of human intellectual and social life. Inequities should be decreased between social subgroups in order to gain justice.Attention to inequalities are necessary to ensure all sections of society's access to health resources and optimum resource allocation. Because of the importance of pharmacies in delivering drugs to people and consequently preventing from intensity of diseases and reducing the days lost from work and increasing national production, in this paper the distribution of pharmacies has been studied in 2006-2011. This survey was a retrospective practical study. Data was gathered from Statistical Center of Iran and Kerman Food and Drugs Administrationof Kerman Medical University in 2006-2011. After entering the data into the software and sorting it from the lowest to the highest, the researchers calculated the share of population and sector's share of pharmacies from the total of them and then cumulative percentage of the population and pharmacies. In the last section, Lorenz curve was plotted putting the cumulative percentage of variables against each other. Gini index was calculated using the software Stata 11. Gini coefficient had a decreasing trend in Kerman in the period between 2006-2011. Gini index is about 0.4 during the period of 2006-2009 and 0.3 during 2009-2011. So the distribution of pharmacies was in equitable, and redistribution of some of them was necessary. Access to pharmacies to receive medicines for patients, especially in rural and deprived areas, are important. As reasons of the unequal distribution of pharmacies one can mention lack of attention to age and gender density and the burden of disease in the region and also paying too much attention to economic situation of communities. Government intervention and its participation in the investment with private sector in the establishment of pharmacies in under served areas can reduce inequality and help timely access to drugs for people.

Hospital wastes have high sensitivity due to their hazardous, toxic, and pathogenic agent's contents; therefore, proper management of them plays an important role in the control of environmental pollution and occurrence of hospital infections. In this study, medical waste management in all affiliated hospitals of Kerman University of Medical Sciences was investigated with the purpose of providing proper information for comprehensive and proper planning and enhancing quality of health services in future. This research was a cross-sectional descriptive study the data of which were collected about production, segregation, storage, collection, treating, transportation, and disposal by completing the questionnaire, raw tables, interviews, observation, and visiting in 2012-2013. The total numbers of beds in the studied hospitals are 1512, 1269 of which are active beds. The bed occupancy percentage of the studied hospitals was measured 83.92 %. Also, the average rate of total generated waste was calculated 6.06 kg/bed/day. The mean rate of infectious, medicinal and chemical waste, general waste, and sharp waste were calculated 2.65, 3.35, and 0.08 kg/bed/day, respectively. Our results showed that about 43% of the generated waste was infectious, medicinal, and chemical. Finally, medical waste management in affiliated hospitals of Kerman University of Medical Sciences was in good condition, but it needs more attention in some cases.

Performance assessment process is aimed to assess the degree of predetermined objectivesachievement of the organizations including information on performance, customer satisfaction and achievements, and organizational effectiveness. BSC model is a toolto make a connection between the strategic objectives and the criteria. It also includes a group of performance assessment indices such as financial performance, costumerrelationship, internal processes, growth, and learning. BSC is not only a comprehensive and integrated approach to performance measurement, but also a management system with a new approach to strategic management. This study aimed to asses the performance of faculty libraries affiliated with Kerman university of medical sciences usingbalanced scorecard model. This study was a descriptive and analytical study which was conducted in a cross-sectional method. Faculty libraries affiliated with Kerman University of medical sciences have formed the research setting. The faculty staff as well as the faculty students comprised the study population. Questionnaires were conducted to collect data. Validity and reliability of the questionnaire was determined using content validity and Cronbach's alpha (reliability coefficient of thequestionnaire was 0.91), respectively. Data analysis was done using the descriptive statistics, average score calculation on the basis of five, doing the Kolmogorov - Smirnov test, and t-test using SPSS version 20 software. These findings showed that the mean score and the standard deviation of performance assessment of the libraries affiliated with Kerman university of medical sciences in dimension of resources and infrastructures was 3.21±0.59, the mean score of the dimension of services was 3.61± 0.63, the mean score of effectiveness dimension was 3.45± 0.53, and the mean score of the dimension of development and capacity was 2.85±0.9. Based on the performance assessment using balanced score model, the situation of libraries affiliated with Kerman university of medical sciences was as moderate. Balanced Scorecard model is a useful tool to improve the performance of academic libraries. Balanced Scorecard strategic alignment model using a library function can have a large impact on librariesperformance improvement.

Clinical governance is a framework through which health organizations are accountable to improve the quality of their services continuously and safeguard high standards of care by creating an environment in which excellence in clinical care will be flourished. Since clinical governance approach has been introduced to Iranian hospitals for more than half a decade, and clinical staff have a very important role in implementing and organizing clinical governance, this study aimed to evaluate the clinical staff's attitude toward clinical governance, barriers, facilitating factors, and outcomes of implementing and organizing this approach. The present study was a descriptive analysis conducted in a cross-sectional method at a hospital affiliated with Kerman University of Medical Sciences in 2014. Data were collected using a five-part researcher-made questionnaire (demographic characteristics, attitude, barriers, facilitating factors, and outcomes of clinical governance). Sampling was conducted by the census method, and 147 people of clinical staff participated in the study. Descriptive statistic (percentage, mean, and standard deviation) and analytic statistic (t-test, analysis of variance, and Pearson’s correlation coefficient) have been used. SPSS version 20 software was used for data analysis. The results showed that 73.5% of staff had a background of participation in educational programs of clinical governance. Clinical staff's attitude toward clinical governance was moderate (3.18±1.21), and also barriers, facilitating factors, and outcomes were in moderate level. The staff claimed that the biggest barriers were the increasing bureaucracy, regulations, and paperwork (4.01 ±1.91). The most important facilitating factor was educational programs, such as seminars and workshops (3.77±1.20), and the most important outcome of clinical governance was to prevent errors and mistakes in the way of service and learning from them (3.48 ± 1.95). Since the implementation of clinical governance is complex and dynamic, successful implementation and organization of clinical governance require a strategic plan proportional to the structure, location, and facilities of Iranian hospitals based on its barriers, facilitating factors and its constructive outcomes.

These days expert's believethat lifestyle is one of the most important factors which canaffect health. Realizing and being awareof lifestyle help us change and improve it, and then counteract the risk factorswhich are included in mortality. Lifestyle in aging impacts on their health and conception of aging process. This study intends to determine the lifestyle level among the elderly in Shiraz. In this descriptive-analytical study, 110 elderly members of nursing homesinShiraz were studied. Demographic characteristicsand elderly healthy lifestyle information was collected using a questionnaire, the validity and reliability of which has been proved. We analyzed them by SPSS 20 version using Chi-Square, ANOVA, and Independent t-test. The average of elderly lifestyle scores was 154/33±7/58 that suggests a desirable lifestyle, and there was no meaningful difference between both sexes. (P>0/05). Chi-Square test showed that there was a significant relationship between the area of personal and social relationship and sex, (P=0/002), (r=0/01). The results also showed that there is a significant relationship between the area of prevention and sex (P =0/042). Despite desirableelderly lifestyle, interventions to raise awareness about their healthy lifestyles, particularly in areas of nutrition, are essential. Increased awareness of chronic diseases in the elderly, can increase theirunderstanding of the potential health consequences resulting from their performance and encourage them to make effective lifestyle changes.