مجله پایش
سال بیست و سوم شماره 1 (پیاپی 113، بهمن و اسفند 1402)

The use of statistical methods to reach the clustering and ranking of health in the society can give a proper view of the state of health in Iranian provinces. The aim of the current research was to cluster and rank Iranian provinces based on some health indicators.

This was a descriptive study. Clustering and ranking Iranian provinces were carried out according to several items such as the number of employees working in faculties of medical sciences, doctors, paramedics, hospitals, active beds, primary health care providers, laboratories, rehabilitation centers, nuclear medicine centers, clinics and emergency centers. The data were collected from the statistical yearbooks of the provinces.  Clustering analysis and data visualizations were performed in R software and ranks were obtained using Topsis software.

The results showed that the provinces of Ilam, Yazd, Semnan, South Khorasan, Zanjan, Ardabil, Fars, Kohgiluyeh and Boyer Ahmad, and Chaharmahal and Bakhtiari had the highest health scores and belonged to the third cluster. Their ranks were 1 to 9 respectively. In the first cluster the following provinces were observed: Qom, Tehran, Alborz, and Hamedan with scores of 0.552, 0.540, 0.460, and 0.36 respectively indicating that these provinces had the lowest health scores and their ranks were 28 to 31. The other provinces appeared on the second cluster and ranked 10 to 27 with almost equal scores.

In order to achieve health equity, the indicators should be improved in provinces belonged to the first cluster to in order to achieve the standard per capita.

Objective (s): 

Health services tariff is “the mandated price of health services determined by authorities and must be paid to healthcare providers in exchange of receiving services”. The pricing and tariff-setting system of healthcare services in Iran is facing challenges. This study aimed to identify and explain healthcare pricing and tariff-setting methods.

This study was conducted in 2023. Five English databases (i.e., PubMed, Web of Science, Scopus, Embase, and ProQuest) and three Persian databases (i.e., Magiran, Iranmedex and SID) and Google and Google scholar search engines were searched to find scientific sources. Finally, 45 documents related to healthcare pricing and tariff-setting methods were selected and analyzed using MAXQDA software version 10.

Overall, 20 healthcare pricing and tariff setting methods were identified, including capitation, per diem, fee-for-service, global budget, negotiation-based, resource-based relative value scale, cost-plus, value-based, pay-for-performance, best practice-based, diagnosis-related groups, bundled, reference, tiered, sliding-scale, premium, market-based, risk-adjusted, subscription and competitive bidding. Each of these pricing and tariff-setting methods has advantages and disadvantages. In general, the prospective and fixed pricing methods reduce healthcare costs and increase the efficiency of healthcare organizations. The use of complementary value and performance based methods improve the quality of health services.

Health care pricing and tariff-setting methods affect access to health services, and quality and cost of health services. The capitation method along with the value and performance based methods are suggested for the pricing of outpatient services; and diagnosis related groups, bundled and best performance-based methods are suggested for the pricing of inpatient services in Iran.

The healthcare environment should provide the highest level of safety for staff and clients. This study aimed to assess the structural and non-structural safety status of Tabriz primary health care centers.

This cross-sectional study assessed 40 comprehensive healthcare centers in Tabriz, Iran in 2019. The data collection instrument was a self-designed questionnaire We assessed the compliance of comprehensive healthcare centers with the standards checklist through conducting interviews, considering observations, and reviewing the documents. The descriptive results for qualitative data were reported as frequency (percentage) and for quantitative data as mean (standard deviation). Furthermore, to evaluate the association between contextual variables and physical safety status of centers, t-test, ANOVA, and Tukey’s post hoc tests were used as appropriate (structural or non-structural).

The results of the study showed that the level of structural, non-structural, and total safety for the physical space of the centers was 48.2%, 37.4%, and 43%, respectively. Accordingly, based on cutting points, the level of structural safety and total safety was identified as moderate, and the level of non-structural safety was identified as low. In addition, descriptive results showed that there is a statistically significant relationship between urban area and non-structural safety so that non-structural safety of centers located in zone 4 was significantly higher than the safety of centers located in zone 10 (P = 0.011).

Based on the findings, the safety status of Tabriz health centers was identified as unfavorable and will not able to provide proper services to their covering population in serious hazards.

Considering the high number of traffic accidents in Iran, it seems necessary to investigate the factors related to the severity of traffic accidents. The purpose of this study was to investigate the relationship between compliance with safety precautions and the severity of injuries caused by traffic accidents in Urmia, Iran.

This was a cross-sectional study. The study was conducted retrospectively on available data of the trauma registration system from 2017 to 2022. The research population included 428 drivers who were admitted to a teaching hospital for trauma caused by the traffic accident in Urmia, Iran. Chi-square and Fisher's statistics were used to investigate the relationship between demographic variables, damaged area, behavioral factors, use of safety equipment (air bag and seat belt) and severity of injury.

From 428 drivers injured in traffic accidents, the most injuries were in the head and neck areas. Non-use of seat belts and absence of airbags were reported in 277 and 340 cases of accidents, respectively. 287 people had a history of alcohol consumption, 284 people had a history substance abuse, and 346 people had a history of drug use. A significant relationship was observed between age, gender, injured area, use of seat belts, having airbags, alcohol and drug consumption with injury severity (P<0.05). While the relationship between substance abuse and injury severity was not significant (P=0.517).

The results showed that age, gender, lack of seat belt use, lack of airbags, drug use, alcohol, and the injured area were the most factors related to the occurrence of higher severity injuries.

The current study was conducted aiming to assess the effect of moral foundations on academic integrity through the mediation of religious orientations.

This was a cross sectional study on 544 (413 females & 131 males) convince sample of students of Tehran universities in Iran. The required data were collected using a multi-part questionnaire including demographic information, the Moral Foundation Questionnaire (MFQ), the Circumplex Religious Orientation Inventory (CROI), and the Academic Dishonesty. Then data were analyzed using Structural Equation Modelling (SEM) and bootstrap test was used to check the mediating role of variables.

The mean age of participants was 23.96 ± 6.43 years ranging from 17 to 53. The results showed that there was a positive and significant correlation between academic integrity and moral foundations (r=0.14, p<0.01). Also the correlation between academic integrity and religious orientation were significant (r=-0.18-0.21, p<0.01). Based on the findings moral foundations and academic integrity had a statistically significant direct relationship (P<0.001), but through the mediation of religious orientation, this relationship was not significant, which indicated that there was a full mediation effect.

The findings suggest that religious orientation mediates the relationship between moral foundations and academic integrity. In general, it seems that by increasing moral foundations, religious orientation could be affected and in turn academic integrity will be increased.

Postpartum depression is common in women. The present study was conducted with the aim of investigating and comparing the prevalence and factors affecting symptoms of postpartum depression in 6 months before and after the beginning of the covid-19 pandemic.

This cross-sectional study compared symptoms of postpartum depression in 39724 women who gave birth 6 months before the COVID-19 pandemic and 6100 women who gave birth after the COVID-19 pandemic. The information related to the symptoms of postpartum depression was extracted from mental health screening records that are commonly used in health centers covered by the Ministry of Health. General information was obtained from the National Integrated Health System of the Ministry of Health and the data were analyzed in SPSS 22 software.

The prevalence of postpartum depressive symptoms 6 months before and 6 months after the COVID-19 pandemic was 1.9% and 2.6%, respectively. Symptoms of Postpartum depression 6 months before the COVID-19 pandemic significantly was associated with age, body mass index, history of infant death, unwanted pregnancy, the number of births (P<0.05), while symptoms of postpartum depression 6 months after the COVID-19 significantly was associated with education, unwanted pregnancy, the number of births (P<0.05). Based on multiple logistic regression analysis, the COVID-19 pandemic increased symptoms of postpartum depression [(OR=1.49, 95% CI: (1.12– 1.83)].

The COVID-19 pandemic influenced postpartum depression. The findings from the current study might be helpful in postpartum depressive symptoms management in the future crises.

Mothers of preterm infants have some challenges in comprehending the maternal role. This study aimed to assess the effectiveness of an educational intervention on maternal role adaptation and anxiety among mothers with preterm infants in the Neonatal Intensive Care Unit (NICU).

This was an interventional study with pre- and post-test design. Participants were 72 mothers selected through convenience method. Then they were divided in two groups randomly (36 samples per intervention and control groups). Data were collected by demographic questionnaire, the Spielberger State-Trait Anxiety Inventory (STAI) and the Adaptation to Maternal Role Questionnaire (AMRQ). Interventions included seven training sessions to clarify and practice intended topics. Data were analyzed in SPSS version 24 software.

The mean maternal role adaptation after the training course increased and showed a significant improvement compared with before the intervention (130.78, SD = 9.94 vs. 113.64, SD = 15.90; P = 0.001). Also, a significant decrease was observed between the mean anxiety score of mothers in the intervention group before and after education (101.89, SD =7.82 vs. 91.83, SD = 8.83; P =0. 001). No significant difference was observed among the control group either for maternal role or anxiety.

Mothers training reduces anxiety and increases maternal role adaptation of mothers of preterm infants. It is suggested that mothers training be used as one of support programs to reduce the anxiety level of mothers in the neonatal intensive care unit.

Objective (s): This study aimed to assess the relationship between aggression and the quality of life of couples applying for divorce.

This was a cross sectional study. The statistical population was all couples who applied for divorce and referred to the Yazd Family Consolidation Center, Iran in 1400. Of these, a sample of 180 individuals were selected through availability.  The Aggression Questionnaire (AQ) and the World Health Organization Quality of Life (WHOQOL-100) questionnaire were used to collect the data. The data were analyzed by performing Pearson's correlation and structural equation modeling.

The findings obtained from the correlation matrix showed that there was an inverse and significant relationship between the dimensions of aggression and the dimensions of quality of life (r = -0.43). The structural equation model also showed that aggression had an inverse and significant effect on quality of life (p<0.01). In total, the aggression explained 18% of the variance of the quality of life. The fit indices indicated the goodness of fit of the model and supported the data for the model.

Quality of life has an inverse relationship with aggression in general. In particular, anger and physical aggression are related to mental health reduction.

Grief is a natural experience that helps bereaved people process the pain of loss and move toward healing. Throughout the COVID-19 pandemic, the bereaved people were faced with unprecedented conditions due to the absence of mourning ceremonies. The present study was to explore the personal experience by which the bereaved ones encountered the situation.

A qualitative study was conducted with a purposeful sample of Iranians who had lost a family member due to the virus. Data were collected using unstructured interviews until saturation was research. The study was conducted during 2021-2022

We interviewed 16 bereaved people. The data analysis revealed 14 subcategories, 3 categories: failed mourning, bitter loneliness, incomplete gestalt of grief and a core theme as endless sorrow.

The findings showed that not holding mourning ceremony during the covid-19 epidemic caused bereaved people with a large number of unfulfilled expectations. It seems that there is need to find a way through the stages of mourning for these people by addressing their expectations and wishes.

Objective (s):

 The Covid-19 or the respiratory acute syndrome disease has become one of the most important health concerns worldwide. Hence, receiving the correct information is a basic need for prevention of the disease. This study aimed to assess how rural population accessed the Covid-19 information.

This cross-sectional study was conducted from April 2022 to February 2023. Using the multi-stage sampling method, nine hundred rural populations from the Sistan, Iran considering the inclusion criteria randomly were entered into the study. Data collection instrument included socio-demographic and specific items. The data were analyzed using descriptive statistics (mean, percentage) and statistical tests (chi square test, and one-way anova test). The significant level set at p≤ 0.05.

The mean age of the participants was 35.85 ± 12.56 years, and 52.4 percent of the participants were women and 38% had primary education. Data analysis according to different social media showed that 66.6% of participants obtained information through rural health workers and the mean scores of knowledge (14.15±2.84 out of a total score of 16) and preventive behaviors (16.69±4 out of 21) were significantly higher than who obtained information from other different sources. In addition, the lowest source information was radio (8.3%).

According to the findings, rural health workers were the most important source for providing information on Covid-19 among rural population. It seems that the rural health networks have a vital role in health promotion of rural population.

Dear Editor, In “before-after" intervention studies with qualitative outcome(s), we should not use the same formula when the outcome(s) are quantitative since the appropriate variance in this formula are not used and thus the sample size will not have adequate confidence and power.  A formula for such studies is proposed to overcome problems highlighted above.

Dear Editor,Health policy is course of actions developed by policy makers and senior managers in the areas of financing, resource generation and health service delivery to promote, restore, and maintain health of the community. In fact, health policies are guides for formulating health programs and actions by front-line managers. Research evidence should be used for health policy making. A policy brief is a short document that presents the findings and recommendations of a research project to policy makers and senior managers. It is a tool for providing policy advice to health policy makers, which includes a summary of the issue or problem, solutions to solve the problem and their advantages and disadvantages. The purpose of the policy brief is to help policy makers or people influencing the policy making process to make better and faster decisions. Therefore, the policy brief should include background information to fully understand the problem and its root causes, convince the policy maker of the necessity of solving the problem, provide the necessary information on the best options for solving the problem and encourage the policy maker to make the right decision. The main and mandatory components of a policy brief are the title, executive summary, introduction, policy problem, research method and findings, policy recommendations and policy implications. Optional components of a policy brief include columns, case studies, tables, figures, graphics, photographs, authors' names, acknowledgments, publication details, and references.