مقالات رزومه دکتر محمدعلی جهانی

Pharmaceutical costs account for a major part of health-related costs, and the induced demand for medicine imposes a large financial and economic burden on individuals and the whole society. Therefore, the aim of the present study is to identify the factors effective in creating induced demand for medicine in Iran.

This study is based on grounded theory approach and it was conducted in 2022. The interview questions were semi-structured and asked by experts. The initial selection of the samples was based on targeted sampling from among experts and scholars in the field of medicine and treatment from all over the country. The snowball method was used to increase the sample volume until it reached sufficiency. This research was completed by interviewing 20 experts.

The key factors effective in creating induced demand were identified in the form of 4 themes, 8 categories and 31 subcategories. The extracted themes included social, structural-organizational, economic and beneficiary-related factors. Social factors included the categories of society's culture and pharmaceutical literacy, structural-organizational factors included the categories of regulatory mechanisms and educational and political factors, economic factors included the categories of payment and insurance systems, and finally the beneficiary-related factors included the categories of suppliers and demanders.

Based on the results of this study, several factors play a role in the creation of induced demand for medicine, and following these factors can help policymakers formulate appropriate strategies to reduce unnecessary medicine prescription.

Accidents as the second cause of disability and the main cause of disability and death can lead to physical and mental disorders and even death. The present study was conducted to investigate the mortality caused by accidents and incidents in Babol, Northern Iran, based on the international classification of diseases.

This cross-sectional study was conducted retrospectively on all the deaths recorded during the years 2016-2022 in registration and classification system of causes of death caused by accidents and incidents at the health department of Babol. Deaths caused by accidents and incidents were extracted and analyzed based on ICD-10.

Out of 18265 deaths, 1305 cases (15.7%) were related to accidents and incidents, of which 686 deaths (52.57%) were caused by traffic accidents. The highest frequency of accidents and incidents was 576 cases (44.13%) due to a person being injured in an unknown (traffic) accident and 182 cases (13.95%) being exposed to an unknown factor. The mean age in deaths caused by accidents and incidents in the traffic accident group was 46.05±22.07 and in the non-traffic accident group was 43.35±23.49 years (p=0.033). As the decades of age increased, the death rate increased (p<0.001).

Based on the results of this study, most of the deaths caused by accidents and incidents based on the classification system of the causes of death were due to the injury of a person in an unknown accident, exposure to unknown factors and poisoning.

Equitable access to health services and their fair distribution in the country, especially in deprived areas, are among the major goals of health systems. The aim of this study was to investigate the amount of health insurance subsidies in different socio-economic classes in public hospitals in Babol, Iran.

This cross-sectional applied study was performed in hospitals affiliated with Babol University of Medical Sciences in 2018. The statistical population consisted of 700 patients selected by simple random sampling. Data were collected using a checklist based on patient statements and a researcher-made questionnaire. SPSS V22 was used to analyze the data applying Mann Whitney and Kruskal Wallis test.

The amount of health insurance subsidies for patients of middle social class was higher than other two groups (good and lower social classes). The most discount on medical bills were offered to good-social class patients and then to patients of middle and lower classes (P<0.05). Also, health insurance subsidy paid to patients with good economic status (450,000 Tomans) was higher than patients with poor economic status (430,000 Tomans) (P<0.05).

Current study showed that health subsidies and medical bill discounts were not commensurate with patients’ social and economic status. In fact, patients who had good conditions in terms of these characteristics, benefited more than other groups.

The assessment of the interest of medical students in continuing their studies in specialized fields and the factors affecting it can play a strategic role in macro educational planning. Therefore, the present study aimed to assess the level of academic interest and the factors affecting the choice of specialty in medical students of Babol University of Medical Sciences.

In this applied cross-sectional study, the study population included incoming medical students from 2009 to 2017 in clinical preparation, stager, and internship. The participants were selected by the convening sampling, and the research tool was a researcher-made questionnaire. Data were collected and entered into SPSS software (version 22) and analyzed by related tests at a significance level of p-value ≤ 0.05.

The mean age of students was 23.02±1.65 years, and124 (61/4%) students were female. Moreover, 96.6% of students wanted to continue their studies in residency. Social status in 142 (70.3%) students and lack of free time in 97 (48%) students, respectively, were the most important positive and negative influential factors in the selection of medicine as the field of study. Three fields of cardiology  (n=9; 145.1%), radiology 84 (n=84; 41.6%) and ophthalmology  (n=82; 40.6%) were the first three priorities. No statistically significant difference was observed in gender in any of the specialties, except urology (P=0.008).

Interest, social status, income, years of study, and hospital attendance status were the factors affecting the choice of residency among medical students.

The mortality in children aged 1-59 months is one of the important indicators in assessing the general health status of a community. The death control system for children aged 1-59 months is used to record and review this indicator in Iran. This study was performed to investigate the mortality rate in children aged 1-59 months in affiliated healthcare centers of Babol University of Medical Sciences based on ICD10.

In this cross-sectional study, all cases of death in children aged 1-59 months registered in affiliated healthcare centers of Babol University of Medical Sciences in 2009-2020 were collected by referring to the reports recorded in the death control system for children aged 1-59 months. Then, information about the cause of death and the trends of mortality during the years 2009-2020 were reviewed.

Out of a total of 303 cases of death in children aged 1-59 months, 179 cases (59.07%) were boys, the mean age of children was 13.08±15.12 months and with 175 cases (57.75%), the highest mortality rate was related to urban areas. The general trend of mortality was declining; from 41 cases in 2009 to 14 cases in 2020 (p≤0.001). Congenital and chromosomal abnormalities in 100 cases (34%), endocrine, nutritional and metabolic diseases in 56 cases (18.48%), nervous system diseases in 23 cases (7.59%) and cancers in 22 cases (7.26%) were respectively the most common causes of death.

The results show a declining trend in the mortality of children aged 1-59 months.

One of the challenges of health care system in Iran is the disproportionate level of the health houses compared to the people’s need. As health houses are considered the first line of defense in the realm of health, their excellence is crucially important to achieve acceptable performance. Thus, this study aimed to analyze the excellence strategies of health houses located in Iran rural areas. In this systematic review study, twelve electronic databases and search engines were searched by related keywords to find articles in both Persian and English from 2000 to 2020. CASP checklist was employed to evaluate the quality of these articles which were about primary health care. Out of 558 articles, 28 were selected with related titles, abstracts, and content. The findings of this study revealed that the main strategies of rural health houses’ excellence included improving the quality of care services, information technology, work conditions, the behavior of service providers, community participation, support and motivation, as well as improving governance and leadership strategies with several sub-strategies. Rural health houses’ excellence strategies revitalize and recreate the passivized role and mission of health houses in achieving the goals of primary health care in Iran health care system. Therefore, rational, balanced, scientific, and systematic investment is required not only in one strategy but in all mentioned strategies.

Risk assessment is one of the most important strategies in estimating the risk of cardiovascular disease and controlling the risk factors. In Iran, half of all deaths and 79% of deaths due to non-communicable diseases are attributed to cardiovascular diseases. The aim of this study was to analyze the results of cardiovascular disease risk assessment program in Mazandaran province.

This cross-sectional study was performed in 2019 on 600 patients referred to comprehensive health centers of Noor and Mahmoudabad cities in Mazandaran province. The data collection tool was a checklist containing the risk factors studied in the SIB system. Descriptive statistics such as mean, standard deviation, frequency and percentage as well as analytical statistical tests such as chi-square, regression and analysis of variance were used using SPSS software version 19.

The prevalence of risk factors for cardiovascular disease including history of diabetes, history of hypertension, obesity, high cholesterol, family history of diabetes and heart disease were 36.5%, 45.5%, 42.3%, 34.8%, 23.5% and 10%, respectively. The four variables of age, history of diabetes and hypertension, and blood cholesterol levels were significantly associated with the 10-year risk of cardiovascular disease. With increasing one year of age, the 10-year risk level increased by 15% (p<0.001), and by seven times in people with a history of diabetes (p<0.001) and increased by 83% in people with a history of high blood pressure compared to others individuals (p=0.022).

The results of the study showed that in Mazandaran province, four variables of age, history of diabetes and hypertension and cholesterol levels are the most common factors that are associated with 10-year risk of cardiovascular disease.

Assessing health systems paves the way for reforms in structures and processes to achieve better results. Therefore, the present study was conducted to evaluate the implementation of family physician program in urban and rural areas of Mazandaran province using process approach.

This cross-sectional study was conducted in 2017 among 238 managers, health experts and health insurance experts who were selected by census from 12 cities. Data were collected and evaluated using a researcher-made questionnaire with high validity and reliability, which evaluates urban and rural family physician program in three domains of structure, process and outcomes.

The mean score of the domain of structure (4.27±27.38), process (4.33±0.41) and outcomes (4.31±0.39) of rural family physician program was significantly higher than urban family physician program (p<0.001). In the urban family physician program, the most important dimension in the domain of structure was equipment (3.35±0.76), in the domain of process was care for non-communicable diseases (3.15±1.06) and in the domain of outcomes was reasonable prescription of medicine (3.07±1.02). In the rural family physician program, the most important dimension in the domain of structure was physical space (4.41±0.60) and in the dimensions of process and outcomes, the health of mothers and children (4.20±0.90) and the improvement of health promotion indicators (4.33±0.76) were more important, respectively.

Based on the results of this study in three domains of structure, process and outcomes, the rural family physician program was relatively better than the urban family physician program.

In addition to reducing the costs in hospitals, manpower planning can ensure the quality of patient care. Therefore, this study, which is part of a comprehensive study, was conducted with the aim of applying the birth rate method to estimate the number of midwives required in the maternity ward.

In this analytical study, 334 patients who referred to the delivery ward of two hospitals affiliated to the Social Security Organization in Khorasan Razavi province were selected by systematic random sampling. Retrospective data were collected from patients  medical records using the Birthrate Plus (BR+) model questionnaire consisting of 34 items related to maternal and neonatal clinical factors based on scores obtained in five groups (score 6 in group one, score 7-9 in group two, score 10-13 in group three, score 14-18 in group four, and score 19 and above in group five). Then, the data were analyzed.

The results showed that the duration of stay in the maternity wards of the province and district hospitals was 12.07±5.18 and 7.17±4.22 hours, respectively (p<0.001). The mean duration of midwife s care in the two hospitals was significantly different (p<0.001). The results indicated more patients with complex conditions in the maternity ward of the province hospital. According to the "BR+" model, about 60% of patients in the province hospital were in groups 4 and 5, while it was 18% in another hospital. The number of midwives required in district and province hospitals was 27 and 72, respectively, based on full-time equivalent (FTE), which was obtained by converting it into an index equivalent to one midwife for 142 and 95 annual deliveries in the mentioned hospitals.

The results of the study showed that the use of the BR+ model, considering the length of stay and the severity of clients symptoms, is a suitable model for determining the midwifery staff in the maternity ward.

Cancers are a wide range of diseases, and their numbers are increasing but the severity of the disease is varied in different cancers. This study was conducted to evaluate the frequency of referrals of cancer patients referred to hospitals affiliated to the Babol University of Medical Sciences based on ICD10.
This retrospective study was conducted on all cancer patients referring to hospitals affiliated to Babol University of Medical Sciences from 1992 to 2016. The information related to the patients who referred to these centers for the first time were collected and reviewed using a checklist including hospital name, case number, age, sex, occupation, marriage, place of residence, type of cancer and ICD code.
FINDINGS: The highest frequency of cancer patients was related to male gender (50.7%, 3575 patients), married patients (87.2%, 6147 patients), and were related to Babol (16.8%, 1889 patients), Amol (14.4%, 1018 patients) and Sari (11.8%, 833 patients). Most of the patients were in the age group of 70 and above and the problem was mostly associated with the gastrointestinal organs, breast and respiratory organs. There was no significant difference between the type of cancer and the place of residence, but there was a significant relationship with age, sex, type of residence, type of occupation and marital status (p=0.05).
The results of the study showed that the pattern of cancer in different cities is similar and increases with age.

Performance indicators are the essential tools for measuring the efficiency of hospital services. Therefore, this study aimed to evaluate the effectiveness of performance indicators by the Pabon Lasso Model in the teaching hospitals of Babol affiliated with Babol University of Medical Sciences. This experimental study was conducted using a descriptive method and the performance indicators of the Pabon Lasso Model from 2011 to 2014 in four major medical centers and hospitals of Babol University of Medical Sciences (Beheshti, Ayatollah Rohani, Yahyanejad and Children’s Hospital of Amirkola). Data were extracted from the monthly database of the Ministry of Health consisting of the inpatient bed occupancy rate, bed turnover rate, bed turnover interval and the patients’ average length of stay. The collected data were evaluated according to the criteria of the Health Ministry. In 2011, the Children’s Hospital of Amirkola and Ayatollah Rohani Hospital accounted for the highest (75.74%) and the lowest (69%) bed occupancy rate, respectively. In 2014, the highest rate of bed occupancy was observed in Ayatollah Rohani Hospital (82%). The comparison of the indices by the Pabon Lasso Model indicated that all the four surveyed centers were located in the third area of the diagram from 2011 to 2014. In general, the indicators surveyed in this study appeared to be desirable compared to the criteria of the Ministry of Health, with the exception of the patients’ average length of stay. Thus, further attempts are required as to reduce the average length of stay in the patients.

Systematic evaluation of hospital information system (HIS) leads to its modification and development in accordance with user's need, increase of hospital efficiency and effectiveness. The aim of this study was to assess the effect of hospital information system on processes and personnel function from user's viewpoint in the hospital affiliated to Babol University of Medical Sciences, Babol, Iran. This cross sectional study was performed on 155 users of affiliated hospitals of Babol University of Medical Sciences who used software daily in 2013 and participated in the census. The data was collected by a questionnaire that its validity and reliability has been confirmed. The questionnaire included basic and specific questions on Likert. In this study 72.9% individuals were women. Hospital information system (HIS) was used the most by nurses. The most average was related to need to learning new skills in users (3.72±0.7), 45.8% of individuals in this study expressed that HIS implementation caused to reduce the personnel workload and 70.4% declared that HIS implementation caused to increase personnel accuracy. 54.2% expressed that HIS implementation caused to increase work facility and 43.2% expressed that HIS implementation caused to reduce total expenditure of work. The results of this study showed that hospital information system has effectiveness on processes of personnel function.

BMI is the most important international indexes for physical health assessment and it is a tool for awareness about optimal nutrition during adolescence. The Aim of this study was a survey about the impact of nutrition on BMI of guidance school and high school students of ghaemshahr city in the academic year 2010-2011. This study is the kind of applied studies that was performed with analytical descriptive, cross-sectional method. The samples of this research were obtained through the table of Kerjcie and Morgan and cluster random sampling method and between guidance and high school students of ghaemshahr city. The volume of samples was 305 people. The collected data were analyzed using SPSS software and associated tests. 52/5% of samples were male and 47/5% were female, 57% of subjects were under weight, more than 13/8% was obese and very obese, and only 29/2% of the sample have normal weight. There was a significant difference between high BMI and consuming fried foods, the speed of eating, eating while watching TV or reading, difficult and low-calorie diet, oil consumption, the number of obese people in the family, and the level of family education. But there was no correlation Between BMI and eating sandwich, chips and snack, milk, fruit juice, salads and vegetables, consumption of protein, carbohydrate, and homemade food, type of diet, the number of persons in family and the occupation of parents. the result of this study revealed the positive effect of education Level of parents and awareness of families about nutrition and BMI. Therefore it is necessary to increase the awareness of families about the nutrition of students.

Drug abuse is a major of medical, social, economic and culturalproblem. The purpose of this study has been determining the pattern of drug abuse and high risk behaviors in patients that referred to DIC and MMTC of Amol (2012). This study was descriptive, analytical, and cross-sectional. Samples were selected by systematic random cluster sampling. The samples were 389, that were selected according to determining sample Krejcie and Morgan table from addicts referred to DIC and MMTC of Amol. Data collection tool was questionnaire that was completed by interview and review of patients records,And analyzed by related test in spss 18. The samples were consisted of 92.5% male and 7.5% female. 80.2% of them were urban and 19.8 % were rural. The number of male addicts referred to this center for abandonment has been 11 times more than females. And most ofthe drug has been used before referral to treatment centers was opium. 15% of patients were single and 85% were married. There was a significant difference Between the variables of drug abuse and gender(p = 0.00), marital status (p = 0.00), occupation (p = 0.00), education (p = 0.003) and a history of drug abuse (p = 0.00) at p<0.01 level. Smoking, unemployment and low education are the influencing factors on drug abuse, so the occurrence of such abnormalities Can be prevented by promoting of cultural and educational fields, especially during the academic career, creating job opportunities for youth And informing the families in the community.

The first step to prevent and reduce the occurrence of addiction in the community as well as helping the addicted people is to determine the status of their mental health and life quality. The current study aimed to investigate the mental health and life quality of addicted referred to the addiction (MMT&DIC) centers in Sari. The present practical investigation was carried out as a descriptive and sectional model on 351 individuals which were selected accidentally in 2012. Data was obtained from questionnaire of mental health (GHQ) and life quality (SF17). The obtained data were analyzed by the relevant statistical tests using statistical package software of SPSS. 70.1% of the individuals showed relatively favorable mental health while 11.1% was classified as unfavorable. Morover, 67.55 of the addicted indicated a relatively desirable life quality but 23.6% had undesirable life quality. There were significant relationships between mental health index with job (P=0.041) and education (P=0.023) level. Also, significant relationships were found between marital status and education level with the quality of life (P=0.001). But mental health index detected significant relationships with age, gender, and marital status as life quality revealed no statistical relationships with age, gender and job (P>0.05). according to the obtained results, the mental health and life quality in the units of the study was not rather favorable that may cause other mental disorders. Hence, the authorities should pay more attention to this group.