aisa maleki

Breast cancer has been identified as the most common cancer and the fifth leading cause of cancer death in the world. Non-clinical risk factors such as socioeconomic status can lead to inequality in the outcomes of the disease. This study aimed to analyze the provincial socio-economic inequality in the incidence of breast cancer in the country.

This cross-sectional study was performed using Iranian provincial data. The required data are obtained from the statistical yearbook report, the report of the Statistics Center and, the national report of the National Cancer Registration Program of the Ministry of Health of Iran in 1397. Extraction of density curves was performed by statistical analysis using STATA 14.

The results of the study showed that provincial per capita income caused the most inequality (CI = 0.113) in cancer incidence (P <0.05). Provincial literacy rate with CI = 0.112 was in the next rank of inequality (P <0.05). The value of the concentration index (CI) of the province's socio-economic development index was also estimated to be 0.110 (P <0.05). The effect of health insurance coverage on inequality in cancer incidence (CI = -0.094) was also statistically significant (P <0.05).

It is suggested that policymakers facilitate early detection of cancer in provinces with lower socioeconomic status by providing insurance coverage for screening services, distribution of screening credit cards, payment exemptions, and public awareness.

In order to have more effective programs and social interventions controlling the burden of diseases, it is necessary for policy makers to have valid evidence about the role of socioeconomic determinants. The present study aimed to provide empirical evidence about the relationship of socioeconomic inequalities and the availability of resources with the burden of diseases among the provinces of the country in 2019.

This descriptive and analytical research was carried out using the provincial data of 2019. The required provincial data were extracted from the Statistical Yearbook Report and the Household Income Expenditure Report of the Statistics Center and the data related to adjusted years with disability and early death (DALI) from the 2019 disease burden estimates. DALY's inequality was investigated by estimating the concentration index and extracting the concentration curve at a 95% confidence interval. The analyses were carried out in the Stata software (version 15).

In 2019, the average per capita DALY was 18.33±3.98. The average socio-economic index and resource availability index for 31 provinces were obtained at 0.37±0.21 and 0.64±0.20, respectively. Considering the difference in the available resources (covariate), there was a statistically significant difference between the socio-economic quartiles in terms of the distribution of per capita DALY (P<0.01). Therefore, the effect size of belonging to the socio-economic quartile was 0.758 (P<0.01). Nonetheless, the effect size of the difference in resource availability was not statistically significant.

Health policymakers at national and provincial levels should try to reduce inequality by promoting programs to encourage healthy lifestyles, developing universal access to early screening services, and preventing the causes of death.

Scene management in accidents reduces losses, speeds treatment, and facilitates immediate victim transfer. Learning the related skills through theory-based educational intervention makes this task possible. This study aimed to determine the effect of theory-based educational intervention on emergency medical personnel skills to manage the scene in chemical accidents.

The present study employed a quasi-experimental design with pre- and post-intervention measurements. Using the random sampling method, 70 emergency medical technicians working in Qazvin Province, Iran, were selected and assigned to experimental and control groups. The data collection tools included demographic questions and scales to assess the theory of planned behavior. The intervention program consisted of 4 sessions. Data were analyzed by SPSS software, version 23 using descriptive statistics and analysis of covariance.

The Mean±SD age of the participants was 35.03±5.57 years, and 82.6% (57 people) were married. After the intervention, the Mean±SD scores of attitudes (40.11±4.77), subjective norms (15.06±4.27), perceived behavior control (18.53±2.55), and behavioral intention (8.49±2.27) increased significantly in the experimental group (P<0.001). Also, the self-report behavior in the experimental group improved significantly (P<0.001). 

Theory-based educational intervention improved psychological variables and safe behaviors in chemical accident management. Implementing educational interventions based on this theory enhances the safety performance of medical emergency technicians in chemical accidents.

This article aims to discover and divulge the hidden and obvious themes of social malingering in the actions of characters in the movie A Hero, by Asghar Farhadi. Since, according to some critics and thinkers, the content and themes of Iranian cinema have a deep connection with social issues and events, this study is an attempt to highlight social interactions and analyze everyday life in contemporary Iran. The research was conducted using a qualitative method and content analysis technique. The main problems discussed here were: Why do we construct a hero? What is the relationship between the phenomena of social malingering and constructing a hero in everyday life? Findings show the phenomenon such as social malingering and a hero construct in everyday life, in the mutual relationship and dialectic of attempt and failure, the inefficiency of social and political institutions, individuality cult, ideological morality, ontological insecurity and the reduction of social capital among others. It seems the social malingering and constructing a hero may be strategies for survival, especially the survival of honor and social acceptability in interactions and everyday life, the last type of social action and initiative to protect oneself and society.

By 2020, colorectal cancer accounted for 10% of global cancer incidence and 9.4% of cancer deaths. Apart from biomedical characteristics, socio-economic status can also play a role in inequality in the outcomes of this disease. In this account, this study aims to analyze the regional socio-economic disparities in the incidence of colorectal cancer in Iran.

This cross-sectional study was executed using provincial data from 2018. The required information was extracted from the report of the statistical yearbook, the report of the Statistics Center, and the national report of the National Cancer Registration Program of the Ministry of Health of Iran. Using STATA 14, concentration indices were estimated and concentration curves were extracted.

Only the concentration index of health insurance coverage percentage and employment percentage was negative. The effect of health insurance coverage on inequality in cancer incidence (CI=-0.364) was also statistically significant (P<0.05). The results showed that per capita income has caused the most inequality (CI=0.632) in the incidence of colorectal cancer (P<0.05). While the effect of provincial employment percentage on incidence inequality was the lowest (CI=-0.064) and was not statistically significant. After per capita income, the per capita expenditure concentration index (CI=0.564) was in second place in terms of inequality (P <0.05). The literacy rate with CI=0.484 was in the next rank of inequality (P<0.05).

Socioeconomic characteristics of the provinces have an important role in the inequality of colorectal cancer. Policymakers can improve early detection of the disease in the country's provinces by covering screening services with medical insurance, providing screening credit cards, payment exemptions for the lower deciles, and social marketing.

Critical thinking is the ability to ask appropriate questions and gather relevant information. It enables rational judgment and problem-solving for physicians and nurses. For the first time, this study examined two major groups of caregivers at the patient's bedside in terms of the relationship between critical thinking and self-efficacy.

This was a descriptive-analytical and cross-sectional study conducted in 2021. The sample was taken from QUMS’s nursing and medical students through stratified random method. It was performed using structural equation method (n=377). Data collection tools included: demographic information, Ricketts critical thinking questionnaire, and GSE-17 questionnaire. Finally, data were analyzed through the correlation coefficient and multiple regression tests using SPSS22 software at a significance level of 0.05.

Results indicated that the model established at this step demonstrates good fitness. In this model χ2 = 1919.91, df = 89, χ2 / df = 2.14, RMSEA = 0.05, NFI = 0.63, GFI = 0. 77 and CFI = 0. 76.   The structural equation model's standard estimation coefficients show that all the existing paths are at a significant level (CTH: CRV 0.96, CTH: COM 0.94, CTH: SFE -0.61; P-value< 0.05). Finally, the regression analysis showed an inverse effect of critical thinking on self – efficacy.

The study showed that critical thinking had a direct effect on self-efficacy. In addition, these two features have a significant effect on increasing the efficiency and making the right clinical decisions in medical and nursing groups. Therefore, upgrading these skills by updating curriculum will ultimately improve healthcare outcomes provided by these two specific groups.

Cost management is the most important factor affecting the economic performance of the hospital. Good management of costs in the short term stabilizes and balances the operating balance of the hospital and secures the hospital in terms of liquidity. Also, good management of costs in the long term makes the hospital financially stable. According to the mentioned cases and increasing hospital costs, the present study was conducted with the aim of identifying and investigating the factors, drivers and obstacles to improve cost management.

Methods & Materials: 

This systematic review was conducted in 2020. Data was collected through  searching keywords in Google scholar, PubMed, Scopus, Web of Science, Science direct, Magiran, SID and Irandoc databases from 2007 to 2020. The classification of the results of the studies was done by the researchers.

All the components identified and extracted from the articles were divided into four dimensions (increasing factors, prerequisites, obstacles and solutions) to improve hospital cost management.

Reviewing the results of each study showed the importance of each component in managing, improving and controlling hospital costs. In this regard, policy makers at decision-making level and managers at executive level should pay attention to the components and dimensions affecting the control and improvement of hospital costs according to the structure, process and expected consequences, and then decide on their implementation.

Medical equipment maintenance plays an important role in improving the equipment's function, increasing its effectiveness and efficiency, providing continuous health services, and improving the quality of services. This study is conducted to investigate the factors affecting medical equipment maintenance management.

The present study was a qualitative investigation based on content analysis that was conducted in 2021. Data collection method was an open ended interview. The interviewees included all medical equipment operators and technicians of educational and medical centers affiliated with Qazvin University of Medical Sciences. The semi-structured interview guide was used as a data collection tool. Qualitative data obtained from interviews were analyzed by the content analysis method. The obtained coded were classified into dimensions and components using MAXQDA Software12 .

According to the findings, categories of time constraints, access to information, instructions and programs, type and number of equipment, financial constraints, user, patients, training programs, and equipment repair agencies were the most important factors affecting medical equipment maintenance management.

Observing purchasing standards and guaranteed equipment, training all the staff involved, developing and explaining instructions and programs are essential for optimal equipment maintenance. These measurements will reduce the cost of repairing.
g medical equipment and the need to purchase equipment; improve equipment, service quality performance, patient and user safety; and increase the device life.

One of the most important income sources of hospitals is the payment of insurance organizations, part of which is not paid as deductions in Iran. Studies have reported different values for insurance deductions, proposing various reasons.

The present study aimed to provide the published evidence of these deductions and their causes over the past 13 years. Data Sources: This systematic review and meta-analysis was conducted in 2021. Data were collected via searching in databases such as Google Scholar, Scopus, PubMed, Web of Science, SID, Magiran, and Irandoc until August 2021 using keywords such as “deduction”, “medical deduction”, “hospital”, “medical center”, and “Iran”. Data Extraction: To calculate the pooled values of hospital deductions, a random-effects meta-analysis was performed in the Stata software version 15 at 95% confidence interval. In addition, the possible heterogeneity of the studies was evaluated using the I2 statistic, and a forest plot was also used to report the results. Publication bias was assessed using a funnel plot.

In total, 16 articles were included in the meta-analysis. The pooled percentage of deductions (PPCD) based on random effects was 5% (95% CI: 2.88 - 7.124), and the hypothesis was rejected (PPCD = 0; Z = 31.26; P = 0.000). Based on the random-effects method, the pooled prevalence of deductions was 45.21% (95% CI: 17.601 - 72.824). Moreover, the pooled prevalence of deductions (PPVD) was considered statistically significant (PPVD = 0; Z = 251.16; P = 0.000). The variation in ES attributable to heterogeneity (I2) was estimated at 99.6%, and documentation problems were considered the most common cause of deductions (17.96%).

According to the results, the prevalence of deductions in Iranian public hospitals is significant, and the share of deductions from the bill claimed by the hospital is manageable, albeit small.

The present study was conducted to investigate the status of performance indicators in hospitals affiliated to Qazvin University of Medical Sciences before and after the implementation of the transformation plan.

This descriptive-analytical study was performed longitudinally based on hospital data. The data collection tool was a checklist including general characteristics of hospitals and performance indicators. Data analysis was performed using Interrupted time series analysis (ITS) and Statistical software for data science (STATA) v.15. Chow test was used to determine the structural fractures in the studied time series.

Hospitals’ performance indicators were examined. In the first month after the intervention, bed rotation increased significantly by 1.148 (P<0.005). The trend of bed rotation after the intervention increased by 0.060 per month (P=0.032). In the first month after the intervention, the decrease or increase in the length of stay in different hospitals was not significant (P>0.005). The length of stay after the intervention increased by 0.170 per month. In the first month after the intervention, the decrease in bed occupancy percentage was 41% (P=0.005) which is significant. The trend of bed occupancy percentage after the intervention was more than 2% per month (P<0.005).

The transformation plan in the period before and after implementation in all studied hospitals has positive effects and has made changes in most performance indicators. This plan is especially beneficial for people who have fallen ill due to a lack of financial resources and have not been able to seek treatment.

The awareness of the current compliance of Joint commission international standards is a prerequisite for their upgrading. The purpose of this study was to provide a systematic review of the evaluation of Iranian hospitals in accordance with International Joint Commission standard.

The present systematic review was conducted in 2019. Data were gathered by searching the Google Scholar, Scopus, PubMed, and Web of science databases. Search keywords were “medical tourism”, “health tourism”, “joint commission international”, “JCI”, “Hospital”, “medical center” and “Iran”. The search protocol was limited to 2009-2019.

The findings showed that the average compliance of patient-based standards was about 68.89% and the average adherence to organization-based standards was about 69.05%. Also, the most compliance with patient-based standards was related to “Anesthesia and Surgical Care”, while the least adherence to them belonged to the area of “Patient and Family Rights”.

According to the results of the study, Iran’s medical tourism standards are not universally desirable; authorities are recommended to focus on continual improvement of their reliability and removal of their weaknesses. In this regard, strategies such as developing a comprehensive and mandatory national qualification program and evaluating its periodic performance in this field are suggested.

The reform in medical records processes is recognized as one of the effective measures implemented for reducing insurance deductions. The present study aimed to evaluate the effect of outsourcing the medical records unit on the insurance deductions in Qazvin Trauma Center within 2013-2018.

The present study was a descriptive and analytical study which was conducted in Qazvin Trauma Center. The intervention variable was the performance of the outsourcing plan in the medical records unit. Changes in the level and trend of basic insurance deductions before and after outsourcing were at the significance level of 0.05 using the independent t-test and segmented regression model in Stata software (version15).

The percentages of deductions before and after performing the outsourcing contract were measured at 0.038±0.112 and 0.194±0.068 for the health insurance (P <0.001), respectively. These values were reported as 0.077±0.028 and 0.031±0.126 for the social security insurance (P<0.001), respectively, and they were obtained at 0.105±0.060 and 0.124±0.087 for the armed forces insurance (P=0.369), respectively. Finally, for the relief committee insurance, these percentages were reported as 0.154±0.078 and 0.183±0.080 (P=0.209), respectively.

As evidenced by the obtained results, the level of y-intercept increased in all observations after outsourcing. Therefore, it can be concluded that outsourcing the services of the records unit did not directly affect the insurance deductions and the insurance deductions can be attributed to some other reasons, apart from the outsourced tasks.