javad babaie

Although the vital role of early diagnosing, and properly controlling hypertension has been emphasized for decades, a large number of hypertension patients still encounter barriers and challenges in accessing qualified cares. This study examined and identified barriers, facilitators, and challenges of providing high-quality care for patients with hypertension in health centers in Tabriz, Iran. A descriptive qualitative study was conducted based on purposive sampling. The participants in this study included health care workers at health centers, patients with hypertension, and health centers managers at official positions (n = 19). Data was gathered through semi-structured interviews. Collected data was analyzed thematically. The mean duration of the interviews was 40 minutes (range: 30 to 60 minutes). The barriers were categorized into areas (sub-themes) of patient-related and health-center barriers. Facilitators included patient-related factors, external and environmental activities of health centers, and activities of Iranian health system. Furthermore, the challenges were categorized into (sub-themes) patient-related, environmental, and health system challenges. There are major barriers and challenges in providing qualified and comprehensive services for patients with hypertension. Stakeholders should consider removing these barriers and challenges, and facilitators should be used to provide health services to hypertension patients.

Disasters occur as a result of the interaction between hazards and the societal conditions. These conditions that turn hazards into disasters are referred to as vulnerability. Vulnerability has different dimensions; one of its important dimensions is the social dimension. This study was conducted to explore social factors influencing disaster risk and vulnerability in Islamic Republic of Iran's social context. This study was conducted with a qualitative approach. Data were collected through in-depth semi-structured interviews with experts who were purposefully selected. Collected data were analyzed and coded manually using the conventional content analysis technique. The trustworthiness of the study findings was checked by Guba and Lincoln's criteria (credibility, conformability, dependability and transformability). In this study, 16 disaster management experts were interviewed. The coding process of the interviews led to the formation of 243 codes, which were merged and 10 categories of social factors affecting disaster risks and vulnerability were identified: personal characteristics, community risk perception, employment, quality of residence, social capital, disaster/risk governance, religious beliefs, economical condition, communication/social isolation, and the existence of infrastructures. Many social factors cause increased disaster risks and vulnerabilities. These factors are affected by the characteristics of societies and act differently in each society. This study has identified and introduced these factors from the point of view of experts, which can be used by policymakers in this field.

This study aimed to comprehensively determine the factors that affect the hospitals’ functionalpreparedness in response to disasters.

A systematic review of studies published in English and Persian up to the end of 2022 was performedby searching PubMed Central, Web of Science, Scopus, ProQuest, SID, and Elmnet databases. Articles thatassessed hospitals’ functional preparedness were searched by using a combination of medical subject headingterms and keywords including disaster, emergency, preparedness, hospital preparedness, health care facilitiespreparedness, hospital functional preparedness, health care facilities functional preparedness, readiness, andeffective factors. Additionally, journals and gray literature were manually searched. Two independent reviewersscreened the eligible papers. The inclusion criteria were the full text should be published up to the end of 2022,in both Persian and English, and focus on hospital preparedness. The extracted data were manually analyzed,summarized, and reported using the content analysis method.

Of the 3465 articles, 105 studies were eventually included in the final analysis. Eighty-two influentialfactors were identified and classified into seven categories: government, coordination, control, and commanding(7 factors), existing guidelines and preparedness plans (12 factors), regulations (6 factors), supplying of resources(37 factors), education and training (8 factors), multi-layered information management and communicationsystems (8 factors), and contextual factors (4 factors).

There are different dimensions of hospital preparedness for disasters, each of which is influencedby several independent factors. Addressing these factors will enhance the actual functional preparedness ofhospitals encountering disasters.

 This study aimed to conduct a systematic review of models describing the integrated logistics operations performed as a response to natural disasters, with the hope to identify the challenges and limitations of healthcare systems in natural disaster management.

 A systematic literature search was carried out in PubMed/Medline, Scopus, Google Scholar, and bibliographies of retrieved articles using MeSH headings and keywords such as natural disaster, logistics, model. A total of 98 publications were identified through the search process. Seven potentially relevant articles met the inclusion criteria. The key demographic, clinical, and pathological information of all qualified studies were extracted from the full-text articles.

 Among the seven included studies, six had either model data or considerations on distribution methods. Storage, human resources, infrastructures, primary priority items, coordination of organizations, and information and communication with the media were also the focus of studies. The articles were mainly from Iran (n=2), the United States (n=2), and Indonesia (n=2). The models presented in the studies has mainly focused on a specific aspect of disaster management, such as smart government development, use of military services, people with logistic training and/or medical team model.

 This study systematically highlighted the crucial points that should be considered in managing natural disasters including human resources, infrastructure, storage, priority items, distribution, access system, coordination of organizations, information, and communication with the media. In this regard, we prepared a comprehensive comparison of possible models and logistics.

One of the most important concerns in responding to disasters is providing Basic Life Support(BLS) services. Considering the key role of Emergency Medical Services (EMS) in providing BLS, the purpose ofthis study is to investigate the experience of provincial EMS during their response to the Arasbaran twin earth-quakes and its challenges in Iran.

This study was conducted using a qualitative approach and theconventional content analysis method. Data were collected through Focused Group Discussions (FGD) andsemi-structured in-depth interviews with purposively-selected EMS paramedics and officials in East AzerbaijanProvince, Iran. To form the main categories, the interviews were encoded in three stages and the similar codeswere placed under the same subcategories and merged.

A total of 26 EMS paramedics participated inthe study. The codes extracted from the interviews, after three stages of reduction, were placed in the top tencategories, including the lack of preparedness and coordination, dead bodies’ management challenges, respon-ders’ psychosocial support, deficiencies in supplies and ambulances, difficulty of access to rural areas, volunteermanagement, non-documentation of the experiences, communication challenges, recalling, and deploying ofEMS responders.

Timely response of the EMS and paramedics’ sense of responsibility for provid-ing services were positive and successful points about the emergency response operations. The weaknesses ofEMS should, therefore, be addressed through transferring of experiences and by planning and arranging trainingcourses.

As a result of destruction and lack of access to vital infrastructures and mental stress, disastersintensify cardiovascular diseases (CVDs) and hence management of CVDs becomes more challenging. The aimof this study is investigating incidence and prevalence of CVDs, morbidity and mortality of CVDs, treatmentand management of CVDs at the time of natural disasters.

In the present systematic review, the arti-cles published in English language until 28. 11. 2020, which studied CVDs in natural disasters were included.The inclusion criteria were CVDs such as myocardial infarction (MI), acute coronary syndrome (ACS), hyper-tension (HTN), pulmonary edema, and heart failure (HF) in natural disasters such as earthquake, flood, storm,hurricane, cyclone, typhoon, and tornado.

The search led to accessing 4426 non-duplicate records.Finally, the data of 104 articles were included in quality appraisal. We managed to find 4, 21 and 79 full textarticles, which considered cardiovascular diseases at the time of flood, storm, and earthquake, respectively.

Prevalence of CVD increases after disasters. Lack of access to medication or lack of medicationadjustment, losing home blood pressure monitor as a result of destruction and physical and mental stress afterdisasters are of the most significant challenges of controlling and managing CVDs. By means of quick establish-ment of health clinics, quick access to appropriate diagnosis and treatment, providing and access to medication,self-management, and self-care incentives along with appropriate medication and non-medication measures tocontrol stress, we can better manage and control cardiovascular diseases, particularly hypertension.

After the Kermanshah earthquake on November 12, 2017, Tabriz University of Medical Sciences dispatched a response team to the earthquake-stricken areas. This team provided the affected people with health services for 10 days. This article intends to examine the experience of this team in Kermanshah earthquake-stricken areas.

After the team’s return from Kermanshah, a meeting was held to examine the challenges and review the learned lessons with 60 participants, including authorities and the people who were members of the team. The discussed issues were coded using content analysis. The similar codes were merged, and then categories were extracted.

The analysis of discussions led to 9 categories of experiences that included delay in recalling process and its challenges, lack of preparedness, use of the virtual space capacity, lack of proper assessment of the health needs and the estimation of facilities, management experience of the team on the dispatch, shortcomings, and imperfections, managerial challenges, lack of coordination, and setting up of field hospitals without planning.

Iran is susceptible to natural disasters, and from time to time, parts of the country are affected by these disasters. One of the priorities in these disasters is people’s need for health services. Since health facilities in the area usually encounter problems in these circumstances, other medical universities should provide help and relief. The present experience shows that there are still many challenges that should be addressed.

Dried Urmia Lake in the northwest of Iran is a major regional source of sodium and toxic metal aerosols which may cause numerous health problems. The aim of this study was to evaluate iron-deficiency anemia (IDA) and some related risk factors among women of reproductive age in the suburb of dried Urmia Lake to provide the information about the problem to the health-care providers.

This cross-sectional study was conducted on 278 healthy nonpregnant, nonlactating women aged 18–45 years, living in the rural area of the Salmas city, closest to the Urmia Lake between February and June 2017. The study participants were selected using a stratified random sampling method with proportional allocation from seven villages. A general questionnaire was completed for each participant to collect sociodemographic information and a 3-day dietary recall questionnaire to obtain daily dietary intakes. IDA was defined as a hemoglobin (Hb) level of <12 g/dl and ferritin concentration of <15 μg/l. Spearman's correlation coefficient and Fisher's exact test were applied to determine sociodemographic factors associated with the serum Hb and ferritin levels.

The prevalence of overall anemia (Hb <12 g/dl) was 7.9%. IDA was determined in 4.3% and iron deficiency (ID) in 19.1% (serum ferritin <15 μg/l) of the participants. There was a significant positive correlation between serum Hb concentrations and the mean daily intakes of protein and iron (P < 0.001). Similarly, a significant positive correlation was observed between serum ferritin levels and body mass index (P < 0.001). Significant inverse associations were found between Hb concentrations and the number of pregnancies and children (P < 0.001), as well as the number of family members (P < 0.05).

Results indicated a mild prevalence of IDA and a relatively high rate of ID among studied participants. Educational programs are needed to improve nutritional habits as well as the use of contraceptives to promote women's health.

The aim of the present study was identifying factors associated with h delayed initiation of post-exposure prophylaxis (PEP) among animal bite victims.

This cross-sectional study assessed biting patterns among 3032 cases that were referred to Tabriz Rabies Center. The delay was described as the initiation of PEP more than 48 hours (h) after possible exposure to the rabies virus. Determinants of delay in initiating PEP were recognizing by a decision tree model.

Totally, 8.5% of the victims who were bitten by an animal had a delay of more than 48 h in the initiation of PEP. The relative frequency of delay more than 48 h in females was higher than the males (12.9% compared to 8.5%) (p-value= 0.004). Relative frequency of delay more of 48 h from carnivorous (dog, jackal, fox) was significantly less than others (p -value< 0.001). Of the decision tree, the overall classification accuracy was 89.5%, with 44.1% sensitivity and 92.3% specificity. The identified variables included gender,biting place (rural, urban), and type of animal.

Based on the study findings on various variables that affect the delayed initiation of PEP, particularly being female, and rural residents were the major factors associated with a delay in the initiation of PEP for rabies prevention. We found relatively low rates of vaccine completion. Our findings indicate that provider training and patient education are required to ensure the completion of appropriate treatment.

Composites are commonly used in pressure vessels. One of the critical problems in manufacturing composite vessel under the external pressure is sealed opening design and its considerations. It's required to review the body resistance in opening locations. In this paper, a special design process for opening closure presented and the influence of such cutouts on vessel body studied. Because of the importance of body resistance, the vessel material and structure mechanical performance were analytically evaluated. Then, Mechanical behavior of the vessel structure was investigated based on the parameters affecting the definition of different opening designs through finite element simulation and analysis in ABAQUS commercial code/software. Hence, the effect of the presence of openings, including the consequences of creating asymmetry in the structure, has been determined in a large aspect ratio. Finally, the results represents, the importance of complying practical requirements and implementation of reinforcement rings in the opening locations to get the suitable design as one of the most effective solutions to compensate the opening reduction consequences i.e.; buckling strength reduction and highly increasing asymmetry.

One of the most important concerns after disasters is managing their health consequences. This study examines the experiences of Primary Healthcare Workers (PHCWs) who involved in managing the health effects of the Arasbaran twin earthquakes of August 2012. 

This study was conducted using a qualitative approach. Data were collected through semi-structured deep interviews. The collected data were analyzed by content analysis using the code extraction of subthemes and themes. Study participants included health managers, healthcare workers, and individuals who received the health services in response to the health effects of the Arasbaran twin earthquakes. A total number of 16 participants were interviewed. The study sample was selected purposefully.

Interview analysis provided 14 subthemes and five main themes, including the lack of preparedness, the challenges of the PHCWs’ contributions in providing healthcare, the inessentiality of the PHCWs’ involvement in health response, the continuity of healthcare by the PHCWs, and the facilitation of coordination. 

The involvement of the PHCWs in managing the health effects of the earthquakes was a successful experience that could prevent health problems. Challenges faced during this experience were mainly caused by the lack of preparedness.

Drugs are one of the essential components in diseases treatment process. Their to-the-point prescription in terms of quality and quantity and their cost are important issues that should be focused by health providing authorities. The present study aims at evaluating the average of prescribed items and their costs in family physician program involved health centers and hospital in 2017 Hashtrood, Iran. 

In this cross-sectional study, the data on prescriptions, items and their averages costs were collected from Hashtrood healthcare centers and hospital. The data were processed by Microsoft Excel. Then, the Mean and Pearson correlation was analyzed by SPSS20 

Totally 72806 prescriptions were issued in 2017. The average of prescribed drugs was 2.79 ± 0/36 for each prescription and the average price was 116123 ± 12486/09 IRL. The highest number of prescribed drugs was for Hashtrood hospital, but the highest price was for the health center No 1. 

The average of prescribed drugs in Family physician program in Hashtrood was less than the national average and the averages mentioned in other published literature. It shows the relative success to control the number of prescribed drugs; however some health centers need more attention and assessments.

On Friday, 14 April 2017, a heavy flash flood occurred in North-West of Iran that affected 12 cities; the most severely affected and damaged ones were Ajabshir and Azarshahr in East Azerbaijan Province. These Flash floods claimed the lives of 42 people. Major casualties occurred when the victims were trapped inside their cars. According to preliminary analyses, flood damages in East Azerbaijan Province are estimated to be around three trillion Rials. Following the Flash floods, disaster relief organizations were activated. Iranian President, Minister of Energy, and the provincial authorities rushed to visit flood-stricken areas and oversee the rescue and relief operations.

Infectious diseases have threatened human health throughout the history. One way of transmission of such diseases is exposing to the needle sticks. The present study was carried out aiming to introduce and investigate risk factors related to needle sticks and ways of prevention of infectious diseases related to needle stick among health care staff.
Searching key words including needle sticks, occupational injuries, occupational exposures (OEs) and infectious diseases, the researchers undertook a comprehensive investigation regardless of publication year of the reviewed articles in references including, Medline, CINAHL, Google Scholar, ScienceDirect and Scopus. Then the collected articles were scrutinized and processed.
Dealing with needle sticks can transmit more than 20 types of pathogens including Hepatitis B, C and human immunodeficiency virus (HIV). Among health care staff, nurses are more vulnerable compared to others.
Exposure to blood and other risky body liquids is a serious risk factor among health care workers. Training medical staff, establishing reporting systems, changing high risk behaviors and vaccination can play an important role in prevention of the infectious diseases.

Emerging infections from caring services are regarded as one common reason behind mortalities among hospitalized patients. The most effective and simplest way to prevent hospital infections is to follow hand hygiene rules. Despite the importance of hand hygiene in the preventing from infections, still there is a low level of attention to the subject matter. The present study tries to investigate the reasons behind disregard for hand hygiene among working staff of Imam Hussein Hospital in Hashtrood, East Azerbaijan, Iran.
Material and In the present descriptive study, 71 working staff of Hashtrood Imam Hussein hospital was scrutinized in 2017. Data were gathered using a questionnaire made by Arshadi et al in 2014. After data collection, they were analyzed by Pearson, independent t-test and variance analysis tests and the Mean, SD, frequency and percentage were obtained.
By studying the Mean score for each item it was revealed that the most important barriers for hand hygiene are respectively: lack of belief in the importance of hand hygiene, attitude toward the role of hand in infection control, skin allergy caused by disinfectants, lack of high quality disinfectants, and lack of hand hygiene tools. There was no meaningful relationship between demographics and total score.
As results suggest, it seems that an integration of mentioned items such as having a positive attitude towards hand hygiene among working staff, presence of high quality disinfectants and providing hand hygiene tools are necessary to prevent and control infections in hospitals.

Since 2014, the "health system transformation plan" was designed and implemented in order to solve some of the problems in Iranian health system. One of the goals of this plan is to reduce direct payments by inpatients. This study aimed to compare the direct payments by inpatients, before and after implementing the transformation plan.
Material and In this analytical-descriptive study, 1351 cases were selected (all cases). Direct costs paid by the inpatients were extracted from medical records and then analyzed using SPSS v.19 software and applying Uman-Whitney test.
The overall level of direct costs paid by inpatients before and after implementing the transformation plan has been decreased from 704 286 to 491815 Rials. A statistical relationship was observed between implementing the plan and the reduction of direct costs; but in detailed costs, there was no cange.
Health system transformation plan reduced the direct costs paid by inpatients; but in detailed costs, there was no reduction in some parts. Cooperation between hospitals is necessary to continue the plan.

Disasters such as earthquake induce large volume of human needs. One of the most important of them is primary health care needs. Following the 5 December 2012 South Khorasan earthquake، the public health system of the province actively involved to provide primary health care for the affected people. This case study investigated the response operations of public health system to earthquake. In this case-descriptive study، data collected by researchers using checklists، interview with healthcare workers in earthquake-affected areas، reviewing documents، and observation of the response operations. An earthquake measuring 5. 5 on the Richter scale hit Qaenat and Zirkouh areas caused 6 deaths and 23 injuries. About 2143 people were affected and 38 villages destroyed about 30 to 100%. Responding to the health needs، a rapid health needs assessment was performed immediately. Then، a response plan designed according to «National Public Health Disaster and Emergency Operation Plan». Public health system in collaboration with expert health groups provided the primary health care services for the affected communities. Although the recent earthquake was mild and occurred in the early of night، but it killed some people and destroyed a number of structures. Public health system provided an appropriate response according to EOP. Nevertheless، because Iran is a disaster prone country، the health system should be prepared for different types of hazards.

Rabies is an acute and fatal infectious disease that is very important due to high economic losses to livestock and the amounts of expenditures that are paid for purchasing serum and vaccine. The main way of disease transmitting is bites by rabid animals. Animal bite is an important threat for human health. The main aim of this research was epidemiological study of animal bite in the students of Hashtrood town. In this cross-sectional study, animal bitten students’ data were collected trough the records of Hashtrood health centers registry lists between 2006-2009. The census data collecting method was used and the data were analyzed with statistical software SPSS15. The incidence of animal bites in the past 5 years was 9.07 per 1,000 students. From 439 animal bitten students, 80.9% were male and 19.1% were female. According to the results, 88.4% were rural and 11.2% were urban residents. Dogs bite was the cause of 87.92%. In 86.5% of the cases, the bite was superficial and in 8.4% of the cases, bites were deeper. Among them, 16.6% received anti rabies serum, 16.2% received vaccine. This study showed that 4.8% had a previous history of bite. Of total, 78.8% made a visit to health centers in the first 24 hours, 11.4% within 25 to 48 hours, and 3.6% within 49 to 72 hours after bites. There was no human death report from rabies. Results showed that 95.2% were given incomplete vaccination and 4.1% had received five complete vaccines. Regarding the high prevalence of animal bites among students, educating students about the importance of rabies, students’ behavior with dogs and immediate visit to health centers after exposure to dogs should be taken serious. Restraining dogs by training dog owners and legal means should be attempted.

Pre-hospital Emergency Medical Services (EMS) is one of the most important components of health care systems. Community awareness about its services could improve the performance. This study is aimed at assessing the citizens’ awareness and satisfaction about Shiraz EMS. Through this cross-sectional study, 1680 residents of Shiraz citizens have been selected by cluster random sampling. Each person has been asked some questions about their knowledge and also satisfaction of EMS performance with a valid and reliable questionnaire through phone interview. The data were analyzed with SPSS using T- test, Anova and Regression with “0.05” level of significance. This study revealed that the knowledge of the residents who are living in lower socioeconomic part of the city is lower than the residents of the other areas. The mean awareness score of each area was significantly different comparing to the other areas, based on their socioeconomic status. In better socioeconomic status, the knowledge score was higher. There was also significant relationship between education and gender with knowledge about EMS performance. Meanwhile, the relationship with age was reverse. Although 48.6% had no idea about EMS, 527 (31.4%) were satisfied by its services. There was only 7.3% dissatisfaction. While the awareness about EMS’s duties could decrease irrelevant calls to EMS, education, especially for the residents of lower socioeconomic areas of the city is recommended. In addition, it is suggested that in feasibility studies or using other methods of evaluating EMS performance, socioeconomic status should be considered as independent variables.