mohammad amerzadeh

Catheter-related bloodstream infection (CRBI) is a prevalent bacterial complication that can lead to severe outcomes, including cardiovascular diseases, cerebrovascular disorders, and increased mortality rates if untreated.

The present study aimed to investigate the epidemiology of CRBI, associated factors, mortality rate, and factors associated with mortality in patients with this infection.

This cross-sectional descriptive-analytical study was conducted on 592 patients with catheter infections in the hemodialysis (HD) unit of Velayat Hospital in Qazvin province from 2018 to 2022. Patients’ demographic and clinical information was extracted from their medical records. Data analysis was performed using univariate and multivariate regression analyses.

Of the 592 patients, 261 (44%) were male and 331 (56%) were female. The majority of patients were in the 60 - 79 age group (277 individuals; 47.6%). The most common catheter insertion site was the cervical vein (270 individuals; 46.9%). Staphylococcus and Escherichia coli were the most prevalent catheter-related microorganisms, with 239 (41.4%) and 65 (11.2%) cases, respectively. The mortality rate among patients with catheter infections was approximately 20%. Femoral catheter placement compared to jugular placement and blood culture samples compared to Sheldon samples increased the odds of mortality by approximately 2.83 times.

The study indicates that clinical factors such as catheter insertion site and duration of hospital stay are associated with mortality in HD patients. Therefore, implementing hygienic measures and focusing on these factors are crucial.

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.

This study aims to determine the predictive factors of active aging among older people in Qazvin City, Iran.

This study, conducted in 2023, included individuals aged >60 years in Qazvin City. Participants were selected using cluster sampling in three zones of Qazvin City. Older adults were selected from mosques and parks in each zone. Data were collected using a demographic information checklist, an Iranian active aging questionnaire, a multidimensional scale of perceived social support (MSPSS) and the World Health Organization (WHO) disability assessment schedule (WHODAS 2.0). A multiple linear regression was performed using R software, version 4.2.3 to detect predictors of active aging.

The mean age of the patients was 66.78±6.22 years. A total of 178 patients (61.6%) were men and 207(71.6%) were married. The mean score for active aging was 109.18±24.15, indicating a moderate level. Multiple regression analysis showed that sex, marital status, educational level, economic situation, job, perceived health, disability and perceived social support were significant predictors of active aging

Based on our results, active aging among older adults was moderate. We suggest that health policymakers pay more attention to older individuals with low literacy, low income, disabilities, and health problems when planning active aging programs. Additionally, increasing intergenerational support is vital to encourage social participation among older adults.

The need for smartification is increasingly recognized in public hospitals, making it crucial to identify the current status, gaps, and factors influencing hospital smartness.

This study aimed to assess the smartness status of public hospitals and investigate its correlation with hospital characteristics and performance indicators.

This descriptive-analytical cross-sectional study was conducted in seven public hospitals in Alborz Province, Iran, during 2023 - 2024. We assessed the characteristics and performance indicators of the hospitals using a researcher-developed questionnaire and evaluated their smartness status with the standardized "Smart Hospital Evaluation" checklist. Data analysis was performed using SPSS24 software, utilizing independent t -tests, Pearson's correlation, Spearman's correlation, and analysis of variance (ANOVA) tests.

The smartness status of the hospitals was found to be moderate, with 71% of hospitals falling into this category. A significant correlation was observed between the smartness of hospital units, the type of hospital (teaching or non-teaching), and the hospital's specialization (specialized or general) (P = 0.013). Significant and direct correlations were also found between information technology and hospital units (P = 0.043), management systems and clinical processes (P = 0.008), and overall smartness and clinical processes (P = 0.049).

Public hospitals need improvements in smartness indicators. Factors such as whether the hospital is teaching or non-teaching and whether it is specialized or general should be taken into account. Moreover, hospital smartification efforts should adopt a comprehensive approach, considering all dimensions of smartness.

 Cancer patients may face challenges in their regular treatments and their quality of life (QoL) due to the coronavirus disease 2019 (COVID-19) outbreak.

 The purpose of this study was to assess the QoL of cancer patients in Iran during the COVID-19 crisis.

 We applied the EORTC (European Organisation for Research and Treatment of Cancer) Core Quality of Life (QLQ-C30) questionnaire to measure the QoL of cancer patients in Rasoul Akram Hospital in 2021 in Tehran. Based on the inclusion criteria (a cancer diagnosis, being 18 years of age or older, and the ability to understand (but not necessarily read) the Persian language), 87 cancer patients were found to be eligible. Of these, 85 completed the questionnaire. We used SPSS to analyze the data with an independent t test and analysis of variance (ANOVA).

 According to the result of the analysis, the global health status (main Qol score) was 55.49 ± 21.27. We found no significant difference in the global health status scores based on any demographic variables. Regarding functional scales, the type of insurance had a significant effect on the average cognitive functioning score (P-value = 0.043), with the highest score (79.37 ± 21.02) for patients with Medical Service Insurance and the lowest score (54.76 ± 29.99) for patients without insurance. We also found that in symptom scales, age (P-value < 0.001) and the type of cancer (P-value < 0.001) had a significant impact on the average appetite loss score.

 The QoL of cancer patients has deteriorated during the coronavirus outbreak in terms of general health status, functional scales, and symptom scales. Cancer patients need to be supported by decision-makers and hospital managers, especially in epidemics, to cope with psychological issues related to epidemics, such as fear, anxiety, and worry, and to ensure that they receive adequate services.

Ensuring equal utilization of health services has always been a priority in health systems globally. Iran implemented reforms such as the Health Transformation Plan (HTP), in which one objective was to reduce inequity in access to inpatient and outpatient services. These studies aimed to measure inequality in health services utilization in Qazvin, Iran, and clarify inpatient and outpatient utilization patterns among socioeconomic subgroups of the population. This cross-sectional study recruited 442 households living in Qazvin, Iran, in 2019. We collected data using a tool that included demographic characteristics, socioeconomic status, and health services utilization. We applied the concentration index to measure inequality and performed data analysis using STATA 15. Based on our estimates, the utilization rates of outpatient and inpatient services in the study sample were 0.89±1.39 and 0.45±0.94, respectively. There was no statistically significant difference in the use of outpatient healthcare services in terms of gender and insurance coverage of the households, while literacy, age, and health condition had statistically significant effects on inpatient healthcare utilization (P<0.05). Furthermore, the marginal effects of age and literacy on the utilization of outpatient services were statistically significant (P<0.05), so that literacy and aging increased the outpatient HSU. Except for age, the marginal effects of other characteristics on the utilization of inpatient services were statistically significant (P<0.05). Our findings indicated that inequality in healthcare utilization reduced over time, showing that in addition to reducing inequality in HSU, population groups with lower socio-economic status have benefited more from both inpatient and outpatient services.

The duration of healthcare services has a significant impact on the quality of care and patient's satisfaction. Having information on service delivery time in both government and outsourced Health Posts (HPs) can contribute to evidence-based policymaking and better resource management. Therefore, this study aims to estimate and compare service delivery time in government and outsourced HPs.

This descriptive-analytical cross-sectional study was conducted in six affiliated HPs under Tehran University of Medical Sciences in 2019–2020. Data were collected through a census using a stopwatch and a time recording form during one working week. The average duration of each service (in minutes) was obtained. The results were reported using descriptive statistics and were analyzed using SPSS24 software and multivariate analysis of variance (ANOVA).

The total mean of duration of services provided in government HPs (777.6 minutes) was greater than that in outsourced HPs (788.5 minutes). Among the 10 services provided, the average duration of services for adolescents (20.4±4.5 minutes), young adults (20.5±5.6 minutes), middle-aged adults (26.1±10.4 minutes), and elderly individuals (24.3±13.6 minutes) in government HPs was significantly longer than in outsourced HPs (p<0.05). Additionally, the average duration of health education services (23.1±10.5 minutes) and health ambassador training (36.1±13.7 minutes) in private HPs was significantly longer than in government HPs (p<0.05).

In outsourced HPs, it is important to focus on creating a balance between the number of visits and the staff available for services which target adolescents, young adults, middle-aged adults, and elderly individuals. In government HPs, emphasis should be placed on increasing the time allocated for educational and promotional health services. By considering the importance of service delivery time and the observed differences in findings of this study, it is crucial to prioritize the duration of service delivery as an important performance measure when comparing government and outsourced HPs.

This study aimed to investigate the necessity of cervical collars in patients with neck problems. This cross-sectional study was conducted on 114 patients who were admitted to the Haft Tir andRasoul Akram Hospitals (Tehran, Iran) from August to September 2022. The Nexus protocol was used to selectthe patients with cervical collars. According to the protocol, a cervical collar was required for individuals whohad at least one symptom. If none of these symptoms existed, the cervical collar was deemed unnecessary. Thedata were analyzed using the Chi-square test and Fisher’s exact test. Of the 114 trauma patients, the cervical collar was used unnecessarily by 49 (43%) patients. Tendernesswas the most common complication in 62 patients (54.4%). The prevalence of unnecessary cervical collaruse was 37.5% in female trauma patients and 43.88% in male trauma patients, which was not statisticallysignificant (p=0.63). The prevalence of unnecessary cervical collar use in trauma patients with multiple traumawas 39.42% and 80% in patients without multiple trauma, which was statistically significant (p=0.018). Patientswith a medical history had a higher rate of unnecessary use of the cervical collar (47.96%) than those withouta history (12.5%), and this difference was statistically significant (p=0.008). The guidelines for using cervical collars need to be updated by the EMS. Due to the large numberof trauma patients in Iran, cervical collars for necessary conditions can help reduce healthcare expensesand injuries caused by unnecessary cervical collars.

 In today's constantly changing world, educational organizations regularly renew their fundamental goals as a factor of development and transformation in society.

 Therefore, this study aimed to evaluate the relationship between organizational pathology and employees' organizational commitment.

 This descriptive-analytical and cross-sectional study was conducted in 2020 among the headquarter employees at Qazvin University of Medical Sciences, Iran. The data were collected using Meyer and Allen standard organizational pathology and organizational commitment questionnaires. In addition, R software version 4.0.3, Spearman or Pearson correlation statistical methods, and multiple linear regression coefficient analysis were utilized to analyze the data based on the research objectives.

 A total of 101 participants were male and 125 were female. There was a statistically significant correlation between organizational pathology and organizational commitment. The organizational commitment increased by increasing pathology (r = 0.1640, P-value = 0.019). The transparency of goals and the organization mission significantly affected the normative scale. The normative scale decreased by 0.35 by increasing one unit of the scale in the transparency of goals and organization mission (B = -0.038, P-value = 0.038). There was a direct and significant relationship between organizational pathology and organizational commitment.

 According to the results, university administrators and policymakers are recommended to take measures to coordinate employees' interests and individual goals with the organization’s interests and goals. Managers can provide employees with a clear and concise vision by expressing short- and long-term goals and planning, allowing employees to know the value of their actions to achieve the goals.

Health workers, especially nurses, are facing a high risk of contracting the COVID-19 and consequent mental disorders such as stress, anxiety and depression. We aimed to study the relationship between anxiety, stress and the protective behavior of nurses during the Covid-19 pandemic.

This cross-sectional study was conducted on nurses working in COVID -19 referral hospitals in Qazvin, Iran, in 2020. Out of 645 nurses working in two hospitals, 260 of them were selected randomly. Three questionnaires including demographic and contextual information, COVID-19 anxiety, stress and precautionary behaviors against COVID-19 were used. Descriptive statistical methods, Pearson correlation, t-test and one-way analysis of variance and binary logistic regression analysis were applied at 95% confidence interval.

The prevalence of anxiety symptoms in nurses was 32.08%, the mean score of protective behavior was 18.45+5.66 and the maximum score was 22.06+4.7. The negative relationship between anxiety and nurses precautionary behavior) β=-0.36, P<0.05) and the significant effect of COVID-19 stress on nurses’ behavior) β=-0.22, P<0.05) were confirmed. Furthermore, adding stress as an interfering factor, affirmed the mediating role of stress in the relationship between anxiety and nurses’ precautionary behavior (β=-0.18, P<0.05). Nurses under 35 years of age were more likely (OR=1.62, P=0.004) to follow the protective rules; those with 6 to 10 years of hospital experience were respectively 32 times and 37 times more probable to use personnel protective equipment (PPE) (OR=1.32, P=0.002) .

The probability of effective use of PPE and observance of protective guidelines among nurses with severe and very severe anxiety levels was less than their counterparts. While in those with controlled level of stress level such obedience was much more probable. Therefore, all health service providers, need to develop supportive programs to emphasize on the promotion of employees’ mental health.

Tackling noncommunicable diseases (NCDs) and their multifaceted, complex risk factors requires identifying policy gaps and translation of successful experiences for each setting. As advocated by World Health Organization (WHO), reducing sugar, salt, and fat are among best buys for prevention and control of NCDs. This article reports the status of existing policies to reduce the consumption of sugar, salt, and fat in Iran.

We created a comprehensive repository of available policy documents about sugar, salt, and fat policies in Iran and conducted content analysis and interviews with relevant stakeholders. Then, we compared policies and their content with the WHO’s best buys’ recommendations.

We categorized policies in 3 groups: red colour (no mention in the policy documents), amber (inspirational policy mention without action), and green (policy in operation). For example, regarding sugar, we found 8 policies in green, 1 in amber. Our matrix of policies on all 3 topics created a platform for further policy analysis and transferrable lessons to improve national actions towards 30% reduction of death due to NCDs in Iran.

It has been globally recognized that beyond technical solutions to combat NCDs, feasible and meaningful policy solutions must be created that are aligned with the political economy of each context. This necessitates learning from national, regional, and global experiences to manage the political economy of NCDs’ main determinants. To this end, our study provides a systematic and evidence-based framework, which may also be beneficial for other nations.

Health Transformation Plan (HTP) has been one of the biggest reforms in Iran's health system over the past 3 decades. The plan has been implemented since May 2014 and includes several packages that can affect the utilization of health care services. We aimed to assess the effect of implementation of HTP on utilization of specialist outpatient visit rate in clinics affiliated to university hospitals. We chose Kurdistan province to collect monthly specialist outpatient visit data for 50 months because this province was not a patient referral hub. An interrupted time series (ITS) analysis and segmented regression analysis were used to evaluate the effects of HTP on specialist outpatient visit rates. Statistical analyses were conducted using STATA version 13. A significant increase was observed in the specialist outpatient visit rate (12.1 outpatient visit per 1000 population) in the first month after the implementation of HTP (p= 0.000, 95% CI= 6.36-17.83). Also, after the implementation of HTP, a significant increase was observed in the monthly trend of specialist outpatient visit rate equivalent to about 0.53 every month per 1000 population compared to the monthly trend in specialist outpatient visit rate before the intervention (p= 0.033, 95% CI= 0.04-1.01). HTP has significantly increased the specialist outpatient visit rate in clinics affiliated to university hospitals in Kurdistan province. Thus, it is necessary to perform some comprehensive studies on all public, private, and semi-private sectors in different parts of the country to provide a better and more comprehensive picture of the effects of HTP on utilization of specialist outpatient visit services.

Job satisfaction of physicians in family physician team is considered as one of the important factors for health system. The aim of the preent study was to compare the quality of work life (QoWL) in rural family physicians and general physicians with private clinics in Kurdistan province.
A cross-sectional study was conducted among 103 general physicians including 50 rural family physicians and 53 general physicians with private clinics in Kurdistan province in 2016. The data were collected using QoWL questionnaire and analyzed using SPSS, v. 16. Descriptive statistics including frequency, percentage, mean, and standard deviation (SD) were used to describe the data and to examine the relationship between the variables, T-test was run.
The QoWL of rural family physicians with a mean of 55 (SD = 7.6) was higher than average scores. But QoWL of other general physicians with a mean of 47.7 (SD = 13.5) was lower than average scores. The results of t-test showed that there was a significant difference between QoWL of family physicians and other general physicians (t = 82.3, p = 0.001). In rural family physicians, there is a significant association between the QoWL and gender (t=2.7, P = 0.009) as well as native status (t=2.53, P = 0.004). In general physicians with private clinics, the QoWL of native physicians was higher than that of non-native physicians (t = 4.3, P = 0.001).
The QoWL of rural family physicians is better than that of others general physicians, even though it is unsatisfactory in both studied groups. Therefore, improving the QoWL of rural family physicians, especially female and non-native rural family physicians, is recommended because promoting the rural family physician's satisfaction can decrease the likelihood of turnover, and thus increase service quality and responsiveness, as a goal of the health system.

Self-confidence is a glorious feature of an effective administrator. Their main goal is the organizational success. Therefore, we approached this idea by evaluating the self-confidence of nursing Administration in Tehran University of Medical Sciences (TUMS) Teaching Hospitals and its relation to vocational satisfaction of the staff. In a cross-sectional study, we interviewed 200 nursing administrators and 200 staff in different departments of the TUMS Teaching Hospitals using a standardized questionnaire to assess the self-confidence among nursing administrators and staff satisfaction. Data were entered in SPSS (17.0) and analyzed using this software and STATA (11.0) using non-parametric tests and Spearman’s correlation of coefficient. The significant level was set as P<0.05. Of 200 nursing administrators 58 (29%) were male and 142 (71%) were female. Mean ± SD of the self-confidence score for the nursing administrators was 134.9 ± 19.8. Among the staff 68 (34%) were male and 132 (66%) were female. The mean ± SD of the vocational satisfaction for staff was 89.12 ± 18.3. After considering the effect of departments in a regression model, the correlation between nursing administration’s self-confidence and the staff’s vocational satisfaction was found not significant (P=0.055). Gender and years of employment were the only factors affecting self-confidence and vocational satisfaction between the nursing administration and staff respectively, which not significantly correlated after adjustment.

Self-reliance is a psychological belief that is formed in an individual during growth and is not changed easily and quickly. The present study aims to evaluate the relationship between nursing manager's self-reliance and patient's satisfaction in hospitals affiliated to Tehran University of Medical Sciences(TUMS). In this cross-sectional study, 400 individuals(200 nursing managers and 200 patients) were interviewed in various clinical wards of TUMS hospitals. Nursing manager's self-reliance and patient's satisfaction were evaluated using a structured questionnaire. The data were entered into Stata 11 software and analyzed with non-parametric ANOVA and Spearman's correlation coefficient tests. The significance level was determined to be p<0.05. Of the nursing managers, 58(29%) were male and 142(71%) were female. The mean and SD of their self-reliance were 134.9 and 19.8, respectively. The patients, however, comprised 81(40.5%) males and 118(59.5%) females. The mean and the standard deviation of patient's satisfaction were 57 and 18.2, respectively; the only individual factors affecting their level of satisfaction were educational level(p<0.005) and insurance status(p<0.0001). Besides, a multivariate analysis showed that there was a significant negative association between manager's self-esteem and patient's satisfaction(P=0.04). The findings revealed that female managers had less self-esteem than male managers. Moreover, it showed that manager's higher self-esteem would cause patient's lower satisfaction. Furthermore, patients with higher education and/or with health insurance were more satisfied than others.