mohammad khammarnia

Iran is classified as an endemic country for malaria, with a notable prevalence in the southern and southeastern regions.

This study aimed to examine malaria prevalence and morbidity among adults in southern Iran between 2016 and 2024. Examining the variables affecting the spread of this disease and suggesting possible ways to manage it, is an objective of the study.

A retrospective study was carried out in Sistan-Baluchistan province, the second-largest province of Iran, in 2024. Clinical and demographical data were collected from the three medical universities from March 2016 to September 2024. The study population was selected using the census method.

The morbidity to malaria has increased from 156 in 2016 to 22079 in 2024 in the southeast of Iran. Most of these cases (77.7%) were reported in the southernmost region. The highest occurrence of the disease was observed in men. Additionally, 44.9% of the patients were border drivers. The occurrence of malaria cases in the region was relatively low between 2016 and 2018. Moreover, 71.7% of the patients were infected with the Plasmodium vivax type of malaria parasite. Also, more men with malaria are diagnosed by the passive care system compared to women (P = 0.001).

To effectively manage malaria in malaria-prone areas like Sistan-Baluchistan province, it is important to increase awareness and vigilance regarding the symptoms of malaria, particularly among men, especially those working at the borders and drivers who transport goods across them. It is crucial for the country's healthcare system to pay closer attention to the effective control of endemic diseases, particularly during the summer season. Additionally, the health issues of immigrants should be considered a priority.

There is widespread consensus that the healthcare system relies heavily on its human resources. Consequently, the capacity and capability of human resources are crucial factors in the success of healthcare systems.

This study examines the correlation between resilience, burnout, and productivity among employees of the health system in Iran.

A cross-sectional study with an analytical approach was conducted at Zahedan University of Medical Sciences (ZAUMS) in southern Iran in 2023. The research population included all employees of health centers and hospitals at ZAUMS, with a sample size of 350 participants. Data were collected using three standard questionnaires: Connor and Davidson's resilience scale, Moslesh's job burnout scale, and a human resource productivity questionnaire. Data analysis was performed using SPSS software, with a significance level set at P < 0.05.

The findings showed that 56.6% of participants were female, and the mean age was 34.3 ± 7.6 years. The total scores for resilience, job burnout, and productivity were 90.0, 85.3, and 73.4, respectively. Job burnout was significantly higher among hospital employees compared to those in health centers (P = 0.001). The results also indicated that as staff age increased, their workplace resilience improved. Additionally, resilience was positively correlated with productivity (P = 0.001). However, no significant correlation was found between job burnout and either productivity or resilience (P = 0.532 and P = 0.476, respectively).

Increasing employees' resilience is essential for boosting their productivity. Efforts to enhance resilience should focus on three key dimensions: Courage, optimism, and cooperation. Providing resilience-enhancing training for hospital and health center employees, along with strategies to address burnout, can be highly effective. Furthermore, managing the relationship between supervisors and employees, designing an appropriate work environment, and fostering work engagement can improve workplace interactions and reduce job-related stress by increasing resilience.

Health system responsiveness is critical in managing infectious disease epidemics.

The purpose of this study was to evaluate the responsiveness of the health system during the Coronavirus disease 2019 (COVID-19) pandemic.

A cross-sectional study was conducted among 350 patients who had been discharged from hospitals after recovering from COVID-19 during 2021 - 2022 in Sistan-Baluchistan province, located in the southeastern region of Iran. Data were collected using the World Health Organization health system responsiveness tool through telephone interviews. Descriptive statistics methods were used to determine the responsiveness score. T -tests and one-way analysis of variance were also used to compare the means between groups.

The overall score for health system responsiveness was 110.12 ± 13.12, indicating a moderate level of responsiveness. The communication dimension received the highest mean score (30.12 ± 4.73), while the choice of provider dimension had the lowest mean score (5.65 ± 2.37). Significant relationships were found between health system responsiveness and variables such as place of residence (P = 0.01), city of residence (P = 0.001), and household size (P = 0.05).

The study identified areas for improvement in health system responsiveness within Sistan-Baluchistan's hospitals during the COVID-19 pandemic. To enhance patient care and strengthen the healthcare system's responsiveness, health policymakers should implement measures such as developing responsiveness guidelines, establishing a dedicated responsiveness unit, and providing training programs for healthcare professionals. Regular evaluation of responsiveness in hospitals is also crucial.

To adapt to the changing conditions and respond to the needs of society, health systems need continuous changes and reforms in their structure and performance, and subsequently, they need to evaluate their indicators. Therefore, this study aimed to investigate the impact of the health system transformation plan (HTP) on the functional indicators and efficiency of hospitals in a country in the Middle East region (Iran). A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‑Analyses) guidelines using the online databases Medline, EMBASE, Scopus, Pubmed, SID, Magiran, and Medlib from 2013 to 2022 using a combination of medical subject heading terms (‘health system transformation plan [Mesh] OR ‘health reform [Mesh] OR implementation of the health transformation plan [Mesh] ‘’AND (‘performance indicators’ [Mesh]) ‘’AND (‘Iran’ [Mesh]). STATA version 11 were used for data analysis. A total of 20 reports (cross‑sectional, cohort, and case‑control) were identified for this study. The results showed that after the HTP, the indices of bed occupancy rate and bed turnover rate have increased and the index of bed turnover distance has decreased. On the other hand, after the implementation of this plan in hospitals, the average of patients’ length of stay has increased. The implementation of HTP has improved most of the performance indicators of hospitals and has generally led to an increase in the productivity of hospitals compared to that before the implementation of the plan. However, efforts to strengthen weak performance indicators and identify effective indicators along with adopting correct policies to increase the overall efficiency of hospitals can be effective in improving HTP.

Improving the non-medical performance of health systems is an integral part of increasing people's well-being, which is the general and ultimate mission of the health systems. Responsiveness is a response to the reasonable expectations of people about non-clinical aspects of the health system. This study aimed to evaluate the responsiveness of health system in Iran.

Electronic databases including Scientific Information Database (SID), Magiran, PubMed, Scopus, Science Direct, Web of Science and Google Scholar were searched to retrieve relevant papers that have been published during 2000 to May 2023 using the keywords of health system, responsiveness and Iran. After a detailed review of related studies, finally 26 papers were included in the meta-analysis. Data were analyzed using Stata software and significance level of the tests was considered P˂0.05.

The overall responsiveness rate in Iran after combining the results of the selected studies was 0.65. Dimensions of human dignity and social support had the highest responsiveness score (0.68, and 0.67, respectively). Also, the right to choose with 0.51 and autonomy with 0.55 had the least responsiveness score. Additionally, social security and private hospitals had shown the highest level of responsiveness (0.74 and 0.71, respectively).  Responsiveness in the studies conducted before the implementation of the health transformation plan (HTP) was evaluated as 0.66 and it was 0.62 after the HTP.

The results of this study showed that Iran's health system has moderate responsiveness to the non-clinical needs of society. Considering the importance of responsiveness and its impact on the quality of life, improving the responsiveness of the country's health system is essential through effective planning and interventions.

Iron deficiency anemia in children is one of the most important challenges in the global health system. Also, it is one of the main problems in Iran, especially in the southern regions. Therefore, the aim of this study was to investigate the factors affecting iron deficiency anemia in children under two years of age. This case-control study was conducted on children under two years of age in Sistan and Baluchestan Province in the southeast of Iran with the highest birth rate in 2020. In the study, 760 children were divided into case and control group (380 vs 380). A standard information form was used for collecting data, and the data were analyzed using SPSS-21 by chi-square test and logistic regression. There were significant associations between the child’s iron deficiency anemia and the type of child nutrition (P=0.000), history of child’s food allergies (P=0.021), child’s congenital anomalies (P=0.009), maternal body mass index (P=0.083), number of previous pregnancies (P=0.035), history of abortion and stillbirth (P=0.027), use of postpartum supplementation (P=0.004), mother’s anemia (P=0.000), family marriage (P=0.001), father’s job (P=0.017), father’s anemia (P=0.000), and father’s addiction (P=0.007). Also, based on multivariate regression, the most important predictor of iron deficiency anemia in children was father’s addiction (OR=1.720; 95% CI: 1.067 – 2.773). The findings showed that parental factors could play an important role in causing iron deficiency anemia in children. These risk factors can be improved and prevented by promoting health education, increasing parental awareness and knowledge, and improving the lifestyle of families. Therefore, holding educational and counseling classes for parents is especially recommended.

Access to healthcare services is a prerequisite for societal justice. Unfair distribution of these services can lead to patient migration to cities with higher quality medical centers for better medical services. This study aimed to determine the direct and indirect non-medical costs of patients referred from Sistan and Balouchestan to hospitals in Mashhad. A descriptive-analytic study was conducted in Eastern Iran in 2020. The research sample included all patients who migrated from Sistan and Balouchestan to Mashhad for medical purposes and were hospitalized in government hospitals affiliated with Mashhad University of Medical Sciences. The total number of these patients was 2062, and they were identified using a census method in 2020. Given the large population size (2060 individuals), 350 patients were selected as a sample based on the Cochrane method. A validated checklist was used for data collection, and SPSS-23 software was used for data analysis. The average direct non-medical cost for medical services in Mashhad was 61,686,857 Rials (270 USD). The highest and lowest costs were related to travel costs (26,545,714 Rials or 116 USD), and care received for children (37,142 Rials or 0.16 USD), respectively. According to the results of this research, an increase in direct non-medical and indirect costs due to patient migration for treatment imposes significant costs on patients and their families. It is crucial to have an equitable distribution of health and treatment resources and facilities across a country’s geographical regions to ensure access to health services.

Major thalassemia patients due to the need for frequent and continuous blood transfusions ; they are exposed to blood-borne diseases, especially Hepatitis B, Hepatitis C and HIV. which is one of the most important health problems in the world and Iran today. The present study aims to determine the prevalence of Hepatitis B, Hepatitis C and HIV in patients with major thalassemia in Zahedan city.

In this cross-sectional study, 816 patients with major thalassemia who had regular blood transfusions at Ali Asghar Hospital in Zahedan were investigated by census method. Demographic data And the results of Anti-HIV, HBs-Ag, HBs-Ab, Anti-HCV, Ferrittin and CBC blood tests have been reviewed. Spss26 software was used for data analysis.

The average number of referrals for transfusion was 25.71 ± 33.71. 501 people (94.9%) had sufficient response to the hepatitis B vaccine and only 27 people (5.1%) had HBs-Ab levels less than or equal to 10 IU/ml. In this study, using chi-square analysis, a significant relationship between the age group of 30 to 60 years and hepatitis C has been observed (P<0.000). However, no significant relationship between hepatitis B and HIV infection with gender and blood group variables has been observed.

HBsAg testing on donated blood and hepatitis B vaccination and the low prevalence of HIV among blood donors are directly related to the low prevalence of hepatitis B and HIV in major thalassemia patients. Considering that there is currently no vaccine against hepatitis C and HIV, careful screening of donated blood and the use of new laboratory methods and the use of high-sensitivity laboratory kits are necessary to reduce the transmission of HCV-Ag contamination for patients.

Policymakers can enhance personnel performance and consequently, improve the quality of healthcare by evaluation of suitable leadership styles for health organizations and establishment of effective team groups. This study aimed to determine the relationship between the leadership styles of nursing managers and the teamwork of nurses.

This descriptive-analytic study was conducted among 500 nurses working in eight selected university hospitals in Mashhad and Zahedan, Iran (2022). Data were collected using two standard questionnaires on leadership styles and teamwork through interviews. Descriptive statistical methods, such as the mean and standard deviation, were employed to determine leadership style and teamwork scores. Additionally, Pearson's and Spearman's correlation coefficients were used to investigate the relationship between these two variables.

The dominant leadership style among the participants was transformational leadership (37.6%). The overall mean teamwork score was 3.66±0.48, with 91.8% of nurses scoring teamwork 3 or higher. Transformational and passive leadership styles exhibited the highest and lowest relationships with teamwork, respectively (P<0.05). Additionally, the mean teamwork score among nurses with managers exhibiting a transformational leadership style was higher, compared to other styles (P<0.05).

Managers and executive supervisors can positively impact teamwork and consequently, the performance indicators of their unit by adopting a transformational leadership style and enhancing their leadership knowledge. To achieve this goal, it is suggested to conduct in-service training courses. Additionally, selecting supervisors of centers who promote teamwork and designing a mechanism to collect feedback from hospital personnel regarding the leadership style of their direct managers are recommended.

Tuberculosis is one of the oldest and best-known diseases that has been with mankind for many years. Despite the reduction of infectious diseases in Iran, tuberculosis still remains in some parts of the country, especially in the south of Iran. The aim of this study was the epidemiological investigation of tuberculosis in Sistan and Baluchistan Province.

The current research was conducted cross-sectionally in 2022. The study population included all the patients with tuberculosis in Sistan and Baluchistan Province. Data were collected by census method and using standard checklist. Data analysis was done using SPSS v16 software and descriptive and analytical tests.

In this study, the files of 5382 patients with tuberculosis in Sistan and Baluchistan Province were examined. 2489 patients (42.6%) were men. The most affected group were 2309 elderly people (39.5%) and 20 patients (0.34%) with HIV. The number of 4309 patients (73.8%) were suffering from pulmonary tuberculosis. There was a significant relationship between the elderly age group (P=0.04), female gender (P=0.02), non-Iranian nationality (P=0.02), and urban residences (P=0.03) with tuberculosis. However, no significant relationship was observed between marital status (P=0.06) and prison history (P=0.07).

The incidence of tuberculosis fluctuated during the five years, but the overall incidence has been decreasing. Considering that some factors such as age groups, gender and symptoms such as cough, weight loss and chest pain increase the chance of contracting the disease. Therefore, doctors of health centers can take an important step in reducing the incidence of tuberculosis with timely visits and regular monitoring of the treatment process of patients.

Context: 

In recent decades, the tobacco epidemic has spread worldwide. The impact of tobacco control policies has been different among countries. This paper aims to explain how two countries, the United Kingdom (UK) and India, with different political, social, and cultural contexts, implemented theWorld Health Organization (WHO) Framework Convention on Tobacco Control.

Evidence Acquisition: 

A comparative study was done for tobacco control in UK and India in 2022. A review of literature in five databases, observational data and legal documents on tobacco use were undertaken. To identify and explain the factors that pose challenges to the implementation of tobacco control policies, country reports and health policy monitoring and research databases (in total, 27 papers and 16 reports) were reviewed.

Having different economic, social, and cultural backgrounds, a similar pathway to control the tobacco industry can be seen in UK and India. The factors that can explain the similar outcomes in two countries are the global pressure of WHO, increased awareness of people and policymakers, and a sense of urgency about the tobacco problem in both societies.

At different stages of tobacco control in both countries, various interest groups with different routes of political influence used veto opportunities to overturn political decisions in the policy process. Continuous analysis of interest groups and their status quo is necessary to restrict the tobacco industry in favor of public health. Governments should carefully recognize the stakeholders and stake challengers in the policy domain and balance their interests.

Children’s health is important as the future builders of society. Many children under 5 years of age around the world and in Iran have growth disorders. Due to the importance of growth disorder and its impact on the development, learning and future of the child, the present study was conducted with the aim of determining the frequency of deviations from the growth curves of children under 5 years of age and related factors in Zahedan city.

This case-control study was conducted in 2020 in Zahedan. The study population included all children under 5 years old, born in Zahedan between 2013 and 2020 that 784 of whom were selected by random sampling method. To determine the factors related to growth disorder multiple logistic regression analysis was used and to check the significance level, chi-square test and Pearson correlation were used. In this research, the data were analyzed with SPSS software.

The results of this research showed that 54% of the boys and 51.20% of the girls had growth disorders. Between child growth disorder and maternal chronic disease (P<0.05), maternal body mass index (P<0.05), Maternal weight gain during pregnancy (P<0.05), distance between births (P<0.05) maternal urinary tract infection during pregnancy (P<0.05), mother’s age (P=0.006), mother’s education (P<0.05), birth weight (P<0.001), birth order (P<0.05), father’s occupation (P<0.05) and father’s education (P<0.05) a significant association was found. In the present study, the average birth weight in children with growth disorders was 2.75±0.58 and in healthy children was 2.95±0.57, and this difference was statistically significant (P=0.001). The average age of mothers of children with growth disorders was 29.19±6.07 and the average age of mothers of healthy children was 27.98±6.10, this difference was statistically significant (P=0.006).

Growth disorder is a multi-causal complication. Risk factors can be corrected and prevented by developing health education and increasing mothers’ awareness and knowledge. Also, the father’s job and literacy are effective in the child’s growth disorder, so Increasing community health literacy and encouraging fathers’ learning and literacy can partially prevent growth disorders in children.

The prevalence of coronary heart disease has affected education systems around the world, including higher education in Iran. The aim of this study was to determine the quality of virtual education system in Zahedan University of Medical Sciences from the perspective of students.

A descriptive-analytical study was conducted in 2016 at Zahedan University of Medical Sciences. The study population in this study included all students studying at Zahedan University of Medical Sciences, of whom 537 completed a questionnaire. A standard electronic questionnaire with the dimensions of quality of educational content presentation, virtual education infrastructure, quality of online classes and quality of virtual tests was used to collect data. SPSS software and descriptive and analytical statistical tests (One way annova, etc.) were used to analyze the data.

From the studentschr('39') point of view, the highest mean score was related to the virtual education infrastructure dimension (2.97) and the lowest mean score was related to the response dimension (2.01). In terms of accountability, 35% of students rated the appropriate response to student problems by the schoolchr('39')s EDO expert as very poor. There was no significant relationship between gender and indigenousness and the quality dimensions of e-learning. There was a significant relationship between the quality of content presentation, online class, response, virtual test with colleges (P> .001). There was a significant relationship between all dimensions of virtual education and educational level (P> .001).

Creating readiness in various human dimensions and equipment requires careful and appropriate planning. Given the current situation and increasing the use of virtual education system, it is necessary to take a big step towards the development of education systems by strengthening the necessary structures and technologies and reforming educational processes and evaluation and training of professors and students.

One of the effective indicators used to determine the efficiency and optimal use of hospital re-sources is the length of stay (LOS). Then, we aimed to determine LOS and its related factors in Iran.

A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, PubMed, SID, MagIran, and Medlib from 1995 to 2022 using a combination of medical subject. STATA ver-sion 11 used for data analysis.

Overall, 75 (cross-sectional, cohort, and case-control) reports were identified. The average length of stay in Iranian hospitals was 6.7 (95% CI: 5.32 -7.74) d. There was a significant relationship between the length of stay in the hospital and different wards of hospital (P=0.001). The average of men’ LOS was longer than women were [6.9 (95% CI: 5.32 -7.74) vs. 3.9 (95% CI: 1.67-9.41)]. Moreover, the average LOS before and after the Health Transformation Plan (HTP) in Iran has changed, so that it has increased from 5.8 (95% CI: 4.39 -7.86) to 7.1 (95% CI: 5.59 -9.25) d after HTP (P=0.30).

The average length of stay of patients in Iranian hospitals is more than the expected index of the Ministry of Health and Medical Education and is in the unfavorable range (> four days). Moreover, considering the direct effect of the type of departments on LOS; therefore, hospital managers should pay more attention to hospital processes using new process-oriented and customer-oriented management approaches.

The coronavirus disease 2019 (COVID-19) pandemic is an emerging global threat to public health.

This study examined the epidemiological and clinical characteristics and death-related factors of COVID-19 in inpatients in Zahedan, Iran.

This multicenter study included all COVID-19 patients admitted to Zahedan hospitals within February to April 2020. Demographic, epidemiological, and clinical characteristics were extracted from medical records. Bivariate and multivariate logistic regression models were used to examine the risk factors associated with inpatient mortality.

Of 425 patients in this study, 237 and 188 were male and female, respectively. Moreover, 31 (7.29%) patients died. The patients with a severe stage of pneumonia and those with a severe/critical condition of COVID-19 were 35.8% and 35.1%, respectively. The most prevalent symptoms were cough (70.8%), shortness of breath (62.1%), fever (34.1%), bruising (28.7%), and shivering (28.5%). The most prevalent underlying diseases were hypertension (23.3%), diabetes (16.7%), cardiovascular disease (13.2%), chronic pulmonary disease (9.6%), and asthma (5.4%). Adjusted odds ratio (OR) of in-hospital mortality increased for patients with older age (OR = 3.74, 95% CI: 1.39 - 10.32), at least one underlying disease (OR = 1.16, 95% CI: 1.01 - 1.32), severe disease (OR = 30.9, 95% CI: 4.01 - 239.09), and critically severe disease (OR = 736.5, 95% CI: 74.75 - 7256.1) compared to mild/moderate disease.

This study showed that older age, disease severity, and underlying diseases were mortality risk factors due to COVID-19 infection. This finding indicates that priorities for hospital admission must be given to patients with a higher risk of mortality due to limited facilities, especially in less privileged areas.

Outsourcing strategy is a simple and economical approach that can help managers of organizations to undertake executive tasks effectively. In practice, the application of this approach at any organization is not easy and usually presented with many problems. The present study aims to investigate the viability, strengths, and weaknesses of outsourcing strategy in the health system.

This qualitative study was conducted with the content analysis approach at Zahedan University of Medical Sciences in 2020. The sampling method was purposeful, and sampling was continued until data saturation. Data analysis was performed manually using contract content analysis.

The data analysis indicated six main categories (including legislative challenges, executive challenges, manpower, regulatory challenges, and financial challenges) and 13 sub-categories.

The outcomes of this study revealed that outsourcing is one of the basic needs to advance organizational goals. Nonetheless, its current implementation method is not very appropriate. Challenges identified as obstacles to the proper implementation of the partnership plan with the private sector in the field of health are sometimes an integral part of such plans. These challenges must be resolved before the implementation of the plan and during planning by conducting studies and reviewing the project background. This will help to prevent further problems during the execution.

The spread of the COVID-19 disease and the increase in healthcare costs have made health care providers look for a solution to evaluate the performance of the healthcare delivery system. One of the effective indicators for determining the optimal use of hospital resources is the length of stay (LOS). This study was conducted to determine the effective factors on the LOS of patients in Zahedan hospitals, in Iran, before and after the outbreak of COVID-19.

The present descriptive study was conducted by examining the records of patients admitted to four general hospitals in Zahedan from 2018 to 2021. To analyze the data, independent t-tests, one-way analysis of variance, and Pearson's correlation coefficient were used.

Out of 1600 examined patients, 59.2% were female and 40.8% were male. The mean and standard deviation of the patients’ LOS in general hospitals of Zahedan city was 3.4±3.5 days. It was found that LOS decreased after the outbreak of COVID-19 (3.5±3.7 days before the COVID-19 outbreak, 3.2±3.2 days after the COVID-19 outbreak). In general, LOS in terms of demographic characteristics, management factors, type of disease, history of underlying disease, and type of hospital had a significant difference (P<0.001).

Based on the findings of the present research, the average LOS of patients in general hospitals of Zahedan was favorable (less than 3.5 days). However, due to the lack of hospital resources, it is recommended to improve hospital processes and pay more attention to the variables affecting them.

Implementation of performance-based payment system is considered as an important and effective factor in improving work productivity, which will increase organizational satisfaction and justice. Performance-based payments actually link material rewards to individual, group, or organizational performance, or a combination of the three. The aim was to explain and prioritize the challenges and solutions of the performance-based payment system to the staff of hospitals.

This study is a qualitative study that was conducted with content analysis approach in 2020 in teaching hospitals of Lorestan. The statistical population was 14 medical and staff members using purposive sampling. The sampling method was purposeful and sampling continued until data saturation. Data analysis was performed using conventional content analysis.

After the process of continuous comparison of data and open, pivotal and selective coding, in 2 main dimensions (organizational factors, individual and internal factors) and 6 sub-dimensions (fair payment system; work quantity; work quality; work based payment And effort; motivation and interest; commitment and commitment) were organized.

Considering the effectiveness of the implementation of performance-based payment plan on the income of hospitals, it can be stated that this plan has a positive effect on the performance of hospital staff and causes them to be more active in hospitals, provide better services and Total improved effectiveness. Therefore, the officials and implementers of the performance-based payment plan in the Ministry of Health and Medical Education are suggested to follow its implementation more widely in other provinces.

Diabetes is a disease in which blood sugar level is high due to hormonal disturbances. Monitoring and evaluation certainly helps to prevent, manage and control this widespread disease. The aim of this study was to study the epidemiology of diabetes in the Diabetes Clinic in Bu-Ali Hospital, Zahedan in South East Iran.

This was a cross-sectional descriptive-analytical study conducted in 2020 including all the 1164 patients referring to the Diabetes Clinic in Bu-Ali Hospital.  Data were collected using a standard check list and analyzed using the Stata-v14 software.

Information on 1164 patients with diabetes was recorded and analyzed. Most (97.7%) of the patients had type-2 diabetes. The average fasting blood sugar in patients with type-1 and type-2 diabetesd was 236 and 201 mg/dL respectively, the corresponding A1C levels being abnormally high ─ 9.6% and 8.4%. Fasting blood sugar was associated with diabetic foot complications and nephropathy (p<0.05).

Based on the findings of this study the level of care of diabetic patients in terms of quantity and quality is not quite acceptable, not conforming to the respective national standards. This issue indicates the unfavorable performance of the Diabetes Center, which can be attributed to the poor conditions of the geographic region, insufficient equipment and specialized manpower and low health literacy of the people. Therefore, increasing the awareness of overweight and obese people, especially those with a family history of diabetes, about prevention can help to reduce the incidence of the disease or minimize its complications.

Information literacy is a capability that enables individuals to create, sustain, and deepen communication with others, which can be effective in many organizational dimensions such as organizational ethics and career development.

This study aimed to determine the relationship of information literacy and professional ethics with career development among Zahedan University of Medical Sciences (ZAUMS) staff.

Using systematic sampling, this cross-sectional study was conducted on 238 ZAUMS staff in southeast Iran in 2018. Data were collected through individual interviews using standard questionnaires Information Literacy, Professional Ethics, and Career Development. The data were analyzed using SPSS-v21 software and descriptive statistics, one-way ANOVA, and t-test.

Of 237 individuals, 116 (48.7%) were males with a mean age of 38 years. The information literacy and career development scores were in the moderate range (means of 170 and 56, respectively), while the professional ethics score of the majority was poor, with a mean of 32. There was a significant direct relationship between information literacy (coefficient = 0.189) and professional ethics (coefficient = 0.391) with career development (P < 0.05). Multivariate linear regression showed that an increased level of employees' access to information had significant positive effects on career development (β = 0.878, P < 0.01). Also, an increase in the level of career development (performance evaluation, workplace environment, supervision status, and educational factors) and professional ethics (loyalty and respect to others) was associated with increased levels of information literacy (P < 0.05).

Information literacy and professional ethics could increase career development. Therefore, it could improve organizational productivity. It is suggested that professional ethics workshops and courses be held to improve staff's information literacy.

COVID-19 has become a global problem. In this case study, the experiences gained from disease control in rural areas are reported.

An observational study was done in 2020 in Sistan and Balochestan, the largest province with most rural areas in the southeast of Iran.

After identification of the first patient of Covid-19 in a rural area, three measures were taken including: 1. Diagnosis, screening and treatment of the disease (Incident command post was established and the village was completely quarantined, etc.; 2. Intersectoral coordination for epidemiological management (limiting traffic for people and any gathering); and 3. Identification of any Covid-19 positive cases. The results of these measures showed that after quarantining the village and performing the mentioned actions, the number of patients decreased, and the disease was controlled.

Quarantine of the contaminated rural area and people’s traffic routes is one of the most important measures in controlling Covid-19.