Journal of Education and Health Promotion
Volume:9 Issue: 6, Jun 2019

With an estimation of every two women newly diagnosed with breast cancer, one dies. It is accounted that 1 in 28 women is likely to develop breast cancer during her lifetime. Developing a risk prediction tool by assessing the prevalence of known risk factors in the community will help public health intervention.

A cross‑sectional study was conducted among 18–64‑year‑old women to gather the prevalence of known breast cancer risk factors, through a community survey (sample survey). In this multistage random number‑based cluster sampling study, the results were compiled, collated, and analyzed in rates and proportions. Statistical conclusions were made using spreadsheets (Microsoft) and the values were converted into ordinal values using modified Likert scale and median was used to estimate central values. The estimated prevalence of these known risk factors was re‑assorted for analysis and these re‑assorted data were categorized into range of values across the communities. The internal validity of the survey questionnaire was measured using Cronbach’s alpha (α).

The analysis of 558 participants was performed for the known risk factors for breast cancer including participant’s age, age at menarche, marriage, first childbirth, menopause, family history of breast cancer and benign breast disease, history of abortion, and body mass index. Based on the estimated prevalence of these risk factors, a community‑based risk prediction tool was developed with Cronbach’s α score of medium internal validity.

The risk assessment tool has collated most of the risk factors of breast cancer that are capable of being measured at community level. The survey findings concluded that the community under survey was bearing moderate risk for breast cancer for women.

The political, social, economic, and security implications of health‑related issues such as emerging infectious diseases or the epidemic of Non Communicable Diseases offer a rare opportunity for professionals in foreign policy and international relations to engage with the health arena and at the same time for global health experts to enter into and intersect with the domain of diplomacy. The aim of this review is to understand and explore the concepts of global health diplomacy (GHD), health security, and human security. For this narrative review, a literature search was done in PubMed, Scopus, and EBSCO for the “global health diplomacy,” “health security,” and “human security,” and full‑texts were reviewed. The recent outbreaks of Ebola in West Africa and Zika in South America are pertinent examples of the nature of the human security crisis and the imminent and severe threat posed to human life across the globe as a result of these epidemics. The Commission on Human Security defines human security as the protection of the vital core of all human lives from critical and pervasive threats. We highlight the ways in which health has now become an issue of national security/global concern and also how GHD can aid in the development of new bilateral or multilateral agreements to safeguard the health and security of people in our globalized world. The paper provides a prospective about, and overview of, health and human security that essentially emphasizes the growing interlinkages between global health, diplomacy, and foreign policy.

 Predicting residents’ academic performance is critical for medical educational institutions to plan strategies for improving their achievement.

This study aimed to predict the performance of residents on preboard examinations based on the results of in‑training examinations (ITE) using various educational data mining (DM) techniques. SETTINGS AND DESIGN: This research was a descriptive cross‑sectional pilot study conducted at Iran University of Medical Sciences, Iran.

A sample of 841 residents in six specialties participating in the ITEs between 2004 and 2014 was selected through convenience sampling. Data were collected from the residency training database using a researcher‑made checklist. STATISTICAL ANALYSIS: The analysis of variance was performed to compare mean scores between specialties, and multiple‑regression was conducted to examine the relationship between the independent variables (ITEs scores in postgraduate 1st year [PGY1] to PG 3rd year [PGY3], sex, and type of specialty training) and the dependent variable (scores of postgraduate 4th year called preboard). Next, three DM algorithms, including multi‑layer perceptron artificial neural network (MLP‑ANN), support vector machine, and linear regression were utilized to build the prediction models of preboard examination scores. The performance of models was analyzed based on the root mean square error (RMSE) and mean absolute error (MAE). In the final step, the MLP‑ANN was employed to find the association rules. Data analysis was performed in SPSS 22 and RapidMiner 7.1.001.

The ITE scores on the PGY‑2 and PGY‑3 and the type of specialty training were the predictors of scores on the preboard examination (R2 = 0.129, P < 0.01). The algorithm with the overall best results in terms of measuring error values was MLP‑ANN with the condition of ten‑fold cross‑validation (RMSE = 0.325, MAE = 0.212). Finally, MLP‑ANN was utilized to find the efficient rules.

According to the results of the study, MLP‑ANN was recognized to be useful in the evaluation of student performance on the ITEs. It is suggested that medical, educational databases be enhanced to benefit from the potential of DM approach in the identification of residents at risk, allowing instructors to offer constructive advice in a timely manner.

One of the important challenges at the Universities of Medical Sciences is the mentorship of postgraduate students’ academic theses. Since 2015, the Research Mentorship Program (RMP) has been implemented with the aim of improving research knowledge and skill, thesis quality, and quantity and quality of papers of emerging from postgraduate students’ theses.

This was a prospective cohort study with census sampling method (nonprobability sampling), completed between 2015 and 2018. Twenty‑eight postgraduate students participated in the program. Each trainee student is done during the research period through the supervisor and another student in a higher level of education as mentor. Questionnaire with open‑ended questions and checklist was used for data gathering. For statistical analysis, Chi‑square test was used.

100% of the mentors and 93% of the mentee participated at the Research Mentorship Program were satisfied. In addition, the duration of the research course for the master’s students participated in the RMP was reduced. Participants in this program had higher quantity and quality of papers resulting from postgraduate student’s academic theses. RMP can enhance the postgraduate students’ knowledge and skills in their research projects and research methods, develop personal and professional relationships, and promote interpersonal communication as a student or mentor.

This program and its similar programs can improve the quality of postgraduate students’ academic theses and reduce their research period.

An important indicator increasing the survival chances of patients and injured people immediately after emergency and disaster is the rapid access to medical services. The establishment of Emergency and Disaster Medical Response Teams (EDMRTs) is one of the main strategies to improve response capacity and capability in the field of EDMRT. This study aimed to probe the structural factors influencing of EDMRTs.

In this study, a comparative review method was used. The current study was conducted between March 2017 and September 2018. For this, articles, books, formal reports, and information concerning the available websites regarding the structure of EDMRTs were analyzed. To access relevant scientific articles, an extensive search was carried out in several steps using divergent keywords in the Scopus, ProQuest, PubMed, ScienceDirect, and Google Scholar databases. After accessing the resources and documents, the process of analyzing and comparing different team structures was carried out using content analysis.

Following the search of relevant databases and websites, the structure of EDMRTs in the United States, Australia, Japan, Turkey, New Zealand, Canada, and the World Health Organization were taken into consideration and compared. Two areas of “Organization and Management” as well as “Capacity and Capability Development” were explored along with multiple subsets.

The results of this study revealed that the model and structure of EDMRTs have direct relationship with such elements as the structure of the disaster risk management system, risk assessment, impact of the hazards and medical needs of the affected area, population distribution, level of team activity, and timing of the teams’ presence after disasters. The research team recommends designing and conducting studies for determine the roles and responsibilities of the teams.

Sexual assertiveness plays a crucial role in the quality of sex, as well as in investigating and treating sexual problems. The purpose of this study was to determine the impact of assertiveness‑based sexual training on the quality of marital relationships of married female students.

This quasi‑experimental study was done in southeastern Iran in the academic year of 2017. A total of 80 married women were chosen from university students through convenience sampling, and they were assigned to the intervention (n = 40) and control (n = 40) groups. Data were collected using the Perceived Relationship Quality Components Inventory. For the intervention group, assertiveness‑based sexual counseling was provided in four sessions (90–120 min each session). The posttest was performed 12 weeks after the last counseling session. Independent t‑test and covariance analysis were employed to analyze data using SPSS version 21 software.

After the intervention, the two groups revealed a significant difference in their respective mean total score of the quality of various dimensions of marital relationships (P = 0.0001). This indicates that assertiveness‑based sexual counseling has improved this mean total score in the intervention group compared to the control group.

Given the positive impact of assertiveness‑based sexual training on the quality of students’ marital relationships, the integration of sexual training with focus on assertiveness in usual sexual counseling will help therapists to improve the quality of marital relationship from the perspective of women.

Initial formative years in every children’s life are critical for their optimal development, as these frame the foundation of future well‑being. With a varied prevalence of developmental delays (DDs) in the world and most of the studies representing the hospital‑based data. The present study was aimed to find the prevalence and risk factors for DDs (domain wise) in children aged 2 months to 6 years in the rural area of North India.

This was a cross‑sectional study in which a multistage random sampling technique was used. From 30 Anganwadi centers, 450 children aged 2 months–6 years were taken in the study. Rashtriya Bal Swasthya Karyakram screening tool developed by the Ministry of Health and Family Welfare, India, was used for developmental screening. Binary logistic regression analysis was done to identify the predictors for DDs (domain wise).

Seventy‑three (16.2%) children were found to have DDs and 60 (13.3%) children had the global DDs. About 84/421 (20.0%) children had cognitive delay, followed by 43/450 (9.6%) children who had delay in speech and language area. About 17/190 (8.9%) children had social delay while 26/407 (6.4%) children had hearing and vision impairment. Gross motor delay was seen in 24/450 (5.3%) children and 16/300 (5.3%) children had fine motor delay. Gestational age (adjusted odds ratio [AOR] – 13.30), complications during delivery (AOR – 25.79), meconium aspiration (AOR – 12.81), and child never breastfed (AOR – 8.34) were strong predictors for the delay in different domains of developmental milestones.

Socio‑economic, ante‑natal, natal and post‑natal factors should be considered for prompt identification and initiation of intervention for DDs. RECOMMENDATION: There is a need for increasing awareness and knowledge of parents regarding the achievement of developmental milestones according to the age. A multipronged approach to the holistic treatment of developmentally delayed children for early intervention is required.

Measures related to birth preparedness and complication readiness (BPCR) during pregnancy play an important role in producing better pregnancy outcome. If the pregnant females are properly counseled during antenatal visits, it could help in bringing out desirable behavior changes.

This study aims to study BPCR‑related awareness and practices among the pregnant females and the effect of focused and structured birth preparedness counseling on complication readiness among pregnant females.

A facility‑based follow‑up study was conducted from July to December 2016, and a total of 130 pregnant females were enrolled. All study participants were initially assessed for various domains of BPCR index consisting of seven key indicators. The index reassessment was done again, after 1 month, during follow‑up visit. Information regarding any pregnancy‑related complication in due course and behavior was also recorded during successive follow‑up. STATISTICAL ANALYSIS USED: The difference in pre‑ and postcounseling mean BPCR index was assessed using paired t‑test, and McNemar’s test was used for paired categorical data analysis. P < 0.05 was considered to be statistically significant.

The postcounseling BPCR index (70.65 ± 19.18) was found to be significantly much higher as compared to pre‑counseling baseline BPCR index (41.12 ± 11.34). Knowledge about danger signs of pregnancy, transportation services provided by government, financial assistance provided in Government schemes, identification of skilled birth attendant, mode of transportation, and arrangement of emergency blood donor was found to increase significantly after counseling. Abortion was found to occur significantly higher (about thrice) among those who had postcounseling BPCR index below average, i.e., <50% (P < 0.05).

The results of the present study revealed that focused birth preparedness counseling on complication readiness could play an important role in increasing the baseline knowledge of pregnant females regarding pregnancy‑related complications and bring out desirable ideal health‑seeking behavior changes during pregnancy.

The dust and sand storms (DSS) in Iran increased in recent years, which have caused adverse health effects. Regarding the effects of DSS on the health indicators, the health system plays a key role based on the mission and the services which it provides. The present study was conducted, in Iran, to fill the existing knowledge gap and to understand the preparedness challenges of the health system in response to the DSS.

Twenty‑one semi‑structured interviews, in 2016–2017, were undertaken. This study carried out using purposeful sampling with key informants in the Khuzestan Province, national policymakers in Tehran, as well as people affected by this phenomenon. A qualitative approach, using the conventional content analysis, was employed to analyze the collected data.

Four main categories that appear to explain the preparedness challenges of the health system for DSS include the risk assessment, knowledge management, organizational elements, as well as monitoring and evaluation.

It is imperative that policymakers of the country pay special attention to the hazard risk understanding and managing the various aspects of the beliefs and attitudes associated with DSS. The development of early warning system, regular drills and exercises, as well as public and specialized health promotion training related to this phenomenon are suggested.

Obesity and iron deficiency (ID) are two forms of the most usual nutritional disorders worldwide. Some studies have discovered a correlation between ID and obesity although more investigation is required. This study was aimed to determine the association between obesity and ID anemia (IDA) in Iranian childbearing age women.

This cross‑sectional study was done on 256 women of reproductive age in northern Iran. The anthropometric measurements including height and weight were measured, and body mass index (BMI) was calculated. Low blood index of the hemoglobin (Hb), mean cell volume (MCV), and mean corpuscular hemoglobin (MCH) were evaluated with ferritin, serum iron, and total iron‑binding capacity. Baseline data were expressed as means ± standard deviations. Chi‑square test was applied to compare the categorical variable. Differences between the two groups were evaluated with independent samples t‑test. A value of P < 0.05 was considered as statistically significant.

Obesity was in urban women higher than rural women (55.1% vs. 44.9%), and this difference was significant (P < 0.021). There was found no association between hematological characteristics and BMI. The data showed that only 13.4% of obese women and 17.1% of the women with normal weight had IDA (odds ratio = 0.75; 95% confidence interval: 0.39–1.49, P > 0.05).

According to the results of this study, it seems that the relationship between obesity and IDA is controversial. Hence, further studies are needed to be done.

Pathology is basic science, and steps are being taken to integrate the clinical sciences in undergraduate pathology curriculum. The present study was undertaken with the aim to assess the need for revision of the undergraduate pathology curriculum with a focus on assessment methods.

This study included a questionnaire‑based, anonymous, survey in a 5‑point Likert‑type scale for undergraduate students who have completed pathology subject including the interns and a qualitative approach through interviews and focus group discussions from the pathology senior residents and faculties using the essentialist thematic analysis.

There were a total of 109 feedbacks from undergraduate students and also the interns. A total of 10 feedbacks from the senior residents and faculties were analyzed. About 70%–90% of the students were satisfied with the pathology curriculum and teaching and clinical integration in pathology. However, only 52.3% of students felt morphology being extremely important as compared to 80% of faculties, showing a discrepancy between the students’ perception of the importance of morphology and that of the faculties.

Although both students and faculties find the curriculum adequate, it is suggested that teaching could be made more clinical oriented. The assessment based on morphology should be given less emphasis during the assessment.

Regarding lack of resources in the health‑care sector, prioritization of these resources is inevitable. The objective of the current study was to elicit public preference in prioritizing and allocating health resources using a discrete choice experiment technique, which is currently the most commonly applied method in this field of researches.

In this discrete choice study, five attributes were selected through interview with 25 health experts to elicit people preferences in Tehran (Iran) in 2017. Eighteen choice tasks were arranged within 3 blocks, and this would be achieved with a sample size of 579. Choice data were modeled using generalized estimating equation method and STATA 14 software.

Five attributes including level of emergency, severity of disease, communicable, benefit from treatment, and age are the most important attributes in the prioritizing health resources from the expert’s point of view. As well as among these attributes, communicable (odds ratio = 2.81) is the most important attributes from the public’s point of view.

The results of this study could be very useful for prioritizing resources which is one of the most challenging measurements of the health system. By identifying the importance of each patient’s characteristic, patients can be categorized in groups with different priorities, as well as the diagnosis‑related group system, based on which resources are allocated.

Given the substantial role of information systems in planning and simplifying the decision‑making process for the government, organizations, health centers, and facilitators, in order to attract medical tourists from less developed and neighboring countries, the comprehensive Iranian Medical Tourism Information System can be used. The objective of this study was to designing a conceptual model for Iranian medical tourism information system.

This study was carried out in a three‑step applied and combined method. In the first step, a systematic review was done on the studies and then the reliability of the results was checked during a semi‑structured in‑depth interview with 11 experts in medical tourism through open questions. In the third step, the Delphi method was conducted quantitatively to get the ideas of 26 experts. SPSS software version 22 was used for factor analysis.

The proposed conceptual model for Iranian Medical Tourism Information System includes a variety of services from the first moment of decision to travel until the moment of returning from a medical journey, following up the treatment, and sharing the patients’ experiences.

It could be concluded that considering the commercial importance and financial benefits of medical tourism, it should provide the necessary facilities to expedite the provision of services to these foreign patients; consequently, an appropriate basis for attracting more medical tourists from neighboring countries, developing countries, and even developed countries will be provided.

The practice style variation (PSV) incurs undesirable clinical and economic consequences for patients and the healthcare system. This review aims to analyze the economic consequences of PSV in medical interventions. A comprehensive electronic search was conducted through PubMed, Web of Sciences, EBSCO, EMBASE, and Cochrane databases to retrieve studies on economic consequences of PSV within 1975–2018. The studies were independently assessed by two reviewers. The quality of studies was assessed by Strengthening the Reporting of Observational Studies in Epidemiology checklist. No language restriction was applied. Only four studies met the eligibility criteria. These studies have been conducted retrospectively in developed countries. Most of the included studies used consumer demand theory to measure the economic consequences of PSV. Findings showed 12%–74% of all variations in healthcare services are related to PSV, thereby incurring up to 23 million dollars for the healthcare system. The PSV is related to the total expenditure, price elasticity, and coefficient of variation of healthcare services. PSV associated with huge inefficiency and inequity in access to healthcare services. To mitigate the consequences of PSV, policymakers should consider PSV in both developing the medical education plans as well as cost management. Using multilevel analysis to investigate the determinants of PSV would be beneficial.

Innovation in the development and review of curriculums is one of the requirements of medical education in the present era. SPICES model has been taken into consideration by nursing faculties to promote quality of nursing education and to eliminate conventional curriculums. In Iran, for competency‑based nursing education, review and development of curriculums are necessary.

The objectives of the present study were to determine the implementation of SPICES model in nursing curriculums of Tehran (Iran), Western (Canada), and Hacettepe (Turkey) nursing faculties and also to present recommendations to operationalize it in the nursing curriculum of Iran.

This study using comparative method with Brady’s model was conducted in 2018. In this study, curriculums of nursing faculties of Tehran, Western Canada, and Hacettepe were compared. Data were extracted through texts and documents available at electronic pages of universities. Curriculums of these nursing faculties were compared from the perspective of SPICES model strategies (student‑based, problem‑based, integration, community‑based, elective, and systematic) at four steps of description, interpretation, juxtaposition, and comparison.

The results showed that curriculums in Western Canada reside at the end of the innovative spectrum of SPICES model. Curriculums in Tehran and Hacettepe in most of the strategies of this model reside at the beginning of the spectrum, and in most cases, conventional methods were used.

According to successful experiences of Western Canada in the implementation of SPICES model’s strategies and also considering this fact that still conventional approaches are prevalent in Iran, it is recommended to focus on experiences and, according to social conditions and facilities of the nursing community, to implement necessary changes in the curriculums based on this model.

Routine episiotomy is a common procedure to shorten the second stage of labor. The attitude of individuals is an important factor in episiotomy, which is often carried out without an indication. Therefore, this study aimed to determine the effect of education and support of labor practitioners on their attitude and performance in conducting routine episiotomy.

This was a quasi‑experimental study. A sample of 66 midwives, physicians, and midwifery faculty members were selected through the convenience sampling method. The data collection instrument was the questionnaire of personnel’s attitude toward episiotomy. This questionnaire was completed by the participants before and 3 months after the intervention. A 16‑h workshop about the education of natural childbirth for 2 days was performed on the experimental group. Data analysis was performed using paired t‑test and Pearson’s correlation test.

The findings showed that mean attitude of the participants toward episiotomy was 50.5 ± 1.58 before the intervention, which changed to 61.18 ± 2.5 after the intervention, demonstrating a significant difference between the attitude of the participants before and after the intervention using paired t‑test (P < 0.001). In terms of the performance of the midwives, participating in the research, there was a significant decrease in the number of deliveries without episiotomy.

According to the results of the study, education and support of midwifery personnel can change the attitude and performance of these individuals in conducting a routine episiotomy, thereby reducing the number of child deliveries without episiotomy.

The condition of epilepsy has a considerable effect on a person’s social and personal life. Currently, a knowledge gap exists regarding the knowledge, attitude, and perception towards epilepsy among graduate students. The objectives of the study were to initially explore the knowledge, attitude, practices and to examine their inter‑relationship among graduate students.

A total of 300 3rd year Bachelor of Science graduate students from colleges near Hombegowda nagar, Bangalore, Karnataka were included from three colleges. To achieve the objective mentioned, an instrument was framed and approved by specialists in the field.

About 26% believed that epilepsy is a mental illness, 64% reported that it is not a disease of the brain, 96% believed it to be a hereditary disease. Attitude shows that 29%, 33%, and 49% believed that Epilepsy can disturb anybody’s normal life, education, and occupation, respectively. About 31% reported that if they see a person with epileptic attack they ran away. Knowledge score have significantly (P < 0.001) positive correlation of r = 0.810 and r = 0.794 with both attitude and practice, respectively. Attitude and practice also have significantly (P < 0.001) positive correlation (0.856) with practice. This clearly shows that if knowledge increases, persons will have positive attitude and good practices whereas less knowledge leads to faulty attitude and practices.

There is a need to include health education programs for school children and college students irrespective of streams, as it is crucial to bring an alteration in the presently observed perspective, behavior, and practice.

A sharp increase in expenditure is one of the challenges of the health system in Iran. Every macroeconomic variable affects health, and if it is disregarded, it will lead to higher macrobudgets. Physical and mental health as well as the use of health services change according to the macroeconomic conditions and business cycles (boom and recession). The present study aimed to determine the effect of macroeconomic indicators on health expenditure.

This study was descriptive analytical. The required data related to macroeconomic indicators and health expenditure in public and private sectors were collected during 1995–2014. The data were analyzed using the time series models in econometrics, Vector Auto Regression, and Granger causality technique.

The results of this study indicated that health expenditure has a positive bilateral relationship with gross domestic production (GDP), gross national production, national income, and national consumption. On the contrary, expenditure has a negative bilateral relationship with liquidity rate and inflation rate. In addition, budget deficit has a negative unilateral relationship with health expenditure while population rate has a positive unilateral relationship with health expenditure.

The results of this study indicated the increase of health expenditure in Iran that GDP is the most critical determining factor of health expenditure. In general, the total expenditure in the health sector in the world increases when the countries become richer. In line with the increase of resources, innovative financing methods and efficiency improvement are required for providing basic health services in low‑income countries.

The Balint group’s seminars were developed by Michael and Enid Balint for the purpose of a better understanding of doctor–patient relationships. This study aimed to introduce the Balint group and its application to the medical science educational program and to provide an up‑to‑date perspective on Balint group research.

The study was carried out as a systematic literature search published from January 2008 to September 2018 in the databases of PubMed, Scopus, Science Direct, and Proquest, which were searched with keywords such as the Balint group and medical education along with numerous related terms. Duplicates, non‑English language articles were discarded from the review.

A total of nine papers entered the study. Among included articles, four used a qualitative methodology, four used a quantitative methodology, and one applied a mixed methodology. Four main aims emerged from the content of papers: (1) to evaluate resident and medical student experiences in Balint groups, (2) to improve communication skills and reduce burnout level, (3) to assess the Balint group’s effects on empathy, and (4) to explore the contexts and triggers of cases presented in Balint groups.

Our results help us to the achievement of a better planning and design of an efficient Balint group in medical education. The findings enable the policymakers to make better decisions on the topic. Balint groups may guide medical students (residents) to become more patient centered by improving their communication skills and empathic abilities and reducing the level of burnout.

Rheumatoid arthritis (RA) is a common multisystemic autoimmune disease with peripheral joint involvement. Many autoantibodies have been introduced in the course of RA; some of them have diagnostic and prognostic value. In this study, our aim is to determine the value of serum glucose‑6‑phosphate isomerase (G6PI) antigen (Ag) as a diagnostic and prognostic marker in RA.

Eighty‑seven known cases of RA who referred to an outpatient clinic of Shiraz University of Medical Sciences and 76 healthy controls were selected. Serum G6PI Ag was measured using sandwich enzyme‑linked immunosorbent assay method, and the enzyme level was compared in the patient and control group, we also compared the enzyme level of patient group with disease activity, disease duration, erythrocyte sedimentation rate (ESR), C‑reactive protein (CRP), rheumatoid factor (RF), and anti‑cyclic citrullinated peptide (anti‑CCP) antibody (Ab). The data were analyzed using SPSS V 16 software.

Positivity for G6PI was detected in 34.5% (30/87) of RA patients and 9.2% (7/76) of control group (P < 0.001). There was no significant correlation between enzyme level and disease activity, disease duration, ESR, CRP, RF, and anti‑CCP Ab.

Overall, in our study, although there was a significant difference in serum G6PI Ag between patient and control group, no significant correlation was detected between serum G6PI level and disease activity score, ESR, CRP, and anti‑CCP Ab, but relative correlation with ESR and disease duration could be challenging. G6PI Ag could be introduced as a diagnostic marker in RA, but its role as a prognostic marker is controversial.

Given that the need to pay attention to measuring efficiency is considered as one of the main pillars of improving the level of efficiency in hospitals, so this study was carried out aimed to determine the mean technical efficiency (The technical efficiency is bound by zero and one and a score of less than one means that the theatre is inefficient as it could) score in terms of type and activity of the hospital, input-oriented and output-oriented attitude, returns to scale (In economics, returns to scale and economies of scale are related but different concepts that describe what happens as the scale of production increases in the long run, when all input levels including physical capital usage are variable (chosen by the firm). The concept of returns to scale arises in the context of a firm's production function. It explains the behavior of the rate of increase) in hospitals of Iran using data envelopment analysis (DEA) (DEA is a nonparametric method in operations' research and economics for the estimation of production frontiers. It is used to empirically measure productive efficiency of decision-making units) and stochastic frontier analysis (SFA) (SFA is a method of economic modeling. It has its starting point in the stochastic production frontier models simultaneously introduced by Aigner, Lovell and Schmidt[1977] and Meeusen and Van den Broeck[1977]

The present study was carried out with a systematic review of all studies conducted on measuring efficiency of hospitals in Iran from March 21, 2001 to December 21, 2017 using DEA and SFA. Eleven databases were searched using appropriate keywords and 470 articles were found and evaluated using a checklist, and finally, 24 articles were entered into the meta-analysis process. Meta-analysis was performed using random effect model and fixed-effect model, and study heterogeneity was investigated using Q-Cochran test and I2 index. Furthermore, the main reasons of study heterogeneity were identified due to meta-regression.

The average technical efficiency score of hospitals using DEA and SFA method was obtained equal to 0.885 and 0.809, respectively. Furthermore, with regard to the DEA method, 0.885, 0.891.0.952 and 0.913 was obtained for input-oriented and output-oriented, general and specialized care hospitals and constant returns respectively. With regard to SFA method, 0.733, 0.664, 0.641, 0.802, was obtained, and the inputs and outputs affect measuring the efficiency.

In contrast, the DEA method can investigate several input and output simultaneously and is used as an effective and flexible tool in order to measure the efficiency of the hospital. DEA can be easily used for calculating efficiency scores based on the proper selection of input and output indicators. The data envelopment analysis method and different input and output variables have been used in most studies conducted in Iran, and Stochastic Frontier Analysis has been less considered. In the present study, the DEA method in governmental educational hospitals showed a higher efficiency than SFA method in the hospitals under study. But in general, due to lack of optimal efficiency level in the hospital, it is suggested that policymakers determine the hospital efficiency indices in order to evaluate their efficiency from different dimensions.

The average technical efficiency score of hospitals using DEA and SFA method was obtained equal to 0.885 and 0.809, respectively. Also, the mean technical efficiency score in terms of input-oriented and output-oriented, general and specialized care hospitals and constant returns to scale using the DEA method was obtained equal to 0.885, 0.891.0.952 and 0.913 and using the SFA method, respectively, it was equal to 0.733, 0.664, 0.641, 0.802, and the inputs and outputs affecting measuring the efficiency. There is no significant difference between the mean efficiency score between the two methods, but the data envelopment analysis method is used more. It is suggested that the hospitals efficiency indicators to be determined in order to more accurately evaluate the hospitals efficiency.

The identification of health education needs through the community results in targeted services and health promotion. Prioritizing these needs, in addition to identifying the desired health system based on the needs of the community, is required for the optimal allocation of resources. Therefore, this study was conducted with the aim prioritizing the health educational needs of Sabzevar‑Iran community.

This study was a two‑step mix study. In the first stage, the qualitative method of the main themes of health educational needs of Sabzevar society was determined. Then, the questionnaire was prepared by a paired scale (36 questions) and quantitative method was used to prioritize the main themes with Analytic Hierarchy Process (AHP) software. The random sampling method was used in this study and data analysis was performed using Expert Choice software using AHP method.

Social problems with 0.206, contagious diseases with 0.205, nutrition with 0.161, and public health with 0.132 were in the first to fourth grades of health educational needs in Sabzevar city and environmental health, health management, noncontagion diseases, elderly, and occupational health were in the fifth to ninth grades. The consistency index in this study was 0.08, although the adjustment index is <0.1 good and acceptable.

Social problems are the first priority of Sabzevar society, which require appropriate training.