مجله فرهنگ و ارتقای سلامت (فرهنگستان علوم پزشکی جمهوری اسلامی ایران)
سال ششم شماره 2 (پیاپی 18، تابستان 1401)

Human resource is one of the most important assets of the health system. One of the priorities of the health system is organizing supply, recruiting and retaining health workforce. Challenges and strategies to achieve these goals are presented in this statement.

Health workforce migration is one of the serious threats to the health system in Iran, which has grown significantly in recent years. The aim of the current research is to investigate factors associated with the emigration of human resources in the field of health in the year 2022.

This is a cross-sectional descriptive study conducted using a survey method. The study population included students, faculty members, staff, and graduates of the Iranian universities of medical sciences. The study sample included 360 participants from medical universities involved by a non-probability, convenient sampling method. The data collection tool was a standard questionnaire whose validity and reliability were evaluated and confirmed by a number of expert professors and experts in the field of health.

Out of a total of 360 participants, 170 were students and 190 were graduates or working in medical universities. 195 participants were female (54/2) and 165 were male (45/8). Associate and Bachelor’s degrees (n=118), Ph.D. (n=87), and general medical practitioner (n=77) had the largest share in the studied sample. The fields of medicine (n=89) and paramedicine (n=76) had the highest participation rate. 189  (52.5%) of the participants had a great desire to emigrate. 135 people (37.5%) of the participants even thought of working in non-specialized and lower jobs abroad. 108 people (30 %) planned to migrate or took practical action and had a definite schedule for emigration. Only 65 (18%) of the participants had the desire to return after emigration. Economic, managerial, and social welfare factors were identified as the most important factors associated with the emigration of the health workforce.

The desire to emigrate is very strong among students and health professionals, and many participants decide to emigrate due to economic and social issues. Solving the emigration problem requires a serious, comprehensive, and long-term commitment to the issue of elite management, structural and legislative reforms, meritocracy, and increasing hope in the academic community.

Health care workers especially medical groups are worthful human capital, that each community’s life depends on. Compensating for the shortage of human resources for health care requires huge time and budgets. The evidence shows that in recent years, Iranians migration trend, especially the highly educated class, have been increasing, unfortunately, most of these people do not intend to return. In this article, while analyzing the situation, the factors affecting the migration of the medical groups and its consequences are presented, and futurology and forecasting are emphasized.

Nowadays, one of the most important challenges for health policymakers is the phenomena of emigration of health graduates. The aim of this manuscript is to assess and analyze factors that influence retaining and maintaining health elites in Iran. Since this issue is complicated and multidimensional, and as it has happened gradually, It is simplistic to think that the problem can be resolved by providing a simple, quick and effective solution. However, it is possible to take measures to solve the problem. Accordingly, in this article, we have presented the existing challenges for faculty members and health elites staying in Iran, and subsequently, the existing strategies to maintain this group in the country.

The comprehensive scientific map has explained Iran’s scientific perspective in 1404, with the aim of delineating the direction of science and technology system and its requirements. It seems that the strategic transformation in science and technology requires a serious revision of the structure and content of the comprehensive scientific map of the country. In this document, proposals of the Academy of Medical Sciences in this regard are presented.

The comprehensive scientific health map was compiled in response to the health needs of the society and with the aim of achieving the first position of the country in terms of health among the countries of the region. However, there are some criticisms regarding science, application and coherence of the content. Presenting strategic, content and process criticisms, the current document provides suggestions with emphasis on the overall revision of the document.

The Supreme Leader's expectations from the youth in the field of science and research were expressed and the task for the policy makers was clarified in the statement of the second step of the Islamic revolution. The comprehensive scientific map of the country was approved about thirteen years ago, and its updating was emphasized in 2018, therefore, according to the scientific progress and the experiences of the country in the field of science and technology, it should be possible to formulate a new road map for the advancement of the country's science as soon as possible in full coordination with the statement of the second step.

By using qualitative content analysis method the recommendations of the Supreme Leader and top-level documents and scientific documents regarding scientific progress and the number of scientific articles in different fields were examined and challenges and solutions regarding the preparation of the country's scientific road map were presented.

Although the scientific resurrection in recent years, the speed of scientific growth, and the achievement of world records are mentioned in the statement of the second step of the Islamic revolution, but historical backwardness and being behind the peaks have also been mentioned. In this statement, creation of the sources of knowledge, continuing scientific acceleration and scientific endeavor are strongly recommended.

Considering the intense competition in scientific acceleration that has arisen in the world, our country should be able to realize the second step with a prudent scientific road map and in accordance with the statement. One of the most important scientific fields of the country is the field of health, in which its progress is rapidly emerging in the society. Therefore, the roadmap should have a schedule and measurable goals. Designing a ten-year map intelligently for this very important scientific field can promote the Islamic Republic of Iran as one of the great powers of the world in the near future.

The aim of present study was to design a systematic framework to estimate needed dental manpower in Iran based on treatment need index.

Initially, dt, mt, and DT, MT indices were extracted from the data of the last national survey in 2012 for all age groups, assuming a linear trend for dental caries in time intervals. Subsequently, medians for each age group were calculated and used. In next phase, according to data of 194 patients in Tehran School of Dentistry and another dental clinic, the detailed need for dental treatments based on dental caries and periodontal status indices were identified, and then classified. The total time needed for dental treatments were determined via a questionnaire completed by dental assistants of 120 dentists. Accordingly, a mathematical model suggested to calculate the number of dentists needed.

It was assumed that all people have enough affordability for dental utilization, and dentist visits, simultaneously. Dental manpower needed to deliver dental services to all age groups, considering dentist’s ability through one year was calculated.

The method of determining dental manpower needed for Iran based on treatment needs, is applicable for maximum estimation of dentists.

In the last decade, traffic accidents have caused more than 170,000 deaths and about 5 million injuries, accounting for about 7% of gross domestic product (GDP). In addition to medical expenses and wasted useful life years of the Iranian population, the important issue is death and disability of active members of the community. Islamic Republic of Iran has failed effective and comprehensive management of this issue due to a number of reasons. The most important include: inefficiency of road policing (Road Safety Commission), weak inter-sectoral coordination, weakness of evidence-based planning and performance, and insufficient attention to socio-cultural aspects in prevention of traffic accidents.The Academy of Medical Sciences has prepared this policy brief with the help of experts, and requests this proposal be included in the agenda of the Board of ministers.

Paying attention to emotions of individuals and their functional status in the acute situation of COVID-19 pandemic is of utmost importance. Useful measures can be undertaken to reduce the consequences of this novel disease. Specifically, the all-round cooperation of the public is necessary in order to lower incidence of morbidities. The aim of the present study is to examine the emotional and functional status of the public in confronting COVID-19.

The present study was a correlational study and the study population was selected from families living in Mashhad in summer of 2021. A researcher-made questionnaire was used and items were dimensioned using factor analysis technique.

Levels of anxiety and worry in most participants were high; i.e., between 15 and 60% were worried, anxious and confused. On the other hand, those who have strong negative feelings about the corona outbreak, also follow health protocols to deal with it. In addition, the hypotheses presented in the study were confirmed using the univariate chi-square technique.

The results showed that the mean scores of emotions were lower than the mean scores of performances, i.e., emotions scored lower than performance. In general, the sample showed strong negative feelings towards the spread of this epidemic in the society, while the performance of people with such feelings is also strong. However, the role of people whose feelings have not changed much or not at all should not be overlooked, as it can quickly spread in society and become a threat.

The present study aimed to evaluate the lived experiences of patients with COVID-19, whether hospitalized or quarantined at home, their caregivers and treatment staff involved in the care and treatment of the patients with COVID-19 between 2020 to 2021 in Tehran.

This was a descriptive phenomenology study. A questionnaire guide was designed and piloted to be used for in-depth interviews. Interviews were conducted by telephone. All interviews were recorded and were coded based on the objectives of the study after completion. The report collected from all interviews was categorized according to key themes and sub-themes. In the end, similar themes were grouped together and eventually the main themes emerged.

Individual interviews were conducted with 14 patients, six medical staff (nurses and physicians) and three caregivers of the patients. The mean age of patients was 40.1±14. Ten main themes were identified for the patient group, five for the treatment staff and eight for the caregivers. Fear of spreading the disease to others and the experience of loneliness and being away from family was the biggest concern of the patients. The findings indicated lack of adequate and specific food services for patients with COVID-19 in the hospitals. In general, patients quarantined at home experienced more favorable conditions during the treatment period compared with hospitalized patients. Some of the participants complained about mistreatment of some members of the medical staff and the public regarding their illness. The economic burden imposed on the patients was another mentioned problem. Psychological and emotional support was the greatest expectation of patients with COVID-19 from those around them. They also called for community members to adhere to the protocols and help break the virus transmission chain.

The results of this study contain valuable points that can be used for future policy-making and will certainly be an aid for those in charge to provide effective and efficient services.

Spiritual health is the most fundamental existential need in the system of creation (from birth to death) and legislation (from the initial to the final evolution) of human beings. It has direct and indirect frequencies, as well as corresponding, inclusion and implied implications in the Quran, the tradition, and revealed teachings. Thus, Quranic verses, hadiths and supplications, and the Fourteen Impeccable’s biography and lifestyle are rich sources in researching and clarifying the Spiritual conduct (sulūki) foundations of spiritual health, which have special importance, necessity and sensitivity.

According to the identity of spiritual conduct and the esoteric nature of spiritual health, this research has endeavored to describe the foundations of spiritual health via a rational method (argumentative explanation of spiritual conduct teachings) and narration (referring to Quran and the traditions, inferences from religious texts, and obtaining revelation teachings).

The most important findings of the present article include the following: a) the rational soul is the basis of movement and transformation and all-round transformation of the essential truth of human existence (ontological and anthropological foundations), and mental and heart health (healthy reason and heart), with the ability to know and be the generator of inspiration knowledge (epistemological foundations). It is the infrastructure, equability of  temperament, the ruling spirit and the dominate discourse on spiritual health, which is objectified by the real closeness to God and the manifestation of the Divine Names and Divine Attributes (teleological foundations). b) Expressing, explaining and proving that spiritual health is the foundation for psychic and social health and then a preparation for emotional, cognitive health and health in aspects and other differences can be its implied result.

Spiritual health, is the infrastructure of health in other areas of human existence (physical, psychological, and social), and on the other hand, it is in the relationship and continuous interaction with these areas, because spiritual wayfaring (sulūk) and health have an all-round connection and interaction and a dialectical relationship. Spiritual health is the cause of Introversive sulūk and the esoteric course and spiritual wayfaring is also the complete cause of spiritual health, which will have various foundations.

Spiritual health is one of the four dimensions of human health, which is known as Islamic spiritual health in Iran according to the culture and social context. In order to include this concept in the medical education system, discussions must be interpreted in different contexts. The purpose of this study is to conceptualize Islamic spiritual health in medical education.

This phenomenological study used a descriptive method. Via examining the theoretical basis and existing literature, the researcher endeavored to conceptualize, clearly describe and identify Islamic spiritual health in the context of Iranian medical education as a neglected or emerging phenomenon. Purpose-based sampling was used and relevant texts were selected from the available sample.

Islamic spiritual health is of remarkable significance in Iranian medical education literature. This concept should be practical and real, wide and focused, and transferable in medical education. Spiritual health should be distinguishable from other areas of health, and user-friendly, and be scientific-based and related to health and well-being.

Without conceptualization of Islamic spiritual health in medical education, spiritual health education programs in the health and medical system are considered uncontrollable informal learning spaces. Islamic spiritual health should be clearly conceptualized in the medical education system through experiential learning environments, so that a medical education system based on Islamic spiritual health is formed.

The family physician program is designed to promote health equity and provide comprehensive and continuous health services for all ages. However, the implementation faced many challenges and problems in different parts. This study investigates the status of family physician program and analyzes its aspects in the Eastern Mediterranean countries, especially in Iran.

This study is systematic review. English and Persian databases such as Google scholar, Pubmed, EBSCo, SID, Magiran, were searched with related keywords in the timeframe of 2016 to 2022. Content analysis of 63 articles was performed and results were categorized in five areas of governance and regulation, training program, financing, quality assurance of services, and community empowerment.

Analyzing previous studies revealed 23 sub-domains in five main 5 areas: Management factors, electronic files, recruitment and retention of human resources, referral system, assessment and evaluation, educational system, content  of education, educational  method, training place, retraining, communication skills, financing, payment to doctors, insurance system, access to services , evaluation for service quality, proper communication with clients, satisfaction of service providers, satisfaction of service recipients, culture building, public education and awareness, modification of social attitude and community participation.

There are challenges and problems in each of the major areas and sub-domains, which can be adjusted and modified with evidence-based policy making and planning. This way, it could be expected that the family medicine program be expanded and institutionalized in the society.

One of the important goals in health policy is to ensure equity in health. Equity in health means absence of systematic and potentially remediable differences in one or more aspects of health in a population and economic, social, demographic and geographic subgroups.

This study was conducted by reviewing available scientific literature and texts and examining articles, theses, reports and resources available in internal and external databases and the conference held by the Academy of Medical Sciences by using relevant

  Analysis of the studies showed that the progress of the index of the policies of the health sector has not been able to create a significant change in the direction of improving equity. Discrimination in service coverage, gender discrimination, access to services in remote areas and lack of health services in low-income groups still exist despite the 40-year achievements of the revolution and emphasis on this issue in the first to fifth development programs. Although the transformation plan was able to reduce costs of inpatient services, the costs of justice in financial participation and the index of health costs of the poor is high.

Recurring budget deficit in the health sector shows the instability of the financial resources of this sector. The inconsistencies between the Ministry of Health and Medical Education and the Ministry of Economy and Welfare are effective in not achieving justice in health.One of the approaches to improve indicators and control costs in all societies, whether rich or poor, is management of limited health resources. According to the law of the fifth development plan, full implementation of the family physician program, the referral system, and expansion of insurance coverage can help improve equity in health and reduce costs for the public.

Creating and developing the infrastructure for timely access to high-quality health information, for all people in accordance with their needs and without discrimination, is the responsibility of of policy-makers and decision-makers in the country. Despite all efforts, there are still inequalities in the provision of health information services between cities and villages, some of which include inequality in health centers, inequality in educational centers, inequality in information technology, inequality in access to information resources, inequality in libraries, inequality in availability of health information professionals. Efforts to address these inequalities will lead to more equitable access to health services, and improve public health.

Since the concept of social health is used by scientific community and policymakers, this research has endeavored to demonstrate the meaning of social health in Iranian studies.

This study is a systematic review of all articles published in the SID database up to February 2019 using the PRISM guideline (PRISM). After an initial screening, articles were analyzed according to methodological features, theoretical bases and scientific field of study.

Both social sciences and health researchers studied social health. Only 17.5% of articles are descriptive studies. 43.57% of the articles did not define social health or there was no consistency between their definition of social health and what was measured. Theoretically, more than 55% was based on Keyes's theory. Conceptually, social health was defied in different ways and social health and social well-being were used interchangeably.

In general, there is no acceptable consensus about the concept of social health in social health studies in Iran. Moreover, due to the method of sampling and the statistical population of the studies, this study cannot present a picture of the social health situation in Iran.

The aim of this study was to investigate the direct and indirect effects of satisfying basic psychological needs on the identity crisis of students of Shiraz University of Medical Sciences.

The present study is a correlational study. The statistical population of the study includes all students of Shiraz University of Medical Sciences. Due to the prevailing conditions in the community and the corona pandemic, 300 members of the community were selected as the research sample by available sampling method. Data were collected using standard questionnaires that evaluated satisfaction of basic psychological needs, dysfunctional attitudes, and identity crisis and were analyzed by structural equation analysis using SPSS and Amos software.

The results showed that the proposed model has a good fit. Based on the results of structural equation analysis, satisfaction of basic psychological needs, affects the identity crisis both directly and indirectly via dysfunctional attitudes.

The results of this research demonstrated the importance of satisfaction of basic psychological needs on identity crisis in students of Shiraz University of Medical Sciences.

Urban green space planning has a special comprehensiveness. There are few fields of science that are so interrelated to different scientific disciplines. The purpose of this study is to express the relationship between urban green space design and planning with sports, health and community welfare, and to emphasize the benefits of green space sports and the basic principles that should be considered by designers.

The electronic search strategy to extract data on research background was created by the authors and performed using research databases such as Scopus, Web of Science, PubMed and Google Scholar. The search terms "green space", "sport" and "health" and their types were queried and the obtained articles were classified.

A city with interconnected green spaces that provides safe opportunities for urban residents to be active and exercise, as well as improve stress, recreation and social contact, will have healthier citizens. In such a city, there would be less demand for health services, a stronger economy will develop, and it would probably be more resistant to extreme environmental events such as heat waves and heavy rainfall.

Outdoor sports increase physical health, mental health and well-being, active citizenship, reduce crime and anti-social behaviors, etc. Therefore, in designing urban spaces, it is necessary to endeavor to design the spaces and related elements in a way that causes desirable behaviors and prevents undesirable behaviors. This can be achieved using the available tools and means of urban design and applying useful and effective techniques.

The issue of body management and the extreme view towards it is common in the country, and has adverse effects on health. Therefore, the present study aimed to identify the main indicators and factors affecting women's body management and to provide a structural and interpretive model for a comprehensive and priority view of the problem.

Initially, the factors affecting women's body management were identified by reviewing research on the topic. Subsequently, a self-interaction matrix with structural and interpretive modeling method was used via purposeful sampling of experts and using a questionnaire. In the next stage,  the level order of the factors was determined by examining the relationships between the factors affecting women’s body management. Finally, using Mick Mac analysis, the type of variables was determined based on penetration power and degree of dependence.

Based on the findings of this study, the variables of media and economic capital with high influence and low dependence are the key independent variables in women's body management. Cultural capital, social capital, reference groups, social acceptance, social pressure, religiosity education, negative body image and body dissatisfaction are also related variables that have both high influence and high dependence on other variables. The variables of opposite sex attraction, self-confidence and consumerism were identified as dependent variables. These variables have high dependence and low penetration power and strongly affect women's body management under the influence of changes in other variables.

Considering the importance of body management measures on women's health, identifying the factors and their leveling can be of significance in health policy.

The increase in the complexity of issues and technological advances has led to expansion and development of interdisciplinary fields to accurately understand the changes and learn how to face them. The Health system has basically become a complex system and it will not be possible to understand this field by merely relying on medical sciences. The main objective of this research is to design the desired model for interdisciplinary developments in medical sciences in Iran. To answer this question, the actors and factors shaping the development of interdisciplinary fields were investigated. What are the factors shaping the situation of interdisciplinary use in Iran's medical sciences? How is the structural-interpretive analysis of these factors based on their influence on each other?

The methods that were used to conduct this study included: an expert panel to collect, prioritize and validate factors affecting the future development of interdisciplinary fields in medical sciences; structural-interpretive analysis using MicMac and Mactor software to identify the role of actors in interdisciplinary studies.

Development of interdisciplinary studies requires support of policy-making institutions as guides and facilitators through establishment of facilitating laws, development of interdisciplinary education and research cores, and development of interdisciplinary modular programs.

The factor "requiring transfer to third generation universities" has the most impact and the factor "revision of human resources recruitment policies" is the most affected. Third-generation university is a factor that can provide substantial ground for development of interdisciplinary studies and influeces other factors and interdisciplinary knowledge. The development of interdisciplinary fields should become the dominant discourse of the university in such a way that it is codified in the form of policies and strategic programs of higher medical education.

 Accountability is regarded as one of the necessities performance measurement, evaluation, and providing an effective and serving democratic system. Universities were accused of being ineffective in responding to the labor market after the 1990s unemployment wave, particularly among highly-educated individuals. Various dimensions of this issue should be investigated in order to identify and define the problem. This research aimed to offer a conceptual framework for universities' responses to the market.

 This study is a qualitative investigation built on an interpretative paradigm that employs thematic research to evaluate information. The data were collected through a semi-structured interview with 15 higher education experts, and sampling was performed according to the chain sampling and criteria-based method.

 There are four dimensions consisting of 17 components, which include: 1) policy-making, structural, and managerial dimension (8 components); 2) educational, skill, and research aspects (5 components); 3) cultural dimension (2 components); and 4) laws and regulations dimension (2 components).

 Policymakers, particularly higher education planners, should pay special attention to the components of this research to reduce the gap between current and desired situation. The status should be improved in terms of responding to the labor market needs, mainly by reducing unemployment and increasing satisfaction of graduates, building trust between university and the labor market, and increasing university popularity in this regard. The main components are as follows: interaction of universities with the labor market, providing curriculums and offering practical and skill training based on the labor market conditions, paying more attention to designation of university managers who are responsive to the labor market, providing demand-oriented courses and student admission, providing statistics on the state of the labor market, the number of students, and graduates, confronting credentialism and educational inflation, amending the labor market laws and regulations for the recruitment and promotion of faculty members.

Supply chain collaboration is critical to coping with disruptions. The importance of this issue in the medical tourism supply chain has been highlighted with the outbreak of the novel coronavirus disease (COVID-19). So far, no research has been performed to investigate this issue in the medical tourism supply chain. Therefore, this research has been conducted with the aim of filling this research gap.

The statistical population of the research is experts in the medical tourism industry. Judgmental and snowball sampling method is used and sample size are determined based on theoretical saturation equal to 26. In-depth interviews were conducted to collect data and Grounded theory was used to analyze them.

According to the research results, 111 concepts were identified, and classified into 26 categories and five main axes.

In order to improve collaboration in the medical tourism supply chain, solutions such as proper management of human resources, improvement of financing methods, management of behavioral issues, management of hardware facilities, supply chain management, appropriate strategic planning and compensation system throughout the chain is recommended.