مجله پایش
سال بیست و چهارم شماره 1 (پیاپی 119، بهمن و اسفند 1403)

Objective (s): 

Comprehensive data on health expenditures is crucial not only for effective policymaking but also for achieving universal health coverage and health-related sustainable development goals. This study provides a detailed analysis of Iran's national health accounts from 2002 to 2020, offering insights into trends and patterns in healthcare spending during this period.

This descriptive study utilizes data from Iran’s national health accounts to examine health expenditures across various dimensions, including health functions, healthcare service providers, financing agents, and funding sources, covering the period from 2002 to 2020. Descriptive statistics were employed to analyze the data.

Total health expenditures experienced a substantial rise, increasing from 53,351 billion Rials in 2002 to 2,372,718 billion Rials in 2020, giving a 44.5-fold increase. However, when adjusted for constant values, the results decreased to a 2.7-fold increase. During the period from 2002 to 2020, curative care accounted for the largest share of expenditures at 57.3%, followed by pharmaceuticals and other medical goods dispensed to outpatients at 17.1%. The majority of health expenditures were allocated to hospital providers, ambulatory care providers, and pharmacies, along with other retailers of medical goods, representing 39.6%, 30.2%, and 16.4%, respectively. The share of out-of-pocket (OOP) payments decreased from 50.6% to 35%. Furthermore, 30% of expenditures were financed by the public sector, while the private sector covered the remaining 70%.

In Iran's healthcare system, a substantial proportion of expenditures is allocated to curative care, with hospitals serving as the primary recipients of these funds. Moreover, a significant share of healthcare expenses is financed through OOP payments, which increases the risk of catastrophic health expenditures for households. Consequently, it is essential to reduce these payments by expanding insurance coverage and enhancing the existing prepayment methods. Furthermore, prioritizing sustainable financing and enhancing financial resources within the health system is crucial for ensuring equitable access to healthcare services.

Objentive (s): 

The use of knowledge based on evidence and adoptive to the societies needs as a human asset to get in the right way of a knowledge which is under the influence of many elements and nowadays is vital to compete in the universal market to improve business cannot be neglected. This research with the goal of analyzing the condition of research centers of medical university of Ilam from various aspects such as the production of knowledge, the transfer of knowledge based on evidence and strategies to improve the condition was made.

This was an explanatory sequential mixed method study using a standard questionnaire, and semi structured interviews. Descriptive statistics was used for quantitative data and content analysis was used for the qualitative information.

The average score of all Ilam medical university research centers for four aspects (production of knowledge, knowledge transfer, the promotion and the usage of evidence) was 70.6%. The qualitative phase indicated 5 themes including: networking, prioritization, internationalization, attraction creation, and value creation. There was a total agreement of 90.46% as final strategies and methods to improve the situation.

The findings from the current study offers a new vision about strategies for improving the output of research center. Further research on the topic is suggested.

Work measurement and time study of services offer insights into human resource management and workload and is crucial for accurate human resource estimation. This study aimed to estimate the workload and time required for health care providers to train and implement a self-care program for middle-aged individuals.

This was a cross-sectional study. Activities were observed and recorded during the study into time study checklist that was designed based on service delivery process, approved and finalized by experts from the Iranian Ministry of Health and the Medical Universities. Prior to data collection, the checklist was assessed in a pilot study. The sample size comprised 240 middle-aged participants. The health care worker completed the checklist based on the process and duration of the activities.

The time study and evaluation of the self-care program for middle-aged individuals were conducted in three stages: recruitment, training, and evaluation. Assuming all anticipated activities in the middle-aged self-care program, the program implementation requires 292.13 minutes per client. The average time for the recruitment phase was 24.02 minutes. The training phase, which included teaching self-care booklets, took 175.47 minutes. The evaluation phase in the first and second modes took 92.41 minutes. The total time was different in different Medical Universities (p. value<0.05)

The average time spent on the self-care program for middle-aged individuals (292.13 minutes) exceeds the average time health-care programs for other age groups (204 minutes). The program revision and rearranging human resources of health centers are required for proper implementation of self-care program for middle-aged.

Reduction of the fertility rate is one of the most critical concerns of policymakers in Iran. Women expressed concerns about the feeling of incompetence in raising children. This study was conducted to provide an intervention program of parenting skills training based on the theory of planned behaviour to increase pregnancy intention.

Through a qualitative study on barriers to childbearing, feelings of inadequacy were identified as an important factor in preventing women to have a child. After searching reliable sites, the educational intervention program on the art of parenting was compiled based on the theory of planned behaviour, with the content of self-awareness skills, the art of parenting by UNICEF, and the Islamic thoughts. Qualitative content validity was used to validate the program. For this purpose, the program was sent to 10 experts. The program consisted of 6 sessions; at the end of each session, there was an evaluation form. After collecting opinions and modifying the program, it was reviewed for final approval.

In this 6-session program, goals, educational strategy and educational content have been developed for each session. The program has been written in a way that teachers can implement the program easily. The program was planned for use by single, married, childless or childbearing women.

Health service providers can use this program to educate women and increase their sense of empowerment to facilitate pregnancy.

Objective (s): 

Multiple sclerosis (MS) can have negative effects via several pathways on sexual activity. The growing trend of the disease in Iran and high prevalence in women (sex ratio: 2.3) intensifies the importance of this issue. It seems that women in the reproductive age (20 to 40 years old) who are sexually active can be the most vulnerable patients. Therefore, this study aimed to investigate the effect of BETTER model-based couples counseling (Bring-up, Explain, Tell-resources, Time, Educate, Record) on six domains of sexual activity (desire, arousal, lubrication, orgasm, satisfaction, pain) in women with MS.

This randomized controlled clinical trial was conducted on 72 married women recruited from Iranian MS Association. The intervention was the use of couple counseling based on the BETTER model during four sessions (each week). Six domains of sexual activity were measured using the Women Sexual Function Index (FSFI) at before, 2 and 3 months after the intervention. The control group received nothing.

The score of each domains of sexual activity were compared between the intervention and control groups and no significant difference was observed before the intervention. After the intervention, a significant difference was observed between the two groups in the all domains of sexual activity except for sexual pain domain (p=0.2). However, in the intervention group, there was a significant difference compared to before the intervention with 2 months and before with 3 months after the intervention.

The BETTER model-based sexual counseling can help improve the desire, arousal, moisture, orgasm and sexual satisfaction in women with MS. Perhaps comprehensive interventions are needed to further improve the domain of sexual pain in this population.

Intimate partner violence is an important public health issue that widely affects women. This study aimed to investigate intimate partner violence and its related factors.

This was a descriptive study of a random sample of married women of reproductive age in Pardis, Tehran province, Iran in 2023.  The data was collected using a validated demographic questionnaire and a conflict resolution questionnaire. Data were analyzed using independent t-tests, one-way analysis of variance and LSD post hoc test using SPSS 16 software.

In total 388 women were studied. The prevalence of physical violence was 35.8%, serious injury 19.6%, psychological 67.8%, sexual 28.6% and the overall prevalence was 71.6%. Although, education of women and their husbands, husband's occupation, economic status, place of residence, family relationship with husband, age of marriage and history of illness had a significant relationship with spousal abuse and its components (p<0.05), only husband's occupation 19% and place of residence significantly predicted 12% of spousal abuse changes.

The findings of the present study showed that spousal abuse and its types are highly prevalent in women and spousal abuse and its components were related to some socio-demographic factors, especially economic status.

This study aimed to explore the behavioral challenges and attachment issues faced by adopted children in Iranian adoptive families, examine how adoptive parents respond to these challenges, and investigate the parents' perceptions of attachment. The study thought to offer practical recommendations for improving support systems in post-adoption care.

A qualitative, phenomenological approach was employed, using Interpretative Phenomenological Analysis (IPA) to understand the lived experiences of four adoptive mothers in Iran. Data were collected through in-depth semi-structured interviews and analyzed with the assistance of PYTHON and MAXQDA software to identify recurring themes related to behavioral challenges, parental responses, and attachment perceptions.

The research revealed that adopted children in Iran frequently face significant behavioral challenges, including attachment disorders, emotional regulation difficulties, and developmental delays, often linked to early trauma and inconsistent caregiving. Adoptive parents employ various coping strategies such as creating structured environments, seeking professional guidance, and relying on emotional support from their social networks. However, many parents struggle to form secure attachments due to societal stigma, secrecy surrounding adoption, and feelings of inadequacy.

This study highlighted the prevalence of behavioral challenges and attachment issues among adopted children in Iranian families, emphasizing the need for enhanced support systems, including counseling services and educational resources for adoptive families. It also calls for public awareness initiatives and policy reforms to address the psychological and emotional well-being of both adoptees and their families in Iran.

Objentive (s): 

Students' exposure to multiple stressors can have adverse effects on their future and lead to a decrease in their mental and physical health. Environmental and psychosocial stressors can be considered as common risk factors for the psyche and widely in two-way interaction with anxiety and depression as the most common psychological disorders of the mood distress. Students are more vulnerable or exposed to harms due to their personality and environmental characteristics. Thus this study aimed to risk factors for anxiety, depression and stress among students.

The statistical population of this research included all students studying in an Educational Complex affiliated with Islamic Azad University, South Tehran Branch in 2023. To determine the sample size of the research, according to the partial least squares method, Barclay's rule. The DASS-21 was used to measure anxiety, depression and measure stress.

In all 211 students were entered into the study. The results obtained from logistic regression analysis based on demographic characteristics showed that the odds ratio for anxiety, depression and stress among postgraduate students was 0.4; 0.49; and 0.52, respectively indicating worse conditions for undergraduate students.

Undergraduate students are more likely to suffer from anxiety, depression and stress compared to postgraduate students, and single students might experience more stress compared to married students.

 This study was conducted aiming to assess the effect of an educational intervention based on the health belief model on the nutritional behaviors of the elderly with non-alcoholic fatty liver disease.

This semi-experimental research was conducted on 156 elderly participants (intervention and control groups) with fatty liver referred to comprehensive health service centers covered by the Shahid Beheshti University of Medical Sciences, Tehran, Iran. The data was collected by a valid questionnaire. The educational intervention based on the health belief model was presented during 5 sessions only for the intervention group. One month after the intervention, the data was analyzed using descriptive and statistical tests.

The mean age of the participants in the intervention group was 64.47±3.68 years and it was 65.32±5.3 years in the control group. The majority of the elderly in both groups were women, married, housewives, and having secondary educational level. By comparing the mean scores of the two groups before and after the intervention, only significant statistical differences were observed for attitude (p=0.011), perceived barriers (p=0.034) and cues to action (p=0.002).

The design and implementation of an educational program based on the health belief model could influence attitude, perceived barriers and cues to action that might possibly improve the nutritional behavior of the elderly with non-alcoholic fatty liver disease.

Chronic kidney failure is considered as a life-threatening disease, and strengthening factors such as hope and self-efficacy improves the quality of life in these patients and also improves their self-care. Therefore, this study was conducted aiming to examine the effect of acupressure on hope and self-efficacy of patients undergoing hemodialysis treatment.

This was a double-blind clinical trial that was conducted on 54 hemodialysis patients in Beshrouye and Tabas in Iran, in 2022. Patients were divided into three groups of control, intervention and sham (fake group) through permutation blocks. Data were collected with short cognitive questionnaire, demographic information, Harth's hope and Scherer's self-efficacy. In the acupressure intervention group during dialysis, in the sham group, acupressure was performed at a distance of 1-1.5 cm from the main points and under the control only thr usual care was offered. Data were analyzed using SPSS24 software.

The results showed that there was a statistically significant difference in the mean hope score among the investigated groups (P<0.001). Also, the mean self-efficacy score among the groups had a statistically significant difference (P<0.001).

The results showed that acupressure was effective in increasing hope and self-efficacy of hemodialysis patients, and as an easy, cheap and simple method, it can be easily implemented by nurses and even patients themselves in the ward.

Wearing face mask is an effective public health measure in epidemics, and it could be an important way to prevent the spread of respiratory diseases. The present study was conducted aiming to assess community response to wearing face mask during the COVID-19 pandemic in Iran.

This was cross-sectional study. A random sample was selected and examined by from January to February 2023. A self-designed questionnaire was used for online data collection. The data was analyzed using SPSS V.21 software.

We received 881 completed questionnaires. Of these 522 (59.3%) were women and 359 (40.7%) were men. The results showed that 97% of the participants used face mask. Difficulty in breathing was the most important reason for not wearing face mask. Pearson's correlation results showed that gender (r=0.091, p=0.001) and education (r=0.055, p=0.021) did not have a strong effect on the use of masks. Although Pearson's correlation findings showed that the probability of contracting COVID-19 increased by reuse of a mask (r=0.055, p=0.05), but this effect was not significant. No significant relationship was observed between the time pattern of changing the mask and contracting Covid-19 (r=0.41, p=0.089).

This study showed that the face mask use during the outbreak of the covid-19 by the Iranian population was promising.

Dear Editor,Medical education is a combination of educational methods, educational philosophies, and conceptual frameworks. Quality medical education is essential for better health care. Perhaps artificial intelligence will fully encompass key areas of medicine, including psychiatry and diagnostic practices such as radiology and pathology. The goal of artificial intelligence in medical education is to train good and competent doctors. The use of artificial intelligence in medical education can be divided into three main categories: first, the curriculum; second, learning; and third, evaluation. Although there are challenges such as data collection, technical problems, medical ethics, digitalization of centers, and lack of trust, these challenges can be overcome aiming to build a society with awareness, skilled, and up-to-date healthcare specialists. Currently artificial intelligence has led governing bodies, heads of medical education, and medical education investigators to begin implementing artificial intelligence in the medical education curriculum. Therefore, it is recommended that the medical education system from now on, need moving towards changing and integrating medical education with artificial

Dear Editor,Health is a universal human right. This should be provided to all populations by governments and under the stewardship of health system. Human resources should be distributed impartially throughout the country after receiving proper academic training. Several factors outside the boundaries of the health system disrupt policy-making and system planning in this regard. This article briefly examines these factors from the perspective of social equity indicators and provides suggestions for future studies.