فهرست مطالب الهام سیاوشی

Acute lymphoblastic leukemia is caused by damage to self DNA leading to uncontrolled cellular growth. The aim of this study was to find out a new appropriate diagnostic and therapeutic methods using differential gene expression and protein analyzes in different methods of the biology system.
Microarray library GSE20011 was downloaded from GEO database and analyzed using GEO2R software. In this study, two groups of control (with benign Hodgkin lymphoma) and treatment (with acute lymphoblastic leukemia of B cells), were compared with each other. In BALL cancer, 338 genes were up-regulated and 252 genes were down-regulated, that analyzes of protein kinases, transcription factors, gene function, protein-protein interaction, and finally, drawing differential genes protein network, were performed by KEA, ChEA, DAVID, Gene2Network, and yEd databases, respectively.
In this study, for the first time, seven transcription factors LYL1, SPI1, TET1, POU3F2, LMO2, CUX1, and ELF1, were reported as the candidate for diagnosis and treatment for BALL. Also, the importance of the role of membrane in BALL cells with the function of 97 up-regulated genes increased from the total 338 genes in cell membranes, showed the importance of membrane protection; and 97 genes were identified in cell resistance function for BALL cells, which can be interpreted as high resistance of BALL cells to molecular-based therapeutic approaches.
The results of this study can help to better understand the cellular resistance mechanism of BALL to treatment and provided seven candidate proteins for diagnosis and possibly treatment.

Gender inequality index shows reduction in human development due to inequality between men and women, which results in vulnerability to diseases. Therefore, this study aimed to investigate gender inequality in all countries with different levels of income and analyze the relationship between gender inequality index and indicators related to children.
The present ecological study assessed all countries of the world in terms of gender inequality index and indicators related to children. All countries were analyzed by census method. The collected data were related to year 2013 and were extracted from the reports of World Bank and United Nations. Spearman correlation coefficient and one way ANOVA tests were used to check the relationship between variables. Data were analyzed using SPSS 20 software.
There was a significant difference in terms of gender inequality in countries with different levels of income (p Increase in gender inequality can enhance the mortality of infants and children less than five years; it also can decrease the percentage of vaccination coverage in children. However, gender inequality happens more in countries with less income. Therefore, to reduce child mortality, not only health interventions, but also socio-cultural and economic activities are required. Hence, Cross-sectoral policies should be developed and implemented.

Strategic plans in hospitals can be considered an investment to improve their performance. However, managers who intend to use strategic planning to achieve success are faced with barriers against its implementation. This study aimed to investigate the barriers against implementation of strategic plans from managers’ perspectives in teaching hospitals of Shiraz University of Medical Sciences.
This descriptive-analytical, cross-sectional study was performed in 2016. The study population consisted of 40 domestic, administrative, financial and accounting, and nursing managers selected through census. The data were collected using a researcher-made questionnaire including questions about effective barriers against implementation of strategic plans. Then, the data were entered into the SPSS statistical software, version 23 and were analyzed using descriptive statistics, ANOVA, t-test, and Pearson’s correlation coefficient.
The results showed that the barriers against implementation of strategic plans were related to structural (27.12±6.58), human (20.12±4.43), process (16.44±3.99), and institutional (15.85±4.80) factors. There was no significant relationship between demographic variables and barriers against implementing strategic plans in hospitals (p>0.05).
Hospital managers should identify and eliminate the barriers against implementation of strategic plans. Considering the dynamic nature of management processes, training courses are recommended to be held based on the needs and priorities obtained in this research.

Hospitals as major energy consumers can manage their energy consumption by intelligent interventions. Therefore, this study aimed to determine the amount of energy consumption of Water, Electricity, and Gas, and their association with functional indicators in teaching hospitals of Shiraz University of Medical Sciences from 2009 to 2011.
The present study was descriptive and cross-sectional in design which analyzed energy consumption and functional indicators from the beginning of 2009 to the end of 2011. The sample consisted of 7 teaching hospitals affiliated to Shiraz University of Medical Sciences. Data were collected from the departments of consumption pattern reform and statistics and recorded in the data collection form developed by the researcher. Data were entered in SPSS16 and analyzed using descriptive and analytical tests such as Pearson correlation test.
The average consumption of water, electricity, and gas per occupied bed days were 0.09 m3, 2.78 kWh, and 1.56 m3, respectively. Also, statistically significant and positive relationships were found between the amount of water consumption and the number of active beds (P = 0.009) and occupied bed days (P = 0.007).
Energy consumption in teaching hospitals of Shiraz is lower than similar domestic studies and in some cases more than foreign studies. More active beds with lower productivity increase energy consumption. Hospitals can reduce energy consumption and their costs with more efficient use of resources.

Cesarean rate is increasing in most countries. This rate in Iran exceeds World Health Organization (WHO) recommendation. Thus, the aim of this study was to identify the determinants of cesarean section within a framework approach via defining the factors affecting it while determining its dimensions and inter-component associations. .
Using meta-synthesis approach to analyze the results of previous studies, 711 articles were found following a thorough search in databases of SID, Magiran (in Iran), Scopus, Pub Med, and Google Scholar, some of which were eliminated due to being irrelevant, repetitive and inaccessibility of authors’ information. Finally, 96 articles were analyzed and factors affecting cesarean section were extracted and categorized based on themes and category.
Medical, socio-cultural and economic factors affect the intention towards cesarean section. The most important medical factors in the tendency to cesarean section are previous cesarean, fetal distress, uncertainty about the fetal heart rate pattern, and dystocia. In the socio-cultural category, individual requests, mother education and fear of damage to the mother are the most important factors. In addition, physician recommendation and type of hospital are the most important factors in the economic category.
Based on this study, not only medical factors affect the intention towards cesarean section, but also socio-cultural and economic factors play dominant role. Other researches support these results by Shannon entropy. The results are deemed to be helpful for policy makers in formulation of policies to reduce the rate of cesarean section taking into account the most important factors influencing it. Also, researchers can achieve more comprehensive understanding of the issue by detailed study of the determinants, using meta-analysis and audit analysis.

Hospital management has been faced with several challenges in the recent decades. Identification and elimination of these challenges lead to improvement of effectiveness and efficiency of hospital activities. This study aimed to determine hospital management challenges.
This qualitative study using content analysis approach was conducted in Shiraz University of Medical Sciences in 2014-2015. The study participants included educational hospitals’ managers, senior managers, faculty members, and post-graduate students of the University. In this regard, 24 subjects were selected by purposeful sampling. The data were collected using interviews and focus group discussions and were analyzed through content analysis.
The hospital management challenges were categorized into five themes, namely structure of the University, rules and guidelines, resources and facilities, weakness of educational courses, and macro polices. On the other hand, changing the culture and beliefs, restructuring, education, and empowerment were mentioned as strategies for eliminating the challenges.
This study showed that the hospital managers were faced with structural challenges. Yet, these challenges could be decreased by increasing the relationship between hospitals and other centers, senior managers supporting hospital managers, empowerment of managerial culture, and clarification of hospital indices.

The hospital, as the most important organization in the delivery of health care services, requires effective and efficient management more than other organizations. Therefore, the skills and capabilities of hospital managers are important issues. The aim of this study was to determine the skills, capabilities, and requirements of hospital managers.
This qualitative study was conducted in Shiraz University of Medical Sciences, Shiraz, Iran, in 2015. The study population was composed of teaching hospital managers, senior managers, faculty members, and postgraduate students of Shiraz University of Medical Sciences. Sampling was conducted through purposive sampling method and continued until data saturation. In this study, interview and focus group discussion were used for data collection, and data analysis was performed using content analysis method.
The skills and capabilities of hospital manager were classified into 7 themes (communication, work experience, managerial knowledge, knowledge of the hospital, motivation and interest, systemic thinking and problem solving, individual characteristics and integrity) and 24 sub-themes. For the enhancement of these skills and capabilities, 2 themes (empowerment before and after obtaining the managerial post) and 8 sub-themes were identified.
Hospital management requires specific skills and capabilities. Decision makers and policy makers in the health sector should select hospital manager based on these skills.

Three aspects of health, responsiveness rate and equitable financing introduced as the main goals of health systems. In this study, responsiveness rate was assessed among private and social security hospitals in 2013. The descriptive-analytical study conducted as a cross-sectional one among 10 hospitals in Tehran city (20 percent of total social security and private, 8:2 respectively) in 2013. Study population consisted of all inpatients and outpatients referee to eight private and two social security hospitals and 333 subjects selected to data gathering randomly. The valid and reliable World Health Survey questionnaire was utilized. Data was analyzed by SPSS17 using descriptive statistic, Mann–Whitney and Kruskal–Wallis tests. In points of view among inpatient and outpatient, the mean score of responsiveness rate were 4.1±0.71 and 3.7±0.60 respectively. These amounts estimated 4.4±0.46 and 3.2±0.82 for inpatient and 3.8±0.58 and 3.5±0.63 for outpatient in private and social security hospitals respectively. Also, the mean score of responsibility rate assessed 4.4 in private hospital which was higher than social security ones (3.2); and this difference was statistically significant (P<0.001). Responsiveness rate dimensions were evaluated moderate to high among assessed hospitals. These results were enhanced in private hospitals rather than social security ones. It is recommended that hospital managers should pay more attention to client and mechanisms to improve responsiveness rate and providing more services quality.

Equity in health implies that all the individuals who need healthcare services must be able to access them timely and adequately. The present study aimed to assess the role and trend of equity in development and implementation of development plans in the health sector. This review study was conducted in databases, such as Magiran, IranMedex, website of Ministry of Health, Treatment, and Medical Education, and website of Parliament of Islamic Republic of Iran, in 2014. For this purpose, we searched keywords, such as strategy, health, and equity, in a five-year period (1988-2014). Finally, 26 related documents were selected. According to the results, the first development plan stressed rural areas and deprived regions of the country. In the second and third plans, in addition to what was emphasized in the first plan, increasing services efficiency and necessity for optimal application of healthcare facilities were considered, as well. Eventually, distributive equity, family physician, and referral system were focused in the fourth and fifth plans. In conclusion, tracking the changes through the study years revealed that emphasis was put more on process rather than structure. Individuals’ needs and expectations are changing and satisfying them fairly requires deeper look into various sectors of the society for development and implementation of development plans.

Today, given the correct information, especially financial information, and financial decision-making, planning and implementation of appropriate a costing system that can detect and identify cost and service cost calculation is correct, the directions has been a special place, so every day the importance increases. Because in our country in recent years the importance of applying the correct information in decision-making and the need for transparency of costs and revenue sources Different emphasis has been given to this issue is very important.

In this study, the costs of Department of Student and Cultural Affairs in 2011 analyzed and the unit cost of services that provided to students at the Department of Student and Cultural Affairs had been calculated. The method applied in calculating is Activity Based Costing (ABC) that after analyzing process and activity, the unit cost of each activity by the right bases calculated and per capita cost of each the center of activity of Department of Student and Cultural Affairs calculated. Calculations were carried out using Excel software.

After the final calculation, the average unit cost of the services that provided to students by the Department of Student and Cultural Affairs calculated. The unit cost of the services that provided to students of Tehran University of Medical Sciences was 10,551,353.64 (Rial) and the unit cost of services provided to students in dormitories of Tehran University of Medical Sciences was 21,705,119.32 (Rial).

Finance information review shows that problems in the Government Accounting System remain and Infrastructure Reform is required.

Every year، the considerable amounts of hospital income are deducted by the insurance organizations as deductions. The aim of this study was to survey the deductions applied by medical services and social security insurances organizations on bills of teaching hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences.

This is cross-sectional study which was conducted in 2009-2010. All of the bills sent by five teaching hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences، to medical services and social security insurance organizations in years 2008-2009 were studied. Instrument for data gathering was checklists designed according to the bills sent to insurance organization. The Checklist validity was confirmed by expert''s opinions. Data analyzed by using descriptive statistics in SPSS software.

The total deduction for outpatient and inpatient bills applied by Medical Services Insurance organization was 6. 62 %. The total deduction for outpatient and inpatient bills applied by Social Security Insurance was 4. 9%. In comparison، the deductions of inpatient hospital bills were more than outpatient hospital bills (6. 99% to 3. 36%).

Results showed that although small percentage of accounts involves deductions but the low amount of this deduction had significant financial imposes to hospitals. Thus، planning to reduce deductions is recommended by the Universities of Medical Sciences.