احمد فیاض بخش

Due to the current structure of the population in the country, the problems related to the care and treatment of the elderly have not yet manifested themselves acutely, but in the near future, the challenges related to the aging of the population will seriously threaten the country’s health system. The aim of this study was evaluate the health status and type of diseases among the Iranian elderly receiving home healthcare.

The present study was descriptive-analytic and cross-sectional. The research population includes the elderly (Ave. & and sta. deviation age: 81±2.5) receiving home health care services(sample size=278 people). Data was collected by checklist and analyzed using descriptive and inferential statistics by SPSS v.19.

In this study, 59.4% of the participants were female and 65.2% were marrie. The results showed that the most common diseases (based on ICD10 classification), among the elderly, was Genital (22%) and the Nervous System (21%). The least common diseases were related to Blood and Immunity (1%) and Infectious and Parasitic (3%). There was a significant relationship between some diseases with age, gender and marital status.

According to the findings of the present study, Genital and Nervous System was the most common diseases among the elderly. Therefore, it is important to address these diseases in formulating programs for promoting health, treatment and care of elderly people in order to take the necessary measures to prevent, treat and monitor the health status of the elderly in the fields related to these diseases.

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.

Improving the family medicine program requires a deep understanding of the matter. This study has been conducted to integrate global experiences in the field of referral system and family medicine in selected countries.

In this comparative study, leading countries in the field of referral systems and family physicians such as the United Kingdom, France and Italy, as well as countries with a similar situation to Iran such as Turkey, which have begun similar reforms in their health system at the same time as Iran were selected to be reviewed.

Presented in four parts, the results of this study consist of the referral condition in the selected countries, financing and methods of the payment, advantages of the referral and family physician systems, and also strengths, weaknesses, opportunities and challenges of implementation system and family physician in the five selected countries.

A high percentage of public health needs can be covered in the form of primary health services and by first-line health care providers. The way to achieve this goal in many countries has been to restrict free access to specialized services in the form of a family physician and referral system . Informing and sensitizing family physicians about the financial consequences of their decisions and involving them in cashier affairs, as well as empowering them at the first level of the referral system to provide primary care and dealing with mistakes of their own and their peers at the first level of primary care comprise the most effective and efficient ways in effective implementation of this program.

Strategic planning has a critical role in achieving competitive advantage for non-for-profit social organizations. However, some strategic plans are failing. This study aimed to identify and to explore the challenges regarding implementing strategic plans in the state welfare (Behzisti) organization, Iran.

The present case study was conducted using the qualitative approach. Semi-structured interviews were carried out with 30 managers and employees of state welfare organization and its Tehran branch. Framework analysis method was used for data analysis. Ethical issues such as university ethics committee approval, informed consent, voluntary participation, participants’ anonymity, information confidentiality and researchers’ objectivity in data collection, as well as analysis and reporting were all considered.

Overall, 27 strategic plan implementation challenges were identified. These challenges were grouped into seven themes, including leadership and management, planning, organizational culture, organizational learning, employees’ management, resources management and external factors. Lack of justification for strategic planning, insufficient senior managers’ commitment and support, lack of systems thinking, high managers’ turnover, inflexibility of strategic plan, unrealistic operational plans, insufficient education and training, staffs shortage and their heavy workloads, low employees’ involvement in strategic plan implementation, resource shortage, insufficient budget and high inflation rate were among those important strategic plan implementation challenges.

Managers at welfare organization are facing challenges in implementing the strategic plan. A strong leadership and management, proper planning, sufficient education and training, a culture of teamwork, creativity, responsiveness and accountability and effective management of employees, resources and processes are required to implement the strategic plan effectively.

The elderly people consume much of the home health care. Therefore how to organize home care services and identify the services needed is important in order to manage and control resources. The purpose of this study was to describe home health services status in Tehran, Iran.

A sample of elderly people receiving home health care during April 2017 to September 2017 was studied. The data was collected using a checklist. Data was entered into SPSS V.19 and analyzed by descriptive statistics.

In all 278 elderly people were studied. Of these 59.4% were female and 65.2% were married and their mean age was 81 ± 2.5 years. The results showed that the most frequent services that needed were nursing service (55.4%), physician visit (17.0%) physiotherapy (15.0%). Medical services had a significant statistical relationship with the age and marital status of the elderly but non-medical services (physiotherapy, nursing and laboratory) had a significant relationship with gender, age, marital status and education (p≤0.05).

The findings showed that elderly people needed a variety of services. Also there were differences in the use of home health care among the elderly by age, gender, and other demographic factors. Overall, it is necessary for health care providers to understand the growth of the elderly population in the country and their needs in the coming years in order to plan appropriate programs and actions.

Increase of healthcare costs has become a major challenge worldwide. In order to ensure the security of treatment for all people, resiliency is necessary for the country’s health economy and must promote in the country. The aim of this article is to introduce the macro-axes and specific issues of each axis.

In this study, concurrent-nested mixed method was used. After discussing in focus group meeting and qualitative content analysis, the macro- axes priority of the resistance economy and specific issues were extracted. Studies in the field of health and resistance economics were identified as the complementary role by searching the databases of sid, magiran and Google scholar and with the keywords health, resistance economy, health system and Iran and the final list was obtained.

Twelve macro-priority areas and specific issues of each axis were identified. The macro-axes are: "Conceptualism", "Basis, Principles, Values, Goals", "Policies and Strategies”, “Pathologic barriers and Challenges of the Health Economics", "Indices", " Intersectoral dimensions of the Health Economics and the Resistance Economics", "Requirements", Examples/Objective Examples in Contemporary History”, “Culture and Culture-Building”, “Dimensions of Health Economics Management”,  and “Implementation Strategies" in each macro-axis, a number of specific issues were introduced.

Strengthening the countrychr('39')s health system in normal conditions, crisis and disaster, war and bioterrorism, and economic sanctions, requires the implementation of health resistance economy. An excellent, efficient and responsive health system is possible with comprehensive implementation of the general health policies, related clauses of the resistance economy general policies, and other upstream documents in the field of health. Monitoring, evaluating and macro observation of health are also necessary for dynamism and prosperity of health economy and the achievement of affect and defense capabilities.

The purpose of this study is to analyze clause 7 and other health related clauses of the general policies of resistance economy.

In this review and comparative study, qualitative methods were used for data collection and analysis.

In this study, clause 7 of general policies of resistance economy especially in health system and other related general clauses were reviewed. Food security and treatment in normal condition, defensive, crisis and disaster have been analyzed and the worthy position of health resistance economy in Islamic Revolution, background for the realization of authority and modern Islamic civilization has been designed.

Most of general policies of resistance economy clauses are related to different parts of health. Policy of resistance economics and achieve it in health is not a cross-sectional tactic for confronting sanctions and economic pressures. It is a long-term strategy and should be extended to all of the conditions (normal-critical and disaster, and defensive). It’s ideal and worthy position is a basis for achieving scientific authority and new Islamic civilization.

According to economics classic assumptions, entrance of technology in health, can transit curve of a countrychr('39')s production facilities by reducing costs and increasing productivity, but from one time, development of technology which is used in the field of health, despite its increase share of health in GDP, will not have a significant effect on promoting social welfare and cheap and easy access to health services. So, the permanent question is where is the limit and border for technology entrance in the health sector for improving indicators? The answer of this question has made an issue named health technology assessment as a main point in health policy, which has an important role for promoting of countrychr('39')s health systemchr('39')s resilience and its level. Health technology assessment in Iran always related to policies of Ministry of Health and Medical Education. Evaluation the approach of countrychr('39')s health policy structure for technology issue needs to assess performance of this ministry.

This study performed by using scientific published references and semi-structured interviews.

Evaluation of health technology in Iran was performed in 5 areas including definition of technology, criteria for evaluating of technology, training of human resources, role of insurances in technology assessment and the role of new technologies.

Revising of the countrychr('39')s technology assessment model and decision-making structure regarding the entry of technology in the health sector is needed, especially considering the new types of technology in the health sector.

 Elderly people are at the highest risk for falling. In order to design and implement effective interventions and reduce the incidence of falling and its resulting injuries, the relative importance of each risk factor should be determined. This study aimed to determine how frequently different factors contribute to falls among the elderly served by one home health agency in Tehran.   This study was a descriptive-analytic and cross-sectional study. A total of 400 elderly were selected through random cluster sampling method from all 22 districts of Tehran City, Iran. The study data were collected through a researcher-made questionnaire of falling risk factors. The questionnaire consisted of two parts: first, demographic questions and second, questions related to falling in 7 dimensions (including 60 questions).  The obtained data were analyzed in SPSS (V. 19) through descriptive and inferential statistics.  In this study, female samples were 52.5% of the participants (n=400) and the elderly mean±SD age was 78±8 years. The total frequency of falling among the elderly was 28% (112 out of 400). Among the elderly who had fallen (n= 112), 64 (57.1%) of them were female and their Mean±SD age was 80±7.5 years. About 82% of them fell down inside their homes, with these separate frequencies:  bathroom (19.6%), toilet (18%), bedroom (18%), and hall (16%). Parts of the body which were more frequently affected by falls in forms of injuries, bone fractures, dislocations, etc., were the pelvis (26.8%), arms (22.3%) and legs (19.6%). Around 43.8% of the falling among the elderly had led to hospitalization, 44.9%, between 1 and 5 days, 36.7% between 6 and 10 days, and 18.4% between 11 and 15 days. The relationship between falls and the medical, lifestyle, or environmental risk factors was non-significant.  A high percentage of affected elderly were hospitalized after the incident, and among them a high percentage stayed in the hospital for a long time imposing considerable costs to the health system. Moreover, sensory and neuromuscular risk factors were the most frequent causes of falls which could be prevented by rehabilitation measures. Results showed that people who are afraid of falling have a higher risk of falling which requires adequate and special attention to this psychological risk factor.

Strategic planning has an important role in achieving competitive advantage for nonprofit organizations. However, some strategic plans fail. The present study aimed to investigate challenges of strategic planning in Welfare Organization.
A qualitative approach was used for this case study. In-depth semi-structured interviews were conducted with 12 senior and middle managers who were members of the strategic planning committee. Content analysis method was used for data analysis, and 7 themes and 16 sub-themes were identified from the data.
Lack of justification of the strategic planning, the strategic planning model, inappropriate composition of the strategic planning team, the structural and managerial changes of the Welfare Organization, time limitation, insufficient training, and budget constraints were the main challenges of strategic planning in the Welfare Organization.
If the strategic planning challenges are not managed well, more problems are expected to occure during the implementation of the strategic plan. Senior managers’ commitment, strong management and leadership, participative corporate culture, education and training, staff empowerment, and provision of required resources will facilitate strategic planning implementation in organizations.

Occupational burnout is one of the aspects of psychological hazards. One of the most important factors that can predict it is emotional intelligence. The aim of this study was to investigate the effect of emotional intelligence on occupational burnout among the managers of Tehran University of Medical Sciences (TUMS) selected hospitals.
This was a cross-sectional descriptive and analytical study in 2014. The subjects were senior, middle and executive managers of TUMS affiliated hospitals. Census was used in this study. Ninety questionnaires were distributed in accordance with the population size. For data collection, Maslach Burnout Inventory (with reliability and retest coefficients of 0.71-0.9 and 0.6-0.8, respectively), Intelligence Questionnaire by Bradberry and Greaves (with reliability and validity of 0.83 and 0.67, respectively) and demographicprofile questionnaire were used. All statistical analyses were performed by SPSS software.
There was no significant relationship between job burnout and demographic variables (e.g. work experience, management experience, education, gender, marital status and occupational position). Emotional intelligence of managers and its subscales were high. The highest and lowest scores of emotional intelligence component belonged to relationship management and social awareness, respectively. There was no meaningful relationship between job burnout and emotional intelligence at the error level of 5% and P-value=0.63.
Since managers’ social awareness was at a low level, by improving it, we can help their emotional intelligence increase; also by identifying the factors affecting hospital managers’ occupational burnout, we can help it decrease.

Job Burnout syndrome consists of emotional exhaustion, depersonalization, and reduced personal accomplishment. The health system personnel to deal with stress because of physical, mental, and emotional intensity are at risk of burnout.
The aim of this study was to determine the relationship between burnout and general health of the financial staff hospitals of Tehran.
In this cross-sectional study, the sample size consisted of 150 financial administrative personnel employed by university hospitals of Tehran University of Medical Sciences which were selected by random sampling.
The instrument was included demographic information, general health questionnaire and the Maslach Burnout questionnaire, which was already confirmed for its validity and reliability.
The results showed a significant correlation (p Regarding the significant relationship between burnout and public health in this study, the use of improved working conditions and the promotion of mental health personnel is recommended.

Glaucoma imposes direct and indirect costs on societies. The current study aimed at estimating the economic burden of glaucoma in Iran in 2012.
The study was performed based on the partial economic evaluation method. The prevalence-based approach and bottom-up method were used. The human capital approach was used to calculate indirect costs. Required data were obtained from interview with 10 eye specialists and 100 patients, literature review, and review of 100 medical records of patients at Farabi Hospital in Tehran.
The total cost of the disease was $US 1,746,412.35, which 77.09% of the costs were related to direct cost; indirect costs accounted for 22.91% of the total costs. The total cost of hospitalization included the highest share of direct medical costs (74.4%). Average cost of outpatient for surgical and nonsurgical groups were $US 14.87 and $US 14.11, respectively. The average cost of hospitalization was $US 180.54.
Glaucoma imposed high economic burden on Iran. Proper planning for the early treatment of the disease and prevention of its complications could reduce costs of treatment and disability.

The main aim of health reform has been justice in availability of health services and lightening the burden of people s share in health expenditures. These objectives are based on three broad assumptions. First, it is assumed that human knowledge in therapeutics is complete, which means he has acquired enough knowledge for each and every diseases. Second, medical specialist and physicians have been fully equipped with these knowledge and third, providers of clinical services all have the same objective of giving the best services to the patients. However, there are enough scientific evidence opposing these arguments. On the other hand, quota system, for health services, though undesirable is unavoidable reality. This is more so in the countries, where health budget is provided by general or public budget. This problem is exacerbated by the fact that the resources are limited but the needs are unlimited. In addition new technology and technical knowledge of therapeutics are very costly. When resources including budget resources, housings, professionals and specialists are limited, the only option for policy makers is resorting to quota system. This policy is also adopted by developed countries time and again. Now under such conditions and keeping in mind logical, moral and legal considerations, the following questions arises as to:-1which measures are to be used?
-2What authorities are permitted to interfere?
-3 What mechanism is to be used for quota system?
Harrison and Hunter tried to find answer for these questions in their writings irrespective of time and places. They then have classified their answers. In this paper we try to illustrate the problems and show how answering these questions is not easy and is highly complicated.

Learning is essential in healthcare environments, where knowledge and skills are quickly outdated due to continuous advances in medical science. Organizational learning is a dynamic process that enables learning organizations to be campatible with change in good time. The aim of this study was to determine the status of organizational learning in an Iranian healthcare organization in Tehran, and to assess the extent to which this organization could be considered as a learning organization.
In this cross-sectional and descriptive study, 200 nurses were selected in an Iranian healthcare organization. Dimension Learning Organizational Questionnaire (DLOQ) was used to collect data to be analyzed using descriptive statistics methods by frequency, percentage, mean, and standard deviation.
The mean overall score for organizational learning was 3.36±0.69. Among the various dimension of organizational learning, continuous learning had the highest average (3.44±0.39), and the empowerment had lowest amount (2.72±0.06).
The findings from this study provide useful information for these organization's managers regarding the areas where there is a need for improvement in OL and to make it a more LO.

From beginning of the Fourth Development Plan in Iran, the policy of reducing public share of health spending was formally adopted by targeting the reduction of out of pocket payments to less than thirty percent. The policy was also considered in the Fifth Development Plan. However, during implementation of the program (2005 to 2013), out of pocket payments not only did not decrease but increased so far. This study aimed to investigate the reasons for failure of this policy.
In this qualitative study, 39 key informants were interviewed using purposive sampling method. Data were also gathered from related documents. Data were analyzed using the Walt and Gilson triangle model analysis.
The data were classified within four categories: 1) actors (including conflicts of interest and power installation; 2) content (including internal logic and cohesion objectives); 3) context (including political feasibility, environmental impact, resource and structure); and 4) process (including monitoring and evaluation, stakeholder involvement and stewardship and leadership).
The behavior of the main political actors, were influenced by individual and group factors such as conflicts of interest and power of discourse. This policy failed within the context of the government's lack of political commitment, economic shocks, and lack of social support from interaction of regulatory bodies.

The criteria for human dignity are among the most important topics associated with the concept. Some related questions are what makes man worthy of dignity، and what properties make him more dignified than other creatures? Although biological classifications of species should be considered in humanities، research on dignity must focus on differences that are fundamental and separate humans from all other species. Morphological، genetic and communal differences cannot be the criteria for dignity، and behaviors are subject to individual outlooks. This manner of reasoning guided scholars to categorize humans on the basis of wisdom، but the author of the present article believes that wisdom cannot be the criterion for dignity. There is a degree of intelligence and wisdom in other creatures that is not sufficient to make a fundamental differentiating factor. Like other faculties، wisdom may be regarded as an instrument for a better life. The authors believes that the “authority” to choose (that is، free will) is the essential difference between humans and other creatures because the latter are driven only by their structures or needs. This authority enables people to choose between good and bad or desirable and undesirable، and shapes most human values. Consequently، this authority creates the basis for dignity and any given type of choice passes its value on to the chooser.

The nature of human dignity is among the most basic queries about the essence of humanity، and research in this area can produce results that may be applied to various health related topics. There is a need for defining comprehensive criteria for the bio-human in order to protect human rights and other values that are attributable to human biology. The present paper first attempts to determine whether abstraction is the base of human dignity، as opposed to contraction. The authors argue that the former may not be the case، as dignity is value-based and therefore implicates moral orders. Such issues cannot be abstracted from external existence، so one can assume contraction to be the base of human dignity. In that case، contraction requires a contractor or an origin for contraction. Self-contracted values are invalid and worthless، and by the same token، external existences are incapable of dignity. Therefore، a stable contractor is required to justify stability and the native essence of contracted dignity، and only God can be that stable، conscious، senior contractor. Among the criteria for dignity، the authors focus on those essential characteristics that differentiate humans from other organisms، and argue that these could be considered as the basis for dignity.

Nurses are major end-users of hospital information systems (HIS). Therefore their views about strengths and weaknesses of the system are important, and, if addressed, could improve the software system and, in turn, the hospital performance. The purpose of this study was to assess the nurse's perspective about the impact of HIS in Farabi Hospital on nursing process in terms of precision, accuracy and speed. This was a cross-sectional study. Validity of the adopted questionnaire was approved by a panel of experts in the field. Its reliability was confirmed by Cronbakh-α coefficient test. Sixty one percent of responding nurses were somehow satisfied with the implemented HIS, while a remaining 30.5 percent had a complete satisfaction. Also, nurses comments on HIS showed, in general, it enhanced the effectiveness of their related processes. According to the nurses, HIS has improved the speed, precision and accuracy of the processes. However, at the same time references was made to some shortcomings in the system, such as; low-speed and lack of envision for some important processes, such as appropriate forms for documentation.

This study is aimed to compare organizational commitment and intention to leave among employees in Teheran`s hospitals. In this survey 3 hospitals with different ownership`s type were examined included: A public hospital، a hospital owned by Social Security Organization، and a private hospital. The data were collected by distributing 450، questionnaires among 450 employees، which were randomly chosen. Among all studied subjects few employees allocated high score of organizational commitment to themselves. This average rate is nearly 20%. Committed employees were impressively low in the Social Security hospitals compared to others. Comparing intention to leave indicate revealed the Public hospital`s employees have lowest scores among all subjects. There is a statistical significant correlation between commitment`s components and intention to leave. Generally the majority of employees have average and low organizational commitment. Employees with high level of commitment and high level of intention to leave make a small proportion of all hospital employees. Social security hospitals must be taken into consideration due to the levels of commitment and intention to leave.

In this study، at first a review is made of developments in theories of human behavioral change، and then views are presented on causes of humans changing their health related lifestyle. Also reference is made to the minimum and desirable time durations that are said to be important for changes in humans to actually take place and to be sustained. Then descriptions are made of the characteristics of Hajj pilgrimage. As an obligatory for every capable Muslim once in a lifetime، this ritual is said to have the specifications of timeperiod previously mentioned to be required for a successful behavior change، in terms of both its duration of almost 40 days and its creation of a very different lifestyle environment for the pilgrim who is far from normal family and friend surrounding. 24-hours a day and close interactions with completely new people and strangers in small hotel rooms، restaurants، buses and inside the holy mosques enable the pilgrims to overcome the usual barriers to change in knowledge، attitude and practices. It is then concluded that due to the large population of pilgrims that annually do the Hajj، this ritual has the potential not only to change directly the people and professional who observe this obligation، but also to transform indirectly many other relatives who interact with them. Therefore، policy makers in Iran can exploit this opportunity and make the necessary changes، at national level، in medical education and practices as well as in health-related lifestyle and education. This in turn will lead to more appropriate، effective and efficient delivery of disease preventive، health promotional، diagnostic، curative، surgical، palliative and rehabilitative services during Hajj and beyond

Internet use has grown largely in recent years in Iran. Students are one of the major users of the Internet. This study evaluated the effects of student Internet users’ lifestyle and behaviors. This cross-sectional study used stratified multistage sampling to select 600 students from universities in Gorgan (Iran) during 2009. Data was collected through a valid and reliable questionnaire and analyzed in SPSS. Most participants had healthy nutrition and 51. 8% did not find the Internet to affect their nutrition status. While 44. 4% of the subjects had not exercised during the month prior to the study، 68. 4% suggested the Internet to be ineffective on their physical activity status. Moreover، 18. 9% reported tiredness and 32. 8% reported satisfaction and calmness after using the Internet. About 90% of the students did not respond to questions about the effects of the Internet on their smoking، drug abuse، and unsafe sex status. Intarnet use did not seem to influence the lifestyle of our participants. However، since Iranian students are increasingly using the Internet، more studies in this field are required.

In strategic planning, there are several procedures to perform internal assessment or strength and weakness of organizations. Among other methods created for this purpose, Wiseboard model is the one in which the following six internal dimensions are considered: Organizational Structure, Leadership, Coordination, Reward System and Communication. This study measures three of these variables in hospitals of Tehran University of Medical Sciences (TUMS). This survey is a descriptive, analytical and cross-sectional study conducted during 2010 and 2011. The research population comprised all those working at TUMS hospitals from which a random sample of about 580 people was selected. The questionnaire's reliability was estimated to be 91% and the data were analyzed by the SPSS software. Of the subjects, 75.4% were below diploma level, 13% above diploma, 7.8% higher diploma, 66.4 bachelor holders, 2.6% master holders, and 5.4% had a doctoral degree or higher. Some 72.6% of the subjects were in Clinical and 19.8% in Nonclinical fields. The mean values of Goal Setting, Organizational Structure, and Leadership came out to be 24.47, 20.37, and 22.06, respectively. Based on the findings of this research study, TUMS hospitals have weaknesses in some aspects and they need improvement in some areas in the following order: Organizational Structure, Leadership, and Goal Setting.