جعفر صادق تبریزی

The healthcare environment should provide the highest level of safety for staff and clients. This study aimed to assess the structural and non-structural safety status of Tabriz primary health care centers.

This cross-sectional study assessed 40 comprehensive healthcare centers in Tabriz, Iran in 2019. The data collection instrument was a self-designed questionnaire We assessed the compliance of comprehensive healthcare centers with the standards checklist through conducting interviews, considering observations, and reviewing the documents. The descriptive results for qualitative data were reported as frequency (percentage) and for quantitative data as mean (standard deviation). Furthermore, to evaluate the association between contextual variables and physical safety status of centers, t-test, ANOVA, and Tukey’s post hoc tests were used as appropriate (structural or non-structural).

The results of the study showed that the level of structural, non-structural, and total safety for the physical space of the centers was 48.2%, 37.4%, and 43%, respectively. Accordingly, based on cutting points, the level of structural safety and total safety was identified as moderate, and the level of non-structural safety was identified as low. In addition, descriptive results showed that there is a statistically significant relationship between urban area and non-structural safety so that non-structural safety of centers located in zone 4 was significantly higher than the safety of centers located in zone 10 (P = 0.011).

Based on the findings, the safety status of Tabriz health centers was identified as unfavorable and will not able to provide proper services to their covering population in serious hazards.

Overall, the four categories of non-communicable diseases (NCDs) (Cardiovascular disease (CVD), Cancer, Diabetes and chronic respiratory diseases) contribute to over 80% of annual premature deaths, with more than 85% of these occurrences transpiring in low- and middle-income countries. This study seeks to assess the likelihood of premature mortality attributable to these diseases across the provinces of Iran.

Data on causes of death from 2016 to 2019 was extracted from the death registration system of the Ministry of Health and Medical Education. To assess the completeness of the death registration system on a provincial level, we employed a novel method introduced by Adair and Lopez.

From 2016 to 2019, non-communicable diseases, specifically the four primary diseases, constituted 68.98%, 69.44%, 69.17%, and 67.94% of all causes of death in Iran, respectively. During the same period, the probabilities of premature mortality attributed to major non-communicable diseases were 14.95%, 15.15%, 15.25%, and 16.63%, respectively. Notably, Golestan province exhibited the highest probability of premature death.

The percentage of probability of death resulting from non-communicable diseases is a crucial indicator for the prevention and control of NCDs at both the international and national levels. This indicator requires ongoing monitoring to effectively address the issue. Given the diverse socioeconomic and epidemiological circumstances across the provinces of Iran, acquiring a comprehensive understanding of the current situation regarding these diseases becomes imperative. Such knowledge facilitates the development of well-informed planning and policy-making strategies aimed at managing the increasing burden of NCDs and ensuring equitable healthcare provision.

Primary health care system provides appropriate prevention and primary mental care services only for rural population. Therefore, the Community Mental Health Center (CMHC) was developed to provide mental health services in urban areas. The present study aimed to outline the performance, achievements, and challenges of CMHC in Tabriz, Iran.

 

This was a qualitative pilot study with in-depth interview approach. The outcomes, implications, and challenges of CMHC in Tabriz city were evaluated from 2015 to 2019 using three methods, including conducting in-depth interviews with two executive managers, holding focus group discussion (FGD) with managers and mental healthcare providers, and collecting mental health care indicators from the patients’ health records. After evaluating the challenges, appropriate recommendations to improve mental health services in urban areas were presented.

 

A total of 17 specialists and general medical doctors collaborated in this study. During the study, 1053 initial visits and/or screenings and 2313 patients with psychological disorders were identified and recorded. Moreover, a total of 988 mental training sessions were held for patients and their families. Five main themes, including the necessity for establishment and objectives, implementation process, achievements, challenges, and recommendations, were identified during in-depth interviews and FGDs.

 

It seems that CMHC is an appropriate strategy and model for providing basic mental health services, especially in metropolitan cities. Longitudinal studies with a randomized controlled trial design as well as cost-effectiveness evaluation studies are required to confirm CMHC in the Iranian context.

Suicide is recognized as a public health issue in Malekan County through a health community assessment. A community-based suicide prevention program was conducted during 2014-2017.

This health system research was conducted in seven steps, including conducting systematic reviews, gathering expert opinions, improving the coverage of suicide attempt records, conducting research to identify regional risk factors, conducting follow ups and managing the individuals attempting suicide, training health gatekeepers, and launching public awareness campaigns. Our goal was to lower the rates of suicide, and suicide attempt by 15% and 20%, respectively. Multiple logistic regression was calculated to estimate the adjusted odds ratios and the 95% confidence intervals.

821 suicide attempts and 32 suicides had been recorded in the county. 70% of the suicides had been committed by men while the majority of attempters were females (64%). Most of the suicides (18cases-56.25%) had occurred in the spring while the majority of suicide attempts (288cases-35.8%) had been recorded in the summer. The common methods (62%) suiciders used were hanging and poisoning, which increased death risk significantly (OR: 8.5, 95% CI: 2.9–76.99). The incidence rates of suicide and suicide attempts reduced from 11.22, and 203 per 100,000 in 2013 to 2.63, and 157 in 2017, respectively. Suicide re-attempts also diminished from 12% in 2013 to 6.7% in 2017.

Suicide, SA, and re-attempt were lowered by 75%, 22%, and 42%, respectively. Practical Implications. The practical framework that emerged out of the present study can be used for generating future suicide prevention strategies. Furthermore, our study highlights the need to consider a wide range of contextual factors when developing suicide prevention programs.

In order to address the community’s health needs during the COVID-19 crisis in 2020, several comprehensive urban health centers affiliated with the primary healthcare system were designated as COVID-19 centers. Considering the importance of evaluating the performance of the mentioned centers and ensuring the continuity of the services provided in accordance with the rules and instructions, the performance evaluation of the mentioned units was conducted from July 2020 to March 2021 in three levels: self-evaluation (first-level evaluation), university evaluation (second-level evaluation) and the evaluation of the experts of the Ministry of Health and Medical Education (third-level evaluation).

This cross-sectional descriptive-analytical study was conducted in all selected COVID-19 centers, including 978 in 63 universities / medical schools across the country in 2020. The sample was selected by census sampling method and included a total of 978 centers. In this study, 28 main criteria in the fields of education and information, safety of staff and clients by observing social distance, use of personal protective equipment, supplying manpower and equipment, disinfection, and work processes, and 91 sub-criteria were determined by using Delphi Technique.

With the criteria and sub-criteria defined in the areas of "community education and information", staff training, observance of social distance, facilities, waste management, manpower supply, supply of medical equipment and work processes, it was identified that in the self-evaluation (first level evaluation), the criterion with the lowest score was "staff training". The lowest score in the evaluation of the level of universities / medical schools (second level evaluation) was related to the observance of social distance in the centers and the highest score in both evaluation levels was related to the criterion of "providing the necessary education to patients regarding prevention and control of COVID-19".

The establishment and setting up of selected COVID-19 centers has been one of the effective measures in controlling and managing the COVID-19 epidemic, which was created as a result of changing the structure of the primary healthcare system. The continuity of service quality of selected centers requires continuous monitoring and evaluation of their performance.

As an emerging disease, COVID-19 is considered more than just a health crisis, as it socially affects communities. Therefore, community-oriented solutions via the primary healthcare system can better manage and control this pandemic. The Ministry of Health and Medical Education, and the Deputy Minister of Public Health executive branch, played an influential role in controlling the epidemic with community-based and network-based interventions in the National Mobilization Plan against COVID-19.

This cross-sectional descriptive study aimed to assess the second step of the National Mobilization Plan (NMP) against COVID-19. The data were extracted from the portal of the Network Management Center, Centers for Disease Control and Prevention (CDC), CLIS system, Reference Health Laboratory, and electronic record systems of the public health networks of all universities across the country from April 11 to August 10, 2020, and was analyzed using Statistical Package for the Social Sciences (SPSS) software.

During the second phase, healthcare providers screened more than 42 million people. About 98.4% of this population were diagnosed with no symptoms, and 0.4% were referred to the selected COVID-19 comprehensive health centers for examination and medical procedures. Of all the direct and referred patients of the selected COVID-19 comprehensive health centers, 55.3% had no problems, 37.8% needed to be tested, 3.6% needed to be referred to a hospital, and 3.3% received outpatient care. In the first days of laboratory screening, 11% of PCR tests were positive. By the end of the second step of the NMP against COVID-19, this rate had increased to 25%.

In times of crisis and epidemic conditions, the health network system, and the primary healthcare providers can effectively manage outpatients and reduce the burden of hospitalization. Only 3.6% of outpatients in the network system were referred to hospitals. The rest were cared for and followed up by the primary health care providers. Therefore, strengthening the network system structure and primary health care should be further considered.

COVID-19 is a global pandemic and has plagued many countries with unprecedented management problems. The rapid spread of COVID-19 around the world has reduced the ability of countries to address and respond to essential health services. Most countries have taken steps to prevent the spread of COVID-19 and improve essential services. The National Mobilization Plan (NMP) against COVID-19 in Iran’s healthcare system was implemented in 5 stages until September 2021. This study aimed to assess and review medical universities' performance in the third step of management and control of COVID-19 to provide documents and reports to be used in similar experiences.

This research is a cross-sectional descriptive study. Data were obtained from electronic records at the primary health care facilities and were analyzed and reported using descriptive statistical methods, including comparative tables and graphs. In order to prepare the report, Excel 2016 software was used. The third step of the NMP against COVID-19 was implemented from August 10, 2020, to November 10, 2020. In this step, while re-emphasizing the importance and necessity of verbal and laboratory screening of COVID-19, essential health services provision was highlighted as "in-person and remote services" for the covered population.

In the third step of national mobilization, 59,109,413 people were screened for COVID-19. During the third step, non-COVID essential services increased compared to the previous three months, with the most significant increase in middle-aged care.

Implementing the third step of NMP against COVID-19 in Iran increased the healthcare service delivery to all target groups, indicating the effectiveness of the third step in the fight against COVID-19 and the provision of Essential Health Services.

COVID-19, caused by a novel beta-coronavirus known as SARS-CoV-2, was first identified in China in late December 2019. The coronavirus outbreak was officially announced in Iran on February 19, 2020. The official report of the virus spread throughout the country was announced in mid-March 2020. While expanding the coverage of the “Each Home as a Health Post” (HAHP) program, universities recruited health messengers and health volunteers and trained them with the educational content “A Guide to Live with COVID-19”.

This study is a descriptive cross-sectional study. The sampling method was the census method. The required data were extracted using the integrated health system and the portal of the Ministry of Health and Medical Education’s Primary Health Network Management Center. Data were analyzed using descriptive and analytical statistical methods.

The numbers of household health messengers and health volunteers were 11,134,290 and 280,619, respectively. The highest total number of health volunteers and health messengers, with 824803 people, were in Shahid Beheshti University, and the lowest, with 7088 people in Gerash, Iran. Households with health messengers were 11656389, covering 50.1% of Iranian households. The national average score of trained messengers in the COVID-19 training course was 79.2%. In 22 universities/colleges, 100% of the health messengers passed the COVID-19 training course.

Implementing the HAHP program has effectively controlled COVID-19 spread by increasing awareness and promoting self-care in the community. Health messengers and health volunteers were the essential elements of the HAHP program. They identified and referred patients to selected COVID-19 care centers, improving care and services such as interception and support.

In December 2019, a new disease was reported in China that spread rapidly worldwide. This disease is called COVID-19, a viral infection of the coronavirus family. COVID-19 has caused health, social and economic problems around the world. In Iran, the first disease cases were reported in February 2020. This article aimed to describe the results of the fourth step of the National Mobilization Plan against the COVID-19 pandemic.

The information used in this cross-sectional-descriptive study is based on the data recorded in the computer program (Portal) of the Network Management Center of the Ministry of Health and Medical Education.The fourth step was devised to manage and control the COVID-19 pandemic with public participation and coordination between departments. It comprised four teams, including contact tracing, home care, supervisory, and support teams. Excel 2016 software was used to analyze the present study's data, and ArcMap software version 10.8 was applied to draw thermal maps.

In this study, every contact-tracing team consisted of 3.2 members. This number was equal to 3.2, 2.9, and 3.8 people per team for supportive, home care, and supervisory teams, respectively. Also, on average, the contact-tracing teams tracked 135.9 cases per team. This number was 518.6 visits per team for supervisory teams, 75.3 for home care teams, and 52.2 households for support teams. During the program's implementation, 3065.3 PCR tests and 3596.7 rapid tests were taken per 100,000 population, of which 15.5% were positive. The average contact tracing in people with close contact with the infected people was 4.87 per patient with a positive test.

The COVID-19 pandemic challenged all political, economic, social, and health policies and revealed the governments’ inadequencies. Statistical evidence suggests that the measures taken to manage and control COVID-19 in Iran have been valuable and effective. Still, this process depends on the persistence of policies and protocols by the government and society.

The outbreak of COVID-19 in Iran in February 2019 prompted the Iran’s health system to plan for pandemic prevention and control. The national mobilization program (NMP) against COVID-19 was devised to support the sick and vulnerable and promote community awareness and skills regarding the crisis. This study aimed to investigate the role of community health workers (CHWs) in preventing and controlling the COVID-19 pandemic.

The present study is a descriptive cross-sectional study. The census method was used to study 30,034 rural health workers (RHW) and 22,573 urban health workers (UHW) working in medical universities. The required data were extracted using the integrated health system and the portal of the Ministry of Health and Medical Education's Primary Health Network Management Center and were analyzed using descriptive and analytical statistical methods.

More than 78 million people were screened during the first phase of the NMP , more than 42 million during the second phase, and more than 59 million during the third phase. In addition, by the end of the fourth phase of the NMP, 4,278,899 highly vulnerable individuals were screened. According to the health system's report, CHWs administered 28,073,777 vaccines since the implementation of the fifth step (until 04.09.2021)

Considering the facilities and capabilities of primary health care networks in providing prevention, diagnostic, and treatment services, the activity of the primary health network management center and all affiliated units in the implementation of the NMP has been significant since the beginning of this pandemic. Inadequacies in human resources, financial resources, and training planning should all be considered.

One of the most effective ways to prevent coronavirus disease 2019 (COVID-19) is to perform general vaccination and actively prevent the outbreak at the primary health care level. The present study aimed to review the measures against COVID-19 in Iran from April to September 2021.

A cross-sectional and descriptive study was conducted at the national level from April to September 2021. Data related to COVID-19 vaccination, prevention, care, and outpatient services was collected from databases, including first level electronic health record systems, the portal of Network Management Center, the portal of Infectious Diseases Management Center, and the portal of Health Observatory. The target population of the study included medical universities and schools in Iran. Using a census sampling method, all 63 medical universities and schools in the country were included in the study. The Statistical Package for the Social Sciences (SPSS) version 16 was utilized to analyze the collected data.

In the fifth step of the national mobilization program against COVID-19 epidemic, a total of 1,228 vaccination centers with 6,490 stations were established across the country from April to September 2021. In these centers, more than 47 million doses of the COVID-19 vaccines were injected. At this step, over 15 million people exposed to close contact with infected people were intercepted. A home care team was deployed at each selected health center for COVID-19, providing 532,551 home care services. At the fifth step, the monitoring teams issued 1,015,831 warnings to trading, industrial, or administrative units, which led to the sealing of 73,443 units. Also, more than six million rapid tests were performed in homes and health units. During the same period, 30,843 vulnerable households received support packages.

The national mobilization program to combat COVID-19 in Iran focused on the community and primary health care system. The program was successful in strengthening the health system to expand vaccination and actively prevent COVID-19 epidemic.

The Islamic Republic of Iran's health system is divided into three levels: the first level is the Primary Health Care (PHC) system, the second level includes specialized polyclinics/clinics, general and specialized hospitals, and the third level is the sub-specialized hospitals. Based on the available evidence, Iran's HS has evolved and progressed since 1984, becoming a comprehensive, public-centered, responsive, and cost-effective system, (Figure 1) (1,2).  
During the COVID-19 pandemic, countries reacted differently based on their HS infrastructure and structure, available primary resources (financial and human resources), and the severity of the disease spread. Evidence reveals that most countries relied on their hospitals and health systems to combat the COVID-19 epidemic. However, the health system’s response was slightly different in the Islamic Republic of Iran. Since the early days of identifying cases and preparing hospitals for admission and treatment of COVID-19 patients, the PHC system initiated a comprehensive reaction to combat the COVID-19 pandemic as the first line and the first point of the HS's contact with the community. In this regard, the PHC system determined the principal policies for combating COVID-19 as follows (3):- General vaccination based on the priorities in the national document Provision of active and essential healthcare and services (in-person/remotely)
- Early identification of COVID-19 cases and tracing their close contacts (family/workplace)
- Protection and isolation of vulnerable populations (reverse quarantine
- Ensuring compliance with isolation and quarantine rules (hotel quarantine and house quarantine)
- Development and improvement of outpatient COVID-19 treatment
Different solutions and strategies have been devised to implement and fulfill the determined policies, which can be divided into three general categories:a) Modifying the structure of service delivery
b) Modifying the programs and procedures
c) Improving the methods of service provision
Strategy 1: The first strategy is to make structural changes in the PHC system (Figure 2), which occurred in the first week of the outbreak in the Iran’s PHC system. Through alterations in structure, human resources, duties, and function, 1200 comprehensive urban (1099) and rural (111) health centers were designated as COVID -19 centers for suspected COVID-19 outpatients from rural health houses, urban health posts, rural/urban comprehensive health service centers, and other private centers.

In late 2019, the outbreak of COVID-19 disease, with symptoms like the common cold or severe respiratory illness, caused a global public health crisis. In order to control and manage this disease, countries and the World Health Organization (WHO) have adopted various strategies and decisions.This study aimed to describe the initial measures of the Ministry of Health and Medical Education of the Islamic Republic of Iran with a focus on the Deputy Minister of Health in the framework of the national mobilization plan to combat COVID-19.

A mixed method study, including reviewing the documents of different departments of the Deputy Minister of Health in the management and control of the COVID-19 epidemic (qualitative) and descriptive cross-sectional (quantitative) study was conducted between March 2020 and April 2020. In this study, data and information related to all 63 universities / medical schools in the country were collected from the electronic health record systems and the portal of the Network Management Center and analyzed using EXCEL software.

The first step in the national mobilization against COVID-19 was to establish 1200 comprehensive health centers for COVID-19, provide self-assessment portal at salamat.gov.ir, and dedicate telephone lines (406,190, and1666) for COVID-19 distance counseling and tips. About 98% of the people registered in the electronic health record systems (78,315,029 people) were orally screened and evaluated, including 6,220,603 elderly, 262,717 people with diabetes, 3,356,131 individuals with high blood pressure, 29,201 obese people, 517,696 pregnant women and 2,722,659 foreign nationals. Another significant aspect of the implementation of the first step of the national mobilization was a significant reduction in the burden of hospitalization and management of outpatients in the first level of the health system (primary health care).

The COVID-19 epidemic caused a global health crisis, the management of which became the top of the world's health activities. The health sysntem in Iran, using the capacity of the health network system structure and service providers, developed appropriate policies for the management and control of the disease. One of these policies is the verbal screening to combat COVID-19, which has led to the optimal management of this epidemic.

Covid-19 pandemic has caused significant disruptions in the provision of non-communicable disease prevention and management services in many countries and there is a concern that this disorder will lead to long-term complications of these diseases; This study aimed to quantitatively analyze the status of some prevention and management services of non-communicable diseases in the primary health care system of Iran during the Covid-19 pandemic.

In this study, the routine data of 8 services related to the prevention and management of non-communicable diseases in the integrated electronic health record system (SIB) within 10 months after the outbreak of Covid-19 were compared to the same period last year.

Non-communicable disease prevention and management services have decreased by an average of 18.89% compared to the same period last year; this decrease was much more severe at the beginning of the epidemic period (up to 75% in some services) and more in the services provided by physicians than in the services provided by non-physicians. Also, observation of the course of selected services during this period showed that after the initial reduction of services, a process of gradual compensation is evident.

like other areas involved in the pandemic, the effect of the Covid-19 epidemic on non-communicable disease prevention and management services in the primary health care system of Iran, has been significant and although partial compensation of some services is promising, more attention and effort is needed to revive the other programs.

Developing specific performance evaluation indices for hospitals affiliated to Iran's Social Security Organization and measuring them can be effective in improving hospitals’ performance. The aim of the present study is to develop and validate specific performance evaluation indicators for hospitals affiliated to Iran’s Social Security Organization.

To formulate specific performance indices for Social Security Hospitals, four steps of literature review (academic papers, books, organizational reports and other resources), expert opinion polls (from 10 experts), two rounds of Delphi, and peer reviews by key social security experts were done.

4563 indices were identified from text searches. After initial screening of the indices by two independent researchers, finally 790 indices were selected (initial screening). In the next step, both researchers discussed selected indices, which resulted in the elimination of 126 indices due to being repetitive or similar (secondary screening). Then 664 indices were sent to 10 experts for initial modification (tertiary screening). Finally, 60 indices were selected and entered the Delphi phase. After performing two stages of Delphi technique (first round 24 people, and second round 8 people), 50 indices were selected. Finally, 49 indices were finalized in four domains:  input (5 indices), process (11 indices), output (18 indices) and financial performance (15 indices).

Using the indices developed in the present study, senior managers can attempt to evaluate their own hospitals to identify weaknesses and plan and improve their performance.

AIDS is an emerging disease, and despite the fact that it has not been recognized for the first half-century since its inception, it has been known as a century-old disaster. This disease, by proliferation in immune cells and ultimately by weakening the immune system, makes people vulnerable to diseases. Our study seeks to examine existing cases of HIV/AIDS patients in East Azerbaijan province in Iran and provides useful guidance for patient diagnosis, treatment, and care.

This is a descriptive-analytic study in which the target group includes all HIV-positive or AIDS patients identified or reported from 2004 to 2014 in Tabriz Medical Sciences or Health Centers of East Azerbaijan province. The demographic information of all patients were recorded by a researcher-made questionnaire during visiting the disease-management counseling centers. All data including transmission of the illness (including all possible ways), the diagnostic date, the onset of treatment and the date of death were collected, and then entered into the software Stata, version 11.0 (Stata Corp., College Station, TX, USA). The information were imported in the ArcGIS software, version 10.7.1 (ESRI Inc., Redlands, CA, USA), maps were created, and geographic and spatial data were analyzed.

According to the results of this study, most patients with 89.9% were male, 28.9% were under the age of 36 years, 32.3% had elementary education, and the most common way of transmission with 42.3% is through the shared infusion.

According to the results of this study, the highest prevalence of AIDS in East Azerbaijan province was observed in men under the age of 36 years and primary and lower secondary education in Tabriz and Maragheh cities.

The aim of this study was to assess the performance of Social Emergency Referral System (SERS) in Tabriz.

This was a mix-method study (quantitative and qualitative). The opinions of the experts regarding SERS were summarized by interview and semi-structured questionnaire and analyzed by content analysis method. Performance indicators and service provision were extracted based on recorded data in the health center of Shahid Chamran and the health center of East Azerbaijan province and presented in descriptive statistics.

According to the findings of the study, among vulnerable people, 84% were related to addiction and 16% were other problems. Of the 11 detected social harms, after drug addiction, the highest rates refer to divorce, spouse abuse and students who dropeed out of schools and was the largest share of referrals to the welfare organization. The most important strengths of the SERS were identifying vulnerable people and guding them to receive support services and activation of NGOs and the most important weaknesses were the weak cooperation of organizations. Also, for SERS progress, the potential of close cooperation of welfare organization, the Red Crescent and the Relief Committee and the lack of cooperation between provincial government and the municipality should be considered.

According to the study findings, in order to improve the performance and expansion of the SERS in Tabriz, one of the most important issues that should be considered, is to improve the participation and cooperation of all stakeholders and related organizations in order to increase public trust in the program and improving its performance.

Primary care governance has been in force since 1999 with the introduction of general practices into local primary care groups in the United Kingdom. The aim of primary health care (PHC) governance is to ensure the use of evidence-based medicine in PHC groups and to reduce the variability in access to PHC services to improve health outcomes and promote the standards of services provided to customers. This study was conducted to validate the primary health care governance model of Iran.

This is a qualitative study. The primary health care governance model components came from the literature review, focus group discussions, and interviews were sent to 40 qualified professionals through the Delphi form. Based on the median score and by holding four experts’ panel sessions, the model was approved. Evaluation indicators of the model were proposed through literature review and expert meetings. By sending these indicators along with other components of the model in the Delphi questionnaire to 30 qualified specialists, the final model was confirmed with the calculation of CVR and CVI in two Delphi rounds.

Proposed Iran’s PHC governance model, with a fundamental pillar, leadership, five main pillars (quality management, community involvement, health information management, human resource development, monitoring and evaluation), 22 components, and 64 assessment indicators, was designed to reduce the weaknesses and challenges by relying on strengths and opportunities of the system.

Iran’s primary health care governance model has the potential to improve the quality and increase accountability level in the health system of the country and to evaluate the progress of the health care system toward the excellence.

Ensuring high quality care for diabetic patients is a challenge for healthcare systems throughout the world. The aim of this study was to evaluate the relationship of quality of services provided to type 2 diabetic patients with self- assessment in comprehensive health service centers.

This descriptive-analytic cross-sectional study was conducted on 203 patients with type 2 diabetes referred to ten comprehensive health service centers of south Tehran/ Iran in 2018 selected through convenience sampling method. Data collection tool was a questionnaire for comprehensive assessment of quality of health services. Data were analyzed through SPSS22 and using t-test, ANOVA and logistic regression statistical tests.

From the perspective of patients, mean score of quality of services was 7.47. Among different health services, the highest mean score of quality was related to trust and continuity of service while, support and prevention gained the lowest mean score of quality. There was a significant statistical relationship between the quality of service and self-assessment of diabetes control in the past 12 months (P= 0.007). Also, a significant relationship was found between the quality of service and diabetes complication (P = 0.04). With each unit increase of the quality of service, the odds of a standard visit increased by 27% (P = 0.013). 

Design and implementation of interventions in order to increase the social support of patients and sharing their experiences with each other as well as improving the dimensions of prevention and safety in care are essential.

Health promoting behaviors are formed during adolescence and often remain until adulthood. This study aimed to explore related factors to health promoting self-care behaviors among adolescents. A cross-sectional study was conducted in 2016 among 426 adolescents living in Tabriz. Adolescent Health Promotion (AHP) questionnaire was used to collect data. Data were analyzed using descriptive statistics, t-test, Pearson and Spearman correlation coefficients applying SPSS v.16. The mean score of the health promoting behaviors was 69.83. Among six healthpromoting behaviors, physical activity and health responsibility were not in good conditions among the students. Adolescents had a high score in the dimension of life appreciation (80.62). There was a significant difference in self-care score between male and female participants (p≥0.05). There were no significant relationships between self-care with age, family size, and birth rank (p≥0.05). There was a significant difference between father education level and family size with nutritional behaviors of the adolescents (p≥0.05). This study showed that the health responsibility among adolescents was low and their physical activities were not sufficient. These results are a warning to policy-makers to pay attention seriously to promoting school health programs in order to promote self-care behaviors among adolescents.

According to the World Health Organization’s report, tobacco use is the first preventable leading cause of deaths in the world.While the prevalence of tobacco use is declining in high-income countries, this prevalence is increasing in the low-income and middle-income countries. Daily, 205 thousand USD and 386 million USD annually spent on cigarette purchasing in Iran, and the health system of the country pays about 1 billion and one hundred and sixty million USD to cure the complications of cigarette smoking. The present study aimed at determination of effective programs and interventions applied in prevention and reduction of tobacco use in societies. Medical databases were searched, related studies retrieved and their content reviewed and classified. According to the results of this study, programs and interventions for prevention and reduction of tobacco use were categorized in six domains including: "studies at different levels of age and groups," "studies in the physical and community environment," "tax and price studies," "electronic cigarette smoking studies," "harm reduction studies," and "interventions facilitating solutions." The results of the study, suggests the followings as appropriate strategies that fit the culture and abilities of the Iranian health system: "culture, the establishment and application of rules", "interventions with a focus on specific groups", "education at all levels and interventions," "organizing training courses and emphasizing the role of the family in protecting adolescents" and “free drug therapy ".

Alcoholic beverages consumption affects all body organs and causes wide range of diseases such as cancers, psychopathy and violent behaviors. There is no precise statistics on alcohol consumption prevalence in Iran. Nevertheless, it is estimated that there are more than one million abusers of alcoholic beverages in the country. Various programs and interventions have been conducted to prevent and reduce alcohol consumption in different nations. The current narrative review study aimed at determining the effective strategies and programs applied in other societies and identifying appropriate approaches to the current situation of Iran. National and international databases were assessed by the research team and related studies were retrieved and categorized after quality assessment. Results of this study indicated that effective programs in prevention and reduction of alcohol consumption can be categorized in six general parts as follows: education and training, health-sector programs, community programs, regulations and policies regarding driving under the influence of alcohol, access-related policies and harm-reduction programs.

Poor nutritional habits along with physical activity levels are among the main causes of obesity and overweight in children and teenagers. Considering the importance of school health and nutrition for children and teenagers, this study was conducted to assess school health activities and programs in the field of healthy diet and nutrition.
This cross-sectional and applied study was conducted in 2017. The statistical population consisted of all school health principals and teachers in Tabriz city. Sampling was done in the first stage by stratified method and in the second stage; a simple random sampling was utilized on 93 schools. The data collection tool was the school health principals and teachers profile. Data were analyzed by SPSS 22 software using descriptive statistics (percentage and frequency/mean ± SD) and analytical tests (U Mann Whitney and Kruskal-Wallis Tests).
According to the findings, 84.9 percent of schools had a store, dining room or buffet for snacks, drinks, and other meals. Promotional activities such as encouraging students to drink water (94.6 %), promoting the use of fruits and vegetables in schools, and providing useful and necessary information for students and their families (76.3 %) were conducted by most schools. 90.3 % of schools prevented the advertisement of candy, sweets, fast food and carbonated soft drinks in the school environment, and 75.3 % prevented the advertisement of candy, sweets, fast food and carbonated drinks in publications and school curriculum.
Most schools do not have much activity in providing healthy food and allocating space for breakfast and meals. Most schools have a good performance profile in terms of educational and training activities, the prohibition of harmful food promotions, and the availability of clean drinking water. Findings of this study can help health managers and health authorities to take the necessary steps to solve the problems based on the status quo.

Licensure is a healthcare evaluation approach which has particular importance in compliance with minimum requirements of healthcare centers for getting started and continuing their performance. The aim of this study was auditing of Tabriz general dentistry offices based on licensure standards.
This descriptive- analytical study was done in 197 general dentistry offices in Tabriz city selected randomly. The required data were gathered using a researcher-made checklist with 75 questions in 7 main dimensions including physical environment, medical equipment, nonmedical equipment, human resources, medical records and informatics, policy consideration, and hygiene and infection control. Data analysis was done using t-test, ANOVA and Tukey statistical tests and through SPSS19 software package.
The total rate of compliance with licensure standards in Tabriz dentistry offices was 78.5%. The highest and lowest rates of compliance were respectively in dimensions of “medical records” (92.3%) and “non-medical equipment” (66.4%). There was significant relationship between “job experience of dentists” and standards compliance score in “law and policy consideration” and “hygiene and infection control” dimensions; so that, more job experience was associated with higher compliance score in these dimensions.
Despite acceptable status of the assessed dentistry offices in regard to licensure requirements, there are still shortcomings in some dimensions. No doubt, the obtained results could help authorities to improve the status of dentistry offices and increase community satisfaction.

Non-communicable diseases (NCDs) have become a major public health problem not only in developed countries, but also in developing countries; as cardiovascular disease is considered to be the leading cause of death in the world. Unhealthy diet, insufficient physical activity and smoking are the main determinants of NCDs in the world. According to the reports, daily intake of salt in Iran is above the recommendations of the World Health Organization (WHO), while taking too much salt affects the human health negatively and WHO regards reducing population salt intake as one of the most cost-effective measures to improve public health. Despite the fact that reducing salt intake in the population is difficult, but with specific actions and strategies, reducing most of the population's salt intake is possible. These actions and strategies include: 1) sodium-restricted diet and monitoring sodium content of foods, 2) awareness campaigns (media and communications strategy), 3) labeling and development of symbols identifying low-salt products, 4) United Kingdom strategy-gradual reduction of sodium, 5) food industry strategy (re-formulation), and 6) taxation on and rising prices of unhealthy food. Successful countries in reducing salt intake have followed these practices.