فهرست مطالب جواد بابایی

Today, the participation of local levels in the health policy process is emphasized, which can be used as a means to more appropriately solve the problems of local communities and support the health system in achieving its goals. This study aimed to design a health policy model based on participation at the local level.

This multi-method study was conducted to design a model for participation in health policymaking at the local level during three phases of systematic review, semi-structured in-depth interview, and Delphi technique. The purpose of the systematic review was to identify the factors affecting this participation, which was done by searching for suitable keywords in English and Persian databases. The objective of the qualitative phase was to identify the barriers and facilitators of participation. To this end, 16 people were selected by purposive sampling method and semi-structured interviews were conducted. The elements and components of the initial model were provided to experts in this field through the Delphi technique to confirm the items and validate them, so that the final model could be designed.

The influential factors for participation included individual, environmental, and contextual factors, which were identified from a systematic review of 21 articles. Facilitators obstacles, challenges, advantages, and disadvantages of local level participation in the policymaking process were identified through the results of a qualitative study, which were categorized into three main themes, including the participation process, the beneficiaries of the process, and the strategies to facilitate participation. Finally, the health policy model based on participation at the city level was validated and finalized using the opinion of experts.

Participation in the health policy process requires the use of facilitators and the removal of obstacles. Local levels in terms of health issues in Iran involve complex and diverse challenges that can be solved through real participation.

Prevention and control programs for hypertension have been integrated into the health system and implemented for many years in Iran. However, executing such programs often faces challenges in practice, and requires continuous promotion. This study aims to share the experience of promoting hypertension prevention and control processes at the Alzahra Healthcare Center in Marand.

This quantitative-qualitative study utilized an action research approach. Initially, the performance of the control process was assessed at Alzahra Healthcare Center in Marand. The nominal group method and semi-structured interviews were then used to identify challenges in the process from the perspective of purposefully selected stakeholders. Suggestions for promotion were generated through focus group discussions and finalized using priority matrices. The interventions were implemented, and the process performance was reassessed.

Implementation of the interventions led to improvements in indicators related to the percentage of newly identified patients, care for patients with high blood pressure referrals and visits to physicians for the thirty-year-old and older population, and referrals to specialists for patients with hypertension.

While the prevention process for patients with high blood pressure at the selected healthcare center showed relatively good performance, there was still a need for promotion. This study provided solutions to enhance aspects of the process. To ensure continued improvement, the action research cycle should be sustained.

The potential capabilities of Autonomous Underwater Vehicle (AUV) compared to traditional tools and equipment have led to increased attention and use of underwater vehicles in various commercial, military, and research fields. The manufacture and development of an offshore operational platform require the design of a complete and expensive system of a maritime laboratory in order for evaluating and validating the characteristics and performance of the integrated system and its subsystems. Modeling can be a cost-effective tool for conducting tests, verifying and certifying components and performance of hardware and software, performing missions, and thus reducing potential errors in marine tests and missions. These goals can be achieved through a relatively accurate dynamic simulation and modeling of equipment and environmental conditions inside the hardware in the loop (HIL) laboratory. The purpose of this paper is to provide real-time modeling and implement a physics-based depth environmental simulator for an AUV to equip the HIL laboratory. Validation of the performance of the depth environmental simulator in the dynamic bed of six degrees of freedom of an Autonomous Underwater Vehicle crawler has been done in real-time. The results indicate that the output of the depth environmental mechanism matches the measured depth of the field experiment at sea and there is no delay and bias between the real and simulated signal.

Composites are commonly used in pressure vessels. One of the critical problems in manufacturing composite vessel under the external pressure is sealed opening design and its considerations. It's required to review the body resistance in opening locations. In this paper, a special design process for opening closure presented and the influence of such cutouts on vessel body studied. Because of the importance of body resistance, the vessel material and structure mechanical performance were analytically evaluated. Then, Mechanical behavior of the vessel structure was investigated based on the parameters affecting the definition of different opening designs through finite element simulation and analysis in ABAQUS commercial code/software. Hence, the effect of the presence of openings, including the consequences of creating asymmetry in the structure, has been determined in a large aspect ratio. Finally, the results represents, the importance of complying practical requirements and implementation of reinforcement rings in the opening locations to get the suitable design as one of the most effective solutions to compensate the opening reduction consequences i.e.; buckling strength reduction and highly increasing asymmetry.

Drugs are one of the essential components in diseases treatment process. Their to-the-point prescription in terms of quality and quantity and their cost are important issues that should be focused by health providing authorities. The present study aims at evaluating the average of prescribed items and their costs in family physician program involved health centers and hospital in 2017 Hashtrood, Iran. 

In this cross-sectional study, the data on prescriptions, items and their averages costs were collected from Hashtrood healthcare centers and hospital. The data were processed by Microsoft Excel. Then, the Mean and Pearson correlation was analyzed by SPSS20 

Totally 72806 prescriptions were issued in 2017. The average of prescribed drugs was 2.79 ± 0/36 for each prescription and the average price was 116123 ± 12486/09 IRL. The highest number of prescribed drugs was for Hashtrood hospital, but the highest price was for the health center No 1. 

The average of prescribed drugs in Family physician program in Hashtrood was less than the national average and the averages mentioned in other published literature. It shows the relative success to control the number of prescribed drugs; however some health centers need more attention and assessments.

The functional environment of the capital market is much more complicated than it has been in the past, which requires strengthening the supervisory foundations of the financial operations of the companies active. One of the important factors in the monitoring, audit, and auditory behavioral and functional characteristics of auditors is to play roles in addition to its specialized roles through the strengthening of social interactions and the development of ethical considerations. Hence, the recognition and the nature of these values can play a significant role in promoting neutrality in the audit profession. The purpose of this research is Content and Link Analysis Moral Values on audit profession neutrality. In this research, 18 academic lucturer were involved in the analysis of the field. Through the seven phases of the analysis process, the components of the value creation ground were identified in the auditor's neutrality. Based on this, three components of ethics, ethical virtuality and social value-orientation were identified as three important dimensions in creating the core values of the audit neutrality, which included 18 components in the analysis of relationships between links and systemic impacts. The results of the second part show that in the ethical sense of ethics and the main factor behind the values of the auditor's neutrality, the proportion of professional perception to performance is considered as a systematic motive. Also, in the area of ethical virtue, it is clear that belonging to the audit profession and the institutionalization of values are two drivers of strengthening the ethical virtues of the auditor to increase the impartiality of the audit. Finally, it was found that in the dimension of social value, the preservation of social norms is a stimulus in this field.

This paper aims is to design an integrated navigation system constituted by low-cost inertial sensors to estimate the orientation of an Autonomous Underwater Vehicle (AUV) during all phases of under water and surface missions. The proposed approach relied on global positioning system, inertial measurement unit (accelerometer & rate gyro), magnetometer and complementary filter technique. Complementary filter operates based on low pass filter and high pass filter to remove noise and bias error of measurement data in the integrated navigation structure, respectively. Consequently, a relatively accurate orientation estimation is provided for guidance/control system. The most important feature of the proposed approach is the ability of switching between GPS and magnetometer sensor consistent with phase-change in the AUV motion. This brings about more accurate estimation of heading angle in both the surface and underwater phase compared to gyro-based navigation. The performance of the proposed algorithm is assessed in a field test executed on a research AUV and in comparison, with Kalman filter.

Because of the high ratio of strength to weight, composite vessels are widely used in maritime and aerospace industries. The way of composite vessels breaking under hydrostatic pressure is assignable by paying attention to the geometry and material's properties. In composite vessels, using of composite stiffeners has high complexity in manufacturing process. On the other hand, due to the low young's modulus of composite materials, usually cannot use of the materials as a stiffener. In this research, effects of using hoop stiffeners on buckling pressure of composite bodies have been studied. In this paper, mechanical manner of a composite body is studied by Finite Element Method (FEM) in two statuses (with metal stiffener and without metal stiffener). According to results, using of a metal hoop stiffener that has 3.6 percents of the composite body weight increases buckling pressure up to 25 percents. Based on results increasing the buckling pressure of composite bodies by mounting steel hoop stiffeners added lower weight to the suite from increasing of thickness of bodies. For verification of numerical results, a composite vessel of GRP (Glass Reinforced Polymer), reinforced by a hoop stiffener mounted on inner surface has been experimentally under hydrostatic pressure to the breaking step. Finally, it was broken by 16 bar pressure. The results showed that the estimated pressure of software has a little difference with the experimental estimation that represents high accuracy of modeling process in the research.

Today, composite cylindrical shells extensively, have been used in aerospace to increase the performance of the structures. Experience has shown that, when the shells are under compressive loading, Buckling phenomenon will be the most important factor in structural failure. Therefore, the main objective of this research was to study the buckling behavior of composite shells and effective parameters in occurrence of buckling. For this purpose, the finite element simulation by ABAQUS software has been used. First, the estimation of the buckling force for an experimental specimen occurred by using three analyses, including: linear buckle, nonlinear static and dynamic, to compare with experimental findings. Results indicated that the nonlinear static and dynamic analysis, were able to estimate the actual buckling force. The estimation accuracy with respect to the experiment results is about 3~7 percent. After validation process, specimens with different thickness and initial geometric imperfections have been studied and buckling force was measured by using linear buckling and nonlinear static analysis. Finding showed that even slight geometric imperfections, especially for low thickness of shell, could extremely reduced the real buckling force. As a result, high sensitivity of composite shells to initial geometric imperfections, will lead to an unreliable estimation of the buckling force, if there is not enough knowledge of these geometrical imperfections.

Emerging infections from caring services are regarded as one common reason behind mortalities among hospitalized patients. The most effective and simplest way to prevent hospital infections is to follow hand hygiene rules. Despite the importance of hand hygiene in the preventing from infections, still there is a low level of attention to the subject matter. The present study tries to investigate the reasons behind disregard for hand hygiene among working staff of Imam Hussein Hospital in Hashtrood, East Azerbaijan, Iran.
Material and In the present descriptive study, 71 working staff of Hashtrood Imam Hussein hospital was scrutinized in 2017. Data were gathered using a questionnaire made by Arshadi et al in 2014. After data collection, they were analyzed by Pearson, independent t-test and variance analysis tests and the Mean, SD, frequency and percentage were obtained.
By studying the Mean score for each item it was revealed that the most important barriers for hand hygiene are respectively: lack of belief in the importance of hand hygiene, attitude toward the role of hand in infection control, skin allergy caused by disinfectants, lack of high quality disinfectants, and lack of hand hygiene tools. There was no meaningful relationship between demographics and total score.
As results suggest, it seems that an integration of mentioned items such as having a positive attitude towards hand hygiene among working staff, presence of high quality disinfectants and providing hand hygiene tools are necessary to prevent and control infections in hospitals.

Since 2014, the "health system transformation plan" was designed and implemented in order to solve some of the problems in Iranian health system. One of the goals of this plan is to reduce direct payments by inpatients. This study aimed to compare the direct payments by inpatients, before and after implementing the transformation plan.
Material and In this analytical-descriptive study, 1351 cases were selected (all cases). Direct costs paid by the inpatients were extracted from medical records and then analyzed using SPSS v.19 software and applying Uman-Whitney test.
The overall level of direct costs paid by inpatients before and after implementing the transformation plan has been decreased from 704 286 to 491815 Rials. A statistical relationship was observed between implementing the plan and the reduction of direct costs; but in detailed costs, there was no cange.
Health system transformation plan reduced the direct costs paid by inpatients; but in detailed costs, there was no reduction in some parts. Cooperation between hospitals is necessary to continue the plan.

Provision and promotion of community health need active public involvement. Islamic councils as representatives of a community can play an important role in this area. The involvement areas should initially be recognized in order to achieve this goal. This research was planed and implemented to identify Islamic council's involvement areas in East Azerbaijan Health system. This qualitative study was conducted using grounded theory approach. Fields of Islamic councils contributions were investigated through Semi-structured in-depth interviews with members of urban and rural Islamic councils and PHC workers. Collected data were manually analyzed using Straus and Corbin methods. We interviewed 29 individuals. The results of interviews analysis were categorized in 6 main categories including: city and rural environmental health, different aspects of PHC administration, health education and health promotion, facilitating community and organizational involvements, facilitating communication and other technical aspects such as maternal health. From the viewpoint of the participants, there is wide variety of fields for members of Islamic councils to involve in health system particularly in environmental health area. Health system administrators and policy makers should implement right strategies for facilitating Islamic councils’ involvement and using their high potential to achieve health system goals.

Disasters such as earthquake induce large volume of human needs. One of the most important of them is primary health care needs. Following the 5 December 2012 South Khorasan earthquake، the public health system of the province actively involved to provide primary health care for the affected people. This case study investigated the response operations of public health system to earthquake. In this case-descriptive study، data collected by researchers using checklists، interview with healthcare workers in earthquake-affected areas، reviewing documents، and observation of the response operations. An earthquake measuring 5. 5 on the Richter scale hit Qaenat and Zirkouh areas caused 6 deaths and 23 injuries. About 2143 people were affected and 38 villages destroyed about 30 to 100%. Responding to the health needs، a rapid health needs assessment was performed immediately. Then، a response plan designed according to «National Public Health Disaster and Emergency Operation Plan». Public health system in collaboration with expert health groups provided the primary health care services for the affected communities. Although the recent earthquake was mild and occurred in the early of night، but it killed some people and destroyed a number of structures. Public health system provided an appropriate response according to EOP. Nevertheless، because Iran is a disaster prone country، the health system should be prepared for different types of hazards.

Consultation with the community members and their participants has been emphasized as one of the principles of primary health services. Islamic Councils as a community representatives have a substantial role in health system. The aim of this study was to determine barriers of East Azerbaijan Islamic Council members’ involvement in health system. This qualitative study was conducted by using content analysis. Study samples were selected purposively. Data were collected by interview with 39 urban and rural Islamic Councils and public health system workers until data saturation. Data collected using semi-structured interviews، simultaneously were analyzed using qualitative content analysis. Result of interview analysis were categorized in 764 codes، 65 subcategory in 7 main category including: lack of education، lack of existing a procedure for participation، legislation problems، executive problems related to existing legislatives، coordination problems، financial and social issues. Islamic Councils can participate in all health related areas، but، at time of involvement with the health system; they should consider many issues. Therefore، involvement in health care systems and resolving problems with practical solutions is suggested.

Due to casualties and financial losses, floods are the most horrible natural disasters. It is responsible for 40-50% of all deaths in the world, about 43% of total population damaged by disasters that have occurred between 2009-2000. Despite the high abundance of floods in Iran, yet little research has been done on how the health system response to the flood. This article aims to study the health system response operation to Chaldoran township flood. In this descriptive case study, data was collected by using checklists that were prepared by researchers through interviews with authorities of health system in affected areas; reviewing existing documentation; and observing of how the response has been provided. A flash flood was occurred and damaged some parts of Chaldoran Township on 16 July, 2011. Initial investigation team dispatched immediately to the affected areas and surveillance system was exacerbated. 24 samples of water had been taken in the region that 6 cases had bacterial contamination. However, no chemical sampling was prepared, 6 drinking water sources restored and also 34 kg of calcium hypochlorite was distributed. Chlorine measurement was performed in 206 cases which 182 were favorable cases. 8 toilets of 11 were reconstructed after damaging in flood. Meanwhile, there were not any unwanted problems in maternal and child and family planning health services. Fortunately, losses resulting from the recent flood were not noticeable and have been managed well by the health system. But for broader disaster management involving high mortality, the health system should design a proper disaster plan in order to prepare and improve employees by training programs in various maneuvers. The health system and employees should be ready. Otherwise, such disasters are very difficult to manage and also the results will be tragic.

Rabies is an acute and fatal infectious disease that is very important due to high economic losses to livestock and the amounts of expenditures that are paid for purchasing serum and vaccine. The main way of disease transmitting is bites by rabid animals. Animal bite is an important threat for human health. The main aim of this research was epidemiological study of animal bite in the students of Hashtrood town. In this cross-sectional study, animal bitten students’ data were collected trough the records of Hashtrood health centers registry lists between 2006-2009. The census data collecting method was used and the data were analyzed with statistical software SPSS15. The incidence of animal bites in the past 5 years was 9.07 per 1,000 students. From 439 animal bitten students, 80.9% were male and 19.1% were female. According to the results, 88.4% were rural and 11.2% were urban residents. Dogs bite was the cause of 87.92%. In 86.5% of the cases, the bite was superficial and in 8.4% of the cases, bites were deeper. Among them, 16.6% received anti rabies serum, 16.2% received vaccine. This study showed that 4.8% had a previous history of bite. Of total, 78.8% made a visit to health centers in the first 24 hours, 11.4% within 25 to 48 hours, and 3.6% within 49 to 72 hours after bites. There was no human death report from rabies. Results showed that 95.2% were given incomplete vaccination and 4.1% had received five complete vaccines. Regarding the high prevalence of animal bites among students, educating students about the importance of rabies, students’ behavior with dogs and immediate visit to health centers after exposure to dogs should be taken serious. Restraining dogs by training dog owners and legal means should be attempted.

Pre-hospital Emergency Medical Services (EMS) is one of the most important components of health care systems. Community awareness about its services could improve the performance. This study is aimed at assessing the citizens’ awareness and satisfaction about Shiraz EMS. Through this cross-sectional study, 1680 residents of Shiraz citizens have been selected by cluster random sampling. Each person has been asked some questions about their knowledge and also satisfaction of EMS performance with a valid and reliable questionnaire through phone interview. The data were analyzed with SPSS using T- test, Anova and Regression with “0.05” level of significance. This study revealed that the knowledge of the residents who are living in lower socioeconomic part of the city is lower than the residents of the other areas. The mean awareness score of each area was significantly different comparing to the other areas, based on their socioeconomic status. In better socioeconomic status, the knowledge score was higher. There was also significant relationship between education and gender with knowledge about EMS performance. Meanwhile, the relationship with age was reverse. Although 48.6% had no idea about EMS, 527 (31.4%) were satisfied by its services. There was only 7.3% dissatisfaction. While the awareness about EMS’s duties could decrease irrelevant calls to EMS, education, especially for the residents of lower socioeconomic areas of the city is recommended. In addition, it is suggested that in feasibility studies or using other methods of evaluating EMS performance, socioeconomic status should be considered as independent variables.

Abstract Health centers are more contaminated and pathogenic- and in briefly more dangerous- than other offices and work places for the employees. The goal for the following research was review of the occupational injuries occurrence and prevalence; and some affective factors among Hashtrood health network employees. This cross sectioned study was conducted by questionnaire distributed to 270 Hashtrood health center employees. Data were analyzed by SPSS through X2, t-test and logistic regression. The incidence and prevalence rates of occupational injuries were 43.8%and 61% respectively. Needles and sharp objects injuries had the highest ratio (Incidence rate 22.4% and 19% respectively, and prevalence rate 34.3% and 25.1% respectively). Only 32.6% of the employees reported their injuries. In 49.5% of cases they havent got the proper trains. The rate of occupational injuries among hospital and laboratory employees (70% and 66.7% respectively) is more than other centers (P<0.05). There was an significant correlation between the employees education level and their occupational injuries, that means the most occupational injuries have been happened for the one who has diploma or less education (P<0.05). Given to the vast occupational injuries, preventing measures must be considered. To reduce the occupational injuries, we suggest providing the needed training for the new comers and periodically for the employees; and also a proper reporting system by employees especially in hospitals and labs.