علی اصغر حائری مهریزی

Drug prescription is one of the strategic issues in the field of health. Rational prescription of medicine and efforts towards appropriate, safe and efficient use of medicine are one of the main missions of health policy makers in the country. This study was conducted with the aim of reviewing the studies was done in the country in the field of drug prescription pattern.

The present research was a scoping review using the Arsky and O'Malley protocol. The English and Persian databases examined in this study were Scopus, Web of Science, PubMed, Magiran and SID. Searched keywords were Prescription, Rational Use, Rational Utilization, Rational Consumption, Overconsumption, Overutilization, Utilization Management, Inappropriate Utilization, and Iran in English and Persian. Original research articles published in journals in English or Persian that estimated WHO prescribing indicators were included to the review. Studies published in other languages, books, theses, conference papers, review studies, articles whose full text was not available and articles published before 2010 were excluded from the study.

In the first stage 2846 citations were retrieved. After considering all inclusion and exclusion criteria 22 full articles were reviewed. About 70% of articles were published in English. 74% of studies focused on the prescription of a specific group of providers and 13% focused on drug administration in elderlies. The average number of drugs per prescription varied from 2 to 4.5 items in different studies. The percentage of prescriptions included antibiotics reported between 8.8 for elderlies’ home health care to 97.6 for dentists’ prescriptions. The prescriptions included injections also varied from 9.3 to 58.9 in medical interns and general practitioners in Kerman.

The trend of drug prescription reflects the success of the country's policies toward rational use of drugs. However, to achievement the global standards, the implementation of policies to improve the prescription pattern in the country should be a priorities of health system.

Dear Editor, In “before-after" intervention studies with qualitative outcome(s), we should not use the same formula when the outcome(s) are quantitative since the appropriate variance in this formula are not used and thus the sample size will not have adequate confidence and power.  A formula for such studies is proposed to overcome problems highlighted above.

Objective (s):

 COVID-19 vaccination is considering to be the ideal solution for the COVID-19 control. This study aimed to investigate the factors affected the COVID-19 vaccination in Iran.

This cross-sectional study included a sample of Iranian men and women over 18 years of age who agreed to participate in the study. A cluster sampling method was used, and the data was collected in 2021 through a self-designed questionnaire via telephone survey. Logistic regression was performed to investigate the influencing factors on vaccination.

Among 2649 participants from 31 provinces of Iran, about 88% had a history of injecting at least one dose of vaccine. The odds ratio of corona vaccine injection was similar among women and men. Age and marital status showed no significant effect on this ratio. The odds ratio of corona vaccine injection in people living in cities was about 40% less than people living in rural areas. Furthermore, the odds ratio of COVID-19 vaccination increased by about 11 times for each unit increase in positive attitude toward vaccination.

The findings indicated that overall those who were employed, students, and people with lower income and living in rural areas were more likely to be vaccinated. It seems that distribution and availability of vaccines by government was acceptable for quick and adequate coverage of vaccination in Iran.

Dear Editor, Sample size calculation is one of the most important steps in developing a plan for research projects/dissertations. The sample size affects the power of the study and also has economic implications for a research project. If the sample size would be less than the required level, the tests used to analyze the research data will not have adequate power. Also, if the sample size would be too many, it will cause a waste of resources. In this regard, it is suggested that researchers report the "correlation coefficient between the data before and after the intervention" in addition to the mean and standard deviation in a pre-and post-intervention study with a quantitative dependent variable so that other researchers can refer to it and calculate the sample size of their study correctly.

 The World Health Organization has recognized public reluctance to vaccinate against Covid-19 as one of the ten biggest threats to global health in 2019. Vaccination hesitancy is likely to be a key obstacle to global production of a Covid-19 vaccine. In order to develop universal access to the corona vaccination program, this study was conducted with the aim of measuring the attitude of Iranian adults regarding the corona vaccine and the factors affecting it in the autumn  of 1400.

This was a cross-sectional study and was conducted among Iranian men and women over 18 years of age who consented to participate in the study using cluster sampling method and through telephone calls. The data was collected by a 13-item valid and reliable questionnaire and were analyzed using the SPSS-22 software.

In all 2649 Iranians were studied (50.2% men and 49.8% women). The mean attitude score towards the corona vaccine injection was 64.1 out of 100 (SD = 11.0). The results of the multivariate logistic regression analysis showed that the positive attitude of adults regarding the corona vaccine was significantly associated with male gender (OR= 1.31, 95% CI: 1.009-1.71), and marital status (OR for married = 1.35, 95% CI: 1.054-1.75). The results showed no significant association between positive attitude and other variables such as, history of corona vaccine injection, history of corona disease, and also the death history of participants' family members due to corona.

The findings suggest to increase positive attitudes towards corona virus females and those who are single, divorced and widowed should be targeted.

Since usually health literacy should be assessed in complex health care settings, this study aimed to develop a short version of the Health Literacy Instrument for Adults (HELIA-SF).

In this methodological study, the research team selected a number of items from the main instrument covering the main constructs of the HELIA. The selection was based on the most relevant items to each construct. A group of 12 experts and ten adults assessed content and face validity respectively. Exploratory and confirmatory factor analysis was performed to assess structural validity. The reliability of the instruments was evaluated by internal correlation (Cronbach's alpha coefficient) and intraclass correlation (ICC).

A nine-item questionnaire was developed. Experts identified the content validity of the short version as desirable (the CVR was more than 0.56 the CVI was more than 0.79). Also, the face validity as assessed by ten adults was satisfactory. The results obtained from exploratory factor analysis showed a two-factor structure for the questionnaire namely basic skills and decision-making skills that jointly accounted for about 61% of variance observed. Furthermore, the confirmatory factor analysis indicated acceptable fit indexes for the data: X2/df =20/2, GFI=95/0, CFI=97/0, NFI=95/0, NNFI=96/0, SRMR=068/0, and RMSEA=074/0. The Cronbach's alpha coefficient and ICC for each of the two dimensions were satisfactory (alpha = 0.84 and 0.81 and ICC = 0.85 and 0.82). The values for the whole items were 0.91 and 0.81, respectively.

The HELIA-SF, including nine items and two subscales (basic skills and decision-making skills) was found to be reliable and valid instrument to measure health literacy in adults. This version is suitable for measuring health literacy in different urban and rural population groups due to its short and concise nature.

Acceptance of COVID-19 vaccination could be influenced by attitude towards the vaccine. The aim of this study was to develop and evaluate the validity and reliability of adult attitudes towards COVID-19 vaccination.

First, an item pool was generated by reviewing existing resources. Then content and face validity was examined. In the next stage, the structural validity (exploratory and confirmatory factor analysis) of the questionnaire was examined in two distinct samples among 505 Iranian adults. Finally, the attitude was assessed among two samples. The internal consistency of the instrument was estimated by calculating Cronbach's alpha.

The initial questionnaire consisted of 38 items that after examining the content and face validity, a number of items was removed and corrections were applied to the remaining items. The results of exploratory factor analysis showed a three factor solution (emphasis on the need for corona vaccine, no need for corona vaccine and emphasis on the side effects of corona vaccine) including 13 items that jointly explained about 52% of variance observed. Similarly, the results obtained from confirmatory factor analysis indicate a good fit for the data. The fit indexes were as follows: (X2/df =2.15, GFI=0.91, CFI=0.95, NFI=0.91, NNFI=0.94, SRMR=0.068, RMSEA=0.076). The reliability of the questionnaire as assessed by the Cronbach’s alpha was 0.853 for the scale and ranged from 0.68-0.74 for its dimensions. Finally, the mean attitude score of the participants was 64.1 out of 100 points.

Considering the validity and reliability of the attitude assessment questionnaire regarding the COVID-19 vaccination in adults, this questionnaire could be used for measuring attitude towards COVID-19 vaccination.

Evidences from various studies through the world reports experiences similar to hallucinations in people without a specific disease. This perception is called extrasensory perception, pseudo hallucination and paranormal cognition in scientific-research texts. The incidence and prevalence of extrasensory perception in different societies and the lack of information in educational programs of health service providers, indicate the necessity of appropriate criteria for diagnosing extrasensory perception from hallucinations and other sensory perception disorders. Differences in the causes and management of these situations increase the necessity of the issue.

Review and qualitative study methods were used in different steps of the study. In the review study, relevant information was collected from scientific sources in the field of psychiatry and psychology and in the field of Islamic philosophy and mysticism. During a series of expert panels and based on documents from review study, different states of perception were identified and a "perceptual diagnostic algorithm and its spectrum without sensory stimulus" were designed.

Perceptual diagnostic algorithm is a tool to distinguish a person with experience of extrasensory perception from people with sensory perception disorders as well as normal sensory perception.Hallucination, extrasensory perception and revelation are categorized as perceptual experiences without the presence of sensory stimuli. These situations Based on these characteristics: awareness of the presence or absence of sensory stimuli, physical and mental health of the experiencer, awareness of the message of perceptual experience forms the spectrum of perception without sensory stimuli.

The use of "perceptual diagnostic algorithm" and its spectrum without sensory stimulus" by physicians, psychiatrists, psychologists, and counselors can meet the need to diagnose various sensory-related conditions in health system.

Birth of an infant with very low birth weight (VLBW) (weight less than 1500 grams) is a major cause of deaths and complications in infancy and childhood. Despite recent progressions in medical care and treatment for VLBW children, the mortality rate is high in this group of children. The present study was performed to better identify the survival rate of these children and the problems that affect the survival of this group of infants in the short and long term.

The study population was all infants weighing less than 1500 grams or infants who borne at less than 32 weeks of pregnancy. Infants whom birth occurred from the beginning to the end of 2018 in hospitals in Tehran were included. Information about these children was provided by the Family and Population Health Office of the Ministry of Health and Medical Education. Sampling was non-random and all information about the infants under study was recorded in a questionnaire. All data from the study were entered into SPSS-22 software and the results were presented using descriptive and analytical statistics. Survival analysis was performed by Kaplan-Meier test and the effect of variables on survival was evaluated using multivariate Cox model.

A total of 338 children were studied. Based on the results of cox regression models, the probability of one-month survival of children was about 68% and the probability of one-year survival was about 60%. Of the 10 variables affecting the survival of VLBW infants and children under study, 6 variables of maternal education, number of pregnancies, parent and infant insurance, gestational age, birth weight and maternal vaccination before pregnancy were significantly related with the death of infant (P ≤0.05).

The findings suggest one of the effective strategies for improving VLBW infant survival rate is encouraging women to continue their education, vaccinating mother before pregnancy, insuring family members and preventing multiple pregnancies.

outpatient services are an important part of health services. One important aspect of outpatient services is outpatient appointments. The study aimed to investigate the outpatient appointments and time management status in private practices.

This was a cross-sectional study that was conducted in Tehran in 2020.  Two hundred and eight practices were selected by using convenient sampling. Data was collected using a 50-items self-designed questionnaire. The validity and reliability of questionnaires were tested before data collection. SPSS software version 23 was used for data analyses.

More than half of the practices (56.3%) were specialists’ offices. In 85.6% of the practices patients were admitted on schedule. Data indicated that in most clinics scheduled patients were in priority for being visited by the physician (59.3%). Compared to younger physicians, the possibility of not using appointment systems was higher in older physicians and among physicians with higher working experiences (P value=0.01 and P value=0.039 respectively).

In general, the findings showed that the age and work experience of the physicians might play an important role in the use of queuing systems in medical practices. It seems that simplifying the appointment methods can be effective in increasing the use of appointment systems and improving the management of waiting time for outpatients in private practices. It is the responsibility of health system managers and experts to produce simple tools and methods without the need for sophisticated technology for this group of outpatient service providers.

Considering the high mortality rate due to traffic accidents in children and the necessity of prevention of these events, the researchers decided to consider accidents caused by vehicles among Iranian children and teenagers.

This study was a systematic review study. The keywords in this study were "Traffic accidents, road accidents, road deaths, child mortality, traffic deaths" in the title and abstract of all published articles from 1991 to November of 2017 in the Google scholar search and the Scientific Information Database – SID. After removing repetitive and unidentified articles from extracted papers, the full text of the final selection papers related to vehicle accidents in schoolchildren was reviewed and the results were categorized and presented in terms of the Phrases and tables.  

Out of 841 articles, after the remove duplicates and articles with unrelated and non-consistent topics for study purposes, 12 papers were finally examined. The prevalence of accidents caused by vehicles in children and adolescents was between 6% and 53.87%. The studies were heterogeneous and were divided into two main categories: a total of 5 studies examined the prevalence of these events and the rest were related to the related cases.

Considering the significant contribution of vehicle accidents to the rate of accidents and incidents in children and adolescents, the need for education them and their parents, as well as the attention and emphasis of legislators on the adoption of laws on the creation of greater safety in Children are essential.

Objective (s): 

The purpose of this study was to review the content of the national health information systems in Iran. The practical purpose was to provide the necessary information to increase the efficiency of national health information systems in order to improve health services.

This was a mixed method study (review and qualitative). First, documents related to the health information system (especially on the website of the Ministry of Health and its affiliated organizations) were reviewed. Search strategy included the following keywords: Health system, Health system in transition, Health information system, Health information system in transition, Health information. At this stage the study was seeking to collect data for following questions: Who is running the site? What are the variables that each system registers and maintains? What are the information recording processes? What outputs and reports are extracted? Who are the users of this information? Then, a qualitative study was conducted and seven experts were interviewed. All systems were checked for the following information such as mission, aims, client, moderator, variables, registration process, output, beneficiaries and target groups.

In all there were 10 national health information systems, and more than 150 specific registries for disease conditions. In addition, we found 11 different names for Electronic Health Record (EHR).

In general, health-related databases (healthcare and insurance databases) have not yet been fully integrated, and it is not possible to detect drug disorders or violations in addition to duplicate or more recording of information. Also, there was no codified program found to analyze the data in the databases studied.

The aim of this study was to evaluate the outpatient visits of elderly people under the Social Security Organization (SSO) and to compare it with other age groups.

This was a cross-sectional descriptive study that used outpatient data of SSO in 2017. All data (14'418'911 cases) were analyzed after restoring and cleaning processes. SPSS software was used for data analysis.

Findings showed that 6.5% of all outpatient visits were by elderly. The elderly group had been referred to outpatient services at an average rate of 6.8 times per year. Elderly people over the age of 85 years referred to physicians 48.1% more than children under the age of 2 year and this was 78.3% for elderly aged 65 to 85 years..

A considerable portion of the economic burden and costs of the health system under social security organization belong to the elderly group, which will continue to increase in the future. In this regard, it seems necessary to manage services demanded by this age group using appropriate measures.

Despite the existence of numerous tools to measure health literacy, there is no general agreement on this issue. Researchers around the world have been involved in the development of an instrument to measure health literacy. The psychometric properties of the Health Literacy for Iranian Adults (HELIA) scale have been approved in the general population; however, the validity and reliability of this indigenous questionnaire has not been explored in students. Therefore, due to demographic differences, the present study investigated this questionnaire in a sample of students for structural validity and reliability. 

This cross-sectional study was conducted on 340 dormitory students of Shahid Beheshti University of Medical Sciences in 2016, in Tehran City, Iran. A single-stage cluster sampling technique was used for sampling. Cronbach’s alpha coefficient was used to verify the reliability of the questionnaire and the confirmatory factor analysis was used to investigate the validity of the constructs by LISREL software. 

The mean±SD age of studied students was 22.93±4.05 years. The questionnaire had a desirable internal consistency (Cronbach’s alpha coefficient: 0.77-0.90) to assess health literacy in participating students. The confirmatory factor analysis result was satisfactory for its overall fitness. (RMSEA=0.095, CFI=0.94, NFI=0.92, NNFI=0.94, SRMR=0.075, X2/df=4.09). 

The study findings revealed that HELIA is a reliable and valid instrument for measuring health literacy among students.