فهرست مطالب مصطفی پیوند

Childbearing is one of the most important components of population science. Today, the decrease in the desire to have children and as a result the population decrease is in the list of important social issues of the country. Declining population growth will have disastrous consequences for the country's health. Despite the importance of the issue of reducing childbearing, no study has been conducted in students for a deeper clear understanding. The present study was conducted with the aim of explaining the experiences of Explaining students' experiences of Childbearing.

This qualitative study was conducted by content analysis method in 2023 in Zahedan University of Medical Sciences. The research population included all married students who did not want to have children. Sampling was purpose-based and continued until data saturation was reached. Data collection was done using a semi-structured interview guide and 18 research participants (10 men and 8 women) were interviewed. Data analysis was done using conventional content analysis method.

In this study, 44% of the participants were between 22-26 years old. The educational level of most of them (8 people) was master's degree. Based on data analysis, 3 main challenges related to unwillingness to have children were extracted. Economic challenges included two subcategories of financial problems and job factors, challenges related to education included two subcategories of factors related to university and time factors related to education, and individual challenges included three subcategories of mental issues, physical issues, and factors related to marriage.

Reducing economic problems as the most important reason for not wanting to have children, even without the approval of encouraging policies in the direction of having children, can lead to an increase in the fertility rate. For this, the social, economic and cultural infrastructures of the society must be developed in a sustainable manner.

Background and Aim:

 Cardiovascular complications in diabetes mellitus are one of the most common complications of this disease. The aim of this study was to determine the cumulative probability of occurrence of cardiac complications in type 2 diabetes mellitus using survival analysis in patients referring to the Diabetes Clinic, Bu-Ali Hospital, Zahedan, Iran.

This was a descriptive and analytical historical cohort study using the survival analysis method in 2020 on 410 patients referring to the Diabetes Clinic, Bu-Ali Hospital, Zahedan, Iran. Data were collected and analyzed using the SPSS-v21 software, the statistical tests being descriptive tests, followed by the Kaplan-Meier method and the Cox proportional hazards model of survival.

The results of this study showed that 122 individuals (29.7%) of the diabetic patients had cardiac complications. The median survival time (in months) of the occurrence of cardiac complications was found to be related to fasting and two-hour postprandial blood sugar levels (p<0.05). Further analysis of the data showed that two variables, namely fasting blood sugar and regular visits, remained in the final model of the multiple Cox regression.

The findings of this study showed that the cardiac complications of diabetes in the population studies are relatively high. Therefore, it is essential to plan and implement interventions aiming to change lifestyle and control regularly blood pressure, cholesterol and blood sugar in the patients in order to prevent the disease

Tuberculosis is one of the oldest and best-known diseases that has been with mankind for many years. Despite the reduction of infectious diseases in Iran, tuberculosis still remains in some parts of the country, especially in the south of Iran. The aim of this study was the epidemiological investigation of tuberculosis in Sistan and Baluchistan Province.

The current research was conducted cross-sectionally in 2022. The study population included all the patients with tuberculosis in Sistan and Baluchistan Province. Data were collected by census method and using standard checklist. Data analysis was done using SPSS v16 software and descriptive and analytical tests.

In this study, the files of 5382 patients with tuberculosis in Sistan and Baluchistan Province were examined. 2489 patients (42.6%) were men. The most affected group were 2309 elderly people (39.5%) and 20 patients (0.34%) with HIV. The number of 4309 patients (73.8%) were suffering from pulmonary tuberculosis. There was a significant relationship between the elderly age group (P=0.04), female gender (P=0.02), non-Iranian nationality (P=0.02), and urban residences (P=0.03) with tuberculosis. However, no significant relationship was observed between marital status (P=0.06) and prison history (P=0.07).

The incidence of tuberculosis fluctuated during the five years, but the overall incidence has been decreasing. Considering that some factors such as age groups, gender and symptoms such as cough, weight loss and chest pain increase the chance of contracting the disease. Therefore, doctors of health centers can take an important step in reducing the incidence of tuberculosis with timely visits and regular monitoring of the treatment process of patients.

Diabetes is a common disease that causes eye complications and leads to vision loss and blindness. Diabetic retinopathy is one of the main causes of blindness in the world and the most common cause of new cases of blindness. Predicting the occurrence time of this complication in diabetic people is one of the health priorities of society. The purpose of this study was to determine the cumulative probability of the occurrence of type II diabetes retinopathy using survival analysis in Zahedan City, Iran.

This was a historical cohort study using the survival analysis method, which was carried out descriptively and analytically on 410 patients in 2019. Data were calculated using SPSS22 software and descriptive tests, followed by the Kaplan-Meier method and the Cox proportional hazards model of survival.

The results of this study showed that 103 (25.13%) patients had retinopathy. The median survival time (months) of the occurrence of cardiac complications was related to marital status, fasting blood sugar, smoking, hemoglobin A1c, and blood lipids (P<0.05). The variables of fasting blood sugar, A1c, and two-hour blood glucose remained in the final model of the multiple Cox regression.

The findings of the current research showed that the prevalence of retinopathy in the studied population was relatively high and had a significant effect on reducing survival time. Therefore, it is necessary to make interventions in lifestyle changes, and regular control of blood pressure, cholesterol, and blood sugar to prevent the disease and reduce complications related to diabetes

The trends of diseases and population have changed in the last three decades and it is necessary that the current services of the country's health field be adapted to the needs of the people in the present and near future. This change in Sistan and Baluchistan province, as the least privileged province of the country, is facing many challenges that have not been  dealt with purposefully. The purpose of this study was to extract managers' experiences of the new challenges in the field of health in the least privileged province of the country.

The current study was of a qualitative type that was conducted in 2022. The samples were selected through purposeful and snowball methods. Data collection method included conducting semi-structured in-depth interview on 30 people based on the decision of the managers of the health field. Data analysis was conducted manually and through the contractual content analysis method.

In the analysis of the interviews, four main categories (management factors, political and social factors, ministerial and country factors, resources) and eight sub categories (Management challenges, administrative challenges, external factors, provincial conditions, the overview of the Ministry of Home Affairs, legislative challenges, lack of financial resources, lack of human resources) were extracted.

Less privileged provinces are not in good conditions in development indicators. Based on the results of this research, it can be concluded that appropriate education, service quality, financial support, permanent, and expert human resources are the factors that will help resolve the challenges in this university.

Cardiovascular disease is one of the most common diseases in the world and is known as the most common cause of adult mortality in the world. It is considered and causes one in eight deaths. The National Blood Pressure Control Mobilization for all people over the age of 30 throughout Iran began in June 2017. In order to investigate the effects and use of people's experiences of the campaign, the present study was conducted to explain the experiences of providers about the blood pressure campaign in Iran.

This study was qualitative research using content analysis method, which was conducted with an applied purpose in 2018. The study population included all employees of the affiliated units of the Deputy Minister of Health. In order to prevent the influence of the researcher's mentality on the interviews and the research process, the researcher simply placed the interviewee in the way of answering the questions and prevented any induction and influence based on their mentalities. Structured was collected Content analysis method was used to analyze the data.

A total of 42 interviewees with an age range of 30 to 40 years, including physicians, experts and managers of health care providers, health workers were included in the study. 24 males and 18 females. Four main themes and 23 sub-themes were extracted

The integration of temporary, short-term and unforeseen programs vertically in the health system reduces the quality and increases the workload of personnel. Which needs to review the current service package and pay attention to the job evaluation, timing of activities.

Children’s health is important as the future builders of society. Many children under 5 years of age around the world and in Iran have growth disorders. Due to the importance of growth disorder and its impact on the development, learning and future of the child, the present study was conducted with the aim of determining the frequency of deviations from the growth curves of children under 5 years of age and related factors in Zahedan city.

This case-control study was conducted in 2020 in Zahedan. The study population included all children under 5 years old, born in Zahedan between 2013 and 2020 that 784 of whom were selected by random sampling method. To determine the factors related to growth disorder multiple logistic regression analysis was used and to check the significance level, chi-square test and Pearson correlation were used. In this research, the data were analyzed with SPSS software.

The results of this research showed that 54% of the boys and 51.20% of the girls had growth disorders. Between child growth disorder and maternal chronic disease (P<0.05), maternal body mass index (P<0.05), Maternal weight gain during pregnancy (P<0.05), distance between births (P<0.05) maternal urinary tract infection during pregnancy (P<0.05), mother’s age (P=0.006), mother’s education (P<0.05), birth weight (P<0.001), birth order (P<0.05), father’s occupation (P<0.05) and father’s education (P<0.05) a significant association was found. In the present study, the average birth weight in children with growth disorders was 2.75±0.58 and in healthy children was 2.95±0.57, and this difference was statistically significant (P=0.001). The average age of mothers of children with growth disorders was 29.19±6.07 and the average age of mothers of healthy children was 27.98±6.10, this difference was statistically significant (P=0.006).

Growth disorder is a multi-causal complication. Risk factors can be corrected and prevented by developing health education and increasing mothers’ awareness and knowledge. Also, the father’s job and literacy are effective in the child’s growth disorder, so Increasing community health literacy and encouraging fathers’ learning and literacy can partially prevent growth disorders in children.

Pregnancy is a natural process in every woman's life, leading to the birth of a child. Since the fate of pregnancy can end in death, an in-depth study of the influential factors in the reduction of maternal mortality rate can significantly improve care programs for pregnant mothers.

This qualitative research was performed in the health services of Zahedan University of Medical Sciences in 2021. In-depth individual semi-structured interviews were used to collect data. The interviews were conducted based on the interview guide. To evaluate the correctness and reliability, four indices were used, including reliability, validity and acceptability, verifiability, and transferability. The contractual content method was used for analysis.

In this research, 27 subjects were included, and 67 primary concepts were obtained. In the analysis of the interviews, in the coding stage, six subcategories and, finally, three main categories (individual factors, social factors affecting health, and service provision) were extracted.

As evidenced by the results of this study, the provision of health services was not optimal. In order to effectively reduce the ratio of maternal deaths, it is necessary to pay attention to the quantity and quality of care before, during, and after childbirth, as well as targeted training. Increasing the coverage and quality of pregnancy care, improving the quality of family planning counseling, and improving the skills and knowledge of the medical and midwifery staff in the field of postpartum care will be among the most critical effective measures in reducing maternal mortality

The Ministry of Health, Treatment and Medical Education at Iran has stated that the promotion of breastfeeding is one of the important strategies for the growth and survival of children. This study was conducted with the aim of explaining mothers' experiences of infants breastfedding challenges in southeast Iran.

This qualitative study was conducted in Zahedan with the highest birth rate in the iran in 2023. Interviews were conducted with women who referred to health centers and had children under one-year-old and had stopped breastfeeding. participants were included in the study by purposeful sampling method. Sampling was done until data saturation. The content analysis method was used to analyze the data.

Data analysis led to the emergence of four main themes and 17 classes including: 1. Factors related to the mother (including classes of mother's illness, physical and hereditary characteristics, mother's malnutrition, use of medicine, lack of breastfeeding, superstitions and religious reasons), 2. Factors related to child (including child’s illness and the child’s unwillingness to consume breast milk), 3. Factors related to the family (including not having enough time, having two infants at the same time, a long interval between two pregnancies and the distance of the child from the mother) and 4. the characteristics of the infant formula (including infant's dependency on milk powder in intermittent use, giving more weight to the infant and not waking the infant at night).

The findings of the present study indicate more emphasis on the issue of education and giving more awareness to mothers. mothers' awareness about Breastfeeding could play an important role in continuing the exclusive feeding of the child.

Outsourcing strategy is a simple and economical approach that can help managers of organizations to undertake executive tasks effectively. In practice, the application of this approach at any organization is not easy and usually presented with many problems. The present study aims to investigate the viability, strengths, and weaknesses of outsourcing strategy in the health system.

This qualitative study was conducted with the content analysis approach at Zahedan University of Medical Sciences in 2020. The sampling method was purposeful, and sampling was continued until data saturation. Data analysis was performed manually using contract content analysis.

The data analysis indicated six main categories (including legislative challenges, executive challenges, manpower, regulatory challenges, and financial challenges) and 13 sub-categories.

The outcomes of this study revealed that outsourcing is one of the basic needs to advance organizational goals. Nonetheless, its current implementation method is not very appropriate. Challenges identified as obstacles to the proper implementation of the partnership plan with the private sector in the field of health are sometimes an integral part of such plans. These challenges must be resolved before the implementation of the plan and during planning by conducting studies and reviewing the project background. This will help to prevent further problems during the execution.

The World Health Organization defines responsiveness as the ability of a health sys tem to respond to the reques ts and needs of individuals in non-clinical but logical cases that s trengthen the health sys tem. This s tudy aimed to evaluate the responsiveness of the health sys tem after the implementation of the health sys tem transformation plan.

This descriptive-analytical s tudy was performed on 310 households in 2019 in Zahedan, Iran. Data were collected by clus ter sampling method. In this s tudy, the World Health Organization Ques tionnaire was used. Ques tionnaires were completed by interviewing the head of the household. Data were analyzed using SPSS-v22.

Regarding outpatient services, the highes t percentage of good performance belonged to the respect for people's dignity dimension (45%), the highes t percentage of average performance belonged to the dimensions of quality of basic amenities (55%), and the highes t percentage of poor performance was in the dimension of freedom of choice (40%). In inpatient services, the highes t good performance belonged to the respect for people's dignity dimension (35%), the highes t average performance belonged to the clarity of communication dimension (48%), and prompt attention, social support, and confidentiality (45%).

In this s tudy, it was found that "prompt attention" and "respect for people's dignity" were the mos t important and "the freedom of choice" was the leas t satisfied, and this low level of satisfaction could be due to the lack of expert and efficient s taff in the field of meeting the needs of the society in the city of Zahedan. Therefore, the university should try to train specialized and efficient s taff.

The COVID-19 disease has become a global problem and its prevention through vaccination has led to a reduction in the damage and human casualties at the time of its occurrence. Recognition of the factors that affect the acceptance of vaccination, identification of the barriers, and facilitation of decision-making in the field of vaccination are important aspects of designing effective strategies to improve the coverage of vaccination among the people of Zahedan province, Iran. This study aimed to explain the experiences of reluctance towards vaccination against COVID-19.

This applied conventional qualitative research was conducted in 2022. The study population included all individuals who refused to receive the vaccine after a public call for vaccination against COVID-19 in Zahedan. The data collection method was the semi-structured interview, based on an interview guide. The sampling method was goal-based till data saturation.

In this study, 40 people who did not want to be vaccinated were interviewed. In the sub-coding stage of the analysis of interviews with participants, 15 concepts and finally 5 main categories (stereotyped beliefs, reception of inhibiting information, physical and taste limitations, lack of facilities and services, and shortness of decision-making bodies) were derived.

According to the results, low health literacy and underestimation of vaccination were the main reasons for reluctance towards vaccination against COVID-19. In order to address this shortcoming, major policies should be developed in the field of education. Attention to religious beliefs and aspects of fatalism, older age, and higher economic and social status can be specifically considered in the future plans of health policymakers regarding vaccination against COVID-19.

One of the most important factors that indicate hospital performance are hospital indicators. One of the fundamental developments and changes in the health system of Iran is the health system transformation plan, the effects of which should be examined from different aspects. The purpose of this research is to determine the performance indicators of hospitals affiliated to Zahedan University of Medical Sciences, Zahedan, Iran and compare them with the standards of the Ministry of Health and Medicine. Medical education was in 2018.

This cross-sectional descriptive study was conducted in 2018 in public hospitals covered by Zahedan University of Medical Sciences, Zahedan, Iran. In this study, the most important performance indicators of the hospital from 2015 to 2018 were investigated in a targeted manner. The entry criterion was the completeness of the indicator's information. In this study, to obtain accurate and reliable information, input data and output data were used as performance indicators. The data was analyzed using EXCEL software and descriptive.

In the present study, a total of 6 hospitals of Zahedan city under the coverage of Zahedan University of Medical Sciences were investigated. On average, 11,200 people were hospitalized and 11,003 people were discharged, which decreased to 11,086 people hospitalized and 10,450 people discharged after the transformation plan. The average number of emergency and outpatients was 71,600 and 124,571 respectively.

To evaluate the hospital, the use of performance indicators as a criterion can guide managers in understanding the current situation of their center as well as in planning and management decisions. The findings of the study showed that in terms of bed occupancy rate, the hospitals were in an average and poor condition compared to the standards of the Ministry of Health. But in terms of the average days of hospitalization, they were in an unfavorable situation.

Considering the need for new health programs, the Health Transformation Plan, as one of the largest health system reform programs, has been implemented in Iran since 2014.

This cross-sectional, applied study was conducted qualitatively on 27 participants in 2019 (19 service providers and eight service recipients). The data collection tool was a semi-structured interview guide that was validated through a comprehensive literature review, and consultation with health strategy transformation experts. The research plan was approved by the ethics committee and the research work commenced accordingly. The research work was carried out at the research participants’ workplace (employees) via interviewing process. All the interviews were recorded daily. The data interpretation and analysis were conducted through coding and content analysis approach.

The data analysis for participants’ groups (i.e., service givers, human resources, infrastructure, education, and service recipients), using the open coding stage and the initial concept in the sub-coding stage, indicated 10 minor and five major categories.

Appropriate education, quality of services, financial support, and specialized manpower can be considered as possible ways to cope with the challenges in the health transformation plan.

Diabetes is a disease in which blood sugar level is high due to hormonal disturbances. Monitoring and evaluation certainly helps to prevent, manage and control this widespread disease. The aim of this study was to study the epidemiology of diabetes in the Diabetes Clinic in Bu-Ali Hospital, Zahedan in South East Iran.

This was a cross-sectional descriptive-analytical study conducted in 2020 including all the 1164 patients referring to the Diabetes Clinic in Bu-Ali Hospital.  Data were collected using a standard check list and analyzed using the Stata-v14 software.

Information on 1164 patients with diabetes was recorded and analyzed. Most (97.7%) of the patients had type-2 diabetes. The average fasting blood sugar in patients with type-1 and type-2 diabetesd was 236 and 201 mg/dL respectively, the corresponding A1C levels being abnormally high ─ 9.6% and 8.4%. Fasting blood sugar was associated with diabetic foot complications and nephropathy (p<0.05).

Based on the findings of this study the level of care of diabetic patients in terms of quantity and quality is not quite acceptable, not conforming to the respective national standards. This issue indicates the unfavorable performance of the Diabetes Center, which can be attributed to the poor conditions of the geographic region, insufficient equipment and specialized manpower and low health literacy of the people. Therefore, increasing the awareness of overweight and obese people, especially those with a family history of diabetes, about prevention can help to reduce the incidence of the disease or minimize its complications.

Diabetes is one of the chronic diseases and the most common disease related to metabolism in humans. Diabetic nephropathy, one of the dangerous complications of diabetes, has a relatively high prevalence in diabetic patients and causes kidney failure. Several factors have an effect on this disorder. The aim of this study was to determine the cumulative probability of occurrence of nephropathy complication of type 2 diabetes using survival analysis.

This study was a historical cohort study of survival analysis, which was conducted in a descriptive-analytical manner in 2019. The required sample size was estimated at 410 patients. Data were calculated using Stata.ver14 software and descriptive tests and then by Kaplan Meyer method and Cox survival proportional hazards model.

The variables of regular visits and smoking showed a significant relationship with the chance of nephropathy complications (p<0.05). Therefore, the chance of nephropathy complications in people who did not have regular visits was 1.03 times that of people who had regular visits. The Log-Rank test showed that the median survival time (months) of the occurrence of nephropathy is related to the variables of fasting blood sugar, blood pressure, systolic, and blood lipids.

With early diagnosis of diabetes and control of the factors that accelerate the development of diabetic nephropathy and effective and timely treatments, it is possible to reduce the progress of the disease and it can be used in the field of prevention and treatment of diabetic patients and prevention of subsequent lesions and complications.

Medical errors and their consequences are one of the most important factors threatening patient safety in the health system of all countries, the incidence of which is increasing alarmingly (3, 4). Today, reducing the incidence of medical errors has become a global challenge (5). Despite all efforts to improve and maintain the safety of patients due to medical errors, various communities suffer a lot of financial and human costs and losses every year (6). In the global classification of causes leading to death, medical errors are one of the top ten causes (7). So that one out of every ten hospitalized patients is injured due to medical errors while receiving health care; about 7% of them lead to death (8). Therefore, considering the importance of the issue, this study was conducted with the aim of systematically reviewing, identifying and collecting information about the occurrence of various medical errors in physicians in Iran as an example of a developing society.

This systematic review study in 2019 using search tools in SID, Magiran, Iran Doc, Scopus, Proquest, Pub Meb, web of science, Springer, Cochrane, Elsevier, Science Direct and Google scholar databases has systematically reviewed the studies conducted on the types of medical errors in Iranian physicians from the beginning of the establishment of each of the above scientific bases until August 1, 2019. The search strategy was retrieved and prepared for related studies using PICO-related search terms (patient or population, intervention, control, or comparison and results). In the article search process, MeSH-compliant keywords including Prevalence, error(s) or mistake(s), prescription, physician(s), Surgery or Surgeons, physician(s) error(s) or mistake(s), surgical error(s) or surgeon(s), administration(s) error(s) or mistake(s), medication or drug error(s) or mistake(s), prescribing error(s) or mistake(s), wrong dose(s), wrong medication(s) and Iran or Iranian and Persian equivalent keywords were used. The Cochrane Handbook for Systematic Reviews for Intervention Studies and the PRISMA statement were used to design this study and refine the articles (51). To collect information from the considered articles, Cochran data extraction form for systematic review was used which included the first author, year of publication, nationality of researchers, study design, type of research, sampling method, sample size, research tool and summary of important study findings. An Excel-designed form was used to collect data. Data according to their nature were analyzed and written in a narrative and thematic manner. The following selection criteria were used to find related articles from databases: 1) articles that had full text and were written in Persian or English, 2) articles were published in the field of medical errors only in physicians and the factors affecting it. Of course, it is worth mentioning that in articles in which medical error was simultaneously examined in physicians and nurses, information about physicians was extracted. Gray resources related to unpublished results in dissertations and articles published in low-credit sources were not reviewed due to access problems and insufficient credit. Also, articles on meta-analysis, systematic review, quality, posters, speeches and letters to the editor that were found in the field of various medical errors were excluded from the study.

A total of 15 articles were found, including: 3 Persian articles and 12 English articles. According to the findings of the present study, the prevalence of medical errors in Iranian physicians ranged from 38.1 to 65% (3, 9, 16-18). The most common types of medical errors were prescription error with 17.3% and medication error with 1.98 errors per patient, respectively (4, 28). The most important factors affecting the occurrence of medical errors include:  the education level and type of specialization of physicians (2), low number of physicians and high number of patients (10), lack of proper training of medical staff (9), staff performance, management levels and executive shortcomings (4), long night shift (17), physicians 'handwriting and how to record patients' information in medical records (8), lack of cooperation between physicians in different wards (10), employment in overcrowded hospital wards (4) and the lack of comprehensive treatment guidelines and violations of existing laws (23,10). The results of this systematic review showed that various interventions have been performed to reduce the incidence of medical errors, which can be divided into three areas: the study of the intervention role of clinical pharmacists (18, 28), the use of software for recording clinical prescriptions systematically by a physician or nurse (25,29,30) and other types of interventions (23). Use of clinical prescription registration software by the nurse can increase the acceptability of physicians' performance by warning and recommending and significantly reduce the medication dose error in the neonatal ward compared to the computer recording of information by a physician. In care systems where the physician opposes the implementation of computerized clinical information recording software by himself but nurses tend to computerized clinical information registration and have the necessary ability to implement it, computer software for recording patient information by the nurse can Should be considered as an appropriate alternative method for entering patient information in hospitals (29).

This systematic review showed that in general, the incidence of medical errors in Iranian physicians during the clinical care process is high. Also, the most common type of medical errors in our country's hospitals is the error of a doctor's prescription and then medication errors (9, 17). Unfortunately, despite all the efforts of the Iranian health system to reduce the occurrence of medical errors, the incidence rate is still significant, although it seems lower than the global rate. Of course, the lower rate of medical errors in Iran than the global rate can also be due to under-reporting of errors (9). Therefore, in order to reduce the incidence of medical errors, preventive approaches such as paying more attention to the importance of the interventional role of clinical pharmacists and providing conditions for their wider productivity (18, 28), using more efficient techniques to predict, diagnose and reduce the incidence of medical errors such as Sherpa technique (3,10) as well as the use of intelligent electronic technologies to reduce clinical errors such as systematic registration of clinical information by physicians and nurses (25,29,30) and design, implementation and evaluation of more appropriate intervention approaches to improve the reporting status of medical errors in physicians (9).

Today's diseases cross borders quickly and show their transmission power very quickly. Some countries are surrounded by a common border that does not have good health care. This leads to rapid disease transmission and subsequent health problems. The corona virus pandemic has shocked countries that did not have good health care facilities and did not have crisis management in the face of epidemics and pandemics. Having common borders, non-observance of border laws, lack of standard health certificates at borders, lack of complete sanitary equipment to clear customs transfers, lack of complete quarantine of goods, illegal entry and exit in some cases, inconsistency of approaches Health of neighboring countries, the lack of a standard health card for individuals, authorized and unauthorized traffic and many other factors affect the process of disease control. Therefore, it is necessary to make decisions in order to apply the new laws on health at the borders as vital points of disease control and management.

Diabetes is one of the most expensive chronic diseases and a global public health problem. One of the objectives of implementing the Health Reform Plan (HRP) was to reduce the out-of-pocket payments for hospitalized patients. The present study was carried out with the aim of determining the direct medical costs in hospitalized diabetic patients after implementation of the HRP.

This cross-sectional descriptive-analytical study was conducted in 2019. The records of diabetic patients hospitalized in Imam-Ali Hospital of Zahedan from March 2017 to June 2018 was reviewed by the census method and the direct medical costs were recorded in a researcher-made checklist. Data were analyzed using the SPSS version 22

In this study, the direct medical costs of 704 hospitalized diabetic patients were evaluated. The majority of the study population was female (517, 73/5%) and 237 had gestational diabetes. The mean direct medical cost per hospitalized diabetic patient was 29,264,465 Rials and the mean out-of-pocket payment was 11.8%. Moreover, direct medical costs of diabetic patients increased with age (P<.001).

Diabetic hospital care imposes a high burden on basic health insurance. Despite the HRP, out-of-pocket payments for hospitalized diabetics are still significant. Government subsidies should focus on expanding access to care for diabetics, financial protection for disadvantaged residents and expanding public education on diabetes.

At the beginning of 2020, at the same time as the New Year celebrations in different countries of the world, the new Corona virus was released from Wuhan, China, all over the world. The disease was officially registered on February 11, 2020 (late February 2015) by the World Health Organization as Coronavirus (Covid-19). The outbreak of the disease, which originally involved a city in China, has now become a widespread pandemic. The official death toll in more than 210 countries has risen to several million and the death toll to more than 100,000.Currently, most people around the world are worried about this disease. Concerns on the one hand and social problems caused by illness on the other hand can cause fear and anxiety and other social problems when people are exposed to infectious diseases such as corona. Some of the problems that people with corona have, including quarantine, being monitored, hospitalized, etc., along with enduring pain and stress caused by illness and fear of death, sometimes negative feelings of others such as rejection, humiliation. And it leads to all kinds of social discrimination, and this causes the consequences and problems caused by social stigma, which is even more painful than the disease itself.

In this article, it is intended to examine the Coronavirus crisis from the perspective of the health system. Like other systems, the health system in all countries, including Iran, has various details and points that have been developed over the years. Some of the most important of these points and their relationship to the recent crisis are examined. This text deals with primary health care, which has been recognized for about four decades as one of the most important and advanced issues in the health system. A week after a meeting of the health ministers from countries around the world in the city of Alma-Ata, the former Soviet Union and present-day Kazakhstan, a declaration was adopted that lighted up the future of all countries in the field of health. The declaration that is still helpful and practical after more than four decades of its codification. In this document, Primary Health Care, or PHC, was announced as a means of achieving the great goal of Health for All (HFA) (1). It comprises four principles and 11 components. The components of PHC are the service package that was supposed to be provided in all countries for free, equal, and to all. However, the more important thing is the announcement of four essential principles as a platform to offer these services that countries should provide a way for the delivery of these services by creating such a context (2). It is evident that health services are a set of different and diverse measures that are not limited to the health care system. Perhaps the ultimate goal of many of the services offered in other sectors of development also leads to the physical, mental, emotional, and spiritual health of the community. Accordingly, the principle of inter-sectoral coordination is an essential and critical policy in the health system and PHC with the assumption that all existing capacities in all governmental and non-governmental organizations must be exploited at all times so that maximum efficiency from a set of various actions is achieved (3). The crisis of Coronavirus (Covid-19) in recent months has highlighted the importance of this policy more than ever before. Possibly, the benefit and integration in the tasks of other organizations in the field of combating the coronavirus have been very fundamental and beneficial, ranging from the armed forces and police and the Iranian Revolutionary Guard Corps (IRGC) and the Basij troops to the capacity of clergymen, Friday prayer leaders and congregation prayer leaders to the actions of other administrative areas such as municipalities, education, the Red Crescent. More importantly, NGOs, health volunteers and charities play a significant role in managing this crisis. A committee called the Health Council was formed in all cities and provinces at the national level to strengthen this principle from the beginning of the establishment of the health care network system in the country in the 60s which was done with the aim of implementing PHC in the country. (4-5) In recent years, it has been operating in the form of a working group on health and food security, and its main task has been to pay attention to the principle of inter-sectoral coordination to promote the health of the people and society.(6) In the crisis of Corona, this committee works in the form of a national campaign to combat Corona at the national, provincial, and local levels. It is responsible for all decisions associated with the prevention and control of the disease with the explanation of the status quo. Some approvals of the committee are very vital and far-fetched, and it has been able to manage the disease effectively. Closing all schools and universities in the early days of the crisis in the country and closing all mosques and religious places a few days later is among the most critical decisions of this committee. Taking into account the cultural and religious conditions and details and different interests and traditions among the people in the decision-making of the Coronavirus control center has been very crucial. All these measures emphasize the progressive principle of inter-sectoral coordination between different agencies and organizations to provide, maintain, and improve the health of the community. Although such measures are very complicated and challenging, it appears that we still should take advantage of this opportunity in the best way possible with the experiences achieved in the crisis of Covid-19 so that they can be influential in the path of health promotion of the community as it was before.