fatemeh setoodehzadeh

To adapt to the changing conditions and respond to the needs of society, health systems need continuous changes and reforms in their structure and performance, and subsequently, they need to evaluate their indicators. Therefore, this study aimed to investigate the impact of the health system transformation plan (HTP) on the functional indicators and efficiency of hospitals in a country in the Middle East region (Iran). A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‑Analyses) guidelines using the online databases Medline, EMBASE, Scopus, Pubmed, SID, Magiran, and Medlib from 2013 to 2022 using a combination of medical subject heading terms (‘health system transformation plan [Mesh] OR ‘health reform [Mesh] OR implementation of the health transformation plan [Mesh] ‘’AND (‘performance indicators’ [Mesh]) ‘’AND (‘Iran’ [Mesh]). STATA version 11 were used for data analysis. A total of 20 reports (cross‑sectional, cohort, and case‑control) were identified for this study. The results showed that after the HTP, the indices of bed occupancy rate and bed turnover rate have increased and the index of bed turnover distance has decreased. On the other hand, after the implementation of this plan in hospitals, the average of patients’ length of stay has increased. The implementation of HTP has improved most of the performance indicators of hospitals and has generally led to an increase in the productivity of hospitals compared to that before the implementation of the plan. However, efforts to strengthen weak performance indicators and identify effective indicators along with adopting correct policies to increase the overall efficiency of hospitals can be effective in improving HTP.

Iron deficiency anemia in children is one of the most important challenges in the global health system. Also, it is one of the main problems in Iran, especially in the southern regions. Therefore, the aim of this study was to investigate the factors affecting iron deficiency anemia in children under two years of age. This case-control study was conducted on children under two years of age in Sistan and Baluchestan Province in the southeast of Iran with the highest birth rate in 2020. In the study, 760 children were divided into case and control group (380 vs 380). A standard information form was used for collecting data, and the data were analyzed using SPSS-21 by chi-square test and logistic regression. There were significant associations between the child’s iron deficiency anemia and the type of child nutrition (P=0.000), history of child’s food allergies (P=0.021), child’s congenital anomalies (P=0.009), maternal body mass index (P=0.083), number of previous pregnancies (P=0.035), history of abortion and stillbirth (P=0.027), use of postpartum supplementation (P=0.004), mother’s anemia (P=0.000), family marriage (P=0.001), father’s job (P=0.017), father’s anemia (P=0.000), and father’s addiction (P=0.007). Also, based on multivariate regression, the most important predictor of iron deficiency anemia in children was father’s addiction (OR=1.720; 95% CI: 1.067 – 2.773). The findings showed that parental factors could play an important role in causing iron deficiency anemia in children. These risk factors can be improved and prevented by promoting health education, increasing parental awareness and knowledge, and improving the lifestyle of families. Therefore, holding educational and counseling classes for parents is especially recommended.

The health system is trying to prevent unnecessary referrals to higher levels by providing tiered services and thus reduce the cost of health care. Therefore, this study was conducted in Zahedan City, Iran with the aim of finding the causes of referrals from level 1 to higher tiers in rural areas.

This cross-sectional study was conducted on 458 rural patients referred to the second level in the rural areas of Zahedan City, Iran. Data were collected from the family health files available in the Sib system and analyzed using the SPSS-16 statistical software, the statistical tests being descriptive statistics (percentage, frequency) and Chi-square test.

The highest (57.6%) and lowest (4.1%) proportions of referrals to the second level of service provision were found to have been in 2018 and 2016, respectively. From among the referred patients nearly 50% had been referred due to the need for a higher expertise, thus most referrals (67.2%) were to specialists. Further analysis of the data showed that only in 23.6% of the cases there was a feedback from the higher level to the first level.

The findings show that referrals from family physicians to higher levels in the health system requires higher medical expertise and patient insistence. In addition, feedback to the first level of service provision has not received proper attention. Establishing interactions between physicians and other health service levels, refresher training of physicians, emphasizing the importance of providing feedback and promoting the awareness of patients can reduce to a large extent inappropriate referrals.

Diabetes (silent death) is one of the problems in the field of health and public health all across the globe. The most important factor in the control of diabetes and its complications is self-care behaviors. The leading cause of death in diabetic patients is a lack of self-care behaviors. Therefore, the present study aimed to assess self-care behavior and its influential factors in people with type 2 diabetes.

In this descriptive-analytical cross-sectional study, 308 diabetic patients who were registered in the Sib system between 2015 and 2021 were selected and included via a multi-stage cluster method. The data collection tool was the self-care behavior questionnaire, and the demographic information was obtained from the electronic file (Sib system). Data were analyzed using SPSS software (version 16) using descriptive statistics (mean, standard deviation, frequency percentage), Mann-Whitney, and Kruskal-Wallis.

The mean self-care score of the patients was 48.07, and their self-care status was average. Self-care behavior score demonstrated a significant relationship with age, job status, education level, marital status, economic status, smoking, hospitalization history, and disease complications (P<0.05).

As evidenced by the results of the present study, the self-care status of the patients was reported at an average level, and it was affected by various factors, such as education level and job status. Therefore, in order to promote self-care behavior, health policymakers should formulate appropriate programs according to the needs of society, and health educators should perform the necessary educational interventions according to effective factors.

 The health transformation plan (HTP) in Iran started in May 2013 with 3 financial support approaches for people, creating justice in access to health services and improving the quality of services in hospitals in 2 health and treatment sectors. In the first phase, this program was divided into 8 separate packages in the treatment section, reducing the amount of payment for hospitalized patients, supporting the longevity of doctors in disadvantaged areas, the presence of resident specialist doctors in hospitals, improving the quality of visiting services in hospitals, improving the quality of hoteling in hospitals, and financial support of incurable, special and low-income patients. It refers to promoting natural childbirth and launching an air emergency service.

 This study aims to investigate the effect of HTP on bed occupancy rate, average length of stay, and bed rotation distance in one of the most deprived areas.

 This study was a semi-experimental and retrospective descriptive-analytical study before and after the health system transformation plan based on the information collected from March 2012 to March 2019 in all Sistan and Baluchistan province hospitals. The data of indicators of monthly bed occupancy rate, average length of stay, and bed rotation interval in 83 months in the years before and after the implementation of the transformation plan were collected from the Vice-Chancellor of Treatment of Universities or the statistical units of hospitals and compared. The data were analyzed by Stata software using the interrupted time series (ITS) model, and split regression analysis was used to evaluate the short-term and long-term effects of HTP on the studied indicators.

 This study showed that the bed occupancy rate increased, and the average length of stay and bed turnover interval decreased immediately after HTP in Sistan and Baluchistan province hospitals. Also, the reform had a long effect on these indicators.

 Possibly due to underdeveloped hospitalization services in the past, the bed occupancy rate increased, and the average length of stay and bed turnover interval decreased in the hospitals after this province's major health system reform.

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.

The prevalence of coronary heart disease has affected education systems around the world, including higher education in Iran. The aim of this study was to determine the quality of virtual education system in Zahedan University of Medical Sciences from the perspective of students.

A descriptive-analytical study was conducted in 2016 at Zahedan University of Medical Sciences. The study population in this study included all students studying at Zahedan University of Medical Sciences, of whom 537 completed a questionnaire. A standard electronic questionnaire with the dimensions of quality of educational content presentation, virtual education infrastructure, quality of online classes and quality of virtual tests was used to collect data. SPSS software and descriptive and analytical statistical tests (One way annova, etc.) were used to analyze the data.

From the studentschr('39') point of view, the highest mean score was related to the virtual education infrastructure dimension (2.97) and the lowest mean score was related to the response dimension (2.01). In terms of accountability, 35% of students rated the appropriate response to student problems by the schoolchr('39')s EDO expert as very poor. There was no significant relationship between gender and indigenousness and the quality dimensions of e-learning. There was a significant relationship between the quality of content presentation, online class, response, virtual test with colleges (P> .001). There was a significant relationship between all dimensions of virtual education and educational level (P> .001).

Creating readiness in various human dimensions and equipment requires careful and appropriate planning. Given the current situation and increasing the use of virtual education system, it is necessary to take a big step towards the development of education systems by strengthening the necessary structures and technologies and reforming educational processes and evaluation and training of professors and students.

The coronavirus disease 2019 (COVID-19) pandemic is an emerging global threat to public health.

This study examined the epidemiological and clinical characteristics and death-related factors of COVID-19 in inpatients in Zahedan, Iran.

This multicenter study included all COVID-19 patients admitted to Zahedan hospitals within February to April 2020. Demographic, epidemiological, and clinical characteristics were extracted from medical records. Bivariate and multivariate logistic regression models were used to examine the risk factors associated with inpatient mortality.

Of 425 patients in this study, 237 and 188 were male and female, respectively. Moreover, 31 (7.29%) patients died. The patients with a severe stage of pneumonia and those with a severe/critical condition of COVID-19 were 35.8% and 35.1%, respectively. The most prevalent symptoms were cough (70.8%), shortness of breath (62.1%), fever (34.1%), bruising (28.7%), and shivering (28.5%). The most prevalent underlying diseases were hypertension (23.3%), diabetes (16.7%), cardiovascular disease (13.2%), chronic pulmonary disease (9.6%), and asthma (5.4%). Adjusted odds ratio (OR) of in-hospital mortality increased for patients with older age (OR = 3.74, 95% CI: 1.39 - 10.32), at least one underlying disease (OR = 1.16, 95% CI: 1.01 - 1.32), severe disease (OR = 30.9, 95% CI: 4.01 - 239.09), and critically severe disease (OR = 736.5, 95% CI: 74.75 - 7256.1) compared to mild/moderate disease.

This study showed that older age, disease severity, and underlying diseases were mortality risk factors due to COVID-19 infection. This finding indicates that priorities for hospital admission must be given to patients with a higher risk of mortality due to limited facilities, especially in less privileged areas.

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.

 As a pandemic disease, Covid 19 has taken the lives of many people all over the world and has put a lot of pressure on the health care system and health care personnel. The experiences of managers and employees can help increase the efficiency of the health systems in future crises. This study was carried out in order to use the experiences of the personnel of the Crisis Section of Zahedan Medical University Public Health Deputy (ZMUPHD) in controlling the Covid-19 epidemic.

 This was a qualitative research conducted in 2021-22 using the content analysis method including 30 employees of the Crisis Staff of the ZMUPHD selected by purposeful sampling. Data were collected based on semi-structured, in-depth interviews and analyzed in eight stages including typing the text of the interviews, determining semantic units, coding the text, revising the codes, classifying and developing the classes, revising the classes, identifying the themes and reporting the data.

Resulte: 

The experiences of the managers and employees of the ZMUPHD to deal withا the Corona pandemic were identified and extracted in 5 main areas including "Legislative", "Operational", "Manpower", "Supervisory" and "Financial", and 13 sub-areas.

 Based on the results of the present study, one of the problems in the administration and management of the Covid crisis was the lack of sufficient supervision and political requirements in order to control and prevent the spread of the disease, as well as the lack of a single decision-making organization. Also, financial problems and problems related to human resources were found to be among the most important issues.  On the other hand, from the point of view of the interviewees, the use of the 4030 system was one of the turning points in crisis management.

Information literacy is a capability that enables individuals to create, sustain, and deepen communication with others, which can be effective in many organizational dimensions such as organizational ethics and career development.

This study aimed to determine the relationship of information literacy and professional ethics with career development among Zahedan University of Medical Sciences (ZAUMS) staff.

Using systematic sampling, this cross-sectional study was conducted on 238 ZAUMS staff in southeast Iran in 2018. Data were collected through individual interviews using standard questionnaires Information Literacy, Professional Ethics, and Career Development. The data were analyzed using SPSS-v21 software and descriptive statistics, one-way ANOVA, and t-test.

Of 237 individuals, 116 (48.7%) were males with a mean age of 38 years. The information literacy and career development scores were in the moderate range (means of 170 and 56, respectively), while the professional ethics score of the majority was poor, with a mean of 32. There was a significant direct relationship between information literacy (coefficient = 0.189) and professional ethics (coefficient = 0.391) with career development (P < 0.05). Multivariate linear regression showed that an increased level of employees' access to information had significant positive effects on career development (β = 0.878, P < 0.01). Also, an increase in the level of career development (performance evaluation, workplace environment, supervision status, and educational factors) and professional ethics (loyalty and respect to others) was associated with increased levels of information literacy (P < 0.05).

Information literacy and professional ethics could increase career development. Therefore, it could improve organizational productivity. It is suggested that professional ethics workshops and courses be held to improve staff's information literacy.

COVID-19 has become a global problem. In this case study, the experiences gained from disease control in rural areas are reported.

An observational study was done in 2020 in Sistan and Balochestan, the largest province with most rural areas in the southeast of Iran.

After identification of the first patient of Covid-19 in a rural area, three measures were taken including: 1. Diagnosis, screening and treatment of the disease (Incident command post was established and the village was completely quarantined, etc.; 2. Intersectoral coordination for epidemiological management (limiting traffic for people and any gathering); and 3. Identification of any Covid-19 positive cases. The results of these measures showed that after quarantining the village and performing the mentioned actions, the number of patients decreased, and the disease was controlled.

Quarantine of the contaminated rural area and people’s traffic routes is one of the most important measures in controlling Covid-19.

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).

Hospital-acquired infections (HAIs) are a global problem in hospitals and significant causes of mortality and morbidity regardless of advances in supportive care, antimicrobial therapy and prevention. The study aimed to determine a comprehensive estimate of the HAIs prevalence, influential factors, and types of these infections in Iran.

A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, Cochrane, SID, Magiran, and Medlib from January 1995 to September 2020 using a combination of medical subject heading terms (‘Nosocomial infection [Mesh] OR ‘’ Hospital infection [Mesh] OR Hospital Acquired Infection[Mesh]  OR Healthcare-associated infection ‘’AND (‘Iran’ [Mesh]) among observational and interventional studies. SPSS version 25 and STATA version 11 were used for data analysis.

A total of 66 (cross-sectional, cohort, and case-control) observational studies were identified. More of the studies had been done before 2014(43 papers or 65%). Based on the random-effects model, the overall prevalence of HAIs in Iran was 0.111 [95% CI: 0.105 - 0.116] with a high, statistically significant heterogeneity (I2= 99.9%). The infection rate was 0.157 and 0.089 before and after the Iranian Health Transformation Plan (HTP), respectively. HAIs rates reported more in the South and West of Iran rather than other regions (0.231 and 0.164) (p= 0.001). Escherichia coli and klebsiella infections were reported in 53 and 52 papers (0.239 and 0.180, respectively). In addition, respiratory and urinary infections were reported 0.296 and 0.286 in 51 and 38 papers, respectively.

The prevalence of HAIs in Iran is relatively high. Preventing and decreasing hospital nosocomial infections can considerably affect reducing mortality and health-related costs. This should be taken into consideration by health policymakers for pathology and revision of some previous programs and standards as well as the development of appropriate and evidence-based control and education programs to reduce this health problem.

Motorcyclists are among the greatest vulnerable individuals of road accident victims. Their behavior has a significant correlation with increased injury and mortality rate. Determining the risky and unsafe behaviors of motorcycle drivers is necessary for preventing riders and other citizen from potential accident risks.

The aim of this study was to determine the risky driving behaviors of motorcyclists in Iran.

A cross-sectional study was done in 2019 in Sistan and Baluchestan Province as the second widest province of Iran. Using randomized sampling method, we included 613 motorcyclists from the province. To collect data, the Persian version of Motorcycle Riding Behavior Questionnaire (MRBQ), as a standard questionnaire, was used. For data analysis, descriptive and analytical statistics such as one-way analysis of variance (ANOVA), t-test, and linear regression were used by SPSS software version 21.

The age range of 57% of the motor riders was 15 - 30 years, and 50% of them did not use any safety equipment. About 58% of the subjects had started motorcycle riding under 18 years old, and 73% of them did not have a motorcycle riding license. Moreover, more than 50% of motorcyclists used mobile phones while driving. The mean score of driving behavior (106 ± 22) was desirable. Based on multivariate analysis, job, average amount of riding, lacking a riding license, type of motor, alert from police, non-fasting helmet band, exceeding speed limits, fatigue, and hand-free riding were the main predictors of risky riding score (P < 0.05).

According to our results, the riding behavior of motorcyclists was desirable; however, many people used motorcycles without a license and safety equipment, which increases high-risk behaviors. Considering the potential dangers of motor riders, it seems necessary to hold training courses to obtain motorcycle certification and how to use safety equipment

Nowadays, information and communications technology (ICT) has deeply influenced different aspects, especially healthcare sector.(1) Increasing public awareness and expectations has encouraged healthcare providers to use modern technologies to improve service quality.(2) Health technologies provide useful information for improving planning,  implementing, monitoring, and policy making based on evidence (3). In fact, an electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR contains the medical and therapeutic histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.(4) From the beginning of applying family physician and rural insurance program in Iran, different software packages have been developed for making EHR; however, due to technical and structural constraints and also different personal motivations, it is removed from the registration process and recording data in the early stages .(5) After implementing the health transformation plan (HTP) in 2014, the Ministry of Health and Medical Education (MoHME) launched the health integrated system (SIB) in 2016 with the aim of recording the EHR of households. SIB system follows valuable goals such as applying electronic health record, creating a national health information base, and providing referral systems in the family physician plan. Now, all health workers such as supervisor, general practitioners and dentists, health care providers, midwives, dietitians, mental health and social workers at the first level of service delivery record information on the SIB system. The information that is registered by users on SIB system are as follows: demographic information, disease reporting, physicians' visit, medical history, medications, vaccinations, and radiology and laboratory results. (6) After four years of SIB implementation at the comprehensive health centers, health centers, and health houses, the significant strengths of this system are:(5) • Possibility of supervision and direct and online evaluation by all managers in the health system • Establishment of a comprehensive EHR system for individuals from birth to end of life • Exclusion of the paper and bureaucratic system and quick extraction of health statistics • Application of new care guidelines and instant access of users On the other hand, constraints of the SIB systems are: • Extensive data recording and time-consuming nature of service registration in the system • Absence of proper internet infrastructure, especially in rural areas   • Increase in the possibility of unrealistic data entry by compulsion of officials in order to increase service recordings • Incompatibility of certain system information with community needs and local preferences and specific diseases in each region of the country, and also lack of connection of SIB system information between specialized and sub-specialized centers after five years from the establishment of this system in Iran. Therefore, for successfully implementation of the system in the health field, it is recommended that we should provide hardware infrastructure, rationalize the number of required services in the system in the first years and then add other services in the long term, hold regular training courses, encourage family physicians as primary caregivers of services at the first level to accept this system, and record the information(7). E-health not only could increase the wellbeing of user, but also the pressure on the health care system could be somewhat relieved. By introducing the SIB, we have expanded the toolkit of user-centered design methods for e-health development. The method facilitates easy communication with novices about a future e-health technology, the identification of factors that can hinder or support end-user acceptance of a future e-health technology, and early and cheap possibility for testing functional design decisions (8). Keywords: Information, Health transformation plan, family physician Iran Ethics approval and consent to participate: Not applicable Consent for publication: Not applicable Availability of data and material: Not applicable Competing interests: The authors declare that they have no competing interests. Funding: Not applicable Authors' contributions: All authors have contributed in all sections of the manuscript preparation. Acknowledgements: Not applicable Study highlights: Although Integrated Health System has limitations, by taking some measures, it can be useful for health care system of Iran.

In 2014, Health Transformation Plan (HTP) started in Iranian health system to improve productivity of health organizations. The aim of the present study was to assess the employees’ productivity in health centers after HTP.

This cross-sectional study with analytical approach was carried out in Zahedan University of Medical Sciences in 2018. 150 health workers were selected using census method. Data were collected by Hersey & Goldsmith Workforce Productivity Questionnaire. For the data analysis, descriptive and statistical methods such as Pearson correlation 2-tailed, one-way ANOVA, T-tests and regression model were used.

Our findings showed that 96% of health workers were female. Mean score of productivity was 63.8±12.7, which is in the moderate level. Besides, we found a significant negative relationship between productivity and job experience of the employees (P = 0.021, F = 2.975).

In this study, productivity was at a moderate level. It seems with better motivation of the staff, there might be an improvement in productivity.

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.