hossein ebrahimipour

Pelvic floor disorders (PFDs) includes defects in the muscle and ligament plates that cause disruption in the anterior, middle, and posterior walls. Facing the symptoms of these disorders can affect many aspects of a woman's life.The results of the studies showed a lack of knowledge on this process.Therefore,the present study aimed to explain the process of women 's confrontation with the symptoms of pelvic floor disorders.

This research was conducted between2017 to 2020.38 participants were entered through purposive and theoretical sampling.Data were collected using in-depth semi-structured interviews to answer the research question. In order to identify how women deal with the symptoms of PFDs, the Granded Theorey based on Corbin and Strauss(2015)was used.Data were analyzed in four phases, 1-Analysis of data for concepts. 2-for context. 3-for Process and 4- Integrating Categories. MAXQDA10 software was used to help manage and analyze qualitative data.

In the present study, the main concern of the participants was "Deprivation of normal life" and the theory extracted from the data was "symptom management in order to normalize the situation". This theory was the result of five actions / reactions. Finally, it had consequences with a range of adaptations to the disease and partial recovery.Participants'concerns occur in the context of"dominance of symptoms on the dimensions of individual and interpersonal life" which included seven sub-concepts.

The main result of this study is the presentation of the theory of "symptom management to normalize the situation"which explains the process of women experiencing symptoms of PFDs.

 Colorectal cancer (CRC) is the third most prevalent cancer in Iran. This study aimed to assess the level of awareness regarding CRC warning signs, risk factors, screening program, and related factors among adults in North-Eastern Iran.

Study Design: 

A cross-sectional study.

 The multi-stage sampling method was used to survey 2614 participants attending primary healthcare centers in Mashhad, Iran. The data collection tools were the demographics section and Bowel/ CRC Awareness Measure (Bowel/Colorectal CAM). The data were analyzed by SPSS, version 25. The significance level of the data analysis was less than 0.05.

 Mean awareness for CRC warning signs and CRC risk factors were 2.85±2.13 and 3.63±1.85, respectively. Most participants (97.2%) had no awareness of the CRC screening program. There was a significant association between marital status, education, job, income, and family history of CRC with awareness of warning signs (P<0.001); moreover, there was a significant association between age, education, job, income, and family history of CRC with awareness of risk factors (P<0.001). The results of logistic regression indicated that there was a significant association between age (P=0.022, OR=1.794, 95% confidence interval [CI]: 1.087, 2.962), gender (P=0.005, OR=0.488, 95% CI: 0.296, 0.803) and warning sign awareness (P<0.001, OR=1.278, 95% CI: 1.124, 1.454) with awareness of the CRC screening program.

 In this study, most of the participants had low awareness of CRC. More aimed educational interventions are needed to promote Iranian adults’ awareness of CRC.

Despite the mass vaccination of people in countries, preventive health guidelines of coronavirus disease 2019 (COVID-19) are still one of the most critical factors for pandemic control. The objectives of this study were to assess the overall use of face masks and investigate the diverse kinds of face masks used among pedestrians in northeast Iran.

This cross-sectional study was designed in Torbat Heydariyeh, northeastern Iran, from February 19 to May 13, 2020. A total of 223 848 pedestrians were selected from 25 points of the city, using a multistage sampling method in 10 stages. Descriptive statistics were presented with frequencies and percentages. Chi-square test and Fisher exact test were used to assess the association between two categorical variables.

The overall percent of face mask usage was 78.68%. Women used face masks considerably higher than men (88.32% vs. 69.02%, P<0.001). Among the male and female pedestrians who used the mask, 6.27% and 2.04% wore face mask incorrectly, respectively. Surgical masks (73.7%) were the most common face masks worn by pedestrians. Overall, the face mask usage was significantly lower during a.m. (88.34%) compared to p.m. (78.52%) (P<0.001). Also, the face mask usage was significantly higher in the center sections of the city (86.49%) compared to the outskirts (43.67%) (P<0.001).

Women use face masks significantly more than men. Using educational programs and establishing laws and regulations to prevent pandemics in cities is considered as a key factor.

Physical access to health services is determined by the geographic location of the patient. This study aims to distribute the bases and hospitals of Mashhad City, Iran, and the extent of coverage of the bases in traffic accidents.

This research is a descriptive cross-sectional and applied study. The study population for high-accident points includes 21142 missions carried out regarding traffic accidents as well as 37 points related to 115 emergency bases in 2014. The information needed by the researcher was collected by receiving the files of the injured from the statistical unit of the center. By forming the database of the road network in Mashhad City in a geographic information system environment as communication links and defining emergency centers as facilities, the radius of emergency centers was drawn using the service area method. 

In this study, the areas that needed more services and the number of provider centers was less compared to the covered area were identified. After matching the distribution map of the bases with the distribution of accidents, the areas with the lowest distribution of accidents and the highest service of emergency medical services, as well as high accidents and less service were obtained. 

The distribution of bases and hospitals does not have a proper distribution situation, which can lead to the lowering of the desired level and the creation of illogical concentration. To cover the emergency missions, it is necessary to set up emergency bases and complete the existing hospitals in the city.

This study aims to assess the productivity loss in diabetic patients living in South Khorasan Province, Iran, in 2017.

This cost of illness and analytical study was performed on 1003 patients with diabetes referred to hospitals and healthcare centers in South Khorasan Province. After being randomly selected, the participants filled the short form health and labor questionnaire by the human capital method to estimate the productivity loss caused by health problems. Data were collected in person or via phone interviews. The collected data were analyzed by data quantile regression model using Stata v. 11.

The Mean±SD productivity loss based on actual and labor law income was 19.61±46.24 and 16.61±49.39 dollars, respectively. In addition, the results showed that the Mean±SD number of lost working days is 0.81±2.39 days. 
According to the regression model, gender, educational levels, marital status, and employment status affected the number of working days lost at 0.25 quantile (P≤0.05).

Improving productivity in diabetic patients and consequently reducing the resulting economic burden is essential to promoting their physical, mental, and social health.

Human resources are the most important asset of any organization; also, the payment system is the main motivating factor for hospital staff. The aim of this study is to evaluate the effect of implementing pay for performance (P4P) instruction on inequality in income distribution between medical and non-medical staff.

The present study is a applied research study conducted through a descriptive method. The statistical population of the study, hospitals, and P4P were selected from Mashhad University of Medical Sciences, Iran. Data on personnel characteristics and their income were also collected for three periods including a six-month pre-implementation period, as well as two six-month post-implementation P4P periods. Meanwhile, we used Lorenz curve and Gini coefficient to measure inequality in the distribution of income.

The Gini coefficient obtained for all employees has increased from 63% for the period before the implementation of the instruction to 62% in the second period and 65% in the third period after the implementation of the instruction. The Gini coefficient between the physicians group and the nurses group for the first period was 64 and 35%; for the second period 61 and 25%; and for the third period 62 and 26%.

Results of this study are expected to be applied to reform current P4P policies in hospital. However, schemes that cause the service compensation change need to be examined from different dimensions; one of which is the impact on income inequality that requires more comprehensive studies.

In the COVID‑19 crisis, nurses are directly involved in patient care, so they face many challenges. This study was performed to determine the challenges faced by nurses while caring for COVID‑19 patients in Iran in 2020.

This qualitative, content analysis was conducted in Iran on ten nurses directly involved in the fight against the corona epidemic, selected through a purposeful sampling strategy. Data were collected through deep interviews consisting of open questions. All the interviews were recorded, and immediately after each interview, it was transcribed into written form. The data were analyzed using MAXQDA software.

All the challenges could be classified into three main categories and 17 subcategories. The main categories were miss‑management in controlling corona conditions, mental and physical complications and challenges in corona work conditions, and lack of sufficient workforce.

Hospital managers and authorities play a significant role in meeting the financial needs and requirements of nurses, and can minimize the job discrimination prevalent at medical centers through providing financial and nonfinancial incentives for nurses. Moreover, the findings of the present study can help hospital managers and authorities to gain a better understanding of the experiences of nurses, and to take the necessary measures to obviate the challenges faced by nurses in public health emergencies.

Patients with inflammatory bowel disease (IBD) experience wide range of physical and psychological problems experience. The use of strategies to improve disease management by patients is of has special importance in solving these problems. The aim of present study was to discover the strategies and behaviors of patients to manage their disease.

The present study was conducted with a qualitative research approach and a qualitative content analysis method. The research participants included 20 patients with IBD referred to gastrointestinal wards in 2020 in Mashhad. Data were collected through unstructured interviews and purposeful sampling method and continued until data saturation. Data analysis was performed continuously and simultaneously with data collection and comparatively.

Data analysis provided five themes of “Improving self‑efficacy and problem‑solving skills,” “Coexistence with disease,” “Reviewing and modifying of interactions,” “Adjusting job and professional conditions” and “Commitment to self‑care.” The combination of these concepts indicated that is the main theme in disease management for these patients.

Reconstruction of individual, social, and professional life can improve self‑regulation and problem‑solving skills in these patients and make them a sense of control on their lives and disease.

Increasing hospital capacity to cover the service demands is an important priority during an epidemic or a pandemic. The aim of this study was to increase hospital capacity using the Six Sigma method to improve the patient discharge process.

This was a quantitative study. The Pre- and post-intervention study was conducted in a big hospital designated for COVID-19 patients. The patient discharge process was evaluated and improved based on seven sub-processes and following the Six Sigma model, including defining the problem, measuring time in each of the discharge stations, analysis times and process, improvement process, and control.

Implementation of the electronic patient discharge led to a 51.9% decrease in discharge time from 7.3  h during the pre-intervention period to 3.8 h post-intervention (P< 0.0001). According to the Sigma level, the yield and defects per million opportunities of the discharge process also improved to 55%.

Increasing hospital capacity by improving the discharge time is a quick action to cover the demand created during pandemics. Also, about 32 beds can be obtained by applying the Six Sigma model to improve the discharge process in a short time and at a very low cost.

Board of Trustees (BOTs) in Iranian medical universities has been considered as one of the most important structural and managerial changes to create a revolution in decision-making and accountability. This study aimed to explore challenges facing BOTs in governing Medical Universities (MUs).   

In this qualitative study, 27 semi-structured interviews were conducted with current and former members of BOTs, chancellors of universities, BOTs’ secretaries, and staff in the Ministry of Health and Medical Education in 2017. These participants were selected using a purposive and snowball sampling method. Data were analyzed by framework analysis and using Atlas-Ti software.

Five key themes were identified, including 1) infrastructure (problems in BOT laws and membership requirement), 2) planning and decision-making (evidence-based decision making and planning and meeting), 3) organizing (ambiguity in positions and lack of necessary administrative structure), 4) performance evaluation (self-reporting, lack of time allocation, lack of evaluation criteria and lack of required structure for evaluation), 5) independence and influence on performance (dependency on the Ministry of Health and Medical Education and financial independence).

Due to obsolete laws, it seems that the structural and executive reform of BOTs is essential. The issues of university autonomy and empowerment of the boards’ members should particularly be considered in such reforms. However, it appears that more delegation and empowering the position of the boards could be effective strategies in governance medicals universities.

The response time is considered as one of the most important criteria for the quality of given care to the injured. This research aimed to investigate the frequency and causes of prehospital emergency delays in the 115 emergency center, in city of Mashhad, in 2015.

In this cross-sectional study, 21,142 missions performed in 2015 were investigated, from among which 640 missions with delays in systematic sampling were recognized. For data analysis purposes, descriptive statistics (frequency, mean and SD) in Excel 2013 software was implemented.

Nearly 60% of the injured were men, 23% women, and the gender of 17% was not recorded in their profiles. The mean age of the injured was 29.8+15.9 years and 30% of the injured were in the age group of 16 to 25. The mean response time was 9:01+2:46. The most prevalent causes related to missions out of the operational zone (29.3%) and the second cause has been related to traffic groups (24.2%).

Establishing new bases and completing the number of ambulances and human recourses, intervention in traffic causing factors, and training the public about emergency cases can be effective in reducing the number of missions and the pace and quality of services provided to the injured.

Pelvic floor disorders (PFDs) are common and complicated problems that occur inwomen with different ages and cultural backgrounds and affect various dimensions of their life.Because of the dearth of information about how the Iranian women manage these disorders, this studywas conducted to explore the experiences of women who live with PFDs. This qualitative study was conducted between 2018 -2019 on women who referred to theclinics of Mashhad educational hospitals . 25 deep and semi-structured interview with 22 patientswith PFDs was done. They were recruited through a purposive sampling method among women withdiagnosis of PFDs. Data were analyzed using conventional content analysis adopted by Graneheim andLundman and organized using the MAXQDA software (Ver.10). The analysis of the data led to the emergence of a theme of “Acceptance and Tolerance”,including four categories: “Trying to adopt sexual conflicts”, “ Concealing the disease”, “Trying tomodify the lifestyle”, and “Controlling negative emotions”, and 15 sub-categories. This study provides an insight into self-management strategies for different aspects ofchallenges faced by women with PFDs.They try to resolve, conceal, modify, and control some issues toaccept and tolerate their disease. By identifying self-management strategies, care providers can designand implement counseling, educating and supporting interventions, and also a program through whichthe patients help and guide each other.

Inflammatory bowel disease (IBD), including Crohn's and ulcerative colitis diseases, is characterized by clinical periods of remission and relapse. Excessive care stress can have long-term negative physical and psychological consequences not only for caregivers but also for the recipients of care. This integrative review aims to identify, describe, and synthesize the results of current available research focused on the burdens of IBDs on family caregiver. An integrative review was performed using Whittemore and Knafl methodology. A systematic search of electronic databases including Web of Science, PubMed, Embase, and Scopus from January 2000 to October 2019 was conducted. Articles were included if published in English and focus on IBD burden on family caregivers. Of 730 records, 16 articles with quantitative, qualitative, and Q methodology study designs were eventually included in the review. The synthesis of these articles led to the identification of four key types of effects: biopsychosocial, daily life activities, physical health, and financial. The chronic and relapsing nature of IBD exposes family caregivers to considerable risk. Thus, the care burden of IBD patients' caregivers needs to be evaluated continuously and relieved through family-centered interventions.

 Mashhad is the second-largest Iranian megacity with a population of roughly 3 million and receiving around 25 million tourists a year, wherein road traffic accidents (RTAs) have become the leading cause of death and injuries.

 The main purpose of this study was to calculate the burden of disease caused by RTAs in the city of Mashhad.

 In this applied research using a descriptive cross-sectional method, data associated with RTAs in the city of Mashhad in March 2016 - March 2017 were collected based on a complete enumeration of RTA-induced fatalities and disabilities from the Organization for Cemetery Management (Ferdows Organization) affiliated to Mashhad Municipality and the database of the Ministry of Health of Iran (MOH). Following verification, the years of life lost (YLL), the number of years lost due to disability (YLD), and the disability-adjusted life years (DALYs) were measured through the method proposed by the World Health Organization (WHO).

 The total number of RTA deaths was 677 cases (men = 494 (73%) and women = 183 (27%)) and the number of DALYs was 29155 years (men = 21219/3 (72/8%) and women = 7935/1 (27/2%)). Of the total DALYs, 96% of them were associated with YLL, and 4% were related to YLD.

 Mortality data are recorded with relatively high accuracy in Iran. Given low YLD in DALYs in comparison with the findings of similar studies in developed countries, there are possible defects in data quality, in particular in terms of non-fatal accidents and injuries. These findings can be thus exploited for optimal allocation of resources in Razavi Khorasan Province and across Iran.

 Mashhad is the second-largest Iranian megacity with a population of roughly 3 million and receiving around 25 million tourists a year, wherein road traffic accidents (RTAs) have become the leading cause of death and injuries.

 The main purpose of this study was to calculate the burden of disease caused by RTAs in the city of Mashhad.

 In this applied research using a descriptive cross-sectional method, data associated with RTAs in the city of Mashhad in March 2016 - March 2017 were collected based on a complete enumeration of RTA-induced fatalities and disabilities from the Organization for Cemetery Management (Ferdows Organization) affiliated to Mashhad Municipality and the database of the Ministry of Health of Iran (MOH). Following verification, the years of life lost (YLL), the number of years lost due to disability (YLD), and the disability-adjusted life years (DALYs) were measured through the method proposed by the World Health Organization (WHO).

 The total number of RTA deaths was 677 cases (men = 494 (73%) and women = 183 (27%)) and the number of DALYs was 29155 years (men = 21219/3 (72/8%) and women = 7935/1 (27/2%)). Of the total DALYs, 96% of them were associated with YLL, and 4% were related to YLD.

 Mortality data are recorded with relatively high accuracy in Iran. Given low YLD in DALYs in comparison with the findings of similar studies in developed countries, there are possible defects in data quality, in particular in terms of non-fatal accidents and injuries. These findings can be thus exploited for optimal allocation of resources in Razavi Khorasan Province and across Iran.

One of the most important relations between reducing organizational costs and maintaining the quality of services provided is the use of appropriate models for managing staff performance; Using these models can increase employee productivity. Therefore, this study aimed to evaluate the volume of environmental health activities in health centers.

This study was a descriptive and applied study that was done in both quantitative and qualitative dimensions. The pilot design of the model was carried out at Mazandaran University of Medical Sciences. Every 10 minutes was considered a unit of work.

51 fields of activity were identified in the field of environmental health activities. The total number of units in the field of environmental health was calculated to be 1019 units. Out of the identified activities, the most frequent repetitions were conduct inspection and recorded in the system, followed by daily chlorometry with 100 and 84 repetitions, respectively.

Personnel in any organization need a decisive mechanism to reduce inequality and a model of value for the amount of work that one does to improve productivity, increase efficiency, work motivation, and reduce inappropriate psychological stimuli in the workplace. This will be achieved using models such as the model presented in this study.

Brucellosis is one of the common diseases between humans and animals. The purpose of this study was to investigate behavioral determinants of brucellosis incidence among stockbreeders and their family members in a rural area based on the PRECEDE model.

This cross-sectional study was carried out among 540 stockbreeders and their family members in Northeastern Iran in 2019. Sampling was done in two stages including stratified sampling and random sampling method. Data collection was conducted by a valid and reliable questionnaire developed based on the PRECEDE model. Data were analyzed using SPSS16 through Pearson correlation coefficient, independent t-test, and ANOVA. Furthermore IBM SPSS AMOS version 20 was used for the path analysis.

The mean age of the participants was 39.02 ± 16.41 years, of whom 53.1% and 46.9% were men and women, respectively. About 23.9% of the participants had a history of brucellosis in their families. Enabling factors were the most important determinant of self-efficacy and self-efficacy was the most important determinants of behavior. Evaluation of the chi-square indicators, chi-square ratio to degree of freedom, root mean square error of approximation, adjusted goodness of fit index, parsimony comparative fit index, comparative fit index, incremental fit index, and parsimonious normed fit index indices indicated that the model was well fitted and there was a positive and significant relationship between the predisposing, enabling, and reinforcing factors on the one hand and behavior on the other. chi-square indicators, chi-square ratio to degree of freedom, root mean square error of approximation, adjusted goodness of fit index, parsimony comparative fit index, comparative fit index, incremental fit index, and parsimonious normed fit index

Designing and implementing health plans based on the PRECEDE model with more emphasis on self-efficacy as the most important behavioral determinants can bring about a positive effect on enhancing the brucellosis preventing behaviors.

Economic constraints have made it difficult to provide health care facilities. Therefore, improving the performance management of employees in organizations is a very important issue, so this study was conducted to investigate the workload in the field of family health in health centers.

The present research is descriptive and cross-sectional conducted using combined methods (qualitative and quantitative). The study population included all activities of the family health unit of Savadkouh health centers. Interview and observation methods were used to identify activities and other qualitative parts, and Excel 2007 software was used to facilitate the above steps.

The total standard time for all activities in the study scope was 2107 working units. Clientschr('39') information registration activity in the Sib system with 482 work units had the highest, and the activity of referring a mother or child with developmental problems to the doctor with 0.3 work units had the lowest workload. The total number of work units calculated for the family health unit was less than the minimum required.

The findings of our study showed that the number of employees in the family health units was more than the required number, and there was a high unemployment rate. Every organization needs indicators or models such as the model presented in this research to improve its performance level in order to reduce the waste of resources and improve the efficiency of the relevant organization.

Health- Labour Questionnaire (SF-HLQ) is a measurement instrument for collecting the quantitative data on the relationship between disease and functional status of individuals of productivity losses related to health problems in individuals with paid or unpaid work. Since road traffic injuries are the leading cause of death for disability in the world. In this regard, we aimed to report on validity and reliability of the Persian version of Health- Labour questionnaire in assessing Productivity losses of the Road Traffic Injuries.

In this cross-sectional study, a sample of 30 injured of traffic accident referring to hospitals affiliated with Mashhad University of Medical Sciences were randomly selected. Samples were evaluated in 2 stages and have been interviewed following 1 month by using the health- labour questionnaire and their loss of productivity was calculated by telephone. Face and content validity was performed by 5 health management and economics specialists and 10 students of Masterchr('39')s Degree of Health Services Management and their opinions were applied.  To determine the content validity of the questionnaire, content validity ratio (CVR) and content validity index (CVI) were used, and to determine reliability, Coefficient Correlation Interclass (ICC) for quantitative variables and kappa coefficient of agreement were used to evaluate the reliability of the nominal questions and SPSS 21 software used for data analysis.

CVI and CVR were calculated at 0.79- 0.49, Respectively, which is acceptable for this questionnaire. Intra-class Correlation Coefficient and Confidence interval in both lost productivity and lost working day variables were 0.99 (0.98-0.99) and 0.96 (0.93-0.98) respectively. Kappa coefficient of agreement for nominal questions was 0.99.

The results of this study showed that the translated version of the health-labour questionnaire had presented excellent validity and reliability in assessing productivity loss in traffic incident patients.

Social responsibility is a concept in which organizations pay particular attention to environmental and social issues in its business processes. The purpose of this study was to investigate social responsibility dimensions in public hospitals affiliated to Mashhad University of Medical Sciences in 2019.

In this cross-sectional and analytical study, social responsibility and its dimensions in 13 public university hospitals of Mashhad were examined using a questionnaire based on 273 samples of staff and customers. Data were analyzed using descriptive statistics (frequency, mean, and standard deviation) using SPSS software version 11.

The highest mean score (2.40) was related to leadership and internal processes, and the lowest mean score (1.83) was related to workplace dimension. The other average scores from highest to lowest were: environmental dimension (2.08), market dimension (2.01), and community and country dimension (1.92). Overall, the social responsibility of the hospitals under study was significantly different from the mean level of 2 (2/05), and considering the positive t-statistic for comparing a sample, it can be concluded that social responsibility was significantly higher than the average level (p-value ≤ 0.05)

Improving the employment status of employees as the most important social capital is very important, which had the lowest score in this study. According to the results of the research, the existence of discrimination and work shifts reduced the satisfaction in this dimension. Lack of employee awareness has been the most important reason for the decrease, which can be promoted by increasing the awareness of employees in this dimension.

Cost information can help policy makers to set user fees, public and private tariffs and budgets and also to conduct an economic evaluation to provide health care with acceptable quality and affordable price. This study aimed to do a cost analysis for the Iranian Comprehensive Health Centers (CHCs), to estimate the unit cost of different dental services.

This was a cross-sectional study. Capital and recurrent cost information of three urban CHCs in Mashhad was collected. Cost identification was based on the provider’s perspective. The step-down costing method was adopted from Konte and Waker and applied in five steps: defining cost centers, identification of operational activities, assigning inputs to cost centers, allocate all costs to final centers, and compute unit costs.

In dental services, the most important cost driver was human resources that comprised 69% of the total cost. The unit cost of a relative K for dental care was 12,189 Rials (1 USD: 31,407 Rials as in 2016). Accordingly, the unit cost for different dental services varied from 182,834 Rials for dental radiography to 1,589,570 Rials for class II composite restoration. The mean cost of a dental visit for examination and diagnosis estimated 247,436 Rials.

Comparison between the estimated unit cost and the current dental tariffs reveled considerable differences. Integration of dental services to primary health care in the Iranian CHCs would result in the economies of scope.

A supportive program during normal childbirth with a holistic approach could reduce the cesarean section rate and make childbirth a positive experience. Therefore, the present study aimed to develop a supportive care plan for labor using the logic model.

The data generated through a grounded theory study were used to develop a program for supporting women during labor based on the logic model. A total of 25 mothers who referred to hospitals for labor as well as eight professionals were recruited through the purposive sampling in Mashhad, Iran during March 2014 to December 2016. The problems and needs of mothers, as well as the viewpoints and recommended strategies of professionals to meet those needs, were elicited through the semi-structured interviews. The stages of supportive program development included identifying the problems, defining the inputs, activities and outputs s well as identifying program outcomes.

In the developed care plan five areas of 'infrastructure', 'equipment', 'facilities', 'training', and 'processes' were classified in the inputs. Three areas of 'designing interventions', 'implementing interventions' and 'following ethical considerations' were categorized under the category of activities. Statements related to assessment were nominated as output. The short-term and long-term results related to the program’s intervention were labeled as outcomes.

The developed supportive care plan as a holistic program could be implemented instead of the existing programs. It will be a guide for both decision-makers and practitioners in terms of managing and supervising women in labour through providing support.

In Iran, a new program called the Family Doctor was started in 1384. The present study aims to determine the challenges of the family physician system in Khorasan Razavi province.

The present study is a quantitative-qualitative study. In this study, a sample-based sampling method was conducted with 11 managers and 9 family physicians working in the project in Khorasan Razavi. Then, based on the results of the interviews, a questionnaire was designed and confirmed by its validity and reliability in a descriptive-analytic study in 1395. The findings of the quantitative study were analyzed using descriptive statistics and Mann-Whitney, T-test and ANOVA tests at a significant level of 0.05

In the analysis of qualitative content 9 basic concepts (comprehensive planning, health insurance system, compensation services, performance appraisal, facilities and welfare facilities, recruitment and maintenance of human resources, information system, culture and financing) were identified.The biggest challenge is in the area of compensation (4.55 ± 0.73) and the smallest in the area of facilities and facilities (3.67 ± 0.83). The greatest difference is between the viewpoints of managers and physicians in the field of facilities and amenities (0/61 ± 0/20) and the least in the field of culture (0.04 ± 0/17).

The most common challenges faced by family physicians in the study are cultural, economic, environmental and working conditions. It is suggested that, in order to properly implement the plan of the family physician, it should be considered in coordination with the objectives of the plan at international level and the experiences of the countries that implemented the program.

Pre-hospital care plays an important role in managing patients who require emergency services and preserving human life. The aim of this study was to evaluate the cost of completed public pre-hospital emergency missions according to the activity-based costing model and to compare it with the cost of private pre-hospital emergency services in Mashhad in 2016.

In this applied and descriptive cross-sectional study, the data were collected using a researcher-made form 4 major groups of costs were identified to estimate the total costs: 1- Personnel salaries, 2- Current expenses 3- Medical consumables 4- Depreciation. The cost of providing pre-hospital services was calculated based on the activity-based costing. Eventually, the cost of pre-hospital emergency services was compared between the public and private sectors. To investigate the cost-effective factors for missions, multiple regression analysis, Breusch-Pagan, Ramsey RESET, Swilk, and Linktest diagnostic tests were used by  Stata 11.0 software.

The average cost of each mission was equal to 2114337 ± 217786 thousand Rials in 58 emergency medical centers of Mashhad in 2016. Of this cost, 78.51 %, (1660129 ± 1578445 Rials) was related to employees' salaries, 19.24 % (406842 ± 375083 Rials) was related to the current costs of each center, 0.23 % (4796 ± 4476 Rials) was related to depreciation, and 2/02 % (42761 ± 42822 Rials) was related to medical consumables in each pre-hospital emergency mission. The value of contract with an emergency pre-hospital emergency was 1104000 Rials for each mission in 2016, which is almost half of the cost related to the public pre-hospital. Results of the regression model estimation also showed that among the variables of the model, the fuel cost variable was identified as an effective variable on the cost of each mission (p = 0.0001).

The private sector provides pre-hospital emergency services at a lower cost. Moreover, before establishing a pre-hospital pre-service center, the cost-effectiveness of establishing a center in each region should be checked.