jafar sadegh tabrizi

 Given the impact of high intake of sugar-sweetened beverages on type 2 diabetes, intervention to reduce their consumption can be a top priority for any health system. Thus, the purpose of the present study is to simulate the impact of policy options related to reduce consumption of sugar-sweetened beverages (SSBs) on the prevalence and mortality of type 2 diabetes in Iranian men and women.

 A discrete event simulation (DES) model was used to predict the effect of several policy options on the prevalence and death from type 2 diabetes in Azar Cohort Databases. Population age- and sex-specific prevalence and incidence rate of diagnosed diabetes were derived from the national health data. The Preventable Risk Integrated Model (PRIME) model was used for coding the input parameters of simulation using R and Python software.

 The prevalence and mortality rate of type 2 diabetes under the scenario of reduced consumption of SSBs indicated that the highest and the lowest prevalence and mortality rates of type 2 diabetes for men and women were related to no policy condition and replacing SSBs with healthy drinks, like water, respectively. Also, the maximum “number of deaths postponed/ prevented” from type 2 diabetes was related to replacing SSBs with water (n=2015), and an integration of reformulation and applying 10% tax on SSBs (n=1872), respectively.

 Simulating the effect of different policy options on reducing the consumption of SSBs showed “replacing of SSBs with water” as the most effective policy option in Iranian setting.

The healthcare environment should provide the highest level of safety for staff and clients. This study aimed to assess the structural and non-structural safety status of Tabriz primary health care centers.

This cross-sectional study assessed 40 comprehensive healthcare centers in Tabriz, Iran in 2019. The data collection instrument was a self-designed questionnaire We assessed the compliance of comprehensive healthcare centers with the standards checklist through conducting interviews, considering observations, and reviewing the documents. The descriptive results for qualitative data were reported as frequency (percentage) and for quantitative data as mean (standard deviation). Furthermore, to evaluate the association between contextual variables and physical safety status of centers, t-test, ANOVA, and Tukey’s post hoc tests were used as appropriate (structural or non-structural).

The results of the study showed that the level of structural, non-structural, and total safety for the physical space of the centers was 48.2%, 37.4%, and 43%, respectively. Accordingly, based on cutting points, the level of structural safety and total safety was identified as moderate, and the level of non-structural safety was identified as low. In addition, descriptive results showed that there is a statistically significant relationship between urban area and non-structural safety so that non-structural safety of centers located in zone 4 was significantly higher than the safety of centers located in zone 10 (P = 0.011).

Based on the findings, the safety status of Tabriz health centers was identified as unfavorable and will not able to provide proper services to their covering population in serious hazards.

The joint operational plan was introduced by Iran’s Ministry of Health and Medical Education in 2015 as a way to improve the quality and efficiency of healthcare services by promoting collaboration and coordination among medical sciences universities. The plan aimed to address issues related to overlapping responsibilities, duplication of efforts, and resource constraints among universities.

This study was conducted to analyze this policy intervention and explore its challenges and opportunities.

Using a qualitative policy analysis approach, this study collected data through documentary analysisandsemi-structured interviews with stakeholders at various health system levels. Research participants were selected using purposive and snowball sampling methods. The collected data were analyzed using the framework analysis approach, supported by the policy triangle framework and heuristic model.

The policy analysis results yielded 14 categories and 29 sub-categories grouped into four overarching themes: Content, context, process, and actors/stakeholders. The content theme included categories such as the plan’s goals, the linkage between the plan’s goals and upstream policy documents, and the consistency between the plan’s goals and the visions and missions of medical universities. The context theme included structural characteristics, economic and financial factors, and social and cultural situations. The process theme included the issue’s priority, service delivery, policy design and formulation, implementation approach, and assessment and evaluation. The actors/stakeholders theme included categories such as the owner and leader of the policy, political support, and ambiguity in assigning responsibilities.

While enforcing a joint operational plan in medical universities can boost performanceandfoster competition, itmay also hinder universities’ ability to pursue innovative interventionsandactivities outside the plan. Toaddress this issue, stakeholders from various health system levels should work together to modify the plan’s development and implementation process. Effective use of planning tools is crucial for ensuring that medical universities and the health system achieve their goals.

This study aimed to comprehensively determine the factors that affect the hospitals’ functionalpreparedness in response to disasters.

A systematic review of studies published in English and Persian up to the end of 2022 was performedby searching PubMed Central, Web of Science, Scopus, ProQuest, SID, and Elmnet databases. Articles thatassessed hospitals’ functional preparedness were searched by using a combination of medical subject headingterms and keywords including disaster, emergency, preparedness, hospital preparedness, health care facilitiespreparedness, hospital functional preparedness, health care facilities functional preparedness, readiness, andeffective factors. Additionally, journals and gray literature were manually searched. Two independent reviewersscreened the eligible papers. The inclusion criteria were the full text should be published up to the end of 2022,in both Persian and English, and focus on hospital preparedness. The extracted data were manually analyzed,summarized, and reported using the content analysis method.

Of the 3465 articles, 105 studies were eventually included in the final analysis. Eighty-two influentialfactors were identified and classified into seven categories: government, coordination, control, and commanding(7 factors), existing guidelines and preparedness plans (12 factors), regulations (6 factors), supplying of resources(37 factors), education and training (8 factors), multi-layered information management and communicationsystems (8 factors), and contextual factors (4 factors).

There are different dimensions of hospital preparedness for disasters, each of which is influencedby several independent factors. Addressing these factors will enhance the actual functional preparedness ofhospitals encountering disasters.

Non-communicable diseases (NCDs) require multifaceted responses from healthcare systems that must complement sustainable healthcare programs.

This study aims to investigate the current state of sustainability of Non-Communicable Disease Prevention and Control Programs (NCP-PCP) and to identify related challenges in various intra- and inter-organizational domains.

This mixed-methods study used a researcher-made sustainability assessment tool and qualitative interviews of 46 managers responsible for implementing NCP-PCP in Iran. Graneheim and Lundman's approach, as well as descriptive statistics, were utilized to analyze the data. The sustainability questionnaire comprised nine domains: environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, communications, strategic planning, and law and governance.

The overall mean score for sustainability was 3.54 ± 0.86, with funding stability (2.79 ± 1.03) and program adaptation (4.24 ± 1.12) receiving the lowest and highest mean scores, respectively. Qualitative data revealed several challenges, including financial instability, lack of budget allocation for such programs, absence of specific mechanisms for program evaluation, inadequate resources, deficiencies in intersectoral cooperation, and failure to utilize hidden community capacities.

It is crucial to maintain and strengthen the current state of program adaptation and program evaluation to ensure the sustainability of NCD-PCP. On the other hand, funding instability is a significant obstacle in prevention and control programs that can bring the entire program to a halt, regardless of its sustainability in other domains.

Overall, the four categories of non-communicable diseases (NCDs) (Cardiovascular disease (CVD), Cancer, Diabetes and chronic respiratory diseases) contribute to over 80% of annual premature deaths, with more than 85% of these occurrences transpiring in low- and middle-income countries. This study seeks to assess the likelihood of premature mortality attributable to these diseases across the provinces of Iran.

Data on causes of death from 2016 to 2019 was extracted from the death registration system of the Ministry of Health and Medical Education. To assess the completeness of the death registration system on a provincial level, we employed a novel method introduced by Adair and Lopez.

From 2016 to 2019, non-communicable diseases, specifically the four primary diseases, constituted 68.98%, 69.44%, 69.17%, and 67.94% of all causes of death in Iran, respectively. During the same period, the probabilities of premature mortality attributed to major non-communicable diseases were 14.95%, 15.15%, 15.25%, and 16.63%, respectively. Notably, Golestan province exhibited the highest probability of premature death.

The percentage of probability of death resulting from non-communicable diseases is a crucial indicator for the prevention and control of NCDs at both the international and national levels. This indicator requires ongoing monitoring to effectively address the issue. Given the diverse socioeconomic and epidemiological circumstances across the provinces of Iran, acquiring a comprehensive understanding of the current situation regarding these diseases becomes imperative. Such knowledge facilitates the development of well-informed planning and policy-making strategies aimed at managing the increasing burden of NCDs and ensuring equitable healthcare provision.

Primary health care system provides appropriate prevention and primary mental care services only for rural population. Therefore, the Community Mental Health Center (CMHC) was developed to provide mental health services in urban areas. The present study aimed to outline the performance, achievements, and challenges of CMHC in Tabriz, Iran.

This was a qualitative pilot study with in-depth interview approach. The outcomes, implications, and challenges of CMHC in Tabriz city were evaluated from 2015 to 2019 using three methods, including conducting in-depth interviews with two executive managers, holding focus group discussion (FGD) with managers and mental healthcare providers, and collecting mental health care indicators from the patients’ health records. After evaluating the challenges, appropriate recommendations to improve mental health services in urban areas were presented.

A total of 17 specialists and general medical doctors collaborated in this study. During the study, 1053 initial visits and/or screenings and 2313 patients with psychological disorders were identified and recorded. Moreover, a total of 988 mental training sessions were held for patients and their families. Five main themes, including the necessity for establishment and objectives, implementation process, achievements, challenges, and recommendations, were identified during in-depth interviews and FGDs.

It seems that CMHC is an appropriate strategy and model for providing basic mental health services, especially in metropolitan cities. Longitudinal studies with a randomized controlled trial design as well as cost-effectiveness evaluation studies are required to confirm CMHC in the Iranian context.

Quality Assessment Frameworks (QAFs) are essential in monitoring progress in the primary health care (PHC) system. Different QAFs are used in countries to assess PHC quality.

This study aimed to review and compare the QAFs and highlight the most frequent quality indicators and dimensions.

This state-of-the-art review was conducted on PHCQAFs. Required data were collected through search in Scopus, Web of Science, and PubMed databases, World Health Organization and World Bank websites, and Ministry of Health websites up to January 2022. The main keywords were quality, “primary healthcare”, PHC, “primary care”, “primary health services”, “basic healthcare”, assessment, evaluation, monitoring, measurement, improvement, indicator, OR index, pattern, framework, and model. Comparative tables were used to compare the defined quality dimensions (QDs) and quality assessment indicators (QAIs).

Finally, 14 PHCQAFs were retrieved, containing 94 QDs and 785 QAIs. Three PHCQAFs were proposed at the international level and others at the national level. Accessibility, coordination, and safety were the most frequent QDs, and QAIs related to smoking, alcohol and substance abuse, diabetes care, vaccination, chronic heart disease care, respiratory/infectious disease care, hypertension care, population coverage, community participation, customer satisfaction, maternal and child health, adverse event, health information management, staff empowerment, referral system, and patient rights were the most frequent among PHCQAFs.

The current study illustrates the similarities and differences between PHCQAFs and highlights important QDs and QIs in PHC. Also, it provides a ready way for health policymakers to address key quality aspects that can help countries accelerate progress in the quality of PHC

Capitation payment is the best-known strategy for paying providers in primary health care. Since health care needs and personal characteristics play an essential role in health care utilization and resource spending, there is a growing tendency on risk adjustment models among health researchers.  The objective of this systematic review was to examine the weights used for risk adjustment in primary health care capitation payment.  

We systematically searched Scopus, ProQuest, Web of Science, and PubMed in March 2018. Two authors independently apprised the included articles and they also evaluated, identified, and categorized different factors on capitation payments mentioned in the included studies.  

A total of 742 studies were identified and 12 were included in the systematic review after the screening process. Risk factors for capitation adjustment included age, gender, and income with the weighted average being 1.76 and 1.03, respectively. Moreover, the weighted average disease incidence adjusted clinical groups (ACGs), diagnostic cost groups (DCGs), principal in patient diagnostic cost groups (PIP-DCGs), and hierarchical coexisting conditions (HCCs) were reported as 1.31, 24.7-.99, 10.4-.65, and 11.7-1.01, respectively.  

In low-income countries, the most effective factors used in capitation adjustment are age and sex. Moreover, the most applied factor in high-income countries is adjusted clinical groups, and income factors can have a better impact on the reduction of costs in low-income countries. Each country can select its most efficient factors based on the weight of the factor, income level, and geographical condition.

The COVID-19 pandemic has caused significant disruptions in the provision of non-communicable disease (NCDs) prevention and control services in many countries, and there is a concern that it would lead to long-term complications of the diseases. The aim of this study is to assess the changes in the provisions of selected NCD services before and after the COVID-19 epidemic in Iran’s primary healthcare system.

In this descriptive-analytical retrospective study, the number of eight NCD services provided during the first 10 months of the COVID-19 pandemic from Feb 2020 to Dec 2020 were compared with the same period in the previous year using the data from the Iranian integrated electronic health record system (SIB) and also the association between the number of deaths due to COVID-19 and a sample of NCD services were assessed using cross-correlation analysis. The statistical analysis was performed in Stata Software v.14.

The NCD services have decreased by an average of 18.89% compared to the same period in the previous year; this decline was much more severe at the beginning of the epidemic period (up to 75% in some services) and was greater in physician-provided services than in non-physician services. Also, examining the course of the selected services during this period, a gradual compensation was evident after the initial reduction.

The general trend of the selected services of prevention and control of NCDs in the PHC system of Iran within 10 months after the onset of COVID-19 showed a sharp decline and subsequent gradual compensation. Although the process of compensation in some services may be considered somewhat reassuring, in the case of some essential services, more effort and attention to the implementation of programs or compensatory policies seem necessary.

Suicide is recognized as a public health issue in Malekan County through a health community assessment. A community-based suicide prevention program was conducted during 2014-2017.

This health system research was conducted in seven steps, including conducting systematic reviews, gathering expert opinions, improving the coverage of suicide attempt records, conducting research to identify regional risk factors, conducting follow ups and managing the individuals attempting suicide, training health gatekeepers, and launching public awareness campaigns. Our goal was to lower the rates of suicide, and suicide attempt by 15% and 20%, respectively. Multiple logistic regression was calculated to estimate the adjusted odds ratios and the 95% confidence intervals.

821 suicide attempts and 32 suicides had been recorded in the county. 70% of the suicides had been committed by men while the majority of attempters were females (64%). Most of the suicides (18cases-56.25%) had occurred in the spring while the majority of suicide attempts (288cases-35.8%) had been recorded in the summer. The common methods (62%) suiciders used were hanging and poisoning, which increased death risk significantly (OR: 8.5, 95% CI: 2.9–76.99). The incidence rates of suicide and suicide attempts reduced from 11.22, and 203 per 100,000 in 2013 to 2.63, and 157 in 2017, respectively. Suicide re-attempts also diminished from 12% in 2013 to 6.7% in 2017.

Suicide, SA, and re-attempt were lowered by 75%, 22%, and 42%, respectively. Practical Implications. The practical framework that emerged out of the present study can be used for generating future suicide prevention strategies. Furthermore, our study highlights the need to consider a wide range of contextual factors when developing suicide prevention programs.

In order to address the community’s health needs during the COVID-19 crisis in 2020, several comprehensive urban health centers affiliated with the primary healthcare system were designated as COVID-19 centers. Considering the importance of evaluating the performance of the mentioned centers and ensuring the continuity of the services provided in accordance with the rules and instructions, the performance evaluation of the mentioned units was conducted from July 2020 to March 2021 in three levels: self-evaluation (first-level evaluation), university evaluation (second-level evaluation) and the evaluation of the experts of the Ministry of Health and Medical Education (third-level evaluation).

This cross-sectional descriptive-analytical study was conducted in all selected COVID-19 centers, including 978 in 63 universities / medical schools across the country in 2020. The sample was selected by census sampling method and included a total of 978 centers. In this study, 28 main criteria in the fields of education and information, safety of staff and clients by observing social distance, use of personal protective equipment, supplying manpower and equipment, disinfection, and work processes, and 91 sub-criteria were determined by using Delphi Technique.

With the criteria and sub-criteria defined in the areas of "community education and information", staff training, observance of social distance, facilities, waste management, manpower supply, supply of medical equipment and work processes, it was identified that in the self-evaluation (first level evaluation), the criterion with the lowest score was "staff training". The lowest score in the evaluation of the level of universities / medical schools (second level evaluation) was related to the observance of social distance in the centers and the highest score in both evaluation levels was related to the criterion of "providing the necessary education to patients regarding prevention and control of COVID-19".

The establishment and setting up of selected COVID-19 centers has been one of the effective measures in controlling and managing the COVID-19 epidemic, which was created as a result of changing the structure of the primary healthcare system. The continuity of service quality of selected centers requires continuous monitoring and evaluation of their performance.

COVID-19 is a global pandemic and has plagued many countries with unprecedented management problems. The rapid spread of COVID-19 around the world has reduced the ability of countries to address and respond to essential health services. Most countries have taken steps to prevent the spread of COVID-19 and improve essential services. The National Mobilization Plan (NMP) against COVID-19 in Iran’s healthcare system was implemented in 5 stages until September 2021. This study aimed to assess and review medical universities' performance in the third step of management and control of COVID-19 to provide documents and reports to be used in similar experiences.

This research is a cross-sectional descriptive study. Data were obtained from electronic records at the primary health care facilities and were analyzed and reported using descriptive statistical methods, including comparative tables and graphs. In order to prepare the report, Excel 2016 software was used. The third step of the NMP against COVID-19 was implemented from August 10, 2020, to November 10, 2020. In this step, while re-emphasizing the importance and necessity of verbal and laboratory screening of COVID-19, essential health services provision was highlighted as "in-person and remote services" for the covered population.

In the third step of national mobilization, 59,109,413 people were screened for COVID-19. During the third step, non-COVID essential services increased compared to the previous three months, with the most significant increase in middle-aged care.

Implementing the third step of NMP against COVID-19 in Iran increased the healthcare service delivery to all target groups, indicating the effectiveness of the third step in the fight against COVID-19 and the provision of Essential Health Services.

As an emerging disease, COVID-19 is considered more than just a health crisis, as it socially affects communities. Therefore, community-oriented solutions via the primary healthcare system can better manage and control this pandemic. The Ministry of Health and Medical Education, and the Deputy Minister of Public Health executive branch, played an influential role in controlling the epidemic with community-based and network-based interventions in the National Mobilization Plan against COVID-19.

This cross-sectional descriptive study aimed to assess the second step of the National Mobilization Plan (NMP) against COVID-19. The data were extracted from the portal of the Network Management Center, Centers for Disease Control and Prevention (CDC), CLIS system, Reference Health Laboratory, and electronic record systems of the public health networks of all universities across the country from April 11 to August 10, 2020, and was analyzed using Statistical Package for the Social Sciences (SPSS) software.

During the second phase, healthcare providers screened more than 42 million people. About 98.4% of this population were diagnosed with no symptoms, and 0.4% were referred to the selected COVID-19 comprehensive health centers for examination and medical procedures. Of all the direct and referred patients of the selected COVID-19 comprehensive health centers, 55.3% had no problems, 37.8% needed to be tested, 3.6% needed to be referred to a hospital, and 3.3% received outpatient care. In the first days of laboratory screening, 11% of PCR tests were positive. By the end of the second step of the NMP against COVID-19, this rate had increased to 25%.

In times of crisis and epidemic conditions, the health network system, and the primary healthcare providers can effectively manage outpatients and reduce the burden of hospitalization. Only 3.6% of outpatients in the network system were referred to hospitals. The rest were cared for and followed up by the primary health care providers. Therefore, strengthening the network system structure and primary health care should be further considered.

In late 2019, the outbreak of COVID-19 disease, with symptoms like the common cold or severe respiratory illness, caused a global public health crisis. In order to control and manage this disease, countries and the World Health Organization (WHO) have adopted various strategies and decisions.This study aimed to describe the initial measures of the Ministry of Health and Medical Education of the Islamic Republic of Iran with a focus on the Deputy Minister of Health in the framework of the national mobilization plan to combat COVID-19.

A mixed method study, including reviewing the documents of different departments of the Deputy Minister of Health in the management and control of the COVID-19 epidemic (qualitative) and descriptive cross-sectional (quantitative) study was conducted between March 2020 and April 2020. In this study, data and information related to all 63 universities / medical schools in the country were collected from the electronic health record systems and the portal of the Network Management Center and analyzed using EXCEL software.

The first step in the national mobilization against COVID-19 was to establish 1200 comprehensive health centers for COVID-19, provide self-assessment portal at salamat.gov.ir, and dedicate telephone lines (406,190, and1666) for COVID-19 distance counseling and tips. About 98% of the people registered in the electronic health record systems (78,315,029 people) were orally screened and evaluated, including 6,220,603 elderly, 262,717 people with diabetes, 3,356,131 individuals with high blood pressure, 29,201 obese people, 517,696 pregnant women and 2,722,659 foreign nationals. Another significant aspect of the implementation of the first step of the national mobilization was a significant reduction in the burden of hospitalization and management of outpatients in the first level of the health system (primary health care).

The COVID-19 epidemic caused a global health crisis, the management of which became the top of the world's health activities. The health sysntem in Iran, using the capacity of the health network system structure and service providers, developed appropriate policies for the management and control of the disease. One of these policies is the verbal screening to combat COVID-19, which has led to the optimal management of this epidemic.

One of the most effective ways to prevent coronavirus disease 2019 (COVID-19) is to perform general vaccination and actively prevent the outbreak at the primary health care level. The present study aimed to review the measures against COVID-19 in Iran from April to September 2021.

A cross-sectional and descriptive study was conducted at the national level from April to September 2021. Data related to COVID-19 vaccination, prevention, care, and outpatient services was collected from databases, including first level electronic health record systems, the portal of Network Management Center, the portal of Infectious Diseases Management Center, and the portal of Health Observatory. The target population of the study included medical universities and schools in Iran. Using a census sampling method, all 63 medical universities and schools in the country were included in the study. The Statistical Package for the Social Sciences (SPSS) version 16 was utilized to analyze the collected data.

In the fifth step of the national mobilization program against COVID-19 epidemic, a total of 1,228 vaccination centers with 6,490 stations were established across the country from April to September 2021. In these centers, more than 47 million doses of the COVID-19 vaccines were injected. At this step, over 15 million people exposed to close contact with infected people were intercepted. A home care team was deployed at each selected health center for COVID-19, providing 532,551 home care services. At the fifth step, the monitoring teams issued 1,015,831 warnings to trading, industrial, or administrative units, which led to the sealing of 73,443 units. Also, more than six million rapid tests were performed in homes and health units. During the same period, 30,843 vulnerable households received support packages.

The national mobilization program to combat COVID-19 in Iran focused on the community and primary health care system. The program was successful in strengthening the health system to expand vaccination and actively prevent COVID-19 epidemic.

The Islamic Republic of Iran's health system is divided into three levels: the first level is the Primary Health Care (PHC) system, the second level includes specialized polyclinics/clinics, general and specialized hospitals, and the third level is the sub-specialized hospitals. Based on the available evidence, Iran's HS has evolved and progressed since 1984, becoming a comprehensive, public-centered, responsive, and cost-effective system, (Figure 1) (1,2).  
During the COVID-19 pandemic, countries reacted differently based on their HS infrastructure and structure, available primary resources (financial and human resources), and the severity of the disease spread. Evidence reveals that most countries relied on their hospitals and health systems to combat the COVID-19 epidemic. However, the health system’s response was slightly different in the Islamic Republic of Iran. Since the early days of identifying cases and preparing hospitals for admission and treatment of COVID-19 patients, the PHC system initiated a comprehensive reaction to combat the COVID-19 pandemic as the first line and the first point of the HS's contact with the community. In this regard, the PHC system determined the principal policies for combating COVID-19 as follows (3):- General vaccination based on the priorities in the national document Provision of active and essential healthcare and services (in-person/remotely)
- Early identification of COVID-19 cases and tracing their close contacts (family/workplace)
- Protection and isolation of vulnerable populations (reverse quarantine
- Ensuring compliance with isolation and quarantine rules (hotel quarantine and house quarantine)
- Development and improvement of outpatient COVID-19 treatment
Different solutions and strategies have been devised to implement and fulfill the determined policies, which can be divided into three general categories:a) Modifying the structure of service delivery
b) Modifying the programs and procedures
c) Improving the methods of service provision
Strategy 1: The first strategy is to make structural changes in the PHC system (Figure 2), which occurred in the first week of the outbreak in the Iran’s PHC system. Through alterations in structure, human resources, duties, and function, 1200 comprehensive urban (1099) and rural (111) health centers were designated as COVID -19 centers for suspected COVID-19 outpatients from rural health houses, urban health posts, rural/urban comprehensive health service centers, and other private centers.

COVID-19, caused by a novel beta-coronavirus known as SARS-CoV-2, was first identified in China in late December 2019. The coronavirus outbreak was officially announced in Iran on February 19, 2020. The official report of the virus spread throughout the country was announced in mid-March 2020. While expanding the coverage of the “Each Home as a Health Post” (HAHP) program, universities recruited health messengers and health volunteers and trained them with the educational content “A Guide to Live with COVID-19”.

This study is a descriptive cross-sectional study. The sampling method was the census method. The required data were extracted using the integrated health system and the portal of the Ministry of Health and Medical Education’s Primary Health Network Management Center. Data were analyzed using descriptive and analytical statistical methods.

The numbers of household health messengers and health volunteers were 11,134,290 and 280,619, respectively. The highest total number of health volunteers and health messengers, with 824803 people, were in Shahid Beheshti University, and the lowest, with 7088 people in Gerash, Iran. Households with health messengers were 11656389, covering 50.1% of Iranian households. The national average score of trained messengers in the COVID-19 training course was 79.2%. In 22 universities/colleges, 100% of the health messengers passed the COVID-19 training course.

Implementing the HAHP program has effectively controlled COVID-19 spread by increasing awareness and promoting self-care in the community. Health messengers and health volunteers were the essential elements of the HAHP program. They identified and referred patients to selected COVID-19 care centers, improving care and services such as interception and support.

The outbreak of COVID-19 in Iran in February 2019 prompted the Iran’s health system to plan for pandemic prevention and control. The national mobilization program (NMP) against COVID-19 was devised to support the sick and vulnerable and promote community awareness and skills regarding the crisis. This study aimed to investigate the role of community health workers (CHWs) in preventing and controlling the COVID-19 pandemic.

The present study is a descriptive cross-sectional study. The census method was used to study 30,034 rural health workers (RHW) and 22,573 urban health workers (UHW) working in medical universities. The required data were extracted using the integrated health system and the portal of the Ministry of Health and Medical Education's Primary Health Network Management Center and were analyzed using descriptive and analytical statistical methods.

More than 78 million people were screened during the first phase of the NMP , more than 42 million during the second phase, and more than 59 million during the third phase. In addition, by the end of the fourth phase of the NMP, 4,278,899 highly vulnerable individuals were screened. According to the health system's report, CHWs administered 28,073,777 vaccines since the implementation of the fifth step (until 04.09.2021)

Considering the facilities and capabilities of primary health care networks in providing prevention, diagnostic, and treatment services, the activity of the primary health network management center and all affiliated units in the implementation of the NMP has been significant since the beginning of this pandemic. Inadequacies in human resources, financial resources, and training planning should all be considered.

In December 2019, a new disease was reported in China that spread rapidly worldwide. This disease is called COVID-19, a viral infection of the coronavirus family. COVID-19 has caused health, social and economic problems around the world. In Iran, the first disease cases were reported in February 2020. This article aimed to describe the results of the fourth step of the National Mobilization Plan against the COVID-19 pandemic.

The information used in this cross-sectional-descriptive study is based on the data recorded in the computer program (Portal) of the Network Management Center of the Ministry of Health and Medical Education.The fourth step was devised to manage and control the COVID-19 pandemic with public participation and coordination between departments. It comprised four teams, including contact tracing, home care, supervisory, and support teams. Excel 2016 software was used to analyze the present study's data, and ArcMap software version 10.8 was applied to draw thermal maps.

In this study, every contact-tracing team consisted of 3.2 members. This number was equal to 3.2, 2.9, and 3.8 people per team for supportive, home care, and supervisory teams, respectively. Also, on average, the contact-tracing teams tracked 135.9 cases per team. This number was 518.6 visits per team for supervisory teams, 75.3 for home care teams, and 52.2 households for support teams. During the program's implementation, 3065.3 PCR tests and 3596.7 rapid tests were taken per 100,000 population, of which 15.5% were positive. The average contact tracing in people with close contact with the infected people was 4.87 per patient with a positive test.

The COVID-19 pandemic challenged all political, economic, social, and health policies and revealed the governments’ inadequencies. Statistical evidence suggests that the measures taken to manage and control COVID-19 in Iran have been valuable and effective. Still, this process depends on the persistence of policies and protocols by the government and society.

 Screening and timely diagnosis of positive individuals is one of the important issues in controlling pandemic of Covid-19. Early and timely diagnosis of asymptomatic individuals, contact tracking, disconnection of Covid-19 transmission chain through early detection of patients and decreasing R0 were the main objectives of the current study.

 The Covid-19 outpatient sampling detection project started in Zanjan province on March 26, 2020 and samples were taken from people suspected of having Corona Virus and people in contact with these patients.

 All 31,937 cases (48% male, 52% female) who had referred to Comprehensive Health Care Centers until May 16, 2020, were selected. A considerable percentage of incidences were observed in Zanjan and Khodabandeh cities. 20% of the examined samples had positive results. A substantial incidence was found in the age group of over 70 -year- old. Following implementation of the outpatient screening project, R0 fell below 1 in the province.

 Prior to the implementation of Covid-19 laboratorial outpatient screening project, the value of R0 was 1.4 in Zanjan province. However, this value fell below 1, after implementation of the laboratorial outpatient screening indicating that the principal way to effectively control Covid -19 is to detect positive cases and manage them.

Highly necessary to evaluate the effectiveness of preventive interventions to prioritize them at the community level. We aimed to systematically investigate the related studies on the effects of fluoride varnish and fissure sealant on dental caries in 6-12 children.

We searched PubMed, EMBASE, Web of Science, Cochrane Library and Scopus databases using Fluoride Varnish, Fissure Sealant, Caries, and Oral Health keywords. The timeframe selected to search for articles is from 2000 to Dec 2020. CMA software: 2 (Comprehensive Meta-Analysis) was used to perform the meta-analysis. The intervention groups in this study were fluoride varnish and fissure sealants, each of them compared to the control groups.

We included nine studies. In the intervention group 84,380 and control group 11,254 individuals were studied. Eight of the studies were Randomized Clinical Trial (RCT) and Field RCT, and two was non-RCT. In the overall Fluoride Varnish efficacy study, 4 were fully effective, 1 was ineffective, and all 4 were completely effective for Fissure Sealant. There was a significant difference between decayed, missing, and filled permanent teeth (DMFT) and decayed, missing, and filled primary teeth (dmft) indices in both interventions and comparison groups. Moreover, the mean difference of DMFT for Fluoride Varnish and Fissure Sealant in the intervention and control groups were -0.55 and -0.29, respectively (P=0.00).

Due to the efficacy of fissure sealant and fluoride varnish in preventing dental caries in children aged 6-12 yr, these interventions can be considered as health priorities of societies and health systems interventions in countries.

Covid-19 pandemic has caused significant disruptions in the provision of non-communicable disease prevention and management services in many countries and there is a concern that this disorder will lead to long-term complications of these diseases; This study aimed to quantitatively analyze the status of some prevention and management services of non-communicable diseases in the primary health care system of Iran during the Covid-19 pandemic.

In this study, the routine data of 8 services related to the prevention and management of non-communicable diseases in the integrated electronic health record system (SIB) within 10 months after the outbreak of Covid-19 were compared to the same period last year.

Non-communicable disease prevention and management services have decreased by an average of 18.89% compared to the same period last year; this decrease was much more severe at the beginning of the epidemic period (up to 75% in some services) and more in the services provided by physicians than in the services provided by non-physicians. Also, observation of the course of selected services during this period showed that after the initial reduction of services, a process of gradual compensation is evident.

like other areas involved in the pandemic, the effect of the Covid-19 epidemic on non-communicable disease prevention and management services in the primary health care system of Iran, has been significant and although partial compensation of some services is promising, more attention and effort is needed to revive the other programs.

Serological surveillance of COVID-19 through conducting repetitive population-based surveys can be useful in estimating and monitoring changes in the prevalence of infection across the country. This paper presents the protocol of nationwide population-based surveys of the Iranian COVID-19 Serological Surveillance (ICS) program.

The target population of the surveys is all individuals ≥6 years in Iran. Stratified random sampling will be used to select participants from those registered in the primary health care electronic record systems in Iran. The strata are the 31 provinces of the country, in which sampling will be done through simple random sampling. The sample size is estimated 858 individuals for each province (except for Tehran province, which is 2574) at the first survey. It will be recalculated for the next surveys based on the findings of the first survey. The participants will be invited by the community health workers to the safe blood sampling centers at the district level. After obtaining written informed consent, 10 mL of venous blood will be taken from the participants. The blood samples will be transferred to selected reference laboratories in order to test IgG and IgM antibodies against COVID-19 using an Iranian SARS-CoV-2 ELISA Kit (Pishtaz Teb). A serologically positive test is defined as a positive IgG, IgM, or both. After adjusting for the measurement error of the laboratory test, nonresponse bias, and sampling design, the prevalence of COVID-19 will be estimated at the provincial and national levels. Also, the approximate incidence rate of infection will be calculated based on the data of both consecutive surveys.

The implementation of these surveys will provide a comprehensive and clear picture of the magnitude of COVID-19 infection and its trend over time for health policymakers at the national and subnational levels.

In recent years, many reforms have been made on the structure of hospital administration, most of which are proposed by Parker–Harding models. Therefore, the purpose of this study is to systematically review global relevant experiences in reforming the hospital governance structure with emphasis on the Parker–Harding model. Required information was collected using keywords autonomization, corporatization, privatization, decentralization, reform, hospital autonomy, governance model, and structural reform in databases such as EMBASE, PubMed, Scopus, SID, MagIran, and other resources. Information on the subjects under study was collected from 1990 to 2020. The content extraction method was used for data extraction and data analysis. Thirty‑nine sources were included in the study. Results of searching for relevant evidence on a variety of hospital governance models (government, board, corporate, and private) based on the Parker–Harding model in four categories including strengths (31), weaknesses (30), outcomes (26), and interventions (21) are outlined. In this study, strengths, weaknesses, outcomes, and corrective interventions were presented for different models of hospital administration that could be used by healthcare policymakers. Also, According to the results of this study, governmental model less recommended.