فهرست مطالب mahdiyeh heydari

Youth is undeniably the most important resource of any country. This study aimed to determine the trend of mortality rate and the cause of death, based on the ICD-10, among young people in Iran and examines significance of the changes in any cause during the last three decades.

The present study is a secondary analysis of data, which examines the trend of death rate and its causes among young adult, aged 15-24 yr, longitudinally during 1990-2019. The data source was the GBD website. Linear Regression analysis was used to measure the slope of changes in mortality rates and causes of death during the period, where "time" was the independent variable and "mortality rate" and "causes of mortality" were dependent variables.

The death rate of young people declined by 56% during the period, equal to an average of 2.17 units per year. The most common cause of death has been injuries (69%), then NCDs (25%), and finally communicable diseases (6%). However, death due to injuries (except SUD), communicable diseases (except HIV), and NCDs (except musculoskeletal disorders) declined significantly by 1.43, 0.3, and 0.09 units per year, over 30 yr respectively.

Examining past trends in death rates and causes strengthens insights into the state and future trends in health and death-related indicators, which are crucial for policy-making, especially in developing countries with limited resources.

A health crisis can disrupt primary health care where telemedicine technology can facilitate the delivery of healthcare services. This study aimed to identify telemedicine applications in primary health care during a crisis.This research was conducted by scoping review method. All studies had been systematically searched through "Web of Science", "Embase", "PubMed", "MEDLINE", "SID", and "Magiran" databases with appropriate keywords in three groups: "telemedicine", "primary health care" and "health crises". Among 2949 screened studies, 76 were included in this research. Finally, the studies were analyzed using the framework analysis method in MAXQDA software. A total of 47 applications were found for telemedicine in primary health care in critical situations, which were classified into 6 areas including teleconsultation, e-learning, remote monitoring, source of medical information, decision support, and patient self-management. The most common medical applications were remote visits, patient consultation, patient education at home, provider screening, self-management of COVID-19 disease, and psychological and social support for patients. Telemedicine technology enables the control and management of crises that arise in health and treatment fields. By improving access, promoting interaction between specialists in urban and rural areas, reducing costs, and reducing mortality and disability, telemedicine provides socioeconomic benefits to patients, providers, and the health care system.

Health financing system is the process of collecting, pooling and managing financial resources to purchase healthcare services and promote, restore or maintain people health. An increase in health expenditure and the governments’ inability to commit sufficient resources introduces challenges to the sustainability of health system financing. This study was conducted to identify sustainable health financing methods in developed countries.

This study was a scoping review research. All studies related to the sustainable health financing solutions in developed countries were searched using appropriate keywords in “PubMed”, “Scopus”, “Science Direct”, “Web of Science”, “Magiran”, “SID” and “Iranmedex” databases and two search engines “Google” and “Google scholar”. Finally, 38 studies were selected and analyzed using the framework analysis method and MAXQDA software.

Overall, 30 solutions were identified for sustainable financing of the health system of developed countries and categorized into three sections: collecting financial resources, pooling and managing financial resources, and purchasing healthcare services. Strategic purchasing, reducing induced demand, using prospective payment methods, consolidating multiple insurance funds, using an efficient patient referral system, using clinical guidelines, public-private partnerships, value based health services package and introducing new innovative health insurance schemes were the most frequent solutions for sustainable health system financing in developed countries.

Innovative solutions are used to strengthen the sustainability of the health financing system in developed countries. Iran’s policymakers can sustain the country’s health system financing by adopting and adapting these solutions.

The Primary Health Care (PHC) system is the most comprehensive, equitable and efficient way to promote people's health and social welfare by providing preventive, curative, rehabilitative and palliatvie services in a place close to where people live and work. Iran's PHC system faces challenges that limit its effectiveness and efficiency. The aim of this study was to identify strategies to strengthen Iran's PHC system.

A realistic review method was used in this research. Published articles on strategies to strengthen the PHC system between 1978 and 2019 were searched in eight databases and Google scholar search engine. Finally, 29 articles were found to be eligible for inclusion in this study; framework analysis was done using the MAXQDA-10 software. 

Twenty-nine strategies were identified for strengthening the PHC system. A well designed PHC system is one with the following characteristics: realistic goals and appropriate strategies  equipped with necessary resources, organized in multidisciplinary teams that provide comprehensive and quality health services (intervention program), with strong governance and leadership, financing, work force, equipment and medicines, information systems and robust health services delivery processes and well adpated to the external environment (context). Such a PHC system will increase healthcare providers’ satisfaction and commitment, as well as the  patients’ trust, participation and satisfaction (the mechanism) and, finally, promotes, restores, and maintains the people health (result).

A strong PHC system is a pre-requisite for strengthening a health system. Various strategies such as strengthening management and leadership, improving organizational structure and culture, improving the information system, empowering human resources and increasing population coverage can lead to an improved PHC system. Historical, social, cultural and economic factors affecting the health system should be considered in redesigning and stregtening a PHC system.

Universal Health Coverage (UHC) is a strategy for achieving the goal of equity of access to health care for all with preventive, curative and rehabilitative measures and without suffering financial hardship. UHC leads to equitable distribution of health care services, reducing out-of-pocket payments and achieving better health outcome for all people. Some measures have been taken in Iran to achieve UHC. However, the Iranian health system has not yet achieved the goal of UHC.

The narrative review method was used to write this article.

Implemention of UHC in Iran requires a comprehensive strategic plan. Futurology is the science and art of forecasting, planning, and backcasting.  Forecasting is a process which can predict probable future scenarios using trend analysis. Planning is the process of identifying strategies and taking necessary measures to achieve a favorable future. Finally, backcasting allows to identify the opportunities and barriers to achieving the goals.

Futurology can be used to develop a roadmap for UHC in Iran. Awareness of possible future opportunities and risks and taking appropriate measures will help achieve the goal of UHC.

The realist review has been introduced to review and synthesize the evidence related to the implementation of complex healthcare interventions. This method interprets the results of an intervention by explaining the causal relationships between the intervention and the results. This study aimed to explain the methodology of realist review in the health system.

This study was conducted using the scoping review. The following databases were used to find articles using appropriate search strategies and relevant key words: Pubmed, Scopus, Science Direct, and Embase electronic databases, as well as Google Scholar and Google search engines. Finally 49 articles were selected (in the period between January 1990 and December 2020) for review.

The realist review is a theory-based approach to synthesize evidence related to the complex interventions, explaining the reasons for the successes or failures of interventions based on the causal relationships between the interventions, contexts, mechanisms and outcomes. A protocol was introduced to conduct a realist review composed of three phases ─ explaining, development and correcting the intervention program theory ─ and including seven steps of determining research questions; explaining the initial program theory; developing search strategies; collecting, evaluating and selecting evidence; synthesizing evidence; modifying the initial theory; and making suggestions. In addition, the structure of a realist review article was described and a checklist for evaluation of a realist review study was introduced.

The realist review is a suitable method for reviewing the complex health system interventions, explaining how an intervention relates to the results obtained. A realist review explains how, under what conditions and for whom a health and therapeutic intervention works.

Medical tourism is a relatively new concept with rapidly growing application. It is defined as purposeful travel to receive the health services provided in other countries and is underlain by patient satisfaction as one of the quality indicators that primarily attract medical tourists. The purpose of this study was to systematically review the factors that affect the satisfaction of people who travel to other countries to receive medical treatment. Evidence Acquisition: To identify contributors to the satisfaction of medical tourists, we conducted a systematic review between July 2016 and March 2017. The Preferred Reporting Items for Systematic Reviews and Prizma checklist was used as a guide for the review. The quality of the papers was examined independently by two of the researchers using the Kmet checklist. Further filtering left us with a final sample of 20 studies, which were subjected to content analysis using the input-process-output (IPO) model. The factors identified were then represented in the IPO model. A total of 376 studies were obtained from 9 English and Persian databases using 6 main search keywords. The specific keywords used were “medical tourist,” “health tourist,” “health tourism,” “medical tourism,” “satisfaction,” and “consent.” were searched from the databases of Scopus, Web of Science, Science Direct, ProQuest, Embase, Ovid, magiran and SID. The examination of the studies yielded 137 effective factors that influence the satisfaction of medical tourists. The factors were classified into six categories, namely, services, manpower, information, costs, physical conditions, and health equipment. Among these categories, the service domain encompassed most of the influencing factors. The satisfaction of medical tourists is determined by different factors, among which satisfaction with the provision of services has been of great interest to medical tourists. Specifically, medical tourists evaluate the manner by which health care providers offer services, the quality of care that they receive, and the behavior of hospital staff. The results present implications for destination countries in their efforts to enhance the positive features of their services and address those that negatively affect the satisfaction of medical tourists.

To compare the stewardship of road traffic accidents (RTIs) prevention in three pioneer countries and three similar ones to Iran. In this descriptive comparative study, the United States of America, Sweden, and Brazil as the pioneer countries in RTIs prevention were compared to the India, Pakistan, and Turkey as the countries socioeconomically similar to Iran. Embase, PubMed, Scopus, IranDoc, IranMedex, SID, and MagIran were searched. Also a hand search conducted on websites and search engines using related keywords. In the pioneer countries in RTIs prevention there was a delegation to a particular organization. In the other three countries a part of the Ministry of Transportation had the overall responsibility of RTIs. In Iran there was uncertainty in the stewardship of RTIs prevention. There was little evidence on the role and activities of health systems in RTIs prevention. It seems necessary to define a lead agency organization on RTIs prevention in Iran with sufficient authority and resources. This study also recommends conducting reliable studies to investigate the possible roles that the health system of a country can assume regarding the RTIs prevention.

  Need to assess the health system performance, various models and frameworks have been developed by different groups and organizations. This study explores health system performance assessment frameworks using the comparative-analytical study.

This is a comparative-descriptive study conducted using descriptive-prescriptive method based on comprehensive comparative analysis. The scope of research includes health system frameworks. The study results compared and interpreted based on identified factors in comparative tables.

Overall, 11 frameworks out of 16 ones described, analyzed and compared to each other. Some of the frameworks in addition to providing insight about the health system have focus on assessment of health system performance. Each framework follows especial goals which focus on importance the health systems assessment.

During the time, health system frameworks have changed and developed according to the health systems changes. Developed Frameworks in recent years are more comprehensive than others which have been presented at first. Utilizing these frameworks in order to identify health system goals, assess based on responsibility (organizational actions or outside the organizations) and ways to reach them can be effective. Using the developed frameworks based on their domains and objectives can be considered in health system performance.

  To perform a systematic review and meta-analysis of self-immolation epidemiology and characteristics in Iran. This was a systematic review and meta-analysis study. PubMed, Scopus, Web of science and Science Direct were searched for English literature and SID and Magiran for Persian in the time period of 2000 to 2016. The retrieved studies were screened and reviewed then quality assessed. Random Effect model was applied for meta-analysis. The qualitative data were analyzed by content analysis method. After literature screening, 39 studies included in the analysis. Women were subject to self-immolation more than men. The rate of self-immolation estimated to be 4.5 cases in every 100,000 populations and it was the reason of 16% of hospitalized burns. The average length of hospital stay calculated to be 12.24 (95% CI: 8.85-15.59) days. The total burnt surface area was 65.3% (95% CI: 56.71-73.89). Death due to self-immolation was 62.1%. The major risk factors of self-immolation were having mental health issues, family problems and characteristics and problems in relation/communication with spouses. Despite the low rate of self-immolation in Iran, it comprises one sixth of the hospitalized burns. The mortality rate of self-immolation also is high and this highlights the importance of providing special care. Psychological consultations and mental health screening in the primary health care would help to prevent the self-immolation

Stroke has an unexpected and destructive effect on patient's lives and affects their quality of life. The aim of this study was to evaluate the quality of life and its related factors in patients with stroke in Tabriz city.
Material and This was a descriptive-analytic, cross-sectional study. The study population consisted of all patients who visited the neurological department of the Razi Hospital in 2015 with a diagnosis of stroke in Tabriz city. The quality of life in 72 patients was assessed by the quality of life questionnaire (SIS-16) using census method. To evaluate the relationship of quality of life with demographic variables and clinical features, one-way ANOVA and t-test were applied using SPSS (version 23) software.
In this study, the mean of total quality of life score was 73.66 ± 29.18. Results showed that there was a significant relationship between educational level and physical therapy with quality of life (p 0.05).
According to the results of this study, patients’ quality of life is reduced after stroke. To prevent side effects and improving the damages made, rehabilitation services (physical therapy) can be applied. Therefore, according to the importance of rehabilitation for stroke patients, it is suggested that access (physically and financially) to rehabilitation and counseling services are provided.

To review the effectiveness of Road Traffic Injuries (RTIs) interventions implemented for prevention of RTIs in Iran and to introduce some methodological issues.
Required data in this systematic review study were collected through searching the following key words: "Road Traffic Injuries", "Road Traffic accidents", "Road Traffic crashes", “prevention”, and Iran in PubMed, Cochrane Library electronic databases, Google Scholar, Scopus, MagIran, SID and IranMedex. Some of the relevant journals and web sites searched manually. Reference lists of the selected articles were also checked. Gray literature search and expert contact was also conducted.
Out of 569 retrieved articles, finally 8 articles included. Among the included studies the effectiveness of 10 interventions were assessed containing: seat belt, enforcements of laws and legislations, educational program, wearing helmet, Antilock Braking System (ABS), motorcyclist's penalty enforcement, pupil liaisons’ education, provisional driver licensing, Road bumps and traffic improvement's plans. In 7 studies (9 interventions) reduction of RTIs rate were reported. Decreased rate of mortality from RTIs were reported in three studies. Only one study had mentioned financial issue (Anti-lock Brake System intervention). Inadequate data sources, inappropriate selection of statistical index and not mention about the control of Confounding Variables (CV), the most common methodological issues were.
The results of most interventional studies conducted in Iran supported the effect of the interventions on reduction of RTIs. However due to some methodological or reporting shortcoming the results of these studies should be interpreted cautiously.