masoud behzadifar

Estimating the prevalence of food insecurity among vulnerable sub‑groups, especially pregnant women, is significant. This study aimed to estimate the pooled prevalence of food insecurity among Iranian pregnant women and to determine its related factors.

This study constitutes a systematic review and meta‑analysis of cross‑sectional studies involving pregnant women, published between January 2000 and September 2022, in English and Persian on seven databases. Finally, 14 studies were analyzed and synthesized, with the results presented in the form of forest plots. Heterogeneity was investigated using the I2 index and the meta‑regression to evaluate variables suspected of causing heterogeneity. Statistical analysis and synthesis were performed using Stata‑16.

The pooled prevalence of food insecurity among Iranian pregnant women was 45% (95% confidence interval: 37–54%). In a multi‑variable meta‑regression model, p </em>values were significant for the year of data collection and the type of the questionnaire. The adjusted I2 and R2 indices were estimated at 84.47 and 51.46%, respectively. The prevalence of food insecurity among Iranian pregnant women has been estimated at half a million.

Given the high prevalence of food insecurity among pregnant women in Iran, we propose the inclusion of food insecurity screening for this vulnerable demographic within the primary healthcare package. Additionally, we advocate for the allocation of food subsidies to pregnant women confronting food insecurity.

Health technology assessment (HTA) plays a crucial role in enhancing equity within universal health coverage (UHC) by making sure that health technologies are accessible, effective, and affordable for all groups, including those historically underserved. HTA informs policy-making concerning the adoption and prioritization of health technologies to fulfill the needs of the populace, particularly those afflicted with rare ailments and those residing in low- and middle-income nations. Through assessing both the clinical and costeffectiveness of health technologies, HTA identifies the most appropriate options for the needs of the community, thereby facilitating a fairer allocation of resources. Furthermore, HTA ensures the development and evaluation of health technologies are conducted impartially, incorporating the viewpoints and necessities of at-risk groups such as women, children, and the elderly. HTA is instrumental in mitigating healthcare disparities by pinpointing and tackling the elements that hinder equal access to health technologies. For instance, it evaluates the availability and accessibility of health technologies across various regions and demographic groups, identifies obstacles to access, and formulates recommendations to overcome these challenges. HTA is vital in advancing equity in UHC, ensuring that health technologies meet the accessibility, effectiveness, and affordability needs of all, particularly marginalized groups. By addressing healthcare disparities and considering the perspectives of vulnerable populations, HTA promotes transparency and accountability in decision-making and suggests ways to rectify inequities in access to health technologies.

Attention to supporting and treating infertile couples is of great importance in the context of Iran's population policies. Infertility treatment means identifying and addressing the health issues of couples that have caused their inability to conceive. Supporting infertile couples not only helps improve their chances of fertility but also enhances all aspects of their health and well-being. Facing infertility can be considerably challenging for couples, inducing feelings of loneliness, anxiety, and depression. Social and psychological support, through counseling services and mental health assistance, can help couples better cope with these challenges and prevent isolation and depression. Attention to the needs and problems of infertile couples can assist policymakers and relevant organizations in designing cultural and health policies and programs tailored to address this challenge and implement necessary improvements in this field. It is essential to establish a culture that upholds respect for couples experiencing infertility and prevents discrimination against them. By promoting the dissemination of accurate information and fostering a culture of empathy and compassion towards infertility, this culture may reduce social tension and lessen the burdens experienced by those coping with infertility. However, attention to supporting and treating infertile couples is not just one aspect of population policy. Instead, it should be one of the important priorities within the framework of a comprehensive program to strengthen population health. Supporting couples struggling with infertility should also be a significant priority within such a program.

The population of any country plays a crucial role in its economic, social, cultural, and political development. A young population enhances the workforce and economic dynamism of the country. Changes in lifestyle and a series of population, economic, and political policies in recent years have exposed Iran to the risk of population aging and demographic warnings from social researchers. The situation is such that population experts unanimously believe that if the current trend of increasing births and population growth continues, the country will face a major population crisis in the next 30 years. The present study examined the challenges and policy solutions in the field of Iran's population, considering a densely populated future. Considering the age pyramid between 1990 and 2000, Iran has experienced significant population growth, providing an effective and active workforce for the country. According to statistical models, Iran's population is projected to age significantly by 2030 and 2050. The complex issue of increasing fertility and population growth requires comprehensive and balanced measures. Promoting public awareness, financial support for families, social security provision, gender balance, housing facilities, population research, rural development, and collaboration with non-governmental organizations can be considered appropriate policies to increase fertility in Iran. The population issue should not be politicized, with some opposing and others supporting it; everyone should collaborate to address this significant gap. Considering the serious concerns and warnings of the Supreme Leader regarding population aging and the expressed concerns about the decline in population and the inadequacy of the current situation, policies for increasing fertility and population growth are on the agenda. However, all organizations, agencies, and individuals who can contribute to the realization of these policies must actively and seriously participate.

The health care sector is a key sector of every country. In the process of economic development, this sector is considered infrastructure since economic development directly affects the productivity of the labor force and, as a result, the increase in production and economic growth. Therefore, the quality of the health care system may be an important factor in attracting foreign direct investment (FDI), accompanied by infrastructure such as labor, education, and research and development costs. As the level of health care increases in a society, the average life expectancy increases as well. Therefore, the life expectancy index (LEI) is an indicator for measuring the progress or backwardness of countries, and thus, it is necessary to examine the factors affecting it.

This study examined the effect of FDI on the LEI in Iran.

The autoregressive distributed lags (ARDL) method was applied from 1981 to 2020, given the time series nature of the data and to test the research hypotheses. The method shows a capacity to be applied to I(0) and I(1) data simultaneously. the following regression model estimation was utilized to investigate the effect of FDI on LEI in Iran: HIt = c0 + c1 gross domestic product (GDP)t + c2 FDIt + c3 literacy rate (LR)t + c4 human immunodeficiency virus (HIV)t + c5 Urbent + c6 real exchange rate (EXR)t + c7 inflation rate (INF)t + c8 interest rate (IR)t + et.

The outcomes indicated that FDI has favorable and substantial impacts on the health expenditure variable in Iran over short and extended periods. As a result, it can be anticipated that investing in the health care industry should influence society’s economic advancement. Consequently, FDI becomes a significant macroeconomic factor in health care, acting as an extra investment source. With proper strategies, it holds the potential to serve as a crucial tool for the country’s progress, especially in enhancing the health care sector. The results demonstrated that FDI has constructive and notable effects on enhancing the LEI in Iran, both in the immediate and prolonged durations.

Generally, the effects of FDI on health care can be described by direct and indirect channels. From the direct channel, FDI may affect health care outputs directly and indirectly, e.g., by providing a wider range of medical supplies and services (such as drugs and medical equipment), the expansion of FDI in the health care sector, and the presence of foreign firms producing medical or health care products that makes the supplies and services available at lower prices and consequently improves health care. From the indirect channel, FDI may influence the health care status of individuals in society indirectly by affecting other variables. Overall, based on the findings, life expectancy is likely to be improved in Iran by attracting more foreign investments in the health care sector.

The family physician program, as one of the core arms of health care systems, has faced various implementation challenges around the world. Experiences in the implementation of family physician program can be helpful for nations that seek to apply for similar programs. The aim of this study is to systematically review the implementation challenges of family physician program across the world.   

A systematic search was conducted from January 2000 to February 2022 across scientific databases of Embase, MEDLINE, Web of Science, Scopus, CINAHL, EBSCO, and Google Scholar. The Framework approach was used to analyze the selected studies. The quality of the included studies was evaluated using the McMaster Critical Review Form for qualitative studies.  

35 studies upon the study inclusion criteria were included. Based on the Six Building Blocks frame, seven themes and 21 subthemes were developed as the implementation challenges of family physician program. 1) Governance: policy guidance, intelligence, coalition, regulation, system design, and accountability; 2) Financing: financing and payment system; 3) Health workforce: education, research, recruitment and motivation opportunities; 4) Service delivery: management of health services, service package, referral system, continuity of care; 5) Health information systems: production and evaluating the health information system; 6) Availability: provision basic health services, maintenance of facilities; and 7) Cultural considerations: behavior and social determinants of health.  

Scientific governance, financing, and payment mechanisms, workforce empowerment, designing a strong health information system, and providing access to services with cultural considerations can result in the successful implementation of the family physician program in communities.

Non-alcoholic fatty liver disease (NAFLD) can lead to serious complications and have adverse effects on physical and mental well-being in young people. This review aimed to investigate the prevalence of NAFLD among Iranians aged 6 to 18 years.

This study was conducted by systematic review and meta-analysis methods. A detailed search was performed on various international and Iranian databases from January 2000 to January 2023. The international databases included Pubmed, Scopus, Embase, and Web of Science, while the Iranian databases consisted of MagIran and SID. The quality of the selected studies was assessed using the Newcastle-Ottawa  Scale. Overall prevalence was estimated using the random-effects model and DerSimonian and Laird criteria with a 95% confidence interval. The Q-Cochrane test and the I2 index were used to assess heterogeneity between studies. In addition, a sensitivity analysis was performed to ensure the reliability of the results. Data analysis was performed in Stata12 software.

Finally, 9 studies were selected for analysis, of which, 7 studies were of good quality, while 2 studies were of average quality based on the assigned scores. According to the random-effects model, the overall prevalence of NAFLD in Iranian individuals aged 6 to 18 years was 35% with a 95% confidence interval (24% to 46%).

The results of our study revealed a high prevalence of NAFLD in Iranian individuals aged 6 to 18 years. Policymakers and healthcare planners in Iran must implement educational programs aimed at the prevention and early diagnosis of this disease.

Physiological childbirth refers to the natural birthing process that does not involve medical or pharmaceutical interventions. This method is characterized by spontaneous labor, the absence of medical interventions, freedom of movement, and active participation of the mother. Rate of cesarean delivery has been increasing over the past decade in Iran, accounting for approximately 50% of all births in the country as Iranian healthcare officials have also promoted physiological childbirth. In this regard, it is important to recognize that physiological birth is a personal choice; therefore, women should receive the necessary information and support to make informed decisions about their birth experiences. Besides, it is critical to provide the necessary education for healthcare providers and engage with women to address their cultural and social beliefs about childbirth. Additionally, the supportive policies of the government that promote physiological childbirth and educational programs can also be valuable in this regard.

Primary healthcare (PHC) is the best method to provide primary healthcare for the people, and is the most efficient and effective way to achieve and improve a high level of health in any society. Failure to pay attention to PHC and low-quality health services can lead to an increase in various diseases, and consequently a higher number of death toll in any society, which would cause economic damages. PHC in Iran received a lot of attention after the revolution in 1979. In PHC, a healthcare network was established throughout the country. With the development of PHC in the Islamic Republic of Iran, the causes of death have decreased, and the death due to infectious diseases, pregnancy, and childbirth problems have also decreased. Despite the vast achievements of PHC in Iran, in recent years, enough attention has not been paid to its reconstruction and consecration. Lack of sufficient financial resources, non-implementation of family doctors in cities and executive problems in family doctors, lack of human resources, lack of attention to the education of students in the health sector, their lack of students’ interest in learning the activities of this field, and structural and administrative problems are some of the existing challenges. Results of the present study suggest that policymakers in Iran need to invest more in PHC in order to improve health indicators, reduce patient admissions to hospitals, and make more appropriate use of limited financial resources. Using the infrastructure that already exists in this sector and strengthening the network of PHC play an important role in reducing household expenses; also, the position of the family doctor and its functions can be properly implemented in the society.

To assess the cost-effectiveness of sacubitril/valsartan compared with enalapril in patients with heart failure with reduced ejection (HFrEF).

A systematic literature search was conducted searching in major electronic databases from inception to January 1, 2021. All relevant full economic evaluation studies of sacubitril/valsartan versus enalapril for the treatment of patients with HFrEF were identified using ad hoc search strategies. Mortality, hospital admissions, quality-adjusted life years (QALYs), life-years (LYQs), annual drug costs, total lifetime costs, and incremental cost-effectiveness ratio (ICER) were considered as the outcomes. The quality of the included studies was assessed using the CHEERS checklist. This study was conducted and reported in accordance with the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines.

The initial search yielded a pool of 1026 articles, of which 703 unique articles were screened, 65 full-text articles were assessed for eligibility and 15 studies finally included in the qualitative synthesis. Studies show that sacubitril/valsartan reduces mortality and hospitalization rate. The mean of death risk ratio and hospitalization were computed at 0.843 and 0.844, respectively. Sacubitril/valsartan produced higher annual and total lifetime costs. The lowest and highest lifetime costs for sacubitril/valsartan were found in Thailand ($4,756) and Germany ($118,815), respectively. The lowest ICER was reported in Thailand ($4857/QALY) and the highest in the USA ($143,891/QALY).

Sacubitril/valsartan is associated with better outcomes and may be cost-effective compared to enalapril for the management of HFrEF. However, in developing countries such as Thailand, sacubitril-valsartan costs must be reduced to yield an ICER below the threshold.

Big data refers to large and complex data sets that cannot be easily processed, managed, or analyzed using traditional data processing tools and techniques. The role of big data in health encompasses a wide range of applications that leverage large and complex data sets to improve health outcomes and healthcare delivery. The goal of universal health coverage (UHC) is to ensure that everyone has access to the health services they need when and where they need them, without financial barriers or catastrophic health expenditures that can lead to poverty. Big data in Iran’s health system has the potential to significantly improve healthcare delivery, enhance patient outcomes, and reduce healthcare costs. Moreover, big data can assist in ongoing monitoring and evaluating the progress toward achieving UHC goals in Iran. 

The health sector (health care sector) is considered one of the key sectors in every country and is known as an infrastructure in economic development since the factor directly affects labor productivity and increases production and economic growth. Thus, the health system’s quality may be considered a crucial and attractive factor of foreign direct investment (FDI) along with infrastructures like education, labor, and research and development costs.

The present study evaluated the short-term and long-term impacts of foreign direct investment on the development of the health sector.

According to the time series data, the ARDL method tests the research hypotheses from 1981 to 2020. The present method can use data of nature I (0) and I (1) simultaneously.

During the years 1982 to 2021 with the increase of foreign capital in the health sector of Iran, health indicators have changed significantly. The rates of some diseases have decreased and in the meantime, the financial resources needed for the health sector have been provided to some extent. According to the coefficients, the highest impact on health expenditures in the short term, foreign directs investment and the lowest impact on the percentage of people living with AIDS.

The research findings indicate that foreign direct investment has had positive and significant impacts on the development of the health sector in Iran in both the short and long terms.

Since the discovery of the SARS-Cov-2 coronavirus on December 30, 2019, in China, and the declaration of the COVID-19 pandemic on March 11, 2020, healthcare systems and economies around the world have faced unprecedented challenges. The impact of the crisis on non-communicable diseases and the delivery of related services, which could lead to a second crisis, has been a particular source of concern. We review the world's experience in this area here.

This is a systematic review of studies related to the effects of COVID-19 pandemic and non-communicable diseases (NCDs) on eachother, and its impact on provision of related healthcare services for NCDs, carried out in 2021 by defining search keywords and database including PubMed / MEDLINE ، ISI / Web of Sciences (WOS) and Scopus.

625 articles were found in the first search, that 98 duplicate onees were removed. Following a review of the article titles, 216 studies were removed as well. The abstracts of the articles were then reviewed, and 139 items were removed too. Finally, the study included 81 articles that met the previously mentioned criteria. The studies' findings were divided into seven groups: increased disease severity, decreased referrals to medical centers, decreased care delivery, increased anxiety and depression, decreased diagnosis of diseases, reduced elective surgeries, and strategies used to provide services to patients.

A review of country policies and experiences and the loss of thousands of human resources in the field of health during the Covid-19 pandemic crisis showed that country governance systems should prioritize capacity building and updating action plans to deal with similar crises. In the meantime, a resilient national program for the prevention and effective fight against NCDs, as the most important cause of death of citizens that is also preventable, and its uninterrupted implementation during crises of the health system is of fundamental importance

According to the World Bank, the medical tourism industry in 2016 generated more than $100 billion revenue turnover for the destination countries. This study aims to investigate the developmental requirements of medical tourism industry in Iran to identify sustainable development strategies within this sector.

The present study was an applied-analytical study performed in a cross-sectional manner. A total of 25 experts, including policy experts, decision-makers, and managers with over 10 years of experience in the health system and familiar with the process of attracting medical tourists from foreign countries were asked to compare options for the development of the medical tourism. Expert opinions were analyzed using a fuzzy analytical hierarchy process using the open-source R Studio software.

Out of the 5 items included in the questionnaire, the criterion of "government policy making and related entities" was ranked the first in terms of importance and prioritization for medical tourism development (0.249) through attracting domestic and foreign investments followed by advertising and marketing (0.241). Also, the criteria of "destination characteristics" and "facilities and status of service capacities with 0.111 and 0.185 weights had the lowest weight among the 5 items, respectively.

In general, governments play a key role in marketing and promoting the nascent medical tourism industry. Experts in the field believe that the role of government, policy and decision-makers in medical tourism can be an advantage for its prosperity and development.

Various frequency rates of occult hepatitis B virus infection (OBI) are reported from different parts of Iran. This systematic review and meta-analysis aimed to characterize the OBI epidemiology in Iran and estimate the pooled prevalence among different populations.

Nine international and Persian electronic databases, as well as some conference proceedings, were searched. Original cross-sectional studies up to December 2018 were included if they investigated the prevalence of OBI by the detection of serum hepatitis B virus surface antigen and hepatitis B virus nucleic acid in at least 30 samples selected with any sampling methods. Comprehensive meta-analysis software was used to analyze the data, and Cochran’s Q-test and I-square statistics were applied to assess the heterogeneity. Meta-regression analysis was performed to assess the impact of the year of study on the OBI frequency. A P value < 0.05 was considered as the level of significance.

Of 412 citations found in electronic sources and 35 relevant citations added by searching the gray literature, 83 non-duplicated non-overlapping studies were evaluated. A total of 55 documents comprising 14,485 individuals from 16 provinces met the inclusion criteria and were used in the analysis. The prevalence of OBI considerably varied in different parts of the country with the highest prevalence (63.1%) reported among the HIV-positive population in Fars province. The rates of the OBI prevalence were estimated at 0.06% (95% CI: 0.02 - 0.16%) among blood donors (BDs) regardless of their anti-HBc status, 7.90% (95% CI: 4.33 - 13.99%) among anti-HBc positive BDs, 2.49% (95% CI: 1.2 - 4.81%) among hemodialysis (HD) patients, 4.44% (95% CI: 1.56 - 12.02%) among HIV-positive patients, and 7.76% (95% CI: 4.57 - 12.86%) among HCV-positive patients. No significant trends were observed in OBI prevalence rates among different groups over time (P > 0.05).

This review revealed high rates of OBI prevalence among high-risk populations in Iran. It is strongly suggested that occult hepatitis B be investigated among populations with a high chance of its occurrence in our country.

In recent years, increased longevity, poor dietary habits, and the rising prevalence of metabolic syndrome and hypertension have increased the prevalence of gout. Gout significantly increases direct and indirect costs and reduces the quality of life. Allopurinol and febuxostat are the most commonly used drugs for reducing uric acid levels and controlling this disease with different cost-effectiveness. The present systematic review compares the cost-effectiveness of these drugs.

This was a systematic review of economic evaluations. Cochrane CENTRAL, Web of Science, PubMed, Embase, and the Cost-Effectiveness Analysis (CEA) Registry were searched up to April 30, 2018, based on the specific search strategy of each database. Keywords used in the search include gout, cost-effectiveness, allopurinol, and febuxostat in MeSH and free-text forms. Screening of identified studies, data extraction, and quality assessment were done independently by 2 reviewers. The quality of studies was assessed based on Drummond Checklist. Finally, a qualitative analysis was done to analyze the results.

A total of 94 studies were identified through database search and the review of references. After screening the titles, abstracts, and full-texts, 6 economic evaluations were included in the review. The majority of the studies had been conducted in the US using the Markov model, within a 5-year horizon, and from the payer’s perspective, with the quality of life as a measure of effectiveness. In most studies, the incremental cost-effectiveness ratios (ICERs) of febuxostat per quality-adjusted life year (QALY) were below the threshold (10 000$/QALY and 30 000€/QALY).

Febuxostat has been shown to be more cost-effective than allopurinol in all treatment sequences in studies that have used uric acid levels as the measure of effectiveness. Furthermore, in studies with the quality of life as the measure of effectiveness, febuxostat has been shown to be very cost-effective as the second-line treatment.

Policy- and decision-making is of extreme importance in the health-care sector, and, in this regard, policy- and decision-makers try to take into account all aspects of health policy and use all the levers necessary for its effective implementation. In the health policy process, individuals, groups and organizations can have an impact, in that they are trying to influence health policies by fulfilling their demands. Social media can play an important role too in improving and increasing awareness among health policy- and decision-makers and people, and, therefore, they can have an influence as one of the most important actors in the health policy process. Health policy- and decision-makers should try to be able to interact with social media before implementing a policy. Of course, the purpose of this interaction is not to align the social media to the unconditional implementation of a policy. The goal is to better explain the challenges and problems created by implementing a policy to better inform public opinion and increase its awareness. Unfortunately, some healthcare providers do not have a proper relationship with social media. Failure to support social media from health-care policy- and decision-makers can have adverse health outcomes.

In different societies, paying attention to spiritual dimension of health has been emphasized as one of the health dimensions according to the WHO. The study aimed to determine the relation between spiritual health and use of virtual social networks among high school students in Firouzabad, Fars province in 2017.

In the cross-sectional study, 380 students (16-18 years) were selected using the multistage stratified sampling. Data collection instruments included demographic information questionnaire, virtual social network use questionnaire, and Poltzea and Ellisons questionnaire of spiritual health assessment.  
To analyze the data, analysis of variance, Pearson correlation coefficient, and logistic regression tests were used.

The mean score of spiritual health was 83.98 ± 17.01 and had a significant correlation with education level (p<0.001) and internet use time (p=0.02). A significant correlation was found between virtual social networks use and monthly income, (r=0.17) religions health (r= -0.64), individual health (r= -0.11), and total score of spiritual health (r= -0.09). Most of the students (65.77%) had internet access and the most frequently used virtual social network was WathsApp. Logisitc regression revealed that the mean score of desirable spiritual health among students who used virtual social networks for 11-20 , 21-30, and >30 hours per week were 0.83 , 0.72, and 0.27 times lower than the students who used these networks less than 10 hours a week.

Internet access was higher in male students than female and the spiritual health was at the average level in both genders. Regarding the effect of virtual social networks on students and its increasing expansion, the issue must be considered by authorities.

Human cytomegalovirus (CMV) able to cause infection for an entire lifetime. This systematic review and meta-analysis was conducted to determine seroprevalence of CMV among women of reproductive age in Iran. English and Persian databases such as Web of Science (WOS), PubMed, Scopus, Cochrane Library, SID, Iran doc, Iran Medex, Magiran, and Medlib were searched (from 2008 to 2017) accurately using the key-words: Cytomegalovirus, Pregnant women or Pregnancy, Epidemiology, Prevalence and Iran. Results of 15 studies with total samples of 5253 persons from 2008 to 2017 were combined and meta-analyzed. The pooled prevalence rate of IgG among women was estimated 90% (95% CI: 87-93%). The highest prevalence rate of IgG was in Tehran, Rasht, Mashhad and Yasoj, all 100% (95% CI: 100-100%), and the low-est prevalence was in Jahrom 0.62% (95% CI: 53-71%). The overall prevalence rate of IgM among women was estimated at 0.06% (95% CI: 0.03-0.13%). The highest prevalence rate of IgM was in Kerman 0.34% (95% CI: 0.29-0.39%) and Mashhad 0.25% (95% CI: 0.2-0.31%), and the lowest prevalence was in Yasoj 0% (95% CI: 0.00%-0.00%) The prevalence of immunity in Iran, is satisfactory. Nevertheless, to maintain and increase the level of immunity across the country, it is necessary to routinely screen the women of reproductive ages across the country.

Burnout is one of the main factors in reducing the performance quality among hospital staff. Appropriate interventions can reduce burnout among physicians and nurses and result in promotion of the quality of services provided at hospitals. The present study aimed to provide a more comprehensive understanding of the interventions on burnout reduction among hospital physicians and nurses.

Studies were searched from January 2000 to June 2017 in PubMed, Embase, Scopus, Cochrane, and Web of Science. Randomized clinical trials (RCTs) and pretest-posttest studies that had interventions to reduce the burnout of physicians and nurses were included. However, studies conducted on medical and nursing students and nonmedical providers or beyond hospitals were excluded. 

Based on the study inclusion criteria, 12 RCTs and 6 pretest-posttest studies were included in the review. Most of the included studies were from Netherlands, the United States, and England. The interventions included team-based program, EMH-approach, and coping and communication skills training. Most of the interventions had a positive effect on burnout reduction. Nevertheless, some studies had no significant impact.

The results showed that the most interventions used to improve burnout were improving communication skills, teamwork, participatory programs, and psychological interventions (Yoga, meditation, and mindfulness). The impact of these interventions can increase mental health in the long term. Burnout is a complicated problem and should be treated by combining interventions.

Context: Emergency department is the first place in the hospital that patients refer to receive services, and patients often experience an emergency referral in their lives. Emergency care and paraclinical services are provided to patients in this department. The current study aimed at evaluating the patients’ satisfaction with emergency department in Iran through a systematic review and meta-analysis. Evidence Acquisition: The databases including Web of Science (WOS), Embase, PubMed, Scopus, Ovid, as well as the Iranian databases such as Irandoc and Magiran in the Persian and English languages were searched from 2000 to 2017. The STROBE (strengthening the reporting of observational studies in epidemiology) checklist was used to assess the quality of the research methodologies. The random model was used to determine the mean value of satisfaction and the results were reported with the confidence interval (CI) of 95%. Also, sensitivity analysis, subgroup and meta-regression were conducted. The Egger test was used to investigate the publication bias in the studies. Based on the random model, the mean of satisfaction with emergency services in Iran was 70.52% (95% CI: 63.81 - 77.23). The results of sensitivity analysis showed no change before and after the analysis of the results. Highest and lowest rates of patient satisfaction were reported in the Eastern (79.17%) and Northern regions (67.15%) of Iran, respectively. The current study findings showed that patients’ satisfaction with emergency services in Iran was high compared with the neighboring countries. Health policymakers should increase patients’ satisfaction through appropriate training, information, and increased human resources

Out-of-pocket (OOP) expenditure directly impacts on poverty and household welfare, especially when there is a decline in healthcare financing. This study was aimed to describe the temporal pattern of OOP expenditures related to Iranian healthcare services during 1995-2014. For describing the trend of OOP spending in Iran, the database of the World Bank was mined for the period under study. Further, the trend analysis has been complemented by an exhaustive and comprehensive review of the extant literature. From 1995 to 2014, out-of-pocket decreased from 53.59% to 47.8% of the total health expenditure, probably because of the different health reforms implemented throughout the years. However, out-of-pocket expenditure in Iran remains higher than the world average (roughly 3 times higher) It is an onus of the Iranian government to make serious attempts in order to reduce out-of-pocket expenditure, as well as to protect particularly poor and vulnerable subjects against catastrophic health expenditure. In order to ensure an equitable and affordable access to the healthcare system, decision- and policy-makers in Iran should implement a review of health care costs, insurance tariffs, and healthcare services packages covered by insurance organizations as well as introduce a progressive tax-based financing scheme as soon as possible.

Out-of-pocket (OOP) expenditure directly impacts on poverty and household welfare, especially when there is a decline in healthcare financing. This study was aimed to describe the temporal pattern of OOP expenditures related to Iranian healthcare services during 1995-2014. For describing the trend of OOP spending in Iran, the database of the World Bank was mined for the period under study. Further, the trend analysis has been complemented by an exhaustive and comprehensive review of the extant literature. From 1995 to 2014, out-of-pocket decreased from 53.59% to 47.8% of the total health expenditure, probably because of the different health reforms implemented throughout the years. However, out-of-pocket expenditure in Iran remains higher than the world average (roughly 3 times higher) It is an onus of the Iranian government to make serious attempts in order to reduce out-of-pocket expenditure, as well as to protect particularly poor and vulnerable subjects against catastrophic health expenditure. In order to ensure an equitable and affordable access to the healthcare system, decision- and policy-makers in Iran should implement a review of health care costs, insurance tariffs, and healthcare services packages covered by insurance organizations as well as introduce a progressive tax-based financing scheme as soon as possible.

Visit length is an indicator that can be used to assess patients’ satisfaction of the health care services. In recent years, some studies have focused on the mean visit time in Iran. This study aimed at determining the average visit time in Iran by performing a systematic review and meta-analysis.

In this study, Embase, PubMed/MEDLINE, Scopus, ISI/Web of Science databases, and Google Scholar search engine, as well as Iranian national databases/thesauri, such as MagIran, SID, and Irandoc were used. These databases were searched from their inception until September 2017. The quality of retained studies was assessed using the STROBE checklist. Average visit length was reported using stochastic model with 95% confidence interval (CI). I2 and Q tests were used to assess the heterogeneity of the studies. A sensitivity analysis was conducted to ensure the stability of the results.

After searching the scholarly databases and reviewing the articles based on inclusion and exclusion criteria, 6 studies were finally selected. Based on the random model, the mean visit time was 4.89 minutes in Iran, ranging from 4.66 to 5.12 minutes (p=0.82). The most time visit in specialists belonged to psychiatrists with 9.12 (7.28 to 10.96) minutes (p=0.19) and the lowest belonged to internists with 3.59 (2.24 to 4.95) minutes (p=0.00), respectively.

The average visit time in Iran was estimated to be 4.89 minutes. To increase patients’ satisfaction and provide a better disease treatment and management in Iran, the following suggestions could be helpful: properly distributing physicians across the country, reducing waiting lists, and implementing the use of guidelines to standardize the visit time.

Nosocomial infections represent a serious public health concern worldwide, and, especially, in developing countries where, due to financial constraints, it is difficult to control infections. This study aimed to review and assess the prevalence of nosocomial infections in Iran.

Different databases were searched between January 2000 and December 2017. To determine the pooled prevalence, the stochastic DerSimonian-Laird model was used, computing the effect size with its 95% confidence interval. To examine the heterogeneity among studies, the I2 test were conducted. The reporting of observational studies in epidemiology (STROBE) checklist was used to assess the methodological quality of observational studies. To further investigate the source of heterogeneity, meta-regression analyses stratified by publication year, sample size and duration of hospitalization in the hospital were carried out.

52 studies were included. Based on the random-effects model, the overall prevalence of nosocomial infection in Iran was 4.5% [95% CI: 3.5 to 5.7] with a high, statistically significant heterogeneity (I2=99.82%). A sensitivity analysis was performed to ensure the stability results. After removing each study, results did not change. A cumulative meta-analysis of the included studies was performed based on year of publication and the results did not change. In the present study, a high rate of infections caused by Klebsiella pneumoniae (urinary tract, respiratory tract, and bloodstream infections) was found.

Preventing and reducing hospital infections can significantly impact on reducing mortality and health-related costs. Implementing ad hoc programs, such as training healthcare staff on admission to the hospital, may play an important role in reducing infections spreading.