mehdi jafari

Nurses often experience high levels of job burnout due to heavy workloads and stressful conditions, which can have a negative effect on the quality of nursing care. This study aims to determine the relationship between job burnout and missed nursing care in nurses from the selected in Tehran, Iran.

In this descriptive-correlational study, 194 nurses of hospitals affiliated to Tehran University of Medical Sciences, were included using a convenience sampling technique from February to April 2024. Data were collected using a demographic form, Maslach burnout inventory (MBI), and Kalisch’s missed nursing care scale. Data were analyzed in SPSS software, version 26 using descriptive statistics (mean, standard deviation, Percentage, and frequency) and inferential statistics (Independent t-test, Pearson correlation test, ANOVA, and regression analysis).

The mean scores for the subscales of MBI including emotional exhaustion, depersonalization, and personal accomplishment were 32.44±10.70, 18.76±4.14, and 29.91±7.10, respectively. The mean score of missed nursing care was 35.78±2.67. The results showed no significant difference in job burnout and missed nursing care scores based on demographic variables (P>0.05). No significant relationship was found between job burnout and age or work experience (P>0.05). Pearson correlation test results revealed a significant direct relationship between the subscales of MBI and missed nursing care (P<0.001). The highest and lowest correlations were for the MBI subscales of emotional exhaustion (r=0.608, P<0.001) and depersonalization (r=0.301, P<0.001), respectively. The results of regression analysis showed that emotional exhaustion (β=0.62), depersonalization (β=0.30), and personal accomplishment (β=0.34) were significant predictors of missed nursing care (P<0.001). 

There is a significant relationship between missed nursing care and job burnout in nurses. Healthcare authorities are recommended to use appropriate interventions to prevent or reduce nurses’ job burnout in order to reduce the occurrence of missed nursing care and improve patient outcomes.

Urban regeneration is a comprehensive, integrated, and holistic approach, and social participation implies the expansion of intergroup relations into voluntary associations, clubs, unions, and groups that are usually local and non-governmental in nature. This purpose-based research is of an applied type with the aim of evaluating social participation in the reconstruction of the historic neighborhood of Soro.  

The research method is descriptive and analytical that the data collection tool is through documentary and library studies, referring to relevant organizations and field visits in the study area. First, the indicators of participation and urban regeneration were extracted and then, using the Amos model, the effect of each of the hidden factors on each other was measured. Entered was analyzed.

Findings show that the results show that the most influential factor is social with a size of 18.33 and the effective factors are originality with a size of 10.05, large axis with a size of 9.68 and economic with a size of 08.09. In other words, if social participation is to be realized in this region for urban regeneration.

According to the findings, the capacity of originality, greatness and economic factors should be used to influence other factors and is the most influential social factor, meaning that the social structures of this region have a more appropriate accompaniment to achieve this.

In today's world, due to intense competition and the rapid pace of production, exploiting knowledge and converting it into economic returns has become a critical management issue for academics and capital owners. Commercialization activities can impact the educational and research programs of universities, potentially leading to resistance against them.

The current study was conducted to identify the challenges of the commercialization process in health science research.

This qualitative study was conducted between June and December 2022 in Tehran province, Iran. Data were collected using semi-structured interviews with 22 key individuals, including university management and technology experts, as well as CEOs and experts from knowledge-based companies, selected through purposive sampling. The interview guide was designed based on four in-depth interviews, theoretical foundations, and comparative study findings. The obtained data were analyzed using the conventional content analysis method in MAXQDA 10 software.

The challenges of the commercialization process for health sciences research results were categorized into six main themes and 16 sub-themes. The main themes identified in this study were rules and regulations, societal culture, university management and infrastructure, human resources, financial systems, and organizational cooperation with industry.

Policymakers, especially senior health managers, can create a suitable platform for the optimal use of resources and the expansion of targeted relationships between universities and industries by incorporating economic insight into academic services. By compiling relevant laws and guidelines, optimizing resource management, achieving financial independence for universities, and increasing the productivity of health research, the high costs associated with the commercialization of academic research projects can be reduced.

The Internet of Things is an extensive network of physical objects such as devices, machines, buildings, and other tools in which sensors, network connections, and software are embedded as a small system. The method of clustering things is one of the efficient methods to reduce energy consumption in the data transfer phase in the Internet of Things. In clustering, each cluster has a node called the cluster head, which is responsible for coordinating network operations and collecting data from sensor nodes. The most important objective of this study is to improve the amount of energy consumption in the data transfer cycle. Most of the communication and computing tasks should be completed within a limited period to avoid unfavorable consequences since IoT applications are very time-sensitive and critical. Thus, ensuring real-time support in large-scale IoT networks is one of the most important and challenging research issues.

PSO, CPSO, and FCPSO algorithms were used in this study. Finally, the FCPSO algorithm was formulated using the theory of fractional order derivatives. MATLAB was used to simulate and evaluate IoT information security and PSO, CPSO, and FCPSO in smart buildings. Also, the results of the proposed method were compared with similar methods. Several parameters are affected. The values of these parameters strongly depend on the convergence improvement. In this study, the following parameters are considered when transferring data to the center or between things:-Etx and Erx: energy used to transfer and receive data, respectively, in the nodes.-Dij: distance between node i and node j.-Eelec: energy available in each node.-Fij: data transfer rate between two nodes.-CS, CR, and CB: base station node cost, sensor node cost, and reinforcing node cost, respectively.All simulations were performed in the Windows 10 operating system using quad-core 2.5 GHz processors, working frequency 2, and a memory capacity of 8 GB. The simulation was done in MATLAB 2020 software. Ten bench test functions were used to examine the effectiveness of the proposed algorithm.

In the scenario where the FCPSO method is used for information transfer, the energy consumption can be reduced by using the FCPSO method for optimization. The second test method uses the same described method to evaluate Etx and Erx parameters. These two parameters can be viewed as a single parameter whose value can be set arbitrarily for each thing. The FCPSO method performs better than the standard transfer mode in this test condition.In this measurement, the amount of memory consumption (in megabytes) to complete authentication requests in smart buildings based on the Internet of Things has been investigated and compared based on the number of sent packages. The results indicate that the third method has the lowest memory consumption for more packets, while the proposed method could reduce the memory consumption for a high number of packets.In the second test, the amount of energy required to transfer data from the source to the destination is evaluated. The number of data packets increased in each successive step. Results shows that the proposed method uses less energy than comparable methods.The accuracy criterion shows how well the proposed technique can accurately display the identity in smart buildings based on the Internet of Things. Results compares the accuracy rate of the proposed technique for 188 unique identity effects with the accuracy of the second and third methods for different packets.The simulation results indicate that the proposed method is more accurate than the second and third methods for identifying distinct packets in IoT-based smart buildings.

In this study, a model based on the cycle and transfer of information to the base station and between items was used for energy consumption and the Internet of Things network. The most crucial challenges in IoT routing are the energy consumption of each node, comparability, error tolerance, and network dynamics. It is necessary to evaluate the quality of a node using appropriate criteria for effective communication and information transfer. In this study, the energy used to transfer and receive data in nodes, the energy available in each node, the distance between two nodes, and the data transfer rate between two nodes were evaluated. Given the objective of this study, which is to optimize energy consumption in the Internet of Things, the FCPSO algorithm was used to reduce energy consumption during information transfer. Using the FCPSO algorithm to reduce energy consumption in the Internet of Things is possible due to the capability of the algorithm to optimize the problem by considering the number of parameters that can significantly affect the performance of the problem, which is the goal of many optimization problems. The simulation results revealed that using the FCPSO method improves and reduces energy consumption during the program execution and information transfer cycle. The most important limitation of this study is that there is not enough data to build an optimal model. Thus, the possibility for model non-convergence increases. Another crucial issue in this regard is the degree of computational complexity that new data transfer models require.
 
 

This paper addresses the growing energy demand by exploring the realm of microgrids (MGs) and their crucial role in modernizing the conventional grid (CG). As energy needs continue to escalate, the CG has integrated advanced communication technologies, including sensors, demand response, energy storage systems, and electric vehicle integration. MGs have emerged as a viable solution to ensure local energy stability and reliability within low or medium voltage distribution systems. They achieve this by efficiently managing power exchanges between the primary grid, locally distributed generators (DGs), and consumers. This article provides an overview of microgrids, explaining their operational principles and examining various energy management methodologies. At the core of microgrid control strategies lies the energy management system (EMS), which orchestrates the interaction between different energy resources (CG, DG, ESS, and EVs) and loads, ultimately enhancing utility profitability. The paper systematically categorizes EMS design methodologies based on their structural attributes, control mechanisms, and underlying techniques.

The main goal of this article was to compare advanced converters in plug-in hybrid electric vehicles. In this article, there are two examples of integrated chargers, the first charger integrates two DC/DC converters and uses the obtained converter in the structure of the charger, and the second charger integrates two power converters and inverters. It introduces a second integrated charger. These two chargers were simulated using valid references and compared with each other and finally the results showed that the second structure is a better structure in the car. The second structure reduced the volume, consumption, charging cost and losses by reducing the power electronic elements. This structure also had a better and higher capacity than the first structure. When it comes to getting the battery voltage to a high enough level to power the motor, the performance of the two structures was not much different, but in all other cases, the second structure performed better than its counterpart. Therefore, it is better and more economical to use this converter in rechargeable hybrid cars.

Poor oral and dental health significantly affects public health, impacting over half the world’s population. Dental caries can undermine children’s academic success and career prospects. Social inequities result in unequal access to oral healthcare, particularly among populations with lower socioeconomic status (SES). National policies that improve access to oral health can reduce these disparities.

This study aims to compile policies implemented by various countries to achieve universal health coverage (UHC) for pediatric dental services.

This scoping review was conducted according to Arksey and O’Malley’s framework and is reported using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. A systematic search was conducted on databases including Scopus, PubMed, Magiran, SID, Irandoc, Google Scholar, the WHO website, and the databases of Iran’s Ministry of Health. The search aimed to identify literature discussing governmental steps taken to achieve UHC for pediatric dental health, published between January 1, 2011, and December 31, 2022. The results were charted and presented in a table.

This review included 22 studies. Six themes were identified based on the roles played by key players in this field, including schools, government policy and support, community-oriented preventive plans, insurance support, parents’ awareness, and inequality in accessing dental services.

A comprehensive policy that reduces barriers to access, increases utilization, and engages all stakeholders—including parents, schools, and community centers—can effectively achieve UHC for pediatric dental health.

‎Our examination of quadratic curvature functionals in Generalized Symmetric Spaces has resulted in the comprehensive classification of critical metric sets within diverse categories of these spaces‎.

Many theories are found for subsurface drainage system design (Kumar et al., 2013). These were formulated by some of the soil characteristics that are important in designing and operating drainage systems. Most of these formulas have simplified and just involved flow parameters or assumed soil media as a maximum of two layers. In paddy fields, used equations for water table depth prediction have no accordance with field condition. Due to specific flow situations in these fields, much difference was observed in results (Darzi-Naftchali et al., 2013). The differences were because of special layered soil in paddy fields and soil hydraulic characteristics, hardpan layer existence formed in long cultivation and tillage, its effect on flow, and of course, lack of a suitable formula for these fields. So, designing rules for subsurface drainage in paddy fields needs investigation and implementation of new relations to predict the flow pattern suitably. Determination of design criteria and suitable formulas needed to predict flow network around drain tubes. Jafari-Talukolaee et al. (2017) reported in predicting water table profile between bilevel subsurface drainage in paddy fields due to the existence of resistance in vertical flow direction based on soil layers, and field results have no suitable agreement with analytical solution. Darzi-Naftchali et al. (2013), analyzing the effect of subsurface drainage systems on water balance and water table in paddy fields for a successive rice and canola cultivation season, obtained that shallow drainage systems were more influenced than deep drainage systems in water table control. The flow pattern of water towards the drain tube and the components of the flow network are the basis of the drainage system design. By determining the flow path towards the drains and the water table profile variation, the distance and depth of the drains in paddy fields can be determined with greater accuracy.

In recent years, the interest in using small satellite constellations has increased due to the reduction of cost and time as well as the greater capabilities of small satellites. This is despite the fact that today, due to high launch costs, new launch strategies have replaced the traditional methods of launching constellations to mission orbits. Depending on the mission of the constellation, various methods have been proposed for launching and deploying satellites in the mission orbit, which are classified in one of two categories, direct or indirect. In this paper, an indirect method for deploying the satellites of a constellation to several orbital planes has been investigated. This method is based on changing the orbital planes with the positive use of the earth's oblateness perturbation in addition to using the satellite propulsion subsystem. This method has been simulated and analyzed for two real satellite constellations with remote sensing and global internet missions. Also, based on this method, the launch and deployment strategy for a regional satellite navigation system covering Iran with 130 satellites has been designed and implemented. The obtained results have been analyzed in terms of the time required for the launch and the required ΔV.

Using the Lie classical method, the potential symmetry of the generalized hyperbolic quasilinear and Boussinesq equations is investigated. To find these symmetries in specific cases, we study various scientific examples that admit these symmetries. In addition, using this method, the potential symmetries of the conservative forms of the Boussinesq equation is determined.

Trust is the foundation of effective nurse-patient communication. Patient trust in the nurse facilitates better acceptance of care interventions and accelerates the healing process. Religious orientation is one of the factors that effectively influences individuals' decision-making and worldview. Religious orientation encompasses individuals' internal beliefs and their inclination to engage in religious practices. This study aimed to investigate the relationship between patients' religious orientation and trust in nurses.

Methods & Materials: 

This is a descriptive-analytical study that was conducted from December 2023 to March 2024 on 350 hospitalized patients in Imam Khomeini and Shariati hospitals affiliated to Tehran University of Medical Sciences using convenience sampling method. Data collection was performed using demographic information questionnaire, patient trust in nurses scale, and religious orientation questionnaire. The data were analyzed using descriptive statistics (mean, percentage, and frequency) and inferential statistics (Pearson correlation coefficient) by SPSS software version 26. The significance level of the data was considered as P< 0.05.

The mean score of patients' trust in nurses was 15.69 ± 3.93 and the mean score of religious orientation was 53.98 ± 10.46. Based on the results of Pearson correlation coefficient, a significant positive correlation was observed between the score of patients' trust in nurses and their religious orientation (P< 0.05, r = 0.76).

The findings of this study highlight the need for nurses to assess patients' religious values and beliefs. Patients with lower religious orientation have lower trust in nurses. Incorporating spiritual care into nursing interventions and enhancing patients' religious orientation can be effective strategies for improving trust in nurses.

Urban regeneration is a comprehensive and integrated approach, emphasizing the expansion of intergroup relationships through voluntary associations, clubs, unions, and typically local and non-governmental groups. This applied research aims to assess the desirability of social participation in the reconstruction of the historical neighborhood of Soro. Utilizing a descriptive-analytical methodology, this study is designed to evaluate the desirability of the social participation component in redeveloping the historical context of Soro from the perspective of local residents. The information was collected through library studies, employing a questionnaire and interviews. The sample size consists of 400 local residents, and for data analysis, SPSS software and the factor analysis method were employed. Through content analysis and a review of various sources and theoretical texts, indicators were extracted and classified into four groups: internal, relatively internal, external, and relatively external indicators. The results revealed that 44% of social indicators are most influenced by internal factors, followed by 28% for cultural indicators, 16% for physical indicators, and 12% for economic indicators, respectively.

Components of the LEO environment consisting of high vacuum, ultraviolet radiation, thermal cycles, Atomic Oxygen, charged particles, electromagnetic radiation, micrometeorites, and space debris significantly degrade the material properties of polymer matrix composite materials. Therefore, in the design of space structures using composite materials, the possible deterioration of mechanical properties due to long-term exposure in LEO space environment should be carefully considered. Accordingly, a reliable understanding of the LEO environment in its effects on composite materials as well as investigating its properties is very important. The space simulator system under vacuum is designed with the aim of creating a standard environment with the ability to reach high vacuums and also the ability to create low temperatures, as well as to check the qualification of space components and research materials used in the satellite. These systems analyze the behavior of satellite components, evaluate their thermal balance and performance to ensure mission success and survivability.

In this paper;, ;we investigate the symmetry group of the (3 + 1)-;dimensional Sakovich equation;. ;We obtain the classical and non-classical Lie symmetries for the equation under consideration;. Therefore;, ;we respond to the question of classification of the equation symmetries and;, ;as a result;, ;its invariant solutions;. Presenting the algebra of symmetries and utilizing Ibragimov&rsquo;s method;, ;we create the optimal system of Lie subalgebras;. ;We obtain the symmetry reductions and invariant solutions of the considered equation using these vector fields;.

In this research;, ;using the multiplier method and the 2-dimensional; homotopy operator;, ;higher order conservation laws for the; ;Hunter-Saxton equation are computed;. ;Also;, ;in order to construct new; ;conservation laws;, ;the invariance properties of the multipliers are; ;studied using Lie classical symmetries;.

In this paper, we prove that the perturbed generalized Benjamin-Bona-Mahony (BBM) equation with a small parameter is approximately nonlinear self-adjoint. It's important for constructing approximate conservation laws associated with approximate symmetries.

In this paper, we investigate the Einsteinian manifolds with parallel null distribution. For this purpose, we first obtain the equations, which are known as Einstein's equations, that lead to finding the mentioned manifolds and then, we reduce Einstein's equations by using Lie symmetry method. In this method, we first obtain the generators of the symmetry algebra and then calculate the differential Invariants for each of the generators and calculate the group invariant solutions of this equation. We also obtain the optimal system of the one-dimensional sub-algebras of these equations which helps us to have a classification on group invariant solutions by using conjugate mapping.

Most patients with diabetes will present to hospital for a reason not directly related to their diabetes. When a person with diabetes is not cared for properly, hospitalization can become complicated and lead to worse consequences for the patient. In fact, it is important to know how to manage a diabetic patient while in hospital. Therefore, a special organization is needed in hospitals for adaptation to chronic diseases such as diabetes. This study intends to help hospital adaptation to the special needs of diabetic patients by identifying patterns of care delivery in selected countries. This comparative study was performed in 2021. The data collection was conducted by searching in PubMed, Web of Knowledge, Scopus, Science Direct, Springer, Proquest, and also the websites of the selected countries hospitals. Based on the sampling method, three countries, Turkey, United Kingdom, and the United States, were selected from the countries with eligibility. However, during the study, according to the good practices about special diabetic care of countries such as Australia and Denmark, they were also examined. In this review study, we organized and compared the effective measures taken in selected countries in relation to the management of these patients in the hospital, focusing on the dimensions of service package, human resource, process, structure, equipment/technology, and information system required by diabetic patients.

Widespread use of screening in high-income countries has led to significant reductions in mortality from cervical cancer. However, in Iran, the main reason for the late diagnosis of cervical cancer was the failure to perform a Pap smear (Papanicolaou).  We aimed to investigate the status of cervical cancer prevention and its challenges and solutions in Iran.

We conducted a systematic review of literature published from 1974 to 2021 in the electronic databases, including PubMed, Web of Science, Embase, Scopus, and Google Scholar, and retrieved all English-language articles. Following the application of the inclusion and exclusion criteria, full-text articles were identified and evaluated for eligibility. Finally, these publications were analyzed as part of the synthesis.

Lower social-economic level, inadequate knowledge of screening tests and health centers for Pap test performance leading to worse outcomes such as lower screening participation or coverage.

By addressing these challenges through increasing education, increasing service accessibility, expanding screening programs, improving public awareness, improving insurance coverage, and establishing a control protocol for follow-up, it is possible to reduce cervical cancer incidence and mortality.

Accurate estimation of required effort for software development plays an important role in the success of the software project. This is always a challenging issue due to the intangible nature of the software project. Therefore, a large category of researches have been performed to develop accurate tools to estimate the required efforts for software development. According to the presented papers in related works, the adoption of methods to identify the types of relationship between software project features and features affecting the required effort for software development have a significant impact on effort estimation accuracy increment. In addition, the effectiveness of various features on the software development effort estimation is different. So, the feature effectiveness determination is advantageous in increasing the effort estimation accuracy. This paper presents a new model consisting of sub-models for project features analyzing and it uses a new and accurate heuristic algorithm called Atom Search Optimization (ASO) Algorithm to configure tools and data modeling methods. The presented model in this article is designed in multiple layers and the sub-models are organized in separate layers. The organizations of sub-models are in such a way to increase performance of other layers and ultimately increase the final estimate accuracy. In accuracy evaluation of the proposed model, 3 data sets from real projects are used and the comparisons of the results with different methods are presented. Based on the results, the proposed model leads to significant improvement of final effort estimation accuracy.

Within the public sector, health managers occupy positions that are typically filled by individuals with a medical, clinical, or nursing experience who are entrusted with assuming an additional role. The primary objective of this study was to employ a scoping review methodology to ascertain a cluster of prevalent subjects encompassing the development of a proficient health care manager.

The purpose of this scoping review study was to identify critical components in the field of management professionalization, as described by Arksey and O'Malley. A total of 13 studies, characterized by predefined keywords, were meticulously culled from Scopus, Web of Science, PubMed, and Embase, Magiran, and SID databases. The inclusion and exclusion criteria considered factors such as language, temporal relevance, redundancy, thematic alignment with the professionalization domain, and congruence with the overarching objectives and methodologies of the present investigation. Subsequently, the contents of the selected studies were subjected to rigorous thematic analysis and judicious categorization using a framework analysis approach.

From a total of 10,117 articles, a rigorous selection process yielded 13 articles to be included in this study. The identified dimensions are classified and elucidated across 6 overarching domains; namely, the science of management, educational trajectory, and curriculum, cultural infrastructure and ideologies, standards, professional institutions and associations, and licenses and certifications.

To enhance the efficacy of health management, policymakers and planners ought to adeptly incorporate these dimensions within the framework of the country's health system.

‎In this paper‎, the Lie group of point symmetries for a‎ ‎kind of Benjamin-Bona-Mahoney (BBM) equation is obtained by applying the classical Lie‎ symmetry method‎. ‎An optimal system of sub-algebras of‎ ‎dimension one for the BBM equation is deduced by classifying the‎ ‎adjoint representation orbits of the Lie symmetry group‎. Then‎, ‎for any infinitesimal symmetry generators of the Lie group‎, ‎the related similarity reductions are generated‎. ‎Also‎, ‎new conservation laws for this equation are constructed by‎ ‎the method of scaling‎. ‎The conservation laws densities is calculated by using the concept‎ ‎of variables weight‎, ‎scaling symmetry and Euler operator‎ ‎and their fluxes is computed by applying the homotopy operator‎.

Tobacco is a major cause of preventable morbidity and mortality, with a considerable economic burden. The purpose of this systematic review was to summarize the evidence on the economic burden of tobacco use by searching national and international databases so as to generate useful information about the costs of tobacco use globally.

A systematic search was conducted in Scopus, PubMed, EMBASE, ProQuest, and Web of Science (ISI) databases to identify relevant studies from 1990 to June 2021 using keywords like burden, productivity, indirect cost, direct cost, economic, monetary, expenditure, tobacco, smoking, and cigarettes. Cost estimates were converted into 2020 international dollars per adult.

A total of 1,781 articles were identified, of which 361 were deemed to be eligible for inclusion. Eventually, 23 articles were found eligible. In most studies, cost estimates were provided using a prevalence-based approach. The highest total cost, as a percentage of gross domestic product (GDP), was reported for South Korea (1.19%). Noteworthy, in all studies, indirect costs accounted for the highest proportion of all costs. The mean total cost amounted to 5,866 million dollars. The direct costs ranged from 179 million dollars in South Korea to 8,156 million dollars in Israel. Meanwhile, the indirect costs ranged from 289 million dollars in Hong Kong to 9,808 million dollars in India. 

The evidence demonstrated the considerable economic burden of tobacco use in various countries, ranging from 0.33 to 1.19% of the GDP of the investigated countries, indicating the necessity of taking immediate measures. Hence, policies are needed to address the economic burden of smoking.

Health system transformation plan (HSTP) of Iran, with three main goals of financial protection of patients, justice in access to health services, and improving the quality of services was implemented since 2014 which has had some achievements and challenges. Considering the large amount of financial resources used in this plan and the limitation of resources in Iran, this study aims to examine the performance of this plan in improving some health-related and financial indicators.

Econometric tools were used in this study. The data of health-related and financial indicators related to the performance of HSTP from 2004 to 2019 were first collected. Then, using the ordinary and generalized least squares estimation methods, the effect of the transformation of HSTP on the selected indicators was examined. Finally, by using the structural break tests of Perron, Zivot-Andrews and Lee-Strazicich, the success of the HSTP in causing positive changes in the indicators and creating structural breaks was examined.

According to the ordinary and generalized least squares regression models, the coefficients of all indicators was significant and the positive effect of the costs of HSTP on the improvement of these indicators were confirmed. The greatest effect was reported on the out-of-pocket payment rate with a coefficient of 0.7 and the lowest effect was on the total death rate with a coefficient of -0.006. According to the results of the structural break tests, all indicators had recorded structural breaks before implementing the plan, while only six indicators showed structural breaks after the implementation.

The HSTP was effective in improving the selected indicators at the beginning. All indicators showed structural break points before implementation of the HSTP, due to their reduction at the related time points, which emphasized the necessity of implementing the HSTP; however, after implementation, no positive structural break points are observed to indicate a considerable improvement in the indicators.