mohsen pakdaman

One of the most important tasks of health care managers is  allocateing resources, controling them and ensuring their effective use when available. This study examines the consequences and costs of emergency services in Yazd in 2018.

This was a descriptive-analytical study performed on patients of 11 centers in Yazd in 2018. The population of the city  was approximately 750,000  in 2018 (1). Direct and indirect costs were extracted, and the consequences and costs of Yazd emergency in 2018 were calculated in riyal and Dollars.

This study showed that in 2018, out of 173154 contacts, 37988 cases led to the dispatch of an ambulance, and the response rate was 18 %. The rate of hospitalization was 52 %. The average time of dispatch in  Yazd pre-hospital emergency department was (10:48) in 2018. Of the 59 high-risk patients who were transported to Yazd's pre-hospital emergency in 2018, 5 patients had successful cardiopulmonary resuscitation(discharge from the hospital). In other words, effectiveness and saving people from death was 8.4 %. Depreciation costs in the pre-hospital emergency department of Yazd in 2018 amounted to 65,061 Dollars (9,759,264,923 Rial). The cost of personnel salaries and benefits was 39669829 Dollars ( 59504743663 Rial). This amount was about 40 % of the total cost of the year for pre-hospital emergency in Yazd city. The average cost of each mission-dispatch was 25 Dollars (3775967 Rial).

This study examines the consequences and costs of per hospital emergency department in Yazd in 2018. The high number of unnecessary calls to Yazd emergency department calls for the need to raise public awareness. Moreover, the lack of need to transfer half of these people to hospital requires training and retraining of telephone triage nurses.

Hazards have always been considered a threat to human life and preparedness to deal with risks for pre-hospital emergency as the first line of care and treatment is highly significant. Pre-hospital emergency (clinical) deals with different natural and man-made hazards which cause various harms. Preservation of disaster preparedness is one of the pre-hospital emergency concerns. In this regard.

The present study aimed to determine the priority of hazards and design preparedness programs based on health response.

The present study was based on a descriptive-analytical study that was conducted in Rasht, Iran in 2019. The method used in this study was a combination of quantitative and qualitative methods. In a qualitative method, the major threats and potential hazards of pre-hospital emergency were identified by reviewing the texts and searching for relevant articles. Afterward, its effectiveness and the significance of its risk or threat were evaluated using a researcher-made checklist. In total, 19 crisis liaisons from the organizations involved in crisis management in Rasht were questioned, 18 of whom responded to the checklist.

The results obtained from the opinions of the experts showed that the risk of earthquakes (88.8%) and seasonal flood (83.3%),among all the risks investigated, have a higher priority than traffic accidents (77.7%) and heavy snowfall (72.2%) in the society. The pre-hospital emergency is closely related to many various risks, among which the earthquake risk was chosen as the priority by the community of experts participating in this research. For the emergency of the earthquake, preparedness plans were produced based on the response plan of the health sector and the additional comments of the expert community.

Identification of high-priority risks and design of appropriate response plans will help those in charge to face and prepare in time and reduce damages.

Osteoarthritis is a common musculoskeletal disorder in elderly people, and the most common form appears in the knee joint. These patients suffer from pain, joint stiffness, and problems with functional activities. So, it is essential to offer a proper treatment plan for these patients.

The goal of this research is to compare the effect of high- and low-intensity transcutaneous electrical nerve stimulation (TENS) therapy on reducing pain and improvement of functional activity.

Using simple randomization method, a total of 36 patients were divided into two groups receiving high- and low-intensity TENS therapy. All patients received ten sessions of physiotherapy (three sessions per week). Pain and functional activities were measured and compared before and after the study.

Although there was a significant difference between the two groups in pain index (P < 0.05), no difference in functional activity was observed between the two groups.

Using both high- and low-intensity techniques can be effective in reducing the pain and improving the knee joint function. However, pain decreased more significantly in the high-intensity group compared to low-intensity group.

Job stress greatly affects the physical and mental health of nurses. Therefore, this study was conducted to investigate the relationship between spiritual health and job stress among nurses working in selected hospitals of Yazd University of Medical Sciences and Health Services in 2020.

This was a cross-sectional and correlational study conducted in 2020 in Rahnemoun and Shahid Sadoughi hospitals in Yazd. The sample size was 203 nurses selected through random cluster sampling. Data were collected using the Pulotzin Wallison Spiritual Health questionnaire and the Tuft and Anderson Job Stress Questionnaire. Data analysis was performed using descriptive statistics, Spearman, Mann-Whitney, and Kruskal-Wallis correlation coefficient by SPSS24.

The mean of nurses' job stress was (109.17 ± 28.66) and the mean of spiritual health was (92.58 ± 14.80). The relationship between job stress and spiritual health was statistically significant and negative (P-value < 0.001). There was a statistically significant relationship between spiritual health and marital status(P-value = 0.0002), age groups(P-value = 0.013), work group(P-value = 0.003)s and employment status (P-value < 0.001); and between job stress and gender (P-value < 0.001), marital status (P-value < 0.001), age groups (P-value < 0.001), work experience(P-value < 0.001) and employment status (P-value < 0.001).

In order to improve spiritual health, experts advise managers and supervisors to hold classes and seminars related to the positive effects of spiritual health regarding physical and mental health. Consequently, their job performance will improve.

Breast cancer is an uncontrolled and unnatural proliferation of cells in different breast tissues. The first measure to diagnose breast cancer is an examination by a surgeon followed by mammography, sonography, sampling, and other diagnosing methods. Given that there are several methods to diagnose breast cancer, and most of them are quite expensive, the present systematic review compares the expenses and effectiveness of different methods to diagnose breast cancer.

The study was carried out as a systematic review through searching databases, i.e., PubMed, Web of Science, Magiran, Scopus, and Embase for articles published from March 1999 to May 31, 2017. The research articles regarding health technology assessment and economic assessment (n = 8) were examined.

Generally, conducting MRI screening and digital mammography every six months after the age of 30 are proved to be the most efficient and economical methods to screen carriers of BRCA (BReast CAncer) mutated genes. Besides, implementing both the techniques simultaneously was more cost-efficient with BRCA1 compared to BRCA2. Some studies have revealed that genetic tests and Oncotype tests, in particular, were the most cost-efficient methods to diagnose the disease, especially in its early stages.

Consequently, indexing gene expression in individuals with BRCA gene mutation is revealed to more cost-efficient.

In Iran, cardiovascular disease is the leading cause of mortality. The economic burden of these diseases imposed on families makes the situation even worse. Health system policymakers need to be aware of the costs of these diseases to make wise decisions regarding the allocation of resources. The present study aimed to estimate the economic burden of cardiovascular disease in selected hospitals in Yazd.

This cross-sectional study was conducted based on a descriptive-analytical design. The economic burden of cardiovascular disease was estimated using the cost-of-illness method and based on the human capital method. Based on the content and purpose of the current study, the prevalence-based approach was used. A researcher-made questionnaire was used for data collection. The statistical population included patients with cardiovascular disease who referred to the hospitals under study in Yazd. They were selected by random sampling (n=200). The data were analyzed in SPSS and EXCEL software.

41.5% of patients were male and 58.5% were female. The total direct medical cost was 2,6184,130 Rials and the total non-medical direct medical cost was 11,521,250 Rials for each patient. The economic burden of cardiovascular disease was 16,721,997,317,485 Rials  at a discount rate of 3% ,and a discount rate of 5%, it was reported as 11,819,209,806,581 Rials.

Cardiovascular diseases impose a huge cost on society. The best way to manage these diseases and reduce costs is to change and modify risky behaviors that make the patient invulnerable.

Cost analysis is a management tool that helps the researchers to identify and manage high costs. The purpose of the present study was to calculate the cost of day bed and patient bed in the ear, nose, and throat departments of a teaching hospital and a private hospital in Yazd City, Iran.

The present descriptive, analytical, and retrospective study was conducted in the ear, nose, and throat departments of a teaching hospital and a private hospital in Yazd in 2016. Data were collected by studying the relevant documents and checklists. Data were analyzed using Excel software.

The costs of day bed occupancy were calculated as 7286715 rials and 2386715 rials in the ear, nose, and throat departments of the private and educational hospitals, respectively. The cost of a private hospital day bed was much higher than that of a training hospital considering the tariff approved in 2016. Income per patient per day was obtained as 2204643 rials in educational hospital and 1500130 rials in the private hospital. The income per patient per day was higher in the teaching hospital than the private hospital.

Hospitals should have a precise financial system in order to manage the day bed pricing based on the final costs and have realistic day bed costs. Given the high cost of staffing, hospitals should pay close attention to control these costs. Hospitals also need to adopt appropriate processes to consume the consumables logically and reduce their costs.

Growth hormone deficiency (GHD) is one of the most important reasons of short stature in children, which can be treated by early diagnosis. Stature is a good measure for assessing a child's overall growth and health, and height can affect one's psychosocial and social well-being. Human Growth Hormone (HGH) has extensive effects on biological processes, and helps to influence height. Due to the high cost of growth hormone GH drugs, in most countries it is prescribed according to scientific indications.
Research

The present study is a systematic review. From the beginning of 2002 to February 2019, by searching Web of Science, PubMed, Scopus, SID, Embase and Magiran databases, related studies in the scope of health technology assessment and Economic evaluation were reviewed. Finally, 11 related studies were entered the study.

The use of GH therapy was effective in increasing the patients' life quality. The growth of children treated with GH was more than 2.5 cm per year more than untreated children. Furthermore, the results of the studies indicated the cost-effectiveness of using GH. So that the cost of each centimeter increase in height is on average US $ 20,000, and the incremental cost-effectiveness based on QALY's criteria in studies for various indications (Turner syndrome, idiopathic short stature, growth hormone deficiency, Prader Willi syndrome , Infants small for gestational age (SGA), chronic renal failure (CRF) and (SHOX-D) is different. The highest cost efficacy per kali is for growth hormone deficiency (from £ 20,000 to £ 30,000) and the lowest cost efficacy is for Prader Willi (from £ 55,000 to £ 135,000).

Considering the cost-effectiveness of using GH and the increase in height of treated children with GHD, compared to other children, it is recommended to use GH therapy for all children with GHD after doing the experiments. And it can attract health policy makers' interest.

For many years, the classical (traditional) insulin injection methods have been used. The first insulin pen was made in the 1980s. These types of pens are divided into two categories, namely analogue and vial-human. Analogue insulin pens are similar to human insulin pens in molecular structure and can lead to differences in pharmacokinetic and pharmacodynamic properties.

This was a systematic review conducted by searching Web of Science PubMed, SID, Embase, Scopus, and Magiran databases for articles published from the beginning of 2007 to June 2017. The related studies in the field of health technology and economic assessment were investigated.

Twenty studies were included; these studies indicated that there is no reason for the higher risk of rapid-acting insulin analogue pens in comparison with vial (human) and that analogue insulin pens significantly reduce the risk of hypoglycemia. Analogue insulin was compared to other existing insulins and was not found cost effectiveness (ICER: 642994$QALY), (ICER: 130865 $ QALY), (ICER: 87932$ QALY), but due to the increased quality of life and patient satisfaction compared to vial insulin pens, this type of pen has been used. Some studies have shown that aspart 30 insulin pens are more cost-effective than other analogues (ICER: 22488$QALY).

Although the use of analogue insulin is more expensive for diabetic patients, it is more effective than vial insulin. Thus, insurance companies are recommended to develop special plans for the three vulnerable groups of seniors, children, and pregnant women to provide them with analogue insulin.

The increasing advances in information technology and electronic devices, as well as limitations in traditional education persuade higher education systems to use virtual model as an alternative. The present systematic review aimed at evaluating the cost-effectiveness of both the traditional and virtual education models.

This was a systematic review study. For the purpose of data collection, articles published in the specialized English and Persian databases such MEDLINE (PubMed), Scopus, Science Direct , HTA, and Cochrane Irandoc, Magiran, and SID were retrieved from 2007 to 2017.. Related studies on health technologies and economic investigations were also reviewed. For this purpose, hierarchical search method and keywords“e-Learning” and “traditional education ” were used.

ten studies were included the results of these studies were slightly different. Most studies showed that the cost-effectiveness of virtual education alone or in combination with traditional education (blended model) was equal or greater than that of traditional education. The data analysis of the articles was performed by comparing cost, effectiveness(Min. SD,QASE), cost effectiveness(ICER)and average cost per student. Cost-effectiveness refers to achieving the highest output at the lowest cost. the economics of distance higher education The results showed that due to the use of multimedia, lack of space and time limitations, admission of a large number of students, And increasing student satisfaction، easy and fast access to information, and use of SCORM model in producing content and instruction, distance higher education reduces education costs, while compensating for the lack of human resources in the teaching-learning process.

The category of health is closely related to growth, comprehensive development, including economic development and human development. Health expenditure are important factors affecting economic growth. These expenditures can increase human development along with human resource and physical capital. The purpose of the present study was to determine the effect of health expenditures (public and private) on the Human Development Index (HDI).

The present study is a time series study, in which data related to health expenditures and human development index were collected in 2001 to 2014 time series. Then, using time series models in econometric and VAR self-regression econometrics, Granger causality techniques were analyzed.

In this study, public health expenditure expenditures had a one-way relationship with adult literacy rate and its direction is from public health expenditures to adult literacy rate. Private health expenditures had a one-way relationship with adult literacy rates and its direction is from private health expenditures to adult literacy rate. There is also a bilateral relationship between public health expenditures and GDP per capita.

The results of the present study indicated that health expenditures have a significant effect on human development index. Given the important role of the private sector in providing and promoting community health, it is suggested that the government should pay special attention to this issue and through further efforts to provide credits, for both public and private sectors, improvent and promotion of the human development index, are provided.

A sharp increase in expenditure is one of the challenges of the health system in Iran. Every macroeconomic variable affects health, and if it is disregarded, it will lead to higher macrobudgets. Physical and mental health as well as the use of health services change according to the macroeconomic conditions and business cycles (boom and recession). The present study aimed to determine the effect of macroeconomic indicators on health expenditure.

This study was descriptive analytical. The required data related to macroeconomic indicators and health expenditure in public and private sectors were collected during 1995–2014. The data were analyzed using the time series models in econometrics, Vector Auto Regression, and Granger causality technique.

The results of this study indicated that health expenditure has a positive bilateral relationship with gross domestic production (GDP), gross national production, national income, and national consumption. On the contrary, expenditure has a negative bilateral relationship with liquidity rate and inflation rate. In addition, budget deficit has a negative unilateral relationship with health expenditure while population rate has a positive unilateral relationship with health expenditure.

The results of this study indicated the increase of health expenditure in Iran that GDP is the most critical determining factor of health expenditure. In general, the total expenditure in the health sector in the world increases when the countries become richer. In line with the increase of resources, innovative financing methods and efficiency improvement are required for providing basic health services in low‑income countries.

Given that the need to pay attention to measuring efficiency is considered as one of the main pillars of improving the level of efficiency in hospitals, so this study was carried out aimed to determine the mean technical efficiency (The technical efficiency is bound by zero and one and a score of less than one means that the theatre is inefficient as it could) score in terms of type and activity of the hospital, input-oriented and output-oriented attitude, returns to scale (In economics, returns to scale and economies of scale are related but different concepts that describe what happens as the scale of production increases in the long run, when all input levels including physical capital usage are variable (chosen by the firm). The concept of returns to scale arises in the context of a firm's production function. It explains the behavior of the rate of increase) in hospitals of Iran using data envelopment analysis (DEA) (DEA is a nonparametric method in operations' research and economics for the estimation of production frontiers. It is used to empirically measure productive efficiency of decision-making units) and stochastic frontier analysis (SFA) (SFA is a method of economic modeling. It has its starting point in the stochastic production frontier models simultaneously introduced by Aigner, Lovell and Schmidt[1977] and Meeusen and Van den Broeck[1977]

The present study was carried out with a systematic review of all studies conducted on measuring efficiency of hospitals in Iran from March 21, 2001 to December 21, 2017 using DEA and SFA. Eleven databases were searched using appropriate keywords and 470 articles were found and evaluated using a checklist, and finally, 24 articles were entered into the meta-analysis process. Meta-analysis was performed using random effect model and fixed-effect model, and study heterogeneity was investigated using Q-Cochran test and I2 index. Furthermore, the main reasons of study heterogeneity were identified due to meta-regression.

The average technical efficiency score of hospitals using DEA and SFA method was obtained equal to 0.885 and 0.809, respectively. Furthermore, with regard to the DEA method, 0.885, 0.891.0.952 and 0.913 was obtained for input-oriented and output-oriented, general and specialized care hospitals and constant returns respectively. With regard to SFA method, 0.733, 0.664, 0.641, 0.802, was obtained, and the inputs and outputs affect measuring the efficiency.

In contrast, the DEA method can investigate several input and output simultaneously and is used as an effective and flexible tool in order to measure the efficiency of the hospital. DEA can be easily used for calculating efficiency scores based on the proper selection of input and output indicators. The data envelopment analysis method and different input and output variables have been used in most studies conducted in Iran, and Stochastic Frontier Analysis has been less considered. In the present study, the DEA method in governmental educational hospitals showed a higher efficiency than SFA method in the hospitals under study. But in general, due to lack of optimal efficiency level in the hospital, it is suggested that policymakers determine the hospital efficiency indices in order to evaluate their efficiency from different dimensions.

The average technical efficiency score of hospitals using DEA and SFA method was obtained equal to 0.885 and 0.809, respectively. Also, the mean technical efficiency score in terms of input-oriented and output-oriented, general and specialized care hospitals and constant returns to scale using the DEA method was obtained equal to 0.885, 0.891.0.952 and 0.913 and using the SFA method, respectively, it was equal to 0.733, 0.664, 0.641, 0.802, and the inputs and outputs affecting measuring the efficiency. There is no significant difference between the mean efficiency score between the two methods, but the data envelopment analysis method is used more. It is suggested that the hospitals efficiency indicators to be determined in order to more accurately evaluate the hospitals efficiency.

Considering that human capital is the most important part of health care, planning for distributing human resources in the health sector should be considered as an integral part. The aim of this study was to evaluate the required maternal force in selected hospitals in Yazd City, Iran, according to the standards of Iranian Ministry of Health and Medical Education in year 2017.

In this descriptive cross-sectional stud, the maternal strength of the Shahid Sadoughi and Shahid Rahnemoon hospitals were estimated according to the standards of the Iranian Ministry of Health and Medical Education in year 2017. Researcher-made checklists were used to assess general specifications and performance indicators of the hospital, the status of administrative, financial, supportive, and paraclinical sections of the hospitals. After collecting data, information was analyzed through simple tables.

Out of 37 departments in Shahid Sadoughi and Shahid Rahnemoon hospitals, 28 (75%) had shortage and 9 (25%) had excess of personnel.

The distribution of power was not in good condition. In order to improve the quality of hospital services, having the right information about the number of required human resources is an essential step for managers to make the necessary plans for fair distribution based on human resource requirements, and delivering the sectors to the standard level. The results of the study can be used by authorities, hospital managers, and policymakers of the health sector.

Recently, the health care sector has been moved towards establishing non-governmental organizations (NGOs); since collaborative approaches are more in these organizations and they provide better services. Hospitals and charity clinics are part of NGO's. These organizations are affected by collaborative management. This collaboration has been conducted in a variety of ways, requiring the investigation of a study with the aim of providing a management pattern of health benefactors’ collaboration in medical sciences universities of Iran..

This is a qualitative and Delphi study conducted in 2017. The study population was all of 13 universities out of 57 universities of medical sciences in Iran which the questionnaire was sent. To obtain experts’ opinion and consensus, using Delphi technique, a questionnaire with initial classifications and subclasses was electronically sent to the social deputy of the universities of medical sciences for three times. Eventually, out of the 13 universities, 10 people collaborated in the Delphi model. The sample of all 13 medical sciences universities in the country that participated in this study was divided into type 1, type 2 and type 3. In order to ensure the consistency of the experts, their responses were analyzed by Kendall correlation analysis in 5 phases, including1. Investigating documents, 2. Determining the type and defining components, 3. Questionnaire results and data collection by using descriptive statistics and excel software, 4. Delphi technique, 5. Suggested pattern. SPSS and Excel software were used to analyze the data.

The findings of this study showed that the factors affecting the participation of the benefactors in the medical sciences universities of Iran include: holding meetings in the beginning of the academic year of the universities, holding meetings in special timeframe, and using benefactors’ financial resources in the research field. The results of Kendall coefficient indicate that by completing the response process from the first to the third stage, the agreement and community opinions were received and analyzed as acceptable, so that the Kendall coefficient was 61% in the first stage. By improving the questionnaire in the second stage, the Kendall coefficient reached 86%, and in the third stage of validation increased to 91%.

According to the results, the factors affecting the organization of health benefactors in medical universities of the country include: 1. Charity hospitals 2. Activated beds, 3. Charity organizations in cities, 4. A new approach to communicate with the university, and 5. Medical and research priorities in benefactors’ collaboration in the university medical sciences that explain an appropriate collaborative management pattern. The management pattern of collaboration can be used to improve the management of health benefactors’ collaboration in Iran Universities of Medical Sciences, and the highest priority to improve its performance depends on the organization and guidance among its members.

One of the factors affecting the health of people in the community is the health status of food procurement distribution and supply. Overlooking and controlling of these centers is the responsibility of environmental health inspectors. Considering the importance of interaction between environmental health inspectors and providers of food supply, distribution and supply centers, and its impact on the implementation of health rules and regulations by the principal, the main objective of this study is to identify the factors affecting the interaction between environmental health inspectors and providers of procurement centers, Distributing and supplying food, as well as identifying the weaknesses and strengths of the system and the environmental health inspection method from the perspective of inspectors and operators. The health condition of supply centres, distribution and supply of food affects the health of the people of the society, which is why it is important to supervise the control of these centres in order to provide food security at a high degree. In Iran, monitoring centres, distribution and supply of food in order to protect the health of consumers from these centres will be directed at the Health Department of Medical Sciences of the Universities of Medical Sciencesacross the country. The proper monitoring and control of these centres has an effective and effective role in preventing and spreading epidemics and epidemics, causing public health and preventing waste of financial resources. In industrialized countries, about 30 % of people are suffering from water and food, while in third world countries, about 80 % of all diseases and 33 per cent of deaths are caused by water use and contaminated food. Therefore, experts and health experts have an important role in planning, implementation and management of health activities all over the local, national and global levels, as part of the advisory process in planning, implementation and management of health activities all over the local, national and global levels. control, distribution, and supply of food were always accompanied by many problems and defects, which in many cases caused the dissatisfaction of consumers. One of the most important of these problems is the failure of the operators to comply with the relevant health laws so that most of the time the enforcement of the regulations and health considerations have been accompanied by the resistance and refusal of the operators. For example, in 2016 alone 40 percent of the supply, distribution and supply of food in the country were in good health condition. there are few studies and researches on the issues of the work of health inspectors of the environment, which are not widely distributed to the long history and variety of work and function of the health inspectors of the environment and its importance. according to the importance of interaction between the health inspectors and the operators of supply centers, distribution and supply of food and its impact on the enforcement of laws and health orders from the incumbent, there has been no specific qualitative study in this regard. the main purpose of this study is to identify the factors affecting the interaction between the health inspectors of the environment and operators of supply centers, distribution and supply of food as well as identifying the strengths and weaknesses of the system and the environment of the environment from the viewpoint of inspectors and operators and became aware.                                                                                           

This study is an applied study, and qualitative analysis of quality content analysis has been done. Participants included eight environmental health experts and six providers of food procurement, distribution and supply centers, Sample selection criteria were sample-based samples that were selected based on objective sampling. The criterion for the determination of the number of samples in this research was theoretical saturation of the researcher. Data was collected using semi-structured individual interviews. Interviews were recorded and then rewritten and analyzed using Maxqda 10 software and codes, subclasses and classes were identified And then for each of the 24 subclasses, a separate interpretation was written. in order to identify the key concepts and concepts in the text, the text of the interviews was written in line and word to each sentence or the keyword, and the initial codes were identified. In the next step, the same initial codes are grouped into one sub - floor and then the main classes of combination of the following categoriesCommon concepts were formed. It has been tried to make the highest heterogeneity among the classes and the highest heterogeneity among the classes. Initially, the classes were named, but it did not have the name of abstraction. By performing a continuous comparison of the same classes, the same themes were merged and finally extracted from the main themes. Also, for assessing codes, subclasses and classes derived from Densin and Linak criteria, including credibility, transferability, trust, and verifiability were used. to determine the validity and validity of the data, the researcher has a long - term relationship with research sites that has helped attract the confidence of the participants and the correct understanding of the environment by the researcher, the maximum diversity in selecting the participants and the right strategy in selecting the sample is to reassure the participants about confidentiality of information and their freedom in the study including means of credit enhancement. To provide data confidence, after analyzing the text of interviews by the researcher, the text of some of the interviews was available to some expert colleagues in order to compare them with the coding of the data, the data can be provided. in fact, the similarity of the second - type code was provided by the researcher's coding so that in the context of one of the interviews, 85 % of the codes written by researcher and the latter were similar. It was, in fact, used the review method by colleagues in this way that the text was copied and coded and analyzed by the colleagues in order to obtain consensus agreements in order to provide the data transmission capability, interview questions, codes, categories and generally the findings of the study were related to other knowledgeable individuals and experts and their comments about the fit of the findings were examined. in order to verify the data and determine the authenticity of the codes from the interviews, the information was confirmed by the participants. So, after interviewing, data mining and coding, the research has again turned to individual participants in the study and examined their approval from the literature and thus evaluation of samples was done from the literature and thus agreement and approval of the participants were obtained.

participation in this research is the first group, experts and health inspectors of the environment with an average age of 41 (65)from both sexes (seven male and one female), with a bachelor's degree (six)and master " s (two), with an average of 75 / 17 (43), and in the second category, operators and operators Managers of the development, distribution and supply of food with an average age of 45 (65), all males, with certificate (one person)and diploma (four persons), with the average history record of 25 years (43 years). After analyzing the data in this study, 338 primary codes were extracted. After analyzing the extracted codes, the codes were classified in six main categories and 24 sub-classes. The main classes are the factors related to education, the focus of the monitoring system, legal measures, the inspection method, the acceptance of the rules by the curator, the attention of the inspector to the managerial and geographical conditions.

The opinions expressed in the interviews by the two groups of inspectors and attendants have many points of contact. This sharing of views between inspectors and attendants can provide the interaction fields between them as well. According to the expressed opinions, it is necessary to modify some methods and approaches in the health inspection of the food procurement, distribution and supply centers, Complete lack of focuson legal tools to change the behavior of operators and paying attention to the implementation of participatory training methods that have been less considered to date to increase the co-operation of service providers and agreed upon by both group of interviewees. Also, the entry of Self-reported health companies to the field of environmental health inspection and its consequence was one of the important issues that the inspectors and the operators looked at in this study with suspicion. Therefore, more attention should be paid to its implementation. The opinions of the interviewees (two groups of inspectors and operators)have a lot of sharing points about the various issues in health inspections. it is suggested that the opinions of operators as one of the stakeholders on the environment of the environment in decisions are investigated. The sharing of opinion between inspectors and operators can provide the fields of interaction between inspectors and operators. According to most participants, the necessity of reforming some methods and approaches is essential in health inspection of supply centres, distribution and supply of food. The focus and focus of the training and empowerment of investigators and the training of operators in modern ways and the lack of complete focus on legal instruments for the change of operators ' behaviour and attention to the implementation of corporate educational practices that have been less noticed today is necessary to enhance the cooperation of operators. It is also possible to consider some of the inspections as an advisory and training inspection at the curator " s workplace. according to the inspectors, under article 13 of the executive code of article 13 of the provisions of article 13 of the provisions of article 13 of the provisions of article 13 of the provision of edible, drinking, cosmetic and sanitary procedures and changing the procedures of legal action in the comprehensive audit system, the auditors are not yet familiar with the law and the executive procedure of recording checks and carrying out legal action has encountered some problems. On the other hand, the introduction of self - declaration to the area of health inspection and its outcome was an important issue in which the study was regarded by investigators and officials in doubt and doubt. Therefore, further consideration should be made about its implementation. finally, with regard to the extent of the activity of health inspectors from medical sciences at the university of medical sciences throughout the country as well as the small number of studies and researches related to various fields of auditors, inspectors are scientifically studied and analyzed and the effectiveness of activities such as inspection and sampling of food is analyzed as well as the effect of inspection from operators ' point of view. From the strengths of this study, it is possible to point out that for the first time with a qualitative study of defects and challenges and views of both groups of health inspectors of the environment and operators of supply centers, distribution and supply of food were examined and explored.

Health monitoring and control of food preparation, supply and distribution centers are the responsibility of environmental health officers. Therefore, the present study was conducted to explain the interaction between environmental health officers and providers of food preparation based on the game theory model.
This research is a descriptive-analytical study in which after the determination of effective factors on the interaction between officers and directors, the so-called 22 games were designed and for each game four behavioral strategies determined and strategies identified as a two-choice I agree, I disagree questionnaire provided to environmental health officers and directors of food preparation, centers to select their desired strategy.. In the quantitative phase, SPSS 22 was used to analyze the data collected by questionnaires in order to determine the percentage of response frequency to each question. Gambit software was used to analyze for determination Nash equilibrium of any Games.
In the present study, the factors affecting the interaction between environmental health officers and directors were categorized to 24 subcategories assigned to six categories, and in the quantitative phase, finally, 22 dominant behavior strategies were identified and the final benefit percentage of each actor was determined.
Investigating selected strategies by directors suggests that there is a good fit between the rules and health behaviors among the directors. The emphasis on health inspection based on education and counseling and lack of acceptance of the activities of health self-reported companies by the directors and officers are the most important outcomes of this study.

Nowadays, the appropriate selection of environmental instruments is considered a political priority in most countries. Given that one of the most important environmental tools in recent years to counteract industrial pollution has been levying green tax on polluting industries, the present study aims to identify interactive factors affecting the enforcement of green taxes between executive agencies [Department of Environment and Administration of Economic and Finance] and industries to reduce pollution.
In this qualitative study, 13 participants from the DOE, MEFA and Deputy of Industries’ Affairs of Yazd were selected by purposive and snowball sampling. The data were collected through semi-structured interviews and then analyzed in the MAXQDA10 software by content analysis method.
From our data analysis, two main categories executive organizations and industries were drawn, which included 8 sub-categories tax justice, tax culture development, tax determination and tax collection, weak tax systems, tax laws, tax penalties, tax incentives and adoption of an environmental framework by the industry.
Reforming the environmental laws, approaches and policies, emphasizing education to develop the culture of tax payment, avoiding unilateralism in enforcing environmental policies and enhancing incentive policies seem essential.

In every country, educational systems are regarded as the axes of development. Therefore, evaluating different academic departments as the main parts of educational systems is one of the most important responsibilities for university managers and authorities This study aimed at evaluating educational performance of all departments at the School of Health, a University of Medical Sciences using Data Envelopment Analysis technique in a time period of 2012-2015. This descriptive, cross-sectional study evaluated the performance of the School of Health departments from 2012 to 2015 using Data Envelopment Analysis technique and Deap version 2.1. The study findings revealed that 57% of the academic departments were efficient and had constant returns to scale (CRS) while others (43%) had decreasing returns to scale (DRS). The Departments of Health Care Management, Nutrition, and Environmental Health were mentioned as reference groups for those inefficient ones. Improving the quality of universities' performance depends greatly on competent and well-organized academic departments. Thus inefficient departments should benchmark reference groups to increase their output and promote the performance.

Over the past two decades, patient-centered care has become one of the important dimensions of health care delivery, given that patients are expected to receive appropriate care from the service center. This study aimed to evaluate the various dimensions of patient-centered care from the viewpoint of nurses and patients in order to improve the patient-centered care of health services. This cross-sectional study was conducted on two hospitals in city of Yazd, Iran. A total of 100 nurses and 100 patients were selected by simple random sampling method. Data was collected using a validated questionnaire and analyzed using one-way ANOVA test. The mean score of patient-centered care was 2.34 (standard deviation (SD) = 0.58) from nurses' point of view and 2.23(SD = 0.07) from patients' point of view. The dimensions of patient's dignity, patient's values and social support for the patient had the highest score and quick attention to the patients had the lowest score from nurses’ perspectives. Respecting dignity and quality of health service provider had the lowest score from the patients’ viewpoint. The quality of health service received significantly lower score from the patients than the nurses (P-value = 0.03). The quality of the physical environment, observance of the patient's dignity and quick considered as the priority of action to improve the patient-centered care. It is recommended that the authorities should give priority to these dimensions in order to increase satisfaction and loyalty of patients.

Considering the role of general practitioners in the family physician plan, policymakers and planners are required to be aware of the factors influencing the practitioners' decision to enter this plan. The aim of this study was to identify the effective factors on the decision of general practitioners to participate in the family physician plan. Furthermore, the interaction among these factors and the demographic characteristics of physicians working in Yazd University of Medical Sciences were identified. This descriptive study was conducted on 137 general practitioners, who were selected using the census method and discrete choice test in 2018. Data were collected using a questionnaire designed by orthogonal method and analyzed by SPSS 24. Data analysis was conducted using the Logit regression model in Stata 13 software. The findings showed that the "higher salary" construct was more favorable among the male married general practitioners who had higher incomes. Furthermore, married physicians were significantly more willing to provide out-of-pack services and use facilities of housing and transportations. On the other hand, these physicians have little desire to continue their education and use their quota for admission in the specialization course. Moreover, a reverse and significant relationship was observed between the place of service and the marital status. The family physician plan should be designed by taking into account the demographic characteristics of general practitioners. Therefore, more general practitioners would participate in and cooperate with the plan. The upstream laws of Iran emphasize the necessity of implementing family physician program and general practitioners have an important role in the formation and successful implementation of this program. Consequently, policy making in this area should take into account the demographic variables of physicians, so that more physicians are attracted to it.

Aging population is one of the most important demographic phenomena associated with increasing costs and demand for health services. Hence, planning and utilizing health services is a very important concern for the elderly as well as the politicians. The purpose of this study was to determine the status of utilization of outpatient health services among the elderlies of Yazd in 2018. This cross-sectional study was conducted on 300 elderly people in Yazd. The participants were selected using stratified sampling method. Data were collected using a structured questionnaire with 37 questions, which included three sections of demographic information, household characteristics, and health care utilization status. To analyze the data, SPSS 20, chi-square test tests, and logistic regression at a significant level of 0.05 were applied. The frequently visited places by patients to receive the outpatient services were specialist physicians' offices (34.0 %) and the most common cause to receive the outpatient services was cardiovascular diseases (34.0 %). Women (59.9 %) more than men and housewives (61.4 %) more than other people benefited from outpatient services. The average cost paid for the outpatient services was 500,000 Rials and 53.2 % of the elderly spent less than this amount. Factors affecting utilization of outpatient services included marriage, complementary insurance, education, specific illness, and household size. Cardiovascular disease is the most common cause of utilizing the outpatient services, which leads to an increase in the demand for outpatient health services. The utilization of these services is also affected by factors such as marital status, complementary insurance, education, specific illness, and household size. Therefore, proper planning is essential in this regard.

In order to achieve the highest level of effective interaction between the insurance organizations and the health system, efforts should be made to identify existing communication challenges for policymakers and decision makers. The present study was conducted to identify interactive behaviors aimed at designing an insurance mechanism based on game theory to cover the existing gaps. This study consisted of two phases of qualitative and quantitative. In the qualitative phase, data were collected and classified by a semi-structured interview with a number of insurance professionals in insurance organizations and the health system. In the quantitative phase of the study, interactive behaviors between the two organizations were studied. Finally, with the help of Gambit software, the insurance mechanism was designed. In the qualitative phase, the data were collected in three main categories: behavioral and communicative, structural and financial and deductibles and 11 sub-categories. In the quantitative phase, 35 optimal interactive behavioral strategies were delineated. The best behavioral strategy for interaction between insurance organizations and health system, to fill gaps in insurance system and to improve the interaction between the two organizations, was introduced in the form of 35 strategies to provide an insurance mechanism.

Today, the infectious wastes of hospitals are considered as a public health problem. Considering the huge amounts of hazardous wastes and the disadvantages of incinerators, we need to investigate the non-combustible devices involved in biochemical treatment. This study was carried out with the aim of evaluating the cost-effectiveness of infectious wastes devices. This descriptive-analytical study was conducted to evaluate the cost-effectiveness and economic efficiency of the infectious waste devices in Yazd and Isfahan hospitals.  In this study, the total cost of infectious waste treatment systems in hospitals, the Incremental Cost Effectiveness Ratio (ICER), as well as the sensitivity rate for the reduction of infectious wastes were calculated using Treeage software version 2011. In order to calculate the cost effectiveness using the total cost and the amount of produced waste, we applied the discount rate of five percent and the useful life of 10 years for each device. Based on the results, devices A and F had the highest and the lowest total cost, respectively. In addition, autoclave D with an ICER of 257.20 was more cost effective than other devices. So, device D, with a discount rate of ±5 and a range of 244.244 - 270.06 was chosen as the best option for infectious waste disposal. The results can be used to explore and outline the future prospects for choosing the best technology for treatment of infectious waste in hospitals. In other words, we have different options on different circumstances and occasions.
Keywords:

The benefits of health services are affected by several factors. The possible consequences of such factors affect the utilization rate of health services and may lead to higher costs of health care induced by the increased use of medical care services. Therefore, this study was conducted to investigate the effect of patient-related factors on the utilization rate of health services among the selected hospitals of Qom city in 2017. The present cross-sectional descriptive-analytic study was carried out in 2017. Data were collected using Goldberg standard health questionnaire and a checklist completed by 400 patients who referred to the selected hospitals of Qom city. Data were analyzed by Stata 13 and the logistic regression test was run to determine the effect of independent variables (effective factors on the use of services) on the dependent variable (service usage). Later, we analyzed results of the regression tests and investigated the relationship of the independent factors and the demographic information on the use of services. The results of logistic regression tests showed the utilization rate of services by investigating the relationship among demographic, independent, and dependent variables. We found that utilization rate of health services increased by the following factors: older age, female gender, higher number of family members, higher family income, higher education level of the head of household, higher education level of patients, and residence in urban areas of Qom city. Further factors included being native of the city, being under the basic and supplementary insurance coverage, and having poor health status. Moreover, married head of family, employment of family members in the medical care system, near distance to the hospital, and more leaves from work led to more application of services. In addition, patients who spent more days to take the doctor's visit, spent more time in the clinic to visit the doctor, and had longer visit duration by the physician used the services more frequently. Furthermore, utilization rate of services had a statistically significant relationship with the health status of the individual, the marital status of the family head, and the visit duration by the physician. Considering the effective factors on utilization rate of services by patients, health system administrators can analyze the risk factors and make practical suggestions to control and reduce the false use of services by patients and physicians. In this regard, they can implement incentive and punitive mechanisms, create awareness among people about the challenges and risks of the induced demand, change the strategies, modify the insurance payments, rate the level of services for different classes of the society, and maintain the financial resources to meet the needs.