noureddin niknam

Years of life lost (YLL) is commonly used to determine the social and economic burden of loss due to premature mortality. The present study estimated YLL based on general mortality groups in Golestan Province, Iran, in 2018.

In this cross-sectional study, by referring to the province death registration system information and using standard expected years of life lost (SEYLL) of the World Health Organization (WHO), YLL was calculated due to premature mortality based on general mortality groups in ICD-10 (international classification of diseases 10th revision).

The total number of deaths in Golestan Province was 8543 in 2018. The overall YLL due to premature mortality was 129838 years, of which 57.4% occurred among men. The major causes of YLL due to premature mortality (YLL%) were diseases of the circulatory system (I00-I99) (32.3%), external causes (V01-Y89) (17.3%), certain conditions originating in the perinatal period (P00-P96) (14.5%), and cancers (C00-D48) (13.9%). After diseases of the circulatory system, the most common cause of YLL due to premature mortality is external causes (22.9%) among men and cancers (16.2%) among women. In general, the highest YLL rate occurred due to circulatory system diseases (22.5 per 1000 people).

According to the results of our study, most years of life lost in both sexes are related to diseases of the circulatory system, followed by external causes of morbidity and mortality. Therefore, it is important to pay attention to the diseases of the circulatory system and its causes, as well as external causes of morbidity and mortality.

Safety culture is the basis and dominant part of patient's safety, and is considered as the main axis of safety promotion programs and service quality. The purpose of this study was to explain the challenges of safety culture in Iranian educational centers with a qualitative approach.

This study was a contractual qualitative content analysis which conducted in 1400. The study population consisted of people who had 5 years of experience in taking care patient or working in the patient's safety and quality control unit in teaching and medical centers affiliated to Tehran University of Medical Sciences. Study data were saturated by purposeful snowball sampling and in-depth and semi-structured interviews with 25 participants. “Granheim and Landman approaches” and “Goba and Lincoln criteria” were used to analyze the data and solidify the research. The process of coding and analyzing research data was performed simultaneously; Finally, the extracted categories and subcategories were confirmed by the interviewees. MaxQDA 10 was used to analyze data.

By analyzing the interviews, 331 codes, 7 categories and 20 subcategories were extracted. Lack of reporting errors, poor culture regarding no-blame, staffing issues, low understanding of patient safety, poor management support for patient safety, poor teamwork between units, and lack of open organizational communication were the main categories found and the most important challenges of safety culture in teaching and medical hospitals.

According to the findings of the research, developing codified and continuous educational programs, strengthening teamwork and communication, adopting a comprehensive approach to increase the presence of all members of the treatment team in the process of reporting, and analyzing and implementing error prevention programs are among the requirements for improving and promoting the safety culture and quality of service to patients.

Iran's population is aging and the quality of life of the elderly in the armed forces, due to the nature of professional activity, needs special attention. The purpose of the present study was to determine the relationship between interpersonal sensitivity and quality of life in the armed forces retirees in Tehran, Iran.

The present study is a cross-sectional correlation with an analytical approach. The statistical population of the study consisted retirees of the armed forces over 65 years old who lived in Tehran, Iran in 2019-2020. By using Morgan table, the sample size was 373 people who were selected by available sampling method. The research tools included Boyce and Parker (1989) Sensitivity Questionnaire with confirmed validity and reliability of 0.81 and also older people's quality of life questionnaire (CASP-19) with confirmed validity and Cronbach's alpha of 0.78. Questionnaires were completed through one-on-one face-to-face interviews with senior retirees of the Armed Forces. The relationship between research variables was assessed by using Pearson correlation coefficient test and SPSS 22 software.

91.42% (341 people) of 373 participants were male. 75.06% (280 people) were 70-65 years old. 75.06% of the samples were 65-70 years old. The mean score of total interpersonal sensitivity was 57.17±35.83 and the mean score of total quality of life of the elderly was 58.00±26.34. The results of Pearson correlation test showed that the level of significance between interpersonal sensitivity and quality of life in the elderly was equal to 0.41 (P-Value<0.05). The interpersonal sensitivity score and its dimensions were at a low level and the elderly quality of life score and its dimensions were at a good level.

The general condition about interpersonal sensitivity with quality of life in elderly retirees of the armed forces living in Tehran, Iran is slightly more favorable than the scores related to studies of the general elderly population of the country. This issue can be related to the systematic structure of the armed forces, emphasis and continuous training during service, the existence of active retirement centers, as well as the continuation in communication with colleagues.

Today, hospitals need managers who, in addition to having the necessary skills for management and leadership, are accountable to stakeholders, especially the community. Accordingly, the purpose of this study was to evaluate the social accountability of managers of public and private hospitals in Tehran.

The present study is descriptive‑analytical and cross‑sectional and was performed on 155 managers of selected public and private hospitals in Tehran. The research tools included a demographic characteristic questionnaire and a researcher‑made social accountability questionnaire for managers. Data analysis was performed using descriptive and inferential statistics in SPSS 22 software.

The situation of social accountability in the managers of public hospitals was at a weak level and in the managers of private hospitals in Tehran was at a good level. In comparing the status of social accountability and its dimensions in the managers of public hospitals with the managers of private hospitals, the status of social accountability in the dimensions of human resource management, quality improvement, executive management, and overall social accountability were significantly different from each other (P ≤ 0.05). However, in terms of governance, the status of social accountability of public hospital managers was not significantly different from private hospitals (P ≥ 0.05). Overall, the results of social accountability in private hospitals were better than in public hospitals.

The social response status of managers in private hospitals was better than public ones. Lack of attention of managers to social accountability affects the quality of other educational, health, and medical services. This fact raises the need for managers to pay more attention to the issue of social accountability.

Outsourcing, as one of the important managerial strategies to improve performance, has become one of the main areas of research in hospital management studies. The aim of this study was to identify the challenges of outsourcing hospital services in Iran.

This research was conducted in a qualitative manner with the aim of determining the challenges of outsourcing hospital services in Iran. The research community consisted of managers and experts in the field of outsourcing. 21 managers and staff experts of the Ministry of Health, universities, and hospitals affiliated to Iran University of Medical Sciences, Tehran, and Shahid Beheshti, were selected as the target for the interview. Finally, the data were analyzed using content analysis method.

Outsourcing challenges were extracted and reported in the form of 6 theme topics and 40 subthemes. The main issues included legal and political challenges, finance, human resources, organizational, managerial, and private sector.

Outsourcing hospital services in all six areas faced serious challenges. To this end, partnership between the private and government sectors through outsourcing requires the continuous development of effective political, organizational, and managerial capacity in order to guide and manage this process properly and efficiently to ensure that the goals and policies in the field of health. It is clearly understood and not forgotten or neglected.

Today, it is important to use different indices to measure the performance of hospitals. This study aimed to investigate and evaluate the performance indicators of military hospitals and measurement of performance by using the Pabon Lasso model.

This was an applied and descriptive‑analytical study that was conducted among five military hospitals affiliated to the Army of the Islamic Republic of Iran by using data from 2017 to 2018. Raw data related to performance indicators such as bed occupancy ratio (BOR), average length of stay (ALoS), and bed turnover rate (BTR) were collected by referring to the hospital medical record unit. After comparing performance indicators with the standards of the Ministry of Health, the Pabon Lasso model was used to measure hospitals’ performance.

In general, the average BOR and bed turnover interval rate are higher than that of the national standard in all hospitals and are in favorable status. However, the average length of stay in all hospitals was in unfavorable status. Furthermore, one and two hospitals were located in zone 3 in Pabon Lasso graph in the years 2017 and 2018, respectively. Overall, there was no change in the performance of the hospitals in the study time periods.

In general, except for the average length of stay indicator, hospitals had a favorable performance level. Therefore, planning to improve performance indicators should be at the top of the programs.

Knowledge management enhances efficiency, empowers employees, and enhances organizational health. Social capital provides a good basis for more productive human resources, and training hospitals also play a key role in the health‑care system. The purpose of this study was to determine the relationship between knowledge management and social capital with organizational health in selected educational hospitals of Tehran in 2018.

This analytical cross‑sectional study was performed on 310 medical staff of hospitals using proportional sampling method. The data gathering tools consisted of three standard questionnaires of knowledge management, social capital, and organizational health. Data were analyzed using descriptive and inferential statistics using SPSS version 22 software.

Most participants in this study were male (8/66%) and in the age group 31–36 years. The mean of knowledge management and organizational health were 3.43 and 3.49, respectively. There is a significant direct relationship between knowledge management components and organizational health. Moreover, there is a significant but weak direct relationship between knowledge management and social capital with organizational health dimensions (P ≤ 0.05).

Considering the relationship between knowledge management and social capital with organizational health, enhancing the level of organizational health can help to improve the dimensions of knowledge management and social capital. It is suggested that hospital managers, using knowledge management and social capital components, enhance organizational health so that the hospital is more prepared to adapt to the complexities and changes in the market providing services.

The literacy level of the elderly is predictive of health behaviors, average hospitalization in health centers, and the type of verbal interaction with health service providers; as the level of literacy changes, the quality of life may also change. This study aimed to determine the relationship between health literacy level and quality of life among the elderly living in nursing homes in 2018–2019.

This study was of a descriptive‑analytic, correlation type that was performed on 175 elderly of selected nursing homes in Tehran. The research tools included the Abbreviated Mental Test; Control, Autonomy, Pleasure and Self‑realization questionnaire‑19; and Health Literacy of Iranian Adults Questionnaire (HELIA). Data were analyzed using descriptive and inferential statistics by SPSS 22 software.

The total score of health literacy and the quality of life of the elderly was 51.01 and 47.75, respectively. The literacy of most of the studied samples was “inadequate” and “not much adequate” (0–66). The relationship between health literacy and quality of life in the elderly was significant, and there was a direct and statistically significant relationship between them (P = 0.003). That is, by an increase in literacy rates, the scores of quality of life of elderly people were also increased. The correlation was equal to r = −0.28. Health literacy has the ability (31.98%) to predict the quality of life.

The results showed a lack of enough education literacy, the average quality of life, and the existence of a significant relationship between health literacy and quality of life in the elderly. The wide range of inadequate literacy in the elderly reveals the importance of paying more attention to the issue of literacy in health planning and health promotion at the national and local levels.

Hospitals are the main axis of health‑care reforms or national health plans; therefore, accurate recognition of hospital costs based on operational indexes to these plans is necessary. The impact of implementing national health plans on the performance of health systems is ambiguous and misleading; therefore, the aim of this study was to assess the impact of Healthcare Reform Plan (HRP) on the micro level (e.g., educational or university hospitals).

This study was a descriptive retrospective study that research variables are checked in 1 year before and mean of 3 years after implementation of HRP by self‑administrated checklist in selected public‑educational hospitals covered by the medical universities in Tehran. The final analysis of the data was performed using cost–performance ratio and independent t‑test for comparing the variables’ changes before and after HRP.

Unlike adjusted hospitalization costs, most operational indexes were not significant. The per capita cost adjusted of hospitalization in first and mean of 3 years after HRP increased 49.49% and 16.31%, respectively (P < 0.001), the adjusted cost per day was increased by 24.48% and 21.46% (P < 0.001), and adjusted cost per bed was increased 47.06% and 20.07% compared to before HRP (P < 0.001).

Given the lack of alignment in adjusted cost changes in exchange for functional indicators, certainly, it cannot be argued that HRP had a favorable or undesirable effect on the hospitals.

In the development perspective of each country, it is important to pay attention to the health sector and improve health indicators; therefore, planning in training and distribution of human resources in the health sector is an important factor to achieve the health system goals. The aim of this study was to investigate the effect of changes in health sector human resources on infant mortality rate (IMR), maternal mortality rate (MMR), and under‑five mortality rate (U5MR) in Iran.

This was an econometric study (data panel) that conducted retrospectively and used data from the period 2006 to 2017 among Iranian provinces. Three regression models were used to determine the effect of health sector human resources (physicians, nurses, and paramedical staff) on the IMR, MMR, and U5MR. The random‑effects model was selected over the fixed‑effects model to assess the effect of health sector human resources on health outcomes.

Results showed that the number of physicians in different models has a stronger impact on these mortality rates than those of nurses and paramedics, so that a 1% increase in the number of physicians leads to 2.1%, 3.8%, and 2.2% decrease in IMR, MMR, and U5MR, respectively. Furthermore, per capita income has a bigger impact on these mortality rates than human health resources.

Increasing the number of human resources in the health sector, especially the number of physicians, by investing in these resources by providing educational facilities, plays an important role in improving the mothers’ and infants’ health indicators.

Selecting variables is a fundamental step in evaluating comparative efficiency because the results of measuring efficiency depend on the used variables.

The aim of this study is to provide a comprehensive set of input and output variables for measuring efficiency with an emphasis on application in general hospitals in Iran.

This study comprised a literature review followed by a Delphi survey process. After extracting the variables from the literature review in order to reach consensus on them and identify the native variables, the researchers used the Delphi technique in three rounds. Thirty Iranian hospital managers, in Alborz, Saveh, Qazvin, Qom, and Hamadan universities, participated in this study. For analysis, the interquartile range (IQR) and median were used. IQR was used to assess the agreement of Delphi panel members.

After literature review, nine indicators were identified as input variables and 11 indicators were identified as output variables. After the proposed changes by Delphi members, 24 input variables and 24 output variables were identified to measure hospital efficacy. Finally, ten variables were selected as inputs and ten variables were selected as outputs to measure the performance of public hospitals in Iran by using the consensus of the members in the Delphi panel.

This study proposes a framework for selecting the most appropriate variables for measuring the hospital efficiency with an emphasis on nonparametric methods. Choosing variables to measure hospital efficiency requires infrastructure such as an intelligent information system.

The burden of premature mortality is used to prioritize health problems. The purpose of this study was to estimate the burden of premature mortality due to colorectal cancer in Golestan from 2011 – 2015. In this sequential cross-sectional study, based on the province mortality registration data and standard expected years of life lost (SEYLL), the burden of premature mortality was calculated. From 2011 to 2015, a total of 3283 years of the lost years of life was due to the Premature Mortality in Golestan province to colorectal cancer, which occurred 1983 years (60.4%) in the men and 1299 years (39.6%) in the women. The rate of lost years of life for the 5-year period was 1.2 per 1000 people in the men and 1.4 per 1000 people in the women. The results of the study showed that people over 60 years old were at risk of death and losing more potential life expectancy due to premature death due to colorectal cancer. Colorectal cancer seems to be the primary cancer of the province's health system. But definitive judgment requires calculating the burden of disability caused by cancers and ranking them based on the complete calculation of the Disability-Adjusted Life Years (DALY) index.

In the Iranian Accreditation System, leadership and management standards have been almost ignored and not paid enough and necessary attention to the structural components and the infrastructures standards in management and leadership sections. Governing body, medical staff, chief executive officer (CEO), and nursing management standards are inadequate and lack accountability. These standards could lead to reform and finally provide the context for accomplishment of an appropriate accreditation program.

This is a descriptive, comparative, and qualitative study. It was done in two phases. The first phase included literature review of the standards of the selected countries followed by comparison of the standards of the board of trustees, medical staff, CEOs, and nursing management standards to develop the primary framework for Iranian hospitals. In phase two, the primary framework was validated true three rounds of Delphi technique.

Surveying the accreditation system standards in selected countries included the USA, Egypt, Malaysia, and Iran. It was found that the management and leadership standards were classify as governing body, medical staff, CEOs, and nursing management standards. The result of this study provides a framework for improvement of the Iranian national accreditation program.

In regarded to the importance of the leadership and management standards in reform and change and promotion of the health services quality, efficiency, and effectiveness, the results of this study showed that the present standards of the Iranian accreditation assessment system and guidelines lack the necessary infrastructures for implementing a successful national accreditation program.

An increase in disasters around the world like bioterrorism attacks emphasizes the need to assess healthcare workers’ preparedness to respond to bioterrorism. Nurses form the majority of first responders in disasters and emergencies, thus it is important to guarantee that their knowledge and skills are adequate to respond to such events.
This study aimed at assessing the level of nurse’s knowledge and attitude of Sari city of Mazandaran province about bioterrorism, in 2015.
Overall, 240 nurses participated in this cross-sectional study that was conducted at the University of Mazandaran Medical Sciences. The units were selected through the accessible sampling method. Data were collected by a questionnaire in 3 sections, demographic data, knowledge, and attitude, respectively.
Results and The results showed that 91.7% of samples had low knowledge about bioterrorism and 93.3% had no opinion in regarding attitude of bioterrorism. Little knowledge of nurses regarding bioterrorism attacks indicates inefficiencies in hospitals units. Therefore, bioterrorism preparedness should be proposed through continuing education for under graduate and post-graduate nursing curriculum.

 The purpose of this study is to investigate the zinc (Zn) and nickel (Ni) removal from aqueous solution by coagulation-flocculation using polyaluminum chloride (PACl) and chitosan (CS) biopolymer. 

 This study was a laboratory scale experiment, which used PACl and CS to remove Zn and Ni with concentrations 3-100 mg/L from aqueous solutions. Jar test was used to compare the Zn and Ni removal efficiencies of the chemical treatment options using PACl and CS. The dosages used for PACl ranged from 5 to 100 mg/L whereas CS dosages varied between 5 and 75 mg/L. 

 The results showed that optimum coagulant doses and pH were found at 50-100 mg/L and 11 for PACl and 20-75 mg/L and 11 for CS, respectively, when CS added with PACl led to a better removal efficiency of the metals (more of 99%). In mixed aqueous solution, the presence of Zn caused increase of Ni removal efficiency and the presence of Ni caused decrease of Zn removal efficacy. 

 The results of this study showed that CS had higher removal efficiency than PACl for removal of Zn and Ni, and also CS as a coagulant aid led to increasing in metal removal.

In the new approach, all health care providers have been obligated to maintain and improve the quality and have been accountable for it. One of the ways is the implementation of clinical governance (CG). More accurate understanding of its challenges can help to improve its performance.

In this study, barriers of CG implementation are investigated from the perspective of the hospitals involved. Besides, some solutions are suggested based on stakeholders’ opinions.

This study used combined method (qualitative content analysis and questionnaire) in hospitals affiliated to Isfahan University of Medical Sciences in 2014. First, experts, and stakeholders talked about CG implementation obstacles in a semi‑structured interview. Interviews were confirmed by the interviewee (double check). After analyzing the interviews using reduction coding the questionnaire was drawn up. The questionnaire “validity was confirmed by Cronbach’s alpha (0/891)” and its reliability was obtained using experts confirmation. Data analyzing was performed using SPSS (18) software.

According to results staffing and management factors were the main obstacles. After them, were factors related to organizational culture, infrastructure elements, information, sociocultural and then process factors. The learning barriers were in final rank. Thirty‑four solutions was proposed by experts and divided into subset of eight major barriers. Most solutions were offered on modifying processes and minimal solutions about modifying of organizational culture, sociocultural, and educational factors.

Removing the obstacles, especially management and human resource factors can be effective by facilitating and accelerating CG. Furthermore, use of experts and stakeholders opinions can help to remove CG barriers.

Removal of toxic heavy metals from wastewater is an important environmental challenge. In this Study, Zn (II) removal from aqueous solution by chitin extraction from crustaceous shells (shrimp and crab) was investigated. The biosorption studies were determined as a function of contact time, pH, initial metal concentration, and the amount of adsorbent. Adsorption of Zn (II) increased with decreasing concentration of the adsorbents and reached maximum uptake at 0.5 g. Effect of pH was studied in the range of 3-7 and the optimum conditions for both adsorbents were found in the range of 5-7. Zn (II) adsorption for both adsorbent was evaluated by Langmuir and Freundlich Isotherms. Results indicated that the Freundlich isotherm model was the most suitable one for the adsorption process using chitin extracted of shrimp and crab shells. The pseudo-first order and pseudo second order kinetic models were used to describe the kinetic data. The adsorption capacity (qmax) calculated from Langmuir isotherm and the values of the correlation coefficient obtained showed that chitin extracted from shrimp shells has the largest capacity and affinity for the removal of Zn (II) compared with the chitin extraction from the crab shells.

Since hospitals give their services to a huge number of people most of whom are sick and disabled and also because they have many expensive and modern equipment and facilities, any negligence regarding the standards of safety management leads to severe damages including financial ones. This may even result in irrecoverable consequences such as their clients’ Death. So, this investigation was conducted to assess the condition of safety management in Isfahan’s AL Zahra hospital. This cross-sectional and descriptive-analytical project was conducted in different wards of AL Zahra hospital. In this study, the hospital''s units under the investigation were determined and no sampling method was used. The data collection was done by a checklist and questionnaire. They had content validity which was confirmed by the viewpoints of psychiatric and behavioral sciences specialists. The data were analyzed through SPSS (version 16) using Kruskal Wallis statistical tests. In this study, the level of significance was 0.05. After assessing safety management in Safety and Accidents Committee and calculating the score average of the studied factors, safety management organization and also hospital’s organizational constructs sectors were 74.43±13.47 and 65.48±12.25, respectively. Their safety management condition was assessed appropriate. Surgery ward was also assessed appropriate regarding the principles of safety management with a mean score of 77.36±13.84. No significant difference was found among the studied standards in these units according to Kruskal Wallis statistical test. (P-value>0.05) The results showed that the condition of safety management in this hospital was acceptable, in general. However, it is necessary to do the following interventions to improve safety condition; training managers and staff, setting and observing the rules and disciplines of safety, regular monitoring of safety issues and considering safety principles implementation as an important factor in evaluating and ranking of hospitals.

 This study investigates the potential of chitin shrimp shells for the removal of arsenic (V) and zinc (II) ions from aqueous solutions. 

 In this study, the chitin was extracted from shrimp shells for arsenate and zinc ions removal from aqueous solutions. The effects of pH, adsorbent dosage, contact time and initial metal ion concentration on As (V) and Zn (II) removal were investigated in a batch system. 

 The equilibrium data were described using the Langmuir and Freundlich isotherm models. The Langmuir equation was used to find the maximum adsorption capacity for arsenate (11.574 mg/g) and Zn (270.27 mg/g). Biosorption was found to depend significantly on the pH of the solution and is optimal at pH values of 4 and 7. To determine the rate-controlling mechanism for metallic ion adsorption, pseudo-first-order and pseudo-second-order equation kinetic models were tested with experimental adsorption kinetic data. Modeling results revealed that As (V) and Zn (II) kinetics data were successfully described using pseudo-first and second-order models, respectively. FTIR analyses showed that hydroxyl and carboxyl groups could be very effective for capturing these metals. 

 Results showed that the chitin is a good adsorbent for the removal of arsenate and zinc ions from aqueous solutions.