مجله تصویر سلامت
سال چهاردهم شماره 2 (تابستان 1402)

Within the healthcare system, health services have been categorized into different levels to enhance healthcare management. The concept of service leveling involves the provision of services in a sequential and adaptable manner. In the event that a specialized environment's client requires more advanced services that are not available within that facility, the patient is transferred to an associated unit at the same or higher level that offers the required specialized services. This sequence of services within the healthcare system is known as the referral system (1). The healthcare referral system facilitates a strong connection between healthcare tiers and the individual receiving medical care (2,3). Patients can benefit from a second opinion from a specialist, access to more specialized care, and enhanced outcomes through the referral system. Additional benefits include lower overall healthcare expenditures, better use of staff and patient time, and lessened "induced demand" for medical care (1).
At present, the health system in Iran lacks definitive guidelines pertaining to the dissemination of patient medical information. In the event that a patient requires specialized information regarding their health, to whom or what service should they direct their inquiry? Based on the available evidence, it can be inferred that the primary source of medical information for patients is their physician (4). In the event that the physician is unable to provide comprehensive and satisfactory responses to the patient's inquiries during the medical visit, will they make a referral to another individual or information resource? Is there a specific program in place within medical center libraries to address the information requirements of patients? Would it be possible for a patient or their companion to obtain accurate and evidence-based information by visiting the medical center's library? It is evident that the healthcare system lacks a structured approach for delivering information services to patients and directing them to authorized sources to address their inquiries.
There have been various approaches and interpretations, such as prescribing information (5) and information therapy (6,7), patient education (8), and information counseling (9), Consumer Health Information (10), that have aimed to improve the accessibility of medical information for patients within the health system. However, none of them are officially recognized as important programs within the current healthcare system of Iran, thus they cannot ensure that vital patient medical information will be communicated at the time of service. It is important for the country's health system to prioritize this issue in order to ensure that patients have access to information.
Without this prioritization, it may be difficult to guarantee patients' rights to information in the health system (11). Therefore, it is crucial to establish clear rules and regulations to ensure that patients receive necessary information and that the information referral system within the healthcare system is effective. It would be beneficial if clinical guidelines provide clear guidance on the referral system for information, in order to ensure that the patient receives information in a timely and effective manner. During a medical visit, it is important for the doctor to understand the patient's need for information and provide appropriate referrals to reliable and specialized sources. If the library or information department of the hospital, clinic , or treatment center is unable to provide information based on medical evidence, alternative sources should be referred. It may be beneficial to direct the patient's inquiry to a higher authority who can provide the most accurate and comprehensible information. This process is the information referral system within the healthcare system. If clinical guidelines provide clear guidance on the referral system for information, it will ensure that the patient receives information in a timely and effective manner. When healthcare professionals utilize the information referral system to communicate with patients, manage treatment processes, monitor disease improvement, gather feedback from patients, and provide feedback to patients, the implementation and management of the referral system within the healthcare system will be more informed, safer, and promote better health outcomes. It is believed that the implementation of an information referral system could potentially ensure the accurate dissemination of information to patients within the healthcare system. One approach to managing costs and improving patient outcomes is to provide evidence-based information at various stages of care. This can help reduce extra costs (12) and unnecessary hospital readmissions, prevent patient errors (13), and better manage the supply and demand of induced healthcare services. The referral system for information services has the potential to enhance and streamline the management of various types of information centers and libraries catering to diverse segments of society, including doctors, students, researchers, women, patients, and others. It is noteworthy that the system is not limited to patients alone. By implementing the referral system and standardizing information services, health information centers and libraries can be optimized for improved efficiency and effectiveness.
It would be beneficial to establish regulations for the information referral system within the health system. Highly trained medical professionals, including doctors and health information specialists with advanced degrees in medical librarianship and information science, are well-equipped to address this crucial issue. It may be possible to implement the health information referral system in both online and physical environments without incurring significant expenses. This could be achieved by utilizing the expertise of medical professionals and medical information experts within the health system.

Workplace violence in the healthcare system has become an important policymaking issue in recent years and is considered one of the most complex issues for the governmental system. Due to the lack of a similar study in Golestan province, this study was conducted to determine the level of exposure to workplace violence against nurses and the factors related to it.

This cross-sectional study was conducted in hospitals affiliated with Golestan University of Medical Sciences in 2021 Where 293 nurses were included after random stratified sampling. The data collection tool was demographic and occupational variables as well as the workplace violence questionnaire and data analysis was done by descriptive statistics methods and Mann-Whitney, Spearman, Kruskal-Wallis, and Chi-square tests in SPSS-23 software at a significance level of 0.05.

The average age of the nurses participating in the study was 33.93 ± 7.16 years and their average work experience was 9.82 ± 6.32 years. Among the subjects, 82.6% were women and the rest were men. The prevalence of workplace violence was 86% in one year. Mental and physical violence with a frequency of 79.5% and 42.7%, respectively, had the highest occurrences. Also, 57.7% did not report any act of violence. In front of these acts of violence, the most reactions were inviting the attacker to calm down (42.3%), discussing the issue with colleagues (23.5%), and not taking any specific action (19.5%). There was a significant relationship between physical violence and gender (P-value=0.024) and department of hospital (P-value=0.003). Sexual violence was also significantly related to department of hospital (P-value=0.046). Also, there was a significant relationship between racial violence and gender (P-value=0.001), department of hospital (P-value=0.028), and work shift (P-value=0.005).

According to the results, the prevalence of workplace violence was generally high in one year, but most of the nurses did not report any act of violence. Therefore, medical policymakers and hospital managers should consider improving nurses' communication skills, and security measures, training staff on anger management, and reducing nurses' workload.

Students and graduates in the field of health management will be future managers of the health field. Improving the skills of health system managers as one of the main pillars of health service organizations is essential to meet the health needs of the community. Therefore, this study aimed to identify and prioritize the key skills required by healthcare management graduates as future managers of the health system.

This study was performed in three steps using the method of content analysis, Delphi, and factor analysis. In the first step, a semi-structured and interactive in-depth interview was used to determine the skills required for managerial jobs in the health system, and the data were analyzed based on the content analysis method. The sample size was 14 health experts. In the second step, a Delphi study was designed to build consensus on skills. The participants scored 44 skills extracted from the interviews through a three-point Likert scale from disagree to agree (from 1 to 3), then the skills were divided into several component groups through factor analysis.

In this study, 44 key skills needed by managers and graduated students in the field of health service management were identified in 10 components.

Costs and resources allocated to the training of health service management graduated students should be based on the need of the labor market and workspace.

Tobacco use is the fifth risk factor for non-communicable diseases in Iran. This study aimed to analyze the policies and measures of tobacco control in Iran in the last four decades (1983-2021).

The present study is a retrospective policy analysis that used a case study plan based on the Walt and Gilson triangle policy analysis framework to examine the content of tobacco control policies in Iran. Data were collected using tobacco use policies and legal documents and analyzed using documentary analysis. MAXQDA 11 software was used to categorize and analyze the findings.

The policies include setting prices and taxes on tobacco to reduce demand; protecting the public from second-hand smoke; controlling the composition of tobacco products; setting regulations on the disclosure of information about tobacco packaging and labeling; educating the public about the dangers of tobacco use; advertising, promotion, and financial support of tobacco; setting measures to encourage smoking cessation and reduce the demand and dependence on tobacco; banning illegal tobacco product trading; banning youngsters from tobacco trading; financially supporting the practical alternatives such as economic activities and research; setting monitoring and evaluation systems; and enhancing the exchange of information.

Strengthening the government's tobacco control capacity and formulating a clear and coherent national tobacco control strategy and roadmap, including a mechanism for practical cross-sectoral cooperation between different actors, can reduce conflicts of interest between the actors involved and determine the country's current and future tobacco control policies.

Illness Anxiety Disorder (IAD) is one of the most common psychiatric disorders. Despite the high prevalence of this disorder, there are few studies and many unknown issues about it. Therefore, this study aimed to investigate the role of childhood traumatic experiences, attachment styles, and metacognitive beliefs in predicting the symptoms of IAD.

In this cross-sectional descriptive study, 395 students (71 male, 324 female) of the University of Tabriz with associate, bachelor, master, and Ph.D. degrees were selected through the available sampling method. The questionnaires used in this research included the Whiteley Index to measure illness anxiety, the metacognitive beliefs questionnaire (MCQ-30), the checklist of traumatic life experiences to evaluate childhood traumatic experiences, and the experiences in close relationships- a revised form to evaluate attachment styles. Participants completed the questionnaires after obtaining the necessary permits and checking the inclusion and exclusion criteria.

The average age of men was 27.2 ± 8.54 and women 25.24 ± 6.84. Pearson Correlation coefficients showed that traumatic childhood experiences 0.289 (p<0.01), anxious attachment 0.402 (p<0.01), and metacognitive beliefs 0.418 (p<0.01) have significant positive correlations with illness anxiety. Also, based on the results of simultaneous multiple regression analysis, research variables predicted 29% of the changes in symptoms of IAD significantly. Furthermore, childhood traumatic experiences, anxious attachment, and metacognitive beliefs with Beta coefficients of 0.22, 0.18, and 0.27 can significantly predict the changes related to IAD symptoms.

Different interpersonal and metacognitive factors can play a role in IAD symptoms, but various studies such as causality and experimental studies are needed to investigate the role of different factors in IAD symptoms.

This research aimed to optimize the technology policy and reduce the costs of technology growth centers at medical sciences universities. Identifying the effective factors in the expansion of technology units facilitates the development and advancement of innovative entrepreneurs through incubators.

The current qualitative research analyzes data collected through structured interviews with 31 individuals from growth centers, administrators of units located in growth centers, and health entrepreneurship experts. In three stages of categorization, the main and sub-categories have been identified. The relationships between the research components were determined using the interpretive structural modeling (ISM) technique.

Based on the results of the ISM, "modeling of technology units for health technology incubators in poor areas" we identified 213 codes of verbal propositions, 25 components and 8 categories which was classified into three levels. The first level is the growth of technological units; the second level includes the infrastructure and planned growth; and the third level includes the indicators of external infrastructure, internal infrastructure, acceptance plan, growth plan, and exit plan.

This study determined the framework and relationships between variables that influence the growth of technology units in health technology development centers at universities in disadvantaged areas. This is the first study to incorporate the internal infrastructure as an independent variable, indicating the effect of compensating for regional infrastructure weaknesses.

Cancers are showing a rising trend in developing countries. In Iran, cancer is the third leading cause of death after cardiovascular diseases and accidents. The cost of cancer diagnosis and treatment places heavy financial burden on health systems, requiring accurate financial assessments and evaluations. Therefore, this study aimed to determine the direct medical expenses of cancer patients undergoing surgery in Ahvaz, Iran, teaching hospitals.

This descriptive-analytical cross-sectional study was conducted in 2021. The research population included cancer patients undergoing surgery in Ahvaz teaching hospitals. Data collection was done using clinical records of the hospital. Quantitative statistical indicators such as frequency, mean, standard deviation, and tables were used for data analysis. In addition, analytical statistical indicators such as independent samples t-test, one-way analysis of variance (ANOVA), Pearson correlation coefficient, and regression were used with SPSS22 software.

The overall mean costs for cancer surgery were calculated at 77,994,903 (SD= 111,224,332) Iranian Rials (IRR). The most expensive cancer surgery was colorectal cancer with an average of 193,558,434 (SD= 266,162,757) IRR, and the lowest cost was pancreatic cancer surgery with an average of 29,284,226 (SD= 23,057,425) IRR. There was a significant positive relationship between the type of cancer (p= 0.000) and the length of hospital stay (p= 0.041) and the cost of hospitalized patients.

The economic costs of treating all types of cancer are very high. Any therapeutic and administrative measure that can reduce the cost of cancer treatment or the duration of treatment will contribute significantly to reducing patients' sufferings, improving their quality of life, and reducing the imposed costs.

Mobile applications have been proposed as a helpful tool to provide health-related information to people, and this is more important in pregnancy-related mobile applications. This review study aimed to investigate the features of Persian and English mobile apps for self-care in pregnancy.This descriptive cross-sectional study was done on all Persian and English mobile applications related to pregnancy in 2022. A search was conducted on Iranian digital app market (Bazaar) and "Google Play", using the following keywords: "pregnancy", "pregnant women", "obstetrics", and their Persian translations. For each app, the extracted information included name, user satisfaction rate, and the features and provided information by mobile app.The total number of retrieved applications was 416 apps. After removing the duplicates and applying the inclusion criteria, 63 applications were selected for features extraction. Reviewing the features and information provided by the applications showed that the most frequent categories of information included the following items: childbirth and pregnancy (including timing contractions, fetal movement, symptoms of pregnancy and predicting delivery time), restrictions and limitations (including behavioral limits, sexual restrictions, smoking and alcohol, cosmetics and pregnancy and drug use during pregnancy), and monitoring and control tools (BMI Calculator, managing weight gain during pregnancy, control of blood pressure).Paying attention to pregnant women and meeting their information needs could lead to healthier generation. A wide range of mobile applications related to pregnancy are available with many capabilities. Considering pregnant women’s need for information and using these apps in self-care, it seems essential to develop and design a series of high-quality apps matching pregnant women's needs.

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

The available evidence has made the long-term accompaniment of COVID-19 and its other variants with human life predictable. Different studies have proposed different and, in some cases, contradictory findings as factors determining the duration of hospitalization of patients with COVID-19. The present study aimed to identify the factors related to the duration of ICU length in patients with COVID-19.

The present study retrospectively analyzed the data related to patients aged 1 to 97 years with COVID-19 registered in Isfahan's COVID-19 registration system. The data of those patients with COVID-19 who were alive at the time of discharge (n=453) were analyzed in the present study. Information related to laboratory findings, clinical data, and co-morbidities were collected. T-test, correlation, and analysis of variance tests were used in crude analysis. The linear regression model was used to determine the factors related to the ICU length and their importance.

The mean (SD) of intensive care unit days was 0.64 (2.39). Higher than normal values of INR, hemoglobin, and creatinine increased the average length of stay in ICU by 2.45 (p=0.001), 3.82 (p <0.001), and 0.72 (p <0.001) days, respectively. Among underlying co-morbidities, the presence of other respiratory diseases significantly increased the average length of stay in the ICU by 1.5 days (p=0.024). Standardized regression coefficients also showed that higher-than-normal hemoglobin and increased WBC values were the most important variables predicting ICU hospitalization length.

The higher-than-normal values of hemoglobin and increased WBC values are the most important predictors of the length of hospitalization in the ICU. The findings of the present study can be helpful in the decision-making of specialists to reduce the duration of hospitalization in the ICU and to help diagnose more critical cases.