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Introduction: Accurate diagnosis of the COVID-19 disease is important. Currently, chest computed tomography (CT) and reverse polymerase chain reaction (RT-PCR) are being used for the diagnosis of the COVID-19 disease. This study was performed to evaluate the Chest computed tomography (CT) diagnostic value in comparison with the RT - PCR method among COVID-19 patients. Methods: This cross-sectional study was performed on suspected cases of COVID-19 in Imam Khomeini Hospital, Jiroft, Iran. Studied patients were evaluated via both a chest CT scan and nasopharyngeal swab for SARS-CoV-2 detection. Data was collected using a self-administered checklist, including demographic information, medical history, and symptoms of COVID-19, chest CT scan, and RT-PCR findings. Data were analyzed using SPSS-V21. Results: One thousand and ninety (1090) cases participated in the study; the mean age of the cases of COVID-19 was 48.20± 7.31 years old. The results of the RT-PCR test were 410 (37.6%) positive and 680 (62.4%) negative cases. According to the results of RT-PCR, which is the gold standard method, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive values of chest CT were 98.5%. (99.4-96.8 CI: 95%), 55.7% (59.5 – 51.9 CI: 95%), 71.5% (74.4 -69.0 CI: 95%), 57.3% (60.9 – 53.5 CI: 95%), and 98.4% (99.4% - 99.6 CI: 95%), respectively. Discussion: The results of the present study showed that a chest CT scan is highly sensitive for the diagnosis of the COVID-19 disease. Therefore, it can be used as a suitable method for screening and early detection, which requires knowledge of its common radiologic patterns. However, the results showed that the use of this method has low specificity, so it cannot be used for definitive diagnosis and should be used as a complementary method concomitant to the RT - PCR test.

INTRODUCTION To estimate the economic burden of tuberculosis treatment in Sistan, the region with the highest number of tuberculosis cases in Iran. METHODS All patients with smear-positive pulmonary tuberculosis who had contracted tuberculosis in 2018 and successfully completed their treatment were interviewed. RESULTS Ninety patients with a mean age of 57 ± 18 years were interviewed. Most of them were women (58%), housewives (57%) and resided in rural areas (84%). The mean cost of treatment for tuberculosis was estimated as 6800 USD per patient. Direct costs were 87% of the total cost. Twenty-two patients lost an average income of 530 USD (8514590 rials) during treatment. The results showed the significant correlation of direct and indirect costs with sex, age, place of residence and education (P

Background One of the leading health indicators during the COVID-19 crisis is health literacy and health-promoting behaviors. The present study aimed to investigate health literacy and health-promoting behaviors among women hospitalized during the COVID-19 pandemic in the southern part of Iran in 2020. Methods This descriptive-analytical study encompassed 465 women hospitalized and treated in none teaching hospitals affiliated with the Shiraz University of Medical Sciences. Data collection tools were the Health Literacy for Iranian Adults (HELIA) and Health Promoting Lifestyle Profile II (HPLP-II). The collected data were analyzed using descriptive and inferential statistical methods. Results The mean scores of the participants’ "health literacy" and "health-promoting behaviors" were 64.41 ± 11.31 and 112.23 ± 16.09, respectively, indicating the poor level of health literacy and the average level of health-promoting behaviors. Moreover, there was a significant direct correlation between health literacy and health-promoting behaviors (P P P P P = 0.002), and decision making and behavior (P = 0.003) were detected as the predictors of health-promoting behaviors. Further, statistically significant relationships were noticed between the mean score of health literacy with age (r = − 0.327, P = 0.007), level of education (F = 3.119, P = 0.002), and place of residence (t = 2.416, P = 0.004) and between health-promoting behaviors with level of education (F = 3.341, P = 0.001) and marital status (F = 2.868, P = 0.02). Conclusion According to the findings, health policymakers should adopt national measures for educational planning to promote health literacy and support health-promoting behaviors to encourage women to adopt a healthy lifestyle.

Background: Informal payment in many developing countries is a serious obstacle towards to improving healthcare system and has negative effects on the function of healthcare system. In order to reduce the informal payments and direct payments from patient's pocket, the Health Transformation Plan (HTP) executed. This study was conducted to assess the informal payments in the hospital related to government. Methods: This study was a survey based on descriptive analytic method in Zahedan, the capital of Sistan-Baluchistan Province, in 2017. The study population included all patients discharged from all wards of the two general hospitals affiliated with Zahedan University of Medical Science (ZaUMS) in a one-month period (from September 23 to October 22), in which 500 patients were selected by multistage cluster sampling. Data collection tool was a standard questionnaire that was conducted by interview method. The data were analyzed using by SPSS v22 and descriptive statistics. Results: In this study 98% of patients were male, 484 (96.8%) lived in the urban area, and about 2% had informal payment. The average amount of informal payments was 51.48 $. The highest number of informal payment was in the maternity ward (n:5, 50%). The doctors didn't have any informal payment, and all of the participants disagreed this type of payments. Conclusion: The rate of informal payments in the hospitals affiliated with ZaUMS in Southeast of Iran after execution of HTP is minimal. Poor economic status of the patients and well executed HTP are the possible explanations for minimal informal payments. Solutions including constant supervision on employees and realization of the medical services tariffs and strengthening insurance companies are effective steps towards elimination of informal payments.

Since the first reported case of coronavirus disease 2019 (COVID-19) in Wuhan, China, on December 30, 2019, the number of confirmed cases of the disease has increased continuously and exponentially The event has emerged as a clear threat to global health, such that the World Health Organization (WHO) officially declared it a pandemic on March 11, 2020 The disease has infected approximately 1,891,000 people and killed around 50,200 in the Eastern Mediterranean region until 29th August 2020 As COVID-19 spreads globally, its economic consequences are also mounting across all countries In this perspective study, we briefly discuss the economic consequences of COVID-19 in the Middle East and North Africa (MENA) region countries © 2020, Journal of Advances in Medical and Biomedical Research All rights reserved

Introduction: Iran's Health Transformation Plan (HTP) was implemented in 2014 to decrease household expenditures. The present study seeks to measure the household financial contribution to healthcare expenditures in Sistan-Baluchistan Province after the implementation of HTP. Methods: A household survey was conducted in 2017 in Sistan-Baluchistan Province. The province is the most remote and poorest in the country and this poverty has extended to most of its main health indicators as well. About 2400 households were selected as the study samples using multistage sampling. Data were collected using the World Health Survey questionnaire. The questionnaire was designed by WHO in 2003 for assessing health system performance. Two main indicators of equity in health were measured: the percentage of households facing catastrophic health expenditure (CHE) and the Fair Financial Contribution Index (FFCI). The multiple adjusted logistic regression model was used to study the likelihood of facing CHE and to calculate the adjusted odds ratios (OR) using the model coefficients. Data were then analyzed the Statistical Package for the Social Sciences. Results: The results showed that 484 (20.2%) of the households faced CHE after implementation of the HTP. The FFCI was approximately 0.7 across the province. Statistically significant relationships were observed between the chances of facing CHE and variables including place of residence (p=0.010), having members aged more than 65 years (p=0.005) and having members with disabilities and in need of care (p=0.001). There were statistically significant relationships between the chance of facing CHE and variables related to the use of health services, including the use of dental (OR=5.212), rehabilitation (OR=2.471), diagnostic and laboratory (OR=3.637), and inpatient (OR=2.511) services. Conclusion: Despite the implementation of HTP, a high percentage of the households faced CHE. The authorities should pay more attention to low-income and remote regions of the country; in addition, the HTP should financially cover outpatient healthcare services in an adequate manner.

Background: The significance of rabies is due to high mortality rate, economic damage caused by livestock loss, and high costs of treatment. Considering the economic problems in developing countries as well as the lack of resources and facilities, economic assessments will be very useful in obtaining the necessary financial information. Therefore, the present study aims to estimate the cost of prevention and control of rabies in Ahar, East Azarbaijan, during 2010-2011 and 2011-2012. Methods: This is a descriptive, cross-sectional study conducted in Ahar, East Azarbaijan. This study was carried out using available documents (Vaccine registries, Human Resources Department records, Staff daily wages) and data collection (Ministry of Health and Medical Education, Taxi Administration, Municipality Office and the Veterinary Network) to estimate the cost of prevention and control of rabies during 2010-2011 and 2011-2012. The societal perspective was taken into account to estimate costs. Data was entered into SPSS version 20 and the total cost was calculated. Also, the Mann-Whitney U test was used for data analysis. Results: The total financial burden of preventing and controlling rabies in Ahar during 2010-2011 and 2011-2012 was about 803 and 850 million rials respectively. The loss of the patient's income (240 and 260 million rials during 2010-2011 and 2011-2012), cost of rabies vaccine (approximately 231 and 237 million rials during 2010-2011 and 2011-2012), and staff costs (approximately 118 and 247 million rials during 2010-2011 and 2011-2012) had the largest share of the cost, while cost of tetanus vaccine (1.3 and 1.2 million rials during 2010-2011 and 2011-2012) had the smallest share. Conclusion: The present study showed that the prevention and control of rabies put a significant financial burden on the government through direct medical expenses, rabies control program for dogs, and care of the disease. It put a burden on the people, as well, through the loss of productivity and income, and transportation costs.

Objective (s): health transformational plan was executed as one the most important plans by the ministry of health and medical education in order to reduce admission fees. In order to evaluate the effectiveness of this plan, this study was conducted with the goal of determining the health expenditures by households after implementation of this new plan. Methods: This cross-sectional study was conducted in Zahedan, Iran in year 2015 and 2016. The study conducted on 816 families including both rural and urban households. They were selected randomly by clustering method. Data were collected by in-person interviews using the World Health Survey. The Data were analyzed using descriptive and inferential statistics. Results: In 93.1% of instances the head of household were men (n = 760) and 78 families did not have any health insurance. After implementation of health transformational plan, 12.99 percent of families were still faced with catastrophic health expenditures. However, the rural families were facing more catastrophic expenditures compared to families living in urban areas. This catastrophic expenditures have a meaningful relation with many variables including dental care (OR: 4.99), drug fees (OR: 2.927), physiotherapy (OR: 2.927), outpatient expenditures (OR: 96. 639), having a family member who needs to be taken care of at home (OR: 3.186), and a family member who needs to be taken care of at a hospital (OR: 1.866). Conclusion: The results showed that a relatively large proportion of people in families in Zahedan still are facing catastrophic health related expenditures and health transformational plan has not been able to reach its goals in this city.

Background: Medicine is considered as strategic goods worldwide and, therefore, a huge amount of health care budget is spent on it. To prepare universal access to appropriate health services and achieve the health-related millennium development goals, rational use of drugs is an essential goal in the health system. This study aimed to investigate the proportion of drug prescription in three categories of injections, antibacterials agents and corticosteroids in a 10 year period. Methods: This is a descriptive study using data from an Iranian national insurance organization and National Center of Drug Use. The data about prescribed drugs during 2003 to 2013 were collected and analyzed by Excel Microsoft software, version 2010. Result: Results indicated that injections were decreased from 49.25% in 2003 to 46% in 2013; also, antimicrobials had a decrease from 64.25% in 2003 to 42.2% in 2013. Totally, it was reduced about 16% in the period of 10 years. Corticosteroids increased 10 % from 13% to 23% in 2013. Conclusion: According the present findings that indicate irrational and increasing use of corticosteroids and antimicrobials, it seems necessary for Iranian policy makers to pay specific attention to customizing clinical and pharmaceutical guidelines along with improvement of medical education system and rational prescription, holding scientific committees of prescription supervision, arranging continuous and effective education of health personnel, and improving public culture and community education.

Background: Hospital-acquired infections (HAIs) are a global problem in hospitals and significant causes of mortality and morbidity regardless of advances in supportive care, antimicrobial therapy and prevention. The study aimed to determine a comprehensive estimate of the HAIs prevalence, influential factors, and types of these infections in Iran. Methods: A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, Cochrane, SID, Magiran, and Medlib from January 1995 to September 2020 using a combination of medical subject heading terms (‘Nosocomial infection [Mesh] OR ‘’ Hospital infection [Mesh] OR Hospital Acquired Infection[Mesh] OR Healthcare-associated infection ‘’AND (‘Iran’ [Mesh]) among observational and interventional studies. SPSS version 25 and STATA version 11 were used for data analysis. Results: A total of 66 (cross-sectional, cohort, and case-control) observational studies were identified. More of the studies had been done before 2014(43 papers or 65%). Based on the random-effects model, the overall prevalence of HAIs in Iran was 0.111 [95% CI: 0.105 - 0.116] with a high, statistically significant heterogeneity (I2= 99.9%). The infection rate was 0.157 and 0.089 before and after the Iranian Health Transformation Plan (HTP), respectively. HAIs rates reported more in the South and West of Iran rather than other regions (0.231 and 0.164) (p= 0.001). Escherichia coli and klebsiella infections were reported in 53 and 52 papers (0.239 and 0.180, respectively). In addition, respiratory and urinary infections were reported 0.296 and 0.286 in 51 and 38 papers, respectively. Conclusion: The prevalence of HAIs in Iran is relatively high. Preventing and decreasing hospital nosocomial infections can considerably affect reducing mortality and health-related costs. This should be taken into consideration by health policymakers for pathology and revision of some previous programs and standards as well as the development of appropriate and evidence-based control and education programs to reduce this health problem.

Background: The high cost of mental health services can be a great barrier to accessing healthcare for patients with mental disorders. Objectives: The present study aimed to measure the catastrophic health expenditure (CHE) for households with severe mental disorders (SMDs) patients. Methods: A cross-sectional study was conducted among 400 households with SMDs patients who referred to four psychiatric university centers located in Tehran for outpatient services from July 2017 to March 2018. We consecutively selected 100 participants from each hospital. Data were collected using the World Health Survey questionnaire through interviews. The method considered by the WHO was used to measure the CHE and a forced-entry logistic regression technique was applied to assess factors affecting the CHE using STATA version 14.0 software. Results: The results showed that 25.75% of the households with SMDs patients faced CHE. There was also a significant relationship between households facing CHE and variables including the age of the household head (40 - 59 years; OR: 0.283, P value = 0.049), education status of the household head (university; OR: 0.075, P value = 0.002), utilization of dental (OR: 12.38, P value = 0.000), rehabilitation (OR: 6.99, P value = 0.012), and medication (OR: 3.17, P value = 0.049) services, and the household expenditures quintile (the fifth quintile; OR: 0.111 P value = 0.000). Conclusions: It is suggested that the Health Transformation Plan financially covers outpatient healthcare services more sufficiently, especially for mental disorders.

Background: Iran’s Health Transformation Plan (HTP) was implemented to decrease households’ out of pocket and protect them from facing catastrophic health expenditure and impoverishment from 2014. It is needed to assess the effect of HTP; therefore, the study aimed to examine the households’ impoverishment due to health expenditure after HTP. Methods: A household survey was carried out in 2017 in Sistan and Baluchestan province in southeast Iran. About 2400 households were selected as the study sample using a multi-stage sampling technique. The household section of the World Health Survey questionnaire was used to collect data. Independent variables contained households’ characteristics, household income, chronic illness status, the use of health services, and health spending. The dependent variable was whether the household was faced with health spending impoverishment. Mixed effects logistic regression was used to assess the effect of the independent variables on the impoverishment using SPSS software 21. Results: About 7.5% of the households had no basic insurance and 757 (31.6) heads’ of the households were unemployment. The results showed that about 5.4% of the households impoverished due to health expenditure. The households in the furthest region were forced with impoverishment more than other regions (23.0%). Living in a rural area, unemployment, economic status, and inpatients and outpatient costs were the main determinates on impoverishment (P < 0.05). In addition, having supplementary insurance was a protective factor in facing impoverishment (P = 0.05). Conclusions: In general, despite the implementation of HTP, healthcare expenditures leading to impoverishment of high percent of the households and Iranian development goals have not been fulfilled in this region. Economic poverty of the people may also be an important factor in this regard. It is recommended that outpatient services are covered by health insurances.

Background: Protecting people from catastrophic health payments is widely recognized as an integral component of health systems and universal health coverage. Objectives: This study aimed to measure the financial protection against catastrophic health expenditure among hospitalized patients in Kermanshah, western Iran, after the implementation of the health sector evolution plan of Iran. Methods: This was a cross-sectional study. A total of 544 patients were selected using the proportional allocation to population size technique. A translated version of the world health survey questionnaire was used to collect data. Catastrophic health expenditure was calculated using WHO recommended methodology. Data were analyzed using STATA v.13. The statistical test performed included descriptive statistics and logistic regression. Results: About 4.8% of households with hospitalized patients were faced with catastrophic health expenditures. The total mean out-of-pocket (OOP) medical expenditures of being hospitalized was 819,220 Rials per patient. Mean OOP in patients with catastrophic payment was 2,220,500 Rial. Major determinants of catastrophic payment were associated with surgical cost (OR: 8.09 P Value = 0.000), chronic disease (OR: 2.78 P Value = 0.025), household size (> 6) (OR: 6.70 P Value < 0.036), and economic status of households (Quintile 5; OR: 0.005 P Value = 0.000). Conclusions: The Health Sector Evolution Plan should target and extend aids especially for chronically ill patients, those who need surgery, and those at poorest quintile due to the fact that they are more vulnerable to catastrophic health expenditure. These groups should be the priorities in the health sector evolution plan revision to achieve a more desired outcome.

International research shows that medical errors (MEs) are a major threat to patient safety. The present study aimed to describe MEs and barriers to reporting them in Shiraz public hospitals, Iran.A cross-sectional, retrospective study was conducted in 10 Shiraz public hospitals in the south of Iran, 2013. Using the standardised checklist of Shiraz University of Medical Sciences (referred to the Clinical Governance Department and recorded documentations) and Uribe questionnaire, we gathered the data in the hospitals.A total of 4379 MEs were recorded in 10 hospitals. The highest frequency (27.1%) was related to systematic errors. Besides, most of the errors had occurred in the largest hospital (54.9%), internal wards (36.3%), and morning shifts (55.0%). The results revealed a significant association between the MEs and wards and hospitals (The medical errors were highly frequent in the studied hospitals especially in the larger hospitals, morning shift and in the nursing practice. Moreover, individual and organisational factors were considered as the barriers to reporting MEs.

There have been claims that community mental health principles leads to the maintenance of better health and functioning in patients and can be more economical for patients with severe and chronic mental disorders. Economic evaluation studies have been used to assess the cost-effectiveness of national health programs, or to propose efficient strategies for health care delivery.The current study is intended to test the cost-effectiveness of an Aftercare Service when compared with Treatment-As-Usual for patients with severe mental disorders in Iran.This study was a parallel group randomized controlled trial. A total of 160 post-discharge eligible patients were randomized into two equal patient groups, Aftercare Service (that includes either Home Visiting Care, or Telephone Follow-up for outpatient treatment) vs Treatment-As-Usual, using stratified balanced block randomization method. All patients were followed for 12 months after discharge. The perspective of the present study was the societal perspective. The outcome measures were the rate of readmission at the hospitals after discharge, psychotic symptoms, manic symptoms, depressive symptoms, illness severity, global functioning, quality of life, and patients' satisfaction with the services. The costs included the intervention costs and the patient and family costs in the evaluation period.There was no significant difference in effectiveness measures between the two groups. The Aftercare Service arm was about 66,000 US$ cheaper than Treatment-As-Usual arm. The average total cost per patient in the Treatment-As-Usual group was about 4651 USD, while it was reduced to 3823 US$ in the Aftercare Service group; equivalent to a cost reduction of about 800 USD per patient per year.Given that there was no significant difference in effectiveness measures between the two groups (slightly in favor of the intervention), the Aftercare Service was cost-effective. The most important limitation of the study was the relatively small sample size due to limited budget for the implementation of the study. A larger sample size and longer follow-ups are warranted.Considering the limited resources and equity concerns for health systems, the importance of making decisions about healthcare interventions based on cost-effectiveness evidence is increasing. Our results suggest that the aftercare service can be recommended as an efficient service delivery mode, especially when psychiatric bed requirements are insufficient for a population.Further research should continue the work done with a larger sample size and longer follow-ups to further establish the cost-effectiveness analysis of an aftercare service program compared with routine conventional care.

Breast cancer is the most common cancer among women. Mammography screening has been used in many countries to reduce early deaths caused by breast cancer. It is important to ensure that screening programs are effective and efficient. We conducted a study to assess the cost-effectiveness of a national breast cancer screening program implemented in Iran.The perspective of the present study was the health system. Over 26,000 women aged 35 and higher, of low socioeconomic background were recruited from ten cities in the program. We used case-finding as the outcome indicator for assessing effectiveness of the program. We measured the service provision costs, the coordination costs and supervision costs of the program that included the staff costs, and measured cost per detected case. We also conducted sensitivity analyses and calculated false-positive rates as a result of the screening program.The total cost of breast cancer screening program was estimated at $377,797. The program resulted in the identification of 24 patients with breast cancers, not different from baseline expectations without a screening program. The cost per cancer detected was calculated $15,742. The minimum and maximum cost per breast cancer detected were about $13,524 and $16,947, respectively. We observed a false-positive rate of 7.5% among the target population.Our findings suggest that the mammography screening program was not cost-effective. Although there were technical efficiency issues in the conduct of the program, the findings do not support the implementation of national mammography screening programs in Iran in women aged less than 50 years. Careful studies of such programs for higher age groups are also recommended before they are rolled-out nationally.

Background: Knowledge management is an attempt to discover the hidden treasure of knowledge in the minds of people and turn this treasure to organizational assets so that people who are involved in the decision making of the organization can use it. Besides, the application of knowledge management, as an organizational improvement technique, is required to assess the quality of working life (QWL). Objectives: This study aimed to determine the association between knowledge management and dimensions of QWL in nurses working in Zahedan teaching hospitals. Materials and Methods: In this cross-sectional study, all nursing personnel of six teaching hospitals in Zahedan, 2014, were selected using the stratified random sampling. Data were collected using two standardized Likert-style questionnaires. Data were then entered into SPSS 17.0 software and analyzed using Pearson, t test and the one-way ANOVA test. Results: Knowledge management score in single and younger participants was higher compared to other participants and it was lower in the larger hospitals. Quality of working life score in the smaller hospitals was higher than the larger hospitals (P = 0.002). There was a strong correlation between knowledge management and all dimensions of QWL in teaching hospitals (P = 0.001). Conclusions: Knowledge management can improve the QWL in nursing personnel in Zahedan teaching hospitals. Based on the findings of the study, hospital managers, especially head nurses, could play a crucial role in improving QWL by institutionalization of knowledge management in nursing personnel and sharing and developing knowledge to advance the practice.