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Even once children can accurately remember their experiences, they nevertheless struggle to use those memories in flexible new ways--as in when drawing inferences. However, it remains an open question as to whether the developmental differences observed during both memory formation and inference itself represent a fundamental limitation on children's learning mechanisms, or rather their deployment of suboptimal strategy. Here, 7-9-year-old children (N = 154) and young adults (N = 130) first formed strong memories for initial (AB) associations and then engaged in one of three learning strategies as they viewed overlapping (BC) pairs. We found that being told to integrate--combine ABC during learning--both significantly improved children's ability to explicitly relate the indirectly associated A and C items during inference and protected the underlying pair memories from forgetting. However, this finding contrasted with implicit evidence for memory-to-memory connections: Adults and children both formed A-C links prior to any knowledge of an inference test--yet for children, such links were most apparent when they were told to simply encode BC, not integrate. Moreover, the accessibility of such implicit links differed between children and adults, with adults using them to make explicit inferences but children only doing so for well-established direct AB pairs. These results suggest that while a lack of integration strategy may explain a large share of the developmental differences in explicit inference, children and adults nevertheless differ in both the circumstances under which they connect interrelated memories and their ability to later leverage those links to inform flexible behaviours.

Objectives: The increase of life expectancy, in spite of its satisfactory and hopeful impressions, has resulted to some problems and difficulties, in the last years of life, particularly with regard to the health, illness, and costs of services of elderly populations. In literature focused on epidemiologic transition, the change on patterns of disease widely discussed. But there is a lack for a detailed analysis to clarify the priorities of providing and consuming services in relation to a specific cronic illnesses and socio-economic and demographic characteristics of service users. For this purpose, and in order to identify the indications of epidemiologic transition, case studies and surveys are needed. The present study mainly focus on this goal to identify which services are used by which groups of elderly population, and on what costs? Methods & Materials: This study conducted in Damghan city in Semnan province. All patients over 60 years old, covered by Medical Services Insurance Organization (MSIO), hospitalized in Damghan>s hospitals (2 hospitals), during year 2006, selected as study population. Medical records of the study population reviewed and analysed. Results: Findings revealed that heart disease and blood system disfunctionning, was the major cause of hospitalization. Conclusion: The most frequent surgeries conducted for Catarakt , and the highest cost belonged to psychology and psychiatrist services.

Objectives: In this paper, aging with its different dimensions is discussed. The characteristics of elderly's life in relation to individual, social, and changes meet aging together with attitudes toward it and major components of elderly are explained. Disease and burden of disease of aging as a central to the areas of Health and Health Economics will be emphasized. The influential factors on the growth of aging, policies and policymakers' responsibilities in this respect, also briefly is analyzed. Methods & Materials: On the whole an attempt will be made to discuss and analyze aging and escalating costs of long - term care of elderly in the context of social problems and phenomenon such as the quality of interactions between elderly and community, attitudes towards elderly and its consequences, as well as gaps between generations. In April 1995, World Health Organization, promoted a program on aging which emphasized more on Healthy aging rather than aging itself. This program followed several purposes including promotion of quality of life and public health particularly among elderly. This paper reflects the program framework in someway. Results: There is a need to reassessment of views towards aging, elderly's health, and their roles and functions in family and community. This approach may enable us to utilize the eldely's effective potentials and enjoy their experience to resolve some existing conflicts among genders and generations. Conclusion: The ideas of scholars either from Iran or from other countries extracted from literature will be the starting point of the present paper since it may help to provide a rather broad and comprehensive picture of life, which aging is considered as a big and important part of it. This picture, however, would demonstrate the weak points of services provided and delivered to the elderly.

Unintended pregnancy is among the most troubling public health problems and a major reproductive health issue worldwide imposing appreciable socioeconomic burden on individuals and society. Governments generally plan to control growth of births (especially wanted births as well as orphans and illegitimate births) imposing extra burden on public funding of the governments which inevitably affects economic efficiency and leads to economic slowdown, too. The present narrative review focuses on socioeconomic impacts of unintended pregnancy from the health system perspective. Follow of Computerized searches of Academic, 53 scientific journals were found in various databases including PubMed, EMBASE, ISI, Iranian databases, IPPE, UNFPA (1985-2013). Original articles, review articles, published books about the purpose of the paper were used. During this search, 20 studies were found which met the inclusion criteria. Unintended pregnancy is one of the most critical challenges facing the public health system that imposes substantial financial and social costs on society. On the other hand, affecting fertility indicators, it causes reduced quality of life and workforce efficiency. Therefore lowering the incidence of intended pregnancies correlates with elevating economic growth, socio-economic development and promoting public health. Regarding recent policy changes in Iran on family planning programs and adopting a new approach in increasing population may place the country at a higher risk of increasing the rate of unintended pregnancy. Hence, all governmental plans and initiatives of public policy must be regulated intelligently and logically aiming to make saving in public spending and reduce healthcare cost inflation.

Background and purposePrevious studies suggest that mechanisms and outcomes in patients with COVID-19-associated stroke differ from those in patients with non-COVID-19-associated strokes, but there is limited comparative evidence focusing on these populations. The aim of this study, therefore, was to determine if a significant association exists between COVID-19 status with revascularization and functional outcomes following thrombectomy for large vessel occlusion (LVO), after adjustment for potential confounding factors.MethodsA cross-sectional, international multicenter retrospective study was conducted in consecutively admitted COVID-19 patients with concomitant acute LVO, compared to a control group without COVID-19. Data collected included age, gender, comorbidities, clinical characteristics, details of the involved vessels, procedural technique, and various outcomes. A multivariable-adjusted analysis was conducted.ResultsIn this cohort of 697 patients with acute LVO, 302 had COVID-19 while 395 patients did not. There was a significant difference (p

مقدمه: دارو، حلقه‌ی جداناپذير از زنجيره‌ی درمان است و نقص فرایند درمان به دليل هزينه‌ی بالاي دارو يا عدم دسترسي مناسب به دارو، مطمئناً هزينه‌هاي بيشتري را در فرايند درمان به دنبال دارد. هدف اين مطالعه، تعیین ميزان تأثير درآمد خانوار، دسترسي جغرافيايي، پرداخت مستقيم بيمار، ويزيت پزشکان و ميزان بستري بيمه شدگان، بر ميزان بهره‌مندي از داروهای تحت پوشش بیمه در داروخانه‌هاي طرف قرارداد سازمان تأمين اجتماعي بود. روش بررسی: اين پژوهش به صورت تحليلی انجام شد. براي سنجش تأثير مؤلفه‌هاي مذکور بر ميزان بهره‌مندي از دارو، از بانک‌هاي اطلاعاتي سازمان تأمين اجتماعي در هر استان طي سال‌هاي 88-1377 استفاده شد. جامعه‌ی پژوهش، 24 ميليون نفر از افراد تحت پوشش اين سازمان بودند که طي اين سال‌ها براي دريافت دارو به بخش درمان مستقيم و غير مستقيم سازمان مراجعه نموده بودند. براي تخمين مدل از رگرسيون دو طرف لگاريتمي با لحاظ اثرات ثابت و از نرم‌افزار Eviews نسخه‌ی 7 استفاده شد. يافته‌ها: يافته‌هاي تخميني حاصل از مدل نشان داد که بار مراجعه به پزشکان متخصص (37/0 = β)، ميزان موارد بستري در درمان غير مستقيم (17/0 = β)، دسترسي جغرافيايي به داروخانه (17/0 = β)، بار مراجعه به پزشکان عمومی (16/0 = β) و پرداخت از جيب بیماران (12/0- = β) به ترتيب بيشترين تأثير بر بهره‌مندي از داروهای تحت پوشش را داشته‌اند. همچنين هزينه‌ی خانوار (924/0 = P و 005/0- = β)، ميزان بستري (076/0 = P و 033/0 = β) و ويزيت پزشکان در درمان مستقيم (577/0 = P و 026/0 = β)، تأثير معني‌دار بر بهره‌مندي از دارو در داروخانه‌ی طرف قرارداد نداشته است. نتيجه‌گيري: اهميت تأمين دارو براي بيمه شدگان به قدري بالا است که افزايش هزينه‌های دارویی بیمه شدگان نمی‌تواند مانع از مصرف آنان شود. بنابراین اين موضوع مي‌تواند زمينه‌ی هزينه‌هاي کمرشکن را براي برخي از خانواده‌ها مهيا سازد. همچنین سياستگذاران درمان سازمان تأمين اجتماعي بايد در توزيع عادلانه‌ی منابع درمان در استان‌هاي مختلف کشور تأمل بيشتري داشته باشند تا پيامد آن، بهره‌مندي عادلانه‌تر از خدمات درماني باشد. واژه‌های کلیدی: تأمين اجتماعي؛ هزینه‌های دارویی؛ بهره‌مندي

Trajectories of cognitive and neural development suggest that, despite early emergence, the ability to extract environmental patterns changes across childhood. Here, 5- to 9-year-olds and adults (N = 211, 110 females, in a large Canadian city) completed a memory test assessing what they remembered after watching a stream of shape triplets: the particular sequence in which the shapes occurred and/or their group-level structure. After accounting for developmental improvements in overall memory, all ages remembered specific transitions, while memory for group membership was only observed in older children and adults (age by test-type interaction [eta-squared] = 0.05). Thus, while young children form memories for specifics of structured experience, memory for derived associations is refined later--underscoring that adults and young children form different memories despite identical experience.

مقدمه: رویکرد بیمار محور و آینده‌نگر که بهداشت را بر درمان مقدم می‌داند، برای بهبود و ارتقای سطح خدمات و مراقبت‌ها نه تنها جریان آزاد اطلاعات بیماران را به رسمیت می‌شناسد، بلکه همزمان به مسأله حفظ امنیت و محرمانگی اطلاعات به عنوان یکی از خصوصیات سیستم بهداشت و درمان اهمیت می‌دهد. هدف از این پژوهش بررسی وضعیت موجود محرمانگی اطلاعات بیماران در بیمارستان‌های شهر تهران بوده است. روش بررسی: این پژوهش، یک مطالعه‌ی توصیفی و از نوع مقطعی بود، که به بررسی سطوح دسترسی و میزان محرمانگی مدارك پزشكی، قوانین و مصوبات، استانداردها و رویه‌های عملکرد برای حفظ این محرمانگی در بیمارستان‌های شهر تهران در سال 1387 پرداخته است. این مطالعه به صورت سرشماری انجام شد و جامعه‌ی پژوهش، کلیه‌ی بیمارستان‌های واقع در شهر تهران (که از نظر جغرافیایی تحت پوشش دانشگاه‌های علوم پزشکی تهران، ایران و شهید بهشتی‌، اعم از آموزشی، غیر آموزشی، تأمین اجتماعی و خصوصی) (120 بیمارستان) بود. اطلاعات مورد نیاز از طریق چک لیست به صورت حضوری در واحدهای مدارک پزشکی بیمارستان‌های فوق تکمیل شد و برای تجزیه و تحلیل داده‌ها از نرم‌افزار SPSS11 استفاده شد. در نهایت محرمانگی اطلاعات بیماران یافته‌های پژوهش به صورت كمی روی مقیاسی كه دامنه آن صفر تا صد می‌باشد، بیان گردید. یافته‌ها: در مجموع در زمینه‌ی محرمانگی اطلاعات بیماران، 54 درصد از بیمارستان‌های دولتی آموزشی و 57 درصد از بیمارستان‌های دولتی غیر آموزشی و 62 درصد از بیمارستان‌های خصوصی وضعیت مناسبی داشته‌اند. نتیجه‌گیری: جهت حفظ محرمانگی مدارک پزشکی و محدود نمودن سطوح دسترسی به اطلاعات بیماران، اقداماتی نظیر تصویب قوانین مختلف برای تضمین محرمانه‌ سازی مدارك پزشکی، تعیین ضوابط روشنی پیرامون نحوه‌ی دسترسی به اطلاعات پرونده‌ی پزشكی بیمار توسط یك مرجع عالی در كشور و اعلام آن به كلیه‌ی بیمارستان‌ها و مراكز بهداشتی درمانی به صورت بخش‌نامه، تعیین جرایم جنایی و مدنی برای انواع موارد افشای اطلاعات بیماران و عدم رعایت محرمانگی اطلاعات پرونده‌های پزشكی بیماران توسط یك مرجع ذی‌صلاح توصیه می‌شود. واژهای کلیدی: راز داری، مدارک پزشکی، بیمارستان‌ها.

Introduction: Hospital has a complex and special structure and the important question that hospital management facing with is how technology can change structure. In the near future, no factor like IT is able to change the structure of organization. This research is a way to know the effect of IT on triple dimensions of organization structure includes complexity, formalization, and centralization. Methods: This cross- sectional analytical-descriptive research includes all of the people in hospitals that have management job and IT expertise. We use simple random sampling and we select finally ten hospitals. All data are collected by valid questionnaire. We analyze data with Normal distribution, Pearson correlation, and linear and multi regression testes. Results: According to the findings, there is significant relationship between generality IT with centralization (p=0.01) and between that with formalization (p=0.06). Study relationship between the five dimensions of IT (including network, hardware, software, staff and utilization) and triple dimensions of organization structure indicating that with the exception of network, rest of them have significant relationship with centralization and there is significant relationship between network and utilization with formalization. Conclusion: The influence of IT was not able to make fundamental change in structure of this organization. Keywords: Information Technology; Organization and Administration; Hospital Administration.

Introduction : Hospitals like other organizations need to be evaluated continuously. This is of vital importance due to the critical role of the hospitals in the society. This study aimed to determine and compare the evaluation scores of hospitals affliated with TUMS with their performance. Methods and materials : It is a cross - sectional study which was performed in 27 public and private hospitals affiliated with TUMS. The required data were collected through interviewing hospital authorities, observing hospital registries, statistical sheets and evaluation tables and using a questionnaire. Results : The findings reveal that there is no significant relationship between evaluation scores and the hospitals performance indices. However, there is a significant relationship between the suggested evaluation rank for the hospitals and their performance indices. In addition, in public hospitals ranked as one and three, there is a significant relationship between the current and suggested evaluation ranks. Conclusion : We can imply that the current evaluation ranks in private hospitals are more realistic and we need to revise the evaluation system is our hospitals. Key words: evaluation studies – program evaluation – hospitals, private – hospitals, public.

BackgroundThe mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke.ObjectiveTo describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort.MethodsWe conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020.ResultsThe total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002).ConclusionCOVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.

Although reflective journal writing (RJW) has become a popular way to evaluate learning, little is known about participants' perceptions upon this educational activity. The purpose of this research paper was to utilize Importance-Performance Analysis (IPA) to determine the dimension of pre-registered student nurses' perception on reflective journal writing. A total of thirty conveniently selected participants contributed to the study. Data was collected based on an adapted survey questionnaire. Data was analyzed through SPSS (V. 24) as well as importance-performance matrix. By using IPA matrix, participants rated the importance attribute in the "ideal" reflective journal writing and how satisfied they were with their performance in the actual setting. With a two-dimensional grid of importance and performance, the location of these attributes would determine what the participants' ideas were regarding RJW and how the educators would take necessary action accordingly. For the most parts, the results indicated that participants were satisfied with the academic practice. IPA proved to be a useful evaluation tool enabling curriculum and syllabus designers to identify the strength and weaknesses of RJW as perceived by participants.