Search

As global efforts to reduce reliance on fossil fuels and improve waste management practices intensify, the development of efficient biogas production methods offers a promising solution. This study addresses the urgent need for renewable energy and effective waste management by investigating biogas production from the anaerobic digestion of food waste and cow manure. Optimal conditions for mono-digestion of cow manure were identified at 8 % total solid in 38 °C. In co-digestion experiments, varying food waste ratios were tested, with a 6:2 ratio based on total solid achieving the highest biogas yield of 325 mL/g VS. The synergistic effects of co-digestion led to enhanced nutrient balance and biogas production, significantly outperforming mono-digestion. The experimental data were analyzed using first-order kinetics, modified Gompertz, modified logistic, and transference models, with the modified Gompertz model providing the best fit (R²=0.999). Results showed improved biogas production and higher rates of volatile solids and COD removal. This study focuses on maintaining a constant optimized total solids concentration for optimizing feedstock composition to enhance biogas production and compares four kinetic models on predicting performance, providing insights into anaerobic digestion system improvement. The study's limitations, such as the lack of post-optimization TS adjustments, absence of pH control, fixed temperature conditions, highlight areas for future work to provide more insights and improve co-digestion efficiency.

Abstract Alzheimer's disease (AD) is the most prevalent neurodegenerative disorder, characterized by the early presence of amyloid‐β (Aβ) and hyperphosphorylated tau. Identifying the neuropathological changes preceding cognitive decline is crucial for early intervention. Axon initial segment (AIS) maintains the orderly structure of the axon and is responsible for initiating action potentials (APs). To investigate the role of AIS in early stages of AD pathogenesis, we focused on alterations in the AIS of neurons from APP/PS1 mouse models harboring familial AD mutations. AIS length and electrophysiological properties were assessed in neurons using immunostaining and patch‐clamp techniques. The expression and function of ankyrin G (AnkG) isoforms were evaluated by western blot and rescue experiments. We observed a significant shortening of AIS in APP/PS1 mice, which correlated with impaired action potential propagation. Furthermore, a decrease in the 480 kDa isoform of AnkG was observed. Rescue of this isoform restored AIS plasticity and improved long‐term potentiation in APP/PS1 neurons. Our study implicates AIS plasticity alterations and AnkG dysregulation as early events in AD. The restoration of AIS integrity by the 480 kDa AnkG isoform presents a potential therapeutic strategy for AD, underscoring the importance of targeting AIS stability in neurodegenerative diseases.

Abstract Couples’ tendency towards voluntary single-childedness and childlessness (VSCC) has turned into a major challenge in all societies and led to different problems such as population aging. A key step to VSCC management is to determine its contributing factors through valid and reliable instruments. This exploratory sequential mixed method study (qualitative-quantitative) was conducted in 2020–2021. Phases of qualitative consists of all couples aged 15–49 in Babol, Iran, who were single or childless. Sampling is based on the purpose, and the number of samples is 20 couples. To collect data, face-to-face and semi-structured interviews were conducted with the participants. Sampling continued until data saturation. The data were analyzed by the conventional content analysis method and quantitative phase. Initially, a qualitative study was conducted on twenty couples, and were analyzed through conventional content analysis. Findings were used to develop QFT-VSCC and then, the face, content, and construct validity as well as reliability were assessed. Construct validity was assessed through exploratory and confirmatory factor analyses and reliability was assessed through internal consistency and stability assessments. The results of the qualitative part analysis consist of 140 codes, 30 primary categories, and nine main categories and two themes (individual limitations and social limitations). The primary QFT-VSCC had 78 items. Fifty-eight items were omitted during validity assessment and the remaining twenty-two items were loaded on five factors during factor analysis. These factors were threatened priorities, inappropriate familial context for childbearing, sense of occupational and social insecurity for the child, social modeling of childlessness, and tendency towards change or stability in marital life. The five factors explained 52.56% of the total variance. All model fit indices in confirmatory factor analysis were acceptable and the Cronbach’s alpha values of QFT-VSCC and all its factors were more than 0.70. The results of convergent validity analysis revealed that all factors had an AVE value greater than 0.5, and the HTMT index for all factors was less than 0.85. This indicated that discriminant validity had been achieved. QFT-VSCC is a simple valid and reliable instrument for VSCC assessment among both men and women.

Background: Couples’ childless and one-child intention is one of the crucial challenges in all societies. Considering the aging of the world's population and the need to review birth control policies, it is necessary to take evidence-based measures. Therefore, the present study aimed to investigate the influencing factors on the tendency of couples to be childless and have only one child. Methods: The present study is the first part of a mixed (qualitative-quantitative) study. The study is qualitative with a conventional content analysis approach. The research population consists of all couples aged 15-49 in 2021 in Babol city, who were single or childless and had no intention of pregnancy in the future. Sampling is based on the purpose, and the number of samples is 40 couples. To collect data, face-to-face and semi-structured interviews were conducted with the participants. Sampling continued until data saturation. The data were analyzed by the conventional content analysis method. Results: The results of the analysis include 140 codes, 30 sub-categories, 9 categories (family economic problems, uncertainty in the future security of the child, threatened priorities, uncertainty about the continuation of life, Fear of becoming a parent, lack or weakness of support, diminishing religious beliefs, social role modeling and negative experiences of childbearing) and two themes (individual limitations and social limitations). These factors indicate the mandatory conditions for childlessness or one-child choice or voluntary child-free. Conclusion: The results revealed that voluntary childlessness and single-child depend on various individual and social aspects. Some of these factors have made couples choose a childless or one-child lifestyle against their will and under forced circumstances. Financial support and welfare of the government, parenting education and efforts to change the attitude of couples towards having children by the government can help to maintain and improve the health of the family and achieve the goals of encouraging population growth policies.

The widespread presence of micro-sized plastic pollution has raised concerns due to their unique physical and toxic properties. Each year, water bodies carry millions of tons of plastic into the ocean. The inherent characteristics (such as size, shape, and density) of microplastics (MPs), along with flow factors like speed, depth, and pressure, significantly influence how MPs are transported and deposited. Therefore, this research aimed to gather experimental data on the transport and deposition of MPs to serve as a benchmark for numerical modeling. To achieve this goal, various test scenarios were set up in a straight channel flume to investigate different flow velocities, channel dimensions, and particle shapes. It was observed that cylindrical particles with the same density and similar size were more likely to become trapped compared to spherical particles. This study represents progress towards validating numerical models concerning the transport and deposition of microplastics.

Abstract The total fertility rate in Iran has declined to below replacement level recently, and a new approach has been taken to tackle this issue. Thus, this study aimed to identify the involved stakeholders and their characteristics in the new population policy change in Iran. We employed a qualitative approach using the purposive sampling of key informants and the identification of relevant documents. The main stakeholders were divided into seven key groups: religious, political, governmental, professional, international sectors, media, and nongovernmental organizations. In addition, there was no centralized, clear, and comprehensive mechanism to guide the activities of stakeholders to coordinate and bring the total fertility rate to the replacement level in Iran. Despite the importance of the new population policy in Iran, in recent years, we still experience dispersion and inconsistency among various actors in this area. It is imperative to go through a consensus and coalition at macro-level authorities alongside evidenced-based population policymaking.

Aim and Background: The covid-19 pandemic and its effects on people's physical and mental health have caused an increase in worry and death anxiety in many of them. Experience has shown that people's attitude towards this disease, how to deal with it, and how much they are affected by it are different based on a number of factors and characteristics. The present study was conducted with the aim of investigating the prediction of death anxiety based on personality characteristics and self-concept in patients with covid-19. Methods and Materials: This research is correlational. The research population consisted of all the patients with covid-19 who visited Masih Deneshvari, Lavasani and Firozabadi hospitals from March 1400 to May 1401, and 205 of them were selected as available sampling based on Morgan's table that participated in the research online. The required information was collected through Templer's death anxiety scale (1970), the short form of Neo's five-factor personality questionnaire (1985) and Lawrence's (1997) self-concept. To analyze the data, Pearson's correlation test and multivariate regression analysis were used using SPSS version 26 software. Findings: The findings of the research showed that there is a relationship between personality traits (-0.64) and God concept (-0.59) with death-anxiety (p

Objectives Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households. Methods This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP. Results Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively. Conclusions In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

BackgroundIn recent years the use of time to death (TTD) variables in the modeling of individual health expenditures has been of interest to health economics researchers. The aim of this study was to investigate the effect of age and TTD on hospital inpatient expenditure (HIE). MethodsWe used a claims database from Iran Health Insurance Organization of Tehran city that includes considerable proportion of Tehran residents and contains information on insured individuals’ HIE. We included HIE of all insured decedents (30 to 90 years old) who died during March 2013 and March 2014 (n = 1018). No sampling was required. According to the decedents’ date of death, we extracted their last 24 months HIE. The period of time March 30, 2011 until March 30, 2014 (3 years) was used to guarantee a full 24 months of observations for decedents. A two-part econometric model was employed to investigate the effect of age, TTD, and some demographic variables on probability and conditional amount of individuals’ hospital expenditure. Stata software (version 16.0) was used for data processing and analysis. ResultsOur results demonstrated that the month-based TTDs especially near months before death of decedents (TTD1 to TTD10) significantly affected both probability and conditional amount of HIE. One month before death incurred more HIE than the rest of the months. A further interesting finding is that after including TTD, age variable as a conditional driver of HIE loses its direct effect on decedents’ HIE, but age TTD interaction effect on HIE is still positive and statistically significant.ConclusionThe results confirm that TTD as a proxy of mortality indicator has a considerable effect on decedents’ HIE. The age variable has not directly affected decedents’ HIE but indirectly and through its interaction with TTD has a statistically significant effect on HIE. In addition to age, policy-makers should consider TTD to make better predictions of future HIE.

The outbreak of COVID-19 has had destructive influences on social and economic systems as well as many aspects of human life. In this study, we aimed to estimate the economic effects of COVID-19 at the individual and societal levels during a fiscal year. This cost of illness analysis was used to estimate the economic burden of COVID-19 in Iran. Data of the COVID-19 patients referred to the hospitals affiliated to Bushehr University of Medical Sciences in 2021 were collected through the Hospital Information System (HIS). The study methodology was based upon the human capital approach and bottom-up technique. The COVID-19 pandemic has resulted in 9711 confirmed hospital cases and 717 deaths in Bushehr province during the study period. The direct and indirect costs were estimated to be $1446.06 and $3081.44 per patient. The economic burden for the province and country was estimated to be $43.97 and $2680.88 million. The results showed that the economic burden of this disease particularly premature death costs is remarkably high. Therefore, in order to increase the resiliency of the health system and the stability in service delivery, preventive-oriented strategies have to be more seriously considered by policymakers.

The aim of this study was to evaluate the effectiveness of God-given multidimensional spiritual therapy on perceived spirituality and selfconcept-Godconcept in Red Crescent staff with symptoms of post-traumatic stress disorder. The method applied in the study was quasi-experimental using pre-test and post-test design with two test and control groups. The statistical population of the current study was all Red Crescent employees with symptoms of post-traumatic stress disorder in 2019 in Tehran. Then Reed (1986) Questionnaires of Perceived Spirituality and the Selfconcept-Godconcept Scale (2016) were completed by both groups. After that, Janbozorgi multidimensional spiritual treatment was performed on the experimental group and then so was post-test. Data were analyzed by using SPSS-24 and analysis of covariance. Findings showed that the multidimensional treatment of God-given spirituality increases the scores of perceived spirituality and selfconcept-Godconcept and their subscales (P=0.001). The result of the research showed that this intervention, by modifying selfconcept (artificial image of self) and Godconcept (artificial image of God), strengthens and creates a real image of self and a real image of God, and also enhances the degrees of spiritual perception.

Abstract Backgrounds Breast cancer is the most prevalent cancer among women. Breast cancer imposes a considerable economic burden on the health system. This study aimed to compare the cost of breast cancer among patients who referred to private and public hospitals in Iran (2017). Methods This was a prevalence-based cost of illness study. A total of 179 patients were selected from private and public hospitals using the census method. The researcher-constructed checklist was used for data collection. Data were analyzed using SPSS software version 22. Results The estimated total mean (SD) direct cost of patients who referred to the private hospital and the public hospital was $10,050 (19,480) and $3960 (6780), respectively. Further, the total mean indirect cost of patients who referred to the private hospital was lower than those referring to the public hospital at $1870 (15 % of total costs) and $22,350 (85 % of total costs), respectively. These differences were statistically significant (P

Objectives: Older adults need vitality to survive. Entertainment and activity for the elderly creates a lively life, boost their self-esteem, and saves them from being inactive and unproductive, which will ultimately improve their mental health. This study aims was to determine the relationship between leisure spending patterns and mental health in the elderly Methods & Materials: This descriptive-analytical study was carried out on 413 elderly people aged ≥60 years, who were selected using a cluster random sampling method from four districts of Tehran, Iran. Data were collected using the standard General Health Questionnaire, and a researcher-made Leisure Spending Scale. The collected data were analyzed in SPSS V. 21 software using descriptive statistics (frequency, standard deviation) and statistical tests including Spearman correlation test and regression analysis. Results: The most frequent leisure activity was TV watching. There was a significant relationship between recreational and religious activities of elderly and their mental health (P

Background: Medical errors are those mistakes committed by healthcare professionals due to wrong execution of a planned healthcare action or execution of a wrong healthcare action plan whether or not it is harmful to the patient. Medical errors may cause patients to suffer and have huge financial costs for the healthcare system. Identifying and measuring medical errors and adverse events are essential for improving patient safety. The objectives of this research were to measure medical errors and adverse events rates, to identify their severity and also analyze their underlying causes in a general educational hospital in Tehran, Iran by using The Global Trigger Tool. Methods: A descriptive, cross-sectional, and retrospective approach was used in this study. The medical records of 377 hospitalized patients between April 2015 and March 2016 were examined using simple random sampling method. Patient’s records were reviewed by a nurse using The Global Trigger Tool. Then, a physician authenticated the findings of the adverse events and rated their severity. The causes of adverse events were identified using brain storming and Ishikawa Cause And Effect Diagram. Results: A total of 205 triggers were detected, and 60 adverse events were identified. About 15.9 percent of patients experienced an adverse event. The rate of adverse events was 19.1 per 100 admissions and 5.7 per 100 Admission days or hospitalization days. Almost half of the adverse events were in the E and F categories (temporary harm). Bleeding, nosocomial infections, and patient fall were the leading adverse events. Employees and working processes were the underlying causes of the medical errors and adverse events. The Global Trigger Tool found 100 times more adverse events than the voluntary reporting method. Conclusion: The adverse event rate of this study was high. Hospital managers should take appropriate actions to reduce medical errors and adverse events and enhance patient safety. The Global Trigger is a Powerful, reliable, strong tool for identifying adverse events and measuring their severity.

Background and Aim: Conflict between health workers is an important problem in health care units around the world. The aim of this study was to identify the causes of conflict between nursing staff and other occupational groups in the hospital. Materials and Methods: This descriptive-analytical study was conducted in 2018. A researcher-made questionnaire was used to collect data. The questionnaire was designed in two parts: demographic variables and causes of conflict between nursing and other occupational groups with a Likert scale of 5 points. 120 nursing staff of Ardabil University of Medical Sciences randomly selected were surveyed. Data were analyzed by SPSS software15 using descriptive and inferential statistical methods. Results: The highest rate of conflict reported by nurses was related to the conflict with the group of managers (4.17±0.94) and the lowest rate was with administrative, financial and support staff (3.55±1.13). The most important reasons for conflict between nursing staff and different groups were: imposing non-specialist roles (such as completing doctorschr('39') documentation); perceived inequality in workload distribution; insufficient understanding of nursing work conditions; unreasonable differences in salaries and other benefits, and unfair distribution of manpower. There was also a statistically significant correlation between the level of conflict with marital status, work experience, age group (p

Background: We investigated the impact of cancer incidence on CHE in Iran by considering spatial variation across provinces as well as temporal trends. Methods: Data from Household Income-Expenditure Survey were merged with cancer incidence rates during 2011-2016. We developed a Bayesian hierarchical model to explore the spatial and temporal patterns of CHE and its associated factors at provincial level. We used a Besag-York-Mollie2 prior and a random walk prior for spatial and temporal random effects respectively. All statistical analysis was carried out in R software. Results: All-type cancer incidence (OR per SD (95% CrI) = 1.16 (1.02, 1.32)), unemployment rate (1.08 (1.01, 1.15)) and income equity (0.88 (0.81, 0.97)) have important association with CHE. Percentage of urbanization and percentage of poverty were not statistically significant. Conclusion: The results suggest the development of new policies to protect cancer patients against financial hardship, narrow the gap in income inequality and solve the problem of high unemployment rate to reduce the level of CHE at provincial level.

Background: Leisure activity helps the elderly to improve their physical and mental health. The purpose of this study is to determine the interlink between leisure activity and mental health in older people. Methods: We select 413 people over 60 years old(213 female and 200male).We collected data using GHQ 15-question survey, Nagi questionnaire, and a new reliable and validated the designed questionnaire. We analyzed our data utilizing spearman correlation, and regression analysis in SPSS21. Results: We report a relationship between recreational and religious activities in the absence of confounding factors but only religious activities were associated with mental health in the presence of confounding factors(p-value

Background and Aim: Autism Spectrum Disorders (ASD) do not cause premature death and has no definitive treatment. Thus, the life time cost of ASD is very high. Identification of the factors contributing to the cost of this disorder has a key role in its cost management. The purpose of this study was to investigate social factors affecting ASD costs. Material and Methods: This descriptive and cross-sectional study was conducted in Tehran, Iran, in 2017, by using a valid and reliable questionnaire. Social and economic factors contributing to ASD’s direct medical costs, direct non-medical costs, indirect costs of ASD were investigated. 290 ASD patients, were entered into the study. Using SPSS software, 21st version, appropriate statistical tests (Spearman and Pearson tests, independent T-test and ANOVA test) were used for data analysis. Results: The mean total cost for an ASD patient was 223,561,841 Rials (6,883 $US). About 32%, 52% and 16% of the total costs were related to direct medical costs, direct non-medical costs, and indirect costs. ASD costs had statistically significant relationships with the patient age, gender, education, type of school, parents’ job, family income and health insurance. Conclusion: Autism imposes heavy costs on the patients and their families. Cost of ASD could be affected by social factors such as age, gender, education, health insurance, job and income. Therefore, health policy makers and health care managers must take special measures for prevention and control of this disorder, treatment, cost management and provision of social and economic support

Abstract Background No systematic review has explored the causes of and factors associated with maternal mortality in the context of Iran. This study reviewed determinants and causes of maternal mortalities during pregnancy, delivery and the puerperium using the International Classification of Diseases-Maternal Mortality (ICD-MM), introduced by the World Health Organization. Methods A systematic electronic search of all the studies that identified causes and/or determinants of maternal deaths in any part of Iran or in the whole country were included, without any restriction of time or language of studies. To identify the studies to include in this study, a combination of hand searching and bibliographies was also conducted. These sources and citations yielded a total of 653 articles; nevertheless, only 29 articles met the inclusion criteria, hence, required data were extracted, summarized, and grouped together from these papers and are reported in the tables. Results Amongst the 29 studies published between 2003 and 2017 in Iran, 24 studies were cross-sectional. Overall, 4633 deaths were reviewed, and 2655 (58%) of the cases included the data on the causes of death generally. According to the ICD-MM, a total of 69.9, 20.6, and 5.2% of the mortalities were due to direct, indirect and unspecified causes respectively and 4.3% of the causes were not clear in several studies. The leading direct and indirect causes of death were identified as hemorrhage (30.7%) and hypertensive disorders (17.1%) and circulatory system diseases (8.1%) respectively. Several factors including gravidity, type of delivery, socio-economic status of mothers, locations of birth, death and maternity care venues were found in the original studies as the most important determinant of maternal mortalities in Iran. Conclusions This study, provided an updated summary of evidences on the causes and determinants of maternal death in Iran, which is critically important for the development of interventions and reduction of the burden of maternal mortality and morbidities.

Background: The prevalence of autism spectrum disorder (ASD) as a child neurodevelopmental disorder has increased significantly during the past 3 decades worldwide and in Iran. This chronic disease does not cause premature death and there is no definitive treatment. Thus, the cost of ASD is extremely heavy and overwhelming. The purpose of this study is to calculate the economic burden of ASD in Iran. Methods: A cross-sectional descriptive-analytic study was conducted to calculate all-important ASD costs. Two hundred and ninety autism patients in Tehran participated in this study in 2017 with the support of Tehran University of Medical Sciences (TUMS). A valid and reliable questionnaire was used to estimate direct medical costs, direct non-medical costs and indirect costs. Results: The annual economic burden of ASD is estimated to be 223,561,841 Rials ($6,883 2014 USD) per patient in Tehran, Iran in 2017. Approximately 32%, 52% and 16% of the total cost were direct medical costs, direct non-medical costs, and indirect costs. The average ASD direct cost was $5,765 of which 38% was direct medical costs and 62% was direct non-medical costs. The average annual ASD direct medical cost was $2,215 per patient of which 70%, 16% and 7% were related to rehabilitation, medicine and doctor visit costs. The average annual ASD direct non-medical cost was $3,550 per patient of which 35% was the cost of parents’ immigration to Tehran to receive health care services. The average annual ASD indirect cost for productivity loss from unemployment or reduced work productivity was estimated at $1,118. The largest cost component was parents’ productivity loss due to caregiving (70%). Conclusion: Autism imposes substantial direct and indirect economic effects on patients and their families. Hence, health policy makers must take the most effective measures to make best use of scarce societal resources, to reduce the cost of the disease for patients and their families and subsequently, reduce its psychosocial burden.

Microplastics pollution has led to irreversible environmental consequences and has triggered global concerns. It has been shown that water resources and marine food consumers are adversely affected by microplastics due to their physico-chemical characteristics. This study attempts to comprehensively review the structure of four well-known Lagrangian particle-tracking models, i.e., Delft3D—Water Quality Particle tracking module (D-WAQ PART), Ichthyoplankton (Ichthyop), Track Marine Plastic Debris (TrackMPD), and Canadian Microplastic Simulation (CaMPSim-3D) in simulating the fate and transport of microplastics. Accordingly, the structure of each model is investigated with respect to addressing the involved physical transport processes (including advection, diffusion, windage, beaching, and washing-off) and transformation processes (particularly biofouling and degradation) that play key roles in microplastics’ behavior in the marine environment. In addition, the effects of the physical properties (mainly size, diameter, and shape) of microplastics on their fate and trajectories are reviewed. The models’ capabilities and shortcomings in the simulation of microplastics are also discussed. The present review sheds light on some aspects of microplastics’ behavior in water that were not properly addressed in particle-tracking models, such as homo- and hetero-aggregation, agglomeration, photodegradation, and chemical and biological degradation as well as additional advection due to wave-induced drift. This study can be regarded as a reliable steppingstone for the future modification of the reviewed models.

Background: The mothers' role in health of family members is very important, and her death has uncompensable losses for the family and society. With regard to the importance of maternal mortal ratio in development indicators of the United Nations (UN) this study is conducted to investigate the impact of socioeconomic factors on maternal mortality ratio Methods: In the current study the role of socioeconomic factors on maternal mortal ratio was investigated by panel regression. Data include number of maternal mortality, total fertility, number of hospital beds, number of midwifes, number of physicians and urbanization in the period between 2008 and 2012. Since the dependent variable was in count form, Poisson estimator, Hausman test, and Breusch-pagan test were used. Results: Based on the findings, household’s income and fertility rate had direct and inverse association with maternal mortality, respectively. Investigating the association between midwifes and maternal mortality showed that increasing the number of midwifes decrease it, but no significant association was found between the number of physicians and maternal mortality. Number of hospital beds also showed a direct association (significant at 10%). Conclusion: All of the variables to somehow are related with the level of development. In developed regions, per capita income, access to health resource and urbanization is higher and there is more equity in distribution of health resources. It could be concluded from the findings that by increasing the level of development, maternal mortality would decrease.

Background: Hospital managerschr('39') success depends not only on internal of the hospital environment, but also on the external. Considering the importance of the social responsibility of hospitals as an external organizational issue, this study aimed to assess the importance of social responsibility and the implementation status of hospitals. Materials and Methods: This analytical descriptive study was conducted in Kermanshah educational hospitals in 2016. The study population consisted of management team of each hospital in middle and first-line level, of which 150 were selected using census sampling method. The data gathering tool was a researcher-made questionnaire. Validity and reliability of the instrument was confirmed. Data analysis was performed using SPSS20 software, descriptive and inferential statistics. Results: The mean score of importance and status of social responsibility implementation were high (86.20 ± 9.98) and moderate (60.62 ± 12.41), respectively. Among the domains, the highest and the least attention were paid to environment (11.65 ± 88.30) and suppliers (13.47 ± 81.48) domains, respectively. The highest level of accountability in patients was (68.87 ± 26/14) and the least was found in organizational processes (14.47 ± 42.02). There was a significant statistically difference in social status according to organizational status and employment type (p

Background & Objectives: Women have a basic role in ensuring the health of future generations and their employment forms an important part of their life. Changes in the traditional roles of women and their growing demand for participation in various job positions, have become an undeniable fact of Iranian society. The purpose of this study was to investigate the effect of formal and informal employment on women's quality of life. Methods: This was a cross-sectional descriptive-analytic study performed from December 2016 to July 2017 on 112 formal employed women and the same number of informal employed women who were randomly selected. To assess subjects’ quality of life, SF-36 standard questionnaire was used as a valid tool. Data were analyzed using Mann-Whitney and independent t- test statistical tests and through SPSS version 21 software. Results: According to the results, 49.1% of women working in the informal sector did not have high school diploma and were younger than 24 years old. The mean score of quality of life in women employed in the formal sector (78.95 ± 13.6) was significantly better than that of women employed in the informal sector (84.77 ± 10.21) (P

Background & Objectives: Accreditation, as a formal external evaluation system, has a critical role in improving quality, safety and effectiveness of hospital services. The aim of this study was to evaluate the effects of accreditation standards on the performance of Accident and Emergency (A&E) departments of hospitals in Sari, Iran. Methods: This cross-sectional descriptive - analytic study was carried out in eight hospitals in Sari, Iran. Information related to the accreditation scores and five performance indicators of A&E departments (i.e., average triage time, percentage of cardiopulmonary resuscitation failure, percentage of patients who were decided upon within 6 hours, percentage of patients sent out of the A&E department within 12 hours and percentage of patients left A&E department against the medical advice) in (March 2013 and March 2014) and (March 2014 and March 20115) were gathered form hospitals and accreditation office of Mazandaran University of Medical Sciences. Data were analyzed through SPSS (V.22) software and using descriptive and inferential statistics. Results: The mean scores of accreditation of A&E departments in 2013 and 2014 were 76% and 62.2% respectively. The differences between performance indicators of A&E departments in 2013 and 2014 were not statistically meaningful. There was no significant relationship between accreditation and the performance of A&E departments of hospitals. Conclusion: Accreditation did not improve A& E performance in Sari hospitals. Hence, there is a pressing need for improving hospital accreditation system including standards, methods and surveyors. Besides, hospital managers should use internal quality management systems to complement and strengthen the impact of external accreditation system in improving key performance indicators of hospitals. Keywords: Standard, Accreditation, Accident and emergency department, Key performance indicators, Hospital Citation: Pourreza A, Mosadeghrad AM, Zoleikani P. The Impact of Accreditation on the Performance of Hospital Emergency Departments. Journal of Health Based Research 2017; 3(3): 277-295.

Despite the recent increase in economic evaluations of health care programs in low and middle income countries, there is still a surprising gap in evidence on the appropriate discount rate and the discounting of health outcomes such as quality adjusted life years (QALYs). Our study aimed to calculate the implied time preference rate for health outcomes in Iran and its key determinants. Data were gathered from one family member from each of the 650 households randomly selected in Tehran. The respondents' private and social preferences for health outcomes were calculated using the time trade-off (TTO) technique based on the discounted utility model. We investigated the main assumptions of the discounted utility model through equality of mean comparison, and the association between private time preference and key socio-economic determinants using multilevel regression analysis. The mean and median implied rates were 5.8% and 4.9% for private time preference and 25.6% and 20% for social time preference respectively. Our study confirmed that magnitude, framing and time effects have a significant impact on implied discount rates, which means that the conventional discounted utility model's main assumptions are violated in the Iranian general population. Other models of discounting which apply lower rates for far health outcomes might provide a more sensible solution to discounting health interventions with long-term impacts.

Pharmacies are a major component of health systems and a major part of health service provision. This study aimed at identifying and introducing the potentials of pharmacies in health promotion. This was a systematic review that searched PubMed, Web of Science, Science Direct, SID, Magiran, and IranMedex from February 1990 to September 2018 for related materials. The main search keywords were (pharmacy services), (community pharmacy services), (retail pharmacy services), (pharmacy practice intervention). Inclusion was limited to those papers that discussed the health-promoting services provided in the pharmacies. The quality of included papers was assessed by the Critical Appraisal Skills Program checklists. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart was followed in all stages of the study. Of the 4156 papers retrieved, 18 met the inclusion criteria and included in the analysis. Study findings were categorized into three main categories: Health and prevention services, services related to treatments, and the awareness about the pharmacies' functions. The health and prevention category consisted of education, vaccination, screening and prevention of diseases, family planning, blood pressure monitoring, quitting smoking, limiting alcohol, and weight management. The treatment-related services consisted of adherence to medication, medication consultation, minor pains, and emergency medical services. Pharmacies can provide a wide variety of services besides the medications. Purposeful development of the services provided in the pharmacies and involving them in an extended array of services may accelerate the health promotion activities of the health system and result in improved quality of life and decreased costs. To do so, the legal, educational-skill, and pricing challenges should be resolved.

BACKGROUND: Over the past few decades, significant demographic and epidemiological changes have been occurred and led to serious changes in the health-care needs of the elderly. Integrated care has been emerged as a strategy to provide better care for the elderly in the community. The aim of this study was conducted to evaluate components of integrated health-care program of the elderly. MATERIALS AND METHODS: This quantitative cross-sectional study was conducted in Tehran (Iran) in 2019. For the purpose of the study, a two-stage cluster sampling method was employed. In the firs stage, primary health-care centers were selected, then in the second stage, a systematic random sampling was conducted based on the number of the elderly covered by each center. level of frailty, medication use awareness, and self-care ability were evaluated by the elderly self-report questionnaire. The questionnaire was piloted with thirty respondents. The test–retest reliability score for the questionnaire was r = 0.795, P < 0.001. Data analysis of the questionnaire was conducted using generalized estimating equation model by SPSS software Version 22. Statistical significance for all analyses was set at P < 0.05. RESULTS: Findings of the components showed that the mean ± standard deviation of frailty (80 ± 17) and self-care ability (87 ± 17) were higher than the mean of medication use awareness (49 ± 19). Frailty and self-care ability (β = frailty, self-care) of the elderly had a positive statistical significance with the ones with good financial status (β = 5, 10) and without chronic disease (β = 4, 5). Medication use awareness had a negative statistical significance with illiteracy (β = −9.5). CONCLUSIONS: It is suggested that the medication use awareness of the elderly should be prioritized by improving integrated health-care program.