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Hossein Jabbari,1 Saber Azami-Aghdash,2 Reza Piri,3 Mohammad Naghavi-Behzad,4 Mark JM Sullman,5 Saeid Safiri6,7 1Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; 2Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; 3Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; 4Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 5School of Humanities and Social Sciences, University of Nicosia, Nicosia, Cyprus; 6Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran; 7Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Introduction: The provision of palliative end-of-life care (P/EOLc) for patients, wherever they live, is an increasingly important service, particularly given the increasing rates of cancer and other life-threatening diseases in Iran. However, unfortunately, those living in the rural areas of Iran are greatly disadvantaged with respect to this type of care. Therefore, the present study explored the feasibility of organizing P/EOLc in the rural areas of Iran. Methods: In this qualitative study, two focus group (FG) discussions were held in Tabriz (Iran) with rural family physicians (FPs, n=23) and key P/EOLc stakeholders (n=13). The FG sessions were recorded, transcribed, and the transcriptions checked by participants before the data were subjected to content analysis. Results: While most FPs indicated that they did not have sufficient involvement in providing P/EOLc, they emphasized the necessity of providing P/EOLc through four main themes and 25 subthemes. The four main themes were labeled as “structures and procedures,” “health care provider teams,” “obstacles,” and “strategies or solutions.” Furthermore, according to the main themes and subthemes identified here, the key stakeholders believed that the Iranian health system and the FPs’ team have the potential to provide P/EOLc services in rural areas. Conclusion: The most feasible strategy for providing P/EOLc in Iranian rural areas would be to use the current health care framework and base the process around the FP. Keywords: palliative end-of-life care, rural areas, family physician team

Background: Attitudes toward childhood disability have historically focused on biomedical efforts on 'fixing'. The introduction of WHO's ICF framework for health and Canadian researchers' 'F-words' (functioning, fitness, fun, friends, family and future) have significantly changed the field. To explore whether the F-words ideas influenced parents' perspectives on their child's abilities and rehabilitation goals, this qualitative pilot study introduced the F-words to Iranian parents with a child with a developmental disability., Methods: This study was conducted in Tabriz, Iran, in 2023, using Iranian educational F-words materials built on ideas available on the CanChild F-words Knowledge Hub. Data were collected through semistructured interviews with five mothers of children <5 years old with a developmental disability before and after attending an 'F-words Awareness Session' and analysed using thematic analysis., Results: In the preinterviews, six themes (and 20 subthemes) were identified: (i) routines (5); (ii) challenges (4); (iii) parental concerns (3); (iv) child's needs and priorities (3); (v) the role of parents in satisfying needs and challenges (2); and (vi) expectations of rehabilitation (3). In the postinterview, the same six themes and four additional subthemes emerged., Conclusion: Findings from the pilot study showed that the intervention had an impact on the attitudes and behaviours of participants. Specifically, teaching about the F-words reduced parents' emphasis on the concept of 'normality'. Families' positive response to the 'F-words Awareness Session' indicates their openness to incorporating this approach into their daily lives. These findings highlight the potential benefits of utilizing the F-words in rehabilitation in Iran. Studies like these can serve as a foundation for developing effective strategies for integrating the F-words into existing rehabilitation practices in Iran., (© 2024 John Wiley & Sons Ltd.)

Background: Breast cancer is the most prevalent cancer worldwide and the leading cause of cancer mortality in women. Uptake of breast cancer screening and early-detection practices in low- and middle-income countries (LMICs) has not been synthesized. We aimed to systematically quantify uptake of breast cancer screening in LMICs., Methods: We performed a systematic review and meta-analysis of observational population-based studies that reported the uptake of screening or early-detection practices. We searched PubMed, Scopus, Embase, and Web of Knowledge databases to January 2024. We pooled data using random-effects meta-analysis, and explored heterogeneity using subgroup analyses., Findings: 174 population-based studies encompassing >78 million women were included. Pooled prevalence of self-reported uptake of screening mammography, self-reported having had clinical breast examination for screening, and self-reported regular breast self-examination (relevant for breast awareness in LMICs) were 22.7% (95% CI: 18.6-27.2), 23.1% (95% CI: 19.5-27.0), and 14.6% (95% CI: 11.6-17.9) respectively. Uptake of breast cancer screening practices was lowest in Africa and low and lower-middle income countries. Uptake of breast cancer screening practices remained stable over time or slightly decreased. Women who lived in rural area, were single, had lower income level, had low educational attainment, were unemployed, were uninsured and had no family history of breast cancer were generally least likely to self-report uptake of breast cancer screening., Conclusion: This meta-analysis identified concerningly low uptake of breast cancer screening practices in LMICs. Governments should prioritize developing context-appropriate strategies to address this low uptake to support population-level stage-shifting of breast cancer in LMICs., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Quality of life (QoL) of women with gestational diabetes mellitus (GDM) is one of the fundamental issues and public health challenges. This study examines the QoL among pregnant women with GDM through a systematic review and meta-analysis., Methods: A search was conducted in Scopus, PubMed, and the Web of Science databases for articles published until Jan 30, 2024. Manual searches of gray literature, Google Scholar, reference checks, and citation checks were conducted. The JBI's Critical Appraisal Checklist for Analytical Cross-Sectional Studies was utilized to assess the quality of the articles' reporting. The random model implemented in Stata software (version 16; Stata Corp.) was utilized to conduct the meta-analysis., Results: Among the 516 studies obtained from the literature, only 15 were deemed suitable for inclusion. Most studies (73.3%) were conducted in nations with high-income levels. Additionally, general QoL was assessed in most studies (11 studies). The SF-36 and WHOQOLBREF questionnaires were the most often utilized. Based on the SF-36 measure, there was no statistically significant difference in the QoL of patients with GDM compared to the control group in most of dimensions. The WHOQOL-BREF instrument was utilized to estimate the QoL score at 49.69. The EQ-5D-5L tool revealed a difference in QoL scores between the GDM and control groups (MD=-7.40). The research findings were highly heterogeneous. The median evaluation score for the reporting quality of the articles was calculated to be 5, with a mean of 4.8 out of 7., Conclusion: The results of the present study showed that GDM reduces the QoL of pregnant women, especially in terms of mental and social health. Therefore, interventions and support programs should be designed and implemented to improve these women's QoL., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Author(s).)

Background: Universal Health Coverage (UHC) is one of the most important strategies adopted by countries in achieving goals of sustainable development. To achieve UHC, the governments need the engagement of the private sector., Objective: The aim of this study was to identify factors affecting private sector engagement in achieving universal health coverage., Methods: The study is a scoping review that utilizes Arkesy & O'Malley frameworks. Data collection was conducted in MEDLINE, Web of Sciences, Embase, ProQuest, SID, and MagIran databases and the Google Scholar search engine. Also, manual searches of journals and websites, reference checks, and grey literature searches were done using specific keywords. To manage and screen the studies, EndNote X8 software was used. Data extraction and analysis was done by two members of the research team, independently and using content analysis., Results: According to the results, 43 studies out of 588 studies were included. Most of the studies were international (18 studies). Extracted data were divided into four main categories: challenges, barriers, facilitators, goals, and reasons for engagement. After exclusion and integration of identified data, these categories were classified in the following manner: barriers and challenges with 59 items and in 13 categories, facilitators in 50 items and 9 categories, reasons with 30 items, and in 5 categories and goals with 24 items and 6 categories., Conclusion: Utilizing the experience of different countries, challenges and barriers, facilitators, reasons, and goals were analyzed and classified. This investigation can be used to develop the engagement of the private sector and organizational synergy in achieving UHC by policymakers and planners.

Introduction: The World Health Organization (WHO) recommends focusing on primary health care (PHC) as the first strategy of countries to achieve the improvement of the health level of communities and has emphasized it again in 2021. Therefore, we intend to take a different look at the PHC system with reform, innovation, and initiative by using the experiences of leading countries and identify practical and evidence-based solutions to achieve greater health., Methods: This is a scoping review study that has identified innovations and reforms related to PHC since the beginning of 2000 to the end of 2022. In this study, Scopus, Web Of Science, and PubMed databases have been searched using appropriate keywords. This study is done in six steps using Arkesy and O'Malley framework. In this study, the framework of six building blocks of WHO was used to summarize and report the findings., Results: By searching in different databases, we identified 39426 studies related to reforms in primary care, and after the screening process, 106 studies were analyzed. Our findings were classified and reported into 9 categories (aims, stewardship/leadership, financing & payment, service delivery, health workforce, information, outcomes, policies/considerations, and limitations)., Conclusion: The necessity and importance of strengthening PHC is obvious to everyone due to its great consequences, which requires a lot of will, effort, and coordination at the macro-level of the country, various organizations, and health teams, as well as the participation of people and society.

Background: Online reporting systems can establish and maintain the community-authority connection for safety promotion initiatives and their sustainability. The aim of this study was to report the development, implementation, and evaluation of an online community safety reporting system in safe communities in Iran., Methods: In the first place, the life cycle approach and software systems development were used for design and implementation, which included 7 steps. In the following, an online Community Safety Reporting System (CSRS) was developed with two main interfaces, including a web-based and phone application. The software was developed using suitable programming languages for the web and as a mobile application for Android and iOS systems., Results: During the six months of implementation, we received 80 reports in different safety areas, which were managed by the administrators and provided feedback for reporters. System user-friendliness and easy to use were the main strengths declared by users. The CSRS program is implemented at two levels of usage: public users to report safety issues and city admin functional evaluation of the system through a short interview with users. Moreover, city authorities believed that the system facilitates community participation in decision-making processes. The address of the web page is www.payamiran.ir., Conclusion: CSRS provides a way for community voices to be heard and facilitates mutual interaction between the community and authorities. CSRS could be used as a community participation tool to ensure safety promotion initiatives sustainability., Competing Interests: The authors declare that they have no competing interests., (© 2024 Iran University of Medical Sciences.)

Objective: The National Mental Health Services (N-MHSs) in Iran was integrated with Primary Health Care (PHC) in 1988. This study aimeds to analyze the policy of integrating N-MHSs in PHC, focusing on the analysis of the current situation, pathology, and the existing challenge. Method : This qualitative research was conducted in 2020 using a case study approach. This study used the policy triangle model to analyze the policy. The required data were collected via interviews, literature review, and document analysis. The interviews were conducted with 23 experts, stakeholders across the country who were selected through purposive sampling, and the data were analyzed using the content-analysis method. Results: The main goals of this policy were to raise mental health literacy among the people and eliminate its stigma in the society, while implementing the referral system for N-MHSs. Twenty weaknesses were extracted in eight areas, including negative views of mental health, weaknesses in human resource training, compensation for the service of psychologists, unfavorable working conditions of the workforce, inappropriate service delivery facilities, lack of meaningful communication between different levels of service delivery, poor inter-sectorial communication, and the challenging nature of mental health care. De-stigmatizing psychological disorders in the society and identifying hidden patients are some of the most significant achievements of this policy. Conclusion: Despite the successful implementation and significant achievements in integrating N-MHSs in PHC, the results of the present study indicate that there are many challenges in this field that require serious planning and attention from relevant authorities., Competing Interests: None., (Copyright © 2024 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

Background and Aim: During the early stage of pandemics, primary health care (PHC) is the first point of contact with the health system for people. This study aimed to find the leading roles and challenges of the PHC system in dealing with the outbreak of infectious diseases., Methods: The current scoping review was conducted in 2022 using the Arkesy and O'Malley framework. A bibliographic search was conducted in PubMed, Web of Science, and Scopus databases. Following a Google Scholar search, a manual search in some journals, reference checks for articles, and a review of organizational reports, websites, and other sources of information were also conducted. Data were analyzed using the content-analysis method., Findings: Finally, 65 documents (42 articles and 23 reports, books, and news) were included in the study. Initially, 626 codes were extracted, and 132 final codes were categorized into eight main themes and 44 sub-themes. The main themes for the roles of PHC included: service provision, education and knowledge, surveillance, access, coordination and communication, management and leadership, infrastructure change and rapid preparation, and patient and community management. Regarding the challenges faced by PHC in the epidemic of infectious diseases, 24 key challenges were identified and categorized into four major areas., Conclusions: Based on the results of the present study, there is a need for further studies to formulate and theorize the specific roles of PHC in managing infectious disease epidemics. The results of this study can be utilized by researchers and officials to inform their efforts in addressing this purpose.

Hospital waste poses numerous concerns for both human health and the environment. Using an action research technique, this study attempts to improve waste management at the Farabi Hospital in Malekan city-Iran. In 2020, integrated (quantitative-qualitative) action research was done. For action research, the Simmons model was employed. First, a list of significant issues was found during the waste management process evaluation using a standard checklist and brainstorming with hospital officials and workers. The identified issues were prioritized using a prioritization matrix. Then, after consulting with hospital officials, 11 interventions were designed and implemented over six months. Finally, waste management performance was re-evaluated. Average knowledge of the participants about hospital waste management (HWM) standards was improved significantly (64 ± 13.8 before the training, 84.6 ± 20.6). General waste production was reduced by 27.7% in terms of garbage bags and 23.4% in terms of waste weight (95.5 kg-73.1 kg), respectively. Infectious waste output was reduced by 22.8% in the number of garbage bags and 32.1% in the weight of waste (57.5 kg-39 kg). The rate of compliance with HWM criteria was improved from 10 to 33 items. Although the interventions in this study improved the HWM to an acceptable level, more interventions and ongoing monitoring are required. The study's findings also show that an action research strategy might address a wide range of issues and weaknesses in hospitals and related facilities., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Desired health outcomes are more achievable through strong Primary Health Care (PHC). Using comprehensive and scientific tools, decision-makers are guided to formulate better PHC reforms and policies. This study introduces a sub-national framework based on the World Health Organization (WHO) proposed frameworks for the PHC performance measurement., Method: By a mixed-method and qualitative approach, the Iranian sub-national PHC Measurement Framework (PHCMF) was developed through a review of the WHO's PHC measurement conceptual framework (for selecting Key Performance Indicators (KPIs)), literature review (academic database), PHC-related national documents, consultations with an advisory committee of national experts (6-meetings), and the Delphi technique for finalizing the framework., Results: The Iranian sub-national PHCMF was finalized with 100 KPIs in three components including Health systems determinants, Service Delivery, and Health system objectives. Based on the result chain domain, most KPIs were related to the output (24 KPIs) and the least were related to the input and the process (9 KPIs)., Conclusion: Regarding the comprehensiveness of the developed measurement framework due to its focus on all PHC operational levers and key aspects of PHC systems' performance, it can be used as a practical tool for assessing and improving the Iranian sub-national PHC system., (© 2023. The Author(s).)

Background and Objective: People with fibromyalgia (FM) often report having difficulty with emotional identification and expression, and this "alexithymia" may contribute to their pain and other symptoms. Multiple studies have assessed alexithymia in FM, and we systematically reviewed and meta-analyzed this literature to: (a) describe the prevalence of alexithymia in people with FM; (b) compare the level of alexithymia in FM to both healthy controls and controls with other pain conditions; and (c) determine the association of alexithymia to pain intensity, depression, and anxiety in people with FM., Databases and Data Treatment: Following PRISMA guidelines, we searched multiple databases (Scopus, PubMed/MEDLINE, Embase, Web of Science, PsycINFO and Google Scholar) from inception to May 31, 2022. Study quality was assessed with The Joanna Briggs Institute (JBI) tools for cross-sectional studies, and STATA:17 was used for meta-analysis. A total of 32 studies met eligibility criteria and were included in meta-analyses., Results: The prevalence of alexithymia in FM averaged 48%. People with FM had substantially higher alexithymia than healthy controls (SMD = 1.00; 95% CI: 0.79 to 1.22), as well people with other pain-related conditions (SMD = 0.35, 95% CI = 0.04 to 0.65), particularly rheumatoid arthritis (SMD = 0.49; 95% CI: 0.08-0.91). Alexithymia was positively associated with pain intensity (r = 0.24), anxiety (r = 0.50), and depression (r = 0.41) among people with FM., Conclusions: Due to the high level of alexithymia in people with FM and the positive relationship of alexithymia with pain and psychological distress, interventions to improve emotional awareness, expression, and processing in FM are recommended., (© 2022 European Pain Federation - EFIC ®.)

Aim: The aim of this paper is to introduce the experience of applying public-private partnership (PPP) in providing primary health care (PHC) in East Azerbaijan Province (EAP), Iran., Background: Moving toward the Universal Health Coverage (UHC) involves using of all health-related resources. Certainly, one of the key strategies for achieving UHC is PPP. Since 2015, a PPP in PHC policy has begun in EAP as a major strategy for strengthening the health system and achieving UHC., Methods: In this case study, data were collected through interviews with stakeholders, document analysis, reviewing of health indexes and published studies. The data were analyzed using content analysis., Finding: PPP in PHC policy was designed and implemented in EAP with the aim of social justice, strengthening the health system and achieving UHC in the framework of health complexes (HCs). HCs provide a defined service package according to the contract. The reimbursement method is a combination of per capita, fee for services and bonus methods. Part of the payments is fixed and the other part is based on the pay for quality system and paid according to the results of monitoring and evaluation. According to the study results, the most important strength of the plan is to improve access to services, especially in marginalized areas. The main weakness is not providing infrastructures before the implementation of the plan, and the most important challenges are financial, political and organizational unsustainability and, sometimes, poor cooperation by the other organizations. The findings show that PPP in PHC in EAP is an effective strategy to provide social justice, implement family practice and achieve UHC.

Objective: This study aimed to comprehensively determine the factors that affect the hospitals' functional preparedness in response to disasters., Methods: A systematic review of studies published in English and Persian up to the end of 2022 was performed by searching PubMed Central, Web of Science, Scopus, ProQuest, SID, and Elmnet databases. Articles that assessed hospitals' functional preparedness were searched by using a combination of medical subject heading terms and keywords including disaster, emergency, preparedness, hospital preparedness, health care facilities preparedness, hospital functional preparedness, health care facilities functional preparedness, readiness, and effective factors. Additionally, journals and gray literature were manually searched. Two independent reviewers screened the eligible papers. The inclusion criteria were the full text should be published up to the end of 2022, in both Persian and English, and focus on hospital preparedness. The extracted data were manually analyzed, summarized, and reported using the content analysis method., Results: Of the 3465 articles, 105 studies were eventually included in the final analysis. Eighty-two influential factors were identified and classified into seven categories: government, coordination, control, and commanding (7 factors), existing guidelines and preparedness plans (12 factors), regulations (6 factors), supplying of resources (37 factors), education and training (8 factors), multi-layered information management and communication systems (8 factors), and contextual factors (4 factors)., Conclusion: There are different dimensions of hospital preparedness for disasters, each of which is influenced by several independent factors. Addressing these factors will enhance the actual functional preparedness of hospitals encountering disasters., Competing Interests: None declared.

Objectives. Investigating the root causes of under-reporting near misses is very important. The aim of this study was investigating barriers to near-miss reporting in East Azerbaijan Province Gas Company from the perspective of health, safety and environment (HSE) officers. Methods. Semi-structured individual interviews were used and 21 interviews were conducted with HSE officers. Inductive content analysis was used for analyzing interviews. After analyzing the interviews, the codes in the interviews were categorized. Results. In general, two categories of code were created: reasons for non-reporting of accident precursors; and suggested solutions to improve the reporting system of accident precursors. However, two main categories were found for not reporting: individual reasons such as lack of commitment to the job, lack of attention to social responsibility, forgetfulness and laches in reporting, etc.; and organizational reasons such as job instability among employees, lack of sufficient training, failure of the organization to provide feedback, etc. Conclusion. This study found that the opinions of people working in the organization can be very effective in promoting reporting, so any organization can choose the appropriate strategy to increase the number and quality of reports by examining the opinions of managers, HSE officers and workers in the organization.

Background: Since the COVID-19 outbreak, preliminary research has shown that some risk-associated conditions increase death and severe complications of the disease, hypertension being one of them. Thus, numerous meta-analyses have been conducted to explore this issue. Therefore, this umbrella review aims to perform a meta-analysis of the meta-analyses to estimate the prevalence and associated risks of hypertension in patients with COVID-19., Methods: PubMed, Scopus, Web of Knowledge, Embase, and Cochrane databases were searched for the published meta-analyses up to January 1, 2022. Google Scholar, citation check, reference check, and Grey literature were also manually searched. A random-effect model approach was used for analysis., Results: The overall death rate was estimated at 12%. Hypertension was present in 25% of the patients as a comorbid disease. The overall RR for death, disease severity, and the possibility of ICU admission were estimated at 1.79 [1.68-1.89 with 95% CI], 1.74 [1.66-1.83 with 95% CI], and 1.91 [1.48-2.34 with 95% CI], respectively. The meta-regression results showed that being "male" significantly increases the risk of disease severity and ICU admission., Conclusions: The results indicated that hypertension is a common comorbid disease in hospitalized patients with COVID-19, which significantly increases mortality risk, the severity of the disease, and the probability of ICU admission., Systematic Review Registration: This study has been registered in PROSPERO (CRD42021231844)., (© 2022. The Author(s).)

Background: This study has been conducted to analyze the processes, models, and policies to assess fitness to drive and improving driving in the elderly in the world., Methods: The Arkesy and O'Malley frameworks were employed. Articles with at least one aspect of driving eligibility in the elderly were included. Expected data were collected using appropriate keywords from PubMed, Web of Science, Scopus, Embase, IranDoc, SID, and MagIran. Data were analyzed using the Content Analysis method., Results: Out of 675 records, 24 papers and reports were included in the study that all of them were High-Income Countries (HICs). Among the studies that referred to the baseline age, the highest frequency was 70 yr old (4 studies). Vision assessment was the main item to judge driving fitness (mentioned in 75% of the studies). The in-person (5 studies) was the most common method of renewal. General practitioners were the principal performers to measure driving fitness (7 studies). Thirteen studies referred to the road tests as part of the driver's license renewal process. In most all reports and papers, there were policies on empowering the elderly driver, including providing safe driving tips, optional driving skills tests, holding retraining courses, etc. The most frequently supporting policies included introducing alternative transportation., Conclusion: Most HICs have worthwhile experience in measuring and improving the fitness to drive in the elderly and enforce different laws according to social and political conditions. Utilizing these experiences by considering economic and social differences can be useful and practical for middle and low-income countries., Competing Interests: Conflict of interest No competing interests were disclosed., (Copyright © 2022 Mohammaddokht et al. Published by Tehran University of Medical Sciences.)

Background: Developing an effective system for measurement and improvement of primary health care (PHC) based on the conditions and characteristics of the countries' health systems is one of the World Health Organization (WHO) recommendations., Aims: This study will aim to develop a framework to assess the Iranian sub-national PHC system performance using the WHO measurement framework for PHC., Methods/designs: This is a mix-method study with a triangulation design. The Iranian sub-national PHC Measurement Framework (PHCMF) will be developed through a review of the WHO's PHC measurement conceptual framework (for selecting key performance indicators (KPIs)), literature review (academic database), PHC-related national documents, consultations with national experts, and the Delphi technique for finalizing the framework. The required data for calculating selected KPIs is expected to encompass qualitative and quantitative data. Discussion: Iranian PHC system performance is not measured based on the holistic and scientific framework and international standards. The information obtained from this project will guide managers and policymakers to be aware of the current situation and the success rate of the PHC system in achieving the desired goals, as well as identify strengths and weaknesses of the PHC system and provide the solution to better policy formulation.

Psychiatric hospitals and centers have more complex conditions than other hospitals in responding to emergencies, given the differences in the design of their buildings and in non-structural elements. This is a qualitative study aimed at reviewing and investigating the experiences and challenges faced by psychiatric hospital staff in response to different fire incidents. A phenomenological approach was employed to conduct the study, believing that human experiences and beliefs are substances in phenomena and can be understood and examined. The contents of interviews and focus group discussion (FGD) sessions were extracted and classified into five categories, 14 themes, and 49 sub-categories. Many psychiatric hospitals in Iran are not ready to respond properly to incidents like fires. The study revealed that in order to ensure appropriate management of incidents and disasters in the hospitals, it is necessary to focus on five areas called the 5s framework, which includes structures, staff, supplies (facilities, equipment etc.), sick persons and systems. This framework is proposed to enhance preparedness, reduce vulnerability, and provoke an effective response to incidents in psychiatric hospitals., (Copyright © 2022 Euro-Mediterranean Council for Burns and Fire Disasters.)

Background: Through designing a surveillance system, steps to policy making and designing measures needed to reduce the potential risks of environmental disasters on human health could be taken. Therefore, this study aimed to develop a model for Environmental Disasters Diseases Surveillance System (EDDS) to monitor Adverse Health Effects (AHEs) of Environmental Disasters (AHEEDs)., Methods: As the first step, the literature review was conducted to identify the AHEEDs. Then, using the results of the first step and analyzing the existing documents, the AHEEDs were identified, and, based on the experts' opinions, high-priority effects were included in the EDDS. Then, using semi-structured interviews, 20 experts' views on the appropriate model of EDDS were investigated. To design the initial model, a panel of experts was formed with six participants. Finally, the Delphi technique was used for expert opinion and model finalization., Results: As a result of the literature review and document analysis, 41 hazards/diseases were identified. Finally, ten diseases were suggested to enter the EDDS. In the experts' view, it is better that communicable diseases be reported actively and urgently and Non-Communicable Diseases (NCD) actively and non-urgently. From the participants' point of view, the most significant achievements of the EDDS can be organizational and managerial, health promotion, and economic achievements., Conclusion: Developing a dedicated EDDS for AHEEDs can be very helpful for better management of these effects. To this end, the model proposed in this study can serve as a guide for national and local policymakers to implement surveillance systems for AHEEDs., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background: The concept of mobile health has attracted considerable attention across the globe, as it provides both healthcare professionals and patients with a distinct means of information and resources., Aim: This study was conducted with the aim of utilising mobile health (mHealth) applications by nurses and presenting a scenario of how and why they are utilised., Methods: This study was a scoping review. Data collection was carried out by searching the related keywords in Google Scholar, Scopus, Cochrane, EMBASE, Ovid, and PubMed databases from January 2000 to March 2019., Results: Regarding the reasons for using mobile applications by nurses, five objectives were identified, including learning and knowledge enhancement, treatment and improvement of the patient care process, diagnostic process, data and patient management, and health promotion. Effective factors in the nurses' use of mobile applications were categorised into eight themes: ease of use, usefulness, security and confidentiality, feasibility and functionality, design and use-interface, effectiveness, infrastructure, versatility, and social norms., Conclusions: Mobile health applications have considerable potential in enhancing nurses' professional activities. This study contributes to both nursing and health policy by providing a scenario of how and why nurses use mobile health applications., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background: Today, cardiovascular disease (CVD) is the leading cause of mortality in both sexes. There are several risk factors for heart diseases; some controllable, others not. However, socioeconomic, technological, and environmental factors can impact CVD as well as exclusive risk factors. Accurate identification and assessment of these factors are often difficult. In the present systematic review, we aimed to explore factors affecting CVD., Methods: Multiple databases (MEDLINE, Scopus, ISI Web of Science, and Cochrane) and gray literature were searched. The included studies described at least one determinant of CVD. The framework method was applied to analyze the qualitative data., Results: A total of 64 studies from 26 countries were included. The contextual determinants of CVD were categorized into 45 determinants, 15 factors, and 4 main social, economic, technological, and environmental categories. The 15 potentially reversible factors were identified as sociodemographic, violence, smoking, occupation, positive childhood experience, social inequalities, psychological distress, eating habits, neighborhood, family income, rapid technology, environmental pollution, living environments, noise, and disaster., Conclusions: Devolution and more efficient health policies are required to achieve further sustained reduction in CVD mortality, increase life expectancy, and reduce its associated risk factors. Policymakers should fully address the value of social, economic, technological, and environmental factors. In fact, a prevention agenda should be developed and updated collaboratively in terms of the determinant factors., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 International Journal of Preventive Medicine.)

Background: The Covid-19 pandemic affected the performance of Primary Health Care (PHC) worldwide. This study was performed to investigate the impact of the Covid-19 pandemic on the utilization of PHC in Iran., Method: A before and after study conducted between 2019 and 2021. 56 medical science universities across the country were studied. The data extracted from Electronic Health Record (EHR) is entitled "SIB". Three major indicators included a weighted average of essential services provided by (physician, dentist, mental health expert, midwife, nutritionist), percentage of actual delivered service, and percentage of customer satisfaction was selected as a criterion for assessing the PHC. Descriptive statistics and analytical statistics (Wilcoxon test) using SPSS 16 software were used for the data analyzing and reporting., Results: There was a significant difference among the examined dimensions before and after Covid-19 separation in all studied indicators except the level of percentage of customer satisfaction (P < 0.05). So that the percentage of actually delivered services decreased about 1% and the weighted average of essential services provided by a physician, dentist, midwife, mental health experts, and nutritionist decreased 627.95, 718.81, 460.85, 2914.66, 2410.65 numbers, respectively., Conclusion: Covid-19 Pandemic has affected the performance of Iranian PHC at the beginning and overall, has a negative consequence on utilization of services. Preparedness to respond to pandemics and develop programs and interventions is necessary to cover the weaknesses of the PHC., (© 2022. The Author(s).)

Background: The role of parents in taking care of children with Autism Spectrum Disorder (ASD) is critical. This systematic review aimed to investigate the characteristics and results of parent training interventions for autistic children., Methods: All relevant studies were searched using Boolean operators such as "AND" and "OR" with the keywords such as "Autism Spectrum Disorders," "Autism," "Autistic disorder," "Asperger syndrome," "Rett's syndrome", "Childhood disintegrative disorder", "Non-specific pervasive disorder", Parent*, Education*, train*, teach*, indoctrinate*, and instruct* in electronic databases such as PubMed, Scopus, Google Scholar, Cochrane Library, Science Direct, Web of knowledge, and also via manual searching in relevant journals, checking the reference list of articles, expert contact, and grey literature from 1 Jan 2000 to 30 Feb 2020. The retrieved studies were screened and reviewed then quality assessed by CONSORT checklist. The qualitative data were analyzed using content analysis method., Results: Eventually, 53 articles were considered in which 1758 parents with autistic children participated. Overall, 49 studies were conducted in high-income countries, 19 at home, 25 in training centers, 14 carried out only in training way, 39 in training along with practices and assignments, 30 individual interventions, and 21 in groups. Moreover, the effectiveness of interventions was studied in both parents and children groups. The results for parents show direct and indirect favorable impacts of interventions on them. The results for the children indicate direct and indirect favorable effects of the parents-based interventions on the child and the symptoms of their disorder., Conclusion: According to the included studies, parents-based training interventions significantly impact parents and their children's behavior., Competing Interests: Conflict of interests None., (Copyright © 2022 Tabatabaei et al. Published by Tehran University of Medical Sciences.)

Purpose. The accident precursor reporting system is a key point in preventing accidents and proper functioning of this system is critical. In the present study, the accident precursor reporting system in the Iranian East Azarbaijan Province Gas Company was investigated. Methods. This quantitative-qualitative study used field survey and document review methods to determine how the company was reporting. Qualitative content analysis approaches were used to analyze the reporting system over a 3-year period. From 1209 accident precursor reports, 2271 codes were extracted. Finally, these codes were reduced to three clusters: 996 (43.86%), 447 (19.68%) and 828 (36.46%) codes related to near misses, unsafe conditions and unsafe acts, respectively. A χ 2 test was used to investigate the reporting process. Results. Reporting rates varied by time (e.g., people reported more accident precursors in the first 6 solar months), by area (some areas had higher reporting rates than others) and by type of job (operational jobs had the highest reporting rate [73.16%] compared to non-operational jobs [26.84%]). Conclusion. It was suggested that policy-makers should improve the accident precursor reporting system. Changes to the current reporting system are essential to help in the prevention of future unpleasant accidents.

Background: The Universal Health Coverage (UHC) is a very important and effective policy in the health system of countries worldwide. Using the experiences and learning from the best practices of successful countries in the UHC can be very helpful. Therefore, the aim of the present study is to provide a scoping review of successful global interventions and practices in achieving UHC. Methods: This is a scoping review study that has been conducted using the Arkesy and O'Malley framework. To gather information, Embase, PubMed, The Cochrane Library, Scopus, Scientific Information Database, and MagIran were searched using relevant keywords from 2000 to 2019. Studies about different reforms in health systems and case studies, which have examined successful interventions and reforms on the path to UHC, were included. Articles and abstracts presented at conferences and congresses were excluded. Framework Analysis was also used to analyze the data. Results: Out of 4257 articles, 57 finally included in the study. The results showed that of the 40 countries that had successful interventions, most were Asian. The interventions were financial protection (40 interventions that were categorized into 14 items), service coverage (31 interventions categorized into 7 items), population coverage (36 interventions categorized into 9 items), and quality (18 interventions categorized into 7 items), respectively. Also, the positive results of interventions on the way to achieving UHC were financial protection (14 interventions), service coverage (7 interventions), population coverage (9 interventions), and quality (7 interventions), respectively. Conclusion: This study provides a comprehensive and clear view of successful interventions in achieving the UHC. Therefore, with consideration to lessons learned from successful interventions, policymakers can design appropriate interventions for their country., (© 2021 Iran University of Medical Sciences.)

Background: The world is facing the current COVID-19 pandemic. The pandemic response is affecting routine health care provision all over the world. We aimed to review the relevant literature and highlight challenges in the provision of routine care for patients with diabetes during the COVID-19 outbreak., Methods: We systematically searched PubMed, ScienceDirect, and Embase databases up till August 13, 2020 and retrieved relevant articles published on difficulties on routine diabetes management during the COVID-19 pandemic., Results: Through our reading of the recent literature discussing the difficulties of routine healthcare provision for patients with diabetes amid the COVID-19 pandemic, we have identified nine themes as follows: lockdown of standard outpatient clinics, decreased inpatient capacity, staff shortage, medicine shortage, unaffordable medicine, delayed care seeking, limited self-care practice, transport difficulties, and undiagnosed cases/events., Conclusion: Diabetes management during lockdown is particularly challenging. This review specified a summary of difficulties of diabetes care during COVID-19 pandemic. Healthcare policy makers as well as healthcare providers could take advantage of the results of this review to mitigate the adverse effect of the crisis on provision of routine care for diabetes as well as other chronic conditions., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Preliminary evidence from the COVID-19 pandemic shows the presence of health disparities, especially in terms of morbidity and mortality. This study aimed to systematically review the evidence on the association of racial/ethnic and socioeconomic status (SES) with health outcomes and access to healthcare services during the COVID-19 pandemic., Methods: We retrieved published evidence from late December 2019 through March 1, 2021. The target population was the population of the countries during the COVID-19 pandemic. The exposures were defined as belonging to racial/ethnic minority groups and/or low SES. The primary outcomes of interest include (1) death from COVID-19, (2) COVID-19 incidence/infection, (3) COVID-19 hospitalization, (4) ICU admission, (5) need for mechanical ventilation, (6) confirmed diagnosis, and (7) access to testing. We systematically synthesized the findings from different studies and provided a narrative explanation of the results., Results: After removing the duplicate results and screening for relevant titles and abstracts, 77 studies were selected for full-text review. Finally, 52 studies were included in the review. The majority of the studies were from the United States (37 studies). Despite the significant incongruity among the studies, most of them showed that racial/ethnic minority groups had higher risks of COVID-19 infection and hospitalization, confirmed diagnosis, and death. Additionally, most of the studies cited factors such as low level of education, poverty, poor housing conditions, low household income, speaking in a language other than the national language in a country, and living in overcrowded households as risk factors of COVID-19 incidence/infection, death, and confirmed diagnosis. However, findings in terms of the association of lack of health insurance coverage and unemployment with the outcome measures as well as the association of requiring mechanical ventilation, ICU admission, and access to testing for COVID-19 with race/ethnicity were limited and inconsistent., Conclusion: It is evident that racial/ethnic minority groups and those from low SES are more vulnerable to COVID-19; therefore, public health policymakers, practitioners, and clinicians should be aware of these inequalities and strive to narrow the gap by focusing on vulnerable populations. This systematic review also revealed a major incongruity in the definition of the racial/ethnic minority groups and SES among the studies., Systematic Review Registration: PROSPERO CRD42020190105., (© 2021. The Author(s).)

Non-Pharmaceutical Public Health Interventions (NPHIs) have been used by different countries to control the spread of the COVID-19. Despite available evidence regarding the effectiveness of NPHSs, there is still no consensus about how policymakers can trust these results. Studies on the effectiveness of NPHSs are single studies conducted in specific communities. Therefore, they cannot individually prove if these interventions have been effective in reducing the spread of the infection and its adverse health outcomes. In this systematic review, we aimed to examine the effects of NPHIs on the COVID-19 case growth rate, death growth rate, Intensive Care Unit (ICU) admission, and reproduction number in countries, where NPHIs have been implemented. We searched relevant electronic databases, including Medline (via PubMed), Scopus, CINAHL, Web of Science, etc. from late December 2019 to February 1, 2021. The key terms were primarily drawn from Medical Subject Heading (MeSh and Emtree), literature review, and opinions of experts. Peer-reviewed quasi-experimental studies were included in the review. The PROSPERO registration number is CRD42020186855. Interventions were NPHIs categorized as lockdown, stay-at-home orders, social distancing, and other interventions (mask-wearing, contact tracing, and school closure). We used PRISMA 2020 guidance for abstracting the data and used Cochrane Effective Practice and Organization of Practice (EPOC) Risk of Bias Tool for quality appraisal of the studies. Hartung-Knapp-Sidik-Jonkman random-effects model was performed. Main outcomes included COVID-19 case growth rate (percentage daily changes), COVID-19 mortality growth rate (percentage daily changes), COVID-19 ICU admission (percentage daily changes), and COVID-19 reproduction number changes. Our search strategies in major databases yielded 12,523 results, which decreased to 7,540 articles after eliminating duplicates. Finally, 35 articles qualified to be included in the systematic review among which 23 studies were included in the meta-analysis. Although studies were from both low-income and high-income countries, the majority of them were from the United States (13 studies) and China (five studies). Results of the meta-analysis showed that adoption of NPHIs has resulted in a 4.68% (95% CI, -6.94 to -2.78) decrease in daily case growth rates, 4.8% (95 CI, -8.34 to -1.40) decrease in daily death growth rates, 1.90 (95% CI, -2.23 to -1.58) decrease in the COVID-19 reproduction number, and 16.5% (95% CI, -19.68 to -13.32) decrease in COVID-19 daily ICU admission. A few studies showed that, early enforcement of lockdown, when the incidence rate is not high, contributed to a shorter duration of lockdown and a lower increase of the case growth rate in the post-lockdown era. The majority of NPHIs had positive effects on restraining the COVID-19 spread. With the problems that remain regarding universal access to vaccines and their effectiveness and considering the drastic impact of the nationwide lockdown and other harsh restrictions on the economy and people's life, such interventions should be mitigated by adopting other NPHIs such as mass mask-wearing, patient/suspected case isolation strategies, and contact tracing. Studies need to address the impact of NPHIs on the population's other health problems than COVID-19., Competing Interests: The authors have declared that no competing interests exist.

Background: Although the main burden of the Road Traffic Injuries (RTIs) is on the health sector, compared with other sectors, no clear definition is available about its role in the prevention of the RTIs. So this study has been performed to define the role of the health sector in the prevention of RTIs -before the incidence., Methods: In this qualitative study with a grounded theory approach, the possible roles of the health sector in the prevention of the RTIs were identified in three phases. At the first stage of the study, the roles of the health system in the prevention of the RTIs identified from the literature. In the next step, semi-structured interviews (ranged from 45 to 90 minutes) with 42 experts were done for identifyingroles. Finally, Consensus attained on the identified roles by using the Delphi technique and with the participation of 30 experts., Results: Literature review and interviews resulted in 42 and 86 roles for the health sector in the prevention of the RTIs, respectively. After removing the duplicates and merging the similar, 46 roles were entered into Delphi. Five roles excluded in the Delphi leaving 41 roles in 7 dimensions of communications (6 roles), intra-sector cooperation (9 roles), inter-sector leadership (6 roles), evaluation (6 roles), research (5 roles), education (3 roles), and health-specific issues (6 roles)., Conclusions: It seems that the health sector can help an impressing reduction of the RTIs by playing the roles identified in this study, which the most important of them is Communication/Informing role. So first the general public and then the health sector itself would benefit from it., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 International Journal of Preventive Medicine.)

Objective: To review the cost-effectiveness of multifactorial interventions to prevent falls in elderly people., Methods: In this systematic review, the databases including PubMed via MEDLINE, Web of Science, Embase, Scopus, Cochrane Library and Google Scholar (from 1st January 2000 to 30 th February) were used. All pre-reviewed articles related to cost-effectiveness analysis of multifactorial interventions to prevent falls in elderly were included in this paper and congresses abstracts were excluded. Descriptive statistics were used for quantitative data and content-analysis method to analyze qualitative data., Results: Out of the 456 articles, 19 were finally included in the study. Eighteen articles were conducted in High-Income Countries (HICs) and 16 were at the community level. Medical visits consultation and education were the most common interventions. Most studies were cost-effectiveness and using the Randomized Control Trial (RCT) methods. A fall of prevention costs ranged from $ 272 to $ 987. Incremental Cost-Effectiveness Ratio (ICER) interventions also ranged from the US $ 120,667 to the US $ 4280.9., Conclusion: The results show that despite the high effectiveness of multifactorial interventions to prevent elderly falls, the cost of the interventions are high and they are not very cost-effective. It would be better to design and implement multifactorial interventions with low cost and high effectiveness that are appropriate for each country., Competing Interests: None declared.