Iranian Journal of

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Background and Objectives: Colorectal cancer, as the third common cancer, is one of the main health problems in Iran. We assessed the burden of colorectal cancer, as one of the high-priority indices, in this cross-sectional study in Iran in 2008.

Methods: CANMOD software was used for calculation. The input data included the population of Iran, all-cause and colorectal cancer mortality rates, and incidence rate of colorectal cancer, which were all obtained from the Iran Statistic Center, Mortality Registry System, and Cancer Registry System.

 Results: The total burden of colorectal cancer according to DALY in Iran in 2008 was 52534 years in the total population. Years of lost life (YLL) amongst males and females were 26455 and 19887 years, respectively. Years lived with disability (YLD) were 3473 and 2719 years for males and females, respectively. The burden of colorectal cancer per 1000 population was 75.4 years for males and 65.7 years for females. The peak age of colorectal cancer burden rate was in the age group 45-79 years.

 Conclusion: The burden of the colorectal cancer in Iran has increased compared to the last study (2003) which is due to the increase in its incidence and the related mortality during this period. Due to the possibility of prevention and effective intervention, this cancer should be a priority in the health care system. However, the final judgment should be made after calculation of the burden of other cancers, diseases, and damages at the country level and their respective rankings.

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  Background and Objectives : Breast cancer is the second most common cancer among Iranian women. The peak age of breast cancer in Iran is one decade lower than the global estimates. The aim of this cross-sectional study was to estimate the burden of breast cancer in Iranian women in the country level.

 Methods: In this study, the CANMOD software was used for the calculation of DALYs as the sum of YLL and YLD. The required data was the population of the Iranian women, mortality due to breast cancer, incidence cases of breast cancer, and mean time of the stages of breast cancer that was obtained from the Mortality Registry System, Cancer Registry System, and expert panel views .

  Results : In this study, the total burden of breast cancer in Iranian women was 75811 years in 2009. Moreover, the years of life lost (YLL) was 54938 years while years lived with disability (YLD) was estimated 20873 years. The rate of DALYs per 100000 female population was 220.9 years. The peak age of breast cancer burden was in the age group 45-59 years. The incidence to mortality ratio was 3/2.

  Conclusion: The incidence rate, mortality rate, and the burden of breast cancer in Iranian women increased in 2009 when compared to a previous study in 2003. The findings of this study may provide Iranian health managers with some information on the determinants of the burden of breast cancer in order to design preventive measures as well as screening programs for early detection of breast cancer.

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Background and Objectives: Different governance approaches have various definitions and systems about health. The purpose of this study was to compare the appropriateness of the health system performance with the ideology of the selected countries.
Methods: In this comparative study, liberal countries (America, Canada, France), social countries (Russia, China, Cuba) and mixed countries (Sweden, Norway, England) were selected purposefully. Data were obtained from World Bank and WHO’s published documents and discourse literature studies. Causal layered analysis framework was used for data analysis.
Results: Comparison of health indicators showed that mixed countries were in a better position than the other two groups. The health system’s stewardship of the liberal, mixed, and social countries were decentralized, semi-centralized, and centralized, respectively. Discourses of the liberal states were based on the capitalist economy, with lack of reliance on natural resources. Socialist countries, a socialist economy system emphasizes the use of natural resources. In these countries governmental involvement is maximum. Mixed countries have a constitutional monarchy government and benefit from both of these approaches to create welfare based on the ideology of liberalism and the welfare state approach.
Conclusion: Mixed countries with appropriate economic- social conditions, semi-centralized structure of service delivery, suitable financing system, and regional and local management of services (highlighting the role of municipalities), have better health status than other countries. The ideology of the countries forms the social, economic, and political structures as well health. Iran should consider various layers of metaphor, discourse, casual structures, and litany for redesigning the health system.

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Background and Objectives: Urban family physician program(UFPP), a program for improving equity in access to, financing, and quality of health services, is piloting in two provinces of Fars and Mazandaran, Iran since 2012. This study aimed to examine the association between the implementation of program and financial protection measures.
 
Methods: This cross-sectional, ecological study was performed on aggregated data of financial protection measures and some independent variables in the above provinces from 2008 to 2015. At first, the Lasso regression model was used for selecting independent variables affecting financial protection indexes. After adjusting the selected independent variables, in separate models, the association between the UFPP and financial protection measures, as outcome variables, was examined using a backward linear regression model.
 
Results: The percentage of households facing catastrophic health expenditure(CHE) in the years of UFPP implementation was 1.82% higher than the years before implementation(P<0.05). This increase was 1.37% in rural areas. the percentage of medical impoverishment in the two provinces increased by 0.83% during the implementation years than the years before(P<0.05). Finally, no significant relationship was observed between UFPP implementation and the Kakwani index and out of pocket payment(as % of total health expenditure) in the two provinces(P>0.05).
 
Conclusion: Despite the achievements attained by UFPP in improving physical access to health services, it seems that this program has had no success in improving financial protection measures and equitable health care financing. However, further research is warranted in this regard.

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Background and Objectives: Universal health coverage will have a problem in achieving it’s goals if it doesn’t consider the quality. This study aimed to Background and Objectives: Universal health coverage cannot achieve it’s goals if it doesn’t consider the quality. This study wants to assess the quality of health services in Iran, identify existing challenges and provide solutions.
 
Methods: This study was a mixed qualitative and review study. In the first stage, the national main indicators of the quality of services were reviewed. Then, the orientation of the available upstream documents on the quality of services was explained. The most important challenges, trends, and recommendations of health quality improvement were extracted via interviews.
 
Results: Proper observation of the Iran health care quality requires appropriate framework and indicators. Upstream documents strongly emphasized on the government's responsibility to play a key role as stewardship and that the health system should provide the necessary structural, procedural, and consequential requirements besides determining appropriate model. Quality management programs had obstacles in some aspects like the performance of managers and human resources, structural/communicational requirements, education, payment system, culture, use of quality management indicators and models, financial, information, and equipment resources, laws and regulations, and supervision.
 
Conclusion: Improving the quality of health services in Iran requires strategies in organizing, resource generation, payment, laws and regulations, and behavior of policy makers and planners. Quality tools should be used without haste and should pay attention changes in the nature of diseases, expectations of stakeholders, and increased global attention to this issue in designing related plans.

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Background and Objectives: Promoting health indicators is a key issue in most societies. In this regard, health deputies, through stewardship, monitoring, and coordination, take meassures to promote these indicators. The aim of the present study was to design a model for ranking the performance of the deputies.
 
Methods: This applied qualitative study was conducted in 2012. The research team included 12 health experts who were selected according to management records and long experience in the health deputy. In this study, a review of the literature and documents was done and then, with the focus group discussions and expert opinions, key indicators were defined.
 
Results: a model consisting of 9 process criteria (13 general indicators and 15 specific indicators) was identified for ranking of health deputies. The general processes included leadership and management, programs and strategies, resources and partnerships, manpower, and comprehensive information and statistics system And specific processes included primary health care (PHC), family physician (FP), social determinants of health (SDH) and pilot national plans. The range of indicators scores was between 1-8, which were compared with the zero indicator.
 
Conclusion: The findings showed that the process components and indicators were more effective in determining the status of the health deputies’ performance, and the proposed model is based on the matter. So, it is recommended that the Ministry of Health ranks health deputies every two years to improve process components and criteria of the model based on practical results.

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Background and Objectives: Due to lack of proper health system coverage in cities, the urban family physician program began as pilot in two provinces in  Iran. Decision on developing the program to other provinces requires a comprehensive assessment. The study aimed to evaluate the  program in Iran.
 
Methods: This cross-sectional study was conducted in 2015 and  2016 in two provinces (Fars and Mazandaran). The data of 141 family physicians working in health centers and 710 patients were collected using a questionnaire. A multi-stage sampling method was used for the samples. Data analysis was performed using descriptive and inferential statistical methods.
 
Results: 81% of the workload of family physicians in a week was patient visits. Co-payment in second and third levels was a real obstacle for some patients. The majority of the patients could receive their required healthcare facilities in up to 40 minutes.  Software programs were infrequently used. Patients were visited by their physicians 5.5 times in a week. The mean duration of each patient visit was less than 10 minutes in 80% of the cases. Referral rate was reported by 14% (Fars= 21.8%, Mazandaran= 4%). 30 out of 45 medical devices were available to family physicians on average.
 
Conclusion: Although the  program has been successful in areas such as  access to health services and comprehensiveness of care, there are some challenges in coordination  and continuity of care. Therefore, it is suggested that the root causes of these challenges be resolved prior to extending this program to other provinces.

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Health and human rights are two inseparable and interrelated elements, whose provision and assurance enhance welfare in any society. Definition of welfare, human rights, and health as indicators of welfare development is controversial which is done in accordance with different approaches and discourses. Although the WHO definition is currently the only definition of health agreed upon by the member states of the Organization, it has been subject to criticism by the international society. In general, the most important criticisms include ambiguity, ideality, limitlessness, lack of comprehensiveness, lack of weighting to aspects of health, being non-operational, reductionism, and lack of a precise definition of the normal condition and disease. These criticisms would expose health systems to some challenges such as increased expectations of people, rapidly growing health expenditure, inconsistent expansion of technology-based systems, increased vulnerability to corruption, and equity and efficiency issues. Identifying and examining these criticisms can lead to a more informed decision to redefine health according to the favorable and context-sensitive discourse of the health doctrine in each country. This short review briefly describes the context and the most important criticisms of the WHO definition of health. Eventually, some policy suggestions are presented for redefining health according to Islamic-Iranian discourse.

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One of the main functions of the health systems in each country is health services delivery which includes a wide spectrum of four levels. The first level includes the reduction of disease prevalence, the second level includes early detection, screening and timely treatment. In the third level, we have rehabilitation and relief services, and finally the fourth level is reducing and controlling unnecessary medical interventions. Health services delivery should encompass all of the health needs of each population in the form of these levels. The focus on just one level leads to a reduction in the importance of other levels, and disrupts comprehensive services delivery. It is obvious that, paying attention to the prevention levels can have a significant impact on reducing the later costs and consequences. At present, the provision of services at different levels of Iran's health system is not balanced, and the promotion of these services requires more attention from health policymakers. The health system of Iran is more focused on treatment and medical services and there are many challenges such as poor stewardship and disadvantages of integrated systems in the rehabilitation, relief and palliative services.
 

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Background and Objectives: The Millennium Development Goals (MDGs) are common goals that were established by the United Nations in 2000. The aim of this study was to compare some of these indicators in Iran, the Eastern Mediterranean Region (EMR), and the world.

Methods: The existing data from the World Health Status in 2014 and some other available sources in Iran, EMR, and across the world were addressed. The most relevant health indicators included decreased childhood mortality, maternal well-being, prevention of AIDS, tuberculosis and other diseases, and environment quality assurance.

Results: The proportion of neonatal mortality to total mortality among those less than 5 years increased from 37 to 44 in the world compared to 39 to 46 in EMRO and 46 to 61 in Iran. About 14.5% (71000 out of 490000) of the AIDS/HIV cases reported in the EMRO belonged to Iran in 2002. The maternal mortality rate (MMR) showed a decline of 72.2%, 50% and 44% in Iran, EMRO and the World respectively. The proportion of delivery by skilled persons and the proportion of pre-delivery care had a positive trend in Iran and were higher as compared to EMRO and the world average.

Conclusion: Iran achieved many MDGs, however, despite a decline in the AIDS/HIV incidence rate, its prevalence rate has increased in Iran, EMRO and the world from 2001 to 2013. The proportion of neonatal mortality rate to under 5-year mortality rate has had an increasing trend. Decision-makers should give priority to indicators that have not achieved MDGs.

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Background and Objectives: Plagiarism is the most prevalent type of scientific misconduct, and various rules and strategies have been proposed to combat it in different countries. A review of other countries' experiences in this area contributes to good policymaking. The present study was conducted to introduce preventive interventions of plagiarism in the leading countries.
Methods: The present study was a qualitative review study of applied practices. In this study, preventive interventions of scientific plagiarism in the 27 European ::::::::union:::::::: countries were studied due to the appropriate coherence and structural similarity at national, organizational, and individual levels. The national-level interventions were analyzed using the content analysis method in mentioned countries.
Results: The results of analyzing the national-level interventions were categorized into eight main themes, including reaching a national agreement on examples of scientific plagiarism and misconduct; policy development; monitoring and supervision; financial support development; development of databanks and software; compiling educational programs for faculty members and students; dissemination and use of successful experiences; and eventually establishment of laws related to scientific misconduct, plagiarism, and punishments activities.
Conclusion: Using preventive interventions at a national level proves the commitment and determination of policymakers to control and prevent plagiarism. Proper use of preventive interventions at a national level strengthens the controlling and preventive infrastructures of this issue at the organizational level, and enhances moral commitment and professional skills among the country's researchers.

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Background and Objectives: Valid, reliable, short, sensitive and accurate tool is needed to diagnose pain in dementia patients. This study aimed to determine the psychometric properties and diagnostic accuracy of short-form Persian version of Doloplus-2 (P-Doloshort) in pain assessment in elderly with dementia.
 
Methods: In this cross-sectional study, 100 elderly were selected using convenient sampling from private clinics and nursing homes in Kashan in 2018-19. Construct validity was determined by exploratory factor analysis, known-groups approach and convergent validity. Also, reliability was evaluated by internal consistency, equivalence, and stability. P-Doloplus-2 and P-Doloshort were used as the reference standard and the index test, respectively. Data were analyzed by SPSS-v16 using independent T-Test, linear regression, Pearson and intra-class correlation coefficients (ICC), Cronbach's alpha, ROC curve, and diagnostic test parameters.
 
Results: Factor analysis identified the tool as a single-factor; it was able to explain 65.851% of total variance. P-Doloshort was able to differentiate between two groups with and without painful underlying diseases (P<0.0001). There was a positive and significant correlation between P-Doloshort score with P-Doloplus-2 score (r=0.975, P<0.0001) and PACSLAC-II-IR score (r=0.0001, P<0.0001). Cronbach's alpha, ICC and standard error of measurement were 0.898, 0.891 and ±1.183, respectively. The relative frequency of minimum and maximum possible score was less than 15%. At the cut-off point of 2.5, area under ROC curve, sensitivity, specificity, and overall diagnostic accuracy were estimated 0.985, 0.956, 1.000 and 0.970, respectively.
 
Conclusion: P-Doloshort can be used as a valid, reliable, sensitive and accurate tool for pain assessment in elderly with dementia.

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