Iranian Journal of

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Background & Objectives: Previous studies and reports show that majority of motorcyclists do not use helmet in Iran. The aim of study was to evaluate the performance of motorcycle helmet use based on health belief model in Markazi province in Iran.
Methods: This cross- sectional study was carried out on 384 subjects selected based on convenience sampling. Participants completed a designed questionnaire on attitudes and behaviors relevant to bicycle helmet use.
 Results: The mean age of participants was 28.9 ± 8.5 years and 42% of drivers were single. There were significant association between performance with perceived severity, benefits, barriers, and motorcyclists’ action (P<0.05). The barriers of using helmet reported by participants were sweating, hearing disturbance, expensiveness, heaviness, and visual limitation, respectively. In time of study, only 16.2% of motorcyclists used helmet. Based on our health belief model, 61.4% of participants believed that education and information are the best method, 22.7% believed that not users of helmet should pay a penalty, and 15.9% believed that confine of motorcycle could be effective actions to encourage them to use helmet.
 Conclusion: According to the results, the helmet use practice was poor and should be increased Meanwhile, the perceived severity should increase especially in young people. The community - based health education programs accompanied with police harsh treatment is necessary.

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Background and Objectives:Among health sector resources, hospital beds are the primary unit of calculation for the capacity of the health service and vital capacity in patient care. Lack of appropriate distribution in different parts of the country leads to transfer of patients and irreparable problems. The aim of this study was to provide accurate information on the number and distribution of hospital beds in the country in 2016 and to estimate the number of beds required by 2026.
Methods:This descriptive-analytic study was conducted in 2016. The population of the study comprised 439 counties covered by 46 medical universities of the country. In this study, the data of 2016 were used and information about the number and ownership of beds and the size of hospitals were obtained from the treatment deputies of medical universities.
Results:The number of active beds in the country was 117580 in 2016, and it is estimated that in order to meet the needs of the community, this number should reach 194471 beds by 2026. There were 1.47 beds for 1,000 people in 2016, which will increase to 2.9 in 2026 by implementing the NEDA project. The coefficient of variation in 2016 was 36%, which will reach 19% by 2026 according to estimates in the Iran's roadmap project.
Conclusion:The distribution of beds was differed in different regions of the country and there are not enough hospital beds in some areas. If the Iran roadmap is implemented, 2026 beds will be distributed more evenly across the country.

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Background and Objectives: Iran is a large country that is often an importer of major medical equipment. There is no comprehensive databank of the status of the equipment in the country. The present study provides a clear description of the dispersal status of major medical equipment in the country in 2016 and the estimated number of required devices in 2026.
 
Methods: This study was conducted in 2016 in Iran. The study included 8 MRI, CT scan, gamma camera, linear accelerator, PET scan, cardiac angiography, peripheral angiography, and CT angiography devices. The data of the number of equipment in each city were collected through a census of devices.
 
Results: At the beginning of the year 2016, 3.5 MRI devices, 6.93 CT scans, 2.18 gamma cameras, 1.23 linear accelerators, 0.04 PET scans, 2.3 cardiac angiography devices, 0.27 peripheral angiography devices, and 0.25 CT angiography devices per million population were active in Iran. CT scan and MRI devices were the most available equipment. It is estimated that the same pattern should be maintained in 2026, but the distribution of devices as well as the total number of devices in the country should improve.
 
Conclusion: In 2016, for most of the devices, the proportion of the device to the population in the whole country was close to the global average, but there was a large accumulation of devices in large cities. This problem has been identified and interventions have been planned to move towards reducing inequalities In Iran's Health Roadmap.

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Background and Objectives: One of the decentralized models that has been formed based on universal health coverage is the model of health complexes in Tabriz. This study was conducted to evaluate the model.
 
Methods: This case study was conducted in 2017. Beside observation, 28 individuals, including informed experts in the field of establishment of health complexes in Tabriz University of Medical Sciences, were purposefully selected and semi-structured interviews were also conducted. To analyze the interviews and the results of observations, the framework analysis was used based on the components of the Primary Care Evaluation Tool (PCET) model.
 
Results: The strengths of the health complex model are decentralized planning, strengthening the private sector participation, have more appropriate methods for assessing the performance of the health team, creating a sense of delivering effective services in providers, using electronic information registration system, using the prospective payment method, strengthening the referral system, enhancing service continuity, and facilitating financial and geographical access, especially in marginalized areas. However, there are some problems such as lack of some facilities and equipment, lack of some workforces and high workload, financial instability, and lack of insurance organizations cooperation with the plan.
 
Conclusion: The health complex model has improved organizational, financial, and geographic access to health services. It seems that if the resources are more stable and by cooperation of basic insurances, the results of this project will be better.
 

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Background and Objectives: The imbalance between the existing human resources and future needs of the health system disturb the service delivery process. The present study aimed at determining human resources needs in the health sector for a 10-year planning program. For this purpose, the researchers examined the geographical distribution of different groups of health system staff in 2016 and 2026.
 
Methods: This descriptive-analytic study was carried out in 2016. The population of this study included 46 universities of medical sciences. Data of the number and distribution of health care staff working in public, private, charity, and semi-public sectors of medical departments of medical universities were collected. The Qlik View software was used for data integration and designing information dashboards.
 
Results: At the beginning of 2016, the ratio of nurses, nursing groups, midwives, pharmacists, dentistry and general physician per 100,000 individuals was 133, 199, 32, 17, 22, and 53 respectively, which are estimated to reach 223, 272, 37, 26, 27, and 79 in 2025, respectively. The coefficient of dispersion variation of the above was 39%, 32%, 43%, 33%, 43%, and 44% in 2016, respectively, which are estimated to reduce by 2026 if the Iran medical roadmap is implemented.
 
Conclusion: The high dispersion index of the medical personnel relative to the population in the cities covered by medical universities indicates unbalanced distribution. If the estimates of the Iran's 2026 medical roadmap are implemented, more appropriate distribution of the medical staff is expected.

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Background and Objectives: The aim of this study was to provide a clear description of the pre-hospital emergency setting and risk management in accidents and disasters in accordance with current Iran’s standards in different regions of the country. This study was part of the national project "Iran Roadmap (Neda 2026)".
 
Methods: The data of the major medical equipment was gathered from 48 medical universities covering all of the country's 32 provinces. Goal standards were obtained from the “Ministry of Health” and the “Department of Statistics for Medical Accident and Emergency Management Centers” in all universities. Coefficient of dispersion was calculated to evaluate any dispersion in major medical equipment.
 
Results: The results of this study showed that in 2017, the highest and lowest coefficient in “pre-hospital facilities” was related to the ambulance engine (301%) and the operational base personnel (93%), respectively. Nio national standards were implemented in “Risk Management in accidents and disasters needs” in most provinces of Iran. In 2026 estimates, all of the factors improved and dispersion decreased.
 
Conclusion: Despite the poor distribution of prehospital indicators in 2017, forecasting showed desirable conditions in distribution of facilities in the pre-hospital emergency and risk management of accidents and disasters.

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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: The distribution of specialists is important in two ways: geographical and specialty. In this study, we provided a description of the distribution of specialists in Iran in 2016 and its estimates in 2026.
 
Methods: This descriptive-analytical study was conducted in 2016 to estimate the number of specialists in 2026. Data were gathered through a census of specialists working in each of 439 cities in the country, including those in public and private sectors. Coefficient of variation and the number of specialists in 100000 populations were applied as distribution measures.
 
Results: In the year 2016, there were 46 specialists per 100,000 populations, and it is estimated that considering the full-time equivalent index of 1.2, 63 specialists per 100,000 populations will be required in the year 2026. The highest and lowest ratio of specialists per population in the year 2016 was reported in Tehran (89 per 100,000 populations) and Jiroft (10 per 100,000 populations), respectively. The gynecologist group and geriatric specialists group were the largest (4747 specialists) and smallest group (4 specialists), respectively.
 
Conclusion: There was a considerable disparity between different regions of the country in terms of access to specialists. Furthermore, the ratio of specialist per population in different specialty groups varied from one province to another. Upon implementation of the Iran Roadmap, according to 2026 estimates, this dispersion will be reduced to some extent; however, part of the dispersion related to the regionalisation pilicy.  

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Background and Objectives: In 1995, a huge revolution occurred in Iran’s health system when the entire medical-related educa-tion program was integrated into the Ministry of Health. This paper was conducted to provide a review of all studies investigating this integration and to synthesize their results.
Methods: This study was a systematic review and qualitative meta-synthesis of the papers on integration using the Walsh and Downe process. An extensive search of the databases of ScienceDirect, PubMed, EMBASE, ISI, Google Scholar, Scopus, SID, Magiran, and Irandoc revealed 187 articles of which 25 were selected. The content of the studies was analyzed and combined using the Walsh and Downe technique.
Results: The results showed 5 main concepts, including the goals and reasons of the medical education integration, integration achievements, challenges, and barriers to achieving the goals of integration, and the future of integration. The greatest success of the integration program was related to health services, while the least positive effects were related to medical education and research.
Conclusion: A review of available documents shows that not all dimensions of integration have been well analyzed and their economic, social, developmental and scientific effects have not been studied. The majority of the limited studies in this regard were surveys and overview studies and few studies used economic analysis and modeling. Therefore, the effects of the integration cannot be evaluated using the available studies.

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Background and Objectives: Before any development in scientific health activities, we have to observe its scope and compare it with health sector. Accordingly, the aim of this study was to determine the quality and quantity of the health-prioritized disciplines mentioned in the comprehensive health plan of Iran.
Methods: This scientometric cross-sectional study was done during 2010-2017. The study population was 26 prioritized areas in three categories of survival, excellence, and infrastructure according to comprehensive health plan of Iran in 2010. The data collection tool was the SCImago database. The number of documents, citation indicators, and h-index were analyzed by Excel.
Results: The findings of the research showed that the highest h-index of Iran in the excellence, survival, and infrastructure category was in Nano (90), infectious diseases (67), and systematic ecology (56), respectively. Moreover, the highest ranked citations in three categories of survival, infrastructure, and excellence were related to traditional medicine, family medicine, and dentistry with a global rank of 8, 9 and 15, respectively. In categories of excellence, survival and infrastructure; public health, bioinformatics, and infectious diseases had the highest number of products with 7045, 5371 and 5135 articles.
Conclusion: There has been a marked improvement in the quality and quantity of all the subject categories over time. The general domains of excellence, survival, and infrastructure categories had the highest mean H-index, and the highest average growth rate of scientific productions was related to excellence, infrastructure and survival categories, respectively.

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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: Child growth health is one of the most important issues that determines the community health. Considering the importance of mothers in family and healthy society, the aim of this study was to evaluate the correlation between maternal employment status and infant growth during the 9-12 months in Ahwaz.
 
Methods: In this prospective cohort study, 345 nine-month infants of three groups of mothers including full time employees, part-time employees, and homemakers were selected using non-probability quotas sampling method. Data was collected using a researcher-made questionnaire and analyzed with the SPSS software version 22 using statistical tests such as chi-square, anova.
 
Results: In the full-time job group, 54.2% of the infants had favorable weights and 45.8% had unfavorable weights. In the part-time group, 69.6% of the infants had favorable weights and 30.4% had unfavorable weights. In the homemaker group, 68.7% of the infants had favorable weights and 31.3% had unfavorable weights. There was a significant difference in the infant’s weight between full-time and part-time job groups
(P= 0.01) and the full-time job and homemaker group (P= 0.04) but there was no significant deference in the infant’s weight between the part-time job and homemaker group (P= 0.87). No significant association was found between maternal employment status and infant’s height (P= 0.11) and head circumference as well (0.08).
 
Conclusion: The growth status of infants with full-time working mothers was lower than that of infants with homemaker and part-time working mothers. It is recommended to reduce the working time of the mothers who have full-time jobs as long as they breastfeed their babies.

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