Payavard Salamat

Isolation and Molecular Identification of Pathogenic Fungi from Cockroaches Caught from Babol Teaching Hospitals during 2021-2022

Mohsen Karami

Background and Aim: Cockroaches are potential carriers of a wide range of pathogenic microorganisms (fungi, bacteria and parasites). Considering the importance of these insects in the transmission of pathogenic fungi and their impact on the health of hospitalized people, the aim of this study was isolation and molecular identification of pathogenic fungi from the external and internal surfaces of cockroaches collected from three educational hospitals of Babol city, Mazandaran Province, Iran.
Materials and Methods: Cockroaches were caught by a sterile manual method and after washing to remove surface contamination with 70% ethyl alcohol for 2min, 100 µL of the solutions from the external and internal parts of cockroaches were cultured on Sabouraud’s dextrose agar with 0.05% chloramphenicol and incubated at 30 °C for 3 weeks. The different yeast and filamentous colonies were distinguished using standard mycological methods. The PCR-RFLP method and the restriction enzymes Msp I and Bln I were used for the differentiation of Candida species, and the restriction enzyme Alw I for Aspergillus species.
Results: A total of 85 fungi species/genera were isolated from all 50 studied cockroaches, including German cockroaches 15 (30%), American cockroach 20 (40%) and brown 15 (30%), which included 52 isolates from external surfaces (61%) and 33 isolates from internal surfaces of cockroaches (39%). Of the total number of 49 filamentous fungi, Aspergillus fumigatus 16 (32.65%) and out of the total number of 36 yeasts identified, Candida albicans 14 (38.89%) were the most common fungi isolated in this study. Other filamentous fungi and yeasts isolated from cockroaches include Aspergillus niger 11 (22.45%), Aspergillus flavus 8 (16.32%), Penicillium 4 (8.2%), Rhizopus 3 (6.1%), Cladosporium 3 (6.1%), Mucor 2 (4%), Alternaria 2 (4%), Candida parapsilosis 6 (16.67%), Candida krusei 12 (33.33%), Candida glabrata 3 (8.33%), and Candida tropicalis 1 (2.78%) were isolated.
Conclusion: Considering the isolation of several fungal species from cockroaches and their importance in the possible mechanical transmission of common fungal infections in hospitals, these insects can be a source of continuous transmission of infection, if there is no regular preventive disinfection of the hospital environment.

Designing the Requirements of the Digital Health Literacy System Focusing on Cancer

Elham Maserat

Background and Aim: Considering the growing trend of cancer in Iran, the development and implementation of digital health literacy systems accelerates the capabilities of digital health and the self-management process of patients. Digital health literacy means the ability to effectively and consciously use digital technologies to access health-related information and services. This skill plays an important role in accessing medical information, disease management, improving the quality of life of people, especially cancer patients. Digital health literacy is considered as one of the most key factors of equal access to digital health information. The purpose of the present study was to formulate the requirements of the digital health literacy system with a focus on cancer.
Materials and Methods: The present study was conducted in two phases of literature review and validity and reliability of requirements in 2023. In the first stage, a literature review was conducted with the keywords of digital health literacy, cancer, requirements, system and application in databases such as PubMed, Scopus, Google Scholar, academic Jihad scientific database and specialized websites. To check the content validity of the survey, 62 experts were surveyed and CVI and CVR were calculated.
Results: Hundered and twenty seven functional and non-functional components were approved. Requirements in the functional section was divided in six main dimensions information literacy module (8 functional components), information and communication technology literacy module (18 functional components), media literacy (5 functional components), public, specialized and population-oriented health literacy module (47 functional components) ), digital health literacy module (28 functional components), and digital health literacy module in cancer (6 functional components) were divided. In the section of digital health literacy in cancer, the main components of needs assessment, digital health literacy training, evaluation and monitoring of the effectiveness of digital interventions and information search skills were approved. Fifteen non-functional components were also approved. Cronbach’s alpha coefficient obtained (92%) indicated high reliability and reproducibility.
Conclusion: Digital health literacy systems can facilitate health care services. Considering the acceptable validity and reliability of the study, the defined requirements can be used to implement digital health literacy systems centered on cancer.

Strategic Analysis of the Financing System of Iran Health Insurance Organization

Mahdi Abbasi

Background and Aim: Health insurance organizations play an important role in increasing people’s access to health services and protecting them financially against catastrophic health costs. Iran Health Insurance Organization (IHIO) is one of the largest public health insurance organizations in Iran, which faces many challenges. The purpose of this research is the strategic analysis of health financing performance of IHIO.
Materials and Methods: This qualitative research was conducted using interpretive phenomenology method through using semi-structured interviews with 25 managers and employees of IHIO. In addition, relevant documents and archival data of IHIO were collected and analyzed. Thematic analysis method was used to analyze the data.
Results: Overall, 19 strengths, 24 weaknesses, 14 opportunities, 37 threats and 43 solutions were identified for the health financing system of IHIO. Increasing the coverage of health services, correcting the information databases of the insured and electronic prescribing were the most important strengths, and inappropriate pooling of financial resources, incomplete risk pooling, high administrative costs, and inefficient control were the most important weaknesses of IHIO. The most important opportunities for IHIO include the government’s support for universal health coverage and emphasis on primary health care, legal support for consolidating health insurance funds and improving the health technology assessment system in the country. The main threats to IHIO include political and economic unstability, low health insurance premiums, decisions without scientific support and insufficient enforcement of laws. Finally, solutions such as modernizing the tax system, increasing the health literacy of the community, reducing bureaucracy, increasing transparency and accountability, and reforming the monitoring and evaluation system were identified to strengthen the performance of the financing system of IHIO.
Conclusion: Iran’s health insurance organization is facing numerous structural, contexual and process challenges that have reduced its productivity. Decrease in revenues, increase in costs and decrease in efficiency have caused problems in the financing performance of this organization. Recognizing the weaknesses and challenges of financing performance and applying corrective interventions is the first step in strengthening the sustainability of health financing of IHIO.

Design and Evaluation of a Management Dashboard for a Children's Subspecialty Hospital: An Action Research Approach

Nader Jahanmehr

Background and Aim: The increase in the amount of information and the need for their daily monitoring have led to the development of tools called management dashboards that have the ability to analyze graphical data. In addition to preparing quick reports in different time frames and user-specific format, the dashboard can be useful for providing dynamic updated information for accurate decision-making and quick response to changes.
Materials and Methods: The current research was carried out in the form of qualitative studies and participatory action research method in 9 steps. In this applied and developmental research that was conducted cross-sectionally using the data of the first half of 2022, 11 members of the leadership team of a super-specialized children’s hospital were selected as research participants. The data collection tool was an interview using a questionnaire to determine the importance of indicators and a usability questionnaire (usability) of the dashboard based on three independent variables (usefulness, ease of use and satisfaction). The Excel file of data needed for the dashboard was collected from the HIS system of the hospital, and the dashboard was designed with Power BI software, and the capabilities and access levels of users were determined based on their duties. Data analysis was done using descriptive statistics and Excel software version 2016.
Results: In the stage of determining key performance indicators, out of 39 indicators selected by the research team, 22 indicators scored an average score of 4 or higher (from 5 points) and 21 indicators were able to be implemented. The data repository in Excel format was used as an intermediate environment. The dashboard was displayed on six pages (indicators related to the performance of inpatient beds, mortality, emergency and other indicators) and the capabilities of each page were determined. After implementing the dashboard and determining the access levels of users, obtaining a high score from the questions of the usability questionnaire (5 out of 7 points) and obtaining an average score of 71.8 out of 5 questions related to usefulness variables, 70.5 out of 8 questions related to ease of use. And 71 out of 3 questions related to the satisfaction variable showed that the dashboard designed for the hospital had high usability.
Conclusion: Hospital management dashboard information can be a basis for informed decision-making to achieve benefits such as identifying the best performance, improving performance quality, making faster decisions, reducing errors, improving capacity management and work flow, allocating resources and planning for growth and development.

Investigating the Effect of Fasting on the Mental Health of Nursing Students

Razieh Mirzaeian

Background and Aim: Nursing students are exposed to various educational, family, and social stresses and various factors can affect their mental health. Therefore, in order to pay attention to different dimensions of health and investigate the effects of spirituality on health, the present study was conducted to determine the effect of fasting on the mental health of nursing students of Borujen Faculty of Medical Sciences.
Materials and Methods: The present semi-experimental study with a pre-test-post-test design was conducted in 2022 at Shahrekord University of Medical Sciences. Ninety nursing students of Borujen Faculty of Medical Sciences were selected by available methods and assigned to two intervention and control groups by a simple random method. The intervention in this study included at least 23 days of fasting during Ramadan. The data before and after the intervention were collected by the demographic information questionnaire and the 21-question depression, anxiety, and stress standard tool (DASS). The validity and reliability of this questionnaire were conducted for the first time in Iran by Sahebi et al. in 2005. SPSS was used for analysis. Descriptive statistical tests including frequency percentage, mean and standard deviation, and inferential statistical tests including t-test, paired t-test, analysis of variance, and chi-square were used.
Results: There was no significant difference in the total mental health score between intervention (32.32±11.62) and control (29.87±14.09) groups before the intervention (P=0.08). There was a significant difference in this score between intervention (20.6±5.71) and control (29.49±8.9) groups after the intervention (P=0.04). The total mental health score in the control group before (29.87±14.09) and after (29.49±8.9) the intervention had no significant difference (P=0.15); while in the intervention group before (32.32±11.62) and after (20.6±5.71) the intervention had a significant difference (P=0.001). Mental health dimensions before and after intervention, indicated that anxiety (P=0.04) and stress (P=0.003) decreased significantly after the intervention in the intervention group. However, there was no significant difference in the depression dimension (P=0.06).
Conclusion: According to the results, it should be said that regular and periodic examination of the health level, and the promotion of educational and training programs on the subject of fasting to improve mental health, should be considered.

The Effect of Information Therapy Program of Quitting Smoking in Parents of Children with Asthma by Nicotine Replacement

Sedigheh Mohammadesmaeili

Background and Aim: Passive smoking is known to have an impact on the respiratory system of infants and children. The aim of this study is to examine the positive effects of parental smoking cessation programs using nicotine replacement on quality of life in children with asthma at the Children's Medical Center of Tehran University of Medical Sciences.
Materials and Methods: This case-control study included 100 children aged 6-10 years with asthma who had their parents smoking in the Allergy Department of the Children's Medical Center of Tehran University of Medical Sciences. During the 2019-2021 period, this study was conducted using a census as the sampling method. Data were collected using standard questionnaires of the Child Health-Related Quality of Life (HRQoL), standard versions of the Short Form (SF-12) and the St George Respiratory Questionnaire (SGRQ). The two groups were compared using independent t-tests and paired t-tests, and Pearson's correlation coefficient was utilized to examine the correlation between the two questionnaires. Statistical analysis was performed using SPSS software.
Results: Children with asthma who had their parents quit smoking had a mean score lower than those who did not intervene. This indicates that the quality of life in children with asthma whose parents underwent nicotine replacement program improved significantly (P=0.03). Nicotine gum consumption can enhance certain aspects of health-related quality of life for both parents and children, as assessed by SF-12 and SGRQ, according to the results. Physical functioning (P=0.007) and school performance (P=0.002) were the two components most significantly affected.
Conclusion: The physical health and quality of life of parents are can affecte children with asthma, who face many challenges in meeting their daily needs. Smoking cessation using nicotine gum can improve the quality of life of parents and children. To maximize the effectiveness of parental smoking cessation information therapy programs for children with asthma, providing personalized support and advice to parents or caregivers, evidence-based treatments, and educating families on how to manage this disease in children seems essential.

Proposing a Model for Managerial Competencies of Hospital Managers in Iran

Mohammad Bagher Karami

Background and Aim: Managers, as the main decision-makers in facing various internal and external organizational problems, play a significant and determining role in the success or even failure of an organization. If competent and experienced managers are positioned at the top of organizations, the success of these organizations in achieving their goals will be guaranteed and an organization can achieve maximum efficiency with minimal resources. The aim of this study was to design a model of managerial competencies for hospital managers.
Materials and Methods: This qualitative research was conducted from year 2020 to 2022. After reviewing studies related to the topic, the extracted competencies were given to 19 experts consisted of relevant academic faculty members and managers with experience in the healthcare system and hospitals. Eventually, a managerial competency model was formulated through the use of the Delphi method and expert panel discussions. Collected data were analyzed in Excel software.
Results: The developed model in this research for the concept of hospital managers’ competencies includes 33 managerial competencies of hospital managers in four main management functions (planning, organizing, leadership and control) and managerial roles, which starts from literature review and performing two Delphi steps and implementing two expert panel plans. In the competency of hospital managers model, the planning dimension consists 4 components, organizing consists 4 components, leadership consists 12 components, control consists 4 components, and managerial roles consists 9 components. Strategic thinking, which is a subset of planning, has the highest weight (0.495) and highest rank among other components, and continuous improvement, which is a subset of managerial roles, has the lowest weight (0.033) and lowest rank among other components.
Conclusion: This study proposes an exclusive and comprehensive model, utilizing practical techniques as a suitable solution for evaluating the managerial competencies of hospital managers. The proposed framework in this study can serve as a standard performance assessment tool for evaluating managers.

Analysis and Identification of Factors Influencing the Survival of Burn Injury Patients with an Artificial Intelligence Approach

Azita Yazdani

Background and Aim: Burn injury are one of the most common traumas worldwide and the sixth leading cause of death in Iran. The challenges related to the survival rate of burn patients, as well as the associated mortality cases, have led to advancements in the identification of risk factors. Early detection and recognition of these risk factors are essential, and the provision of predictive models can be beneficial. This research was conducted with the aim of reviewing the effectiveness of artificial intelligence in predicting survival in burn patients.
Materials and Methods: This study was a systematic review. A comprehensive search of Scopus, PubMed, IEEE, and Web of Science databases was conducted from inception to July 2023 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Keywords and Mesh terms related to burn, artificial intelligence, survival and prediction were used in the search.
Results: Out of 3599 identified studies, only nine were included in the analysis. Based on the articles reviewed, the effective factors in predicting survival or mortality in burn patients were classified into four main categories: demographic, clinical, tests and co-morbidities. Some of the known effective factors in patient survival, which have been examined in over 40% of studies, include age, gender, total body surface area, inhalation injury, and type of burn. The results showed that in the studies reviewed, the volume of the smallest dataset used in the analyses was 92 samples. In contrast, the volume of the largest dataset used was reported to be 66,611 samples. Among these studies, 33% have indicated that artificial neural network algorithms and random forest show the best performance. The criteria used to evaluate the models in the retrieved studies are diverse.
Conclusion: The use of machine learning algorithms in predicting the survival of burn patients is promising. The results obtained from identified influential factors can assist data science researchers in the data understanding phase and can serve as a roadmap in collecting the initial dataset.