Journal of School of Public Health and

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Background and Aim: Visceral leishmaniasis (kala-azar), the most dangerous form of leishmaniasis, is endemic in some parts of Iran, e.g. Ardabil, Fars, East Azerbaijan, Bushehr and Qom provinces. In recent years, the incidence of VL has increased in the Nourabad-Mamassani district in Fars Province. This study was carried out to detect VL vectors and infection rates in this region over the 2003-2004 period.
Material and Methods: Sand flies were captured in the selected villages by means of sticky traps, aspirators and CDC miniature light traps. Heads and distal abdominal segments were used for species identification and other body parts were used for DNA extraction. We employed a semi-nested PCR technique to detect Leishmania, with specific kDNA primers (LIN R4 - LIN 17 – LIN19). Some specimens were dissected for leptomonad infection.
Results: A total of 12688 sand flies were collected. Phlebotomus (Paraphlebotomus) alexandri was the second most prevalent species (17.34%). The anthropophilic index of this species was 32.5%. Five cases (4.17%) of L. infantum infection were detected among the 120 P. alexandri examined by PCR method. We also observed two cases of leptomonad infection among the 112 dissected specimens.
Conclusion: High prevalence rates and anthropophilic index of P. alexandri plus its natural infection with L. infantum provide enough evidence to implicate this species as the main vector species of VL in the region and the second proven kala-azar vector in Iran. Besides, the Mahoor-Milaty district of Noorabad-Mamassani was identified as a new endemic focus.

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Background and Aim: Non-communicable diseases (NCD), also referred to as chronic or lifestyle-related diseases, are a serious health problem in most countries today. The World Health Organization (WHO) has discussed this issue and presented solutions for it in its annual meetings. This paper reviews and reports on the action taken by the Medical University of Isfahan (MUI) through its Non-communicable Disease Control Program based on the WHO "Prevention and control of non-communicable diseases: implementation of the global strategy", which is a comprehensive program for controlling non-communicable diseases.

Materials and Methods: In this descriptive-analytical study, the activities of 21 Non-communicable Disease Units in Isfahan Province affiliated to MUI in its Non-communicable Disease Surveillance System aiming at combating non-communicable diseases were assessed using a self-assessment technique and the relevant documents reviewed. All the NCD officers (n=30) were enrolled in the study. A validated researcher-designed questionnaire containing items related to six areas based on the WHO "Prevention and control of non communicable diseases: implementation of the global strategy", the reliability of which had been confirmed, was used. The data were analyzed using the SPSS software, the statistical tests being the t-test.

Results: The general self-assessment score of MUI in the activities related to non-communicable disease surveillance and control program was 1.44 0.59 (out of 4). From among the six strategies studied, the "increasing public awareness about non-communicable diseases" strategy and the "improving collaboration and participation in prevention and control of non-communicable diseases" strategy achieved the highest and the lowest score, respectively. Documentation was weak (less than 50%), and there was no significant difference between the scores of actions documented and those not documented (P = 0.1).

Conclusion: Isfahan Medical University is one of the leading universities in Iran. It has taken important valuable measures in the area of non-communicable disease control and surveillance programs. However, our findings show that there are several weaknesses in these programs. Not paying sufficient attention to documentation, for example, is a serious weakness, since documentation plays an important role in the performance and excellence of an organization, guaranteeing its success.

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Background and Aim: Responsiveness is of extreme importance in every health system, especially for policy-makers and health managers. Responsiveness relates to how the health system responds to legitimate expectations of the patients regarding non-clinical aspects of health care. Furthermore, justice in an organization requires fair treatment of the patients on the part of the health personnel. In other words, organizational justice relates to how to treat the personnel so that they feel they are treated fairly. The objective of this study was to investigate the responsiveness of hospital as perceived by patients and nurses and the relationship between the responsiveness rate and organizational justice as perceived by nurses in the hospitals.

Materials and Methods: This was a descriptive-analytical study aiming at determining the correlation between responsiveness and organizational justice in 8 elected hospitals (4 private and 4 public) in Isfahan, Iran. The study population was patients and nurses. A total of 320 individuals (160 patients and 160 nurses), selected by stratified random sampling, participated in this study. Two questionnaires, namely the adjusted WHO Responsiveness Questionnaire (for patients and nurses) and the Equity Questionnaire (for nurses), the validity and reliability of both of which had been determined, were used to collect data. The software used for data analysis was SPSS

Results: The overall score (out of 4) of organizational justice was 1.9 0.77, while the mean score of responsiveness as perceived by the nurses and the patients was 2.32 0.54 and 2.48  0.58, respectively. There was no statistically significant difference between the 2 groups with regard to responsiveness, but there was a positive association between responsiveness and organizational justice as perceived by nurses (r = 0.2, p = 0.03).

Conclusion: The variables in the hospitals studied are generally at an intermediate level and there are no statistically significant differences between private and public hospitals. There is no difference in organizational justice between private and public hospitals, but responsiveness is higher in private hospitals as compared to public ones. Thus, the public sector needs to attempt to create more incentives in health professionals in the health sector in order to guarantee higher-quality services and better responsiveness.

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 Background and Aim: Global growth in the elderly population for both health care providers and families and also the community is an important challenge . Elders are the largest and fast factor for increasing hospital admissions in Society . Increasing costs of aging is the most concern to elders and their families. This study aimed to investigate the health team s approach about cost–effective alternatives for aging health services.

  This study is a qualitative research which was done through content analysis.

  18 people consisting of five faculty members , 6doctors , 3 nurses and 4health public health expert were participated. Samples were selected based on purposive sampling . Data were collected through interviews .

  Results: Four core themes derived from this study which included: 1- Emphasis on training for aging care ( including training doctors, nurses , health professionals , public health experts, elder sand their family caregivers). 2- Emphasis on proper implementation of primary health care for the elderly. 3- Emphasis on home care for elderly.4-attntion to mental health of elderly.

  Conclusion: It seems effectiveness of tree alternatives emphasis to training, home care and mental health for elderly are obvious and evident, so implementing and applying these suggestions would be helpful.

  But the second alternative emphasis on proper implementation of primary health care for the elderly must be performed based on a comprehensive needs assessment in elders population. Finally it is stressed that calculating and comparing actual costs of each alternative in elders caring must be measured through quantitative researches.

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  Background and Aim : It is impossible to deny the threats and risks endangering the process of health care when offering the services. Confirming this fact does not mean ignorance the risk, or allowance to medical and nursing mistakes to happen however, it can mean approaching the problem to come up with practical solutions and minimize the risks in the process of providing health care services. The present study was conducted periodically as an applied multi-stage research.

  Materials and Methods : To do a model of clinical risk management, different authentic texts on risk management in health sector were reviewed focusing on the models available. All such models were tabulated, analyzed and compared together which resulted 62 primary variables. The variables were, then, validated being used in a questionnaire responded by 20 nurses and doctors which, this time, produced a confirmed questionnaire of 40 variables. After that, 215 subjects chosen through a random and a stratified sampling were asked to respond to that questionnaire, making an exploratory factor analysis as well.

  Results : This study was done, using principal components analysis as with a rotation of Varimax loadings showed a variety of factors (19 factors) available in the models of clinical risk management were loaded as "organizing and policy-making" factor. This factor illuminated a sum of 25.3% of variances in the model of clinical risk management. The results also showed the loading factor of variables as among 0.5 and 0.7 which indicated a fine correlation among them and the participants' view.

  Conclusion: It was concluded that "the best care of the patient is accepted as a common perspective in organization" and "the effect of the treatment team's clinical performance on their financial payments" are the most and the least important variables respectively with 0.739 and 0.548 as factor load.

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Background and Aim:  In 1995 the new plan (system) of hospital administration plan/scheme (fee for service) was communicated. According to this plan a proportion (percentage) of the hospital income would be allocated to the hospital staff as a fee for service; the remaining would, after deducting other expenditures, be allocated for the autonomy of the hospital. Based on the plan/scheme, the Supervisory Board will consist of two main committees, namely, the High Supervisory Board and the Supervisory Board for the Centers (hospitals). The main objective of this study was to evaluate the performance of the Supervisory Board in the new system of hospital administration plan in selected teaching hospitals of Esfahan, Iran in 2014.

Materials and Methods: This was a qualitative research. Eleven individuals were selected by targeted sampling and interviewed using semi-structured interviews. The thematic analysis method was used to analyze the data.

Result: Based on the thematic analysis results, the main source of weakness in the underlying and structural factors (developing programs and the implementation phase) was the Hospital Administration Supervisory Board in the new system.

Conclusion: It can be concluded that the most notable findings in this study are weaknesses in the underlying and structural factors (developing the program) and weak underlying and structural factors (implementation of the program). The findings will help health policy-makers to develop suitable strategies and a plan of action to minimize weaknesses of the new fee for service scheme/plan.

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Background and Aim: Iran's Health Sector Evolution Plan (HSEP) is one of the most important national health reform plans. HSEP has attracted many criticisms. An important criticism is about its service costs. This article reports the results of a project conducted to compare the costs of normal and caesarian section delivery before and after implementation of the HSEP.
Materials and Methods: This was an applied research project using hospital accounting records as data. A total of 120 delivery files (60 normal delivery and 60 caesarian section) were selected randomly from the accounting software of a large hospital in Isfahan before and after May, 2014.The data in each subject’s file ─ paid shares of the hospital, patient and insurance ─ but not hoteling, inpatient and other costs was extracted. The health service providers’ incomes based on the annual tariffs of the services and changes in payments for each service for gynecologist and anesthesiologists were calculated. Data were analyzed using the excel software.
Results: The costs of normal delivery and caesarian section after implementation of the National HSEP had increased by 193% and 226%, respectively. In addition, of the treating physicians (gynecologists and anesthesiologists) had also increased by 257% for the normal and by 130% for caesarian section. Changes in the sums of money involved in service delivery indicates shifting of parts of the costs from the patients to the health subsidy and insurance systems.
Conclusion: The health System Evolution has not lead to real reductions in the out-of-pocket money paid by the patients. Higher cost of services will imply the need for better cost management. Increased costs of services will be to the benefit of neither patients nor the health system. This would mean that in designing and implementation of the Health Sector Evolution Plan economic aspects should be taken into consideration more carefully.

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Background and Aims: Nocardia asteroides complex is the most common cause of infectious diseases due to nocardiosis. Interspecies differentiation of Nocardia genera is essential for prognosis and timely proper treatment, as well as for epidemiological studies. Since each genus has its own antibiotic resistance, precise careful diagnosis is of prime importance. As compared to biochemical and phenotypic methods, the efficacy of molecular methods for fast and accurate identification of Nocardia species has been proven. The aim of this study was to detect for the first time Nocardia asteroides complex in clinical isolates using real time polymerase chain reaction (Real-Time PCR).
Materials and Methods: Out of the 25 clinical isolates suspected to be Nocardia asteroides genus 10 were identified as Nocardia asteroids complex by biochemical and phenotypic methods, followed by genomic DNA extraction of the suspicious isolates. Nocardia asteroides complex positive controls were prepared using standard strains. Real-time PCR was conducted on all the 10 suspicious isolates. The final real-time PCR samples were sent for sequencing to verify the identified species.
Results: Based on sequencing results 3 of 10 clinical isolates suspected to be identified as Nocardia asteroides complex were confirmed as belonging to the Nocardia asteroids complex genera ─ Nocardia asteroids, Nocardia farcinica, and Nocardia nova.
Conclusion: This study shows that, as compared to biochemical and phenotypic methods, real-time polymerase chain reaction is faster and more specific, and is considered as an efficient method, for Nocardia interspecies identification and differentiation.

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Background and Aim: Hospital social workers as a group of discharge planners perform effective interventions for the safe discharge of patients. The purpose of this research was to investigate the interventions of medical social workers in safe discharge of patients.
Materials and Methods: This was a qualitative study conducted in 2023 in Iran. Data were collected through semi-structured interviews with a sample of 16 social workers working in public hospitals selected by purposeful, accessible and snowball sampling and analyzed using the thematic analysis method.
Results: The findings of this research show that hospital social workers implement specialized interventions within a framework of six planning stages with the aim of safe patient discharge. The three main themes are: professional intelligence, supportive framework and sustainability of interventions; the main theme of the current research is safe discharge.
Conclusion: The findings of this research indicate that the interventions of social workers for the safe discharge of the patients include measures before, during and after the discharge of a patient, based on the principles, values, intelligence, professional skills and the social work process. Social workers in this field need the support of responsible officials in the health system.