Publications by authors named "Ali Akbari-Sari"

162 Publications

Barriers toward the practice of healthy behaviors among patients with non-communicable diseases in Gaza Strip, Palestine.

SAGE Open Med 2021 28;9:20503121211029179. Epub 2021 Jun 28.

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran.

Objectives: Non-communicable diseases are non-infectious health conditions caused by genetic, physiological, environmental, and behavioral factors. Currently, non-communicable diseases account for almost two-thirds of deaths globally. This study aimed to explore the patients' adherence level to the key recommendations, and the main barriers toward the practice of healthy behaviors among non-communicable diseases patients.

Method: This cross-sectional study was conducted among a representative sample of non-communicable diseases patients, receiving care in five primary healthcare centers in the Gaza Strip, Palestine. An interview-based questionnaire about demographics, medical history, and barriers toward the practice of healthy behaviors was developed and collected based on the health belief model and the theory of planned behaviors. Independent samples -test, one-way analysis of variance, chi-square, and Fisher's exact test were used for analysis.

Results: Four hundred patients with non-communicable diseases, aged (53.06 ± 10.03) years old, (56.8% females and 43.3% males) were included in this study. The patient's adherence was reported as 50.1%, standard deviation = 18.3 in terms of attended regular physical activity, and 44.0%, standard deviation = 15.4 in terms of eating a healthy diet. The main barriers to being active among patients were lack of accessibility to materials, lack of social support, and lack of reminder; while in terms of eating a healthy diet were lack of accessibility to materials, lack of social support, and lack of self-efficacy.

Conclusion: The non-communicable diseases patients' adherence to healthy behaviors is suboptimal. Varied implementation strategies targeting the main barriers are extremely required to enhance the access to physical activity infrastructure, affordable healthy diet options, and to reinforce the change toward healthy behaviors at all levels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/20503121211029179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246565PMC
June 2021

Barriers of Adherence among Palestinian Healthcare Professionals towards the Protocol of Health Education and Counselling on Healthy Behaviours for Non-Communicable Diseases.

Ethiop J Health Sci 2021 Jan;31(1):73-84

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran.

Background: Despite the huge numbers of the universally produced and employed protocols, the adherence with them is still low to moderate in the healthcare settings. This study was employed to assess the attitudes of Palestinian healthcare professionals in Gaza Strip to health education and counseling on healthy behaviours protocol (WHO-PEN Protocol 2), for patients with non-communicable diseases in the Ministry of Health primary healthcare centers.

Methods: This cross-sectional study was conducted with a census sample of all governmental family physicians and nurses (n=175). The study questionnaire was developed based on Cabana theoretical framework. The Arabic version questionnaire was developed based on the cross-cultural adaptation framework. The psychometric properties of the Arabic version questionnaire was finally evaluated.

Results: The psychometric properties of the Arabic version questionnaire showed good construct validity and internal consistency reliability. The overall adherence level to WHO-PEN Protocol 2 was 70.0, SD=6.9. The main perceived barriers were lack of incentive, patients' factors, and lack of time. In general, most of healthcare professional respondents had a positive attitude toward the protocol, but this attitude was not predictor to protocol adherence.

Conclusion: The good validity and reliability of the questionnaire can provide support for the accuracy of the study results. Varied implementation strategies targeting the major barriers derived from the study are extremely required for addressing the lack of incentives, patients' factors and time constraints.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4314/ejhs.v31i1.9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188095PMC
January 2021

Model for Value-based Policy-making in Health Systems.

Int J Prev Med 2021 24;12:13. Epub 2021 Feb 24.

Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Background: Values are at the heart of discussions related to policy-making and any kind of reforms in health systems. Despite wide recognition of its importance, the concept of value is still vague and the policy-making processes remain astray with respect to values. This study aims to provide a model of value-based policy-making and to explain the concept value and how it affects policy-making.

Methods: The main question of the current study is to explain the concept of value-based policy-making and developing a model, based on the explained concept. In this line, critical review method and Carnwell and Daly approach and using particular keywords related to stewardship, and searching databases were used. In the initial search, 739 studies were obtained, of which using targeted sampling method, 11 studies were finally selected. Then, in order to design and explain different aspects of the value concept in the health system and to develop a model, selected studies were criticized, and finally, the conceptual model of value is designed and explained.

Results: The concept of value and its effects, dimensions and its relation to principles, evidence and criteria were determined at different stages of the policy-making process. It was also revealed that value-based policy-making in a health system is contingent upon the realization of terminal values.

Conclusions: In the process of selecting the best policy option, it is necessary to identify the relationship between terminal, instrumental, criterion, and evidence to avoid deviating from the reference value framework in any country and to avoid blindly imitating other experiences in other countries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijpvm.IJPVM_325_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106279PMC
February 2021

The impact of common chronic conditions on health-related quality of life: a general population survey in Iran using EQ-5D-5L.

Cost Eff Resour Alloc 2021 May 13;19(1):28. Epub 2021 May 13.

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Poursina Ave, 1417613191, Tehran, Iran.

Background: Diseases have undeniable effects on Health-Related Quality of Life (HRQoL). Chronic diseases, in particular, limit the productive potentials and HRQoL of individuals. EQ-5D is a very popular generic instrument, which can be used to estimate HRQoL scores in any diseases. The current study investigates mean HRQoL scores in certain chronic diseases and examines the relationship between utility scores and chronic diseases in Iran.

Method: This cross-sectional study was carried out among the general adult population of Tehran. 3060 individuals were chosen by a stratified probability sampling method. The EQ-5D-5L questionnaire was applied. The utility scores were estimated using the Iranian crosswalk-based value set. The effect of chronic diseases on the HRQoL scores was derived by the Ordinary Least Squares (OLS) method. Data was analyzed using Stata version 13 software.

Results: The mean ± standard deviation utility and EQ-VAS scores were 0.85 ± 0.14 and 76.73 ± 16.55 in the participants without any chronic conditions. The scores were 0.69 ± 0.17 and 61.14 ± 20.61 in the participants with chronic conditions. The highest and lowest mean utility scores were related to thyroid disease (0.70) and Stroke (0.54), respectively. Common chronic conditions had significant negative effects on the HRQoL scores. Stroke (0.204) and cancer (0.177) caused the most reduction in the EQ-5D-5L utility scores. Lumbar disc hernia, digestive diseases, osteoarthritis, breathing problems, and anxiety/nerves cause 0.133, 0.109, 0.108, 0.087, and 0.078 reductions, respectively, in the EQ-5D-5L utility scores.

Conclusion: This study provides insight into some common chronic conditions and their effects on the HRQoL. Policymakers and planners should pay attention to the effects of chronic conditions especially high prevalence one. They should adopt effective interventions to control this issue and increase health. The results of this study can also be beneficial in economic evaluation studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12962-021-00282-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117596PMC
May 2021

COVID-19 and Comparative Health Policy Learning; the Experience of 10 Countries.

Arch Iran Med 2021 03 1;24(3):260-272. Epub 2021 Mar 1.

Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Since December 2019, the world has been facing one of the most critical health threats of the last decades. In March 2021, the official number of deaths passed 2.6 million worldwide. Most countries have developed policies to control the disease. Nevertheless, countries have experienced different outcomes related to their various adapted policies. Complementing our first report, in this article, we report our findings of comparing the policies adopted to combat coronavirus disease 2019 (COVID-19) in Iran, with those from nine selected countries, including China, Japan, South Korea, Singapore, Germany, the United States, the United Kingdom, Spain, and Italy, to draw evidence-informed policy lessons.

Methods: This is a qualitative study conducted based on document analysis related to COVID-19 policies in Iran and nine selected countries. Using a deductive approach, data were extracted and analyzed based on the components of the WHO Building Blocks Framework. Finally, we compared the Iranian policies with the nine selected countries.

Results: Documents analysis revealed a spectrum of policies, which have led to a variety of outcomes. Based on our findings, three main strategies (widespread testing, comprehensive contact tracing, and timely measures) were the most effective directions to combat COVID-19.

Conclusion: The experience of the first and second waves of COVID-19 showed that the risk of coronavirus is serious and will continue until a vaccine or decisive treatment is achieved. Therefore, countries are required to adopt appropriate and tailored policies to deal with this crisis effectively. Applying the experiences from the previous waves is essential for more efficient performance in the likely upcoming waves.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34172/aim.2021.37DOI Listing
March 2021

Health related quality of life in adults with asthma: a systematic review to identify the values of EQ-5D-5L instrument.

J Asthma 2021 May 8:1-10. Epub 2021 May 8.

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran.

Introduction: The EQ-5D is the most popular generic preference-based instrument used for asthma patients. This study aims to explore the psychometric properties of the EQ-5D-5L instrument in patients with asthma and identify the EQ-5D-5L scores in these patients.

Method: PubMed, Scopus, Web of Science, Google Scholar and CEA Registry were searched with English language from 2009 until April 2020. Retrieved studies were checked against the inclusion criteria. Reference lists of the included articles were also reviewed. The quality of included articles was evaluated using Mitton checklist and the data were extracted by a reviewer and were checked by a second reviewer. Meta-analysis was done to calculate the overall scores based on type of asthma control.

Results: A total of 17 articles were included. The EQ-5D-5L scores ranged from 0.45 to 0.93 and the VAS scores ranged from 35.67 to 83.80. The EQ-5D-5L is higher in well-controlled (0.88, 95% CI: 0.81-0.96,  = 0.0001) than partly controlled (0.80, 95% CI: 0.74-0.85,  = 0.001) and poorly controlled asthma (0.72, 95% CI: 0.67-0.77,  = 0.01). Validity in two studies was weak and, in other studies, it was moderate to strong. Responsiveness of the EQ-5D-5L, that was shown in a study, was less than other generic instruments, and reliability was adequate in only study that had been reported. Ceiling effects were between 8.30% to 35%.

Conclusion: Higher score of the EQ-5D-5L was consistent with well-controlled asthma patients and those with lower severity of asthma. The assessment of psychometric properties of the EQ-5D-5L needs further observations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02770903.2021.1917607DOI Listing
May 2021

Assessment of public hospitals performance in Gaza governorates using the Pabón Lasso Model.

Int J Health Plann Manage 2021 Jul 14;36(4):1223-1235. Epub 2021 Apr 14.

Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Measuring hospital performance can be undertaken in different areas including efficiency, productivity, and quality. Many studies have been conducted using several indicators in this regard.

Aim: This study aimed at measuring efficiency of obstetrics and gynaecology, and paediatrics departments at the public hospitals affiliated with the Palestinian Ministry of Health in 2016, 2017 and 2018.

Method: This descriptive study includes 12 hospitals; four (A-D) and eight (E-L) providing obstetrics and gynaecology, and paediatrics services, respectively. Data were collected from health annual reports for the 3-year study period. Pabón Lasso charts were drawn using Microsoft Excel 2013.

Results And Conclusion: During the 3 years, hospitals B, D and C lied in zones 3, 1 and 2, respectively. Hospital A was in Zone 4 in 2016 and 2018, but in Zone 1 in 2017. In 2016, hospitals E, F and H were in Zone 3, while, hospitals I, J, K, and L were in Zone 1. In 2017, hospital G shifted from Zone 2 to Zone 3, and backed to Zone 2 in 2018. Hospital L has moved from Zone 1 to Zone 2 in 2018, whereas other hospitals have remained in the same zones. Inefficiency in hospitals provides an important opportunity for addressing the gaps in a quality and less costly manner. Emphasis antenatal care in primary healthcare is important. Further researches are required to cover other types of hospitals through employing frontier techniques of efficiency measurement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hpm.3159DOI Listing
July 2021

Improving Transparency of Hospitals' Performance: Recommendations for Iran.

Hosp Top 2021 Apr 7:1-10. Epub 2021 Apr 7.

Transparency for Iran Think-Tank, Tehran, Iran.

Public reporting of hospitals' performance data is a growing trend. This transparency may improve patient choices, competition, and service quality. This study aims to provide recommendations to improve hospitals' transparency in Iran. A qualitative study designed with 18 semi-structured interviews. Recommendations were categorized into five main themes, including passing a comprehensive law on transparency to create political commitment, educating people and healthcare providers to create the culture, developing a simple and efficient structure to foster transparency, and monitoring and evaluating transparency. The most important issue is political commitment. If it exists, the rest of the obstacles can be solved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00185868.2021.1904803DOI Listing
April 2021

Integrated early childhood development policy in Iran: a qualitative policy process analysis.

BMC Public Health 2021 04 2;21(1):649. Epub 2021 Apr 2.

Population, Family and School Health Office, Ministry of Health and Medical Education, Tehran, Iran.

Background: Integrated early childhood development (IECD) is a comprehensive approach to optimal development of children in different developmental domains from fetal stage to eight years of age. The aim of this study was to identify the factors affecting the process of policy-making for early childhood development and to clarify how these factors affect decision-making and create challenges in this regard.

Method: In a qualitative study, we used two main data sources including document analyses and interviews. Using purposive sampling, forty semi-structured interviews with policymakers and informants in the fields related to children were conducted in Tehran from October 2017 to June 2018. Also, 62 national and 10 international relevant documents were reviewed. A deductive-inductive approach was used to analyze the data. We used the MAXQDA11 software for data management.

Results: we identified 13 themes and 29 subthemes related to the stages of policymaking process including: Agenda setting (problem stream, policy stream, politics stream), Policy formulation (formulation and approval process, policy sustainability, mechanisms of stakeholders' participation in policymaking), Policy implementation (conceptual ambiguity, intersectoral and trans-sectoral issues, structural capacities, mobilization of resources), and Policy evaluation (continuous and routine data registry system, comprehensiveness of indexes). We propose 19 policy recommendations to improve the situation.

Conclusion: As a multidisciplinary and multi-sectoral field with different domains, early childhood development (ECD) requires a more active role on the part of policymakers in governmental levels in supporting the related policies. Unless policymakers change their approach to decrease nonintegrated and non-comprehensive policymaking for ECD, child development will be compromised, which endangers the eventual sustainability of the society since improved IECD policy-making process improves developmental outcomes in children. In this regard, attention should be paid to the role of reinforcing intersectoral collaboration through incorporating it in the missions and the evaluation items of organizations, creating commitment in high organizational levels, and developing an inter-ministerial policymaking framework that clearly specifies the roles and responsibilities of every single sector and their interactions and collaborations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12889-021-10646-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017628PMC
April 2021

Assessment of Utility in Migraine: Mapping the Migraine-Specific Questionnaire to the EQ-5D-5L.

Value Health Reg Issues 2021 Mar 24;25:57-63. Epub 2021 Mar 24.

Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: There are increasing demands for studies of cost-effectiveness to allocate resources for disease prevention and treatment strategies. The aim of this study is to measure quality of life in migraineurs, based on the Migraine-Specific Questionnaire (MSQ) and EQ-5D-5L, and thereafter map an algorithm to estimate health-state utility values from the MSQ in individuals with migraine.

Methods: In this cross-sectional study conducted between May and July 2018 in a tertiary headache clinic in Tehran, Iran, migraineurs diagnosed based on International Classification of Headache Disorders (ICHD)-3β were enrolled and were asked to complete the MSQ questionnaire and EQ-5D questionnaire. The Spearman correlation coefficient (ρ) was calculated to measure the correlation between the EQ-5D-5L and MSQ v2.1 domains' score. A P value of <.05 was considered statistically significant. After statistical analysis, several regression models were presented to map the results of the MSQ domains to the utility index, and the preferred model was achieved based on goodness of fit and the model's predictive performance.

Results: The preferred MSQ algorithm had approximately the same prediction errors in all migraineurs, episodic and chronic migraine (root mean square error 0.24, 0.24, and 0.23, respectively). The preferred MSQ model explained a variance of 0.26 (R) in episodic and 0.38 in chronic migraine in the EQ-5D-5L questionnaire.

Conclusion: The preferred MSQ mapping algorithm will be suitable in estimating health state utilities in trials of patients with migraine that contain MSQ scores but lack utility values.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.vhri.2020.12.003DOI Listing
March 2021

Relationship between Socioeconomic Factors and Incidence of Cosmetic Surgery in Tehran, Iran.

Iran J Public Health 2021 Feb;50(2):360-368

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Cosmetic surgery accompanied with high economic cost is increasing in Iran. It is necessary to be aware about factors affecting cosmetic surgery in order to control its increasing trend. Therefore, we aimed to determine the factors affecting the incidence of cosmetic surgery in Tehran, Iran.

Methods: This survey was conducted on 2002 subjects between the ages of 15 to 60 yr using random digit dialing in Tehran, Iran 2015. Demographic data was collected from all of participants and in the presence of cosmetic surgery, the related cosmetic questions were asked in details. Cosmetic surgery was considered as an event and the incidence rate ratio for variables were estimated. For univariate analysis, Poisson regression was used as well as multi-level Poisson regression was used for multivariate analysis.

Results: Totally, 224 participants (11%) undergone cosmetic surgery. There was a significant relationship between the age at surgery of participants with the incidence of cosmetic surgery (<0.001). Cosmetic surgery in women was 1.9 times greater than in men ( <0.001). Incidence Rate Ratio (IRR) for the average and wealthy economic status in comparison to poor level was estimated (IRR=5.6, CI%95: 3.64,8.63) and (IRR=3.14, CI%95: 1.93,5.11), respectively. In addition, according to multivariate analysis all variables except the level of education and occupation, had significant relationship with the incidence of cosmetic surgery (<0.001).

Conclusion: Cosmetic surgery was related to socioeconomic and demographic factors. Given the high economic burden of this unnecessary surgery, it can be effective to emphasize on awareness-raising programs for those are more likely to undergo cosmetic surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18502/ijph.v50i2.5351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956103PMC
February 2021

The economic burden of tuberculosis in Sistan: a high-risk region in Iran.

Trop Med Int Health 2021 06 28;26(6):649-655. Epub 2021 Mar 28.

Master of Health Care Management, Zahedan University of Medical Sciences, Zahedan, Iran.

Introduction: To estimate the economic burden of tuberculosis treatment in Sistan, the region with the highest number of tuberculosis cases in Iran.

Methods: All patients with smear-positive pulmonary tuberculosis who had contracted tuberculosis in 2018 and successfully completed their treatment were interviewed.

Results: Ninety patients with a mean age of 57 ± 18 years were interviewed. Most of them were women (58%), housewives (57%) and resided in rural areas (84%). The mean cost of treatment for tuberculosis was estimated as 6800 USD per patient. Direct costs were 87% of the total cost. Twenty-two patients lost an average income of 530 USD (8514590 rials) during treatment. The results showed the significant correlation of direct and indirect costs with sex, age, place of residence and education (P < 0.05).

Conclusion: It appears essential to improve social protection and implement interventions to promote knowledge in rural areas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/tmi.13570DOI Listing
June 2021

Evaluation of performance at Palestinian public hospitals using Pabón Lasso model.

Int J Health Plann Manage 2021 May 3;36(3):896-910. Epub 2021 Mar 3.

Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Hospitals have a paramount role in provision of health care services, which in turn significantly impacts the performance of any health system, especially in developing countries.

Aim: This study aimed to evaluate the performance of the Ministry of Health general hospitals in Gaza according to their surgical and internal medicine departments during a 3-year period (2016, 2017 and 2018) using Pabón Lasso model.

Method: This descriptive study includes the overall public general hospitals in Gaza Strip (7). Data have been collected from the officially disseminated reports, mainly about average length of stay, bed occupancy rate, and bed turnover ratio in the surgical and internal medicine departments for the study period. Pabón Lasso charts have been drawn using MS Excel 2013.

Results And Conclusion: For surgical departments, about 42.8% were efficient (zone 3) during the 3 years, while, 42.8% were inefficient (zone 1). Only one hospital was relatively efficient (zone 4) in 2017 and 2018. Regarding internal medicine departments, 28.6%-42.8% of hospitals were efficient during the study period, 14.3%-42.8% were inefficient, and 28.6%-42.8% were relatively efficient (zone 2 and 4). It is recommended to count on such type of analysis in decision-making and identify obstacles for best utilization of the available resources. Inefficiency in hospitals serves as a good opportunity for resources mobilization or innovation in demand-creating interventions, thereby, regular evaluation of resources' distribution. Further research is required by applying frontier techniques of efficiency measurement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hpm.3124DOI Listing
May 2021

The Effect of Individual Time Preferences on Smoking Behavior: Insights from Behavioral Economics.

Iran J Public Health 2020 Sep;49(9):1787-1795

Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Background: We aimed to explore the correlation between the time and risk preferences and the smoking behavior of adult population in western Iran.

Methods: Overall, 792 individuals with the age of 35 to 65 yr participating in an ongoing national cohort study (Persian Cohort) were approached to complete a pre-structured questionnaire in 2017. Time preferences were measured using a standard choice-based method. The individuals' discount rates were identified by questions that offered binary monetary choices on immediate future and distant future, by making trade-offs between them. Probit regression model was used to investigate the relationship between time preferences and smoking when controlling for demographic and socioeconomic variables.

Results: Time and risk preferences had statistically significant direct correlations with smoking. A unit increase in discount rate was associated with a 4.4% percentage point increase in the likelihood of being smoker. A present-biased individual had 5.7% percentage points lower likelihood of being smoker. Moreover, a unit increase in willingness to take the risk increased the likelihood of being a smoker by 1.5% percentage points.

Conclusion: Time and risk preferences are important determinants of smoking behavior. These factors should be considered in designing effective prevention and control programs. Policies that increase the immediate costs of cigarette smoking or the immediate benefits of smoking cessation are likely to have a greater impact on reducing the prevalence of cigarette smoking.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18502/ijph.v49i9.4100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898103PMC
September 2020

Public Sector Capacity to Prevent and Control of Noncommunicable Diseases in Twelve Low- and Middle-Income Countries Based on WHO-PEN Standards: A Systematic Review.

Health Serv Insights 2021 1;14:1178632920986233. Epub 2021 Feb 1.

School of Public Health, Department of Health Management and Economics, Tehran University of Medical Sciences, International Campus (TUMS-IC), Iran.

This review was conducted to assess the capacity of the public sector to prevent and control noncommunicable diseases (NCDs) in low-and middle-income countries (LMIC) based on WHO-PEN standards. A PRISMA systematic search appraisal of PubMed, Scopus, and Embase was conducted during May-2020 for original articles conducted in LMIC and reported the capacity of the public sector to prevent and control NCDs. The country readiness score was calculated as the mean score of items for each domain. The indices were compared to an agreed cutoff at 80% the WHO optimal target of availability of affordable essential medicines and basic technologies required to treat NCDs. The literature search yielded 5 original studies, conducted in twelve countries, and surveyed 304 public health facilities. All countries failed to reach the WHO optimal target of availability of affordable essential medicines and basic technologies. The readiness index score according to WHO-PEN standards among countries in terms of essential medicines, diagnostic investigations, and basic equipment were range from 13.5% to 51%, 0.0% to 59.4%, and 29.2% to 51.2% respectively. This review revealed critical gaps in the twelve LMIC public sector capacity to prevent and control of NCDs in terms of essential medicines, basic equipment, and diagnostic investigations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1178632920986233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863145PMC
February 2021

Cost per DALY averted in low, middle- and high-income countries: evidence from the global burden of disease study to estimate the cost-effectiveness thresholds.

Cost Eff Resour Alloc 2021 Feb 4;19(1). Epub 2021 Feb 4.

Department of Health Management and Economics, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran.

Background: Determining the cost-effectiveness thresholds for healthcare interventions has been a severe challenge for policymakers, especially in low- and middle-income countries. This study aimed to estimate the cost per disability-adjusted life-year (DALY) averted for countries with different levels of Human Development Index (HDI) and Gross Domestic Product (GDP).

Methods: The data about DALYs, per capita health expenditure (HE), HDI, and GDP per capita were extracted for 176 countries during the years 2000 to 2016. Then we examined the trends on these variables. Panel regression analysis was performed to explore the correlation between DALY and HE per capita. The results of the regression models were used to calculate the cost per DALY averted for each country.

Results: Age-standardized rate (ASR) DALY (DALY per 100,000 population) had a nonlinear inverse correlation with HE per capita and a linear inverse correlation with HDI. One percent increase in HE per capita was associated with an average of 0.28, 0.24, 0.18, and 0.27% decrease on the ASR DALY in low HDI, medium HDI, high HDI, and very high HDI countries, respectively. The estimated cost per DALY averted was $998, $6522, $23,782, and $69,499 in low HDI, medium HDI, high HDI, and very high HDI countries. On average, the cost per DALY averted was 0.34 times the GDP per capita in low HDI countries. While in medium HDI, high HDI, and very high HDI countries, it was 0.67, 1.22, and 1.46 times the GDP per capita, respectively.

Conclusions: This study suggests that the cost-effectiveness thresholds might be less than a GDP per capita in low and medium HDI countries and between one and two GDP per capita in high and very high HDI countries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12962-021-00260-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863358PMC
February 2021

Application of discrete choice experiments to estimate value of life: a national study protocol in Iran.

Cost Eff Resour Alloc 2021 Jan 30;19(1). Epub 2021 Jan 30.

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Background: Global concerns regarding the significant burden of non-communicable diseases and injuries (NCDIs) exist from both public health and economic perspectives. Our research focuses on the reduction of fatal risks due to NCDIs and the citizens' preferences about health programs and intervention to reduce premature death due to NCDIs. Governments and health authorities need reliable evidence and information to prioritize the interests of their citizens. One crucial piece of evidence to justify the resources spent on NCDIs is the value derived from the interventions on prevention and NCDIs control. This concept is usually called "Value of Statistical Life" (VSL), meaning the monetary value that individuals place on changes in the risk levels of life- threatening events. To the best of our knowledge, for the first time, our study will estimate the statistical value of life for selected interventions for the prevention and control of NCDIs at both national and sub-national levels in the context of Iran. This paper reports the development of a national protocol through Discrete Choice Experiments (DCEs) method.

Methods And Designs: Our study comprises several stages: (a) a literature review to identify the attributes and levels of the prevention programs and Willingness to Pay (WTP) for reducing the NCDI's fatal risks; (b) experimental design to assessing, prioritizing, and finalizing the identified attributes and levels; (c) instrumental design to conduct face-to-face structured survey interviews of 3180 respondents aged 18-69 across the entire country; (d) statistical analysis to estimate the results through the Mixed Multinomial logit (MMNL) model.

Discussion: We anticipate that our findings will help build a stronger empirical basis for monetizing the value of small changes in selected fatality risks. It paves the way for other national or vast VSL estimates for NCDIs, as well as other major causes of morbidity and mortality in the context of Iran, and perhaps other low and middle-income countries (LMICs).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12962-021-00259-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846904PMC
January 2021

Mapping QLQ-C30 Onto EQ-5D-5L and SF-6D-V2 in Patients With Colorectal and Breast Cancer From a Developing Country.

Value Health Reg Issues 2021 May 25;24:57-66. Epub 2021 Jan 25.

Health Policy and Management Research Center, Department of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Electronic address:

Objectives: Many studies have mapped the QLQ-C30 onto the EQ-5D or the SF-6D utilities; however, these studies were limited to developed countries. So this study aimed to map QLQ-C30 onto the SF-6D version 2 (SF-6D-v2) and EQ-5D-5L using the data collected from patients with colorectal and breast cancer in a developing country.

Methods: A cross-sectional data set of 668 inpatient and outpatient patients with cancer was gathered from 4 teaching hospitals of cancer treatment in Tehran and Yazd from May 2017 to November 2018. The ordinary least squares (OLS) and censored least absolute deviations (CLAD) models were applied to estimate the utility values of both EQ-5D-5L and SF-6D-V2 using the QLQ-C30. Predicted R and adjusted R were used to evaluate the goodness of fit of the models. Moreover, the predictive performance of 2 models was assessed through estimating the mean absolute error (MAE), root mean square error (RMSE), intraclass correlation coefficients (ICC), and Spearman's rho. The 10-fold cross-validation method was also applied for validation of models.

Results: The OLS Model E4 was the best-performing model for EQ-5D-5L (Adj R = 71.7%, Pred R = 71.15%, MAE = 0.0770, RMSE = 0.1026), and the OLS Model S4 performed best for SF-6D-V2 (Adj R = 74.64%, Pred R = 73.86%, MAE = 0.0465, RMSE = 0.0621).

Conclusion: The OLS Model E4 for EQ-5D-5L and the OLS Model S4 for SF-6D-V2 were the best models for policy makers to have more accurate evaluation of the healthcare interventions when the data are gathered through non-preference-based instruments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.vhri.2020.06.006DOI Listing
May 2021

Assessing progress in the national health financing system towards universal health coverage in Iran: a mixed-method study protocol.

Health Res Policy Syst 2021 Jan 12;19(1). Epub 2021 Jan 12.

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran.

Methods: An explanatory mixed-method approach will be used in two phases. In the quantitative phase, the performance of the Iranian health financing system will be assessed using a well-established set of indicators to draw on progress over 5-year intervals starting in the year 2000 up to the present. Data will be extracted from the global health expenditure database using a specific form and will be classified in accordance with each indicator. A qualitative phase will then take place considering the Kutzin et al. framework and by using health financing progress matrices. The qualitative phase will consist of two successive stages; first, a descriptive overview on the major health coverage schemes along with key attributes of each scheme. This initial mapping will be the underlying background for the second stage. In the second stage, the matrices comprised of a series of questions and relevant to the core functions of health financing and cross-cutting options will be invested in enhancing the evaluation of the ongoing reforms or policies. In this phase, data will be collected by reviewing national policy documents and in-depth interviews with key informants who will be recruited using purposive sampling. Finally, a policy discussion with key stakeholders will be held in order to review and verify the consistency between the current health financing policy and UHC goals.

Discussion: This study will provide a comprehensive image about the current status of the national health financing system progress towards achieving UHC in Iran. Such assessment will give detailed insight about the performance of the current financing system through identifying encountered challenges. Furthermore, some other defects in the design of the financing system are expected to appear. In all likelihood, the results will be fruitful enough to make informed decisions about interventions and policies in relation to UHC.

Ethics And Dissemination: The study protocol has been approved by the Ethics Committee for Research at Tehran University of Medical Sciences. Informed consent will be obtained from all key informants and the data will be collected and transcribed anonymously in order to maintain utmost confidentiality. The results will be disseminated in peer-reviewed journals and presented in national and international conferences and meetings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12961-020-00610-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805138PMC
January 2021

Ensuring Sustainable Development in Ghana: Public Health Security and Policy Concerns.

Iran J Public Health 2020 Aug;49(8):1580-1581

Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18502/ijph.v49i8.3909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554391PMC
August 2020

Validity of a Serological Diagnostic Kit for SARS-CoV-2 Available in Iran.

Arch Iran Med 2020 09 1;23(9):629-632. Epub 2020 Sep 1.

Department of Environmental Health Engineering, Tehran University of Medical Sciences, Tehran, Iran.

Background: The Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic broke out in December 2019 and is now characterized as a pandemic. Effective control of this infectious disease requires access to diagnostic techniques, for both case finding and epidemic size estimation. The molecular technique is routinely used worldwide. Although it is the "standard" case detection and management method, it has its own shortcomings. Thus, some easy-to-use rapid serological tests have been developed.

Methods: One hundred and fourteen positive RT-PCR-diagnosed patients were tested by VivaDiag Kit, a brand of rapid serological kits available in hospitals affiliated to Tehran University of Medical Sciences (TUMS), Tehran, Iran. Frozen serum specimens taken from healthy people in summer and fall 2019 were also tested as negative controls.

Results: Test sensitivity was 47.9% (95% confidence interval [CI]: 38.8-56.9) for IgM and 47.0% (95% CI: 38.0-56.0) for IgG. There was no difference between IgG and IgM seropositivity except in one case. Specificity was calculated as 99.0% (95% CI: 96.4-99.9) for IgM and of 100.0% (95% CI: 0.98.2-100.0) for IgG. Sensitivity was higher in men and older participants.

Conclusion: This test can be used for epidemiological investigations, especially for the estimation of the level of infection in the community, after it is properly corrected for sensitivity and specificity. The low sensitivity could be attributed to the technical limitations of the kit or low levels of antibodies after infection. The different sensitivity in age and sex groups supports the hypothesis that different people show different immune responses to this virus.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34172/aim.2020.75DOI Listing
September 2020

Economic burden of medication-overuse headache in Iran: direct and indirect costs.

Neurol Sci 2021 May 18;42(5):1869-1877. Epub 2020 Sep 18.

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background And Objective: Medication-overuse headache (MOH) as a secondary chronic headache imposes a considerable burden on both individuals and societies. Nevertheless, little is known about the burden of MOH in Iran. Therefore, in the current study, we aimed to quantify the annual cost of MOH among Iranian patients.

Methods: In this cross-sectional study, 84 patients were recruited. Demographic data, headache attack characteristics, related disability, and information about the economic burden of MOH were collected through face-to-face interview. Direct medical and nonmedical costs as well as indirect costs were included in our cost analysis. The prevalence-based approach was applied to estimate the economic burden of MOH.

Results: We found that MOH patients in Iran spend averagely $1046 for medical services, $132 for nonmedical services, and $1432 due to lost productivity per year. The per-person annual cost of MOH was US$2610, and the total annual cost for Iran was $10,179,000,000, with direct and indirect cost accounting for 45% and 55%, respectively.

Conclusion: MOH leads to substantial healthcare costs and significant loss of productivity in Iran. Therefore, raising awareness in this area especially for policymakers can use in future health planning and lead to resource allocation in the field of disabling type of headache disorders such as MOH. Our findings also provide a different insight into the burden of MOH, which are likely closer to the actual costs in middle- and low-income countries, and also it could be a sample of such a study in western Asia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10072-020-04716-8DOI Listing
May 2021

Real-Life Incentives Driving Public-Private Partnership in Diagnostic Services.

Ethiop J Health Sci 2020 May;30(3):409-416

Associate Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Diagnostic services are highly critical in the success of treatment processes, overly costly nonetheless. Accordingly, hospitals generally seek the private partnership in the provision of such services. This study intends to explore the incentives owned by both public and private sector in their joint provision of diagnostic services under the public-private partnership agreement.

Method: A qualitative, exploratory study was employed in Tehran hospitals from October 2017 to March 2018. Around 25 face-to-face, semi-structured interviews were conducted with the purposively recruited hospital managers, heads of diagnostic services and managers of private companies. Interviews were transcribed and analyzed using conventional content analysis, assisted by "MAXQDA-12".

Results: Three main categories and nine sub-categories represented the incentives of public sector, and four main categories and seven sub-categories signified those of private sector. The incentives of public sector included the status-quo remediation, upstream requirements, and personal reasons. As such, the individual, social and economic incentives and legal constraints were driving the behavior of the private sector.

Conclusions: Financial problem and gain were the most noted incentives by the partners. Attention to the either side's incentives and aims is likely to ensure the durability and effectiveness of such partnerships in the health sector.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4314/ejhs.v30i3.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445953PMC
May 2020

Capacity of Palestinian primary health care system to prevent and control of non-communicable diseases in Gaza Strip, Palestine: A capacity assessment analysis based on adapted WHO-PEN tool.

Int J Health Plann Manage 2020 Nov 31;35(6):1412-1425. Epub 2020 Aug 31.

Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran.

The prevalence of non-communicable diseases (NCDs) are increasing in low-income countries including Palestine. This study was conducted to assess the capacity of Palestinian primary health care system to prevent and control of NCDs. This cross-sectional study in which, the World Health Organization package of essential NCDs interventions (WHO-PEN) tool, was used to assess the capacity of primary health care centers (PHCs) to prevent and control of NCDs. All governmental PHCs (n = 52) in Gaza Strip, Palestine were included in the final analysis. The centers readiness score was calculated as the average of domains indices. Then, the indices were compared to an agreed cutoff at 70%. Statistical analysis was performed using SPSS version 22. Out of 52 PHCs, only 21 (40.4%) were considered ready to prevent and control of NCDs; the highest readiness score was 79.4% and the lowest score was 29.2%. Furthermore, all governorates were not ready to prevent and control of NCDs (The readiness scores were < 70%), distributed as follow: 68.6%, 68.1%, 67.7%, 62.5% and 56.4%, for Rafah, Gaza, Khan-Yunis, Deir Al Balah and North Gaza, respectively. The governorates were differed significantly in terms of availability of aneroid blood pressure measuring devices, electrocardiography devices, Glibenclamide and Salbutamol tablets, patients counseling for diabetes self-management, patients education for self-administration of insulin (P values <.05 for all). The current study demonstrated critical gaps in the governmental PHCs capacity to prevent and control of NCDs, as most of PHCs failed to reach the minimum threshold of the WHO-PEN standards.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hpm.3022DOI Listing
November 2020

Prioritizing the Potential Applications of Mobile-Health in the Iranian Health System.

J Res Health Sci 2020 Mar 1;20(1):e00473. Epub 2020 Mar 1.

National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran.

Background: Access and the use of information and communication technology, especially mobile phones, have expanded significantly in recent years; therefore, we aimed to rank the potential applications of mobile apps in the Iranian health system.

Study Design: A multi-attribute decision making design.

Methods: First, the main applications of apps and also the related attributes for prioritization were extracted from a systematic and comparative review of studies. Then, the weight of these attributes was extracted using the Shannon Entropy method. The values of attributes for each application were questioned by the 11 experts. By having the decision matrix and the weight of attributes, the applications were separately weighted and ranked using four MADM techniques. Finally, using the Copeland technique, the results of different techniques were combined, and a final ranking was achieved.

Results: Based on the results extracted from the studies and the opinions of experts, 8 main applications, and, 14 attributes were determined and entered into the modeling phase. The most significant weight obtained was related to "the feasibility of monitoring activities" (weight=0.220), and the least was related to "the feasibility of access to apps in any location" (weight=0.017).

Conclusion: The apps related to the physicians' access to patients' health information had the highest priority, and the apps related to the selection of proper health behavior patterns had the least priority.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34172/jrhs.2020.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585758PMC
March 2020

Expanding Fiscal Space for Healthcare System through Efficiency: A Qualitative Study from Iran.

Iran J Public Health 2020 Apr;49(4):727-735

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Healthcare systems are always facing increasing public demands to provide better services. Therefore, countries always need more resources and are constantly seeking more fiscal space for health. Freeing up resources through improving efficiency can be a practical option for all settings, particularly countries with low resources. This study aimed to identify feasible options for expanding fiscal space through efficiency within Iran's healthcare system.

Methods: This was a qualitative study. We conducted 29 semi-structured in-depth interviews with stakeholders at various levels of healthcare system in 2017 and 2018. We used mixed method (deductive and inductive) qualitative content analysis. Pre-defined themes extracted from literature and meanwhile new subthemes were developed and added to the initial framework.

Results: We identified three main themes that affect the efficiency of healthcare system in Iran: administration, implementation, and monitoring. Problematic administration, inappropriate implementation and lack of good monitoring in healthcare initiatives may lead to inefficiencies and wasting resources. Recognizing these leakages in every healthcare system can free up some resources.

Conclusion: Irrespective of their economic development, all countries may, to some extent, face limited resources to address ever-increasing needs in their healthcare systems. While generating new resources is not always possible, enhancing efficiency to expand fiscal space might be a feasible option. Healthcare systems should identify the leakages and respond to wastages with appropriate planning. Getting the most out of current resources is possible through proper administration, good implementation and a well-established monitoring system for healthcare initiatives.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283193PMC
April 2020

Correction to: Health-related quality of life measured using the EQ-5D-5 L: population norms for the capital of Iran.

Health Qual Life Outcomes 2020 05 21;18(1):147. Epub 2020 May 21.

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Poursina Ave, Tehran, 1417613191, Iran.

An amendment to this paper has been published and can be accessed via the original article.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12955-020-01397-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243323PMC
May 2020

Health-related quality of life measured using the EQ-5D-5 L: population norms for the capital of Iran.

Health Qual Life Outcomes 2020 Apr 25;18(1):108. Epub 2020 Apr 25.

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Poursina Ave, Tehran, 1417613191, Iran.

Objectives: EQ-5D is the most commonly used generic preference-based health-related quality of life (HRQoL) measure. The current study aimed at estimating the HRQoL index scores using EQ-5D-5 L measure in the capital of Iran; moreover, identifying some determinants of the HRQoL.

Methods: A sample of 3060 subjects was selected by a stratified random sampling method from the general adult population of Tehran. Face-to-face interview was conducted to fill out the questionnaire, in this cross-sectional survey. EQ-5D-5 L utility score were estimated using an interim value set, based on a crosswalk methodology. Additionally, the relationships between HRQoL and sociodemographic characteristics were tested by generalized linear model, using STATA version 13.

Results: The mean ± standard deviation utility and EQ-VAS scores were 0.79 ± 0.17 and 71.72 ± 19.37. The utility scores ranged 0.61 ± 0.19 in > 69 year-old females to 0.88 ± 0.12 in < 30 year-old males. In mobility, self-care, and usual activity dimensions, most of the respondents reported "no problems" (70.47, 90.62, and 76.34%, respectively). However, in anxiety/depression and pain/discomfort dimensions, most of the respondents had problems (53.23 and 54.03%, respectively). Females had lower utility score than males; the utility score reduced with age increase; the educational level lead to higher utility scores; and the utility scores of individuals without spouse (divorced or widowed) were lower than those of the married individuals and never married ones.

Conclusions: The current study reported HRQoL norm data for the general adult population in the capital of Iran; these data could be very useful for policy making and economic evaluations. A significant percentage of people in Tehran reported anxiety/ depression, which highlights the risk of psychological problems. Effective interventions are needed to increase their HRQoL, especially for the vulnerable groups of the community.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12955-020-01365-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183694PMC
April 2020

Cost Effectiveness of Mobile versus Fixed Computed Tomography and Magnetic Resonance Imaging: A Systematic Review.

Iran J Public Health 2019 Aug;48(8):1418-1427

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Mobile technologies are widely used in healthcare. The purpose of this study was to compare the effectiveness and cost-effectiveness of fixed computed tomography (CT) and magnetic resonance imaging (MRI) with the mobile ones.

Methods: In this systematic review, PubMed, Cochrane Library, Scopus and CRD database were searched from 1995 to 2015. The data on safety and effectiveness of technologies were extracted from included studies. Because the review showed no significant differences in the performance of mobile CT and MRI compared to the fixed ones, then a cost minimization approach was used to explore the cost-effectiveness of three scenarios.

Results: Twenty two articles were included in the review that showed no statistically significant differences in the performance of mobile MRI and CT scan compared to the fixed ones. The cost minimization approach showed that the third scenario based on purchasing a common mobile MRI and CT scan; and using it by two or more hospitals that are in rational distance from each other is associated with the lowest costs, so it is the most cost-effectiveness strategy.

Conclusion: The performance of Mobile CT and mobile MRI is comparable to the fixed ones; and using a combined mobile CT and MRI by two or three hospitals is the most cost-effective approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145907PMC
August 2019

Perceived gaps in early childhood development-related health policies in Iran: Findings from a qualitative exploratory study.

Med J Islam Repub Iran 2019 23;33:146. Epub 2019 Dec 23.

Population, Family and School Health Office, Ministry of Health and Medical Education, Tehran, Iran.

Early childhood development (ECD) refers to physical, cognitive, emotional, and social development between 0 and 8 years. The aim of this study was to identify the gaps in ECD-related upstream and health policies in Iran. This qualitative study consisted of 2 main methodologies. First, a document analysis of heath and upstream policies related to ECD in Iran was done. Second, following a purposive sampling approach, 24 semi-structured interviews were conducted with policymakers, managers, academics, and service providers in the field of children health from October 2017 until June 2018 in Tehran, Iran. Also, a mixed approach was used for content and thematic analysis of the data. In this study, 3 categories of gaps and weaknesses were found: (1) the inferior position of ECD in macro policies and lack of health considerations in upstream social development policies; (2) the imbalance approach to policymaking in health, lack of attention to removing inequalities, and centralized policymaking; (3) lack of effective ECD interventions and programs with regards to contextual considerations to improve children's development, and long-standing ignorance of developmental policies for 3-8 year-old children. ECD is a fundamental policy approach for childhood development, which requires the policymakers' deep insight to shift their focus from physical development to combating the shortcomings in children's development cycle, eg, physical, mental, social, emotional, cognitive, and spiritual aspects. Unless policymakers change their approach to decrease nonintegrated and noncomprehensive policymaking for ECD, child development will be compromised, endangering the eventual sustainability of the society.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34171/mjiri.33.146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137827PMC
December 2019
-->