Iran health system reform plan methodology

The Ministry of Health and Medical Education of Iran, along with the country movement towards achievements of Iran's Vision 2025 put compilation of the health system reform plan on its agenda. In this article, we are trying to show the method we used for developing this plan and how this method considered the general condition of the country along with maintaining the standards of scientific and technical programs. All steps of this planning are described in the paper and finally we discuss the techniques and the appropriateness of the method compare with the experience of the other countries

Health system vision of Iran in 2025

Vast changes in disease features and risk factors and influence of demographic, economical, and social trends on health system, makes formulating a long term evolutionary plan, unavoidable. In this regard, to determine health system vision in a long term horizon is a primary stage. After narrative and purposeful review of documentaries, major themes of vision statement were determined and its context was organized in a work group consist of selected managers and experts of health system. Final content of the statement was prepared after several sessions of group discussions and receiving ideas of policy makers and experts of health system. Vision statement in evolutionary plan of health system is considered to be: "a progressive community in the course of human prosperity which has attained to a developed level of health standards in the light of the most efficient and equitable health system in visionary region[1] and with the regarding to health in all policies, accountability and innovation". An explanatory context was compiled either to create a complete image of the vision. Social values and leaders' strategic goals, and also main orientations are generally mentioned in vision statement. In this statement prosperity and justice are considered as major values and ideals in society of Iran; development and excellence in the region as leaders' strategic goals; and also considering efficiency and equality, health in all policies, and accountability and innovation as main orientations of health system

Future of health care delivery in Iran, opportunities and threats

The aim of this study was to determine the impact of important social and technological trends on health care delivery, in the context of developing "Iran's Health System Reform Plan by 2025". A detailed review of the national and international literature was done to identify the main trends affecting health system. To collect the experts' opinions about important trends and their impact on health care delivery, Focus Group Discussions [FGDs] and semi-structured in-depth interviews techniques were used. The study was based on the STEEP model. Final results were approved in an expert's panel session. The important social and technological trends, affecting health system in Iran in the next 15 years are demographic transition, epidemiologic transition, increasing bio-environmental pollution, increasing slums, increasing private sector partnership in health care delivery, moving toward knowledge-based society, development of information and communication technology, increasing use of high technologies in health system, and development of traditional and alternative medicine. The opportunities and threats resulting from the above mentioned trends were also assessed in this study. Increasing healthcare cost due tosome trends like demographic and epidemiologic transition and uncontrolled increase in using new technologies in health care is one of the most important threats that the health system will be facing. The opportunities that advancement in technology and moving toward knowledge-based society create are important and should not be ignored

[ cross sectional study on the results of participatory needs assessment in zone 17 of Tehran: three years after intervention]

Introduction: The aim of this study was to assess the effects of a previously conducted needs assessment on West Abouzar neighborhood changes after three years

Methods: This was a cross sectional study in two qualitative and quantitative parts. In the qualitative phase, we conducted semi-structured interviews to determine the types of interventions and selection criteria, and their effects on the approaches of the local headquarters. Based on the qualitative results, a questionnaire was designed in order to use in the quantitative part of the study. A total of 352 individuals selected through random cluster sampling were recruited to the study. Data were gathered by local trained individuals and were analyzed using appropriate methods

Results: The results revealed that for all identified problems, except for drug abuse and unemployment, at least one intervention was performed. Majority of interventions were constructive, while in social issues limited interventions were conducted. It was shown that 29.5% of the interventions were good in quality, 47% were moderate and 23.5% were weak. More than half of the participants [51%] stated that interventions were effective regarding their quality of life; however, they expected more influential interventions. A total of 21.1% of respondents believed that the interventions were relatively effective; 11.1% reported that the interventions were very effective; and 17% stated that the interventions had no effect on their lives

Conclusion: Participatory needs assessment and conducting interventions based on the local needs are effective approaches to resolve health-related problems

Correlation between anxiety in labor and duration as well as outcome of delivery in women attended to hospitals affiliated to Shahid Beheshti Medical University and Shahid Akbar Abadi Hospital

Delivery is a stressful event. It seems that the cervix of an anxious woman does not dilate easily. The purpose of this study was determine the correlation between anxiety during labor and duration as well as outcome of delivery in women referring to hospitals affiliated to Shahid Behshti Medical University and Shahid Akbar Abadi Hospital. A descriptive correlational design was used. 200 women were selected via a multistage quota sampling in each hospital. A demographic and obstetrical questionnaire, Spielberg's State Trait Anxiety Inventory, and a checklist regarding the condition of the parturient women during hospitalization, duration of labor as well as delivery and Apgar score of the neonate were used for data collection.Data were analysed' using SPSS 16 statistical software. most women experienced moderate anxiety [%53/5].Mean of total time of delivery was 250/87 +/- 150/34 minutes,%94/5 was normal delivery and the mean of apgar score in first minute was 9 and in 5 minute was 10. No significant correlation was found between anxiety in labor room and duration [first, second and third stage] as well as outcome [type and Apgar score] of delivery. Since most women experienced moderate anxiety, midwives and other healthcare workers should consider psychological aspects of mothers in labor rooms and make the atmosphere of these placed favorable addition, preparative educational courses during pregnancy is needed

[Callus distraction by a distractor device for lengthening of short bones of hand and foot]

This study is performed to evaluate the results of lengthening of the fingers or congenitally short phalanxes, metacarpal and metatarsal bones by callus distraction technique. In this study we used a newly designed callus distraction device which is simple, reliable and easy to use. This study included 46 patients, 20 females and 26 males with short bones of hands or feet. The mean age of the patients was 17 years [age range 4-23 years]. 67% of our patients had traumatic amputation of fingers or toes. The mean duration of follow up of the patients was 56 months. The mean length of metacarpal, phalangeal and metatarsal bones before surgery was 31 mm [range 30-35 mm]. The mean bone length increase after surgery was 16 mm [range 15 to 27 mm] i.e. more than 50% of the bone length. Mean healing index ratio was 5.53 days/millimeter. No bone graft was required after bone lengthening. Complications were, pin tract infection in 2.5%, hypertrophic scar on the dorsum of foot in 8.5%, neurovascular complications in 1%, reversible stiffness in joints in 9.5% and bone pain in 12% of the patients. Callus distraction is an effective and reliable method for lengthening of short phalangeal, metacarpal and metatarsal bones. It also preserves the periosteal bone tissue. Our distractor device is reliable and highly effective for callotesis

[Evaluation of maxillofacial injuries in sportswomen participated in martial art champion ship in Iran in 2003]

As the martial sports are in fully contact group of sports, this makes the athletes worry about the injuries, specially in the sportswomen. The martial arts are special because they are one of the only group of sports that women can take part in international championships. Our main objective in this study was to determine the frequency of maxillofacial injuries among the female athletes participating in championship competitions of martial arts. Also injury type and locations of injuries in three popular forms of these sports [tae kwon do, judo and karate] were studied and compared in order to find the best ways to prevent these injuries. In a cross sectional study, all injuries were registered by the medical delegate of the competitions in a well designed questionnaire regarding personal information, dental, skeletal and soft tissue injuries. The championships were held in Kerman, Shahrkord, and Karaj. Among 938 athletes participated [170 in tae kwon do, 507 in karate and 261 in judo], overall 14 athletes had trauma [The total number of injuries were 20]. Most injuries occurred in karate competitions. There were no injuries in judo. Most injuries occurred in soft tissue. No dental injuries were seen. Skeletal injuries included two cases of dislocation and two cases of fracture. Soft tissue injuries included 11 cases of hematoma, 3 cases of scratch and 2 cases of laceration [12 cases in karate and 4 cases in tae kwon do]. Maxillofacial injuries are low risk injuries in martial sports. We recommend that dental and medical examinations be done before matches. The results in this study emphasize on the correct use of face and mouth guards