Key factors in the future of oral and dental health in Iran using scenario writing approach.

BACKGROUND: Oral and dental health can significantly impact individuals' quality of life. The World Health Organization introduces oral health as one of the essential priorities of public health worldwide. Given the lack of studies on the future of oral and dental health in Iran, this study used a futures studies approach to identify the factors in oral and dental health in Iran through scenario writing. METHODS: This study was conducted in three stages including the scenario writing approach, qualitative methods, and exploratory future research. First, potential variables affecting future oral and dental health systems were extracted through interviews. The focus group discussion determined the uncertainty and importance of the variables. Then, the cross-impact balance matrix was imported into the Scenario Wizard software to identify the different states of the scenario generator variables and compatible scenarios were extracted. RESULTS: Seventy variables were extracted as key variables affecting the future of oral and dental health. Regarding the importance and uncertainty, seventeen variables scored higher and fell into policy and governance, economy and financing, social, service delivery, and technology, serving as five categories of scenario generators. Fifteen scenarios with weak consistency and three with strong consistency were obtained using the Cross-Impact Balance matrix in Scenario Wizard software. CONCLUSION: The probability of a pessimistic scenario where all five categories of the scenarios were in the worst possible state was higher due to its consistency. The government's support policies and commitment to oral and dental health were two key factors in the future. Achieving an optimistic and favorable scenario for the future of the country's oral and dental health system depends on the government and policymakers in the health sector adopting a positive attitude towards the role of oral and dental health services in improving societal health. In this scenario, the five categories of the scenario generators were in the best condition.

Application of Policy Analysis Models in Oral Health Issues: A Review.

INTRODUCTION: Oral health is a complex interaction that contains factors such as disease status and physiological and psychosocial properties. Because of complexity of the health system, policymakers should find some ways to simplify the relations to increase the chance of understanding the conditions, values, and ideas behind it. Policy learning could be built on the appropriate policy models application corn stone. The aim of this study was to answer this question that what policy models were applied in oral health policy studies and what oral health policy issues were analyzed by policy models. MATERIALS AND METHODS: A systematic review was conducted across international electronic databases (PubMed, ISI Web of Knowledge, and Scopus) with no time limitation and using prearranged keywords. All publications such as articles and thesis were included. Searched terms were selected based on frequent health policy model components and an initial search. Search strategy based on each data base instruction was applied. RESULTS: Eight models or frameworks were applied in total. Most of these models were focused on process stage of oral health policy making. Five main themes such as the role of stakeholders in oral health policy making, assessment of oral health system, oral health policy development, the process of oral health policy making, and oral health policy learning and capacity building were synthesized. CONCLUSION: Oral health policy issues could be analyzed more comprehensively, and researchers could be guided by applying policy models and frameworks to answer policy-learning questions. Application of models and frameworks should be based on the nature of problem and issue, and the level of problem screening is a critical point in applying appropriate model.

Geographic distribution indices of general practitioners, midwives, pediatricians, and gynecologists in the public sector of Iran.

BACKGROUND: Health workforce distribution is so important in access posture, coverage and equity. Following millennium development goals (MDGs), special attention to health workforces in relation with maternal and child health is required. OBJECTIVE: The aim of the current study was to determine distribution of maternal and child health related workforces in Iran during 2010-2012, using inequality measures. METHODS: In this cross-sectional study, data about the number of physicians and midwives obtained from Ministry of Health reports and demographic statistics were obtained from the Statistical Center of Iran. Gini coefficient and Robin Hood index were calculated in terms of population ratio, need adjusted index for birth (NAIB) and need adjusted index for mortality (NAIM). For calculations, DAD software version 4.6 was used. RESULTS: Gini coefficient was reduced for general physicians (GPs) and pediatricians, and had increasing and decreasing trends for gynecologists. For achieving equality within provinces, the number of transferable health workforces was more than 1 person per 10 health workforces. CONCLUSION: Health workforce distribution had various trends in Iran. Special attention to deprived provinces is required. Most of the reduction in Gini coefficient is due to the increase in health workforce in developing provinces, and deprived provinces still have serious problems. The health system could achieve better equality by considering deprived provinces and using Gini coefficient and Robin Hood index together.

Development and validation of a questionnaire to evaluate the state of Iranian hospital nutrition support.

BACKGROUND: Recently, nutrition support was implemented as a part of clinical services in hospitals. The implementation of nutrition support needs to be assessed for its improvement. OBJECTIVE: This study aimed to develop and validate a questionnaire to assess the state of nutrition support in Iranian hospitals. METHODS: A mixed method approach was used in this study. This study was performed in training hospitals of Iran in 2016. In the development stage, pre-determined keywords were searched on international electronic databases. Additionally, semi-structural interviews were performed with 13 key informants based on purposive sampling. Themes were extracted from articles and interviews by thematic analysis. A primary questionnaire was generated based on extracted themes. In the validating stage, the content validity ratio (CVR) and content validity index (CVI) were used. The reliability of the questionnaire was also computed through a pilot study using Cronbach's alpha test. SPSS version 16.0 was used for data analysis. RESULTS: Based on 16 items elicited from the content analysis, 110 questions were generated, out of which, 65 questions were selected. Then, 55 questions showing acceptable CVI and CVR were chosen for the pilot study. The Cronbach's alpha coefficient of the questionnaire was found to be 0.80. This value remained stable for each item, even after an item was deleted. CONCLUSION: For the first time, a validated questionnaire for the assessment of the state of nutrition support in hospitals was developed in a methodological approach process with high validity and reliability indexes which intended to be comprehensive based on the mixed method approach.

Comparison of esthetics perception and satisfaction of facial profile among male adolescents and adults with different profiles.

OBJECTIVE: To evaluate esthetics perception and satisfaction of the facial profile among Iranian male adolescents and adults. MATERIALS AND METHODS: In this cross-sectional study, male subjects referred to Orthodontic Department of Mashhad Dental School were enrolled (n = 84) and were divided into two groups: Adolescents (n = 39), and adults (n = 45). They were also assigned to straight, convex, or concave profile groups based on the facial profile angle (G-Sn-Pog'). An ideal silhouette of the lower facial profile was designed in Adobe® Photoshop® CS2 software (Kansas, USA). Then, eight other silhouettes representing different relations of the maxilla and mandible were constructed. Patients were asked to use numbers 1-10 to rank the facial profiles in the order of the attractiveness, and choose a silhouette that best closely resembled their own profile. Moreover, using a questionnaire patients were asked to rank their satisfaction with their profile, and asked to assign a number (1-5) to each question as follows; one represented the least satisfaction, while five reflected the highest satisfaction. RESULTS: Adult and adolescent subjects with straight (adults: 12.0 ± 1.9, adolescents: 12.8 ± 1.05) and concave (adults: 10.0 ± 2.14, adolescents: 10.0 ± 2.08) profile showed the highest and the least satisfaction with their own profile, respectively. Both adult and adolescent group selected "retrognathic maxilla, prognathic mandible" as the least attractive profile. Overall, "straight" and "bimaxillary dentoalveolar retrusion" were chosen as the most attractive silhouettes in adolescent and adults, respectively. In comparison to a professional opinion (clinician ranking), 42.9% of adolescents and 22% of adults were able to correctly diagnose their own profiles type. CONCLUSION: Most of the male adolescents and especially adults diagnosis of their own profile differed with a professional assessment.

Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study.

BACKGROUND: Previous research has shown that Ramadan fasting has beneficial effects on cardiovascular risk factors, however there are controversies. In the present study, the effect of Ramadan fasting on cardiovascular risk factors has been investigated. METHOD: This is a prospective observational study that was carried out in a group of patients with at least one cardiovascular risk factor (including history of documented previous history of either coronary artery disease (CAD), metabolic syndrome or cerebro-vascular disease in past 10 y). Eighty two volunteers including 38 male and 44 female, aged 29-70 y, mean 54.0 ± 10 y, with a previous history of either coronary artery disease, metabolic syndrome or cerebro-vascular disease were recruited. Subjects attended the metabolic unit after at least 10 h fasting, before and after Ramadan who were been fasting for at least 10 days. A fasting blood sample was obtained, blood pressure was measured and body mass index (BMI) was calculated. Lipids profile, fasting blood sugar (FBS) and insulin, homocysteine (hcy), high-sensitivity C-reactive protein (hs-CRP) and complete blood count (CBC) were analyzed on all blood samples. RESULTS: A significant improvement in 10 years coronary heart disease risk (based on Framingham risk score) was found (13.0 ± 8 before Ramadan and 10.8 ±7 after Ramadan, P <0.001, t test).There was a significant higher HDL-c, WBC, RBC and platelet count (PLT), and lower plasma cholesterol, triglycerides, LDL-c, VLDL-c, systolic blood pressure, body mass index and waist circumference after Ramadan (P <0.05, t test). The changes in FBS, insulin, Homeostasis Model Assessment Insulin Resistance (HOMA-IR), hcy, hs-CRP and diastolic blood pressure before and after Ramadan were not significant (P >0.05, t test). CONCLUSIONS: This study shows a significant improvement in 10 years coronary heart disease risk score and other cardiovascular risk factors such as lipids profile, systolic blood pressure, weight, BMI and waist circumference in subjects with a previous history of cardiovascular disease.