Evidence of High-Risk Human Papillomavirus in Esophageal Cancer in East Azerbaijan Province, Northwest of Iran

Background. Human papillomavirus (HPV) is one of the most important viral agents associated with several classes of cancers in humans. The aim of this study was to investigate HPV in esophageal cancer in the East Azerbaijan province, northwest of Iran. Methods. 140 paraffin-embedded specimens of esophageal tissues were investigated using nested-polymerase chain reaction (nested-PCR) with primer designing for the L1 region of HPV genome. According to the pathological diagnosis, the samples were divided into two groups: 70 patients with esophageal cancer EADC (n = 35) and ESCC (n = 35) as the case group and those without tumour in esophagus tissue as a control (n = 70). Results. HPV DNA was isolated from 20 (28.57%) of the 70 paraffin-embedded tissue specimens of esophagus cancer. Of these, 6 cases (17.14%) of EADC and 14 cases (40%) of ESCC were positive. In contrast, all cases of the control group were negative for the HPV genome. Sequence analysis revealed that HPV types 16 and 18 are the most frequent ones identified in this study. Conclusion. The prevalence of HPV in esophageal cancer can vary depending on the geographical location and other factors. Based on the findings of this study, HPV infection may possibly have contributed to an increased risk of esophageal cancer in a group of patients in Tabriz.

Effect of Professional Ethics Workshop on the Moral Intelligence of Prehospital Emergency Personnel in East Azerbaijan, Iran

Background: Moral intelligence is one of the several types of human intelligence. It is the ability to understand right from wrong and behave based on the value which is believed to be right. Objectives: This study was conducted to evaluate the effect of a professional ethics workshop on the moral intelligence of prehospital emergency technicians in East Azerbaijan Province, Iran, and consequently the improvement of their performance and increase in their work efficiency. Methods: In this before- and after-interventional study conducted in Tabriz University Prehospital Emergency Center, Iran, in 2020, a total of 234 participants were evaluated. The sample was collected using the Lennick and Kiel’s Moral Intelligence Questionnaire and full census method. Before the workshop, the questionnaire was completed by the participants. After the workshop, the same questionnaire was completed again. Results: The pretest and posttest scores for moral intelligence were 83.02 ± 7.33 and 83.49 ± 8.40, respectively, which showed a statistically significant difference (P < 0.05). In the three components of moral intelligence, namely consistent behaviors based on principles, values, and beliefs, persistence for the right, and responsibility for personal decisions, there were statistically significant differences (P < 0.05) before and after the workshop. Conclusions: According to the results, holding a professional ethics workshop was effective in increasing the overall level of moral intelligence, particularly in the three aforementioned components of moral intelligence. It is recommended to continue holding such workshops and improve the conditions and methods of training to increase their efficiency as much as possible.

Developing a Medical Tourism Marketing Model by a Meta-Synthesis Method

Background: Today, medical and health tourism is one of the most promising sectors in the tourism industry in the world, which has led the organizations involved ,and the countries interested in developing tourism ,to focus their attention on this aspect of the tourism industry and plan for it. Hence, the aim of this study was to design the marketing model of medical tourism using meta-synthesis method. Methods: The present study was designed as a meta-synthesis research in several stages for East Azerbaijan Province, Iran. Accordingly, after identifying the categories, concepts and marketing codes of medical tourism and evaluating its validity and reliability, the initial conceptual model of the research was formed. Out of 100 retrieved studies, 8 studies completely related to the purpose of the study were included in final analysis. In order to present the marketing model of medical tourism, the qualitative research method of meta-synthesis,s Sandlowski and Barroso (2006) was used. Results: The conceptual model in the present study consists of 5 dimensions, 10 components and 40 indicators which can show the marketing model of medical tourism. 5 main dimensions included; quality of medical and tourism services, price of medical and tourism services, development of tourism and medicine, medical and tourism facilities and equipment, and information and communication technology. Conclusion: The results of the research show that the dimensions, components and indicators extracted from the meta-synthesis method are approved by the panel of experts. The findings provide a new model and perspective on how to market medical tourism for the Iranian tourism industry, which will help managers, planners and policy makers of the healthcare system.

Incidence rate and financial burden of medical errors and policy interventions to address them: a multi-method study protocol

Medical error is one of the most critical challenges facing medical services. They pose a substantial threat to patient safety, and their costs draw attention from policymakers, health care planners and researchers. We aim to make a realistic estimation of medical error incidence and related costs and identify factors influencing this incidence in Iranian hospitals. In the first phase of this multi-method study, through two reviews of systematic reviews and a meta-analysis, we will estimate the incidence of medical errors and the strategies to reduce them. We will extract available data among 41 hospitals supervised by the East Azerbaijan University in the second phase. We will also develop a model and use a Delphi method to predict medical errors incidence and calibrate our model output using the Monte Carlo simulation. We will compare this estimation with the incidence rate based on meta-analysis results from the first phase. In the third phase, we will investigate the relationship between several factors potentially influencing medical error incidence. In the fourth phase, we will estimate costs associated with medical errors by conducting a patient records review and matching those with claims related to medical errors. In the fifth phase, we will present a policy brief related to strategies for medical errors and associated costs reduction in Iran. Our findings could benefit Iranian and policymakers in other countries to reduce medical errors and associated costs.

Effect of the Iranian Health Sector Evolution Plan Implementation Focused on the Type of Delivery on Maternal and Neonatal Health Indicators in Selected Hospitals of East Azerbaijan Province

Background: Health systems are making reforms to ensure and promote public health. Measuring the effects of reform is one way to determine its effectiveness and consequences. Objectives: This study was aimed at investigating the effect of the Iranian Health Sector Evolution Plan (HSEP) implementation with a focus on the type of delivery on maternal and neonatal health indicators in East-Azerbaijan Province. Methods: This descriptive-analytical study was conducted in 2017. The data of 800 patients were randomly selected through the dataset of eight hospitals equally in the two time periods of before and after the HSEP implementation. A researcher-made checklist was used for data extraction. Data were analyzed by SPSS version 22 using descriptive statistics, t-test, and chi-square. Results: The mean age of the mothers in both periods was 27 years. Most of the participants did not have a previous delivery and had a diploma or a lower level of education. The rate of natural childbirth increased from 34.5% (before the HSEP) to 44.2% (after the HSEP) (P < 0.05). Maternal and neonatal mortality rates decreased from 0.3 and 0.8% to 0.0 and 0.5%, respectively. Maternal and neonatal mortality and stillbirth rates were not significantly different based on the study period and type of delivery (P > 0.05). Conclusions: The findings indicated a significant increase in the rate of natural childbirth after the HSEP implementation. Maternal and neonatal mortality rates had also decreased. These results can guide policymakers in deciding whether to continue or review the reform.

Detailed reconstruction of the Iranian COVID-19 epidemic reveals high attack rates of SARS-CoV-2 in several provinces

Since the first cases of COVID-19 were reported in Qom, Iran, almost 19 months ago, the transmission dynamics across the country and the health burden of COVID-19 has remained largely unknown due to the scarcity of epidemiological analyses and lack of provincial data on the number of COVID-19 cases and deaths. For the first time, we reconstruct the epidemic trajectory across the country and assess the level of under-reporting in infections and deaths using province-level age-stratified weekly all-cause mortality data. Our estimates suggest that as of 2021-09-17, only 48% (95% confidence interval 43-55%) of COVID-19 deaths in Iran have been reported. We find that in the most affected provinces such as Qazvin, Qom, and East Azerbaijan approximately 0.4% of the population have died of COVID-19 so far. We also find significant heterogeneity in the estimated attack rates across the country with 11 provinces reaching close to or higher than 100% attack rates. Despite a relatively young age structure in Iran, our analysis reveals that the infection fatality rate gradually increased over time in several provinces and reached levels that are comparable some of the high-income countries with a larger percentage of older adults, suggesting that limited access to medical services, coupled with undercounting of COVID-19-related deaths, can have a significant impact on COVID-19 fatalities. These results also show that despite several waves of infection and high attack rates in many provinces with largely unmitigated epidemics, herd immunity through natural infection has not been achieved.