Elaboration of a Framework for Assessment of IT-based Interventions in the Field of Autism Disorder

Background and Objectives Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder in which individuals have difficulty in emotional processes related to social cognition and other behavioral patterns. The use of technology in therapeutic and educational interventions for people with ASD - who face ongoing challenges - is increasing. Therefore, to select the interventions more appropriately and ensure their effectiveness, such interventions need to be evaluated. Thus, this study is an attempt to develop a framework for evaluating IT-based interventions in people with ASD. Material and Methods The present study is a descriptive-applied study examining the information technology-based intervention studies in the field of ASD. The search and review of studies continued without any restrictions until an appropriate and complete framework of interventions was obtained. The required data were extracted and collected in a table focusing on the evaluation of ASD interventions. The data were then analyzed to determine an appropriate framework for the objectives of the study. Finally, the evaluation framework was prepared using the one-step Delphi method and sent to 15 experts in the field of autism and health information technology to obtain their views on changing, modifying, approving the framework. Results In the framework developed in this study, two aspects of the interventions including the type of information technology interventions and their outcome are generally presented. . Moreover, the technologies used were presented from three main aspects: evaluation methods, technical evaluation cases, and clinical evaluation cases. Conclusion The results revealed that technology-based interventions in the treatment, education and increasing social interactions of people with ASD can be of tremendous help and bring about significant effects. Therefore, according to experts, the prepared assessment framework of interventions based on information technology leads to identifying the strengths and weaknesses of interventions, improving technologies as well as choosing appropriate interventions and ultimately increasing the quality of life of people with autism spectrum disorder. Extended Abstract Background and Objectives Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder in which individuals have difficulty in emotional processes related to social cognition and other behavioral patterns. The use of technology in therapeutic and educational interventions for people with ASD - who have ongoing challenges - is increasing. Technology-based interventions have demonstrated a variety of skills for people with autism, including the ability to initiate, maintain or end behavior, recognize emotions, improve functional activities of daily living, learn vocabulary, and reading skills. The unique appeal of electronic technology to children and adolescents with autism has greatly motivated their use in clinical and medical services, education and social communication. Therefore, to select interventions better and ensure their effectiveness, they need to undergo an evaluation. Thus, this study develops a framework for evaluating IT-based interventions in people with ASD. Material and Methods The present study is a descriptive-applied study that examines the information technology-based intervention studies conducted in Iran and the world in the field of ASD. The data were extracted from Databases including Pubmed, Scopus, Science Direct, Embase, Google scholar, SID, Web of Science, Magiran without any time limitation. The search continued until a complete framework of IT-based interventions was obtained. The data collection tool for data extraction was a table containing items with a focus on evaluating interventions in the field of aASD, which examined any type of technology used in the intervention of people with ASD from two perspectives: evaluation method of intervention and technical and clinical cases. The required data were extracted and collected in a table focusing on the evaluation of ASD interventions. In the third step, the extracted data were examined to determine the appropriate framework for the objectives of the study in two aspects, including the type of interventions based on information technology and the outcome of the interventions. Also, based on the objectives of the study, the technologies were evaluated from three main perspectives including evaluation methods, technical evaluation cases, and clinical evaluation cases. Finally, the prepared evaluation framework was sent to 15 experts in the field of autism and health information technology to get their opinions on changing, modifying, or approving the framework. After obtaining the cooperation of these people through the informed consent form, the opinion poll was conducted in 1 stage of Delphi method by e-mail. In general, the results showed that the most common IT-based interventions used in the field of autism included virtual reality, mobile phones, serious games, telemedicine, robots, respectively, wearable technologies, computer technologies, video conferencing and music integration technologies. Each of these technologies was used to achieve specific goals. The most important clinical goal in the interventions of patients with autism is to improve their social interaction. It is also important to improve educational skills and their performance and duties. The use of technology is very valuable and effective in removing barriers to patients’ access to the required health interventions. The least common use of IT-based interventions is to achieve the goal of creating a business for patients. Evaluation of IT-based interventions is very important in order to determine the effectiveness of each and select the appropriate intervention. Various methods are used to evaluate interventions. Based on the findings of the study, observation and interview were found to be the most commonly used assessment method used to evaluate almost all technologies while the least commonly used methods for evaluating interventions were related to the specific method of each. Evaluation of IT-based interventions was conducted from two perspectives, which included the evaluation of the technical cases of the technology used and the evaluation of the clinical cases of technology-based interventions. From the point of view of clinical evaluation, the greatest emphasis of the interventions was related to the improvement of communication skills, and from the aspect of technical evaluation, the greatest emphasis was related to the confidentiality and privacy of individuals. Conclusion According to the results, technology-based interventions in the treatment, education and increasing social interactions of people with ASD can be of enormous help and bring about significant gains. According to experts, the prepared assessment framework of interventions based on information technology can lead to identifying the strengths and weaknesses of interventions, improving technologies as well as choosing appropriate interventions and ultimately increasing the quality of life of people’ with autism spectrum disorder. Therefore, given the effectiveness of information technology-based interventions in the recovery of patients with autism, it is better to increase their use in the treatment of patients. Based on the framework prepared in this study, the evaluation of these interventions was done properly, in fact, different aspects of the evaluation were considered to ensure their correct evaluation. As a result, proper evaluation may lead to improving the quality of the technologies used. In addition, medical professionals can easily select the most appropriate intervention using this framework. Practical implications of research One of the practical consequences of the present study is to increase the precision of the specialists in selecting an intervention based on appropriate technology to treat patients with autism. Therefore, autism specialists would benefit from the use of the framework presented in this study in the selection of the most appropriate technology. Ethical considerations This article has been licensed by the Ethics Committee of Tabriz University of Medical Sciences with ethics code IR.TBZMED.REC.1398.704. Also in the present study, researchers are trustworthy in the use, presentation and publication of scientific materials and all the rights of researchers have been observed. Conflict of interest The authors of this article hereby declare that they have no conflict of interest with each other. Acknowledgement The authors of this article would like to thank all the experts and specialists participating in this research and all the collaborators who contributed in any way tothe implementation of this research.

Correlation between Creativity and Entrepreneurial Skills in Managers of Educational Hospitals

Background and Objectives The aim of this study was to investigate the correlation between creativity and entrepreneurial skills in health system managers of the educational hospitals. Material and Methods This research is descriptive-analytical and applied in terms of purpose. The study population includes the managers of teaching hospitals in Ahvaz, south west Iran. The data was collected by census method from 110 senior and middle managers by validated questionnaire. Data were analyzed using absolute and relative frequency, mean, standard deviation, independent samples t-test, ANOVA, Pearson correlation coefficient and stepwise linear regression in SPSS software version 22. Results The mean score of creativity for managers was 44.74 7.91. 64.6% of the managers were highly creative and 35.4% of them were considered relatively creative. The average score of entrepreneurial skills of managers was 3 0.67 and was estimated to be appropriate. The correlation between creativity and entrepreneurial skills was 0.645, which showed a positive and strong relationship between these two variables (P <0.001). Simple linear regression showed that managerial skills among entrepreneurial skills determine 44.4% of creativity (P <0.001). Conclusion It is suggested to strengthen the level of managerial skills among managers by training courses Extended Abstract Background and Objectives Since creativity is assumed to be the mainstay of the spirit of entrepreneurship, thereforeit is necessary due measures be taken to establish the degree of creativity of health managers if one is to have any reasonable hope of developing enterepreueship in healthcare organizations. One way to do so might be to assess health managers’ creativity and determine if there is a correlation between their creativity and entrepreurship. Therefore, this study aimed to investigate the correlation between creativity and entrepreneurship skills among managers of educational hospitals in Ahvaz. Material and Methods This research was descriptive-analytical and applied in terms of purpose. The present research population consisted of managers of educational hospitals in Ahvaz city and data were collected by census method from 110 senior (management, metrons, educational assistants of hospitals) and mid-level (Supervisors, Head Nurses, Service Officers, Heads of Finance and Administration, Laboratory and Radiology Officers) managers through a questionnaire. In this study, two questionnaires were used: the Creativity Questionnaire, developed by Dorabjee et al., and the Smith Entrepreneurship Skills Questionnaire. The former consists of 12 five-point Likert scale items indicating the extent of the organization's support for creativity while the latter consists of 16 questions summarized in four components with each component having four questions. The validity of the questionnaire was confirmed in accordance with professors’ and experts’ opinions. The reliability of the questionnaires was estimated using Cronbach's alpha coefficient, which was 0.83 and 0.88 for for creativity questionnaire and entrepreneurial skills questionnaire, respectively. Data were analyzed using absolute and relative frequency, mean, standard deviation, independent samples t-test, ANOVA, Pearson correlation coefficient and stepwise linear regression in SPSS software version 22. Results The mean score of creativity for managers was 44.74±7.91. 64.6% of managers were found to be very creative and 35.4% were relatively creative. The mean score of managers' entrepreneurship skills was 3±0.67 which was considered at an appropriate level. Pearson correlation coefficient was estimated -0.27 (P=0.017) between age and creativity and-0.31 (P=0.04) between work experience and creativity indicating a small size and negative correlation between the former variables and a moderate and negative correlation between the latter ones. Likewise, Pearson correlation coefficient between age and entrepreneurial skills was calculated -0.28 (P=0.01) pointing to a small size and negative correlation between these two variables. As for the correlation coefficient between work experience and entrepreneurial skills was -0.32 (P=0.005) showing that these two variables have a moderate negative correlation. However, creativity and entrepreneurial skills were found to be positively and strongly correlated (r= 0.645, P<0.001). Simple linear regression showed that managerial skills among entrepreneurial skills come to determine 44.4% of creativity (P<0.001). Conclusion Managers of Ahvaz teaching hospitals were found to possess the required level of creativity and entrepreneurial skills as measured by the research tools in the present study with the creativity component showing a strong correlation with entrepreneurial skills. Management skills might be the most important indicators of creativity among hospital managers, it is suggested the barriers to creativity in the organization be removed, a financial system be formulated to encourage entrepreneurs, support creativity and innovation in the organization by formulating the necessary policies and guidelines, as well as holding classes and training courses to strengthen management skills among managers. Also, given the negative correlation between age/work experience on the one hand, and creativy/entrepreneurial skills on the other, it seems reasonable that due measures had best be taken to pave the way for the younger generation taking on managerial responsibilities. Practical implications of research The findings of the present study seem to point toa strong and significant relationship between creativity and entrepreneurial skills. Therefore, appropriate training programs should be designed and implemented to increase the creativity of hospital managers. Also, due to the high level of creativity and entrepreneurial skills of the managers of educational hospitals in Ahvaz, the trustees should take action to provide the best possible conditions for benefiting from this capacity. Ethical considerations Observance of ethical instructions: This study is based on the protocols of the ethics committee in the research of Ahvaz Jundishapur University of Medical Sciences with the code of ethics number IR.AJUMS.REC.1399.269 and also the study was conducted with the consent of the statistical population of the study. Conflict of interest The authors state that there is no conflict of interest in the present study. Aknowledgment This research has been done with the financial support of the Student Research Committee of Ahvaz Jundishapur University of Medical Sciences with the number 99S27. The authors are grateful to all the directors who participated in this study.

The Role of Exercise and Physical Activity against COVID-19: A Narrative Review Study

The aim of this study was to understand the role of sport on covid-19 through reviewing the published literature. This was a narrative review that used valid keywords for searching the related scholarly articles. The search for the related keywords on Pubmed, Scopus, Science Direct library and Google Scholar lead to 1158 articles in 2020. After screening 28 article found eligibility to be inclouded in the review. The result indicated that physical activity and exercise play a role in preventing novel coronavirous infection and strengthening the immune system againt the covid-19. Extended Abstract Background and Objectives Since COVID-19 virus is an unknown virus which has caused alarming death toll over the past year, researchers felt implelled to take measures through doing extensive research studies in a variety of related fields to control the virus. On the other hand, exercise is known as a useful non-pharmacological method to improve the function of the immune system, so researchers in the field of sports science have done valuable research studies in this research domain, albeit limited, which can provide us with valuable information in this regard. Hence, there is a pressing need to collect and categorize these latest findings. Therefore, the very aim of this study was to review literature on the role of exercise and physical activity against the COVID-19. Material and Methods This was a narrative review, the data was collected through searching and reteriving available articles published in information resources like Medline (PubMed), Scopus , Science Direct collection, and also Google Scholar. The keywords employed for search strategy building included: "Exercise Training", "Physical Activity", "Aerobic Exercise", "Interval Training", "Resistance Training", "Endurance Training", "COVID-19", "novel Coronavirus" and "Immune System". Based on the results of our searches conducted in databases, initially 1185 articles were selected. After screening the titles and abstracts of the retrieved articles and removal of the duplicate and irrelevant ones, 59 articles were included in the reveiew stage. Then, full text of eligible articles were put underclose scrutiny which led to the final selection of only 28 articles to be studied. Results According to our review, exercise can play a role in different ways against COVID-19 diseases and novel coronavirous, which is now recognized as a global problem. These roles include preventing some underlying diseases such as hypertension, coronary artery disease and diabetes and improving immunity. Exercise lowers cortisol levels in long term, which reduces the stress induced by COVID-19, which in turn strengthens the immune system. On the other hand, doing moderate- intensity exercise can strengthen the immune system in the long run, while low-intensity or high-intensity exercise types do not bring about similar degree of adaption. Conclusion It is necessary to pay special attention to exercise training in Covid-19 pandemic period. However, it should be noted that due to the novelty of this phenomenon, limited research has been done in this area to date and more research studies are required to be done in this regard. Practical implications of research It is best for people to stay home during Covid-19 pandemic period and to have 150 minutes of moderate-intensity regular exercise during the week to boost their immune system. Ethical considerations In this review research, the ethical issues of research and fiduciary have been observed. Conflict of interest We have no conflicts of interest to disclose. Acknowledgment No sources of funding were used to assist in the preparation of this article.

Investigating the most Important Advantages, Disadvantages and Obstacles of Public-Private Sector Partnership in Providing Primary Health Care Services from the Viewpoint of Health Managers

Background and Objectives Public-private partnerships can lead to increased efficiency, equity, accountability, quality and access to services in the health system. The aim of this study was to explore the opinion of health system managers about the advantages, disadvantages and barriers of public-private partnership in the provision of primary health care services. Material and Methods We used both quantitative and qualitative methods to explore the opinion of experts about the objectives of the study. First of all a literature reviewe was done to identify the problems and challenges of public-private partnership in health sector in year 2020. Based on the literature review and interview with experts a two-part questionnaire was built to collect data. The sample for interview was selected by snowball method until saturation was reached. After validity and reliability, the questionnaire was completed by 100 health managers. The collected data were analyzed using Stata software version 14. Results The most important benefits of public-private partnership in providing primary health care services from the point of view of health managers include providing financial resources for health services plans with an average of 4.02 (SD 1.00) , as well as the high technical and managerial efficiency in the private sector with an average of 3.90 (SD 0.60). Lack of full coverage of primary health care services and incomitment to social justice with an average score of 3.99 (SD 0.92) as well as the inadequate job security of human resources in the private sector with an average score of 3.97 (SD 0.9) were known as the most important disadvantages of partnership of public-private. It was revealed that that the major barriers hindering public-private partnership in service delivery include "legal, and monitoring shortcomings alongside hampering rules and regulations in partnership with the private sector" with a mean score of 4.06(SD 0.60), "reluctance of health managers for risk-taking when in partnership with the pivate sector "with a mean score of 4.05 (SD 0.61) and" Insufficient expertise of government managers regarding knowledge of partnership with the private sector "with a meaan score of 4.04 a(SDf 0.53). Conclusion It seems that managers' attention to the disadvantages of partnership, such as lack of full coverage of services and withdrawal from social justice, etc., can pave the way for developing much clearer and smoother public-private sectors’ partnerships. Extended Abstract Background and Objectives Partnership with the private sector is one of the most important pillars of health system reform in all over the world. Public-private partnerships can lead to increased efficiency, equity, accountability, quality and access to health services. The aim of this study was to investigate the views of health managers about the advantages, disadvantages and barriers of public-private partnership in the provision of primary health care services. Material and Methods In the present study, a mixed method (quantitative-qualitative) was adopted to achieve the research objectives. In order to prepare the questions of the public-private partnership questionnaire in providing primary health care services, the views and opinions of experts experienced in the fields of public health care, public-private, managerial and executive participation were were sought and incorporated into the researcher's assumptions. For this purpose, semi-structured interviews developed and conducted with a number of specialists working in the field of primary health care. Finally, the main themes of the questionnaire were drafted in 3 sections: advantages (8 questions), disadvantages (9 questions) and obstacles (18 questions) the grading of the questionnaire was determined on a 5-point Likert scale ranging from completely agree, to completely disagree. The content validity and face validity of the questionnaire were assessed through interviews with experts. The results of validation showed that the questionnaire has sufficient validity for being employed in the studies related to the subject under study.The quantitative part of the study was also conducted in two phases. In the first phase,based on the validation results of the questionnaire, the overall content validity of the questionnaire was assessed through CVR (content validity ratio) and CVI (content validity index) both of which were estimated 90%, and the reliability of the questionnaire was measured using Cronbach's alpha which was estimated to be 0.83. In the second phase, the population of the satudy was selected through convenient sampling method for data collection. The study population consisted of senior and mid-level managers who had managerial experience providing health services in public and private sectors in Tehran.. The data obtained from 100 questionnaires completed officially and in person by the participants were included in the data analysis. The mean and standard deviation of the scores for the sections of the questionnaire were estimated separately. The collected data were analyzed, using Stata 14 at confidence level of 0.95. Results The results of the first part of the study found the highest score to belong to the benefits of public-private partnership in the provision of primary health care services, including three cases of "financing of public partnership projects in primary health care" with a meanof 4.02 and standard deviation of 1/00, "High technical and managerial efficiency in the private sector" with mean of 3.89 and standard deviation of 0.60 and "Increasing the quality of primary health care services in the private sector through fair competition" with a mean of 3.87 and standard deviation 0.57 . "Low cost of services in the private sector" received the lowest score in this sector. The findings of the second part of the study showed that the three most important disadvantages assiciated with public-private partnership for providing primary health care services include "lack of full coverage of primary health care services and ignoance of social justice" with a mean score of 3.99 and standard deviation of 0.92, "inadequate job security in the private sector" with the mean score of 3.97 and standard deviation of 0.9 and "insufficient government supervision of private sector performance" with a mean score of 3.95 and standard deviation of 0.79,. "Lack of financial protection of private service recipients" was given a minimum score. The findings of the third part of the study revealed that the three major obstacles hindering public-private partnership in service delivery include "legal, and monitoring shortcomings alongside hampering rules and regulations in partnership with the private sector" with a mean score of 4.06 and a standard deviation of 0.60, "reluctance of health managers for risk-taking when in partnership with the pivate sector "with a mean score of 4.05 and standard deviation of 0.61 and" Insufficient expertise of government managers regarding knowledge of partnership with the private sector "with a meaan score of 4.04 and standard deviation of 0.53. Conclusion The results of this study show that the financing of participatory projects in the primary health care sector by the private sector and also the positive performance of the private sector compared to the public sector as the most important benefits of partnership can provide opportunity to develop primary health care services. It seems that managers' attention to the disadvantages of partnership, such as lack of full coverage of services and withdrawal from social justice, etc., can pave the way for developing much clearer and smoother public-private sectors’ partnerships. Recognizing the barriers to public-private sector participation, such as legal, regulatory barriers, lack of expertise of public managers in knowledge of participation, lack of risk-taking of managers in the public sector, etc. can make the removal of barriers more visible. Practical implications of the research By removing legal barriers, focusing on the benefits of public-private partnerships, and creating healthy competition, the government can enable the private sector to participate in the provision of health services. The transfer of services to the private sector and its participation, and alsothe reduction of entrepreneurship can create a opportunity for the quantitative and qualitative development of primary health care services. Ethical considerations This article is taken from thePhD dissertation with code 14121213972004 and ethics ID IR.SBMU.RETECH.REC.1399.832, and ethical considerations, human and ethical principles have been observed based on the Helsinki Declaration. Conflict of interest The authors state that this work is the result of an independent study and has no conflict of interest with other organizations and individuals. Aknowledgement This study is taken from a specialized PhD dissertation in the Department of Health Services Management, Faculty of Management, Islamic Azad University, South Tehran Branch. All participants in the study, including senior and mid-level managers working in the Deputy of Health in the Ministry of Health and Medical Education, the Deputy of Health at Shahid Beheshti University of Medical Sciences, Tehran University of Medical Sciences and Iran University of Medical Sciences, are appreciated for completing the questionnaire and cooperation in designing the questionnaire.

The Establishment of a Clinic for Personality Modulation in Iran: A Novel Approach in Personality Psychiatry with a Dimensional Approach

Mental health and treatment approaches have indeed garnered attention in health care. Treatment approaches have shifted from severe and chronic disorders prevalent in the past to milder disorders. Further, these approaches aid in improving performance, health, happiness, and superiority (1). To this end, new diagnostic systems have been introduced to move away from traditional approaches (i.e., stratified diagnosis and treatment) to a dimensional approach. This shift in attitude may affect major current mental health practices requiring innovative approaches, guidelines, and care to revolutionize mental health. Thus, setting up the clinic of personality modulation was inevitable as it provides educational-therapeutic services in accordance with the most up-to-date diagnostic classification system. It can also promote the growth of mental health. Even healthy people or those who pay attention to their mental growth and development can also benefit from the clinic's services. In a dimensional approach, services are provided for those who fall in the category of difficult code of personality in the new psychiatric divisions of the ICD-11. These services will lead to their personal and professional development.To compensate for the shortcomings of previous classification systems, the ICD-11 has adopted a dimensional approach, a new approach to the classification of personality disorders, in which the focus is primarily on diagnosing and determining the severity of the disease. Moreover, the range of symptoms includes five ranges of traits related to personality disorders. These five domains encompass Negative Affectivity, Detachment, Dissociality, Disinhibition, and Anankastia (2-3). Thierry, Crawford, Mulder, Bleschfeld, Farnam, et al. (4), establishing this dimensional classification, proposed a new diagnosis called personality difficulty. Diagnosis of the personality difficulty is not a psychological disorder in itself. However, it can still be used for the clinical benefit of virtually normal individuals and has been included in the Z-scores of the ICD-11 for Non-Patients. This diagnosis consists of people who are neither typically ill nor have a personality disorder. Rather, these people have problems with life management that causes medical problems and incurs costs for the community and treatment systems (5). The researchers concluded that the proposed changes could aid clinical efficacy in diagnosing the personality disorder and selecting appropriate treatment. In this way, the misconceptions concerning the false label attached to the disorder term can be dispelled (4).Therefore, current psychiatry is moving in a direction with a program not only for patients but also for almost normal people who have problems in their lives or feel that there are some difficulties in developing their personality. One style of psychiatric treatment called cosmetic psychiatry (6) or positive psychiatry (7) has attracted attention among the whole range of psychiatric disciplines. Cosmetic Psychiatry refers to the empowerment and strengthening of people's cognitive, behavioral, and emotional processes who do not suffer from a specific disorder. In other words, the treatment is to improve a person's mental state in the absence of any clinical disorder (8). The development of the ICD-11 has led to innovative approaches which were not available before. The reason for the clinic's foundation lies in the philosophical theories presented by Georg Wilhelm Friedrich Hegel and Sadr al-Muta'allehin Shirazi. They saw soul and psyche as a constantly evolving category. According to their theories, the soul is inherently growing and ascending unless a factor disrupts this process (9). The theoretical foundation of the approaches used in the personality modulation clinic rests on Cloninger's personality theory. This theory is known as the model of temperament and character. Cloninger divides personality into three components: temperament, character, and self-aware psyche. Temperament concerns the genetic and inherited aspect of individuals and has certain biological elements. Character deals with the semantic component of human personality and considers the individual's relationship with himself, others, and the universe. The third component is the self-aware psyche which its definition hinges on the individual's sense of intuition towards his inner abilities (10). Each element has its own characteristics and brain structures. The elements of this model and the treatment strategies presented in Cloninger's theory are employed to regulate the clinical approach in the personality modulation clinic. In this regard, pharmacotherapy and new neuroscience therapies (e.g., Biofeedback, Neurofeedback, and rTMS) are implemented to moderate temperament status and its extreme features, which can worsen the condition by affecting the patient's somatic state and ultimately inhibit Rhythmic growth of self-awareness. Understanding the neurotransmitters involved in the four temperamental traits (i.e., harm avoidance, novelty seeking, reward dependence, and persistence) and the role of neuroscience trends in our context are vital. After identifying and determining the fundamental conflicts related to character traits, pertinent psychodynamic analysis methods and eclectic psychotherapy are used for their treatment. Character aims to identify and remove barriers to the growth of all three components of self-direction, cooperation, and self- Transcendence involved in the relevant conflicts. In this particular treatment, different interventions are regarded for each person commensurate with his/her inner problems and conflicts. To develop the personality of these people, participatory intervention methods are opted. This model combines the training and supervision of a specialized psychiatric team to identify and treat clients' problems. The ultimate aim of this treatment method is to expand self-awareness on the physiological and psychological processes of the mind so that the person becomes more self-aware. Hitherto, no educational-therapeutic program with the objectives of the personality modulation clinic has been introduced and implemented neither in our country nor in the world. Hence, there is a call for a codified and coherent program with regard to the educational-therapeutic course of personality modulation due to lack of evidence. Considering the importance of this field of psychiatry, as described earlier, setting up such a clinic becomes indispensable. Also, finding such a place to get medical care is difficult for people with personality difficulty who feel that their existing personality practices do not match their capacity for growth and development. These people need to receive services with a biopsychosocial approach, although they might receive some degrees of non-specific services. This sort of service is offered to them in psychological clinics. On the other hand, counselors' opinions were based on scattered styles derived from schools of psychoanalysis- they often considered the psychological development of character and lacked a biological component (i.e., biological therapies such as pharmacotherapy and advanced neuroscience techniques used as accelerators). In sum, the clinic was established to adapt mental health services to up-to-date approaches in the country and the region to prevent the progression of personality difficulty to severe psychiatric disorders, increasing self-satisfaction in society, facilitating personal growth, and lowering high medical costs. This clinic was established by the suggestion of the first author in 2016 to combine the existing knowledge in psychotherapy, personology, and psychiatric pharmacotherapy leading to a new solution for people in need of receiving the diagnosis of personality difficulty.In addition, there is a golden opportunity for training skilled psychiatrists and residents in this field to provide services for clients in the future.

Concepts and Applications of Action Research in Improving the Performance of the Health System: A Guide for Managers

Background and Objectives Action research has become popular in health system research and problem solving. The aim of this study was to introduce the concepts and applications of action research in health system. Material and Methods This study reviewed the related documents and literatures in Persian and English Language by comprensive search in web-based resources. Results This study compares the Simmons model and other methods and provides a successful model for the use of pilot research in the health system. Conclusion This study recommends utilization of action research in solving health system problems in practice and also for learning in environment. Extended Abstract Background and Objectives Many experts believed that classic research methods have not been sufficient to help solve numerous problems faced by the health system. Thus, researchers have developed a new approach to this problem called "action research."The results of various studies in different countries have confirmed positive effects of this type of study in improving the performance of the health system. The aim of this study was to introduce the concepts and applications of action research in improving the performance of the health system. Material and Methods The present study is a revie of the existing documents and literature. Relevant books and websites were searched through to find various approaches and methods of action research. In order to review action research studies conducted in the field of health and other sectors, valid Persian and English electronic references were reviewed by using the keywords "action research", "health system" and "health" in 2020. At first, definitions and key concepts of action research in the health system were discussed, then the model introduced by Simmons in 1995 for action research, as a comprehensive model, was described and examples of action research studies conducted worldwide, were provided. Results In action research, the researcher with the participation of stakeholders identifies the problems in the system and collects information to solve the problems. Then, in accordance with the conditions of the organization and the solutions provided, the researcher tries to improve the performance. Finally, the results of interventions are evaluated. For this reason, action research is known as a method to improve performance and quality. The Simmons model includes subject identification, data collection, planning, implementation, evaluation and feedback. By summarizing the information obtained, the following steps can be suggested for conducting successful action research in health system: determining the subject of the research, describing the current situation, collecting information, analyzing and interpreting data, selecting and implementing a new solution, collecting information, evaluating the impact of the new action and determining its validity, revising and presenting the final report. Action research includes looking (gathering information and describing the current situation), thinking (discovering what is happening, interpreting it and explaining why and how) and acting (planning, implementing and evaluating). FOCUS PDCA is a proposed model for action research. This model includes 9 steps: finding a problem, organizing the research team, clarifying the process, understanding the causes of change, selecting an item to improve, planning, doing, checking and acting. Conclusion One of the most important reasons for the success of and attention to action research is the inadequacy of traditional research in answering basic questions and problems in the field of health, and the reason for this inefficiency is the gap between traditional research and the needs of the health system, a weakness that can be properly addressed by action research. Finally, it is recommended that if health managers are looking to promote standards and improve the health system in practice and in their specific situation, it is better to continue action research. Since action research is one of the most practical and basic types of research that provides realprospects to promote standards and improve the health system by analyzing the existing issues and problems and taking action to solve them. Practical implications of research Action research is one of the most central and basic types of research that provides the ground for raising standards and improving the health system by analyzing existing issues and problems and taking action to address them. Ethical considerations In selecting sources, extracting and also in reporting the content of sources and studies, the principle of fidelity and ethical principles have been observed. Conflict of interest The authors of the article declare that there is no conflict of interest for the authors of the article. Acknowledgement The authors of the article thank the Vice Chancellor for Research and Technology of Tabriz University of Medical Sciences for approving and financially supporting this study in the form of project number IR.TBZMED.REC.1397.154.

Quality of Health Services and the Factors Affecting it: A Cross-Sectional Study in Pilot Hospitals for Electronic Referral System

Background and objectives Health system services are not reliable without quality assessment. It is important to explore gaps between standard services and existing situation to improve the quality of health system. His study aimed at studding the quality assessment of electronic referral system in one of the major provinces of Iran. Material and Methods This study was a cross-sectional study utilizing SERVQUAL model. The population comprised 3 groups totaling approximately 11,004 people. The sample size allocated to each city was determined in view of the ratio of patients. A sample of 384 patients who used electronic referral service at level 2 and revived outpatient services constructed the population of study. The data were collected through a two-part questionnaire. The validity of the questionnaire was confirmed by 10 experts including senior and mid-level managers and medical science university faculty members. The questionnaire assessed demographic data and the patients' perceptions and expectations. Data was analyzed using descriptive statistics and analytical statistics such as nonparametric mean comparison tests, in view of the normality assumption,) including Wilcoxon test, Mann-Whitney and Kruskal-Wallis. Spearman correlation test was used to determine the intensity of correlation between the study variables. The significance level of all tests was considered 0.05. Results There were identified gaps throughout all dimensions of health service among the studied clinics (P <0.001). The highest gap was observed in the empathy dimension (0.57) and the lowest gap was observed in the tangible dimension (-0.38). The gap between the services provided to patients was different in terms of guarantee, gender (P = 0.005), empathy , level of education (P = 0.028) and reliability based on the city vise (P = 0.028). Conclusion In the hospitals implementing the electronic referral system in Golestan province, there is a gap in all dimensions and it indicates that in none of the dimensions, the expectations of the recipients have not been fully met. Extended Abstract Background and Objectives Quality assessment is doubly important in the health sector, compared to other sectors, due to the sensitivity of services provided in this area. This study was conducted to investigate the gap in the quality of medical services provided in hospitals implementing electronic referral system in Golestan province, using SERVQUAL model. Material and Methods In this cross-sectional study, 384 patients were selected through stratified random sampling with allocation proportionate to each city’s population. These patients were referred to level 2 in the frame of electronic referral system and received outpatient services by a specialist physician in the clinics of hospitals implementing the electronic referral system in Golestan province in 2019. This study was conducted in the cities of Bandar-e-Turkmen, Aq-Qala and Aliabad-e-Katoul, where the electronic health referral system had been fully. The population comprised 3 groups totaling approximately 11,004 people. The sample size allocated to each city was determined in view of the ratio of patients referred to level 2 in each city. Accordingly, the sample size selected included 84 subjects from Bandar-e-Turkmen City, 203 from AqQala is 203, and 115 from Aliabad. Having referred to these centers, we collected, from the patient registration office, the record of the patients whose family physician had referred them to level 2 and who had received the desired services. Then, the subjects were systematically and randomly selected according to the referral code registered in the system and the patient list. The data were collected through a two-part questionnaire. The first part of the questionnaire revolved around demographic variables, including age, sex, marital status, level of education, occupation and clinical and medical characteristics such as the number of visits to this clinic, type of disease and type of patients' insurance. The second part of the questionnaire assessed the patients' perceptions and expectations by 30 questions which were similar in content and number but different in wording. In this study, the validity of the questionnaire was confirmed by 10 experts including senior and mid-level managers and faculty members of Golestan University of Medical Sciences. Cronbach's alpha coefficient was calculated to determine the overall reliability of the questionnaire. The data were analyzed using SPSS software version 23. The data were analyzed descriptively through tables, number, frequency percentage for qualitative data, and Mean and Standard Deviation for quantitative data. In addition, we employed analytical statistics such as nonparametric mean comparison tests, in view of the normality assumption,) including Wilcoxon test, Mann-Whitney and Kruskal-Wallis and also Spearman correlation test to determine the intensity of correlation between the study variables. In the present study, the significance level of all tests was considered 0.05. Results Out of a total of 402 patients studied, information on only 384 patients was fully recorded (response rate 95.5%). The majority of subjects were female (74.5%), married (81.5%), high school graduate (24.9%), housewife (64.9%). The mean age of the patients was 37.17 ± 14.54 years, so that 62.4% of the subjects fell in the age bracket of 30-60 years. 53.6% of the patients had referred to the center more than once. 56.2% had rural insurance and the highest number of referrals had been made to gynaecologist (21.4%). The relationship between expectations and perceptions of service quality in all dimensions was statistically significant (P < 0.001). The results of Wilcoxon test showed that the gap between the patients' expectations and perceptions with a 95% probability was significant (P<0.001) in all three cities and among all patients., found that. That is, there was a difference between the patients' expectations of service quality and their perceptions in the whole sample. The highest mean score in the expectations section was related to the guarantee and confidence dimension (4.49) and it was related to the tangible dimension in the perceptions section (4.10) is) while the lowest score is in the expectations and perceptions section related to the empathy dimension (4.34 and respectively. 77.3). After calculating the difference between the mean scores of perceptions and expectations, in all dimensions, the level of the patients' expectations of services was found higher than the level of perceptions with a negative gap. The largest gap in service quality was related to the empathy dimension (-0.57) and the lowest quality service gap was related to the tangible dimension (-0.38). There was no significant relationship between service quality gap and age groups, marital status, occupation groups, number of visits, type of insurance and type of illness (P> 0.05). But the gap in service quality was significantly associated with the patients' gender (P = 0.005) and education level (P = 0.028). So that the biggest gap was related to women and illiterate people. Also, the quality gap was different according to the city (P = 0.028), with the largest gap related to Aq-Qala city. Conclusion The results showed that the studied hospitals could not meet the expectations of the patients in any of the five components of service quality, with the perceived quality always lagging behind the expected quality. This highlights need to improve the quality of services through paying more attention to people in the community in order to deliver committed services reliably, accurately and correctly in a timely manner, as well as, enhancing the knowledge, etiquette and ability of employees to build trust and confidence in customers. Since at the time of the study, only three cities, Bandar-e-Turkmen, Aq-Qala and Aliabad-e-Katoul, were implementing an electronic referral system, it was not possible to study other cities in this field and the statistical population was outpatients from level 1 to level 2. A wider study should be conducted at the provincial level to include all referrals to family physicians at level one and all inpatient and outpatient referrals. In addition, the SERVQUAL questionnaire does not cover all the expectations, perceptions and beliefs of patients, so the use of qualitative study methods along with quantitative methods in future studies could provide a better understanding of the issue of quality. Practical implications of research According to the results of this study, it is suggested that officials and providers of health services should prioritize:- Continuous improvement and evaluation of service quality in planning;- Equipping medical centers with efficient and new equipment;- Providing services at the promised time and in the shortest time to clients;- Availability of staff and service providers when patients are referred;- Familiarity with the knowledge and skills of the day to meet the needs of clients and- Understanding the values and emotions of clients Ethical considerations study protocol, with the number IR.GOUMS.REC.1397.289, was ethically approved by the Research Ethics committee of Golestan University of Medical Sciences. At the time of data collection, respondents were assured that their information would remain confidential and the questionnaire was completed anonymously. Meanwhile, those who did not want to participate in the study were excluded from the study. Conflict of interest The authors state that there is no conflict of interest in the present study. Acknowledgement The Vice Chancellor for Research and Technology of Golestan University of Medical Sciences and the Research Center for Health Management and Social Development for approving the research plan with code 110602 and the assistance of officials and staff of selected hospitals in conducting this research plan are appreciated.

Design and Psychometric Evaluation of User Satisfaction Questionnaire in Integrated Health System for Reliability and Validity

Background and Objectives: Evaluating the effectiveness of health information systems and users' satisfaction with system performance is important. The success of an information system is directly dependent on the system responding to user needs. Due to the importance of this issue, a tool has been designed to evaluate users' satisfaction with Integrated Health System. Material and Methods: This cross-sectional study was conducted in 2018 to design a questionnaire to assess the users' satisfaction with Integrated Health System. In the first step, the areas of user satisfaction were identified by reviewing literature and reliable scientific sources. Then a bank of questions was created and after classifying the indicators and identifying related questions the primary tool was developed in several areas. Face validity and content validity of the questionnaire were determined using CVI and CVR indices. Reliability over time was assessed by 20 users of in an Integrated Health System with two-week intervals. Results: The final questionnaire included demographic information and 55 questions about the components of a System Satisfaction Questionnaire. Questions related to each component included system interface, system functions, system performance, system information and statistics, system supportive services, System services, and and total satisfaction from the system. The average CVI and CVR for total questions were 0.84 and 0.73, respectively. For reliability over time, the coefficient (ICC) for the whole structure was 0.98. The reliability of the questionnaire evaluated by Cronbach's alpha and internal consistency method, that this value was obtained 0.914 for total questionnaire. Also, separately for each structure was obtained in the "good" range. Conclusion: In this study, we tried to provide a brief and expressive user satisfaction assessment tool that required the least amount of time to respond. The high response rate of all questions indicates that designed tool achieved the objectives of the study. The most emphasized component by users is the system support component. Ease of use of the system, usefulness and support of the system from performing daily activities are other things that are more important for users.

The Relationship between Workaholism and Workplace Incompatibility: The Role of Family-Work Enrichment and Gender

Background and objectives: Incompatibility in the workplace causes destructive behaviors and the desire to withdraw employees from the organization. Therefore, identifying the factors affecting its occurrence is inevitable. The present study investigated the relationship between work-related addiction and workplace incompatibility: the role of family-work enrichment and gender. Materials and Methods: This research is applied in terms of purpose and descriptive correlational study in terms of method. The statistical population is 590 employees of Qom Health Center. A total of 233 samples were selected randomly according to Krejcie & Morgan sample size determining table. Data analysis was performed by Structure Equation Modeling using SPSS 25 and AMOS 18 software. Results: Work addiction has a positive effect on incompatibility and work-family enrichment has a negative effect on it. Work addiction has a positive effect on work-family incompatibility and enrichment. Also, family-work enrichment plays a median role between work-to-work addiction and incompatibility. In addition, gender only moderates the relationship between work-related addiction and incompatibility. Conclusion: The results of this study showed that reducing workplace incompatibility can be done by considering the status of work addiction and enriching the employees' work-life and implementing methods to improve them.

Effectiveness of Acceptance and Commitment Therapy on Safety Performance, Quality of Life and Somatic Symptoms in Patients with Irritable Bowel Syndrome

Background and Objectives: The aim of this research was to evaluate the effectiveness of acceptance and commitment based therapy on immune function, quality of life and physical symptoms in patients with irritable bowel syndrome. Material and Methods: This research was an experimental with pre-test, post-test and 90 days later follow-up with the control group. The research sample were selected as available and included 30 patients with irritable bowel syndrome. Using available sampling method with the consent of the patients, They randomly sampled into two groups of 15 experimental and control, using availa be sampling method with the consent of the patients. The experimental group received acceptance and commitment group therapy for 8 sessions, while the control group did not receive any intervention. Both groups were assessed before and after the intervention and in the follow-up stage using quality of life questionnaires, irritable bowel syndrome evaluation questionnaire (Rome IV) and fecal calprotectin test for immune function. Data analysis was performed first by repeated measures analysis of variance and then by repeated measures analysis of variance by considering the protein variable in the pre-test stage as a covariate variable. Results: In the repeated measures method, the results showed that the effect of time on all three variables of safety function (F = 8.597, P = 0.001), physical condition (F = 63.95, P = 0.0001) and quality of life (F = 65.93, P = 0.0001) is significant. In the method of repeated measures with covariate, the effect of time on the safety performance variable is not significant (F = 0.217, P = 0.645) and it is significant in the variables of physical condition (F = 11.302, P = 0.0001) and quality of life (F = 13.154, P = 0.0001). The results of intergroup test also indicated the significance of the effect of treatment (control and experiment) in all three variables studied in both methods. Conclusion: The findings of the research showed that acceptance and commitment therapy can play an effective role in reducing physical symptoms and improving patients' immune function and improving their quality of life. Therefore, this treatment is recommended as an adjunctive therapy in patients with irritable bowel syndrome.