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Yazdizadeh B, Ahmadi A, Najafi F, Mohammad K, Fariden M, Khalili D, Mahdavi M, Rahimpour E, Jouyban A, Kelishadi R, Monazzam MR, Eftekhari MB, Falahat K, Nikooee S, Majdzadeh R. Establishing research impact assessment in Iran: The first report from a non-high-income country. J Glob Health 2024; 14:04050. [PMID: 38483444 PMCID: PMC10939117 DOI: 10.7189/jogh.14.04050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Background This study presents the first report on research impact assessment (RIA) in non-high-income countries, undertaken as a pilot initiative in 2021. Within it, we aimed to explore the feasibility of employing the 'payback' model for evaluating the impact of health research and enhancing the accountability of universities. We focussed on three key impact domains: 'production of decision support documents and knowledge-based products,' 'implementation of research results,' and 'health and economic impact.' Methods We adopted a case study approach to assess the impact of 5334 health research projects conducted by researchers from 18 universities from 2018 to 2020. Researchers were required to submit evidence related to at least one of the specified impact domains; six scientific committees verified and scored claimed impacts at the national level. Results Only 25% of the assessed projects achieved impact in at least one domain, with the production of decision support documents and knowledge products being the most reported impact. Notably, economic impact was verified in only three projects, indicating room for improvement in this area. Technology research exhibited the highest acceptance rate of claimed impact, suggesting a positive correlation between technology-focused projects and impactful outcomes. Conclusions This study demonstrates the feasibility of employing a case study approach and the 'payback' model to evaluate the impact of health research, even within the constraints of a moderately equipped research infrastructure. These findings underscore the potential of integrating RIA into the governance of health research in Iran and other non-high-income countries, as well as the importance of using RIA to assess the accountability of health research systems, guide the allocation of research funding, and advocate for the advancement of health research. The study sets a precedent for future assessments in similar contexts and contributes to the ongoing global dialogue on the societal impact of health research.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Equal contribution
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kazem Mohammad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Fariden
- Environmental Health Research Center, Department of Occupational Health and Safety at Work Engineering, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Mahdavi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Rahimpour
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abolghasem Jouyban
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Monazzam
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences
| | | | - Katayoun Falahat
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Sima Nikooee
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- School of Health and Social Care, University of Essex, Colchester, UK
- Equal contribution
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Mohtasham F, Yazdizadeh B, Mobinizadeh M. Research gaps identified in Iran's health technology assessment reports. Health Res Policy Syst 2023; 21:132. [PMID: 38082442 PMCID: PMC10714446 DOI: 10.1186/s12961-023-01043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/19/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Identifying gaps in the evidence is a useful byproduct of conducting a health technology assessment (HTA). This study aims to identify research gaps in Iran's HTA reports. METHOD We reviewed the HTA reports published between 2014 and 2016. Then, we developed two separate questionnaires for principal investigators (PIs) and independent HTA researchers. The questionnaire for independent HTA researchers consisted of four main parts. However, the PIs' questionnaire consisted of two main parts. We also conducted a literature search in the PubMed database in November 2017 to find frameworks for prioritizing research gaps. We also conducted a semi-structured interview with the head of the Iran's HTA Office at that time and sought feedback based on his expert opinion about questionnaires, the priority-setting tool and our process for extracting research gaps. RESULTS A total of 11 HTA reports published between 2014 and 2016 by Iran's HTA Office were selected for the study. Of these 11 reports, 5 involved technologies related to medical equipment, while 6 involved medical and surgical interventions. Assessing the outcomes of technology use in various indications and updating HTAs when new evidence arises; evaluating the viewpoints of patients, clinicians and key technology users; conducting post-marketing evaluations of technology; comparing the impact of the technology in question to other treatments for the same condition; and requesting long-term clinical and cost-effectiveness data for technologies with limited follow-up periods were identified as the main gaps by independent HTA researchers and PIs. CONCLUSIONS The research gaps identified from Iran's HTAs could be utilized by research funding agencies.
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Affiliation(s)
- Farideh Mohtasham
- Knowledge Utilization Research Centre (KURC), Tehran University of Medical Sciences, Kargar St., Keshavarz Blvd, P.O. Box 1417993357, Tehran, Iran.
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Centre (KURC), Tehran University of Medical Sciences, Kargar St., Keshavarz Blvd, P.O. Box 1417993357, Tehran, Iran
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Alipour A, Hantoushzadeh S, Hessami K, Saleh M, Shariat M, Yazdizadeh B, Babaniamansour S, Ghamari A, Aghajanian S, Moradi K, Abdolmaleki AS, Emami Z. A global study of the association of cesarean rate and the role of socioeconomic status in neonatal mortality rate in the current century. BMC Pregnancy Childbirth 2022; 22:821. [PMID: 36336679 PMCID: PMC9639272 DOI: 10.1186/s12884-022-05133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Caesarean section (C/S) rates have significantly increased across the world over the past decades. In the present population-based study, we sought to evaluate the association between C/S and neonatal mortality rates. Material and methods This retrospective ecological study included longitudinal data of 166 countries from 2000 to 2015. We evaluated the association between C/S rates and neonatal mortality rate (NMR), adjusting for total fertility rate, human development index (HDI), gross domestic product (GDP) percentage, and maternal age at first childbearing. The examinations were also performed considering different geographical regions as well as regions with different income levels. Results The C/S rate and NMR in the 166 included countries were 19.97% ± 10.56% and 10 ± 10.27 per 1000 live birth, respectively. After adjustment for confounding variables, C/S rate and NMR were found correlated (r = -1.1, p < 0.001). Examination of the relationship between C/S rate and NMR in each WHO region resulted in an inverse correlation in Africa (r = -0.75, p = 0.005), Europe (r = -0.12, p < 0.001), South-East Asia (r = -0.41, p = 0.01), and Western Pacific (r = -0.13, p = 0.02), a direct correlation in America (r = 0.06, p = 0.04), and no correlation in Eastern Mediterranean (r = 0.01, p = 0.88). Meanwhile, C/S rate and NMR were inversely associated in regions with upper-middle (r = -0.15, p < 0.001) and lower-middle (r = -0.24, p < 0.001) income levels, directly associated in high-income regions (r = 0.02, p = 0.001), and not associated in low-income regions (p = 0.13). In countries with HDI below the centralized value of 1 (the real value of 0.9), the correlation between C/S rate and NMR was negative while it was found positive in countries with HDI higher than the mentioned cut-off. Conclusions This study indicated that NMR associated with C/S is dependent on various socioeconomic factors such as total fertility rate, HDI, GDP percentage, and maternal age at first childbearing. Further attentions to the socioeconomic status are warranted to minimize the NMR by modifying the C/S rate to the optimum cut-off.
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Yazdizadeh B, Mandil A, Nikooee S, Rashidian A. Assessing the impact of small-research grants supported by WHO in the Eastern Mediterranean Region 2010-2018. East Mediterr Health J 2022; 28:751-757. [PMID: 36382730 DOI: 10.26719/emhj.22.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/14/2022] [Indexed: 12/26/2022]
Abstract
Background For decades, WHO has been providing targeted funding for health research on priority areas of public health in the Eastern Mediterranean Region through different grant schemes. Aims This paper investigated the impact of WHO/EMRO's funding schemes and factors facilitating or hindering such impact. Methods We assessed the impact of health research funded by WHO/EMRO during 2010-2018 from the health, economic, decision-making, and knowledge translation perspectives, emphasizing accountability and analysis, using the Payback framework, mixed-method approach (quantitative, qualitative), and triangulation. Results Principal investigators of 45 (45.9%) out of the 98 funded projects responded to the questionnaire. Almost all (88.0%) the 45 projects reported developing at least one decision-making document. Less than half reported producing peer-reviewed documents and conducting target group empowerment, while 24.0% said they secured research funds from other organizations. For 23 projects (51.0%), research results could have had a direct impact on health and on economy, and 25 (56.0%) projects conducted at least one active knowledge translation activity. Using multiple logistic regression, there was no significant association between the country of research and impact on decision-making and implementation of result if health or economic impact was expected. Conclusion To strengthen the impact of research, WHO/EMRO should embark on a series of interventions to guide and empower countries in the use of research results. Discrepancies between health research systems in the Eastern Mediterranean Region and differences in individual and organizational capacities in the different countries require targeted interventions.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Ahmed Mandil
- World Health Organization Office for the Eastern Mediterranean, Cairo, Egypt
| | - Sima Nikooee
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Arash Rashidian
- World Health Organization Office for the Eastern Mediterranean, Cairo, Egypt
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Mahdavi M, Sajjadi Khasraghi J, Sajadi HS, Yazdizadeh B, Nikooee S, Ehsani-Chimeh E, Dargahi H, Doshmangir L, Ghaffari S, Toyserkanmanesh R, Majdzadeh R. Developing Framework and Strategies for Capacity Building to Apply Evidence-Informed Health Policy-Making in Iran: Mixed Methods Study of SAHSHA Project. Int J Health Policy Manag 2022; 11:2236-2247. [PMID: 34814672 PMCID: PMC9808291 DOI: 10.34172/ijhpm.2021.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/10/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND SASHA, which stands for "evidence-informed health policy-making (EIHP)" in Persian, is a national project to draw a roadmap for strengthening EIHP in Iran. As a part of SASHA, this research aimed to develop evidence-based and context-aware policy options for increasing the capacity of decision-makers to apply EIHP in Iran. METHODS This was a qualitative study, which was informed by a literature review of pull efforts' capacity building programs. Based on the review, we developed policy options and validated them through an expert panel that involved twelve experts. Data were analyzed using a content analysis method. RESULTS We extracted data from 11 articles. The objectives of capacity building programs were: single-skill development, personal/professional development, and organizational development. According to these objectives, the contents and training methods of the programs vary. Capacity building programs have shown positive impacts on individual knowledge/attitudes to use EIHP. However, the impacts of programs at the organizational or the health system level remain under-researched. We followed several threads from the literature review through to the expert panel that included training the management team, instead of training managers, training for problem-solving skills, and designing tailored programs. Barriers of capacity building for EIHP regard the context of the health system (weak accountability and the widespread conflict of interest) and healthcare organizational structures (decision support systems, knowledge management infrastructures, and lack of management team). Experts suggested interventions on the barriers, particularly on resolving the conflict of interests before launching new programs. A proposed framework to increase the capacity of health policy-makers incorporates strategies at three levels: capacity building program, organizational structure, and health system context. CONCLUSION To prepare the context of Iranian healthcare organizations for capacity building programs, the conflict of interests needs to be resolved, decision-makers should be made more accountable, and healthcare organizations need to provide more knowledge management infrastructures and decision support systems.
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Affiliation(s)
- Mahdi Mahdavi
- The Bernard Lown Scholar in Cardiovascular Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Nikooee
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ehsani-Chimeh
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Dargahi
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Doshmangir
- Tabriz Health Services Management Research Center, Department of Health Policy & Management, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Reza Majdzadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Ahmadi A, Yazdizadeh B, Doshmangir L, Majdzadeh R, Asghari S. PROTOCOL: Systematic review of methods to reduce risk of bias in knowledge translation interventional studies in health-related issues. Campbell Syst Rev 2022; 18:e1236. [PMID: 36911351 PMCID: PMC9005927 DOI: 10.1002/cl2.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Review studies have reported on the low quality of study methodologies and poor reporting of knowledge translation (KT) interventional studies. This flaw cause the result of such studies to become misleading. OBJECTIVES The present review is designed to evaluate the effect of methodological factors on the results of interventional studies that aimed to evaluate KT strategies at the policy level. SEARCH METHODS Bibliographic databases and grey literature databases will be searched. The retrieved studies will be recorded in Covidence. After screening titles and abstracts, the full texts of selected studies will be assessed against the inclusion criteria. Disagreements will be resolved through discussion or by consultation with a third author. SELECTION CRITERIA Primary studies are studies that aimed to estimate the efficacy of KT strategies to improve evidence-informed policymaking. Study participants include policymakers and the intervention is a KT strategy. The main outcome is the desired changes in policy-makers towards evidence-informed decision-making. DATA COLLECTION AND ANALYSIS The main effect sizes will be expressed as standard mean difference and its variance for the main efficacy outcome of KT strategies in primary studies. Forest plot meta-analysis will be used to synthesize the effect of each group of KT strategies. The contribution of ROB to the efficacy of KT interventions will be assessed via Meta-epidemiology analysis. The overall estimate will be calculated using inverse-variance random-effects meta-analysis with a 95% confidence interval for the estimate.
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Affiliation(s)
- Ayat Ahmadi
- Knowledge Utilization Research CenterTehran University of Medical SciencesTehranIran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research CenterTehran University of Medical SciencesTehranIran
| | - Leila Doshmangir
- Department of Health Policy & ManagementTabriz Health Services Management Research Center, School of Management & medical informatics, Tabriz University of Medical SciencesTabrizIran
| | - Reza Majdzadeh
- Community Based Participatory Research Center, Knowledge Utilization Research CenterTehran University of Medical ScienceTehranIran
| | - Shabnam Asghari
- Family MedicineMemorial University of NewfoundlandSt. John'sCanada
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Yazdizadeh B, Ehsani-Chimeh E, Zendehdel K, Mobinizadeh M, Mesgarpour B, Fakoorfard Z. Knowledge gaps and national research priorities for COVID-19 in Iran. Health Res Policy Syst 2022; 20:25. [PMID: 35236369 PMCID: PMC8889392 DOI: 10.1186/s12961-021-00805-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the present COVID-19 crisis, one of the greatest challenges for research funding at both the international and national level is selecting the best research topic to achieve efficiency and equity in health research and to address the knowledge gap urgently raised due to the event. Despite international recommendations, countries should consider their context-specific situation and define local research priorities. We aimed to exercise a priority-setting activity to identify the knowledge gaps and suggest research priorities in response to the COVID-19 epidemic in Iran. METHODS First, we tried to identify the contextual knowledge gaps based on an online survey, performing key informant interviews (i.e. health professionals, policy-makers and managers) and media analysis. We also performed a literature review and considered international research priorities for COVID-19. Subsequently, we prepared a list of research questions and challenges to respond to the COVID-19 crisis in Iran using a systems approach. Then we mapped approved COVID-19 research projects in the country to research questions. Finally, we compared the identified research questions (not challenges) with the prioritized research from international organizations and then prioritized them for Iran. RESULTS We found risk factors and epidemiological dissemination patterns of the virus and its consequences in an epidemiology domain, implementation of clinical and hygiene in a clinical management domain, genetic studies for targeting prevention and treatment in a candidate treatment and vaccine research and development (R&D) knowledge domain, examination of the manifestations of ethics in society instead of ethics in research in an ethics domain, "care, access and health system" and "public health and participation in response to public health and clinical research" as two sub-domains of a social sciences domain, and finally, no new questions in either the virology, transmission, diagnosis or animal and environmental domain. CONCLUSIONS In the event of global health crises like COVID-19, prioritization of research questions can be done globally, but some of the research priorities are context-specific and may vary by regional needs. To better manage research resources, researchers must respond to the challenges faced in each country based on its political, economic, social and cultural characteristics, and to make evidence-informed decisions, global knowledge gaps must be customized in each country.
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Affiliation(s)
- Bahareh Yazdizadeh
- Epidemiology, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ehsani-Chimeh
- Health Services Management, National Institute for Health Research, Tehran University of Medical Science, Tehran, Iran.
| | - Kazem Zendehdel
- Epidemiology, Cancer Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Mobinizadeh
- Health Services Management, National Institute for Health Research, Tehran University of Medical Science, Tehran, Iran
| | - Bita Mesgarpour
- Pharmacoepidemiology, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Zeinab Fakoorfard
- Health Economics, National Institute for Health Research, Tehran University of Medical Science, Tehran, Iran
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Doshmangir L, Mostafavi H, Behzadifar M, Yazdizadeh B, Sajadi HS, Hasanpoor E, Mahdavi M, Majdzadeh R. Individual and institutional capacity-building for evidence-informed health policy-making in Iran: a mix of local and global evidence. Health Res Policy Syst 2022; 20:18. [PMID: 35151312 PMCID: PMC8841080 DOI: 10.1186/s12961-022-00816-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Providing valid evidence to policy-makers is a key factor in the development of evidence-informed policy-making (EIPM). This study aims to review interventions used to promote researchers’ and knowledge-producing organizations’ knowledge and skills in the production and translation of evidence to policy-making and explore the interventions at the individual and institutional level in the Iranian health system to strengthen EIPM.
Methods
The study was conducted in two main phases: a systematic review and a qualitative study. First, to conduct the systematic review, the PubMed and Scopus databases were searched. Quality appraisal was done using the Joanna Briggs Institute checklists. Second, semi-structured interviews and document review were used to collect local data. Purposive sampling was used and continued until data saturation. A qualitative content analysis approach was used for data analysis.
Results
From a total of 11,514 retrieved articles, 18 papers were eligible for the analysis. Based on the global evidence, face-to-face training workshops for researchers was the most widely used intervention for strengthening researchers’ capacity regarding EIPM. Target audiences in almost all of the training programmes were researchers. Setting up joint training sessions that helped empower researchers in understanding the needs of health policy-makers had a considerable effect on strengthening EIPM. Based on the local collected evidence, the main interventions for individual and institutional capacity-building were educational and training programmes or courses related to the health system, policy-making and policy analysis, and research cycle management. To implement the individual and institutional interventions, health system planners and authorities and the community were found to have a key role as facilitating factors.
Conclusion
The use of evidence-based interventions for strengthening research centres, such as training health researchers on knowledge translation and tackling institutional barriers that can prevent well-trained researchers from translating their knowledge, as well as the use of mechanisms and networks for effective interactions among policy-makers at the macro and meso (organizational) level and the research centre, will be constructive for individual and institutional capacity-building. The health system needs to strengthen its strategic capacity to facilitate an educational and training culture in order to motivate researchers in producing appropriate evidence for policy-makers.
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Majdzadeh R, Sajadi HS, Yazdizadeh B, Doshmangir L, Ehsani-Chimeh E, Mahdavi M, Mehrdad N, Lavis J, Nikooee S, Mohtasham F, Mohseni M, Akbari P, Asgardoon MH, Rezaei N, Neyazi N, Ghaffarifar S, Haghdoost AA, Khodayari-Zarnaq R, Mosadeghrad AM, Pourabbasi A, Rafinejad J, Toyserkanamanesh R. Policy options for strengthening evidence-informed health policy-making in Iran: overall SASHA project findings. Health Res Policy Syst 2022; 20:10. [PMID: 35033096 PMCID: PMC8760808 DOI: 10.1186/s12961-021-00803-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 12/03/2021] [Indexed: 01/18/2023] Open
Abstract
Background The institutionalization of evidence-informed health policy-making (EIHP) is complex and complicated. It is complex because it has many players and is complicated because its institutionalization will require many changes that will be challenging to make. Like many other issues, strengthening EIHP needs a road map, which should consider challenges and address them through effective, harmonized and contextualized strategies. This study aims to develop a road map for enhancing EIHP in Iran based on steps of planning. Methods This study consisted of three phases: (1) identifying barriers to EIHP, (2) recognizing interventions and (3) measuring the use of evidence in Iran's health policy-making. A set of activities was established for conducting these, including foresight, systematic review and policy dialogue, to identify the current and potential barriers for the first phase. For the second phase, an evidence synthesis was performed through a scoping review, by searching the websites of benchmark institutions which had good examples of EIHP practices in order to extract and identify interventions, and through eight policy dialogues and two broad opinion polls to contextualize the list of interventions. Simultaneously, two qualitative-quantitative studies were conducted to design and use a tool for assessing EIHP in the third phase. Results We identified 97 barriers to EIHP and categorized them into three groups, including 35 barriers on the “generation of evidence” (push side), 41 on the “use of evidence” (pull side) and 21 on the “interaction between these two” (exchange side). The list of 41 interventions identified through evidence synthesis and eight policy dialogues was reduced to 32 interventions after two expert opinion polling rounds. These interventions were classified into four main strategies for strengthening (1) the education and training system (6 interventions), (2) the incentives programmes (7 interventions), (3) the structure of policy support organizations (4 interventions) and (4) the enabling processes to support EIHP (15 interventions). Conclusion The policy options developed in the study provide a comprehensive framework to chart a path for strengthening the country’s EIHP considering both global practices and the context of Iran. It is recommended that operational plans be prepared for road map interventions, and the necessary resources provided for their implementation. The implementation of the road map will require attention to the principles of good governance, with a focus on transparency and accountability. Video abstract
Supplementary Information The online version contains supplementary material available at 10.1186/s12961-021-00803-0.
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Affiliation(s)
- Reza Majdzadeh
- Community Based Participatory Research Center, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Doshmangir
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elham Ehsani-Chimeh
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Mahdavi
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - John Lavis
- McMaster Health Forum and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Sima Nikooee
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Mohtasham
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Mohseni
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Paria Akbari
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Niloofar Rezaei
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Neyazi
- International Campus, School of Public Health, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran.,Trusted Organization for Research and Development, Kabul, Afghanistan
| | - Saeideh Ghaffarifar
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Mohammad Mosadeghrad
- School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ata Pourabbasi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Rafinejad
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Toyserkanamanesh
- Department of Treatment and Social Support, IRAN Drug Control Headquarter, Tehran, Iran
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Doshmangir L, Yazdizadeh B, Sajadi HS, Mohtasham F, Majdzadeh R. What is going on in the future for evidence-informed health policymaking in Iran? J Evid Based Med 2021; 14:285-290. [PMID: 34904390 DOI: 10.1111/jebm.12458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/08/2021] [Accepted: 09/22/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Leila Doshmangir
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management & Medical Informatics, and Social Determinants of Health Services Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research & Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Mohtasham
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Community-Based Participatory Research Center, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Babashahi M, Omidvar N, Yazdizadeh B, Heidari-Beni M, Joulaei H, Narmcheshm S, Zargaraan A, Kelishadi R. Systematic review and meta-analysis of the most common processed foods consumed by Iranian children. East Mediterr Health J 2021; 27:918-930. [PMID: 34569048 DOI: 10.26719/emhj.21.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/01/2021] [Indexed: 11/09/2022]
Abstract
Background The trend of increasing overweight and obesity among children is a huge burden on health systems. In this regard, the growing availability of processed foods, often energy dense and nutrient poor, has become a major concern. Changing this trend will require evidence-based policies. Aims This systematic review aimed to identify the most common processed/ultraprocessed foods consumed by 4-12-year-old Iranian children. Methods We searched PubMed, Scopus and Web of science, as well as Persian scientific search engines, including Iran Research Information System, Scientific Information Database and Mag-Iran. We also assessed grey literature, that is, national studies and papers presented at relevant Iranian congresses. All data collected from studies were converted to daily servings (S/D). Mean and standard deviations of the included results were combined by performing meta-analysis with a random effects model. The I2 test was used to compute heterogeneity. Egger's test was used to assess publication bias. Results Ten studies with 67 093 children were included in this review. The meta-analysis demonstrated that the highest consumption of processed foods belonged to the sugars and sweets group with 8.01 S/D, followed by oils, and biscuits and cakes with 5.58 S/D and 3.33 S/D, respectively. Conclusion Given the high consumption of less healthy processed foods, robust policies to support healthy eating and help improve Iranian children's food environment are recommended.
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Affiliation(s)
- Mina Babashahi
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Motahar Heidari-Beni
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran
| | - Hassan Joulaei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Saba Narmcheshm
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Azizollaah Zargaraan
- Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran
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Yazdizadeh B, Walker R, Skouteris H, Olander EK, Hill B. Interventions improving health professionals' practice for addressing patients' weight management behaviours: systematic review of reviews. Health Promot Int 2021; 36:165-177. [PMID: 32447397 DOI: 10.1093/heapro/daaa039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Health professionals require education and training to implement obesity management guidelines and ultimately impact on the health outcomes experienced by their patients. Therefore, a systematic review of systematic reviews that evaluated interventions designed to change the practice of health professionals when addressing diet and physical activity with their patients was conducted. MEDLINE Complete; Cochrane database of systematic reviews; PsycINFO; CINAHL Complete; Global Health; Embase; INFORMIT: Health Subset; Health System Evidence and RX for change were searched in March 2019, with no date or language limits. Identified references underwent screening, full-text analyses and data extraction in duplicate. The search identified 15 230 references. Five systematic reviews that provided a narrative syntheses of a combined 38 studies were included. Health professional participants generally reported being satisfied with the training interventions. Heterogeneity between and within included reviews, non-controlled designs of individual studies and low quality of evidence at an individual study level and review level made it difficult to draw firm conclusions regarding what interventions are most effective in changing health professionals' knowledge, skills, self-efficacy, attitudes and practice. However, similar gaps in the literature were identified across included reviews. Key areas that could be addressed in future interventions including organization and system-level barriers to providing advice, health professionals' attitudes and motivation and weight stigma have been highlighted. Health professionals and patients could be more involved in the planning and development of interventions that work towards improving diet and physical activity advice and support provided in healthcare.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, 21, Dameshgh st, Vali-e Asr Avenue, Tehran 1416753955, Iran
| | - Ruth Walker
- School of Public Health and Preventive Medicine, Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
| | - Ellinor K Olander
- School of Health Sciences, Centre for Maternal and Child Health Research, City, University of London, London EC1V 0HB, UK
| | - Briony Hill
- School of Public Health and Preventive Medicine, Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
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Sajadi HS, Majdzadeh R, Ehsani-Chimeh E, Yazdizadeh B, Nikooee S, Pourabbasi A, Lavis J. Policy options to increase motivation for improving evidence-informed health policy-making in Iran. Health Res Policy Syst 2021; 19:91. [PMID: 34098971 PMCID: PMC8186173 DOI: 10.1186/s12961-021-00737-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Current incentive programmes are not sufficient to motivate researchers and policy-makers to use research evidence in policy-making. We conducted a mixed-methods design to identify context-based policy options for strengthening motivations among health researchers and policy-makers to support evidence-informed health policy-making (EIHP) in Iran. METHODS This study was conducted in 2019 in two phases. In the first phase, we conducted a scoping review to extract interventions implemented or proposed to strengthen motivations to support EIHP. Additionally, we employed a comparative case study design for reviewing the performance evaluation (PE) processes in Iran and other selected countries to determine the current individual and organizational incentives to encourage EIHP. In the second phase, we developed two policy briefs and then convened two policy dialogues, with 12 and 8 key informants, respectively, where the briefs were discussed. Data were analysed using manifest content analysis in order to propose contextualized policy options. RESULTS The policy options identified to motivate health researchers and policy-makers to support EIHP in Iran were: revising the criteria of academic PE; designing appropriate incentive programmes for nonacademic researchers; developing an indicator for the evaluation of research impact on policy-making or health outcomes; revising the current policies of scientific journals; revising existing funding mechanisms; presenting the knowledge translation plan when submitting a research proposal, as a mandatory condition; encouraging and supporting mechanisms for increasing interactions between policy-makers and researchers; and revising some administrative processes (e.g. managers and staff PEs; selection, appointment, and changing managers and reward mechanisms). CONCLUSIONS The current individual or organizational incentives are mainly focused on publications, rather than encouraging researchers and policy-makers to support EIHP. Relying more on incentives that consider the other impacts of research (e.g. impacts on health system and policy, or health outcomes) is recommended. These incentives may encourage individuals and organizations to be more involved in conducting research evidence, resulting in promoting EIHP. TRIAL REGISTRATION NA.
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Affiliation(s)
- Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Community-Based Participatory-Research Center, Knowledge Utilization Research Center, and School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ehsani-Chimeh
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Nikooee
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ata Pourabbasi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - John Lavis
- McMaster Health Forum and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
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Yazdizadeh B, Sajadi HS, Mohtasham F, Mohseni M, Majdzadeh R. Systematic review and policy dialogue to determine challenges in evidence-informed health policy-making: findings of the SASHA study. Health Res Policy Syst 2021; 19:73. [PMID: 33947402 PMCID: PMC8097912 DOI: 10.1186/s12961-021-00717-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 04/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Various interventions have been undertaken in Iran to promote evidence-informed health policy-making (EIHP). Identifying the challenges in EIHP is the first step toward strengthening EIHP in each country through the design of tailored interventions. Therefore, the current study was conducted to synthesize the results of earlier studies and to finalize the list of barriers to EIHP in Iran. Methods To identify the barriers to EIHP in Iran, two steps were taken: a systematic review and policy dialogue. To conduct the systematic review, three Iranian databases and PubMed, Health Systems Evidence (HSE), Embase, and Scopus were searched. The reference lists of included papers and documentation from some local organizations were hand-searched. Upon conducting the systematic review, given the significance of stakeholders in clarifying the problem of EIHP, policy dialogue was used to complete the list previously extracted and to do advocacy. Selection criteria for the stakeholders included influential and informed individuals from knowledge-producing, knowledge-utilizing, and knowledge-brokering organizations. Semi-structured interviews were held with three important absent stakeholders. Results Challenges specific to Iran that were identified included the lack of integration of the health ministry and the medical universities, lack of ties between health knowledge utilization organizations, failure to establish long-term research plans, neglect of national research needs at the time of recruiting human resources in knowledge-producing organizations, and duplication and lack of coordination in routine data obtained from surveillance systems, disease registration systems, and censuses. It seems that some challenges are common across countries, including neglecting the importance of inter- and intra-disciplinary studies, the capacity of policy-makers and managers to utilize evidence, the criteria for evaluating the performance of policy-makers, managers, and academic members, the absence of long-term programmes in knowledge-utilizing organizations, the rapid replacement of policy-makers and managers, and lack of use of evaluation studies. Conclusions In this study, we tried to identify the challenges regarding EIHP in Iran using a systematic review and policy dialogue approach. This is the first step toward determining the best interventions to improve evidence-informed policy-making in each country, because these challenges are contextual and need to be investigated contextually. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-021-00717-x.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Mohtasham
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Mohseni
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Community Based Participatory Research Center, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Yazdizadeh B, Majdzadeh R, Ahmadi A, Mesgarpour B. Health research system resilience: lesson learned from the COVID-19 crisis. Health Res Policy Syst 2020; 18:136. [PMID: 33339524 PMCID: PMC7747187 DOI: 10.1186/s12961-020-00667-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 12/06/2020] [Indexed: 12/28/2022] Open
Abstract
Producing evidence in epidemics is crucial to control the current epidemic and prevent its recurrence in the future. Data must be collected and analyzed rapidly to recognize the most efficient and feasible methods with proper timelines. However, there are many challenges a research system may encounter during a crisis. This article has presented lessons learned from the COVID-19 pandemic for health research system (HRS) to deal with current and future crises. Therefore, a HRS needs to produce and use evidence in such a situation. The components Knowledge Translation Self-Assessment Tool for Research Institutes (SATORI) framework was used to review the actions required and respond to the COVID-19 pandemic in a national HRS. This framework consists of four categories of defining the research question, conducting research, translating the research results, and promoting the use of evidence. The work is proposed actions in response to the COVID-19 crisis and improving a HRS's resilience. While COVID-19 has serious harm to the health and broader socio-economic consequences, this threat should be accounted for as an opportunity to make research systems more accountable and responsible in the timely production and utilization of knowledge. It is time to seriously think about how HRS can build a better back to be resilient to potential shock and prepare for unforeseen emerging conditions.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Community-based Participatory Research Center, Knowledge Utilization Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Mesgarpour
- National Institute for Medical Research Development (NIMAD), Tehran, Iran
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Ahmadi A, Doshmangir L, Gordeev VS, Yazdizadeh B, Majdzadeh R. Behavioral barriers of tuberculosis notification in private health sector: policy implication and practice. IJHG 2020. [DOI: 10.1108/ijhg-01-2020-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeUnderreporting of new tuberculosis (TB) cases is one of the main problems in TB control, particularly in countries with high incidence and dominating role of a private sector in TB cases diagnosing. The purpose of this paper was to explore behavioral determinants of underreporting of new TB cases among private sector physicians in Iran.Design/methodology/approachThe authors conducted a population-based, cross-sectional study of physicians working in private clinics. The data collection tool was designed using the theory of planned behavior (TPB). The authors used structural equation models with maximum likelihood estimation to examine attitude toward the notification behavior.FindingsOf 519 physicians, 433 physicians completed the questionnaire. Attitude toward notification had the highest score (mean score = 87.65; sd = 6.79; range: 0–100). The effect of perceived behavioral controls on the notification behavior ((β^) = 0.13; CI: 0.01–0.25) was stronger than the total effect of attitude ((β^) = 0.06; CI: 0.00–0.12) and subjective norms ((β^) = 0.01; CI: −0.00–0.03) on the behavior. However, the attitude was the main predictor of intention and justified 46% of the intention variance. Intention had a significant effect on the behavior ((ß^) = 0.09; CI: 0.1–0.16).Practical implicationsConsidering stronger effect of perceived behavioral control on the behavior, interventions aiming at facilitating notification process would be more effective than those aiming at changing the attitude or enhancing intention among physicians.Originality/valueTo the best of our knowledge, no other study previously explored determinants of underreporting from the behavioral and cognitive perspective. Specifically, the authors explored the role of the TPB constructs in predicting intention to notify new TB cases.
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Abstract
BACKGROUND Classical galactosaemia is an autosomal recessive inborn error of metabolism caused by a deficiency of the enzyme galactose-1-phosphate uridyltransferase. This is a rare and potentially lethal condition that classically presents in the first week of life once milk feeds have commenced. Affected babies may present with any or all of the following: cataracts; fulminant liver failure; prolonged jaundice; or Escherichia coli sepsis. Once the diagnosis is suspected, feeds containing galactose must be stopped immediately and replaced with a soya-based formula. The majority of babies will recover, however a number will not survive. There are long-term complications of galactosaemia, despite treatment, including learning disabilities and female infertility. It has been postulated that galactosaemia could be detected on newborn screening and this would prevent the immediate severe liver dysfunction and sepsis. This is an update of a previously published review. OBJECTIVES To assess whether there is evidence that newborn screening for galactosaemia prevents or reduces mortality and morbidity and improves clinical outcomes in affected neonates and the quality of life in older children. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from electronic database searches, handsearches of relevant journals and conference abstract books. We also searched online trials registries and the reference lists of relevant articles and reviews. Date of the most recent search of Cochrane Cystic Fibrosis Group's Trials Register: 12 December 2019. Date of the most recent search of additional resources: 02 February 2020. SELECTION CRITERIA Randomised controlled studies and controlled clinical studies, published or unpublished comparing the use of any newborn screening test to diagnose infants with galactosaemia and presenting a comparison between a screened population versus a non-screened population. DATA COLLECTION AND ANALYSIS No studies of newborn screening for galactosaemia were found. MAIN RESULTS No studies were identified for inclusion in the review. AUTHORS' CONCLUSIONS We were unable to identify any eligible studies for inclusion in this review and hence it is not possible to draw any conclusions based on randomised controlled studies. However, we are aware of uncontrolled studies which support the efficacy of newborn screening for galactosaemia. There are a number of reviews and economic analyses of non-trial literature suggesting that screening is appropriate.
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Affiliation(s)
- Rohollah Lak
- Vice-Chancellery for Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Davari
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Nouhi
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
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Abdi Z, Yazdizadeh B, Ahmadnezhad E, Rahimi M, Majdzadeh R. Universal health coverage in Iran: What kind of knowledge is needed to achieve the goals? Med J Islam Repub Iran 2019. [DOI: 10.47176/mjiri.33.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abdi Z, Yazdizadeh B, Ahmadnezhad E, Rahimi M, Majdzadeh R. Universal health coverage in Iran: What kind of knowledge is needed to achieve the goals? Med J Islam Repub Iran 2019; 33:65. [PMID: 31456989 PMCID: PMC6708118 DOI: 10.34171/mjiri.33.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Indexed: 12/07/2022] Open
Abstract
Achieving universal health coverage (UHC), which means ensuring access to high quality and equitable services by all without financial hardship, requires local evidence. To find interventions appropriate to local needs, local knowledge and evidence are required in addition to global evidence. Thus, every country should have its own plan for research production and utilization and strengthening researchers' capacities to achieve UHC. To accomplish the goals of UHC, the research system should be able to determine the research priorities and agenda, collect resources, improve the capacity for evidence generation, and maximally utilize the country's capacity for finding local solutions by establishing research networks. In this study, inputs for UHC research priority setting in Iran and its challenges have been discussed.
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Affiliation(s)
- Zhaleh Abdi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ahmadnezhad
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Rahimi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Community-Based Participatory-Research Center, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Sajadi HS, Majdzadeh R, Yazdizadeh B, Mohtasham F, Mohseni M, Doshmangir L, Lavis J. A roadmap for strengthening evidence-informed health policy-making in Iran: protocol for a research programme. Health Res Policy Syst 2019; 17:50. [PMID: 31101047 PMCID: PMC6525369 DOI: 10.1186/s12961-019-0455-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/16/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Many initiatives have been taken in the Islamic Republic of Iran to promote evidence-informed health policy-making (EIHP). However, these initiatives are not systematic. Since the implementation of EIHP is not consistent and the interventions in this regard are complex, a comprehensive plan could be a useful tool for employing initiatives to achieve and promote EIHP. Hence, this study aims to develop a roadmap for strengthening EIHP over a 3-year period in Iran. METHODS Nine projects will be conducted to define the roadmap for strengthening EIHP. These projects include two reviews and a stakeholder analysis to identify the factors that facilitate or hinder achieving EIHP. The next study will be a qualitative study to prioritise the challenges and outline the main causes. The following steps will be a review of reviews to extract global experiences on interventions used for strengthening EIHP and two qualitative studies to examine the adoption of these interventions and develop an operational plan for strengthening EIHP in Iran. The research will be completed through conducting two qualitative-quantitative studies to design a tool for measuring EIHP and assessing EIHP in Iran at baseline. DISCUSSION This national EIHP roadmap will surely be able to identify the gaps and bumps that might exist in the implementation plan for establishing EIHP and eliminate them as needed in the future. This roadmap can be a step in moving towards transparency and accountability in the health system and as thus towards good governance and improvement of the health system's performance. Although the plan can be a good model for developing countries and may promote the use of evidence in health policy-making, we should assume that there are some critical contextual factors that could potentially hinder the complete and successful implementation of EIHP. Thus, to enhance EIHP in these countries with a policy-making context that does not fully support the use of evidence, it is crucial to think about not only those interventions that directly address the EIHP barriers, but also some long-term strategies to make required changes in the context, both beyond and within the health system.
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Affiliation(s)
- Haniye Sadat Sajadi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Mohtasham
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Mohseni
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Doshmangir
- Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - John Lavis
- McMaster Health Forum and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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Mansoori P, Majdzadeh R, Abdi Z, Rudan I, Chan KY, Aarabi M, Ahmadnezhad E, Ahmadnia S, Akhondzadeh S, Azin A, Azizi F, Dehnavieh R, Eini-Zinab H, Farzadfar F, Farzaei MH, Ghanei M, Haghdoost A, Hantoushzadeh S, Heydari G, Joulaei H, Kalantari N, Kelishadi R, Khosravi A, Larijani B, Mahvi AH, Bavani ARM, Mesdaghinia A, Mokri A, Montazeri A, Mostafavi E, Motevalian SA, Naddafi K, Nikfar S, Nojoumi SA, Noroozian M, Olyaeemanesh A, Omidvar N, Ostadtaghizadeh A, Pourmalek F, Rahimi R, Rahimi-Movaghar A, Rashidian A, Razaghi E, Sadeghi-Bazargani H, Zalani GS, Soori H, Tabrizi JS, Vedadhir A, Yazdizadeh B, Yunesian M, Zare M. Setting research priorities to achieve long-term health targets in Iran. J Glob Health 2018; 8:020702. [PMID: 30356511 PMCID: PMC6188089 DOI: 10.7189/jogh.08.020702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Background In 2015, it was estimated that the burden of disease in Iran comprised of 19 million disability-adjusted life years (DALYs), 74% of which were due to non-communicable diseases (NCDs). The observed leading causes of death were cardiovascular diseases (41.9%), neoplasms (14.9%), and road traffic injuries (7.4%). Even so, the health research investment in Iran continues to remain limited. This study aims to identify national health research priorities in Iran for the next five years to assist the efficient use of resources towards achieving the long-term health targets. Methods Adapting the Child Health and Nutrition Research Initiative (CHNRI) method, this study engaged 48 prominent Iranian academic leaders in the areas related to Iran’s long-term health targets, a group of research funders and policy makers, and 68 stakeholders from the wider society. 128 proposed research questions were scored independently using a set of five criteria: feasibility, impact on health, impact on economy, capacity building, and equity. Findings The top-10 priorities were focused on the research questions relating to: health insurance system reforms to improve equity; integration of NCDs prevention strategy into primary health care; cost-effective population-level interventions for NCDs and road traffic injury prevention; tailoring medical qualifications; epidemiological assessment of NCDs by geographic areas; equality in the distribution of health resources and services; current and future common health problems in Iran’s elderly and strategies to reduce their economic burden; the status of antibiotic resistance in Iran and strategies to promote rational use of antibiotics; the health impacts of water crisis; and research to replace the physician-centered health system with a team-based one. Conclusions These findings highlight consensus amongst various prominent Iranian researchers and stakeholders over the research priorities that require investment to generate information and knowledge relevant to the national health targets and policies. The exercise should assist in addressing the knowledge gaps to support both the National General Health Policies by 2025 and the health targets of the United Nations’ Sustainable Development Goals by 2030.
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Affiliation(s)
- Parisa Mansoori
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Joint corresponding authors
| | - Reza Majdzadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Community Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran.,School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Joint corresponding authors
| | - Zhaleh Abdi
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Kit Yee Chan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Nossal Institute for Global Health, University of Melbourne, Australia.,Joint corresponding authors
| | | | - Mohsen Aarabi
- Department of Family Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Diabetic Research Center, Cancer Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Ahmadnezhad
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Azin
- Reproductive Biotechnology Research Center, Avicenna Research Institute (ACECR), Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Dehnavieh
- Health Services Management Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisoning Institute, Tehran, Iran
| | - AliAkbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sedigheh Hantoushzadeh
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Gholamreza Heydari
- Tobacco Prevention & Control Research Center, National Research Institute of TB & Lung Diseases, Shahid Beheshti University of Medical Sciences Tehran, Iran
| | - Hassan Joulaei
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naser Kalantari
- National Institute and Faculty of Nutrition Sciences and Food Technology, Department of Community Nutrition, Shahid Beheshti University of Medical Sciences
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ardeshir Khosravi
- Deputy for Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Mahvi
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Center for Solid Waste Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Massah Bavani
- Department of Irrigation and Drainage Engineering, Aburaihan Campus, University of Tehran, Pakdasht, Iran
| | - Alireza Mesdaghinia
- School of Public Health, Tehran University of Medical Sciences, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Azarakhsh Mokri
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Institute for Health Sciences Research, ACECR. Tehran, Iran
| | - Ehsan Mostafavi
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed Abbas Motevalian
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Kazem Naddafi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.,Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy and Pharmaceutical Management and Economics Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Nojoumi
- Microbiology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Maryam Noroozian
- Memory and Behavioral Neurology Division, Department of Psychiatry, Tehran University of Medical Sciences (TUMS), Iran
| | - Alireza Olyaeemanesh
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran.,Health Equity Research Centre, Tehran University of Medical Sciences, Tehran Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition, Tehran, Iran
| | - Abbas Ostadtaghizadeh
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical sciences, Tehran, Iran
| | - Farshad Pourmalek
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Roja Rahimi
- Department of Pharmacy in Persian Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Director of Information, Evidence and Research, Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - Emran Razaghi
- Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Hamid Soori
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences
| | - Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, Health, Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - AbouAli Vedadhir
- Department of Anthropology, Faculty of Social Sciences, University of Tehran, Tehran, Iran.,UCL Department of Science and Technology Studies, University College London, Gower Street, London, UK
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Zare
- Engineering Seismology Department, International Institute of Earthquake Engineering and Seismology (IIEES), Tehran, Iran
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Dakhesh S, Ostovar A, Yazdizadeh B, Hamidi A. Knowledge Translation Process among Academic Researchers: A Case Study of Bushehr University of Medical Sciences. Libri 2018. [DOI: 10.1515/libri-2017-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Today, most of the results and knowledge obtained from national and international research do not actually change the health status of people, which has led to a gap or distance between knowledge and practice. This research was a descriptive survey and examined the status of the knowledge translation process among the researchers of Bushehr University of Medical Sciences, Iran, from 2011 to 2015. The study population consisted of the researchers of the Bushehr University of Medical Sciences, who were chosen using a completely randomized design. 83 researchers were finally selected by the inclusion criteria of presenting or collaborating on at least five approved areas of research during the 2011–2015 period. Data collection was undertaken using the Assessment Questionnaire of Academic Researchers Knowledge Translation Activities, with its psychometric test also used. The results showed that the researchers’ performance was rated in the fields of transfer of the research question, knowledge production, knowledge transfer and promoting the use of evidence with 64, 75, 63 and 67 % of the total score (mean± SD) of 19.40 ± 3.89, 26.30 ± 3.97, 37.79 ± 6.89 and 13.39 ± 3.41 respectively. Based on the results of this study, the performance of the researchers in the process of knowledge translation was at a desired level while, in the fields of the research tool, the researchers had the best research performance in knowledge production and promoting the use of evidence, transfer of research question and knowledge transfer (all at the desirable level). However, the gap between knowledge and practice of the researchers in the fields of transfer of the research question and knowledge transfer was noticeable. Therefore, in order to strengthen all aspects of the research activities of the knowledge translation process, the provision of proper premises and structure will be a priority for the university’s research and technology departments.
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Yazdizadeh B, Mohtasham F, Velayati A. Correction to: Impact assessment of Iran's health technology assessment programme. Health Res Policy Syst 2018; 16:89. [PMID: 30193593 PMCID: PMC6128982 DOI: 10.1186/s12961-018-0369-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 11/10/2022] Open
Abstract
It has been highlighted that the original article [1] contains a typesetting mistake in affiliation 2.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Centre (KURC), Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Mohtasham
- Knowledge Utilization Research Centre (KURC), Tehran University of Medical Sciences, Tehran, Iran.
| | - Ashraf Velayati
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Yazdizadeh B, Mohtasham F. Assessment of research systems in universal health coverage-related organizations. Med J Islam Repub Iran 2018; 32:15. [PMID: 30159266 PMCID: PMC6108238 DOI: 10.18869/mjiri.32.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Indexed: 11/28/2022] Open
Abstract
Background: Universal health coverage (UHC) is the desired goal of achieving universal access to health services without having to endure pain and financial difficulties. Multiple factors can help steer countries toward UHC. One of the most important factors is the production of valid quality evidence that can be achieved through research. The present study aimed at outlining the status of research systems in UHC–related organizations and identifying the barriers faced by research.
Methods: The key individuals and organizations that could provide rich, relevant, and diverse data in response to the research question were purposively selected for the interviews. Thematic analysis was used to analyze the interviews. Categories and subcategories were deductively extracted from the text based on research system performance as follows: resource provision, production and utilization of knowledge, existing resources, and stewardship. Then, the themes were inductively extracted from the interviews.
Results: Many barriers existed for performing research in UHC–related organizations. The stewardship barrier seemed to play a key role such that structural changes in organizations affected the production & utilization of evidence. Limited financial and human resources were evident in most of the organizations. Research questions were not comprehensively identified. The conducted studies either were not designed to answer the relevant questions and/or were not appropriately reported to policy makers. As a result, their implementation in decision- making did not reach the ideal status.
Conclusion: Research utilization aimed at achieving UHC will come to realize only when and if research is conducted to produce evidence required for decision–making and implementation. Therefore, in addition to the interventions recommended by the World Health Organization, we should design and implement interventions tailored to the local barriers and needs of UHC–related organizations.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Mohtasham
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
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25
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Abstract
BACKGROUND Following approximately 10 years from the beginning of Iran's national Health Technology Assessment (HTA) programme, the present study aims to evaluate its success by examining the impact of HTA and identifying the determinant factors leading to the implementation of HTA report results. METHODS The triangulation method was employed herein. HTA reports were initially identified and their impact and determinant factors were then examined from the perspectives of both researchers (by preparing a questionnaire according to the Payback model and sending it to HTA principle investigators) and stakeholders (semi-structured interviews held with each HTA stakeholder). Simultaneously, the quality of the HTA reports was examined with relevant critical appraisal checklists. RESULTS The impact of 19 equipment technologies and four pharmaceutical technologies were assessed in this study. Twenty researchers replied (response rate, 86.96%) to the questionnaire on the impact of HTA reports from the researcher's perspective. To assess the impact of HTA reports from the stakeholder's perspective, seven policy-makers were chosen and interviewed as the main target audience. The most common step taken to disseminate the results of the HTA projects was publication. Conducting the HTA had taught researchers and their colleagues' new skills and had facilitated the securing of research grants from other organisations. Most reports had used the systematic review method but the relevant details had been scarcely presented regarding outcomes, costs and analysis. The greatest impact of HTA reports on decision-making had been on policy-makers providing and allocating finances. Barriers in stewardship, identification and prioritisation of topics, performance and dissemination of HTA results were the main barriers of implementing HTAs. CONCLUSIONS In most aspects, the status of HTA impact reports need improvement. Thus far, the barriers and facilitators of the HTA programme in Iran have been investigated in other studies. These findings should be pooled to reach a solution that can be actively applied to the health system to improve the status quo of HTA in Iran.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Centre (KURC), Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Mohtasham
- Knowledge Utilization Research Centre (KURC), Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Velayati
- Shaheed Beheshti University of Medical Sciences, Tehran, Iran
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26
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Shalviri G, Yazdizadeh B, Mirbaha F, Gholami K, Majdzadeh R. Choosing Appropriate Theories for Understanding Hospital Reporting of Adverse Drug Events, a Theoretical Domains Framework Approach. Iran J Pharm Res 2018; 17:811-821. [PMID: 29881437 PMCID: PMC5985197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adverse drug events (ADEs) may cause serious injuries including death. Spontaneous reporting of ADEs plays a great role in detection and prevention of them; however, underreporting always exists. Although several interventions have been utilized to solve this problem, they are mainly based on experience and the rationale for choosing them has no theoretical base. The vast variety of behavioural theories makes it difficult to choose appropriate theory. Theoretical domains framework (TDF) is suggested as a solution. The objective of this study was to select the best theory for evaluating ADE reporting in hospitals based on TDF. We carried out three focus group discussions with hospital pharmacists and nurses, based on TDF questions. The analysis was performed through five steps including coding discussions transcript, extracting beliefs, selecting relevant domains, matching related constructs to the extracted beliefs, and determining the appropriate theories in each domain. The theory with the highest number of matched domains and constructs was selected as the theory of choice. A total of six domains were identified relevant to ADE reporting, including "Knowledge", "Skills", "Beliefs about consequences", "Motivation and goals", "Environmental context and resources" and "Social influences". We found theory of planned behavior as the comprehensive theory to study factors influencing ADE reporting in hospitals, since it was relevant theory in five out of six relevant domains and the common theory in 55 out of 75 identified beliefs. In conclusion, we suggest theory of planned behavior for further studies on designing appropriate interventions to increase ADE reporting in hospitals.
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Affiliation(s)
- Gloria Shalviri
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran. ,Corresponding author: E-mail:
| | - Fariba Mirbaha
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kheirollah Gholami
- Research Center for Rational Use of Drugs, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Majdzadeh
- Knowledge Utilization Research Center; Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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27
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Abstract
BACKGROUND Classical galactosaemia is an autosomal recessive inborn error of metabolism caused by a deficiency of the enzyme galactose-1-phosphate uridyltransferase. This is a rare and potentially lethal condition that classically presents in the first week of life once milk feeds have commenced. Affected babies may present with any or all of the following: cataracts; fulminant liver failure; prolonged jaundice; or Escherichia coli sepsis. Once the diagnosis is suspected, feeds containing galactose must be stopped immediately and replaced with a soya-based formula. The majority of babies will recover, however a number will not survive. There are long-term complications of galactosaemia, despite treatment, including learning disabilities and female infertility. It has been postulated that galactosaemia could be detected on newborn screening and this would prevent the immediate severe liver dysfunction and sepsis. OBJECTIVES To assess whether there is evidence that newborn screening for galactosaemia prevents or reduces mortality and morbidity and improves clinical outcomes in affected neonates and the quality of life in older children. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from electronic database searches, handsearches of relevant journals and conference abstract books. We also searched online trials registries and the reference lists of relevant articles and reviews.Date of the most recent search of Cochrane Cystic Fibrosis Group's Trials Register: 18 December 2017.Date of the most recent search of additional resources: 11 October 2017. SELECTION CRITERIA Randomised controlled studies and controlled clinical studies, published or unpublished comparing the use of any newborn screening test to diagnose infants with galactosaemia and presenting a comparison between a screened population versus a non-screened population. DATA COLLECTION AND ANALYSIS No studies of newborn screening for galactosaemia were found. MAIN RESULTS No studies were identified for inclusion in the review. AUTHORS' CONCLUSIONS We were unable to identify any eligible studies for inclusion in this review and hence it is not possible to draw any conclusions based on randomised controlled studies. However, we are aware of uncontrolled studies which support the efficacy of newborn screening for galactosaemia. There are a number of reviews and economic analyses of non-trial literature suggesting that screening is appropriate.
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Affiliation(s)
- Rohollah Lak
- Isfahan University of Medical SciencesVice‐Chancellery for HealthIsfahanIran
| | - Bahareh Yazdizadeh
- Tehran University of Medical SciencesKnowledge Utilization Research Center1547 North Karegar St, Enghelab AveTehranIran
| | - Majid Davari
- Faculty of Pharmacy, Tehran University of Medical SciencesDepartment of Pharmacoeconomics and Pharmaceutical AdministrationTehranIran
| | - Mojtaba Nouhi
- Tehran University of Medical SciencesHealth Equity Research CenterEnqelab StEnqelab SqTehranIran1996713883
| | - Roya Kelishadi
- Isfahan University of Medical SciencesChild Growth and Development Research Center, Research Institute for Primordial Prevention of Non‐Communicable DiseasesHezar Jerib AveIsfahanIran
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Imani-Nasab MH, Yazdizadeh B, Salehi M, Seyedin H, Majdzadeh R. Validity and reliability of the Evidence Utilisation in Policymaking Measurement Tool (EUPMT). Health Res Policy Syst 2017; 15:66. [PMID: 28778204 PMCID: PMC5545013 DOI: 10.1186/s12961-017-0232-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 07/18/2017] [Indexed: 11/25/2022] Open
Abstract
Background As a well-known theory in studying the effective factors on behaviour, the theory of planned behaviour (TPB) is frequently used in evaluating the health behaviour of people and healthcare providers, but rarely applied in studying the behaviour of health policymakers. The aim of the present study is to design and validate a TPB-based measurement tool for evidence utilisation in health policymaking (the EUPMT) through a mixed approach using confirmatory factor analysis. Methods The study population consisted of all the specialised units and their employees in the five deputies of Iran’s Ministry of Health and Medical Education in 2013. All those eligible were invited to participate in the study, which comprised 373 persons. The reliability of the EUPMT was determined through test-retest and internal consistency. Additionally, its validity was determined by face, content, convergent, discriminant and construct validities. SPSS-20 and LISREL-8.8 were employed to analyse the data. To assess the fitness of the measurement models, three groups of indices were used, i.e. absolute, relative and parsimonious. Results The content and face validities of the tool were 83% and 67%, respectively. Cronbach’s alpha of different constructs ranged from 0.7 to 0.9. In the test-retest method, the intra-class correlations were between 0.75 and 0.87. Confirmatory factor analysis showed that the penta-factorial structure of the experimental data had acceptable fitness with the TPB (GFI = 0.86, NFI = 0.94, RSMEA = 0.075). Conclusion TPB is able to explain the behaviour of evidence utilisation in health policymaking. The finalised TPB-based tool has relatively good reliability and validity to assess evidence utilisation in health policymaking. The EUPMT can be applied to determine the status quo of evidence utilisation in health policymaking, whilst designing interventions for its improvement and assessing their outcomes.
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Affiliation(s)
- M H Imani-Nasab
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.,Department of Public Health, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - B Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - M Salehi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - H Seyedin
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - R Majdzadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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29
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Hasan Imani-Nasab M, Seyedin H, Yazdizadeh B, Majdzadeh R. A Qualitative Assessment of the Evidence Utilization for Health Policy-Making on the Basis of SUPPORT Tools in a Developing Country. Int J Health Policy Manag 2017; 6:457-465. [PMID: 28812845 PMCID: PMC5553214 DOI: 10.15171/ijhpm.2016.158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 12/31/2016] [Indexed: 12/12/2022] Open
Abstract
Background: SUPPORT tools consist of 18 articles addressing the health policy-makers so that they can learn how to make evidence-informed health policies. These tools have been particularly recommended for developing countries. The present study tries to explain the process of evidence utilization for developing policy documents in the Iranian Ministry of Health and Medical Education (MoHME) and to compare the findings with those of SUPPORT tools.
Methods: A qualitative research was conducted, using the framework analysis approach. Participants consisted of senior managers and technicians in MoHME. Purposeful sampling was done, with a maximum variety, for the selection of research participants: individuals having at least 5 years of experience in preparing evidence-based policy documents. Face-to-face interviews were conducted for data collection. As a guideline for the interviews, ‘the Utilization of Evidence in Policy-Making Organizations’ procedure was used. The data were analyzed through the analysis of the framework method using MAXQDA 10 software.
Results: The participants acquired the research evidence in a topic-based form, and they were less likely to search on the basis of the evidence pyramid. To assess the quality of evidence, they did not use standard critical tools; to adapt the evidence and interventions with the local setting, they did not use the ideas and experiences of all stakeholders, and in preparing the evidence-based policy documents, they did not take into consideration the window of opportunity, did not refrain from using highly technical terms, did not write user-friendly summaries, and did not present alternative policy options. In order to develop health policies, however, they used the following innovations: attention to the financial burden of policy issues on the agenda, sensitivity analysis of the preferred policy option on the basis of technical, sociopolitical, and economic feasibility, advocacy from other scholars, using the multi-criteria decision-making models for the prioritization of policy options, implementation of policy based on the degree of readiness of policy-implementing units, and the classification of policy documents on the basis of different conditions of policy-making (urgent, short-term, and long-term).
Conclusion: Findings showed that the process of evidence utilization in IR-MoH enjoys some innovations for the support of health policy development. The present study provides IR-MoH with considerable opportunities for the improvement of evidence-informed health policy-making. Moreover, the SUPPORT process and tools are recommended to be used in developing countries.
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Affiliation(s)
- Mohammad Hasan Imani-Nasab
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.,Department of Health Services Management, School of Medical Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Seyedin
- Department of Health Services Management, School of Medical Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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30
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Yazdizadeh B, Parsaeian M, Majdzadeh R, Nikooee S. Impact of Health Research Systems on Under-5 Mortality Rate: A Trend Analysis. Int J Health Policy Manag 2017; 6:395-402. [PMID: 28812835 PMCID: PMC5505109 DOI: 10.15171/ijhpm.2016.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 11/19/2016] [Indexed: 11/09/2022] Open
Abstract
Background: Between 1990 and 2015, under-5 mortality rate (U5MR) declined by 53%, from an estimated rate of 91 deaths per 1000 live births to 43, globally. The aim of this study was to determine the share of health research systems in this decrease alongside other influential factors.
Methods: We used random effect regression models including the ‘random intercept’ and ‘random intercept and random slope’ models to analyze the panel data from 1990 to 2010. We selected the countries with U5MRs falling between the first and third quartiles in 1990. We used both the total articles (TA) and the number of child-specific articles (CSA) as a proxy of the health research system. In order to account for the impact of other factors, measles vaccination coverage (MVC) (as a proxy of health system performance), gross domestic product (GDP), human development index (HDI), and corruption perception index (CPI) (as proxies of development), were embedded in the model.
Results: Among all the models, ‘the random intercept and random slope models’ had lower residuals. The same variables of CSA, HDI, and time were significant and the coefficient of CSA was estimated at -0.17; meaning, with the addition of every 100 CSA, the rate of U5MR decreased by 17 per 1000 live births.
Conclusion: Although the number of CSA has contributed to the reduction of U5MR, the amount of its contribution is negligible compared to the countries’ development. We recommend entering different types of researches into the model separately in future research and including the variable of ‘exchange between knowledge generator and user.’
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Parsaeian
- Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Nikooee
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Shafiee G, Nasli-Esfahani E, Bandarian F, Peimani M, Yazdizadeh B, Razi F, Farzadfar F, Larijani B. Iran Diabetes Research Roadmap (IDRR): the study protocol. J Diabetes Metab Disord 2016; 15:58. [PMID: 28018867 PMCID: PMC5160021 DOI: 10.1186/s40200-016-0277-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/23/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Diabetes mellitus is a common metabolic disorder which is increasing worldwide. This study aimed to undertake a survey of the diabetes research in Iran to identify gaps and highlight strengths in order to develop a roadmap for diabetes research in Iran for the next years. METHODS To develop a roadmap and to identify major areas of diabetes research, we carried out a systematic assessment of Iranian diabetes research publications. All obtained studies were categorized to 11 groups and each group was classified according to the "study design", "subject area", "World Health Organization (WHO) classification", and "Australian Standard Research Classifications". The number of publications per each year was calculated. Research trends in publications in each area were assessed and compared. CONCLUSION By this study, we will provide the highlighted priorities, the gaps of research and strategic mapping of each area of diabetes research that could serve as a precious guideline for national research initiatives in the field of diabetes. By a strategic map, we can achieve many advances in the all aspects of diabetes research that finally impact on the health, quality of life and well-being of diabetic patients.
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Affiliation(s)
- Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Researcher Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 5th floor, Diabetes Clinic, Cross Heyat Ave., Shahrivar Ave., North Kargar St., Tehran, Iran
| | - Fatemeh Bandarian
- Diabetes Researcher Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 5th floor, Diabetes Clinic, Cross Heyat Ave., Shahrivar Ave., North Kargar St., Tehran, Iran
| | - Maryam Peimani
- Diabetes Researcher Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 5th floor, Diabetes Clinic, Cross Heyat Ave., Shahrivar Ave., North Kargar St., Tehran, Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Razi
- Diabetes Researcher Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 5th floor, Diabetes Clinic, Cross Heyat Ave., Shahrivar Ave., North Kargar St., Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Researcher Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Yazdizadeh B, Majdzadeh R, Janani L, Mohtasham F, Nikooee S, Mousavi A, Najafi F, Atabakzadeh M, Bazrafshan A, Zare M, Karami M. An assessment of health research impact in Iran. Health Res Policy Syst 2016; 14:56. [PMID: 27461105 PMCID: PMC4962356 DOI: 10.1186/s12961-016-0129-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 06/30/2016] [Indexed: 11/20/2022] Open
Abstract
Background In recent years, Iran has made significant developments in the field of health sciences. However, the question is whether this considerable increase has affected public health. The research budget has always been negligible and unsustainable in developing countries. Hence, using the Payback Framework, we conducted this study to evaluate the impact of health research in Iran. Methods By using a cross-sectional method and two-stage stratified cluster sampling, the projects were randomly selected from six medical universities. A questionnaire was designed according to the Payback Framework and completed by the principle investigators of the randomly selected projects. Results The response rate was 70.4%. Ten point twenty-four percent (10.24%) of the studies had been ordered by a knowledge user organization. The average number of articles published in journals per project was 0.96, and half of the studies had no articles published in Scopus. The results of 12% of the studies had been used in systematic review articles and the same proportion had been utilized in clinical or public health guidelines. The results of 5.3% of the studies had been implemented in the Health Ministry’s policymaking. 62% of the studies were expected to affect health directly, 38% of them had been implemented, and among the latter 60% had achieved the expected results. Concerning the economic impacts, the most common expected impact was the reduction of ‘days of work missed because of illness or disability’ and impact on personal and health system costs. About 36% of these studies had been implemented, and 61% had achieved the expected impact. Conclusion In most aspects, the status of research impact needs improvement. A comparison of Iran’s ranking of knowledge creation and knowledge impact in the Global Innovation Index confirms these findings. The most important problems identified were, not conducting research based on national needs, and the lack of implementation of research results. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0129-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Majdzadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Epidemiology and Biostatistics Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farideh Mohtasham
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Nikooee
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdmohammad Mousavi
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Azam Bazrafshan
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Morteza Zare
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Manoochehr Karami
- Social Determinants of Health Research Center and Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Affiliation(s)
- Rohollah Lak
- Tehran University of Medical Sciences; Department of Public Health; Tehran Iran
| | - Bahareh Yazdizadeh
- Tehran University of Medical Sciences; Knowledge Utilization Research Center; 1547 North Karegar St, Enghelab Ave Tehran Iran
| | - Majid Davari
- Faculty of Pharmacy, Tehran University of Medical Sciences; Department of Pharmacoeconomics and Pharmaceutical Administration; Tehran Iran
| | - Mojtaba Nouhi
- Iran University of Medical Sciences; Health Management and Economics Research Center; ValiAsr St Vanak Square Tehran Iran 1996713883
| | - Roya Kelishadi
- Isfahan University of Medical Sciences; Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases; Hezar Jerib Ave Isfahan Iran
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Mohtasham F, Yazdizadeh B, Zali Z, Majdzadeh R, Nedjat S. Health technology assessment in Iran: Barriers and solutions. Med J Islam Repub Iran 2016; 30:321. [PMID: 27390691 PMCID: PMC4898849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/08/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health technology assessment (HTA) is a tool utilized for efficient dissemination of technology. For the purpose of encouraging decision-makers to utilize this tool, at first, we need to identify the obstacles in the processes of preparation, utilization, and implementation of HTAs. This study aims to define these barriers and offer solutions for effective utilization of HTA reports produced in Iran. METHODS This qualitative content analysis determines the various beneficiaries of HTA, and utilizes a semi-structured interview with the participants who are all involved in the HTA. RESULTS Nine out of ten people invited for the interviews accepted the researchers' invitation. An analysis of barriers and solutions for improving the utilization of HTA reports was conducted in three levels of policy makers (policy level), specialists in healthcare (professional level), and ordinary people (public level). The barriers in the policy level include unsuitability of reports for their audience, incompatible views toward the definition and necessity of health technology assessment, lack of financial resources for report preparation, and limitations in large-scale policymaking in Ministry of Health. Barriers in the professional level include lack of knowledge on HTA among serviceproviders. Barriers in the public level consist of information asymmetry. CONCLUSION There are various barriers toward accurate utilization of HTAs in Iran. Thus, a systematic approach which involves people, brings about culture, improves infrastructures, and boosts supervision on the performance is recommended.
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Affiliation(s)
- Farideh Mohtasham
- 1 BS Ntr, MSc in HTA, Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bahareh Yazdizadeh
- 2 MD, PhD in Epidemiology, Assistant Professor, Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran. ,(Corresponding author) MD, PhD in Epidemiology, Assistant Professor, Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Zali
- 3 BPH, MSc in HTA, Department of Health Economics, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Reza Majdzadeh
- 4 DVM, MSc in HTA, PhD in Epidemiology, Professor of Epidemiology, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sima Nedjat
- 5 MD, MPH, PhD candidate of Gerontology, Knowledge Utilization Research Centre, Tehran University of Medical Sciences, & University of Social Welfare and Rehabilitation, Tehran, Iran. ,
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Mirbaha F, Shalviri G, Yazdizadeh B, Gholami K, Majdzadeh R. Perceived barriers to reporting adverse drug events in hospitals: a qualitative study using theoretical domains framework approach. Implement Sci 2015; 10:110. [PMID: 26250159 PMCID: PMC4528309 DOI: 10.1186/s13012-015-0302-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 07/30/2015] [Indexed: 12/29/2022] Open
Abstract
Background Adverse drug events (ADEs) are a major source of morbidity and mortality, estimated as the forth to sixth cause of annual deaths in the USA. Spontaneous reporting of suspected ADEs by health care professionals to a national pharmacovigilance system is recognized as a useful method to detect and reduce harm from medicines; however, underreporting is a major drawback. Understanding the barriers to ADE reporting and thereafter design of interventions to increase ADE reporting requires a systematic approach and use of theory. Since multiple theories in behavior change exist that may have conceptually overlapping constructs, a group of experts suggested an integrative framework called theoretical domains framework (TDF). This approach considers a set of 12 domains, came from 33 theories and 128 constructs, covering the main factors influencing practitioner behavior and barriers to behavior change. The aim of this study is to apply TDF approach to establish an evidence-based understanding of barriers associated with ADE reporting among nurses and pharmacists. Methods A total of three focus group discussions were conducted; among them two consisted of nurses and one involved pharmacists. Discussions were guided by questions designed based on TDF. Transcriptions of discussions were then thematically analyzed, and detected barriers to reporting ADEs were categorized based on extracted themes. Results A total of 34 nurses and pharmacists attended the group discussions. Six domains were identified to be relevant to barriers of ADE reporting in hospitals. These domains included “Knowledge,” “Skills,” “Beliefs about consequences,” “Motivation and goals (intention),” “Social influences (norms),” and “Environmental constraints.” We detected several barriers to ADE reporting, such as lack of knowledge of what should be reported, fear of punishment and criticism, lack of time, lack of teamwork, and lack of active support by hospital managements and other colleagues. Based on detected barriers, “Cognitive and behavioral factors,” “Motivational factors and teamwork,” in addition to “Organizational processes and resources” could be targeted in designing appropriate interventions. Conclusions Detection of barriers to reporting ADEs is necessary to design appropriate interventions. The TDF is a comprehensive approach that enables us to better understand barriers to behavior change in reporting ADEs.
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Affiliation(s)
- Fariba Mirbaha
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, No. 1547 North Karegar St, Enghelab Ave, Tehran, Iran.
| | - Gloria Shalviri
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, No. 1547 North Karegar St, Enghelab Ave, Tehran, Iran. .,Iranian Pharmacovigilance Center, Food and Drug Organization, No. 24, Daneshkian Ave. Vali Asr St., Tehran, Iran.
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, No. 1547 North Karegar St, Enghelab Ave, Tehran, Iran.
| | - Kheirollah Gholami
- Research Center for Rational Use of Drugs, Faculty of Pharmacy, Tehran University of Medical Sciences, No. 92, Karimkhane Zand Street, 1584775311, Tehran, Iran.
| | - Reza Majdzadeh
- Knowledge Utilization Research Center; Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Yazdizadeh B, Majdzadeh R, Alami A, Amrolalaei S. How can we establish more successful knowledge networks in developing countries? Lessons learnt from knowledge networks in Iran. Health Res Policy Syst 2014; 12:63. [PMID: 25354533 PMCID: PMC4233097 DOI: 10.1186/1478-4505-12-63] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 10/25/2014] [Indexed: 11/17/2022] Open
Abstract
Background Formal knowledge networks are considered among the solutions for strengthening knowledge translation and one of the elements of innovative systems in developing and developed countries. In the year 2000, knowledge networks were established in Iran’s health system to organize, lead, empower, and coordinate efforts made by health-related research centers in the country. Since the assessment of a knowledge network is one of the main requirements for its success, the current study was designed in two qualitative and quantitative sections to identify the strengths and weaknesses of the established knowledge networks and to assess their efficiency. Methods In the qualitative section, semi-structured, in-depth interviews were held with network directors and secretaries. The interviews were analyzed through the framework approach. To analyze effectiveness, social network analysis approach was used. That is, by considering the networks’ research council members as ‘nodes’, and the numbers of their joint articles - before and after the network establishments - as ‘relations or ties’, indices of density, clique, and centrality were calculated for each network. In the qualitative section, non-transparency of management, lack of goals, administrative problems were among the most prevalent issues observed. Results Currently, the most important challenges are the policies related to them and their management. In the quantitative section, we observed that density and clique indices had risen for some networks; however, the centrality index for the same networks was not as high. Consequently the attribution of density and clique indices to these networks was not possible. Conclusion Therefore, consolidating and revising policies relevant to the networks and preparing a guide for establishing managing networks could prove helpful. To develop knowledge and technology in a country, networks need to solve the problems they face in management and governance. That is, the first step towards the realization of true knowledge networks in health system.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Science, No 1547, North Karegar St, Enghelab Ave, Tehran, Iran.
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Yazdizadeh B, Majdzadeh R, Alami A, Amrolalaei S. How can we establish more successful knowledge networks in developing countries? Lessons learnt from knowledge networks in Iran. Health Res Policy Syst 2014; 12:63. [PMID: 25354533 PMCID: PMC4233097 DOI: 10.1186/1478-4505-12-63#citeas] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 10/25/2014] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Formal knowledge networks are considered among the solutions for strengthening knowledge translation and one of the elements of innovative systems in developing and developed countries. In the year 2000, knowledge networks were established in Iran's health system to organize, lead, empower, and coordinate efforts made by health-related research centers in the country. Since the assessment of a knowledge network is one of the main requirements for its success, the current study was designed in two qualitative and quantitative sections to identify the strengths and weaknesses of the established knowledge networks and to assess their efficiency. METHODS In the qualitative section, semi-structured, in-depth interviews were held with network directors and secretaries. The interviews were analyzed through the framework approach. To analyze effectiveness, social network analysis approach was used. That is, by considering the networks' research council members as 'nodes', and the numbers of their joint articles--before and after the network establishments--as 'relations or ties', indices of density, clique, and centrality were calculated for each network. In the qualitative section, non-transparency of management, lack of goals, administrative problems were among the most prevalent issues observed. RESULTS Currently, the most important challenges are the policies related to them and their management. In the quantitative section, we observed that density and clique indices had risen for some networks; however, the centrality index for the same networks was not as high. Consequently the attribution of density and clique indices to these networks was not possible. CONCLUSION Therefore, consolidating and revising policies relevant to the networks and preparing a guide for establishing managing networks could prove helpful. To develop knowledge and technology in a country, networks need to solve the problems they face in management and governance. That is, the first step towards the realization of true knowledge networks in health system.
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Affiliation(s)
- Bahareh Yazdizadeh
- />Knowledge Utilization Research Center, Tehran University of Medical Science, No 1547, North Karegar St, Enghelab Ave, Tehran, Iran
| | - Reza Majdzadeh
- />Knowledge Utilization Research Center; Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Ali Alami
- />Department of Health, School of Public Health; Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Sima Amrolalaei
- />Knowledge Utilization Research Center, Tehran University of Medical Science, No 1547, North Karegar St, Enghelab Ave, Tehran, Iran
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Yazdizadeh B, Mohammad K, Nedjat S, Changizi N, Azemikhah A, Jafari N, Radpoyan L, Majdzadeh R. Application of Capture-Recapture for Fine-tuning Uncertainties About National Maternal Mortality Estimates. Int J Prev Med 2014; 5:624-31. [PMID: 24932395 PMCID: PMC4050684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Maternal mortality ratio (MMR) is one of the main indicators of the millennium development goals and its accurate estimation is very important for the countries concerned. The objective of this study is to evaluate the applicability of capture-recapture (CRC) as an analytical method to estimate MMR in countries. METHODS We used the CRC method to estimate MMR in Iran for 2004 and 2005, using two data sources: The maternal mortality surveillance system and the National Death Registry (NDR). Because the data registry contains errors, we defined three levels of matching criteria to enable matching of cases between the two systems. Increasing the matching level makes the matching criteria less conservative. Because NDR data were missing or incomplete for some provinces, we calculated estimates for two conditions: With and without missing/incomplete data. RESULTS According to the CRC method, MMR in 2004 and 2005 were 33 and 25 in the best-case scenarios respectively and 86 and 59 in the worst-case scenarios respectively. These estimates are closer to the ones reported by United Nations Agencies published in 2010, 38 and Hogan's study, 30 in 100,000 live births in 2005. CONCLUSIONS The MMR estimation by CRC method is slightly different from the international studies. CRC can be considered as a cost-effective method, in comparison with cross-sectional studies or improvement of vital registration systems, which are both costly and difficult. However, to achieve accurate estimates of MMR with CRC method and decrease the uncertainty we need to have valid databases and the absence of such capacities will limit the applicability of this method in developing countries with poor quality health databases.
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Affiliation(s)
- Bahareh Yazdizadeh
- Department of Biostatistics and Epidemiology, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Mohammad
- Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Nedjat
- Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Changizi
- Department of Family Health and Population, Ministry of Health and Medical Education, Tehran, Iran
| | - Arash Azemikhah
- Department of Family Health and Population, Ministry of Health and Medical Education, Tehran, Iran
| | - Nahid Jafari
- Center for Network Development, Ministry of Health and Medical Education, Teran, Iran
| | - Laleh Radpoyan
- Department of Family Health and Population, Ministry of Health and Medical Education, Tehran, Iran
| | - Reza Majdzadeh
- Department of Biostatistics and Epidemiology, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran,Correspondence to: Prof. Reza Majdzadeh, Knowledge Utilization Research Center, No 1547, Floor 7, Unit 7, North Karegar St, Enghelab Ave, Tehran, Iran. E-mail:
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Imani-Nasab MH, Seyedin H, Majdzadeh R, Yazdizadeh B, Salehi M. Development of evidence-based health policy documents in developing countries: a case of Iran. Glob J Health Sci 2014; 6:27-36. [PMID: 24762343 PMCID: PMC4825355 DOI: 10.5539/gjhs.v6n3p27] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/19/2014] [Indexed: 11/12/2022] Open
Abstract
Background: Evidence-based policy documents that are well developed by senior civil servants and are timely available can reduce the barriers to evidence utilization by health policy makers. This study examined the barriers and facilitators in developing evidence-based health policy documents from the perspective of their producers in a developing country. Methods: In a qualitative study with a framework analysis approach, we conducted semi-structured interviews using purposive and snowball sampling. A qualitative analysis software (MAXQDA-10) was used to apply the codes and manage the data. This study was theory-based and the results were compared to exploratory studies about the factors influencing evidence-based health policymaking. Results: 18 codes and three main themes of behavioral, normative, and control beliefs were identified. Factors that influence the development of evidence-based policy documents were identified by the participants: behavioral beliefs included quality of policy documents, use of resources, knowledge and innovation, being time-consuming and contextualization; normative beliefs included policy authorities, policymakers, policy administrators, and co-workers; and control beliefs included recruitment policy, performance management, empowerment, management stability, physical environment, access to evidence, policy making process, and effect of other factors. Conclusion: Most of the cited barriers to the development of evidence-based policy were related to control beliefs, i.e. barriers at the organizational and health system levels. This study identified the factors that influence the development of evidence-based policy documents based on the components of the theory of planned behavior. But in exploratory studies on evidence utilization by health policymakers, the identified factors were only related to control behaviors. This suggests that the theoretical approach may be preferable to the exploratory approach in identifying the barriers and facilitators of a behavior.
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Affiliation(s)
| | - Hesam Seyedin
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences.
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Yazdizadeh B. Health science and technology evaluation: emerging for innovation. Int J Prev Med 2013; 4:985-7. [PMID: 24130937 PMCID: PMC3793497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 05/24/2013] [Indexed: 11/08/2022] Open
Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran,Correspondence to: Asst. Prof. Bahareh Yazdizadeh, #169, Gol Building, North Kargar Ave, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran. E-mail:
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Baradaran-Seyed Z, Nedjat S, Yazdizadeh B, Nedjat S, Majdzadeh R. Barriers of clinical practice guidelines development and implementation in developing countries: a case study in iran. Int J Prev Med 2013; 4:340-8. [PMID: 23626892 PMCID: PMC3634174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 12/21/2012] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Knowledge products such as clinical practice guidelines (CPG) are vitally required for evidence-based medicine (EBM). Although the EBM, to some extent, has been attended during recent years, no result has achieved thus far. The current qualitative study is to identify the barriers to establishing development system and implementation of CPGs in Iran. METHODS Twelve semi-structured, in-depth interviews were conducted with a purposive sample of health policy and decision makers, the experts of development and or adaptation of CPGs, and the experts of EBM education and development. In addition, 11 policy-makers, decision-makers, and managers of the health system participated in a focus group discussion. The analysis of the study data was undertaken by thematic framework approach. RESULT Six themes emerged in order of their frequency include practice environment, evidence-based health care system, individual professional, politician and political context, innovation (CPG) and patients. Most of the indications in the treatment environment focused on such sub-themes as regulations and rules, economical factors, organizational context, and social context. While the barriers related to the conditions of treatment environment, service provider and the features of innovation and patients had been identified before in other studies, very little attention has been paid to the evidence-based health care system and politician and political context. CONCLUSION The lack of an evidence-based healthcare system and a political macro support are mentioned as the key barriers in Iran as a developing country. The establishment of a system of development and implementation of CPGs as the evidence-based practice tools will not be possible, unless the barriers are removed.
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Affiliation(s)
| | - Sima Nedjat
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Nedjat
- School of Public Health, and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- School of Public Health, and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran,Correspondence to: Prof. Reza Majdzadeh, Knowledge Utilization Research Center, 7th Floor, #1547, North Kargar,Tehran, Iran. E-mail:
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Tajik P, Nedjat S, Afshar NE, Changizi N, Yazdizadeh B, Azemikhah A, Aamrolalaei S, Majdzadeh R. Inequality in maternal mortality in iran: an ecologic study. Int J Prev Med 2012; 3:116-21. [PMID: 22347608 PMCID: PMC3278876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 07/17/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Maternal mortality (MM) is an avoidable death and there is national, international and political commitment to reduce it. The objective of this study is to examine the relation of MM to socioeconomic factors and its inequality in Iran's provinces at an ecologic level. METHODS The overall MM from each province was considered for 3 years from 2004 to 2006. The five independent variables whose relations were studied included the literacy rate among men and women in each province, mean annual household income per capita, Gini coefficients in each province, and Human Development Index (HDI). The correlation of Maternal Mortality Ratio (MMR) to the above five variables was evaluated through Pearson's correlation coefficient (simple and weighted for each province's population) and linear regression - by considering MMR as the dependent variable and the Gini coefficient, HDI, and difference in literacy rate among men and women as the independent variables. RESULTS The mean MMR in the years 2004-2006 was 24.7 in 100,000 live births. The correlation coefficients between MMR and literacy rate among women, literacy rate among men, the mean annual household income per capita, Gini coefficient and HDI were 0.82, 0.90, -0.61, 0.52 and -0.77, respectively. Based on multivariate regression, MMR was significantly associated with HDI (standardized B=-0.93) and difference in literacy rate among men and women (standardized B=-0.47). However, MMR was not significantly associated with the Gini coefficient. CONCLUSION This study shows the association between socioeconomic variables and their inequalities with MMR in Iran's provinces at an ecologic level. In addition to the other direct interventions performed to reduce MM, it seems essential to especially focus on more distal factors influencing MMR.
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Affiliation(s)
- Parvin Tajik
- School of Public Health, Tehran University Medical Sciences, Tehran, Iran
| | - Saharnaz Nedjat
- School of Public Health, Tehran University Medical Sciences, Tehran, Iran
- Knowledge Utilization Research Center, Tehran University Medical Sciences, Tehran, Iran
| | - Nozhat Emami Afshar
- Department of Family Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Nasrin Changizi
- Department of Family Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University Medical Sciences, Tehran, Iran
| | - Arash Azemikhah
- Department of Family Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Sima Aamrolalaei
- Knowledge Utilization Research Center, Tehran University Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- School of Public Health, Tehran University Medical Sciences, Tehran, Iran
- Knowledge Utilization Research Center, Tehran University Medical Sciences, Tehran, Iran
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Majdzadeh R, Yazdizadeh B, Nedjat S, Gholami J, Ahghari S. Strengthening evidence-based decision-making: is it possible without improving health system stewardship? Health Policy Plan 2011; 27:499-504. [PMID: 22027555 DOI: 10.1093/heapol/czr072] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Health systems worldwide have always suffered resource constraints. Therefore, making decisions informed by scientific evidence to optimize costs and prevent wastage of resources is both important and necessary. The current study was designed to identify barriers to evidence-based decision-making (EBDM) in Iran's health system. METHODS Participants were purposively selected. In-depth interviews with policy-makers and focus group discussions (FGDs) with researchers were used to collect data. Thirteen in-depth interviews and six FGDs were held. Data were analysed using thematic analysis. RESULTS The barriers mentioned were categorized into decision-makers' characteristics, the decision-making environment and the research system, with each category consisting of further relevant themes and subthemes. Organizational values, criteria for selecting decision-makers, and the attitude toward EBDM were found to be important barriers to EBDM, and were related to stewardship. CONCLUSION There are various barriers to EBDM at different levels, and multi-dimensional solutions are required to strengthen the impact of scientific evidence on decision-making. Several recognized barriers to EBDM are rooted in health system stewardship, such as the weakness of inter-sectoral collaborations and ill-defined priorities. It appears that improvement of EBDM is secondary to the strengthening of health system stewardship.
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Affiliation(s)
- Reza Majdzadeh
- Knowledge Utilization Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Yazdizadeh B, Nedjat S, Mohammad K, Rashidian A, Changizi N, Majdzadeh R. Cesarean section rate in Iran, multidimensional approaches for behavioral change of providers: a qualitative study. BMC Health Serv Res 2011; 11:159. [PMID: 21729279 PMCID: PMC3146409 DOI: 10.1186/1472-6963-11-159] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 07/05/2011] [Indexed: 12/02/2022] Open
Abstract
Background The cesarean section rate has been steadily rising from 35% in 2000 to 40% in 2005 in Iran. The objective of this study was to identify barriers of reduce the cesarean section rate in Iran, as perceived by obstetricians and midwives as the main behavioral change target groups. Methods A qualitative study with purposive sampling was designed in which data were collected through in-depth interviews and document analyses. Hospitals were selected on the bases of being public and or private and their response to the ministry's C-section reduction interventions. The hospital director, obstetricians and midwives from each hospital were included in the study. The classification of barriers suggested by Grol and Wensing was used for the thematic analysis. Results After 26 in-depth interviews and document analyses, the barriers were identified as: financial, insurance and judicial problems at the economic and political context level; the type and ownership of hospitals, absence of an on call physician, absence of clear job-descriptions for obstetricians and midwives, too many interventions in the delivery process and shortage of human resources and facilities at the organizational context level; distrust and insufficient collaborations between obstetricians and midwives from macro to micro level at the social context level; attitudes toward complications of C-section, reduced capabilities of obstetricians, midwives and residents at the individual professional level; and finally, at the innovation level, vaginal delivery is time consuming, imposes high stress levels and is unpredictable. Conclusion Changing service providers' behavior is not possible through presentation of scientific evidence alone. A multi-level and multidisciplinary approach using behavior change theories is unavoidable. In future studies, the effect of the barriers should be determined to help policy makers recognize the most effective interventional package.
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Affiliation(s)
- Bahareh Yazdizadeh
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Gholami J, Majdzadeh R, Nedjat S, Nedjat S, Maleki K, Ashoorkhani M, Yazdizadeh B. How should we assess knowledge translation in research organizations; designing a knowledge translation self-assessment tool for research institutes (SATORI). Health Res Policy Syst 2011; 9:10. [PMID: 21342517 PMCID: PMC3053266 DOI: 10.1186/1478-4505-9-10] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 02/22/2011] [Indexed: 11/26/2022] Open
Abstract
Background The knowledge translation self-assessment tool for research institutes (SATORI) was designed to assess the status of knowledge translation in research institutes. The objective was, to identify the weaknesses and strengths of knowledge translation in research centres and faculties associated with Tehran University of Medical Sciences (TUMS). Methods The tool, consisting of 50 statements in four main domains, was used in 20 TUMS-affiliated research centres and departments after its reliability was established. It was completed in a group discussion by the members of the research council, researchers and research users' representatives from each centre and/or department. Results The mean score obtained in the four domains of 'The question of research', 'Knowledge production', 'Knowledge transfer' and 'Promoting the use of evidence' were 2.26, 2.92, 2 and 1.89 (out of 5) respectively. Nine out of 12 interventional priorities with the lowest quartile score were related to knowledge transfer resources and strategies, whereas eight of them were in the highest quartile and related to 'The question of research' and 'Knowledge production'. Conclusions The self-assessment tool identifies the gaps in capacity and infrastructure of knowledge translation support within research organizations. Assessment of research institutes using SATORI pointed out that strengthening knowledge translation through provision of financial support for knowledge translation activities, creating supportive and facilitating infrastructures, and facilitating interactions between researchers and target audiences to exchange questions and research findings are among the priorities of research centres and/or departments.
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Affiliation(s)
- Jaleh Gholami
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Majdzadeh R, Nedjat S, Denis JL, Yazdizadeh B, Gholami J. 'Linking research to action' in Iran: two decades after integration of the Health Ministry and the medical universities. Public Health 2010; 124:404-11. [PMID: 20537362 DOI: 10.1016/j.puhe.2010.03.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 02/14/2010] [Accepted: 03/19/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the impact of integration of the Iranian Health Ministry and medical universities, which took place in 1985, on 'linking research to action'. STUDY DESIGN A qualitative study including 18 in-depth interviews and 10 focus group discussions with different stakeholders ranging from researchers, policy makers and service providers in medical and non-medical groups. METHODS A thematic framework was used to identify various positive and negative aspects of the integration on 'linking research to action' to date. RESULTS The positive influences on universities that have been established since integration and/or in the peripheral provinces are more prominent. Distribution of health manpower in various parts of the country has almost unanimously been stated as a positive aftermath. On the other hand, the negative influence most agreed upon was the deviation of larger universities from their main commitment of knowledge production, due to overindulgence in service delivery. CONCLUSIONS Before making any decisions about changing the current structure of the health-research system, the country's national innovation system should be defined. This is because national research problems are not confined to integration and health research, and cover more general aspects. Therefore, any change in integration and health research should be considered secondary to the latter.
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Affiliation(s)
- R Majdzadeh
- Knowledge Utilization Research Centre and School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Yazdizadeh B, Majdzadeh R, Salmasian H. Systematic review of methods for evaluating healthcare research economic impact. Health Res Policy Syst 2010; 8:6. [PMID: 20196839 PMCID: PMC2845122 DOI: 10.1186/1478-4505-8-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 03/02/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The economic benefits of healthcare research require study so that appropriate resources can be allocated to this research, particularly in developing countries. As a first step, we performed a systematic review to identify the methods used to assess the economic impact of healthcare research, and the outcomes. METHOD An electronic search was conducted in relevant databases using a combination of specific keywords. In addition, 21 relevant Web sites were identified. RESULTS The initial search yielded 8,416 articles. After studying titles, abstracts, and full texts, 18 articles were included in the analysis. Eleven other reports were found on Web sites. We found that the outcomes assessed as healthcare research payback included direct cost-savings, cost reductions in healthcare delivery systems, benefits from commercial advancement, and outcomes associated with improved health status. Two methods were used to study healthcare research payback: macro-economic studies, which examine the relationship between research studies and economic outcome at the aggregated level, and case studies, which examine specific research projects to assess economic impact. CONCLUSIONS Our study shows that different methods and outcomes can be used to assess the economic impacts of healthcare research. There is no unique methodological approach for the economic evaluation of such research. In our systematic search we found no research that had evaluated the economic return of research in low and middle income countries. We therefore recommend a consensus on practical guidelines at international level on the basis of more comprehensive methodologies (such as Canadian Academic of Health Science and payback frameworks) in order to build capacity, arrange for necessary informative infrastructures and promote necessary skills for economic evaluation studies.
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Affiliation(s)
- Bahareh Yazdizadeh
- Department of Biostatistics and Epidemiology, School of Public Health and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Naieni KH, Ardalan A, Mahmoodi M, Motevalian A, Yahyapoor Y, Yazdizadeh B. Risk factors of breast cancer in north of Iran: a case-control in Mazandaran Province. Asian Pac J Cancer Prev 2007; 8:395-398. [PMID: 18159976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Breast cancer is the most common cancer among Iranian women. This study aimed to determine risk factors for breast cancer in the north of Iran. METHOD A matched case-control study was conducted in Mazandaran province of Iran in 2004 of 250 biopsy proven cases of breast cancer and 500 neighbor controls that were matched by age within a 3 year period. Statistical analysis was carried out using conditional logistic regression with the backward elimination method and crude and adjusted odds ratios with related 95% CIs were estimated with Stata 8.0 software RESULTS Multivariate analysis showed that higher education (OR=4.70, 95%CI: 1.71-12.88), late menopause (OR=4.18, 95%CI: 2.54-6.88), history of induced abortion (OR=1.62, 95%CI: 1.13-2.31), positive first-degree family history of breast cancer (OR=3.14, 95%CI: 1.37-7.20), and BMI (OR=1.02, 95%CI: 1.01-1.03) were risk factors for breast cancer. Furthermore, having more episodes of full term pregnancy (OR=0.87, 95%CI: 0.80-0.95), longer duration of breast feeding (OR=0.993, 95%CI: 0.989-0.997) and parity more than 2 were shown to be protective factors. CONCLUSIONS Our study revealed the role of some modifiable determinants of breast cancer that can be focused by public health intervention in the northern community of Iran. Accordingly, the women who have one or more of the following risk factors should take the special attention to risk of breast cancer: obesity, being menopause, positive family history of breast cancer and history of induced abortion. The protective effect of longer duration of breast feeding should be encouraged too.
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Affiliation(s)
- Kourosh Holakouie Naieni
- Department of Epidemiology and Biostatistics, School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran.
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Mosavi-Jarrahi A, Moini M, Mohagheghi MA, Alebouyeh M, Yazdizadeh B, Shahabian A, Nahvijo A, Alizadeh R. Clustering of childhood cancer in the inner city of Tehran metropolitan area: A GIS-based analysis. Int J Hyg Environ Health 2007; 210:113-9. [PMID: 17008129 DOI: 10.1016/j.ijheh.2006.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 07/17/2006] [Accepted: 08/07/2006] [Indexed: 11/19/2022]
Abstract
The aim of this study was both to map the childhood cancer incidence in the districts of Tehran metropolitan area and to explore possible clustering of cancer cases in the diverse environments of this area. All incidence cases of childhood cancers (age group under 15 years) belonging to the 22 districts of Tehran metropolis and occurring during the period of 1998 till 2002 were ascertained from three sources. Each case's place of residency was geo-referenced. The scan statistics cluster detecting technique was used to evaluate clustering of cases throughout Tehran. The overall incidence rate (IR) of childhood cancer was 176.3/1,000,000 children under 15 years of age. The lowest IR among both boys and girls was observed in district 22 (69.4/1,000,000) and the highest was observed in district 6 (242.09/1,000,000). The detection of clusters was performed for all cancer sites. All the cancer sites combined category showed clustering in the districts 7, 13, 8, 6, 3, 14, 12, 11, and 4. For this category, the clustering likelihood was marginally statistically significant (p-value=0.056), with an overall relative risk of 1.30. No statistically significant patterns of clustering were detected for other categories.
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Affiliation(s)
- Alireza Mosavi-Jarrahi
- Department of Social Medicine, Medical School, Shaheed Beheshti University of Medical Sciences, P.O. Box 15875-4194, Tehran, Islamic Republic of Iran.
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Yazdizadeh B, Jarrahi AM, Mortazavi H, Mohagheghi MA, Tahmasebi S, Nahvijo A. Time trends in the occurrence of major GI cancers in Iran. Asian Pac J Cancer Prev 2005; 6:130-4. [PMID: 16101320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to study the changes in occurrence of esophageal, stomach and colon cancers (cancers of interest) over the last 30 years in Iran. MATERIAL AND METHODS Cancer cases referred to two main cancer centers in the country (the Shiraz cancer center and the Tehran cancer center) during last 30 years and published by the two centers were utilized. Morbidity odds ratios (MOR) were used to study trend in the occurrence of each cancer site in each center. For this purpose the cancers of interest were considered as cases; childhood cancers as controls; and calendar year as exposure. A regression line was fitted to morbidity odds ratios over years and the slope of the regression line was considered to indicate the overall trend. MORs and 95% CIs comparing the last five and first five years were computed to measure the magnitude of the change over time. RESULT The overall trend for esophageal cancer was decrease (slopes = -0.02 for Shiraz and -0.03 for Tehran); for stomach was increase (slopes = 0.04 for Shiraz and 0.08 for Tehran), and for colon cancer was sharp increase (slopes = 0.02 for Shiraz and 0.10 for Tehran). The magnitude of changes showed stomach cancer to increase by 35% in Shiraz (MOR = 1.35 with 95% CI 1.1, 1.65) and 13% in Tehran (MOR = 1.13 with 95% CI 0.96, 1.38), esophageal cancer to decrease by 20% in Shiraz (MOR = 0.82 with 95% CI 0.62, 1.11) and 50% in Tehran (MOR = 0.52 with 95% CI 0.45, 0.60), and colon cancer to increase by 65% in Shiraz (MOR = 1.65 with 95% CI 1.26, 2.16) and 82% in Tehran (MOR = 1.82 with 95% CI 1.52, 2.25). CONCLUSION During the last thirty years the occurrence of major GI cancers has changed in Iran with sharp increase in colon cancer, slight to moderate increase in stomach cancer and sharp decrease in esophageal cancer.
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Affiliation(s)
- Bahareh Yazdizadeh
- The Cancer Institute Research Center, the Imam Khomeini Medical Center, P.O. Box 18575-4194, Tehran, I. R. of Iran
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