BackgroundOne of the effective strategies in the fair distribution of human resources is the use of estimation norm of human workforce. A norm is a coefficient or an indicator for estimating the required human resources in an organization. Due to the changes in the available working hours of nurses in recent years and to use of a standard method, the Iranian Ministry of Health decided to update nursing estimation norm in hospitals in 2014–2015. This study aimed to design a nurse-required estimation norm for educational and non-educational hospitals based on the workload indicator in Iran.MethodsThis was a descriptive cross-sectional study, carried out from December 2015 to November 2016 in 49 wards in 12 educational and 17 non-educational hospitals in Mashhad, Iran. The wards and hospitals who had the best performance in nursing care quality indicators were selected. Focus group, work study, consensus, interview, and reviewing documents, staff and patient records, and the calculations of modified Workload Indicators of Staffing Needs (WISN) were used to collect the data.ResultsPatient care, cardiopulmonary resuscitation, and transfer out of the hospital were identified as the main activities of holding focus groups. Interviews and reviewing documents led to the identification of 10 factors associated with nurses’ available working time. In both educational and non-educational hospitals, the annual working time of all nurses except nurses working in the burn and psychiatric, burn ICU, and pediatric psychiatry wards, which was 1302 h per year, was 1411 h per year. The calculations of the modified WISN method showed that the lowest norm in educational hospitals was for psychiatric, eye surgery, and dermatology wards (0.53) and in non-educational hospitals was for ENT ward (0.57). The highest norm in educational and non-educational hospitals was for burn ICU (3.95) and general ICU (3.07) wards, respectively.ConclusionThe nursing estimation norm in different wards of the hospital varies, considering that the time available to nurses and their workload in different wards and hospitals are different, and each ward has its special norm therefore, a single norm for all wards and hospitals cannot be used for a fair distribution of nurses.

Summary Introduction Although slum emerged in industrialized countries, today, all cities in the world are somehow facing this phenomenon. Slums create many problems in different areas, especially health for residents. Therefore, this research was conducted with the aim of identifying the health problems of the slum residents of Kerman city by using the social determinant of health approach. Method The present study is an applied study that was carried out qualitatively using semistructured interviews. Samples were selected using purposeful and snowball sampling methods. Data were analyzed using the Colaizy method. Results In this study, the health problems of residents of slums in the city of Kerman were identified by interviews. In total, seven main themes and 32 sub‐themes were extracted. The main concepts extracted include the economic and social class, the early childhood development, social exclusion and social support, employment and unemployment, addiction, food, transport, and traffic. Conclusion The problems of slums people are very widespread, and almost all of the problems affect the health of slums people. The place of living, job, income, the early childhood development and nutritional status are determinants that affect people's health.

Introduction: Household food insecurity (FI) is defined as limited or uncertain access to nutritionally adequate and safe food or limited ability to obtain foods in socially acceptable ways has become a global issue in recent decades. Methods: This cross-sectional study was conducted in Kerman, southeast of Iran in 2019, covering 559 marginalised households. United States Department of Agriculture food security measure was used for data collection.Finally, data were analysed using t-test, χ 2 , Mann-Whitney tests and logistic regression. Results:The prevalence of FI was 82% among slums households. The most important experience of FI in households was reliance on low-cost foods. There was a significant relationship between slums FI and gender of head of household, household size, household income, household education level and marital status (p ˂ 0.05). According to the results of the multivariate regression the variables of education, household income level and household size significantly determined FI (p ˂ 0.05). Conclusion:The most important determinant of FI was low socioeconomic status (income, education, household size).Hence, public policies targeting socioeconomic factors should be made to improve the socioeconomic status of slum dwellers.

Summary Introduction Today, countries are faced with the fact that despite unlimited human needs, resources are limited. The health sector has the same limitations as other sectors. Therefore, this study aimed to prioritize the health problems of the Kerman residents slums by using the social determinants of health. Methods The present study was carried out using a hierarchical analysis. The study population included experts of the deputy of social affairs, experts of the research center for SDH, experts of deputy of health, experts of social welfare in governing board of Kerman, and community health practitioners. Sixteen of these experts were selected using purposeful and snowball sampling methods. Expert Choice software was used to analyze the information. Results In this study, the health problems were prioritized. The highest priority among the main themes and subtheme was related to early childhood development and child labor, respectively. Conclusion The early years of life are the most important years of life, and the experiences of these years will be the foundation of the future life of every human being. Therefore, if their needs and developmental areas are not answered properly during this period, their health will be compromised.

Background: One of the concerns of health managers in regard to improving the oral health of residents in deprived areas is to increase the tendency of dentists to stay in those areas. The purpose of this study was to explore factors affecting the intention of dentists to stay in deprived areas.Methods: The present qualitative study was carried out using semi-structured interviews. We interviewed 22 informants (4 oral health managers and 18 dentists) who were identified purposefully. Informants were asked what factors affecting retention in remote and deprived areas. Content analysis through the 7-step Colaizzi approach was used for data analysis. Results: Fifteen subthemes under five themes of individual factors, the development level of the region, social and cultural factors, financial issues, and managerial and organizational factors were identified as factors affecting tendency of dentist to stay and work in deprived areas. Conclusion: According to the results of our study, health policymakers and managers should focus on culture and attitudes of the residents, Provision of financial incentives, structural problems and underdevelopment of the region, and high workload to increase the tendency of dentists to stay in remote and deprived areas.

Background Numerous invasive and noninvasive diagnostic tests with different cost and effectiveness exist for detection of coronary artery disease. This diversity leads to unnecessary utilization of health services. For this reason, this study focused on the cost-effectiveness analysis of diagnostic strategies for coronary artery disease from the perspective of the health care system with 1-year time horizon. Results Incremental cost effectiveness ratios of all strategies were less than the threshold except for the electrocardiography-computed tomography angiography-coronary angiography strategy, and cost of the cardiac magnetic resonance imaging-based strategy was higher than the cost of other strategies. Also, the number of correct diagnosis in the electrocardiography-coronary angiography strategy was higher than the other strategies, and its ICER was 15.197 dollars per additional correct diagnosis. Moreover, the sensitivity analysis found that the probability of doing MRI and sensitivity of the exercise electrocardiography had impact on the results. Conclusion The most cost-effective strategy for acute patient is ECG-CA strategy, and for chronic patient, the most cost-effective strategies are electrocardiography-single photon emission computed tomography-coronary angiography and electrocardiography-exercise electrocardiography-coronary angiography. Applying these strategies in the same clinical settings may lead to a better utilization of resources.

Introduction Terrorist attacks are one of the human problems that affect many countries, leaving behind a huge toll of disabilities and deaths. The aim of this study was to use a mixed-method analysis to design and validate an evaluation tool for pre-hospital emergency medical services for terrorist attacks. Methods The present study is a mixed-method (qualitative and quantitative) study that was conducted in two phases. In the qualitative phase (item generation), semi-structured interviews were conducted with 34 Iranian emergency medical technicians who were selected through a purposive sampling method and a scoping literature review was conducted to generate an item pool for the preparedness evaluation of Emergency Medical Services (EMS) in terrorist attacks. In the quantitative phase (item reduction), for validity of tool face, content and construct validity, were performed; for tool reliability, the test and retest and intra-class correlation coefficient were evaluated. Results At the first stage, 7 main categories and 16 subcategories were extracted from the data, the main categories including “Policy and Planning”, “Education and Exercise “,“ Surge Capacity”, “Safety and Security”, “Command, Control and Coordination”, “Information and Communication Management “and “Response Operations Management”. The initial item pool included 160 items that were reduced to 110 after assessment of validity (face, content and construct). intra-class correlation coefficient (ICC = 0.71) examination and Pearson correlation test (r = 0.81) indicated that the tool was also reliable. Conclusion The research findings provide a new perspective to understand the preparedness of pre-hospital emergency medical services for terrorist attacks. The existing 110-item tool can evaluate preparedness of pre-hospital emergency medical services for terrorist attacks through collecting data with appropriate validity and reliability.