Introduction: While the prevalence of thalassemia carriers is 4-8% in Iran, it reaches to 10% in Sistan-Balouchestan and Fars Provinces. Regarding the high prevalence of the disease and different cultural, social, and economic situation in the mentioned provinces, we have attempted to calculate the marginal cost-effectiveness ratio through a decision analysis approach based upon the best evidences.

Methods: Screening was included as part of existing mandatory premarital blood tests. The couples at risk (thalassemia minor) were offered information and genetic counseling for dissuation. This study is a summative external program evaluation. The required data were collected from Health Deputy of the Governor House, Civil Registry Organization, Governor House, and other related centers during a 4-year period from 1998 to 2002. Collected data and costs were placed in the decision tree and analyzed through average folding back method.

Results: The marriage dissuasion rate was 3.5% in carrier couples of Sistan-Balouchestan in 2000 and reached to 0.5% in 2002. It is while marriage dissuasion rate was 61.1% in 2000 and 48% in 2002 in Fars province. The incidence rate of major thalassemia was 150 per 100,000 live births in Sistan-Balouchestan in 1999 and increased to 180 per 100,000 live births in 2002. The rate was 54.5 per 100,000 live births in Fars in 1999 and decreased to 24.8% in 2002. Marginal cost-effectiveness ratio of the program reveals that prevention from birth of a thalassemia major child costs 36470.5$ in Sistan-Balouchestan and 1568.2$ in Fars.

Conclusion: Although the thalassemia prevention program has been successful over the country, evaluation studies show major differences in the assessed provinces. Despite all activities for prevention of thalassemia and small increase in coverage index of the program in Sistan-Balouchestan in recent years, cost of prevention from birth of a major thalassemic child in the province is 30 times more than Fars. One of the main reasons of the difference is ineffective consultation in Sistan-Balouchestan. In this province, religious marriage is often performed before official registration. Consultation is a prerequisite before official registration. Many couples are visited in the consultation centers even after having a child.

Hakim Research Journal 2006 8(4) 8-14.

Introduction: Health professional workers, including nurses, need continuous in-service training due to the rapid growth of the health industry, competition, diverse and numerous needs of customers. High-quality and effective courses guarantee the competency of staff and efficiency and productivity of organizations. The aim of this study is reviewing the effectiveness of in-service training courses for nurse according Kirkpatrick model.
Methods: This is a review of existing literature based on a systematic search, focusing on published studies on the effectiveness of in-service training for nurses in Iran in the period of 2009-2022. Scopus, PubMed, google scholar and Google search engines, Iranian Research Institute for Information Science and Technology, Magiran databases, Scientific Information Database were searched. Data analysis was performed with a qualitative approach and content analysis method.
Results: 45 articles in the initial search and 3 articles in manual review of references were identified. After initial assessment 11 articles include in final analysis. Based on the findings, in-service training in general have been relatively effective. This effectiveness is mostly focused on the first and second level, i. e. reaction and learning, and it has not been very successful in terms of improving skills and performance.
Conclusion: policymakers and managers in the field of human resources should revise the current approach in employee training, take measures at all levels to improve the process, content, methods of training and evaluation, as well as incentive strategies for participation in courses with a special focus on improving their effectiveness.