[National and sub national mortality effects of metabolic risk factors and smoking in Iran: a comparative risk assessment]

Mortality from cardiovascular and other chronic diseases has increased in Iran. Our aim was to estimate the effects of smoking and high systolic blood pressure [SBP], fasting plasma glucose [FPG], total cholesterol [TC], and body mass index [BMI] on mortality and life expectancy, nationally and sub-nationally using representative data and comparable methods. We used data from the Non-Communicable Disease Surveillance Survey to estimate means and standard deviations for the metabolic risk factors, nationally and by region. Lung cancer mortality was used to measure cumulative exposure to smoking. We used data from the death registration system to estimate age-, sex-, and disease-specific numbers of deaths in 2005, adjusted for incompleteness using demographic methods. We used systematic reviews and meta-analyses of epidemiologic studies to obtain the effect of risk factors on disease specific mortality. We estimated deaths and life expectancy loss attributable to risk factors using the comparative risk assessment framework. In 2005, high SBP was responsible for 41,000 [95% uncertainty interval: 38,000, 44,000] deaths in men and 39,000 [36,000, 42,000] deaths in women in Iran. High FPG, BMI, and TC were responsible for about one-third to one-half of deaths attributable to SBP in men and/or women. Smoking was responsible for 9,000 deaths among men and 2,000 among women. If SBP were reduced to optimal levels, life expectancy at birth would increase by 3.2 years [2.6, 3.9] and 4.1 years [3.2, 4.9] in men and women, respectively; the life expectancy gains ranged from 1.1 to 1.8 years for TC, BMI, and FPG. SBP was also responsible for the largest number of deaths in every region, with age-standardized attributable mortality ranging from 257 to 333 deaths per 100,000 adults in different regions. Management of blood pressure through diet, lifestyle, and pharmacological interventions should be a priority in Iran. Interventions for other metabolic risk factors and smoking can also improve population health

assessing of inappropriate admissions and hospitalization based on appropriate evaluation protocol in Alinasab hospital in Tabriz-2009

Assessing applied resources in a hospital as a health system will lead to identify organizational problems in this section and subsequently the necessary actions to resolve them. The aim of this study was to determine measurement of inappropriate admission and hospitalization [ISP: Inappropriateness Patient Stay] and associated reasons. One widely used tools to assess appropriate use of hospital recourse is Appropriateness Evaluation Protocol which include objective criteria related to clinical services provided to the patient. Survey of admission and hospitalization in a cross-sectional and prospective study for 246 patients in the Alinasab hospital affiliated insurance organization carried out in Tabriz. The total of 7 percent of admissions and 6.2 percent of hospitalized were diagnosed inappropriate manner. There was no significant association between inappropriate admissions and other variables. There was significant relationships between Inappropriate bed days with insurance [P=0/041] and duration of hospital stay [P=0/041]. However, there were no association between sex, disease diagnosis and hospital days per week with Inappropriate bed days. The reasons of inappropriate admission and hospitalization in Iran are similar to other countries. Upgrading strategies to referral system performance, creating standard protocols to evaluate criteria for medical personnel and increasing outpatient diagnostic institutions could be reduce inappropriate admissions and stay of patients