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Objectives@#Insufficient evidence exists regarding factors that affect screening adherence among people with a family history of diabetes, who comprise roughly half of all patients with diabetes. Therefore, we aimed to identify the determinants of diabetes screening adherence in adults with a family history of diabetes who had not yet been diagnosed with diabetes. @*Methods@#This cross-sectional study was conducted at selected urban primary healthcare facilities in Tehran, Iran. The study population was clinically non-diabetic adults above 20 years of age with a family history of diabetes in at least 1 first-degree relative. All eligible people identified on randomly-selected days of the month were invited to join the study. @*Results@#Among 408 participants, 128 (31.4%) had received a fasting blood glucose check during the last year. Using binary logistic regression, the independent predictors of screening adherence were knowledge of adverse effects of diabetes such as sexual disorders (odds ratio [OR], 3.05) and renal failure (OR, 2.73), the impact of family members’ advice on receiving diabetes screening (OR, 2.03), recommendation from a healthcare provider to have a fasting blood glucose check (OR, 2.61), and intention to have a fasting blood glucose check within the next 6 months (OR, 2.85). Other variables that predicted screening adherence were age (OR, 1.05), job (being a housekeeper; OR, 3.39), and having a college degree (OR, 3.55). @*Conclusions@#Knowledge of the adverse effects of diabetes, physicians’ and healthcare providers’ advice about the benefits of early disease detection, and family members’ advice were independent predictors of screening adherence.
ABSTRACT
Objectives@#Insufficient evidence exists regarding factors that affect screening adherence among people with a family history of diabetes, who comprise roughly half of all patients with diabetes. Therefore, we aimed to identify the determinants of diabetes screening adherence in adults with a family history of diabetes who had not yet been diagnosed with diabetes. @*Methods@#This cross-sectional study was conducted at selected urban primary healthcare facilities in Tehran, Iran. The study population was clinically non-diabetic adults above 20 years of age with a family history of diabetes in at least 1 first-degree relative. All eligible people identified on randomly-selected days of the month were invited to join the study. @*Results@#Among 408 participants, 128 (31.4%) had received a fasting blood glucose check during the last year. Using binary logistic regression, the independent predictors of screening adherence were knowledge of adverse effects of diabetes such as sexual disorders (odds ratio [OR], 3.05) and renal failure (OR, 2.73), the impact of family members’ advice on receiving diabetes screening (OR, 2.03), recommendation from a healthcare provider to have a fasting blood glucose check (OR, 2.61), and intention to have a fasting blood glucose check within the next 6 months (OR, 2.85). Other variables that predicted screening adherence were age (OR, 1.05), job (being a housekeeper; OR, 3.39), and having a college degree (OR, 3.55). @*Conclusions@#Knowledge of the adverse effects of diabetes, physicians’ and healthcare providers’ advice about the benefits of early disease detection, and family members’ advice were independent predictors of screening adherence.
ABSTRACT
Background: Recurrent implantation failure is one of the most issues in IVF cycles. Some researchers found that beneficial effects of endometrial Scratching in women with recurrent implantation failure, while some authors demonstrated contrary results
Objective: The present study aimed to investigate the effect of intrauterine. Saline infusion as a form of endometrial injury, during fresh in vitro fertilization-embryo transfer cycle, among patients with recurrent implantation failure
Materials and Methods: In this clinical trial study 63 women undergoing assisted reproductive technology were divided into two groups either local endometrial injury by intrauterine saline infusion during day 3-5 of the ongoing controlled ovarian stimulation cycle, or IVF protocol performed without any other intervention in Taleghani Hospital, Tehran, Iran. The main outcome measure was clinical pregnancy rates
Results: Patients who received intra uterine saline infusion [n=20], had significantly lower clinical pregnancy numbers [1 vs. 9, p<0.05] and implantation rates [4.7% vs. 41.6%, p<0.05], compared to controls [n=39]. However, there was no significant difference in miscarriage rates [9.4% vs. 8.7%, p>0.05] and multiple pregnancy numbers [1 vs. 3, p>0.05] between groups
Conclusion: When intrauterine saline infusion as a form of endometrial injury is performed during the ongoing IVF cycles it has negative effect on reproductive outcomes among patients with recurrent implantation failure
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The prevalence of Non-Alcoholic Fatty Liver Disease [NAFLD], as one of the health problems, and its complications are increasing. Inadequate physical activity and obesity are the determinants of the incidence of NAFLD. This study aimed to compare physical activity and Body Mass Index [BMI] in both groups of patients with and without NAFLD in Tehran. In this cross-sectional study, 170 outpatients aged 20 to 55 who referred to Taleghani Hospital of Tehran for sonography participated. They were selected using convenience sampling method. Using completing the questionnaires through systematic interviews with individuals, socio-demographic characteristics, complain and the level of physical activity were assessed. Anthropometric measurements and ultrasound were also performed. Data were analyzed using descriptive methods for descriptive data analysis, T-test and Chi-square tests to compare of the means between groups and to determine the relationship between variables. Most patients with NAFLD [60%] had intense level of physical activity and only a small percentage of them [11.3%] had low level of physical activity. While in the group of patients with NAFLD, most people [36.7%] had moderate level of physical activity and 28.9% had low level physical activity. The difference between the level of physical activity in the two groups was significant [p=0.001]. The mean [SD] BMI of patients with NAFLD was higher than patients without NAFLD [32.8[6.6] vs. 24.4[3]] [p<0.001]. Considering the prevalence of obesity and inadequate physical activity in patients with NAFLD, life style change recommended through designing and implementation of educational interventions to increase their knowledge and improve attitude, also physical activity interventions as option with diet to improve clinical status
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Background: Today, the health sector in many countries is facing with severe resource constraints; hence it is absolutely necessary that cost-benefit and cost-effectiveness assessment have a major role in design of health services. The purpose of this study was to evaluate the cost-benefit and effectiveness of cervical cancer screening service [Pap smear test] done by the health centers in Damavand County in 2013
Methods: This is a descriptive study with cross-sectional method. All data was extracted from existing documents in Damavand health network. Cost of service screening for doing Pap smear test [manpower costs of performing the service, the cost of transferring samples, water, electricity, telephone and gas] was estimated in all health centers then results, were compared with the incomes of this service
Results: Screening program coverage was 22.3%, 6.9% and 6.05% in 2011, 2012 and 2013 respectively. All costs and incomes of units performing Pap smear screening test were calculated. Entire costs and incomes of this service during 2013 were respectively 303,009,000 and 11,640,000 RLS equal $12,227 and $496.73. Therefore, the cost-benefit ratio of this screening test was approximately 0.040
Conclusion: The costs of units performing cervical cancer screening test in Damavand Health Center were much more than this benefit and because of a none-positive Pap smear test in spite of high cost, performing this test in Damavand health centers was not cost effective
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Background: Mental health of medical students who will be responsible for community health has great importance. This study was designed to determine the prevalence of probable mental disorders during the internship period of medical students
Methods: This descriptive cross sectional study evaluated 404 medical students of Shahid Beheshti University of Medical Sciences, in Tehran, the capital of Iran. The data collecting instrument was a self-rated questionnaire including standard mental health questionnaire SCL-90-R, demographic and socio-economic data. The score 0.7 and above were designated as possible cases of mental disorders. Analysis performed by SPSS software, version 14 [SPSS Inc, Chicago, Il, USA]. p-value<0.05 was considered significant
Results: 53.8% of participants were female, and 79.4% were single. From all participants, 14.1% had Global Severity Index [GSI] score more than 0.7. Mean and standard deviation of GSI score was 0.32 [0.27]. The frequency of probable mental disorder in medical students was 16.3% in somatization; 24.5% in obsessive-compulsive; 15.6% in interpersonal sensitivity; 16.8% in depression; 18.8% in anxiety; 14.6% in hostility; 11.4% in phobic anxiety; 16.8% in paranoid ideation and 13.9% in psychoticism. Students who had no children, lived in dormitory, had good economic status and were satisfied with their private life and studying course had significantly lower GSI scores
Conclusion: Between 11 to 24% of the students had mental disorders in different dimensions and economic status, living place and number of children were related to the disorders
ABSTRACT
Background: Although diabetes control and prevention program has been initiated in Tehran, Iran and five other large cities in the country since 2010, patients' satisfaction with the services provided by this program has not been evaluated yet. The aim of this study was to determine the patient satisfaction with this program in Tehran
Methods: This cross-sectional study, were conducted in 15 primary health care centers in Tehran, Iran in 2013. We enrolled 386 people aged older than 30 yr referred to primary health care centers. A questionnaire was used to evaluate the degree of patients' satisfaction with the services [the questionnaire included six domains: access to services, continuity of care, the humanness of staff, provision of health education materials, effectiveness of services, comprehensiveness of care]. The chi-square test, independent t test and one-way ANOVA were used for data analysis
Results: Overall, 239 patients [62%] were female. The mean age [SD] of the patients was 51 +/- 11 yr. Overall, 263 patients [68%] were highly satisfied with providing services. The highest levels of patients' satisfaction were in the domains of continuity of care, the humanness of staff, and effectiveness of services. The lowest level of satisfaction was in the domain of provision of health education materials
Conclusions: Diabetes control and prevention program seems to be a suitable program in health care centers in Tehran, however, it is necessary to make further plans to improve the level of training materials provided to patients and comprehensiveness of care
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It is obvious that, because of the lack of resources, we should devote our limited resources to priorities in order to reach an acceptable level of health. The objective of this study was to research priority setting for Pediatric Surgery Research Center; with the participation of all stakeholders. This is a Health System Research [HSR] project in order to apply governance and leadership issues with the participation of 41 people including faculty members in Pediatric Surgery Research Center, Shahid Beheshti Medical University and the other pediatric specialists and health system stakeholders as well as the people associated with health system inside and outside the university. This was performed in 2010 using the Council on Health Research for Development [COHRED] model with little change. Based on the model, at first the stakeholders were identified and the field situation of Pediatric Surgery was analyzed. Then, research areas and titles were specified and research priorities were set out by giving scores according to the criteria. The seven obtained research areas in priority order are included pediatric trauma, pediatric cancers, pediatric urology diseases, undescended testicles in children, developmental genetics and congenital defects, emergency in children and application of laparoscopic surgery in children. Because each of the research areas is composed of multiple subareas, we managed to finally specify 43 research subareas as research priorities. These subareas included epidemiology, risk factors, prevention, screening, diagnosis and treatment. They also included follow-up, complications, knowledge and attitudes of parents, quality of life, economy aspects and data bank for further research. In this project, research priorities were set out for Pediatric Surgery Research Center of Shahid Beheshti University of Medical Sciences, with the participation of all the stakeholders based on the recommended model of WHO [COHRED]. It seems that the reliability of the priorities is in moderate level, but there is certain validity in obtaining the best content in terms of the study conditions
ABSTRACT
Well-designed interventions can improve the communication skills of physicians. Since the understanding of the current situation is essential for designing effective interventions, this study was performed to determine medical interns' confidence and use of communication skills. This descriptive-analytical study was performed in spring 2013 within 3 branches of Islamic Azad University [Tehran, Mashhad, and Yazd], on 327 randomly selected interns. Data gathering instrument was a questionnaire with 14 items for confidence and 17 items for use of communication skills. Data analysis was performed using descriptive statistics as well as Spearman and Mann- Whitney U tests. Students' confidence and use of communication skills was evaluated moderate. There was a significant positive correlation between students' confidence and use of communication skills [r=0.42, p=0.001]. Male students reported higher scores for confidence and use of communication skills compared to female, but this was not significant [p=0.055 and p=0.292, respectively]. Considering significant correlation between confidence and use of communication skills, designing educational interventions is recommended for development of confidence and resulting use of communication skills in medical students
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Following the entrance of new technologies in health information era, this study aimed to assess changes in health information sources of Iranian people during past decade. Totally 3000 people were asked about their main sources of health information. They were selected as two community-based samples of 1500 people of more than 18-years-old in two different periods of time in August 2002 and August 2010 from the same locations in Tehran, the capital of Iran. Data analyzed based on age group, sex, educational level and household income in two different periods of time using Chi-square. Odds ratios associated with each basic characteristic were calculated using logistic regression. Most common sources of health information in 2002 were radio and television [17.7%], caregivers [14.9%] and internet [14.2%] and in 2010 were radio and television [19.3%], internet [19.3%] and caregivers [15.8%] [P < 0.001]. In 2010, young adults female used television and radio and male used internet as the main source of health information [P = 0.003]. In moderate educational level women got their health information from radio and television and caregivers; while men used radio and television and internet as main source of health information [P = 0.005].Highly educated women and men mainly got their health information from internet and radio and television [P > 0.05]. Although during 8 years of study radio and television remained as main source of health information but there is an increasing tendency to use internet especially in men. Policymakers should revise their broadcasting strategies based on people demand
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High Cesarean section rate is a major health problem in developing countries. This study was established to evaluate the effectiveness of Iranian Ministry of Health and Medical Education protocols on Cesarean section rate trend. Through a non-concurrent controlled quasi-experimental study, Cesarean section rate in Shohada-e-Tajrish and Taleghani hospitals in Tehran was compared during 2008-2009. Intervention group included 578 participants hospitalized because of premature rupture of membranes, prolonged pregnancy, pre-eclampsia, intra-uterine growth retardation, vaginal bleeding and premature labor in first and second trimester underwent interventions based on MOHME new protocol. On the other hand 594 cases as control group were selected during the same time before the intervention and underwent routine treatments. Descriptive statics, t-test, chi square and univariate analysis were used when appropriate. Basic characteristics in two groups had no statistically significant difference. Cesarean section applied for 360 [67.8%] women in case group and on the other hand, 270 [48.8%] Cesarean sections were done for control group [P<0.001]. There was 19% difference between intervention and control groups. Complication of pregnancies had increased by 6% in intervention group [P<0.001]. Mortality rate in the study was zero in both groups. Applying clinical practice guidelines does not guarantee decreasing Cesarean section rate. Providing appropriate service may increase the ability of service providers to find more indications for Cesarean section
Subject(s)
Humans , Female , Maternal Welfare , Developing Countries , Maternal Health Services , Obstetric Labor, Premature , Pregnancy, Prolonged , Case-Control StudiesABSTRACT
This study was conducted to determine the total expenditure and out of pocket payment on pregnancy complications in Tehran, the capital of Iran. A cross sectional study conducted on 1172 patients who admitted in two general teaching referral Hospitals in Tehran. In this study, we calculated total and out of pocket inpatient costs for seven pregnancy complications including preeclampsia, intrauterine growth restriction [IUGR], abortion, ante partum hemorrhage, preterm delivery, premature rupture of membranes and post dated pregnancy. We used descriptive analysis and analysis of variance test to compare these pregnancy complications. The average duration of hospitalization was 3.28 days and the number of visits by physicians for a patient was 9.79 on average. The average total cost for these pregnancy complications was 735.22 Unites States Dollars [USD] [standard deviation [SD] = 650.53]. The average out of packet share was 277.08 USD [SD = 350.74], which was 37.69% of total expenditure. IUGR with payment of 398.76 USD [SD = 418.54] [52.06% of total expenditure] had the greatest amount of out of pocket expenditure in all complications. While, abortion had the minimum out of pocket amount that was 148.77 USD [SD = 244.05]. Obstetrics complications had no catastrophic effect on families, but IUGR cost was about 30% of monthly household non food costs in Tehran so more financial protection plans and insurances are recommended for these patients.
Subject(s)
Humans , Female , Delivery, Obstetric/economics , Cost of Illness , Hospital Costs , Cross-Sectional Studies , Insurance, Major Medical , Length of Stay/economicsABSTRACT
The main purpose of this study was to assess the effects of daily physical activity on exercise tolerance ability using the six minute walk test in healthy female students. The participants in this field study were 252 healthy girls, 9-12 years old, studying in an elementary school in Tehran from March to June 2011. A three months daily physical activity protocol, with 15 minutes exercise per day, was designed as a curricular-based exercise intervention program. The six minute walk test was used as a tool to measure exercise tolerance ability before and after the intervention. Paired t-test, ANOVA and correlation tests were used when appropriate. The participants, with mean age of 10.6 [SD = 1.1], formed different body mass index groups known as underweight, normal, at risk and overweight with 8.3, 60.7, 18.7, and 12.3% respectively. The mean of the distances moved along in a six minute walk test, before and after the intervention, increased from 833.4 meter to 923.3 meter, indicating 10% increase and the difference was found to be statistically significant [P<0.001]. However, analysis of mean differences of the walked distances, before and after the intervention, showed no statistically significant difference for the body mass index groups [P> 0.05]. A 15-minutes daily physical activity could enhance the exercise tolerance of school-age girls; the activity, as an easy and inexpensive form of intervention, is recommended to students
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To measure clients' satisfaction with primary health care in the capital of Oman, Muscat, and also to identify the factors affecting their satisfaction. Through a cross-sectional study in health centers, 400 participants during the period from November 2009 to February 2010 were interviewed about their satisfaction degree with the primary health care services and setting. Four urban primary health care clinics from Muscat were selected randomly. Six domains of satisfaction including accessibility to services, continuity of care, humaneness of staff, comprehensiveness of care, provision of health education, and effectiveness of services were calculated from selected variables. The mean score of each area were calculated and then divided by the number of items in each area. Finally satisfaction areas were ranked based on recent criteria. Mean age was 29.5 years [SD = 9.37] for male and 26.01 years [SD = 7.12] for female participants. All the areas were suitable and only continuity of care had negative score. The ranked areas of satisfaction were as humanness of staff, effectiveness of services, access to services, provision of health educational materials, comprehensiveness of care, continuity of care. Primary health care were accepted as a suitable strategy for providing health care among clients of urban health centers of Muscat. It can be recommended to other countries to use this as a choice for health care provision
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Treatment delay in the management of ST-elevation myocardial infarction conversely correlates with prognosis and survival of the patients. This study aimed to investigate factors associated with delay in the thrombolytic therapy of these patients in Tehran. Between 2007 and 2010, the interval between the self-reported time of the onset of symptoms and initiation of the thrombolytic agent in 513 patients with a diagnosis of acute ST-elevation myocardial infarction was recorded. Medical history and socio-demographic characteristics of the patients treated within two hours after the onset of symptoms and patients treated after two hours from the onset of symptoms were compared, and the odds ratios were calculated using logistic regression. The mean age of the patients was 61.2 [SD = 11.1] years, and 76% of the patients were male. The median time between the onset of symptoms and treatment was 158 [SD = 30.4] minutes. Mean for decision time was 61 [SD = 19], which was responsible for 83% of the entire treatment delay. The mean transportation time was 34 [SD = 12] minutes, and the median door-to-needle time was 44 minutes. Odds ratio for history of diabetes mellitus was 1.90 [95% CI: 1.26-2.87], for hypertension was 1.55 [95% CI: 1.08-2.23], and for prior coronary heart disease was 1.47 [95% CI: 1.17-1.84]. The most important factor associated with delay in treatment was decision time. Improving emergency medical services dispatch time, obtaining pre-hospital electrocardiograms for early diagnosis, and pre-hospital initiation of thrombolytic therapy may reduce the delay time
Subject(s)
Humans , Middle Aged , Aged , Male , Female , Thrombolytic Therapy , Early Diagnosis , Electrocardiography , Prognosis , Cross-Sectional StudiesABSTRACT
This study aimed to evaluate the design of emergency departments regarding to the patients' and staff's privacy, confidentiality and facilities in general teaching hospitals. Emergency departments of all the general teaching hospitals of Shahid Beheshti University of Medical Sciences, Tehran, Iran were evaluated in 2007 through both direct observation and interview with hospital authorities, and staff. Relevant criteria were studied by a 27-item questionnaire including 19 items for facilities and 7 items for privacy and confidentiality. Extent of emergency departments was the last common criterion. Data analysis has been done using t-test and descriptive statistics when appropriate. SPSS Software version 16 was used to facilitate quantitative analysis. Eleven out of nineteen criteria [58%] for the facilities were not found in the emergency departments. Privacy criteria had an overall partially more acceptable situation. Only one criterion of privacy and confidentiality was negative for all the emergency departments. It was calm gynecologic and delivery room with specific toilet. The mean was 469.6 [SD=96] square meters for existing extent of emergency departments and 1461.6 [SD=262.1] square meters for the idea for the ideal values [P<0.01]. Privacy, confidentiality and enough facilities should be considered in designing of teaching hospitals for both stuff and patients. Most of them need to be reconstructed based on new national standards
Subject(s)
Confidentiality , Hospitals, Teaching , Health Facilities , Emergency Service, Hospital , Surveys and QuestionnairesABSTRACT
Injuries and realed wounds are one of the most common causes of admission in emergency departments. In this study the national protocol for tetanus prevention is compared with Eliza as the golden standard for detecting immunity of person. In a cross sectional study 200 individuals with wound admitted at Imam Hussein hospital [a teaching hospital in Tehran, Iran] were assessed and questionnaires were filled in based on physician decision as protocol recommended and also the result of Eliza. Agreement of physician decision and Eliza result has been evaluated by Kappa index. Sensitivity, specificity, predictive values, likelihood ratios and accuracy were also detected for different methods of vaccine and immunoglobulin administration. Immunoglobulin was administered for 30 percent of persons and vaccine for 23.5 percent. Kappa index for agreement between protocol administration and real administration in emergency department was 0.307 for immunoglobulin and 0.136 for vaccine [p<0.05]. It was 0.081 [P>0.05] and 0.199 [P<0.001] for agreement of protocol administration and Eliza and 0.008 and 0.054 [P>0.05] for agreement of administration in emergency depertment and Eliza respectively. For immunoglobuline sensitivity was 0.33, specificity 0.24, positive predictive value 0.25, negative predictive value 0.82, positive likelihood ratio 1.38, negative likelihood ratio 0.88 and accuracy 0.68. For vaccine sensitivity was 0.82, specificity 0.52, positive predictive value 0.29, negative predictive value 0.92, positive likelihood ratio 2.2, negative likelihood ratio 0.35 and accuracy 0.58. The sensitivity, specificity, predictive value, likelihood ratio and accuracy for national protocol are not enough for using in emergency department. It seems that there is need for another reliable and valid substitute method
Subject(s)
Humans , Cross-Sectional Studies , Sensitivity and Specificity , Predictive Value of Tests , Surveys and Questionnaires , Tetanus Toxoid , ImmunoglobulinsABSTRACT
Acute diarrhea is the fifth leading cause of death due to infectious diseases and responsible for 16.2% of the infectious disease burden in Iran. This study assessed the incidence and some determinants of acute diarrheal diseases in Tehran, the capital of Iran. Using cluster sampling, a population based survey was conducted among 2095 children aged 6 to 60 months in the southern districts of Tehran during May 2005. The incidence of acute diarrhea during the past 2 weeks, the duration and frequency of diarrhea, acute diarrhea in siblings and socioeconomic determinants were gathered by a questionnaire. Totally, 10.3% of children experienced new onset of diarrhea during the past two weeks with the average number of episodes of 2.8 per child. Half of the cases were 6-18 months of age [p<0.001]. The mean [ +/- standard deviation] duration of disease was 4.5 +/- 2.1 days and the frequency of diarrhea was 5.1 +/- 5 episodes per day. In 9.1% of the families, other cases of concurrent acute diarrhea were reported in siblings [OR=1.29, 95%CI:0.67-2.47]. The mean age of the mothers was 31 +/- 7.5 years. Less than 4% of the parents were illiterate. Childhood acute diarrhea remains a public health concern in Tehran. Improving the environmental sanitation and personal hygiene and raising the socioeconomic status of the population will contribute to the elimination of the underlying causes of acute diarrhea