Proper distribution of specialist physicians: a strategy towards realizing justice and equity in access to health care services

Background: Paving the way for having equitable access to medical intervention programs is the most important action that a health system can take in realizing social justice. This study aims at examining proper distribution of specialist physicians as an strategy towards realizing justice and equity in access to and use of health services as well as providing recommendations for policy-makers

Methods: This is a review-narrative and bibliographic research that used databases consisting of Magiran, Irandoc, Iranmedex, SID, PubMed, Scopus, EMBASE, Direct Science with the key words including Specialists, Health, Equity, Accessibility, Health system and Human resources. The data were collected from 1990 to 2015

Results: There are evidences of regions in the world that still are lacking sufficient number of physician workforce and are not only faced with challenges of recruiting, but also with retention of specialist physicians. In fact, migration of human workforce from deprived regions to more organized and prosperous parts has been a factor influencing workforce shortage in these regions; thereby it adds further problem of recruitment and retention of specialist workforce

Conclusions: Human workforce distribution [Specialist or non-specialists] has direct effects on realizing equity and justice in health system; it also influences economy of a given country indirectly. On the other hand, compensation is one of the important incentives that drives workforce behavior and makes them more inclined towards working in deprived regions. Taking the above mentioned ideas, it is recommended for the health system to use more economic incentives and insure proper distribution that fits individuals' needs. Using various tax policies in deprived, wealthy, and generally different geographical regions is one of the most important incentives available to leverage this purpose

Validation of the adult domain-specific hope scale in Iranian postgraduate students

The aim of the present study was to investigate psychometric properties and the Standardization of Simpson's Hope Scale [1999] in Iranian university students. In this descriptive-survey research, 1000 students with age range of 18 to 34 and with the mean age of 23.9 +/- 5.13 were selected via the categorical cluster sampling method from different universities. Then they answered the Snyder's Hope Scale, Oxford Happiness Scale, the Ahwaz Hardiness Scale, the Beck Hopelessness Inventory, Riff's Psychological Well-being Scale, as well as Sympson's [1999] Hope Scale [with little change]. Coefficients of Cronbach's alpha [0.94], split-half [0.85], convergent validity with Hardiness [0.40], Happiness [0.64], Psychological Well-being scales [0.47], divergent validity [Beck Hopelessness, -0.25] criterion validity [Snyder's Hope 0.55] were calculated, which were significant at p<0.01 level. The exploratory factor analysis showed that the 40-item Hope Scale for adults is saturated with five factors [social, academic, family, occupational, and leisure hope] that explain 56% of the scale's variance. Second-order confirmatory factor analysis indicated that the five mentioned factors are well loaded on a principal factor, and therefore, the six-factor model was well fitted with the data [AGFI=0.93, RMSEA= 0.037, NFI=0.98]. The results showed that this test has high reliability and validity and can be used in other studies.

effect of clofibrate on decreasing serum bilirubin in healthy term neonates under home phototherapy

This study was designed to determine the effect of clofibrate on neonatal uncomplicated jaundice treated with home phototherapy. This clinical trial study was performed on 60 newborns with jaundice that received home phototherapy. Inclusion criteria were body weight between 2500 to 4000 gr, breastfed, I total serum bilirubin [TSB] between 14 to 20 mg/dl, aged over 72 hours. The neonates were randomly divided into two groups. All received home phototherapy. Group I received a single dose of 50 mg/kg clofibrate and the other group served as control group. Total serum bilirubin level was measured every 24 hours. Two groups were matched regarding weight, sex, age and first TSB. At 24 and 48 hours of treatment, the mean values of TSB in the clofibrate group were 13.72 [1.56], 9.5 [0.56] and in the control group 15.30 [1.44], 12.6 [1.44]. The results show that TSB was significantly decreased after 24 and 48 hours in clofibrate group [P<0.001]. The mean duration of phototherapy in group I was 72[0.0] hours and in the control group 76.80 [ +/- 9.76] hours. The duration of phototherapy was significantly shorter in clofibrate group [P<0.001]. Clofibrate is effective for outpatients with neonatal hyperbilirubinemia who are under home phototherapy. Of course, further studies are needed for approved routine use of this drug in the treatment of neonatal jaundice

[Students' view points on the educational problems in medical school of Kermanshah University of Medical Sciences [2007]]

There is no doubt that improving quality in medical education is based on analysis of the current situation. Medical students are considered one of the best resources whose viewpoints on the educational shortcomings can provide valuable information on where there is still work to be done. This study presents the students perspective on the educational problems in Medical School of Kermanshah University of Medical Sciences in 2007. This phenomenological qualitative study included 24 medical students who were at different stages of medical training. Group discussions were held and students were interviewed over several sessions. All the sessions were tape recorded and transcribed by the 3 assistants. Information was then categorized in terms of three areas of basic sciences, traineeship and internship. The most important problems were cited under the categories of educational objectives, planning, management, ethics and evaluation by the students. Among subcategories, offering specialty and subspecialty materials, the gap between basic sciences and traineeship, lack of motivation and lack of supervision on education were rated as the most important factors causing concern among the students. The results of the study have revealed a series of problems that require measures at the national level including the shortage of high -quality academic staff. However, most issues can be addressed through careful planning on the part of university officials and academic staffs

Pediatric cystine calculi in west of Iran a study of 22 cases

Cystinuria is an autosomal recessive disorder which clinically presents as cystine calculi. In this study, we reviewed cystine calculi cases in the west of Iran to determine their common presentations and response to different therapeutic modalities. Between 1999 and 2005, we had 22 pediatric patients [11 boys and 11 girls] with cystine calculi. The demographic characteristics and clinical data of the patients as well as the treatment results were reviewed. The mean age of the patients was 34.20 ' 42.99 months [range, 4 to 156 months]. They were followed for a mean duration of 23 months [range, 3 to 70 months]. Thirteen patients [59.1%] had bilateral and 9 [41%] had unilateral kidney calculi. The sizes of the calculi were between 2 mm and 20 mm. Nine patients [41%] had renal atrophic changes and 1 [4.5%] had obstructive acute renal failure. Hydration and urinary alkalinization were administrated to all of the patients which yielded an excellent result in 54.5% and a poor response in 27.2%. Captopril started for 5 patients was effective only in 1. D-penicillamine had no favorable response. Extracorporeal shockwave lithotripsy was successful in 5 attempts and failed in 4. Surgical interventions were performed for 13 patients [59.1%] and 6 [27.2%] required more than 1 surgical operation. We recommend metabolic workup of childhood urolithiasis and appropriate medical management of its underlying disease. We also recommend minimally invasive urologic techniques including shockwave lithotripsy only when there are clear indications for nonmedical procedures

Urethroplasty for long anterior urethral strictures report of long term results

We reviewed the long-term outcome of substitution urethroplasty with skin flaps for anterior urethral strictures, comparing 1-stage with 2-stage repairs. A total of 45 patients with urethral strictures, 2.5 cm or longer, had undergone skin flap urethroplasty. A 1-stage surgical operation had been done in 10 patients [Orandi and bilateral pedicle island of penile skin] and a 2-stage surgical repair had been performed in 35 using the Johanson technique. They were followed up by retrograde urethrography for 1 to 10 years. The mean age of the patients was 46.3 +/- 17.1 years. Etiology of the stricture was instrumentation in 33.3% of the patients, urethritis in 28.9%, trauma in 13.3%, and unknown in 24.5%. At the first postoperative year, the success rate was 75.6%. This rate was 71.4% and 90% for the 1-stage and 2-stage operations, respectively [P = .23]. There were 1 [10%] and 10 [28.6%] cases of recurrent structure and 1 [10%] and 3 [8.6%] cases of fistula in the patients with the 1-stage and 2-stage operations within the first year, respectively. During the 5 postoperative years, 70% of the patients with the 1-stage repair, 57.1% with the 2-stage repair, and 60% in total had no complications. Based on the previous studies and our experience, we recommend skin flap urethroplasty. However, some measures such as proper tailoring of the flap and the extension of the incision onto the intact segments should be considered for achieving a better outcome