Regional odontodysplasia: report of a case

Regional odontodysplasia is a rare dental anomaly affecting both primary and adult dentitions in the maxilla or mandible or both jaws, whilst involvement of the maxilla is more common [1-2]. In most cases, one quadrant is affected. One of the characteristics of this anomaly is discolored and soft teeth that can be accompanied by swelling or abscess

In this anomaly, enamel and dentin are thin and hypoplastic, therefore, the teeth give the impression of [ghost teeth] [2, 8]. In radiography, the delineation between enamel and dentin is not clear and pulp chamber is wide. Histologically, areas of hypocalcified enamel are observed and the enamel prisms appear to be irregular in direction [2]. There is a disturbance in dentin formation and dentinal tubules are reduced in number

The etiology of regional odontodysplasia is still unknown [8]. Managements of these cases should be based on the esthetics and functional needs as well as the degree of involvement

This report describes a case of regional odontodysplasia in a 3.5 year old Iranian girl whose chief complaint was the abscess formation in the left maxillary primary molar region

This case study aims to report the clinical and radiological findings of the current case

Health observatories in Iran

The Islamic Republic of Iran, in her 20 year vision by the year 2025, is a developed country with the first economic, scientific and technological status in the region, with revolutionary and Islamic identity, inspiring Islamic world, as well as effective and constructive interaction in international relations. Enjoying health, welfare, food security, social security, equal opportunities, fair income distribution, strong family structure; to be away from poverty, corruption, and discrimination; and benefiting desirable living environment are also considered out of characteristics of Iranian society in that year. Strategic leadership towards perceived vision in each setting requires restrictive, complete and timely information. According to constitution of National Institute for Health Researches, law of the Fifth Development Plan of the country and characteristics of health policy making, necessity of designing a Health Observatory System [HOS] was felt. Some Principles for designing such system were formulated by taking following steps: reviewing experience in other countries, having local history of the HOS in mind, superior documents, analysis of current production and management of health information, taking the possibilities to run a HOS into account. Based on these principles, the protocol of HOS was outlined in 3 different stages of opinion poll of informed experts responsible for production on management of information, by using questionnaires and Focus Group Discussions. The protocol includes executive regulations, the list of health indicators, vocabulary and a calendar for periodic studies of the community health situation

[Types of moral hazards and its effects on insurance marketing and health system]

Insurance coverage has a tendency to alter the consumer and provider's behavior. Moral hazard is a serious problem in all risk pooling systems, such as insurance and taxes-based financial systems that cause negative consequences as increased costs in the health system. Therefore we decide, at this review article, to discuss about moral hazard, in different classifications and effects on the insurance marketing and health system. This is a review article. Relevant materials selected from published articles, studies, and sites. The databases of Medline, Web of Science, Science Direct, Google Scholar, and Springer were explored to use the key words of moral hazard and health insurance. Insurance covered individuals, knowing that their health expenditures will be reimbursed by insurance in the time of illness, and their demand medical services are more than un insurance covered individuals. On the other hand the providers have financial incentive to provide unnecessary and excess medical services. Different types of moral hazard like as ex ante and ex post moral hazard; hidden information and hidden action moral hazard; provider and consumer moral hazard may arise due to insurance coverage. These lead to negative consequences such as consumption of unnecessary care services, alteration of consumption pattern for inefficient use of resources, welfare loss, and an increase in the health expenditures. Studying and controlling the effects of moral hazards seems necessary to prevent unwelcome outcomes as well as misallocation of financial resources

Malaria status in economic cooperation countries; achievement and gaps toward United Nations Millennium Development Goals

Evaluating the malaria status of the Economic Cooperation Organization [ECO] member countries relation to goal 6 of 3rd Millennium Development Goals [MDGs] which includes have halted by 2015 and begun to reverse the incidence of malaria. By 2009, we reviewed the MDGs reports, extracted the data from surveillance system, published, and unpublished data. The main stakeholders, from both governmental and international organizations in the country have been visited and interviewed by the research team as part of the data validation process. The malaria incidence is very heterogeneous among ECO countries, which differ less than 200 cases in total country in Kazakhstan, Kyrgyzstan, Turkey, Turkmenistan, Uzbekistan, and Azerbaijan to 82,564 cases [2,428/100,000] in Afghanistan and 59,284 cases [881/100,000] in Pakistan and about 18/100,000 in Iran in 2008. Malaria has been a major public health problem in Pakistan and Afghanistan and will continue to pose serious threat to millions of people due to poor environmental and socioeconomic conditions conducive to the spread of disease. The main malaria endemic areas of Iran are in southeastern part of the country; consist of less developed provinces that are bordered in the east by Afghanistan and Pakistan. There are little valid information about proportion of population in malaria-risk areas using effective malaria prevention and treatment measures indicators. All ECO countries could achieve MDGs malaria indicators by 2015 except Pakistan and Afghanistan, unless preparing urgent intervention programs to fulfill the goals

effect of service quality on patient loyalty: a study of private hospitals in Tehran, Iran

Service quality is perceived as an important factor for developing patient's loyalty. The aim of this study was to determine the hospital service quality from the patients' viewpoints and the relative importance of quality dimensions in predicting the patient's loyalty. A cross-sectional study was conducted in 2010.The study sample was composed of 943 patients selected from eight private general hospitals in Tehran. The survey instrument was a questionnaire included 24 items about the service quality and 3 items about the patient's loyalty. Exploratory factor analysis was employed to extracting the dimensions of service quality. Also, regression analysis was performed to determining the relative importance of the service quality dimensions in predicting the patient's loyalty. The mean score of service quality and patient's loyalty was 3.99 and 4.16 out of 5, respectively. About 29% of the loyalty variance was explained by the service quality dimensions. Four quality dimensions [Costing, Process Quality, Interaction Quality and Environment Quality] were found to be key determinants of the patient's loyalty in the private hospitals of Tehran. The patients' experience in relation to the private hospitals' services has strong impact on the outcome variables like willingness to return to the same hospital and reuse its services or recommend them to others. The relationship between the service quality and patient's loyalty proves the strategic importance of improving the service quality for dragging and retaining patients and expanding the market share

Estimating the frequency and rate of first 50 common types of invasive procedures in Iran healthcare system

The aim of this study was to estimate the frequency and rate of the first 50 common types of invasive procedures in Iran. Data about the number of all invasive procedures and each type of procedure that were conducted in Iran in 2010 were collected using the main insurance organizations database. These numbers were sorted in an excel database, and the first 50 invasive procedures with the most common frequency were selected. Then according to the population covered by the given insurance organizations, and based on the total population of Iran in 2011, we estimated the number and rate of each invasive procedure for the selective procedures. It was estimated that a total of 769,500 [1,026 per 100,000 population] natural vaginal delivery [NYD] was performed in Iran in 2011, followed by 416,790 cataract operation [556 per 100,000 population], 401,436 cesarean delivery [535 per 100,000 population], 260,514 coronary angiography disease [347 per 100,000 population], 181,836 varicocele [242 per 100,000 population], 144,918 appendectomy [193 per 100,000 population], 134,766 rhinoplasty [180 per 100,000 population] and 105,912 pilomdal cyst [141 per l00,000 population]. The result could be used to identify and select the most frequent invasive procedures in Iran, to calculate the average cost of each procedure and to use these costs to estimate hospital budget and improve policy-making

Assessing health system responsiveness: a household survey in 17[th] district of Tehran

Responsiveness is an indicator by WHO to evaluate the performance of health systems on non-medical expectations of consumers. This study measures the health system responsiveness and the factors affecting responsiveness in Iran health system. World Health Survey [WHS] questionnaire was used to collect data on a two-stage cluster sampling in 17[th] District of Tehran in 2003. Of a sample of 773, 677 and 299 individuals who respectively had outpatient or inpatient services utilization responded to the responsiveness module of WHS questionnaire. More than 90% of respondents believed that responsiveness issues were very important. Performance of outpatient services was better than hospital services in terms of responsiveness. [Prompt attention] and [quality of basic amenities] received low score for outpatient services. Service user variables had no significant effect on responsiveness, while type of centers was significantly related to responsiveness. Principal component analysis found three factors for both outpatient and inpatient services that explained 62% and 61% of total variances respectfully. Iran health system should pay more attention to responding non-medical expectations of service users. It sounds that health system interventions are main determinant of responsiveness score compared to demographic or user variables. Training health staff, allocating more resources and reengineering some processes may play a role in improving responsiveness. Responsiveness domains seems to be tailored based on each society's cultural factors

Patients length of stay in women hospital and its associated clinical and non-clinical factors, Tehran, Iran

Length of Stay [LOS] is an appropriate hospital indicator to evaluate hospital resource utilization rate, efficiency, and quality of services delivered. In this survey, we aimed to study hospital LOS and determine its association with clinical and non-clinical factors in Women Hospital in Tehran. In this cross-sectional study, we reviewed all 3421 charts of patients admitted in Oncology, Surgery and Obstetrics units in 2008. We used a data collection sheet and conducted interviews to collect the following data: distance from living area, medical insurance coverage types, admission and discharge months, days and times, inpatient units, final diagnoses and the number of diagnostic tests. The overall median of the LOS in the studied hospital was 50.8 hours. The medians were 48.5, 54.4, and 94.2 hours in the Obstetrics, Surgical and Oncology units, respectively. Results showed that the associated factors with the LOS were patient admissions on Thursdays, admitting by residents, the number of performed diagnostic tests [p<0.001], suffering from neoplastic diseases [p=0.005] and spouse jobs. Among the associated factors, policy makers and managers can only change the admission days and the number of diagnostic tests to decrease the LOS. Further researches are needed to find other factors associated with LOS

[Using the social marketing model to reduce risky driving behaviors among taxi drivers in Tehran]

In social marketing, the common techniques of commercial marketing are used to increase the chances of acceptability of an idea or action by the target group. In this study, we determined the impact of an intervention based on social marketing to reduce risky driving behaviors among taxi drivers in Tehran. This was a quasi-experimental study, consisting of a quantitative and a qualitative part, on taxi-drivers in 2 regions [an intervention and a control groups] in the City of Tehran. Based on a formative research approach, the components of social marketing, namely, the product [reminder message for concentrating on avoidance of two target behaviors, tailgating and not driving between lines], price, place and promotion were determined. An 8-week educational program was implemented, the components being installation of stickers before the driver's eyes, distributing a pamphlet, and transferring messages through taxi route supervisors as opinion leaders. After six weeks, risky driving behaviors were assessed by checklists and compared. The intervention resulted in statistically significant reductions in the two target behaviors in the intervention group as compared with the control group. Furthermore, logistic regression showed that the odds ratio for avoiding both behaviors increased significantly in the intervention group. Determining specific target groups, designing interventions based on actual needs and wants of the target group, and focusing on the factors influencing the behavior market are the basic elements of social marketing. Due consideration of these elements when designing behavioral interventions would lead to reductions in risky driving behaviors

Patients' perspectives on factors that influence diabetes self-care

Although diabetes mellitus is of high concern in Iran, and the level of control is unacceptable, few qualitative studies have been carried out to reflect the experiences of patients on the barriers and motivators to self-care. This study aimed to explore a culturally based experience of Iranian diabetic patients regarding the personal and environmental barriers to and facilitating factors for diabetes self-care. Six focus groups were conducted among type 2 diabetic patients in the Charity Foundation for Special Diseases' diabetes clinic. Purposeful sampling was used. Newly diagnosed patients [less than six months] and all type 1 diabetic patients were excluded. Three focus groups were held on for each sex. A total of 43 patients participated in the study. Framework analysis was used to extract the themes from the data. Data analysis showed five main barriers: physical barriers [such as physical effects of diabetes]; psychological barriers [such as health beliefs]; educational barriers [such as lack of knowledge about diabetes]; social barriers [such as group pressure]; and care system barriers [such as service availability]. Along with the barriers, there were some motivators that the participants mentioned as a stimuli to control their diabetes. They include beliefs about diabetes, perceived responsibility for family, religious beliefs, and the views of significant others. Culturally based interventions are needed to improve diabetes care management in Iran. In addition to personal factors, diabetes health educators should pay attention to the environmental factors when they develop programs

survey of satisfaction rate and the effective factors on the aged peoples satisfaction regarding to the given services in the hospitals Tehran university of medical sciences

The elderly population in Iran is increasing. The aim of this study is the survey of satisfaction rate and the effective factors on the elderly - aged peoples satisfaction regarding to the given services in the hospitals affiliated to the Tehran university of medical sciences. This research is a descriptive - analytical study with applied results. It shows the problems cross - section ally. The research society involves the whole elderly - aged people whit 65 years old and more than that used the bedridden services of the hospitals affiliated to the Tehran university of medical sciences. The sample involves 360 elderly. For collecting the data, a questionnaire with three parts was used. The validity of questionnaire by the content measurement and the reliability of questionnaire by test re test [r = 0.84] were achieved. And also we used SPSS software for data analysis. Results showed that 25/6%patients from management type, 41/9%from facilities, 17/2% from behavior personality and 30/3% from public services are dissatisfaction. A total of 12 variable were analyzed, and the results showed that: The education level, age, sex, type of refer, dealing with the bed shortage and occupations have the meaningful relation with their satisfaction rate. The one -variable - analyzers in the logistic regration model showed that among the whole meaningful variables, the education level has the strongest relation with satisfaction. With increasing the education level, the satisfaction rate have been decreased. Due to results satisfaction rate among participant of this study is good and accepted. Using of results is effective step in increase productivity services and further evaluation needed to be done for functional styles patient elderly satisfaction

What do patients expect from their physicians?

To identify the most important expectations that patients have from their physicians. We collected data from 199 hospitalized and 201 ambulatory patients [response rates 88% and 93% respectively]. We used random sampling for selection of hospitalized patients and systematic sampling for the ambulatory ones. The questionnaire consisted of 18 different expectation items categorized in 5 domains. The participants scored each item from 1 ' to 9 using a VAS scale and ranked domains based on their importance. We analyzed the data using univariate and regression analyses. Among the ambulatory patients, the mean +/- standard error of the most important expectations was as follows: competency [8.9 +/- 0.01], courteousness [8.8 +/- 0.04], consultation in case of need [8.8 +/- 0.4], clear explanation of the disease [8.8 +/- 0.05] and attentiveness [8.8 +/- 0.04]. In hospitalized patients, the following items were the most important: competency [8.4 +/- 0.08], courteousness [8.4 +/- 0.09], availability of physician [8.4 +/- 0.09], consultation in case of need [8.2 +/- 0.11], setting following appointments [8.2 +/- 0.1], and disease follow-up [8.2 +/- 0.09]. In both groups, the most important domain of expectations was [competency and quality of care] followed by [availability] in hospitalized and [giving information and patient autonomy] among ambulatory patients. Our findings are similar to what reported in the literature from other countries and cultures. In addition to physician expertise and knowledge, patients value giving information and efficient doctor-patient relationship

[Application of an integrative approach to identify determinants of junk food consumption among female adolescents]

The increasing consumption of junk foods by adolescents is associated with adverse health consequences. The purpose of this study was to identify determinants of unhealthy snack consumption among female adolescents using an integrative method based on the theory of planned behavior. The sample included 90 female adolescents aged 12-15 years, from 2 guidance schools in Tehran, selected by systematic sampling. In the qualitative phase of the study, which was of a phenomenology type, the data were collected through 9 focus group discussions. After obtaining parental consent, in each discussion session a moderator followed a topic outline developed based on the theory of planned behavior [TPB]. Data analysis was done using the framework method. The quantitative phase consisted of a cross-sectional study on 790 female adolescents aged 12-15 years old from 10 schools, selected using a randomized stratified cluster sampling method. Data on social cognition [based on TPB] and food consumption [using a 48-item food frequency questionnaire] were collected and analyzed using the multiple regression method. In both phases of the study there was a broad range of factors, some of them contradicting each other, influencing selection of snacks by the adolescents. Taste was identified as the most important factor influencing their attitude towards junk foods consumption. The major predictors of behavior of the adolescents were found to be easy access to junk foods, personal taste preferences, peer pressure, media advertisements, and low price of unhealthy snacks [p<0.05]. The most influential individuals in snack choice, based on the qualitative phase findings, were peers, while quantitative findings identified parents as the most influential. Applying an integrative approach provided a comprehensive insight into the underlying factors of junk food consumption by adolescents. Intervention programs with due consideration of these factors can help reduce unhealthy snack food consumption in this vulnerable group

[Developing appropriate criteria for benign prostatic hyperplasia surgery using RAND Appropriateness Method [RAM]]

Results of different studies show that a relatively large number of healthcare services offered are inappropriate or unnecessary. Benign prostatic hyperplasia is a benign enlargement of the prostate gland. Clinical features of this disease are one of the most common problems encountered by elderly males. The aim of this study was to assess the appropriateness of benign prostatic hyperplasia surgery. In this qualitative study which was conducted in 2008-9, in Tehran University of Medical Sciences, the RAN/UCLA method was used, which was designed in 1980 by the RAND institute and the University of California in Los Angeles. Regarding the stages of our method, scenarios and indications for benign prostatic hyperplasia surgery were chosen from the latest approved scientific resources and subsequently sent to urology specialists, who were chosen as members of the specialized panel. Panel members gave scores ranging from 1 to 9 to each indication and scenario based on scientific resources, clinical experiences and patient's condition in two separate panel sessions. After compilation, the indications were finally grouped as appropriate, equivocal, and inappropriate so that they could be used to determine appropriateness of benign prostatic hyperplasia surgery in hospitals. In this study, the most suitable and most approved clinical guidelines related to benign prostatic hyperplasia, the Guidelines Evaluation and Research Appraisal [AGREE] were used.The selected guidelines were used as scientific resources for choosing the indications of benign prostatic hyperplasia surgery. SPSS version 16 and kappa weighted value were used in analysis process of the study. Out of 282 scenarios grouped as 9 conditions related to benign prostatic hyperplasia surgery, which were extracted from scientific sources, 73 cases [25.9%] were considered as appropriate, 14 cases [5%] as equivocal and 7 cases [2.5%] were considered as inappropriate. Also 22 cases [7.8%] were considered as appropriate indications for drug therapy and none were found to be suitable for waiting and watching. There were 94 scenarios related to surgery that 75 scenarios [80%] were grouped in appropriate and 8 scenarios [8.5%] identified inappropriate. At the present time, due to the lack of scientific evidence for suitable decision-making in providing health services, methods based upon agreement, including the one used in the present study, and the use of treatment standards derived from similar studies, are amongst the most important measures taken to improve the standard of hearth, provide suitable health services, and to reduce unnecessary costs. In addition, RAM appropriateness method could be an ideal method in determining the appropriateness of health care and in reducing the rate of inappropriate services provided. The similarity of results derived from other studies performed by the RAND method in determining the appropriateness of benign prostatic hyperplasia treatment with the current study shows the validity and reliability of this method

[Knowledge translation: a model for research utilization]

The present study was aimed to design a knowledge transfer model that would provide a conceptual framework for linking the different components of a knowledge translation cycle. Such a theoretical model will enable us to organize and evaluate the current situation and design further studies on the transfer of research generated knowledge. This research, performed in 2006-7 in Tehran University of Medical Sciences, utilized two district methodologies: the first part was a narrative review with the goal of identifying the existing knowledge transfer models; the second part included focus group discussions to find out the views and opinions of researchers and decision-makers concerning the factors that promote or hinder knowledge translation within the health system. The two studies have provided the input for designing a "Knowledge Translation Cycle" with five domains: Knowledge Creation, Knowledge Transfer, Research Utilization, Question Transfer, and the context of University. Within each domain, the model includes two components [with the exception of the university context]. This model offers a theoretical basis for identifying the basic requirements and the linking mechanisms for the translation of knowledge

[Qualitative assessment of dimensions and degree of autonomy granting to university hospitals]

The aim of this study was to determine the key organizational dimensions that influence the autonomy of university hospitals and the level of granted autonomy in each dimension. Six hospitals were randomly selected from those affiliated with three medical universities of Tehran, Iran and Shahid Beheshti. In this qualitative study, we interviewed 27 hospital managers [response rate of 82%]. The semi-structured interview guide was developed based on the results of four initial in-depth interviews and the organizational reform model of the World Bank. We used the framework method for the analysis of qualitative data. Nine themes were identified as the key factors influencing hospital autonomy: decision right in strategic management, decision right in human resources management, decision right in financial management, decision right in physical resources management, product market exposure, procurement market exposure, financial residual claim, governance arrangements and accountability mechanisms, and social functions of the hospitals. Limited decision rights in strategic, human resources, and physical resources management were granted to hospitals. Hospitals were not the financial residual claimant, but were exposed to competitive product market. Autonomy was limited regarding the procurement market. Governance systems were hierarchical and accountability mechanisms were supervisor-supervisee oriented. Some of the social functions of the hospitals were defined, but the expenses of these functions were not totally reimbursed by the government and the insurance industry. The autonomy granted to the hospitals is unbalanced and paradoxical. More decision rights should be granted for management of strategic, human resources and physical resources as well as hospitals entry to the procurement market. Hospitals need to be the financial residual claimant. The hierarchical administrative systems should be transformed to cooperative ones. Instead of supervisor-supervisee oriented control measures, Ministry of Health and Medical Education needs more regulatory mechanisms for controlling hospitals' performance and social functions

[Perinatal care regionalization and geographical distribution model in the Islamic Republic of Iran]

During the past decade, neonatal mortality rate in Iran has not decreased satisfactorily. Regionalization of perinatal care services is a potential solution to improve the access of those in need to the best quality care within economic and administrative constraints. This study aims to develop a framework for optimized and efficient distribution of perinatal care services at different levels of care provision. We utilized small area analysis in an iterative process to divide the country into service areas of Perinatal Care Regions [PCRs], to distribute three levels of perinatal services and hospital beds in PCRs, to minimize patients' traveling distances, and to fit the facilities to the needs while incurring minimum changes to the current administrative borders and available infra-structure. We divided the country into 33 PCRs. A total of 1256 level-III [Neonatal Intensive Care Unit] beds and 3768 level-II neonatal beds were required in the country and distributed to the districts. One level-Ill district was designated as the center for each PCR. Sixty one districts were identified as level-III and 104 as level-II. Level-I and Ib districts were allocated to the nearest next level districts. Our proposed model decreased the average distance of districts from the center from 125 to 109 km. The average distance and the distance weighted by population of the districts from the PCR center also reduced to 79 and 42 km, respectively. Our model reduced the distance between levels of care provision and balanced the care facilities with population needs at the district level Implementing this model requires resources. It may encounter some resistance in practice. Such resistance should be tackled with setting regulations, monitoring, training, advocacy, and appropriate incentives. A sustainable national regionalization model should be developed centrally, and customized to the specific needs and circumstances of each region