Health-Related Quality of Life in Osteoporosis Patients with and without Fractures in Tehran, Iran

Background@#This study aimed to measure the health-related quality of life (HRQOL) of patients with osteoporosis with and without fractures in Tehran, the capital city of Iran. @*Methods@#We surveyed a sample of 478 patients with osteoporosis aged over 50 years. Participants with fractures included patients referred to hospitals due to osteoporotic fractures which were alive 6 months after the fracture. Participants without fractures were randomly selected from patients with a definite diagnosis of osteoporosis admitted to 3 outpatient clinics in Tehran. Data were collected using the EuroQol 5-dimensional 5-level questionnaire. Statistical differences between patients with and without fracture were tested with Pearson’s χ2 test, Student’s t-test, and the Mann–Whitney U-test. The association between HRQOL and other variables was evaluated using a multiple linear regression model. @*Results@#The patients’ mean age±standard deviation was 67.3±11.9 years, and 74.1% were women. One hundred and seventeen (23%) patients had hip fractures, 56 (11%) had vertebral fractures, 127 (25%) had forearm fractures, and 178 (40%) had no fractures. The median (interquartile range) values of HRQOL scores of those with hip, vertebral, and forearm fractures and those with no history of fracture were 0.53 (0.22), 0.60 (0.28), 0.64 (0.26), and 0.64 (0.27), respectively. The multiple regression model revealed a significant relationship between the HRQOL scores and sex, marital status, employment status, presence of any chronic illness in addition to osteoporosis, and type of fracture. @*Conclusions@#Osteoporosis and its related fractures can reduce the HRQOL.

A Scoping Review of Components of Physician-induced Demand for Designing a Conceptual Framework / 예방의학회지

OBJECTIVES@#The current study presents a new conceptual framework for physician-induced demand that comprises several influential components and their interactions.@*METHODS@#This framework was developed on the basis of the conceptual model proposed by Labelle. To identify the components that influenced induced demand and their interactions, a scoping review was conducted (from January 1980 to January 2017). Additionally, an expert panel was formed to formulate and expand the framework.@*RESULTS@#The developed framework comprises 2 main sets of components. First, the supply side includes 9 components: physicians’ incentive for pecuniary profit or meeting their target income, physicians’ current income, the physician/population ratio, service price (tariff), payment method, consultation time, type of employment of physicians, observable characteristics of the physician, and type and size of the hospital. Second, the demand side includes 3 components: patients’ observable characteristics, patients’ non-clinical characteristics, and insurance coverage.@*CONCLUSIONS@#A conceptual framework that can clearly describe interactions between the components that influence induced demand is a critical step in providing a scientific basis for understanding physicians’ behavior, particularly in the field of health economics.

A Scoping Review of Components of Physician-induced Demand for Designing a Conceptual Framework / 예방의학회지

OBJECTIVES: The current study presents a new conceptual framework for physician-induced demand that comprises several influential components and their interactions. METHODS: This framework was developed on the basis of the conceptual model proposed by Labelle. To identify the components that influenced induced demand and their interactions, a scoping review was conducted (from January 1980 to January 2017). Additionally, an expert panel was formed to formulate and expand the framework. RESULTS: The developed framework comprises 2 main sets of components. First, the supply side includes 9 components: physicians’ incentive for pecuniary profit or meeting their target income, physicians’ current income, the physician/population ratio, service price (tariff), payment method, consultation time, type of employment of physicians, observable characteristics of the physician, and type and size of the hospital. Second, the demand side includes 3 components: patients’ observable characteristics, patients’ non-clinical characteristics, and insurance coverage. CONCLUSIONS: A conceptual framework that can clearly describe interactions between the components that influence induced demand is a critical step in providing a scientific basis for understanding physicians’ behavior, particularly in the field of health economics.

Effect of dual practice on service delivery time by surgeons in the Islamic Republic of Iran: multi-level analysis of a national survey, 2016

Background: One of the work patterns which affects the supply of specialists is the phenomenon of dual practice [DP], i.e., working simultaneously in the public and private sectors. Uncontrolled DP in the surgery health workforce can have adverse effects on access to surgeons, efficiency, effectiveness and quality of surgery services.

Aims: The aim of this article is to examine the impact of DP on service delivery time by surgeons.

Methods: We used a prestructured form to collect data on surgery specialists in all 925 Iranian hospitals. National medical ID codes, council ID codes, first name, surname and father's name were used for data matching. Multilevel linear regression was used to assess the association between DP and study variables, which were recruitment type, faculty status, experience, sex and age.

Results: The 4642 surgery specialists in this study, representing 31.08% of the total number of surgeons identified, spent mean 1.09 [standard deviation 0.33] hours full-time equivalent [FTE] on health care service delivery. Specialists with DP had long service delivery time [beta = 0.427]. Female specialists [beta = –0.049] and full-time specialists [beta = –0.082] spent less time on health care service delivery. Permanent specialists had higher FTE [P < 0.001] and as the population increases, FTE increases [P < 0.05].

Conclusions: Although DP had a direct impact on surgeons' working hours, it seems that a greater share of the difference in working time was used in the private sector services, leading to poor access to surgery services in the public sector. Therefore, it is necessary to develop a systems approach to regulate DP.

Factors influencing medical specialists' dual practice in the Islamic Republic of Iran

Background: Dual practice [DP] is performing several different jobs at the same time and has effects on healthcare services delivery.

Aims: To identify the causes of medical specialists' tendency towards DP in the Islamic Republic of Iran.

Methods: We used a qualitative approach to identify the factors affecting DP in medical specialists in 2016. We used a purposive and outlier sampling method to conduct semistructured deep interviews with 14 key informants. The data analysis was performed simultaneously with data collection using thematic content analysis by MAXQDA [version 10.0]. Interviews continued up to data saturation. The quality of the study was ensured by addressing the criteria of Guba and Lincoln.

Results: The results of the interviews showed six themes and 16 subthemes for specialists' propensity to DP. Major themes included financial incentives, cultural attitudes about professional identity of physicians, experience and academic level of specialists, controlling approaches in the public sector, available infrastructure for responding to the population needs in the public sector, and regional characteristics of health service locations.

Conclusions: Medical specialists' DP is a multidimensional issue, influenced by different factors such as financial incentives, cultural attitudes and available infrastructure. Considering the capacities and conditions of each country, control and management of this phenomenon require regulatory and incentive mechanisms, which in the long term can modify private and public sector differences and increase the willingness of doctors to work in the public sector.

Life and health satisfaction in the adult population of Iran / 한국역학회지

OBJECTIVES: Increasing interest has emerged in the use of subjective well-being as a development indicator and for the evaluation of public policies. The aim of this study was to assess life and health satisfaction and their determinants in the adult population of Iran. METHODS: We conducted a survey of a sample of 3,150 adults at least 18 years of age in Tehran, the capital of Iran. The subjects were selected using a stratified random sampling method, and they were interviewed face-to-face at their usual residence by trained interviewers. Life satisfaction was used as a measure of subjective well-being. We used ordinary least square regression models to assess the associations of life and health satisfaction with socio-demographic variables. RESULTS: On a 0-10 scale, the mean (standard deviation) scores for life and health satisfaction were 6.93 (2.54) and 7.18 (1.97), respectively. The average score for life satisfaction in females was 0.52 points higher than in males. A U-shaped relationship was found between age and life satisfaction, with respondents 35 to 44 years of age having the lowest average level of life satisfaction. Satisfaction with life and health among divorced respondents was significantly lower than among never-married and married participants. The scores for life satisfaction in respondents who rated their health status as poor were 3.83 points lower than in those who rated their health status as excellent. CONCLUSIONS: The majority of the population of Tehran was satisfied with their life and health. Self-rated health status had the greatest impact on life satisfaction.

Self-reported health-related quality of life (HRQoL) and factors affecting HRQoL among individuals with health insurance in Iran / 한국역학회지

OBJECTIVES: The aim of this study was to measure the health-related quality of life (HRQoL) and to evaluate the factors affecting HRQoL in individuals with health insurance in Tehran, Iran. METHODS: A cross-sectional analytical study was conducted using the 3-level EuroQol 5-dimensions (EQ-5D) questionnaire. In order to estimate the determinants of HRQoL, information about participants’ demographic, socioeconomic, and health status was gathered. The cluster sampling technique was used to collect data from May to June, 2016. The chi-square test and weighted least squares method were employed for data analysis. Data were analyzed using Stata version 11.0. RESULTS: A total of 600 Iranians with insurance completed the study, of whom 327 (54.5%) were male and 273 (45.5%) were female. The mean age of the participants was 41.48 years (standard deviation [SD], 14.60 years). Meanwhile, the mean duration of education was 12.36 years (SD, 4.68 years). The mean EQ-5D score was 0.74 (SD, 0.16). The most common health problems in the participants were anxiety/depression (42.3%), followed by pain/discomfort (39.2%). Sex, age, years of schooling, income, chronic disease, and body mass index had a significant effect on HRQoL (p<0.05). Healthy insured individuals, on average, had a HRQoL score 0.119 higher than that of people with a chronic disease, all else being equal (p<0.001). CONCLUSIONS: Among all determinants of HRQoL, chronic disease was found to be the highest priority for interventions to improve the health status of Iranians with insurance. This finding can help policymakers and health insurance organizations improve their planning to promote the HRQoL of individuals with insurance and society as a whole in Iran.

Estimating economic burden of cancer deaths attributable to smoking in Iran in 2012

Background: There is a broad consensus among health policy-makers that smoking has a significant impact on both heath system and society. The purpose of this study was to estimate the economic burden of major cancer deaths caused by smoking in Iran in 2012

Methods: Number of major cancer deaths due to smoking by sex and age groups in 2012 was obtained from GLOBCAN database. The life expectancy and retirement age were used to estimate years of potential life lost [YPLL] and cost of productive lost attributable to smoking, respectively. Data on prevalence of smoking, relative risk of smoking, life expectancy table, annual wage and employment rate were extracted from the various resources such as previous studies, WHO database and Iranian statistic centers. The data analysis was conducted by Excel software

Results: Smoking was responsible for 4,623 cancer deaths, 80808 YPLL and $US 83,019,583 cost of productivity lost. Lung cancer accounts for largest proportion of total cancer deaths, YPLL and cost of productivity lost attributable to smoking. Males account for 86.6% of cancer deaths, 82.6% of YPLL and 85.3% of cost of productivity lost caused by smoking

Conclusions: Smoking places a high economic burden on health system and society as a whole. In addition, if no one had been smokers in Iran, approximately two out of ten cancer deaths could be prevented

Stated time preferences for health: a systematic review and meta analysis of private and social discount rates

The present study aimed to provide better insight on methodological issues related to time preference studies, and to estimate private and social discount rates, using a rigorous systematic review and meta-analysis. We searched PubMed, EMBASE and Proquest databases in June 2013. All studies had estimated private and social time preference rates for health outcomes through stated preference approach, recognized eligible for inclusion. We conducted both fixed and random effect meta-analyses using mean discount rate and standard deviation of the included studies. I-square statistics was used for testing heterogeneity of the studies. Private and social discount rates were estimated separately via Stata11 software. Out of 44 screened full texts, 8 population-based empirical studies were included in qualitative synthesis. Reported time preference rates for own health were from 0.036 to 0.07 and for social health from 0.04 to 0.2. Private and social discount rates were estimated at 0.056 [95% CI: 0.038, 0.074] and 0.066 [95% CI: 0.064, 0.068], respectively. Considering the impact of time preference on healthy behaviors and because of timing issues, individual's time preference as a key determinant of policy making should be taken into account. Direct translation of elicited discount rates to the official discount rates has been remained questionable. Decisions about the proper discount rate for health context, may need a cross-party consensus among health economists and policy makers

[Estimation of Price Elasticity and Effective Factors on Demand for Supplementary Insurance]

Background: The development supplementary insurance and the increasing of insurance coverage results to increase the level of health of society and helps to provide more services. The aim of this study was estimate price elasticity demand for supplementary insurance and effective factors on its use or non-use, among board's members and staffs of health faculty of Tehran University of medical sciences in 2011.

Methods: This was a descriptive analytic cross-sectional study. The data collection tool was a questionnaire. For data analysis from SPSS 20 version was used. Also, descriptive and inferential statistics such as average test and logistic regression were used.

Result: Price elasticity of demand for supplementary insurance was 0.53. Also, the results showed the cost of health care, education level and health status is a significant correlation with demand for supplementary health insurance.

Conclusion: Increasing quality of services and expanding package of suggested services such as dental services can be results to increase of demand for health insurances even if the premium is risen.

Rate of pressure ulcers in intensive units and general wards of Iranian hospitals and methods for their detection

This study aimed to estimate the rate of pressure ulcers in intensive care units [ICUs] and medical and surgical wards of Iranian hospitals and compare the performance of methods of medical record review as well as direct observation for their detection. The research team visited 308 patients in medical and surgical wards of hospitals affiliated with Tehran University of Medical Sciences and a further 90 patients in their ICUs between March 2009 and April 2010. In addition 310 patient records were randomly selected from patients discharged from the ICUs between March 2009 and April 2010. And a further 600 patient records were randomly selected from the patients that were discharged from medical and surgical wards between March 2010 and April 2011. These 910 selected records were retrospectively reviewed to identify pressure ulcers. Data were collected by a structured checklist. In ICUs 24 of 90 patients [26.7%, 95% CI: 17.56 to 35.84] that were directly observed and 59 of 310 patients [19.0%, 95% CI: 14.63 to 23.37] that were studied by retrospective review of medical records had pressure ulcers. In medical and surgical wards, 5 of 308 patients [1.6%, 95% CI: 0.20 to 3.00] that were directly observed had pressure ulcers, but no pressure ulcer was detected by review of 600 medical records. Pressure ulcers are significantly more frequent in ICUs than in medical and surgical wards and a significant proportion of pressure ulcers are not reported

Is scores derived from the most internationally applied patient safety culture assessment tool correct?

Hospital Survey on Patient Safety Culture, known as HSOPS, is an internationally well known and widely used tool for measuring patient safety culture in hospitals. It includes 12 dimensions with positive and negative wording questions. The distribution of these questions in different dimensions is uneven and provides the risk of acquiescence bias. The aim of this study was to assess the questionnaire against this bias. Three hundred nurses were assigned into study and control groups randomly. Short form of HSOPS was distributed in the control group and totally reversed form of it was given to the study group. Percent positive scores and t-test were applied for data analysis. Statistical analyses were conducted using SPSS Version 16. Finally a total of 272 nurses completed the questionnaire. All dimensions with positive wording items in both groups had higher scores compared with their negative worded format. The first dimension "organizational learning and continued improvement" which had the only statistically significant difference, got 16.2% less score in the study group comparing the other group. In addition six out of 18 differences in questions were statistically significant. The popular and widely used HSOPS is subject to acquiescence bias. The bias might lead to exaggerate the status of some patient safety culture composites. Balancing the number of positive and negative worded items in each composite could mitigate the mentioned bias and provide a more valid estimation of different elements of patient safety culture

Malaria elimination in Iran, importance and challenges

The aim of study is to assess the importance and challenges of Malaria elimination [ME] in Iran's health system. Opinion of experts from Ministry of Health and Medical Education and the chancellors of medical universities affected by malaria were gathered using Focus Group Discussions and in-depth interviews. We asked them about the importance and main challenges of ME in Iran. Main factors on importance of ME were: it's a struggle to reach to equity in the poorest regions of county, prevention of emerging disease in susceptible regions, lowering the cost of control and its effects on the region's socioeconomic condition. Main challenges were Iran's long border with malaria-endemic countries Pakistan and Afghanistan and illegal immigrants, underdevelopment in rural areas, system's insensitivity and diagnosis problem due to reduction of cases. Quantitative and holistic researches are needed for assessing the consequences of ME

systematic review of the effects of diffuse optical imaging in breast diseases

Optical mammography is a new diagnostic method that uses Near infrared for detection of functional abnormalities and shows tissue activities by measuring absorption and scattering of Near-infrared light. This study aims to evaluate the safety and effectiveness of this technology. Cochrane Library [Issue 10, 2012] and Medline [Nov 2012] were searched using free text and Mesh. Studies that compared optical mammography with other diagnostic methods and used outcomes such as sensitivity, specificity and safety were included. Twelve studies were included in this review. A multicenter RCT showed that among 875 biopsied lesions, suspicion index led to 97% sensitivity, 14% specificity, 95% negative predictive value and 24% positive predictive value. In terms of oxygenation index, the included studies found that the process should be used with various wavelengths compared to single wavelength technique [690, 750, 788, 856 nm or 683, 912, 975 nm]. In terms of sensitivity and specificity, Diffuse Optical Tomography Computer Aided Detection is capable of distinguishing healthy tissues from malignant ones with 89% sensitivity and 94% specificity. Also, this technology could show increased blood flow around the tumor tissue compared to the healthy tissue effectively. Included studies did not report any information about the effects of technology on changing the treatment process or the final health outcomes. Optical mammography is a safe, noninvasive, non-ionized diagnostic technology that can be used as a diagnostic supplement alongside conventional mammography for differentiating benign and malignant tumors. Women with higher breast density should be screened at younger ages and with more persistence than those who have lower densities

Patient safety in Tehran university of medical sciences' general hospitals, Iran

It is important to focus on creating opportunities for patients' participation at all levels of health systems in order to promote their ability to improve patient safety and quality of services. The general aim of this study was to determine patient safety level in Tehran University of Medical Sciences' [TUMS] general hospitals, Tehran, Iran from patients' perspective and to determine the contributory factors on their perspective. This was a cross-sectional study. In the spring 2011, the list of clinical departments of the six general hospitals affiliated to TUMS was obtained through the Website of TUMS. By using stratified random sampling, the sample size was calculated 300 patients. Data were collected by using a structured questionnaire and its validity and reliability were acceptable. Descriptive statistics, linear regression and logistic regression were used for analyzing the data. Totally, 60% of patients were female. Patient safety was evaluated high by 60% of respondents. The unmarried or educated or employed individuals tend to score lower than others. TUMS's general hospitals are enough safe from patients' perspective, patient safety should be improved. In clinical governance, contributing patients' perspective to the improvement of patient safety reforms is critical in generating new models of good practice