Food insecurity increases the odds of obesity among Iranian women: A population-based study of northwestern Iran.

AIM: The main objective of the present study was to evaluate the association between obesity and food security status. The sample comprised of Iranian adults with an age range of 15-64 years. METHODS: In this cross-sectional study (n = 1277), the short form of the Household Food Security Scale was used to determine food security status. Height, weight and waist and hip circumferences were measured, and body mass index, waist-to-hip ratio, waist-to-height ratio and conicity index (CI) were also calculated. One-way analysis of variance and logistic regression were used for statistical analyses. RESULTS: There were no statistically significant differences in the mean anthropometric measurements of males and females with different food security status (P > 0.05). After adjusting for covariates, there was no statistically significant association between food security status and anthropometric measurements in men. However, the low food-secure females were 72% more likely to be overweight in comparison with very low food-secure women (P = 0.04). Moreover, food-secure females were 32% less likely to have CI >1.25 compared with very low food-secure females (P = 0.04). CONCLUSIONS: The results showed that there is an association between food insecurity and overweight, which is consistent with the finding of prior researches. In addition, for the first time, we showed the significant association between low food security and CI.

Service quality of delivered care from the perception of women with caesarean section and normal delivery.

BACKGROUND: Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. METHODS: A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 - (Importance × Performance) based on importance and performance of service quality aspects from the postpartum women's perspective.A hierarchical regression analysis was applied in two steps using the enter method to examine the associations between demographics and SQ scores. Data were analysed using the SPSS-17 software. RESULTS: "Confidentiality", "autonomy", "choice of care provider" and "communication" achieved scores at the highest level of quality; and "support group", "prompt attention", "prevention and early detection", "continuity of care", "dignity", "safety", "accessibility and "basic amenities" got service quality score less than eight. Statistically significant relationship was found between service quality score and continuity of care (P=0.008). CONCLUSION: A notable gap between the participants? expectations and what they have actually received in most aspects of provided care. So, there is an opportunityto improve the quality of delivered care.

Advantages and Disadvantages of Health Care Accreditation Mod-els.

BACKGROUND: This systematic review seeks to define the general advantages and disadvan-tages of accreditation programs to assist in choosing the most appropriate approach. METHOD: Systematic search of SID, Ovid Medline & PubMed databases was conducted by the keywords of accreditation, hospital, medical practice, clinic, accreditation models, health care and Persian meanings. From 2379 initial articles, 83 articles met the full inclusion criteria. From initial analysis, 23 attributes were identified which appeared to define advantages and disadvantages of different accreditation approaches and the available systems were compared on these. RESULTS: Six systems were identified in the international literature including the JCAHO from USA, the Canadian program of CCHSA, and the accreditation programs of UK, Australia, New Zealand and France. The main distinguishing attributes among them were: quality improve-ment, patient and staff safety, improving health services integration, public's confi-dence, effectiveness and efficiency of health services, innovation, influence global standards, information management, breadth of activity, history, effective relationship with stakeholders, agreement with AGIL attributes and independence from government. CONCLUSION: Based on 23 attributes of comprehensive accreditation systems we have defined from a systematic review, the JCAHO accreditation program of USA and then CCHSA of Can-ada offered the most comprehensive systems with the least disadvantages. Other programs such as the ACHS of Australia, ANAES of France, QHNZ of New Zealand and UK accredita-tion programs were fairly comparable according to these criteria. However the decision for any country or health system should be based on an assessment weighing up their specific objec-tives and needs.

Customer quality and type 2 diabetes from the patients' perspective: a cross-sectional study.

BACKGROUND: Quality in health care can be seen as having three principal dimensions: service, technical and customer quality. This study aimed to measure Customer Quality in relation to self-management of Type 2 diabetes. METHODS: A cross-sectional survey of 577 Type 2 diabetes people was carried out in Australia. The 13-item Patient Activation Measure was used to evaluate Customer Quality based on self-reported knowledge, skills and confidence in four stages of self-management. All statistical analyses were conducted using SPSS 13.0. RESULTS: All participants achieved scores at the level of stage 1, but ten percent did not achieve score levels consistent with stage 2 and a further 16% did not reach the actual action stage. Seventy-four percent reported capacity for taking action for self-management and 38% reported the highest Customer Quality score and ability to change the action by changing health and environment. Participants with a higher education attainment, better diabetes control status and those who maintain continuity of care reported a higher Customer Quality score, reflecting higher capacity for self-management. CONCLUSION: Specific capacity building programs for health care providers and people with Type 2 diabetes are needed to increase their knowledge and skills; and improve their confidence to self-management, to achieve improved quality of delivered care and better health outcomes.

Quality of delivered care for people with type 2 diabetes: a new patient-centred model.

BACKGROUND: The quality of care from the perspective of people with Type 2 diabetes using a new model (CQMH) including three dimensions of quality in health care (Technical, Service and Customer Quality) was assessed. METHODS: A cross-sectional survey with a sample of 577 people with Type 2 diabetes was conducted. Measures were self-reported adherence to national guidelines for technical quality, the Netherlands Institute for Health Services Research questionnaire for service quality and the short form of the Patient Activation Measure for Customer Quality. RESULTS: There was a significant gap in technical quality between what diabetes care the patients reported receiving and what was recommended in the guideline, particularly for management and lifestyle aspects. For service quality, the lowest scores were for choice of care provider and accessibility of care. The mean Customer Quality score was 64.5 (meaning higher score indicating better quality). A positive relationship was demonstrated between higher technical, service and customer quality scores, and better diabetes control status as well as maintaining continuity of care. The average Quality Index was 70.0 of a 0-100 scale. CONCLUSIONS: Customer Quality appears to be a useful third dimension in conceptualising quality in health care, particularly in the context of chronic disease, where good self-management can improve the outcomes of care. A high proportion of Queensland adults with Type 2 diabetes reported receiving suboptimal care in the majority aspects of provided care services as reflected in the overall Quality Index score indicating substantial room for quality improvement.

Review of patient-reported type 2 diabetes service quality.

A critical review was conducted of the literature from 1960 to June 2005 on service quality in type 2 diabetes. The review demonstrated that improving service quality may improve the outcomes for people with type 2 diabetes. The potential service quality factors from the perspective of people with type 2 diabetes were: timeliness, confidentiality, continuity, dignity, communication, access, education, cost, amenities and autonomy.

Clients' perspective on service quality for type 2 diabetes in Australia.

OBJECTIVES: To explore the needs, expectations, feelings and experiences of people with type 2 diabetes for developing quantitative instruments for a questionnaire study of service quality. METHODS: Using two focus group discussions (n=33), potential service quality dimensions for type 2 diabetes were assessed for Australian relevance. These included 11 indicators identified from a systematic literature review: communication, autonomy, choice of care provider, continuity of care, quality of basic amenities, dignity, timeliness, prevention and early detection, safety, confidentiality and availability. RESULTS: The focus group discussions supported the importance of the 11 service quality indicators but gave more importance to education, diet, communication, autonomy, choice of care provider and support group and less to confidentiality and availability. Three new themes were generated from the discussions: education, diet and support group. CONCLUSION: Measuring service quality for type 2 diabetes requires considering health system, culture and disease-specific factors.