The effect of geo-climatic determinants on the distribution of cutaneous leishmaniasis in a recently emerging focus in eastern Iran.

BACKGROUND: Cutaneous leishmaniasis (CL) has been reported in recent years in South Khorasan Province, a desert region of eastern Iran, where the main species is Leishmania tropica. Little is known of the influence of geography and climate on its distribution, and so this study was conducted to determine geo-climatic factors by using geographic information system. METHODS: The home addresses of patients with CL patients who were diagnosed and notified from 2009 to 2017 were retrieved from the provincial health center and registered on the village/town/city point layer. The effects of mean annual rainfall (MAR) and mean annual humidity (MAH), mean annual temperature (MAT), maximum annual temperature (MaxMAT), minimum annual temperature (MinMAT), mean annual number of high-velocity wind days (MAWD), mean annual frosty days (MAFD) and snowy days (MASD), elevation, soil type and land cover on CL distribution were examined. The geographical analysis was done using ArcMap software, and univariate and multivariate binary logistic regression were applied to determine the factors associated with CL. RESULTS: A total of 332 CL patients were identified: 197 (59.3%) male and 135 (40.7%) female. Their mean age was 29.3 ± 2.1 years, with age ranging from 10 months to 98 years. CL patients came from a total of 86 villages/towns/cities. By multivariate analysis, the independent factors associated with increased CL were urban setting (OR = 52.102), agricultural land cover (OR = 3.048), and MAWD (OR = 1.004). Elevation was a protective factor only in the univariate analysis (OR = 0.999). Soil type, MAH, MAT, MinMAT, MaxMAT, and MAFD did not influence CL distribution in eastern Iran. CONCLUSIONS: The major risk zones for CL in eastern Iran were urban and agricultural areas with a higher number of windy days at lower altitudes. Control strategies to reduce human vector contact should be focused in these settings.

A comparison of global surgery tariffs and the actual cost of bills at Hazrate Rasoole Akram educational and medical center.

BACKGROUND: the health service tariff is an appropriate policymaking tool and the financial leverage of the health system control which affects quality, availability, cost, efficiency, equity and accountability of health services. Global surgeries include 91 common cases of general and specialized surgeries in hospitals; fixed tariffs are annually defined for these surgeries, and insurance companies must pay medical centers based on these tariffs. The aim of this study was to examine and compare hospital bills with global surgery tariffs at Hazrate Rasoole Akram Educational and Medical Center in 2017. METHODS: This descriptive-analytic study was conducted retrospectively and compared the global and actual costs of global surgeries performed in the third quarter of the year 2017 at Hazrate Rasoole Akram Educational and Medical Center. Required data on the actual costs of surgeries was collected through the Hospital Information System (HIS) and patients' records. Information on the global costs was obtained from the Annual Circulars of Insurance Council for the studied period about the cost of global surgeries. Linear regression (STATA13 software) was used to investigate the effect of items on tariff and invoice differences; concerning other calculations, EXCEL software was used. RESULTS: The highest frequency of global surgeries was related to ophthalmic surgery which accounted for approximately half of total surgeries performed at Hazrate Rasoole Akram Hospital. The most significant difference between global tariff and invoice was also related to ophthalmic surgery (188709.3 Dollar a year).Overall, the actual hospital bills were much higher than the tariffs approved for global surgeries, and the total difference was 461805.5 Dollar. The results revealed that there was a significant relationship between some of the items such as the cost of operating rooms, anesthesia and other services. CONCLUSIONS: Referral hospitals which are at the level three of referral networks usually treat more complex patients; this should be taken into account when defining surgery tariffs of these centers. On the other hand, hospitals need to control the costs and reduce the end cost of these surgeries by improving clinical management and cost management. In addition, prospective and case-based payment methods can control health costs.