Shiraz Emedical Journal
Volume:17 Issue: 12, Dec 2016

All governments, regardless of available resources, should move to establish a balance between the conflict of resource scarcity of health system and health care services required. This study applied a multi criteria decision analysis (MCDA) approach to contribute to priority-setting and the coverage decision-making on including uninsured orthopedics interventions in the healthcare transformation plan’s subsidized in Iran during year 2015.
This study was conducted in four phases: a comprehensive review of studies related to the methods and criteria for prioritizing health services, identifying prioritization criteria, scoring and finalizing them, weighting of the criteria identified, and planning for a prioritized uninsured coverage for orthopedics intervention.
After screening the retrieved titles via PRISMA, from 350 papers, 12 studies were included. The main criteria used for the priority step in the health sector were as follows: safety, efficacy, need, existence of alternative procedures, life expectancy impact, cost, cost-effectiveness, catastrophic health expenditure, impact on the budget, acceptance of social/economic and equity in access. According to the viewpoint of the experts, the safety criteria had maximum weight (0.4) and equity in access had the least weight (0.03). Finally, ten uninsured orthopedics services were prioritized with a score of 9.01 to 5.01.
This practical and real-life project significantly contributed to rational, apparent, and unbiased priority-setting practice by using the MCDA methodology. Prioritizing and weighting the criteria in this study indicated that the Iranian policymakers should pay more attention to clinical aspects and benefits of the service than financial issues. This could indicate that there are social perspective and health as the public right in the country.

Deep Vein Thrombosis (DVT) is a major problem in hospitalized patients. There is discrepancy between healthcare providers’ knowledge and their clinical practice regarding DVT prophylaxis. In this study we aimed to evaluate knowledge, attitude and practices of internal medicine residents at an educational hospital in Tehran.
This cross-sectional study was conducted during December 2015 at Shariati hospital of Tehran, IRAN. A questionnaire covering five domains of clinical scenarios, adherence to guidelines, personal beliefs, practice, preferences and personal beliefs, was distributed between internal medicine residents. Medical records of patients at the internal ward were reviewed to assess the status of DVT prophylaxis in patients, who needed DVT prophylaxis based on American college of chest physicians’ (ACCP) guidelines.
Overall, 71 residents out of 88 residents returned the questionnaire, and 43.7% were aware of the guidelines. Furthermore, 97.2% thought DVT prophylaxis is clinically important but only 66.90% of the patients, who needed DVT prophylaxis, were receiving DVT prophylaxis. More than 50% of the residents underestimated the incidence of DVT and mortality rate due to pulmonary embolism. The most common reason for not prescribing DVT prophylaxis was concern about bleeding in 53.5% of the participants. Further analysis of different components of the questionnaire showed that there is a significant association between “awareness” and “adherence” scores (P = 0.041) and correct answers to “clinical scenarios” and “practice” (P = 0.012).
Although the level of knowledge on these clinical situations is good, underestimation of the risk of DVT development in hospitalized patients needs more attention. This might be due to low levels of awareness of presence and content of DVT prophylaxis guidelines. Programs should be designed to uphold the levels of information of DVT prophylaxis guidelines among internal medicine residents.

Environmental factors have a dominant impact on health especially aircraft noise is one of the environmental factors, which have a strong effect on emotional states.
The aim of the present study was to investigate the effect of aircraft noise on emotional states between airport neighboring and city residents in Zahedan City, Iran.
The sample size of this study consisted of 200 residents of Zahedan city (100 city residents and 100 residents from airport neighboring) that were selected through the convenience sampling method. To collect the data, depression, anxiety, and stress scale-21 (DASS-12) was used. Data were analyzed by one-way MANOVA using SPSS version 16.
Results showed that there were significant differences regarding anxiety, stress and overall scores of DASS between airport neighboring and city residents in Zahedan city. However, there was no significant difference between the two groups regarding depression.
Findings of this study show that aircraft noise has a negative effect on the level of emotional states and it increases the amount of anxiety, stress, and overall scores of DASS among the neighboring residents of International Airport of Zahedan city.

Addiction is an anomaly with different clinical, behavioral and cognitive symptoms, in the development of which, social and psychological factors, on one hand, and biological and pharmacological factors, on the other hand, are involved.
The present study aimed to examine perceived social support, positive affection, and spirituality, as resilience factors, between two groups of drug dependent and nondependent males, who had drug dependent fathers.
This descriptive study had a correlational design. The statistical population included all boys aged 16 to 24 years old, who had drug dependent fathers in Saravan, Iran. The sample constituted of 91 subjects selected through applying the snowball sampling method (31 drug-dependent males (the low resilience group) and 60 nondependent males (the high resilience group)). The measurement tools were the medical outcomes study (MOS) social support scale, the positive and negative affect schedule (PANAS), and the spirituality questionnaire (SQ). Analysis of Variance (ANOVA) was used for data analysis.
The results indicated that the mean score of perceived social support of the group with high resilience (M = 76.6) was higher than that of the group with low resilience (M = 45.6). Moreover, the mean score of positive affection of the nondependent group (M = 76.8) was higher than that of the drug dependent group (M = 43.8). Additionally, the mean score of spirituality of the nondependent group (M = 98.8) was higher than that of the drug dependent group (M = 77.8). These differences were all statistically significant (P ≤ 0.01).
Accordingly, enhancing teenagers’ positive affection, perceived social support, and spirituality by their families or through instructions, could help solve their problems and can increase their resilience.

Maternal mortality is still one of the most important health challenges and considered as a global indicator. One of the effective strategies to reduce this indicator is prenatal education regarding the danger signs during pregnancy and postpartum through the use of appropriate methods of education.
The aim of this study was to compare the effect of education using multimedia software and face to face education on pregnant women’s level of awareness about the danger signs of pregnancy and postpartum period.
The present study was a quasi-experimental research in which, 120 primigravida mothers who referred to the health centers in the city of Karaj were randomly divided into 2 groups. The first group received face to face education on the danger signs of pregnancy and postpartum period while the second group received their education through a compact disc (CD). Data were collected using a two-part questionnaire including; 15 demographic variables and 27 items about the danger signs of pregnancy and postpartum period. After ten weeks of intervention, the posttest was taken and finally the collected data were analyzed using SPSS software version 21.
Ten weeks after intervention, the mean awareness score of the two groups showed no significant difference, however, comparison of awareness score in each group before and after the intervention showed a statistically significant difference (P Both methods of education resulted in the same effectiveness in raising the awareness of pregnant women about the danger signs during pregnancy and postpartum period. However, by considering the time required for health care providers to conduct face to face education, it seems that multimedia software would be a good alternative.