مجله تحقیقات نظام سلامت حکیم
سال سیزدهم شماره 2 (پیاپی 49، تابستان 1389)

The aim of this study was to understand the viewpoint of professionals about developing home health care system (home care services and home nursing) in Iran. In this qualitative study, semi structured interviews and focus group discussions were conducted and thematic analysis was performed. After each session, the correctness of all notes was checked with the participants. For expert validation, interview contents were separately checked with two academic members and then were combined. Five themes regarding home health care advantages were identified which were: economic advantages, social advantages, advantages for the patient, family, and health care system. Findings indicate that home care insures solidarity in family and society it will also promote the quality of life and community health, and reduce health care costs. Home care increases satisfaction of patient and family and improves quality of services, since it is being provided in familiar and friendly context. It also reduces medical errors and adverse affects caused by clinical and hospital procedures. Based on participants’ perception, home care has socioeconomic advantages and uses the capacity of the families, communities, and non governmental organizations in service provision thus, plays an important role in providing health care services. Implementing home care will help to develop better community participation, which is a principle of primary health care that has not yet been reached in Iran. Obviously, evidence-based studies such as assessment of cost effectiveness are needed to identify the exact benefits of home health care systems in Iran.

This study aims to explore the applicability of a needs-based resource allocation method in Iran and to compare healthcare resources currently allocated to Iranian provinces using this method. MEDLINE and Google Scholar were searched and experts were contacted to identify methods of resource allocation based on needs in addition, experts were interviewed to explore which methods are more appropriate in Iran according to the level and accuracy of data available. A combination of indicators was used to estimate the relative amount of resources each province should receive and compare it with the exact amount each province received. The main indicators were population, mortality rate, socio-economic indicators, costs of prevalent diseases, extra costs for rural areas, previous budget, costs of family physician services, hospital services and drugs. In Iran reliable data about population, mortality and the level of deprivation is available for each province. Comparing the two methods, 12 provinces have received a relatively high budget, 14 a relatively low budget and in 4 provinces the budget was relatively balanced. Using a good combination of indicators has the potential to improve allocation of Iran’s healthcare resources based on needs. There are currently significant differences between the amount of budget allocated to each Iranian province and the amount should have been allocated according to the needs-based method used in this study. This method has the potential to be further developed for allocating resources, although any change should be implemented gradually and over time.

Acute myocardial infarction (AMI) is one of the most common causes of hospitalization and mortality in industrialized countries. Work disability is common in these patients. This study was aimed to learn the main demographic, professional and clinical variables which may In this study we surveyed 384 patients referred to Hazrat Rasoul Hospital from 2005 to 2008. The patients were interviewed through phone calls to collect data of return to work. Demographic, clinical and occupational variables were collected from the medical records. 79% of patients (303 patients) returned to work. The mean time the patients returned to work was 2.23 months (SD=2.2). Based on logistic regression analysis, predictor factors of returning to work were: age, duration of hospitalization, ejection fraction, history of diabetes mellitus, and occurrence of angina after AMI in hospital and CABG surgery (P-value<0. 05). Successful return to work after first myocardial infarction is related to clinical, demographic, psychological and occupational factors. Also, based on the study results, precise evaluation of occupational factors such as job title, metabolic rate required for work and fitness for work may affect successful return to work.

According to the attachment theory, maternal behavior and maternal reactions toward her child is affected by her attachment style. The purpose of this study was to evaluate the relationship between maternal attachment and social maturity of their mentally retarded sons. All male mentally retarded students of secondary schools of Shiraz during academic year of 2008-2009 (127 students) were included. The adult attachment style questionnaire (AAS) (1987) was used to assess maternal attachment and Vineland's social test (1965) was used to assess the social maturity of mentally retarded male students. The Spearman correlation and sheffe's method were used for data analyses. Secure attachment style of mothers had a positive significant correlation with social maturity of mentally-retarded boys of secondary school (p<0.001) while insecure avoidant and insecure ambivalent attachment style of mothers had negative significant correlation with it (p=0.019 and p<0.001, respectively). Mother's with more secure attachment style have children with higher social maturity and mothers with more insecure attachment style (avoidant and ambivalent), have children with less social maturity.

Child health and child mortality rate are important health indicators in different communities. Different studies have shown variations in these indicators in Iran’s provinces. The purpose of this study was to evaluate children's health status and its relationship with social and economic indicators in Iran. Data of health indicators were collected from the Center for health promotion and development of Ministry of Health and Medical Education. Based on factor analysis method, the health rank of each province was determined. Based on the standardized score of the first factor of factor analysis, the relation between children’s health status and socioeconomic status of provinces was assesses using multiple regression. Assessment of 46 health and mortality indicators as the first factor showed that provinces of Tehran, Gilan, Semnan and Esfahan have more favorable health status, while provinces of Sistan Baluchestan, Hormozgan, Khuzestan and Lorestan have more unfavorable condition. In addition, assessment of health status based on 13 indicators of socioeconomic condition showed that the number of population under 5 years and the number of orphans have negative impact on health status. Furthermore, the provinces with more immigrants had better health status. Provinces with better socioeconomic status have more favorable child health status. Therefore, socioeconomic development was found as an important factor affecting health status of provinces.

Many studies have shown that smoking decreases the quality of physical activities and results in the early fatigue among athletes. Generally, athletes are so popular in society and they can be considered as role models for the young generation. In this study, smoking status in champion sportsmen and their knowledge and attitude toward this issue were studied. This was a cross-sectional study which was run among the sportsmen of 10 different national teams. Data was collected through face to face questioning from the members of popular national teams during their camping time. The questionnaires were designed based on the standard WHO questionnaire. Finally, the data was analyzed by software SPSS 16. In this study 220 sportsmen were studied. Their mean age was 28.8 ± 10 years. 88 sportsmen (40.7%) reported the experience of cigarette or hookah smoking. 30 sportsmen (13.6%) were smokers. 7 sportsmen (6.4%) were ex-smokers. The mean score of their knowledge about harmful effects of smoking was 21.02 ± 22.6 and the mean score of their attitude was 66.3 ± 13.9. The prevalence of s moking among sportsmen is lower than the society however, it is still worrisome. In this population knowledge about harmful effect of smoking is low, but their attitude is acceptable meanwhile, there is no significant relation between their knowledge and attitude. It is suggested to do further studies on this issue.

Market failure in providing individual and social stock of health, or capital, cause exigency of government interference in these sectors. Therefore, providing a part of society’s needs in the field of health is one of the basic acts of government. It has been further argued that unless government intervenes, the provision of equity cannot be achieved. The main purpose of the present study is to conduct a survey on effectiveness of governmental financial support of health sector in some Islamic Organization Countries (OIC). Thus, we applied classical econometrics methods (including cross section and panel data) using data period of 1991-2005. Results show that government health expenditure has a positive and significant effect on various social indicators. In addition, it was shown that per capita income is one of the important determinants of health indicators (such as infant mortality and under-five mortality rate). Adult’s literacy rate is one of the significant variables affecting health status In other words the health and education sectors correlate to each other. Studying the role of government in providing finance to the health sector and observation of its outcomes shows that we cannot condemn the priority of public sector in developing countries’ health sector. Moreover achieving millennium development goals needs governmental financial support, specially in the field of health care.

Length of stay (LOS) is an indicator of resource utilization in hospitals. In this survey, we have studied the patient's LOS and its influential clinical and nonclinical factors in gynecology and obstetrics hospital affiliated with Tehran University of Medical Sciences.

This survey is a cross sectional descriptive-analytical study. We reviewed 3421 inpatient charts in oncology, surgery and obstetrics units in 2008. The required data were collected using a data collection sheet and inpatients interviews. Data were analyzed using Kolmogrov-Smirnov, Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests.

The median of LOS in the studied hospital was 50.8 hours and 48.5, 54.4 and 94.2 hours in obstetrics, surgical and oncology units, respectively. The factors which increased LOS were being single, having worker or farmer & stockbreeder or retired husbands, rural insurance coverage, admission in oncology unit, admissions on Wednesdays and Thursdays, being admitted by internists and by residents, relative recovery or need to follow up at discharge time, elective admission, the number of performed diagnostic experiments, and diseases such as gastrointestinal, neoplastic or endocrine diseases (all p values<0.005).

Among influential factors, policymakers and managers can only change the admission days and the number of diagnostic experiments in order to decrease LOS. Thus, they should prevent admissions in last days of week, except emergent admissions, and primary diagnostic experiments should be performed before admitting into the hospital to be able to use hospital beds and other resources properly.