فهرست مطالب

  • Volume:20 Issue:10, 2019
  • تاریخ انتشار: 1398/06/02
  • تعداد عناوین: 8
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  • Marita Mohammadshahi, Minoo Alipouri Sakha, Leila Zarei, Maryam Karimi, Farzad Peiravian * Page 1
    Context

    Increasing demand for medicines can influence the health system performance and impose a financial burden on individuals and society. Therefore, the current study aimed to investigate factors affecting the induced demand for medicines and provide strategies to address the issue. Evidence Acquisition: A scoping review was conducted using three databases including PubMed, Cochrane Library, and Embase from January 1990 until March 2017. By defining inclusion and exclusion criteria, 33 papers that considered the factors affecting the induced demand for medicines and the strategies to reduce the demand were included in the study. The papers were used to extract common themes.

    Results

    The final factors were categorized into eight groups, including monitoring mechanisms, demand-side factors, supply-side factors, structural factors, legal-political factors, insurance coverage and subsidies, commercial interactions and advertisements, and educational factors. In addition, strategies to address them were extracted.

    Conclusions

    Since in developing countries the most important factors are the lack of a comprehensive monitoring system and supply-side factors, it seems that monitoring mechanisms such as performance audit and guideline development can reduce the induced demand for medicines.

    Keywords: Induced Demand, Medicines, Irrational Use of Medicines
  • Sanaz Zargar Balaye Jame , Nader Markazi Moghaddam, Zahra Ebrahim, Zahra Kavosi , MiladAhmadi Marzaleh, Ali Reza Yusefi* Page 2
    Background

    One of the goals of the Health Sector Evolution Plan (HSEP) in Iran was to increase the fairness of the household’s financial contribution in health systems with the aim of reducing out of pocket (OOP) payment.

    Objectives

    The study was aimed to measure patients’ OOP payment for coronary artery bypass grafting (CABG) surgery before and after the implementation of HSEP in the south of Iran.

    Methods

    This cross-sectional study was conducted as descriptive-analytic in Shiraz as the center of medical tourism in the south of Iran in 2017. The study population consisted of patients admitted to Namazi Hospital from which 316 patients were selected before and after implementation of HSPE according to census. Data was collected through a checklist and analyzed using descriptive statistics, t-test and One-way ANOVA in SPSS 23.

    Results

    The study results showed that the average of total cost has increased significantly from 1198.59$ to 3260.36$ after the plan (P < 0.001). The percentage of patients’ contribution to the total cost decreased significantly from 17.78% to 7.46% after the plan. The ratio of patients’ OOP payment has been reduced significantly after adding the plan’s share in the patients’ bill. The percentage of OOP payment to total cost has decreased for different insurance organizations from 5% in social security insurance to 13% in rural insurance.

    Conclusions

    The ratio of patients’ OOP payment has been reduced for CABG surgery after implementation of HSEP, which can be an indication of the effectiveness of the out-of-pocket reduction instructions. However, the average of patients’ OOP payment has increased.

    Keywords: Out of Pocket, Health Sector Evolution Plan, Coronary Artery Bypass Graft, Shiraz
  • Sodabeh Alinejhad, Yousef Veisani, Sehat Aibod, Akbar Azizifar, Mostafa Alirahmi, Fathola Mohamadian* Page 3
    Background

    Divorce is an obscure phenomenon in marital life which has led many researchers to investigate its related factors.

    Objectives

    The purpose of this study was to investigate demographic, social, and personality factors in women with early divorce versus those with late divorce.

    Methods

    The method of the present study is cross sectional, the statistical population of the study consisted of 389 divorced women who referred to the family court in the city of Ilam in 2016 and 2017. Among these, 196 were selected by simple random sampling method as the sample of the study; data were collected using demographic information questionnaire and NEO five-factor inventory (NEO-FFI). Finally, the data were analyzed using descriptive statistics and logistic regression analysis using SPSS software.

    Results

    Based on the results of this study, women’s outside home employment (P < 0.005) and religious beliefs at the beginning of marriage reduced early life divorce (P = 0.038). The results also showed that considering the personality factors there was not a significant difference between the two groups (P = 0.234).

    Conclusions

    Results showed that early marriage, lack of children, and living with the husband’s father family are predictors of early- life divorce, also residence dissatisfaction, neuroticism, conscientiousness traits, and the desire for new experiences can be other predictors for early life divorce in women.

    Keywords: SocialFactors, PersonalityFactors, Divorce, Women
  • Fatemeh RahimiKian, Maryam Alikamali*, Mandana Mirmohammad Aliei, Abbas Mehran Page 4
    Background

    Domestic violence is the most common form of violence against women with the most social, psychological, and economic consequences. Partner violence threatens the life of the family and society.

    Objectives

    The current study aimed to assess domestic violence against pregnant and non-pregnant women in urban and rural populations.

    Methods

    This cross-sectional study was conducted on 800 pregnant and non-pregnant women referring to urban and rural health centers in Kerman, Iran, in 2015 - 2016. The data were collected using a standardized violence questionnaire and analyzed using the One-way ANOVA for normal variables and non-parametric test (Kruskal-Wallis) was used for non-normal variables.

    Results

    There were positive significant correlations between the spouse’s education level and physical violence (P = 0.003), sexual violence (P = 0.005), and injury caused by violence (P = 0.041). The residence place had no significant effect (P = 0.69) on the occurrence of physical violence. Rural women experienced significantly more psychological violence, sexual violence, and violence-induced injury than urban women (P = 0). Generally, the overall violence was significantly higher in rural women than in urban women (P < 0.05). The most physical violence, psychological violence, sexual violence, and injury caused by violence were observed in rural non-pregnant women (P < 0.01).

    Conclusions

    Rural women, especially non-pregnant ones, experienced greater violence than urban women. It suggests that pregnancy is a protective period that reduces the prevalence of violence. The spouse’ education level was a risk factor for committed violence. Therefore, a comprehensive program for the prevention of violence against women and screening of violence in all health centers in the south of Iran are proposed.

    Keywords: DomesticViolence, PregnantWomen, Non-PregnantWomen, UrbanAreas, RuralAreas
  • MohsenMomeni, MinaDanaei*, ArezooSaeidifar Page 5
    Background

    Increasing the level of physical activity (PA) is an important strategy for reducing the burden of non-communicable diseases.

    Objectives

    This study aimed at addressing the level and related factors of PA among adults in Kerman.

    Methods

    This cross-sectional study was performed among 1000 adults, using a multistage sampling method. The short form of the International Physical Activity Questionnaire (IPAQ) was used. Chi-square, one-way ANOVA, and ordinal regression tests were used to assess the correlation between independent variables (age, gender, level of education, income, employment, marital status, and living in deprived areas) and level of PA.

    Results

    The median of PA was 1584 MET-minutes/week. The level of PA was low in 25.6%, moderate in 44.4%, and vigorous in 30% of participants. Participants with higher ages (OR = 0.98; P = 0.008), those with pre-college education (OR = 0.63; P = 0.027), and students (OR = 0.50; P = 0.019) had a lower probability to be in a high level of PA. Men (OR = 2.17; P < 0.001) and those with an average income (OR = 1.53; P = 0.027) had a higher probability to be in a high level of PA.

    Conclusions

    The level of PA is relatively low in Kerman. It seems that increasing awareness of the benefits of PA, creating a positive attitude towards PA, providing healthy transportation options, increasing PA facilities including sports spaces and enhancing social support are the most important strategies for increasing the level of PA in the Iranian society.

    Keywords: PhysicalActivity, Prevalence, RiskFactors
  • Mojtaba Heydari, Majid Nimrouzi, Zahra Hajmohammadi, Pouya Faridi, Gholam hossein Ranjbar Omrani, Mesbah Shams* Page 6
    Background

    The study was designed to examine the efficacy and safety of Rhus coriaria L. (Sumac) supplementation in patients who are overweight or obese.

    Methods

    The study was designed as a parallel two-arm, double-blind, randomized placebo-controlled clinical trial conducted in an endocrinology clinical affiliated by Shiraz University of Medical Sciences at 2016. Fifty patients with body mass index (BMI) ≥ 25 kg/m2 were randomly assigned to receive Sumac supplementation (500 mg twice daily) or placebo for six weeks. The patients were evaluated before and after the intervention in terms of their BMI, waist-hip ratio (WHR), leptin, fasting blood glucose, and insulin resistance index (HOMA-IR). Beside clinical adverse event monitoring, liver and kidney function tests were measured before and after the intervention.

    Results

    Statistically significant decrease in weight, waist circumference, and BMI were observed in the Sumac group, which was more prominent as compared to the placebo after six weeks of intervention (1.34 vs. 0.64 P = 0.003; 1.10 vs. 0.54 P = 0.027, and 0.49 vs. 0.24 P = 0.002, respectively). Insulin resistance was also decreased (0.45 vs. -0.14 P = 0.020). No significant change in leptin and fasting blood glucose was observed. No clinical or laboratory adverse event was observed.

    Conclusions

    Sumac supplementation showed to have a potential weight-reduction effect, along with a positive effect on insulin resistance in patients who were overweight or obese.

    Keywords: Obesity, Overweight, Sumac, Rhus, ComplementaryMedicine, TraditionalPersianMedicine
  • Maryam Shaygan *, Sasan Rahmanian, Farhad Emadi, Mahnaz Rakhshan Page 7
    Background

    Headache is one of the most common types of pain which is considered among the most disabling of diseases. However, the severity of disability in some headache patients is more than others.

    Objectives

    The aim of the present study was to compare different types of headache regarding pain-related variables and psychological factors. We also examined the predicting factors of disability in patients with headache.

    Methods

    This cross-sectional study was performed in 320 patients with various types of headache based on the International Headache Society criteria, which was assessed by neurologists. Data was collected using migraine disability assessment for disability, frequency of headache and for pain intensity, patient health questionnaire for depression, and pain anxiety symptoms scale for pain-related anxiety. ANOVAs and post hoc Tukey’s tests were used for comparing various types of headaches regarding pain-related and psychological factors. Regression analyses assessed the relation of pain-related and psychological variables with disability.

    Results

    Patients with different types of headache revealed no significant differences regarding pain intensity (P = 0.27). Migraine patients showed the most pain frequency and chronicity compared to the other patients (P = 0.000). The levels of disability (P = 0.000), anxiety (P = 0.000) and depressive symptoms (P = 0.000) were also higher in patients with migraine compared to patients suffering from cluster or tension type headache. Pain chronicity (P = 0.01), anxiety (P = 0.007) and depression (P = 0.002) made significant contributions to the explanation of variance in ‘disability’.

    Conclusions

    The findings add further evidence to the relevance of cognitive-behavioral models of pain suggesting an important role for pain-related emotions regarding the consequences of pain (e.g. disability). The current data could help clinicians to decide which factors should be considered for a successful treatment of disability in headache patients.

    Keywords: Headache, Disability, Chronicity, Depression, Anxiety
  • VahidGharibi, AbdullahBarkhordari, MehdiJahangiri *, MeysamEyvazlou, Fateme Dehghani Page 8
    Background

    It is generally accepted that laboratory staff are often exposed to chemical risks in various ways.

    Objectives

    The aim of this study is to evaluate the occupational exposure risk assessment from chemical substances utilized in the laboratories of health centers at Shahroud University of Medical Sciences in 2016 - 2017.

    Methods

    The method used in this study was based on the methodology presented by the Department of Occupational Safety and Health-Ministry of Human Resources (DOSH). Also, descriptive statistics, as well as the chi-square statistical tests were used to examine the relationship between occupational incidents and independent variables.

    Results

    Approximately 19.81% of the studied laboratories had a significant exposure risk such that 6.6% of laboratories had a very high-risk level and 13.21% had a high-risk level. The most dangerous substance was Formalin 10% solution (Formaldehyde solution). The lowest risks were accredited to the endocrinology and serology laboratory.

    Conclusions

    It is recommended that hazardous chemicals (risk rating = 4 or 5) specifications be determined on a specific form. This form can include the chemical name, the chemical composition, the name of the test, which may use the specified chemical substance, the TLV values, and instructions for using the chemicals and the places where the chemicals are stored and maintained. Finally, the necessary training is provided on employee risk management. Also, it is recommended to work under ventilation hood and use of appropriate PPE.

    Keywords: Semi-Quantitative Risk Assessment, Harmful Chemicals, Occupational Healt