Journal of Health Scope
Volume:12 Issue: 2, May 2023

Context: 

Arsenic has metallic and non-metallic properties. It is widely found in sulfide ores and belongs to the nitrogen family. Arsenic is used as an insecticide due to its high toxicity. Arsenic has caused many environmental concerns, including the widespread availability of arsenic in the environment, biological toxicity, and exploitation. Potential routes of arsenic exposure in humans include drinking water, industrial manufacturing, diet, cosmetics, smoking, and air. A recent debate has focused on the link between arsenic exposure and diabetes. Diabetes is a common disease in the world that affects many people. This disease is caused by a long-term increase in blood sugar levels in the body.

Evidence Acquisition:

The purpose of this review study was to epidemiologically review the side effects of arsenic on diabetes.

 A total of 466 articles were retrieved from PubMed, Web of Science, Springer, Cochran, and ScienceDirect databases. Eighty-one full-text articles were entered into the analysis process. Finally, 16 articles were selected for this study.

 Arsenic is available in a variety of sources, including natural resources, groundwater, industrial activities, food, and tobacco. Arsenic can affect the function of pancreatic β cells and cause diabetes.

 Toxic air pollutants, especially arsenic, are attributed to human activities, industrial processes, fuel uses, transportation, power plants, and energy consumption. The emission of these pollutants can increase the prevalence of diabetes. Also, exposure to arsenic in the air can be very harmful and cause cancer and non-cancerous disorders in the long term and even in the short term.

Non-communicable diseases (NCDs) require multifaceted responses from healthcare systems that must complement sustainable healthcare programs.

This study aims to investigate the current state of sustainability of Non-Communicable Disease Prevention and Control Programs (NCP-PCP) and to identify related challenges in various intra- and inter-organizational domains.

This mixed-methods study used a researcher-made sustainability assessment tool and qualitative interviews of 46 managers responsible for implementing NCP-PCP in Iran. Graneheim and Lundman's approach, as well as descriptive statistics, were utilized to analyze the data. The sustainability questionnaire comprised nine domains: environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, communications, strategic planning, and law and governance.

The overall mean score for sustainability was 3.54 ± 0.86, with funding stability (2.79 ± 1.03) and program adaptation (4.24 ± 1.12) receiving the lowest and highest mean scores, respectively. Qualitative data revealed several challenges, including financial instability, lack of budget allocation for such programs, absence of specific mechanisms for program evaluation, inadequate resources, deficiencies in intersectoral cooperation, and failure to utilize hidden community capacities.

It is crucial to maintain and strengthen the current state of program adaptation and program evaluation to ensure the sustainability of NCD-PCP. On the other hand, funding instability is a significant obstacle in prevention and control programs that can bring the entire program to a halt, regardless of its sustainability in other domains.

Context: 

School health refers to a set of measures implemented to diagnose, provide, and improve the physical, mental, social, and spiritual health of students and those staff who are in some way in contact with students. In this regard, various school health policies and programs are developed, each presenting a different aspect of school health. Therefore, the present study aims to review the scope of existing school health policies worldwide.

Evidence Acquisition: 

This scoping review study was conducted in 2022 following the PRISMA-ScR reporting guideline. In this regard, PubMed, Scopus, Web of Science, ProQuest, and Google Scholar databases were searched from 2000 to 2022 for English documents using the keywords of policy, program, and school health. Finally, the related data were extracted by two reviewers independently and analyzed using thematic content analysis.

 Based on the initial search, 16,439 records were retrieved, and 24 articles were eligible to be included in the study. Most of these studies were conducted in 2014, 2018, and 2020; three were conducted in 2021. Eleven studies employed the literature review method, nine were conducted in the United States, and 18 focused on presenting a comprehensive school health policy in all aspects. The most important aspects of school health policy include school nutrition policies, school environmental health, school, home, and community cooperation, comprehensive health education, provision of health services in school, physical activity, counseling, social and psychological services, and promoting the health of the working environment of school employees. Most of these articles had good quality.

 This review shows that the number of school health policies is low globally, and each country must prepare a comprehensive school health policy regarding their economic, social, cultural, environmental, and political conditions.

Context: 

The issue of insurance deductions is one of the major problems that lead to the shortage of financial resources in hospitals. The present study was conducted to review the root causes of insurance deductions and propose solutions to reduce them in Iranian hospitals.

 This was a scoping review of the literature on health insurance deductions in hospitals in Iran within 2000 - 2023 to synthesize the findings of original Persian and English studies that focused on the causes of deductions and propose strategies to reduce them in Iranian hospitals. The relevant concepts and terminology in health insurance deductions were found through medical subject headings (MeSH). The articles were screened based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist. Analysis of research data (text of the articles) was carried out by the content analysis technique in MAXQDA software (version 10).

 A total of 1121 publications were identified, of which 41 publications met the inclusion criteria and were reviewed. Based on the present analysis, most studies (61%) were published within 2016 - 2020, 12.2% of the included studies were qualitative, and 48.8% were performed in hospitals. Finally, 46 causes of deductions and 35 solutions to reduce insurance deductions were extracted. The leading causes of deductions were associated with service delivery, service registration, sending documents, and conversion of services into revenue. The most important causes of deductions in dimensions of providing and registering services were a lack of familiarity of service providers with insurance rules and regulations, coding and relative value book, extravagance and motivation of providers to earn more revenue, and lack of strong infrastructure to register services. Furthermore, strategies for reducing health insurance deductions were categorized into three groups, namely meta (ministries of health), macro (universities), and mezzo (hospitals). The top strategies to reduce health insurance deductibles were associated with several dimensions, such as providers, process modification, policy reform, and infrastructure modification. The most important strategies to reduce deductions in these four dimensions were teaching the documentation principles to all medical staff, familiarizing physicians with insurance laws and correct coding, continuous interaction between insurance companies and hospitals, and revisions in the repayment system.

 The causes of deductions could be determined through several dimensions. To manage and reduce the number of deductions, these causes should be carefully examined in the dimensions of service delivery, service registration, and document regulation and audit, and each hospital should use relevant strategies according to the weak points. However, solving the issue of deductions is not only related to hospitals; it is necessary for policymakers and health managers in the ministries of health, universities of medical sciences, and health insurance organizations to adopt necessary policies, especially in the field of hospital information management, to reduce deductions. According to the presented topics, the efficiency of hospitals and, ultimately, the quality of medical care can improve through a correct and more accurate understanding of the causes of deficits. It also prevents the waste of financial resources in hospitals, which is the main support in providing services and survival.

 Infertility disrupts the life of infertile couples and causes violence against women. Women who experience violence must deal with the painful memories of that stressful event. Those who go through events beyond normal experience may develop post-traumatic stress disorder (PTSD).

 The present study aimed to determine the relationship between perceived violence and PTSD in infertile women.

 This case-control study was conducted on 148 infertile women with PTSD and 148 infertile women without PTSD who had attended Milad Infertility Treatment Center in Mashhad, Iran. A score above 50 from the PTSD checklist-civilian version (PCL-C) was considered for the diagnosis of PTSD, and the mean score of violence was compared between the groups of subjects with and without PTSD.

 The results showed a significant relationship between PTSD and violence against infertile women (P < 0.001). The mean violence score was 59.22 ± 7.31 in subjects with PTSD and 41.10 ± 13.33 in the group of subjects without PTSD. Moreover, the risk of violence was 1.11 times higher in subjects with PTSD than in the healthy group (OR = 1.11, CI 95%: 1.08 - 1.14).

 The results of this study showed that the risk of violence was higher in subjects with PTSD than in women without this disorder. Therefore, necessary measures must be taken to help infertile women affected by violence.

 Hospitals play a crucial role in providing medical services to medical tourists and their satisfaction; however, they face many problems in this field.

 This study aimed to explain hospitals’ challenges in providing healthcare services to medical tourists.

 In this qualitative-phenomenological study conducted in 2021, data were collected through semi-structured interviews, purposive sampling, and the participation of 21 key informants involved in hospitals and medical tourism industries in six large cities in Iran. They were then analyzed using the thematic analysis method with the MAXQDA-10 software.

 Hospital challenges were included in 165 final codes. The six main ones were governance and leadership, financing, human resources, technology-equipment-medicine, information systems, and service delivery. Three categories of structure, process, and outcomes related to medical tourism were also identified.

 Improving the information and communication infrastructure, developing the activities of facilitator companies, updating the standards of the International Patient Department (IPD), compiling guidelines related to insurance, and setting tariffs are suggestions that can help reduce the existing challenges.

 In-service training is one of the requirements for developing health workforce skills and providing quality services to patients.

 This study aimed to determine the policy formulation of in-service training for the health workforce in Iran.

 In this qualitative policy analysis study, semi-structured interviews with key informant persons and document analysis were used to gather data. Interviews were conducted with 12 informed people about health system policies, experts, and managers of in-service training centers of medical universities and the Ministry of Health and Medical Education (MOHME) selected purposively. Targeted and snowball sampling was used to identify the participants. Data analysis was performed using the MAXQDA10 software, and framework analysis was run using the Kingdon model.

 Centralized planning, lack of access in rural and remote areas, and the inability to use the potential of universities in staff training were the most frequent problems in in-service training of the health workforce. Establishing the Board of Trustees for universities affected the opening of the opportunity window to policy-making, and political entrepreneurs in MOHME took advantage of it and developed policies for in-service training.

 The development of policies has created a suitable platform for medical universities to increase the number of training hours and develop the skills of the health workforce. It also seems that policymakers' attention can lead to improving processes and using new approaches in the continuous development of health professions.

 Cardiovascular disease remains the primary cause of death within the Malaysian population. Sedentary behavior, unhealthy dietary habits, smoking, and alcohol consumption are firmly established as the key risk factors associated with cardiovascular disease.

 This study aimed to identify the lifestyle practices within the Kuala Lumpur community that contribute to an increased risk of cardiovascular disease.

 A cross-sectional survey was conducted, collecting data from 278 participants aged 18 and above in Kuala Lumpur. Participants completed a directly administered questionnaire, providing necessary information such as height and weight measurements for body mass index (BMI) calculation, physical activity levels, dietary habits, alcohol consumption, smoking history, and ethnic backgrounds to assess potential variations.

 Among the 278 respondents, 114 (41%) were identified as smokers, 130 (46.8%) reported alcohol consumption, and 108 (38.8%) had a high BMI. Significant variations were observed across different ethnic groups regarding alcohol consumption and smoking, with Malays showing the lowest involvement compared to the Chinese and Indian groups. Males exhibited a higher prevalence of increased BMI than females, and older adults were more susceptible to overweight and obesity than younger age groups. Out of the total respondents, only 71 (25%) expressed a strong intention to adopt healthy dietary practices, and 82 (29%) showed a solid intention to engage in regular exercise.

 Smoking, alcohol consumption, and high BMI are highly prevalent within the Kuala Lumpur community, posing a significant risk for cardiovascular disease and mortality. Consequently, implementing lifestyle modifications is essential to enhance cardiovascular outcomes in the Kuala Lumpur community.

 The presence of anticancer drugs in water sources has become critical in recent years. Anticancer drugs are used in controlled amounts and conditions in medical centers. Cancerostatic platinum complexes (CPC) like cisplatin, carboplatin, and oxaliplatin are used in oncology centers to treat many cancers.

 We determined the environmental risk of these compounds in municipal wastewater effluent of Qom, Iran.

 The LC-MS/MS technique quantified platinum complex drugs in wastewater effluent. Based on the blank laboratory method, the limit of detection (LOD) was determined as 0.009 µg/L, 0.013 µg/L, and 0.017 µg/L for oxaliplatin, carboplatin, and cisplatin, respectively.

 The cisplatin, carboplatin, and oxaliplatin concentrations in wastewater effluent were 0.19 ± 0.098, 0.22 ± 0.094, and 0.12 ± 0.059 µg/L, respectively. Ecological risk assessment results indicated that RQsw for cisplatin, carboplatin, and oxaliplatin was 0.017, 0.013, and 0.02, respectively, showing that the platinum complex drugs had insignificant ecological exposure risk. Furthermore, ΣRQsw was estimated at < 1.

 Managing cytotoxic waste from hospital oncology wards is vital for environmental pollution control. The use of other methods to remove these compounds, such as advanced oxidation processes and membrane systems, is inevitable.

This study aimed to determine the relationship between self-care and physician-patient relations in patients with Heart Failure (HF). This cross-sectional study was conducted on 200 patients with HF, referring to the outpatient clinics affiliated with Tabriz University of Medical Sciences, Iran. Utilizing a systematic random sampling method, the patients were selected from those who had made intake appointments. The Physician-Patient Relationship Questionnaire and the European Heart Failure Self-Care Behavior scale (EHFScB scale) were used to collect the data. Data were analyzed using descriptive statistics, Pearson correlation coefficient, logistic regression, Student’s t-test, and one-way ANOVA in SPSS (ver. 25). The total score of the self-care behaviors in the patients referring to the outpatient clinics was moderate (31.88 ± 8.66). Also, significant relationships were observed between the scores of self-care behaviors and physician’s gender, patient’s marital status, patient’s education, and between physician-patient relations scores and physician gender (P-value < 0.05). Moreover, physician-patient relations and marital status could predict the patient’s self-care variable by 22% (R2 = 0.221, F = 5.35). The study results revealed that physician-patient relations could explain the self-care behaviors of patients with HF.

 Patients with COVID-19 may experience symptoms for a long time.

 The aim of this study is to determine the prevalence of COVID-19 related problems after discharge from the hospital.

 This cross-sectional study was conducted on 194 hospitalized COVID-19 patients (110 [56.7%] men and 84 [43.3%] women) using the census method in 2021-2022. The patients were followed up for 4 weeks.

 The mean age and body mass index (BMI) of the patients were 57.57 ± 16.79 years and 25.9 ± 4.64 kg/m2. The major complaint was fever (75,3%), followed by dyspnea (62%), general weakness (60.8%), cough (59.3%), and anorexia (49%). On admission, lung high-resolution computed tomography (HRCT) scans were normal in 51 patients (26.3%). Regardless of the underlying disease, at least 1 symptom was present in 63 (32%) of patients at the end of the study. Increased appetite was observed in 16 (8.2%) patients at discharge and thereafter. Hair loss was reported in 2% at the beginning and 8% at the end of the study.

 Prolonged symptoms in COVID-19 patients are common and require long-term care.