مجله تحقیقات نظام سلامت حکیم
سال چهاردهم شماره 1 (پیاپی 52، بهار 1390)

If relative values for services are not determined correctly, they might have negative consequences on availability of care. In this study, we aimed to compare relative values of medical tariffs determined in 1993 (known as the 'California' book) with proposed changes to relative values in 2005 (clinical and diagnosis relative values); and assess the effects of the proposed changes on payment weights of different clinical specialties and costs of health system. In this descriptive cross-sectional study, we conducted a situational analysis, compared the codes, and assessed the potential effects on costs. We, also, investigated views of different experts on relative value changes of some medical tariffs in the proposed book. Findings showed imbalance between different relative values of clinical services in the country. If the proposed relative values were implemented for different clinical services, payment weights for different services would have changed considerably. If the proposed relative values were implemented, the present imbalances between the relative values within and between different fields of clinical services would have been reduced; however, the total healthcare cost would have been increased.

Fungi have ability to attack and contaminate plants and animal's dead or alive organs; therefore, possibility of contamination of agricultural products is high. Alfatoxins and Ochratoxins are mostly produced by Aspergillus species such as A.flavus, A.parasiticus, A.nomius, A.orhizeus, A.orhizea, A.ochraceus and penicillium puberculum. In this study, we aimed to assess the rate of fungal Aflatoxins and Ochratoxin in breakfast grains presented in supermarkets in Tehran. Eighteen samples were randomly selected. The samples were grinded and separately packed. Then, they were assessed during three stages of extraction, purification, and determination. The diagnosis was done using fluorescence detector: λme: 333, λxe: 460 and grain: 1000, Attn: 16. The rate was determined comparing the under curve level of each sample and the standards. No Ochratoxin was found in the samples (rate= 0.0). Aflatoxin B1, B2 were found in some samples; however, the rates were below the standards of Iran (5 ppb), Europe (2- 4 ppb) and the US. (2ppb). The Aflatoxin G1 and G2 rates were 0.0 in our samples. There was positive correlation between reduced amount of fungi generating Aflatoxin and controlling factors with reduced Aflatoxin rates. The control factors can be used to prevent grain contamination to Aflatoxin.

Regarding proximity of Caspian Sea to Mazandaran province and lack of information on magnitude of drowning in this province, it seems to be necessary to determine the epidemiologic pattern of drowning in Mazandaran to make efficient planning and intervention programs. Various data sources on drowning in Mazandaran province have been used in this study. After extracting information from various sources and checking for duplications, we reported the results. Results showed that during 2008, 273 individuals (91.2% male and 8.8% female) died due to drowning. The mean age of the drowned was 25.3 (SD=11.7) years. Of all, 175 individuals were visitors. Regarding time and place, most of drownings (93.4%) occurred in the sea in August (33%). The drowning death rate in residents was 3.3 per 100,000 populations in the province. Considering that the majority drowned in the unproteceted areas, more efforts should be placed to improve and expand protected beaches. Moreover, establishing warning signs might be helpful.

After Islamic revolution in Iran, huge steps were taken towards self-sufficiency in drug production among which was the establishment of novel drug system (generic project). However, this project could not reach the rank of designated projects for production of raw material, herbal medicine and drugs for treatment of obstinate diseases. This paper aims to provide analysis of the following issues: 1) The reason for carrying out generic project; 2) The outcome of the generic project performance and its status in the current drug industry; and 3) Obstacles to generic project. In order to gather data in this survey, we used documents, records, interviews, and questionnaires. Of 30 companies recruited to the study, 17 completed the questionnaires. Data were presented using descriptive analyzes methods. Generic project has been able to meet the needs of low-cost and essential drug production in vulnerable situations. In addition, it has created infrastructures such as highly skilled human resources in formulation processes, management improvement and establishment of production lines for new drugs. However, due to the subsidy protective policies and lack of effective collaboration with national and international research centers, this project was confined to only generic drug reproductions until 2008. Absence of innovative projects and Research and Development (R&D) systems has made the pharmaceutical industry stagnant, and hence industrial R&D could not benefit from academic research. Furthermore, licensed projects could not increase the capabilities of R&D systems due to the lack of fundamental pharmaceutical disciplines for innovations. Generic project has been started at appropriate time and was able to meet the needs for low-cost and essential drug production in vulnerable situations and also built up infrastructures. Monopolistic conditions has stopped generic plan in the level of brand generic drugs production. This trend resulted in limited activities in innovative projects and R&D systems and made the pharmaceutical industry stagnant.

The extent and effects of reproductive morbidities on health and quality of life of women in developing countries are evident. Measuring maternal and reproductive morbidities are suggested to be considered as indicators of maternal and reproductive health. This study aimed to assess prevalence of reproductive morbidities including reproductive tract infections (RTIs), pelvic organ relaxation (POR), and abnormal uterine bleeding (AUB) in Iran, to be a base for planning of necessary reproductive health care and education services. In this community-based descriptive study, 1239 women aged 18-45 years were recruited using a randomized cluster sampling method from four selected provinces in Iran. Data were collected using a questionnaire with demographic and fertility sections and an observational checklist for physical examination. Face and content validities as well as test-retest and inter-rater reliability of these tools had been assessed beforehand. The prevalence of RTIs, POR, and AUB were 37.6%, 40.4%, and 31%, respectively. Results demonstrated that 35.1, 34.5 and 9.6 percent of women experienced one, two, and three kinds of morbidities, respectively. Only 20.6% of participants had none of above-mentioned reproductive morbidities. Reproductive health screening programs are necessary for prevention, diagnosis, and treatment of reproductive morbidities. Achieving global definitions of reproductive indexes is necessary for estimating the prevalence of reproductive morbidities in order to planning health care programs.

Esophageal cancer is one of the eight common cancers in the world and the sixth cause of cancer death. The standard survival analysis, Cox proportional hazard model, is based on the assumption that all individuals in study experience the desired event; however, due to the nature of information and type of event, this assumption would be unrealistic. Naive use of Cox regression analysis can be misleading. In this study, we aimed to determine impact of risk factors and demographic factors on survival and cure fraction of patients with esophageal cancer using cure parametric models. Data were collected from the cancer registry of Babol affiliated to Tehran University of Medical Sciences, School of Public Health. A total of 359 patients were recruited to the study and were followed for a period of 15 years. Results showed that 62.7% of patients were men and 37.3% were women. The mean age was 60.0 year for men and 55.3 years for women. Estimated survival rates in one, three, and five years following diagnosis were 23%, 15%, and 13%, respectively. The median of survival time was 8.9 months. To assess the impact of personal factors on survival of patients, we used the mixture cure parametric (weibull and Log-normal). In both models, family history of patients was statistically significant. The results of this study suggest that screening of individuals who have family history of cancer (especially in men) can be an effective factor in reducing the risk of death in patients with esophageal cancer. Preventive programs and monitoring should be greatly considered. Since proportional hazards assumption is rejected in this study, log normal Mixture Cure Model with Logit link function could be used instead of Cox and Weibull models in survival analysis of patients with esophageal cancer.

Performance evaluation is a major task for management of organizations. Models of organizational excellence, modern techniques of performance evaluation, are used to identify strengths and to design improvement projects. This study aimed to assess current methods of performance evaluation in health departments of medical sciences universities in 2010. In this cross-sectional study, 13 universities were recruited using systematic randomization and stratified sampling. Performance evaluation methods of the health departments of these universities were assessed. Data were collected using a self- structured valid and reliable questionnaire. The questionnaires were completed face to face through interviewing with executives and experts in charge. T he health departments of all 13 universities had annual self-assessment program. However, none of them took advantage of scientific models. All 13 universities had a few compiled indicators that mainly covered processes and key results of the performance. The results of performance evaluations were analyzed using purposes, trends and others; however, they were not analyzed using reason. The assessment indicators in five universities were somewhat weighted. The other eight universities did not take any action in this regard. Existing indicators are not able to determine true position of organization and compare it with similar organizations. Application of one of the organizational excellence models is suggested.

Medical wastes produced in physicians’ offices are one of the most important environmental problems in developing countries. Medical wastes are heterogeneous in nature and contain infectious compounds. There is no appropriate strategy to separate medical wastes of physicians’ offices in Sabzevar. The aim of this study was to assess quantity, composition, and the way of management of wastes of physician's offices in Sabzevar in 2009. In this descriptive study, we collected three samples of wastes at the end of working day from both GP's and specialist's offices. The waste components were classified based on the category proposed by World Health Organization. The wastes were separated into four categories (domestic, infectious, sharp devices, and pharmaceuticals) and were weighted. According to the results, total annual wastes produced from physician's offices were 37276Kg/yr. Offices of the GP's and specialists produced 18965 and 18311 Kg/yr wastes, respectively. The amounts of domestic type, potentially infectious, and sharp wastes were 70%, 14% and 16%, respectively. The statistical analyses showed that the mean ± SD weight of wastes (sharps, infectious, and domestics) for both types of medical offices were 185.99 ± 45.29, 165.52 ± 35.99 and 818.75 ± 114.32, respectively. This study indicated that separation procedures of medical wastes were incomplete in Sabzevar. In order to reduce these kinds of pollutants, appropriate measurements should be taken to deal with the pollutants at their source of generation. The staff members involved in waste collection and transport should apply all personal protection measures.