Shiraz E-Medical Journal
Year:2018 | Volume:19 | Issue:10|Papers Count:7

Background: The middle-income countries (MICs) target universal health coverage through varieties of policies. However, they face many struggles such as socio-economic and political problems along with flawed policy-making process. Objectives: The current study aimed at presenting a very brief situational analysis of the health policy making and its outcomes in the MICs and accordingly some strategic suggestions to improve this process. Methods: The current brief review study was conducted on the existing evidence on challenges of health policy-making in MICs and its combating solutions. To search literatures, an unlimited time review was conducted in medical databases with predefined keywords. To classify the barriers and their solutions, the current study employed the World Health Organization (WHO) health systems framework; i. e. six building blocks. Results: Reviewing literatures conducted the researchers to the main challenges of health policy-making process in the MICs including poor governance, imperfect health information system, weak resource management, piecemeal plan instead of inclusive national plan, low efficiency, and equitable outcome of their public policies. Conclusions: To improve health policy-making process in MICs, a wide variety of strategies is applicable. These strategies are: (1) Replacing passive problem-solving approach with an active informed-policy making; (2) Preparing a master plan based on sustainability and reality, prediction power of the future events, and active participation of all stakeholders; (3) establishing a health system with focus on primary health care, service leveling, referral system, and integrated and quality care; (4) Effective health interventions, reducing corruption, managed use of private beside the public sector, and improvement of their contracting systems, equitable distribution of all resources, and establishing and/or strengthening health technology assessment (HTA) Committee; (5) Reinforcing the role of governance to control health market, community involvement, and mandatory health attachment to all policies.

Background: The emphasis placed on ethics and moral considerations has always been considered in individual and social domains, and moral intelligence is one of the important components that can play a key role in the improvement of nursing profession. In fact, among different professions, nursing is a clear indication of moral performance. Objectives: The overriding aim of the present study was to evaluate the moral intelligence of nurses working in hospitals of Guilan Province, Iran. Methods: This cross-sectional descriptive study was conducted among 200 nurses working in hospitals of Guilan Province. The participants were chosen using the two-stage cluster sampling method. Data were collected using Lennick and Kiel’ s moral intelligence scale, which is a standard and localized questionnaire. To analyze the data, Mann– Whitney and KruskalWallis tests were run in SPSS, version 16. Results: The highest percentage of the respondents (65%) had a moderate level of moral intelligence, and the least percentage of the subjects (4. 5%) had a low level of moral intelligence. Three moral competencies including “ Admitting mistakes and failures” (15. 46  0. 093), “ Keeping promises” (15. 24  2. 13) and “ Actively caring about others” (15. 16  2. 32) achieved the maximum scores within the range of 4 to 20. Were the most important competencies of moral intelligence, respectively. The KruskalWallis test reflected a significant difference in the comparative study of nurses’ moral intelligence based on age, gender, department, and educational level (P < 0. 05). Conclusions: The desirable level of moral intelligence in nurses indicates the importance of obtaining moral values and emphasizes the existence of moral values in the clinical environment. Attention to factors affecting moral intelligence plays an important role in improving nurse’ s clinical performance.

Background: The exchange rate is one of the factors whose deviation from equilibrium amounts can lead to the instability in economyperformance at the macro level. This study attempted to investigate the effects of exchange rate fluctuations on the import and export of medicine in Iran during 2001-2014. Methods: This longitudinal study collected the required data in each season from 2001 to 2014. The sources of our data were Iran Central Bank, Islamic Republic of Iran Customs Administration, and Food and Drug Administration. The exchange rate and some other variables such as gross domestic product (GDP), oil revenues, and the relative price of medicine import and export were used in the medicine export and import model. Finally, by using E-views software, version 8, an Engle-Granger approach was utilized to investigate the long-term relationship between the study variables. The autoregressive integrated moving average model (ARIMA) was used to estimate the fluctuations in the exchange rate. Results: The results of estimating the equations by the use of the regression method indicated that every 1% increase in oil revenues would lead to a 0. 13% increase in the medicine import in short-term. Every 1% increase inGDPwould averagely lead to a 1. 61% increase in the same variable in long-term. Moreover, the exchange rate fluctuations had a reverse effect on medicine exports so that a 1% increase in the exchange rate fluctuations would moderately result in a 0. 17% decrease in medicine export in short-term. The relative price of import had no statistically significant relationship with any of the variables. Conclusions: Since medicine plays a specifically significant role in the health system and the pharmaceutical industry uses a large amount of exchange, fluctuations in the exchange rate have negative effects on the export of medicine; therefore, health officials and policy-makers need to pay much more attention to this issue.

Background: Urine is the most commonly used liquid for diagnosis and prognosis of diseases and is still the only body fluid that is applied to many diagnostic purposes. There is little information of physicians’ knowledge about correct urine sampling, interpretation in Iranian. Objectives: Evaluation the knowledge of the physicians in urine analysis and identifying related factors to provide useful measures and recommendations to raising physicians’ knowledge. Methods: This cross-sectional study was conducted on 272 physicians who were attended to the congress of retraining in Tehran (capital of Iran) in 2015. The first questionnaire was demographic and the second one was researcher-made consisting of 30 multiple choices questions in 3 different sections. Statistical analysis was performed using STATA 13 software. Results: The Cronbach’ s alpha of the researcher-made questionnaire was 76% and response rate was 45. 3%. Most of the physicians were in the moderate level in terms of knowledge about sampling for urine analysis (62. 5%), knowledge about interpretation of the urine analysis results (54. 8%) and knowledge to link urinalysis result with the patient’ s clinical symptoms (73. 5%). Knowledge was reduced in male sex, increasing in age and time elapsed since graduation and increased with more time studying medicine, and attending in retraining congresses. Conclusions: It is recommended that physician, especially, who have long passed their graduation, spend more time studying medicine and if possible, take part in the congresses and retraining program to keep their information update and apply best diagnostic treatments to their patients.

Background: Nowadays, many health information technology (HIT) interventions are developed for self-care management of chronic diseases. Application of these interventions requires patients’ readiness to use HIT. The current study aimed at determining the readiness of patients with chronic diseases referring to the clinics of educational hospitals in Khorramabad, Iran, to use HIT. Methods: The current cross sectional study was conducted on patients with chronic diseases referring to the clinics of teaching hospitals in Khoramabad, Iran, in 2016. A sample of 475 patients with chronic diseases was selected by the convenience sampling method. Data were collected using the valid and reliable PRE-HIT (patient readiness to engage in health information technology) questionnaire. This questionnaire is composed of two sections, sociodemographic characteristics and patient readiness factors including health information need, computer/internet experience, computer anxiety, preferred mode of interaction, relationship with doctor, cell-phone expertise, internet privacy concerns, and health news on a four-point Likert-scale. Data were analyzed with SPSS version 20. Results: The results showed that 24. 4% (n = 100) of the participants had the experience of using computers. Participants’ experience of computer application had a significant relationship with their age, marital status, job, educational level, living place, health status, and disease type (P = 0. 001), but it had no significant relationship with their gender. The readiness of patients with chronic diseases and the experience of computer application was at a medium level (mean  standard deviation (SD) = 2. 77  0. 59). The highest and lowest scores of readiness were related to the relationship with doctors (mean SD = 3. 37 0. 52) and computer anxiety factors (mean SD = 2. 30 0. 60), respectively. Conclusions: The results of the current study showed that patients’ readiness to engage in HIT was at a medium level. Hence, any plans to use computers and improve readiness of patients with chronic diseases to use HIT can eliminate the challenges of accepting IT by the patients. These can also change patients’ lifestyle and improve self-care management of chronic diseases.

Background: Blood concentration of many hormones fluctuates during a 24-hour period and sleep deprivation affects this circadian rhythm. The ghrelin hormone is secreted from gastric cells and stimulates hunger. There are a few studies regarding the 24-hour ghrelin secretion pattern in normal subjects, but no studies have addressed the effects of sleep deprivation on this pattern. Objectives: To assess the 24-hour ghrelin secretion pattern and the effect of sleep deprivation on this pattern. Methods: This work was conducted on 16 young soldiers (age: 19-23 years old) who served in AJA University of Medical Sciences. The participants were divided into two groups. The first group had regular sleep-wake cycle (n = 8). The second group did not have normal arousal cycle (n = 8). Six blood samples were taken from each subject within 24 hours. The samples were centrifuged and serum was frozen to-20° C until the various assays were performed. Serum cortisol and ghrelin levels were measured by the enzymelinked immunosorbent assay (ELISA). Results: Cortisol showed a diurnal rhythm with a peak at 06. 00 A. M. in the normal and disrupted sleep subjects. However, ghrelin did not show a significant diurnal rhythm in neither group. Sleep deprivation did not have a significant effect on the time pattern of the cortisol and ghrelin secretion. Conclusions: It seems that in real life, ghrelin does not show a circadian rhythm and sleep deprivation does not impact this rhythm.

Background: Different factors affect individuals’ behaviorswhenthey encounter a health problem or a disease. This cross-sectional study was conducted to analyze health-seeking behaviors and utilization pattern of primary health care services among the households living in Shiraz, Iran. Methods: This household survey was conducted among 500 households living in urban and rural areas, selected through threestage sampling during 2016-2017. The data were collected via a questionnaire designed by the researcher (Cronbach’ s alpha coefficient: 0. 747), and the questions were answered by the most informed family members. The data were then analyzed using Chisquare, independent samples t-test, one-way analysis of variance (ANOVA) and Pearson correlation coefficient. Results: We found that 52. 4% of the subjects were female, 65. 6% were married and 34. 4% had academic education. Furthermore, 95% were under the coverage of a health insurance, of which 64. 4% had social security insurance. The mean age of the participants was 39. 08 years. In terms of socio-economic characteristics of the households, 52. 4% had a personal house and 56. 6% were in the income group of 10-20 million Rials. The average household size was 3. 86. Further, 41. 8% of the households had elderly member(s), 49. 6% had hypertensive patient(s) and 32. 8% of the households had diabetic member(s). Only 31. 2% of the participants said they needed consultation on high-risk behaviors. According to our findings, the subjects had inappropriate health-seeking behaviors (direct referral to a specialist physician and disregarding the problem) when facing four out of the seven services surveyed (about 60%). The most important reason for disregarding the problem was that it did not seem serious to the individuals. Our results showed when facing simple illnesses, education level (P = 0. 003), age (P = 0. 001), insurance (P = 0. 000), type of insurance (P = 0. 000), income level (P = 0. 001), residence (P = 0. 001) and type of referral system (P = 0. 004) had a statistically significant relationship with the possibility seeking service and the level of services utilized. The factors affecting the utilization of primary health care services when requiring nutritional counseling, psychological services, counseling for high-risk behaviors, elderly care, as well as hypertension and diabetic care were different. Conclusions: In half of the studied first-level health services, referral to specialist physicians was more common; this behavior would increase the health costs of the country. Therefore, it seems necessary to improve the quality of primary health care services, promote culture and adopt policies to encourage the referral system usage and carry out patient screening.