Payesh
Year:2015 | Volume:14 | Issue:1|Papers Count:18

Objective (s): This paper investigates the impact of health expenditure on health status for 68 middle income countries over the period 1980-2011.Methods: Random effects panel data regression model was fitted to determine the effects of health care expenditure on health outcomes.Results: The results showed that health care expenditure significantly influences health status through improving life expectancy at birth, reducing death and infant mortality rates. Both public and private health care spending showed strong positive association with health status. Although public health care spending had relatively higher impact on reducing death and infant mortality rates, private health care spending had relatively higher impact on life expectancy at birth.Conclusion: The findings suggest that health care expenditure is one of the most important determinants of health status across countries. Therefore increasing resource allocations to health sector can significantly improve health outcomes.

Objective (s): Due to rapid growth in health care expenditures in recent decades, finding new methods to control costs seems necessary. As such activity based costing (ABC) is one of the new costing methods that increasingly used by managers. This method will help managers to better control costs. This study aimed to investigate the possibility of using activity-based costing system in a specified range of imaging services (radiology and sonography) in centers under the contract of Iran Health Insurance Organization.Methods: This was a multi-phase study so different methods were used. First a review of the literature on the topic was carried out. Then related centers (public and private) were selected randomly. The study population was hospitals and radiology centers under the contract of Iran health insurance organization in Tehran, Iran. Data was collected by system observation, review of documents and interview by system experts.Results: The centers were classified into 3 groups according to the financial documentation: For group A all 4 categories of financial data were accessible for implementation of ABC in systems. For group B the costs of unit and batch level were available and for group C only the costs of unit level can be estimated.Conclusion: The findings suggest that financial data documentation in different centers is the most important factor that affects the feasibility of using the activity-based costing techniques. To control costs in health care it seems that there is need to improve financial documentation both in public and private hospitals.

Objective (s): Endometriosis is a common disease among women of reproductive age with negative consequences on mental and physical health as well as social life and job competency. The impact of disease on sexual health of patients has received less attention and most studies focused primarily on infertility, pain, and dyspareunia as main complaints of patients. The aim of this paper was to review the existing body of information on the impact of endometriosis and its medical and surgical treatments on sexual health of patients, providing new insight into the issue, and call attention to this overlooked aspects of women’s life.Methods: Using the PRISMA guideline, papers published between 1975 and 2013 on the topic of endometriosis, and its treatments retrieved and with a critical narrative synthesis the effect of disease or its treatments on sexual health of patients were reviewed.Results: In total, 37 papers were found relevant. Of these 32 papers used quantitative methods and 5were qualitative studies. The results showed that dyspareunia was the most common symptom as part of a pain syndrome and not a sexual problem. Sexual well-being of patients has been included in the treatment outcomes only in recent years. Pain, frequency of sexual intercourse, sexual function, and satisfaction, and orgasm were the most accounted outcomes.Conclusion: Endometriosis strongly affects sexual and marital relationships and quality of life in women. Therefore, these aspects of patients’ life as well as biological and clinical indicators should be integrated into the health care and the future research.

Objective (s): Sexual functioning is an important component of women's lives. Several factors can affect sexual function in menopausal women. The objective of this study was to review factors affecting sexual function in menopausal women and to identify challenges they face.Methods: This was a systematic review of the literature (from 2003 to 2013) indexed in Pubmed, Science Direct, Iranmedex, Google Scular, EMBASE, Scopus and the SID databases.Results: In all 46 articles related to menopause and sexual function were studied. The results indicated that age, estrogen deficiency, kind of menopause (natural or surgical), chronic medical problems, hysterectomy, sexual partner’s sex problems, the severity of menopause symptoms (except hot flashes), dystocia history, and health status were among the physical factors affecting sexual function. There were conflicting results regarding the amount of androgens, hormonal therapy, exercise/physical activity, body mass index and obstetric history. In the mental-emotional area, all studies confirmed the impact of depression and anxiety. Social factors, including smoking, the quality of relationship with husband, sexual partner’s loyalty, sexual knowledge, access to health care, a history of divorce or the death of a husband, living apart from a spouse, and a negative understanding of women’s health were found to affect sexual function. However, there were conflicting results regarding the effects of education, occupation, socioeconomic status, alcohol drinking, marital duration, and frequency of sexual intercourse.Conclusion: Several factors affect sexual function in menopausal women. Early recognition of these factors (physical, mental-emotional, and social) factors might help to improve women’s health.

Objective (s): Elective caesarean sections in most countries including Iran have increased dramatically and became a serious problem for the health system. This study aimed to assess challenges and strategies to decrease elective cesarean section as faced by health system management using a qualitative approach.Methods: Eleven semi-structured interviews conducted with midwives, obstetricians and sociologist. They were asked to elaborate on issues that health system is facing with. Data were analyzed in a conventional fashion.Results: Four concepts emerged from the qualitative data analysis including: ‘performance supervision’, ‘standardization’, ‘regulations’, and ‘education’.Conclusion: Any decrease in caesarean sections requires integrative coordination and can be achieved only by substantial interventions by health system management.

Objective (s): Pregnancy is the transition to parenthood. Being mentally prepared is essential for successful psychosocial adaptation to pregnancy. So, an unplanned pregnancy challenges the self-sufficiency and control expected of women. The main focus of this study was to provide a better understanding of women’s coping with an unplanned pregnancy.Methods: The data were collected through 23 semi-structured in depth interviews from May to September 2013 in Tabriz and analyzed using descriptive-interpretive approach of content analysis. The participants were 15 women having a recent unplanned pregnancy, interviewed from the 20th week of gestation until 40 days after childbirth. All interviews were audio recorded and transcribed verbatim. Data analysis was conducted using MAXQDA 2007.Results: Findings fell into four main themes: initial negative reactions, social rejection of abortion, values and religious beliefs and post-continue conflicts indicating negative reactions when facing with an unplanned pregnancy. Although socio-cultural context of Iran helped women to copy with an unplanned pregnancy, post-continue conflicts remained.Conclusion: Unplanned pregnancy for women begins with initial negative reactions and leads to the post-continue conflicts. These findings highlight the importance of promoting primary prevention of unplanned pregnancy and also designing secondary prevention programs to help positive coping with such pregnancies.

Objective (s): This study aimed to measure health status and explains the role of gender and education on health related quality of life, health awareness and life style in Tabriz, Iran.Methods: A sample of 650 individuals aged between 15-65 years old were selected randomly from 9 municipality area of Tabriz. A questionnaire with three sections was used for data collection.Results: The results showed that, compared to women, men scored higher on quality of life but women’s scored higher on healthy life style. Peoples with higher education had better health compared to those with lower education.Conclusion: The findings confirm that gender and education has effect on people’s health status.

Objective (s): Injury is a major public health problem in Iran. The aim of this study was to estimate the burden of injury in Ilam (a province I west), Iran in 2011.Methods: This was a second analysis of the death registration data. Using Disability Adjusted Life Years (DALYs) and life table of Ilam population, the burden of injury was calculated.Results: In 2011, there were a total of 12002.7 years life lost (YLL) due to premature mortality due to injuries in Ilam province, the average of 21.5 per 1000 population. Globally, men had the larger share of burden than women (69.7% compared to 30.3%). Across all age groups, distribution of burden showed predominant of 15 to 35 age groups with 68.4%. The highest proportion of burden in men and women was due to road traffic injuries and suicides, respectively.Conclusion: The study revealed that the injuries imposed a significant burden especially on youth in Ilam population. Thus, designing and implementation of effective programs regarding prevention and control of injuries is required.

Objective(s): To translate and validate the “Mishel’s Uncertainty in Illness Scale-Adult Form” (MUIS-A) in Iranian cancer patients.Methods: The scale was translated into Persian and back translated into English and revised according to the comments of the scale designers. Then, content and face validity, construct validity, internal consistency reliability and stability of the Persian version were measured. Data were analyzed using SPSS version 16 and LISREL 8.5.Results: In all 420 cancer patients completed the questionnaire. The mean score for the MUIS-A was 90.1(16.8). Confirmatory factor analysis showed satasfactory results for the whole instrument and its four subscales. The stabilty of the instrument with a three-week interval was 0.91. Cronbach's alpha was 0.89 for the whole scale of 32 MUIS-A items and a ranged from 0.58 to 0.86 for its four factors.Conclusions: The Persian version of the MUIS-A has good validity and reliability indices. It can be used to assess uncertainty in illness in Iranian patients with cancer.

Objective (s): Consumption of omega-3 fatty acids can alter the inflammatory response in diabetic patients, which may enhance the benefits of aerobic training. The purpose of this study was to determine the effects of 8 weeks aerobic training with omega-3 supplementation on inflammatory and metabolic syndrome parameters in type 2 diabetic patients.Methods: In this semi-experimental study with pretest–posttest design, thirty diabetic patients (aged 48.58±7.4 y) were randomly assigned to omega-3 supplementation only (2000 mg/d), omega-3 supplementation plus aerobic training or non-exercising control groups. Aerobic training program was performed 50-60 min/d, 3d/wk, for 2 months. Serum levels of CRP, TNF-a and IL-1, body composition and metabolic parameters were assessed before and after the training period.Results: The data analysis showed that omega-3 supplementation in conjunction with aerobic training lead to greater improvements in adiposity indices (p=0.03), total cholesterol (p=0.03), and triglyceride (p=0.03). Inter-group comparison (among the 3 groups) showed that there were no significant differences with regard to CRP (p=0.27), TNF-a (p=0.15) and IL-1 (p=0.12).Conclusion: The results suggest that aerobic training and omega-3 supplementation can have beneficial effects on metabolic indices over a two-month period. Based on the results a daily consumption of omega-3 and aerobic training is suggested for patients with type 2 diabetes.

Objective (s): Due to the wide influence of public media, they become important communication channels for changing health beliefs and behaviors. One of the areas that have gained increased attention in public media is nutritional information. The goal of this study was to analyze nutritional information related to cancer published in popular Iranian Magazines during year 2012-2013.Methods: This was an applied study using a content analysis method. The data was collected using a checklist designed by the researcher. All massages printed in 173 issues of 8 most popular magazines were selected. Then a purposive sample of 295 massages from 96 magazine issues was analyzed.Results: Findings showed that perversion trends had the highest (86.8%) and treatments had the lowest (4.7%) frequency. Pomegranate was the most commonly mentioned preventive food, while Mayonnaises was the most commonly mentioned carcinogen and Tangerine was the most commonly mentioned food for tratment. Among different types of cancer, more than half of the massages (51.2%) mentioned cancer in general followed by breast cancer (13.2%) and prostate cancer (10.51%).Conclusion: The findings of this study showed that the main goal of these massages were to increase the readers' information, although some doubts regarding the scientific credibility of the claims made in these massages still remain.