Payesh
Year:2014 | Volume:13 | Issue:3|Papers Count:14

Objective (s): The out of pocket is one of financial resources in health system that might cause severe suffering for many households. The aim of this study was to estimate the out of pocket expenditures for outpatient diagnostic services.Methods: This was a cross sectional study of a sample of 800 individuals attending outpatient diagnostic services of teaching hospitals in Quazvin, Iran. Data were collected using structural interviews and existing documents. The percentage of out of pocket expenditures was calculated as follows: the out of pocket expenditures was divided to the total expenditures (the out of pocket + the insurer organization).Results: 76% of the study sample was under insurance coverage and or had the condition of using insurance. There was no significant relationship between the persons’ age and the out of pocket expenditure. There was a meaningful relationship between gender and the out of pocket in laboratory services (P=0.03), and between gender and the imaging services Sina hospital (P=0.042). The percentage of out of pocket expenditures for laboratory varied from 41% to 52% in different hospitals and it was 46% in imaging ward of the same hospitals.Conclusion: It seems that the out of pocket expenditures are descending due to increase of insurance.

Objective (s): This study aimed to determine the relationship between the hospital functional indices and energy consumption rate in the selected hospitals of Tehran University of Medical Sciences.Methods: The present practical, cross-sectional study was conducted in a period of three years (2008-2010). The study population included six hospitals affiliated to Tehran University of Medical Sciences. Two categories of information were collected: the information about energy consumption which was extracted from bills and the information related to the bed indicators that obtained from the Information Technology Center of Tehran University of Medical Sciences. Data were analyzed using SPSS software.Results: The results showed that during the three years, the mean water and electricity consumption was 2.99 and 13.38 to 22.3 times above the international standards, respectively. Besides, the average gas consumption was 19.5 cubic meters per bed occupancy. There was a statistically significant relationship between hospital functional indices and energy consumption.Conclusion: Optimization energy consumption and reduction of hospital expenditures can be achieved by culturalization, and learning effective energy consumption management, presenting functional plans, and creating more relationships among the engineering groups and the hospitals.

Objective (s): Gastric cancer (GC) is the most prevalent cancer in men and third for women. The aim of this study was to analyze the survival of GC patients and then the prediction of death in these patients using a neural network model.Methods: This was a historical cohort study with data selected from 232 registered gastric cancer patients who underwent surgery between 2002 and 2007 at a referral center for gastrointestinal cancers, in Tehran, Iran. Prognostic factors of survival using Kaplan-Meier and Cox proportional hazards models were estimated. To analyze the data using the neural network, the data were divided randomly into two groups, training and testing sets, and homogeneous survival times were tested using log rank test. To select the best network structure, the characteristics of network models modified and the best model was selected using ROC analysis. The analysis was performed using SPSS version 19.Results: The median survival time of GC patients was 25.1 months. One and three year survival times of GC patients were 0.769 (CI 95%: 0.711, 0.833) and 0.256 (CI 95%: 0.185, 0.373), respectively. The prediction error was 37.7% and the area under the ROC was 0.732 at final model. True prediction for censorship and death were 71.4% and 50%, respectively.Conclusion: Neural network is an appropriate approach for predicting the survival of GC patients and its predictions can be used to classify these patients.

Objective (s): The aim of this study was to compare mother's attachment to infant, and parenting stress in infants with and without feeding problems.Methods: In this cross sectional study, a sample of 50 mother-infant dyads was selected applying a convenience sampling method. The Maternal Postnatal Attachment Scale and the Parenting Stress Index were used to collect data. The data were analyzed using MANOVA and independent sample t-test.Results: The results showed that attachment was higher in mothers of infants without feeding problems and their interaction were more pleasure and they showed less parenting stress, compared to mothers of infants with feeding problems.Conclusion: The results of this study might be useful for development of postpartum care and preventive programs for infants feeding problems.

Objective (s): Malnutrition in early months of life can cause many negative consequences. The family food security and feeding practices are two important factors contributing to childhood nutritional health. This study aimed to determine the association between child feeding practices in the second six months after birth, and their nutritional status at the age of one, derived from the Household Food Security Study.Methods: This was a case-control study conducted among 160 children aged 1y in 2010. The USDA’s 18-item food security questionnaire, socio-economic questionnaire, and feeding practices questionnaire were administered to collect data.Results: Paying no attention to advices about starting complementary food, improper behaving about d food consumption, and lower active feeding score were significantly associated with under nutrition in food insecure households. Existence of distractive factors during feeding and lower active feeding score were significantly associated factors with under nutrition in food secure households.Conclusion: Feeding practices, especially behavioral factors, can be related with children under nutrition, in food secure and insecure households.

Objective (s): The purpose of this study was to test predictors of physical activity to prevent osteoporosis using an adapted form of the Health Belief Model in a sample of women.Methods: This was a cross sectional study among women aged 30 years and over using a theory-based new instrument. In this methodological study, path analysis was used for testing predictors of a desired behavior (physical activity).Results: In all 240 women wer entered into the study. The results obtained form path analysis indicated that the data was fit with the extended Health Belief Model (X2/df=2.54, P<0.0001, CFI=0.94, GFI=0.96, and RMSEA=0.07). As such results showed that the model explained 48% of variances observed. Cues to action, Self-efficacy, and Self-regulation had the greatest effect on the behavior studied.Conclusion: The findings support the application of the extended Health Belief Model for prediciting a behavior change.

Objective (s): Menopause is a psychosocial and biological event. Several factors including socio-cultural conditions might affect it. These factors may cause unique experiences and concerns among menopausal women. This study aimed to explain these experiences and concerns.Methods: This was a qualitative study with phenomenological approach. Eighteen eligible menopausal women were selected using a purposeful sampling method. The participants were interviewed using in-depth individual interviews. Interviews were recorded and were analyzed using theme analysis.Result: Four main themes emeregred from analysis: ‘disability’, ‘transion to elderly life’, ‘isolation’, and ‘losing wellness’. Women were concerned about inability for keeping an independent life, performing religious ritual, performing daily housework and forgetfulness. Their concerns about transion to elderly life included the appearance and their future. The participants concerned about isolation due to their mood changes and bad smell following urinary inconsistency. They concerned about losing their wellness and occurrence of some diseases such as osteoporosis, cardiovascular diseases.Conclusion: It seems that development of training programs for family members in support of women will lead to decrease women's concerns and easier spending of menopausal period.

Objective (s): To assess midwives’ attitudes toward cesarean section.Methods: This was a descriptive study to determine the attitudes of midwives and related factors towards elective cesarean section. In all 325 midwives working in hospitals and health care centers in Tehran were entered into the study. A study specific questionnaire was administered in order to collect data. It was consisted of two sections on work experience, age, place of work, physiologic childbirth preparation courses, education, place of graduation and attitudes.Results: The mean age of participants was 37 years (SD=49). Among participants 44.9 and 55.1 percent were working in the delivery room and prenatal care or health center respectively. There were positive attitudes toward elective cesarean among 80 participants (24.6%). There were significant association between midwives’ attitude about elective cesarean and place of graduation, choice of method of delivery for themselves or their daughter, effect of delivery method among inpatient mothers, time of termination, and their views about cesarean section rate in Iran.(P<0.05).Conclusion: The findings indicated that positive attitudes toward elective cesarean were high among midwives. Indeed it is important to change midwives’ attitudes if there is a wish to reduce cesarean section rates in Iran.

Objective (s): Burnout has been described as a syndrome of emotional exhaustion, depersonalization, and decreased personal accomplishment. Measuring burnout among midwives is important because their well-being has implications for stability in the healthcare workforce and for the quality of care provided.Methods: This was a cross-sectional study. A sample of 300 midwives who were working in teaching hospitals and health centers took part in the study. The data were collected by a designed questionnaire and the Maslach Burnout Inventory.Results: Moderate and severe job burnout were found in most participants (76.7%). There were low levels of emotional exhaustion (59.7%) and depersonalization (75%), and personal accomplishment (59.3%). There were a significant inverse association between age and depersonalization (p=0.03), a significant direct association between education and emotional exhaustion (p=0.04) and between three dimensions of job burnout and place of work (p=0.02). However, no significant relationships were found between job burnout and marital status and employment status.Conclusion: Midwives’ level of burnout was found to be relatively substantial. Interventions at individual and organizational levels are needed to respond to job demands, minimize the level of chronic stress and decrease the prevalence of job burnout.

Objective (s): Angina pectoris greatly affects quality of life. The aim of this study was to examine quality of life and related factors in patients with angina pectoris.Methods: This was a cross-sectional study of 200 patients with angina pectoris attending a teaching hospital in Qom Iran, in 2012. The Short Form Health Survey (SF-36) was used to measure quality of life. Data were analyzed using the SPSS 16 performing descriptive statistical tests, Pearson correlation coefficient, independent t-test and ANCOVA.Results: Higher scores observed for social functioning (mean=59.0), while it was lowest for role limitation due to physical problems (mean=33.12). Female participants had lower quality of life, and these differences were statistically significant for all subscales (p<0.05). All quality of life subscales except mental health and role limitation due to emotional problems had significant correlation with functional class. Mental health had negatively significant correlation with coronary artery bypass surgery (P=0.002).Conclusion: The findings indicated that gender and functional class might worsen quality of life in angina pectoris patients. It seems that more nursing care is needed for this subgroup of angina patients.

Objective (s): To explore perceptions of men living with HIV regarding perceived susceptibility to sexually transmission of HIV.Methods: In-depth, semi-structured interviews were held with a purposively selected group of individuals living with HIV recruited from three HIV care clinics in Tehran, Iran. Participants were initially selected from HIV-positive male patients by convenience sampling and narrowed-down by maximum diversity sampling. All interviews were recorded and typed, and the codes were extracted from reviews. Data were analyzed using the content analysis approach.Results: In this study 32 participants were interviewed. Half of participants did not know that they are at risk of AIDS and indicated that they did not use condoms in their sexual relationship. The majority of participants did not believe that the disease could be transmitted during unprotected sexual contact and thought that only men who have sex with men could be affected with HIV. In contrast, others knew themselves at risk of AIDS, but believed that this is out of their control and it depends on God’s willing.Conclusion: Extensive public education on prevention of HIV transmission. for all groups especially thos who are at higher risk is recommended.