Shiraz E-Medical Journal
Year:2016 | Volume:17 | Issue:1|Papers Count:5

Unlimited and mostly competing demands in health care systems even in developed societies, always force decision makers to choose among the priorities for allocation of resources. However, recent developments in health technology assessment (HTA) have created a better opportunity for allocation of limited resources available in health care systems.....

Background: Offspring sex ratio (OSR) serves as an important social factor, and various other factors are hypothesized to be associated with it, such as maternal diet, time of ovulation and insemination, environmental phenomena, parental age, and infertility treatment.Objectives: This research was performed to assess the association between mothers’ menarche age, first pregnancy age, and sex ratio of first offspring.Patients and Methods: In this retrospective study, 2, 000 Iranian women of reproductive age were recruited to assess their menarche age, first pregnancy age, and first OSR.Results: The mean age of the participants was 29.6  7.09, their mean menarche age was 13.25  1.21, and the mean age of their first pregnancy was 23.9 4.35. Total OSR was 0.932. The OSR (calculated as the proportion of male to female offspring) was higher when the menarche age was younger (P<0.05). In women of younger pregnancy age, the OSR was higher (P<0.05). First pregnancy age was younger in women with a menarche age under 13 years (P<0.05).Conclusions: Women of younger menarche age will have younger first pregnancy ages and a greater chance of having a male first offspring.

Background: Hypothyroidism, a preventable cause of mental retardation, is one of the most common diseases of the endocrine gland in children. The disorder can be corrected if it is identified and treated within the first few days of birth. In Iran, hypothyroidism is estimated to affect one out of 400 to 900 neonates, which is much higher than the global average.Objectives: This article is conducted to investigate the most cost–utility option i.e. whether to implement the neonatal screening of genetic hypothyroidism or to merely treat such patients in the absence of the screening process.Patients and Methods: The present research is a cross-sectional, descriptive and analytical study. The provider perspective was employed to calculate the direct costs imposed on Shiraz University of Medical Sciences, insurance organizations, charities and patients concerning the implementation of screening program and the treatment of detected cases along with the direct costs related to patients treated in the absence of the screening process; costs related to death were excluded. The statistical population of the study consisted of all 81837 newborns referred to university laboratory in Shiraz in 2010. In order to measure the utility, time-trade-off method was employed to determine the life quality of patients.Results: The incremental cost-effectiveness ratios (ICER) of hypothyroidism, calculated through dividing the cost difference (ΔC) by utility difference (ΔQALY), indicated that screening saved a total of 13413 US. $.Conclusions: The economic evaluation (cost-utility analysis) resulted from the comparison of the above choices revealed that implementing the screening plan can actually be better and more cost-effective.

Context: The millennium development goals (MDG) are global committed efforts to provide anti-poverty and disparity document. During the past 15 years and based on MDGs, nearly all countries have made efforts to achieve its related goals. Therefore, the current narrative review aimed to analyze the MDGs’ challenge and achievements with the focus on Islamic Republic of Iran.Evidence Acquisition: This study was a non-systematic narrative review conducted through studies and reports published from 2000 to 2015, about MDGs’ progress worldwide, compared to the Islamic Republic of Iran.Results: According to the review, almost all countries have had remarkable improvement in all MDGs. Among them Iran’s achievements are significant in five goals out of eight, but to reach the goals number 6 and 7 related to HIV/AIDS control and environmental sustainability, Iran has a rough way to go. The challenges that countries are facing to reach MDGs are slow growth outlook, limited resources, institutional reforms deficiency, insufficient development capacity, unequal income distribution, global economic situation especially during the past five years, absence of political commitment to the MDGs, lack of supportive environment to attract private sector for investment and development and the last but not least un-inclusive growth.Conclusions: All countries reported improvements in MDG indicators, while SDGs has opened new doors of opportunity for countries to promote their socio-economic status.

Background: Complex decongestive therapy (CDT) is one of the most common treatments used in lymphedema. Effects of lymphedema treatment and its predictive factors were studied previously but its impact on quality of life (HRQOL) is still unknown.Objectives: This study, in addition to investigating CDT effects on HRQOL, examined factors that can influence it, to estimate the effect of treatment according to patient’s condition in our setting.Patients and Methods: The present study was a quasi-experimental study on health-related HRQOL. A general data gathering form was used in 120 patients who developed lymphedema following breast cancer surgery and referred for treatment to Shiraz Motahari clinic in 2014. All patients’ arm size was measured by “direct voltmeter” before the intervention to determine the grade of lymphedema. SF-36 questionnaire was used pre- and one month post-intervention to collect HRQOL data. Complete decongestive therapy (CDT) with or without Pump was used as the intervention.Results: Patients had higher scores after treatment in all subscales of quality of life (except for “role limitation due to physical problems”), but a statistically significant difference (P=0.023) was observed only in the “mental health” subscale. The results showed significant changes in bodily pain after the intervention in patients less than 40 years old (P=0.03), “general health” and “vitality” in single patients (P values equal to 0.013 and 0.02, respectively) and “mental health” in those with education “less than high school” (P=0.018).In the case of household patients, only PF changed significantly after treatment (P=0.027). Moreover, “role limitation due to physical problems” and “mental health” subscales changed significantly after treatment with CDT+Pump (P values equal to 0.004 and 0.003).Other groups represented no significant changes in other subscales. Besides, duration of lymph edema had no effect on improvement of HRQOL after treatment.Conclusions: Although this study showed that some factors can improve patients’ feeling and HRQOL after treatment in our population, inmanyaspects no changes were observed. It isrecommendedto improve patients’ HRQOLthroughmoresocial and physiological support in our setting. Also, more follow-up duration after the intervention is recommended in future studies.