Association between inter-arm blood pressure difference and cardiovascular disease: result from baseline Fasa Adults Cohort Study

The inter-arm blood pressure difference has been advocated to be associated with cardiovascular mortality and morbidity. Our study aimed to investigate the association between Inter-arm systolic and diastolic blood pressure differences and Cardio Vascular Disease (CVD). A total of 10,126 participants aged 35–70 years old were enrolled in a prospective Fasa Persian Adult Cohort. In this cross-sectional study, the cutoff values for inter-arm blood pressure difference were less than 5, greater than 5, greater than 10, and greater than 15 mm Hg. Descriptive statistics and logistic regression were used to analyze the data. Based on the results the prevalence of ≥ 15 mmHg inter-arm systolic and diastole blood pressure difference (inter-arm SBPD and inter-arm DBPD) were 8.08% and 2.61%. The results of logistic regression analysis showed that inter-arm SBPD ≥ 15 and (OR<5/≥15 = 1.412; 95%CI = 1.099–1.814) and inter-arm DBPD ≥ 10 (OR<5/≥10 = 1.518; 95%CI = 1.238–1.862) affected the risk of CVD. The results showed that the differences in BP between the arms had a strong positive relationship with CVD. Therefore, inter-arm blood pressure could be considered a marker for the prevention and diagnosis of CVD for physicians

Quantitative optimization of emergency department’s nurses of an educational hospital: a case study

Introduction: Nurses account for the majority of human resources in hospitals, as such that 62% of the workforce and 36% of hospital expenditures are related to nurses. Considering its vital role in offering round-the- clock emergency healthcare services, an Emergency Department (ED) requires adequate nurses. Therefore, this study was conducted to optimize the number of nurses in ED. Methods: This was an applied study conducted using a Linear Programming (LP) model in 2015. The study population were selected by census who were all ED nurses (n=84) and patients referred to ED (n=3342). To obtain the statistics related to the number of patients and nurses, the hospital information system and human resources database were employed respectively. To determine the optimum number of nurses per shift, LP model was created via literature review and expert advice, and it was executed in WinQSB software. Results: Before implementing the model, the number of nurses required for ED morning shift, evening shift, and night shift (2 shifts) was 26, 24 and 34 respectively. The optimum number of nurses who worked in ED after running the model was 62 nurses, 17 in the morning shift, 17 in the evening shift and 28 in the night shift (2 shifts). This reduced to 60 nurses after conducting sensitivity analysis. Conclusion: The estimated number of nurses using LP was less than the number of nurses working in ED. This discrepancy can be reduced by scientific understanding of factors affecting allocation and distribution of nurses in ED and flexible organization, to reach the optimal point

Contrasting socioeconomic inequality with noncommunicable diseases: Insights from a population‐based survey using the concentration index in Kong cohort study

Abstract Background Noncommunicable diseases (NCDs) are the major causes of mortality across the globe, which impose a substantial burden on health care systems, particularly in low‐ and middle‐income countries. The present study aimed to determine socioeconomic inequality in the prevalence of NCDs using the concentration index (CI). Methods This cross‐sectional study was conducted on the baseline data of the Bandar Kong cohort. The principal component analysis was used to determine people's socioeconomic status (SES). The CI and Lorenz Curve were used for the assessment of socioeconomic inequality. Multivariate logistic regression was used to assess the relationship between SES and the prevalence of NCDs. A p Value less than 0.05 is considered significant. Results Frequency and prevalence of diabetes was 653 (16.22%), hypertension 848 (21.06%), chronic lung diseases 161 (4%), epilepsy 70 (1.74%), mental disorders 191 (4.74%), stillbirth 299 (13.94%), thyroid disorders 391 (9.71%) and depression 146 (3.63%). CI for the prevalence of diabetes was [−0.107, %95 CI: −0.146 to −0.068], hypertension [−0.122, %95 CI: −0.155 to −0.088], chronic lung disease [−0.116, %95 CI: −0.202 to −0.03], psychiatric disorders [−0.230, %95 CI: −0.304 to −0.155], depression [−0.132, %95 CI: −0.220 to−0.043] and stillbirth [−0.162, %95 CI: −0.220 to −0.105]. The Gini index was negative for all these diseases, indicating that these are significantly concentrated in people of poor SES. Conclusions The findings suggest that selected NCDs were concentrated among the poor and the low‐income. Particular attention may be necessary to address the problem of NCDs among these groups

Strength and Weakness of Crisis Management in Hormozgan Medical University’s Hospitals

Background & Objective: Various communities continuously try to manage the unexpected events. In this regard, hospitals with providing timely health care services has transformed to the most pragmatic unit of health system. Planning and preparation of them should be strategic policy of health system. This paper aimed to investigate the strength and weakness of crisis management in training hospitals of Hormozgan University of Medical Sciences. Materials & Methods: This is descriptive-analytic research. Research statistical population includes managers, nursing directors, financial directors and masters of crises committee of hospitals, totally 34 persons. Data collected with questionnaire in 8 domains and demographic information. Questionnaire was validated and reliabled. Collected data entered to SPSS and analyzed by descriptive & inferential statistics. Results: Preparedness Rate of Hospitals encounters Unexpected Events was average (50%). Preparedness rate in managerial policies (44.1%), structural and non-structural stability (41.2%) and register & informed (47%) domains were in average level. In this regard HEICS (32.3%), maneuvers (55.9%) and use of relative technologies were in very low grade. Between preparedness rate with crises committee function, training and maneuvers there were meaningful relations (P<0.05). Conclusion: Suitable crises management will be feasible by documented planning, preparing intra and extra organizational relations, reinforcing human resources with organizing, delivering of training and durational maneuvers to them. Keywords: Strength, Weakness, Crisis, Crisis Management Type of Article: Original Articl

Success rate evaluation of clinical governance implementation in teaching hospitals in Kerman (Iran) based on nine steps of Karsh’s model

Background: One of the ways to improve the quality of services in the health system is through clinical governance. This method aims to create a framework for clinical services providers to be accountable in return for continuing improvement of quality and maintaining standards of services. Objective: To evaluate the success rate of clinical governance implementation in Kerman teaching hospitals based on 9 steps of Karsh’s Model. Methods: This cross-sectional study was conducted in 2015 on 94 people including chief executive officers (CEOs), nursing managers, clinical governance managers and experts, head nurses and nurses. The required data were collected through a researcher-made questionnaire containing 38 questions with three-point Likert Scale (good, moderate, and weak). The Karsh’s Model consists of nine steps including top management commitment to change, accountability for change, creating a structured approach for change, training, pilot implementation, communication, feedback, simulation, and end-user participation. Data analysis using descriptive statistics and Mann-Whitney-Wilcoxon test was done by SPSS software version 16. Results: About 81.9 % of respondents were female and 74.5 have a Bachelor of Nursing (BN) degree. In general, the status of clinical governance implementation in studied hospitals based on 9 steps of the model was 44 % (moderate). A significant relationship was observed among accountability and organizational position (p=0.0012) and field of study (p=0.000). Also, there were significant relationships between structure-based approach and organizational position (p=0.007), communication and demographic characteristics (p=0.000), and end-user participation with organizational position (p=0.03). Conclusion: Clinical governance should be implemented by correct needs assessment and participation of all stakeholders, to ensure its enforcement in practice, and to enhance the quality of services

Cost-price estimation of clinical laboratory services based on activity-based costing: A case study from a developing country

Background: It is believed that laboratory tariffs in Iran don’t reflect the real costs. This might expose private laboratories at financial hardship. Activity Based Costing is widely used as a cost measurement instrument to more closely approximate the true cost of operations. Objective: This study aimed to determine the real price of different clinical tests of a selected private clinical laboratory. Methods: This study was a cross sectional study carried out in 2015. The study setting was the private laboratories in the city of Kerman, Iran. Of 629 tests in the tariff book of the laboratory (relative value), 188 tests were conducted in the laboratory that used Activity Based Costing (ABC) methodology to estimate cost-price. Analyzing and cost-price estimating of laboratory services were performed by MY ABCM software Version 5.0. Results: In 2015, the total costs were $641,645. Direct and indirect costs were 78.3 Laboratory consumable costs by 37 group of hormone tests cost the most$147,741 (23.03%), and other tests group cost the least $3,611 (0.56%). Also after calculating the cost of laboratory services, a comparison was made between the calculated price and the private sector’s tariffs in 2015. Conclusion: This study showed that there was a difference between costs and tariffs in the private laboratory. One way to overcome this problem is to increase the number of laboratory tests with regard to capacity of the laboratories

Investigating the Factors Related to the Development of Children in Southern Iran

Background: Given that the evolution of various mental aspects includes physical, mental, emotional and social changes. Screening for the developmental status of children can prevent significant complications and disorders. Therefore, the developmental status of children in Hormozgan province was examined based on the ages and stages of questionnaire age and stages questionnaire (ASQ). Methods: This was an analytical study performed by a cross-sectional method in December 1997 in health units of Hormozgan province. Based on the cluster random sampling, the names of 2260 children aged 60 months (3 to 5) were extracted through the integrated health system. Data collection tool was age and stages questionnaire (ASQ) used to assess the development of children in five areas of communication, large movements, fine movements, problem solving and socio-personal skills. The collected data were analyzed using SPSS software version 22 and statistical tests, ANOVA, Chi-square, mean   standard deviation and frequency percentage (P<0.05). Results: The mean age of the children in the study was 3.14 ± 2.3. From 2260 children, 1036 (45.8%) were girls and 1224 (54.2%) were boys. In terms of communication, 1.5% cases, fine movements 2%, 4.5% large movements, 3% problem solving and socio-personal skills, 4% children were abnormal. Conclusion: The results showed that despite the normal development in most children, a number of children had developmental disorders in at least one area. Therefore, the need for programs to deal with related risk factors and continuous follow-up in terms of the development of these areas is essential to prevent future complications

The Analysis of the Content of Tobacco Control Policymaking and Legislation in Iran and Providing Policy Solutions

Background. Tobacco use is the fifth risk factor for non-communicable diseases in Iran. This study aimed to analyze the policies and measures of tobacco control in Iran in the last four decades (1983-2021). Methods. The present study is a retrospective policy analysis that used a case study plan based on the Walt and Gilson triangle policy analysis framework to examine the content of tobacco control policies in Iran. Data were collected using tobacco use policies and legal documents and analyzed using documentary analysis. MAXQDA 11 software was used to categorize and analyze the findings. Results. The policies include setting prices and taxes on tobacco to reduce demand; protecting the public from second-hand smoke; controlling the composition of tobacco products; setting regulations on the disclosure of information about tobacco packaging and labeling; educating the public about the dangers of tobacco use; advertising, promotion, and financial support of tobacco; setting measures to encourage smoking cessation and reduce the demand and dependence on tobacco; banning illegal tobacco product trading; banning youngsters from tobacco trading; financially supporting the practical alternatives such as economic activities and research; setting monitoring and evaluation systems; and enhancing the exchange of information. Conclusion. Strengthening the government's tobacco control capacity and formulating a clear and coherent national tobacco control strategy and roadmap, including a mechanism for practical cross-sectoral cooperation between different actors, can reduce conflicts of interest between the actors involved and determine the country's current and future tobacco control policies