Comparison of quality of work life in rural family physicians and other general physicians in Iran

Background: Job satisfaction of physicians in family physician team is considered as one of the important factors for health system. The aim of the preent study was to compare the quality of work life (QoWL) in rural family physicians and general physicians with private clinics in Kurdistan province.Methods: A cross-sectional study was conducted among 103 general physicians including 50 rural family physicians and 53 general physicians with private clinics in Kurdistan province in 2016. The data were collected using QoWL questionnaire and analyzed using SPSS, v. 16. Descriptive statistics including frequency, percentage, mean, and standard deviation (SD) were used to describe the data and to examine the relationship between the variables, T-test was run.Results: The QoWL of rural family physicians with a mean of 55 (SD = 7.6) was higher than average scores. But QoWL of other general physicians with a mean of 47.7 (SD = 13.5) was lower than average scores. The results of t-test showed that there was a significant difference between QoWL of family physicians and other general physicians (t = 82.3, p = 0.001). In rural family physicians, there is a significant association between the QoWL and gender (t=2.7, P = 0.009) as well as native status (t=2.53, P = 0.004). In general physicians with private clinics, the QoWL of native physicians was higher than that of non-native physicians (t = 4.3, P = 0.001).Conclusion: The QoWL of rural family physicians is better than that of others general physicians, even though it is unsatisfactory in both studied groups. Therefore, improving the QoWL of rural family physicians, especially female and non-native rural family physicians, is recommended because promoting the rural family physicians' satisfaction can decrease the likelihood of turnover, and thus increase service quality and responsiveness, as a goal of the health system

Out-of-Pocket and Informal Payment Before and After the Health Transformation Plan in Iran: Evidence from Hospitals Located in Kurdistan, Iran

Background: One of the objectives of the health transformation plan (HTP) in Iran is to reduce out-of-pocket (OOP) payments for inpatient services and eradicate informal payments. The HTP has three phases: the first phase (launched in May 5, 2014) is focused on reducing OOP payments for inpatient services; the second phase (launched in May 22, 2014) is focused on primary healthcare (PHC) and the third phase utilizes an updated relative value units for health services (launched in September 29, 2014) and is focused on the elimination of informal payments. This aim of this study was to determine the OOP payments and the frequency of informal cash payments to physicians for inpatient services before and after the HTP in Kurdistan province, Iran. Methods: This quasi-experimental study used multistage sampling method to select and evaluate 265 patients discharged from hospitals in Kurdistan province. The study covered 3 phases (before the HTP, after the first, and third phases of the HTP). Part of the data was collected using a hospital information system form and the rest were collected using a questionnaire. Data were analyzed using Fisher exact test, logistic regression, and independent samples t test. Results: The mean OOP payments before the HTP and after the first and third phases, respectively, were US$59.4, US$17.6, and US$14.3 in hospital affiliated to the Ministry of Health and Medical Education (MoHME), US$39.6, US$33.7, and US$13.7 in hospitals affiliated to Social Security Organization (SSO), and US$153.3, US$188.7, and US$66.4 in private hospitals. In hospitals affiliated to SSO and MoHME there was a significant difference between the mean OOP payments before the HTP and after the third phase (P<.05). The percentage of informal payments to physicians in hospitals affiliated to MoHME, SSO, and private sector, respectively, were 4.5%, 8.1%, and 12.5% before the HTP, and 0.0%, 7.1%, and 10.0% after the first phase. Contrary to the time before the HTP, no informal payment was reported after the third phase. Conclusion: It seems that the implementation of the HTP has reduced the OOP payments for inpatient services and eradicated informal payments to physician in Kurdistan provinc

The Effect of Sagittal STIR and FLAIR Sequences Compared to Sagittal T2-W for Characterizing MS Lesions in Cervical Spine MRI

Purpose: Multiple Sclerosis (MS) is an acute, autoimmune, and inflammatory disease in the central nervous system. This study investigated the effect of sagittal Short Tau Inversion Recovery (STIR) and T2-W Fluid Attenuated Inversion Recovery (FLAIR) sequences rather than sagittal T2-W as complementary sequences in patients with cervical spinal cord lesions and suspected MS. Materials and Methods: This cross-sectional study was performed on all individuals referred to the Shahid Ghazi MRI center in Sanandaj for six months. Sixty patients with a cervical spine MRI request that were suspected of having MS were examined. The number of MS plaques in the sagittal T2-W FSE, sagittal STIR, and sagittal T2-W FLAIR were recorded separately. A comparison between routine sequences and sequence supplementation has been made for characterizing MS plaque in the spine. Results: Results showed that the greatest agreement was related to sagittal STIR, and sagittal FLAIR (Cohen’s kappa = 0.56). Whereas the least agreement values were from sagittal T2-W and sagittal FLAIR, STIR and FLAIR, T2-W and FLAIR, T2-W and STIR (Cohen’s kappa = 0.20, 0.33, 0.48, 0.55), respectively. Sagittal STIR and sagittal FLAIR were excellent predictors for MS plaques diagnosis due to the area under the ROC curve = 0.56; sensitivity (95% CI) = [0.85 (0.73426 to 0.929044)] and specificity (95% CI) = [0.46 (0.336699 to 0.600035)]. Conclusion: Results show that FLAIR T2-W images in sagittal sequence are appropriate for detecting lesions around spinal cord lesions. Furthermore, using thresholds obtained via statistical analysis, plaques in the cervical spinal cord can be identified in sagittal STIR images

Epidemiology, clinical characteristics, and outcome of hospitalized COVID-19 patients in Kurdistan Province, Iran

BACKGROUND: The present study aimed to evaluate the epidemiology, clinical characteristics, and outcome of confirmed and suspected hospitalized coronavirus disease 2019 (COVID-19) cases in Iran hospitals affiliated with the Kurdistan University of Medical Sciences, Sanandaj, Iran. METHODS: This cross-sectional study was performed on all confirmed and suspected hospitalized COVID-19 cases in hospitals affiliated with the Kurdistan University of Medical Sciences between March and September 2020. Required data were obtained from the Hospital Intelligent Management System of hospitals. Independent t-test, chi-square test, Fisher's exact test, and one-way analysis of variance (ANOVA) were used for univariate analysis. Variables with P-value < 0.3 in univariate analysis were entered into the multivariate model, and the adjusted odds ratio (AOR) was calculated. RESULTS: Out of 9176 cases, 3210 cases (35.03%) were confirmed with COVID-19. The mean and standard deviation (SD) of age of the cases was 56.5 ± 19.3 in the confirmed and 57.5 ± 20.6 in the suspected cases. The confirmed and suspected cases’ mortality rate was 15.0% and 10.2%, respectively. In both groups, the most common symptoms of admission to the hospital were respiratory distress, coughing, fever, and muscular pain. The variables of older age, male gender, being transferred to hospitals by ambulance, intensive care unit (ICU) hospitalization, being intubated, blood oxygen saturation level less than 93, and having an underlying disease were statistically associated with an increased chance of death. CONCLUSION: The mortality rate among both confirmed and suspected hospitalized COVID-19 cases was significant, and this rate was higher for the confirmed cases. Death-related risk factors should be considered in resource allocation, management, and patient prioritization to reduce the outcome of death

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Microsoft Word - 1

ABSTRACT This paper provides the findings of an applied and experimental study about the gap of views regarding the role of auditing in prevention‚ detection and reporting of a corporate fraud. The main objective of this study is the evaluation of a corporate fraud from the aspect of performance gap‚ and logical gaps related to standards have been examined as sideway goal of the study. In order to recognize each one of these gaps‚ there should be a certain degree of skill about fraud. So‚ in this study‚ the gap and distance of views from the point of view of independent auditors and users is evaluated. In this study, the required information was collected through randomly sending out five-item Likert questionnaires and with the ratio of sample to the community. Among the users‚ financial managers and financial providers were chosen as the sample. Finally‚ the study hypotheses were evaluated with the use of parametric t-test for the two independent groups and levin test. The results indicate that all the research hypotheses were confirmed with confidence level of 95%. In other words‚ there is a performance gap in the field of fraud between the independent auditors and users viewpoints

Assessing horizontal equity in health care utilization in Iran : a decomposition analysis

Background: Despite the goal of horizontal equity in Iran, little is known about it. This study aimed i) to assess socioeconomic inequality and horizontal inequity in the healthcare utilization; and ii) to explore the contribution of need and non-need variables to the observed inequalities. Methods: This study used national cross sectional dataset from Utilization of Health Services survey in 2015. Concentration Index (C), Concentration Curve (CC) and Horizontal Inequity index (HI) were calculated to measure inequality in inpatient and outpatient health care utilization. Decomposition analysis was used to determine the contribution of need and non-need factors to the observed inequalities. Result: Results showed the pro-poor inpatient services in both rural (C = − 0.079) and non-rural areas (C = − 0.096) and the pro-rich outpatient services in both rural (C = 0.038) and non-rural (C = 0.007). After controlling for need factors, HI was positive and significant for outpatient services in rural (HI = 0.039) and non-rural (HI = 0.008), indicating that for given need, the better off especially in rural make greater use of outpatient services. The HI was pro-poor for inpatient services in both rural (HI = − 0.068) and non-rural (HI = -0.090), was significant only in non-rural area. Non-need factors were the most important contributors to explain inequalities in the decomposition analysis. Conclusion: Disentangle the different contribution of determinants, as well as greater HI in rural areas for outpatient and in non-rural areas for inpatient services, provide helpful information for decision makers to re-design policy and re-distribute resource allocation in order to reduce the socioeconomic gradient in health care utilization

Has Iran achieved the goal of reducing the prevalence of households faced with catastrophic health expenditure to 1%?: A national survey

Abstract Background and Aims One of the goals of the Islamic Republic of Iran is to reduce the prevalence of catastrophic health expenditures among Iranian households to 1% by the end of the sixth 5‐year development plan (2016−2021). This study was conducted to evaluate the level of access to this goal in the final year of this program. Methods A national cross‐sectional study was conducted on 2000 Iranian households in five provinces of Iran in 2021. Data were collected through interviews using the World Health Survey questionnaire. Data from households whose health care costs were more than 40% of their capacity to pay were included in the group of households with catastrophic health expanditure (CHE). Determinants of CHE were identified using univariate and multivariate regression analysis. Results 8.3% of households had experienced CHE. The variables of being a female head of household (odd ratio [OR] = 2.7), use of inpatient (OR = 1.82), dental (OR = 3.09), and rehabilitation services (OR = 6.12), families with disabled members (OR = 2.03) and low economic status of the households (OR = 10.73) were significantly associated with increased odds of facing CHE (p < 0.05). Conclusion In the final year of the sixth 5‐year development plan, Iran has not yet achieved its goal of “reducing the percentage of households exposed to CHE to 1%.” Policymakers should pay attention to factors increasing the odds of facing CHE in designing interventions