The Effect of Moral Hazards in the Health Insurance Industry in Iran in 2008-2010

Background: Health insurance is one of the most important financial resources for covering the growing costs of health care. Asymmetric information in the insurance market means that the insurer has less information about the health status of the insured person than the insured person him/herself and this leads to waste of treatment resources due to moral hazards. The aim of this study was to determine the effect of moral hazards in the health insurance industry. Methods: This study was a cross-sectional descriptive-analytic research. The study population was all households residing in Iran. For data collection, the questionnaire of urban and rural households Income and Expenditure Survey of Iran Statistics Center was used. For identification and estimation of utility function parameters , the generalized method of moments (GMM) and instrumental variables model were used. GAUSS and E-views software were used for data analysis. Results: According to the results, there were moral hazards in the basic health insurance organizations (medical service insurance organization and Social Security organization) and the complementary insurance. In addition, during these three years, individuals covered by the medical service insurance, with an average elasticity of -2.78, had the lowest moral hazards and those covered by the complementary insurance, with an average elasticity of -3.86, had the highest moral hazards. Conclusion: Insurance policy makers should control consumer's moral hazards

The Effect of Health Care Financing on Income Distribution in Iran: 2008- 2010

Background: Inequality in income distribution leads to the incidence of poverty and increase of the gap between social classes. Evidences suggest that policymakers in many developed and developing countries are concerned about the effects of health care financing on income distribution. The aim of this study was to investigate the effects of paying for health care on the distribution of income in rural and urban households in Iran. Methods: This descriptive- analytical, retrospective study was composed of a 3-year time series. Data were collected from the household income and expenditure survey of the Statistical Centre of Iran. To measure the inequality in the distribution of resources, Lorenze Curve and Gini index estimations were used. Data were analyzed using Stata11 software. Results: Gini coefficient for prepayment income, for the years 2008 to 2011, was respectively 0.367, 0.348 and 0.369 for urban households and 0.404, 0.362, 0.396, for rural households. The values of this index for post payment income in urban households were 0.300, 0.286 and 0.302 and 0.324, 0.300, 0.320 for rural households respectively. According to the results, paying for health care services has led to a significant reduction in the Gini coefficient and increase of equity. Conclusion: The results showed that paying for health care had a significant relationship with income distribution; it means that paying for health care and households’ contribution in health care financing reduced the Gini coefficient and improved income distribution. Keywords: Health care payment, Income distribution, Gini coefficient, Ira

Antimicrobial effects of Zingiber officinale extracts against multi-drug resistant Acinetobacter baumannii clinical isolates recovered from hospitalized patients in ICU

Zingiber officinale as an herbal medicinal plant is used for its potential antimicrobial activity against different microbial pathogens. Multi-drug resistant Acinetobacter baumannii as an important nosocomial pathogen especially in intensive care units is responsible for a wide range of serious infections in humans. The purpose of this study was to investigate the antimicrobial activity of Z. officinale extracts on growth of A. baumannii strains isolated from hospitalized patients in intensive care units in Tehran, Iran. During a 9 month study, 50 multi-drug resistant A. baumannii isolates were recovered from patients in ICU. The Kirby-Bauer disk diffusion method was used to determine resistance patterns of Multi-drug resistant A. baumannii isolates to antimicrobial agents. Micro-broth dilution method was used to determine the antimicrobial activity of methanol, acetone, and chloroform extracts of Z. officinale against multi-drug resistant A. baumannii isolates. The results of susceptibility testing showed that all the isolates were resistant to ceftriaxone, ciprofloxacin, ceftazidime, cefotaxime, cefepime and piperacillin. Resistance to colistin was found to be low (4%) and exhibited good antibacterial activity against tested isolates. This study’s findings revealed that methanol, acetone, and chloroform extracts of Z. officinale have anti-bacterial activity against tested bacterial isolates. Based on the results, the chloroform extracted fraction showed the highest level of activity at a minimal inhibitory concentration of 25 mg/ml on multi-drug resistant A. baumannii (64%). The minimal inhibitory concentration of ginger extract was as low as 3.2 mg/ml. The present study indicated that Z. officinale extracts, at various concentrations could be used as an antibacterial agent for treatment of patients in ICUs

Nosocomial Infections Caused by Drug-Resistant Bacteria in a Referral University Hospital, Tehran, Iran

Background: The emergence of antimicrobial-resistant pathogens associated with hospital-acquired infections (HAIs) is a major public health problem worldwide. Although being drug resistance is common in some countries and rare in others, the extent of this condition is not precisely known in most parts of Iran.Materials and Methods: Clinical specimens from patients who had been in the hospital for at least 48 hours were included in this study. The pattern of antibiotic resistance was determined by disk diffusion method as recommended by the Clinical Laboratory and Standards Institute (CLSI).Results: Of 11164 patients that were investigated, 369 (3.3%) had nosocomial infections. The most frequently isolated organisms from all sites of infections were Acinetobacter species (14.2%), Escherichia coli (13.7%) and Pseudomonas aeruginosa (9.9%). Among the Gram-negative bacilli, Acinetobacter spp was mostly resistant to ciprofloxacin, ceftriaxon, co-trimoxazole and centamicin, while P. aeruginosa was frequently resistant to ampicillin/sulbactam (87%). Imipenem and piperacillin/tazobactam were the most active antimicrobials against gram-negative microorganisms whereas vancomycin was the antimicrobial agent most consistently active against the Gram-positive cocci.Conclusions: This study highlights the importance of antimicrobial-resistant pathogens associated with nosocomial infection in Tehran, Iran. Using proper diagnostic criteria as well as administering more effective treatment may limit the frequency of drug-resistant bacteria associated with HAIs.

Effect of progressive muscle relaxation and aerobic exercise on anxiety, sleep quality, and fatigue in patients with chronic renal failure undergoing hemodialysis

Insomnia, anxiety, and fatigue are more common in hemodialysis patients than in healthy people and affect patients' quality of life. In the present study, the effects of progressive muscle relaxation (PMR) and aerobic exercise on anxiety, sleep quality, and fatigue in patients with chronic renal failure undergoing hemodialysis were evaluated. In this double-blind clinical trial, 100 hemodialysis patients were randomly assigned to three groups: PMR, aerobic exercise, and control. Patients performed relaxation and aerobic exercise daily for 60 days. Questionnaires of anxiety, sleep quality, and fatigue were completed by participants before and after the interventions. Data were analyzed by Stata software. PMR program significantly decreased general anxiety, trait anxiety, state anxiety, and Beck anxiety and aerobic exercise significantly reduced beck anxiety. PMR program and aerobic exercise both significantly improved sleep quality in hemodialysis patients. PMR program significantly reduced Rhoten fatigue but did not affect Piper fatigue. Aerobic exercise had no effect on Rhoten and Piper fatigue. Results showed better function of PMR compared to aerobic exercise in improving the symptoms of anxiety, sleep disorders, and fatigue in hemodialysis patients. Given that fatigue and sleep quality cause severe anxiety and somehow undermine quality of life in hemodialysis patients, taking into account non-pharmacological treatments such as aerobic exercise particularly PMR is a highly economical but efficient and efficacious strategy to manage several problems of these patients. Healthcare teams can incorporate these safe programs in care designs

Optimization of Auto-induction Conditions for the Heterologous Expression of a Maltogenic Amylase in Escherichia coli

Background and Objectives: Auto-induction is usually employed to achieve high cell density and overproduction of proteins with a simple and low-cost operation. The efficiency of heterologous protein expression in Escherichia coli is determined by different parameters. Interactions between these parameters usually complicate the identification of those that contribute more to the improvement of protein expression. As optimal implementation of the auto-induction considerably relies on both the composition of the auto-induction medium and induction conditions, the present study focused on the optimization of related culture parameters through response surface methodology. Materials and Methods: In the first step, the optimum culture temperature and auto-induction duration were determined with the aim of achieving the highest specific activity. Then the culture composition was optimized through response surface methodology considering the concentration of carbon sources, glucose and lactose, as the variables for the simultaneous maximizing of the Maltogenic Amylase volumetric yield and specific activity. Results and Conclusion: Expression of recombinant Maltogenic Amylase under optimum conditions in the shake-flask cultures of Escherichia coli harboring pET 28a increased by 1.7 folds in comparison with an un-optimized auto-induction culture. The Maltogenic Amylase specific activity and volumetric yield were found to be 34.93 U mg-1 and 390.78 U ml-1 at optimum conditions, respectively

The effect of red lentil hydroalcoholic extract on retention and retrieval of memory in young and aged mice

Background: Since ancient times, people have believed that certain foods or plants can affect learning and memory potency in humans. The consumption of food and beverages rich in flavonoid compounds has been proposed as a way to restrict the neurodegeneration associated with many neurological complications and to reverse or prevent deterioration in cognitive performance. Objectives: In the present study, we have attempted to show the effect of red lentil extract (RLE), an edible legume with a high quantity of flavonoid, on retrieval and retention of memory in young and aged animals with the use of a passive avoidance apparatus. Materials and Methods: For the experiments, after coding, the animals (128 total) were weighted and classified into different groups as follows: Group 1 as a control received only electric shock, while group 2 as a blank received electric shock plus normal saline (1 mL/100 g). The test groups (groups 3 and 4) received electric shock plus 400 and 800 mg/kg ip. RLE, respectively. The delay in leaving the platform of avoidance apparatus was measured for both retrieval and retention tests of memory in all groups, whereas experiments were conducted on two age levels - young and aged mice. In the test of retention after getting electric shock, RLE immediately, whereas in the test of retrieval 23.5 hours after the shock was administered. Results: Our findings demonstrated where applying both400mg/kg and 800 mg/kg of RLE significantly increased (the latency time increased about 2- and 3-fold respectively in comparison with the control group) retention and retrieval (at least 7-fold compared to the control group) of the memory of young (P < 0.05) and aged (P < 0.01) mice. Conclusions: It can be concluded that the devisable memory-enhancing effects of red lentil (lens culinaris) are due to the antioxidant activity of its flavonoid, tannins, and terpenoids. © 2016, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences

Toward a More Accurate Web Service Selection Using Modified Interval DEA Models with Undesirable Outputs

With the growing number of Web services on the internet, there is a challenge to select the best Web service which can offer more quality-of-service (QoS) values at the lowest price. Another challenge is the uncertainty of QoS values over time due to the unpredictable nature of the internet. In this paper, we modify the interval data envelopment analysis (DEA) models [Wang, Greatbanks and Yang (2005)] for QoS-aware Web service selection considering the uncertainty of QoS attributes in the presence of desirable and undesirable factors. We conduct a set of experiments using a synthesized dataset to show the capabilities of the proposed models. The experimental results show that the correlation between the proposed models and the interval DEA models is significant. Also, the proposed models provide almost robust results and represent more stable behavior than the interval DEA models against QoS variations. Finally, we demonstrate the usefulness of the proposed models for QoS-aware Web service composition. Experimental results indicate that the proposed models significantly improve the fitness of the resultant compositions when they filter out unsatisfactory candidate services for each abstract service in the preprocessing phase. These models help users to select the best possible cloud service considering the dynamic internet environment and they help service providers to improve their Web services in the marke

An ant-based rate allocation algorithm for media streaming in peer to peer networks: extension to multiple sessions and dynamic networks

In this paper, we introduce a novel algorithm for rate allocation in media stream- ing P2P networks where multimedia contents are distributed among network members and streamed toward any requesting peer. The proposed algorithm is based on ant-colony optimization. It is capable of handling network dynamism, which is an inherent property of unstructured P2P networks. Another advantage of our algorithm is its ability to get over uncertainties in network state information, particularly the rate of supplying peers that could happen due to lack of accurate measurements. In addition, the suggested method does not rely on any information about the topology of the network. We have investigated both single and multiple streaming sessions scenarios in which more than one peer is receiving media streams from media providers. We show that the suggested algorithm will reach the maximum achievable rate of the network quite fast. A key feature of the proposed algorithm is its low pass filter property, which makes it discriminate between transient and permanent network changes. If the changes are transient, the algorithm easily and rapidly compensates the temporary losses. In cases where the network changes last longer, the algorithm overcomes losses by employing other nodes that have the media stream available. The rate of adaptation is adjustable and must be carefully determined according to network conditions. Moreover, adaption rate is not constant and varies during the streaming session. This results in uninterrupted services for current users in cases where multiple sessions are present in the network. Finally, since we have assumed that fountain codes are used to encode media streams in the P2P networks, the suggested algorithm does not require the user to receive different parts of the streams according to a predefined order and from a specific list of media suppliers. It suffices that the user gets as many stream chunks as necessary, regardless of their order or the fact that not all the media suppliers have all the parts available. In other words, using fountain codes enables us to overcome a big difficulty of P2P media streaming and that is to receive different parts of media streams according to a specific order