A Study of the Performance of Referral System in Urban Family Physician Program in Fars Province, Iran

Introduction: The family physician referral system has been determined as a major goal to economic, social, and cultural development in the field of health in Iran. The necessity of implementing this system has been explicitly stated in high-level documents. Hence, the aim of this study was to evaluate the overall performance of the referral system in Fars Province in 2015. Methods: In this cross-sectional study, 20% of family physicians (75 doctors) were randomly selected; then, all patients of these physicians (1289 patients) in one work shift were studied. The data were collected in three parts containing the questions related to the physician and patients using data collection forms. Finally, data analysis was performed through SPSS, version16, using descriptive statistics and Chi-square test. Results: The results showed that 70.3% of the patients (906 patients) had used the referral system to visit specialists. Most of the referral forms had been completed correctly (63.6%). Most of the referrals (820 cases) were recognized as necessary (59.4%) and from the first level of referral, i.e. by the family physician (96.3%: 1241 cases). The patients aged 70 and over had the minimum self-referrals, whereas young people aged lower than 20 had the maximum selfreferrals (P=0.03). Also, more self-referrals were observed among highly educated patients (P=0.001). Conclusion: Based on the findings, the most important problems of the referral system included self-referrals, incomplete referral forms, and unnecessary referrals. Self-referral could be solved through education, establishment of an electronic referral system, and legal measures. Also, educating doctors, making an electronic referral system, and using auxiliary staff and incentive measures can reduce the incompleteness of the referral forms. To reduce the patients’ unnecessary referrals, development of referral guidelines might be very effective

Prevalence and determinants of under-nutrition among children under six: a cross-sectional survey in Fars province, Iran

Background: Childhood malnutrition as a major public health problem among children in developing countries can affect physical and intellectual growth and is also considered as a main cause of child morbidity and mortality. The objective of this study was to estimate the prevalence of under-nutrition and identify determinants of malnutrition among children under 6 years of age in Fars province, Iran. Methods: This survey was conducted by house to house visit through multi-stage sampling in 30 cities of Fars province, during December 2012 to January 2013. A total of 15408 children, aged 0–6 years old, were studied for nutritional assessment in terms of underweight, stunting, and wasting. Also, socio-demographic measures were obtained from structured questionnaire. Backward stepwise logistic regression was used to relate underlying factors to the odds of under-nutrition indices. Results: The rates of stunting, underweight, and wasting were 9.53, 9.66, and 8.19%, respectively. Male children were more stunted compared to females (OR= 1.41, CI: 1.26–1.58). Also, stunting was significantly associated with lower family income (OR= 3.21, CI: 1.17–8.85) and lower maternal education (OR= 0.80, CI: 0.64–0.98). Living in urban areas, and poor water supply were identified as significant risk factors of all three types of childhood under-nutrition. Moreover, Khamse and Arab ethnic groups were more vulnerable to under-nutrition. There was a suggestion that non-access to health services were associated with wasting (OR= 1.87, CI: 1.39–2.52) and also large family size was related to underweight (OR= 1.35, CI: 1.10–1.65). Conclusion: The prevalence of under-nutrition in the study population was categorized in low levels. However, planning the public preventive strategies can help to control childhood under-nutrition according to underlying factors of malnutrition in the study population including gender, settlement area, family size, ethnicity, family income, maternal education, health services, and also safe water supply

Associated factors of birth weight outcomes in the south of Iran: A cross-sectional survey

Background: Adverse birth outcomes are serious health problems that increase morbidity and mortality in neonates. Socioeconomic inequities are linked with Low Birth Weight (LBW) and High Birth Weight (HBW); however, the associations of these factors differ in various groups. The present survey aimed to estimate the prevalence of LBW and HBW and also to determine the associated demographic and socioeconomic factors. Methods: A population-based, cross-sectional survey was conducted on 6495 children, aged 0-2 years, selected through cluster and multistage sampling methods in 30 cities of Fars province, Iran, from December 2012 to January 2013. Determinants were assessed using a questionnaires including demographic, health parameters, and socioeconomic variables. Also, birth weights were recorded from health report cards. We examined the association between probable factors related to LBW and HBW, and analyzed the data using multinomial regression model. Results: Among the study population, 636 (9.7%) were LBW and the rate of HBW was estimated to be 152 (2.3%). In multinomial regression, the odds ratio of LBW was significantly higher in girls (OR=1.38, 95%CI=1.17-1.63), and the first (OR=1.7, 95%CI=1.25-2.31) and the second born child (OR=1.4, 95%CI=1.06-2.02); this ratio was lower in families with the father as the head of the family (OR=0.31, 95%CI=0.13-0.68) or mother (OR=0.43, 95%CI=0.11-1.64), and children from low populated families (OR=0.54, 95%CI=0.42-0.68). Moreover, the lower maternal education (OR=2.52, 95%CI=1.36-4.70) was significantly associated with increased HBW; however, girls (OR=0.56, 95%CI=0.39-0.79), low populated families (OR=0.60, 95%CI=0.37-0.96), and fathers as family head (OR=0.19, 95%CI=0.05-0.71) lowered the odds of HBW. Conclusion: LBW was identified at a relatively high level. The prevention of adverse birth outcomes may be applicable by targeting demographic and social determinants like gender, birth order, family size, mother’s education, and family head as predictors of birth weight in public health interventions

Evaluation of the association between KIR polymorphisms and systemic sclerosis : a meta-analysis

Background: The results of investigations on the association between killer cell immunoglobulin-like receptor (KIR) gene polymorphisms and the risk of systemic sclerosis (SSc) are inconsistent. To comprehensively evaluate the influence of KIR polymorphisms on the risk of SSc, this meta-analysis was performed. Methods: A systematic literature search was performed in electronic databases including Scopus and PubMed/ MEDLINE to find all available studies involving KIR gene family polymorphisms and SSc risk prior to July 2019. Pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were measured to detect associations between KIR gene family polymorphisms and SSc risk. Results: Five articles, comprising 571 patients and 796 healthy participants, evaluating the KIR gene family polymorphisms were included in the final meta-analysis according to the inclusion and exclusion criteria, and 16 KIR genes were assessed. None of the KIR genes were significantly associated with the risk of SSc. Conclusions: The current meta-analysis provides evidence that KIR genes might not be potential risk factors for SSc risk

Prevalence and Determinants of Under-Nutrition Among Children Under Six: A Cross-Sectional Survey in Fars Province, Iran

Background: Childhood malnutrition as a major public health problem among children in developing countries can affect physical and intellectual growth and is also considered as a main cause of child morbidity and mortality. The objective of this study was to estimate the prevalence of under-nutrition and identify determinants of malnutrition among children under 6 years of age in Fars province, Iran. Methods: This survey was conducted by house to house visit through multi-stage sampling in 30 cities of Fars province, during December 2012 to January 2013. A total of 15408 children, aged 0–6 years old, were studied for nutritional assessment in terms of underweight, stunting, and wasting. Also, socio-demographic measures were obtained from structured questionnaire. Backward stepwise logistic regression was used to relate underlying factors to the odds of under-nutrition indices. Results:The rates of stunting, underweight, and wasting were 9.53, 9.66, and 8.19%, respectively. Male children were more stunted compared to females (OR= 1.41, CI: 1.26–1.58). Also, stunting was significantly associated with lower family income (OR= 3.21, CI: 1.17–8.85) and lower maternal education (OR= 0.80, CI: 0.64–0.98). Living in urban areas, and poor water supply were identified as significant risk factors of all three types of childhood under-nutrition. Moreover, Khamse and Arab ethnic groups were more vulnerable to under-nutrition. There was a suggestion that non-access to health services were associated with wasting (OR= 1.87, CI: 1.39–2.52) and also large family size was related to underweight (OR= 1.35, CI: 1.10–1.65). Conclusion:The prevalence of under-nutrition in the study population was categorized in low levels. However, planning the public preventive strategies can help to control childhood under-nutrition according to underlying factors of malnutrition in the study population including gender, settlement area, family size, ethnicity, family income, maternal education, health services, and also safe water supply

The Relationship between Energy Consumption and Hospital Functional Indicators in Teaching Hospitals of Shiraz University of Medical Sciences: 2009-2011

Background: Hospitals as major energy consumers can manage their energy consumption by intelligent interventions. Therefore, this study aimed to determine the amount of energy consumption of Water, Electricity, and Gas, and their association with functional indicators in teaching hospitals of Shiraz University of Medical Sciences from 2009 to 2011. Methods: The present study was descriptive and cross-sectional in design which analyzed energy consumption and functional indicators from the beginning of 2009 to the end of 2011. The sample consisted of 7 teaching hospitals affiliated to Shiraz University of Medical Sciences. Data were collected from the departments of consumption pattern reform and statistics and recorded in the data collection form  developed by the researcher. Data were entered in SPSS16 and analyzed using descriptive and analytical tests such as Pearson correlation test. Results: The average consumption of water, electricity, and gas per occupied bed days were 0.09 m3, 2.78 kWh, and 1.56 m3, respectively. Also, statistically significant and positive relationships were found between the amount of water consumption and the number of active beds (P = 0.009) and occupied bed days (P = 0.007). Conclusion: Energy consumption in teaching hospitals of Shiraz is lower than similar domestic studies and in some cases more than foreign studies. More active beds with lower productivity increase energy consumption. Hospitals can reduce energy consumption and their costs with more efficient use of resources

Shift Work and Related Health Problems among Medical and Diagnostic Staff of the General Teaching Hospitals Affiliated to Shiraz University of Medical Sciences, 2012

Introduction:Today, shift work is considered as a necessity in many jobs and for some 24-hour services the use of shift-work is growing. However, shift work can lead to physiological and psycho-social problems for shift workers. This study aimed to determine the effects of shift work on the associated health problems, together with the demographic and job characteristics underlying the problems, among the medical and diagnostic staff of the general teaching hospitals affiliated to Shiraz University of Medical Sciences in 2012. Method:This study was an applied, cross-sectional and descriptive-analytical one. The study employed a sample of 205 employees from the medical and diagnostic staff using stratified sampling proportional to the size and simple random sampling methods. Data were collected using the Survey of Shift workers (SOS) questionnaire, validity and reliability of which have already been confirmed. Finally, the collected data were analyzed using SPSS 16.0 software through ANOVA, Chi-square, Independent-Samples T-Test, as well as Pearson Correlation Coefficient. A P<0.05 was considered statistically significant. Results: The results showed that among the demographic and job characteristics studied, the individual, family and social problems had significant associations with work schedules, shift work and job satisfaction. In addition, there were significant associations between musculoskeletal disorders and the satisfaction of shift work; cardiovascular disorders and marital status and occupation; digestive disorders and the work schedules; sleep disorders and the satisfaction of shift work; musculoskeletal disorders, cardiovascular disorders and sleep disorders and age, job experience and shift work experience. And finally, there were significant associations among sleep disorders and age, job experience and the shift work experience. Conclusion: Based on the findings of this study, demographic characteristics such as age, marital status, as well as job characteristics can increase the individual, family and social problems, and cardiovascular, musculoskeletal, digestive and sleep disorders. Therefore, in order to reduce these problems and disorders, the following suggestions are made: allowing voluntary shifts for the staff, shortening the hours of night work, limiting the employment of older people in the shift work systems, etc

The impact of rural health system reform on hospitalization rates in the Islamic Republic of Iran: an interrupted time series

OBJECTIVE: To assess the effects on hospital utilization rates of a major health system reform – a family physician programme and a social protection scheme – undertaken in rural areas of the Islamic Republic of Iran in 2005. METHODS: A “tracer” province that was not a patient referral hub was selected for the collection of monthly hospitalization data over a period of about 10 years, beginning two years before the rural health system reform (the “intervention”) began. An interrupted time series analysis was conducted and segmented regression analysis was used to assess the immediate and gradual effects of the intervention on hospitalization rates in an intervention group composed of rural residents and a comparison group composed of urban residents primarily. FINDINGS: Before the intervention, the hospitalization rate in the rural population was significantly lower than in the comparison group. Although there was no significant increase or decline in hospitalization rates in the intervention or comparison group before the intervention, after the intervention a significant increase in the hospitalization rate – of 4.6 hospitalizations per 100 000 insured persons per month on average – was noted in the intervention group (P < 0.001). The monthly increase in the hospitalization rate continued for over a year and stabilized thereafter. No increase in the hospitalization rate was observed in the comparison group. CONCLUSION: The primary health-care programme instituted as part of the health system reform process has increased access to hospital care in a population that formerly underutilized hospital services. It has not reduced hospitalizations or hospitalization-related expenditure