The process of evolution of medical services tariffs and reimbursements based on Diagnosis-Related Groups

Introduction: Diagnosis Related Groups (DRG) is a classification system used for the inpatients in which the inpatients who use similar resources are classified as one similar category. This classification is based on the following components: diagnosis codes, taken actions, age, complications, gender and the discharge status. This study intended to explore the universal approach for the evolution of this reimbursement and its challenges and benefits so that an appropriate strategy can be agreed for the reimbursement system in Iran. Methodology: This study of descriptive comparative nature was conducted in 2013 to shed some light on the evolution process of the DRG in the health care system. The data were gathered though using information resources including articles, books, magazines and valid web-sites. To obtain the strategies used in the selected nations, 110 articles were extracted from varied magazines and scientific resources. Then, the status of the nations on the development of this reimbursement system was compared so that the related obtained results can be used as guide for developing an appropriate strategy for Iran's repayment system. Findings: Based on the findings of this study, one of the criteria for development of DRG is its high penetration coefficient in terms of determining the accuracy of the row of the diagnosis, the accuracy of main diagnosis coding, the accuracy of the used codes and the condition of the patient at the discharge time. Using DRG, the speed of calculating the medical and healthcare services' costs increases, since checking the profile, the skillful coder is able to perform coding appropriately and rapidly and finally, the payment of costs can be done based on the respective codes. Conclusion: As a prospective payment system, DRG acts as a motivator for the service providers for decreasing the level of services and consequently, the patient's length of stay. © IDOSI Publications, 2014

A Survey on the State of Physical Activity Among Middle-Aged Women in Health Center in Zarin Shahr City in Iran, fall 2016

Background and aims: Studies have shown that regular physical activity (exercising) has a critical role in improving physical and mental health of people in all age groups and reduces the dangers caused by non-communicable disease such as high blood pressure, overweight, severe obesity, and increased lipoprotein serum. In this survey, the aim of the study was to study the state of physical activity among middle-aged women and its barriers, constraints and its related factors such as job and BMI because of the effective role, which women play in providing health and hygiene for their families and the society. Methods: The current study was a cross sectional research in which 220 middle-aged women (age range of 30-59) selected using convenience sampling, which visited the Health Clinic in Zarin Shahr. The data were gathered using two standard questionnaires designed by the Office of Middle Aged Health in the Ministry of Health and Medical Education. The gathered data were analyzed using SPSS and significant P- value was considered P<0.05. Results: The findings show that 57.2% of the elderly women had physical activity and 42.8 had no physical activity. There is a significant statistical relationship between job and physical activity. The level of physical activity among the employed women was less than those who are homemakers, P=0.015. There was no significant statistical relationship between BMI and physical activity P=0.769 and there was not much of a difference in terms of BMI between those who have and do not have physical activity (P>0.05). Conclusion: Not having enough time, taking care of a child who is under 2 years of age, lack of motivation, and not awareness about the positive effects of physical activity on physical and mental wellbeing are the main reasons for not having suitable physical activity. Therefore, it is suggested that appropriate programs for improving women’s health, improving knowledge, attitude, and change of behavior among these people should be performed

The Effect of Twin Birth on Neonatal and Infant Mortality Rates: A Systematic Review

Background and aims: Twin birth may account for higher mortality rates in infants and neonates. To investigate the potential relationship between twin birth and infant and neonatal mortality rates (NMRs), a systematic review was conducted. Methods: To gather the evidence for the relationship between twin birth and its potential effect on mortality during infancy and neonatal periods, a systematic review was conducted. The most important used databases were PubMed, Google Scholar, Web of Science, Scopus, ProQuest, Cochrane and Springer. Then, the databases were searched by appropriate keywords. After reviewing and evaluating the collected studies, trends in the different countries were compared. Results: A total of 13 790 related studies were found, of which 128 studies were selected in the first step. The studies which were not related to the subject, in addition to repetitive studies, were excluded from the search in the second step based on inclusion and exclusion criteria by reviewing the abstract and, in some cases, the full article. Finally, 7 studies entered the last step. Conclusion: This study showed that the mortality could be higher among twins than among non-twins, especially among boys

Prevalence of major coronary heart disease risk factors in Iran

Background and aims: Coronary heart diseases (CHDs) contribute to mortality, morbidity, disability, productivity and quality of life. This study was aimed to determine the prevalence of major risk factors for CHD in the provinces of Iran. Methods:This study reported pre-existing data and was of secondary, descriptive type. Prevalence of non-communicable disease (NCD) risk factors was defined for the provinces of Iran. A reliable report of NCD risk factors, the national surveillance program conducted in Iran, such as type II diabetes, hypertension and mean body mass index (BMI), smoking, hookah smoking, high cholesterol and obesity was used. Results: The highest and lowest prevalence of hypertension was obtained in Bushehr (20.85) and Yazd (12.86) provinces, respectively. The highest mean BMI was reported from Mazandaran province (26) and the lowest from Sistan and Baluchestan province (22.50). Qom province had the highest prevalence of diabetes (27.65). The highest prevalence of high cholesterol was obtained in Lorestan province (50.87 ) and the lowest in the Khouzestan province (22.71). East Azarbaijan province had the highest prevalence of smoking (14.8) and Kurdistan province the lowest (0.16). Hookah smoking was most prevalent in Hormozgan province (7.62). The highest prevalence of physical activities was reported from Sistan and Baluchestan province (47.84) and the lowest from Kohgiluyeh and Boyer-Ahmad (22.2). Conclusion:Prevalence of CHD risk factors is the main priority for the Iranian health system. There is a need for intervention programs in the provinces which are at greater risk as well as for modification of people’s lifestyle

A Double-Blind Randomized Trial Comparing the Effectiveness and Safety of Nifedipine and Isosorbide Dinitrate in Chronic Anal Fissure

Background: Chronic anal fissure is a common disease that is accompanied with pain and bleeding during defecation. Various surgical and non-surgical methods have been offered for the treatment of this condition. The aim of this randomised clinical study was to compare the effectiveness and safety of nifedipine and isosorbide dinitrate (ISDN) in the treatment of chronic anal fissure. Methods: This double-blind clinical trial study was performed on patients aged 20 to 60 years old in 2012 to 2013. The samples with a primary diagnosis of chronic anal fissure were enrolled from the patients admitted to public treatment at the educational Imam Ali Clinic, Shahrekord, Iran by researchers and general surgery specialists. The patients were randomised into two groups: nifedipine 0.3% (n = 35) or ISDN 0.2% (n = 35) applied three times a day for three weeks. The patients were examined on the 7th, 14th, and 21st days of treatment, and the symptoms including bleeding, pain, and healing status, as well as the side effects of the drugs, were assessed. Pain was evaluated using a visual analogue scale (VAS). Results: After 21 days of follow-up, complete healing was achieved in 77.1% (n = 27) of patients in the nifedipine group and 51.4% (n = 18) in the ISDN group (P = 0.05). The mean VAS of the pain on day 21 was 0.91 (SD 0.01) in the ISDN group and 0.45 +/- 0.78 in the nifedipine group, with a statistically significant difference (P = 0.038). The bleeding was similar in the two groups (P = 0.498). Conclusion: In view of the findings on healing status and pain in the patients, nifedipine may be significantly more effective in the treatment of chronic anal fissure than ISDN

Study of pregnant women’s mortality in Chaharmahal va Bakhtiari province in a 10-year period (2002-2012)

Background and aims: Women’s pregnancy- and childbirth-associated mortality is one of the most important indices of a country’s development status. Therefore, It was examined the mortalities of pregnant women in Chaharmahal va Bakhtiari province within a 10-year period. Methods: This descriptive, cross-sectional, retrospective study was conducted in 2013-2014 in Chaharmahal va Bakhtiari province. All files of the pregnant women from 2002 to 2012 were examined. Results: Within this 10-year period, 28 (17.2% of 100000 live births) pregnant women died. The mean age of women was 31.1±5.9 years old and the mean gestational age was 35.17±6.61 years old. The majority of the women were illiterate and rural (71.4%). A high proportion (46.4%) of the women experienced ≥4th pregnancy and most (46.4% of the) deliveries were cesarean. 19 (67.9% of the) deaths were directly pregnancy-related and nine were indirectly pregnancy-related. The most prevalent reasons for direct and indirect deaths were bleeding and heart disease, respectively. 4 (14.28% of the) died women whose death was due to direct reasons did not receive complete pregnancy healthcare. Conclusion: Regarding the results, promotion of literacy and knowledge of mothers, prevention from repeated pregnancies in older ages, appropriate pregnancy healthcare, and prevention from unnecessary cesareans help to decrease mortalities among pregnant women

Comparison of N-acetylcysteine and angiotensin converting enzyme inhibitors in blood pressure regulation in hypertensive patients

BACKGROUND: Hypertension (HTN) is the most prevalent non-infectious disease worldwide and can lead to mortality. This trial aimed to compare the effect of N-acetylcysteine (NAC) and angiotensin-converting enzyme inhibitors (ACEIs) on controlling blood pressure in hypertensive patients. METHODS: This cross-sectional clinical trial was conducted in Hajar Hospital, Shahrekord, Iran, in 2009. A sample of 126 patients with HTN was selected and randomly divided into 2 groups (group A and group B). First, group A was treated with ACEI alone and group B with ACEI + NAC for 2 months. Blood pressure of all patients was evaluated each week. After a 2 week period of washout, the drugs were changed. In the second period of the trial, group A was treated with ACEI + NAC and group B with NAC alone and their blood pressure was evaluated in the same manner as the previous period. The data were analyzed using SPSS. RESULTS: A significant reduction was observed in systolic and diastolic blood pressure of patients (P < 0.050). However, during both periods of the trial, the group receiving NAC + ACEI experienced a more significant reduction in blood pressure compared with the ACEI group (P < 0.050). CONCLUSION: NAC accompanied with ACEI decreased the patients' systolic and diastolic blood pressure significantly; however, ACEI alone did not have any significant effects on blood pressure. Systolic blood pressure decreased 7 mmHg on average and fluctuated during the trial

Effects of epidemiology learning software on nursing and midwifery students

Background: Being informed of new methods of teaching and comparing their outcome help teachers use more effective and efficient methods in developing and implementing new training courses. The aim of this study was to examine the efficacy of epidemiology learning software on learning epidemiology courses. Methods: This quasi-experimental study included 101 nursing and midwifery students taking epidemiology course in two separate classes. One of the classes was selected as intervention group (taught via software) and another one as the control group. At the end of the semester, scores of the courses were analyzed using covariance analysis. Results: After adjusting the effect of grade point average, covariance analysis indicated a significant difference in epidemiology scores between the two groups (p<0.001). The students taught through the software obtained significantly higher scores compared to the students in traditional group. Conclusion: By means of this training software, teachers can use several strategies for presenting lessons and increasing training efficacy, leading to active learning in students

The study of health, cultural and social conditions of the Chaharmahal va Bakhtiary province’s rural population in 2007

زمینه و هدف: شناخت مشکلات و سختی های خاص جمعیت روستایی، می تواند در برنامه ریزی های بعدی مفید و موثر باشد. از آنجا که شناخت وضعیت موجود اولین قدم در برنامه ریزی های توسعه اقتصادی، اجتماعی و فرهنگی می باشد، لذا این مطالعه با هدف بررسی جنبه هایی از وضعیت بهداشتی، فرهنگی و اجتماعی ساکنین مناطق روستایی استان چهارمحال و بختیاری انجام شده است. روش بررسی: در این مطالعه توصیفی - مقطعی، 1638 نفر از سرپرستان خانوارهای روستایی استان چهارمحال و بختیاری بوسیله نمونه گیری در دسترس انتخاب شدند. روستاهای منتخب در این پژوهش حدوداً 90 روستا بود که اردوی طرح هجرت سال 1386 در آن مناطق برگزار شد. داده ها به کمک پرسشنامه چند قسمتی (آلفای کرونباخ 89) با 47 سوال شامل اطلاعات دموگرافیک، وضعیت آموزش، اشتغال، توان اقتصادی، تنظیم خانواده، تغذیه، فشارخون، دخانیات و بهداشت فردی جمع آوری و توصیف گردید. یافته ها: بیکاری در مناطق روستایی استان 6/31 بود. 86 دارای منزل شخصی، 30 دارای خودرو شخصی و 87 دارای توالت و حمام بهداشتی در منزل بودند. 22/43 تمایل به مهاجرت داشتند. میزان آگاهی از مشکلات ناشی از عدم رعایت تنظیم خانواده 74/75 و بیشترین روش مورد استفاده قرص خوراکی (1/45) بود. بالاترین میزان استفاده از گوشت قرمز (09/46)، مرغ (23/36) و ماهی (56/62) 1 تا 5 مرتبه در ماه بود. میزان ابتلاء به پرفشاری خون، 25/26 بود. میزان آگاهی از مضرات دخانیات 81/91 و میانگین سنی فرد استفاده کننده، 51/14±81/57 سال بود. وجود فرد حادثه دیده زیر 10 سال در خانواده 65/16 و بیشترین جنسیت فرد حادثه دیده (70) مذکر بود. نتیجه گیری: وضعیت بهداشتی، فرهنگی و اجتماعی ساکنین مناطق روستایی استان در برخی زمینه ها در سطح مطلوبی قرار ندارد و ریشه یابی آن نیاز به مطالعات بیشتری دارد

ENVIRONMENTAL IMPACT ASSESSMENT OF URBAN DEVELOPMENT PATTERN ON MARGINAL AREAS (CASE STUDY: ZABOL CITY)

Abstract. Environmental assessment of urban development on marginal areas in Iran as an inevitable approach to assessing the degree of compatibility of this policy with sustainable urban development components seems to be necessary due to its wide impact on the ecology of cities in Iran. In this framework, the main objective of this article was to assess the environmental impacts of urban development on marginal areas in Zabol city. The research method in this research in termsof research goal, is Applied, and in terms of the research framework, it is analytical and descriptive. SPSS and Expert Choice software were used to analyze the data. The results of single-sample T-test of the environmental indicators in the marginal areas of Zabol city, as well as the environmental impact on the marginal areas, showed that in all indicators, the average obtained is above the average of 3. In fact, the results show the environmental impact of the urban development pattern in the marginal areas of Zabol city is high. In the following, Spearman correlation test has been used to determinethe relationship between these two variables (Environmental impacts of developmental pattern and marginal areas). The results showed that there is a significant relationship between the environmental impacts of urban development and marginal areas, with a significant level of 0/00. Finally Expert Choice software is used to evaluate and rank the most important environmental impacts of urban development pattern on marginal areas from experts' point of view. The results showed, among the desired indicators, air pollution with a weight of 0.374, soil pollution with a weight of 0.220, waterpollution with a weight of 0.177, vegetation changes with a weight of 0.125 and noise pollution with a weight of 0.105 ,respectively, have the highest and lowest weights.Key words: Environmental Impacts, Urban Development, Marginal Areas, Zabol