Outcome of patients with anorectal malformations after posterior sagittal anorectoplasty: a study from Ahvaz, Iran

Aim and purpose The aim of this study was to evaluate the outcome of patients who underwent posterior sagittal anorectoplasty (PSARP) for the treatment of low or high anorectal malformation (ARM).Patients and methods All patients who underwent standard PSARP were included in this study. Patients with mental retardation were excluded from our study. Patients were classified according to the Rintala score into four categories: poor (6–9); fair (9–11); good (12–17); and normal (18–20). We used a questionnaire introduced by Rintala. The type of anomaly was divided into two categories. We used low and high ARM definitions according to the relationship of the terminal colon to the levator muscles of the pelvic floor. The Student t-test, the Pearson v2-test, one-way analysis of variance, and the Levine test were used for data analysis using SPSS ver. 13.0.Results Sixty patients aged 3–17 years (13.63 ± 3.27 years) were included. The mean of score in patients with low-type ARM was 14.5± 2.6 and that in patients with hightype ARM was 13.19± 3.75 (P = 0.28). The mean of scores was 13.34± 3.5 among male patients and 13.94± 2.9 among female patients. There was no statistically significant difference (P = 0.46). The score was significantly higher in patients with fistula (n= 51, 13.9 ± 3.1) than in patients without fistula (n= 9, 11.8± 3.3; P= 0.03). Excluding two cases with scrotal-type fistula and rectal atresia, there was no significant difference between the two groups (P= 0.06).Conclusion There was no significant difference in the outcome after PSARP between boys and girls. There was no significant difference between low-type and high-type ARM. The mean of score was significantly higher among patients with fistula than among patients without fistula.Keywords: anoplasty, anorectal malformation, constipation, fistula, scrotal,vesical, vestibula

Factors Affecting Patients' Preferences Based on the Mixing Factors of Marketing Services in Hospital Selection

oai:ojs.ijhs.shmu.ac.ir:article/696Background: Today, health care market has become a competitive market. Various factors affect the care of the hospital and the choice of hospital by patients. The present study aimed to investigate the effective factors on patients' preferences based on the mixing factors of marketing services in hospital selection. Methods: This descriptive-analytic study was performed on 300 patients referred to educational hospitals in Iran in 2018. The instrument used was a researcher-made questionnaire include two sections (demographic and Patients' Preferences questionnaire). Data was analyzed using descriptive and analytical. Results: Among the 7 components, the highest and the lowest mean and standard deviation were related to staff (1.03 ± 3.89) and location (1.10 ± 2.96), respectively. The index value of the RMSEA for the compiled model it is equal to 0.059, comparative fit index (CFI) is 0.837 and the IFI index is 0.839. Employee component with coefficient of 1.00 and price component with coefficient of 0.72 had the highest and the least effect. Conclusions: Staff and physicians and hospital space have the greatest role in attracting patients. Therefore, it is expected that the hospital management will make the essential planning, and by intervening in the process of work of physicians and staff. Key words: Patient preferences, mixed Marketing, marketing of health services, Hospital

Evaluation of risk factors affecting the lifespan and efficiency of dialysis accesses installed in dialysis patients referees to Ahvaz therapeutic centers in a two-year cohort study

Introduction: It is crucial in order to provide optimal hemodialysis to patients with end-stage renal disease (ESRD) to establish venous access with the least amount of complications. Objectives: In this study, we examined the risk factors that affect the efficiency and longevity of dialysis access for patients receiving dialysis in Ahvaz medical centers. Patients and Methods: In our retrospective study, 180 hemodialysis patients were referred to the Golestan educational and medical center in Ahvaz, Iran. An arteriovenous fistula (AVF) or catheter was conducted to provide them with vascular access. Detailed demographic information about the patient was collected, including age, gender, height, weight, body mass index (BMI), cause of ESRD, duration of renal failure, duration of dialysis, and comorbidities. There were instances of access inefficiency as a result of infection, stenosis, closure, thrombosis, bleeding, and pseudoaneurysms. The data was analyzed using Mann-Whitney U, t test, and chi-square tests with SPSS version 22. Statistics were considered significant at a P value of 0.05. Results: The mean age of the patients was 50.08 ± 12.213 years, and the mean BMI was 27.90 ± 9.112 kg/m2 . Among dialysis patients, there was a significant relationship between male gender, clopidogrel administration, diabetes history, hypertension and access failure. It is estimated that 36.7% of vascular access failures are caused by thrombosis, while 32.8% are due to access stenosis or closure. Conclusion: Our study showed that male gender, clopidogrel administration, and a history of diabetes and hypertension were risk factors affecting dialysis access quality and efficiency. According to our study, it may be possible to develop a more appropriate approach for determining the type and location of dialysis access

Explaining the Challenges of the Iranian Health System in Fighting the Covid-19 Pandemic: a qualitative study

Introduction: The covid-19 pandemic has become a global threat for the general public and health care workers and it has created major challenges for all healthcare sectors. The challenges created by this disease can vary in different countries depending on cultural, social, and economic factors. To explain the challenges of the Iranian health system in fighting the covid-19 pandemic from the managers’ and executive authorities’ viewpoints. Methods The present study is a basic-applied research performed using a qualitative approach. It has studied 30 managers of the hospitals and medical centers’ managers, and deputies of the Ministry of Health, and the universities of medical sciences which were selected by purposive and snowball sampling with the maximum variety in March-September 2020. Data collection was done through semi-structured interviews and content analysis was used to explain the challenges of the Iranian health system in fighting the covid-19 pandemic (2020). Results Most of the interviewees (87%) had a Ph.D. degree (34%), and 40% of the participants were graduated in management and health economy and policymaking fields. Analysis and synthesis of the data collected from the interviews led to the creation of 19 sub-themes and 12 main themes classified into four general scopes including the organizational factors, resources, management factors, and other factors. Conclusion Identifying the mentioned challenges can provide useful information for the managers and policymakers to develop appropriate plans and take the necessary measures for resolving the challenges and using the available resources to provide the most effective services

Strengthening the primary health care system in the face of emerging and re-emerging epidemics — provide a native and Applicable model based on best practices of countries

INTRODUCTION: Disasters affected the primary health care system in many ways. Maintaining primary health care services is a challenging issue during disasters such as epidemics. A review was conducted to study the lessons learned and successful experiences of other countries in opposing the spread of infectious diseases using the capacity of primary health care. MATERIAL AND METHODS: The present study is a comprehensive review of countries’ experiences, successful models, and structural components for development of a model for Iran. A systematic search with suitable keywords was conducted in many databases including web of science, PubMed, Scopus, Science Direct, Google Scholar, and Persian databases; Magiran, and SID. RESULTS: The results showed that generally, the successful actions of countries in case of emergency are divided into disaster cycles including preparedness, response, and recovery. PHC can help health systems to identify new epidemics through surveillance system as an early warning system. Because of the importance of continuity of care in primary health care facilities, business continuity plans are needed. CONCLUSIONS: In order to use the consequences and play an effective role in this field, Iran should use the country’s capacity and inter-sectoral cooperation to establish a comprehensive system for telemedicine programs Providing people with doctors and health professionals can strengthen the performance of the primary health care system finally can strengthen the performance of the primary health care system

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years : an analysis of the Global Burden of Disease Study 2017

Background Many countries have shown marked declines in diarrhoea! disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. Methods This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. Findings Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162-593 145) among children younger than 5 years globally in 2017, a rate of 78.4 deaths (70.1-87.1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69.6% (63.1-74.6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13.3% decrease, 11.2-15.5), childhood wasting (9.9% decrease, 9.6-10.2), and low use of oral rehydration solution (6.9% decrease, 4-8-8-4). Interpretation Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors-particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution-appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.Peer reviewe

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 development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000-18 : a geospatial modelling study

Background More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels.Methods We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km x 5 km resolution in 98 LMICs based on 2.1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution.Findings Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205000 (95% uncertainty interval 147000-257000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution.Interpretation Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. FINDINGS: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30-30·30 million) new cases of TBI and 0·93 million (0·78-1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40-57·62 million) and of SCI was 27·04 million (24·98-30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (-0·2% [-2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (-3·6% [-7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0-10·4 million) YLDs and SCI caused 9·5 million (6·7-12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. INTERPRETATION: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments