Determining the Frequency of Defensive Medicine Among General Practitioners in Southeast Iran

Background: Defensive medicine prompts physicians not to admit high-risk patients who need intensive care. This phenomenon not only decreases the quality of healthcare services, but also wastes scarce health resources. Defensive medicine occurs in negative and positive forms. Hence, the present study aimed to determine frequency of positive and negative defensive medicine behaviors and their underlying factors among general practitioners in Southeast Iran. Methods: The present cross-sectional study was performed among general practitioners in Southeast Iran. 423 subjects participated in the study on a census basis and a questionnaire was used for data collection. Data analysis was carried out using descriptive and analytical statistics through SPSS 20. Results: The majority of participants were male (58.2%). The mean age of physicians was 40 ± 8.5. The frequency of positive and negative defensive medicine among general practitioners in Southeast Iran was 99.8% and 79.2% respectively. A significant relationship was observed between working experience, being informed of law suits against their colleagues, and committing defensive medicine behavior (P< 0.001). Conclusion: The present study indicated high frequency of defensive medicine behavior in the Southeast Iran. So, it calls policy-makers special attention to improve the status quo

Prevalence of smoking in northwest Iran: a meta-analysis

Background: Tobacco addiction is a major cause of preventable death worldwide. Thus, efforts to eliminate its use have the potential of producing significant health benefits. The purpose of this study was to conduct a meta-analysis to estimate the prevalence of cigarette smoking among people in the age range of 15 to 64. The specific objective of this meta-analysis was to provide valid data that policy makers can use to make evidence-based decisions. Methods: To determine the prevalence of smoking among the adult population in northwest Iran, we used reports published by the surveillance system used to assess the risk factors for non-communicable diseases in different provinces in northwest Iran for the years 2004 and 2006-2009. Several variables were extracted, including the years of study, gender, ages, and smoking prevalence. Based on the heterogeneity of the results, we used fixed or random effects models to estimate the overall prevalence of cigarette smoking. The analyses were performed using Stata 11 software. Results: A total of 28,436 subjects (14,248 males and 14,188 females) in five age groups, i.e., 15-24, 25-34, 35-44, 45-54, and 55-64, were interviewed. Meta-analysis in men showed that, across the age groups, the lowest prevalence was 22.9%, the highest prevalence was 26.5%, and the average prevalence was 24.7%. Among women, the lowest prevalence was 0.3%, the highest prevalence was 0.8%, and the average prevalence was 0.5%. Conclusion: We found that approximately one-fourth of males in the age range of 15-64 in northwest Iran smoked cigarettes daily. Therefore, it is necessary to conduct effective interventions to reduce the prevalence of addiction to tobacco in this area

Determining the frequency of defensive medicine among general practitioners in Southeast Iran

Abstract Background: Defensive medicine prompts physicians not to admit high-risk patients who need intensive care. This phenomenon not only decreases the quality of healthcare services, but also wastes scarce health resources. Defensive medicine occurs in negative and positive forms. Hence, the present study aimed to determine frequency of positive and negative defensive medicine behaviors and their underlying factors among general practitioners in Southeast Iran. Methods: The present cross-sectional study was performed among general practitioners in Southeast Iran. 423 subjects participated in the study on a census basis and a questionnaire was used for data collection. Data analysis was carried out using descriptive and analytical statistics through SPSS 20. Results: The majority of participants were male (58.2%). The mean age of physicians was 40 ± 8.5. The frequency of positive and negative defensive medicine among general practitioners in Southeast Iran was 99.8% and 79.2% respectively. A significant relationship was observed between working experience, being informed of law suits against their colleagues, and committing defensive medicine behavior (P&lt; 0.001). Conclusion: The present study indicated high frequency of defensive medicine behavior in the Southeast Iran. So, it calls policy-makers special attention to improve the status quo

Estimating the Annual Risk of Tuberculosis Infection and Disease in Southeast of Iran Using the Bayesian Mixture Method

Background: Tuberculosis is still a public health concern in Iran. The main challenge in monitoring epidemiological status of tuberculosis is to estimate its incidence accurately. Objectives: We used a newly developed approach to estimate the incidence of tuberculosis in Sistan, an endemic area in southeast of Iran in 2012-13. Patients and Methods: This cross-sectional study was conducted on school children aged 6-9 years. We estimated a required sample size of 6350. Study participants were selected using stratified two-stage cluster sampling method and recruited in a tuberculin skin test survey. Indurations were assessed after 72 hours of the injection and their distributions were plotted. Prevalence and annual risk of tuberculosis infection (ARTI) were estimated using the Bayesian mixture model and some traditional methods. The incidence of active disease was calculated using the Markov Chain Monte Carlo technique. Results: We assumed weibull, normal and normal as the best distributions for indurations due to atypical reactions, BCG (Bacillus Calmette–Guérin) reactions and Mycobacterium tuberculosis infection, respectively. The estimated infection prevalence and ARTI were 3.6% (95%CI: 3.1, 4.1) and 0.48%, respectively. These estimates were lower than those obtained from the traditional methods. The incidence of active tuberculosis was estimated as 107 (87-149) per 100000 population with a CDR of 54% (40%-68%). Conclusions: Although the mixture model showed slightly lower estimates than the traditional methods, it seems that this method might generate more accurate results for deep exploration of tuberculosis endemicity. Besides, we found that Sistan is a high endemic area for tuberculosis in Iran with a low case detection rate

Predictive factors of death in patients with tuberculosis: a nested case-control study

Tuberculosis is one of the main causes of death worldwide. This study aimed to determine predictive factors for death in patients with tuberculosis to set priorities for public heath interventions to reduce mortality in these patients. This nested case-control study was carried out in Mazandaran province of Islamic Republic of Iran among tuberculosis patients who were treated during 2002-2009. Each deceased patient was individually matched with a control patient according to sex, age, area of involvement and time of follow-up. Potential risk factors for death were evaluated using multivariate conditional logistic regression models. From 2206 patients 376 cases and 376 matched controls were selected. Only positive serology for HIV (OR = 19.1), history of kidney disease (OR = 6.81) and use of immunosuppressant drugs (OR = 3.96) significantly increased the risk of death in tuberculosis patients. These potentially modifiable risk factors could be taken into account in preventive interventions for tuberculosis patients in our country