Prevalence Rate of Diabetes and Hypertension in Disaster-Exposed Populations: A Systematic Review and Meta-Analysis

BACKGROUND: Non-communicable diseases (NCD) such as hypertension (HTN) and diabetes mellitus (DM) have been one of the major health problems in the world. The aim of this study was to evaluate the prevalence rate of DM and HTN following natural and man-made disasters that impose significant economic and psychological burdens on human communities.METHODS: In this systematic and meta-analysis review, all crosssectional studies that at least one of their objectives was to measure the prevalence of HTN or DM in individuals affected by natural and man-made disasters were included. Literature review was done in international databases including PubMed, Scopus and Web of Science, from database inception to February 17, 2019. The extracted data included the bibliographic characteristics of the article, the age of the participants, number of participants, gender, sample size, outcome, duration of the follow-up, and prevalence of DM and HTN. Data were analyzed by STATA software (version11) and random effect method and the I2 index were used to investigate heterogeneity between the articles.RESULTS: A total of 16 articles met the inclusion criteria. Based on the quality assessment, 11 papers were categorized as moderate and 5 paper were categorized as high quality. The prevalence of HTN and DM in disaster-exposed populations were 47.35 (CI 95%: 38.53-56.17) and 13.56 (CI 95%: 10.12-17.01), respectively.CONCLUSION: The results of this study show a high prevalence of HTN and DM in survivors of major disasters, which is higher in comparison to the general population.&nbsp

Macroeconomic policies and increasing social-health inequality in Iran

Background: Health is a complex phenomenon that can be studied from different approaches. Despite a growing research in the areas of Social Determinants of Health (SDH) and health equity, effects of macroeconomic policies on the social aspect of health are unknown in developing countries. This study aimed to determine the effect of macroeconomic policies on increasing of the social-health inequality in Iran. Methods: This study was a mixed method research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect the data along with a multiple attribute decision-making method for the quantitative phase of the research in which the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was employed for prioritization. The NVivo and MATLAB softwares were used for data analysis. Results: Seven main themes for the effect of macroeconomic policies on increasing the social-health inequality were identified. The result of TOPSIS approved that the inflation and economic instability exert the greatest impact on social-health inequality, with an index of 0.710 and the government policy in paying the subsidies with a 0.291 index has the lowest impact on social-health inequality in the country. Discussion: It is required to invest on the social determinants of health as a priority to reduce health inequality. Also, evaluating the extent to which the future macroeconomic policies impact the health of population is necessary

History and Structure of the Fourth Leading Emergency Medical Service in the World; a Review Article

Over forty-three years have passed since the foundation of pre-hospital emergency care system in Iran. Considering the changes that have taken place in recent years in pre-hospital emergency and limited studies in this area, the present review aimed to describe the history, organizational structure, combination of workforce, dispatch system, medical direction and innovations in the pre-hospital system of Iran.  The present paper also discusses the strengths and weaknesses of the current system

Exploring Factors Affecting Emergency Medical Services Staffs’ Decision about Transporting Medical Patients to Medical Facilities

Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs’ decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: “degree of perceived risk in EMS staffs and their patients.” This theme consisted of two main categories: (1) patient’s condition’ and (2) the context of the EMS mission’. The patent’s condition category emerged from “physical health statuses,” “socioeconomic statuses,” and “cultural background” subcategories. The context of the EMS mission also emerged from two subcategories of “characteristics of the mission” and EMS staffs characteristics’. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients’ needs for transportation in a prehospital situation

Health economic evaluation of home and hospital-based care in T2D patients on insulin therapy

Background: Type 2 Diabetes is a main concern of public health in  contemporary world with remarkable mortality, delayed complications and  health costs. Governments are obliged to improve the quality of health care and consider appropriate strategies to reduce the costs. An alternative strategy for  hospital services is care at home. Therefore, this study was aimed to evaluate  the cost-effectiveness of home-based and hospital-based diabetes care. Methods: A quasi-experimental, pre-test and post-test design was conducted in Northwest Iran. Sixty subjects who were eligible insulin-treatment type 2  diabetes mellitus were randomly assigned into two equal groups to receive home-based or conventional hospital-based care. Data on glycosylated  hemoglobin (HbA1c), hypoglycemia episodes, time needed to achieve glycemic control level, diabetes treatment satisfaction, diabetes knowledge and costs during three months were collected. Results: The cost of home-based care in insulin therapy diabetes was 61% less compared with the hospital-based methods. The former strategy was  cost-effective in terms of reduction in HbA1C and the time needed to achieve glycemic control. The patients in home care group were more satisfied and knowledgeable. Conclusions: The care at home approach for type 2 diabetic patients can be introduced and supported as a cost-effective care method in the country.  Keywords: Cost-effectiveness, type 2 diabetes, insulin therapy, home care, hospital care

Assessment of Emergency Response of Teaching Hospitals Affiliated to Iran University of Medical Silences against Disasters

Background & Objectives: In case of disasters, hospitals as one of the first centers to admit casualties, need to be well prepared. Emergency response of hospitals to deal with disasters is essential to success in providing qualified emergency services. The aim of this study was to evaluate emergency response of teaching hospitals affiliated to Iran University of Medical Sciences against disasters. Methods: This cross-sectional descriptive study was conducted in 14 teaching hospitals affiliated to Iran University of Medical Sciences in 2017. To collect data, hospital emergency response checklist provided by WHO (2011) with 90 questions in 9 domains (command and control, communication, safety and security, triage, surge capacity, continuity of essential services, human resources, logistics and supply management, and post-disaster recovery), was used. Data were analyzed using descriptive tests by SPSS version 15. Results: Mean score of emergency response of the hospitals against disasters was 56.93. The highest and lowest levels of response were related to human resources (63.57) and Materials and inventory management (57.03), respectively. Conclusion: Planning and providing a systematic framework to deal with disasters is essential, and the major role of hospitals in providing services should not be ignored, it should be considered as a priority in planning and budgeting for disasters. Key¬words: Emergency response, Hospital, Disasters, Iran University of Medical Sciences Citation: Seyedin SH, Hasanpoor E, Hasanzadeh E, Sheikhy-Chaman MR. Assessment of Emergency Response of Teaching Hospitals Affiliated to Iran University of Medical Silences against Disasters. Journal of Health Based Research 2018; 4(2): 159-67. [In Persian

Earthquake and the Educational Needs of People With Physical Disabilities and Related Groups: A Qualitative Study

Objective People with disabilities are highly vulnerable during disasters and their mortality is higher than normal population. The causes of this vulnerability, in addition to the physical problems and movement limitations, can be lack of their knowledge in facing with disasters. Such deficiencies can adversely affect their preparedness surviving in the disastrous situations and cause adverse consequences. Hence, this study aimed to identify the educational needs of people with physical disabilities and related groups in earthquakes, through understanding their views. Material & Methods The study was done in a qualitative method. Participants were selected from people with physical disability who had an experience of earthquake, literate, and in the age range of 18-60 years, through purposive sampling in two methods of maximum variation and snowballing. Semi-structured interviews were used for data collection and data saturation was reached with the entry of 18 eligible individuals. Thematic analysis was applied for data analysis assisted by MAXQDA software V 10. Results According to the participants, education was an essential factor for improving their preparedness for earthquake. The educational needs were categorized as two main themes. The first main theme included two subthemes: 1. Basic educational needs such as saving life and prevention of secondary disabilities, keeping calm, stress management, and decision making; and 2. Empowerment educational needs such as coping with disabilities in critical situations, providing relief to other people in case of having enough ability, and educating other people with disabilities. The second theme included two subthemes: 1. General educational needs related to families and public, such as rescue of people with disabilities, saving self-life and prevention of disabilities, proper relief to public for prevention of disabilities, accompanying and psychological support of people with disabilities; and 2. The specialized educational needs for relief workers and disaster managers, including relief to people with disabilities, prevention of disability and injury while rescuing public, familiarity with different groups of people with disabilities and their needs, and considering the needs of people with disabilities in the response measures.. Conclusion Based on the findings, the educational needs of people with physical disabilities and related groups, emerged in the form of preserving life, health and disability prevention, empowerment and improving the quality of services in the earthquake. Fulfilling the educational needs can increase the preparedness of these people in facing with earthquakes, although it requires the development of standard and practical educational programs by obtaining their opinions and implementing it in the situations before the disasters. On the other hand, considering that no serious and principled action has been taken so far in the field of education of people with disabilities, it is necessary for the planners and policymakers to formulate specialized policies in accordance with the country's conditions. This measures can be effective in reducing mortality and improving the health of these people in disaster situations

Health systems effectiveness for disasters and conflicts : a study in Iran

The study of disaster management has been one of the main concerns of medical doctors, managers, policy makers and scientists since mid twentieth century. There is an urgent need to improve our understanding of disaster management systems and principals especially within health services. This will maximise the efficiency of organisations dealing with disasters. This thesis studies the disaster management system used by health organisations within the health ministry of Iran in order to look at productivity, weaknesses and strengths of the system among subordinate organisations and teams working within the health ministry. The study also looks at effects of previous disasters on preparedness of the organisations and the differences between hospitals and health centers in disaster management activities. Moreover the research uses the findings of the research as evidences to design an appropriate model and suggest reforms in the current system for the health ministry. The work is a mixed-method study that uses both qualitative and quantitative approaches. The population of the study included health managers in the three levels of local, regional and national organisations. For the qualitative part, some other stakeholders such as Red Crescent Organisation and WHO were included and interviewed. Seventy-eight face-to face semistructured interviews in two phases (65 interviews for the first stage and the remainder of 13 for the model test) and an online and post questionnaire survey of 114 respondents (out of 214) sample at local (53% response rate) and 20 (out of 40) sample at regional (50% response rate) were conducted. The findings of the study showed that although there are variations among subordinate organisations within the health ministry with regard to different aspects of disaster management and outcomes. These variations were evident in planning; training; policy; organisational issues and resources. The conclusion is that the current system is not sufficiently robust or productive. Further previous disaster experiences did not have any systematic effect on the future efficiency of the system despite of a better , performance in the short term. Moreover, some reforms were suggested as a model to increase efficiency and performance of the system in the health organisations.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Macroeconomic Policies and Increasing Social-Health Inequality in Iran

Background: Health is a complex phenomenon that can be studied from different approaches. Despite a growing research in the areas of Social Determinants of Health (SDH) and health equity, effects of macroeconomic policies on the social aspect of health are unknown in developing countries. This study aimed to determine the effect of macroeconomic policies on increasing of the social-health inequality in Iran. Methods:This study was a mixed method research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect the data along with a multiple attribute decision-making method for the quantitative phase of the research in which the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was employed for prioritization. The NVivo and MATLAB softwares were used for data analysis. Results:Seven main themes for the effect of macroeconomic policies on increasing the social-health inequality were identified. The result of TOPSIS approved that the inflation and economic instability exert the greatest impact on social-health inequality, with an index of 0.710 and the government policy in paying the subsidies with a 0.291 index has the lowest impact on social-health inequality in the country. Discussion: It is required to invest on the social determinants of health as a priority to reduce health inequality. Also, evaluating the extent to which the future macroeconomic policies impact the health of population is necessary