Prompt attention of the diagnostic medical imaging centers in Tehran: An experience of people with physical disability

Background: Nowadays, change in the pattern of diseases to chronic has been with increasing use of medical imaging services. People with physical disability require continuous diagnostic and therapeutic services. Objectives: This study aimed to measure the waiting time for receiving medical imaging services and to examine sociodemographic factors associated with the poor experience of these people. Patients and Methods: In a cross-sectional study to assess the responsiveness of comprehensive rehabilitation centers in Tehran in 2016-2017, 610 people with physical disabilities who were referred to 10 comprehensive physical rehabilitation centers for rehabilitation services were asked whether they had used medical imaging services during their rehabilitation. The 477 participants (218 women) with positive response consisted the sample of this study. A checklist was used for data collection. T test, Chi-Square and Multiple Logistic Regression Model were used for analytical reports. Results: Poor experience in prompt attention of centers was reported by 26 of public diagnostic service users while 16 of private sector users and 21.2 by total sample. Waiting time for appointment and waiting time at the center were significantly longer in public medical imaging centers compared to the private sector (P < 0.05). Overall experience of public service users about prompt attention was poorer than the private sector (P < 0.05). Physical status (odd ratio OR = 3.2; 95% confidence interval CI = 1.3-7.8) and duration of disability (OR = 0.28; 95% CI = 0.09-0.9) were the predictors of poor experience of respondents about prompt attention in public and private centers respectively. Conclusion: From the service users� viewpoint, private centers had better performance in prompt attention than public centers. Attention to physical condition and duration of disability in scheduling diagnostic services is recommended. © 2018, Author(s)

Predictors of poor responsiveness in physical rehabilitation centers in Tehran

Background: Responsiveness as a nonmedical, nonfinancial aspect of a health system's goals requires special attention, particularly in people with physical disabilities. This study aimed to investigate the predictors of poor responsiveness of rehabilitation centers in Tehran. Methods: A cross sectional study was conducted to investigate 610 individuals with physical disabilities who referred to 10 comprehensive rehabilitation centers in Tehran using Quota sampling in 2016-2017. The following questionnaires were used in this study: Health System Responsiveness questionnaire, recommended by World Health Organization (WHO); Activities of Daily Living (ADL); and Instrumental Activity of Daily Living (IADL). Multiple logistic regression models were used to determine the sociodemographic characteristics (sex, age, perceived social class, etc.), self-assessed health, and physical functioning (eg, Instrumental Activities of Daily Living (IADL) as predictors of poor responsiveness in comprehensive rehabilitation centers of Tehran. Results: The mean years of education of respondents was 12.57 (SD=5.07). The majority of the participants perceived themselves as belonging to the middle class. Among the participants, 17.1% were completely dependent in their instrumental activities of daily living (IADL). Respondents who were not satisfied with their health insurance accounted for 40.2% of the sample. Also, 20.9% of the participants reported poor responsiveness. Based on the logistic regression model, variables of education, perceived social class, satisfaction with health insurance, and IADL were predictors of overall poor responsiveness after adjusting other covariates. Conclusion: Level of education was a strong predictor of poor responsiveness. Insurance companies should make policies to facilitate people's access to rehabilitation services and increase customer satisfaction. Moreover, rehabilitation service providers should pay special attention to those with physical disabilities who are more severely disadvantaged. © Iran University of Medical Sciences

The dsm-5 levels of personality functioning and severity of iranian patients with antisocial and borderline personality disorders

Background: Fundamental problems with Personality Disorders (PD) diagnostic system in the previous version of DSM, led to the revision of DSM. Therefore, a multidimensional system has been proposed for diagnosis of personality disorder features in DSM-5. In the dimensional approach of DSM-5, personality disorders diagnosis is based on levels of personality functioning (Criteria A) and personality trait domains (Criteria B). Objectives: The purpose of this study was firstly, to examine the DSM-5 levels of personality functioning in antisocial and borderline personality disorders, and second, to explore which levels of personality functioning in patients with antisocial and borderline personality disorders can better predicted severity than others. Patients and Methods: This study had a cross sectional design. The participants consisted of 252 individuals with antisocial (n = 122) and borderline personality disorders (n = 130). They were recruited from Tehran prisoners, and clinical psychology and psychiatry centers of Razi and Taleghani Hospitals, Tehran, Iran. The sample was selected based on judgmental sampling. The SCID-II-PQ, SCID-II and DSM-5 levels of personality functioning were used to diagnose and assess personality disorders. The data were analyzed by correlation and multiple regression analysis. All statistical analyses were performed using the SPSS 16 software. Results: Firstly, it was found that DSM-5 levels of personality functioning have a strong correlation with antisocial and borderline personality symptoms, specially intimacy and self-directedness (P < 0.001). Secondly, the findings showed that identity, intimacy and selfdirectedness significantly predicted antisocial personality disorder severity (P < 0.0001). The results showed that intimacy and empathy were good predictors of borderline personality disorder severity, as well (P < 0.0001). Conclusions: Overall, our findings showed that levels of personality functioning are a significant predictor of personality disorders severity. The results partially confirm existing studies. © 2015, Iranian Red Crescent Medical Journal