111 research outputs found
Identifying associations between health services operational factors and health experience for patients with type 2 diabetes in Iran
No full textAbstract Background Facing limited health resources, healthcare providers need to rely on health service delivery models that produce the best clinical outcomes and patient experience. We aimed to contribute to developing a patient experience-based type 2 diabetes service delivery model by identifying operational structures and processes of care that were associated with clinical outcome, health experience, and service experience. Methods We conducted a cross-sectional survey of type 2 diabetes patients between January 2019 to February 2020. Having adjusted for demand variables, we examined relationships between independent variables (behaviours, services/processes, and structures) and three categories of dependent variables; clinical outcomes (HbA1c and fasting blood glucose), health experience (EuroQol quality of life (EQ-5D), evaluation of quality of life (visual analgene scale of EQ-5D), and satisfaction with overall health status), and service experience (evaluation of diabetes services in comparison with worst and best imaginable diabetes services and satisfaction with diabetes services). We analysed data using multivariate linear regression models using Stata software. Results After adjusting for demand variables; structures, diabetes-specific health behaviours, and processes explained up to 22, 12, and 9% of the variance in the outcomes, respectively. Based on significant associations between the diabetes service operations and outcomes, the components of an experience-based service delivery model included the structural elements (continuity of care, redistribution of task to low-cost resources, and improved access to provider), behaviours (improved patient awareness and adherence), and process elements (reduced variation in service utilization, increased responsiveness, caring, comprehensiveness of care, and shared decision-making). Conclusions Based on the extent of explained variance and identified significant variables, health services operational factors that determine patient-reported outcomes for patients with type 2 diabetes in Iran were identified, which focus on improving continuity of care and access to providers at the first place, improving adherence to care at the second, and various operational process variables at the third place
Mental Health Problems and the Associated Family and School Factors in Adolescents: A Multilevel Analysis
No full textObjective: Mental health is one of the most important issues in adolescents' life. Adolescents' health is highly important, because of their role in the future. This study was conducted using multilevel analysis to investigate the risk factors at student and school levels. Method: This was a cross sectional study for which 1740 students and 53 schools were selected between February and March 2018 in Qazvin, Iran. Multistage stratified cluster sampling was used for data collection. Mental health problems were measured by the Strengths and Difficulties Questionnaire (SDQ). Emotional symptom, conduct problem, hyperactivity, peer relationship problem, and prosocial behavior were the subscales. This study used multilevel analysis to determine the association between each of the questionnaire scales and students and schools variables. Results: The prevalence of the mental health problems was 16.2%. Conduct problem was more prevalent than others (21.1%). Overall, the score of mental health problems was significantly lower in boys' schools, in adolescents with physical activity, and in families with high socioeconomic status. Hyperactivity and emotional symptoms were significantly higher in girls' schools. While prosocial behavior and peer relationship problems were significantly higher in boys' schools. The association between variables and the scales of mental health problems was different. Conclusion: Results indicated desirable physical activity and socioeconomic status are effective components in the adolescents' mental health, and, mostly girls' schools were more vulnerable than boys' schools. Therefore, the educational authorities and health policymakers should consider this diversity to design interventional programs and pay more attention to the high-risk adolescents in different schools. Copyright © 2021 Tehran University of Medical Sciences.
Author keywords
Adolescents; Iran; Mental Health; Multilevel Analysis; SDQ; Student
Predicting Malaria Transmission Risk in Endemic Areas of Iran: A Multilevel Modeling Using Climate and Socioeconomic Indicators
No full textBackground: Over the past years, the malaria elimination program has considerably decreased the malaria indigenous cases and confined their incidence to the southeastern areas of Iran encompassing 28 less developed counties with favorable transmission conditions. Objectives: The aim of the study was to investigate the effects of climatic and socioeconomic indicators on malaria transmission and to predict malaria transmission risk until 2025 for all the southeastern endemic counties in Iran. Methods: The aggregated data from indigenous malaria cases, as well as, climatic and socioeconomic indicators of malaria endemic areas were collected on the monthly basis from each county between 2005 and 2015. The collected variables were, then, estimated until 2025 using time series analysis. Considering the nature of these data, two different multilevel models were implemented for vivax and falciparum based on the socioeconomic variable that was used. Finally, applying two different models, two sets of estimates were obtained for malaria transmission risk in each county. Results: The annual decline of malaria transmission was estimated to be 17% based on model 1, and 25% based on the model 2 for vivax (P < 0.001). These estimates were 13% and 21% for falciparum (P < 0.001), respectively. For every increased unit in the wealth index, malaria transmission for vivax and falciparum decreased by 33% (P = 0.001) and 12% (P = 0.54), respectively. Also, for every increase in the mean years of schooling, the transmission decreased by 65% (P < 0.001) and 57% (P = 0.001) for vivax and falciparum. Conclusions: The results of this study, using climatic variables along with socioeconomic variables, indicated the obvious influence of socioeconomic status improvement on decreasing malaria transmission. According to the results, malaria transmission risk will considerably diminish in the next few years. The pattern of malaria transmission decline was consistent with the declining trend of malaria incidence which will move from the west to the east and from the north to the south in the years to come. The transmission risk for falciparum was considerably lower than that of vivax and the endemic areas of falciparum move towards 0 faster than vivax.Full Tex
Impact of Health Research Systems on Under-5 Mortality Rate: A Trend Analysis
No full textBackground
Between 1990 and 2015, under-5 mortality rate (U5MR) declined by 53%, from an estimated rate of 91 deaths per 1000 live births to 43, globally. The aim of this study was to determine the share of health research systems in this decrease alongside other influential factors.
Methods
We used random effect regression models including the ‘random intercept’ and ‘random intercept and random slope’ models to analyze the panel data from 1990 to 2010. We selected the countries with U5MRs falling between the first and third quartiles in 1990. We used both the total articles (TA) and the number of child-specific articles (CSA) as a proxy of the health research system. In order to account for the impact of other factors, measles vaccination coverage (MVC) (as a proxy of health system performance), gross domestic product (GDP), human development index (HDI), and corruption perception index (CPI) (as proxies of development), were embedded in the model.
Results
Among all the models, ‘the random intercept and random slope models’ had lower residuals. The same variables of CSA, HDI, and time were significant and the coefficient of CSA was estimated at -0.17; meaning, with the addition of every 100 CSA, the rate of U5MR decreased by 17 per 1000 live births.
Conclusion
Although the number of CSA has contributed to the reduction of U5MR, the amount of its contribution is negligible compared to the countries’ development. We recommend entering different types of researches into the model separately in future research andincluding the variable of ‘exchange between knowledge generator and user.
Recent Iranian Health System Reform: An Operational Perspective to Improve Health Services Quality
No full textThe operational management of healthcare services is expected to directly touch patient experiences. Iranian Ministry of Health and Medical Education (MoHME) for the first time, as such, has sought to improve the operational management of healthcare delivery within a reform agenda by setting benchmarks for ‘number of visit per hour’ and waiting time in outpatient clinics of about 700 affiliated hospitals. As a new initiative, it has faced with mixed reactions and various doubts have been cast on its successful implementation. This manuscript aims to shed some light on the operational challenges of the initiative and the requirements of its successful implementation
Recent Iranian Health System Reform: An Operational Perspective to Improve Health Services Quality
No full textAbstract
The operational management of healthcare services is expected to directly touch patient experiences. Iranian
Ministry of Health and Medical Education (MoHME) for the first time, as such, has sought to improve the
operational management of healthcare delivery within a reform agenda by setting benchmarks for ‘number of
visit per hour’ and waiting time in outpatient clinics of about 700 affiliated hospitals. As a new initiative, it has
faced with mixed reactions and various doubts have been cast on its successful implementation. This manuscript
aims to shed some light on the operational challenges of the initiative and the requirements of its successful
implementation
Academic stress from the viewpoint of Iranian adolescents: A qualitative study
No full textBACKGROUND: Academic stress is one of the major affecting factors on adolescent health. This study investigates adolescents' view about the sources of academic stress, with which their identification could be used for the reduction of adolescent academic stress.
MATERIALS AND METHODS: This qualitative study was conducted with Directional Content Analysis methodology. Semi-structured interview methods were used for data collection. Participants were students aged 12–18 years old. Purposeful sampling with Opportunistic Maximum Variation Method was performed in terms of type of schools, socioeconomic classes, and gender of students. A total of 43 interviews and were conducted by two interviewers.
RESULTS: A total of 173 codes, 11 subcategories, and 5 categories were extracted as academic stressors. The categories included family factors (32 codes); peers (18 codes); teachers, school supervisors, and educational system (72 codes); homework and test scores (32 codes); and educational assistance classes (19 codes).
CONCLUSION: This study showed that students have different sources of academic stress. Awareness of their source of stress can help parents and teachers to revise their treat about students' function and policymaker to provide better planning and management for students
Impact of Health Research Systems on Under-5 Mortality Rate: A Trend Analysis
No full textBackground: Between 1990 and 2015, under-5 mortality rate (U5MR) declined by 53%, from an estimated rate of 91
deaths per 1000 live births to 43, globally. The aim of this study was to determine the share of health research systems
in this decrease alongside other influential factors.
Methods: We used random effect regression models including the ‘random intercept’ and ‘random intercept and
random slope’ models to analyze the panel data from 1990 to 2010. We selected the countries with U5MRs falling
between the first and third quartiles in 1990. We used both the total articles (TA) and the number of child-specific
articles (CSA) as a proxy of the health research system. In order to account for the impact of other factors, measles
vaccination coverage (MVC) (as a proxy of health system performance), gross domestic product (GDP), human
development index (HDI), and corruption perception index (CPI) (as proxies of development), were embedded in
the model.
Results: Among all the models, ‘the random intercept and random slope models’ had lower residuals. The same
variables of CSA, HDI, and time were significant and the coefficient of CSA was estimated at -0.17; meaning, with the
addition of every 100 CSA, the rate of U5MR decreased by 17 per 1000 live births.
Conclusion: Although the number of CSA has contributed to the reduction of U5MR, the amount of its contribution
is negligible compared to the countries’ development. We recommend entering different types of researches into the
model separately in future research and including the variable of ‘exchange between knowledge generator and user.’
Keywords: Under-Five Mortality Rate (U5MR), Research Impact Assessment, Research Payback, Research
Contributio
Comparing Normal and Multiple Sclerotic Patients Short Term Memory
No full textObjective: Multiple sclerosis (MS) is a disease of the central nervous system. The main pattern of neuropsychological impairment in M.S. patients characterized with deficits of attention and memory. Memory problem are known to occur in approximately 50% to 60% of people with M.S. The purpose of the present study is to asses memory function in M.S. patients.
Materials & Methods: 40 M.S. patients (30 patients suffering from as relapsing – remitting and 10 patients are chronic progressive M.S.) assessed using Luria – Nebraska memory scale.
Results: All of multiple sclerosis patients (without sever depresive state evaluated by BDI) exhibited significant impairments in all of memory veriable (verbal , non - verbal , delayed and whole memory performance) as compared with control groups (normal subjects). Difference of memory performance between the patients with two type of M.S. were not significant. Furthermore no significant relation was found between memory loss and MRI lesions.
Conclusion: This study is guidedas such one can lead to a better understanding of memory deficits in M.S. patients. In addition, specific rehabilitation strategies can be planed on the patterns of memory impairment in M.S. patients
Towards Sub-Quadratic Diameter Computation in Geometric Intersection Graphs
No full textISSN:1868-896
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