Inpatient healthcare utilization among people with disabilities in Iran: determinants and inequality patterns.

BACKGROUND: People with disabilities (PWD) have different health service needs and different factors affect the utilization of these services. Therefore, the aim of this present study was to identify determinants of inpatient healthcare utilization among PWDs in Iran. METHODS: This research was a secondary data analysis of a cross-sectional study. The present study used data gathered for 766 PWDs (aged 18 years and older) within the Iranian Society with Disabilities (ISD) between September and December 2020. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals in order to identify determinants of inpatient healthcare utilization among PWDs. RESULTS: Data for 766 people with disabilities were analyzed. A large number of participants were over 28 years of age (70.94%), male (64.36%), and single (54.02%). In the present study, more than 71% of participants had no history of hospitalization during the last year. In this study, males [aOR 2.11(1.14-3.91), participants with Civil Servants health insurance coverage [aOR 3.44 (1.16 - 10.17)] and individuals in the 3th quartile of disability severity [aOR 2.13 (1.01 - 4.51)] had greater odds of inpatient healthcare utilization compared to the other groups. The value of the concentration index (C) for inpatient healthcare utilization was - 0.084 (P.value = 0.046). The decomposition analysis indicated that gender was the greatest contributor (21.92%) to the observed inequality in inpatient healthcare utilization among participants. CONCLUSION: Our findings suggested that the likelihood of hospitalization among the study participants could be significantly influenced by factors such as gender, the health insurance scheme, and the degree of disability severity. These results underscore the imperative for enhanced access to outpatient services, affordable insurance coverage, and reduced healthcare expenditures for this vulnerable population. Addressing these issues has the potential to mitigate the burden of hospitalization and promote better health outcomes for disadvantaged individuals.

Intention to leave the profession and related factors in nurses: A cross-sectional study in Kermanshah, Iran.

AIM: To investigate the intention to leave the profession and its related factors among nurses in Kermanshah, western Iran. DESIGN: Cross-sectional study. METHODS: A total of 377 nurses were enrolled in a stratified random sampling method. Data were collected by the Anticipated Turnover Scale and a sociodemographic information form. and analysed by descriptive and inferential statistics (logistic regression analysis). RESULTS: The results showed that 49.6% (n = 187) of nurses tended to leave the profession and the mean score of intention to leave was 36.6 ± 0.5 of 60. There were no statistically significant differences between nurses who intended to leave and those who did not in terms of age, marital status, gender, type of employment, type of shift and work experience. But a statistically significant association was found between workplace (p = 0.041, adjusted OR = 2.07) and job title (p = 0.016, adjusted OR = 0.58) and intention to leave the profession. PATIENT OR PUBLIC CONTRIBUTION: No.

Quality Assessment of Services in Primary Healthcare in Iran: A Systematic Review and Meta-analysis.

Background: Primary healthcare (PHC) plays an important role in achieving universal health coverage (UHC). The SERVQUAL instrument is the tool for evaluating the quality of services in the health sector. The main purpose of this study is to evaluate the quality of services provided in PHC in Iran using the SERVQUAL instrument. Materials and Method: We searched eight databases from January 2000 to September 2021. We analyzed the mean of various SERVQUAL instrument items using the DerSimonian-Laird approach via a random model with 95% confidence interval. Also, we used I2 to evaluate the heterogeneity of the studies. Results: Finally, 17 studies were chosen for analysis in the present study. There were 8,767 study participants, out of which 8,237 were female and 530 were male. The mean dimensions of perception were as follows: Tangibles = 3.71, reliability = 4, responsiveness = 3.79, assurance = 3.83, and empathy = 3.86. For the expectation, the mean dimension were: Tangibles = 4.46, reliability = 4.46, responsiveness = 4.36, assurance = 4.36, and empathy = 4.36 respectively. The total gap quality between perception and expectation was -0.53. Conclusion: All dimensions of quality based on SERVQUAL were negative, and the quality of service in PHC is not satisfactory. Therefore, policymakers must adopt serious and effective programs to improve services in this area. We also recommend that quality management of services in PHC in Iran should move toward comprehensive optimization in all areas, and quality in this area should be a priority.

The incidence of breast cancer in northwest iran (2003 -2008).

INTRODUCTION: Breast Cancer is the most common cancer in Iranian women and Iranian patients are relatively young. Given that Iran has a female population of about 38 million, this corresponds to a total number of 6000 new cases of breast cancer annually. This study aims to demonstrate the characteristics of breast cancers according to pathologic records in East Azerbaijan province, Iran. METHODS: In this retrospective cross-sectional study, 159314 pathology records of the main hospitals and pathology laboratories were observed for a period of 5 years. For each patient, sex, age, breast specimen pathology, pathological grading of malignant lesions and place of residence of patients were collected and statistically analyzed. RESULTS: There were 12083 cancer cases; 902 of which were primary breast cancer. Breast cancer was the most common cancer in females (22.2%) but it ranks the 22(nd) in males. The annual incidence of breast cancer in women was 52.3 per 100,000. The mean age of women with breast cancer was 48.3±12.7 years (range, 16-85) and for male 54.0±13.6 years (range, 23-76). The highest frequency of malignancies was observed in the 40-49 year old age groups (34.5%). Invasive ductal carcinoma was the most common histological type diagnosed in both sexes. CONCLUSION: In Iran, breast cancer affects women at least one decade younger than developed countries. In spite of the rare incidence of breast cancer in men, the descriptive epidemiology of this malignancy is surprisingly similar to that of women. A considerable proportion of cancers of our research were in breast which mandates a national cancer detection program encouraging women for breast self-examination and participation in screening tests to improve breast cancer care.

Comparison thoracic epidural and intercostal block to improve ventilation parameters and reduce pain in patients with multiple rib fractures.

INTRODUCTION: Chest wall blunt trauma causes multiple rib fractures and will often be associated with significant pain and may compromise ventilator mechanics. Analgesia has great roll in rib fracture therapies, opioid are useful, but when used as sole agent may require such high dose that they produce respiratory depression, especially in elderly .the best analgesia for a severe chest wall injury is a continuous epidural infusion of local anesthetic. This provides complete analgesia allowing inspiration and coughing without of the risk of respiratory depression. METHODS: sixty adult patients who with multiple rib fractures were enrolled in this study. They were divided into Group A or thoracic epidural with bupivacaine 0.125 % +1mg/5ml morphine and group B or intercostal block with 0.25% bupivacaine. The patients were assessed through ICU and hospital stay length, ventilation function tests. Pain score among the patients was measured with verbal rating scale, before and after administration of the analgesia. RESULTS: We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd days after epidural analgesia compared with the intercostal block (P < 0.004). Changes in the visual Analogue Scale were associated with marked improvement regarding pain at rest and pain caused by coughing and deep breathing in group A compared group B... ICU and hospital stay markedly reduced in Group A. CONCLUSION: thoracic epidural analgesia is superior to intercostals block regarding pain relief of rib fractures. Patients who received epidural analgesia had significantly lower pain scores at all studied times.