Effect of relationships' quality on patients' loyalty in selected state hospitals

Background: Given the competitive environment prevailing in the market, service organizations are looking for loyal customers and hospitals are no exception. In the meantime, attention to relationships' quality and establishment of long term relationships have an important role. The objective of the present study is to examine the effect of relationships' quality on loyalty of patients in selected state hospitals

Methods: The present cross-sectional research was conducted in 2014 in selected state hospitals of Arak and Yazd. The population consisted of 160 patients in the selected hospitals. Simple random sampling was conducted to choose participants. Data were collected through two questionnaires; a part of Hon and Gruning's measurement of relationships questionnaire with four dimensions [satisfaction, trust, commitment, and mutual control] and loyalty questions as a part of the Parasuraman et al.'s behavioral tendencies with one dimension [loyalty dimension]. Data were analyzed with SPSS19 using Spearman correlation coefficient and regression

Results: Results from Spearman correlation indicated a positive and significant relationship between relationships quality and loyalty [r = 0.722, P-value = 0.001]. In addition, results from regression indicated that 60% of the variance of patients' loyalty is explained by satisfaction

Conclusion: Findings revealed that strategies to improve the quality of relationships with patients could lead to loyalty in patients

Mothers' Views on Food Security and Complementary Feeding: a Qualitative Study in Urban Iran

Food insecurity may be associated with poor nutrition, which in turn can increase the risk of adverse nutrition and health outcomes among infants and toddlers. This study was undertaken in 2008 to gain an insight of mothers' views on complementary feeding practices and food security. In this qualitative study, data were collected through 10 Focus Group Discussions [FGDs] with groups of mothers who had under two-year-old children in the urban areas of Damavand [7 FGDs; n=51] and Varamin [3 FGDs; n=29]. Each FGD was held in the presence of a moderator, two note takers, and an observer. All notes were collected, and the emerging themes were reported. In the study, nine general themes were identified: 1] The mothers viewed adequate food as a food, which is useful for health in both quality and quantity; 2] Households have limited access to adequate food because they cannot afford it; 3] In hard situations, household's strategies are: changing the type and amount of food, and buying cheaper foods; 4] In case of poverty, mothers abstain from eating to save food for their children; 5] The mothers viewed complementary feeding as soft, simple and light foods, which are especially made for children; 6] The best time for introducing complementary feeding was 6 months of age; 7] There were no complementary local foods in the region; 8] For under one-year-old children, a different type of food was separately prepared; 9] Home-made complementary food was preferred over the readymade type. Despite mothers' sufficient knowledge about the advantages of complementary feeding, the majority of them had not good performance. This qualitative study provides a foundation and valuable information for future studies on the nutritional health of children in food insecure households

[ epidemiology of gastrointestinal cancers [Stomach, esophageal, colorectal] In Markazi province during 2005-2010]

Introduction and Aims: cancer is the third leading cause of death after Coronary Artery Disease and accidents in Iran. This Research has been carried out to Study the epidemiology of gastrointestinal cancers [Stomach, esophageal, colorectal] in Markazi province during 2005-2010

Methods: this is an analytical cross-sectional study that was carried out on cancer registry data collected from Markazi province between 2005-2010 years. Cancer incidence adjusted based on the age structure and agespecific incidence rates were calculated

Results: most statistics on the Morbidity of gastric cancers in the study was 642 patients [51.2] that associated with gastric cancer and after which the CRC 444[35.4%] patients and esophageal numbers of 169 [13.5%] patients. in this study 61.8 % [801 patients] of cases in the age group 80-70 years, male, 387 cases [30.8%] and the highest 77.1% living in urban areas has been observed in terms of location. mean age at estimated time of diagnosis was 69 years. Rates age standardized incidence of digestive cancers in males and female was 141.04 and 73.39 respectively

Conclusion: identification of risk factors and prevention of gastrointestinal cancers in Markazi province is required. Training programs related to the prevention of cancer in people at high risk should be presented

[Epidemiology of prostate cancer in Markazi province in 2005-2010]

Background and Aims: prostate cancer is one of the most common cancers among men, that is increasing in incidence and mortality. Considering the epidemiologic trend of prostate cancer, the aim of this study was to investigate the incidence of prostate cancer in the years 2005-2010 in Markazi Province

Methods: in this analytical study, which data was derived from the Cancer Registry of Markazi Province, crude incidence per 100 thousand persons and age-standardized incidence in the method of direct standardization using the world standard population were calculated. Data Analysis was conducted using the Cochran-Armitage and winpepi software version 2.1

Results: in this study among 182 patients with prostate cancer in 2005-2010, 144 patients [%79] inhabited in city and others in rural. Regarding age, 16 persons [%8.8] were between 50-60 and majority 84[%46] were 70-80 years old. In the 6- year study, 182 cases of prostate cancer were recorded. Age-standardized incidence rate during the years 2005 to 2010 was respectively: 3.24, 3, 3.44, 5.05, 5.75, and 5.61 cases per hundred thousand people which show an increase in the disease. The highest observed incidence in the age group was above 70

Conclusion: the standardized incidence rate of prostate cancer in Markazi province in comparison with the world, particularly developed countries, is much less that can be due to lack of screening programs or the incomplete records

Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: the Isfahan healthy heart program

This study evaluated the outcome of a comprehensive, community-based healthy lifestyle program on cardiometabolic risk factors. The Isfahan Healthy Heart Program [IHHP] was a comprehensive action-oriented, multi-component intervention with a quasi-experimental design and reference area. IHHP targeted the population-at-large [n = 2,180,000] in three districts in central Iran. Data from independent sample surveys before [2000 - 2001] and after [2007] this program were used to compare differences in the intervention area and reference area over time after controlling for age, education level and income. The samples in 2000 - 2001 and 2007 included 6175 and 4719 participants in intervention area, and 6339 and 4853 in reference area, respectively. Multiple interventional activities were performed based on the four main strategies of healthy nutrition, increased physical activity, tobacco control and coping with stress. The prevalence of abdominal obesity, hypertension, hypercholesterolemia, hypertriglyceridemia and high LDL-C decreased significantly in the intervention area versus the reference area in both sexes. However the reduction in overweight and obesity was significant only in females [P < 0.05 for all]. There were no significant changes in the prevalence of diabetes mellitus. In the intervention area, the prevalence of hypercholesterolemia decreased from 23.5% to 12.5% among females without any changes in females in the reference area [p < 0.0001]. In males, hypercholesterolemia decreased significantly in both intervention area [18.5% to 9.6%] and reference area [14.4% to 9.8%; p = 0.005]. Mean triglyceride levels had a significant decrease in the intervention area and a non-significant decrease in the reference area [p < 0.0001]. A comprehensive healthy lifestyle program comprising preventive and promotional activities that considers both population and high risk approaches can be effective in controlling cardiometabolic risk factors in a middle-income country

Socioeconomic inequity in health care utilization, Iran

Reducing poor-rich inequities in health is one of the priorities of both national and international organizations and is also one of the main challenges of health sectors in Iran. Since, in the view of policy making, quantifying the size of inequity in health care utilization [HCU] is a prerequisite for achieving this goal, the current study aimed to determine and compare the socioeconomic inequity in HCU by concentration [C] index and odds ratio [OR]. A total of 758 households, consisting of 2,131 subjects who were aged 15 or older, were involved in this cross-sectional study, and their data were gathered through interviews. Household economic index [HEI] was created by the factor analysis from the asset data. The C index and OR were used as measures to determine the overall inequity in HCU according to sex [male/female], living area [urban/rural], insurance, and types of HCU [general physician [GP], specialist, and Health Workers [HWs]]. The overall rate of HCU was 66.4%. The rates of using GP, specialist care, and HW care were 21.4%, 21.6% and 21.8%, respectively. The overall inequity in HCU was equal to 0.05 [95% confidence interval; -0.069 to 0.165]. The C indexes in HCU, according to the subgroups of HCU, were measured as 0.11 [0.09-0.12] for GP, 0.115 [0.01-0.13] for specialist and -0.065 [-0.08 to -0.05] for HWs. Although the rate of utilization increased from poor to rich quintiles, the inequity regarding sex and living area was also low and non-significant. People with higher HEI used more specialist and GP care, while people with lower HEI used more HW care. The inequity in HCU was low and non-significant in different quintiles of males, females, urban and rural, as well as those who were insured

introduction to common systematic errors in medical research

Considering the continuous increase in number of published articles by Iranian researchers in recent years, the matter of quality in design, implementation, analysis and publication of articles is receiving its relevant attention. Of issues in quality of articles and studies are methodological errors. There are different kinds of errors that a researcher may fall into during various phases of a study. Of these errors systematic ones [or biases] can be counted. In this paper we aim to shortly introduce various sorts of biases that might happen in medical research. These biases are of two categories; selection and information biases.

[Geographical distribution and survival rate of cancers among elderly Iranians]

Objective [s]: To determine the pattern of incidence and survival rates of cancers in elderly adult in the period of five years to obligate the screening and therapeutic aged care services to old people

Methods: This is a historical cohort study based on the data analysis years [2001 to 2005] and cancer registries reporting survival rates for these cancers in people aged 60 years and older. Collecting data was through observation and data gathering Cancer Research Center, Shaheed Beheshti University of Medical Sciences. The inclusion criteria were cancer patients 60+ years registered through the annual reports of cancer cases and survival patients followed. To compare the survival and separation of sex Kaplan Meier coax method was used. The death and death of the relative risks of various cancers were calculated by regression model

Results: Based on data 33.5% of women surveyed aged 60 years and older and 66.5% were elderly men. The mean age was 71.2 years. Mean survival in this study was 88.2 years. The highest incidence of skin cancer was 5 years old. The geographical distribution of incidence was bladder cancer among elderly in Kermanshah province. Yazd province was the highest prevalence of common cancers in elderly. The average of five-year survival in Lorestan province was the highest and the Ardabil province had the lowest. The relationships between sex and death from cancers were [0.84 to 0.95], and the relationships between the relative risks of death from cancers [1.03 to 1.09] which were significant

Conclusion: The risks of cancer death among nine provinces were varied comparision to Tehran metropolitan. In oderwords survival rate of cancers in the nine provinces significantly were less than Tehran province

Epidemiology of four main nosocomial infections in Iran during March 2007 - March 2008 based on the findings of a routine surveillance system

Annually, around six million patients are admitted to hospitals in Iran. Information about the prevalence of nosocomial infections [NIs] is necessary for both appropriate management and establishment of preventative measures in hospitals. This article is based on the findings of the Nosocomial Infection Surveillance System [NISS] which has been providing information on NIs in Iran since March 2007. NISS covers 95 hospitals throughout Iran, each with over 200 beds. There are four main infections; urinary tract infection [UTI] surgical site infection [SSI], bloodstream infection [BSI] and pneumonia [PNEU] included in NISS. Reports are completed on forms that have been provided based on national guidelines. In all selected hospital there is one designated nurse who conducts infection control activities and is trained in the detection and reporting of NIs based on NISS guidelines. During March 2007 - March 2008, a total of 1, 879, 356 patients were admitted to the selected hospitals. The total detected NIs were 10557 with a prevalence of 0.57%. Of these, UTI was the most prevalent infection [32.2%] and BSI was the least [16.3%]. Based on gender, females had more UTI, whereas PNEU was the highest in males. Of reported NIs, 9% were detected in children less than five years of age and included BSI [45%], PNEU [20%], SSI [19%] and UTI [16%]. There were 26% reported NIs in the age group over 65 years, of which the most prevalent infections were UTI [42%] followed by PNEU [31%], SSI [15%] and BSI [12%] NIs were most often detected in intensive care units [ICUs; 26.7%], followed by surgery wards [12.8%]. In comparison with other studies and the World Health Organization [WHO] estimates, the rate of NIs appears to be less according to NISS. NISS has the capability to provide basic information for efficient management and control measures, in addition to indicating variations in NIs based on gender, age and location [hospital ward]. In order to have a more estimate of NIs and strengthen NISS, it is advisable to conduct a point prevalence study

Symptoms of natural menopause among Iranian women living in Tehran, Iran

Menopause is a step of a woman's life when hormonal changes cause menstruation to stop permanently. Menopausal symptoms can affect women's health and differ between different races and societies. The aim of this study was to survey the symptoms associated with menopause among Iranian women living in Tehran, Iran. In this cross sectional study which has been done between 2004 and 2005, women aged equal or more than 35 years old living in districts of Tehran were selected by multistage randomized cluster sampling. For each woman a questionnaire was completed. The data gained from each questionnaire was analyzed by using SPSS version 13. At time of study, 2462 women were naturally menopause. The mean age of natural menopause onset was 47.71 [SE=0.11] years. In 52.9% of cases, the onset of menopause was sudden. The symptoms associated with menopause were night sweats [61.2%], joint and muscle pain [59.9%], hot flashes [53.1%], fatigue [45.6%], decreased libido [33.9%], insomnia [33.7%], weight gain [30.1%], forgetfulness [24.9%] and urinary symptoms [17.4%]. This study showed that night sweats, joint and muscle pain and hot flashes are the most common symptoms associated with menopause

[Calculation of population attributable burden of excess weight and obesity to non-contagious diseases in Markazi province of Iran]

Overweight and obesity are the most important factors in the development of chronic diseases and have a great impact on the health and quality of life of individuals. World Health Organization [WHO] encourages the countries continually for calculation burden of diseases at national level as the best guideline for take policy in health system. Therefore, this study was conducted to determine the attributable burden of risk factors in non-contagious diseases in Markazi providence of Iran. Death registered data in Markazi providence were applied for calculation years of life lost [YLL] based on comparison risk assessment [CRA] method of WHO. Attributable burden of obesity and overweight was calculated by multiply the impact fraction of any risk factors by YLL of any diseases in counterfactual analysis method. From 7176 registered death, 252214 years lost from preterm death. The total of YLL in female and male were 102245 years and 149969 years, respectively. In this study, the most important causes of YLL were attributable obesities to brain stroke, and cardiovascular diseases and attributable overweight to cardiovascular disease in females, respectively. This study showed the importance and necessity of diagnosis for obesity and over weight as one of the most important risk factors in non-contagious diseases, especially in women. Therefore, it seems there is a necessity for developing and conducting comprehensive intervention programs about these risk factors and then assessing the programs

[ effect of age group under 15 years on cholera morbidity during the past 10 years in Iran [1996-2005]]

The study of the effect of age, especially children under 15 years, on cholera morbidity during a period often years [1996-2005] was carried out in Iran. There are no other studies on this topic in Iran and other countries. In this cross sectional study, we used cholera surveillance data collected in Center for Disease Control. All cholera cases were divided into two groups: under 15 years and above 15 years. Incidence rate of cholera per 100000 was calculated in total population and the two mentioned groups during 10 years. The relative risk of less than 15 year-olds group to above 15 year-olds was calculated with95% CI for 10 years by EPI6 and SPSS software. The trend of cholera incidence during the past 10 years shows two epidemic peaks in 1998 and 2005 by the rate of 15.7 and 1.63 per 100000, respectively. During the year with no epidemic and the years between two peaks, the age group under 15 year-olds was more affected with significant relative risk. For example, in 2001 this rate was 4.53. So, we can consider this age group as a risk factor to cholera morbidity. The age group of above 15 year-olds was more affected to cholera during epidemic years [1998, 2005] and relative risk was less than one. So, the age was protective on cholera morbidity for children in these years. One of the most important causes of periodic cholera epidemics every 5-6 years is changing of herd immunity. During the years between two epidemics adults have sufficient immunity and children are more affected because of first exposure and less immunity. With reduced herd immunity epidemics occur. We recommend continuing and strengthening of cholera surveillance system for detection of epidemics and treatment of highly sensitive age groups

The association of smoking with components of the metabolic syndrome in non-diabetic patients

<p><b>INTRODUCTION</b>There is limited evidence about the association between smoking and metabolic syndrome (MS). The aim of this study was to assess the association of smoking with MS components.</p><p><b>MATERIALS AND METHODS</b>As part of the baseline survey of a community-based study, we studied 5,573 non-diabetic men. All participants were interviewed and underwent physical examinations and blood collection.</p><p><b>RESULTS</b>The study participants comprised 1,625 smokers and 3,948 non-smokers, with a mean age of 38.07 +/- 14.85 years. Serum low-density lipoprotein-cholesterol (LDL-C) and triglycerides (TG) were higher in smokers than in non-smokers (LDLC: 115.34 +/- 39.03 vs 112.65 +/- 40.94 mg/dL, respectively, P = 0.015 and TG: 175.13 +/- 102.05 vs 172.32 +/- 116.83 mg/dL, respectively, P = 0.005). Body mass index, waist circumference and waist-hip ratio were lower in smokers than in non-smokers. Mean systolic and diastolic blood pressures were significantly lower in smokers than in non-smokers (systolic: 112.06 +/- 15.888 vs 117.25 +/- 17.745 mmHg, respectively, P = 0.000; diastolic: 73.66 +/- 10.084 vs 76.23 +/- 10.458 mmHg, respectively, P = 0.000). The percentage of individuals with 2 MS components was higher in smokers than in non-smokers (39.64% vs 33.00%, respectively, P = 0.000). However, the percentage of non-smokers with 3 MS components was higher than in smokers (49.62 % vs 43.82%, respectively, P = 0.000).</p><p><b>CONCLUSIONS</b>Our findings support the hypothesis that lifestyle factors such as smoking can adversely affect MS components. However, we should acknowledge that these differences may have resulted from the large sample sizes studied and may not be clinically significant. The lower prevalence of some MS components in smokers than in nonsmokers might be because of their lower anthropometric measures.</p>

Neonatal mortality risk assessment in a neonatal intensive care unit [NICU]

This study aims to assess the utility of a scoring system as predictor of neonatal mortality rate among the neonates admitted within one year to the neonatal intensive care unit [NICU] of the Children's Medical Center in Tehran, Iran. Data were gathered from 213 newborns admitted to the NICU from September 2003 to August 2004. In addition to demographic data, Apgar scores at 1 minute and 5 minutes, history and duration of previous hospital ization, initial diagnosis and final diagnosis, and scoring system by using the score for the neonatal acute physiology-perinatal extension II [SNAP-PE II] were carried out within 12 hours after admission to the NICU. All of the parameters were prospectively applied to the admitted newborns. The exclusion criteria were discharge or death in less than 24 hours after NICU admission. 198 newborn infants met the inclusion criteria. The mean and standard deviation [SD] of the variables including postnatal age, birth weight, SNAP, and finally Apgar scores at 1 minute and 5 minutes of neonates under this study were 7.6 [0.5] days, 2479.8 [29.4] grams, 21.6 [1.1], 7.47 [0.08], and 7.71 [0.06], respectively. Twenty five of the 198 patients died [12.6%]. Gestational age [p=0.03], birth weight [P=0.02], Apgar score at 5 minutes [0.001], and SNAP-PE II [P=0.04] were significantly related to the mortality rate. By Analyzing through logistic regression to evaluate the predictive value of these variables in relation to the risk of mortality, it was shown that only SNAP-PE II and Apgar score at 5 minutes could significantly predict the neonatal mortality. According to this study SNAP-PE II and Apgar score at 5 minutes can be used to predict mortality among the NICU patients. SNAP-PE II score had the best performance in predicting mortality in this study. More studies with larger samples are suggested to evaluate all of the above-mentioned parameters among neonates who are admitted to NICUs countrywide

Screening for hepatocellular carcinoma in chronic carriers of hepatitis Band C in Markazi province, Iran

Chronic HBV and HCV infections are known as important underlying causes of hepatocellular carcinoma [HCC]. Their prevalence in Iran are estimated to be 1.7-5% and 0.5-1%, respectively. We investigated the prevalence of HCC in chronic carriers of HBV and HCV via alpha-feto protein [AFP] measurement and ultrasonography as well as pathological assessments. In this cross-sectional study, HBV and HCV positive cases were determined from documents in blood banks since 1985. From 1064 aviable cases, 514 were randomly selected and followed up for two consecutive years. For all patients, AFP testing and sonography were done after reconfirmation of chronicity. Cases with nodules or mass in sonography and AFP levels above 20 ng/ml were considered suspicious for HCC and after rechecking were referred for liver biopsy. Finally, HCC was confirmed pathologically. The mean subjects' age was 35.19 +/- 13.16 years and hepatitis duration was 6.12 +/- 5.66 years. Twenty-nine [5.7%] had elevated AFP and 18 [3.5%] had nodules in sonogram. In 16 [3.13%] cases, HCC was detected pathologically. Risk of HCC was correlated with age >40 years, cirrhosis and hepatitis duration [P<0.001]. There was no correlation between the risk of HCC and the type of hepatitis, HBeAg positivity, sex and ALT levels. Early screening for HCC using AFP and sonography can be useful for HCC detection in HCV and HBV chronic carriers