Circulating salivary and serum miRNA-182, 320a, 375 and 503 expression levels in type 2 diabetes.

Aim: Early-stage diagnosis of diabetes through non-invasive and diagnostic biofluid-like saliva has become a very popular approach to facilitate future preventive interventions and improve patient care. Meanwhile, the alteration of small non-coding RNA in human fluids has been suggested as a probable precedent for the early stages of diabetes. Methods: In the present study, we checked the expression of miR-320a, 182-5p, 503, and 375 by using quantitative PCR in both stimulated and unstimulated saliva and blood samples of 40 adult patients with type-2 diabetes compared to 40 healthy individuals. In addition, we have sought to understand the possibility that miRNAs could provide new information about the status of type 2 diabetes in salivary samples beyond what can now be identified from blood samples and link their expression to the presence of clinically relevant risk factors. For this purpose, we have used a set of multivariate models. Results: The results showed that three miRNAs were more highly expressed in patients with type 2 diabetes, while miR-320-a was down-regulated in those patients compared to healthy subjects. Furthermore, the data showed that miR-320a was the most reliable predictor for distinguishing diabetic patients from healthy subjects, with AUCs of 0.997, 0.97, and 0.99 (97.4% sensitivity and 100% specificity, p = 0.001) for serum, unstimulated, and stimulated saliva samples, respectively. Conclusions: Interestingly, the results of this study indicated that the amount of four miRNAs expressed in stimulated saliva was the same as in serum samples, which could conclude that specific miR-320a and 503 in stimulated saliva may introduce credible, non-invasive, and diagnostic biomarkers that can be used to monitor diabetic patients' status, while there is a need to design more research studies to confirm these findings.

Disaster Risk Assessment in Educational Hospitals of Qazvin Based on WHO Pattern in 2015.

INTRODUCTION: In addition to damaging communities and infrastructures, unexpected disasters affect service provider centers as well. Structural, non-structural, and functional components of hospitals could be affected when hazards or disasters occur, and they may be unable to admit casualties, have their own personnel and patients killed or injured, have their property destroyed. In such as case, they would increase the burden of death resulting from the disaster. Therefore, in this study, hospital safety was reviewed in two hospitals in Qazvin in 2015. METHODS: This cross-sectional descriptive study was conducted on two of the Rajaee and Velayat Hospitals in Qazvin. The tools used to assess for the hospitals' risk of experiencing a disaster were observation, interviews, and a checklist of hospital disaster risk assessment provided by the World Health Organization (WHO), including 5 sections and 145 indices for the safety assessment of hospitals. To determine the general weight, three main parts of the questionnaire, i.e., functional safety, non-structural safety, and structural safety, were given weights of 0.2, 0.3, and 0.5, respectively, according to the original version of the indices. Each index was scored as 0, 1, and 2 based on the low, medium, and high scores. The safety scores that were obtained were categorized in three groups, i.e., low safety (≤ 34%), medium safety (34-66%), and high safety (> 66%). The data were analyzed using Excel 2007 software. RESULTS: Functional, structural, and non-structural safety scores were evaluated as 60.20% (medium safety), 67.61% (high safety), and 76.16% (high safety), respectively. General preparedness of the hospitals we studied were 71.90%, a high safety level. This high preparedness was related to the indices of availability of medicines, equipment, water supply, and other resources required in emergency conditions (85%), and the lowest preparedness was related to contingency plans of medical operations (19%). CONCLUSION: The preparedness of the two hospitals in the study was evaluated as being high. Considering the history of disasters in this Province, it would be effective to retrofit hospitals and compile written plans for administrative measures at the time of disasters. These measures must be consistent, and there should be safe installation of risky office and medical equipment.

Evaluation of the Quality of Health Service Providers: The Iranian People Perspective 2014.

INTRODUCTION: Quality is the center of attention in all service providing organizations that are effective in promoting satisfaction of patients who are referred to medical centers. The aim of this study was to investigate the quality of health service providers in a case study of Qazvin, Iran, in 2014. METHODS: This descriptive study was conducted on 1,002 people who were residents of Qazvin Province (Iran) in 2014. The people were selected randomly from the population of the study area. The main variables studied were education, perceptions, expectations, and gaps in service quality. The data collection tool was the standard Servequal questionnaire. To determine the reliability of the research tool, we used Cronbach's Alpha coefficient and the test-retest method. Statistical analyses were conducted using SPSS and the ANOVA test. RESULTS: The mean age of people included in the study was 32 ± 9.9 years, and the average waiting time to receive services was 73 ± 47 minutes. Hospitals and doctors' offices had the highest quality gap of -1.420 ± 0.82 and -1.01 ± 0.75, respectively. The service quality gaps in medical centers, health providers of rural area, and health providers of urban area were -0.883 ± 0.67, -0.882 ± 0.83, and -0.804 ± 0.62, respectively. There was a significant relationship between peoples' perceptions and expectations concerning the quality of health services and their educational levels. CONCLUSION: The higher gaps in quality in hospitals and in doctors' offices require more attention. Managers and policy makers should consider developing and implementing plans to reduce these gaps in quality and to promote better health services in these two sectors.

Comparison Quality of Health Services between Public and Private Providers: The Iranian People's Perspective.

INTRODUCTION: Health services quality has been the most important criteria of judging, and its improvement causes people's satisfaction of health systems. In a health system, public and private sectors provide services and typically have been effective in promoting health services quality of community. The aim of this study was to compare the quality of health services in both public and private sectors from the perspective of residents in Qazvin (Iran). METHODS: This cross-sectional study was conducted in 2014. The study population included all residents of Qazvin Province, and the sample size was estimated to 1002. The research tool was a perceptions of services quality standard questionnaire. Data were collected by trained interviewers visiting homes and were analyzed by IBM-SPSS software version 22 and t-test and linear regression. Cronbach's alpha coefficient was 0.91 and test-re-test coefficient was 83%. RESULTS: 741 people (74%) in their last visit to receive services were referred to the public sector. Between the perception of people participating in the study about medical equipment and supplies, welfare facilities, competence and experience of doctor, waiting time, rapid reception, and access to doctor in public and private sectors, significant differences were observed (p < 0.05). In the tangible realm in perception of health services, there was a significant difference in quality between the public and private sectors (p < 0.05). In addition, place of receiving services, waiting time, education, occupation, and type of received services were affecting factors in regards to perceptions of health services from the perspective of Iran's population (p < 0.05). CONCLUSION: The results showed the importance of a tangible realm on people's satisfaction of health services. It seems that the public sector should pay more attention to this issue.

Study of Out-of-Pocket Expenditures for Outpatient Imaging Services in Imam-Khomeini Hospital in 2014.

BACKGROUND: Direct out-of-pocket (OOP) payment is the most inequitable way to pay for healthcare services, and this trend exposes patients and their families to backbreaking financial risks. The aim of this study was to estimate the out-of-pocket expenditures for outpatient imaging services in Imam-Khomeini Hospital in Tehran. METHODS: This cross-sectional study was conducted in 2014 on 100 users of outpatient imaging services (radiology, ultrasonography, CT-scan, and MRI) in Imam-Khomeini Hospital in Tehran. Structured interviews and the analysis of related documents were used to acquire the pertinent data. The percentage of out-of-pocket expenditures was obtained by dividing the out-of-pocket expenditures by the total expenditures paid to the service provider, i.e., the sum of out-of-pocket expenditures and insurance payments. To analyze the data, we used descriptive-analytic statistics, distribution indices, the t-test, and the Pearson product-moment correlation coefficient. RESULTS: Health insurance covered 84% of costs incurred by users of outpatient imaging services. There was no significant relationship between the user's age and the amount of out-of-pocket expense (p = 0.01). The relationship between the user's gender and out-of-pocket expense was significant (p = 0.05). The average payment for males was greater than the average payment for females. The highest percentage of the total payment the users incurred was 41% for a CT-scan, and the lowest percentage the users incurred was 30% for radiology services. CONCLUSION: It is suggested that expensive diagnostic tests, such as CT-scans, be prescribed according to the actual needs of patients to make the financial burden of diagnostic services reasonable for all patients.

Study of Educational Hospital Employees' Satisfaction with the Administration of the Health Reform Plan in Ghazvin, 2015.

INTRODUCTION: Employee satisfaction is considered to be an important component in the promotion of service quality and increased efficiency and effectiveness in the reform plan for a healthcare system. Neglecting this issue could result in a lack of success in achieving the healthcare system's objectives. The healthcare reform plan is being implemented to achieve the objectives of the healthcare system. Thus, given the key role of hospital employees in implementing the reform plan, the aim of this study was to determine the levels of hospital employees' satisfaction with their jobs. METHODS: This was a qualitative study in 2015 that included thematic analysis, and 138 employees of the Kosar, Rajaii, and Ghods Hospitals participated. Data were collected using semi-structured interviews, and the data were analyzed using content analysis. RESULTS: After analyzing the data collected by interviewing the employees, 132 codes were identified. The codes were classified into five general concepts including opinions about 1) the reform plan and its administrative barriers, 2) changes in visits, 3) changes in working conditions, 4) changes in salaries and 5) General satisfaction of personnel. CONCLUSION: Increasing workloads, stagnant salaries, and the shortage of personnel were the main factors that reduced the satisfaction of the hospitals' employees with the administration of the healthcare reform plan.