A cross-sectional study determining prevalence and factors associated with ST-segment elevation myocardial infarction and non-ST segment elevation myocardial infarction in Iran: results from fasa registry on acute myocardial infarction (FaRMI).

BACKGROUND: Acute myocardial infarction is still a leading cause of death worldwide, accounting for roughly three million deaths yearly. This study aimed to investigate the prevalence and factors associated with ST-Segment Elevation Myocardial Infarction and Non-ST Segment Elevation Myocardial Infarction in Iran. METHODS: This cross-sectional study was conducted using the databases of the Fasa Registry on Acute Myocardial Infarction (FaRMI) and the Fasa Adult Cohort Study (FACS). chi-squared and one-way ANOVA tests were utilized to calculate the unadjusted associations between the study variables. A multivariate multinomial logistic regression model was also employed to determine the adjusted association of each independent variable with the risk of ST-elevation myocardial infarction (STEMI). RESULTS: The prevalence of STEMI and non-STEMI was 31.60% and 11.80%, respectively. Multinomial logistic regression showed that older age, anemia, high WBC, and high creatinine levels were associated with higher odds of STEMI and non-STEMI compared to healthy individuals. In addition, based on the analysis being a woman(OR = 0.63,95%CI:0.51-0.78), anemia(OR = 0.67,95%CI:0.54-0.63)and hypertension (OR = 0.80,95%CI:0.65-0.97)decreased the likelihood of STEMI occurrence compared to non-STEMI, while high WBC(OR = 1.19,95%CI:1.15-1.23)increased the odds. CONCLUSION: In this study, significant predictors of MI risk included age, gender, anemia, lipid profile, inflammation, and renal function. Subsequent investigations ought to prioritize the comprehensive understanding of the underlying mechanisms that drive these connections and assess the effectiveness of specific interventions aimed at diminishing the occurrence of MI and improving patient outcomes.

Contrasting socioeconomic inequality with noncommunicable diseases: Insights from a population-based survey using the concentration index in Kong cohort study.

Background: Noncommunicable diseases (NCDs) are the major causes of mortality across the globe, which impose a substantial burden on health care systems, particularly in low- and middle-income countries. The present study aimed to determine socioeconomic inequality in the prevalence of NCDs using the concentration index (CI). Methods: This cross-sectional study was conducted on the baseline data of the Bandar Kong cohort. The principal component analysis was used to determine people's socioeconomic status (SES). The CI and Lorenz Curve were used for the assessment of socioeconomic inequality. Multivariate logistic regression was used to assess the relationship between SES and the prevalence of NCDs. A p Value less than 0.05 is considered significant. Results: Frequency and prevalence of diabetes was 653 (16.22%), hypertension 848 (21.06%), chronic lung diseases 161 (4%), epilepsy 70 (1.74%), mental disorders 191 (4.74%), stillbirth 299 (13.94%), thyroid disorders 391 (9.71%) and depression 146 (3.63%). CI for the prevalence of diabetes was [-0.107, %95 CI: -0.146 to -0.068], hypertension [-0.122, %95 CI: -0.155 to -0.088], chronic lung disease [-0.116, %95 CI: -0.202 to -0.03], psychiatric disorders [-0.230, %95 CI: -0.304 to -0.155], depression [-0.132, %95 CI: -0.220 to-0.043] and stillbirth [-0.162, %95 CI: -0.220 to -0.105]. The Gini index was negative for all these diseases, indicating that these are significantly concentrated in people of poor SES. Conclusions: The findings suggest that selected NCDs were concentrated among the poor and the low-income. Particular attention may be necessary to address the problem of NCDs among these groups.

Predictive value of triglycerides to high-density lipoprotein cholesterol and triglyceride glycemic index for diabetes incidence in pre-diabetes patients: a prospective cohort study.

BACKGROUND: The triglyceride glucose (TyG) and triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-c) are the indices that can predict the progression of pre-diabetes to type 2 diabetes mellitus (T2DM). This study aimed to examine the relationship between TyG and TG/HDL-c indices with the incidence of T2DM in pre-diabetes patients. METHODS: A total of 758 pre-diabetic patients aged 35-70 years who were enrolled in a prospective Fasa Persian Adult Cohort were followed up for 60 months. TyG and TG/HDL-C indices were obtained at baseline data and divided into quartiles. The 5-year cumulative incidence of T2DM was analyzed by Cox proportional hazards regression analysis while controlling for baseline covariates. RESULTS: During 5 years of follow-up, there were 95 incident cases of T2DM, with an overall incidence rate of 12.53%. After adjusting for age, sex, smoking, marital status, socioeconomic status, body mass index, waist circumference, hip circumference, hypertension, total cholesterol, and dyslipidemia, the multivariate-adjusted hazard ratios (HRs) demonstrated that patients with the highest TyG and TG/HDL-C indices quartile were at higher risk of T2DM (HR = 4.42, 95%CI 1.75-11.21) and (HR = 2.15, 95%CI 1.04-4.47), respectively, compared to participants in the lowest quartile. As the quantiles of these indices increase, the HR value shows a significant increment (P < 0.05). CONCLUSION: The results of our study showed that the TyG and TG/HDL-C indices can be important independent predictors for the progression of pre-diabetes to T2DM. Therefore, controlling the components of these indicators in pre-diabetes patients can prevent developing T2DM or delay its occurrence.

Predictors of hospital length of stay and mortality among COVID-19 inpatients during 2020-2021 in Hormozgan Province of Iran: A retrospective cohort study.

Background and Aims: About one-fifth of patients with COVID-19 need to be hospitalized. Predicting factors affecting the hospital length of stay (LOS) can be effective in prioritizing patients, planning for services, and preventing the increase in LOS and death of patients. The present study aimed to identify the factors that predict LOS and mortality in COVID-19 patients in a retrospective cohort study. Methods: A total of 27,859 patients were admitted to 22 hospitals from February 20, 2020 to June 21, 2021. The data collected from 12,454 patients were screened according to the inclusion and exclusion criteria. The data were captured from the MCMC (Medical Care Monitoring Center) database. The study tracked patients until their hospital discharge or death. Hospital LOS and mortality were assessed as the study outcomes. Results: As the results revealed, 50.8% of patients were male and 49.2% were female. The mean hospital LOS of the discharged patients was 4.94. Yet, 9.1% of the patients (n = 1133) died. Among the predictors of mortality and long hospital LOS were the age above 60, admission to the ICU, coughs, respiratory distress, intubation, oxygen level less than 93%, cigarette and drug abuse, and a history of chronic diseases. Masculinity, gastrointestinal symptoms, and cancer were the effective variables in mortality, and positive CT was a factor significantly affecting the hospital LOS. Conclusion: Paying special attention to high-risk patients and modifiable risk factors such as heart disease, liver disease, and other chronic diseases can diminish the complications and mortality rate of COVID-19. Providing training, especially for those who care for patients experiencing respiratory distress such as nurses and operating room personnel can improve the qualifications and skills of medical staff. Also, ensuring the availability of sufficient supply of medical equipment is strongly recommended.

Success rate evaluation of clinical governance implementation in teaching hospitals in Kerman (Iran) based on nine steps of Karsh's model.

BACKGROUND: One of the ways to improve the quality of services in the health system is through clinical governance. This method aims to create a framework for clinical services providers to be accountable in return for continuing improvement of quality and maintaining standards of services. OBJECTIVE: To evaluate the success rate of clinical governance implementation in Kerman teaching hospitals based on 9 steps of Karsh's Model. METHODS: This cross-sectional study was conducted in 2015 on 94 people including chief executive officers (CEOs), nursing managers, clinical governance managers and experts, head nurses and nurses. The required data were collected through a researcher-made questionnaire containing 38 questions with three-point Likert Scale (good, moderate, and weak). The Karsh's Model consists of nine steps including top management commitment to change, accountability for change, creating a structured approach for change, training, pilot implementation, communication, feedback, simulation, and end-user participation. Data analysis using descriptive statistics and Mann-Whitney-Wilcoxon test was done by SPSS software version 16. RESULTS: About 81.9 % of respondents were female and 74.5 have a Bachelor of Nursing (BN) degree. In general, the status of clinical governance implementation in studied hospitals based on 9 steps of the model was 44 % (moderate). A significant relationship was observed among accountability and organizational position (p=0.0012) and field of study (p=0.000). Also, there were significant relationships between structure-based approach and organizational position (p=0.007), communication and demographic characteristics (p=0.000), and end-user participation with organizational position (p=0.03). CONCLUSION: Clinical governance should be implemented by correct needs assessment and participation of all stakeholders, to ensure its enforcement in practice, and to enhance the quality of services.

Quantitative optimization of emergency department's nurses of an educational hospital: a case study.

INTRODUCTION: Nurses account for the majority of human resources in hospitals, as such that 62% of the workforce and 36% of hospital expenditures are related to nurses. Considering its vital role in offering round-the-clock emergency healthcare services, an Emergency Department (ED) requires adequate nurses. Therefore, this study was conducted to optimize the number of nurses in ED. METHODS: This was an applied study conducted using a Linear Programming (LP) model in 2015. The study population were selected by census who were all ED nurses (n=84) and patients referred to ED (n=3342). To obtain the statistics related to the number of patients and nurses, the hospital information system and human resources database were employed respectively. To determine the optimum number of nurses per shift, LP model was created via literature review and expert advice, and it was executed in WinQSB software. RESULTS: Before implementing the model, the number of nurses required for ED morning shift, evening shift, and night shift (2 shifts) was 26, 24 and 34 respectively. The optimum number of nurses who worked in ED after running the model was 62 nurses, 17 in the morning shift, 17 in the evening shift and 28 in the night shift (2 shifts). This reduced to 60 nurses after conducting sensitivity analysis. CONCLUSION: The estimated number of nurses using LP was less than the number of nurses working in ED. This discrepancy can be reduced by scientific understanding of factors affecting allocation and distribution of nurses in ED and flexible organization, to reach the optimal point.

Patients' awareness of their rights: insight from a developing country.

BACKGROUND: Considering the effect of human right observance on patients' satisfaction from the treatment process, in Iran the Patient Rights Charter (PRC) was developed by the Ministry of Health and Medical Education (MOHME) in 2001 and enforced to all hospitals across the country. The purpose of the current study was to evaluate patients' awareness of their rights based on PRC in two tertiary teaching hospitals affiliated with Shiraz University of Medical Sciences (SUMS) in Iran. METHODS: Current study was a cross-sectional descriptive and analytical survey. The research sample consisted of 200 inpatients and data were gathered through questionnaires filled out during the interview. The rate of awareness of patients was measured on a Likert scale ranging from 1 to 4. Validity and reliability of the questionnaire were confirmed. Data were analysed by descriptive and analytical statistics. RESULTS: In 30.5% of cases, the total awareness of patients was weak, in 59.4% was moderate, and in 10.1% of them was good. The most awareness was about trust and assurance to confidentiality of treatment team, and the least was about providing sufficient information about treatment options and their complications. There was a significant relationship between educational level and the place of residency with patients' awareness (P<0.001). CONCLUSION: Total awareness of patients from their rights was medium. Although compared to similar studies this rate was not unsatisfactory, attempts should be made to improve it. Health care organizations are to deliver PRC to patients and make sure they have proper information about their rights. Assuring observance of patients' rights requires not only informing healthcare policy makers and providers, but also educating citizens about what they must expect from their governments and health care providers. This will consequently improve the quality of services. Establishment of Patient Right Committee for supervision and monitoring of informing and observance of patients' rights is also recommended.