Financial protection of populations against healthcare costs is one of the fundamental responsibilities of governments. This study aimed to investigate the incidence of catastrophic health ...expenditures (CHE) and it's affecting factors in hospitalized patients with delta variant of COVID-19.
In this cross-sectional study, we included 400 hospitalized COVID-19 patients at Kosar Hospital of Semnan in 2022, using a researcher-made checklist. Based on qualitative nature of the variables, chi-square test was used to investigate the statistical associations between the demographic/background characteristics and the incidence of CHE.
On average, COVID-19 imposed 1833.43 USD direct medical costs per one hospitalized patient. The ratio of direct-medical costs to household's non-food expenses was 2.35, and 61% (CI:±4.78%) of the patients were subject to CHE. Besides, residence place, basic insurance type, benefitting from supplementary insurance, suffering from underlying diseases, hospitalization in ICU, falling into a coma, facing pulmonary failure, and performing hemoperfusion had significant associations with CHE (
<0.05).
The incidence of CHE in hospitalized COVID-19 patients was undesirable, which may be due to geographical, economical, and occupational inequalities apart from the factors related to the severity of the disease. So, health policymakers should pay attention to the provision of proper financial risk protection policies to make the health insurance system more efficient and appropriate.
Background: The main purpose of a health system is to provide quality care services, and providing orderly, high-quality, safe, and economic services requires skillful and knowledgeable nurses. ...Critical Care M.Sc. curriculum in Iran was revised in June 2010. Studies show that, since specialized associations such as the World Health Organization have demanded the improvement of educational standards for the graduates of this major, educational planner have tried to design a successful and efficient curriculum through examining other successful educational systems in the world. By comparing different educational systems, quality of educational programs can be improved. In addition, comparative studies are one of the most dynamic scientific approaches adopted by educational planners in various countries, such that it is considered a prerequisite for designing modern educational systems. In light of this, the present study tried to compare Critical Care M.Sc. curriculum in Iran with that of the university of Glasgow. It is one of the oldest universities in the UK, the fourth oldest and of the top 100 universities in the world.
Methods: This was a comparative and descriptive study conducted in 2020 to compare the Critical Care M.Sc. curriculum in Iran with a corresponding one in the university of Glasgow through Beredy model.
Results: Although Critical Care M.Sc. Curriculum in Iran is in an acceptable position compared to the university of Glasgow's evidence-based education approach, the focus on academic writing skills for improving the graduates’ skill of writing research papers, and the availability of a part time program were of the advantages of Critical Clinical Care curriculum at the university of Glasgow. On the other hand, lack of a specific and strategic programing, and ambiguities about missions of the graduates were the weaknesses. The curriculum in Iran was clear about the philosophy, mission, and perspective, while job opportunities of the graduates in clinical settings were not clear. This was one of the reasons for the reluctance of the graduates to enter clinical environment, which was a disadvantage of the program in Iran.
Conclusion: Although Critical Care M.S Curriculum in Iran is in an acceptable position compared to the one in the University of Glasgow's evidence-based approach, Focus on the academic writing skills for improving the graduates’ skills of writing research papers, and availability of a part time program were of the advantages of the critical clinical care program at the University of Glasgow. On the other hand, lack of a strategic programing and the ambiguities about missions of the graduates were the weaknesses. The curriculum in Iran was clear about the philosophy, mission, and perspective, while the job opportunities of the graduates in clinical setting were not clear. This is one of the reasons for the reluctance of graduates to enter clinical environment, which is a disadvantage of the program in Iran.
Accreditation is a prerequisite for scientific management of the health system, owing to its numerous benefits on health centres' performance. The current study examined Iran's primary healthcare ...accreditation program to ascertain the challenges to its successful implementation.
This qualitative study examined the perspectives of 32 managers and staff members in the pilot accreditation program (from the Ministry of Health and Medical Education, Semnan University of Medical Sciences, and Aradan District Health Network). Three in-depth group interviews were conducted using a semi-structured questionnaire, and the data obtained were assessed using thematic analysis. As a result of this investigation identified six themes, 29 sub-themes, and 218 codes as challenges to the successful accreditation of primary health care in Iran.
Six main themes, including "organisational culture", "motivational mechanisms", "staff workload", "training system", "information systems", and "macro-executive infrastructure", were identified as the main domain of challenges, with seven, five, two, four, three, and eight sub-themes respectively.
Accreditation of PHC in Iran faces significant challenges and obstacles that, if ignored, can jeopardise the program's success and effectiveness. By identifying challenges and obstacles and making practical suggestions for overcoming them, the findings of this study can aid in the program's successful implementation and achievement of desired outcomes.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Introduction: Evidence on the impacts of accreditation on primary health care (PHC) services is inconsistent. Thus, this study aimed to assess the impacts of accreditation on the performance of PHC ...centres.
Methods: This study systematically reviewed articles published from 2000 to 2019 in the Web of Science, Scopus, ScienceDirect, Springer, PubMed and ProQuest. The following keywords were used: ((primary care OR primary health care) AND (accreditation) AND (impact OR effect OR output OR outcome OR influence OR result OR consequences)). The database search yielded a total of 41256 articles, among which 30 articles were finally included in the review.
Results: Accreditation showed the most positive impacts on the quality, effectiveness, human resource management and strategic management of PHC services. Accreditation also positively affected safety, responsiveness, accessibility, customer satisfaction, documentation, leadership, efficiency and continuity of care. Few negative impacts were noted, including the possibility of accreditation being used as a bureaucratic tool, high cost of acquiring accreditation, difficulties in understanding the accreditation process, high staff turnover rate in accredited PHC centres and weak sustainability of some accreditation programmes.
Conclusion: Given its numerous positive impacts, accreditation could be used to effectively improve the performance of PHC centres.
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FFLJ, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UL, UM, UPUK
Magnesium (Mg)-based alloys are biodegradable metallic biomaterials that show promise in minimizing the risks of permanent metallic implants. However, their clinical applications are restricted due ...to their rapid in vivo degradation and low surface hemocompatibilities. Surface modifications are critically important for controlling the corrosion rates of Mg-based alloys and improving their hemocompatibilities. In the present study, two heparinization methods were developed to simultaneously increase the corrosion resistance and hemocompatibility of the AZ31 Mg alloy. In the first method, the surface of the AZ31 alloy was modified by alkali-heat treatment and then aminolyzed by 3-amino propyltriethoxy silane (APTES), a self-assembly molecule, and heparin was grafted onto the aminolyzed surface. In the second method, before heparinization, polyamidoamine dendrimers (PAMAM4-4) were grafted onto the aminolyzed surface with APTES to increase the number of surface functional groups, and heparinization was subsequently performed. The presence of a peak with a wavelength of about 1560 cm
in the FTIR spectrum for the sample modified with APTES and dendrimers indicated aminolysis of the surface. The results indicated that the corrosion resistance of the Mg alloy was significantly improved as a result of the formation of a passive layer following the alkali-heat treatment. The results obtained from a potentiodynamic polarization (PDP) test showed that the corrosion current in the uncoated sample decreased from 25 µA to 3.7 µA in the alkali-heat-treated sample. The corrosion current density was reduced by 14 and 50 times in samples treated with the self-assembly molecules, APTES and dendrimers, respectively. After heparinization, the clotting time for pristine Mg was greatly improved. Clotting time increased from 480 s for the pristine Mg sample to 630 s for the APTES- and heparin-modified samples and to 715 s for the PAMAM- and heparin-modified samples. Cell culture data showed a slight improvement in the cell-supporting behavior of the modified samples.
Background: Multiple sclerosis (MS) is one of the critical diseases due to its adverse clinical, social, and economic consequences for affected people. This study aims to assess the quality of life ...(QoL) of patients with MS in East Azerbaijan, Iran. Methods: This cross-sectional study was conducted using the multiple sclerosis quality of life-54 (MSQoL-54) questionnaires to interview 300 randomly selected MS patients in East Azarbaijan Province, Iran. The independent t-test, analysis of variance (ANOVA), and Tukey post hoc test were used to examine the relationship between demographic variables, and QoL, and all analyses were performed using SPSS software, version 19. Results: The QoL score in MS patients is 48.22±22.48. The “life satisfaction” is the best and “physical role limitation” is the worst QoL aspect. Significant relationships were observed between marital status, education level, employment status, age of symptoms onset, and years of illness with QoL (P<0.05). Conclusion: The QoL of the MS patients in East Azarbaijan Province is lower than in other parts of Iran and much lower than in Organization for Economic Co-operation and Development (OECD) countries.
Faults at either the link or router level may result in the failure of the system. Fault-tolerant routing algorithms attempt to tolerate faults by rerouting packets around the faulty region. This ...rerouting would be at the cost of significant performance loss. The proposed algorithm in this paper is able to tolerate both faulty routers and links with negligible impact on the performance. In fact, the proposed algorithm avoids taking unnecessary longer paths and the shortest paths are always taken as long as a path exists. On the other hand, fault-tolerant routing algorithms might be based on deterministic routing in which all packets use a single path between each pair of source and destination routers. Using deterministic routing, packets reach the destination in the same order they have been delivered from the source so that no reordering buffer is needed at the destination. For improving the performance, fault-tolerant algorithms might be based on adaptive routing in which packets are delivered through multiple paths to destinations. In this case, packets should be reordered at the destinations demanding reordering buffers. The proposed algorithm can be configured in both working modes, such that it can be based on deterministic or adaptive routing.
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CEKLJ, DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The purpose of this study was to systematically review the literature and use meta-analysis to investigate whether chlorhexidine (CHX) application after acid etching as an adjunct treatment has any ...influence on the immediate and delayed bond strength to primary dentin.
In this review, PubMed, ISI (all data bases), Scopus and Cochrane were searched according to the selected keywords up to April 30, 2018. The full texts of all published articles that met our primary inclusion criteria were obtained. The studies were analyzed in two parts: in vitro studies that evaluated the effect of CHX application during the bonding procedures (application after acid etching) on immediate and delay dentin bond strength of resin-dentin interface.
The initial search yielded 214 publications, of which 8 were selected after thorough methodological assessment. None of the clinical studies fulfilled the eligibility criteria. Our results indicated that in comparison to the control group, CHX significantly reduced immediate resin-dentin bond strength (P=0.043). These values were increased after aging (P<0.001).
Based on this invitro Meta-analysis CHX application, improve resin-dentin bond strength durability in primary teeth.
Background & Objective: This study aimed to compare the perception of undergraduate dental students with digital, blended, and conventional learning experiences. Materials & Methods: A search of the ...literature was performed in PubMed, Cochrane, Scopus, Web of Science, and Embase databases with keywords of study, yielding 3541 articles. Educational intervention studies that compared undergraduate dental students’ perceptions toward digital and traditional learning were included. The quality of articles was analyzed by the risk of bias 2 (ROB2). Using Comprehensive Meta-Analysis software and a random-effect model, 4 main outcomes of self-reported acquired knowledge, self-reported acquired competence, satisfaction level, and usefulness of learning were compared among the E-learning, blended, and conventional groups. The standardized mean difference (SMD) was calculated. The GRADE approach was used to analyze the certainty of evidence. Results: After removing the duplicates and assessing the abstract and full text of the articles, 23 articles were systematically reviewed, and 15 articles underwent meta-analysis. In quantitative analysis, 13 studies had a high risk of bias and 2 had some concern risk of bias. No significant difference was found among the E-learning, blended and conventional learning in self-reported acquired knowledge (SMD=0.19, 95% CI: -0.20-0.58, P=0.34), self-reported competence (SMD=-0.07, 95% CI: -0.57-0.43, P=0.77), satisfaction level (SMD=0.05, 95% CI: -0.42-0.31, P=0.77) or usefulness of learning (SMD=0.28, 95% CI: -0.72-0.15, P=0.2). Conclusion: No significant difference was noted among the E-learning, blended and conventional groups in self-reported acquired knowledge and competence, satisfaction level, and usefulness of learning to accord to the opinion of undergraduate dental students. However, considering the low level of evidence, the results should be interpreted with caution.
In order to lessen health inequalities, the obstacles to health equity will need to be identified. This study aimed at investigating the barriers to access to health-care services from the medical ...ethics point of view. Data were collected through a qualitative study by performing semi-structured interviews. Purposive sampling was used to recruit participants involved in health provision and/or management. Content analysis was done using MAXQDA software. Overall, 30 interviews were conducted. The content analysis of the interviews identified two themes including "micro factors" and "macro factors", five sub-themes including "cultural, financial, geographical, social and religious barriers", and 44 codes. Based on our findings, differences in individuals' perceptions, cultural control, religious beliefs and social stigmas create cultural barriers. Financial barriers consist of the financial connection between service recipients and service providers, insurance premiums, and inadequate coverage of health-care services. The most important geographical barriers identified in our study were differences in urbanization, inequality in various geographical areas, marginalization, and inequality in resource distribution. Finally, differences in the level of income, education and occupational diversity were among the social barriers. Given the wide range of barriers to access to health-care services, a comprehensive plan covering various dimensions of health equity should be implemented. To this end, innovative and progressive strategies emphasizing the principles of equity and social equality should be developed.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
