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Table of Contents
April-June 2014
Volume 2 | Issue 2
Page Nos. 73-131
Online since Monday, August 18, 2014
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REVIEW ARTICLE
Trade in health services and mode 4 in Asian Countries: Challenges and opportunities
p. 73
Alireza Jabbari, Raja Mardani
DOI
:10.4103/2347-9019.138929
Trade in health services is becoming a rapidly growing trend due to the ease of using information and communication technology. Health services are traded under the General Agreement on Trade in Services (GATS) through four modes. Migration of health professionals, the 4
th
mode, showed a growing trend due to increasing demand factors, such as demographic changes, aging population, and rising healthcare costs in high-income countries, and encouraging supply factors, such as export development, increasing foreign exchange earnings, and increasing employee knowledge and skills. Countries must obtain the benefit from migration of healthcare professionals also as it can be a challenge. This paper reviews the opportunities and challenges resulting from migration of healthcare professionals in Asian countries. Studies showed that countries importing and exporting health services do not face identical opportunities and challenges. Migration to higher-income countries provides better working and living conditions for healthcare professionals and acts as a revenue source for exporter countries. However, the lack of explicit policies in this area will lead to depletion of professionals in the home country and loss of national wealth that was spent on educating these migrating professionals.
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ORIGINAL ARTICLES
Experts' perspectives on barriers due to induced demand in health services
p. 78
Mahmoud Keyvanara, Saeed Karimi, Elahe Khorasani, Marzie Jafarian Jazi
DOI
:10.4103/2347-9019.138931
Introduction:
Induced demand is a debatable subject in health care economy. It is defined as inducing provision, care and delivers an inessential service to clients of health care system using provider's power. It eventually increases health care costs and catastrophic cost index by confronting unlimited needs and limited resources. This article aims to investigate the barriers due to induced demand in health services with the use of expert's experiences of Isfahan University of Medical Sciences.
Materials
and
Methods:
This is a qualitative research. Semi-structured interview was used for data gathering. Participants in this study were people who had been informed and experienced in this regard and were known as 'experts'. Total of 17 people were interviewed by purposive sampling and some criteria such as data "reliability of information" and "stability" were considered. The anonymity of the interviewees was preserved. The data were transcribed, categorized, and then the thematic analysis was used.
Results:
In this study, thematic analysis was conducted so that three themes and 41 sub-themes were extracted. The three main themes include insurance organizations barriers, health systems barriers, and patient's barriers. Each of them has some sub-themes.
Discussion:
The results of this study provide barriers due to induced demand. The most notable findings include double financial pressure on insurance, unreal expectations of the insurance to confirm non-essential drugs, inappropriate allocating the resources reducing the service quality, damaging equity in health system, reducing economic productivity, rising health care and diagnostics costs, patient's confusion and causing undue influence on patients. These findings will help health policy-makers consider challenges of design appropriate strategies to reduce them.
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Presentation of strategic model and predict the interaction formula crisis with emphasis on earthquake crisis: District 22 of Tehran Mega-city
p. 84
Seyed Mahdi Hashemi, Amir Mahmoudzadeh, Fariba Yousefi
DOI
:10.4103/2347-9019.139039
Introduction:
Nearly five centuries have passed after the appearance of the word crisis (crisin) in Latin. During the last two centuries, the words (crisin, crise) have had a wide literature in English and French languages. In Persian language in the case of crisis literature and crisis management in political and economical fields and especially in international crisis, despite the growing importance of them, the works are negligible. Natural disasters losses in the world since 1990 in average have been over 40 billion dollars annually.
Aim:
Purpose of studying the interaction of various items of earthquake. Losses incurred in 1995 only are totaled were estimated 167 billion dollars and despite the fact that the accumulation of capital assets in developed countries in compare with developing countries is higher, the economic effects of natural disasters and catastrophes are equally divided between the two groups of the countries.
Materials and Methods:
Method used in this research is the analytic hierarchy process (AHP) for the evaluated criterion. Among the results of this research, the abundance of gardens and green areas can be noted as a point of strength. So that these spaces can play a special role in crisis management, this research presented formula for evaluation.
Results:
This formula is defined based on effective indicators, such as time coefficient, location coefficient (safety coefficient of the area), regional coefficient, culture and education level coefficient, equipment coefficient (individuals-Facilities), regulations coefficient, vital arteries and the communication coefficient, rescue and relief coefficient, that each one will be separately defined.
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The study of the quality and capacity of equipments' functionality and non-structural vulnerability in selected Tehran general hospitals during an earthquake
p. 93
Ali Maher, Shahin Mohammadi Yeganeh, Mohsen Asadi Lari, Sayed Hesam Sayedin
DOI
:10.4103/2347-9019.139041
Introduction:
In this research project, we studied the quality and capacity of the equipments' functionality and non-structural vulnerability of seven hospitals in the city of Tehran during an earthquake.
Materials and Methods:
The research's place was general hospitals with private and governmental management; the research society was all Tehran general hospitals where a random sample of seven general hospitals were studied in eleven different categories. The methodology of the study was descriptive cross sectional; sampling was random simple and the instrument for the study was World Health Organization (WHO)/Pan American Health Organization (PAHO) Standard checklist. The lowest levels of functionality were observed in emergency exit systems, communication systems, furniture, and equipments.
Results:
The heating and cooling systems, air conditioning of specific sections, medical gas systems, fire detection and extinguisher of most hospitals in the study were functioning at satisfactory levels. Even though in general assessment, 56% of the hospitals were functioning at satisfactory levels in non-structural features, in every hospital the critical, vital, and effective sections were functioning at an average and some in even low levels.
Conclusions:
In conclusion, non-structural assessment of hospitals under the study did not show the satisfactory level of ability to respond appropriately at the time of crisis. There are existing standard guidelines for the safety of non-structural elements in hospitals that explain all the necessary steps needed to maintain and protect these components in great details. Therefore, any strategies for improvement in aforementioned components are due to the establishment of better laws and regulations. Our suggestions procedures are as fallowing: 1. Official quality assessment of all hospitals, detection of non-structural safety problems, and introduction of strategies to solve these problems. 2. Passing of an official, mandatory safety and response capability bill for hospitals and medical centers. 3. Establishment and enforcement of incentive and fines for the medical center management to ensure the ability to respond to crisis and/or national disasters.
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Knowledge and practices of school teacher regarding disaster management
p. 98
Joshi Sonopant Ganpatrao
DOI
:10.4103/2347-9019.139055
Introduction:
Developing countries suffer major losses due to disasters. Reducing disaster losses is a fundamental goal for most governments. School teachers must be aware of disasters and its consequences to tackle the disasters at school.
Aims:
An exploratory study was conducted to assess knowledge and self-expressed practices regarding disaster management among secondary school teachers at selected schools of Pune city.
Materials and Methods:
A non-experimental research design was used. Five hundred and forty secondary school teachers were selected by purposive sampling technique. Survey was conducted using a structured interview questionnaire.
Results:
Findings revealed that mean knowledge score was 15.9 (53%) and mean practice score was 7.05 (47%). There was moderate positive correlation between knowledge score and practice score (r = 0.54).
Conclusions:
Study concluded that that teachers knowledge and self-expressed practices were not at satisfactory level. Capability building among teachers is utmost necessary.
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The study of outputs and collaboration of Iranian Researchers in disaster in Scopus citation database from 1999 to 2013
p. 103
Behjat Taheri, Hasan Ashrafi-Rizi, Leila Shahrzadi, Nayere Sadat Soleimanzade Najafi
DOI
:10.4103/2347-9019.139060
Background
: The phenomenon of collaboration is the largest knowledge sharing network and real interference of researchers in science production and scientific development. So, in the present study we define the outputs and collaborations of Iranian researchers in field of disasters in Scopus citation database from 1999 to 2013.
Materials and Methods
: Methodology of this study was scientometrics based on collaborations indexes and type of applied study. The population of study composed of all scientific production of Iranian researchers in the field of disasters from Scopus citation database getting indexed from 1999 to 2013 (448 document). Then information for regulation and the final analysis moved to excel software and the collaboration coefficient was obtained by cc formula. The type of descriptive statistics was (frequency, percentage, average, and standard deviation).
Findings:
Results show that the maximum collaboration were between Iran and Great Britain with (21%) and after that with the United States of America with (20%) and minimum amount of collaboration between Iran with Japan and France with (4%). The group collaboration between authors in1999 − 2011. Results show that Iranian researchers overall can publishe 448 documents in Scopus citation database between 1999 and 2013. Among the years that studied maximum collaboration coefficient in document writing are in 1999 and 2000.
Conclusion
: Results of author's collaboration coefficient in field of disasters are in appropriate conditions. However, with respect to importance of teamwork and its Influence in the country researches should be encouraged to collaborative research work which can increase quality and numbers of citations furthermore enhanced quantity of scientific production.
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The dynamics of arrival and service delivery in a Nigerian public ophthalmic outpatient clinic
p. 110
Lasisi Akinola Muideen, Lasisi Abiodun Folake, Obasohan Philip
DOI
:10.4103/2347-9019.139069
Aim:
To investigate the dynamics of patients' arrival and service uptake in order to propose a way of achieving the time target of the 'Service Delivery Charter' of the Federal Government of Nigeria.
Materials and Methods:
One hundred and seventy one presenting sample of patients between the 8 and 25 February, 2005 were monitored at the outpatient ophthalmic clinic of the Federal Medical Center, Bida-Nigeria. A trained principal confidential secretary using a digital watch timer and timed closed-circuit television (CCT) camera conducted a timed motion record - as developed by Frederick Taylor in 1911- of patients and service provider for the entire clinic period. These records included patients' order of arrival as well as the time for waiting, service call up, service times at different service stations as well as the time of exit from service for each patient. Data were entered and analyzed using the Statistical Package for Social Science computer software.
Results:
Only 3.6% of patients arrived before the commencement of clinic operations, but as much as 75% arrived before 9.00 am, a time that is 30 minutes before the attainment of peak clinical service operation. Only 6.4% will arrive spontaneously at an interval of time that is big enough to discharge the patient who arrived before them. With respect to the time for service uptake, 700% of time was spent in waiting for services, while clinic layout and logistic redesign offers a maximum time saving of 57% of service uptake time.
Conclusion:
A timed appointment system is therefore hypothesized to be a very important option to add to the booking systems for the attainment of time targets in public hospitals in Nigeria.
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Study of the prevalence of intestinal parasitic infections in a tertiary care hospital located in central India
p. 113
Taruna Singh, Ganesh S Bhatambare, Arvind B Deshmukh, Trupti Bajpai, Ila Srivastava, Kamlesh B Patel
DOI
:10.4103/2347-9019.139070
Background:
Intestinal parasitic infections are important public health problems, especially in the developing countries like India. The prevalence of different parasitic diseases depends upon social, environmental, and economic factors.
Aim:
To evaluate the year-wise, gender-wise, and age-wise prevalence of intestinal parasites among the patients visiting a tertiary care hospital located in central India.
Materials and Methods:
The present study was conducted in the microbiology section of central laboratory located in our hospital. All the stool samples received in the laboratory were macroscopically and microscopically examined. The parasite prevalence data collected from June 2007 to May 2012 was evaluated retrospectively.
Results:
Out of the total 7,215 samples evaluated, 1,004 (13.9%) samples were found to be positive for least one parasite. A total of 969 (13.4%) samples had protozoan parasite and 35 (0.4%) samples had helminthes. Among these, the 670 (9.2%) samples had a single parasite, 278 (3.8%) had dual infection, 51 (0.7%) had triple, and 5 (0.07%) had quadruple infection.
Discussion:
The parasite prevalence gradually declined from the year 2007 (17.5%) to 2012 (11.7%). The rate of infection was found to be high in males (15.6%) as compared to females (12%) as influenced by day to day activity. More of the infected patients were found to be among age groups 21-30 years as affected by food habits and higher exposure of young adults to contaminated environments.
Conclusions:
The prevalence of intestinal parasitic infections has though declined year after year due to increased awareness, improved health and sanitary practices, and availability of potable water in our place; still negative reports can be increased by personal implementation of these practices by every individual from rural as well as from urban areas.
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An analytical study on burns in Isfahan province from 2009 to 2011 focusing on ICD-10
p. 117
Hamid Moghadasi, Azamossadat Hosseini, Maryam Jahanbakhsh
DOI
:10.4103/2347-9019.139071
Background:
Among the critical world health problems, burns are considered as one of the major causes of illness and death.
Materials and Methods:
This research is an analytical-retrospective. The study population included all inpatients (n = 2604) admitted to Imam Musa Kazim Center from 2009-2011. The demographic data and in-hospital outcomes in the burned people were classified based on factors in ICD-10 (anatomical site, cause of burn, place of burn and total burn surface area, TBSA) and then were analyzed by analytical statistics.
Results:
The finding showed the ratio of women's mortality due to burns to men's was 2:1. The probability of mortality was also doubled by an increase in TBSA. The rate of burns in men compared to the women was 1.6-1 with the highest frequency in the patients aged 15-30. There was statistically significant correlation between TBSA and gender, age, marital status and finally mortality factors (P < 0.0001). The frequency of burns, from 2009 to 2011, was higher for the 15-30 age group, females as well as the married ones. TBSA, age, gender, marital status, and cause of burn found to be the most significant factors influencing mortality's risk due to burns, respectively.
Conclusion:
ICD-10 can portray many epidemiological information needs in health care domain. It can be used as a proper tool for providing statistics reports and preventive guidelines.
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CASE REPORT
Risk management to control needle stick injuries: Case report of Hazrate Zahra Hospital (2010-2012)
p. 122
Masoud Ferdosi, Mehrnoosh Torkan, Shirin Abbasi
DOI
:10.4103/2347-9019.139072
Needle stick injuries are one the most common types of injuries caused by infected sharps which threaten all staff employed at medical system. Prevention of needle stick injuries should be considered as one of the Hospital's strategic programs for authorities. The Hospital established the risk management in controlling needle stick injuries as preventive measures before injuries occurs. These measures include engineering controls, administrative controls, reviewing occupational hazards, proper corrective measures after injuries, calculation of manpower arrangement standard in high risk personnel, and improvement of work processes. This case report studies the performance of Hazrate Zahra Hospital of Isfahan during the years 2010-2012 in the field of needle stick risk management. Sampling was not performed and 71 employees injured were investigated. For reporting and collecting data, a questionnaire was used. Forms collected by the Infection Control Committee Administrator were examined and the results were analyzed using root cause analysis (RCA). The 3-year data were finally analyzed by T-test and Chi-square test using Statistical Package for the Social Sciences (SPSS) Software. Based on 3-year data, findings showed that there was a significant relation between employees' age and injuries. Also, there was a significant relationship between shift sequences and the number of injuries (P > 0.05). Findings showed that nurses and service personnel had the highest number of injuries with 22.5%. The results of the 3-year study show that the hospital has been able to reduce needle stick injuries by establishing strategies and have the risks under control.
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SHORT COMMUNICATIONS
Need of a sound health information system in public health: Program managers
p. 127
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI
:10.4103/2347-9019.139073
Background:
In the global mission to achieve health for all, a comprehensive and holistic strategy is needed, which when formulated on the scaffolding of reliable health information can enable policy makers to identify the problems and needs of people.
Objectives:
The objectives of the study are to explore the epidemiological types of data, identify the role of health information system (HIS) in formulation of evidence-based policies, ascertain the factors limiting its utilization, and to suggest measures to strengthen its utility.
Materials and Methods:
An extensive search of all materials related to the topic was made using library sources including Pubmed, Medline, and World Health Organization. Keywords used in the search include health, information, and program managers.
Results:
A well-functioning HIS is crucial for effective and efficient quality assured health service delivery, especially in resource poor settings. The onus of formulating any policy for prevention and control of a specific disease based on its exact burden lies with the policy makers/health system managers.
Conclusion:
An effective HIS has been identified as a key element in ensuring the availability of valid data that will not only enable program managers in formulating effective planning strategies but will also aid in monitoring and evaluation of health services.
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Medical social worker: Strengthening linkages between the hospital and the community
p. 130
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI
:10.4103/2347-9019.139074
The concept of medical social work had emerged towards the end of the eighteenth century, and has gradually become an integral element in the practice of medicine. It is executed with the help of Medical Social Worker (MSW) - a paramedical worker who has been trained in the social case work and art of interviewing. The aim of this manuscript is to describe the role of MSW in establishing a linkage between the healthcare system and the members of the community. The MSW is a pivotal member of the health team for any public health initiative whose success is based on community engagement and participation. Recognizing the importance of medical social worker in healthcare system, they are now considered as an essential part of the health care along with doctors and other allied health professionals in the analysis and correction of the social and emotional factors, eventually leading to ill health. They are also increasingly being relied upon for supplying information that is of fundamental importance in reaching the correct diagnosis and management of the patients' health. To conclude, the MSW plays a decisive role in helping sick people - individual-by- individual, both through the best use of the patient's capabilities and community resources and thus eventually assists in the strengthening of the healthcare delivery system of the entire nation.
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© International Journal of Health System and Disaster Management | Published by Wolters Kluwer -
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Online since 15 Oct, 2013