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کاربرد نوع شرط:
- جایگاه : پژوهشی
- مجله: Journal of Health Sciences and Surveillance System
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی: Compiling clinical guidelines is one of the requirements of family physician plan and classification of health care services.1 The high prevalence of type 2 diabetes can easily be seen in general practice so that 2.5% of referrals to general practitioners are due to diabetes. More than half of the patients with Type 2 diabetes are left undiagnosed and most of them suffer from its complications at the time of diagnosis. For example, 6.2% of patients suffer from diabetic retinopathy at the time of diagnosis.2 Most patients diagnosed with diabetes take more than one type of medication to treat the complications; about 60% take only oral medications, and 14 percent take oral medications and insulin.3 Although the principles of care for people with Type 2 diabetes is well known, there is a gap between the quality of care in general practice and optimal care so that up to 50% of patients’ condition are weakly controlled.4 Chronic care model for patients with chronic diseases explains the necessary measures to improve the care of people with chronic diseases. These elements include supporting disease management by the patients themselves, patient care, and support teams. Consultation and training are often done in general practice while it is usually a brief consultation about weight, medication or exercise. There is little evidence that mere printed texts are effective in controlling the disease. Extensive training programs are designed to develop self-management skills for diabetes control.4 The implementation of clinical guidelines in medical practice is a challenging task. But, a number of evidences have been shown to accelerate effective clinical guideline implementation and care improvement.5 Management of diabetes mellitus type 2 is shown in Figure 1.
- انتشار مقاله: 08-07-1394
- نویسندگان: Seyed Esmaeil Managheb,Mesbah Shams,Mahmood Soveid,Mohamad Hadi Imanieh,Mohsen Moghadami
- مشاهده
- جایگاه : پژوهشی
- مجله: Journal of Health Sciences and Surveillance System
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی: Incidence of diabetes is increasing in developing countries as well as Iran. Half of the patients are not aware of their disease so screening of diabetes is necessary. Lifestyle changes in society, high-saturated fat diet and decreased physical activity are the factors that influence the growing rate of diabetes in Iran.1 The need for addressing type 2 diabetes has been clarified for family physicians.2 Diabetes is a common disease that is associated with significant morbidity and mortality. It has an asymptomatic stage that may be present for up to several years before diagnosis.3 Diabetes is the leading cause of kidney disease.4 In a study among patients over 45 years with type 2 diabetes, these results were reported: 22% suffered from retinopathy, 7% had impaired vision, 6% had kidney diseases, 9% had clinical symptoms, and 19.1% were at risk for foot ulcers.5 Early treatment of type 2 diabetes can reduce or delay complications.6 Optimal glycemia and BP are important in the prevention of diabetic chronic kidney disease (CKD).4 Therapeutic goals in patients with complications, such as CKD, include maintaining renal function and stopping the trend of renal deterioration.5 Progression of diabetic nephropathy can be slowed through the use of some medications.4 How to screen and manage chronic kidney disease in patients with type 2 diabetes is shown in Figure 1.
- انتشار مقاله: 08-07-1394
- نویسندگان: Seyed Esmaeil Managheb,Mesbah Shams,Mahmood Soveid,Mohamad Hadi Imanieh,Mohsen Moghadami
- مشاهده
- جایگاه : پژوهشی
- مجله: Journal of Health Sciences and Surveillance System
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی: Health care system is organized to achieve more efficiency as well as developing public equity and providing access to the first, second and third levels of services. Family physician is in the first line of the health care system; in other words, family physician is the health system’s goalkeeper. According to classification of health services, gaining access to specialized services becomes possible through the referral system.1 Referral system is a system in which the client should primarily refer to the family physician in order to gain access to health care services and be referred to a specialist if necessary. The specialist refers the patient to the family physician for following treatment modalities after doing necessary medical care and advice and recording the results in the feedback form.2 Despite the different levels of service delivery, the boundaries between these levels are not clear enough and have caused problems in the referral system. Certainly, for better implementation of family physician plan, empowering family physicians, clarifying the referral procedure, and localizing its components are of great importance. One of the life long concerns of the Ministry of Health and Medical Education, especially Shiraz University of Medical Sciences, has been developing clinical guidelines to empower family physicians based on clinical referral system and local conditions of the country. Among effective measures in this field is preparing clinical guidelines, according to the level of services and in line with the referral system. The purpose of developing clinical guidelines is improving the quality of health care and increasing the patient’s satisfaction through the following specific objectives:
- انتشار مقاله: 08-07-1394
- نویسندگان: Seyed Esmaeil Managheb,Mesbah Shams,Mahmood Soveid,Mohamad Hadi Imanieh,Mohsen Moghadami
- مشاهده
- جایگاه : پژوهشی
- مجله: Journal of Health Sciences and Surveillance System
- نوع مقاله: Journal Article
- کلمات کلیدی: fertility,Trend Analysis,Health Services,Dependency ratio
- چکیده:
- چکیده انگلیسی: Background: The dependency ratio (DR) is defined as the ratio of the non-working population to the economically active population. Dependency ratio is calculated by the sum of population under fifteen years and over 65 years divided by 15-64 year old population. The interpretation of DR variation gives us the impact of health care services and some reproductive interventions. This study analyzed a 23-year DR trend in rural population of Fars province and the effect of some fertility variables on it. Methods: In this study, using data from vital horoscope and regression analysis, we analyzed a 23-year period of DR and some fertility indicators. Results: The total DR significantly declined from 102.5% in 1990 to 41.4% in 2012 (P<0.001). Most of this reduction is attributed to reduction in young DR. Old dependency ratio (population of 65 years and more) was significantly growing (P<0.035). Number of rural health house, family planning coverage, total fertility rate and general fertility rate was significantly associated with total dependency ratio (P<0.009). Conclusion: We passed the first stage of demographic transition, i.e. young dependency ratio declining. But the old dependency ratio slowly increased; it is recommended that the health care services should be promoted in future, especially services for old age people.
- انتشار مقاله: 27-02-1394
- نویسندگان: Alireza Mirahmadizadeh,Mitra Rahimi Haghighi,Pegah Shoa Hagighi,Abdolrasool Hemmati,Mohsen Moghadami
- مشاهده
- جایگاه : پژوهشی
- مجله: Journal of Health Sciences and Surveillance System
- نوع مقاله: Journal Article
- کلمات کلیدی: Iran,Unwanted pregnancy,Women health
- چکیده:
- چکیده انگلیسی: Background: Prevention of unwanted pregnancy is a key strategy to improve the women’s health through spacing of birth and avoiding pregnancy at high-risk maternal ages. Unmet need by definition is the percentage of fecund married women who are not using contraceptives while they do not want to get pregnant. They do this due to unavailable quality services, limited choice of methods, lack of information, safety concerns or side-effects and partner disapproval. The present study aimed to assess the magnitude of unmet need for prevention of unwanted pregnancy in Shiraz.Methods: In this descriptive cross-sectional study, 2000 married women of childbearing age (10-49 years) were selected randomly in a survey in Shiraz. Data collection was done using a researcher-made questionnaire and the results were reported using descriptive statistical methods.Results: In the present study, 85.6% of the women used a contraceptive method. 58.7% of them used modern methods of contraception. Reported reasons for not using contraceptives included recent delivery (25%), intention to have more children (20.6%), lack of awareness about contraceptive methods or where such services were offered (6.3%) and irregular sexual intercourse with husband (4.5%). Interrupted intercourse ranked the highest among the methods used. Finally, the unmet need for prevention of unwanted pregnancy in this study was reported to be 4.3 percent.Conclusion: Women in Shiraz had a relatively lower level of unmet need. Counseling is recommended for higher risk women with unmet need in order to keep the descending trend of unmet need for prevention of unwanted pregnancy in Shiraz.
- انتشار مقاله: 02-06-1392
- نویسندگان: Fariba Moradi,Zohreh Balaghi,Hassan Joulaei,Najaf Zare,Samad Mohammadi,Mohsen Moghadami
- مشاهده
- جایگاه : پژوهشی
- مجله: Journal of Health Sciences and Surveillance System
- نوع مقاله: Journal Article
- کلمات کلیدی: Iran,Goiter,IDD,Surveillance system
- چکیده:
- چکیده انگلیسی: Background: Iodine deficiency disorders (IDD) have been recognized as a major public health problem worldwide. Consequences of IDD include goiter, hypothyroidism, and intellectual disability followed by retarded growth and development of the brain. This report aimed to determine the state of IDD in Fars province, south of Iran.Methods: In this study, we gathered data from all scientific papers, published and unpublished reports of IDD surveillance system, results of IDD-related surveys and all data from the center for disease control (CDC) at provincial and national levels during 1989-2012. Five main IDD indices are summarized, interpreted, and then organized in graphs and tables.Resuits: After formation of national committee of IDD followed by launching of extensive iodine delivery, most of IDD indices have improved. The percentage of iodized salt intake has increased from 0 to near 100%, and that of salt with adequate amount of iodine has increased to 94.5%. Median of urinary iodine concentration (UIC) has always been higher than the acceptable value (≥100 μg/L) and 68% of people had a mean of UIC ≥100 μg/L. The percentage of TSH (Thyroid-Stimulating Hormone) >5 mU/L in the screened newborns has persistently been less than 1% during 2005-11. Prevalence of goiter has declined from 68% in 1989 to 1.3% in 2007.Conclusion: Present findings address those efforts to combat iodine deficiency which were effective. According to the small sample size and also the fact that some data have been derived at the national level, we recommend that a comprehensive populationbased survey should be carried out with sufficient sample size to achieve information with high accuracy and precision.
- انتشار مقاله: 28-07-1392
- نویسندگان: Alireza Mirahmadizadeh,Elham Kavoosi,Marzieh Vakili,Razieh Shenavar,Mohsen Moghadami
- مشاهده
- جایگاه : پژوهشی
- مجله: Iranian Journal of Medical Sciences
- نوع مقاله: Journal Article
- کلمات کلیدی: Iran,mass screening,Congenital hypothyroidism,Neonatal screening
- چکیده:
- چکیده انگلیسی: Congenital hypothyroidism (CH) may lead to irreversible mental retardation. To prevent the complication, screening was conducted routinely for all neonates in Iran. This study aimed to evaluate the appropriateness of CH screening programs in Fars province, southern Iran. This retrospective study (February–May, 2017) was conducted in the Health System Research Center of Shiraz University of Medical Sciences (SUMS). The data were obtained from the non-communicable diseases’ unit of SUMS regarding congenital hypothyroidism screening of all neonates born in Fars province from 2005 to 2015. We evaluated the coverage of CH screening, the incidence rate of CH, the percentage of the neonates screened for CH in ideal time, and neonates with CH treated in appropriate time. Descriptive statistics were used to determine the indices. To compare the incidence rate of boys and girls, we used Chi-square test. The coverage of CH screening in Fars Province increased from 50.0% in 2005 to 99.7% in 2015. Furthermore, the percentage of the neonates screened in the ideal time and the neonates with CH treated in an appropriate time increased from 26.0% and 78.0% in 2005 to 86.6% and 99.7% in 2015, respectively. In the evaluated period, the coverage of CH screening in Fars province (98.1%) was higher than that of the other provinces of Iran (83.0%). The study showed good screening coverage in Fars Province from 2005 to 2015. The coverage was considerably better than other provinces of Iran and improved during the study period. Also, over the course of time, more neonates were screened in an ideal time and treated in the appropriate time.
- انتشار مقاله: 10-04-1397
- نویسندگان: Soheila Shaghaghian,Nazila Rahimi,Razieh Sadat Mousavi-Roknabadi,Fatemeh Azadian,Behnam Nazemzadegan,Hamidreza Ghasempour,Mohsen Moghadami,Soheila Keshavarz
- مشاهده
- جایگاه : پژوهشی
- مجله: Iranian Journal of Medical Sciences
- نوع مقاله: Journal Article
- کلمات کلیدی: Influenza,Human,Vaccination,Respiratory System
- چکیده:
- چکیده انگلیسی: Influenza is an acute respiratory disease caused by the influenza A or B virus. It often occurs in outbreaks and epidemics worldwide, mainly during the winter season. Significant numbers of influenza virus particles are present in the respiratory secretions of infected persons, so infection can be transmitted by sneezing and coughing via large particle droplets. The mean duration of influenza virus shedding in immunocompetent adult patients is around 5 days but may continue for up to 10 days or more—particularly in children, elderly adults, patients with chronic illnesses, and immunocompromised hosts. Influenza typically begins with the abrupt onset of high-grade fever, myalgia, headache, and malaise. These manifestations are accompanied by symptoms of respiratory tract illnesses such as nonproductive cough, sore throat, and nasal discharge. After a typical course, influenza can affect other organs such as the lungs, brain, and heart more than it can affect the respiratory tract and cause hospitalization.The best way to prevent influenza is to administer annual vaccinations. Among severely ill patients, an early commencement of antiviral treatment (<2 d from illness onset) is associated with reduced morbidity and mortality, with greater benefits allied to an earlier initiation of treatment. Given the significance of the disease burden, we reviewed the latest findings in the diagnosis and management of influenza.
- انتشار مقاله: 14-12-1394
- نویسندگان: Mohsen Moghadami,Mohsen Moghadami,Mohsen Moghadami,Mohsen Moghadami
- مشاهده
- جایگاه : پژوهشی
- مجله: Iranian Journal of Medical Sciences
- نوع مقاله: Journal Article
- کلمات کلیدی: Pertussis,Pertussis Vaccine,Whooping cough
- چکیده:
- چکیده انگلیسی: Background: It seems that the incidence of pertussis-like illnesses is considerably increasing despite the wide coverage of immunization with the whole cell pertussis vaccine. We aimed to investigate the occurrence of pertussis in vaccinated children by measuring anti-pertussis antibodies. Methods: In this cross-sectional study, blood samples were taken from vaccinated children aged 2, 4, 6, 12, 18, and 72 months. Anti-pertussis IgG and IgA were measured by ELISA. P<0.05 was considered significant. Results: 725 children were enrolled in the study. Geometric mean titers for IgG that showed a slight decease after 2 months of age and increased distinctly in children aged 72 months. The frequency of the individuals whose IgG was above the determined cut-off (derived from mean+2SD) was observed in 1% of the 2, 4, and 6-month-old infants, 6% of the 12 and 18-month-olds and 12% of the 6-year -old children. Positive IgA titers were detected in 5, 9, 6, 23, 11, and 8% of children aged 2, 4, 6, 12, 18, and 72 months, respectively. Conclusion: Since a considerable percentage of children had high levels of anti-pertussis IgG antibodies (≥2 SD), positive anti-pertussis IgA, and most importantly an increased level of anti-pertussis IgG geometric mean titer at 6 years of age, further investigations regarding the protection provided by the presently used pertussis vaccine seems necessary.
- انتشار مقاله: 13-09-1392
- نویسندگان: Abdollah Karimi,Anahita Sanaei Dashti,Reza Arjmand,Mohsen Moghadami,Taherh Kheirkhah,Farideh Shiva,Zari Gholinejad,Hassan Joulaei
- مشاهده
- جایگاه : پژوهشی
- مجله: Iranian Journal of Medical Sciences
- نوع مقاله: Journal Article
- کلمات کلیدی: Coma,Seizure,Neurological,nfluenza A (H1N1)
- چکیده:
- چکیده انگلیسی: Background: World Health Organization declared pandemic phase of human infection with novel influenza A (H1N1) in April 2009. There are very few reports about the neurological complications of H1N1 virus infection in the literature. Occasionally, these complications are severe and even fatal in some individuals. The aims of this study were to report neurological complaints and/or complications associated with H1N1 virus infection.
Methods: The medical files of all patients with H1N1 influenza infection admitted to a specified hospital in the city of Shiraz, Iran from October through November 2009 were re-viewed. More information about the patients were obtained by phone calls to the patients or their care givers. All patients had confirmed H1N1 virus infection with real-time PCR assay.
Results: Fifty-five patients with H1N1 infection were studied. Twenty-three patients had neurological signs and/or symptoms. Mild neurological complaints may be reported in up to 42% of patients infected by H1N1 virus. Severe neurological complications occurred in 9% of the patients. The most common neurological manifestations were headache, numbness and paresthesia, drowsiness and coma. One patient had a Guillain-Barre syndrome-like illness, and died in a few days. Another patient had focal status epilepticus and encephalopathy.
Conclusions: The H1N1 infection seems to have been quite mild with a self-limited course in much of the world, yet there appears to be a subset, which is severely affected. We recommend performing diagnostic tests for H1N1influenza virus in all patients with respiratory illness and neurological signs/symptoms. We also recommend initiating treatment with appropriate antiviral drugs as soon as possible in those with any significant neurological presentation accompanied with respiratory illness and flu-like symptoms.- انتشار مقاله: 02-02-1393
- نویسندگان: Ali Akbar Asadi-Pooya,Ehsan Yaghoubi,Alireza Nikseresht,Mohsen Moghadami,Behnam Honarvar
- مشاهده