Seyed Esmaeil Managheb; Mesbah Shams; Mahmood Soveid; Mohamad Hadi Imanieh; Mohsen Moghadami
Volume 3, Issue 4 , October 2015, , Pages 165-166
Abstract
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 ...
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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.
Seyed Esmaeil Managheb; Mesbah Shams; Mahmood Soveid; Mohamad Hadi Imanieh; Mohsen Moghadami
Volume 3, Issue 4 , October 2015, , Pages 167-168
Abstract
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 ...
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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.
Alireza Mirahmadizadeh; Mitra Rahimi Haghighi; Pegah Shoa Hagighi; Abdolrasool Hemmati; Mohsen Moghadami
Volume 3, Issue 3 , July 2015, , Pages 107-112
Abstract
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 ...
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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.
seyed esmaeil Managheb; Mesbah Shams; Mahmood Soveid; Mohamad Hadi Imanieh; Mohsen Moghadami
Volume 3, Issue 3 , July 2015, , Pages 125-127
Abstract
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. ...
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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:
Fariba Moradi; Zohreh Balaghi; Hassan Joulaei; Najaf Zare; Samad Mohammadi; Mohsen Moghadami
Volume 2, Issue 4 , October 2014, , Pages 140-144
Abstract
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 ...
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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.
Alireza Mirahmadizadeh; Elham Kavoosi; Marzieh Vakili; Razieh Shenavar; Mohsen Moghadami
Volume 1, Issue 2 , October 2013, , Pages 57-66
Abstract
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 ...
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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.