مجله پیاورد سلامت
سال یازدهم شماره 1 (فروردین و اردیبهشت 1396)

Early diagnosis is a tenet in oncology and enables early treatment with the expectation of improved outcome. The aim of this study was to determine the factors associated with personal characteristics and clinical signs in patients with breast cancer.
This research was a descriptive analytic that cross-sectionally assessed 232 patients with definite breast cancer diagnosis that referred to Razi hospital located in Rasht using a researcher designed questionnaire including demographic and clinical signs. Collected data (mammography, tumor size, pathological stage of tumor) were obtained from medical records of patients. Gathered data analysis was accomplished with SPSS V.19 and for description of data from average and standard deviation for inference statics fisher test with a P value of 0.05 were used.
Mean age of subject was (49.80.27). 44 individuals (14%) had a precedent regular mammography before disease. Hundred and four (44.8%) in first appointment were referred to a general surgeon. Hundred and thirty six (58%) women were in stage III of the disease. Hundred and twenty nine (60%) patients had a tumor size more than 5 cm and 106 (46%) had a lymph node metastasis at the time of diagnosis. Patients referring with advanced stage of breast cancer had a low education (P=0.04) and income level (P=0.01).
Recognizing associated personal and clinical factors with early diagnosis can provide essential information for planning health education, screening and presenting appropriate solutions to overcome barriers to treatment and care in health system planning in this provinc

The most important issues that always absorb accuracy and effort of hospital, is the mastery and control over the financial status for the hospital resources management. In all countries, the medical centers are considered as a vital community resource and must be managed in line with the interests of society. Hence, these studies aimed to investigate the causes of insurance deductions and were made to assist hospital administrators in reducing the deductions against them.
This descriptive research is retrospective study in year 2012. The study population consisted of 100 insurance experts deployed in insurance centers (including Health care’s, Social security, Armed forces, Help Committee) from which 25 experts were randomly selected from each Insurance Center. Researcher madden questionnaire was used to collect data. For validating of questionnaire justifiability, questionnaire was provided to insurance expert, professors and ambiguities were resolved. Test-retest procedure was used to ensure the Stability of the questionnaire. The collected data was analyzed and classified using Excel software.
These findings indicate that between all parts of surgery wards deductions are the highest (%45/55), and between surgery wards, orthopedics surgery had the highest amount of deductions (%40/75).
Healthcare provider should be more careful and minimize documentation errors in reporting and documentation. Also the hospital administrators for reducing deductions against patient records must provide educational course for correct documentation.

Conflict, is a natural and inevitable phenomenon in any organization. Nursing organizations, especially due to environmental stresses, nature of work, variety of interaction, responsibilities and staff are vulnerable to conflict. The purpose of this study was to determine the level of conflict, cause of conflict and conflict management strategies among nurses in selected hospitals of Tehran University of Medical Sciences (TUMS) in 2013.
This research is cross-sectional and descriptive - analytic study. The research sample included 240 nurses at four hospitals of Tehran University of Medical Sciences. In order to measure conflict level dubrins conflict level questionnaire and for measure conflict management Robins conflict management strategies were used, for survey to accept or reject the study hypothesis, Chi-square and Fisher's exact tests with SPSS software was performed.
Results showed that the nurse's conflict level was located at average level. Factors relating nurse practitioner frequent cause of conflict, identified strategies of conflict management were solution orientation, non-intervention, control, In the present study conflict level had showed significant statistical relation with age of nurses (p=0.048).
Control strategy had showed significant statistical relation with age (p=0.006) and work experience (p=0.024). Solving oriented strategy had showed significant statistical relation with age (p=0.02).
Conflict is a two-dimensional phenomenon, conflict can be both positive and negative results, how to deal with conflict, it is crucial for consequences.

The number of patients who leave hospital against medical advice could reflect patient dissatisfaction and it is a notable important problem. The present study aimed to identify the causes of discharge against medical advice at a hospital of Shiraz University of medical sciences.
This was a qualitative study using grounded theory. Data were collected through telephone interviews with patients or their concomitants. All interviews were recorded by researcher and thematic method used to analyze the data. Based on it, causes of discharge against medical advice were determined and solutions were provided.
Causes of discharge against medical advice were categorized into 3 general themes: "causes related to the status of the hospital", "causes related to hospital staff", and "causes related to patients" that each of them include some sub-themes. Between the sub-themes, the issues relating to the hospital staff and economic status of patient had the most and the least frequency respectively.
The research findings make it possible for the hospital managers to find solutions to prevent creation of DAMAs and side effects for early discharged patients, patient's readmission and imposing additional costs on them. These solutions can be mentioned as attention and understanding of authorities, preparing some amenities for patients, holding justification meetings for medical personnel and students and reengineering some hospital processes.

Research in the medical field requires large budgets, specialist human resources and modern equipment and instruments. Scientific collaboration is a way to overcome such problems. Main goal of this study was analyzing scientific collaboration of universities of medical sciences in different aspects.
In this research, by using scientometrics methods and social network analysis techniques, the Universities of Medical Sciences co-authorship network was mapped. Source of collecting Data, was Web Of Science database. For mapping and analyzing of scientific networks, we used Bibexcel, VOSviewer, Pajek and UCINET software.
Shahid Beheshti University of Medical Sciences and Tehran University of Medical Sciences, with 933 co-authorship papers are in the first place in scientific collaboration among Iranian Universities of Medical Sciences. And at the international level, Shahid Beheshti University of Medical Sciences has more scientific collaboration than other Iranian universities with the University of Malaya. Tehran University of Medical Sciences, Shahid Beheshti University of Medical Sciences, Isfahan University of Medical Sciences, Tabriz University of Medical Sciences and Shiraz University of Medical Sciences, have significant position in terms of centrality index in co-authorship network.
Medical sciences researchers have very strong tendency to make scientific collaboration with Tehran University of Medical Sciences researchers. For this reason, scientific collaboration network has become a monopoly network around Tehran University of Medical Sciences. This form of collaboration prevents creation of opportunities for collaboration.

Today journals are one of the main platforms to exchange information between researchers. This study aimed to assess the status of Approved Latin indexing journals in the field of medical science citation indexes Web of Science and Scopus databases.
This study was a cross-sectional descriptive survey. Statistical population of the study was 83 titles Latin journals approved by the Ministry of Health that examined indexing situation of them in Web of science and Scopus databases between the years 2005-2010. Data collection tool was a controlled checklist that was established by consult with experts and specialists in related areas and its reliability was estimated 90 percent. Data were analyzed using the software spss16.
Survey the status of journals showed that slightly less than 26 percent of titles indexed in Web of Science. Also in Scopus Citation Index 69 percent of journals was indexed. Compare criteria for indexing journals in Web of Science and Scopus database show that bibliography information of not indexed journals considered and in some journals (29/30 percent) number of international standards were not mentioned. Also, some journals contact information (postcode publication 9 percent) was not included.
In general, it was observed that despite the enormous growth of scientific journals between examined years, terms of adaption with the criteria of indexing are in unfavorable condition and managers of Latin scientific journals should try to improve their quality and quantity.

Organizations must collect, process and analyze different types of necessary information and give them to managers and other individuals. Such information includes the management of medical records and documents in insurance companies. This study aims to evaluate the potentialities of medical records management electronic systems in such companies.
In this cross-sectional applied research, the systems existing in insurance companies were checked using researcher-made checklists to study the capabilities of medical records management electronic systems in all governmental and private insurance companies of Gorgan. For data-analysis, descriptive statistics (frequency, percentage) was used.
In data register and entry, the share of insurance companies as well as the amount of deductions was 92%. In the ability to search, store and retrieve, the search based on the names of persons had the highest percentage (100%). Security was one of the features considered in the software of insurance companies. In the reporting section, the possibility to report the titles of medical documents was 92%. Lack of physical and electronic documents manageability through check-out method was 14%.
In terms of functional capabilities, softwares observed in insurance companies have both strong points (security feature) and weak points (classification and indexing capabilities). The management of medical records and documents can be enhanced in the softwares of insurance companies by using the mentioned capabilities of the existing softwares.

The present study aimed to assess the impact of trade openness and vaccination on child mortality under five because the mortality of under-five-year-old children is one of the most important indexes of health and development.
Using an Eviews6 software, this study is doing a causal-analytic approach by exhausting a Johansen-Juselius method over the period of first quarter of 1984 to forth quarter of 2013, in Iran.
Coefficients for each of the variables in the model were consistent with the theoretical bases. Based on the findings of the study, the increase of one unit in each of the variables of DTP vaccine and trade openness leads to the decrease of child mortality as much as 0.23 and 4.36 units, respectively. Also, the results based on error correction model indicate that in each period, about 0.04 of short-run imbalances is adjusted to achieve a long-term balance.
Since the increase of vaccination and trade openness reduce the mortality of under-five-year-old children, it is suggested that the immunization of children be trained in all parts of the country so that we can achieve high rates of growth and development by the delivery of healthy factors of production to the society. Moreover, by increasing trade relations and dealings with other countries, we can prepare the grounds for the entry of new knowledge and medical equipment as well as health promotion and human development.

With the assumption that health is as one of the luxury goods, therefore making efforts in reducing health spending and inflation in this section will be ineffective.
But if health is an essential service, then in the national level for better redistribution of the resources and financial protection of the households against the health expenditures will be needed. The main objective of this study was determination of income impact of health care expenditures in Tehran household in years 2011-2012.
This study was a population based survey. The instrument of data gathering was a "WHO questionnaire" which was integrated by interview with an acquainted person in each one of the 792 families who live in Tehran. The least ordinary squares, Granger causality test, Breusch-Pagan-Godfery and White heteroskedasticity test were used for data analysis. Eviews 8 software was used for running the tests.
The results showed that heath is a cause for increasing income but the converse is not true. Otherwise, Health with income elasticity equal to 0.25 is an essential service, and is not perceived as luxury goods. Moreover results represented that income is not a good variable for rationalizing the variation of health expenditures.
Health was an essential good, and although income changes affect the expenditures of health care, but the sensitivity is not high and recommended that health policy-makers should in adoption policies such as tariff increases do a comprehensive survey because prices increase are borne by the consumers.