Price transparency in Iranian healthcare market

Insufficient price transparency has emerged as a pivotal contributor to patient dissatisfaction, escalating costs, and diminished productivity within Iran's health system. This study aims to delineate and elucidate a definition of price transparency, identify suitable strategies, and present the outcomes associated with establishing a health system that embraces transparent pricing while also addressing the challenges ahead. Employing a quantitative-qualitative research design, data were extracted from a semi-structured interviews with stakeholders. A purposive sampling method, encompassing sequential and snowball techniques, was employed to capture the perspectives of all stakeholders involved in the issue of price transparency in Iran. The interview data were analyzed using the grounded theory approach was classified into three categories: price transparency before, during, and after the receipt of healthcare services. Our findings reveal the causes of low price transparency, strategies to address the issue, and the consequences associated with increased levels of transparency. Ultimately, we contend that health systems can significantly enhance efficiency, patient satisfaction, and the performance of health insurance by adopting transparent pricing for health services, thus obviating the need for resource-intensive restructuring efforts.

Development and psychometric evaluation of an occupational health and safety performance tool for manufacturing companies

Background

The occupational health and safety (OHS) performance of organizations maybe affected by internal and external factors. According to a literature review, standardized tools for studying these factors are limited. Therefore, the main aim of this study was to examine psychometric properties of a tool for evaluating OHS performance. The tool was used to investigate the relationship between the identified OHS performance influencing factors and occupational injury.

Methods

The questionnaire developed through conducting a literature review about the OHS performance and constructing a question pool. The number of items was reduced to 93 after performing a screening process. Sixteen OHS scholars offered feedback on the tool's phrasing and applicability to check face and content validity. Test-retest reliability was examined through intraclass correlation coefficients. 850 questionnaires were distributed at 12 manufacturing companies in the West Azerbaijan province in Iran, 600 valid questionnaires were returned. Exploratory and confirmatory factor analysis were conducted to assess construct validity. Criterion validity was investigated by measuring agreement between its OHS performance scores and occupational injury. A set of regression analyses examined the variables associated with OHS influencing factors.

Results

Validity analysis revealed that 93 items had an excellent content validity ratio (>0.79) and content validity index (>0.47). The exploratory factor analysis resulted in eleven OHS performance factors. Thirty-three items were removed because of inadequate reliability. The result of confirmatory factor analysis showed that the OHS performance model is satisfactory. The final 60-item scale's reliability score was 0.96. The safety system was identified as the main influencing factor (3.54 ± 0.65). Participants with more safety training reported more injuries. Safety training and injury experiences, company size, and occupational health and safety management system (OHSMS) adoption affected OHS performance influencing factors. Occupational injuries were linked to company size (OR = 1.39, CI = 1.06-1.82), whereas the absence of OHSMS was connected with an increased risk of occupational injury (OR = 0.09, CI = 0.02-0.55).

Conclusions

The developed tool had satisfactory psychometric properties for assessing OHS performance in manufacturing companies. OHS performance could be improved by implementing safety systems and focusing more on incentive programs. Implementing the requirements of an OHSMS may improve the OHS performance and decrease occupational injuries.

Probabilistic health risk assessment of occupational exposure to crystalline silica in an iron foundry in Urmia, Iran

This study aimed to quantify the exposure of foundry workers to crystalline silica and associated cancer and non-cancer health risks using a probabilistic approach. Breathing zone air samples were collected according to the NIOSH 7602 method and analyzed using Fourier transform infrared spectroscopy. The health risks posed by crystalline silica were then assessed using the EPA-developed inhalation risk assessment model and Monte Carlo simulation. The sensitivity analysis was also conducted to determine the contribution of input parameters to the health risks. The mean concentration of crystalline silica in six foundry stations ranged from 0.029 to 0.064 mg m-3, exceeding the occupational exposure limits. The average values of cancer risks were greater than the USEPA level, i.e., 1E - 6 in all workstations of the foundry. Workers in sand preparation and molding stations suffered the greatest cancer risks, with the mean value of 2.35E - 5 and 2.10E - 5, respectively. Non-cancer hazard quotient exceeded 1 in all foundry stations ranging from 1.56 (in melting and pouring) to 3.37 (in sand preparation). The 95% upper-bound values of the health risks decreased by 77.52% and 56.77%, assuming the use of engineering controls and wearing respirators by workers, respectively. Sensitivity analyses indicate that concentration was the most sensitive factor contributing to the carcinogenic (46.13%) and non-carcinogenic (67.08%) risks. These findings can aid managers in gaining a better understanding of the silica risks faced by foundry workers and the role of engineering controls and respirators in protecting workers' health.

A qualitative investigation to discover causes of occupational injuries and preventive countermeasures in manufacturing companies

Background and aims

Occupational injury rates are high in developing nations, making it critical to develop preventive measures. The purpose of this study was to determine the causes and preventive measures for occupational injuries in Iranian manufacturing industry.

Methods

Semi-structured interviews with managers and employees were used to obtain data. Inductive content analysis was used to analyze verbatim transcripts.

Findings

The investigation identified six major causes of injuries including improper safety management and three control measures involving supervision and support for safety promotion.

Conclusions

The findings suggest that the managers and employees should make serious efforts to control the identified causes of injuries. It is necessary for occupational health and safety authorities to inspect and enforce safety regulations, as well as for the government to support the implementation of safety plans in the companies.

Quantification of the Whole Lymph Node Vasculature Based on Tomography of the Vessel Corrosion Casts

Lymph nodes (LN) are crucial for immune function, and comprise an important interface between the blood and lymphatic systems. Blood vessels (BV) in LN are highly specialized, featuring high endothelial venules across which most of the resident lymphocytes crossed. Previous measurements of overall lymph and BV flow rates demonstrated that fluid also crosses BV walls, and that this is important for immune function. However, the spatial distribution of the BV in LN has not been quantified to the degree necessary to analyse the distribution of transmural fluid movement. In this study, we seek to quantify the spatial localization of LNBV, and to predict fluid movement across BV walls. MicroCT imaging of murine popliteal LN showed that capillaries were responsible for approximately 75% of the BV wall surface area, and that this was mostly distributed around the periphery of the node. We then modelled blood flow through the BV to obtain spatially resolved hydrostatic pressures, which were then combined with Starling’s law to predict transmural flow. Much of the total 10 nL/min transmural flow (under normal conditions) was concentrated in the periphery, corresponding closely with surface area distribution. These results provide important insights into the inner workings of LN, and provide a basis for further exploration of the role of LN flow patterns in normal and pathological functions.

Diagnosis of poor safety culture as a major shortcoming in OHSAS 18001-certified companies

The evaluation of safety performance in occupational health and safety assessment series (OHSAS) 18001-certified companies provides useful information about the quality of the management system. A certified organization should employ an adequate level of safety management and a positive safety culture to achieve a satisfactory safety performance. The present study conducted in six manufacturing companies: three OHSAS 18001-certified, and three non-certified to assess occupational health and safety (OHS) as well as OHSAS 18001 practices. The certified companies had a better OHS practices compared with the non-certified companies. The certified companies slightly differed in OHS and OHSAS 18001 practices and one of the certified companies had the highest activity rates for both practices. The results indicated that the implemented management systems have not developed and been maintained appropriately in the certified companies. The in-depth analysis of the collected evidence revealed shortcomings in safety culture improvement in the certified companies. This study highlights the importance of safety culture to continuously improve the quality of OHSAS 18001 and to properly perform OHS/OHSAS 18001 practices in the certified companies.

Sheep greenhouse gas emission intensities under different management practices, climate zones and enterprise types

Greenhouse gas emissions (GHG) from broadacre sheep farms constitute ~16% of Australia’s total livestock emissions. To study the diversity of Australian sheep farming enterprises a combination of modelling packages was used to calculate GHG emissions from three sheep enterprises (Merino ewe production for wool and meat, Merino-cross ewes with an emphasis on lamb production, and Merino wethers for fine wool production) at 28 sites across eight climate zones in southern Australia. GHG emissions per ha, per dry sheep equivalents and emissions intensity (EI) per tonne of clean wool or liveweight sold under different pasture management or animal breeding options (that had been previously determined in interviews with farmers) were assessed relative to baseline farms in each zone (‘Nil’ option). Increasing soil phosphorus fertility or sowing 40% of the farm area to lucerne resulted in the smallest and largest changes in GHG/dry sheep equivalents, respectively (–66%, 113%), though both of these options had little influence on EI for either clean wool or liveweight sold. Breeding ewes with greater body size or genotypes with higher fleece weight resulted in 11% and 9% reductions, respectively, in EI. Enterprises specialising in lamb production (crossbred ewes) had 89% lower EI than enterprises specialising in fine wool production (Merino wethers). Thus, sheep producers aiming for lower EI could focus more on liveweight turnoff than wool production. Emissions intensities were typically highest in cool temperate regions with high rainfall and lowest in semiarid and arid regions with low aboveground net primary productivity. Overall, animal breeding options reduced EI more than feedbase interventions.

Development and Validation of a Safety Climate Scale for Manufacturing Industry

BACKGROUND

This paper describes the development of a scale for measuring safety climate.

METHODS

This study was conducted in six manufacturing companies in Iran. The scale developed through conducting a literature review about the safety climate and constructing a question pool. The number of items was reduced to 71 after performing a screening process.

RESULTS

The result of content validity analysis showed that 59 items had excellent item content validity index (≥ 0.78) and content validity ratio (> 0.38). The exploratory factor analysis resulted in eight safety climate dimensions. The reliability value for the final 45-item scale was 0.96. The result of confirmatory factor analysis showed that the safety climate model is satisfactory.

CONCLUSION

This study produced a valid and reliable scale for measuring safety climate in manufacturing companies.

His bundle electrocardiography in manifest and concealed right bundle branch extrasystoles

His bundle electrocardiography was helpful in the diagnosis of impulse formation in the right bundle branch. Ten patients with narrow QRS complexes had ectopic beats with an "incomplete" left bundle branch pattern and almost simultaneous activation of His bundle and ventricles. Both QRS morphology and H- - V intervals depended on the more proximal or distal location of the ectopic focus. In four patients with "complete" right bundle branch block the morphology of ectopic ventricular complexes and H- - V intervals also depeneded on the presence or absence of retrograde block and differential degrees of forward and/or retrograde conduction delays. Nine patients with "complete" right bundle branch block and four with "complete" left bundle branch block had premature beats which could have originated in the proximal right bundle branch, proximal left bundle branch, or distal His bundle. In one patient with "complete" left bundle branch block, "concealed" His bundle depolarizations (probably originating in an ectopic focus located in the right bundle branch) produced pseudo Type II (Mobitz) A-V block. Although lidocaine appeared to have been more effective in patients with bundle branch block than in those with narrow QRS complexes, further studies are necessary to corroborate this impression.

The retrograde His bundle deflection: its recognition and value in the analysis of tachyarrhythmias induced by stimulation on the T wave

Interpretation of deflections presumably retrograde His bundle in origin has to be performed in context considering the coexisting changes in simultaneously recorded intracardiac and surface leads. His bundle electrocardiography thus conceived is helpful in the analysis of the runs of ectopic beats elicited by premature ventricular stimulation during the antecedent T wave in patients without coronary artery or primary myocardial disease. Identification of AV nodal echoes within the paroxysms as well as the subsequent runs of reciprocating tachycardias, was possible in patients with and without preexcitation, although a thorough study of these cases also requires recording of coronary sinus and low lateral right atrial electrograms. The behavior of the retrograde H deflection in respect to the first extra beat following the premature QRS complex helped in excluding bundle branch reentry. The latter is improbable in patients with 'complete' bundle branch block pattern, if extra beats show a contralateral bundle branch morphology. However, in absence of bundle branch block, retrograde H deflections were not helpful in elucidating the mechanisms of pacemaker-induced intraventricular (bundle branch, fasicular or vulnerability-related) reentry.

Coronary revascularization in patients surviving unexpected ventricular fibrillation

Coronary angiography and hemodynamic studies were performed in a group of 13 patients who had been successfully resuscitated from unexpected ventricular fibrillation, had had angina pectoris prior to the cardiac arrest, and who had not had an acute myocardial infarction in the periarrest period. Eleven of the 13 had one or more coronary artery lesions which were amenable to surgical intervention, and eight of the 11 accepted surgery. Left ventricular end-diastolic pressure was elevated in most patients, while cardiac index and ejection fraction were depressed. Bypassable lesions were found in the main left coronary artery in one patient, and the proximal left anterior descending artery in two. Both of these patients had disease elsewhere. The remaining five patients had diffuse three-vessel disease. The eight patients have survived for periods ranging from 8 to 32 months (average = 24 months). This contrasts to an overall 1-year mortality of approximately 30% in survivors of hospitalization after unexpected ventricular fibrillation.

Role of coronary artery surgery in patients surviving unexpected cardiac arrest

During the past 3-1/2 years, 101 of 199 patients who were successfully resuscitated by fire rescue squads in the community after unexpected cardiac arrest (documented ventricular fibrillation--VF) were admitted to the hospital. Forty-two of these patients ultimately were discharged from the hospital. However, the intermediate and long-term results were disappointing, for their mean survival after discharge was only 12.7 months. Sudden deaths (recurrent unexpected VF) occurred during the first 12 months after discharge in 28 percent of the patients surviving the initial hospitalization. Among the survivors of sudden and unexpected VF (i.e., survivors of the initial hospitalization), 16 patients who had had pre-existing symptoms of coronary heart disease had hemodynamic and coronary angiographic studies. Of these, 11 were considered surgical candidates. This report concerns the follow-up results in these patients with particular emphasis on the eight patients who accepted surgery and had myocardial revascularization. Five patients had moderate hemodynamic abnormalities, but none had had an acute myocardial infarction at the time of the initial arrest. The group of eight patients had a total of 18 vein graft bypasses performed. The significant findings is that all eight survived operation, and there was one late death at 10 months. The remaining patients are alive at 14 to 34 months, and six are free of symptoms. Despite patent vein grafts, one patient has had a second serious arrhythmia. It is concluded that surgical intervention can be done safely and may decrease the high posthospitalization, recurrent arrest, and mortality rates in selected survivors of unexpected cardiac arrest. It is concluded further that all patients sustaining an unexpected arrest should have postarrest coronary catheterization and angiography, and all patients should be on antiarrhythmic agents whether or not they receive myocardial revascularization.

Results of direct coronary artery surgery in women

In the past 4 years, among 260 patients receiving coronary bypass grafts for coronary artery disease and stable angina pectoris, there were 34 women (13 per cent). The operative mortality rate for women was 8 per cent (3 of 34), and one late death due to myocardial infarction occurred in spite of a patent coronary bypass graft. The intraoperative infarction rate was 20 per cent (6 per cent in men). Although preoperative cardiac pump and muscle function parameters were better in women than in men (p less than 0.05), postoperatively only 30 per cent of women showed improvement in function as compared with 50 per cent of men. At 6 to 46 months' follow-up, 84 per cent of women were free of angina in contrast with 94 per cent of men. The early (4 month) graft patency rate was 50 per cent (14 of 27 grafts), as opposed to 80 per cent (20 of 25 grafts) in men. These results indicate that, although coronary artery disease shows anatomic similarity in women and men, the result of coronary revascularization in women is inferior to that in the male population.

Complications of coronary bypass surgery

In the past three years, among 170 patients undergoing aortocoronary bypass surgery, 11 (6%) developed acute myocardial infarction within 24 hours after surgery. An additional four patients (2%) developed myocardial infarction within three months after discharge. Clinically, acute myocardial infarction was suspected because of sudden, transient hypotension associated with dysrhythmia, angina, or cardiac arrest which responded to conventional therapy. Elevation of serum enzymes with acute ECG changes was also observed. Three of the 15 patients developing myocardial infarction died. In 12 patients cardiac catheterization studies were performed within two to ten weeks after the incident. Eleven of the 20 grafts were found occluded, and progression of coronary occlusive disease was seen in five. There was a marked decrease in left ventricular function, contractility, and compliance in all patients with left ventricular aneurysm formation or dyskinesia. Eight of these patients were asymptomatic. The results indicate that after coronary surgery a combination of sudden arrhythmia and transient hypotension is diagnostic of graft closure or development of acute myocardial infarction. Also, in spite of depressed cardiac function, most surviving patients remain angina free.

Clinical, surgical, and pathologic correlation in patients with acute myocardial infarction and pump failure

A review was made of the entire hospital course of 20 patients aged 44 to 79 years who suddenly developed clinically intractable left-heart pump failure as a result of acute myocardial infarction. They were divided into three groups according to their presenting circulatory state. Thirteen patients were in cardiac arrest (group I), four had cardiogenic shock due to myocardial rupture (group II), and three had severe intractable left-heart failure (group III). Preoperative partial or complete cardiac catheterization was possible in six patients.

Surgical treatment using cardiopulmonary bypass was selectively undertaken as a mode of therapy in 11 of the 20 cases. In 10, the area of infarction was delineated and was resected. Pathologically, the infarcts were from 1 to 14 days old, and in 19 of 20 cases involved the anterior wall. The specimens weighed 25 to 83 g. One patient, who was discharged, had infarctectomy and double coronary vein bypass graft. One patient lived for 3 weeks after infarctectomy and pulmonary embolectomy. Two others survived after surgery for 2 and 36 hours, respectively.

The results of this prospective study suggest that identification of patients possibly amenable to successful treatment of medically irreversible pump failure by surgical means will require earlier recognition of the high-risk group and intensive hemodynamic and radiographic evaluation of the extent of the disease process.