Availability of and accessibility to health services are critical factors to maintain the wellbeing of any society. This study aims to investigate the spatial patterns and accessibility levels of urban and rural residents to health centers—i.e., hospitals—in the case of Kermanshah Province located at the western part of Iran. The study employs a spatial analysis technique as the methodological approach. Datasets were obtained from the latest population statistics—i.e., the 2011 Population and Housing Census—and public and private hospitals in the Kermanshah Province. Access levels to health centers were calculated in a geographical information system environment with network analysis capability. The results revealed that: (a) spatial distribution of health centers in the Kermanshah Province follows a random pattern, (b) health centers are mainly concentrated in the Kermanshah Township, (c) there is a clear inequality in terms of access to health centers in the Kermanshah Province, (d) children, women, and the elderly residing in rural areas are found to be the most vulnerable groups. The bipolar status of the rural population’s access to healthcare compared with those residing in the Kermanshah Township clearly underlines an unequal structure of the health system in the Kermanshah Province. There is, hence, a need for effective interventions of policymakers and health managers in the province to eliminate this disparity.

Measures of spatial accessibility to health centers: investigating urban and rural disparities in Kermanshah, Iran

Background: Comorbidity is prevalent among patients with Ischemic Heart Disease (IHD) and may influence patients’ subjective and objective domains of well-being. Objectives: We aimed to investigate the associations between comorbidity and different measures of well-being (i.e. health related quality of life, psychological distress, sleep quality, and dyadic adjustment) among patients with IHD. Methods: In this cross-sectional study, 796 outpatients with documented IHD were enrolled from an outpatient cardiology clinic in 2006. Comorbidity (Ifudu index), quality of life (SF36), psychological distress (Hospital Anxiety Depression Scale; HADS), sleep quality (Pittsburg Sleep Quality Index; PSQI), and dyadic adjustment quality (Revised Dyadic Adjustment Scale; RDAS) were measured. Associations between comorbidity and different measures of well-being were determined. Results: Significant correlations were found between comorbidity score and all measures of well-being. Comorbidity score was correlated with physical quality of life (r = -0.471, P < 0.001), mental quality of life (r = -0.447, P < 0.001), psychological distress (r = 0.344, P < 0.001), sleep quality (r = 0.358, P < 0.001), and dyadic adjustment (r = -0.201, P < 0.001). Conclusions: This study showed a consistent pattern of associations between somatic comorbidities and multiple aspects of well-being among patients with IHD. Findings may increase cardiologists’ interest to identify and treat somatic conditions among IHD patients.

Comorbidity Influences Multiple Aspects of Well-Being of Patients with Ischemic Heart Disease

Background and purpose: Prehospital emergency medical service (EMS) is an important part of the health care system. Today, the need for integrated emergency care services and delivering qualified preventive and care services felt more than before in accidents and emergencies. This survey aimed to investigate the views of emergency medical personnel on the concept and nature of preventive and care services and current challenges in delivering these services in prehospital EMS centers in Golestan province, Iran. Materials and methods: A qualitative study was done with 16 emergency medical personnel working in EMS sites in Golestan province using purposeful sampling. Data was collected by semi- structured interview guide and framework analysis was implemented to analyze the data. Results: Two general themes were identified including 1) the concept of preventive and care services in the EMS and 2) the challenges in providing qualified services in the EMS sites in Golestan province. Also, five sub-themes and 12 subclasses were determined. Conclusion: To enhance and promote services, the EMS system of Golestan province need reforms in organizational structure, laws and administrative regulations, training programs, the system of monitoring and evaluation of personnel, also provision of equipment and manpower and provision of personnel amenities to improve the staff performance. Furthermore, it is necessary to boost emergency services at the community level through training people and enhancing collaboration and participation with other organizations.

http://jmums.mazums.ac.ir/article-1-5824-fa.pdf

Concept and Challenges of Delivering Preventive and Care Services in Prehospital Emergency Medical Service: A Qualitative Study

Background: Although several studies have been conducted on the association between lipid profile and sexual function among men with coronary artery disease, there is a paucity of knowledge about this association among women with coronary artery disease. Objectives: Our study aimed to evaluate the link between lipid profile and sexual function in men and women with coronary artery disease. Methods: One hundred and twenty patients with documented coronary artery disease were consecutively sampled from an outpatient cardiovascular clinic. The patients were assessed for lipid profile and sexual relationship using the Relation and Sexuality Scale (RSS). In addition, the Hospital Anxiety and Depression Scale (HADS) was used to measure the symptoms of anxiety and depression. The characteristics of chest pain were also measured using the Rose Angina Questionnaire. The data were analyzed through linear regression analysis. Results: This study was conducted on 91 males (75.8%) and 29 females (24.2%). Multivariate analysis showed that low-density lipoprotein cholesterol was correlated with sexual function (B = 0.01, P = 0.010) and total sexual relationship (B = 0.01, P = 0.050). A correlation was also observed between the level of high-density lipoprotein and sexual frequency score (B = -0.02, P = 0.040). Gender moderated these correlations. Among males, serum cholesterol (r = 0.193, P = 0.047) and low-density lipoprotein (r = 0.224, P = 0.037) were correlated to sexual function. In females, however, low-density lipoprotein was correlated to the total sexual relationship (r = 0.426, P = 0.021) and highdensity lipoprotein was correlated to sexual frequency (r = -0.334, P = 0.046). Conclusions: The findings of this study showed a relationship between lipid profile and sexual relationship among both male and female patients with coronary artery disease. The link between lipid profile and sexual function of the patients with coronary artery disease is thus beyond just the effect of lipid profile on erectile dysfunction.

Gender Differences in the Association between Lipid Profile and Sexual Function among Patients with Coronary Artery Disease.

Introduction: Prehospital care is a fundamental and decisive component in the treatment of emergency patients. In accidents, the first contact with emergency patients is by emergency prehospital staff. Hence, they must have sufficient knowledge and skills in all fields with airway management been one of the important measures. Various factors are involved in emergency personnel's knowledge and skills whereas the evidences show that staff performance is not desirable. This study aimed to investigate emergency medical technicians' cognitive and practical skills in airway management and its relationship with some related factors. Materials and Methods: This study is a cross-sectional, descriptive-analytical research. Sixty-eight emergency medical technicians were randomly selected by simple convenience sampling method. The tools used for data collection were personal and demographic characteristics form, cognitive skills inventory, and clinical skills checklist, including five skills in airway management. Face and content validities of tools were investigated and verified by ten experts and lecturers. The data were collected using personal and demographic characteristics form, cognitive skills inventory, and filling out the clinical skills checklist and observing the skills performed by technicians and then analyzed by SPSS version 20 software. Results: The results showed that, in airway management, 49.2% of technicians had good cognitive skills and 81% of them had practical skills. There was a direct relationship between the score of cognitive skills and the score practical skills (P

A study of emergency medical technicians' cognitive and practical skills in airway management and its relationship with some related factors in emergency medical centers selected in Isfahan in the year 2015–2016

Background & Aim: A significant part of \"Golden Hour\" for urgent health care of children is wasted in prehospital setting, and delays in providing health care may be followed by undesirable outcomes. The current study was conducted with the aim of assessing time indices of pediatric prehospital emergency care in Tehran. Patients and Method: In this cross-sectional observational study, 115 calls requesting urgent health care services for children at the age of 15 and less were extracted from all recorded calls between 2005 and 2006. Demographic variables, accident type, very early outcomes, and time indices(Response time, Scene time, Total run time, Transport time, Round trip time) were registered. We described qualitative variables using frequency tables, and mean and standard deviation were used to describe quantitative variables. Independent t-test and Chi-square were applied to analyze the data. Results: Out of 6787 calls, 1052(15.5%) were related to children. 717(68%) of these calls were because of the problems of internal medicine and the rest(32%) were related to trauma. Road accident(18.7%), epilepsy(18.3%), unconsciousness(12.4%) and respiratory disorders(10.4%) were among the most common causes for 115 calls. 21 subjects(5.36%) died before ambulance arrival, but no one died while being taken to the hospital. The means(SD) of response time, scene time, total run time, transport time, round trip time were 14.98±6.72, 20.90±11.12, 52.60±23.98, 18.45±12.10 and 60.79±30.34 respectively. The mean ages of deceased and survived patients were 7.95±5.04 and 10.74±4.41 respectively(p=0.009). Average ambulance response time was 16.75±3.88 vs. 14.23±6.31 in deceased and survived patients respectively(p=0.022), which was indicative of a significant difference. Conclusion: Some of the time indices in this study are at the level of reported standards around the world but some others are not. The rate of very early mortality in our country is higher than other countries. Therefore, careful planning to improve time indices, assessing the causes of prolonged time indices, and making effective interventions are highly recommended. Also, staff training courses should focus on more common problems such as trauma, convulsion, unconsciousness, and respiratory disorders.

Time indices of pediatric prehospital emergency care in tehran, 2006

Objective: Congenital chloride diarrhea (CCD) is a rare autosomal recessive disorder of intestinal chloride absorption. Pathognomonic features consist of watery diarrhea, failure to thrive, dehydration and hypokalemic hypochloremic metabolic alkalosis. 
Case Presentation: This is the report on an 8-month old Iranian girl with severe and complicated course of CCD and poor response to current treatment. In addition, she had a renal tubular defect in uric acid handling, resulted in persistent hyperuricosuria and hypouricemia.
Conclusion: Specific characteristics of CCD in our population need additional investigation. But, it is recomm¬ended to consider CCD in any patient with severe resistant diarrhea to prevent its irreversible and long term organ damage.

/pdf/prehospital-emergency-service-for-internal-medicine-problems-3qvbyqpz5v.pdf

Prehospital emergency service for internal medicine problems in pediatrics; causes, time indices and outcomes

Background: There are several reports on the association between body mass index (BMI) and depression in the general population and in patients with some chronic diseases. However, despite the established effects of weight changes and depression on the outcomes of patients suffering from respiratory disorders, little data exists on the topic in relation to chronic obstructive pulmonary disease (COPD). This study assessed the relationship between BMI and depression in patients with COPD. Materials and Methods: This cross-sectional study was conducted on 148 COPD patients admitted to the chest clinic of Baqiyatallah Hospital from October 2006 to February 2007. Patients were selected by systematic sampling. Demographic data (gender, age, marital status, monthly income and level of education), clinical data (symptoms, and medications), spirometric findings (VC, FEV1, FVC, FEV1/FVC, PEF, MMEF, predicted VC, predicted FVC, and predicted FEV1), depressive symptoms assessed by "Hospital Anxiety Depression Scale" (HADS), and body mass index (BMI) were recorded for each patient. Patients were divided into three groups. Group I had (GOLD) stage I; FEV1≥ 80%, group II had GOLD stage II, 50% ≤ FEV1<80% and group III had GOLD stage III, FEV1< 50%. The two-by-two correlations between BMI, depressive symptoms and pulmonary function indices were evaluated separately. Results: A significant association was found between BMI and depressive symptoms (r=0.429, P<0.001), but not between pulmonary indices and BMI or the severity of depressive symptoms. Conclusion: There was a significant correlation between BMI and depressive symptoms indicating the important effect of mental health on weight in COPD patients. A multidisciplinary approach by a team of specialists from different disciplines is mandatory to address these factors in COPD patients. (Tanaffos 2007; 6(3): 47-53)

S H Asaari

Papers

Time indices of pediatric prehospital emergency care in tehran, 2006

Prehospital emergency service for internal medicine problems in pediatrics; causes, time indices and outcomes

Association of Depression with Body Mass Index in Patients with Chronic Obstructive Pulmonary Disease

Ambulance runs for pediatric trauma in tehran