Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations503505304710.15171/ijhpm.2015.120ENRussellMannionHealth Services Management Centre, University of Birmingham, Birmingham,
UK0000-0002-0680-8049Huw TODaviesSchool of Management, University of St Andrews, Fife, UKJournal Article20150516‘Whistleblowing’ has come to increased prominence in many health systems as a means of identifying and addressing quality and safety issues. But whistleblowing – and the reactions to it – have many complex and ambiguous aspects that need to be considered as part of the broader (organisational) cultural dynamics of healthcare institutions.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801The Pill is Mightier Than the Sword507510304010.15171/ijhpm.2015.109ENMalcolmPottsThe OASIS Initiative, University of California, Berkeley, CA, USAAafreenMahmoodThe OASIS Initiative, University of California, Berkeley, CA, USAAlisha A.GravesThe OASIS Initiative, University of California, Berkeley, CA, USAJournal Article20150319One determinant of peace is the role of women in society. Some studies suggest that a young age structure, also known as a “youth bulge” can facilitate conflict. Population growth and age structure are factors amenable to change in a human rights context. We propose that policies which favor voluntary family planning and the education of women can ameliorate the global burden of disease associated with conflict and terrorism.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801The Effect of Mutual Task Sharing on the Number of Needed Health Workers at the Iranian Health Posts; Does Task Sharing Increase Efficiency?511516295410.15171/ijhpm.2015.22ENAliFakhriSocial Determinants of Health (SDH) Research Center, Kashan University
of Medical Sciences, Kashan, Iran0000-0002-2914-5268AidinAryankhesalHealth Management and Economics Research Center, Iran University of Medical Sciences, Tehran, IranSchool of Health Management and Information Sciences, Iran University of Medical
Sciences, Tehran, Iran0000-0002-6695-227XJournal Article20140916Background <br />Nowadays task sharing is a way to optimize utilization of human resources for health. This study was designed to assess the effect of task sharing, mutually between midwives and Family Health Workforces (FHWs), on the number of needed staff across the Iranian Health Posts. <br /> <br />Methods <br />The workload and required number of midwives and FHWs in a Health Post were calculated and compared in two different scenarios of task division using a combined approach for estimating the number of required staff. In the first scenario, the midwives and FHWs provide their specialized services and in the second one, using mutual task sharing, a midwife provides all services traditionally delivered by FHWs and each FHW provides prenatal care in addition to the special tasks. Sensitivity analysis was performed to estimate the effects of different hypotheses. <br /> <br />Results <br />By applying mutual task sharing, the required number of staff for Health Posts was one midwife and two FHWs for a standard population of 12,500; one FHW less than that when no task sharing was applied. Sensitivity analysis illustrated that the number of needed staff is the same in both scenarios when different demographic, epidemiologic, cultural and organizational conditions were applied. <br /> <br />Conclusion <br />Task sharing can reduce the required number of health workers which increases efficiency and productivity at health facilities. However, apart from a need to consider quality, acceptability, and feasibility of care, increasing efficiency must be judged against the contextual circumstances.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801Social Responsibility of the Hospitals in Isfahan City, Iran: Results from a Cross-Sectional Survey517522295710.15171/ijhpm.2015.29ENMahmoudKeyvanaraSocial Determinants of Health Research Centre, Isfahan University of Medical
Sciences, Isfahan, IranHaniye SadatSajadiHealth Management and Economics Research Center,
Isfahan University of Medical Sciences, Isfahan, IranJournal Article20140830Background <br />Changes in modern societies develop the perception that the external environment is essential in organization’s practices, especially in the way they deal with aspects such as human rights, community needs, market demands and environmental interests. These issues are usually under the umbrella of the concept of social responsibility. Given the importance of this concept in the context of health care delivery, suggesting a new paradigm in hospital governance, the aim of this study was to measure the social responsibility in hospitals. <br /> <br />Methods <br />A cross-sectional survey was employed to collect data from a sample of 946 hospital staff of Isfahan city. Data was obtained by structured and valid self-administrated questionnaire and analyzed by descriptive and analytic statistics using SPSS. <br /> <br />Results <br />The mean score of hospitals’ social responsibility was 3.0 compared with the justified range from 1.0 to 5.0. Results showed that there was a significant relationship between social responsibility score and hospitals’ ownership (public or private). Also, there was no significant relationship between social responsibility and type of hospital specialty. <br /> <br />Conclusion <br />It is recommended that hospital managers develop and apply appropriate policies and strategies to improve their hospitals’ social responsibility level, especially through concentrating on their staff’s working environment.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801An Instrumental Variable Probit (IVP) Analysis on Depressed Mood in Korea: The Impact of Gender Differences and Other Socio-Economic Factors523530301110.15171/ijhpm.2015.82ENLaraGittoCEIS Sanità, Università di Roma “Tor Vergata”, Roma, Italy0000-0002-0510-9238Yong-HwanNohDepartment of
Economics, Seoul Women’s University, Seoul, South KoreaAntonioAndrésDepartamento
de Administración de Empresas, Facultad de CC. Jurídicas y Económicas,
Universidad Camilo José Cela, Villanueva de la Cañada, Madrid, SpainJournal Article20140926Background <br />Depression is a mental health state whose frequency has been increasing in modern societies. It imposes a great burden, because of the strong impact on people’s quality of life and happiness. Depression can be reliably diagnosed and treated in primary care: if more people could get effective treatments earlier, the costs related to depression would be reversed. The aim of this study was to examine the influence of socio-economic factors and gender on depressed mood, focusing on Korea. In fact, in spite of the great amount of empirical studies carried out for other countries, few epidemiological studies have examined the socio-economic determinants of depression in Korea and they were either limited to samples of employed women or did not control for individual health status. Moreover, as the likely data endogeneity (i.e. the possibility of correlation between the dependent variable and the error term as a result of autocorrelation or simultaneity, such as, in this case, the depressed mood due to health factors that, in turn might be caused by depression), might bias the results, the present study proposes an empirical approach, based on instrumental variables, to deal with this problem. <br /> <br />Methods <br />Data for the year 2008 from the Korea National Health and Nutrition Examination Survey (KNHANES) were employed. About seven thousands of people (N= 6,751, of which 43% were males and 57% females), aged from 19 to 75 years old, were included in the sample considered in the analysis. In order to take into account the possible endogeneity of some explanatory variables, two Instrumental Variables Probit (IVP) regressions were estimated; the variables for which instrumental equations were estimated were related to the participation of women to the workforce and to good health, as reported by people in the sample. Explanatory variables were related to age, gender, family factors (such as the number of family members and marital status) and socio-economic factors (such as education, residence in metropolitan areas, and so on). As the results of the Wald test carried out after the estimations did not allow to reject the null hypothesis of endogeneity, a probit model was run too. <br /> <br />Results <br />Overall, women tend to develop depression more frequently than men. There is an inverse effect of education on depressed mood (probability of -24.6% to report a depressed mood due to high school education, as it emerges from the probit model marginal effects), while marital status and the number of family members may act as protective factors (probability to report a depressed mood of -1.0% for each family member). Depression is significantly associated with socio-economic conditions, such as work and income. Living in metropolitan areas is inversely correlated with depression (probability of -4.1% to report a depressed mood estimated through the probit model): this could be explained considering that, in rural areas, people rarely have immediate access to high-quality health services. <br /> <br />Conclusion <br />This study outlines the factors that are more likely to impact on depression, and applies an IVP model to take into account the potential endogeneity of some of the predictors of depressive mood, such as female participation to workforce and health status. A probit model has been estimated too. Depression is associated with a wide range of socioeconomic factors, although the strength and direction of the association can differ by gender. Prevention approaches to contrast depressive symptoms might take into consideration the evidence offered by the present study.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801Estimation of the Cardiovascular Risk Using World Health Organization/International Society of Hypertension (WHO/ISH) Risk Prediction Charts in a Rural Population of South India531536301610.15171/ijhpm.2015.88ENArun GangadharGhorpadeSri Manakula Vinayagar Medical College and Hospital, Pondicherry, IndiaSaurabh RamBihariLalShrivastavaShri Sathya Sai Medical College and Research Institute, Kancheepuram,
India0000-0001-6102-7475Sitanshu SekharKarJawaharlal Institute of Postgraduate Medical Education and Research,
Pondicherry, IndiaSonaliSarkarJawaharlal Institute of Postgraduate Medical Education and Research,
Pondicherry, IndiaSumanth MallikarjunaMajgiMysore Medical College and Research Institute, Mysore,
Karnataka, IndiaGautamRoyJawaharlal Institute of Postgraduate Medical Education and Research,
Pondicherry, IndiaJournal Article20141224Background <br />World Health Organization/International Society of Hypertension (WHO/ISH) charts have been employed to predict the risk of cardiovascular outcome in heterogeneous settings. The aim of this research is to assess the prevalence of Cardiovascular Disease (CVD) risk factors and to estimate the cardiovascular risk among adults aged >40 years, utilizing the risk charts alone, and by the addition of other parameters. <br /> <br />Methods <br />A cross-sectional study was performed in two of the villages availing health services of a medical college. Overall 570 subjects completed the assessment. The desired information was obtained using a pretested questionnaire and participants were also subjected to anthropometric measurements and laboratory investigations. The WHO/ISH risk prediction charts for the South-East Asian region was used to assess the cardiovascular risk among the study participants. <br /> <br />Results <br />The study covered 570 adults aged above 40 years. The mean age of the subjects was 54.2 (±11.1) years and 53.3% subjects were women. Seventeen percent of the participants had moderate to high risk for the occurrence of cardiovascular events by using WHO/ISH risk prediction charts. In addition, CVD risk factors like smoking, alcohol, low High-Density Lipoprotein (HDL) cholesterol were found in 32%, 53%, 56.3%, and 61.5% study participants, respectively. <br /> <br />Conclusion <br />Categorizing people as low (<10%)/moderate (10%-20%)/high (>20%) risk is one of the crucial steps to mitigate the magnitude of cardiovascular fatal/non-fatal outcome. This cross-sectional study indicates that there is a high burden of CVD risk in the rural Pondicherry as assessed by WHO/ISH risk prediction charts. Use of WHO/ISH charts is easy and inexpensive screening tool in predicting the cardiovascular event.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801Application of Systems Thinking in Health: Opportunities for Translating Theory into Practice; Comment on “Constraints to Applying Systems Thinking Concepts in Health Systems: A Regional Perspective from Surveying Stakeholders in Eastern Mediterranean Countries”537539299610.15171/ijhpm.2015.69ENAsmat UllahMalikIntegrated Health Services, Islamabad, PakistanJournal Article20150301Systems thinking is not a new concept to health system strengthening; however, one question remains unanswered: How policy-makers, system designers and consultants with a system thinking philosophy should act (have acted) as potential change agents in actually gaining opportunities to introduce systems thinking? Development of Comprehensive Multi-Year Plans (cMYPs) for Immunization System is one such opportunity because almost all Low- and Middle-Income Countries (LMICs) develop and implement cMYPs every five years. Without building upon examples and showing practical application, the discussions and deliberations on systems thinking may fade away with passage of time. There are opportunities that exist around us in our existing health systems that we can benefit from starting with an incremental approach and generating evidence for longer lasting system-wide changes.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801Reflecting on Backward Design for Knowledge Translation; Comment on “A Call for a Backward Design to Knowledge Translation”541543302010.15171/ijhpm.2015.92ENNealeSmithCentre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health
Research Institute, Vancouver, BC, CanadaEvelynCornelissenDepartment of Family Practice,
Faculty of Medicine, University of British Columbia, Vancouver, BC, CanadaCraigMittonCentre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health
Research Institute, Vancouver, BC, CanadaJournal Article20150309In a recent Editorial for this journal, El-Jardali and Fadlallah proposed a new framework for Knowledge Translation (KT) in healthcare. Many such frameworks already exist; thus, new entrants to the field must be scrutinized in regard to their unique contributions to advancing understanding and practice. The El-Jardali and Fadlallah framework focuses on policy-level discussions, a relatively under-studied issue to date. Their framework usefully incorporates both priority setting questions at the front-end (which KT efforts get undertaken and which do not) as well as evaluation questions at the back-end (how do we show that more evidence-informed decisions are actually better ones?). Their framework also emphasizes capacity building among both decision-makers and researchers. This is an area worthy of additional attention, particularly because it is likely to be far more challenging than El-Jardali and Fadlallah allow.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801Backwards Design or looking Sideways? Knowledge Translation in the Real World; Comment on “A Call for a Backward Design to Knowledge Translation”545547300010.15171/ijhpm.2015.71ENSarahBowenSchool of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada0000-0002-1341-5307Ian D.GrahamSchool of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada0000-0002-3669-1216Journal Article20150221El-Jardali and Fadllallah provide an excellent summary of the many dimensions of knowledge use, and the breath of issues and activities that must be considered if knowledge is to be put into practice. However, reliance on a continuum (rather than a cyclical, multidirectional, systems) model creates a number of limitations, particularly when promoting evidence-informed action in the areas of health policy and management, where diverse forms of knowledge must be synthesized and decisions made in a rapidly evolving context. We propose a paradigm shift - from viewing Knowledge Translation (KT) as a linear ‘knowledge transfer’ activity, to a commitment to full stakeholder engagement in knowledge production, dissemination and implementationKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801Healthcare Reimbursement and Quality Improvement: Integration Using the Electronic Medical Record; Comment on “Fee-for-service Payment - an Evil Practice That Must Be Stamped Out?”549551302110.15171/ijhpm.2015.93ENJohn R.BrittonColorado Permanente Medical Group, Denver, CO, USAJournal Article20150414Reimbursement for healthcare has utilized a variety of payment mechanisms with varying degrees of effectiveness. Whether these mechanisms are used singly or in combination, it is imperative that the resulting systems remunerate on the basis of the quantity, complexity, and quality of care provided. Expanding the role of the electronic medical record (EMR) to monitor provider practice, patient responsiveness, and functioning of the healthcare organization has the potential to not only enhance the accuracy and efficiency of reimbursement mechanisms but also to improve the quality of medical care.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801Lessons and Leadership in Health; Comment on “Improving the World’s Health through the Post-2015 Development Agenda: Perspectives from Rwanda”553555303510.15171/ijhpm.2015.107ENGeorgeAlleynePan American Health Organization, Washington, DC, USAJournal Article20150502This paper comments on the principles that informed Rwanda’s successful efforts to adapt its health system to population needs, and more specifically to reduce health inequities. The point is made that these may be universally applicable for countries as they deal with the challenges of post-2015 health agenda.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801Quaternary Prevention and the Challenges to Develop a Good Practice; Comment on “Quaternary Prevention, an Answer of Family Doctors to Overmedicalization”557558302410.15171/ijhpm.2015.98ENHamiltonWagnerCuritiba Health System Physician, Curitiba, BrazilJournal Article20150415The article analyzes literature problems using as a parameter the quaternary prevention concept, introducing guidelines to have good shared decisions that avoid overdiagnosis and overtreatment and improve the quality of life. The author proposes a four-step approach: reliable evidence, awareness about populations profile, independent research analysis, and an understandable format by ordinary people.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801The Difficult Choice of “Not Doing”; Comment on “Quaternary Prevention, an Answer of Family Doctors to Overmedicalization”559560303610.15171/ijhpm.2015.108ENGiorgioVisentinCentro Studi E Ricerche Medicina Generale, Dueville, ItalyJournal Article20150426The article of Marc Jamoulle shows the importance of the contribution of general practitioners (GPs) in improving the quality and the efficiency of the health systems. Starting from the concept of quaternary prevention for reducing excessive costs in the preventive procedures, he suggests a change of paradigm in every daily activity of the GP in order to have a stronger ethical approach to the patient. This means spending more time in the consultation in order to better understand her/his real needs and share a common decision for minimizing the costs and solving the patient’s problems in agreement with her/his believes and values.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801Care and Do Not Harm: Possible Misunderstandings With Quaternary Prevention (P4); Comment on “Quaternary Prevention, an Answer of Family Doctors to Over Medicalization”561563302510.15171/ijhpm.2015.99ENDanielWidmerInstitut Universitaire de Médecine de Famille, Policlinique Médicale Universitaire, Lausanne, SwitzerlandJournal Article20150419The discussion between general practitioners (GPs) and healthcare delivery organizations necessitates a common language. The presentation of the 4 types of GP’s activities, opens dialogue but can lead to possible misunderstandings between the micro- and macro-level of the healthcare system. This commentary takes 4 examples: costs reduction by P4, priority of beneficence or nonmaleficence, role of evidence-based medicine (EBM) and use of a constructivist model.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394820150801Including Both Costs and Effects – The Challenge of Using Cost-Effectiveness Data in National-Level Policy-Making: A Response to Recent Commentaries565566305110.15171/ijhpm.2015.123ENNathalieEckardDivision of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, SwedenMagnusJanzonDepartment of
Cardiology and Department of Medicine and Health Sciences, Linköping University, Linköping, SwedenLars-ÅkeLevinDivision of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, SwedenJournal Article20150623