Publications by authors named "Enayatollah Homaie Rad"

38 Publications

Household Overcrowding in Iran, a Low-middle-income Country: How Major of a Public Health Concern Is It?

J Prev Med Public Health 2021 Jan 11;54(1):73-80. Epub 2021 Jan 11.

Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Objectives: Household overcrowding (HC) can contribute to both physical and mental disorders among the members of overcrowded households. This study aimed to measure the status of HC and its main determinants across the provinces of Iran.

Methods: Data from 39 864 households from the 2016 Iranian Household Income and Expenditures Survey were used in this study. The Equivalized Crowding Index (ECI) and HC index were applied to measure the overcrowding of households. Regression models were estimated to show the relationships between different variables and the ECI.

Results: The overall, urban, and rural prevalence of HC was 8.2%, 6.3%, and 10.1%, respectively. The highest prevalence of HC was found in Sistan and Baluchestan Province (28.7%), while the lowest was found in Guilan Province (1.8%). The number of men in the household, rural residency, the average age of household members, yearly income, and the household wealth index were identified as the main determinants of the ECI and HC.

Conclusions: The study demonstrated that the ECI and HC were higher in regions near the borders of Iran than in other regions. Therefore, health promotion and empowerment strategies are required to avoid the negative consequences of HC, and screening programs are needed to identify at-risk families.
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http://dx.doi.org/10.3961/jpmph.20.568DOI Listing
January 2021

Development and validation of a questionnaire to determine medical orders non-adherence: a sequential exploratory mixed-method study.

BMC Health Serv Res 2021 Feb 12;21(1):136. Epub 2021 Feb 12.

Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Patients' non-adherence with medical orders of physicians in outpatient clinics can lead to reduced clinical effectiveness, inadequate treatment, and increased medical care expenses. This study was conducted to develop and validate a questionnaire to determine the reasons for patients' non-adherence with physicians' medical orders.

Methods: A sequential exploratory mixed-method study was conducted in two stages. The first stage comprised a qualitative stage to generate the primary items of the questionnaire. This stage provided findings of two sub-stages comprising a literature review and the findings of a qualitative conventional content analysis of 19 semi-structured interviews held with patients, physicians, and managers of the outpatient clinics in Kerman, an area located in southeastern Iran. The second stage comprised a quantitative study aiming evaluation of the instrument psychometric properties, including the face, content, construct, and reliability assessment of the questionnaire. Construct validity assessment was evaluated using exploratory factor analysis (EFA). The reliability assessment was done using assessing internal consistency (Cronbach's alpha). To assess the construct validity of the questionnaire, four hundred and forty patients referred to outpatient clinics in Kerman were selected using stratified convenience sampling to fill out the questionnaire. The sample size was calculated using the Cochran formula. Qualitative and quantitative data were analyzed by MAXQDA 10 and Stata version 14, respectively.

Results: The primary items contained 57 items, of which 42 met the minimum acceptable value of 0.78 for item-level content validity index (I-CVI = 1 for 24 items and I-CVI = 0.8 for 18 items). Item-level content validity ratio (I-CVR) was confirmed for 18 items with a minimum acceptable value of 0.99 for five experts. Finally, 18 items obtained the acceptable value for both I-CVI and I-CVR indicators and were confirmed. Using EFA, four factors (intrapersonal-psychological, intrapersonal-cognitive, provider-related, and socio-economic reasons) with 18 items and Cronbach's alpha coefficient of 0.70, 0.66, 0.73, and 0.71, respectively, were identified and explained 51% of the variance. The reliability of the questionnaire (r = 0.70) was confirmed.

Conclusion: The questionnaire with four dimensions is a valid and reliable instrument that can help determine the perceived reasons for non-adherence with medical orders in the outpatient services system.
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http://dx.doi.org/10.1186/s12913-021-06147-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881677PMC
February 2021

Cigarette Smoking and Its Financial Burden among Iranian Households: Evidence from Household Income and Expenditures Survey.

J Res Health Sci 2020 Oct 13;20(4):e00494. Epub 2020 Oct 13.

Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: The financial burden of cigarette smoking on households' budget is not well documented in Iran. We aimed to identify the determinants of cigarette consumption and its financial burden among households in Iran.

Study Design: A cross-sectional study.

Methods: A total of 39,864 Iranian's households from 31 provinces were included in the analysis. Data on sociodemographic and socioeconomic characteristics (age, sex, household size, education level, employment status, income and wealth index), living area, number of cigarettes smoked and cigarette expenditures for households were extracted from the 2016 Household Income and Expenditures Survey (HIES). Tobit model was used to identify the determinants of cigarette smoking frequency and expenditures among Iranian households.

Results: The average number of cigarettes smoked and cigarettes expenditures by all household members was 85.25 cigarettes and US$ 2.64 per month. Living in urban areas, wealth index of households, household income, household size and low educational attainment of household members were positively associated with frequency and expenditures of cigarette smoking. Results also indicated increasing patterns in the number of cigarettes smoked and cigarettes expenditures from east to west of the country. East Azerbaijan, Hamadan, Markazi and Chaharmahal va Bakhtiari provinces had higher cigarette smoking frequency and expenditures in Iran.

Conclusion: Tobacco control interventions in Iran should focus more on households living in urban areas and low-educated households. As the frequency of cigarette smoking was higher in the western region of Iran, comprehensive tobacco control policies should be adopted in western provinces.
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http://dx.doi.org/10.34172/jrhs.2020.28DOI Listing
October 2020

Quality and quantity of price elasticity of cigarette in Iran.

Int J Health Plann Manage 2021 Jan 25;36(1):60-70. Epub 2020 Aug 25.

Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Objective: Effectiveness of tax policies to control cigarette consumption largely depends on the sensitivity of cigarette demand due to price change. Price elasticity is the measurement of this responsiveness. The main objective of this study is to measure quantity, and quality price elasticity of demand (PED) and cross-price elasticity of demand (XED) for Iranian and non-Iranian cigarette brands in Iran.

Methods: This study used data from the 2017 Iranian household income and expenditures survey conducted in all 31 provinces of Iran. A total of 39,864 households were included in the survey. PED of quantity and quality and XED were estimated using restricted, unrestricted and quintile regression models.

Results: Our results s show that the Iranian and non-Iranians brands cigarettes were price inelastic and elastic, respectively. XED between Iranian and non-Iranian brands was positive suggesting households' preference for Iranian brands of cigarettes over non-Iranian brands. Quintile regression results suggest that PED varied between -1.20 and -0.91 across the distribution of quantity demanded.

Conclusion: Imposing tax could be a useful policy tool to control smoking initiation and intensity in Iran. However, the effectiveness of such policy would depend on the better governance of taxation imposed on different brands of cigarettes.
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http://dx.doi.org/10.1002/hpm.3062DOI Listing
January 2021

Decomposing socioeconomic inequality in dental caries in Iran: cross-sectional results from the PERSIAN cohort study.

Arch Public Health 2020 18;78:75. Epub 2020 Aug 18.

Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: The current study aimed to measure and decompose socioeconomic-related inequalities in DMFT (decayed, missing, and filled teeth) index among adults in Iran.

Methods: The study data were extracted from the adult component of Prospective Epidemiological Research Studies in IrAN (PERSIAN) from 17 centers in 14 different provinces of Iran. DMFT score was used as a measure of dental caries among adults in Iran. The concentration curve and relative concentration index (RC) was used to quantify and decompose socioeconomic-related inequalities in DMFT.

Results: A total of 128,813 adults aged 35 and older were included in the study. The mean (Standard Deviation [SD]) score of D, M, F and DMFT of the adults was 3.3 (4.6), 12.6 (10.5), 2.1 (3.4) and 18.0 (9.5), respectively. The findings suggested that DMFT was mainly concentrated among the socioeconomically disadvantaged adults (RC = - 0.064; 95% confidence interval [CI), - 0.066 to - 0.063). Socioeconomic status, being male, older age and being a widow or divorced were identified as the main factors contributing to the concentration of DMFT among the worse-off adults.

Conclusions: It is recommended to focus on the dental caries status of socioeconomically disadvantaged groups in order to reduce socioeconomic-related inequality in oral health among Iranian adults. Reducing socioeconomic-related inequalities in dental caries should be accompanied by appropriate health promotion policies that focus actions on the fundamental socioeconomic causes of dental disease.
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http://dx.doi.org/10.1186/s13690-020-00457-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436972PMC
August 2020

Chaharshanbeh souri: Developing concerns and update.

Burns 2020 05 31;46(3):739-740. Epub 2020 Jan 31.

Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.burns.2019.12.019DOI Listing
May 2020

Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017.

Authors:
Juanita A Haagsma Spencer L James Chris D Castle Zachary V Dingels Jack T Fox Erin B Hamilton Zichen Liu Lydia R Lucchesi Nicholas L S Roberts Dillon O Sylte Oladimeji M Adebayo Alireza Ahmadi Muktar Beshir Ahmed Miloud Taki Eddine Aichour Fares Alahdab Suliman A Alghnam Syed Mohamed Aljunid Rajaa M Al-Raddadi Ubai Alsharif Khalid Altirkawi Mina Anjomshoa Carl Abelardo T Antonio Seth Christopher Yaw Appiah Olatunde Aremu Amit Arora Hamid Asayesh Reza Assadi Ashish Awasthi Beatriz Paulina Ayala Quintanilla Shivanthi Balalla Amrit Banstola Suzanne Lyn Barker-Collo Till Winfried Bärnighausen Shahrzad Bazargan-Hejazi Neeraj Bedi Masoud Behzadifar Meysam Behzadifar Corina Benjet Derrick A Bennett Isabela M Bensenor Soumyadeep Bhaumik Zulfiqar A Bhutta Ali Bijani Guilherme Borges Rohan Borschmann Dipan Bose Soufiane Boufous Alexandra Brazinova Julio Cesar Campuzano Rincon Rosario Cárdenas Juan J Carrero Félix Carvalho Carlos A Castañeda-Orjuela Ferrán Catalá-López Jee-Young J Choi Devasahayam J Christopher Christopher Stephen Crowe Koustuv Dalal Ahmad Daryani Dragos Virgil Davitoiu Louisa Degenhardt Diego De Leo Jan-Walter De Neve Kebede Deribe Getenet Ayalew Dessie Gabrielle Aline deVeber Samath Dhamminda Dharmaratne Linh Phuong Doan Kate A Dolan Tim Robert Driscoll Manisha Dubey Ziad El-Khatib Christian Lycke Ellingsen Maysaa El Sayed Zaki Aman Yesuf Endries Sharareh Eskandarieh Andre Faro Seyed-Mohammad Fereshtehnejad Eduarda Fernandes Irina Filip Florian Fischer Richard Charles Franklin Takeshi Fukumoto Kebede Embaye Gezae Tiffany K Gill Alessandra C Goulart Ayman Grada Yuming Guo Rahul Gupta Hassan Haghparast Bidgoli Arvin Haj-Mirzaian Arya Haj-Mirzaian Randah R Hamadeh Samer Hamidi Josep Maria Haro Hadi Hassankhani Hamid Yimam Hassen Rasmus Havmoeller Delia Hendrie Andualem Henok Martha Híjar Michael K Hole Enayatollah Homaie Rad Naznin Hossain Sorin Hostiuc Guoqing Hu Ehimario U Igumbor Olayinka Stephen Ilesanmi Seyed Sina Naghibi Irvani Sheikh Mohammed Shariful Islam Rebecca Q Ivers Kathryn H Jacobsen Nader Jahanmehr Mihajlo Jakovljevic Achala Upendra Jayatilleke Ravi Prakash Jha Jost B Jonas Zahra Jorjoran Shushtari Jacek Jerzy Jozwiak Mikk Jürisson Ali Kabir Rizwan Kalani Amir Kasaeian Abraham Getachew Kelbore Andre Pascal Kengne Yousef Saleh Khader Morteza Abdullatif Khafaie Nauman Khalid Ejaz Ahmad Khan Abdullah T Khoja Aliasghar A Kiadaliri Young-Eun Kim Daniel Kim Adnan Kisa Ai Koyanagi Barthelemy Kuate Defo Burcu Kucuk Bicer Manasi Kumar Ratilal Lalloo Hilton Lam Faris Hasan Lami Van C Lansingh Janet L Leasher Shanshan Li Shai Linn Raimundas Lunevicius Flavia R Machado Hassan Magdy Abd El Razek Muhammed Magdy Abd El Razek Narayan Bahadur Mahotra Marek Majdan Azeem Majeed Reza Malekzadeh Manzoor Ahmad Malik Deborah Carvalho Malta Ana-Laura Manda Mohammad Ali Mansournia Benjamin Ballard Massenburg Pallab K Maulik Hailemariam Abiy Alemu Meheretu Man Mohan Mehndiratta Addisu Melese Walter Mendoza Melkamu Merid Mengesha Tuomo J Meretoja Atte Meretoja Tomislav Mestrovic Tomasz Miazgowski Ted R Miller G K Mini Erkin M Mirrakhimov Babak Moazen Naser Mohammad Gholi Mezerji Roghayeh Mohammadibakhsh Shafiu Mohammed Mariam Molokhia Lorenzo Monasta Stefania Mondello Pablo A Montero-Zamora Yoshan Moodley Mahmood Moosazadeh Ghobad Moradi Maziar Moradi-Lakeh Lidia Morawska Ilais Moreno Velásquez Shane Douglas Morrison Marilita M Moschos Seyyed Meysam Mousavi Srinivas Murthy Kamarul Imran Musa Gurudatta Naik Farid Najafi Vinay Nangia Bruno Ramos Nascimento Duduzile Edith Ndwandwe Ionut Negoi Trang Huyen Nguyen Son Hoang Nguyen Long Hoang Nguyen Huong Lan Thi Nguyen Dina Nur Anggraini Ningrum Yirga Legesse Nirayo Richard Ofori-Asenso Felix Akpojene Ogbo In-Hwan Oh Olanrewaju Oladimeji Andrew T Olagunju Tinuke O Olagunju Pedro R Olivares Heather M Orpana Stanislav S Otstavnov Mahesh P A Smita Pakhale Eun-Kee Park George C Patton Konrad Pesudovs Michael R Phillips Suzanne Polinder Swayam Prakash Amir Radfar Anwar Rafay Alireza Rafiei Siavash Rahimi Vafa Rahimi-Movaghar Muhammad Aziz Rahman Rajesh Kumar Rai Kiana Ramezanzadeh Salman Rawaf David Laith Rawaf Andre M N Renzaho Serge Resnikoff Shahab Rezaeian Leonardo Roever Luca Ronfani Gholamreza Roshandel Yogesh Damodar Sabde Basema Saddik Payman Salamati Yahya Salimi Inbal Salz Abdallah M Samy Juan Sanabria Lidia Sanchez Riera Milena M Santric Milicevic Maheswar Satpathy Monika Sawhney Susan M Sawyer Sonia Saxena Mete Saylan Ione J C Schneider David C Schwebel Soraya Seedat Sadaf G Sepanlou Masood Ali Shaikh Mehran Shams-Beyranvand Morteza Shamsizadeh Mahdi Sharif-Alhoseini Aziz Sheikh Jiabin Shen Mika Shigematsu Rahman Shiri Ivy Shiue João Pedro Silva Jasvinder A Singh Dhirendra Narain Sinha Adauto Martins Soares Filho Joan B Soriano Sergey Soshnikov Ireneous N Soyiri Vladimir I Starodubov Dan J Stein Mark A Stokes Mu'awiyyah Babale Sufiyan Jacob E Sunshine Bryan L Sykes Rafael Tabarés-Seisdedos Karen M Tabb Arash Tehrani-Banihashemi Gizachew Assefa Tessema Jarnail Singh Thakur Khanh Bao Tran Bach Xuan Tran Lorainne Tudor Car Olalekan A Uthman Benjamin S Chudi Uzochukwu Pascual R Valdez Elena Varavikova Ana Maria Nogales Vasconcelos Narayanaswamy Venketasubramanian Francesco S Violante Vasily Vlassov Yasir Waheed Yuan-Pang Wang Tissa Wijeratne Andrea Sylvia Winkler Priyanka Yadav Yuichiro Yano Muluken Azage Yenesew Paul Yip Engida Yisma Naohiro Yonemoto Mustafa Z Younis Chuanhua Yu Shamsa Zafar Zoubida Zaidi Sojib Bin Zaman Mohammad Zamani Yong Zhao Sanjay Zodpey Simon I Hay Alan D Lopez Ali H Mokdad Theo Vos

Inj Prev 2020 Oct 8;26(Supp 1):i12-i26. Epub 2020 Jan 8.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.

Background: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates.

Methods: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate.

Results: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced.

Conclusions: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.
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http://dx.doi.org/10.1136/injuryprev-2019-043296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571356PMC
October 2020

The relationship between weight indices and injuries and mortalities caused by the motor vehicle accidents: a systematic review and meta-analysis.

J Inj Violence Res 2020 Jan 21;12(1):85-101. Epub 2019 Dec 21.

Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran. Email:

Background: The relationship between weight indices and injuries and mortality in motor vehicle accidents is unknown. Systematic review studies addressing the collection and analysis of the relationship in investigations are very limited. The purpose of this systematic review is to determine the relationship between BMI, obesity and overweight with mortality and injuries and their severity and vulnerable organs after the motor vehicle accident.

Methods: The databases (MEDLINE/PUBMED, EMBASE, Web of Science, etc) were searched for relevant abstracts using certain keywords. Of all the articles, similar ones were removed considering different filters. The collected data were entered into the STATA SE v 13.1. The heterogeneity of the data was analyzed using i2 statistics. In addition, the estimates of the study were done based on the age group (children and adults) and the impact of obesity on different regions of the body.

Results: A direct relationship was observed between the overall BMI and the degrees of injuries (CI=0.503-1.139), and mortality due to motor vehicle accident (CI=1.267-1.471). A positive relationship was found between obesity and AIS+2 (CI=0.653-1.426), and AIS+3 (CI=1.184-1.741), and ISS (CI=1.086-1.589). Also, a negative relationship between overweight and injuries rates, and a direct relationship between overweight and mortality (CI=0.979-1.167), and injuries with index of AIS+2 (CI=1.178-0.768) and AIS+3 (CI=0.48-2.186) were found.

Conclusions: The prediction of injury, mortality and severity of injuries in the motor vehicle accident by the variable of obesity and overweight determines the need to design prevention programs for this vulnerable group at all levels.
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http://dx.doi.org/10.5249/jivr.v12i1.1198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001613PMC
January 2020

Changes in serum phosphorus level in patients with severe burns: A prospective study.

Burns 2019 12 2;45(8):1864-1870. Epub 2019 Nov 2.

Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: The second most abundant mineral in the body, phosphorus (P), is absorbed in the small intestine after ingestion enhanced by 1,25-dihydroxy vitamin D, and its excretion is exclusively regulated by the kidney. It is clinically significant, aside from its disturbance in burn ICU patient's P mechanism. The increasing rate of morbidity and mortality among the patients can be associated with severe hypophosphatemia. The current study aimed at investigating the changes in serum P levels in the early period after burns, the relationship between serum P level and TBSA (total body surface area) of burn, and the impact of hypophosphatemia on patients' clinical outcomes.

Material And Methods: The current prospective, observational study was conducted on 137 patients hospitalized in the burn intensive unit (BICU) of Velayat Sub-specialty Burn and Plastic Surgery Center from December 2015 to May 2017. According to the TBSA percentage, the patients were divided into three groups. The level of serum P was determined in the 1st, 3rd, 5th, 7th, and 9th days of hospital stay and before discharge. To evaluate the trend of P changes in the sixtime-points, the average changes along with 95% confidence intervals (CI) were used for multivariate analysis of variance with repeated measures (repeated measures ANOVA). A P-value of 0.05 or less was considered statistically significant. The analyses were performed using SPSS software, version 19 (SPSS Inc.).

Results: Totally, 137 patients (70% male, mean age 32 ± 21years, and TBSA 32.6 ± 14%) were included in the study. The overall incidence of hypophosphatemia was 75.1%. Hypophosphatemia developed as early as 1.66 ± 0.136 (95%CI: 1.4-1.9) days after injury. The highest decrease in the serum P level was observed on the 3rd and 5th days after burn as 2.78 mg/dL and 2.85 mg/dL, respectively (P-value = 0.001). A correlation was observed between TBSA and serum P level. The mean serum P level decreased with increasing the percentage of burns. There was a correlation between serum P level and mortality; therefore, a decrease in serum P level increased the patient's mortality rate (P < 0.05).

Conclusion: The current study highlighted that hypophosphatemia is often observed in patients with burn injuries during their hospitalization. It is potentially beneficial to identify patients at risk of hypophosphatemia. Therefore, it is suggested that P level be assessed regularly in patients with burn injuries for the timely initiation of P replacement therapy.
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http://dx.doi.org/10.1016/j.burns.2019.03.015DOI Listing
December 2019

Dental status of the Iranian elderly: A systematic review and meta-analysis.

J Investig Clin Dent 2019 Nov 18;10(4):e12459. Epub 2019 Oct 18.

Oral & Maxillofacial Medicine, Faculty of Dentistry, Guilan University of Medical Sciences, Rasht, Iran.

Tooth loss is an important health dilemma. The aim of the present study was to perform a systematic review and meta-analysis of dental status and edentulism in the elderly residing in Iran. An electronic search of the literature was carried out on Farsi and English databases using the following keywords: edentulism, dental caries, elderly, oral and dental health, edentulous, geriatric, caries, dentate, Iran, and prevalence. Articles that met the eligibility criteria according to the STROBE (Strengthening the Reporting of Observational Studies In Epidemiology) checklist were selected and entered into the meta-analysis. Data were analyzed using Stata 13.1 software, and the metan and metareg packages for used for the meta-regression and meta-analysis. Of the 172 articles retrieved, 154 were used after eliminating the duplicates, and their full texts were read. Of the 4574 participants evaluated in 13 studies, 2227 (48.7%) were completely edentulous (95% confidence interval [CI]: .49-.49). Of the 4423 participants evaluated in 12 studies, 2286 (51.7%) were dentate (95% CI: .52-.52). The mean number of remaining teeth was 5.73 (95% CI: 5.73-5.73) in six studies conducted on 2782 participants. Approximately 50% of the elderly in Iran are completely edentulous. Efforts should be made to improve dental care instruction, provision of dental care services in the public sector, and dental insurance coverage to promote the dental status of elderly Iranians.
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http://dx.doi.org/10.1111/jicd.12459DOI Listing
November 2019

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Authors:
Roy Burstein Nathaniel J Henry Michael L Collison Laurie B Marczak Amber Sligar Stefanie Watson Neal Marquez Mahdieh Abbasalizad-Farhangi Masoumeh Abbasi Foad Abd-Allah Amir Abdoli Mohammad Abdollahi Ibrahim Abdollahpour Rizwan Suliankatchi Abdulkader Michael R M Abrigo Dilaram Acharya Oladimeji M Adebayo Victor Adekanmbi Davoud Adham Mahdi Afshari Mohammad Aghaali Keivan Ahmadi Mehdi Ahmadi Ehsan Ahmadpour Rushdia Ahmed Chalachew Genet Akal Joshua O Akinyemi Fares Alahdab Noore Alam Genet Melak Alamene Kefyalew Addis Alene Mehran Alijanzadeh Cyrus Alinia Vahid Alipour Syed Mohamed Aljunid Mohammed J Almalki Hesham M Al-Mekhlafi Khalid Altirkawi Nelson Alvis-Guzman Adeladza Kofi Amegah Saeed Amini Arianna Maever Loreche Amit Zohreh Anbari Sofia Androudi Mina Anjomshoa Fereshteh Ansari Carl Abelardo T Antonio Jalal Arabloo Zohreh Arefi Olatunde Aremu Bahram Armoon Amit Arora Al Artaman Anvar Asadi Mehran Asadi-Aliabadi Amir Ashraf-Ganjouei Reza Assadi Bahar Ataeinia Sachin R Atre Beatriz Paulina Ayala Quintanilla Martin Amogre Ayanore Samad Azari Ebrahim Babaee Arefeh Babazadeh Alaa Badawi Soghra Bagheri Mojtaba Bagherzadeh Nafiseh Baheiraei Abbas Balouchi Aleksandra Barac Quique Bassat Bernhard T Baune Mohsen Bayati Neeraj Bedi Ettore Beghi Masoud Behzadifar Meysam Behzadifar Yared Belete Belay Brent Bell Michelle L Bell Dessalegn Ajema Berbada Robert S Bernstein Natalia V Bhattacharjee Suraj Bhattarai Zulfiqar A Bhutta Ali Bijani Somayeh Bohlouli Nicholas J K Breitborde Gabrielle Britton Annie J Browne Sharath Burugina Nagaraja Reinhard Busse Zahid A Butt Josip Car Rosario Cárdenas Carlos A Castañeda-Orjuela Ester Cerin Wagaye Fentahun Chanie Pranab Chatterjee Dinh-Toi Chu Cyrus Cooper Vera M Costa Koustuv Dalal Lalit Dandona Rakhi Dandona Farah Daoud Ahmad Daryani Rajat Das Gupta Ian Davis Nicole Davis Weaver Dragos Virgil Davitoiu Jan-Walter De Neve Feleke Mekonnen Demeke Gebre Teklemariam Demoz Kebede Deribe Rupak Desai Aniruddha Deshpande Hanna Demelash Desyibelew Sagnik Dey Samath Dhamminda Dharmaratne Meghnath Dhimal Daniel Diaz Leila Doshmangir Andre R Duraes Laura Dwyer-Lindgren Lucas Earl Roya Ebrahimi Soheil Ebrahimpour Andem Effiong Aziz Eftekhari Elham Ehsani-Chimeh Iman El Sayed Maysaa El Sayed Zaki Maha El Tantawi Ziad El-Khatib Mohammad Hassan Emamian Shymaa Enany Sharareh Eskandarieh Oghenowede Eyawo Maha Ezalarab Mahbobeh Faramarzi Mohammad Fareed Roghiyeh Faridnia Andre Faro Ali Akbar Fazaeli Mehdi Fazlzadeh Netsanet Fentahun Seyed-Mohammad Fereshtehnejad João C Fernandes Irina Filip Florian Fischer Nataliya A Foigt Masoud Foroutan Joel Msafiri Francis Takeshi Fukumoto Nancy Fullman Silvano Gallus Destallem Gebremedhin Gebre Tsegaye Tewelde Gebrehiwot Gebreamlak Gebremedhn Gebremeskel Bradford D Gessner Birhanu Geta Peter W Gething Reza Ghadimi Keyghobad Ghadiri Mahsa Ghajarzadeh Ahmad Ghashghaee Paramjit Singh Gill Tiffany K Gill Nick Golding Nelson G M Gomes Philimon N Gona Sameer Vali Gopalani Giuseppe Gorini Bárbara Niegia Garcia Goulart Nicholas Graetz Felix Greaves Manfred S Green Yuming Guo Arvin Haj-Mirzaian Arya Haj-Mirzaian Brian James Hall Samer Hamidi Hamidreza Haririan Josep Maria Haro Milad Hasankhani Edris Hasanpoor Amir Hasanzadeh Hadi Hassankhani Hamid Yimam Hassen Mohamed I Hegazy Delia Hendrie Fatemeh Heydarpour Thomas R Hird Chi Linh Hoang Gillian Hollerich Enayatollah Homaie Rad Mojtaba Hoseini-Ghahfarokhi Naznin Hossain Mostafa Hosseini Mehdi Hosseinzadeh Mihaela Hostiuc Sorin Hostiuc Mowafa Househ Mohamed Hsairi Olayinka Stephen Ilesanmi Mohammad Hasan Imani-Nasab Usman Iqbal Seyed Sina Naghibi Irvani Nazrul Islam Sheikh Mohammed Shariful Islam Mikk Jürisson Nader Jafari Balalami Amir Jalali Javad Javidnia Achala Upendra Jayatilleke Ensiyeh Jenabi John S Ji Yash B Jobanputra Kimberly Johnson Jost B Jonas Zahra Jorjoran Shushtari Jacek Jerzy Jozwiak Ali Kabir Amaha Kahsay Hamed Kalani Rohollah Kalhor Manoochehr Karami Surendra Karki Amir Kasaeian Nicholas J Kassebaum Peter Njenga Keiyoro Grant Rodgers Kemp Roghayeh Khabiri Yousef Saleh Khader Morteza Abdullatif Khafaie Ejaz Ahmad Khan Junaid Khan Muhammad Shahzeb Khan Young-Ho Khang Khaled Khatab Amir Khater Mona M Khater Alireza Khatony Mohammad Khazaei Salman Khazaei Maryam Khazaei-Pool Jagdish Khubchandani Neda Kianipour Yun Jin Kim Ruth W Kimokoti Damaris K Kinyoki Adnan Kisa Sezer Kisa Tufa Kolola Soewarta Kosen Parvaiz A Koul Ai Koyanagi Moritz U G Kraemer Kewal Krishan Kris J Krohn Nuworza Kugbey G Anil Kumar Manasi Kumar Pushpendra Kumar Desmond Kuupiel Ben Lacey Sheetal D Lad Faris Hasan Lami Anders O Larsson Paul H Lee Mostafa Leili Aubrey J Levine Shanshan Li Lee-Ling Lim Stefan Listl Joshua Longbottom Jaifred Christian F Lopez Stefan Lorkowski Sameh Magdeldin Hassan Magdy Abd El Razek Muhammed Magdy Abd El Razek Azeem Majeed Afshin Maleki Reza Malekzadeh Deborah Carvalho Malta Abdullah A Mamun Navid Manafi Ana-Laura Manda Morteza Mansourian Francisco Rogerlândio Martins-Melo Anthony Masaka Benjamin Ballard Massenburg Pallab K Maulik Benjamin K Mayala Mohsen Mazidi Martin McKee Ravi Mehrotra Kala M Mehta Gebrekiros Gebremichael Meles Walter Mendoza Ritesh G Menezes Atte Meretoja Tuomo J Meretoja Tomislav Mestrovic Ted R Miller Molly K Miller-Petrie Edward J Mills George J Milne G K Mini Seyed Mostafa Mir Hamed Mirjalali Erkin M Mirrakhimov Efat Mohamadi Dara K Mohammad Aso Mohammad Darwesh Naser Mohammad Gholi Mezerji Ammas Siraj Mohammed Shafiu Mohammed Ali H Mokdad Mariam Molokhia Lorenzo Monasta Yoshan Moodley Mahmood Moosazadeh Ghobad Moradi Masoud Moradi Yousef Moradi Maziar Moradi-Lakeh Mehdi Moradinazar Paula Moraga Lidia Morawska Abbas Mosapour Seyyed Meysam Mousavi Ulrich Otto Mueller Atalay Goshu Muluneh Ghulam Mustafa Behnam Nabavizadeh Mehdi Naderi Ahamarshan Jayaraman Nagarajan Azin Nahvijou Farid Najafi Vinay Nangia Duduzile Edith Ndwandwe Nahid Neamati Ionut Negoi Ruxandra Irina Negoi Josephine W Ngunjiri Huong Lan Thi Nguyen Long Hoang Nguyen Son Hoang Nguyen Katie R Nielsen Dina Nur Anggraini Ningrum Yirga Legesse Nirayo Molly R Nixon Chukwudi A Nnaji Marzieh Nojomi Mehdi Noroozi Shirin Nosratnejad Jean Jacques Noubiap Soraya Nouraei Motlagh Richard Ofori-Asenso Felix Akpojene Ogbo Kelechi E Oladimeji Andrew T Olagunju Meysam Olfatifar Solomon Olum Bolajoko Olubukunola Olusanya Mojisola Morenike Oluwasanu Obinna E Onwujekwe Eyal Oren Doris D V Ortega-Altamirano Alberto Ortiz Osayomwanbo Osarenotor Frank B Osei Aaron E Osgood-Zimmerman Stanislav S Otstavnov Mayowa Ojo Owolabi Mahesh P A Abdol Sattar Pagheh Smita Pakhale Songhomitra Panda-Jonas Animika Pandey Eun-Kee Park Hadi Parsian Tahereh Pashaei Sangram Kishor Patel Veincent Christian Filipino Pepito Alexandre Pereira Samantha Perkins Brandon V Pickering Thomas Pilgrim Majid Pirestani Bakhtiar Piroozi Meghdad Pirsaheb Oleguer Plana-Ripoll Hadi Pourjafar Parul Puri Mostafa Qorbani Hedley Quintana Mohammad Rabiee Navid Rabiee Amir Radfar Alireza Rafiei Fakher Rahim Zohreh Rahimi Vafa Rahimi-Movaghar Shadi Rahimzadeh Fatemeh Rajati Sree Bhushan Raju Azra Ramezankhani Chhabi Lal Ranabhat Davide Rasella Vahid Rashedi Lal Rawal Robert C Reiner Andre M N Renzaho Satar Rezaei Aziz Rezapour Seyed Mohammad Riahi Ana Isabel Ribeiro Leonardo Roever Elias Merdassa Roro Max Roser Gholamreza Roshandel Daem Roshani Ali Rostami Enrico Rubagotti Salvatore Rubino Siamak Sabour Nafis Sadat Ehsan Sadeghi Reza Saeedi Yahya Safari Roya Safari-Faramani Mahdi Safdarian Amirhossein Sahebkar Mohammad Reza Salahshoor Nasir Salam Payman Salamati Farkhonde Salehi Saleh Salehi Zahabi Yahya Salimi Hamideh Salimzadeh Joshua A Salomon Evanson Zondani Sambala Abdallah M Samy Milena M Santric Milicevic Bruno Piassi Sao Jose Sivan Yegnanarayana Iyer Saraswathy Rodrigo Sarmiento-Suárez Benn Sartorius Brijesh Sathian Sonia Saxena Alyssa N Sbarra Lauren E Schaeffer David C Schwebel Sadaf G Sepanlou Seyedmojtaba Seyedmousavi Faramarz Shaahmadi Masood Ali Shaikh Mehran Shams-Beyranvand Amir Shamshirian Morteza Shamsizadeh Kiomars Sharafi Mehdi Sharif Mahdi Sharif-Alhoseini Hamid Sharifi Jayendra Sharma Rajesh Sharma Aziz Sheikh Chloe Shields Mika Shigematsu Rahman Shiri Ivy Shiue Kerem Shuval Tariq J Siddiqi João Pedro Silva Jasvinder A Singh Dhirendra Narain Sinha Malede Mequanent Sisay Solomon Sisay Karen Sliwa David L Smith Ranjani Somayaji Moslem Soofi Joan B Soriano Chandrashekhar T Sreeramareddy Agus Sudaryanto Mu'awiyyah Babale Sufiyan Bryan L Sykes P N Sylaja Rafael Tabarés-Seisdedos Karen M Tabb Takahiro Tabuchi Nuno Taveira Mohamad-Hani Temsah Abdullah Sulieman Terkawi Zemenu Tadesse Tessema Kavumpurathu Raman Thankappan Sathish Thirunavukkarasu Quyen G To Marcos Roberto Tovani-Palone Bach Xuan Tran Khanh Bao Tran Irfan Ullah Muhammad Shariq Usman Olalekan A Uthman Amir Vahedian-Azimi Pascual R Valdez Job F M van Boven Tommi Juhani Vasankari Yasser Vasseghian Yousef Veisani Narayanaswamy Venketasubramanian Francesco S Violante Sergey Konstantinovitch Vladimirov Vasily Vlassov Theo Vos Giang Thu Vu Isidora S Vujcic Yasir Waheed Jon Wakefield Haidong Wang Yafeng Wang Yuan-Pang Wang Joseph L Ward Robert G Weintraub Kidu Gidey Weldegwergs Girmay Teklay Weldesamuel Ronny Westerman Charles Shey Wiysonge Dawit Zewdu Wondafrash Lauren Woyczynski Ai-Min Wu Gelin Xu Abbas Yadegar Tomohide Yamada Vahid Yazdi-Feyzabadi Christopher Sabo Yilgwan Paul Yip Naohiro Yonemoto Javad Yoosefi Lebni Mustafa Z Younis Mahmoud Yousefifard Hebat-Allah Salah A Yousof Chuanhua Yu Hasan Yusefzadeh Erfan Zabeh Telma Zahirian Moghadam Sojib Bin Zaman Mohammad Zamani Hamed Zandian Alireza Zangeneh Taddese Alemu Zerfu Yunquan Zhang Arash Ziapour Sanjay Zodpey Christopher J L Murray Simon I Hay

Nature 2019 10 16;574(7778):353-358. Epub 2019 Oct 16.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
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http://dx.doi.org/10.1038/s41586-019-1545-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800389PMC
October 2019

Effects of Hemodynamic Factors and Oxygenation on the Incidence of Pressure Ulcers in the ICU.

Adv Skin Wound Care 2019 Aug;32(8):359-364

At the Guilan University of Medical Sciences, in Rasht, Iran, Mostafa Soodmand, MSc, is a medical-surgical nursing student, School of Nursing and Midwifery; Mohammad Taghi Moghadamnia, PhD, is Assistant Professor of Health in Disasters and Emergencies, Department of Medical-Surgical Nursing, School of Nursing and Midwifery; Iraj Aghaei, PhD, is Assistant Professor of Neurosciences, Social Determinants of Health Research Center; Golshan Ghasemzadeh, BSN, is a researcher, Healthy Heart Research Center, Heshmat Hospital; Ehsan Kazemnejad Lili, PhD, is Associate Professor of Biostatistics, School of Nursing and Midwifery; and Enayatollah Homaie Rad, PhD, is Assistant Professor of Health Economics, Social Determinants of Health Research Center.

Objective: To investigate the roles of hemodynamic factors and oxygenation on the incidence of pressure ulcers in patients in the ICU on mechanical ventilation.

Methods: This prospective analytical cross-sectional study was performed in several ICUs for a period of 8 months in Iran. Researchers checked patients for pressure ulcers on a daily basis. They collected demographic, hemodynamic, and oxygenation data until a pressure ulcer occurred, the patient's artificial airway was removed, the patient died, or the patient was discharged.

Results: From August 2017 to February 2018, a total of 2,581 patients were admitted to the study ICUs; of these, 133 patients were eligible for the study. The results indicated that 41.4% (n = 55) of the patients ended up with pressure ulcers. Investigation of the variables using a Cox regression model showed that, among other variables considered in this study, age, mean arterial pressure, and positive end-expiratory pressure in the mechanical ventilator can contribute to the risk of pressure ulcers.

Conclusions: Providers should pay attention to changes in hemodynamic parameters, especially mean arterial pressure; carefully determine the most appropriate positive end-expiratory pressure for patients connected to mechanical ventilation; and take special care of susceptible groups such as older adults and hospitalized patients to decrease the incidence of pressure ulcers.
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http://dx.doi.org/10.1097/01.ASW.0000553599.20444.f4DOI Listing
August 2019

Effectiveness of an educational program on decreasing burns and injuries in Persian festival of fire: A burden of diseases approach.

Burns 2019 03 22;45(2):466-470. Epub 2018 Dec 22.

Neuroscience Research Center, Guilan University of Medical Sciences, Rasht, Iran. Electronic address:

Chaharshanbeh souri is a historical Persian firework festival which has several health and financial damages for Iranians near celebration of New Year. In this study we tried to find effectiveness of Chaharshanbeh souri educational campaign on decreasing burden of injuries due to fireworks of this day. In this before-after study, an educational campaign was done for 2017 focusing on children and students. Data of a registry which was designed for gathering information of injuries and mortalities of this festival was used to show effectiveness of the program. Disability adjusted life years was calculated and compared before and after intervention. The results of this study showed that mean age of injuries was increased from 27.75 to 32.65 years and DALY decreased significantly after the intervention (P=0.0460) showing that the intervention was effective. Educational programs might be effective to decrease burden of injuries related to Chaharshanbeh souri festival.
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http://dx.doi.org/10.1016/j.burns.2018.07.011DOI Listing
March 2019

Physicians' retention rate and its effective factors in the Islamic Republic of Iran.

East Mediterr Health J 2018 Dec 9;24(9):830-837. Epub 2018 Dec 9.

Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Islamic Republic of Iran.

Background: Migration of physicians from less developed countries to affluent ones has become as one of the major concerns of human resource policy-makers. This leads to problems such as inequity in the distribution of physicians, lack of physicians in less developed areas, as well as an excess of the health workforce in developed environs. Thus, policy-makers aim to increase retention of physicians in their places of origin.

Aims: This study aimed to find those effective factors for the retention of physicians in the Islamic Republic of Iran.

Methods: 30 569 records of public sector physicians in 2016 were gathered from the Ministry of Health and Medical Education database, and the retention rate of each province was calculated. Geographic information system (GIS) was used to show retention in each province, and linear and logistic regression analysis were used to determine the effective factors for physicians' retention in the country.

Results: There was a significant relationship between per capita gross domestic product of each province and its retention rate of physicians (OR = 1.56), retention rate of family physicians (OR = 7.38), and retention rate of specialists (OR = 1.59). In addition, relationships were significant for the human development index (all physicians [OR = 1.22], family physicians [OR = 2.36], and specialists [OR = 1.23]). Married physicians, higher paid physicians, and those who worked in headquarters and clinics showed greater willingness to stay in their area of origin.

Conclusions: Physicians' retention rate is dependent on both macro and microlevel factors.
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http://dx.doi.org/10.26719/2018.24.9.830DOI Listing
December 2018

Higher Income for Male Physicians: Findings About Salary Differences Between Male and Female Iranian Physicians

Balkan Med J 2019 05 12;36(3):162-168. Epub 2018 Dec 12.

Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

Background: In recent decades, the role of women in the organizations of developed and less developed countries has increased, but little is known about gender gap in salaries of Iranian physicians.

Aims: To analyze the gender gap in the salary of physicians working in public health sector of Iran and its predicting factors in 2016.

Study Design: Cross sectional study.

Methods: Thirty thousand eight hundred and twenty four records about characteristics of study population were extracted from national human resources for health database. Nearest neighborhood matching technique was used to find adjusted differences of salary between male and female physicians. In addition, by using Oaxaca decomposition method, the reasons for the differences were found.

Results: The results showed that there was a difference of 117 dollars in monthly salaries of male and female physicians in favor of men. Differences in male and female salaries could be predicted by place of work and residency, type of specialty, type of employment and marital status.

Conclusion: Gender gap in physicians’ salaries exists in public health sector of Iran. The payment methods of salaries for men and women should be revised in order to remove the inequalities.
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http://dx.doi.org/10.4274/balkanmedj.galenos.2018.2018.1082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528530PMC
May 2019

Effect of Cost Sharing on Utilization of General Physician Care: A Cross-Sectional Survey from Shiraz, Iran.

Int J Prev Med 2018 5;9:96. Epub 2018 Nov 5.

Health Human Resource Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: High-cost sharing in physician care may result in worse health outcomes and financial burdens for individuals, and it reduces needed health-care utilization. Hence, this study examines the impact of cost sharing on utilization of Physician care.

Methods: In the present study, multistage sampling ( = 1610) was done to collect general physician utilization and quality of life. Count data model was used to analyze the effect of cost sharing and other factor on the ratio of referring to the general physician. Negative binomial regression was employed to analyze the utilization model.

Results: People who have high-cost sharing had used general physician services much less, so that ratio of incidence among them was 0.18 less than individuals with low-cost sharing ( < 0.05). Gender and age variables showed a significant effect on the demand for the general physician visit ( < 0.05).

Conclusions: A low cost-sharing policy would remove the clinically and financial threat from the patient decision-making so as to provide them with access to needed care.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_133_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6238355PMC
November 2018

Complementary health insurance, out- of- pocket expenditures, and health services utilization: A population- based survey.

Med J Islam Repub Iran 2017;31:59. Epub 2017 Sep 9.

Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Studies have shown that people using complementary health insurances have more access to health services than others. In the present study, we aimed at finding the differences between out- of- pocket payments and health service utilizations in complementary health insurances (CHIs) users and nonusers. Propensity score matching was used to compare the 2 groups. First, confounder variables were identified, and then propensity score matching was used to compare out- of- pocket expenditures with dental, general physician, hospital inpatient, emergency services, nursing, midwifery, laboratory services, specialists and rehabilitation services utilization. Our results revealed no significant differences between the 2 groups in out- of- pocket health expenditures. Also, the specialist visits, inpatient services at the hospital, and dental services were higher in people who used CHIs compared to nonusers. People did not change their budget share for health care services after using CHIs. The payments were equal for people who were not CHIs users due to the increase in the quantity of the services.
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http://dx.doi.org/10.14196/mjiri.31.59DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5804461PMC
September 2017

The impact of health sector evolution plan on hospitalization and cesarean section rates in Iran: an interrupted time series analysis.

Int J Qual Health Care 2018 Feb;30(1):75-79

Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Objective: To investigate the effect of the health sector evolution plan (HSEP) on hospitalization and cesarean section (C-section) rates in Kermanshah province in the western region of Iran.

Design: Interrupted time series analysis.

Setting: Hospital care system in Kermanshah province.

Study Participants: Fifteen hospitals affiliated to Ministry of Health and Medical Education (MoHME) in Kermanshah province.

Intervention(s): Health sector evolution plan.

Main Outcome Measures: Hospitalization rate and C-section rate.

Results: We observed a statistically significant increase in the hospitalization rate (12.9 hospitalizations per 10 000 population, P < 0.001) in the first month after the implementation of the HSEP. Compared with the monthly trend in hospitalization rate before the intervention, we found a significant increase of 0.70 hospitalizations per 10 000 population (P < 0.001) in monthly trend in hospitalization rate after the HSEP. Although the proportion of C-section from total deliveries decreased by 11% (P = 0.044) in the first month after the implementation of the HSEP, the proportion of C-section from total deliveries increased at the rate of 0.0017% (P = 0.001) per month during post-intervention period.

Conclusion: We found an increase in the hospitalization rate after the intervention of HSEP. Although the C-section rate in the first month after the HSEP decreased, we observed an increasing trend in C-section rate over the study period; this implies that the HSEP did not promote vaginal delivery in Iran, which is outlined as one of the objectives of the intervention.
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http://dx.doi.org/10.1093/intqhc/mzx169DOI Listing
February 2018

Dental health-care service utilisation and its determinants in West Iran: a cross-sectional study.

Int Dent J 2018 Jun 23;68(3):176-182. Epub 2017 Nov 23.

Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Background: Dental health care is not only an effective strategy for the prevention, early diagnosis and treatment of oral diseases but also contributes to the general health of communities. This study aimed to investigate the situation of dental health-care service utilisation and its determinants in Kermanshah city, western Iran, in 2015.

Methods And Materials: A cross-sectional study on a total of 894 household heads was conducted. The participants were selected using a multistage sampling technique. A self-administered questionnaire was used to collect the data. Multiple logistic regression was performed to assess factors associated with utilisation of dental-care services and a negative binomial regression was carried out to identify the main factor associated with the frequency of visiting a dentist for dental health care. A statistically significant association was considered at a value of P < 0.05. All the analyses were performed using STATA version 12.

Finding: Of the total household heads who participated in the study, 60.3% and 9.9% reported visiting a dentist for dental treatment in the past year and for 6-monthly dental check-ups, respectively. The average ± standard deviation number of visits by a respondent was 2.08 ± 2.97. Of the total number of respondents, 281 (31.4%) reported visiting a dentist once or twice in the last 12 months for dental health-care services, while 28.9% reported visiting a dentist more than twice in the same time period. Ageing, having dental insurance, higher income, being a university graduate, self-rated poor oral health and not regularly brushing own teeth were the main factors associated with utilisation of dental health-care services.

Conclusion: Our study indicates that dental health-care utilisation among households in the study area was influenced by a number of factors, including being socio-economically disadvantaged, self-rated poor oral health and not regularly brushing own teeth. Therefore, in this setting, dental-intervention programmes, including dental health insurance, should focus on mechanisms that can strengthen utilisation of preventive dental health-care services among disadvantaged households.
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http://dx.doi.org/10.1111/idj.12346DOI Listing
June 2018

Does Economic Instability Affect Healthcare Provision? Evidence Based on the Urban Family Physician Program in Iran.

Korean J Fam Med 2017 Sep 22;38(5):296-302. Epub 2017 Sep 22.

Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Iran.

Background: The main aim of this study was to evaluate the achievements of some important goals of Iran's urban family physician plan. This plan was implemented when the country experienced economic instability. We examine whether an economic crisis affects the efficacy of a healthcare program.

Methods: We used the household income and expenditures survey data for 2011 (before program implementation) and 2012 (after program implementation). Changes in out-of-pocket payments and healthcare utilization were investigated using the propensity score matching estimator. Furthermore, changes in inequality in these two dimensions were examined.

Results: No changes in out-of-pocket payments and healthcare utilization were found after the implementation of this program; however, inequality in out-of-pocket payments increased during the reform.

Conclusion: The urban family physician program was not implemented completely and many of its fundamental settings were not conducted because of lack of necessary healthcare infrastructure and budget limitations. Family physician programs should be implemented under a strong healthcare infrastructure and favorable economic conditions.
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http://dx.doi.org/10.4082/kjfm.2017.38.5.296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637222PMC
September 2017

Pros and cons of the health transformation program in Iran: evidence from financial outcomes at the household level.

Epidemiol Health 2017 18;39:e2017029. Epub 2017 Jul 18.

Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.

Objectives: The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program's important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis.

Methods: Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated.

Results: Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%).

Conclusions: The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization.
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http://dx.doi.org/10.4178/epih.e2017029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675984PMC
August 2017

Cost-Utility Analysis of Single-Fraction Versus Multiple-Fraction Radiotherapy in Patients with Painful Bone Metastases: An Iranian Patient's Perspective Study.

Value Health Reg Issues 2017 May 19;12:84-89. Epub 2017 May 19.

School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: To evaluate two of the various treatment strategies of bone metastasis- single-fraction radiotherapy and multiple-fraction radiotherapy.

Methods: A multistage Markov decision model was applied to assess the incremental costs per quality-adjusted life-year (QALY) gained of single fraction against multiple fractions. The model had a monthly cycle length over a lifetime horizon with 1000 hypothetical cohort samples. The EuroQol five-dimensional questionnaire was used to estimate the health-related quality of life in patients. To cope with parameters of uncertainty, we conducted a probabilistic sensitivity analysis using a Monte-Carlo simulation technique. Both cost and utility variables were discounted by 3% in the base model. Strategies were assessed considering a willingness-to-pay threshold of US $6578 per QALY gained.

Results: The expected mean cost and quality-adjusted life-years were, respectively, US $447.28 and 5.95 months for patients receiving single-fraction radiotherapy and US $1269.66 and 7.87 months for those receiving multiple-fraction radiotherapy. The incremental cost-utility ratio was US $428.38 per QALY. Considering the Iranian gross domestic product per capita (US $6578) as the recommended willingness to pay for 1 QALY gained, the multiple-fraction method was found to be a cost-effective strategy.

Conclusions: Policymakers should advocate the multiple-fraction method instead of the single-fraction method in the treatment of patients with painful bone metastases.
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http://dx.doi.org/10.1016/j.vhri.2016.10.004DOI Listing
May 2017

Risk Factors of Road Traffic Accidents Associated Mortality in Northern Iran; A Single Center Experience Utilizing Oaxaca Blinder Decomposition.

Bull Emerg Trauma 2017 04;5(2):116-121

Emergency Management Research Center, Iran University of Medical Sciences, Tehran, Iran.

Objectives: To investigate the differences in death after receiving emergency services in traffic accidents between urban and rural regions, and decompose factors of the gap in Langerood, Northern Iran.

Methods: This cross-sectional study was conducted in Langrood, Northern Iran during a 1-year period from 2013 to 2014. The hospital data of traffic crashes were used. Data contained those patients who survived at the scene of accident. Injury severity score, time to admission, age, gender, season of crash and type of collision were variables used in this study. Oaxaca decomposition technique was used to show the amount of inequity. In addition, three regression models were used to show the reason of inequity.

Results: Overall 1520 patients with road traffic accidents were admitted to our center during the study period. The mean age of the patients was 35.45 ± 17.9 years, and there were 1158 (76.1 %) men among the victims. Motorbike accidents accounted for 869 (57.1%) injuries and 833 (54.8 %) accidents occurred in rural regions. The in-hospital mortality rate was 60 (3.9%). The results of this study showed that 95% of inequity came from factors used in this study and 2.04% disadvantages were for rural crashes. Severity of crash and time to admission had relationship with death, while the effects of time to admission was higher in rural region and severity of the accident had more effect on mortality in urban regions in comparison with rural ones.

Conclusion: The high rate of fatal accidents could be decreased by deleting the gap of access to health care services between urban and rural regions. This study suggested that more efforts of health system are needed to reduce the gap.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5406182PMC
April 2017

Comparison the effects of poor health and low income on early retirement: a systematic review and meta-analysis.

Ind Health 2017 Aug 9;55(4):306-313. Epub 2017 May 9.

Department of Economics, University of Tehran, Tehran, Iran.

The main aim of this study was to estimate the effects of poor health and low income on early retirement. For this purpose systematic review and meta-analysis were conducted. Web of Science, PUBMED and Scopus databases were searched systematically. Finally 17 surveys were added in meta-analysis. These studies were conducted in 13 countries. At the end a Meta regression was done to show the effects of welfare system type on effect sizes of poor health and low income. The results of this study showed that poor health had effect on the risk of early retirement. (Poor health pooled effect sizes: 1.279 CI: (1.15 1.41), low income pooled effect sizes: 1.042 CI: (0.92 1.17), (poor health pooled marginal effects: 0.046 CI: (-0.03 0.12), low income pooled marginal effects: -0.002 CI: (-0.003 0.000). The results of this study showed that association between poor health and early retirement was stronger in comparison with low income and early retirement.
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http://dx.doi.org/10.2486/indhealth.2017-0010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546840PMC
August 2017

The Effect of Catastrophic Health Expenditure on Work After Retirement.

Int J Aging Hum Dev 2017 03 16;84(3):313-323. Epub 2016 Nov 16.

2 Faculty of Economics, University of Tehran, Iran.

Several factors can force retirees to go to paid work. Catastrophic health-care expenditure (CHCE) is one of the driving forces for retirees to go to paid work. This cross-sectional study was based on 6,307 Iran retirees' data. Xu method was used to calculate CHCE, and a logit model was estimated to show the association between CHCE and bridge employment. Other control variables were added to the model. The findings showed that there was positive relationship between CHCE and bridge employment. Retirement pension had negative relationship with work after retirement. Prevalence of work after retirement was higher in people who lived in rural region and increased due to increase in household size. The financial constraint was the main pushing factor for the retiree to go to paid work. Thus, covering retirees with health insurances and identifying and listing diseases that may face the retirees with CHCE are some possible efforts to decrease CHCE.
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http://dx.doi.org/10.1177/0091415016677971DOI Listing
March 2017

Inequity in Health Care Financing in Iran: Progressive or Regressive Mechanism?

Eurasian J Med 2016 Jun;48(2):112-8

Department of Computer Engineering, The University of Guilan School of Engineering, Rasht, Iran.

Objective: Having progressive health finance mechanism is very important to decrease inequity in health systems. Revenue collection is one of the aspects of health care financing. In this study, taxation system and health insurance contribution of Iranians were assessed.

Materials And Methods: Data of 2012 household expenditures survey were used in this study, and payments of the families for health insurances and tax payments were extracted from the study. Kakwani index was calculated for assessing the progressivity of these payments. At the end, a model was designed to find the effective factors.

Results: We found that taxation mechanism was progressive, but insurance contribution mechanism was very regressive. The portion of people living in urban regions was higher in the payments of insurance and tax. Less educated families had lower contribution in health insurance and families with more aging persons paid more for health insurance.

Conclusion: Policy makers must pay more attention to the health insurance contribution and change the laws in favour of the poor.
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http://dx.doi.org/10.5152/eurasianjmed.2015.32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970548PMC
June 2016

Economic inequalities in dental care utilizations in Iran: Evidence from an urban region.

Med J Islam Repub Iran 2016 6;30:383. Epub 2016 Jun 6.

MSc of Health Economics, Department of Health Economics and Management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran.

Background: Health utilization inequality is a major concern for health policymakers. Equality in utilization of services is very important for having a healthy society. The aim of this study was to describe inequality in dental care utilization in Iran, Therefore, concentration index, its curve, and the predictors of inequality in utilization of dental services and their spending were calculated.

Methods: Data of a health utilization survey which previously had been gathered in Shiraz, Iran were used for this study. Tobit and Poisson estimators were used to estimate utilization and out of pocket models. Furthermore, concentration index and curve was calculated to show inequality in dental care utilization.

Results: High inequalities was found in dental care utilization in Iran (concentration index=0.19). In the utilization model, the relationship between income and utilization was positive. People with higher income could utilize more services. Being covered by insurance increased the probability of dental care utilizations too.

Conclusion: Policy makers must find solutions like increase the coverage of dental insurances to decrease inequality in dental care utilization.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972081PMC
August 2016

Female Labor Supply and Fertility in Iran: A Comparison Between Developed, Semi Developed and Less Developed Regions.

Iran J Public Health 2016 Feb;45(2):186-93

Dept. of Health Management, School of Health Management and Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Female labor supply has been changed dramatically in the recent yr. In this study, we examined the effects of development on the relationship between fertility and female labor supply.

Methods: We used data of population and housing census of Iran and estimated three separate models. To do this we employed Logistic Regressions (BLR).

Results: The estimation results of our study showed that there was a negative relationship between fertility rate and female labor supply and there are some differences for this relationship in three models.

Conclusion: When fertility rate increases, FLS would decreases. In addition, for higher fertility rates, the woman might be forced to work more because of the economic conditions of her family; and negative coefficients of the fertility rate effects on FLS would increase with a diminishing rate.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841873PMC
February 2016

Estimating the Relationship between Economic Growth and Health Expenditures in ECO Countries Using Panel Cointegration Approach.

Acta Med Iran 2016 Feb;54(2):102-6

Department of Health Services Management, School of Management and Medical Information, Shiraz University of Medical Sciences, Shiraz, Iran.

Increasing knowledge of people about health leads to raising the share of health expenditures in government budget continuously; although governors do not like this rise because of budget limitations. This study aimed to find the association between health expenditures and economic growth in ECO countries. We added health capital in Solow model and used the panel cointegration approach to show the importance of health expenditures in economic growth. For estimating the model, first we used Pesaran cross-sectional dependency test, after that we used Pesaran CADF unit root test, and then we used Westerlund panel cointegration test to show if there is a long-term association between variables or not. After that, we used chaw test, Breusch-Pagan test and Hausman test to find the form of the model. Finally, we used OLS estimator for panel data. Findings showed that there is a positive, strong association between health expenditures and economic growth in ECO countries. If governments increase investing in health, the total production of the country will be increased, so health expenditures are considered as an investing good. The effects of health expenditures in developing countries must be higher than those in developed countries. Such studies can help policy makers to make long-term decisions.
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February 2016

Does Using Complementary Health Insurance Affect Hospital Length of Stay? Evidence from Acute Coronary Syndrome Patients.

Hosp Pract (1995) 2016 3;44(1):28-32. Epub 2016 Feb 3.

a School of Public Health , Zabol University of Medical Sciences , Zabol , Iran.

Background: Length of stay (LOS) is used as an indicator to show the efficacy of hospitals. An increase in hospitalized days is not cost effective and decreases the efficacy of hospitals. Using insurance has some side effects. One of these side effects is increasing the LOS. In this study we attempt to discover the effects of complementary health insurance (CHI) on LOS in patients with acute coronary syndrome (ACS).

Methods: In this cross-sectional study, 260 patients were surveyed. By using Poisson regression, the effects of using complementary health insurance on LOS were examined. The effects of confounders were also controlled in the model.

Results: The results of this study demonstrated that the relationship between use of CHI and LOS is direct. In addition, an increase in age and income also increases the LOS. The average LOS was 4.13 days, while it was 5.31 for CHI users, and 3.81 for CHI nonusers.

Conclusion: Government budget is restricted and ACS treatments are costly. Decreasing LOS in ACS patients can help to spend the budget more effectively.
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http://dx.doi.org/10.1080/21548331.2016.1143781DOI Listing
June 2016