Publications by authors named "Siavash Moradi"

14 Publications

  • Page 1 of 1

Relationship between Serum Osteocalcin Level and Gestational Diabetes Mellitus: A Case-Control Study.

Ethiop J Health Sci 2020 Sep;30(5):681-686

Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Background: Osteocalcin (OC) is the most common noncollagenous protein in bone matrix, which is synthesized only in bone tissue and by osteoblasts. The potential role of osteocalcin on glucose and fat metabolism has been previously reported. The aim of this study was to compare the serum OC level in pregnant women with and without gestational diabetes mellitus (GDM).

Methods: In the present case-control study, all pregnant women who were referred to a obstetrics and gynecology clinic in Sari, Iran, and met the inclusion criteria underwent an overall screening with a 75-g glucose tolerance test (GTT) at week 24 to 28 of gestation. The study was conducted between September 2018 and February 2019. Based on criteria, the pregnant women with confirmed GDM were matched with pregnant women without GDM in terms of baseline characteristics such as chronological age and BMI. The serum OC levels were also measured if vitamin D and calcium levels were normal. All data were analyzed using SPSS 21.

Results: The two groups with and without GDM had no significant difference in terms of age, BMI and OC level. There was no significant correlation between age and BMI with OC level in healthy pregnant women, respectively (P=0.49 and P=0.58). The correlation between BMI and age with OC level in GTT-positive pregnant women was 0.05 and -0.172, respectively, which was not significant (P=0.77 and P=0.36).

Conclusion: According to the results of this study, there is no significant difference of serum OC levels in pregnant women with GDM compared to healthy pregnancy. Given that the levels of serum insulin or insulin resistance have not been assessed, these indices are recommended to be evaluated in future studies.
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http://dx.doi.org/10.4314/ejhs.v30i5.6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047259PMC
September 2020

Idiopathic granulomatous mastitis: challenges of treatment in iranian women.

BMC Surg 2021 Apr 21;21(1):206. Epub 2021 Apr 21.

Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Background And Objective: As a chronic inflammatory disease of an unknown origin, the treatment of granulomatous mastitis has always been controversial. According to some researchers, surgical treatment and certain medications, especially steroids, are more effective in treating the disease. This study aimed at evaluating the results of treatment in a group of patients with granulomatous mastitis.

Materials And Methods: This longitudinal cohort study evaluated the treatment outcomes of 87 patients with pathology-confirmed granulomatous mastitis referred to the surgical clinic of Central Hospital in Sari, Iran. Demographic, clinical, and pathological information, treatment methods and results, and the recurrence rate were analyzed.

Findings: A total of 87 female patients with granulomatous mastitis aged 22-52 years with a mean age of 34 years were evaluated. All patients had palpable masses; the breast masses were painful in 48.3% of patients, and 55.2% of patients suffered from erythema and inflammation, and8% had fistulas and ulcers at the inflammation site. The patients were followed-up for an average duration of 26 months (8-48 months) after treatment and recovery. The overall recurrence rate was 24.1%, and the recurrence rate was 29.4% in patients underwent surgery, 34.8% in patients received high-dose prednisolone, and 17% in those received low-dose prednisolone together with drainage (p < 0.001).

Conclusions: According to the results, the low-dose prednisolone plus drainage was more effective with a lower recurrence rate than only surgical excision or high-dose prednisolone. In fact, the use of minimally invasive methods such as drainage plus low-dose steroids is a more effective method with fewer side effects than the other two methods.
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http://dx.doi.org/10.1186/s12893-021-01210-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061012PMC
April 2021

Evaluating the Effect of Dexmedetomidine on Hemodynamic Status of Patients with Septic Shock Admitted to Intensive Care Unit: A Single-Blind Randomized Controlled Trial.

Iran J Pharm Res 2020 ;19(4):255-263

Directr of Medical Education Development Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Septic shock, known as the most severe complication of sepsis, is a serious medical condition that can lead to death. Clinical symptoms of sepsis include changes in body temperature in the form of hypothermia or hyperthermia, tachypnea or hyperventilation, tachycardia, leukocytosis or leukopenia, and variations in blood pressure, as well as altered state of consciousness. One of the main problems in septic shock is poor response along with reduced vascular reactivity to vasopressors used to increase blood pressure. Therefore, low vascular response associated with reduced sensitivity or lower number of alpha-1 agonist receptors can result in shock and death. In addition to being the state-of-the-art treatment including volume load and vasopressor, use of alpha-2 agonists . dexmedetomidine (DXM) in septic shock can reduce vasopressors needed to restore adequate blood pressure. They can further moderate massive release of endogenous catecholamine. Therefore, the purpose of this study was to investigate the effect of DXM on outcomes of patients with septic shock, especially their needs for vasopressors and impacts on their hemodynamic status. This single-blind randomized controlled trial was performed on a total number of 66 patients with septic shock admitted to the intensive care unit (ICU) of Imam Khomeini Teaching Hospital in the city of Sari, in northern Iran. To this end, DXM (0.6 µg/kg/h) and normal saline (6 mL/kg/h) were infused for 12 h in the study and control groups, respectively. The results revealed that DXM could increase mean arterial pressure (MAP) ( = 0.021), systolic blood pressure (SBP) ( = 0.002), and reduced heart rate ( < 0.001) but diastolic blood pressure (DBP) ( =0.32) and norepinephrine dose requirement didn't change statistically in septic shock patients ( = 0.12).
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http://dx.doi.org/10.22037/ijpr.2019.112343.13699DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019859PMC
January 2020

Utilization of the Parenteral Morphine in Emergency Department using the Anatomical Therapeutic Chemical Classification/Defined Daily Doses (ATC/DDD) System.

Bull Emerg Trauma 2020 Jul;8(3):186-192

Student Research Committee, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.

Objective: To evaluate the utilization of the parenteral morphine in Emergency Department (ED) using the Anatomical Therapeutic Chemical Classification/Defined Daily Doses (ATC/DDD) system.

Methods: In this retrospective cross-sectional study, morphine administration was recorded in 4-year time period from January 2013 to December 2016 in the ED of a referral center. The dose of the administered morphine was evaluated using the ATC/DDD system. The ATC/DDD of the parenteral morphine was calculated based on the world health organization (WHO). The data was evaluated based on the different diagnosis and conditions using the ATC/DDD protocol.

Results: In this study, 500 patients referred to ED with mean age of 48.29 ± 10.10 years were included. There were 306 (61.2%) men and 194 (38.8%) women among the patients. The lowest and highest DDD of parenteral morphine were 0.1 and 0.43, respectively. The utilization of parenteral morphine was significantly higher in men when compared to women (<0.001). Those with history of tricyclic anti-depressant (TCA) consumption (<0.001) and opium addiction (<0.001) had significantly higher parenteral morphine utilization. Those with pain in the extremities and chest pain had significantly higher parenteral morphine utilization (<0.001).

Conclusion: The utilization of parenteral morphine in the ED of our center was higher than the WHO standard dosage. The morphine utilization was associated with male gender, opium addiction and TCA consumption.
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http://dx.doi.org/10.30476/BEAT.2020.86225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468224PMC
July 2020

Evaluation of the efficacy of sofosbuvir plus daclatasvir in combination with ribavirin for hospitalized COVID-19 patients with moderate disease compared with standard care: a single-centre, randomized controlled trial.

J Antimicrob Chemother 2020 11;75(11):3373-3378

Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran.

Background: New therapeutic options are urgently needed to tackle the novel coronavirus disease 2019 (COVID-19). Repurposing existing pharmaceuticals provides an immediate treatment opportunity. We assessed the efficacy of sofosbuvir and daclatasvir with ribavirin for treating patients with COVID-19.

Methods: This was a single-centre, randomized controlled trial in adults with moderate COVID-19 admitted to the Ghaem Shahr Razi Hospital in Mazandaran Province, Iran. Patients were randomly assigned to 400 mg sofosbuvir, 60 mg daclatasvir and 1200 mg ribavirin (intervention group) or to standard care (control group). The primary endpoint of this study was length of hospital stay. This study is registered by IRCT.ir under the ID: IRCT20200328046886N1.

Results: Between 20 March 2020 and 8 April 2020, 48 patients were recruited; 24 patients were randomly assigned to the intervention group and 24 to the control group. The median duration of hospital stay was 6 days in both groups (P = 0.398). The number of ICU admissions in the sofosbuvir/daclatasvir/ribavirin group was not significantly lower than the control group (0 versus 4, P = 0.109). There was no difference in the number of deaths between the groups (0 versus 3, P = 0.234). The cumulative incidence of recovery was higher in the sofosbuvir/daclatasvir/ribavirin arm (Gray's P = 0.033).

Conclusions: This randomized trial was too small to make definitive conclusions. There were trends in favour of the sofosbuvir/daclatasvir/ribavirin arm for recovery and lower death rates. However, there was an imbalance in the baseline characteristics between the arms. Larger randomized trials should be conducted to investigate this treatment further.
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http://dx.doi.org/10.1093/jac/dkaa332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454669PMC
November 2020

Comparison of the effects of the Feldenkrais method versus core stability exercise in the management of chronic low back pain: a randomised control trial.

Clin Rehabil 2020 Dec 29;34(12):1449-1457. Epub 2020 Jul 29.

Department of Sports and Exercise Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Objective: To investigate the effect of the Feldenkrais method versus core stability exercises on pain, disability, quality of life and interoceptive awareness in patients with chronic non-specific low back pain.

Design: A single-blinded, randomised, controlled trial.

Setting: Outpatient, sports medicine clinic of Mazandaran medical university.

Participants: Sixty patients with chronic non-specific low back pain randomised equally into the Feldenkrais method versus core stability exercises groups.

Intervention: Intervention group received Feldenkrais method consisting of training theoretical content and supervised exercise therapy two sessions per week for five weeks. Control group received educational programme and home-based core stability exercises for five weeks.

Outcome Measures: All patients were examined by World Health Organization's Quality of life Questionnaire, McGill Pain Questionnaire, Oswestry Disability Questionnaire and Multidimensional Assessment of Interoceptive Awareness Questionnaire. All outcomes were measured at baseline and the end of the intervention.

Results: There were statistically significant differences between groups for quality of life ( = 0.006, from 45.51 to 60.49), interoceptive awareness ( > 0.001, from 2.74 to 4.06) and disability ( = 0.021, from 27.17 to 14.5) in favour of the Feldenkrais method. McGill pain score significantly decreased in both the Feldenkrais (from 15.33 to 3.63) and control groups (from 13.17 to 4.17), but there were no between-groups differences ( = 0.16).

Conclusion: Feldenkrais method intervention gave increased benefits in improving quality of life, improving interoceptive awareness and reducing disability index.
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http://dx.doi.org/10.1177/0269215520947069DOI Listing
December 2020

Effect of platelet-rich plasma on pregnancy outcomes in infertile women with recurrent implantation failure: a randomized controlled trial.

Gynecol Endocrinol 2021 Feb 2;37(2):141-145. Epub 2020 May 2.

Laboratory Hematology and blood Banking Department School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences HSCT research center, Tehran, Iran.

Methods: This study was directed to assess the efficacy of autologous platelet-rich plasma (PRP) on pregnancy rate in recurrent implantation failure. Between 2016 and 2019, a total of 98 women who unsuccessful to be pregnant after three or more high-quality embryo transfers undergoing frozen-thawed embryo transfer with or without an intrauterine infusion of platelet-rich plasma. Thus, 0.5 ml of platelet-rich plasma at 4-6 times higher concentration than peripheral blood infused intrauterine 48 h before embryo transfer. A control group underwent standard protocol.

Results: There were no significant differences between the two groups in terms of age, body mass index and duration and cause of infertility and total transferred embryos and kind of treatment protocol, but secondary infertility and endometrial thickness 96 h before embryo transfer, was more in the intervention group. The clinical pregnancy (48.3% versus 23.26;  = .001) and ongoing pregnancy (46.7% versus 11.7%;  = .001) and implantation rate (58.3% versus 25%;  = .001) was more significant in the intervention group rather than controls. In conclusion, intrauterine infusion of platelet-rich plasma 48 h before freeze-thawed embryo transfer may have more effectiveness in fertilization (IVF) outcomes in recurrent implantation failure.
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http://dx.doi.org/10.1080/09513590.2020.1756247DOI Listing
February 2021

Is Necessary Intraoprative Frozen Section In Sentinel Lymph Node Biopsy For Breast Cancer Patients?

Asian Pac J Cancer Prev 2020 Mar 1;21(3):647-651. Epub 2020 Mar 1.

Department of Surgery, Mazandaran University of Medical Science, Sari, Iran.

Background: Improvements in the process of staging and surgical treatment of axillary lymph nodes in recent years, have led to the use of intra operative frozen section pathology to examine the sentinel lymph node biopsy in breast cancer patients.

Materials And Methods: we evaluated the results of the Sentinel biopsy in 102 patients with early stage breast cancer, which were negative clinical lymph nodes, and analyzing the true positive and false negative rate, diagnostic accuracy of frozen section lymph node biopsy. It also studied the factors affecting the sentinel and non-sentinel lymph nodes in patients treated by axillary lymph dissection.

Results: In this study, we investigated 102 patients' stage 1and 2 breast cancer with clinical negative axillary lymph node and candidates for sentinel lymph node biopsy, were placed under investigation. 15.7 % of the real positive results of sentinel and 62.7 % of the real negative and 2 % false positives and 20.9 % false negative results and% 78. 4 diagnostic accuracy, has been frozen section. Among the patients who were initially or delayed in the axillary dissection, 37% had more than two lymph nodes. While in general, 16.7% of patients had a need for axillary lymph node dissection based on z11 criteria. Lymph-vascular invasion was a major contributor to lentil involvement in Sentinel and non-Sentinel nodes.

Conclusion: Frozen section pathology during the operation of sentinel lymph node biopsy has been initiated to prevent the need for a reoperation in early stage breast cancer patients. However, due to low tumor burden in patients who are candidates for this procedure, and the constraints in the initial sections and their false negative results, also the removal of frozen section will not have an effect on the rate of increasing reoperation and can be effective in reducing the time and cost of surgery.
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http://dx.doi.org/10.31557/APJCP.2020.21.3.647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437324PMC
March 2020

Clinical Effectiveness of a High Dose Versus the Standard Dose of Meropenem in Ventilator-associated Pneumonia Caused by Multidrugresistant Bacteria: A Randomized, Single-blind Clinical Trial.

Infect Disord Drug Targets 2021 ;21(2):274-283

Department of Clinical Pharmacy, Faculty of Pharmacy, Pharmaceutical Research Center, Mazandaran University of Medical Sciences, Sari, Iran.

Background: Meropenem standard doses are based on the minimum inhibitory concentration of sensitive pathogens and the pharmacokinetic parameter of not critically ill patients. We compared the efficacy of high versus standard dose of meropenem in ventilator-associated pneumonia (VAP). ; Methods: 24 out of 34 eligible patients were randomized to receive meropenem 3 g q8h (high dose group, 11 patients) or 2 g q8h (standard-dose group, 13 patients) as a 3h infusion. The primary outcome was considered as clinical success that was defined as stable hemodynamic, improved sequential organ failure assessment (SOFA) score, stable or improved PaO2/FiO2 after 7 days. Sputum culture was taken before the intervention. ; Results: Clinical success rate was not significantly different between the high and standard-dose group (54.5% vs. 38.5%, P= 0.431). There was a significant difference in the reduction of clinical pulmonary infection score (CPIS) compared to a high dose to the standard group (P=0.038). SOFA score declined significantly in the high dose group throughout the study (P=0.006). A shorter duration of VAP treatment was recorded in the high dose group (P=0.061). We did not observe any significant adverse event related to meropenem. Acinetobacter spp. (34.8%), Klebsiella spp. (32.6%) and Pseudomonas aeruginosa (19.5%) isolated more frequently from sputum cultures. ; Conclusion: Treatment with the high dose of meropenem seems to be safe. However, it did not provide a significantly higher clinical success rate in comparison with the standard dose, but could be considered as an appropriate empirical treatment in patients with severe infection due to reduction in SOFA and CPIS. ; The trial protocol was registered with IRCT.ir (registration number IRCT2010010700 3014N19 in April 2018).
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http://dx.doi.org/10.2174/1871526520666200227102013DOI Listing
January 2021

Demographic and epidemiologic evaluation of mushroompoisoning: a retrospective study in 4-year admissions of Razi Hospital (Qaemshahr, Mazandaran, Iran).

Med Glas (Zenica) 2020 Feb;17(1):117-122

Orthopedic Research Centre, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Aim Wild mushroom intoxication is a public health problem, which causes a wide range of symptoms: from mild gastrointestinal symptoms to multiple organ failure and death. The present study aims to evaluate the epidemiology of mushroom intoxication in 4-year admissions of Razi Hospital, Qaemshahr, Mazandaran, Iran. Methods Medical records of all identified cases of mushroom poisoning admitted during the period between 2015 and 2018 were extracted and patients' demographic data including age, sex, latency period, season of poisoning, clinical presentations, laboratory findings, prognosis, duration of hospitalization and therapeutic interventions were recorded. Results A total of 65 mushroom poisoning cases were identified (mean age of 35.68 years), of which 32 (49.2%) were females. Latency of ≤ 6 hours was seen in 63 (96.4%) cases. The most prevalent season of intoxication was spring (60.7%). The most frequent symptoms were nausea and vomiting (86.5%) and abdominal pain (51.2%). No case required intensive care unit (ICU) care or mechanical ventilation. Mean hospital stay was 1.89 days without any mortality. Mean aspartate aminotransferase (AST) level was 21.89 (±9.55), but the disturbance of liver function tests (LFTs), coagulopathy, elevated level of bilirubin and/or platelet was not noted. In 93% of patients ranitidine, in 7% Penicillin G, and in 3.6% cefaclor and ceftriaxone was administrated. Conclusion People and health care providers must be educated about mushroom poisoning. Prompt transfer of suspicious cases with history of wild mushroom ingestion to the emergency department is crucial since patients showing toxicity symptoms after 6 hours might have worse and mortal prognosis despite treatment.
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http://dx.doi.org/10.17392/1050-20DOI Listing
February 2020

Diagnostic Accuracy of a Three-point Compression Ultrasonography Performed by Emergency Medicine Resident for the Diagnosis of Deep Vein Thrombosis: a Prospective Diagnostic Study.

Acta Inform Med 2019 Jun;27(2):119-122

Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Introduction: Deep vein thrombosis (DVT) is a common cause of admission to the emergency departments (ED). Doppler ultrasonography of the entire lower limb is the first-line imaging modality. But most EDs do not access to full-time radiologists which can lead to delayed diagnosis.

Aim: The aim of this study was to evaluate the diagnostic accuracy of three-point compression ultrasonography performed by emergency medicine resident for diagnosis of DVT.

Methods: This prospective diagnostic study was carried out at Imam Khomeini Hospital in Sari from March 2018 to November 2018. For all patients with suspected lower extremity DVT, first bedside 3-point compression ultrasound were performed by a third year emergency medicine resident at ED. Then Doppler ultrasonography were performed by a radiologist in the radiology department, as a reference test. Sensitivity, specificity, and positive predictive value of the three-point compression ultrasound performed by emergency medicine resident was calculated.

Results: Of the 72 patients enrolled in our study, 50% of the patients were male, with an average age of 36±19 years. The mean of patient admission time to perform ultrasonography by an emergency medicine resident and radiologist were 14.05±19 and 216±140.1 minutes, respectively. The two groups had a statistically significant difference (P<0.0001). In ultrasonography performed by emergency medicine resident and doper ultrasonography by radiologist, 91.67% and 36.1% of patients were diagnosed with DVT, respectively. Although the ultrasonography performed by emergency medicine resident has a relatively low sensitivity (53.8%), it has a good specificity (85.7%). The positive and negative predictive value was 70 and 75%, respectively.

Conclusion: Although the results of this study indicate insufficient sensitivity of bedside three-point compression ultrasound performed by emergency medicine resident in diagnosis of lower limb DVT, the specificity, positive and negative predictive values and positive likelihood ratio were almost appropriate.
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http://dx.doi.org/10.5455/aim.2019.27.119-122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688293PMC
June 2019

CYP2D6*3 (A2549del), *4 (G1846A), *10 (C100T) and *17 (C1023T) genetic polymorphisms in Iranian breast cancer patients treated with adjuvant tamoxifen.

Biomed Rep 2018 Nov 7;9(5):446-452. Epub 2018 Sep 7.

Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari 48166-33131, Iran.

There is controversy regarding the efficacy of tamoxifen in breast cancer patients who are carriers of cytochrome P450 2D6 (CYP2D6) gene polymorphisms. Poor metabolizer genotypes may not fully convert tamoxifen to its active metabolite endoxifen and thus have less exposure to anti-estrogen therapy. The present study was conducted to identify the prevalence of CYP2D6 genotypes among Iranian breast cancer patients. A total of 84 estrogen receptor-positive breast cancer patients treated at a referral center in the north of Iran were examined. A peripheral blood sample was obtained from each patient to determine the presence of *3, *4, *10 and *17 single nucleotide polymorphisms of the CYP2D6 gene by polymerase chain reaction-based restriction fragment-length polymorphism analysis. Of the four genotypes assessed, CYP2D6*4 was the most common variant and was identified in 41 (48.8%) patients as heterozygous (G/A) and 3 (3.6%) as homozygous (A/A) alleles. CYP2D6*10 heterozygous mutated alleles (C/T) were also a common genotype that presented in 22 (26.2%) of the study subjects. Variant *17 was less common and was detected only as heterozygous (C/T) in 3 patients (3.6%). No CYP2D6*3 heterozygous or homozygous mutated alleles were observed. In conclusion, the frequency of the CYP2D6 nonfunctional alleles *4 and *10 appeared relatively high in Iranian patients with hormone-sensitive breast cancer. This finding may affect the selection of an optimal hormone therapy, as patients with low CYP2D6 pathway activity may not sufficiently convert tamoxifen to its active metabolite endoxifen.
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http://dx.doi.org/10.3892/br.2018.1145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176100PMC
November 2018

Macro determinants of Iranian provincial healthcare expenditures from 2006 to 2013: evidence from panel data.

Electron Physician 2015 Dec 20;7(8):1584-9. Epub 2015 Dec 20.

Ph.D. of Health Care Management, Associate Professor, Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Introduction: During the last few decades, healthcare expenditures (HCEs) have increased significantly in Iran and throughout the world. Understanding the determinants of such increases is essential to health policymakers in finding the best policies to manage healthcare costs. This study aimed to determine the impact of some of the key explanatory variables on household healthcare expenditures across the provinces of Iran.

Methods: A panel data econometric model was used to determine the main factors that affected household healthcare expenditures (HHCEs) across the provinces of Iran from March 21, 2006 to February 19, 2013. The data on household healthcare expenditures per capita, number of physicians per 10,000 population, the degree of urbanization, the proportion of the population that was 65 or older, household income per capita, and literacy rate were obtained from the Household Expenditure and Income Survey (HEIS) data in the Statistical Center of Iran. F-Limer and Hausman tests were used to choose the panel data, and Stata V.12 was used to analyze the data.

Results: Our findings indicated that income per capita, physicians per 10,000 population, and the degree of urbanization had significant impacts on healthcare expenditures. Also, the results of the study showed the elasticity of income, physicians, urbanization, proportion of the population 65 or older, and the literacy rate were 0.25 (p < 0.002), 0.37 (p < 0.001), 5.01 (p < 0.001), -0.1 (p < 0.73), and -1.02 (p < 0.082), respectively.

Conclusion: The results of the study indicated that the income elasticity of healthcare expenditures was less than 1; health expenditures were considered to be a "necessity good" across the provinces of Iran during the period that was studied. In addition, there were some other factors that affected healthcare expenditures that were not considered in the study, such as the advancement of new technology and the costs of dying. However, it is recommended that future research examine the effect of these factors on HCEs in Iran.
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http://dx.doi.org/10.19082/1584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725410PMC
December 2015

Reproductive Health of Women in Rural Areas of East Azerbaijan - Iran, before and after Implementation of rural Family Physician Program: an Ecologic Study.

J Caring Sci 2015 Dec 1;4(4):321-30. Epub 2015 Dec 1.

Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran.

Introduction: Implementation of rural family physician program in Iran in 2005 has been evaluated and shown that this program has been led to some improvements in health indicators. In this study, some reproductive health (RH) indicators were compared before and after implementation of this program in rural areas of East Azerbaijan, Iran.

Methods: In this ecologic- time trend study, the data of 191075 births of rural women of East Azerbaijan from 2001 to 2010 was extracted from vital horoscope (ZIJ) and used for calculation of 20 important RH indicators. The paired t-test and correlation analysis wear used for data analysis.

Results: Some indicators such as adolescent marriage rate, adolescent birth and over 35 year olds birth rate were increased after rural family physician program implementation in 2005. Also stillbirth rate and unsafe delivery were decreased during this period. There was a significant correlation between increasing adolescent birth rate and increasing low birth weight deliveries (r= 0.911, P= 0.031) and also between increasing over 35 year olds birth rate and increasing neonatal mortality rate in term of prematurity and congenital malformations (r= 0.912, P= 0.031) after program implementation.

Conclusion: Perinatal care and safe delivery even for pregnancies outside the typical child-bearing ages are promoting after implementation of rural family physician program in East Azerbaijan. Also decreasing unsafe delivery and stillbirth rate can be considered as achievements of running this program in this province.
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http://dx.doi.org/10.15171/jcs.2015.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4699507PMC
December 2015