فهرست مطالب الهام احمدنژاد

The Urban Family Physician Program (UFPP) has been implemented in Fars and Mazandaran provinces of Iran since 2013 with the aim of improving access and utilization of health services, with a particular focus on children and adolescents. In order to evaluate the effectiveness of the program in achieving this goal, this study aimed to compare the access and utilization of health services among children living in areas covered by the UFPP with those living in other regions of Iran.

A secondary analysis was performed using data from the 2015 National Health Utilization Survey. The data of people aged under 18 were extracted and indicators on the use of health services based on three main models of health service provisions were compared:(1) cities in Fars and Mazandaran provinces (UFPP implemented);(2) cities in other Iranian provinces (excluding Fars and Mazandaran); and (3) villages and cities with a population under 20,000.

The study included 20,689 children. The outpatient and inpatient visits in children living in Fars and Mazandaran provinces were higher than in children from other provinces and smaller towns (11.89 vs. 7.92 and 7.21 for outpatient and 4.74 vs. 3.51 and 4.27 for inpatient, respectively). Furthermore, UFPP was found to be associated with a higher utilization of health services in children residing in cities (odds ratio=1.50 (1.98-1.15)). Additionally, the cost of outpatient and inpatient health services in areas where the UFPP was implemented was lower compared to other parts of the country.

The urban family physician program has been successful in increasing the access to health services and reducing health costs in children.

Practical Implications: 

The findings suggest that the urban family physician program can be an effective strategy for improving healthcare access and reducing costs, especially in areas with high population density. Policymakers and healthcare providers can use the results of this study to inform the development and implementation of similar programs in other countries, with the aim of improving healthcare access and reducing healthcare costs in children and adolescents.

According to the concept of Universal Health Coverage (UHC), health services include health promotion, prevention, treatment, rehabilitation and palliative services. The aim of this study was to investigate the contribution of each health service to out-of-pocket payments (OOP) and financial protection.

In this study, OOP were extracted from the 1396 (2017) national household income expenditure survey with a sample of 37866 households. Catastrophic health expenditures were defined as health expenses greater than 10 percent of a household's expenditures and impoverishing health expenditures were calculated using WHO method. Binary logistic regression test was used to examine the effect of payment for different health services on households having catastrophic and impoverishing health expenditures.

According to the survey questionnaire, health services could be classified into 4 categories of treatment, prevention, diagnosis and rehabilitation services, and questions about promotion and palliative services were not been asked specifically. Treatment services accounted for the largest out-of-pocket share with 81%. In urban households, Per capita OOP payments in all aspects of health services were higher than rural households. Treatment services alone were alone responsible 75% and 89% of households suffering from catastrophic and impoverishing health expeditures respectively. OOP payments for all types of health services had a significant effect on a household's exposure to catastrophic and impoverishing health expenditures.

Focusing and implementing interventions to reduce out-of-pocket payments for Treatment services can significantly improve financial protection indicators, paving the way to the achievement of UHC in Iran.

The Ministry of Health and Medical Education for the first time drafted and communicated the National Nutrition and Food Security Document in order to implement targeted programs. This study aims to evaluate the provincial nutrition and food security document and outline strategies to improve the efficiency and effectiveness of provincial document deployment at the organizational, inter-organizational and community level.

Documents received by the universities / colleges of medical sciences were classified for evaluation purposes. The studied dimentions consisted of the provincial document cut-off, the beneficiaries of the program, the establishment and implementation of the submitted documents. In the next step, self-declaration compliance assessment and scoring were performed.

Out of 28 provincial documents (90%), 60% were documented, 21% provincial data were not used, and desirable measures were taken to attract stakeholders. No effective measures were taken to evaluate the results as the most important pillar of the document. Among 255 projects anticipated, 7 were documented and 6 were approved, and only 4 projects were submitted to the researchers, and for 5 projects had written

Despite the relatively favorable performance in most of the documented and targeted areas of the document at the national level, assessments show that this trend has not been very successful at the provincial level. This study clearly shows policy makers' lack of support for nutrition programs and poorly evaluates nutrition support.

Health inequalities can determine the risk of diseases and the measures employed to prevent and treat diseases when they occurs. The COVID-19 pandemic has played an important role in creating and reinforcing numerous health inequalities across the globe. This study aimed at investigating inequalities in access to health services in patients with COVID-19 and mortality caused by it at the provincial level of Iran.

This descriptive cross-sectional study assessed all provinces of Iran for a number of hospital measures, including total hospital beds, ICU beds, the number of CT scans, and the number of specialists and nurses. To determine the effect of hospital infrastructure and facilities on death and hospitalization, the Pearson correlation coefficient was used. Multivariate linear regression was employed to determine the relationship and significance of the variables, and the Gini coefficient and the Lorenz curve were used to measure inequalities in the distribution of facilities and infrastructures.

The results showed that on the basis of hospital facilities, the rate of hospitalization and death due to COVID-19 can be predicted by 96%. Increasing ICU beds increased hospitalization and death by 1.16 and 0.97 respectively. Also, for every increase in the number of doctors and nurses, the chance of hospitalization increased by 0.423 and decreased by 0.741 respectively. Isfahan, West Azerbaijan, Yazd, Kermanshah and Zanjan provinces had the lowest Gini coefficient in bed distribution.

The distribution of resources among provinces is not fair. Therefore, in order to achieve universal health coverage and comply with the leveling of service provision, it is necessary to make policies and plans according to the needs of the society and allocate resources based on the needs and burden of the disease.

Some factors have been found to be associated with increased mortality from Covid-19. This study is a systematic review and meta-analysis aimed at finding the factors associated with the increased mortality among Covid-19 patients.

Systematic searches of Medline/PubMed, Scopus, and Google Scholar databases were performed using keywords that correlated mortality, including relative risk (RR), risk ratio, and odds ratio(OR). A total of 20 articles were included in this study. Four factors including age (years) with OR, underlying diabetes with OR, gender (male vs. female) with OR, and gender (male vs. female) with OR which reported by in more than two studies, were meta-analyzed.

A total of 65 factors were identified that are associated with an increase in death from Covid-19. The most important factors were: History of diabetes with an odds ratio of 12.23 (4.13–36.27); Hospitalization in the intensive care unit with a relative risk of 5.79 (4.00-8.38); and requiring which reported by mechanical ventilation with a relative risk of 7.36 (5.06–10.7). These factors can be classified into three categories: 1) individual and genetic factors 2) underlying diseases and conditions, and 3) clinical and laboratory findings.

Having identified these risk faktors, it is necessary to pay more attention on preventive measures and raising awarness among  people with these risk factors. This findings may help health care organizations to prioritize high risk groups for screening and triaging for Covid-19 and for receiving Covid-19 vaccine.

According to the global strategy for polio eradication, targeted surveillance of the disease is one of the main tasks of the health system. The purpose of this study was to review the status and surveillance of poliomyelitis/acute flaccid paralysis (AFP) in Iran.

The present study was a review on the processes, structures and achievements of the poliomyelitis/AFP surveillance system in Iran during 2017-2019. The data of this study were obtained from the surveillance system of the Center for Communicable Disease Control; a review of the records, documents, books and published articles; and interviews with process owners and experts of poliomyelitis/AFP surveillance.

The polio eradication program in Iran is based on the action plan of the World Health Organization that was introduced initially in 1988. Currently, the surveillance system of AFP is active at three levels: country, university, and city. The number of poliomyelitis cases in the country decreased from 50 cases per year in 1985 to zero in 2001, and Iran has been a polio-free country since 2001. The final report on polio eradication in Iran was approved by the regional commission on polio detection in April 2006.

The surveillance system of AFP has had a proper effectiveness throughout the country. Maintaining this situation in the country requires an increase in the sensitivity of the surveillance system of the disease, regular monitoring of vaccine coverage, strict implementation of international health regulations, especially on the eastern borders of the country, and providing technical assistance to neighboring countries.

Iran has carried out a series of surveys based on the Global school-based student health survey (GSHS) referred to as the CASPIAN. The aim of this paper was to compare the methodology and tools of CASPIAN surveys and to propose recommendations and suggestions for future implementations. 

The data of this systematic review study were gathered from the World Health Organization (WHO) documentations, international databases including Pubmed, EMBASE, Scopus, GoogleScholar, and ScienceDirect, and national databases including Magiran, SID, and Irandoc. The search was conducted in both English and Persian (for the time period from 2003 to 2018). The time and place of the study, target population, questionnaire(s), sample size, and sampling method were compared between the surveys. 

Five rounds of CASPIAN survey were conducted in Iran from 2003 to 2015. The surveys had two sets of questionnaires for students and parents. In all five rounds, sampling methods and questionnaires were similar in the core and differed in some details that were added selectively in each round. The questionnaires were designed based on the GSHS and the WHO stepwise approach to non-communicable disease risk factor surveillance (STEPS) programs. 

Considering the small variation in each series and compliance with the global model, it is suggested that the next CASPIAN survey be conducted according to the previous series in accordance with the standards presented in the global model in recent years in a reasonable interval from the 2015 survey.

One of the most important measures to ensure achieving Universal Health Coverage (UHC) is expanding health insurance coverage to all population. Accordingly, the present study was conducted with the aim of investigating the effect of having health insurance on the utilization of outpatient services provided by physicians using the data of the utilization of health services survey (2015).

This study is a secondary analysis of the utilization of health services survey data that was conducted in two groups of the insured and uninsured to examine the differences between these two groups in outpatient healthcare utilization provided by physicians. The variables were insurance status as an independent variable and the number of physician visit as a dependent variable. This analysis was disaggregated by place of residence and income.

The visit per capita for outpatient services was lower in all uninsured groups. The visit per capita in insured people was almost two times more than that of uninsured individuals, which was 4.25 and 2.61 among insured and uninsured individuals, respectively. Therefore, the lack of basic health insurance decreased the utilization of outpatient services by 50 percent. General physician visits per capita for insured people living in urban and rural areas were 11.2 and 0.35, respectively.

Based on the results of this study, the visit per capita is directly related to the insurance status of the individuals. Therefore, it is necessary to ensure the equity in utilization of outpatient services provided by the physicians among various groups of population.

Epidemics of diarrhea caused by contaminated food and water occur frequently worldwide, especially in developing countries. The aim of this study was to identify the factors contributing to the development and spread of diarrhea epidemics caused by Shigella flexneri in Isfahan in the spring of 2015.

Following the first reports and activation of the surveillance system, a matched case-control study was conducted in 360 cases with diarrhea and 360 controls. Data were gathered using a questionnaire, and conditional logistic regression was used to provide adjusted odds ratios and 95% confidence intervals.

Consumption of contaminated fresh vegetable (OR=4.50, 95% CI=2.88-7.01) was the source of the epidemic. Contact with similar patients (OR=7.19, 95% CI=4.26-12.12), presence of similar patients in the family (OR=33.2, 95% CI=13.64-80.82), food consumption on special events (party, wedding ceremony, funeral, etc.) (OR=1.67, 95% CI=1.06-2.62), being a government employee (OR=3.08, 95% CI=1.64-5.78) and being illiterate (OR=2.91, 95% CI=1.10-7.67) were the risk factors of the spread of the epidemic.

In this study, consumption of fresh vegetable contaminated with Shigella flexneri was the source of the infection. According to the Epidemic Management Team, contamination occurred due to non-standard wastewater irrigation of agricultural lands. Therefore, it is important to consider the standards of agricultural production and compilation of a comprehensive program to improve the status of the wastewater purification system in the environmental sciences by the relevant organizations to prevent diarrhea epidemics

Tuberculosis (TB) is an important issue which its control is still unsatisfactory at global level. Traditional diagnostic techniques for active TB diagnosis are inadequate: the diagnostic gold standard is the cultural exam which suffers from lengthy processing and requires highly specialized laboratories. Nowadays more specific tests have been recommended. The aim of this study is to evaluate the performance of Quanti FERON-TB (QFT)Gold In Tube-Test as a substitute for specific test tuberculin skin test for diagnosis of latent tuberculosis infection in high risk groups.

One hundred thirty four (134) individuals who worked in Bo-Ali hospital (Zahedan) enrolled in this study. They had no active tuberculosis. TST and QFT tests were performed. The cut-off point of TST was considered based on 15 (mm) or more indurations as positive. The result of QFT was evaluated by manufactured guidelines. Multivariate logistic regression was used to identify the putative risk factors of positive tests.

Proportion of employees with latent TB were 111(82.8%) were positive by either TST or QFT, and 76(56.7%) were positive by both tests. Agreement between the tests was high (73.8%, k=0.39; 95%CI: 0.21-0.44). Positive family history of Tuberculosis was significant risk factor for both positive tests.

This study showed high latent tuberculosis infection prevalence in hospital workers and high agreement between TST and QFT. Decision to select one of the tests will be depended on the population, purpose of study and availability of resources. The results revealed that the QFT can be appropriate alternative test for high risk group.

Earthquakes cause thousands of deaths and injuries worldwide every year. Islamic Republic of Iran has a deadly history of earthquakes. The aim of this study is to describe injuries rate, causes of injuries, structural characteristics of buildings and occupant actions immediately after earthquake in Damghan in 2010.

This case-study was conducted one week after occurring the earthquake in five villages of Damghan city in Iran. We used the Physical Injuries Assessment Questionnaire which was particularly designed for injuries after earthquakes. Also for acquiring information about region and amount of losses, some interviews was conduct with local authorities.

Four death and fifty six injuries occurred in five villages of Damghan city. There were three types of injuries including superficial injuries (50%), contusions (35%) and fractures (10%). The findings of this study indicating building structural failure (87.4%), nonstructural factors (7.1%) and trapping (5.3%) seems the most possible cause of injuries in this region.

This study showed that the building structural failure is the main cause of injuries (87.4%). Increasing structural resistance of building especially in village regions and education about earthquake preparedness should encourage in order decreasing the total number of people affected by earthquake.

Community assessment process is the foundation for developing the basis for effective community health strategies. The aim of this study was providing a framework for comprehensive and participatory community assessment in Shahin-Shar, Isfahan, Iran.

This assessment performed in Shahin Shar city based on some experiences of Community Medicine and Epidemiology and Biostatistics departments of Tehran University of medical sciences since 1989 and North Carolina Community Assessment Guide Book (2002). The community assessment team included wide ranges of key stakeholders and local people. Our community assessment team has three levels of participants: An advisory group, a work group and a project facilitator. Observation, interview, focus group discussion and summary list of health resources used for data collection. The map of asset was also provided. We reported data to community and Hanlon method -based on magnitude of the problem, seriousness of the consequences and feasibility of correcting- was used for selecting health priorities.

Drug abuse, smoking among adults and depression were the important health priorities. After creating community assessment document, Based on the risk factors that contribute to each problem, the health action plans were developed.

The results of this study showed that community assessment could be the foundation for improving and promoting the health of community members. It could be the basis for effective community health strategies in Iran.