علی کاظمی کریانی

Down syndrome or trisomy 21 is one of the most common human chromosomal disorders that affect cognitive functions, communication and behavioral skills. At the macro level, various factors can contribute to the Down syndrome prevalence and mortality. This study aimed to investigate the association of health system functions with Down syndrome prevalence and mortality worldwide.

The study was a cross-sectional study conducted based on the secondary analysis of existing data in 2019. Data from 202 countries in six different regions (African Region [AFRO], Eastern Mediterranean Region [EMRO], European Region [EURO], South-East Asia Region [SEARO], Western Pacific Region [WPRO], and Pan American Health Organization [PAHO]) were included in the study. Data were extracted from the World Health Organization (WHO), the World Bank and the Institute for Health Metrics and Evaluation databases. The adjusted linear regression analysis was used to examine the association between health system-related factors with prevalence of, and death due to Down syndrome as the outcome variables. In the present study, two functions of health financing (domestic general government health expenditure [GGHE-D] per capita in PPP [purchasing power parity] int$, domestic private health expenditure [PHE-D] per capita in PPP int$, external health expenditure [EXT] per capita in PPP int$) and health system resources (nurse and midwifery personnel, generalist medical practitioners [GMP], specialist medical practitioners [SMP], pharmacists, dentists, physiotherapists) were included in the study as independent variables. We used the Stata software version 14 to analyze 

Africa and low-income countries had the highest deaths due to Down syndrome. On the other side, Europe and high-income countries had the highest prevalence of Down syndrome worldwide. According to the available data, Iran had a lower prevalence (29.31 vs 38.44 per 100,000 population) and higher deaths (0.34 vs 0.32 per 100,000 population) compared to high- income countries. The 20-year trend of prevalence of, and deaths due to Down syndrome in Iran has always been lower and higher than high-income countries, respectively. Linear regression analysis showed that GGHE-D per capita (β=0.385, P<0.001) and PHE-D per capita (β=0.354, P=0.02) could predict the prevalence of Down syndrome significantly in the study countries. On the other hand, nurse and midwifery personnel (β=-0.607, P=0.014) and number of SMP (β=0.420, P=0.025) were associated with increased deaths from Down syndrome in the included countries. 

Our findings showed GGHE-D and PHE-D are associated with a higher prevalence of Down syndrome in health systems.  On the other hand, health system resources (nurses and SMP) were the main predictors of death due to Down syndrome in the included countries. International organizations and governments need to monitor and improve the equitable access of vulnerable groups to health services in low-income countries.  Improving health insurance coverage and equitable distribution of health resources is suggested to reduce deaths due to Down syndrome in Iran.

The aim of this study was to evaluate the effect of health sector evolution plan (HSEP) on the prevalence of cesarean section and vaginal delivery in public hospitals in Kermanshah province.

In the present study, cesarean section (C-section) and vaginal delivery data were collected and evaluated in 17 public hospitals from 2009 to 2019. The main variables of this study included the prevalence of C-section and the prevalence of vaginal delivery for 121 months, both were obtained by dividing the number of deliveries by C-section and vaginal delivery by the total number. Interrupted time series analysis was used to examine the effect of HSEP on the prevalence of cesarean and vaginal delivery rates.

The prevalence of C-section before and after the HSEP was 42.5% and 43.2%, respectively. Months before the intervention, the rate of C-section was increasing by 0.13%, which was statistically significant. In the first month after the intervention, the prevalence of     C-section decreased by 3.6% that was statistically significant. The share of C-section in the months after the implementation of the HSEP showed a monthly increase of 0.12% compared to before the intervention, which was statistically significant.

The results of the study showed that the HSEP has led to a significant reduction in C-section in short term, but in the months after the implementation of the plan, the prevalence of C-section has increased again.

 Demographic and epidemiological changes in the 21st century have created new challenges such as aging and the rising trend of non-communicable diseases. The high prevalence of disability (due to the growing aging population), non-communicable diseases, and accidents have increased the demand for rehabilitation services. However, there are not enough resources to meet all current needs in many parts of the world. The purpose of this study is to investigate the inequality in the utilization of rehabilitation services between Iranian households in urban and rural areas.

This is a descriptive-analytical study with a cross-sectional design using the household expenditure, income survey data from the Statistics Center of Iran in 2018. The used instrument was a questionnaire surveying the expenditure and income of urban and rural households (social characteristics of household members, place of residence and main living facilities, food/non-food expenses, and household income), which was completed through interviewing the household head or a member over 15 years of age. The study samples were 18610 households in rural areas and 20348 households in urban areas. After extracting and refining the data, 38958 households were included in the study. Factors affecting their utilization of rehabilitation services and the inequality in utilization were analyzed using the Chi-square test and the concentration index (CI), respectively. Data were extracted in MS Access 2013 and MS Excel 2013 applications and were analyzed in STATA V.14.1 software. The geographic distribution of the service utilization was plotted using ArcGIS Map V. 10 software.

 A total of 258 households (0.77%) used rehabilitation services. Of these, 226 (87%) had a male head, and 32 (13%) had a female head. About 60% had 3-4 members, and 239 (92%) had insurance coverage, and others (8%) had no insurance coverage. Also, 173 (67%) had an employed head. Finally, 55% were living in rural areas, and 45% in urban areas. Uninsured households had less use of rehabilitation services (P<0.05). Also, 1.32% of the fifth income quintile (highest income) used rehabilitation services, while this rate was 0.35% for households in the first quintile (P<0.001). Zanjan, Qazvin, Khuzestan, Isfahan, Lorestan, Bushehr, and Semnan provinces had the lowest service utilization rates in urban/rural areas and the whole country. Qom province had a better status regarding service utilization in urban areas, while East Azerbaijan, Mazandaran, Golestan, Yazd, Fars, and Hormozgan provinces had higher service utilization rates in rural areas. Overall, East Azerbaijan, Mazandaran, and Qom provinces had a higher rate of utilization. The CI value for the whole country was reported at 0.24 (95% CI: 0.17-0.30), indicating a higher inequality in utilization in favor of the rich. The CI values for rural and urban areas were 0.27 and 0.19, respectively (P<0.001).

There is inequality in the utilization of rehabilitation services in favor of the rich households in Iran, and low-income households have lower access to these services. The inclusion of rehabilitation services in the primary health insurance package with appropriate pricing and population coverage, and fair distribution of rehabilitation services following the needs of public and private sectors, can increase the access and utilization of rehabilitation services.

 Congenital anomalies are functional or structural anomalies that can occur as a single or a group of anomalies. Studies have shown that socioeconomic factors can affect congenital anomalies such that the middle- and low-income countries suffer more from the congenital anomalies. This study aimed to determine the essential socioeconomic determinants of the disability-adjusted life year (DALY) for congenital anomalies in children aged <5 years.

This is a cross-sectional study using the latest available data in 2017, which were extracted from the international databases of the World Bank, the Institute for Health Metrics and Evaluation, and the United Nations Educational, Scientific, and Cultural Organization. In the study, we analyzed data from 196 countries divided into 6 geographical regions of African Region (AFRO), European Region (EURO), Pan American Health Organization (PAHO), Eastern Mediterranean Region (EMRO), Western Pacific Region (WPRO), and South-East Asia Region (SEARO). To identify the main determinants of the DALY, gross domestic products (GDP) per capita, poverty rate, government, private and external health expenditures per capita, mean years of schooling, and literacy rate were used. Data analysis was performed in STATA v.15 using the one-way ANOVA and the linear regression analysis.

 The lowest and highest rates of DALY was reported in Luxembourg (856.29 per 100000 population) and Sudan (21714.7 per 100000 population), respectively. The AFRO and EURO regions had the highest (9392.78±4250.56), and the lowest (2969.11±1961.64) mean of DALY. In Iran, the DALY rate was reported 7721.48 per 100000 population, which was higher than those in the EURO and PAHO regions and lower than those in the AFRO and EMRO regions. The results of linear regression analysis showed that mean years of schooling was the strongest predictor of DALY (β=-0.44, P=0.001) followed by the poverty rate (β=0.36, P=0.002). The results of one-way ANOVA indicated that the rate of DALY was significantly different between different social and economic groups, and it was higher in the lower socioeconomic groups. 

 Mean years of schooling and poverty rate are the strongest predictors of DALY for congenital anomalies in children under 5 years of age. Low-income countries, especially those in the AFRO and EMRO regions, are the most prone to the disability and premature death caused by congenital anomalies in children under 5 years of age compared to the high-income countries. Therefore, the equitable distribution of screening and health care services and educational infrastructures for deprived and lower socioeconomic countries should be taken into account by national and international health organizations.

Health insurance is one of the financing mechanisms in the health sector that reduces expensive and unforeseen costs of the health care for households and converts these costs into predictable premiums. The purpose of this study was to identify the appropriate attributes and levels using the discrete choice experiments for health insurance, which can describe health care services appropriately.

The present study is the result of a qualitative phase of the simultaneous analysis that was conducted in 2017 in Yazd and included several stages. First, the literature was reviewed through a search on valid websites to identify the related features. Later, 8 health insurance and health policy makers, sampled by snowball method, were interviewed and specific health insurance weighting characteristics were assessed. Eventually, the research team decided to include the traits and levels in the final design after several panel meetings with the experts.

The findings of this study showed that the most important attributes of health insurance included: public hospitals, and private hospitals benefits, outpatient services, drug service coverage, dental insurance coverage, Para clinical services, medication and medical equipment cost coverage, and monthly premium.

Policymakers and health insurance organizations need to focus on health and premium benefit packages appropriate to people's ability to pay and community inflation to improve insurance coverage in this area. These attributes can help individuals to pay for health insurance and lead to changes in the insurance system of the country. They also enhance planning to improve basic insurance and increase the benefits of insurance packages.

 Studies show that almost every country across the world will experience a remarkable increase in their healthcare costs and ageing population by 2030. Also, people with disabilities are more likely to impose considerable healthcare costs on families and governments than their counterparts. On the other hand, socioeconomic status of countries can be an important factor to predict healthcare costs. In this study, we aimed to evaluate the relationship between disability rate, ageing rate and development rate of countries with their current health expenditure.

This is a descriptive correlational study conducted based on secondary analysis of existing data of 202 countries under six different regions of African Region (AFRO), Eastern Mediterranean Region (EMRO), South-East Asia Region (SEARO), Western Pacific Region (WPRO), European Region (EURO), and Region of the Americas (PAHO) in 2016 . The linear regression analysis was applied to investigate the association between the explanatory variables of age, Years Lost due to Disability (YLD) per 100000 general population, Human Development Index (HDI), Gross Domestic Product (GDP) growth, and unemployment rate with Current Health Expenditure (CHE) per capita as the outcome variable. The costs were expressed based on Power Purchasing Parties (PPP) in USD. One-way ANOVA was applied to compare the means of YLD and CHE per capita between three levels of HDI. 

 The highest mean YLD (13272.76±1577.22 per 100000 general population) and mean CHE (2698.39± 1915.01 USD) was belonged to EURO region, while AFRO region showed the lowest mean YLD (10005.65± 847.03 per 100000 general population) and mean CHE (281.11± 335.84 USD). In Iran, the mean YLD and CHE was lower than that of EURO region but higher than that of other five regions. EURO, PAHO, and WPRO had the highest rate of ageing compared to other regions. For Iran, the rate of ageing population was higher than AFRO and EMRO. In the regression model, population aged 15 to 49 (YLD=0.167), aged >65 years (YLD=0.651), aged ≥70 years (YLD=0.359) and HDI (0.391) had a positive association with the CHE per capita. In contrast, the population aged ≤5 years (YLD=-0.585), aged 15-64 years (YLD=-0.274), and aged 50-69 years (YLD=-0.938) and the unemployment rate (-0.138) showed a negative association with the CHE per capita. Moreover, ANOVA results revealed that the rate of ageing population (P<0.001), YLD (P<0.001) and CHE per capita (P<0.001) were significantly higher in countries with higher HDI than in countries with lower HDI. 

In the study period, YLD can predict healthcare expenditure of countries better compared to HDI and ageing population. Therefore, it is suggested that cost control interventions in ageing period should be implemented through programs aimed at preventing chronic diseases.

Glaucoma imposes direct and indirect costs on societies. The current study aimed at estimating the economic burden of glaucoma in Iran in 2012.
The study was performed based on the partial economic evaluation method. The prevalence-based approach and bottom-up method were used. The human capital approach was used to calculate indirect costs. Required data were obtained from interview with 10 eye specialists and 100 patients, literature review, and review of 100 medical records of patients at Farabi Hospital in Tehran.
The total cost of the disease was $US 1,746,412.35, which 77.09% of the costs were related to direct cost; indirect costs accounted for 22.91% of the total costs. The total cost of hospitalization included the highest share of direct medical costs (74.4%). Average cost of outpatient for surgical and nonsurgical groups were $US 14.87 and $US 14.11, respectively. The average cost of hospitalization was $US 180.54.
Glaucoma imposed high economic burden on Iran. Proper planning for the early treatment of the disease and prevention of its complications could reduce costs of treatment and disability.

Background Given the scarcity of resources in the areas of health, the efficient use of these resources is very important. The purpose of this study was to assess the efficiency of rural health centers of Ghazvin province in the period of 2006-2010.
Materials & Methods This is a descriptive-analytical study, in which all rural health centers in Qazvin Province, 43 centers, were included. Independent variables were the number of physicians, health experts, technicians, and community health workers, and the dependent variables were percentages of screening for congenital hypothyroidism, percentages of iron supplementation in the first guidance school students, number of visits of public procurements and food distribution centers, number of general practitioner’s visit, and number of specialist referral by the general physician. In this study, input-oriented model and variable returns to scale (VRS) assumption were used. Also, time trend of efficiency was estimated with a regression model. Data envelopment analysis (DEA)-solver and Stata software were used to measure efficiency and estimate regression models, respectively.
Results The mean technical efficiencies during 2006 to 2010 were 0.77, 0.77, 0.78, 0.92, and 0.89, respectively. Also, the average scale efficiencies in these years were 0.98, 0.95, 0.95, 0.97, and 0.97, respectively. Average score of managerial efficiency increased from 0.78 to 0.92 during this period. The results of time trend showed that β-coefficient for average score of efficiency was 0.039 and statistically significant (P=0.03).
Conclusion The mean levels of efficiency and health outcomes have been improved in these years but some of resources are still wasted. It seems that some practices such as ongoing evaluation of performance, improving the quality and quantity of services, and programing for optimal use of inputs, can be particularly useful.

Women's health and prenatal care have always been important issues for health authorities and policy makers. The purpose of this study was to investigate the geographical distribution of gynecologists and midwives and to determine their distribution trend in Kermanshah province in the period 2008-2013. Gini coefficient was used to analyze the distribution of human resources involving in women’s health and t-test was used to examine the assumption of equal distribution of the resources. Gini coefficient was calculated for gynecologists and midwives on the basis of number of live births per year and women population. Four regression models were fitted to determine the time trend of inequality. Gini coefficients for gynecologists and on the basis of the number of women for the study period were 0.489, 0.587, 0.677, 0.545, 0.474 and 0.46, respectively. The minimum and maximum Gini coefficient based on the number of live births were 0.457 and 0.566, respectively. The Gini coefficient for midwives on the basis of the number of women decreased from 0.249 in 2008 to 0.215 in 2013. Moreover, the minimum and maximum Gini coefficients based on the number of live births were 0.268 and 0.397, respectively. Inequality declined during the study period, but was not statistically significant. the distribution of human resources associated with the women's health has improved in recent years, however, it is still far from ideal distribution of the resources. Therefore, the women are recommended to be provided with adequate healthcare services by performing the required planning.

Promotion of health and access to healthcare resources are regarded as one of the main factors affecting the development of every country. This goal can be achieved as a result of fair distribution and proper access of individuals to healthcare resources. The aim of the current study was to evaluate the status of the development of Kurdistan province towns and access to healthcare resources, using numerical taxonomy and Morris Model. This was a retrospective cross-sectional study and all towns of Kurdistan province (10 towns) were evaluated in regard to healthcare indices. Data concerning 23 health indices were obtained from statistical yearbook of Kurdistan province. Status of development was assessed by using numerical taxonomy and Morris model. The score of development was 0.877 to 0.489 based on numerical taxonomy and 0.278 to 0.753, based on Morris model. Regarding development and access to health resources, Sanandaj and Sarvabad ranked as the first and last areas respectively. The results showed that, regarding health care resources, there is a high inequality among the towns of Kurdistan province. Therefore, allocation of resources in different parts of Kurdistan should be based on the degree of development of the towns in this province.

Due to the development of drugs and With regard to this matter that customers of health services are unable to assess the clinical and financial aspects of medical technologies, evaluation the clinical efficacy of drugs is avery important. The Study aim was to evaluate the clinical efficacy of zoledronic acid in the prevention and treatment of postmenopausal osteoporosis. This study was a systematic review. Cochrane, PubMed and Google scholar databases were searched using keywords: “Bone mineral density, Male Osteoporosis, Zoledronic acid postmenopausal women osteoporosis”. Inclusion criteria were all menopausal women at risk of osteoporosis or suffering from it that have been used zoledronic acid at least once for the prevention or treatment of osteoporosis. Desired outcomes include reduced bone fractures, bone resorption and bone turnover markers, increase bone density, significant improvement in health-related quality of life in patients who have had a fracture. The designs of included studies were randomized clinical trials and their languages were English. The use of zoledronic acid significantly increased BMD at the total hip, lumbar spine, femoral neck, hip trochanter, the distal radius, reduced the incidence of hip fractures, morphometric vertebral fractures, vertebral fractures, any clinical fracture, clinical vertebral fractures, risk of nonvertebral fracture and decreased bone turnover markers in the intervention group compared with the control group. According to safety and clinical effectiveness of zoledronic acid, using this medication in the prevention and treatment of osteoporosis in postmenopausal women is recommended.

Access to health care facilities and healthcare services is one of the most influential factors in the maintenance and promotion of health in society. The purpose of this study was to determine and compare the cities of Kermanshah province in terms of access to healthcare facilities. The present study was a descriptive cross-sectional study which was performed using 16 indices of health care facilities in 2011. Numerical taxonomy technique and TPSIS method were used to determine the level of development in access to health care facilities. Also, Shannon entropy technique was used to determine the weights of healthcare indices. according to the results of numerical taxonomic technique, the Qasr-e Shirin and Salas-e Babajani towns had the highest and lowest access to health care facilities, respectively. Shannon's entropy technique introduced the number of beds per 10000 people as the most important index. According to the findings of TOPSIS technique, Qasr-e Shirin and Salas-e Babajani towns obtained the highest and lowest ranks in terms of access to health care facilities. There was a gap in access to the health facilities between the towns of Kermanshah and health tesoiurces were not evenly distributed. Therefore, health resources should be distributed according to the level of development and the allocation priorities should be determined based on scientific evidence.

In most countries، socioeconomic status and demographic characteristics are somehow associated with all health consequences. Generally، the health problems and mortality among people who live in lower socioeconomic levels is higher، and the extent of those varies according to age، gender and race. It seems that the main factor for the differences is in the socioeconomic level. This is a review study، and related articles were collected by searching the keywords like socio - economic status، health outcomes، health behaviors، life expectancy in the published literature and databases such as: Web of Science، Science Direct، Google Scholar، Springer and Google. This study has compared the effects and interactions between health variables and demographic variables. In recent decades، several studies have shown positive relationship between individual’s socioeconomic statuses (SES) with their health. This Studies have shown that the individual’s socioeconomic status (age، sex، race، location and migration، education، income، occupation، etc.) are closely associated with mortality، life expectancy، disease، health behaviors، and access to health services in the western countries، but this relationship has not been yet established in the other countries and this relationship should be separately examine in every country based on economic، social، and demographic characteristics of the country. The results of studies show that socioeconomic status indicators have a strong relationship with the social and community health and economic growth.

Introduction and The present study has investigated the trend of aging changes in Iran and health costs related to the aging. This is a review study about aging in Iran. Published articles and texts about the subject were gathered by valid websites and databases such as Web of Science, Science Direct, Google Scholar, Springer, and Google with key words: elderly population, the costs of aging, the challenges of aging and their solutions. After receiving the relevant articles and reading them, useful articles and papers have been selected and used in this paper. Iran and the world are increasing in older population, and projected that nearly 25 to 30 percent of Iran’s population will be old in 1410s. In all studies, it has been proved that with aging, treatment costs in various forms and sections will be increased. The causes of this increase compared with other age groups are: the continuous and frequent use of high volume of health services, the longer period of service (such as: increased length of stay and admission to hospitals and health accommodation) higher drug and medical’s expenses compared with other age groups because of the type of disease and response rate to treatment. Elderly population is vulnerable to higher chronic diseases, and it could impose a heavy financial costs. The appropriate insurance coverage for the elderly, the provision of long term cares, the suitable aging facilities and equipment in the hospital and planning to train specialists in this field, increasing the retirement age and training of health staff and personnel about long term care, and other similar cases can be very effective in reducing the problems of aging.

One method to increase the performance and efficient use of hospital resources is using tools of economic analysis such as production function. The aim of this study was the estimation of production function among public hospitals of Kermanshah University of Medical Sciences during 2001- 11 using Cub Douglas production function.

The data about the dependent variable (number of hospitalized patients) and explanatory variables (numbers of active beds، nurses، doctors and other staffs) for six public hospitals during 2001- 11 were collected using information form. The Data was analyzed employing Eviews software version 6.

The production elasticity and the marginal production for all inputs were positive. The marginal production of active beds، doctors، nurses and other staffs were 76. 7، 73. 7، 19. 3 and 6. 7 respectively. The results also showed that the return to scale was increasing and the total input coefficient was equal to 1. 45.

The maximum of elasticity and marginal production belonged to the active beds. This implies that the hospitals administrators in response to change demands can use active beds more than others inputs. Besides، the marginal production of other staffs was less than other studies، so incentive policies for effective and efficient use in hospital resources will be essential.