فهرست مطالب dr. mohammad hadian

Doogh is a fermented dairy product that is produced by blending yogurt with water and some salt. This fermented beverage is widely consumed as a refreshing drink in Iran and other Middle East countries. Doogh is a source of calcium needed by the body on a daily basis and contains B vitamins that are effective in the health and strength of teeth and bones. In addition, doogh contains a low percentage of fat, which makes it a diet drink. Whey Protein Concentrate (WPC) is a product contains 25 to 89% protein and different amounts of lactose, fat and minerals. Due to the functional properties of whey protein and its nutritional value; whey protein is widely used in dairy products. The development of cross-linking bonds between protein chains by enzymes is very important today. Enzyme cross-linking of proteins can affect some of their functional properties such as solubility, water absorption, rheological and emulsifying properties. One of the most widely used enzymes in the food industry is the transglutaminase enzyme. In this study the effects of WPC in three levels (0%,1% and 2%) and the transglutaminase enzyme in two levels (0 and 1 unit per gram of milk protein) in two method of dough preparation (adding water to yogurt and fermented milk diluted with water) on rheological characteristics, and microstructure of doogh were studied. 

Raw milk was provided by Pegah Khorasan Company, WPC from Multi Company) Mashhad (and Trans glutaminease enzyme from BDF Company of Spain. WPC was first added to milk at 45 ̊ C at three levels of zero, 1 and 2%.The milk samples were then pasteurized at 85 ̊ C for 30 min. After lowering the temperature to 45 ̊ C, the enzymatic operation was performed at two levels of zero and one unit (per gram of protein).To complete the enzyme function, the samples were incubated for 180 minutes at 45 ̊ C. Then a temperature of 90 ̊ C was applied for 1 minute to inactivate the enzyme. The samples were then cooled to 45  ̊ C. At this stage, the samples were divided into two parts. In one part of the samples; milk was diluted with water in a ratio of 6% of the total dry matter for direct production of doogh. After adding the starter, the samples were transferred to an incubator and hold at 43-42 ̊ C, until the pH reaches about 4.1.Thefermented samples were then transferred to a refrigerator. In the second part, starter was added to milk to produce yogurt; after adding starter, the mix was transferred to an incubator and hold at 43-42 ̊ C, until the pH reaches about 4.1. Doogh was produced by diluting yogurt with waterto givethe final product with 6% of  total dry matter. 

 In both production methods, in samples treated only with WPC, the average particle size increased with increasing WPClevel. In both methods, the production of only enzymatically treated samples  led to the formation of smaller particles with a more uniform shape and distribution. In samples of doogh produced by both production methods, WPC and transglutaminase enzyme changed the flow characteristics of doogh to non-Newtonian behavior. Samples made directly from milk had significantly higher viscosity than samples made from yogurt. In samples without enzymatic treatment, the microstructure was smooth and homogeneous with smaller particles than other samples. These particles settle very quickly. In the samples where WPC treatment was applied, the amount of large particles and non-uniformity increase with increasing WPC level. The distribution of particles in samples made directly from milk was more regular than samples made from yogurt.

Context:

 Due to the chronic nature of cancer, screening programs were a set of sequential decisions taken over time. Markov decision process (MDP) and partially observable Markov decision process (POMDP) models were the mathematical tools applied in studies, including sequential decision-making such as screening protocols for medical decision-making.

 The main goal of this study was to investigate optimal policy for cancer screening using MDP and POMDP models.

 We performed a review of articles published within July 2000 to November 2022 in PubMed, Web of Science, and Scopus databases. The stopping age, the type of optimal strategy, the benefits of the optimal policy, and the relationship between age and risk threshold were extracted. Studies that did not use MDPs and POMDPs as the mathematical maximization models in cancer screening, review articles, editorials or commentaries, non-English articles, and those that did not focus on optimization were excluded.

 From 532 articles, 6 studies met the study criteria. All studies suggested that the optimal policy was control-limit, and the cancer risk threshold was a non-decreasing function of age. Three studies specified a stopping age for cancer screening. In five studies, the optimal policies outperformed the guidelines or no screening strategy.

 Two essential factors in screening decisions were cancer risk and age, which were individual variables. The control-limit policy included these factors in decision-making for cancer screening. These policies highlighted personalized screening and showed that this type of screening could outperform cancer screening guidelines regarding economic and clinical benefits.

The bidentate Schiff-base ligand, N,N'-bis((E)-3-phenylallylidene)-4-nitro-1,2-phenylenediamine, [L], was synthesized and characterized along with its Cu(II) complexes, CuLX2 (where X = Cl and Br). The characterization involved elemental analysis, 1H NMR, 13C NMR, FT-IR, and UV-Vis spectroscopy, as well as thermal and conductivity studies. The elemental analyses of these complexes were consistent with the stoichiometry of the type CuLX2. The confirmation of their stabilization and their slight electrolytic nature is reinforced by their low molar conductivity. Furthermore, the alterations in both the location and shape of the peaks in the UV-Vis and FT-IR spectra of the complexes, relative to those of the free ligand, serve as additional evidence supporting the formation of Schiff-base complexes. Also, cathodic and anodic shifted in the potential’s peaks of complexes compared to free ligand approve formation of compounds. Catalytic activity of these complexes in the room temperature deoximation using sodium periodate were studied. Obtained aldehydes and ketones as single products in excellent yields confirm catalytic activity of these complexes. Lastly, in vitro cytotoxic features of all samples studied against A549 and HT29 cancer cell lines and the outcomes exhibited excellent cytotoxic potential of synthesized complexes.

One of the most important parts of the health system ispre-hospital emergency services that provide immediate services to patients. This study investigates the relationship between selected indicators of justice and performance of Iranian pre-hospital emergency services.

The research was done quantitatively and analytically. The society included pre-hospital emergency and the sample consisted six study variables. Using data combination method, the data were entered in the eviews and statasoftware;Flimer and Hausman tests were performed, and data regression of the data panel with fixed effects was obtained and estimated by ordinary least squares method.

Traffic incident prevalence index has a positive effect on three functional indicators. The index, the number of emergency medical missions, Provinces of Tehran, Qom, Khorasan Razavi, Mazandaran, Alborz, Yazd and Fars had the highest average for each medical emergency base.The incidence of traffic accidents in the provinces of Tehran, Khorasan Razavi, East Azarbaijan, Isfahan, Khuzestan, Mazandaran and Fars were the most prevalent.

The most important indicator of the Emergency organization of the country was the prevalence rate of traffic accidents which was effective in all three functional variables and consideredan important factor in distribution of pre-hospital emergency bases. Tehran and Qom provinces need to pay close attention to the number of medical emergencies.

In the development perspective of each country, it is important to pay attention to the health sector and improve health indicators; therefore, planning in training and distribution of human resources in the health sector is an important factor to achieve the health system goals. The aim of this study was to investigate the effect of changes in health sector human resources on infant mortality rate (IMR), maternal mortality rate (MMR), and under‑five mortality rate (U5MR) in Iran.

This was an econometric study (data panel) that conducted retrospectively and used data from the period 2006 to 2017 among Iranian provinces. Three regression models were used to determine the effect of health sector human resources (physicians, nurses, and paramedical staff) on the IMR, MMR, and U5MR. The random‑effects model was selected over the fixed‑effects model to assess the effect of health sector human resources on health outcomes.

Results showed that the number of physicians in different models has a stronger impact on these mortality rates than those of nurses and paramedics, so that a 1% increase in the number of physicians leads to 2.1%, 3.8%, and 2.2% decrease in IMR, MMR, and U5MR, respectively. Furthermore, per capita income has a bigger impact on these mortality rates than human health resources.

Increasing the number of human resources in the health sector, especially the number of physicians, by investing in these resources by providing educational facilities, plays an important role in improving the mothers’ and infants’ health indicators.

 Health policymakers need to use prioritization for resource allocation in the health system because of limitations to financial resources.

 This study aimed to explore the criteria affecting the appropriate allocation of health system resources to different diseases.

 A qualitative study was carried out in 2017 using semi-structured interviews. Participants were chosen using purposeful and snowball sampling methods. Totally, 25 experts in the health care system were interviewed. The present study employed conventional content analysis and data were analyzed using MAXQDA10 software.

 The findings were categorized into four main categories and 21 sub-categories. The main categories included criteria related to “type of disease”, “patients’ characteristics”, “type of treatment”, and “ethical and responsiveness issues”. Furthermore, the most effective factors on resource allocation included the emergency or non-emergency aspects of the disease, disease severity, disease onset, treatment effectiveness, and disease prevention.

 Health policymakers should direct resources toward emergency and severe diseases that significantly affect people’s quality of life. According to the findings of the present study, the “type of disease” was one of the most important criteria in health resources allocation. Therefore, similar to DRG, we can categorize diseases and health system problems based on their priority and use such grouping for health resources allocation.
 

Estimation of suspended sediments in flowing waters is a matter of importance due to the different aspects such as the performance of hydraulic structures, environmental problems, and ... The main goal of this research is using remote sensing technology to estimate the concentration of suspended sediments at the water level entering the reservoirs of dam by flood since the dam was constructed and its annual estimation. For this purpose, the experimental results and 〖ETM〗^+ data of Landsat satellite related to the reflection spectrum of suspended sediments at various concentrations. In a lab work by using an ASD spectro radiometer, the water reflection values containing different amounts of suspended sediments were measured in the range of 400 to 2500 nm. Then, these reflection values for OLI Bands of Landsat 8 were reexamined using their spectral response functions. In the study of the correlation between bands with the amount of suspended sediments, band2 (blue) and band5 (infrared) were detected most appropriate. In this research, a range of different sediment concentrations in 90 samples of 0.16 gr⁄lit to 100.05 gr⁄lit was used.
In the reviews, Landsat 5 band reflection centered at 865 nm and Landsat 2 band reflection centered at 482/4 showed the most and least sensitivity to the amount of sediment respectively. Therefore, a relationship with appropriate correlation was diagnosed between reflection differences of these two bands 〖R_865-R〗_482.5 and concentration of suspended sediments. In this relation, its RMSE was 1.57 and R2 parameter determination factor was

 There are numerous factors which affect the health status in different ways, including financing mechanisms, health‑care expenditures, socioeconomic characteristics, and health‑care resources. One of the most important factors which contribute to the health status of a population is health‑care resource which includes number of beds or health‑care professionals for instance.

The objectives of this study were as follows: to examine the regression of the life expectancy and health‑care inputs and also to investigate the regression of death rate and health‑care inputs. SETTINGS AND DESIGN: This study was a panel dataset analysis of OECD countries.

A generalized method of moment (GMM) regression models with country‑level health outcomes (death rate and life expectancy) as dependent variables were estimated. A panel dataset with n = 26 (the number of countries) and T = 12 (the number of time periods) was used. The GMM regression model was used to estimate the effect of health‑care resources on health outcomes.

Findings showed that there are strong reverse correlations between immunization rate and number of physicians with crude rate of death (−2.64 [P < 001] and −76.50 [P < 001], respectively). There were also positive correlations between immunization rate and number of physicians with life expectancy at birth (0.01 [P < 001] and 1.03 [P < 001], respectively). Moreover, there were negative correlations between inpatient rate and beds with life expectancy (−0.00003 [P < 001] and −0.12 [P < 001], respectively).

It is essential for policymakers to consider the optimal level of health resource to achieve better health outcomes. Oversupply of hospital beds and specialist doctors could lead to induced demand and put the patients at risk of unnecessary procedures.

Cardiovascular diseases are common and chronic diseases that impose many financial and health burdens on individuals and communities. Patients with these diseases have always experienced a high rate of death, disability and poor quality of life. Telemedicine is a promising approach to improving the care of these individuals.The aim of this study was to evaluate the efficacy and effectiveness of telemedicine in the management and monitoring of heart disease.
Information sources or data: This study is a systematize review in which all papers related to the effectiveness and efficiency of telemedicine in the management and monitoring of heart disease between March 2011 and July 2017 were extracted from ProQuest, Sciencedirect, PubMed, Scopus, and Google Scholar databases with keywords.
Selection methods for study: After screening the titles and abstracts of all the papers, finally 21 studies were selected and analyzed. For screening articles, the criteria for entry included the publication of articles in English, the relevance of articles to the efficacy and effectiveness of telemedicine in the management and monitoring of heart disease and access to full text articles.
Combine content and Telemedicine has had an effective and unique effect on the timely diagnosis of heart disease, facilitating access for patients to professionals, reducing the length of stay and allocating resources efficiently, and reducing costs and improving quality of life. The findings also indicate that advanced countries have been ahead in using telemedicine to manage and monitor heart disease ever more than other countries. The use of telemedicine can be provided as a practical solution to overcome time and space constraints in the diagnosis and treatment of various diseases, especially cardiovascular diseases. This technology has also maximized the health status by motivating patients, self-control, managing clinical symptoms and providing a screening program.

Nowadays, the demand for a kidney allograft is increasing in Iran as well as the rest of the world, which is growing the wait list. The Iranian model of a kidney transplant was initiated for solving organ shortage and has been extremely controversial both inside and outside of Iran. This narrative review was done by using Iranian and international databases to retrieve literature dealing with the Iranian model of kidney transplantation. All publications up until January 2018 were included. It has drawn out the weaknesses and strengths as well as the advantages and disadvantages, then, it provides some suggestion for better functioning of the Iranian model. Overall, 61 publications were retrieved and selected. After exclusion of unsuitable and duplicate articles, 17 were included. The main strengths of the Iranian model were having a lawful structure, supporting health centers and patients financially by government and charity funds, as well as reducing the waiting list. The main weaknesses include inadequate public awareness regarding the concept of brain death, the absence of a well-defined kidney registry system, need for renewing existing laws, regulations, and guidelines, the absence of permanent health insurance and follow-up for donors, as well as absence of a comprehensive network organ bank. The transplant authorities in Iran should work on reinforcement of the model by solving and overcoming some challenges. Preventing organ failure, as well as its risk factors, public education and encouraging organ donation from individuals who are brain dead, improving the outcomes of circulatory death donation, and investment in tissue engineering could significantly reduce organ shortage. The final solution is living unrelated renal donation (LURD).

Flaxseed is the richest source of lignan which is one of the main categories of phytoestrogens. In addition to the estrogenic and anti-estrogenic properties of lignan, it has non-hormonal properties as well. The treatment of menopausal hot flashes and cyclic mastalgia, the reduction in vasomotor symptoms and tumor cell growth and recurrence, the prevention of breast and ovarian cancer,  and the improvement of the symptoms of premenstrual syndrome are some of the indications of this plant. Therefore, the current study aimed to review the effect of flaxseed on the control of menopausal symptoms, premenstrual syndrome as well as breast and ovarian cancers. In this study, English keywords of mastalgia, mastodynia, ovarian neoplasm, ovarian cancer, breast neoplasm, breast cancer, hot flashes, premenstrual syndrome, flax, flaxseed, lignan, phytoestrogen, and linum usitatissimum along with their Persian equivalents were searched through databases incluing PubMed, Proquest, Scopus, Science Direct, Google Scholar, SID, and Magiran. All the selected articles were the clinical trials and case-control studies performed from 1991 to 2017. Finally, 30 English and 8 Persian studies were reviewed in this study. The results obtained from most studies on this plant showed its positive effects on menopausal symptoms, breast cancer, mastalgia, and premenstrual syndrome. According to the results, it can be concluded that due to the high properties of this plant (i.e., the negligible side effects and safe use of it in recommended amounts), it can be used within the field of obstetrics and gynecology.

  A cost-effectiveness analysis is used to evaluate and compare the cost versus the benefits of different treatment modalities. The clinical effectiveness of laparoscopic cholecystectomy has been well documented. To our knowledge, there was no published data on the cost-utility of laparoscopic cholecystectomy in Iran. This study aimed to compare the cost-utility of the two surgical methods for removing gallstones: open cholecystectomy and laparoscopic cholecystectomy. Patients and Methods: In this comparative cross-sectional analysis, we investigated the data of patients who had undergone laparoscopic and open cholecystectomy operations in Kashani hospital, Iran, between 2012 and 2014. Using the available samples, two groups of 30 patients were randomly selected. SF-36 was used to assess the quality of life (QoL) of patients 30 to 35 days after operation, and quality-adjusted life years (QALYs) were calculated by multiplying the SF-36 score by healthy years of life. An activity-based costing method was used to determine the costs of the operations. The cost-effectiveness ratio (CER) was calculated by dividing the costs of each method by the gained QALY. To determine the difference between the two surgical methods, we used independent-samples t test. The data of 60 patients, 40 men and 20 women, with the mean age of 54.30 ± 16.44 in the laparoscopic group and 51.77 ± 18.41 in the open cholecystectomy group were analyzed. The mean cost of surgery was lower in the laparoscopy group (2259 ± 895 USD) than in the laparotomy group (2972 ± 907.9 USD) (P = 0.003). The mean SF-36 score was higher in the laparoscopic group (65.98 ± 9.22) than in the open cholecystectomy group (58.03 ± 11.30) (P < 0.004). The cost of gaining QALY was also significantly lower in the laparoscopic group. The mean of the gained QALY index was 1.79 ± 0.29 and 1.14 ± 0.41 for the laparoscopic and open surgeries, respectively (P < 0.001). The incremental CER was 1067 USD for each QALY for the laparoscopic group in comparison to the value of open cholecystectomy. Laparoscopic cholecystectomy was more cost-effective than open cholecystectomy and is therefore preferred and recommended in patients with gallstones

The exchange rate is one of the factors whose deviation from equilibrium amounts can lead to the instability in economy performance at the macro level. This study attempted to investigate the effects of exchange rate fluctuations on the import and export of medicine in Iran during 2001-2014. This longitudinal study collected the required data in each season from 2001 to 2014. The sources of our data were Iran Central Bank, Islamic Republic of Iran Customs Administration, and Food and Drug Administration. The exchange rate and some other variables such as gross domestic product (GDP), oil revenues, and the relative price of medicine import and export were used in the medicine export and import model. Finally, by using E-views software, version 8, an Engle-Granger approach was utilized to investigate the long-term relationship between the study variables. The autoregressive integrated moving average model (ARIMA) was used to estimate the fluctuations in the exchange rate. The results of estimating the equations by the use of the regression method indicated that every 1% increase in oil revenues would lead to a 0.13% increase in the medicine import in short-term. Every 1% increase in GDP would averagely lead to a 1.61% increase in the same variable in long-term. Moreover, the exchange rate fluctuations had a reverse effect on medicine exports so that a 1% increase in the exchange rate fluctuations would moderately result in a 0.17% decrease in medicine export in short-term. The relative price of import had no statistically significant relationship with any of the variables. Since medicine plays a specifically significant role in the health system and the pharmaceutical industry uses a large amount of exchange, fluctuations in the exchange rate have negative effects on the export of medicine; therefore, health officials and policy-makers need to pay much more attention to this issue.

Insurance industry is recognized as a major economic entity. Development of insurance, and particularly life insurance, is among the necessities of industrial societies as this plays a substantial role in reinforcement of the society’s economic power and, thus, establishes security and confidence. Aimed at analyzing the economic-social factors affecting insurance demand, the present study deals with estimation of life insurance demand function using panel data from 2006 up to 2014 in Iran.
The present research is a descriptive-analytical study of the retrospective cohort applied type. Information registered in Iran’s Statistics Center encompassing the interval from 2006 to 2014 was analyzed. Benefitting from economic evaluation mechanism and macro-scale economic and social variables affecting life insurance demand were investigated in 30 provinces of Iran. Finally, the country’s demand function of life insurance was estimated using Stata12 and Eviewes8 software packages with panel data method.
Life expectancy rate has the largest impact on life insurance demand among the variables analyzed. In addition, urban settlement rate leaves the smallest effect on life insurance demand.
Results of the study indicate that increase and rise of variables such as life expectancy rate, dependency rate, urban settlement rate, literacy rate, likelihood of family head’s death, population, and average net annual expenditures of urban family lead to increased tendency of individuals to life insurance. Furthermore, increase of other parameters like inflation rate and interest rate result in reduction of people’s tendency toward life insurance.

Research on the utilization of health services provides an opportunity to identify and determine the quantity and quality of factors, which can facilitate or debilitate access to services. Policymakers believe that factors affecting the use of health services should be quantified in order to allocate further resources to indicators, which can help reduce inequalities. This study aimed to investigate factors affecting the utilization of outpatient services and to determine the effect of health insurance on financial support for individuals.
The present study included all Iranian households, which had been recruited by the Statistical Center of Iran in 2012 - 2013. The data were analyzed in 2 logit models and divided into urban and rural areas.
According to the results, basic and full insurance coverage was the main factor, influencing the utilization of outpatient health services. Furthermore, age composition of households affected their utilization of these services. More precisely, households with more members aged 65 years tended to use outpatient services more frequently. In addition, households with female heads and those from higher decile groups were more likely to use outpatient services. On the contrary, educational level and household size had negative effects on demand for outpatient health services.
Based on the results, there was a significant association between social and economic status and utilization of outpatient services. For decreasing the observed inequalities, policymakers should pay particular attention to households with low income and members aged 65 years and provide access to health services for these groups (eg, access to family physicians).

When a country’s health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed.
This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC).
This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods.
Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people’s behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment.
With regard to the current challenges in Iran’s health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system’s features. However, future research should focus on the development of the risk-adjusted capitation model.

In a severely inflationary environment with unemployment, social problems increase and, therefore, high health care expenses are imposed on the society. This was a correlational study. Panel data model and EVeiws 6 software were used in this study. The data were collected from the World Bank website. The required pre-tests, including F-Limer and Hauseman tests, were given to check the appropriateness of data and to determine a appropriate model. Following the pre-tests, the results were estimated in the form of a regression model. The results indicated that F-test and t-statistic were significant, and that R2 statistic was high. In the three models, R2 was 99%, 99% and 98%, respectively. Moreover, it can be said that employment is positively related with life expectancy, but negatively related with infant mortality and total fertility rate. Also, inflation is negatively related with life expectancy, but positively related with infant mortality, and total fertility rate. Finally, Gross Domestic Product (GDP) is negatively related with total fertility rate and life expectancy, but has no meaningful relationship with infant mortality (p = 0.31). Employment, inflation and GDP are the variables that have the greatest impact on health indicators. however, life expectancy is more sensitive to explanatory variables.

Although studies reported diabetes mellitus screening cost effective, the mass screening for type2 diabetes remains controversial. In this study we reviewed the recently evidence about the cost effectiveness of mass screening systematically.
We reviewed the MEDLINE, Scopus, Web of Science (WOS), and Cochrane library databases by MeSH terms to identify relevant studies from 2000 to 2013. We had 4 inclusion and 6 exclusion criteria and used the Drummond’s checklist for appraising the quality of studies.
The initial search yielded 358 potentially related studies from selected databases. 6 studies met our inclusion and exclusion criteria and included in final review. 3 and 2 of them were conducted in Europe and America and only one of them in Asia. Quality-adjusted life year (QALY) was the main outcome to appraise the effectiveness in the studies. Incremental cost effectiveness ratio (ICER) was computed in range from $516.33 to $126,238 per QALY in the studies.
A review of previous diabetes screening cost effectiveness analysis showed that the studies varied in some aspects but reached similar conclusions. They concluded that the screening may be cost effective, however further studies is required to support the diabetes mass screening.

Location allocation of healthcare centers facilitates the accessibility of health services and the lack of proper distribution of these centers leads to increasing problems of citizen's access to these centers. The main objective of this study was to evaluate the distribution of healthcare centers in the region of the study and to determine deprived areas from this services. This research is a case study that has been done on region 11 of Tehran. The data were collected form maps and they have been analyzed by Analytical Hierarchy Process (AHP) in GIS environment. There are 10 hospitals in the study area that include seven percentage of all hospitals in Tehran. In the evaluation of the information layers, the layers of the residential and the industrial centers were respectively weighted %19(maximum weight) and %1(minimum weight). After the compatibility analysis, the rate of incompatibility of different lands with treatment land was four percentage. This study showed overlapping services of existing hospitals by determining service radius of 1500 m. In addition, with combining information layers on the final map, suitable areas for optimal placement of health centers were identified. The results of this study showed that current locations of medical centers in region11 of Tehran do not match with scientific standards.

Having knowledge about utilization of health care services is necessary for resource allocation and scheduling in health sector. The general consensus is that the inequality in the utilization of health care is unjust and unfair and health care systems should ensure equal access to health care based on need.

The main objective of this study was to identify factors influencing the utilization of health services, inpatient and outpatient both in the public and private sectors using logit econometric models. Domain of this study is 2011 and all regions of Tehran are considered. Urban HEART questioners’ data was used in this research. Gathered data were analyzed and interpreted in several stages and in the form of several logit models for inpatient services, outpatient services and private and public services.

The research findings showed that in 2011, overall 40.07% of the populations of Tehran have used outpatient health services and 18.69% of inpatient services. The main reasons for not utilization of outpatient services was reported existing of medicine and self-treatment at home and after that were having no money and services expensiveness and resolve the problem. Between reasons for not utilization of inpatient services, having no money and services expensiveness and lack of the expertise required for households were more important than other factors. After estimation of logit models the income, education, employment status, insurance and household size have been diagnosed effective on health services utilization. Existence of patients with chronic disease in households was the most effective factor on health care utilization in both inpatient and outpatient service groups.

Policy makers in health sector need to improve financial or economical access to health services, and in this regard, the identification of households in the bottom expenditure deciles, living in deprived regions, households with people over 60 and less than 5 years or patient with chronic disease will be a good help for planning for increase in health services accessibility.

Health price inflation rate is different from increasing in health expenditures. Health expenditures contain both quantity and prices but inflation rate contains prices. This study aimed to determine the factors that affect the Inflation Rate for Health Care Services (IRCPIHC) in Iran. We used Central Bank of Iran data. We estimated the relationship between the inflation rate and its determinants using dynamic factor variable approach. For this purpose, we used STATA software. The study results revealed a positive relationship between the overall inflation as well as the number of dentists and health inflation. However, number of beds and physicians per 1000 people had a negative relationship with health inflation. When the number of hospital beds and doctors increased, the competition between them increased, as well, thereby decreasing the inflation rate. Moreover, dentists and drug stores had the conditions of monopoly markets; therefore, they could change the prices easier compared to other health sectors. Health inflation is the subset of growth in health expenditures and the determinants of health expenditures are not similar to health inflation.

Growing in health care costs lead to increasing concern about the economic impact of health costs on the family facing the disease. The aim of this study was to investigate factors affecting the probability of catastrophic expenditures exposure among households in Tehran. The main goal of research was understanding the factors affecting the probability of catastrophic expenditures exposure among households in Tehran using Econometrics Logit model. The study considered all the areas of the Tehran city. The data were gathered with Urban Health Equity Assessment and Response Tool (Urban HEART) has been used in the research. In the year 2011 about 11 percent of people in Tehran have been faced to catastrophic health costs. The results of Econometrics models show that households with the number of members under 5 years or over 65 years, unemployed or less educated head, or households with a chronic patient and without insurance supports are more likely to face with catastrophic health care costs. This study showed that catastrophic health care costs of the various groups and households had significant difference, of course, clearly, with the performance of the health system transformation project, changes have taken place in this important indicator and factors affecting it, that requires a separate study and research

Pharmaceutical expenditures are responsible for a major part of health systems’ cost. According to the WHO’s statistics, Iran is the first among the 20 countries in the world in terms of drug consumption. The first step in controlling consumption of a particular good is to identify factor inducing the relevant demands. Hence, this study aimed to identify the pattern and demand-inducing factors of drug consumption in Iran. The time series data of pharmaceutical expenditures was acquired from the yearbooks of Iranian Ministry of Health and Medical Educations. The time series data of medicine price index and per capita income were obtained from the documentation of the Central Bank of Iran. Pharmaceutical demand was modeled as a function of economic variables using the logarithmic transformation of Cobb-Douglas demand function and regression coefficients were estimated. Households income and medical liability insurance and medicine prices showed a positive and a negative impact on medicine expenditures, respectively. The elasticity of price and income was found to be less than one suggesting medicine as an inelastic and normal good. Our results imply that policies such as enhancing financial resources of insurances, rationalizing the allocated expenditures, and appropriate packaging of the insured medicines based on elasticity of income and demand, providing insurance premium based on the type and rank of the disease, implementation of coinsurance according to the type of medicinal services would help control of drug consumption.