Bijan Nouri

Catastrophic Health Expenditure after the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran

BACKGROUND One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE. METHODS A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. RESULTS The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. CONCLUSION The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of recent reform, thus financially protecting public against CHE.

The effect of dairy consumption on the prevention of cardiovascular diseases: A meta-analysis of prospective studies

Introduction: There is no global consensus on the relationship of dairy products with cardiovascular diseases. This study was conducted to evaluate the effect of the consumption of dairy products on cardiovascular diseases, including stroke and coronary heart disease (CHD). Methods: Important electronic databases such as the Scopus, Science Direct, and PubMed were evaluated up to September 2014. All prospective cohort studies that evaluated the relationship between dairy products consumption and cardiovascular diseases were included regardless of their publication date and language. The study participants were evaluated regardless of age, sex, and ethnicity. The STROBE checklist was used to assess quality of the study. Two investigators separately selected the studies and extracted the data. The designated effects were risk ratio (RR) and hazard ratio (HR). The random effect model was used to combine the results. Results: Meta-analysis was performed on 27 studies. There were 8648 cases of cardiovascular diseases (CVD), 11806 cases of CHD, and 29300 cases of stroke. An inverse association was found between total dairy intake and CVD (RR=0.90, 95% CI: 0.81-0.99) and stroke (RR=0.88, 95% CI: 0.82-0.95) while no association was observed between total dairy intake and CHD. The total diary intake was associated with decreased mortality of stroke (RR=0.80, 95% CI: 0.76-0.83) although it had no association with its incidence (RR=0.96, 95% CI: 0.88-1.04). Conclusion: This is the first meta-analysis of the relationship of total dairy intake with CVD. This study showed an inverse relationship between total dairy intake and CVD while no relationship was found for CHD. Considering the limited number of studies in this regard, more studies are required to investigate the effect of different factors on the association of dairy intake and CVD.

Effective Medicinal Plant in Cancer Treatment, Part 2: Review Study:

Cancer is the second cause of death after cardiovascular diseases. With due attention to rapid progress in the phytochemical study of plants, they are becoming popular because of their anticancer effects. The aim of this study was to investigate the effective medicinal plants in the treatment of cancer and study their mechanism of action. In order to gather information the keywords “traditional medicine,” “plant compounds,” “medicinal plant,” “medicinal herb,” “toxicity,” “anticancer effect,” “cell line,” and “treatment” were searched in international databases such as ScienceDirect, PubMed, and Scopus and national databases such as Magiran, Sid, and Iranmedex, and a total of 228 articles were collected. In this phase, 49 nonrelevant articles were excluded. Enhancement P53 protein expression, reducing the expression of proteins P27, P21, NFκB expression and induction of apoptosis, inhibition of the PI3K/Akt pathway, and reduction of the level of acid phosphatase and lipid peroxidation are the most effective mechanisms of herbal plants that can inhibit cell cycle and proliferation. Common treatments such as radiotherapy and chemotherapy can cause some complications. According to results of this study, herbal extracts have antioxidant compounds that can induce apoptosis and inhibit cell proliferation by the investigated mechanisms.

Epidemiology and socio-demographic risk factors of self-immolation: A systematic review and meta-analysis

OBJECTIVE Self-immolation or self-inflicted burn is the most tragic and violent method of suicide. The higher prevalence of this dramatic phenomenon in Iran is a serious social and health problem. In this study, we conducted a meta-analysis to combine the results from available studies to examine the epidemiology and socio-demographic characteristics of individuals who attempted self-immolation in Iran. METHOD Pertinent studies were identified by searching the electronic bibliographic databases including PubMed, Scopus, Science Direct, Iran Medex, Magiran, Medlib and Scientific Information Database (SID) (2000-October 2016). Meta-analysis was used to summarize the research results on socio-demographic risk factors of self-immolation in Iran. The STROBE checklist was used to assess quality of the study. The random effect model was employed in the meta-analysis to account for the observed heterogeneity among the selected studies. RESULTS Twenty-nine studies (sample size=5717) were included in the meta-analysis. The estimated average age of individuals who attempted self-immolation was 27.31 (95% confidence interval [CI]: 25.81-28.81) years. Women account for 70% (95% CI: 64-77) of all self-immolation attempts in Iran. Thirty-nine (95% CI: 34-43) per cent of all self-immolation were among singles. Nineteen (95% CI: 16-22) per cent of self-immolators had mental disorder. Meta-regression model showed that the average age of individuals who attempted self-immolation increased significantly over the period between 2000 to 2016 (P-value=0.006). CONCLUSIONS Our study indicated that individuals who attempted self-immolation in Iran were mainly women, married and young adults.

Dental care utilization in the west of Iran: a cross-sectional analysis of socioeconomic determinants

Purpose Oral health is a major public health problem, both in developed and developing countries. The purpose of this paper is to examine the utilization of dental care and identify the main socioeconomic factors affecting the use of these services in the city of Sanandaj, west of Iran, in 2015. Design/methodology/approach A cross-sectional survey using multistage sampling was conducted to obtain information on the dental care visits of 520 head of households in Sanandaj. A self-administered questionnaire was used to collect data on the utilization of dental visits. Multivariable logistic regression was used to identify the main socioeconomic factors affecting the utilization of dental care in Sanandaj. Findings Results showed that 61.3 percent of the respondents visited a dentist at least once in the last year, of which 45 percent visited dentist for restoration, 27.9 percent had extraction and 10.3 percent had a dental checkup. The average number of dentist visits by respondents was 1.9. Regression results indicated a significant association between socioeconomic factors (e.g. income, educational level and employment status) and utilization of dental care. Originality/value This study suggested that dental care visit was influenced by socioeconomic status of households. Therefore, strategies aimed at improving dental care utilization for socioeconomically disadvantaged households (e.g. dental health insurance) are required to promote oral health among socioeconomically disadvantaged groups.

Validation study methods for estimating odds ratio in 2 × 2 × J tables when exposure is misclassified.

Background. Misclassification of exposure variables in epidemiologic studies may lead to biased estimation of parameters and loss of power in statistical inferences. In this paper, the inverse matrix method, as an efficient method of the correction of odds ratio for the misclassification of a binary exposure, was generalized to nondifferential misclassification and 2 × 2 × J tables. Methods. Simple estimates for predictive values when misclassification is nondifferential are presented. Using them, we estimated the corrected log odds ratio and its variance for 2 × 2 × J tables, using the inverse matrix method. A two-step weighted likelihood method was also developed. Moreover, we compared the matrix and inverse matrix methods to the maximum likelihood (MLE) method using a simulation study. Results. In all situations, the inverse matrix method proved to be more efficient than the matrix method. Matrix and inverse matrix methods for nondifferential situations are more efficient than differential misclassification. Conclusions. Although MLE is optimal among all of the methods, it is computationally difficult and requires programming. On the other hand, the inverse matrix method with a simple closed-form presents acceptable efficiency.

Prevalence and risk factors for HBV and HCV in prisoners in Iran: a national bio-behavioural surveillance survey in 2015

To provide more accurate estimates of the prevalence of Hepatitis B (HBV) and Hepatitis C (HCV) and their contributing factors among prisoners in Iran.

What explains socioeconomic inequality in health-related quality of life in Iran? A Blinder-Oaxaca decomposition

Objectives This study aimed to explain the health-related quality of life (HRQoL) gap between the poorest and the wealthiest quintiles in the capitals of Kermanshah and Kurdistan Provinces (Kermanshah and Sanandaj), in western Iran. Methods This was a cross-sectional study conducted among 1772 adults. Data on socio-demographic characteristics, socioeconomic status (SES), lifestyle factors, body mass index, and HRQoL of participants were collected using a self-administered questionnaire. The slope and relative indices of inequality (SII and RII, respectively) were employed to examine socioeconomic inequality in poor HRQoL. Blinder-Oaxaca (BO) decomposition was used to quantify the contribution of explanatory variables to the gap in the prevalence of poor HRQoL between the wealthiest and the poorest groups. Results The overall crude and age-adjusted prevalence of poor HRQoL among adults was 32.0 and 41.8%, respectively. The SII and RII indicated that poor HRQoL was mainly concentrated among individuals with lower SES. The absolute difference (%) in the prevalence of poor HRQoL between the highest and lowest SES groups was 28.4. The BO results indicated that 49.9% of the difference was explained by different distributions of age, smoking behavior, physical inactivity, chronic health conditions, and obesity between the highest and lowest SES groups, while the remaining half of the gap was explained by the response effect. Conclusions We observed a pro-rich distribution of poor HRQoL among adults in the capitals of Kermanshah and Kurdistan Provinces. Policies and strategies aimed at preventing and reducing smoking, physical inactivity, chronic health conditions, and obesity among the poor may reduce the gap in poor HRQoL between the highest and lowest SES groups in Iran.

Detection of Extended-Spectrum Beta-Lactamases (ESBLs) and antibiotic susceptibility patterns in Klebsiella pneumoniae in Western, Iran

BACKGROUND Production of Beta-Lactamase enzymes, especially extended- spectrum Beta -Lactamases (ESBL), is a primary mechanism of resistance in these bacteria.The purpose of this study was detection of blaTEM, blaSHV, blaCTXM, blaCTX-M-15, blaPERand blaVEBin K. pneumoniae, isolated from clinical specimens by the PCR method and antibiotic susceptibility patterns in these strains isolated. MATERIALS AND METHODS During a period from October 2015 to July 2016, 52 K. pneumoniae isolates were collected from general hospitals in the city of Sanandaj, Iran. After identifying the strains by biochemical testing, the disc diffusion method was used for determining antimicrobial susceptibility and screening the ESBL-producing isolates. Detection of blaTEM, blaSHV, blaCTX-M, blaCTX-M-15, blaPER and blaVEBESBL-producing K. pneumoniae was carried out by PCR. RESULTS Out of 52-collected K. pneumoniae, highest and lowest rates of resistance related to co-trimoxazole with 67.3 % and amikacin with 30.7 %. 55.7% identified as MDR and 69.23% were ESBL-producing K. pneumoniae.blaSHV was the most prevalent gene in ESBL-producing K. pneumoniae. blaTEM,blaCTX-M,blaCTX-M-15 producing K. pneumoniae strains showed higher rates of drug resistant compared with negative strains (P < 0.05). CONCLUSION Results of this study showed that the prevalence rate of ESBL-producing K. pneumoniae isolates is increasing in MDR strains, which raises concerns regarding the treatment of K. pneumoniae. Therefore, molecular research in the field of antimicrobial resistance of bacteria is essential to prevent the spread of resistant strains.

Effects of intrathecal dexmedetomidine on shivering after spinal anesthesia for cesarean section: a double-blind randomized clinical trial

Background Shivering is among the common troublesome complications of spinal anesthesia (SA), and causes discomfort and discontentment in parturients undergoing cesarean sections (CSs). The aim of this study was to investigate the effects of intrathecal dexmedetomidine in the prevention of shivering in those who underwent CS under SA. Subjects and methods Fifty parturients planned for elective CSs under SA were enrolled in this prospective, double-blinded, controlled study and randomly divided into two equal groups. Spinal block was achieved with 12.5 mg 0.5% heavy bupivacaine plus 5 μg dexmedetomidine (BD group) or 0.5 mL 0.9% normal saline (BN group). The incidence and intensity of shivering, peripheral and core body temperature, hemodynamic parameters, and adverse events was recorded. Results The incidence of shivering was significantly higher in the BN group (52%) than the BD group (24%) (P=0.04). Likewise, the intensity of shivering was significantly higher in the BN group than the BD group (P=0.04). The incidence of adverse events, such as hypotension, nausea/vomiting, and bradycardia, was not significantly different between the two groups, although the grade of sedation was higher in the BD group than the BN group (P=0.004). Conclusion We conclude that intrathecal dexmedetomidine is effective in lowering the incidence and intensity of shivering in parturients undergoing CSs under SA without major adverse effects.