Iranian Health Research Articles

The impact of Covid 19 pandemic on life satisfaction and health of Iranian bank employees

BackgroundCOVID-19 pandemic has affected various aspects of human life. Bank employees who are more in contact with people are more likely to be infected during the pandemic situation. Moreover, mental, physical and social impacts of COVID-19 are more intense among these employees.Objective: this study aims to determine the effect of COVID-19 pandemic on bank employees’ health and life satisfaction in Iran. MethodsThis cross-sectional study was conducted during the fifth wave of COVID-19 from July to October 2021. The population included all the employees of Tejarat Bank in 20 provinces of Iran, 350 of whom were selected using the multi-stage cluster sampling method. The data were collected by demographic questionnaire, 12-item short-form (SF-12) personal health assessment survey and satisfaction with life scale (SWLS). The objective of the study was examined by the structural equation modeling (SEM). ResultsThe results showed the two default models of health function (CFI = 0.95) and life satisfaction (CFI = 0.99) had acceptable fit. Assessing the bank employees with COVID-19 revealed this disease had no direct impact on life satisfaction (β = −0.05, P = 0.28) and health function (β = 0.04, P = 0.48). However, it had a direct impact on physical function (β = −0.18, P = 0.001) and, consequently, an indirect impact on life satisfaction. Moreover, low mental function reduced life satisfaction. ConclusionCOVID-19 infection had no direct impact on life satisfaction. However, it had an indirect and positive impact on it. Considering gender showed COVID-19 infection had a direct and positive impact on life satisfaction among women. The employees who recovered from COVID-19 infection reported higher life satisfaction after returning to work for various reasons than those who never got it.

Socioeconomic status and health literacy as the important predictors of general health in Iran: a structural equation modeling approach


 Background: We aimed to determine the level of health literacy (HL), and its association with general health. In addition, we investigated the direct and indirect association of socioeconomic status (SES) and general health among the adult population in Iran.
 Methods: This cross-sectional study involved 750 literate adults' people. The SES was assessed based on the owning of assets. HL was evaluated using a validated questionnaire in Iran. General health was assessed using the WHO general health questionnaire. The simple and adjusted linear regression models, and structural equation modeling (SEM) were used for data analysis.
 Results: In adjusted model, female gender, higher level of education, use of books, pamphlets, or brochures as a source of health information, the higher level of SES were positively associated with higher HL. In addition, the HL was significantly associated with higher scores of general health. Results of SEM showed that the direct effect of SES on general health was not significant, but the indirect effect via HL was significant (path coefficient: 0.24; p<0.001).
 Conclusion: Results of our study indicated HL is strongly associated with general health among the adult population. SES had a significant indirect association with general health via the effect on health literacy.

Strengthening the resilience of Iran's health system against climate change

Strengthening the resilience of Iran's health system against climate change

Development of a modified physiological birth programme integrated into Iran’s health system and its effect on maternal and neonatal outcomes: an embedded mixed-methods study protocol

IntroductionAs recommended by the WHO, promotion of physiological birth is a main strategy to reduce the rate of caesarean section and achieve Sustainable Development Goals. A modified version of the...

The effect of Covid-19 pandemic on healthcare utilization in public vs private centers in Iran: a multiple group interrupted time-series analysis

BackgroundThe outbreak of Coronavirus in late 2019 and its continuation in the following years has affected all human societies, government organizations, and health systems. Access to health services is an important issue during crises. The present study aimed to investigate the effect of the Covid-19 pandemic on the consumption of health services in the public sector compared to the private sector in Iran.MethodsThe research population consisted of all insured individuals covered by Iran Health Insurance Organization in Fars province, which amounts to approximately 2,700,000 people. The required information including the utilization of laboratory, radiology, medicine, and hospitalization services was extracted on a monthly basis from February 2019 to February 2021. The Multiple Group Interrupted Time Series Analysis (MGITSA) was used for data analysis along with STATA.15 software.ResultsAccording to the findings of MGITSA, in the short-term, the utilization of private laboratory, radiology, medication, and hospital admissions had decreased by approximately 18,066, 8210, 135,445, and 1086 times, respectively (P < 0.05). In the long-run, the use of laboratory and radiology services had increased by about 2312 and 514 times (P < 0.05), respectively. The comparison between the public and private sectors showed that in the short-term, the use of radiology services decreased by about 12,525, while the use of medication increased by about 91,471 times (P < 0.05). In the long-run, the use of laboratory services decreased by about 1514 times (P = 0.076) and no change was observed in the other services utilization (in public relative to private centers).ConclusionsUtilization of health services in the public versus private centers, except for medication and hospitalization, significantly decreased in the short-term. However the utilization of most services returned to the usual trend in the long-term. The reduction in access to health services could impose a significant burden of various diseases, at least in the short-term, and increase health costs in the coming years.

Visual representation of the menopause in Iran

This study investigates the visual representation of menopause in Iranian health promotion resources. The author uses Kress and Van Leeuwen’s approach to visual analysis (Kress G and Van Leeuwen T (2002) Colour as a semiotic mode: Notes for a grammar of colour. Visual Communication 2(3): 343–368 and Kress G and Van Leeuwen T (2006) Reading Images: The Grammar of Visual Design, 2nd edn. London: Routledge.) to study publications about the menopause by the Iranian Government and two major medical universities. Two research questions guide the investigation: How do Iranian health promotion resources visually represent the menopause? How do these representations reflect and reproduce cultural values and religious beliefs? Findings reveal that: the publications address both men and women, but exclude widows, single and divorced women; the publications encourage women to stay healthy and lead a fulfilling post-menopausal life; and that they have a distinctly Iranian approach to the use of visual communication, characterized by abstract modality, visual symbolism and the emotive expressivity of a vivid use of colour. However, the publications have not been updated since 2008 and are currently not distributed so that their generally positive message cannot, at present, challenge some traditional masculine beliefs which restrict women to the roles of wife and mother.

Evaluation of scientific productions in the field of health system management in Iran and its comparison with regional countries

ABSTRACT Introduction Recognizing and evaluating studies in the field of health system management can be a solution to achieve better and more people in need of well-being and health. This study aimed to evaluate the scientific production of Iran's health system management compared with other countries. Methods: The present applied study was carried out using scientometric techniques. The study population was all the scientific documents available in the Scopus reference database, which were indexed with keywords in the field of health system management from 2000 to 2021. After filtering, 53,794 academic papers from 21 countries of the region were retrieved. Data analysis was done with VOS Viewer and SPSS22 software. Findings: By producing 14,152 scientific degrees, Iran has accounted for 26.31% of the total production of the studied countries and 1.15% of the world's production. There was a significant difference between the studied countries in terms of scientific production (p<0.001), citations received (p<0.001), and H index (p<0.001). Conclusion: Despite the growth of scientific production in the field of health system management in Iran and the countries of the region, its amount is still low compared to the global scale.

Cost-effectiveness analysis of ceftazidime avibactam versus colistin in carbapenem-resistant enterobacteriaceae in Iran

IntroductionCeftazidime avibactam (CA) is an effective treatment against carbapenem-resistant Enterobacteriaceae (CRE), but its cost-effectiveness is unclear. This study was performed to evaluate the cost-effectiveness of CA against the best available treatment colistin (Col) for patients with CRE-related infections in Iran.MethodologyA model of a decision tree was designed to evaluate the cost-effectiveness of CA in CRE patients over a period of 5 years. The Iran health system was the perspective of the study, and the discount rates of 5.8% and 3% were considered for the data of cost and utility, respectively. The clinical inputs were obtained from a prospective observational study. We established the costs of medical services and medical tariffs of Iran’s health system, and obtained the rate of medical service resources used by patients from specialists. The results of this model included the quality-adjusted life years (QALYs), increasing costs, and incremental cost-utility ratio (ICUR). We also performed the deterministic and probabilistic sensitivity analyses.ResultsCA reduced the burden of related to treatment failure and the need for treatment of nephrotoxicity and chronic failure, whereas, the costs related to drug procurement and long-term care (due to longer survival) increased. Treatment with CA versus Col resulted in a 53% increase in QALYs and $425 in costs, leading to an ICUR equal to 798 $/QALYs. Sensitivity analyses proved the model’s strength and indicated that the cost-effectiveness of CA can reach 88% when paying 1111 $/QALY. Budget impact analysis estimated CA regimen will increase the health system costs by $1,270,462 in 5 years.ConclusionIn Iranian settings, CA can significantly increase the quality of life and patients’ survival; therefore, in comparison to the Col drug regimen, CA is a cost-effective strategy.

Iran's Health after A Hundred Years: Snapshots of the Beginning and End of the Solar Hijri Century.

The Article Abstract is not available.

Identifying flood response experiences in Iranian health system: A qualitative study

AbstractOne of the most essential purposes of the health system is to ensure that people affected by various disastrous events, such as floods, have access timely to basic health services. Therefore, enhancing the preparedness and response plans for such events should be a national priority. Because of the complexity and devastating impacts of floods on public health, it is a crucial to understand the various aspects of flood experience in the country. The experiences of managers and operational staff from various units of the Iranian health system are a valuable source for understanding flood complexities. These experiences were explored using 19 semi‐structured interviews with people who had firsthand experience of this phenomenon. Based on the results, in order to provide a flood response plan, it is necessary to adhere to the principles and foundations that can meet the needs arising from the flood. Our study showed that the health system's response to flooding can be divided into two categories: initial and specific functions. A comprehensive response requires an initial function to prevent flood impacts, and specific functions are needed to prevent and treat flood‐related diseases. These results could form the basis for the health system's response to future floods.

Factors Influencing Iranian Women's Participation in Breast Cancer Screening Programs: A Systematic Review

Background: Breast cancer screening programs are one of the most important methods for the early detection of breast cancer in women. Several studies have been conducted to identify factors affecting breast cancer screening behaviors among Iranian women. This study is conducted to systematically review the factors influencing women’s participation in breast cancer screening programs in Iran.&#x0D; Methods: Papers were collected by using the keywords breast, mammary, screening, early detection, diagnosis*, examination, testing, and Iran from various English-language databases, including PubMed, Scopus, Web of Science, and databases in Persian language including SID and Magiran. The search was limited to the title and abstract of papers published between January 1, 2000, and May 1, 2021. A narrative synthesis was performed to summarize findings of the obtained papers.&#x0D; Results: In this study, 1345 papers were initially found and, after screening the title, abstract, and full-text, 39 papers were selected. Most of them were cross-sectional (n= 28). Results indicated that socioeconomic factors, individual characteristics, recommendation of health workers, knowledge, Islamic beliefs, support by family, and activities of the Iranian government are frequently mentioned as contributing factors and can be applied to increase participation of Iranian women in breast cancer screening.&#x0D; Conclusion: The results demonstrate that lack of knowledge and a positive attitude towards breast cancer screening is a major problem regarding Iranian women's non-participation in the screening programs. Therefore, the need for regular implementation of the national screening program in the country, providing appropriate educational methods to increase women's awareness, removing barriers and improving women's access to health care providers should be the priorities of the Iranian health system to prevent breast cancer.

A qualitative evaluation of the challenges in management for patients with chronic diseases during disasters in Iran.

Iran's health care system faces significant challenges in managing the growing burden of non-communicable diseases, and these are exacerbated during the frequent natural disasters. The current study was designed to understand challenges in providing healthcare services to patients with diabetes and chronic respiratory diseases during such crisis periods. The conventional content analysis was used in this qualitative study. Participants included 46 patients with diabetes and chronic respiratory diseases, and 36 stakeholders with knowledge and experience in disasters. Data collection was carried out employing semi-structured interviews. Data analysis was performed using Graneheim and Lundman method. Four major challenges in providing care to patients with diabetes and chronic respiratory diseases during natural disasters include integrated management, physical, psychosocial health, health literacy and the behavior and barriers to healthcare delivery. Developing countermeasures against medical monitoring system shutdown in order to detect medical needs and problems faced by chronic disease patients including those with diabetes and chronic obstructive pulmonary disease (COPD), is essential in preparedness for future disasters. Developing effective solutions may result in improved preparedness and better planning of diabetic and COPD patients for disasters.

Design and Evaluation of the Internal Structure of Beliefs Affecting the Online Health Information Seeking Behavior Questionnaire among University Students

Background: Due to the fact that in the Iranian health information seeking literature, a questionnaire to examine the factors affecting the online health information seeking behavior of students and their health beliefs, was not found, the present study designed a questionnaire for this purpose, and approved its validity and reliability using exploratory and confirmatory factors analysis. Materials and Methods: The statistical population of the present study consisted of all students studying in all educational levels in public and private universities of Ahvaz during year 2019, the total number of which was 46054 people. According to Cochran's formula, 600 students were selected for the research sample. The instrument used in the present study was a questionnaire. The questionnaire was a combination of 36-item questionnaire base on Mo, Sheen and Cohen and Deng, Liu and Hinz research questionnaires. The validity of the questionnaire was assessed by three methods: the use of scientific articles, factor analysis and its reliability calculated by use of Cronbach's alpha coefficient. Data analysis was performed using SPSS and LISREL software. Results: By performing explanatory factor analysis, the variables affecting online search for health information were categorized and renamed into ten factors: Trust in quality and efficiency, Useful intention, Self-efficacy, Cognitive values, Perceived severity, Perceived anxiety, Perceived sensitivity, Perceived barriers, Individual health beliefs, and Social values. Then these factors were investigated using confirmatory factor analysis. Conclusion: Examination of the standardized coefficients in the obtained structural model showed that almost all factor loads have the desired value.

Epidemiologic Aspects of Animal Bite, Rabies, and Predictors of Delay in Post-exposure Prophylaxis: A National Registry-based Study in Iran.

The increasing trend in animal bites and rabies in recent years makes the disease a public health concern in Iran. The objectives of the current study were to investigate the epidemiologic aspects of the animal bite and determine the associated risk factors of the delay in initiation of post-exposure prophylaxis (PEP) against rabies in Iran. National registry-based cross-sectional study. This study included all registered cases of animal bites between March 2021 and March 2022 at the Ministry of Health and Medical Education in Iran. We retrieved epidemiologic data on person, time, place, and PEP outcome. A total of 260470 animal bite cases (approximately 334 per 100000 populations, and 11 deaths) were registered during the study period. About 77.2% of them were reported in males, 4.3% in children aged less than 5 years, 56.4% occurred in urban areas, 98% in domestic animals, and mostly in north and northeast areas of Iran. Additionally, 2.8% of cases had a delay of more than 48 hours in the initiation of PEP. Significant determinants of the increase in delay were female gender (OR=1.43, 95% CI: 1.36, 1.51, P<0.001), foreign nationality (OR=1.19, 95% CI: 1.01, 1.12, P=0.001), rural residence (OR=1.07, 95% CI: 1.01, 1.12, P=0.010), and the wild animals (OR=1.22, 95% CI: 1.12, 1.34, P<0.001). The observed frequency of animal bites in a year indicates a serious public health concern and the need for targeted interventions, especially in at-risk areas and vulnerable populations.

National and Subnational Incidence Trend of Bladder Cancer in Iran: Report of a 12-Year Period

Background: Bladder cancer is one of the most common cancers worldwide and also in Iran. Understanding of bladder cancer epidemiology is of great value for policymakers and assists in the prevention and early detection of the disease. Objectives: The aim of the present study was to report national and subnational incidence trends of bladder cancer in Iran between 2003 and 2015. Methods: This study investigated the age-standardized incidence rates (ASIRs) per annum of bladder cancer from 2003 to 2015 in Iran using the data from the cancer registration system of the Ministry of Health and Medical Education of Iran. The crude incidence rates were calculated by dividing incident cases by the country and province population, which were provided by the Statistic Center of Iran. Age standardization was performed using the WHO standard population, and ASIRs were compared by age, sex, and province. Results: The ASIR of bladder cancer increased from 8.35 in 2003 to 13.57 in 2015 in men. The ASIR of bladder cancer also showed a mild increase in females, 2.12 in 2003 versus 2.86 in 2015. The province of Yazd had the highest rate of bladder cancer in men, and West Azerbaijan had the highest rate for women (15.13 and 7.79 per 100,000), while Sistan va Baluchestan and Ilam had the lowest ASIRs for men and women (3.01 and 0.96 per 100,000, respectively). Conclusions: The increasing trend of bladder cancer incidence in Iran, despite the clear decreasing global trend accompanying to ongoing aging of the population highlights the diseases as a potential health problem in the upcoming years in Iran. Therefore, it is necessary for health organizations to implement effective research and control programs in the country to prevent further increases in disease burden.

Identification and Prioritization of Required Managerial Competencies for Healthcare Management Graduates in Iran Health System

Background. Students and graduates in the field of health management will be future managers of the health field. Improving the skills of health system managers as one of the main pillars of health service organizations is essential to meet the health needs of the community. Therefore, this study aimed to identify and prioritize the key skills required by healthcare management graduates as future managers of the health system. Methods. This study was performed in three steps using the method of content analysis, Delphi, and factor analysis. In the first step, a semi-structured and interactive in-depth interview was used to determine the skills required for managerial jobs in the health system, and the data were analyzed based on the content analysis method. The sample size was 14 health experts. In the second step, a Delphi study was designed to build consensus on skills. The participants scored 44 skills extracted from the interviews through a three-point Likert scale from disagree to agree (from 1 to 3), then the skills were divided into several component groups through factor analysis. Results. In this study, 44 key skills needed by managers and graduated students in the field of health service management were identified in 10 components. Conclusion. Costs and resources allocated to the training of health service management graduated students should be based on the need of the labor market and workspace.

Is Neighborhood With a Steel Factory Associated With Cardiovascular Disease Risk Factors?

Background and aims: Staying adjacent to steel plants may raise the chance of cardiovascular disease (CVD) risk factors for their inhabitants. The present study aimed to compare some CVD risk factors in the residents of a city adjacent to the steel plant as the exposed city in comparison with the residents of a control city in the Isfahan province. Methods: In a cross-sectional study in 2021, the data related to the prevalence rate of hypertension (HTN), diabetes mellitus (DM), Hyperlipidemia, overweight, and obesity were collected in the over 30 years old inhabitants who were living in Chamgordan as the exposed city and Ferydounshahr as the control city and underwent cardiovascular risk assessment. The data were gathered from the Iranian electronic health file system by the census sampling method. Results: Among the more than 30 years old population who stayed in the exposed and the control cities, the prevalence rates of CVD risk factors were as HTN (20.53% and 16.54%), DM (10.32% and 7.13%), and overweight and obesity (32.55% and 27.07%), respectively. There were no significant statistical differences between the exposed and control cities regarding HTN (P=0.471), DM (P=0.447), and overweight and obesity (P=0.355). However, hyperlipidemia was significantly more prevalent in the exposed city by 11.53% in comparison with 0.45% in the control city (P=0.001). Conclusion: Except for hyperlipidemia, there was no significant statistical difference in the prevalence rates of HTN, DM, overweight, and obesity between the exposed and the control cities.

Proposing a Novel Data-Driven Optimization Methodology to Calculate the Insurance Premium in the Iranian Health Insurance Industry

ABSTRACT This study aims to manage the two most common and critical disruptions of Iranian health insurance (declining market share and errors in predicting the indemnities) by proposing a novel data-driven methodology for calculating its insurance premium. Here, using the optimal machine learning algorithm selected using a Bayesian best-worst method, insurers are classified based on their preparedness for causing disruptions. Then, the indemnity of each group of insureds is predicted. Finally, the appropriate premium for each group of insureds is calculated separately using a new mathematical optimization model. The results of our real-life case study guarantee the insurer’s profitability and reduction of its bankruptcy risk even by announcing lower premiums.

Upfront DPYD Genotype-Guided Treatment for Fluoropyrimidine-Based Chemotherapy in Advanced and Metastatic Colorectal Cancer: A Cost-Effectiveness Analysis

ObjectivesFluoropyrimidines are the most widely used chemotherapy drugs for advanced and metastatic colorectal cancer (CRC). Individuals with certain DPYD gene variants are exposed to an increased risk of severe fluoropyrimidine-related toxicities. This study aimed to evaluate the cost-effectiveness of preemptive DPYD genotyping to guide fluoropyrimidine therapy in patients with advanced or metastatic CRC. MethodsOverall survival of DPYD wild-type patients who received a standard dose and variant carriers treated with a reduced dose were analyzed by parametric survival models. A decision tree and a partitioned survival analysis model with a lifetime horizon were designed, taking the Iranian healthcare perspective. Input parameters were extracted from the literature or expert opinion. To address parameter uncertainty, scenario and sensitivity analyses were also performed. ResultsCompared with no screening, the genotype-guided treatment strategy was cost-saving ($41.7). Nevertheless, due to a possible reduction in the survival of patients receiving reduced-dose regimens, it was associated with fewer quality-adjusted life-years (9.45 vs 9.28). In sensitivity analyses, the prevalence of DPYD variants had the most significant impact on the incremental cost-effectiveness ratio. The genotyping strategy would remain cost-saving, as long as the genotyping cost is < $49 per test. In a scenario in which we assumed equal efficacy for the 2 strategies, genotyping was the dominant strategy, associated with less costs (∼$1) and more quality-adjusted life-years (0.1292). ConclusionsDPYD genotyping to guide fluoropyrimidine treatment in patients with advanced or metastatic CRC is cost-saving from the perspective of the Iranian health system.

Popular diffusion as an instrument for overcoming barriers to digital health in Iran: the critical role of the pandemic

PurposeThe importance of champion leaders including tech-savvy leaders to digital government has been highlighted in the literature. Meanwhile, what was in the authors’ interest to explore was the role of business-savvy leaders or non-governmental digital champions as units of analysis, those who mobilized people's interest in digitalization and bypassed governmental barriers through this popular mobilization. They could be considered policy entrepreneurs for understanding policy change in the digitalization of the health sector. This study sought to shed light on the barriers and drivers of digital health in Iran.Design/methodology/approachThe researchers conducted interviews with actors of digital health businesses in Iran, including the Health Information Technology Center affiliated to the Ministry of Health and Medical Education (MOHME) administrative body and authorities, private companies active in digital health and health service providers. The purposive sampling method was applied, and 15 experts with relevant and valuable experiences as well as maximum variation to obtain representativeness and rich data were interviewed. Trustworthiness criteria were also used to assure the quality of the results. The data were analyzed based on directed content analysis using the MAXQDA10 software.FindingsIt was found out how popular diffusion was effective to overcome barriers to health digitalization. Access to the internet and diffusion of information technology helped the net-enabled businesses to connect directly to people and provide services to them. Diffusion of these services forced the public sector to adjust itself, and thus MOHME banned digital consultation services because of the so-called “insecure and unknown physicians”, following the increased popularity of digital services diffusion, but they were not able to resist popular diffusion of new technology. Hence, it was allowed to work. The main barriers to telemedicine spreading in Iran have been divided into five main categories including government incapacity for digital health governance, conflict of interest, professional obligations for information transparency, protection of patients' rights and data security and privacy.Originality/valueAs a game changer in digital health governance in Iran, popular diffusion will determine the future of digital health. To the best of the authors’ knowledge, this study is among the first ones to explore digital health governance in relation to the private digital health business in Iran with a public policy approach.