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Objectives The impact of population aging on health expenditure is inevitable. It affects health expenditure by causing changes in people’s health status and the demand for health care services. In this study, we aim to investigate the age-related and gender-related differences in hospital admission rate, length of stay, and hospital costs of people in Iran. Methods & Materials This is a quantitative, descriptive-analytical study with a cross-sectional design conducted on data of 41 million Iranian people covered by the Iran Health Insurance Organization in 2020. Hospital admission rate, length of stay, and hospital costs were dependent variables. Hospital costs included insurance payments, patients’ out-of-pocket spending, and government subsidies. Age and sex of the patients, ownership of the hospital, type of patients’ medical files were descriptive variables. The Mann-Whitney U test was used to compare hospital costs between elderly (>60 years of age) and non-elderly (

Introduction: Prevention of heat-related diseases requires the participation of the workers. For this reason, the aim of this study was the development and validation of the tools for evaluating awareness and practice related to heat stress among the workers of warm workplaces. Material and Methods: The various items and factors related to the awareness and practice of the workers were identified by the literature review. Then, several questions for evaluating these items were designed. In the next step, the reliability and validity of the questionnaires were appraised using calculating the content validity ratio (CVR) and content validity index (CVI), and Cronbach’s alpha coefficient, respectively. After that, these questionnaires were completed by 2338 employees of six industries in various regions of Iran. Finally, collected data were analyzed using SPSS software. Results: In total, 77 questions, including 53 questions on awareness and 24 questions on practice in six groups of water and beverages, food, snacks and additives, heat exchange, thermal strain risk factors, clothing and heat protection equipment, and heat-related disorders and body reactions, were designed. The values of content validity index (CVI) of remained questions in the questionnaires of awareness and practice were equal to 0.954 and 0.824, respectively. The values of Cronbach’s alpha coefficients of these questionnaires were calculated by 0.755 and 0.716, respectively. The values of the chi-square divided by degrees of freedom (CMIN/DF) and root mean square error of approximation (RMSEA) in the construction of the awareness questionnaire were computed as 4.58 and 0.079, respectively. These values in the construction of the practice questionnaire were calculated by 2.33 and 0.084, respectively. Conclusion: The results showed that the designed questionnaires had appropriate reliability and validity and could be used to evaluate the awareness and practice in warm workplaces.

Objectives: Considering the rapid growth of Iran’s elderly population with consequent increase in the costs of health services, it is necessary to be aware of the pattern of outpatient health service utilization, in the elderly for resource allocation and health planning. This study aims to determine the pattern of outpatient service utilization for the elderly in Iran and explore determinant factors. Methods & Materials: This is a cross-sectional study using secondary analysis method and the data from 2015 National Study of Health Service Utilization. Study population consists of older people aged ≥60 years. Of these, 8205 were selected as study samples. The data were collected using personal and household questionnaires collecting information on subjects’ need for, referral to, utilization from, and satisfaction with outpatient services. Logistic regression analysis was used to identify factors related to the need, referral, benefit, and satisfaction with the received outpatient services. Results: Out of 8205 participants, 3172 (39%) reported the need for outpatient services, of which 66% referred for services; of these, 98% (N=2060) benefited outpatient services. Females, older subjects, villagers, unmarried and illiterate subjects were more in need of outpatient services, but their referrals to receive the services were not more than those of other groups. Lack of basic insurance, supplementary insurance, and a personal care had a significant impact on reducing the number of subjects referred to receive outpatient services. Inability to pay treatment costs (30%), self-treatment (28%) and lack of proper insurance coverage (13%) were the most important reasons for not referring to receive outpatient services. The highest satisfaction was related to the behavior of physicians and medical staff and the lowest satisfaction was related to the cost of outpatient services. Conclusion: Although the use of outpatient health services should be based on the need for these services, the present study showed that the older people with higher socio-economic status had higher utilization from the services in Iran. Therefore, there is an inequality in access to outpatient services in the elderly. The reasons for not using outpatient services and dissatisfaction with these services should be seriously considered by health policy makers.

Background and Objective: Cardiovascular diseases are a main reason of disability and death around the world. Evidence suggests that many social and individual-based health-related factors are changeable and modifiable. The aim of this study was to evaluate the effect of a theory-based intervention based on the health belief model on health-promoting lifestyle behaviors in individuals susceptible to cardiovascular diseases. Materials and Methods: In this quasi-experiment, we recruited 180 individuals having at least two risk factors out of five cardiovascular risk factors, including smoking, diabetes, hypertension, high cholesterol, and obesity. Data were gathered in three phases (before, immediately after, and five months after implementing the intervention) using the health-promoting lifestyle questionnaire (HPLQ), general health questionnaire (GHQ), and a designed questionnaire to measure the health belief model constructs. The intervention included five training sessions based on the health belief model. Data were analyzed using the statistical tests in the SPSS. Results: Findings showed that the theory-based educational intervention was effective in improving some domains of lifestyle, including nutrition, physical activity, interpersonal relationships, stress management and health accountability. Also, the mean blood pressure and the mean tobacco use showed a significant decrease in the intervention group after the intervention. Educational intervention also led to improvements in health belief model constructs including perceived susceptibility, perceived severity and perceived benefits (P

Background and purpose: Some skin injuries are caused by occupational skin exposures that are resulted from production of reactive oxygen species and oxidative stress (ROS). Thus, protecting the skin is a key issue. Recently, several surveys have introduced novel alternatives such as nanofibers for skin protection. In this research, Poly (ε-caprolactone) (PCL)/gelatin (Gt)/ Vitamin E (VE) was investigated as a nanofiber antioxidant protective layer in occupational skin exposures. Materials and methods: Vitamin E was combined with PCL/Gt nanofiber mats by electrospinning method. The diameter of nanofibers and chemical characteristics were determined using scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR). Adhesion characteristics and proliferation of human dermal fibroblast cells (HDFC) on nanofibers were analyzed by Methylthiazol Tetrazolium (MTT) assay. Finally, we studied the application of PCL/Gt/VE nanofibers against oxidation stress induced by tert-butyl hydroperoxide (t-BHP). Results: With increase in Vitamin E levels, the PCL/Gt/VE nanofibers were found to be thiner. The culture of HDF cells on nanofibers showed that adding Vitamin E to PCL/Gt mats caused increased attachment and proliferation of the cells. PCL/Gt/VE nanofibers significantly assisted human skin cells against ROS (P< 0.001). Conclusion: According to current study, PCL/Gt/VE nanofibers could be an appropriate candidate for protecting skin against ROS as a novel method to maintain workers’ health.

Background: People with limited health literacy show a low level of health promoting behaviors. This study is performed aiming to determine relationship between health literacy status and health promoting behaviors among female high school students in Tehran, Iran, in 2018. Methods: This descriptive-analytic study was conducted on 370 people using cluster sampling method. Data were collected through demographic and background questionnaires, Health Literacy Measure for Adolescents (HELMA), and Health Promoting Lifestyle Profile II (HPLP-II) and analyzed using descriptive and analytical tests in SPSS software. Findings: The mean scores of health promotion behaviors and health literacy were 57.54 ± 11.24 (moderate) and 59.92 ± 12.87 (inadequate), respectively. The highest mean scores of health promotion behavior and health literacy dimensions were stress control (65.55) and perception (74.15) and the lowest mean scores were health responsibility (50.18) and calculation (43.69), respectively. There was a direct and significant relationship between health literacy and health promotion behaviors (r = 0.43, P < 0.001) with the study of magazines and the interest in health issues. However, the relationship between the use of the Internet and the evaluation of the health status with these dimensions was inverse and significant. There was an inverse relationship between the health promoting behaviors with educational stage (r = -0.35, P < 0.001) and age (r = -0.31 , P < 0.001), and a significant relationship with the field of study (r = 0.30, P < 0.001). Conclusion: According to the study results, it is necessary to develop curriculum for promoting these behaviors and increase the health literacy in cyberspace.

Background: equality in access of health care services is one of the most important goals of Health system .In this study, we provided a description of the distribution of Otorhinolaryngology Head & neck surgery specialists in the Provinces of Iran in 2017. Materials & Methods: This descriptive-analytical study was conducted in 2017 to describe the distribution of Otorhinolaryngology Head & neck surgery specialists in the Provinces of Iran in 2017. Data were gathered through Ministry of Health and Statistical Center of Iran. Gini Coefficient, Concentration Curve ,Multiple Regression and Geographic Maps used by Microsoft R Version 3-6-0 for data analysis. Results: The highest and lowest ratio of Otorhinolaryngology Head & neck surgery specialists per population in the year 2017 was reported in Tehran (2.31 per 100,000 populations) and Hormozgan (0.39 per 100,000 populations). Conclusion: There was a considerable disparity between different regions of the country in terms of access to Otorhinolaryngology specialists.

Background: Identifying determinants of maternal mortality is essential in developing appropriate health policies for reduction of maternal death. This study aimed to determine the determinants of maternal mortality in Iran during 1990- 2015 and also to identify the trends of these determinants during the same period. Methods: This is a quantitative longitudinal study that has been conducted at the Tehran University of Medical Science, Iran, from March to December 2018. Initially, a long list of determinants (n=32) were identified through a comprehensive systematic reviews. Variables with more than 25% missing data were omitted and the missing values for remaining variables were estimated through statistical methods. The data for the identified variables were gathered through internal sources including Iran’s Ministry of Health and international sources including the websites of World Bank, World Health Organization and United Nations. Finally, 12 indicators as determinants of death were constructed after data processing and data management and their associations with maternal mortality rate in Iran were examined through regression analysis. Results: Maternal mortality rate has been reduced by 80% during 1990- 2015 in Iran. Improvement of indicators including employment status, total health expenditure share (as a percent of GDP), vaccination coverage, urbanization, access to health and welfare facilities, GDP per capita and political performance played a significant role in reduction of maternal deaths according to the multivariate analyses. A reduction in out of pocket payment and total fertility rate also showed a significant association with lower maternal mortality. However neither education level in the country nor life expectancy at birth showed an important role in the maternal mortality rate. Conclusion: Maternal mortality rate was reduced significantly in Iran during the last quarter of the century. Maternal death is not only affected by health and biological factors of mothers, but also, by macro-economic, social and welfare factors. A high political performance of the countries also is a grantor of better health of mothers and the community in general.

Introduction: Current study with aims to investigate the effect of educational programs on citizenship based on the theory of planned action on Asadabad high schools girls. Method: In this quasi-experimental study, three schools were randomly selected from girls’ high schools in Asadabad city. One of these schools was randomly selected as an intervention group (80 students) and the two other schools were chosen as control group (120 students). The research instrument is a researcher-made questionnaire containing 67 questions. The educational program was conducted using the methods of lecture, group interaction, question and answer in 10 to 12 hours of direct verbal education, and guided learning activities using the educational resources. The post test was performed 3 times before the intervention, 1 month and 6 months after the training. Results: The results of the study showed that in the experimental group the students’ level of knowledge (7.44+2.00) and attitude (74.19+7.14), subjective norms (22.33+4.41), behavioral intention (18.44+2.69) and perceived behavioral control (17.98+2.71) were relatively low in the pre-test. The first post-test revealed an increase in the level of knowledge (11.17+1.72) as well as the attitude (80.21+5.42). Also, the subjective norms (25.48+3.64), the behavioral intention (21.08+3.04) and perceived behavioral control (20.77+3.04) had significantly increased as compared to the pre-test. Discussion and Conclusion: Based on the results of the study, educational intervention based on rational action theory has been effective in promoting citizenship behavior, and the results of the present study emphasize the necessity of the education on citizenship in school schedules.

Introduction: Anesthetic gases used in hospitals include N2O and halogenated hydrocarbons (such as sevoflurane) which can be released through leakages and uncontrolled exhalation by the patient into the ambient air of clinical staff. These gases have greenhouse effect and damage to the ozone layer and serious risks such as reproductive, preterm delivery and fetal abnormalities and increased spontaneous abortion on the health of operating room personnel. Therefore, removal of these gases from the workplaces is essential especially in the treatment centers. The purpose of the present study was to investigate the adsorption of sevoflurane from air by using activated Charcoal and also the effect of acid modification on its performance. Material and Method: In this study, two adsorbents of unmodified and modified activated charcoal with nitric acid were used to remove sevoflurane. After preparation, the adsorbents were characterized using XRD, FT-IR, BET and FE-SEM methods. After characterization, the breakthrough and adsorption capacity of sevoflurane on both adsorbents were determined using the modified wheeler equation. Result: The results of characterization showed that acid modification did not affect the crystalline structure of activated charcoal and increased the adsorption and microporous of acid-modified activated charcoal in comparison with unmodified activated charcoal. It also reduces surface functional groups of the activated carbon. The results of determination of adsorption capacity indicated that the adsorption capacity of modified activated charcoal was improved in comparison with unmodified activated charcoal. Conclusion: The results demonstrated that both adsorbents have the ability to absorb sevoflurane and modified activated charcoal have a better performance in this process. This effect may be due to the surface area of adsorption and volume of micro pores more than the unmodified activated charcoal.

Introduction: The Surgical Safety Checklist has been introduced by the World Health Organization (WHO) as a tool for reducing medical errors. Reviewing the results of the checklist application indicates significant reduction in mortality and complications in surgery. Thus, this study aimed to customize and validate surgical safety checklist in order to complying with the surgical protocol in Iran. Material and Method: In this cross-sectional and descriptive study, the WHO Safety Surgery Checklist was first translated. Next, through interviews with specialists and direct observation of activities, those tasks that were susceptible to the incident, identified, prioritized and analyzed using Hierarchical Task Analysis (HTA) and the results presented in form of HTA charts. Then, using Tabulate Task Analysis (TTA) and based on the recommendation and modification commented by expert panel, some questions added to the checklist and a customized version of the Surgical Safety Checklist was provided. Hence, the faced validity, content validity and reliability of the checklist have been evaluated. Result: In the surgery, four major tasks identified for analyzing using the HTA chart. Accordingly, 41 subtasks obtained and analyzed by TTA. The Lavashe method was used to determine the content validity ratio (CVR) and the content validity index (CVI). The question from the checklist, in which, CVI was less than 0.79, modified and replaced with appropriate question. Also, the scores for 3 questions were less than 0.49, and they were removed from the checklist due to the low CVR score. In the reliability assessment, the intra-observer method is used, and the Kappa coefficient obtained was acceptable and it was higher than 0.6, which confirmed the validity of the checklist. Conclusion: In this study, the surgical safety checklist customized in terms of content validity and reliability, in a field study. Considering the compliance of the checklist items with the surgical protocol in Iran, we hope to use it to improve the quality of teamwork and reduce the complications and mortality caused by surgical errors

Objective (s): Physical inactivity is one of the biggest public health concerns. Due to various reasons such as pregnancy, women are more at risk of physical inactivity. This study performed to determine the influence of an educational intervention on promoting postpartum physical activity based on BAZNEF model, among women referred to health centers. Methods: This was a quasi-experimental study which conducted on 168 women referred to health centers during six weeks to one year after delivery. Samples divided in two groups; intervention and control by using a random allocation. Data collected by BASNEF questionnaire and International Physical Activity Questionnaire(IPAQ).. The educational intervention was designed in four sessions. Control group received no intervention except postpartum routine care. Three months after intervention, the questionnaire was completed again in two groups. Results: Pretest results revealed no significant differences in demographic characteristics and BASNEF model constructs in both groups (p>0/05). However, after intervention there was a significant differences between two groups in terms of BASNEF model including knowledge, attitude, normative believes, enabling factors and intention (P

Background: Use of laparoscopy in gynecologic surgeries, including adnexal masses, has increased in recent years. The present research intended to study the role of laparoscopy in adnexal masses surgery. Methods: The algorithm for the use and role of laparoscopy in adnexal masses surgery was designed via using first, the model of Ovarian Malignancy Prediction Score (OMPS1) according to findings related to age and ultrasound with high sensitivity and then, the model of OMPS2 (a more specific model). Findings: In case, the surgeon possesses the skill for the level three of laparoscopy, the patients with OMPS1 of less than 2.3 (rule out of malignancy) may undergo laparoscopy. As concerns other cases, provided that frozen section is available, surgery starts with laparoscopy and shall continue up to the end with complete staging, in case the surgeon possesses the skill for the level four of laparoscopy. Conclusion: In adnexal masses surgery, management of the patients is determined via using frozen section and on the basis of the clinical guideline and this method may be used depending on the skill the surgeon possesses for laparoscopy.