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Published Erratum. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050. Lancet. 2021 Sep 11;398(10304):956. doi: 10.1016/S0140-6736(21)01806-7. PMID: 34509230. BACKGROUND: Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. METHODS: We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health. FINDINGS: Between 1995 and 2016, health spending grew at a rate of 4·00% (95% uncertainty interval 3·89-4·12) annually, although it grew slower in per capita terms (2·72% [2·61-2·84]) and increased by less than $1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5·55% [5·18-5·95]), mainly due to growth in government health spending, and in lower-middle-income countries (3·71% [3·10-4·34]), mainly from DAH. Health spending globally reached $8·0 trillion (7·8-8·1) in 2016 (comprising 8·6% [8·4-8·7] of the global economy and $10·3 trillion [10·1-10·6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$5252 (5184-5319) in high-income countries, $491 (461-524) in upper-middle-income countries, $81 (74-89) in lower-middle-income countries, and $40 (38-43) in low-income countries. In 2016, 0·4% (0·3-0·4) of health spending globally was in low-income countries, despite these countries comprising 10·0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($9·5 billion, 24·3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6·27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($644·7 million in 2018). Globally, health spending is projected to increase to $15·0 trillion (14·0-16·0) by 2050 (reaching 9·4% [7·6-11·3] of the global economy and $21·3 trillion [19·8-23·1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1·84% (1·68-2·02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0·6% (0·6-0·7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15·7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130·2 (122·9-136·9) in 2016 and is projected to remain at similar levels in 2050 (125·9 [113·7-138·1]). The decomposition analysis identified governments' increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending. INTERPRETATION: Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets. FUNDING: Bill & Melinda Gates Foundation. Bill & Melinda Gates Foundation Sí

Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. The Lancet Publishing Group

The associations between socioeconomic status (SES) and tobacco use, alcohol consumption and drug use are poorly understood in the Islamic Republic of Iran.To measure education- and wealth-related inequalities in cigarette smoking, hookah smoking, illicit drug use and alcohol consumption in Kermanshah Province, Islamic Republic of Iran.We used baseline data from the Ravansar Noncommunicable Disease (RaNCD) study. The study collected information on socioeconomic and demographic characteristics, cigarette and hookah smoking, alcohol consumption and illicit drug use of 10 015 adults aged ≥ 35 years between 2014 and 2016. The relative concentration index and absolute concentration index were used to measure education- and wealth-related inequalities in cigarette smoking, hookah smoking, illicit drug use and alcohol consumption.Cigarette smoking was concentrated among less-educated and less-wealthy men and women. Similarly, illicit drug use was concentrated among lower-SES men. In contrast, hookah smoking and alcohol consumption were more prevalent among higher-SES men.There were education- and wealth-related inequalities in tobacco, alcohol and illicit drug use in the west of the Republic of Iran. Future studies should aim to identify the main socioeconomic determinants of these inequalities in Kermanshah Province and generally in the Islamic Republic of Iran.ارتباط تعاطي التبغ والمُسكرات وتعاطي المخدِّرات غير المشروع بتفاوت الحالة الاجتماعية الاقتصادية: بيّنات من الأكراد الإيرانيين.فريد نجفي، محمد حجيزاده، يحيى باسدار، يحيى سليمي، بهروز حمزة، بهزاد كرامي ماتين، بختيار بيروزي، ستار رضايي.ثَمَّة عدم فهم جيد للروابط بين الحالة الاجتماعية الاقتصادية وتعاطي التبغ والمُسكرات والمخدِّرات في جمهورية إيران الإسلامية.قياس أوجه التفاوت في التعليم والثروة فيما يتعلق بتدخين السجائر، وتدخين النرجيلة، وتعاطي المخدِّرات غير المشروع، وتعاطي المُسكرات في محافظة كرمانشاه بجمهورية إيران الإسلامية.استخدمنا البيانات المرجعية المُستمَدة من دراسة رافانسار للأمراض غير السارية. وجمعت الدراسة معلوماتٍ عن الخصائص الاجتماعية الاقتصادية والديموغرافية، وتدخين السجائر والنرجيلة، وتعاطي المُسكرات وتعاطي المخدِّرات غير المشروع لدى 10015 بالغاً عُمر كلٍّ منهم 35 عاماً في الفترة بين عامَيْ 2014 و2016. واستُخدم كلٌ من مؤشر التركيز النسبي ومؤشر التركيز المُطلَق لقياس أوجه التفاوت في التعليم والثروة فيما يتعلق بتدخين السجائر، وتدخين النرجيلة، وتعاطي المخدِّرات غير المشروع، وتعاطي المُسكرات.يتركَّز تدخين السجائر بين الرجال والنساء الحاصلين على قدرٍ متدنٍ من التعليم والأقل ثراءً. وبالمثل، يتركَّز تعاطي المخدِّرات غير المشروع بين الرجال ذوي الحالة الاجتماعية الاقتصادية المتدنية. وعلى النقيض من ذلك، كان تدخين النرجيلة وتعاطي المُسكرات أكثر انتشاراً بين الرجال الذين يتمتعون بحالة اجتماعية اقتصادية رفيعة.ثَمَّة أوجه تفاوت في التعليم والثروة فيما يتعلق بتعاطي التبغ والمُسكرات وتعاطي المخدِّرات غير المشروع في غرب جمهورية إيران. وينبغي أن تهدف الدراسات المستقبلية إلى الوقوف على المُحدّدات الاجتماعية الاقتصادية الرئيسية لهذه التفاوتات في محافظة كرمانشاه، وبصفةٍ عامة في جمهورية إيران الإسلامية.Inégalités socio‐économiques en matière de tabagisme, de consommation d’alcool et de drogues illicites : témoignages des Kurdes iraniens.Les associations entre le statut socio-économique et la consommation de tabac, d’alcool et de drogues sont mal comprises en République islamique d’Iran.La présente étude avait pour objectif de mesurer les inégalités en matière d’éducation et de niveau de vie liées au tabagisme par cigarette, à l’usage de la houka, à la consommation de drogues illicites et d’alcool dans la province de Kermanshah, en République islamique d’Iran.Nous avons utilisé les données de référence de l’étude menée à Ravansar sur les maladies non transmissibles. L’étude a permis de recueillir des informations sur les caractéristiques socio-économiques et démographiques, le tabagisme par cigarette et l’utilisation de la houka, la consommation d’alcool et de drogues illicites chez 10 015 adultes âgés de 35 ans et plus entre 2014 et 2016. L’indice de concentration relative et l’indice de concentration absolue ont été utilisés pour mesurer les inégalités en matière d’éducation et de niveau de vie liées au tabagisme par cigarette, à l’utilisation de la houka et à la consommation de drogues illicites et d’alcool.Le tabagisme par cigarette concernait principalement les hommes et les femmes moins instruits et moins aisés. De même, la consommation de drogues illicites concernait essentiellement les hommes présentant un statut socio-économique plus faible. Par contre, l’utilisation de la houka et la consommation d’alcool étaient plus fréquentes chez les hommes dont le statut socio-économique était plus élevé.Il existe des inégalités liées à l’éducation et au niveau de vie en matière de consommation de tabac, d’alcool et de drogues illicites dans l’ouest de la République islamique d’Iran. Les études futures devraient viser à identifier les principaux déterminants socio-économiques de ces inégalités dans la province de Kermanshah et en général en République islamique d’Iran.

BACKGROUND: The study aimed to investigate the associations between life and health satisfaction with health-related quality of life (HRQoL), body mass index (BMI) and chronic disease among people who are covered by health insurance schemes in Tehran city, Iran. METHODS: A cross-sectional study was conducted in Tehran city, Iran, from May to June 2016. A total of 600 people were included in the study using a cluster sampling technique. The questionnaire that used for data collection included demographic and socioeconomic variables, questions about health variables such as chronic disease, weight, height, smoking status, and EQ-5D-3L questionnaire. Two univariate and multivariate regression models performed to examine affecting factors on life and health satisfaction. RESULTS: The univariate regression showed that on average female have 0.22 and 0.69 score lower than males with their life and health satisfaction, respectively. Explanatory variables of gender, age, level of education, and employment status were not significantly associated with life and health satisfaction in multiple regression models. However, marital status was correlated with life satisfaction. Furthermore, HRQoL, BMI and chronic disease and smoking were associated with dependent variables (P < 0.001). CONCLUSIONS: The result showed that there was a strong association between BMI, HRQoL, chronic disease, and life and health satisfaction among participants. Therefore, the Iranian policymakers need to consider these factors on life and health satisfaction of adults and design health-promoting programs to improve health outcomes of them. Further studies should assess the associations between BMI, HRQoL, chronic conditions, and life and health satisfaction among Iranian adults.

Self-esteem is one of the most important psychological determinants. This study aimed to determine the level of self-esteem and its association with academic achievement among students of Kermanshah University of Medical Sciences (KUMS). This cross-sectional study was carried out among 300 students in KUMS in 2016. The sample population was selected using probability proportional-to-size method in all faculties. Participants filled out a self-reporting questionnaire. Data were analyzed using SPSS version 20 with t-test, one-way ANOVA and Pearson correlation statistical tests at 95% significant level. We found that MD students had higher self-esteem (P < 0.017). There was a significant relationship between mother’s education level and self-esteem (P < 0.001). In addition, self-esteem was significantly correlated with academic achievement (r = 0.292). From our results, it appears that planning psychological interventions to increase levels of self-esteem may be useful in promoting academic achievement.

Purpose In Iran, the most common cause of injuries and the second leading cause of deaths are traffic accidents, and those problems impose a substantial financial burden on the society. This study aims to determine traffic accident mortality trends and their epidemiologic characteristics in the Kermanshah province, west of Iran. Methods In a cross sectional study, road traffic fatality data from 2004 to 2013 were analyzed to determine the epidemiological pattern of traffic accident mortality. Trend assessment was performed to ascertain the decreasing or increasing status. Chi-square and one-way analysis of variance (ANOVA) tests, as well as Poisson regression were used to determine the significance of the data in time. Data were analyzed using Excel and statistical package of SPSS version 19. Results Out of 5110 people that died in traffic accidents, 4024 (78.7%) were males. The state of accidents indicated that 404 (43.8%) female pedestrians died as a result of car crashes, and 1330 (41.4%) males died because of car collisions. 1554 (31.9%) deaths happened to pedestrians and 1556 (32.1%) to vehicle drivers, and the rest belonged to vehicle passengers. Head trauma was the cause of death for as much as 3400 (69.9%) cases. Fatal crashes in which pedestrians were involved mostly occurred between the hours 13:00 to 15:00, while the time for vehicle drivers was between 16:00 to 18:00. 2882 people (59.1%) died before reaching to health care facilities. Traffic crash mortality trend for pedestrians follows a linear pattern with a gentle downward slope, but the trend shows various swings when it comes to vehicle drivers. Conclusion The number of traffic crash deaths from 2004 to 2013 indicates a decreasing trend in two groups of road users: vehicle drivers and car occupants. This can be due to some interventions such as modification of traffic rules and enhancement of police control which has been implemented in recent years. Moreover, more attention should be paid to promote the optimal health care services to save the lives of the injured from traffic accidents.

This study aimed to evaluate inequalities in the geographical distribution of human and physical resources in the health sector of Kermanshah province, Islamic Republic of Iran. In a retrospective, cross-sectional study, data from the Statistical Centre of Iran were used to calculate inequality measures (Gini coefficient and index of dissimilarity) over the years 2005-11. The highest Gini coefficient for human resources was observed for pharmacists in 2005 (0.75) and the lowest for paramedics in 2010 and 2011 (0.10). The highest indices of dissimilarity were also for pharmacists in 2005 (29%) and paramedics in 2011 (3%). For physical resources, the highest and lowest Gini coefficients were for rehabilitation centres in 2010 (0.59) and health houses in 2011 (0.12) respectively. Generally, inequalities in the distribution of health care resources were lower at the end of the study period, although there was potential for more equitable distribution of pharmacists, specialists, health houses and beds.

Introduction: During the last few decades, healthcare expenditures (HCEs) have increased significantly in Iran and throughout the world. Understanding the determinants of such increases is essential to health policymakers in finding the best policies to manage healthcare costs. This study aimed to determine the impact of some of the key explanatory variables on household healthcare expenditures across the provinces of Iran. Methods: A panel data econometric model was used to determine the main factors that affected household healthcare expenditures (HHCEs) across the provinces of Iran from March 21, 2006 to February 19, 2013. The data on household healthcare expenditures per capita, number of physicians per 10,000 population, the degree of urbanization, the proportion of the population that was 65 or older, household income per capita, and literacy rate were obtained from the Household Expenditure and Income Survey (HEIS) data in the Statistical Center of Iran. F-Limer and Hausman tests were used to choose the panel data, and Stata V.12 was used to analyze the data. Results: Our findings indicated that income per capita, physicians per 10,000 population, and the degree of urbanization had significant impacts on healthcare expenditures. Also, the results of the study showed the elasticity of income, physicians, urbanization, proportion of the population 65 or older, and the literacy rate were 0.25 (p < 0.002), 0.37 (p < 0.001), 5.01 (p < 0.001), -0.1 (p < 0.73), and -1.02 (p < 0.082), respectively. Conclusion: The results of the study indicated that the income elasticity of healthcare expenditures was less than 1; health expenditures were considered to be a “necessity good” across the provinces of Iran during the period that was studied. In addition, there were some other factors that affected healthcare expenditures that were not considered in the study, such as the advancement of new technology and the costs of dying. However, it is recommended that future research examine the effect of these factors on HCEs in Iran.

Introduction: In recent decades, the development of medical and pharmaceutical science has led to a heavy financial burden on the government, insurance companies, and the general population. Due to the increasing the cost of pharmaceutical products in the Kermanshah Province, policy makers have tried to identify the factors that resulted in the increases. The aim of this study was to determine the main factors that affect the expenditures for pharmaceutical products by urban households in Kermanshah Province, Iran. Methods: This analytical-descriptive study was conducted using time series method. The study population was urban households of Kermanshah Province from 1991 to 2013. The explanatory variables of the log-log model were drug price index (LnDPI), the average income of urban households (LnINC), the number of physicians per 1,000 people (LnPH), and the number of hospital beds per 1,000 people (LnBE).The required data were acquired from the Statistical Center of the Ministry of Health and Medical Education. The unit root was evaluated by the Dickey-Fuller test. Stata v.11 software was used for the statistical analysis. Results: Coefficients of LnDPI and LnPH were 0.97 and 0.77, respectively, and they were statistically significant (p < 0.05). Also, the coefficients of D. LnINC (first difference of LnINC) and LnBE were 0.34 and 1.8, respectively, and both of them were statistically insignificant (p > 0.05). Conclusion: The results showed that drugs are non-elastic and essential for households. It should be noted that the health policy makers in Iran should conduct appropriate planning to ensure both the physical and financial accessibility to drugs by urban households. The development of basic and supplementary health insurance coverage, especially for poor populations and urban areas where there are patients with chronic diseases, can be a suitable solution to reduce barriers to acquiring the required drugs.

Background: Expenditure on healthcare has become a persistent issue of policymaking at both national and international levels. The aim of this study was to investigate the main factors affecting household healthcare expenditures in Kermanshah province by Econometric ARDL model over 20 years (1991-2011). Methods: This retrospective-analytical study investigated the impact of such variables as per capita income, proportion of population aged >65 years, number of physicians and urbanization rate) on healthcare expenditures. These data were obtained from the yearbook of Kermanshah province and Iranian Statistical center (ISC). The data analysis was done by Stata 12 and Microfit 4.1 software. Results: The results showed a positively significant relationships both in short- and long-run, between healthcare expenditures and per capita income, number of physicians and urbanization rate. Also, no significant correlation was observed between the proportion of the population aged 65 years and above and healthcare expenditures both in short-term and long-term. Conclusion: The findings showed the elasticity of income was less than 1 and healthcare was an essential goods in Kermanshah province during the study period. Because the impact of variables could be different in different areas and during the time, the healthcare expenditures and its determinants are suggested to be evaluated over time.

Introduction Althoughthere is a consensus that the economic burden of burn injury is high, but few studies have conducted about cost of burns injury among pediatric in developing countries. We explored the main factors influencing on hospital costs and length of stay (LOS) associated with pediatric burns injury in Kermanshah, Iran. Methods and Material We performed a review ofmedical records from 105 pediatric burn (16 years and younger) admitted to burn center at Imam Khomeini Hospital in Kermanshah, Iran. Univariate and logistic regressions were employed to identify the main factors affecting hospital costs and LOS associated with pediatric burn injury. Also, the data analysis was done by Stata statistical software. Results The results showed theoverall mean hospital costs and LOS was 9,853,758 IRR and 7.5 days, respectively. Also, the LOS, gender and Burn Body Surface (BBS) were identified as the main independent predictor of costs and the cause of burn, BBS and age were the main factors affecting LOS. Conclusion This study highlights that the independent predictors affecting hospital costs and LOS associated with pediatric burn injury in Kermanshah. Also, our study indicates the BBS was the main factors affecting hospital costs and LOS for the study population.

This study was aimed at assessing any association between smoking and health-related quality of life (HRQoL) among adults aged 18 years and above living in Kermanshah city, western Iran. A cross-sectional study was conducted on a total sample of 1,543 participants obtained by convenient sampling during the period from February 1st to May 30th, 2017. Data were collected using a self-administrated questionnaire. The HRQoL of the study participants was assessed with reference to the EuroQol 5-dimensions-3-level (EQ-5D-3L). The impact of smoking behavior of the participants on HRQoL with controls for potential confounders was examined by multiple regression. Out of the total of 1,543 participants, current smokers, past smokers, and never smokers accounted for 19.7%, 4.2% and 76.1%, respectively. The mean EQ-5D indices were 0.69 ±SD 0.20, 0.70 ± SD 0.22, and 0.78 ± SD 0.16. The highest proportion of self-reported problems (including both ‘some’ and ‘severe’) were related to current, heavy smokers, with high nicotine dependence. Regression analysis indicated that current smokers had a significantly lower HRQoL compared to past smokers and never smokers (p < 0.05). The heavy smokers also had a significantly lower HRQoL score than moderate and light smokers (p < 0.05) and there was an inverse relationship between the HRQoL score and nicotine dependence (p

Background: Protecting people from catastrophic health payments is widely recognized as an integral component of health systems and universal health coverage. Objectives: This study aimed to measure the financial protection against catastrophic health expenditure among hospitalized patients in Kermanshah, western Iran, after the implementation of the health sector evolution plan of Iran. Methods: This was a cross-sectional study. A total of 544 patients were selected using the proportional allocation to population size technique. A translated version of the world health survey questionnaire was used to collect data. Catastrophic health expenditure was calculated using WHO recommended methodology. Data were analyzed using STATA v.13. The statistical test performed included descriptive statistics and logistic regression. Results: About 4.8% of households with hospitalized patients were faced with catastrophic health expenditures. The total mean out-of-pocket (OOP) medical expenditures of being hospitalized was 819,220 Rials per patient. Mean OOP in patients with catastrophic payment was 2,220,500 Rial. Major determinants of catastrophic payment were associated with surgical cost (OR: 8.09 P Value = 0.000), chronic disease (OR: 2.78 P Value = 0.025), household size (> 6) (OR: 6.70 P Value < 0.036), and economic status of households (Quintile 5; OR: 0.005 P Value = 0.000). Conclusions: The Health Sector Evolution Plan should target and extend aids especially for chronically ill patients, those who need surgery, and those at poorest quintile due to the fact that they are more vulnerable to catastrophic health expenditure. These groups should be the priorities in the health sector evolution plan revision to achieve a more desired outcome.

AIMS To estimate the 1-year period prevalence of medication errors and the reporting rate to nurse managers among nurses working in hospitals in Iran. BACKGROUND Medication errors are one of the main factors affecting the quality of hospital services and reducing patient safety in health care systems. METHOD A literature search from Iranian and international scientific databases was developed to find relevant studies. Meta-regression was used to identify which characteristics may have a confounding effect on the pooled prevalence estimates. RESULTS Based on the final 22 studies with 3556 samples, the overall estimated 1-year period prevalence of medication errors and its reporting rate to nurse managers among nurses were 53% (95% confidence interval, 41%-60%) and 36% (95% confidence interval, 23%-50%), respectively. The meta-regression analyses indicated that the sex (female/male) ratio was a statistically significant predictor of the prevalence of medication errors (p

Over the past few decades, caring for special patients has taken center stage in healthcare systems. Moreover, what necessitates conducting a comparative study into the conditions of special patients and designing a suitable model are as follows: high admission rates of these patients in hospitals, continual recurrence of the illness, sky-high costs of treatment and medicine, lack of coordination between the services offered by hospitals and community needs, and severe pressure of special patients on their families. Therefore, the present study aimed to compare the models of government support programs for special patients in Iran, the United Kingdom, the USA, Italy and Sweden through a descriptive-documentary method. The findings revealed that the Ministry of Health and Welfare and the private sector were the major providers of health services to special patients in most of the countries under study. It was also demonstrated that the services offered to special patients are jointly mainly funded by governments, associations, and non-governmental organizations and partially by insurance premiums and so forth. The results also indicated that the bulk of healthcare provision was shouldered by non-governmental sectors and the contribution of charitable people. Finally, it can be concluded that both health-related policies and the health of special patients can be closely honed and monitored through the formation of committees on the health of special patients at the Supreme Council of Health, the establishment of an office for special patients at the Vice-chancellery for Health at the Ministry of Health, Treatment and Medical Education, provision of decentralized services, and financing through taxation and contribution of charitable people and international organizations. [GMJ.2020;9:e1403]

Background: burn injuries are a major public health in the world, especially in developing countries. The aim of this study was investigate to the epidemiological data and cost of hospitalization due to burn in pediatrics in Kermanshah provinces from 2011 to 2013.Material and Methods: this was a retrospective cross sectional study. The study subject was all of patient lee than 15 years who admitted in Burns Center at Imam Khomeini Hospital in Kermanshah, Iran, from 21 March 2011 to March 2013 (two years). The data including age, gender, cause of burn, burn degree, place of burn, length of stay (LOS), burned body surface (BBS) and cost of hospitalization was obtained from hospital data and analyzed by SPSS version 18. Results: the overall mean age was 5.27 ± 4.52 years; the ages ranged from less than 1 year to 15 years. The mean BBS % and LOS was 22.8 % and 7.48 day, respectively. The mean cost per patient, per hospitalization day and per % BBS were 15000000 IRR, 657981 IRR and 20045348 IRR, respectively. Conclusion: The current study showed the main cause of burn and mortality in the pediatric population was hot liquids and flame, respectively. An important point is that most of burn injuries in pediatric population are preventable and avoidable if the necessary training about cause of these burns provides for their parent.

Background and Objectives: Giving birth to a child with disabilities is two-three times more likely in consanguineous marriages. Due to the various negative consequences of such marriages, this study aimed to determine the cognitive predictors of consanguineous marriages. Materials and Methods: In this cross-sectional study, convenience sampling was applied to select 516 people who visited four different marriage counseling centers in Kohgiluyeh-Boyer Ahmad Province. A self-report questionnaire was administered to collect data. Bivariate correlations and logistic regression analysis were performed to analyze the data in SPSS-20. Results: The mean age of the respondents was 23.43 ± 3.96 years (range: 15-30 years). About 43.4% of the participants had married a relative. Regression analysis suggested subjective norms (OR = 1.304) and cultural factors (OR = 1.244) as the best predictors of cousin marriage. Conclusion: Considering the high rate of cousin marriage in the studied population, it is pre-marriage genetic counseling seems essential. Designing educational interventions on subjective norms and cultural factors related to cousin marriage may also be useful in reducing the rates of cousin marriages.

Introduction: Ambulatory education is an integral part of medical education. The present study was carried out to evaluate the quality of ambulatory education from the viewpoint of clinical medical students at Kermanshah University of Medical Sciences. Methods: In this descriptive cross-sectional study, the study sample included medical externs externs and interns of Kermanshah University of Medical Sciences that were selected through census sampling technique in the academic year 2012-2013. The instrument for data collection was a researcher-made questionnaire with acceptable validity and reliability. The obtained data were analyzed by SPSS-16 software using descriptive statistics. Results: 65 (50%) externs and 75 (65%) interns participated in the study and 1588 questionnaires were completed via self-administered technique. The mean of the teachers’ quality of ambulatory education at Kermanshah University of Medical Sciences was 22.6±5.2 and the mean for the clinics’ quality of physical environment was 19±5.13, indicating favorable and semi-favorable status, respectively. Qualitative evaluation of ambulatory education from the viewpoint of externs and interns showed a significant difference with more satisfaction from the part of the interns (p

BACKGROUND: Road Traffic Injuries (RTIs) as a result of road traffic crashes (RTCs) rank as the leading cause of death, disability and property loss worldwide, especially in low- and middle-income countries. This study aims to analyze the costs of RTCs in Iran. METHODS: A standard human capital approach was used to estimate the costs. Costs included medical, administrative and funeral costs, property damage, production lost and intangible costs. Data about the number of deaths and injuries resulting from RTIs between 20 March 2009 and 20 March 2010 was obtained from two national databases designed at the Center for Disaster Management and Medical Emergencies (CDMME) and the Legal Medicine Organization (LMO), respectively. The severity and medical costs of injuries were identified by reviewing 400 medical records that were selected randomly from patients who were admitted to two large trauma centers in Shariati and Sina hospitals in Tehran province. Moreover, information about production lost, property damage, rehabilitation cost, intangible costs and administration costs were collected by review of current evidence and consulting with expert opinion. RESULTS: In total 806,922 RTIs and 22,974 deaths resulted from the RTCs in the study period. The total cost of RTCs was about 72,465 billion Rials (7.2 billion US Dollars), which amounts to 2.19% of Iran’s Gross Domestic Production (GDP). Direct costs were 3,516 billion Rials (around 48.6 % of the total costs), following by 24,785 billion Rials (around 34.2 % of the total costs) for production lost and 12,513 billion Rials (around 17.2 % of the total costs) for intangible costs. CONCLUSIONS: This study indicated that the burden of both RTCs and RTIs in Iran is substantial. Moreover, RTCs have significant economic consequences and are a large drain on healthcare resources. © 2013 KUMS, All rights reserved

Background: Assessment of hospital performance plays an important role in improving the quantity and quality of services. The purpose of this study was to evaluate the performance of the teaching hospitals of Kermanshah University of Medical Sciences using Pabon Lasso model during 2006-2011. Methods: This descriptive-analytical study was carried out to assess the performance of six teaching hospitals of Kermanshah University of Medical Sciences during 2006-2011 using Pabon Lasso Model. This model uses three indexes of bed occupancy rate, bed turnover rate and the average length of stay, simultaneously. The data were collected using a standardized checklist, and Excel software was used for analyzing the data and charting Pabon Lasso. Results: The results showed that one of the studied hospitals had high bed occupancy rate and low turnover rate, two hospitals had high turnover rate and low bed occupancy rate, one hospital had high bed occupancy rate and high bed turnover rate, and two hospitals had low bed turnover rate and high bed occupancy rate. Conclusion: According to this study, about 85 percent of hospitals had low performance in indexes of bed occupancy rate, bed turnover rate or both. So, the reasons for the low performance must be evaluated and analyzed. Also, based on the characteristics of the hospitals, proper strategies can be applied to improve the performance of hospitals and increase the efficiency of resources.

Background: Hospitals are among the most interactive organizations in which the rate of knowledge transfer and learning is considerably high. The investigation of the level of organizational learning between public and private sector hospitals can be useful for managers to select proper organizational learning strategies aiming at improving service delivery and organizational behaviour (1). This study was carried out to compare the organizational learning capabilities of the personnel in public and private sector hospitals of Kermanshah. Methods: This descriptive survey was performed on the personnel in public and private sector hospitals of Kermanshah. According to Krejcie and Morgan’s table, 175 employees were selected via stratified random sampling from 6 public and 2 private hospitals. The instrument for gathering data was Organizational Learning Capability Questionnaire (OLCQ) by Gomez et al. (2005) (2). Data were analysed by inferential statistics (K-S test, Levene’s test, t-test, one-way ANOVA using SPSS software (version 20.00). Results: The level of organizational learning capabilities of personnel was higher in the private hospitals than in public hospitals, indicating a statistically significant difference between them (T (26)= 11.779, P0.01، F (3, 68) = 1.859). Conclusion: With regard to the higher average of knowledge transfer and integration than the other capabilities in public and private hospitals, it seems that the managers of hospitals should make use of this component to promote the organizational knowledge of the personnel and improve other organizational learning capabilities too.

Background: In developing countries, people with disabilities (PWD) are more likely to have unequitable access to health care services than their counterparts without disabilities. Access to health care is a multidimensional concept and PWD experience various barriers to use health care. This quantitative study explored the predictors and determents of access to health care for PWD in an Iranian context. Methods: Data were collected from a cross sectional study conducted in Tehran in 2017. A total of 403 adults with physical and/or intellectual disabilities were selected using census method. The data on PWD were collected from 14 rehabilitation centers affiliated to Welfare Organization and Red Crescent Organization. The self–report World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to collect data on disability status. T test, ANOVA, and multiple linear regressions were used to determine factors influencing access to health care for PWD. Significance level was set at 5%. Also, SPSS software version 20.0 was used for data analysis. Results: The mean of access to health care among people with intellectual disabilities (mean: 61.77, 95% confidence interval (CI):59.20, 64.35) was significantly lower than their counterparts with physical disabilities (Mean: 67.97, 95% CI: 65.26, 70.69). The results of multiple linear regression analysis showed that in the affordability dimension, type of disability, marital status, and supplemental health insurance could predict access to health services for PWD. In availability dimension, only location predicted the outcome variable significantly. Also, location and type of disability were considered to be potential predictors of access to health services in acceptability dimension. Conclusion: The results indicate that various factors can limit access to health services for PWD. To achieve universal health coverage, vulnerable groups and their needs should be identified to increase equitable access to health care services. Also, the health care system should pay more attention to demographic differences when planning and providing affordable and acceptable health care for PWD. Finally, the role of the government as the heath stewardship is vital to promote health care access for PWD in Iran.

Background: Fecal occult blood test (FOBT) is one of the common screening tests for colorectal cancer. This study was designed to determine the socio-cognitive determinants related to FOBT uptake for colorectal cancer screening based on intervention mapping (IM). Methods: A total of 500 individuals aged over 50 years were randomly selected to participate in this study in Kermanshah, Iran, in 2016. Data were collected by interviews based on a questionnaire and analyzed by SPSS16 using bivariate correlation, linear, and logistic regression models. Results: Of the 500 respondents, 468 (93.6%) signed the consent form and voluntarily participated in the study. Almost 11.1% of the participants had a history of FOBT uptake. Socio-cognitive variables accounted for 38% of the variation in the outcome measure of the intention to uptake FOBT. Perceived self-efficacy (OR = 3.345 & 95% CI: 1.342, 8.339), perceived susceptibility (OR = 2.204& 95% CI: 1.320, 3.680), attitude (OR = 1.674& 95% CI: 1.270, 2.137), and perceived severity (OR = 1.457& 95% CI: 0.954, 2.224) were the strongest predictors of fecal occult blood test uptake. Conclusion: IM-based analysis of behavior may provide insights to design interventions for modifying individuals’ beliefs about the usefulness of FOBT uptake to prevent colorectal cancer.

Introduction: Evaluation of teachers is considered among top priorities in an educational institution. Most of the universities around the world including universities in Iran have considered feedback from students as the only or main source of assessment of the quality of teaching process for many years. Regarding the existing disagreements in evaluation, the purpose of this study is to investigate the factors affecting teachers’ evaluation from the viewpoint of the students’ at Kermanshah University of Medical Sciences Methods: This descriptive analytical study was performed with the participation of 848 students studying at second semester or above in 91-92 academic year. Self-administrated questionnaire was used to collect data. Content validity of the questionnaire was determined by the respective experts, and its reliability was calculated 0.73 through Chronbach’s alpha test. The results were analyzed by SPSS-16 using descriptive statistics, Kolmogrov-Smirnov, Mann-Whitney, Kruskal-Wallis and Chi-square tests. Results: Results showed that from the students’ viewpoint, the areas of teaching skills (74.93±17.06), teacher’s personal characteristics (71.23±15.43), physical features and time of course presentation (68.41±25.10), student’s personal characteristics and attitude (63.79±20.83), and the quality of evaluation process in the university were important, respectively. In addition, there was a significant difference between two genders in the areas of teaching skills (P=0.007) and teacher’s personal characteristics (P=0.015). Conclusion: In scope of teaching skills, the most important effective factors on teachers’ evaluation based on the students’ viewpoint were teachers’ knowledge and scientific proficiency in the course subject, teachers’ efforts to convey the course materials, and teacher’s manner of expression, respectively.

Clinical training is an important process in residency academic program in different fields. In this cross-sectional descriptive study, we identified the views of clinical residents about clinical training status at Yazd University of Medical Sciences at their second-year of residency or above. We used questionnaire as the instrument for collecting information and select all residents as the sample of study. Data were analyzed using descriptive statistical tests. Clinical training status was assessed to be at an intermediate level by residents, and the areas of evaluation method, resources and facilities, training system, performance, performance of personnel of therapeutic departments, and resident’s performance received the highest score, respectively. Areas of evaluation method and facilities were determined as strengths, and areas of the performance of therapeutic department’s personnel and residents as the weaknesses of clinical training.

Smoking is recognized as a main leading preventable cause of mortality and morbidity worldwide. It is responsible for a considerable nancial burden both on the health system and in society. This study aimed to examine the effect of smoking on cost of hospitalization and length of stay (LoS) among patients with lung cancer in Iran in 2014.A total of 415 patients were included in the study. Data on age, sex, insurance status, type of hospitals, type of insurance, geographic local, length of stay and cost of hospitalization was extracted by medical records and smoking status was obtained from a telephone survey. To compare cost of hospitalization and LoS for different smoking groups, current smokers, former smokers, and never smokers, a gamma regression model and zero-truncated poisson regression were used, respectively.Compared with never smokers, current and former smokers showed a 48% and 35% increase in hospitalization costs, respectively. Also, hospital LoS for current and former smokers was 72% and 31% higher than for never smokers, respectively.Our study indicated that cigarette smoking imposes a signi cant nancial burden on hospitals in Iran. It is, however, recommended that more research should be done to implement and evaluate hospital based smoking cessation interventions to better increase cessation rates in these settings.

Breast cancer is the second leading cause of death in industrial countries and the third one in developing countries. The aim of this study was determined the stages of change of mammography screening behavior among women. This cross-sectional study was conducted on 400 women aged 30 to 60 years old referred to health centers in Kermanshah County, the west of Iran, during 2016, who were randomly selected to participate in the study. Data collected by standard questioner and were analyzed by SPSS version 21. The mean age of respondents was 39.61 years [SD: 8.28]. Our findings indicated, nearly 59 % (236/400), 27.3 % (109/400), 2.5 % (10/400), 9.3 % (37/400), and 1.8 % (7/400) of the respondents reported that pre-contemplation, contemplation, preparation, action, and maintenance, respectively. Our results showed most of the women were in pre-contemplation and contemplation stages regarding doing mammography. These results can be highly useful to the researchers in designing effective interventional plans for achieving the intended objectives.

Cancer is the second leading cause of death in developed countries and the third one in developing countries. The aim of this study was to determine the knowledge on colorectal cancer and the related background factors in the urban population aged over 50 years in the western of Iran. This study was of descriptive cross-sectional type which was conducted among 500 individuals aged over 50 years in city Ravansar were randomly selected to participate voluntarily in the study. Data collected by questioner and were analyzed by SPSS version 21 using independent t-test, ANOVA and correlation statistical tests at 95% significant level. The mean age of respondents was 58.32 years [95% CI: 57.7, 58.9], ranged from 50 to 73 years. Only 4.7 percent of the participants knew what colorectal cancer was and what its screening methods were. The mean score of knowledge construct about colorectal cancer among the participants was 5.72 with standard deviation of ±2.57. Furthermore, knowledge of cervical cancer was significant association with sex, educational level and positive family history of colorectal cancer. In addition, knowledge about colorectal cancer was significantly related to the age (r= -0. 095 & P=0.040). Based on our result, it seems that designing and implementation of educational programs to improve knowledge about colorectal cancer among population is necessary.

Background Self-esteem and behavioral consequences, which are due to external or internal locus of control, are effective on academic achievement of students. Objectives The aim of this study was to determine the prediction of locus of control and self-esteem in academic achievement among the students. Materials and Methods This cross-sectional study was conducted on 300 college students in Kermanshah University of Medical Sciences in 2014. Data collection tools were in three sections: demographic, Rotter internal-external locus of control scale and Coopersmith self-esteem inventory. Data were analyzed using the SPSS software version 21. Results Results showed that 29.8% and 76.2% of the participants had internal locus of control, and high self-esteem, respectively. There was a significant correlation between self-esteem, locus of control and academic achievement of the students. Self-esteem accounted for 39.5% of the variation in academic achievement. Conclusions It seems that interventions to increase self-esteem among student can help improve academic achievement among them.

Background Fitness is a very important goal among young adults that may lead to eating disorders. Objectives The aim of this study was to identify the factors influencing fitness intention based on the theory of planned behavior (TPB) and its relationship to eating attitudes. Materials and Methods A cross-sectional study was conducted among 231 female college students during the winter of 2012. Participants were randomly selected in proportion to their distribution among the different faculties at Hamadan University of Medical Sciences. A structured questionnaire was applied for collecting data and data was analyzed by SPSS version 21 using a T-test, ANOVA, bivariate correlations, and linear regression at a 95% significant level. Results Nearly 21.6% of the participants had abnormal eating attitudes. The TPB variables accounted for 40% of the variation in fitness intention. Bivariate correlations indicated a positive correlation between fitness intention and eating attitude (r = 0.417, P < 0.05). Conclusions Based on our results, it seems that designing and implementing educational programs to reduce positive attitudes and encourage subjective norms toward fitness may be useful for preventing abnormal eating attitudes.

Background: A major issue to consider in high risk behaviors such as substance abuse is personality factors. Objectives: This study aimed to determine the role of personality factors (anxiety sensitivity, sensation seeking, hopelessness, and impulsivity) in substance use, psychotropic drug use, smoking, and alcohol drinking in a sample of male medical students in Iran. Patients and Methods: In this cross-sectional study, conducted in Isfahan and Kermanshah Medical Universities in Iran, a total of 425 male medical students were randomly selected with the proportional to size from different faculties to participate voluntarily in the study. A self-report written questionnaire was applied to collect data. Then, the obtained data were analyzed by SPSS version 20 using logistic regression statistical tests at 95% significant level. Results: Our findings showed that hopelessness (OR = 1.095, 95% CI: 1.033, 1.160) and sensation seeking (OR = 1.139, 95% CI: 1.065, 1.219) were the main influential predictors on smoking. Anxiety sensitivity (OR = 1.436, 95% CI: 1.114, 1.851) and impulsively (OR = 1.443, 95% CI: 1.153, 1.806) were the main influential predictors on drug abuse. In addition, anxiety sensitivity (OR = 1.460, 95% CI: 1.004, 2.124) and sensation seeking (OR = 1.756, 95% CI: 1.120, 2.753) were the main influential predictors on psychotropic drug abuse. Finally, sensation seeking (OR = 1.222, 95% CI: 1.121, 1.331) was the main influential predictor on alcohol drinking. Conclusions: Our findings indicated that sensation seeking was the best predictor for alcohol drinking, cigarette smoking, and psychotropic drug abuse.

Introduction: Critical thinking as a process of purposeful self-regulatory judgment leads to problem solving and correct decision making in individuals. In the modern world, health care faces rapid change and burgeoning amount of knowledge. Possessing critical thinking is essential for individuals in health care centers, specially when they are forced to solve clinical problems. The aim of this study was to evaluate critical thinking disposition among medical students in various levels of education.Methods: In this descriptive, cross-sectional study, we determined critical thinking disposition among 289 medical students of Kermanshah University of Medical Sciences. The students were studying at different levels of general physician education. In Iran general physician education divided into four levels; basic sciences, physiopathology courses, clerkship and internship. They were selected using stratified sampling. Data were collected using a questionnaire that consisted of two parts; demographic information of the participants and California Critical Thinking Disposition. To analysis the data, both descriptive and inferential statistics (One-way ANOVA) were employed using SPSS-16 software.Results: Our findings indicated that 98.6% of the students lacked critical thinking disposition, 1.4% were ambivalent disposition and no one had positive disposition to critical thinking. The highest acquired score of critical thinking was for truth-seeking (20.4%) and the lowest score acquired for analyticity (4.8%). The results revealed that there was no statistically significant difference between mean score of participants with regards to their critical thinking disposition in various educational levels. Conclusion: The findings of this study indicated that medical students lacked appropriate critical thinking disposition.

Introduction: Among the most important strategies for controlling cardiovascular diseases are preventive steps such as training and enhancing the awareness level, and preventive skills for protecting individuals. The aim of this study was to investigate the effect of training based on Health Belief Model on the awareness and attitude of nursing and midwifery students in preventing cardiovascular diseases.Methods: In this quasi-experimental study, 110 participants were selected from nursing and midwifery students during 2010 and 2011. They had not passed courses related to cardiovascular diseases. Four 2-hour training sessions were designed based on Health Belief Model. Demographic information questionnaire had questions related to awareness, perceived susceptibility, perceived severity, perceived benefits, perceived barriers and action guide which was completed before training and six weeks after training by questionnaire and interview. Data was analyzed using SPSS 16 software and paired T-test.Results: The findings indicated that the mean scores of the students’ awareness before and after training were 14.5 and 16.1, respectively and there was a statistically significant difference between them. The findings also showed that the mean scores of the students’ attitude before and after training were 41.9 and 41.8, respectively and there was no statistically significant difference between them.Conclusion: Since changing in behavior is the result of changing in attitude, in order to change the attitude of the people about health issues such as health behavior toward cardiovascular diseases, training should be considered as a continuous procedure.

Reiner RC Jr, Hay SI. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000–17: analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395: 1779–801—In this Article, the author byline has been amended to Local Burden of Disease Diarrhoea Collaborators. This correction has been made to the online version as of June 4, 2020, and the printed version is correct. © 2020 Elsevier Ltd

Background: Economic burden due to premature mortalities is significant both on health system and on the society as a whole. This study aimed to determine the productivity costs and years of potential life lost associated with five leading causes of death in Iran from 2006 to 2010. Methods: Data on mortality by sex and age-groups due to five main leading causes of death (myocardial infarction (MI), cerebral vascular diseases (CVD), transport accidents (TA), hypertensive heart disease (HHD) and gastric cancer (GC)) were obtained from the Ministry of Health and Medical Education from 2006 to 2010 for 29 providences of Iran (data on Tehran province was not available). Three measures including years of potential life lost (YPLL), years of potential productive life lost (YPPLL) and the cost of productivity loss (CPL) due to premature mortality were used. To estimate the CPL and YPLL, the human capital approach and life expectancy method were used, respectively. Results: There were 518,815 deaths due to the five main leading causes of death; of which, 58% occurred in males. The estimated YPPLL resulted in 209,552,135 YPPLL from 2006 to 2011; of which, 141,966,592 (67%) were in males and 67,585,543 (33%) in females. The total cost of productivity loss caused by premature deaths due to the five leading causes of death was 7.86 billion dollars (US$) from 2006 to 2010, ranging from 1.63 billion dollars in 2006 to 1.31 billion dollars in 2010. Conclusion: This study revealed that the economic burden of premature mortalities due to the five main causes of death is substantial, and that these five leading causes should be considered in policy/decision making and prevention programms. The allocation of financial resources to control these causes may decrease their economic burden, resulting in higher level of health and well-being.

Asian Pacific Journal of Cancer Prevention, 17, 9

Adverse drug reaction includes all negative, random and unexpected effects a drug may have on human which could be observed in doses used to prevent diagnosis and treatment; which report it could be helpful to prevent and decrease the side effects. The aim of this study was to determine the prevalence and factors related with adverse drug reaction reporting among pharmacists. In this cross-sectional study, conducted in the west of Iran, a total of 117 pharmacists, were randomly selected to participate voluntarily in the study during 2014. Participants filled out a self-administered questionnaire. Data were analyzed by SPSS version 21 using bivariate correlations, logistic and linear regression statistical tests. Almost 21.4% of the participants had history of adverse drug reaction reporting. The best predictors for adverse drug reaction reporting was perceived behavioral control (OR: 1.227) and attitude (OR: 1.164). In addition, attitude was the best predictor for intention to adverse drug reaction reporting among pharmacists (B: 0.490 & P: 0.001). Based on our result, it seems that designing and implementation of retraining programs to improve positive attitude towards adverse drug reaction reporting and incensing pharmacist’s behavioral control to adverse drug reaction reporting may be usefulness of the results in order to promotion of adverse drug reaction reporting.

Background Addiction is considered a basic structural problem in modern society, and seems to reach an epidemic scale in the last decades. Choosing a method to fulfill the intervention is an important issue to conduct educational interventions to prevent addictive behaviors. In this regard, web-based education has been widely used to introduce preventive programs to risky behaviors during recent years. Objectives The aim of the present study was to investigate the impact of web-based education intervention to decrease positive beliefs encouraging drug abuse among male medical college students. Patients and Methods This was a prospective-retrospective intervention study that was conducted among 75 male students in Kermanshah University of Medical Sciences, Kermanshah, Iran, during 2014. t-test was used for the statistical analysis. Results Our findings indicated that the belief toward drug abuse was significantly reduced after education (P = 0.003). In addition, compared pre and post-intervention scores on survey items showed a significant reduction in enjoyment, improve energy, attraction, higher strength, and higher self-esteem items after education (P < 0.05), whereas there was no significant reduction in excitement, relaxation, improved mental ability and forgetting problems after education (P > 0.05). Conclusions Our findings showed that designing and implementing web-based educational intervention could be effective to reduce the positive beliefs toward drug abuse among college students.

1Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran 2Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, IR Iran 3Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, IR Iran 4Department of Applied Linguistics, Ilam University, Ilam, IR Iran 5Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, IR Iran

Thalassemia is one of the most common chronic and genetic blood disorders in the world that can followed by several complications, such as mental disorders. The aim of this study was to determine the prevalence and socio-demographic characteristics associated with stress, anxiety and depression among patients with thalassemia major in Kermanshah during 2014. This cross-sectional study done among 64 patients with thalassemia major during 2014; in the participants were randomly selected among patients who referred to Mohammad Kermanshahi hospital in the Kermanshah County to take part in this study. A standard questionnaire (DASS-21) which analyzed stress, anxiety and depression was applied for collecting data and data were analyzed by SPSS version 20 using chi-square statistical tests. The mean age of respondents was 22.31 years [95% CI: 20.42, 24.21], ranged from 14 to 58 years. Findings showed the 60.9%, 59.4 % and 18.8 % of the respondents were suffering from extremely severe anxiety, depression, and stress, respectively. Furthermore, our findings showed marital status and job have significant relationship with anxiety (P

This cross-sectional study was conducted on 103 pharmacy students in Kermanshah University of medical sci-ences in the west of Iran, during 2014. Participants were randomly selected to participate voluntarily in the study. Participants filled out a self-administered questionnaire including the theory of planned behavior components. Data were analyzed by SPSS version 21 using bivariate correlations, t-test, and linear regression statistical tests at 95% significant level. The mean age of respondents was 22.3 years [95% CI: 21.9, 22.6], ranged from 20 to 28 years. The mean score of attitude, subjective norms, perceived behavioral control, and professional commitment were 53.27, 19.23, 18.69, and 33.80, respectively. The results showed that professional commitment was correlat-ed with the positive attitude (r=0.506) and subjective norms (r=0.365), and perceived behavioral control (r=-0.213). Our findings showed the three predictor variables of (1) attitude, (2) subjective norms, and (3) perceived behavioral control accounted for 26% of the variation in professional commitment among pharmacy students. In addition, attitude toward professional commitment was the most influential predictor on perceptions of profes-sional commitment.

"Aggressive behavior in college students can be considered as an analyst for crime, drug abuse, depression and academic failure. The aim of this study was to determine the prevalence of and the factors related with aggression among a sample of Kermanshah medical college students. In this cross-sectional, showed in Kermanshah University of Medical Sciences, in the western Iran, a total of 601 students were randomly selected to voluntarily participate in the study. Participants filled out a Buss-Perry aggression questionnaire. Data were analyzed by SPSS version 21 using logistic regression statistical tests at 95% significant level. Almost, 15.3% of the participants were aggressive. The mean score of aggression was 61.1 [95% CI: 59.6, 62.7], ranged from 29 to 140. Logistic regression showed that marital status and smoking were the most influential predictive factors on aggressive behaviour. Our findings showed a high level of aggressive behaviour among college students; it seems that a designing intervention to reduce aggressive behaviour and improve mental health program among college students is necessary."

This article developed an approached model of congestion, based on relaxed combination of inputs, in stochastic data envelopment analysis (SDEA) with chance constrained programming approaches. Classic data envelopment analysis models with deterministic data have been used by many authors to identify congestion and estimate its levels; however, data envelopment analysis with stochastic data were rarely used to identify congestion. This article used chance constrained programming approaches to replace stochastic models with ‘‘deterministic equivalents”. This substitution leads us to non-linear problems that should be solved. Finally, the proposed method based on relaxed combination of inputs was used to identify congestion input in six Iranian hospital with one input and two outputs in the period of 2009 to 2012.

Adverse drug reaction (ADR) has been known as a main reason to mortality, which pushes a significant pressure on health care resources; in addition reporting ADR could be helpful to decrease the consequences. The present study aimed to de- termine the attitude and barriers of not reporting ADR cases among a group of Iranian pharmacologists. This cross- sectional study was conducted among 117 pharmacists during 2014. Participants were selected in random sampling with probability proportional to size among pharmacy in the west of Iran. Data were collected by using questionnaire in self- report. Data were analyzed by SPSS version 21 using t statistical tests and bivariate correlations. Mean score of the ADR report barriers was 17.82 years (ranging from 7 to 35 years). Lack of motivation, not having report forms available, ineffi- ciency of reporting and lack of investigations received higher scores as major barriers. Also, increasing the trust between pa- tients and pharmacist, decreasing health care system charges and efficiency had the highest mean scores considering atti- tudes. Generally, there was a meaningful statistical relationship between reporting ADR by pharmacist and barriers (P = 0.007). According to the results from the present study, it seems essential to hold retraining programs in order to improve reporting ADRs by pharmacists, introducing advantages of reporting ADRs and removing barriers to report ADRs.

Backgrounds: Drug abuse is one of the most serious social problems in many countries. College students, particularly at their first year of education, are considered as one of the at risk groups for drug abuse. The present study aimed to determine cognitive factors related to drug abuse among a sample of Iranian male medical college students based on the social cognitive theory (SCT). Method: This cross-sectional study was carried out on 425 Iranian male medical college students who were randomly selected to participate voluntarily in the study. The participants filled out a self-administered questionnaire. Data were analyzed by the SPSS software (ver. 21.0) using bivariate correlations, logistic and linear regression at 95% significant level. Results: Attitude, outcome expectation, outcome expectancies, subjective norms, and self-control were cognitive factors that accounted for 49% of the variation in the outcome measure of the intention to abuse drugs. Logistic regression showed that attitude (OR=1.062), outcome expectancies (OR=1.115), and subjective norms (OR=1.269) were the most influential predictors for drug abuse. Conclusions: The findings suggest that designing and implementation of educational programs may be useful to increase negative attitude, outcome expectancies, and subjective norms towards drug abuse for college students in order to prevent drug abuse.

Substance abuse is one of the most complicated social problems. Understanding socio-demographic characteristics of those who abuse substances could help deal with this problem more efficiently. The main objective of this study was to determine socio-demographic characteristics associated with alcohol drinking, cigarettes smoking and drug abuse among a sample of male medical university students in Iran.This cross-sectional study was conducted in 2014 among 425 male medical college students randomly selected with the proportional to size among different faculties in Isfahan and Kermanshah medical universities in Iran. A self-report written questionnaire was applied to collect data. Data were analyzed by the SPSS-20.Mean age of the respondents was 19.9 yr (ranging from 18 to 22 yr). About 19.4%, 3.9%, and 10.1% of the respondents had history of cigarette smoking, drug use, and alcohol drinking during the past three months, respectively. Logistic regression showed that mother's educational level, living place, economic status, and parents' divorce were the most influential predictive factors on substance abuse.Considering the high prevalence of substance abuse (especially smoking and alcohol drinking), it seems essential to design educational interventions to prevent substance abuse, paying attention to predictive factors mentioned above, among college students.