Search

Abstract Background Regarding the paucity of evidence on the side effects of the booster dose of Oxford AstraZeneca vaccine in vaccinated people with Sinopharm or Sputnik V, we aimed to set up a cohort event monitoring (CEM) study to capture adverse events occurring in individuals who will receive the booster doses of AstraZeneca (either the first or second booster dose) following being vaccinated with Sinopharm or sputnik V vaccines in Iran. Methods The present study is an active COVID-19 vaccine safety surveillance through an observational prospective cohort study that will be conducted in vaccination centers in Iran. The study will be conducted in twelve provinces of Iran. Study sites are vaccination centers where the AstraZeneca vaccine is administered to the cohort population. The study population includes all individuals who have received two doses of Sinopharm or Sputnik V vaccines and either the first or second booster dose of AstraZeneca according to the national guidelines for immunization in Iran in 2023. We are planning to include 30,000 eligible people in this study. Each individual will be followed up for 13 weeks after either the first or second booster dose of the AstraZeneca vaccine. Furthermore, convenience sampling is used to include participants in the present study. Participation in the study will be strictly voluntary. Discussion With the planned study we will provide a valid epidemiological evidence to improve the understanding of the safety of the booster dose of the AstraZeneca and to better evaluate the effectiveness of public health interventions. This could help policy makers in managing the COVID-19 pandemic according to scientific evidence.

Abstract Background Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15–59 years across SSA. Methods We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. Results We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. Conclusions As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.

Objective: Down syndrome or trisomy 21 is one of the most common human chromosomal disorders that affect cognitive functions, communication and behavioral skills. At the macro level, various factors can contribute to the Down syndrome prevalence and mortality. This study aimed to investigate the association of health system functions with Down syndrome prevalence and mortality worldwide. Materials & Methods: The study was a cross-sectional study conducted based on the secondary analysis of existing data in 2019. Data from 202 countries in six different regions (African Region [AFRO], Eastern Mediterranean Region [EMRO], European Region [EURO], South-East Asia Region [SEARO], Western Pacific Region [WPRO], and Pan American Health Organization [PAHO]) were included in the study. Data were extracted from the World Health Organization (WHO), the World Bank and the Institute for Health Metrics and Evaluation databases. The adjusted linear regression analysis was used to examine the association between health system-related factors with prevalence of, and death due to Down syndrome as the outcome variables. In the present study, two functions of health financing (domestic general government health expenditure [GGHE-D] per capita in PPP [purchasing power parity] int$, domestic private health expenditure [PHE-D] per capita in PPP int$, external health expenditure [EXT] per capita in PPP int$) and health system resources (nurse and midwifery personnel, generalist medical practitioners [GMP], specialist medical practitioners [SMP], pharmacists, dentists, physiotherapists) were included in the study as independent variables. We used the Stata software version 14 to analyze Results: Africa and low-income countries had the highest deaths due to Down syndrome. On the other side, Europe and high-income countries had the highest prevalence of Down syndrome worldwide. According to the available data, Iran had a lower prevalence (29.31 vs 38.44 per 100,000 population) and higher deaths (0.34 vs 0.32 per 100,000 population) compared to high- income countries. The 20-year trend of prevalence of, and deaths due to Down syndrome in Iran has always been lower and higher than high-income countries, respectively. Linear regression analysis showed that GGHE-D per capita (β=0.385, P

Abstract Background Individuals with autism spectrum disorder (ASD) are more likely to use healthcare than their counterparts without disabilities, which imposes high medical costs to families and health systems. This study aimed to investigate healthcare costs and its determinants among individuals with ASD. Methods In this systematic review, we searched online databases (Web of Science, Medline through PubMed and Scopus) for observational and experimental studies that included data on service use and costs associated with ASD and published between January 2000 and May 2021. Exclusion criteria included non-English language articles, duplicates, abstracts, qualitative studies, gray literature, and non-original papers (e.g., letters to editors, editorials, reviews, etc.). Results Our searches yielded 4015 articles screened according to PRISMA guidelines. Of 4015 studies identified, 37 articles from 10 countries were eligible for final inclusion. Therapeutic interventions, outpatient visits and medications constituted the largest proportion of direct medical expenditure on individuals with ASD. Included studies suggest lack of health insurance, having associated morbidities, more severe symptoms, younger age groups and lower socioeconomic status (SES) are associated with higher medical expenditure in individuals with ASD. Conclusions This systematic review identified a range of factors, including lower SES and lack of health insurance, which are associated with higher healthcare costs in people with ASD. Our study supports the formulation of policy options to reduce financial risks in families of individuals with ASD in countries which do not have a tax-based or universal health coverage system.

Abstract Background One of the most important routes of HIV transmission is through injections of drugs, and this group, due to unawareness of their infection, causes the spread of HIV. The coexistence of other opportunistic infections and diseases with HIV among people who inject drugs (PWID) imposes healthcare costs and is associated with high morbidity/mortality rates. Early detection of HIV among PWID is essential to prevent and control the spread of the disease. Objectives This study aimed to determine the prevalence of PWID among those with late presentation (LP). Methods Three electronic databases of PubMed, Scopus, and Web of science were searched using appropriate keywords. Besides the prevalence data reported for PWID among LP, the other outcomes of interest were LP defined as having CD4 count

Abstract Objectives Knowing about accurate customer expectations is the most important step in defining and delivering high-quality services. This study aimed to evaluate the preferences of patients referring to two hospitals in Kermanshah, Iran. Method Discrete choice experiment (DCE) method used to elicit preferences of 328 patients who were admitted in two hospitals of Kermanshah city in the west of Iran. Literature review and experts opinion were used to identify a candidate list of attributes related to the quality of cares in hospitals. The final study attributes were quality of physician care, quality of nursing care, waiting time for admission, cleaning of wards and toilets, and behavior of staff. Experimental design applied to extract choice sets of hospitals. The data was analyzed by a conditional logit regression. Results The regression results showed the most important predictors of hospital selection by respondents was the good quality of physician care (aOR: 3.18, 95% CI 2.61, 3.87), followed by friendly behavior of staffs (aOR: 2.03, 95% CI 1.81, 2.27), cleanness of wards and toilet (aOR: 1.61, 95% CI 1.40, 1.85), and finally quality of nursing cares (aOR: 1.13, 95% CI 0.89, 1.44). However, increasing waiting time made disutility in the study participants (aOR: 0.69, 95% CI 0.60, 0.80). Conclusions Our study finding emphasized some potential opportunity of quality augmentation in hospital sector by paying attention to different quality attributes including quality of physician, friendly behavior of staffs, cleanness of hospital environment and finally quality of nursing cares. Considering patients preferences in decision making process could lead to substantial satisfaction improvement.

Abstract Background Studies indicate that women with intellectual disabilities (ID) face various personal and socio-environmental barriers in their sexual lives. This study aimed to identify the concerns and sexual health needs experienced by women with ID. Method A systematic review of relevant qualitative articles was conducted in PubMed, Web of Science Scopus and PsycINFO databases from June 2018 to August 2018. We designed our search strategy according to two main foci: (1) sexuality; and (2) women with ID. In the study, searches were limited to articles published from January 2000 to December 2017. In this review, studies on women ages 16 and over were included. Results Within the four databases, the search found 274 unique articles. After three steps of screening (title, abstract and full text), 22 studies were included in the final review. The articles mentioned difficulties with lack of sexual experience, negative experiences with sexuality, negative attitudes towards sexuality by nondisabled individuals, limited cognitive capacities to understand sexual identity, difficulty with finding the right partner, lack of access to sexual health information, lack of school-based sexuality education, violence and sexual abuse, lack of support from families and caregivers about sexuality, fear of sexual acts and unwanted pregnancy, shyness in expressing sexual desires, and limited knowledge of sexual behaviors. Conclusion Our findings indicate that women with ID need to be provided with school-based sexuality education tailored to the level of understanding needed to attain the requisite knowledge to form relationships, understand sexual and romantic relationships, and practice safe sex when they choose this option. Families along with education and healthcare systems should provide opportunities for women with ID to talk about their sexual needs and make their own choices.

Abstract Background Coronary artery ectasia (CAE) is characterized by the enlargement of a coronary artery to 1.5 times or more than other non-ectasia parts of the vessel. It is important to investigate the association of different factors and CAE because there are controversial results between available studies. We perform this systematic review and meta-analysis to evaluate the effects of hypertension (HTN) on CAE. Methods To find the potentially relevant records, the electronic databases, including Scopus, PubMed, and Science Direct were searched on 25 July 2019 by two of the authors independently. In the present study, the pooled odds ratio (OR) accompanied by 95 % confidence intervals (CIs) were calculated by a random-effects model. Heterogeneity presented with the I2 index. Subgroup analysis and sensitivity analysis by the Jackknife approach was performed. Results Forty studies with 3,263 cases and 7,784 controls that investigated the association between HTN and CAE were included. The pooled unadjusted OR of CAE in subjects with HTN in comparison by subjects without HTN was estimated 1.44 (95 % CI, 1.24 to 1.68) with moderate heterogeneity (I2 = 41 %, Cochran’s Q P = 0.004). There was no evidence of publication bias in the analysis of HTN and CAE with Egger’s test (P = 0.171), Begg’s test (P = 0.179). Nine articles reported the adjusted effect of HTN on CAE by 624 cases and 628 controls. The findings indicated the overall adjusted OR was 1.03 (95 % CI, 0.80 to 1.25) with high heterogeneity (I2 = 58.5 %, Cochran’s Q P = 0.013). Conclusions We found that when the vessel was in normal condition, HTN was not very effective in increasing the chance of CAE and only increased the CAE chance by 3 %. This is an important issue and a warning to people who have multiple risk factors together. More studies need to be performed to further establish these associations by reported adjusted effects.

Little evidence is available on the epidemiological and economical dimensions of certain foodborne diseases such as wild mushroom poisoning. This study aimed to investigate the epidemiology and estimate the costs of poisoning with cyclopeptide-containing mushrooms in Kermanshah province in 2018. In this study, poisoning was investigated in different subgroups. The cost of illness method with a bottom-up approach was used to estimate the poisoning costs. Both direct and indirect costs of the poisoning were included in the analysis. The perspective of the study was society. Required data were obtained from the medical records of Imam Khomeini hospital and completed through a line survey with the patients. Two hundred eighty-three patients were poisoned in Kermanshah due to poisoning with cyclopeptide-containing mushrooms. Of 283 patients, 143 (50.53%) were men and 59.01% of patients were rural residents. About 43% of admissions were out-patient cases and ~40% of patients were hospitalized within 1–3 days. Also, eight patients were pronounced dead in the area. The total cost of poisoning with cyclopeptide-containing mushrooms in Kermanshah province was $ 1,259,349.26. Of that, $ 69,281.65 was related to direct medical costs and $ 10,727.23 was direct non-medical costs. The indirect costs of death were estimated to be $ 1,125,829.7. The current study revealed that there is a significant financial burden due to cyclopeptide-containing mushrooms on patients, the health system, and society as a whole. Further studies are recommended to clarify the epidemiological and economic burden of foodborne illnesses related to wild mushroom poisonings. Sharing the outputs with health authorities, and informing the general public are warranted to reduce the burden of such diseases.

Abstract Background Studies show that different socio-economic and structural factors can limit access to healthcare for women with disabilities. The aim of the current study was to review barriers in access to healthcare services for women with disabilities (WWD) internationally. Methods We conducted a systematic review of relevant qualitative articles in PubMed, Web of Science and Scopus databases from January 2009 to December 2017. The search strategy was based on two main topics: (1) access to healthcare; and (2) disability. In this review, women (older than 18) with different kinds of disabilities (physical, sensory and intellectual disabilities) were included. Studies were excluded if they were not peer-reviewed, and had a focus on men with disabilities. Results Twenty four articles met the inclusion criteria for the final review. In each study, participants noted various barriers to accessing healthcare. Findings revealed that WWD faced different sociocultural (erroneous assumptions, negative attitudes, being ignored, being judged, violence, abuse, insult, impoliteness, and low health literacy), financial (poverty, unemployment, high transportation costs) and structural (lack of insurance coverage, inaccessible equipment and transportation facilities, lack of knowledge, lack of information, lack of transparency, and communicative problems) factors which impacted their access healthcare. Conclusions Healthcare systems need to train the healthcare workforce to respect WWD, pay attention to their preferences and choices, provide non-discriminatory and respectful treatment, and address stigmatizing attitudinal towards WWD. In addition, families and communities need to participate in advocacy efforts to promote WWD’s access to health care.

Abstract Background The current study aimed to measure and decompose socioeconomic-related inequalities in DMFT (decayed, missing, and filled teeth) index among adults in Iran. Methods The study data were extracted from the adult component of Prospective Epidemiological Research Studies in IrAN (PERSIAN) from 17 centers in 14 different provinces of Iran. DMFT score was used as a measure of dental caries among adults in Iran. The concentration curve and relative concentration index (RC) was used to quantify and decompose socioeconomic-related inequalities in DMFT. Results A total of 128,813 adults aged 35 and older were included in the study. The mean (Standard Deviation [SD]) score of D, M, F and DMFT of the adults was 3.3 (4.6), 12.6 (10.5), 2.1 (3.4) and 18.0 (9.5), respectively. The findings suggested that DMFT was mainly concentrated among the socioeconomically disadvantaged adults (RC = − 0.064; 95% confidence interval [CI), − 0.066 to − 0.063). Socioeconomic status, being male, older age and being a widow or divorced were identified as the main factors contributing to the concentration of DMFT among the worse-off adults. Conclusions It is recommended to focus on the dental caries status of socioeconomically disadvantaged groups in order to reduce socioeconomic-related inequality in oral health among Iranian adults. Reducing socioeconomic-related inequalities in dental caries should be accompanied by appropriate health promotion policies that focus actions on the fundamental socioeconomic causes of dental disease.

Background: Coronary artery ectasia (CAE) is dilatation of an arterial segment to a diameter at least 1.5 times that of the adjacent normal coronary artery. The incidence of coronary artery ectasia is distinct in different countries that can be found in 1.2% to 5% of angiographic examinations. Methods: This is a retrospective study that was conducted from September 2019 to February 2020 in Kermanshah University of Medical Sciences and the results were reported briefly. To obtain the desired articles, electronic searches were conducted in databases including the Scopus, PubMed, and Science Direct databases without time limited until October 2019. The keywords used were Coronary Artery Ectasia AND (Diabetes OR "Diabetes Mellitus"). This was done by two individuals separately and the final results were confirmed by a third person. Mixed method appraisal tool (MMAT) was used to evaluate the quality of studies. The structure of writing and the process of performing and reporting the study are based on the PRISMA checklist. Results: Based on the search strategy carried out at PubMed, Scopus and Science Direct databases, 106 studies were found, which resulted in 24 articles being analyzed based on inclusion and exclusion criteria of which three were conducted in China, 18 in Turkey and one in Sweden, Egypt, and France. Finally, 24 articles were analyzed and the results showed a direct and effective relationship between diabetes mellitus and CAE (OR=1.19, CI: 0.94, 1.51). Conclusion: Based on these results, the risk of CAE in subjects with diabetes mellitus was 19% higher than in subjects without diabetes mellitus.

Abstract Background The clients’ willingness to accept (WTA) and willingness to pay (WTP) for a given good or service can help elicit the monetary value of that good or service. This study aims to assess the WTA and WTP of mothers attending primary health centers for vaccines to their children during 2019 in Kermanshah city, western Iran. Methods We conducted a cross-sectional study on a total of 667 mothers attending primary health centers for vaccines to their children aged two to 18 months. A multistage sampling technique was employed to involve the mothers in the study, and data were collected using a self-administrated open-ended questionnaire. The multivariate linear regression model was used to identify the factors associated with the mothers’ WTP and WTA for vaccines to their children. Results The study indicated that 94.2 and 93.1% of the mothers respectively had WTA and WTP values greater than zero, with their corresponding mean values of US$ 6.8 and US$ 4.4. The mothers in the higher monthly household income category, mothers born in the urban areas, and being a female child showed statistically significant positive associations with the mothers’ WTA for the vaccines. While there was a statistically significant positive relationship between monthly household income and the mothers’ WTP; a statistically significant negative relationship exists between the mothers’ age and their WTP for the vaccine to their children. Conclusions The findings indicated the mothers’ WTA to WTP ratio of greater than one for the vaccines to their children. The most important factor associated with the mothers’ WTA and WTP was the monthly household income. Thus, improving the socio-economic standards of women in the study area might contribute to reinforcing their immunization services seeking behavior to their children.

Abstract Background Socioeconomic inequality in mental health in Iran is poorly understood. This study aimed to assess socioeconomic inequality in poor mental health among Iranian adults. Methods The study used the baseline data of PERSIAN cohort study including 131,813 participants from 17 geographically distinct areas of Iran. The Erreygers Concentration index (E) was used to quantify the socioeconomic inequalities in poor mental health. Moreover, we decomposed the E to identify factors contributing to the observed socioeconomic inequality in poor mental health in Iran. Results The estimated E for poor mental health was − 0.012 (95% CI: − 0.0144, − 0.0089), indicating slightly higher concentration of mental health problem among socioeconomically disadvantaged adults in Iran. Socioeconomic inequality in poor mental health was mainly explained by gender (19.93%) and age (12.70%). Region, SES itself, and physical activity were other important factors that contributed to the concentration of poor mental health among adults with low socioeconomic status. Conclusion There exists nearly equitable distribution in poor mental health among Iranian adults, but with important variations by gender, SES, and geography. These results suggested that interventional programs in Iran should focus on should focus more on socioeconomically disadvantaged people as a whole, with particular attention to the needs of women and those living in more socially disadvantaged regions.

Abstract Background Overweight and obesity are major health concerns worldwide, with adverse health consequences during the life span. This study measured socioeconomic inequality in overweight and obesity among Iranian adults. Methods Data were extracted from 129,257 Iranian adults (aged 35 years and older) participated in the Prospective Epidemiologic Research Studies in IrAN (PERSIAN) in 14 provinces of Iran in 2014. Socioeconomic-related inequality in overweight and obesity was estimated using the Concentration Index (Cn). The Cn further decomposed to find factors explaining the variability within the Socioeconomic related inequality in overweight and obesity. Results Of the total number of participants, 1.98, 26.82, 40.76 and 30.43% had underweight, normal weight, overweight and obesity respectively. The age-and sex standardized prevalence of obesity was higher in females than males (39.85% vs 18.79%). People with high socioeconomic status (SES) had a 39 and 15% higher chance of being overweight and obese than low SES people, respectively. The positive value of Cn suggested a higher concentration of overweight (0.081, 95% confidence interval [CI]; 0.074–0.087) and obesity (0.027, 95% CI; 0.021–0.034) among groups with high SES. There was a wide variation in socioeconomic-related inequality in overweight and obesity rate across 14 provinces. The decomposition results suggested that SES factor itself explained 66.77 and 89.07% of the observed socioeconomic inequalities in overweight and obesity among Iranian adults respectively. Following SES, province of residence, physical activity, using hookah and smoking were the major contributors to the concentration of overweight and obesity among the rich. Conclusions Overall, we found that overweight and obesity is concentrated among high SES people in the study population. . Accordingly, it seems that intersectional actions should be taken to control and prevent overweight and obesity among higher socioeconomic groups.

Abstract Background Socioeconomic-related inequality in oral hygiene behaviors in Iran is poorly understood. This study aims to measure and decompose socioeconomic-related inequalities in oral hygiene behaviors among middle-aged and elderly adults in Iran. Methods A cross-sectional analysis was performed using data from the Prospective Epidemiological Research Studies in IrAN (PERSIAN), a large national cohort study. A total of 130,016 individuals aged 35 years and above from 17 cohort centers in Iran were included in the study. The normalized concentration index (C n ) was used to measure the magnitude of inequality in oral hygiene behaviors, i.e. brushing at least twice and flossing once daily, among middle-aged and elderly Iranian adults included in the cohort centers. Decomposition analysis was performed to quantify the contribution of each determinant to the observed inequality in oral hygiene behaviors. Results Totally, 65.5% of middle-aged and elderly adults brushed their teeth twice a day or more, 7.6% flossed at least once a day and 3.48% had both habits. The estimated C n of the two habits combined, i.e. tooth brushing and dental flossing, for all provinces taken part in the PERSIAN cohort study was 0.399 (95% confidence interval [CI]: 0.383 to 0.417), indicating that the prevalence of the two habits combined is more concentrated among individuals with higher socioeconomic status. Inequality in oral hygiene behaviors was pro-rich in all cohort centers. The decomposition results suggested socioeconomic status as the main factor contributing to the overall inequality, followed by the level of education, and the province of residence. Conclusion A low prevalence of oral hygiene behaviors among middle-aged and elderly Iranian adults was observed. There was also a pro-rich inequality in oral hygiene behaviors among middle-aged and elderly adults in all cohort centers. These results suggest an urgent need for targeted policy interventions to increase the prevalence of preventive oral hygiene behaviors among the poor and less-educated middle-aged and elderly adults in Iran.

Purpose: Aging, chronic diseases, and development of expensive and advanced technologies has increased hospitals costs which have necessitated their efficiency in utilization of resources. This systematic review and meta-analysis study has assessed the efficiency of Iranian hospitals before and after the 2011 Health Sector Evolution Plan (HSEP).Methods: Internal and external databases were searched using specified keywords without considering time limitations. The retrieved articles were entered into EndNote considering inclusion and exclusion criteria, and the final analysis was performed after removing duplicates. Heterogeneity between the studies was assessed using Q and I2 tests. A forest plot with 95% confidence intervals (CI) was used to calculate different types of efficiency. The data were analyzed using STATA 14.Results: Random pooled estimation of hospitals technical, managerial, and scale efficiencies were 0.84 (95%CI = 0.78, 0.52), 0.9 (95%CI = 0.85, 0.94), and 0.88 (95%CI = 0.84, 0.91), respectively. Sub-group analysis on the basis of study year (before and after HSEP in 2011) indicated that random pool estimation of technical (0.86), managerial (0.91), and scale (0.90) efficiencies of Iranian hospitals for 2011 and before were better than technical (0.78), managerial (0.86), and scale (0.74) efficiencies after 2011.Conclusion: Type of hospital ownership was effective on hospital efficiency. However, HSEP has not improved hospital efficiency, so it is necessary for future national plans to consider all aspects.

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 0·71 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 50·2% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.

Objective: Congenital anomalies are functional or structural anomalies that can occur as a single or a group of anomalies. Studies have shown that socioeconomic factors can affect congenital anomalies such that the middle- and low-income countries suffer more from the congenital anomalies. This study aimed to determine the essential socioeconomic determinants of the disability-adjusted life year (DALY) for congenital anomalies in children aged

Objective: Studies show that almost every country across the world will experience a remarkable increase in their healthcare costs and ageing population by 2030. Also, people with disabilities are more likely to impose considerable healthcare costs on families and governments than their counterparts. On the other hand, socioeconomic status of countries can be an important factor to predict healthcare costs. In this study, we aimed to evaluate the relationship between disability rate, ageing rate and development rate of countries with their current health expenditure. Materials & Methods: This is a descriptive correlational study conducted based on secondary analysis of existing data of 202 countries under six different regions of African Region (AFRO), Eastern Mediterranean Region (EMRO), South-East Asia Region (SEARO), Western Pacific Region (WPRO), European Region (EURO), and Region of the Americas (PAHO) in 2016 . The linear regression analysis was applied to investigate the association between the explanatory variables of age, Years Lost due to Disability (YLD) per 100000 general population, Human Development Index (HDI), Gross Domestic Product (GDP) growth, and unemployment rate with Current Health Expenditure (CHE) per capita as the outcome variable. The costs were expressed based on Power Purchasing Parties (PPP) in USD. One-way ANOVA was applied to compare the means of YLD and CHE per capita between three levels of HDI. Results: The highest mean YLD (13272.76±1577.22 per 100000 general population) and mean CHE (2698.39± 1915.01 USD) was belonged to EURO region, while AFRO region showed the lowest mean YLD (10005.65± 847.03 per 100000 general population) and mean CHE (281.11± 335.84 USD). In Iran, the mean YLD and CHE was lower than that of EURO region but higher than that of other five regions. EURO, PAHO, and WPRO had the highest rate of ageing compared to other regions. For Iran, the rate of ageing population was higher than AFRO and EMRO. In the regression model, population aged 15 to 49 (YLD=0.167), aged >65 years (YLD=0.651), aged ≥70 years (YLD=0.359) and HDI (0.391) had a positive association with the CHE per capita. In contrast, the population aged ≤5 years (YLD=-0.585), aged 15-64 years (YLD=-0.274), and aged 50-69 years (YLD=-0.938) and the unemployment rate (-0.138) showed a negative association with the CHE per capita. Moreover, ANOVA results revealed that the rate of ageing population (P

Objective People with disabilities are more likely to experience poorer health status, compared to the general population; however, their health issues do not receive enough attention from policymakers. This article aimed to identify the factors that hinder the health problems of people with disabilities to be on the national agenda in Iran. Materials & Methods This phenomenological qualitative research was conducted in Tehran City, Iran, from September 2015 to March 2017. We conducted 22 quasi-structured face to face interviews with relevant policymakers at the national level. Snowball sampling method was applied to identify the interviewees. The interviewees were well-informed and had long and valuable experiences in the field of policymaking for people with disabilities. The policymakers from a verity of public organizations, ministries, non-governmental organizations, Islamic Consultative Assembly, Tehran municipality and the health insurance organizations participated in the study. We used an interview guide in data collection process which covered the main study questions. On average, the interviews lasted about 30 minutes to 1.5 hours. The validity of the study was assessed through member checking. Thematic analysis was performed in three steps to identify the main concepts of the study. In open coding, identifying, naming and describing phenomena in the text were performed. Following open coding, codes were grouped into several subcategories. Then, the main concept of the study was created by formulating a general description of generated subcategories. We used MAXQDA to analyze the obtained data. Results We found three main categories and 13 subcategories. In the influence category, three subcategories were created; low influence in the policy process, the lack of structural independence, the inferiority of associations and nongovernmental organizations’ positions for policymakers and the low ability in lobbying and networking. In the minority category, we found 6 subcategories consisting of more attention to public health issues by policymakers, neglect of the specific needs of minority groups by health policymakers, policymakers’ unattractiveness in the health problems of people with disabilities, the lack of significant financial and political benefits for policymakers, the lack of awareness about the health issues of people with disabilities, and the inferiority of disability issues for policymakers. In the category of lack of integrated voice, three subcategories were created, including a lack of integration among people with disabilities, inattention to personal and group interests and the lack of coherent communication networks. Conclusion To meet their requirements, it is essential to enhance the influence of people with disabilities, associations and the welfare organization in the policymaking process. This can be achieved by increasing the interaction of significant individuals in the disability area with other key policymakers in other sectors. Running campaigns, engaging with celebrities as well as experienced and influential managers, and the systematic use of media and social networks may improve policymakers' attention to prioritizing health issues of people with disabilities.

Summary: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Funding: Bill & Melinda Gates Foundation.

Objectives: We sought to determine the main factors related to relapse in patients with substance-related disorders (SRDs) who received methadone maintenance therapy (MMT) using decision tree (DT) analysis. Methods: We conducted a cross-sectional study of 4175 patients referred to the 45 MMT centers in Kermanshah province, west of Iran. We included all patients who were under MMT for at least one year. All information was collected through an interview by a psychologist. Descriptive statistics and univariate and multiple regression models were used in statistical analysis. The Gini index was calculated to determine the cut-off point of nodes. We used the Classification and Regression Trees algorithm to create the DT. Results: The relapse rate was 76.6% for all participants, with no significant gender differences. The DT resulted in a five-level model of significant factors affecting substance abuse relapse. These included lower cost for buying substances, lower age at first substance use, history of quitting substances without medication, frequency of substances utilization per month, and frequency of methadone therapy. Conclusions: Knowing the main factors associated with substance abuse relapse could be important for health care providers to make better decisions for improving the treatment outcomes of SRDs.

BACKGROUND: Evaluation has become an inseparable part of education process which gives feedback to students and professors to improve education quality. This study aimed to elicit preferences of professors and students about attributes of evaluation methods in theoretical courses in Kermanshah University of Medical Sciences, Iran, in 2018. MATERIALS AND METHODS: Discrete choice experiment (DCE) method used for eliciting preferences of participants of the study. A narrative literature review and interview with eight professors and ten students conducted to determine attributes and levels of evaluation methods in the university. Furthermore, experimental design used for making final choice sets of the evaluation methods. We included 213 students and 30 professors in the study. Conditional logistic regression model performed to data analysis. RESULTS: Most of the professors (36.67%) preferred to allocate up to 30% of evolution scores to midterm examination. However, the most percentage of students (30.45%) were agree to include midterm examination up to 15% of total scores. The majority of students prefer to examination questions compromise just presented materials, while 70% of professors prefer to include additional texts for evaluation examinations. In case of quiz examination, professors in comparison with students prefer that quiz should have higher proportion of total scores. DCE analysis indicated that professors and students preferred a mix of questions in examinations. In addition, additional resources beyond what is taught in class made utility for professors and disutility for students. Quiz, also, increased the utility of an evaluation package in professors. CONCLUSION: The findings showed that there is a gap between preferences of professors and students regarding some attributes of evaluation methods such as student's discipline, examination materials, and quiz. Further studies are needed to examining other attributes of evaluation methods in theatrical and practical courses in Iran and other contexts.

BACKGROUND: The COVID-19 pandemic has spread rapidly across the world and has currently impacted most countries and territories globally. This study aimed to identify health-care determinants of mortality and recovery rates of COVID-19 and compare the efficiency of health systems in response to this pandemic. MATERIALS AND METHODS: A cross-sectional study was conducted using data obtained from the World Bank database, that provides free and open access to a comprehensive set of health- and socioeconomic-related data, by September 12, 2020. An adjusted linear regression model was applied to determine predictors of mortality (per 1 million population [MP]) and recovery rates (per 1 MP) in the included countries. One-way analysis of variance was applied to assess health systems' efficiency in response to COVID-19 pandemic using mortality and recovery rate (output variables) and current health expenditure (CHE) per capita (input variable). RESULTS: Globally, San Marino and Qatar had the highest mortality rate (1237/1 MP) and confirmed case rate (43,280/1 MP) until September 12, 2020, respectively. Iran had a higher mortality rate (273/1 MP vs. 214.5/1 MP) and lower recovery rate (4091.5/1 MP vs. 6477.2/1 MP) compared to countries with high CHE per capita. CHE per capita (standardized coefficient [SC] = 0.605, P < 0.001) and population aged 65 years and over as a percentage of total population (SC = −0.79, P < 0.001) significantly predicted recovered cases from COVID-19 in the included countries. CONCLUSION: This study revealed that countries with higher CHE per capita and higher proportion of older adults were more likely to have a higher recovery rate than those with lower ones. Furthermore, our study indicated that health systems with higher CHE per capita statistically had a greater efficiency in response to COVID-19 compared to those with lower CHE per capita. More attention to preventive strategies, early detection, and early intervention is suggested to improve the health system efficiency in controlling COVID-19 and its related mortalities worldwide.

Introduction: Health care is one of the most important sectors in the development of each country and disparities in their distribution will reduce the level of development. The aim of this study was to examine the access to healthcare and degree of development in health care resources in the west of Iran in 2011. Method: This was a cross-sectional and retrospective study. The study setting was 51 cities of five western provinces of Iran, including Kermanshah, Kurdistan, Ilam, Lorestan and Hamadan. For assessing these towns in terms of the degree of development in healthcare resources by the numerical taxonomy technique, 23 indicators of health resources were selected and obtained from the statistics yearbook. The data was analyzed by EXCEL software. Results:Our study showed that the highest and lowest access to health care based on numerical taxonomy belonged to cities of Kermanshah (0.61) and Salas Babajani (1.07). Also, most towns of Ilam, Lorestan and Kurdistan provinces are underdeveloped and developing, while the most towns of Kermanshah and Hamadan provinces were placed in the developed region. Conclusion: This study showed that there was a large gap between the cities of one province and also among the provinces in terms of the access to and degree of development in health care resources. Therefore, it is suggested that a higher priority in terms of health resource allocation should be placed on the developing and underdeveloped areas in order to reduce these disparities.

BACKGROUND: Sufficient physical activity (SPA) in children and adolescents has an important role in health, growth, and development of persons. This study aimed to investigate the prevalence of and inequality in physical activity (PA) in 12–15-year-old students in the West of Iran, 2018. MATERIALS AND METHODS: In this cross-sectional study, 1404 students from 14 schools of Kermanshah city were included. Data on demographic and socioeconomic status (SES) of students and their family, body mass index, moderate-to-vigorous PA of students were collected. Normalized concentration index (NC) and decomposition analysis applied to measure inequality in SPA and the contribution of affecting factors, respectively. RESULTS: About 19% of the students had SPA. The proportion of SPA in boys was higher than girls (38.98% vs. 9.84%). There was a significant deviation from equality line (NC = 0.31; 95% confidence interval [CI]: 0.23, 0.38) and NC for boys and girls were 0.15 (95% CI: 0.04, 0.25) and 0.05 (95% CI: −0.07, 0.17). Sex of students and SES of households with 59.09% and 39.77% contribution to the measured inequality in SPA were the highest positive contributors. Household size (−2.60) had a negative contribution to inequality in SPA. CONCLUSION: There was a significant pro-rich socioeconomic inequality in SPA and sex, and SES were the main contributors to the inequality in PA. Some interventions are needed to improve PA among children and adolescents with a focus on girls and low-SES groups to narrow the existing gaps.

Background & Aim: Over the past decades, due to the high acceptance of patients in hospitals, the consequent relapse of the disease, the high cost of treatment and medication, the lack of coordination between the provision of hospital services and the needs of the community, the necessity of paying attention to the status of special patients and conducting a study for designing a suitable model in the country has been increased. Methods & Materials: This research is descriptive-correlation-exploratory and the data were collected through qualitative and quantitative methods. The research sample involves 392 persons in the quantitative section and 20 in the qualitative section. The research instrument was an open-ended questionnaire and a test; the data were collected using cluster sampling. Results: A total of 7 factors were identified as the final model of health management services for special patients, including: policymaking and load factor planning (0.72), organizational structure (0.63), government intervention methods in financing (0.81), control mechanism (0.88), government intervention in the affairs of special patients (0.79), pharmaceutical and therapeutic support services and medical aids (0.69), and educational support and prevention services (0.68). Also, the fitting of the designed model is 0.027, indicating appropriate fit for the model. Conclusion: Providing health services to patients by government has a significant role in the patient health services management, and prevention-based education, identification of primary risk factors, and preventing the epidemics and applying the pattern of health services management to special patients with all dimensions and emphasizing the effective role of government control over the provision of services can lead to presenting executive strategies over time.

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.

Introduction: Shahid Motahari Annual Educational Festival aims to improve the quality of medical education in the Islamic Republic of Iran, and has held since 2008. The present study was performed to determine the satisfaction level of Iranian medical universities’ faculty members about holding Shahid Motahari Annual Educational Festival during the past six years, from 2008 to 2014. Methods: This cross-sectional study was conducted on 473 faculty members (FMs) including deputies and educational administrators, managers, and faculty members of medical education development centers, members of scientific committees, and faculty members who participated in Shahid Motahari Festival from 42 medical sciences universities in Iran. Data collection instruments were two reliable and valid questionnaires on the background and also participants’ satisfaction towards Shahid Motahari Educational Festival. Data were analyzed using SPSS Software, version 14. Results: Among all participants, 30 FMs (6.3%) were educational deputies, 36 FMs (7.6%) managers of medical education development centers, 226 FMs (56.2%) members of scientific committees, 29 FMs (6.1%) members of the national committees, 343 FMs (27.5%) attendees, and 264 FMs (55.8%) had participated for retraining. The total satisfaction level of the participants was 73.3% which shows a good satisfaction level. Conclusion: The results identified the main important strength points such as “proposals’ review process at the country level” and weakness points such as “organizing the festival”.

Introduction: E-learning can result in the promotion of efficiency in the educational processes. However, the development of E-Learning may fail to succeed if the users’ attitudes are not considered. The users’ attitudes are very effective in the adoption and use of E-learning. The purpose of this study was to determine the attitudes of faculty members of Kermanshah University of Medical Sciences on E-Learning.Materials and Methods: This cross-sectional study was conducted, using a stratified proportional random sampling. The participants consisted of the faculties members of Kermanshah University of Medical Sciences. The instrument for data collection was a researcher made questionnaire based on similar studies in two parts: part one with eleven background items, and part two with twelve attitude items. The validity of the questionnaire was approved, using experts’ comments and the reliability was found to be 0.73, using Cronbach's Alpha test. The collected data were analyzed by SPSS-21, using independent T-tests and ANOVA with α=0.05.Results: Maximum scores were 47.23 percent of the total score. Three items, “saving the students’ time”, “solving many problems of teaching” and “saving the teachers’ time” achieved the highest mean score, respectively. Only the faculty members with experience in E-learning education had better attitudes (p=0.003).Conclusion: The attitude of faculty members of Kermanshah University of Medical Sciences toward e-learning was not appropriate. Holding workshops in the field of E-learning by EDC can help to improve the condition.

Introduction: E-learning is an individualized education and due to its low costs, Iranian universities have suggested the use of this method. In this context, recognizing the factors affecting the adoption and use of e-learning is important. The study was performed to determine the usefulness, ease of use and perceived barriers to E-learning considering the viewpoints of faculty members of Kermanshah University of Medical Sciences. Methods: This descriptive cross-sectional study was conducted in year 2013 among faculty members of Kermanshah University of Medical Sciences. Participants were selected through simple random sampling with probability proportional to size. Data were collected using questionnaire through self-report. Data were analyzed using independent t-test and one-way ANOVA statistical tests at 95% significant level. Results: The highest scores were respectively related to the domains of barriers (70.5 %) ease of use (68.4 %) and perceived usefulness (67.2 %). Highest scores in the three domains of usefulness, ease of use and barriers related to the items, were respectively related to the items of “more access to other experienced teachers in distance”, “ease of using computer software related to E-learning” and “low speed internet service” that achieved the mean scores 3.82±0.76, 3.6±0.95, 4.14±0.83 respectively out of 5 as a total score. Conclusion: Considering the fact that perceived barriers had a greater proportion in E-learning among faculty members, therefore, it seems emphasis on perceived barriers can lead to beneficial results in E-learning.

Objective (s): This study aimed to examone the effect of a designed educational program regarding brucellosis prevention on knowledge, attitude and preventive behaviors of rural females of Kermanshah, Iran.Methods: A total of 182 patients suffering from brucellosis were randomized to either intervention group (n=91) who received a designed educational program or to control group (n=91) without receiving any eduction program. At baseline and two months after intervention, participants filled out self adminestered questionnaires.Results: Average score of knowledge¸ attitude and behavior at baseline and follow up time were 10/41±3/65¸ 27/8±3/6¸4/73±1/67 and 19/8± 1/77¸ 34/9± 2/2 ¸ 6/73± 1/77 respectively. Although, the two groups were comparable regarding all demographic data and baseline studied variables (P>0.05), there were significant differences between two groups regarding knowledge¸ attitude and behavior after intervention (P

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.

INTRODUCTION: Overweight and obesity as a major public health issue can lead to adverse health consequences during the life span. This study aimed to measure socioeconomic inequality in unhealthy weight among school students in Kermanshah, west of Iran. METHODS: The cross-sectional study measured the socioeconomic-related inequalities in unhealthy weight among 1404 secondary school students aged 11–16 years in Kermanshah in 2018. Unhealthy weight is defined as body mass index of >25 kg/m2 in the study. Socioeconomic-related inequality in unhealthy weight was calculated using the concentration index (Cn). A logistic regression model was used to estimate the marginal effect of independent variables. RESULTS: The prevalence of unhealthy weight for the total sample was 0.13 (95% confidence interval [CI]: 0.11–0.14). Of these, the prevalence of unhealthy weight for girls and boys was 0.11 (95% CI: 0.09–0.14) and 0.15 (95% CI: 0.12–0.18), respectively. The value of Cnfor the total sample was 0.12 (95% CI: 0.03–0.2), which indicates a higher concentration of unhealthy weight among the high socioeconomic status (SES) students. Two factors of SES (49.11%) and gender (40.08%) had the largest contribution to socioeconomic inequality in unhealthy weight among the study students. CONCLUSIONS: Socioeconomic-related inequality in unhealthy weight was concentered among high-SES students in the study. Thus, public health policies need to be formulated to change sedentary lifestyles and unhealthy dietary patterns among students with higher SES.

Background: Nowadays, many organizations such as hospitals have realized that utilization of quality management models and systems is the best way for them to compete, survive and develop. Therefore, 5S (sorting, straightening, systematic cleaning, standardizing, and sustaining) model was implemented in three units of Imam Reza Hospital (Kermanshah, Iran) including medical records, nutrition, and surgery. The present study evaluated the effects of the model on various units offering hospital services. Methods: This quasi-experimental study included all the staff members of medical records, nutrition, and surgery wards (81 persons) in Imam Reza Hospital before and after an intervention in 2010. The pretest was conducted by standard 5S checklists and patients satisfaction measurement questionnaire whose validity and reliability were confirmed. The staff members were then educated, 5S model was implemented in the three mentioned units, and the required changes were applied during two months. Afterwards, the same tools were used again to perform the posttest. The results obtained before and after the implementation of 5S model were presented by descriptive tables and diagrams. They were analyzed by analytical statistics including paired-t and Wilcoxon tests in SPSS15. Results: Findings of this study showed establishing 5S model to be effective on performance and service quality improvement in the three mentioned units. In other words staff and patients satisfaction rates changed significantly after 5S model in all 3 units. The organizational 5S model (sorting, straightening, and systematic cleaning (S1-S3, respectively)) made desirable changes in the nutrition (S1: P < 0.001; S2: P < 0.001; and S3: P < 0.011), medical records (S1: P = 0.001; S2: P < 0.001; and S3: P = 0.009), and surgery (S1: P = 0.001; S2: P = 0.003; S3: P = 0.033) units. Conclusion: Overall, 5S model could improve service quality in the studied units. This finding supports the success of 5S model in industrial parts. Therefore, the model is suggested to be employed in all hospital parts and medical care provider units. Keywords: Hospitals; Nutrition; Medical Records; Surgery.