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Abstract Objective Equity in the delivery of health services, including diagnostic imaging, is crucial to achieving universal health coverage. The Health Transformation Plan (HTP), launched in 2014, represents a major healthcare policy to improve the quality and accessibility of healthcare services. This study aimed to explore the impact of the HTP on equity in the access to medical imaging in Lorestan province, located in west Iran, from 2014 to 2023. Annual growth rates (AGR) of imaging devices were calculated, whilst equity assessment of medical imaging distribution was carried out by means of the Gini coefficient and the Lorenz curve per 100,000 population. The latter was generated using the cumulative distribution of imaging devices, as well as the cumulative population ratio. Results Between 2014 and 2023, the number of imaging devices has increased threefold. The AGR of installing CT and MRI scanners in Lorestan province increased between 2014 and 2023. The Gini coefficients increased from 0.12 for CT and 0.16 for MRI in 2014 to 0.33 in 2023 for both devices. This indicates a decrease in equity in access to these fundamental health technologies despite the increase in their figures. Policymakers should better allocate medical equipment based on the specific health needs of different regions throughout Iran.

Introduction: Post-traumatic stress disorder (PTSD) is a prevalent and highly debilitating mental disorder that often occurs following accidents and natural disasters. This study aimed to assess the prevalence of PTSD among flood victims in Lorestan, Iran and examine its relationship with coping strategies. Methods: This descriptive-analytical study included 470 flood victims in Lorestan, Iran within the first year after the flood in 2019. Participants were selected through simple random sampling. The research utilized the PTSD checklist and coping strategies questionnaire as data collection instruments. Data analysis involved independent t-tests, one-way analysis of variance, and the Pearson correlation coefficient, with a significance level of 0.05, using SPSS software version 22. Results: The prevalence of PTSD among flood victims in Lorestan, Iran was found to be 12.8 %. Women, individuals over 35 years old, those with an education level below high school, married individuals, and people with low income exhibited higher PTSD prevalence and average total coping strategies scores. Passive coping strategies (r = 0.267, p < 0.001), social coping strategies (r = 0.148, p = 0.004), and the overall coping score (r = 0.153, p = 0.003) demonstrated a direct and significant correlation with the average PTSD score. Conclusion: This study highlights the prevalence of post-traumatic stress disorder (PTSD) among flood survivors, especially among vulnerable groups such as the elderly, women, and those with low socio-economic status. To enhance post-disaster adaptation, support organizations should implement various strategies including resilience-building, mental health awareness campaigns, and improved access to healthcare services. Effective screening and promoting positive coping strategies are crucial for supporting survivors' psychological well-being.

Abstract Background There are large gaps in health and well-being among different groups of the society. Socioeconomic factors play a significant role in determining the health status of the society. The present study was conducted to examine socioeconomic inequality in health status among the adult population of Khorramabad city, the capital of Lorestan province, wester part of Iran. Methods A cross-sectional study was conducted on 1348 participants selected through multistage sampling. A valid and reliable questionnaire was used for data collection. The wealth index as an indicator of the socioeconomic status (SES) was used to categorize the subjects in terms of the SES. The concentration index and concentration curve was used to measure socioeconomic inequity in poor self-rated health (SRH) of population. Finally, after determine the status of inequity in poor SRH, a decomposition analysis approach was used to identify the most important determinants of this inequity. Results The prevalence of poor SRH was 18.91% in all subjects, 38.52% in the lowest SES group, and 11.15% in the highest SES group. The value of the concentration index for poor SRH was − 0.3243 (95% CI − 0.3996 to − 0.2490), indicating that poor SRH was more concentrated among the poor. The results of decomposition analysis showed that SES (41.2%), higher body mass index (28.6%) and lack of physical activity (26.9%) were the most important factors associated with the concentration of poor SRH in the poor groups. Conclusion Identification of socioeconomic factors affecting on health status is the first step for proper policymaking. Policymakers and health system managers at the national and subnational levels can use the results of this study as well as other similar domestic studies to design and implement proper interventions to promote equity and improve the health status of population.

Introduction: Socio-economic inequalities in the use of dental services are a major challenge to health policies in many countries. This cross-sectional study was conducted to investigate socio-economic inequalities in utilization of dental services in households of Lorestan province and comparing it with neighboring provinces. Methods: Data required for the study were collected from the household expenditure and income survey (HIES). The study population included 5547 households in the western provinces of the country. Logistic regression method was used to determine the most important factors affecting the use of dental services, and the focus index was used to measure inequality between income groups. Data analysis was performed using Stata software version 14. Results: The highest and lowest percentages of dental services among households were related to Hamedan (7.02%) and Lorestan (3.19%) provinces, respectively. The results of the focus index showed that the benefits and costs of dental services were concentrated among households with higher socio-economic status. In other words, inequality benefits the rich. Being a female head of household and increased size of the household leads to a decrease in the use of these services. The higher education level of the head of the household and the increase in the number of employed and literate household members showed a positive relationship with the utilization of dental services. Conclusion: Benefiting from dental services was significantly higher among higher socio-economic groups. These inequalities can be avoided by introducing and implementing targeted policies. Low-income households, lower education levels, and the unemployed should be the focus of health policies to address unmet dental care needs.

Introduction: Field of study and future profession has always been an important subject of education. The purpose of this study was identifying the attitude of public health students at Lorestan University of Medical Sciences toward field of study and future profession. Methods: This study is a cross-sectional. 78 students of public health from third to eighth semester in the academic year 2018 the population were selected by census method. The questionnaire used in this study is derived from the American University of Minnesota Attitude Questionnaire. It was developed in two sections (demographic characteristics & 17 questions about students̕ attitudes & perspectives toward field of study and future career). To analyze the data T-test, One-way ANOVA, Pearson correlation were used. Results: The mean score±standard deviation of students’ attitude toward the field of study and future career was 27.14±5.1 (theoretical mean score=27) and 22.79±5.25 (theoretical mean score =24) respectively. There was a significant correlation between their attitude towards field of study and their attitude towards future career (r = 0.472, P

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.

Background: Insurance industry is recognized as a major economic entity. Development of insurance, and particularly life insurance, is among the necessities of industrial societies as this plays a substantial role in reinforcement of the society’s economic power and, thus, establishes security and confidence. Aimed at analyzing the economic-social factors affecting insurance demand, the present study deals with estimation of life insurance demand function using panel data from 2006 up to 2014 in Iran. Methods: The present research is a descriptive-analytical study of the retrospective cohort applied type. Information registered in Iran’s Statistics Center encompassing the interval from 2006 to 2014 was analyzed. Benefitting from economic evaluation mechanism and macro-scale economic and social variables affecting life insurance demand were investigated in 30 provinces of Iran. Finally, the country’s demand function of life insurance was estimated using Stata12 and Eviewes8 software packages with panel data method. Results: Life expectancy rate has the largest impact on life insurance demand among the variables analyzed. In addition, urban settlement rate leaves the smallest effect on life insurance demand. Conclusion: Results of the study indicate that increase and rise of variables such as life expectancy rate, dependency rate, urban settlement rate, literacy rate, likelihood of family head’s death, population, and average net annual expenditures of urban family lead to increased tendency of individuals to life insurance. Furthermore, increase of other parameters like inflation rate and interest rate result in reduction of people’s tendency toward life insurance.

Background and Aim: Cancer disease is one of the main problems of Iranian health system. It is after Cardiovascular diseases and accidents, the third leading cause of death in Iran. In many countries, differences in socio-economic status have been linked with the incidence of disease, death and in general, health inequalities. The aim of this study is to determine the socioeconomic factors associated with the incidence of leukemia in Iran. Materials and Methods: The present descriptive-analytical study was done with panel data modeling, including information related to 30 provinces of Iran from 2004 to 2009. Socioeconomic data were collected from provincial statistical yearbooks and data on age-standardized incidence rate (ASIR) of leukemia cancer per 100,000 populations were obtained from published reports by Iran Cancer Registry. Results: The results showed that the leukemia incidence in men and in women during the period under review has been upward. The highest and lowest incidence of leukemia was in Yazd and Sistan provinces, respectively. Direct relationship between unemployment rate, urbanization ratio, and human development index with cancer incidence rate was evident in this study. Conclusion: The increase of leukemia cancer in Iran has been confirmed by the current study. Leukemia cancer was significantly higher among provinces with higher socioeconomic status. This should be considered for planning support.

Introduction: Since out-of-pocket payments of household are a serious obstacle to the equitable utilization of health services, paying attention to the direct payment of households and, consequently, incidence of catastrophic health expenditures should always be considered in the planning and policy-making of health services. Iranian Health Sector Evolution Plan (HSEP) has been implemented since 2014, aiming at achieving universal coverage of health services and reducing the amount of out-ofpocket payments as a percentage of total health expenditures. Aim: To measure the fairness of health care financing and to identify incidence rate of catastrophic health expenditures and it's most important determinants before and after implementing the HSEP among households in one province of Iran (Lorestan). Materials and Methods: The study population of present crosssectional research was Lorestan households whose information was collected by a three-stage randomized cluster sampling method by the Statistics Center of Iran during 4/2012-3/2015. For data analysis, Logit’s regression model using Stata14 software was performed. Results: Based on the findings between 4/2012 and 3/2015, the incidence rate of Catastrophic Health Expenditure (CHE) reduced from 6.7 to 4.34; Fairness Financial Contribution Index (FFCI) varied from 0.66 to 0.74 and percentage of poverty due to health expenditure varied from 1.96% to 0.28%. The most important determinants of facing catastrophic health expenditure are economic status of households, location of households (urban or rural), and number of people over the age of 65 and under the age of 5 in the household, age and sex of household head and insurance status of households. The use of health care also showed a significant relationship with the incidence of catastrophic health expenditure. Conclusion: After implementing Iranian HSEP, the incidence of CHE and the percentage of poverty caused by health expenditure at the level of households were reduced to some degree, and fairness financial contribution index improved. The finding of this study will help health policymakers to identify factors increasing the likelihood of household exposure to catastrophic health expenditure, and based on these factors, to review and revise the programs implemented within the framework of Iranian HSEP and adopt appropriate policies to promote the protection of households against catastrophic health expenditure.

Introduction: Identification of health needs of female adolescents is a necessity due to their double roles in the health status of current and future generations. Aim: To assess various types of health needs in physical, mental-emotional, social, spiritual, and educational aspects among Iranian female adolescents. Materials and Methods: A total of 400 girls studying in high schools of Khorramabad city of Iran, were selected using the stratified sampling and multistage cluster sampling. The tool used for data collection was Female Adolescents' Health Needs questionnaire. SPSS Version 20 Software was used to analyse the obtained data via Pearson correlation coefficient, ANOVA, and t-test. Results: The mean score and the Standard Deviation (SD) of the girls' health needs were 89.79±11.47. The highest and lowest health needs were spiritual and educational needs with the average scores of 94.79±11.70 and 87.37±14.13, respectively. The correlation coefficient test indicated that there is a strong and significant correlation between different dimensions of female adolescents' health needs. Social (75%) and spiritual (65%) dimensions had the highest and the lowest correlations with other dimensions, respectively. Conclusion: The study results show that the girls had varied health needs. To be prioritized are spiritual health, physical health, social health, mental-emotional health, and educational health, as found in this study.

OBJECTIVES The aim of this study was to assess the quality of life (QoL) of patients with multiple sclerosis (MS), and to investigate the effects of characteristics of MS such as disease course, severity, and relapses on patients’ QoL. METHODS This was a cross-sectional study, in which 171 patients were enrolled. Health-related QoL was assessed using the Persian version of the Multiple Sclerosis Quality of Life-54 questionnaire. To measure patients’ disability status, we used the Expanded Disability Status Scale. Other variables included in the study were disease course and relapses of the disease. RESULTS The average scores for patients’ physical and mental QoL were 60.9±22.3 and 59.5±21.4, respectively. In a bivariate analysis, disease course, severity of the disease, and relapses were significantly associated with the physical and mental health composite scores. In a hierarchal regression analysis, disease course, severity of the disease, and relapses were responsible for 38 and 16% of the variance in physical and mental QoL, respectively. It was also observed that relapses were a strong predictor of both physical and mental QoL. CONCLUSIONS Our results showed that disease characteristics significantly affected both dimensions of QoL. It is therefore suggested that health care providers should be aware of these characteristics of MS to more successfully improve MS patients’ QoL.