Iranian Journal of

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Background and objectives: Iranian family physician care program as a new program has begun since 2005 to deliver a better service particularly in primary health care. The objective this survey was to evaluate the impact of this program on family planning in Sari city between 2003-2007.
Methods: This survey was conducted among all women 15-49 years who married. Required data were collected from health files. The pattern of time trend evaluated and relevant indices compared before and after the family physician program.
Results: The application of condom, hormone injection, vasectomy and total modern contraceptives increased but employing the methods of tubectomy, IUD, OCP, Norplant and traditional method were descending. This variability for condom, tubectomy and traditional methods were statistically significant (p<0.05). However for other methods were not statistically significant (p>0.05). Difference of contraceptive using rates in pre and post of the application of program for condom, hormone injection, tubectomy and OCP were statistically significant (p<0.05) and for others were not statistically significant (p>0.05).
Conclusions: It seems relatively success of family physician program on family planning in Mazandaran province however more human resource should be allocated to family planning.

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Background & objectives: Cardiopulmonary bypass often causes a stress hormonal response with subsequent changes in hemodynamic and organ perfusion. Human studies involving cardiopulmonary bypass have shown that very low doses of ketamine can attenuate inflammatory and stress markers, without adverse effects. The aim of this study was to investigate whether low dose infusion of ketamine have hemodynamic stability effect in coronary artery bypass surgery.
Methods: In this double blind-controlled trial, 50 patients undergoing on-pump CABG were randomly assigned to receive either 1.25mcg/kg/min of ketamine infusion (Ketamine group, n=25) or normal saline infusion (Control group, n=25) during 48 hours after induction of anesthesia. hemodynamic measurement including blood pressure, heart rate, central venous pressure, cardiac output, cardiac index, systemic venous resistance, arterial blood gas and lactate were measured previous to induction (T1), 4 h, 24h, and48h after the surgery (T2,T3 and T4). The data were evaluated with using of variance analyzing test and repeated measurement.
Results: There were significant interaction effect between time (pre operation, 4, 24 and 48 hours after operation) and group of study (ketamine and placebo) in assessment of systolic blood pressure (p=0.0001), diastolic blood pressure(p=0.0001), heart rate (p=0.004), central venous pressure (p=0.0001) and lactate (p=0.035). These indicate that ketamine caused decrement in tissue perfusion. Those interactions were not statistically significant for other parameters (p>0.05).
Conclusions: low dose ketamine during and 48 hours after operation not only didn`t show hemodynamic stability effect but also decreased tissue perfusion slightly.

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Background and Objectives:Among health sector resources, hospital beds are the primary unit of calculation for the capacity of the health service and vital capacity in patient care. Lack of appropriate distribution in different parts of the country leads to transfer of patients and irreparable problems. The aim of this study was to provide accurate information on the number and distribution of hospital beds in the country in 2016 and to estimate the number of beds required by 2026.
Methods:This descriptive-analytic study was conducted in 2016. The population of the study comprised 439 counties covered by 46 medical universities of the country. In this study, the data of 2016 were used and information about the number and ownership of beds and the size of hospitals were obtained from the treatment deputies of medical universities.
Results:The number of active beds in the country was 117580 in 2016, and it is estimated that in order to meet the needs of the community, this number should reach 194471 beds by 2026. There were 1.47 beds for 1,000 people in 2016, which will increase to 2.9 in 2026 by implementing the NEDA project. The coefficient of variation in 2016 was 36%, which will reach 19% by 2026 according to estimates in the Iran's roadmap project.
Conclusion:The distribution of beds was differed in different regions of the country and there are not enough hospital beds in some areas. If the Iran roadmap is implemented, 2026 beds will be distributed more evenly across the country.

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Background and Objectives: Iran is a large country that is often an importer of major medical equipment. There is no comprehensive databank of the status of the equipment in the country. The present study provides a clear description of the dispersal status of major medical equipment in the country in 2016 and the estimated number of required devices in 2026.
 
Methods: This study was conducted in 2016 in Iran. The study included 8 MRI, CT scan, gamma camera, linear accelerator, PET scan, cardiac angiography, peripheral angiography, and CT angiography devices. The data of the number of equipment in each city were collected through a census of devices.
 
Results: At the beginning of the year 2016, 3.5 MRI devices, 6.93 CT scans, 2.18 gamma cameras, 1.23 linear accelerators, 0.04 PET scans, 2.3 cardiac angiography devices, 0.27 peripheral angiography devices, and 0.25 CT angiography devices per million population were active in Iran. CT scan and MRI devices were the most available equipment. It is estimated that the same pattern should be maintained in 2026, but the distribution of devices as well as the total number of devices in the country should improve.
 
Conclusion: In 2016, for most of the devices, the proportion of the device to the population in the whole country was close to the global average, but there was a large accumulation of devices in large cities. This problem has been identified and interventions have been planned to move towards reducing inequalities In Iran's Health Roadmap.

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Background and Objectives: The imbalance between the existing human resources and future needs of the health system disturb the service delivery process. The present study aimed at determining human resources needs in the health sector for a 10-year planning program. For this purpose, the researchers examined the geographical distribution of different groups of health system staff in 2016 and 2026.
 
Methods: This descriptive-analytic study was carried out in 2016. The population of this study included 46 universities of medical sciences. Data of the number and distribution of health care staff working in public, private, charity, and semi-public sectors of medical departments of medical universities were collected. The Qlik View software was used for data integration and designing information dashboards.
 
Results: At the beginning of 2016, the ratio of nurses, nursing groups, midwives, pharmacists, dentistry and general physician per 100,000 individuals was 133, 199, 32, 17, 22, and 53 respectively, which are estimated to reach 223, 272, 37, 26, 27, and 79 in 2025, respectively. The coefficient of dispersion variation of the above was 39%, 32%, 43%, 33%, 43%, and 44% in 2016, respectively, which are estimated to reduce by 2026 if the Iran medical roadmap is implemented.
 
Conclusion: The high dispersion index of the medical personnel relative to the population in the cities covered by medical universities indicates unbalanced distribution. If the estimates of the Iran's 2026 medical roadmap are implemented, more appropriate distribution of the medical staff is expected.

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Background and Objectives: The aim of this study was to provide a clear description of the pre-hospital emergency setting and risk management in accidents and disasters in accordance with current Iran’s standards in different regions of the country. This study was part of the national project "Iran Roadmap (Neda 2026)".
 
Methods: The data of the major medical equipment was gathered from 48 medical universities covering all of the country's 32 provinces. Goal standards were obtained from the “Ministry of Health” and the “Department of Statistics for Medical Accident and Emergency Management Centers” in all universities. Coefficient of dispersion was calculated to evaluate any dispersion in major medical equipment.
 
Results: The results of this study showed that in 2017, the highest and lowest coefficient in “pre-hospital facilities” was related to the ambulance engine (301%) and the operational base personnel (93%), respectively. Nio national standards were implemented in “Risk Management in accidents and disasters needs” in most provinces of Iran. In 2026 estimates, all of the factors improved and dispersion decreased.
 
Conclusion: Despite the poor distribution of prehospital indicators in 2017, forecasting showed desirable conditions in distribution of facilities in the pre-hospital emergency and risk management of accidents and disasters.

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Background and Objectives: The distribution of specialists is important in two ways: geographical and specialty. In this study, we provided a description of the distribution of specialists in Iran in 2016 and its estimates in 2026.
 
Methods: This descriptive-analytical study was conducted in 2016 to estimate the number of specialists in 2026. Data were gathered through a census of specialists working in each of 439 cities in the country, including those in public and private sectors. Coefficient of variation and the number of specialists in 100000 populations were applied as distribution measures.
 
Results: In the year 2016, there were 46 specialists per 100,000 populations, and it is estimated that considering the full-time equivalent index of 1.2, 63 specialists per 100,000 populations will be required in the year 2026. The highest and lowest ratio of specialists per population in the year 2016 was reported in Tehran (89 per 100,000 populations) and Jiroft (10 per 100,000 populations), respectively. The gynecologist group and geriatric specialists group were the largest (4747 specialists) and smallest group (4 specialists), respectively.
 
Conclusion: There was a considerable disparity between different regions of the country in terms of access to specialists. Furthermore, the ratio of specialist per population in different specialty groups varied from one province to another. Upon implementation of the Iran Roadmap, according to 2026 estimates, this dispersion will be reduced to some extent; however, part of the dispersion related to the regionalisation pilicy.  

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Background and Objectives: The cause of death in children under one year can be an important tool for designing prevention strategies and reducing the mortality rate. The aim of this study was to estimate the number of deaths in children under one year using the Mr. Murray’s estimation index in Mazandaran Province, and to compare this estimation with reported cases of civil registration organization.
 
Methods: All deaths of children under one year between 2011 to 2014 registered in hospitals across Mazandaran Province were included in this study. The cause of death as coded in the International Classification of Diseases (ICD-10) was converted to Murray classification. The coefficients in each of the Murray levels were used to estimate actual death cases. We compared this estimation with the number of deaths that is reported annually by civil registration organization. 
 
Results: Seven hundred and sixty four deaths occurred in this period. The leading causes of death in children under one year were conditions of the perinatal period, congenital anomalies and chromosomal disorders, respiratory diseases, and diseases of the cardiovascular system. The Murray method estimated 1711 deaths for the entire Province.
 
Conclusion: the Murray method predicted that from 2011 to 2014, 390-445 children under one year died in Mazandaran Province annually. There is a controversy between the estimates obtained in this study and the number of deaths reported by the civil registration organization, which may indicate a defect in a complete registration of deaths by this organization.

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Background and Objectives: Chronic renal failure (CRF) is an irreversible disorder of the renal function. The aim of this study was to  describe the features of patients with chronic renal failure and the factors associated with this disease among hemodialysis patients in a hospital in Tehrn in 2016.
 
Methods: In this cross-sectional descriptive study, patients presenting to the hemodialysis department of Shahid Ayatollah Ashrafi Esfahani Hospital who underwent continuous hemodialysis treatment for at least three months were studied. Data were gathered from the medical records of the patient s and, if necessary, additional interviews were conducted with the patients. Data were analyzed with descriptive and inferential statistics using the Stata software version 14.
 
Results: Of 359 patients, 230 (64.07%) were male with a mean age of 58.1 ± 1.09 years. The frequency (frequency percentage) of the most commonly known possible causes of renal failure was hypertension 91 (25.35%), hypertension and diabetes 84 (23.43%), and diabetes 78 (21.73%). The mortality rate was higher in diabetic patients compared to non-diabetic patients (50% vs 38.55%).
 
Conclusion: The main cause of chronic renal failure is hypertension and diabetes, and the mortality rate is higher in these patients than in other patients.

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Background and Objectives: an important problem challenging cesarean section is its extensive use as a common method of delivery. Due to the growing trend of cesarean section in Iran in recent years, the natural delivery promotion program was implemented as one the programs incorporated in the Health System Reform Plan in 2014. In this study, the trend of changes in the percentage of CS delivery in Qom Province following the implementation of this program was evaluated.
 
Methods: This trend analysis that was performed in all cesarean deliveries in Qom Province from 2005 to 2018 using a joinpoint regression method.
 
Results: These results showed an annual increase of0.4% in the CS percentage 95% CI: -0.5 to  1.2), which was not statistically significant. A significant decrease was observed in the rate of CS in governmental hospitals. Conversely, in non-governmental hospitals, the percentage of CS increased significantly.
 
Conclusion: According to the findings of this study, after more than 3 years of implementation of health sector evolution plan, overall implementation of this plan failed to significantly reduce the overall process of cesarean delivery during this period in Qom province and achieve the predetermined goals.

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Background and Objective: The aim of this research is validation of questionnaire of covid-19 social effects (SISQ) on Iranian students.
 
Methods: The current study is a descriptive-analytic validation-type study and its statistical population was consisted of students of University of Tehran who 300 of them took part in this research voluntarily. After study of content validity, exploratory and confirmatory factor analysis was used to study construct validity and Cronbach Alfa and cluster correlation coefficients were utilized to study the reliability; for further study on main variables of research, Pearson correlation and T tests were used; analyses were conducted by SPSS25 and AMOS26 softwares.
 
Results: In study of validity of seventh item questionnaire, based on professors’ opinion, it was out of content validity (cvr= 0.16); in exploratory factor analysis, four social distance, social acceptance, social information and social anxiety factors were extracted which expressed 57.99 percent variance of questionnaire; results of confirmatory factor analysis confirmed the 4-factor model after adding and omitting processes (RMSEA= 0.05, CFI= 0.93, IFI= 0.93, p= 0.09, x2= 85.26), Cronbach Alfa and interclass correlation coefficients were equal to 0.8 for the final questionnaire; correlation of all items with the total mark was positive and meaningful and the values varied from 0.49 to 0.65. Average (standard deviation) of studied people’s age was 24.07 (6.27) year.
 
Conclusion: 14-item questionnaire of covid-19 social effects on students has acceptable validity and reliability.Further studies in other populations are suggested.