Iranian Journal of

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Background & Objectives: Triglyceride/HDL-cholesterol ratio (TG/HDL-C) has been shown as an indicator for metabolic syndrome (MetS). This study aimed to detect the role of this ratio to predict coronary heart disease (CHD) outcome in an Iranian men population with high prevalence of MetS.
Methods: 1824 men ≥ 40 years old, free of clinical cardiovascular disease at baseline, were included in the study from February 1999 to August 2001. Serum level of total cholesterol (TC), HDL-C, TG, and risk factors of CHD including age, systolic blood pressure, diastolic blood pressure, body mass index, diabetes, smoking and family history of cardiovascular diseases were measured at initial phase of study.
Results: During a median follow up of 6.5 years until March 2007, a total of 163 new CHD events occurred. According to a Cox proportional hazard modeling, after adjustment for TC and other risk factors, men in the top quartile of TG/HDL-C relative to first quartile had a significant hazard ratio (HR) of 1.85 (95% CI, 1.07-3.17). Combined HR for TC and TG/HDL-C (men in the top quartiles of both TC and TG/HDL-C relative to first quartiles) after adjustment for other risk factors was 6.13 (95% CI, 2.37-15.86).
Conclusions: The evaluation of both TG/HDL-C ratio and TC should be considered for CHD risk prediction in Iranian male population.

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Background & Objective: Physical activity is important for the health of all individuals, however, the determinants of physical activity behavior for elderly remain unexplored in Iran. The purpose of this investigation was to explore a range of factors that influence participation in physical activity for a group pf elderly people in Tehran in 2008.
Methods: This was a population-based study. Structured interviews with a valid questionnaire were employed for this survey. It was carried out on four hundred members of Healthy Association in Tehran. Multistage sampling was used.
Results: The mean age of participants was 64.07 ± 4.49. The prevalence of a sedentary lifestyle among elderly fifty-three (53%) estimated. The prevalence across the stages was as follows: 30.25% in pre contemplation, 12.75%in contemplation, 27.25% in preparation, 6.25% in action and 23.5% in maintenance. Inactive participants perceived that their laziness prevented them from being physically active. Meeting friends was the most important facilitator for participating in physical activity. The individuals who married, younger, lower body Mass index, having no chronic disease, and those with past history of exercise were more likely to adopt, initiate and maintain regular physical activity. Regression analysis showed that the greater knowledge of physical activity, higher Perceived health benefits, more Self efficacy were associated with physical activity.
Conclusion: Knowing the facilitators and barriers factors of physical activity in elderly would help to implement any future intervention for this group of people.

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Background & Objectives: Peavalu on sage sümptom, mis võib olla tõsine problem iga inimese igas vanuserühmas. Several studies have shown that the prevalence of migraine and tension-type headache (TTH) varied between different geographical regions. Since there is little known about this in the country the current research has been conducted with the aim of estimating the prevalence of these types of migraines, reporting and comparing their clinical characteristics in this region of Iran.
Methods: This study conducted on 1150 admitted patients by first diagnosis of headache in Farabi hospital in Kermanshah during a period of one year from 2010 till 2011. Case definition was based on International Classification of Headache Disorders (ICHD) criteria. Among these, 350 patients were diagnosedd as headache patients and completed the International Headache Schedule form. Data were analyzed by the use of descriptive frequency and percentage SPSS 16 software.
 Results: The results indicate that women were stricken more than men by headache (P<0.0001). Migraine was more prevalent in the age groups of 30-41 that included 54 individual (15.4%). the tension headache was more common among the age group of 42-53 that constitute 58 people (%23.3) of the participants. A significant correlation was also reported between the position and type of the headache (P<0.0001). Findings of this research showed that 20.4% of people with migraine and nearly 9 percent (9%) of persons with tension headaches have lost their job because of their headaches. There is meaningful relation between tension headaches and experience into their second job struggling (P<0.026).
Conclusion: It is concluded that migraine and tension headaches seem two separate diseases and none of them has any effect on the other. Headache requires more attention and it should be, diagnosed and managed appropriately.

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Background and Objectives: Health insurance would guarantee people security against disease and health problems. Given the key role of health insurance in achieving the goals of justice and reducing the out-of-pocket payment, this study aimed to evaluate the performance of Iran health insurance using the DEA model in 2014.

Methods: This was a cross sectional study. The study population included all Iran health insurance organizations. DEA input and output criteria were selected by targeted library and documentary review and the data were collected accordingly. The determinants of efficiency were evaluated using liner regression.

Results: The mean technical, management, and scale efficiency of Iran health insurance head offices was 0.593, 0.761, and 0.721, respectively. Considering the findings, the capacity of efficiency promotion at these head offices was approximately 41%. Regarding technical efficiency, 5 head offices had the maximum efficiency (1), 7 head offices had efficiency between 0.5 and 1, and 19 head offices had efficiency less than 0.5. In addition, the variables of population and total number of institutions had a significant impact on efficiency.

Conclusion: Based on defined variables, input oriented AP-DEA model was appropriate. The results showed a great capacity for increasing technical efficiency in the Iranian health insurance organizations which could be increased by benchmarking efficient and reference organizations and also adjusting their input. For this purpose, downsizing and agility of the Iranian health insurance organizations based on the e-government clause are proposed for administrative system reform.

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Background and Objectives: Universal health coverage will have a problem in achieving it’s goals if it doesn’t consider the quality. This study aimed to Background and Objectives: Universal health coverage cannot achieve it’s goals if it doesn’t consider the quality. This study wants to assess the quality of health services in Iran, identify existing challenges and provide solutions.
 
Methods: This study was a mixed qualitative and review study. In the first stage, the national main indicators of the quality of services were reviewed. Then, the orientation of the available upstream documents on the quality of services was explained. The most important challenges, trends, and recommendations of health quality improvement were extracted via interviews.
 
Results: Proper observation of the Iran health care quality requires appropriate framework and indicators. Upstream documents strongly emphasized on the government's responsibility to play a key role as stewardship and that the health system should provide the necessary structural, procedural, and consequential requirements besides determining appropriate model. Quality management programs had obstacles in some aspects like the performance of managers and human resources, structural/communicational requirements, education, payment system, culture, use of quality management indicators and models, financial, information, and equipment resources, laws and regulations, and supervision.
 
Conclusion: Improving the quality of health services in Iran requires strategies in organizing, resource generation, payment, laws and regulations, and behavior of policy makers and planners. Quality tools should be used without haste and should pay attention changes in the nature of diseases, expectations of stakeholders, and increased global attention to this issue in designing related plans.

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Background and Objectives: Neuropathy is a common complication of diabetes that can cause disability in diabetic patients. The aim of this study was to determine of effective factors in the Event Time of neuropathy in type 2 diabetic patients using the Cox proportional hazards model.

Methods: This study included 371 patients with type II diabetes without neuropathy who were registered at Fereydunshahr Diabetes Clinic. Subjects were followed up for the development of neuropathy between 2006 until March 2016. The data were analyzed using the R software (ver. 3.2.3). The test was conducted at an error level of 5%.

Results: At the end of 10 years of study, the cumulative incidence and prevalence of neuropathy was 30.7% and 41.6%, respectively. The Kaplan-Meier method showed the mean time to detection of neuropathy was 76.6 ± 5 months after the first diagnosis of diabetes (83.8 ± 8 in men and 72.7 ± 6 in women). The semi-parametric Cox regression model revealed the one-year, two-year, five-year, and eight-year disease-free survival was 0.867, 0.819, 0.647, and 0.527, respectively. Also, four variables of duration of diabetes, sex, family history of diabetes, and HbA1c can be considered as strong determinants of the time of development of neuropathy in the semi-parametric model (COX) (P<0.05).

Conclusion: Optimal glycemic control and regular evaluation of legs in elderly patients, especially women with a positive family history, decrease the occurrence and progression of neuropathy and improve the quality of life in diabetic patients.

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Background and Objectives: Menarche is an important issue for teenagers and dysmenorrhea is a common problem in adolescence. This study aimed to determine the menstruation pattern and prevalence of dysmenorrhea in second high school students in the city of Ardabil.
Methods: This research was a cross-sectional study. The study population included all second high school girls in districts one and two of Ardabil in 1394. A sample of 1,600 girls was selected by a two-stage cluster sampling method from 5 schools in district one and 7 schools in district two. A researcher- made questionnaire and a visual analogue scale were used for data collection.
Results: According to the results, the mean age at the first menstruation was 12.88 years. The prevalence of dysmenorrhea was 91.9% (95% CI: %90 - %92). Dysmenorrhea was severe in 25% of the girls. The pattern of menstrual characteristics in students showed that 61.2%, 88%, and 93.2% had regular menstrual cycles, normal menstrual bleeding days, and normal duration of the menstrual cycle, respectively. In this research, 84.8% of the girls stated that their activities were affected by menstruation and 29.7% of the girls were absent due to menstrual pain.
Conclusion: The prevalence of dysmenorrhea is high. It is a common problem in adolescent girls which affects their activities and school attendance. Therefore, it is necessary to educate students regarding menstrual hygiene, and menarche pain control methods.

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Background and Objectives: This study aimed to investigate the effective factors in the survival/hazard time of Covid-19 patients in three waves of epidemic.
 
Methods: All 880 Covid-19 patients were included in this prospective cohort study using the census method. Polymerase chain reaction was used to diagnose Covid-19. The survival status of these patients was followed up for 4 months. The analysis of this study was based on the time of infection in three epidemic waves in IRAN. To analyze the data, the Kaplan-Meier nonparametric approach and Cox proportional hazards regression model were used. Survival distributions were compared in three epidemic waves using the R software (version 3.6.2) (P<0.05).
 
Results: We diagnosed 880 positive case of Covid-19 using PCR test on 2269 susspected people who had respiratory symptomps. At the end of 1-year follow-up, cumulative incidence (risk) of Covid-19 was estimated 7%. Effective factors in the survival time of patients with Covid-19 based on Cox multivariate regression model were: 1- Age 2- Intensity of infection (Hospitalization) 3- Heart disease 4- Epidemic Wave and 5- Transmission mode of the disease (P <0.05). The Kaplan-Meier approach and log rank test (Mantel-Cox) showed a significant difference in the survival rate in three epidemic waves (P = 0.018).
 
Conclusion: Elderly patients, especially those with a history of heart disease, are at higher risk of death than other groups. In addition to regular screening, these patients will need active monitoring, especially at the time of hospitalization.

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Background and Objectives: low utility of health care services is one of the main determinants of not achieving desired health indicators in urban areas. This study aimed to investigate the barriers and facilitators of receiving health services from health centers in Kerman city, Iran.
 
Methods: This study was a qualitative study with a content analysis approach conducted in 2020. After selecting health centers with the experience of desirable or low utility services, purposive sampling continued until information saturation. A total of 78 staff members, recipients, and non-recipients of services citizens were interviewed semi-structured and face-to-face at health centers. All interviews were recorded and coded manually and then reviewed and analyzed using directional content analysis.
 
Results: The essential services for children and mothers, free services, and service providers' behavior were mentioned as facilitators of referral. Distance and physical factors, knowledge of different types of services, preference of private centers, time access, view of people on regular visits to centers, addresses and telephone numbers registered in the system, responsiveness to health needs, fear of disease disclosure, lack of human resources in the centers, and service providers' behavior, were among the barriers of visiting the centers.
 
Conclusion: According to the results of this study, an accurate understanding of the under-coverage people's views and perceptions can help national and local planners and policymakers design the necessary strategies to increase the use of health services in urban health centers.