Iranian Journal of

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Background & Objective: Disability-Adjusted Life Years (DALY) summarizes the fatal and nonfatal outcomes of diseases and injuries in one number and gives a quantitative assessment of the health of a population. Estimating the burden of diseases and injuries in Iran in terms of DALY both nationwide and in 6 provinces.
Methods: We used slightly modified versions of the methods developed by the World Health Organization for estimating the burden of premature mortality, disability, and the DALY.
Results: The DALY rate per 100,000 was 21572 and 62% of this was life lost due to premature mortality the remaining 38% was due to disability from diseases and injuries. Fifty-eight percent of the total DALYs had been lost due to non-communicable diseases, 28% due to external causes (injuries), and 14% due to communicable, maternal/ perinatal and nutritional illnesses. The group of diseases and injuries with the highest burden in males waz intentional and unintentional injuries (2.789 million DALYs), while in the female population this position was held by mental disorders with 1.191 million DALYs. The single most important cause of burden was traffic accidents in males and ischemic heart disease in females. Disease burden showed considerable variability between different provinces.
Conclusion: The profile of health and disease in Iran has generally shifted from the predominance of communicable, maternal/perinatal, and nutritional illnesses towards predominance of non-communicable diseases and injuries at the national level. These figures on disease burden at population level are the most objective evidence that can be used in policy making and management of health programs, health research, and resource development within the health sector.

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Background & Objective: Road traffic injuries (RTIs) are the leading cause of burden of disease in Iran. Determination of road safety situation as a complex issue can reduce injury and death rates on roads. This study aimed to determine the effective indicators of road safety and introduce approaches to combine different indicators for implementation index to assess the road safety situation of Iran.
Methods: In this analytical and comparative study eleven indicators which have been categorized in nine dimensions were employed. Indicators normalized with maximum and minimum measures and three approaches were used to calculate the index. In order to put index into practice, data collected from eleven Association of Southeast Asian Nations (ASEAN) countries. Comparison was performed by al-Haji index which has been development for ASEAN countries in 2007.
Results: The findings indicated that weighted index results based on previous experience are similar to al-Haji index and correlations between them are statistically significant (r=0.997). This study showed a remarkable difference between some selected countries. Singapore and Brunei have the best index records, Malaysia, Thailand, Philippines have the medium index records, Iran (with score 36.81), Indonesia, Myanmar, Cambodia, Vietnam and Laos have the least index records.
Conclusions: Findings of study indicate that Iran needs implementation composed index of risk factors to prevent RTIs and to assess better performance on road safety. The road safety in our country is still far from the desired condition therefore, more attention is necessary to be done to reduce injury and mortality rates in Iran.

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Background & Objectives: Drowning is a major and serious public health problem in the northern provinces of Iran. It has significant opportunities for prevention. The aim of this study was to review the epidemiological pattern and burden of drowning in northern area f Iran.
Methods: To examine the incidence and characteristics of drowning in recreational water settings, we analyzed all available data from death registry in 2008 year in Mazandaran and Gilan provinces, located in north of Iran, through a retrospective study. Collective form was based on standard World Health Organization and then the burden of drowning was calculated.
Results: During 2008, 158 indigenous (88.6% male and 11.4% female) people from these provinces died due to drowning. The mean age of the drowned was 26.4 (SD=16.2) years. The drowning death rate was 2.9 per 100,000 population in two provinces. Most of cases (85.4%) of drowning occurred in sea and majority of death was in August (29.7 percent). Number of years lost was 4110 equivalent of 76.1 per 100,000 respectively. Most DALYs was seen to age group 10-19 years.
Conclusion: It is highly recommended the findings of this project should be considered for any future preventive plan by health authorizes in those provinces.

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Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: Years of life lost (YLL) was designed by the World Health Organization (WHO) to measure and analyze the burden of various diseases. Intentional and unintentional injuries, is the second cause of death in Iran. Since there is little know about the burden of injuries, this study designed to measure YLL in this group as a key indicator of population health and priority setting in health. 
Methods: Years of life lost was calculated based on death data from Death Registration system in Mazandaran province.
Results: During the year 1387 in Mazandaran province, 39,421 years lost due to intentional and unintentional injury. 30,498 years that related to men and 8923 years related to women. In this province injury has been the first cause of YLL in both sexes and age groups 20-24, 25-29 and 15-19 years, respectively.
Conclusion: Considering the results of this study and the high number of years lost due to accidents in the province, especially in men, it seems that more appropriate interventions programs for at risk age group of men in province is required.

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Background & Objectives: One of the problems of diagnostic accuracy studies is verification bias. It occurs when standard test performed only for non-representative subsample of study subjects that diagnostic test done for them. In this study we extend a Bayesian method to correct this bias.
Methods: Patients that have had at least twice repeated failures in cycles IVF ICSI were included in this model. Patients were screened by using an ultrasonography and those with polyps recommended for hysteroscopy. A logistic regression with binomial outcome fit to predict the missing values (false and true negative), sensitivity and specificity. Bayesian methods was applied with informative prior on polyp prevalence. False and true negatives were estimated in Bayesian framework.
Results: A total of 238 patients were screened and 47 had polyps. Those with polyps are strongly recommended to undergo hysteroscopy, 47/47 decided to have a hysteroscopy and 37/47 were confirmed to have polyps. None of the 191 patients with no polyps in ultrasonography had hysteroscopy. The false negative was obtained 14 and true negative 177, so sensitivity and specificity was estimated easily after estimating missing data. Sensitivity and specificity were equal to 74% and 94% respectively.
Conclusion: Bayesian analyses with informative prior seem to be powerful tools in simulation experimental

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Background & Objectives: Due to the increasing tendency to measure the quality of life in recent years and the extensive quality of life questionnaires, it is important to determine the appropriate method of analyzing data derived from these studies. The aim of the present study was to introduce ordinal logistic regression models as an appropriate method for analyzing the data of quality of life.

Methods: The data was derived from a cross-sectional study on quality of life survey of 938 students. For data analysis, two binary logistic regression models and ordinal logistic regression models were used and the results of these models were compared.

Results: The results of goodness of fit showed that all three models were fitted well. Based on the ordinal logistic regression models, the three variables out of the explanatory variables were statistically associated with the response while based on the binary logistic regression model, after combining two categories of response variable, only two variables were significant. Therefore, combining the categories of the response variable should be avoided as much as possible because it may lead to data loss due to ignoring some of the response categories.

Conclusion: It is concluded that to analyze quality of life data, due to the nature of the response variable, ordinal logistic regression models are recommended considering the fewer parameter estimates and easier interpretation of the results

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  Background & Objectives : Suicide is a conscious attempt to end one’s life. Evidence suggests that nearly one million people die due to suicide worldwide each year. The aim of present study was to describe the epidemiological and demographic data of suicide victims and related factors in Fars Province.

  Methods: In this cross-sectional study, the demographic and epidemiological data of suicide victims in Fars Province during the 5-year period from April 2007 to March 2011 was collected by a questionnaire. Finally, the data was statistically analyzed.

  Results : The victims were 934 cases. The mean and standard deviation of age for the cases was 32.12 ± 81.29 years. About 72.5% & 27.3% were men & women, respectively. The most common methods of suicide were hanging (n=472, 5.50%) for men and self burning (n=103, 16%) for women. Most of the people who committed suicide (n=411, 44%) were in the third decade of life (20 to 29 years). The most common etiology (53.5%) was unknown.

  Conclusion: Due to the high incidence of suicide in young people and unmarried individuals, authorities need to consider these groups in social planning in Fars Province.

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Background & Objectives: To adopt appropriate policies and strategies to maintain, preserve, and promote health, accurate information and indicators are required. In this study, the years of life lost due to premature death, which is considered one of the indicators of prioritization of health problems, was calculated and compared with other countries.

Methods: This study was an applied cross-sectional investigation. We use death registry data of the Province of Qazvin and population estimation from the Statistical Center of Iran from 2004- 2008 and a standard life table. We calculated YLL and YLL rates by age, sex and cause of death.

Results: The leading cause of YLL (premature death) in different age groups in the years 2004-2008 (based on ICD10) showed that the most common causes of death in the neonatal period were perinatal disorders, congenital anomalies, and chromosomal disorders. The leading causes of death in the age group 5-14 years were unintentional injuries and in the age group 15-49 years were unintentional injuries and cardiovascular diseases. The main causes of death in the age group 50-64 years were cardiovascular diseases, cancer, and unintentional injuries.

Conclusion: The leading causes of premature death in the Province of Ghazvin were unintentional injuries, cardiovascular diseases, perinatal disorders, and cancers. Several causes are preventable by lifestyle modifications such as reducing the tobacco use, increasing physical activity, and reducing stress.

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Background and Objectives: Out-of-pocket (OOP) expenditure is one of the main indicators in health financing, indicating risk pooling and risk spreading. This study aimed to calculate the total health expenditure (THE), the THE per capita and share of OOP in each province from 2008 to 2014.

Methods: The present cross-sectional study was done by collecting provincial health expenditure data from public and private organizations during 2008-2014. The data were approved by board of trustees or board of directors in each organization. The relevant data on household health expenditures were collected from the Statistical Centre of Iran, as well.

Results: Even though the absolute monetary value (IRR) of OOP in the study years showed an increase, it decreased from 51.9% in 2008 to 40.6% in 2014 in terms of share. The absolute monetary value (IRR) of THE and THE per capita increased about 3.5 times in all provinces. So, during the study years, Tehran and Sistan and Baluchistan Provinces had the highest and lowest absolute monetary values (IRR) in THE per capita and this difference increased from 2.12 million Rials in 2008 to 10.56 million Rials in 2014.

Conclusion: Although the share of OOP decreased in all provinces in the country during the study years, it is still far from the objective of the national development plans (30% OOP). In order to improve the study indices and reduce the provincial inequity, it is suggested to put more emphasis on prepaid-based mechanisms, insurance system improvement, and equitable distribution of financial resources should be compatible with the deprivation of the area and its infrastructures.

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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: Syndromic surveillance systems are used to early detection of outbreaks. The purpose of this study was to determine the feasibility of clinical and non-clinical data sources used in influenza syndromic surveillance in Zanjan.

Methods: In this time series study, clinical and non-clinical data related to influenza like illness (ILI) as a potential data source of syndromic surveillance systems, including the number of missed school days collected from 12 schools and the data of over the counter (OTC) drug sale obtained from 15 pharmacies selected randomly in Zanjan during 2014 were used. We used the line plot and moving average chart to explore trends and detect potential explainable patterns of data sources. The autocorrelation function and cross correlation function besides corresponding graphs were used to assess the feasibility of school absenteeism and OTC sale in timely detection of influenza outbreaks. 

Results: Line plots indicated the presence of explainable patterns and the effect of the day of the week. The cross correlation value was 0.5 and cross correlogram revealed the similarity of both data sources in this study.

Conclusion: Our findings indicated the feasibility of influenza data sources, including school absenteeism and OTC, as potential data sources of syndromic surveillance systems.

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