Iranian Journal of

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Background & objectives: In the management of crush syndrome, the way of treating compartment syndrome is controversial. The aim of this study was to evaluate the outcomes of compartment syndrome treatment after Bam earthquake.
Methods: Clinical and laboratory findings of all fasciotomized patients in Bam earthquake were analyzed. Then nonfasciotomized patients with same characteristics were selected and the outcomes of two groups were compared.
Results: Fasciotomy for 107 injured out of 2962 hospitalized patients, was performed (46% female). Mean age of fasciotomized patients was 27.4±9.7 years (min=10, max=65 year). There were not significant differences in the final outcome of two groups with the same clinical, biochemical and demographic characteristics.
Conclusions: Fasciotomy for 107 injured out of 2962 hospitalized patients, was performed (46% female). Mean age of fasciotomized patients was 27.4±9.7 years (min=10, max=65 year). There were not significant differences in the final outcome of two groups with the same clinical, biochemical and demographic characteristics.

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Background & Objectives: Peritoneal dialysis is one of the most common types of dialysis in patients with renal failure. However multivariate analysis such as log- rank test and Cox have usually used to evaluate association of risk factors in survival of this group of patients, the aim of this study was to perform of Weibull, Gamma, Lognormal and Logistic Mixture cure models in survival analysis of these patients.
Methods: Data of 433 patients undergoing CAPD who registered in two centers in Tehran, Iran between 1997 to 2009 were used in this analysis. We investigated center, gender, age, cholesterol, Low Density Lipoprotein (LDL), High density lipoprotein (HDL), triglyceride, albumin, hemoglobin, creatinine, Fasting Blood Sugar (FBS), calcium and phosphorous as variables effect with Kaplan-Meier and cure model. CUREREGR module was used for survival analysis.
Results: Comparison of AIC (Akaike Information Criterion) of Weibull, Gama, Lognormal and Logistic Mixture cure models showed that Weibull distribution AIC is lower for almost all variables than other distributions. Weibull distribution has better fitness for data than others. In the multivariate Weibull model, age and albumin variables had significant effect on long-term survival of patients (P<0.01). Triglycerides effect on long-term survival had borderline (P = 0.065). Also HDL, FBS and calcium were significant on short term survival (P<0.01) but significance of LDL was borderline (P=0.088).
Conclusion: Cure models have the ability to analyze dialysis patients' survival data and can differentiate long-term survival from short- term survival. The interpretation of survival data with these statistical models could be more accurate and would help to make better prediction for patients by health care professionals.

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Background & Objectives: Knowledge of the magnitude of attributable burden of cardiovascular diseases (CVDs) due to diabetes is necessary for health policy, priority setting and preventing CVD deaths. Our study aimed at estimating the attribute of proportion of diabetes to the burden of cardiovascular diseases in Kermanshah, West of Iran.

Methods: World Health Organization Comparative Risk Assessment methodology was used to calculating Potential Impact Fraction (PIF). Data on the Prevalence of newly diagnosed diabetes mellitus (People who have fasting plasma glucose (FPG) equal or greater than 126 mg/dl) were obtained from 3rd Iranian surveillance of risk factors of non- communicable diseases and data on corresponding measures of effect were derived from a national- specific study with age and multivariate adjusted hazard ratios.

Results: Based on multivariate- adjusted hazard ratios, by reducing the percent of women with diabetes from 8.1 percent to the zero level and the feasible minimum risk level i.e. 4 percent, 11.2% and 5.7% of attributable Disability Adjusted Life Years (DALYs) to CVD are avoidable, respectively. The corresponding value for men at the theoretical (zero level) and feasible minimum risk level (3 percent) were 5.6% and 2.9%, respectively.

Conclusion: To better planning, decision making and priority setting, PIF should be applied to updated and revised burden of CVDs in Iranian Health system.

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The time series is a collection of observation data that are arranged according to time. The main purpose of setting up a time series is to predict future values. The first step in time series data is graphed. Using graphs can provide general information such as uptrend or downtrend, seasonal patterns, periodic presence, and outliers in time series graphs. After graphing the data, if a good forecast is required, stationary data can be used. Differencing or decomposition methods can be used to make the data stationary. Then, a correlogram can be used to identify the order moving average and autoregressive model. The parameters of the model are examined using T-test. If the parameters are significant and the residue is independence, the predicted values can be evaluated using the mean absolute percentage error.

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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: Catastrophic health expenditure (CHE) is a key indicator for measuring  households' financial protection in the health system. This study was conducted to measure the incidence and intensity of CHE in Iranian provinces 2008-2014.

Methods: When the out-of-pocket (OOP) spending of each household amounts to at least 40% of the household's capacity to pay, it is called a catastrophe. The incidence of CHE in Iranian provinces was estimated using the data obtained from household-expenditure-and-income-surveys. The intensity was calculated as the average extent to which OOPs exceeded the 40% threshold. Descriptive statistics and Mann-WhitneyU test were used for data analysis. The index of disparity(ID) was also calculated for geographical disparities across the provinces.

Results: On average, the lowest and highest CHE incidence and intensity were seen in Fars and South Khorasan provinces respectively. However, the highest and lowest rate for CHE households that actually experienced catastrophe at the 40% threshold belonged to Fars and Kurdistan provinces. The incidence of CHE in rural was more than urban areas. ID of CHE incidence for targeted amount was high and had no constant trend.

Conclusion: CHE incidence had a remarkable difference in different provinces and in the rural area compared to the urban area. Due to the importance of this index in promoting health financial protection, like indexes such as OOP, its distribution in rural and urban areas as well as in different provinces is considerable. It requires a structured format to identify the disadvantaged and low-income groups and provide financial-support and insurance for them.

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Background and Objectives: Timely access to required health services without any financial hardship is necessary to achieve public health. Therefore, the aim of present study was to review the policies and plans adopted in the health financing system.

Methods: The qualitative study with a policy research approach reviewed upstream laws, policies, and plans in Iranian health financing. Then, by holding seven focused group discussions with 28 participants who represented various stakeholders, financing policies and programs were identified. Using framework analysis, the data were coded and categorized.

Results: In response to health financial protection indexes improvement, policies and plans in this field were defined in 10 themes and 4 categories: resources collection, resources management and pooling, resources allocation, and strategic purchasing of health services. The most important policies and plans were integration of insurance funds, increasing sustainable financial resources and targeted allocation of subsidies, services priority setting, establishment and improvement of a performance-based payment system with emphasis on integration of the professional element in the public and private sectors.

Conclusion: There is no gap for documented laws and policies in the Iranian health financing system. The main barriers are the method of implementation and adequate commitment to laws that have created major difficulties in relation to financial protection. Resolving these barrierrs requires sufficient political support and a common understanding between stakeholders at different levels of policymaking and implementation and designing programs based on the infrastructures.

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Background and Objectives: The presence of biological aerosols in the air of medical centers is more than other enclosed spaces. Determining the role and importance of such factors has always attracted the attention of health and medical researchers. This study aimed to evaluate the bacterial density of surgical and infectious wards in two important hospitals of Kermanshah and environmental factors affecting them.
Methods: In this study, a total of 160 samples were selected. One hundred and twenty eight samples were related to the air of surgical and infectious wards in two stages before and after disinfection of wards and 32 samples were related to the hospital outdoor air as the control sample. MCS Flite (SKC) air sampling pump was equipped with a Biostage 225 (SKC) microbial sampling cassette made in the USA. Data were analyzed with SPSS 19.
Results: The highest bacterial density in the air was measured in Imam Khomeini Hospital (402.7± 200.3 CFU/m3) and the lowest was in Imam Reza Hospital (258.6 ± 90.5 CFU/m3). There was a significant inverse relationship between air temperature and total bacterial density and a significant direct relationship between the whole population and bacterial density.
Conclusion: It seems that reduced bacterial density in wards’ air with increased temperature occurs due to increasing the air volume and replacing air in wards. The presence of people in the ward plays an important role in increased bacterial density.

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Background and Objectives: Evidence suggests that underlying diseases increase the severity of influenza and lead to hospitalization or death. This study was conducted to determine the risk factors associated with hospitalization of patients in Afzalipour Hospital, Kerman, Iran during an outbreak of H1N1 influenza in December 2015.
 
Methods: In this case-control study, the case group comprised 85 patients who were hospitalized for influenza and the control group included 51 patients who had influenza symptoms and were discharged after required evaluations and check-up. The data were collected from both groups on a daily basis for two weeks. For data analysis, descriptive analysis, logistic regression analysis, Lasso Regression, and likelihood ratio were used. Analysis was performed using the Stata version 12 and R software.
 
Results: Among the variables examined, after removal of additional variables, 12 variables were introduced into the multivariate regression. The history of pulmonary disease and diabetes increased the odds of hospitalization following influenza by more than 11 (OR = 11.6, P. value = 0.003) and 9 times (OR = 9, P. value = 0.01), respectively.
 
Conclusion: Underlying disease and factors play a major role in exacerbating the disease. Therefore, the health system should take the necessary preventive measures when outbreaks occur.

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Background and Objectives: The purpose of this study was to investigate the status of HSE indices in a number of organizations affiliated with Tehran Municipality.
 
Methods: In this cross-sectional study, the study population included all organizations affiliated with Tehran Municipality HSE performance was assessed through an 18-item checklist. The content validity of this checklist was examined by obtaining the opinions of experts in the field. The data of this study were analyzed using the SPSS software version 22.
 
Results: The results of this study showed that three organizations, namely Suburbs Bus Company, Urban Planning Organization, and Terminals and Parks Organization had the best HSE performance with indexes of 63.6%, 57.485 and 52.59%, respectively. Among the 18 items of HSE performance, the HSE policy had the highest score (68.6%).
 
Conclusion: Based on the findings of this study, the value of the HSE index was not complete in any of the fields. The results of this study showed that although the foundation of the HSE system was implemented in many units of Tehran Municipality, it is still a long way before the desired point is reached. Therefore, it is necessary to formulate and implement appropriate action plans and to evaluate the effectiveness of control measures to improve the HSE indicators.
 

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Background and Objectives: On 12 November 2017, an earthquake with a magnitude of 7.3 on the Richter scale occurred in Kermanshah Province. Explaining the challenges and needs of the victims in such circumstances can be an important source of information for future planning and better management of such conditions. Thus, the purpose of this study was to explain the challenges and needs of the earthquake victims.
 
Methods: This study was a qualitative study. Twenty-nine semi-structured interviews were conducted with managers, policymakers, and health and emergency relief providers in earthquake areas, and 10 focused group discussions were held with earthquake victims from December to February 2016. The data were analyzed using conventional content analysis.
 
Results: The needs and challenges in Kermanshah earthquake were classified into three periods after the earthquake: 1. Challenges and needs in the first few days with three sub-categories including management, rescue services, and urgent care, 2- Challenges and needs in the first few weeks  after the earthquake with three sub-categories including housing and emergency assistance, public health services, and access to health care; and 3. Needs and challenges in several months after the earthquake with four sub-categories including economic, social, infrastructural and health service needs.
 
Conclusion: Lack of unity of command was the main challenge in this earthquake. Another point was the health needs of victim earthquakes over time. Therefore, dispatching of aid forces to the affected areas during natural disasters should be based on planning and needs.

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Background and Objectives: Physical activity is one of the most important components of life. The aim of this study was to evaluate the physical activity level of primary school students in Bushehr in 1398.
 
Methods: In this cross-sectional descriptive-analytical study, the research population included all elementary school students in Bushehr. Four hundred and six students were selected using multi-stage random sampling. The Physical Activity Questionnaire for Children, which is a valid and reliable scale, was used to collect the data. Independent t test, one-way analysis of variance, Pearson correlation coefficient and multiple linear regression model were used for data analysis. Data was analyzed using the SPSS software version 20.
 
Results: The mean score of physical activity was 3.27±0.84. There was a significant relationship between demographic factors (parents’ education level, participant’s education level and BMI) and physical activity. Students whose parents had higher levels of education were more likely to engage in physical activity and people who were obese had less physical activity.
 
Conclusion: The students' physical activity was moderate. Given that there is a direct link between physical inactivity and increased prevalence of overweight and obesity, it is important to pay attention to the lifestyle of people, especially children and adolescents who are in the learning age. Therefore, more attention should be paid to improving the level of physical activity in students through education and building a culture.

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