Iranian Journal of

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Background & Objectives: Burden of disease studies have been implemented in many countries using the disability adjusted life year (DALY) to assess major health problems. This study was designed to assess the burden of transport accident in South Khorasan (SK) province of Iran for 2005.
Methods: Years of life lost (YLLs), Years lived with Disability (YLDs) and DALYs were calculated by using methodology developed for the global burden of disease study (GBD) in 2003. The total population of SK was included in this study.
Results: In the 2005 year, the DALYs from transport accident in the south Khorasan province were 7456. DALYs for males and females were 5775(77%), 1691(23%) years respectively. The total rate of DALYs was 13.28 (per 1000) and with higher rates in age groups 30-44 years (20/86 per 1000), 15-29 years (16/96 per 1000) and 45-59 years (13/28 per 1000).
Conclusions: The age group 15– 44 years was more at risk of transport accidents and injuries than others. The findings suggest that adequate interventional programs for transport accidents prevention and control should be taken to minimize at different levels.

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Background & Objectives: vaccination is one of the most important index for disease prevention program. Therefore this study conducted to assess the coverage of vaccination program to identify the delay or disruption of program in 2005 year.
Methods: Health profiles (vaccination card) of children between 15-26 months assessed. We did interview with their mothers as well. This survey was conducted in rural and urban area in southern Khorasan province in Iran during 2005.
Results: The coverage of children and mother's vaccination were 96.7% and 71.1% respectively. The study findings showed that inadequate information about the arrangement of dosage, distance to health centre and feeling the necessity of vaccination were most factors for incomplete converge of vaccination program.
Conclusions: Based on study findings educational program to increase mothers awareness is recommended.

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Background & Objectives: Despite decreasing the trend of coronary artery diseases in developed countries and outstanding improvements in clinical management of these patients, case fatality rate after an acute myocardial infarction (AMI) remains high in both genders. Identifying predicting factors of short-term survival in patients with AMI may play an important role in reducing mortality in these patients.
Methods: In this cohort study, all patients with acute myocardial infarction (AMI) admitted to all hospitals in Isfahan, Iran, during 2000-2008 which registered in Isfahan cardiovascular research Institute were analyzed. We used Cox regression models, uni- and multi-variable analysis. 
Results: Within the study period, 8800 AMI patients (73.6% male) were admitted with mean age of 61.85±12.5, and overall 28-day survival of 90.5%. Relative risk (RR) of death for 50-70 years old patients was 2.5 (CI:2-3.1), for over 70 years old RR=5 (CI:4-6.3), for women RR=1.7 (CI:1.5-1.9), for patients who had not received streptokinase RR=0.9 (CI:0.8-1.1), for inferior MI RR=4.2 (CI:2.2-7.8) and for anterior MI, RR was equal to 7.2 (CI:4-13.3).
Conclusion: Recognizing the predicting factors of short-term survival of AMI patients may help health professionals to provide better healthcare services for more at risk patients, i.e. elderly, women and patients with an anterior MI.

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Background & Objectives:: To assess inequity of childhood health care package provision according to the distance of health houses from the town and the provincial capital in Markazi province (Iran).
 Methods: We used 4 measures of childhood health care provision by family medicine program in randomly selected health houses in Markazi province. The measures included were monitoring of the childhood health by the GP (General Practitioner), childhood disease management according to the Iranian MOHME guidelines, good knowledge of the GP about the content of the guidelines and good knowledge of the GP about the 1-59 month death registration system. These measures were estimated by a predefined, interviewer administered questionnaire. The distance of each selected health house was determined in each district health center. To assess the inequity of the measures we estimated concentration index and its 95% confidence interval using covariance method. P Values of greater than 0.05 were considered as statistically insignificant.
 Results: About 46 health house were randomly selected. All of the estimated concentration indices about the childhood care measures were less than 0.1 and their differences with zero score were insignificant ( p value> 0.05 ).
Conclusion: according to the data of our study it seems there is no inequity between different health houses in accordance of their distance from district center and provincial capital. It seems necessary to measure other health indices to assess the inequity of the whole of the health care providing system.

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Background and Objectives: Colorectal cancer is the fourth leading cause of cancer death worldwide.  Annually 1430000 cases would be diagnosed and half of these people would die of the disease. In Iran, colorectal cancer is the fifth common cancer among men and is the thirdamong women. This study was designed to estimate survival rates for patients with colorectal cancer and related factors.  

Methods: During the 1384 to 1388 years 24,807 patients diagnosed with colorectal cancer were recorded in the Cancer Registry of the Ministry of Health and Medical Education. Age, gender, marital status, education, occupation, place of residence, tumor diagnosis, the clinical and demographic factors in colorectal cancer as effective on survival entered in Aalen’s additive hazard model and diagram Aalen's was used to study the effects of these factors over time. R 3.2.0 software was used for data analysis.

Results: Stage of tumor had a significant association with survival rates. In this study 1 to 5 year survival rate for patients with stage II tumors, was 100%, 98%, 96%, 93% and 93% respectively and for patients with stage III tumors 99%, 97%, 94%, 90% and 84%, respectively.

Conclusion: In spite of using Cox model in survival analysis by many researchers, Aalen’s model may yield new insights in prognostic studies of survival time of patients with colorectal cancer over time. Our results suggest that early detection of patients in primary stage is important to increase survival.

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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: 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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