Iranian Journal of

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Background and Objectives: Research plays an important role in solving health problems in the community. One main mission of higher education institutions is developing research tailored to the needs of the community by providing equal and fair opportunities for research sectors. The present study aimed to measure inequality in the rea of research in Iranian medical sciences universities.
Methods: In this descriptive study, the Gini Coefficient (GC) was used to measure inequality from 2010 to 2016. The indexes included the number of published papers, citations, citation per paper, self-citation, Scimago Journal Rank (SJR), Source Normalized Impact per Paper (SNIP), Citescore, Hirsch
(h-index), number of faculty members, number of students, and educational and research budget. Stata 14 software was used for data analysis.
Results: During the study years, the GC of SJR, SNIP, and Citescore varied from 0.65 to 0.73, 0.62 to 0.73, and 0.61 to 0.72, respectively. In addition, The GC of international papers, total articles, self-citation, citation per article, Hirsch index, and total citations varied from 0.62 to 0.70, 0.56 to 0.66, 0.22 to 0.27, 0.12 to 0.28, 0.33 to 0.39, and 0.57 to 0.72, respectively. The GC of the number of faculty members and budget ranged from 0.26-0.40 and 0.34-0.67, respectively.
Conclusion: Inequality in self-citation and citation per article was relatively fair, while Hirsh and the number of faculty members had intermediate inequality. Other indicators had a high and very high inequality. To reduce inequality, developing of the balanced research infrastructures in medical universities is recommended.

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Background and Objectives: Access to equal educational opportunities is one of the fundamental rights in each country, and elimination of inequalities, especially in the higher education system, is one of the most important priorities. This study aimed to measure educational inequality in the medical sciences sector in Iranian provinces.
Methods: In this study, educational inequality in medical sciences was measured using the Gini coefficient. The study indexes included the number of students, faculty members, staff, majors and educational budget. Data were analyzed using Stata 14 software.
Results: During the study years, the Gini coefficient of the number of female students, male students, and faculty members showed a more or less decreasing trend from 0.51 to 0.46, from 0.53 to 0.46, and from 0.59 to 0.53, respectively. However, the values of inequality in the number of personnel working in educational sector and educational budget showed a slight increasing trend from 0.49 to 0.50 and from 0.53 to 0.54, respectively. According to the academic majors, the lowest Gini coefficient was related to non-continuous bachelor’s degree that varied from 0.13 to 0.17, and the highest value was related to fellowship degree ranging from 0.66 to 0.69 in the study years.    
Conclusion: Despite reduced inequality in some educational indicators, there is a high inequality in the number of academic majors of some postgraduate degrees, number of students by gender, and educational budget, which requires policy makers to focus more on balanced distribution of educational infrastructures among provinces to provide equal educational opportunities.

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Background and Objectives: The effect of heart diseases on the quality of life is the issue needs attention of health care providers. Improving quality of life is considered as the goals of rehabilitative therapies. This study conducted to evaluate the McGill Quality of Life Questionnaire in patients with heart diseases.
Methods: In this cross-sectional study, 500 patients with heart diseases were recruited from BooAli Sina Hospital and Velayat Hospital affiliated with Qazvin University of Medical Sciences from May to August 2016. The participants completed the McGill Quality of Life Questionnaire. The construct validity (including convergent and discriminant validity) and Reliability using the Cronbach’s alpha, theta, and McDonald's Omega of the McGill Quality of Life Questionnaire were evaluated. The structure of the Questionnaire was assessed using factor analysis.
Results: Three factors, including overall view of the quality of life, physical aspect, and psychological dimension, were extracted. Model fit indexes confirmed a good fit of he McGill Quality of Life Questionnaire (Comparative of Fit Index: CFI=.918, incremental fit index: IFI=.919, Adjusted Goodness of Fit Index: AGFI=.844, RMSEA=.079, Minimum Discrepancy Function by Degrees of Freedom divided: CMIN/DF=2.97, Parsimonious Normed Fit Index: PNFI=.681, Parsimonious Comparative Fit Index: PCFI=.709). Convergent and divergent validity, internal consistency, and construct reliability of the questionnaire were confirmed.
Conclusion: The findings revealed that the three-factor model of the McGill Quality of Life Questionnaire has satisfactory validity and reliability. Thus, this questionnaire can be used in future studies to assess the quality of life of patients with heart diseases.

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Background and Objectives: Muscle weakness and fatigue decrease the functional capacity and quality of life of multiple sclerosis patients. Although routine exercise is acceptable in these patients, its impact has not been proven. The aim of this study was to assess the effect of exercise on muscular performance and function, degree of disability, fatigue, and quality of life of patients with MS.
Methods: Twenty-four women aged 20-50 years old with multiple sclerosis and an expanded disability status scale (EDSS) of 2- 5 were randomly divided into two groups of control (12 patients) and case (12 patients). The training program included three sessions per week, lasting for 12 weeks (two sessions of aerobic training and one session of resistance training).
Results: The results showed that 12 weeks of combined training caused a significant improvement in lower body strength (P=0.019), upper body strength (P=0.001), dynamic balance (P=0.025), gait speed (P=0.008), endurance (P=0.0001), quality of life (P=0.007) and a significant decrease in the degree of disability (P=0.007) and fatigue (P=0.001). 
Conclusion: In general, a combined training program, including aerobic and resistance training, in three non-consecutive days per week is helpful for women with MS and improves their sensorimotor function. The relevant specialists can use these exercises along drug therapy to reduce the clinical complications of MS.

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Background and Objectives: Life satisfaction is one of the important dimensions of health, which is influenced by health determinants. The aim of this study was to investigate the status of socioeconomic inequalities in satisfaction with life in women aged 15-54 in Iran.
 
Methods: In this cross-sectional study, randomized multistage cluster sampling with equal clusters was done to select the participants. A total of 35,305 women aged 15-55 were enrolled in the study. Data analysis was done in two stages. In the first stage, social and economic inequalities were investigated using the concentration index and concentration curve method. In the second stage, a multilevel method was used to identify the determinants.
 
Results: The mean life satisfaction was 12.81±4.23. The concentration index for dissatisfaction with life was -0.06 [95% CI: -0.1, -0.02], indicating dissatisfaction with life in low socioeconomic groups. The results of multilevel analysis showed that age, marital status, occupation, place of living, education, and the economic class correlated with dissatisfaction with life in women (P<0.05).
 
Conclusion: There is inequality in dissatisfaction with life. Dissatisfaction is concentrated in the poorer groups of the society and varies in different provinces. Socioeconomic variables affect inequality in satisfaction with life in women, which need to be addressed to reduce inequalities.

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Background and Objectives: This research was conducted to investigate the socioeconomic and geographical inequality in mortality from road traffic accidents in Iran in 2016.
 
Methods: In this descriptive cross-sectional study, the data of 16,584 people that died from road traffic accidents in 2016 were received from the Legal Medicine Organization. Theil entropy index was used to determine inequality in geographic areas. Moreover, relative and absolute concentration indices were used to measure inequality in mortality from RTAs across educational levels.
 
Results: The mortality rate from road traffic accident was 21.5 per 100,000 people. Theil index was 0.66 for traffic-related deaths among the provinces, indicating an unequal distribution of traffic injuries caused by traffic accidents among the provinces. When inequality was measured at smaller geographical levels, i.e., among cities in each province, the results indicated a fair distribution across smaller geographic levels. The focus index also indicated a fair distribution of traffic accidents among the deceased sub-classes (concentration index & 95% CI: -0.13 (-0.41; 0.16).
 
Conclusion: Our findings showed that the distribution of mortality from road traffic accidents was unequal at provincial positions. According to our findings, mortality from traffic accidents was distributed equally among the socioeconomic and urban levels. Therefore, health managers can use the findings of this study to develop interventions to reduce inequalities. In addition to targeting factors contributing to known social inequalities in the health and social status, other factors should be considered and applied to evaluate their interventions in the future.

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Background and Objectives: Progressive muscle relaxation (PMR) training as part of an educational program for patients involved in pathologic and physiological events (PPE) can have important physiological and psychological benefits for the patients, and can affect various dimensions of their lives including the quality of life. This systematic review and meta-analysis was conducted to determine the effect of PMR on the quality of life of patients involved in PPE.
 
Methods: Through searching the words “PMR” and “quality of life (QOL)” in Persian databases including SID, MagIran, IranMedex, and IranDoc and international databases including Google Scholar, Scopus, PubMed, Web of Science, ProQuest, and ScienceDirect, all studies published on the effect of PMR on the QOL were extracted. The methodological quality of the papers was examined using Cochrane risk of bias. Data analysis was carried out using a random-effects model and heterogeneity was assessed by I2. The data were analyzed using the STATA software version 14.0.
 
Results: Of 495 studies, only 10 explored the effect of PMR on the QOL of patients. The pooled mean of the QOL and all dimensions were statistically significant, including physical functioning (0.339), physical role limitation (0.378), bodily pain (0.341), general health (0.598), social functioning (0.873), mental health (0.736), emotional role limitation (0.791), vitality (0.706), total physical dimensions (0.652), total mental dimensions (1.316), and total QOF score (0.480). Only one study had a low risk of bias.
 
Conclusion: Implementation of PMR has a significant effect on the quality of life of patients involved in PPE. PMR is recommended to improve the QOL of the patients.

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Background and Objectives: Rheumatoid arthritis is a chronic, progressive disease of the joints that presents with articular and systemic symptoms. The purpose of this study was to determine the quality of life in patients with rheumatoid arthritis and its relationship with body mass index.
 
Methods: This descriptive-analytical study was performed in 195 patients with rheumatoid arthritis in Tohid Hospital, Sanandaj, Iran. The data collection tool was a questionnaire including demographic and clinical characteristics. The SF-36 instrument was used to evaluate the quality of life.
 
Results: In the study, 40% of men and 58% of women had a disease severity higher than 2.6 according to the Disease Activity Score 28. There was a significant difference in all dimensions of quality of life including physical function, energy / fatigue and general health between men and women (P <0.05). All dimensions of quality of life were inversely correlated with BMI. There was a significant relationship between the disease severity and each of the dimensions of pain, general health and general changes (P <0.05).
 
Conclusion: Quality of life in patients with rheumatoid arthritis is correlated with body mass index and severity of rheumatoid arthritis; therefore, it seems that health policy makers or clinical practitioners need to pay more attention to these two factors to increase the patients’ quality of life.
 

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Background and Objectives: A large proportion of the data of cause of death is registered in hospitals in Iran. Assessment of the death data can help to identify the problems of cause of death registration system and improve it. Therefore, this study was conducted to review the quality of cause of death registration in Iranian hospitals in 2016.
 
Methods: All hospital deaths in 2016 were reviewed and classified by age group and sex using the Ministry of Health’s death registration system. Analysis of Causes of National Deaths for Action (ANACONDA) was used to evaluate the quality of the data of cause of death.
 
Results: About 24% of the recorded hospital deaths were assigned to garbage code categories. The highest percentage of this group was seen in the age group over 70 years old and the highest percentage of well-defined causes of death was seen in the age group below one year. Moreover, among the five groups of garbage code causes of death, the group with insufficient details of the cause of death based on ICD classification had the highest percentage in all age groups.
 
Conclusion: Since a substantial proportion of the causes of deaths registered in the Iranian hospitals are categorized in the garbage code categories and cannot be used for planning and health policy making, it is necessary to design a comprehensive plan to implement interventions such as implementation of process evaluation programs and training programs for physicians and coders.

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Background and Objectives: The main purpose of this study was to compare the predictive power of the Inequality-adjusted Human Development Index (IHDI) with the Human Development Index (HDI) with regard to the share of deaths caused by Non-Communicable Diseases (NCD) among all deaths in the world and Iran.
 
Methods: The data required for this cross-sectional ecological study were extracted from the reports of the United Nations Human Development Program and the WHO in 2015. Pearson correlation test was used to investigate the correlation of HDI and IHDI with the share of deaths caused by NCDs and linear regressions models were used to determine the associations of IHDI and HDI with the dependent variable.
 
Results: At a significant level of P<0.01, the dependent variable showed a strong positive correlation with HDI (0.892) and IHDI (0.899). Simple linear regression showed that HDI alone predicted the dependent variable well (Adj.R2=0.794, P<0.001).However, according to the multivariate linear regression model, when IHDI and HDI were included in the model, IHDI was able to predict the dependent variable well (Adj.R2=0.809, P=0.001), while the relationship between HDI and the dependent variable was no longer significant.
 
Conclusion: Although HDI alone is an important predictor of NCD status, it loses its influence in the presence of IHDI. Therefore, in addition to HDI, IHDI that illustrates the impact of inequality on human development can provide more information on the status of deaths caused by NCDs.
 

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Background and Objectives: Clinical trials are used extensively in the compilation of systematic review studies and clinical guidelines. Critical appraisal of articles is a part of systematic review writing and also effective in citation. This study aimed to evaluate quality of randomized clinical trial articles of Mashhad University of Medical Sciences with consideration report of randomized, blindness, and allocation concealment methods in them.
 
Methods: In this study, all randomized clinical trials with Mashhad University of Medical Sciences affiliation indexed in PubMed by 2018 were evaluated.
Results: Of 257 eligible articles, dentistry (n=44 , 17.1%) , obstetrics and gynecology (n=28 , 10.9%) and internal medicine (n=23 , 8.9%) had the highest relative frequency of published randomized clinical trial articles. Eithy-three articles (32.3%) reported the randomization method and most of them (86.9%) used simple randomization. Blinding was done in 138 papers (53.7%) with double blinding being the most common (70.2%). Only three articles (1.2%) reported allocation concealment.
 
Conclusion: The report of "random allocation and randomization" in articles was far less than acceptable. It may seem that there may be different biases in the methodology. Upholding the principles of scientific writing and avoiding errors and biases increase the validity of the scientific articles and citation, which is one of the criteria of the scientific ranking of top universities.

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Background and Objectives: Quality of life is a valuable indicator for measuring people's health. The purpose of this study was to determine the predictors of quality of life in the staff of Shahid Beheshti University of Medical Sciences, Tehran, Iran using the path analysis model.
 
Methods: This cross-sectional study was performed on subjects participating in the Health Cohort Study of Shahid Beheshti University of Medical Sciences, Tehran, Iran in 2018. A demographic information form and standard quality of life, general health, physical activity and burnout scales were used for data collection. The SPSS version 24 and Amos version 24 were used for data analysis.
 
Results: A total of 770 individuals were selected for the study, of whom 345 (44.8%) were male. The mean age ± standard deviation of the participants was 42.6±8.4. Analysis of the quality of life pathway of the participants showed an appropriate model (RMSEA= 0.014, CFI=0.999, NFI = 0.991, TLI = 0.994, CMIN/DF = 1.146). In addition, general health (0.560) and physical activity (0.078) had a direct correlation and occupational burnout (-0.178) and age (-0.082) had an inverse correlation with quality of life.
 
Conclusion: The results of this study suggest that factors such as general health, physical activity, and burnout have an impact on the participants. Therefore, it is necessary to consider the factors affecting the quality of life.

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Background and Objectives: Fair financial protection against health expenditures is one of the most critical goals of health systems. This study was conducted to investigate the most appropriate threshold for measuring the exposure to catastrophic health expenditure (CHE) in Iran.
 
Methods: The present study was conducted using 2018 national household income and expenditure data of the Iran statistics center. The occurrence and intensity of the households' exposure to CHE at different thresholds and for economic quintiles was measured using two World Health Organization (WHO) and World Bank (WB) methodologies. The most appropriate threshold for each methodology was also determined using the Kappa statistics adaptation estimation.
 
Results: The occurrence of households’ exposure to CHE was 3.02% and 8.51% in urban households and 4.66% and 9.22% in rural households, respectively. According to asset quintiles, the highest occurrence was in the first quintile and the lowest in the fifth quintile. In addition, the results of adaptation estimation based on Kappa statistics showed that a threshold of 40% in the WHO methodology and 25% in the WB methodology were the most appropriate thresholds.
 
Conclusion: The results showed a relatively high rate of exposure to CHE. CHE occurrence was also more in poorer households, and common thresholds were the most appropriate thresholds for estimating CHE.

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