Journal of

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Background: Achieving equitable financial contribution and removing the risk of households' exposure to catastrophic expenditures are the most important challenges for health systems all over the world. This study aimes to measure Iranian households' exposure to catastrophic health care expenditures and surveying the factors affecting this expenditure, based on the World Health Organization and the World Bank approach.
Materials & Methods: Sectional data of the World Health Survey in Iran in 2001 has been analyzed. This survey covered 10300 urban and rural households across the country. The catastrophic expenditure has been calculated based on the ability to pay in the thresholds of 40, 50, and 60 percent and the income at the threshold of 20 percent. Logistic regression model was used to examine factors influencing catastrophic health expenditures.
Results: The proportion of families confronting catastrophic health expenditures was estimated at 9-15 per cent. Facing catastrophic expenditures showed a statistically significant relationship with variables such as having a family member suffering from a chronic disease, family`s financial condition, and living in rural areas regardless of the thresholds used. The insurance coverage showed a statistically significant relationship with exposure of catastrophic health expenditure just in case it was measured using the 40% threshold.
Conclusion: Political interventions and policies of the government such as implementing fee exemptions for certain target groups, designing benefits packages, extending population coverage through prepayment mechanisms and protecting the poor and disadvantaged groups can protect households from experiencing catastrophic health expenditures.

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Abstract Background: Job environment is a strong stimulus for created of emotions and there are several stressful situations which could causes dissatisfaction, low work performance, quit or job-changing. The purpose of this study is to determine the relationship between sensation seeking with job stress among emergency medicine workers and non emergency medicine workers. Methods: In this cross-sectional study, 60 emergency medicine workers chosen the census method and 60 non emergency medicine workers chosen the convenience sampling method, in border cities of KUMS, were selected for study. Data were collected by valid and reliable questionnaires of job stress and sensation seeking. Data were analyzed using descriptive and analytical statistics. Results: The most rate of job stress among emergency medicine workers was in the level of moderate (46.6percent) and in the non-emergency medicine workers was the low level (56.4percent) and the most rate of sensation seeking among emergency medicine workers was in the level of lower the moderate (35 percent) and in the non-emergency medicine workers was lower the moderate level (40 percent). There were indirect relationship between job stresses with to be thrilled, to be experienced and to be diversity of the variable of sensation seeking and there was a direct relationship between to be blues and to be scope of inhibition of the variable of sensation seeking. Conclusion: Results can be regarded managers to decrease of losses due to job stress and increase productivity, especially in emergency medicine workers across the country

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Background: the using of economic tools such as production function is one of the ways to improving performance and efficient use of hospital resources. The aim of this study was the estimation of production function in educational hospitals of Kurdistan University of Medical Sciences during 2007- 2011. Material & Methods: the number of inpatient as dependent variable and the numbers of active beds, nurses, doctors and other staffs as explanatory variables was considered. These data For 12 of hospitals since 2007 to 2011 was collected by production form. Also with Eviews software version 6 and panel data, the production function of hospitals was estimated. Results: the elasticity and marginal of production for all variables explanatory was positive. The marginal of production for bed active, physician, nurse and other staff was 16.7, 54, 23.6 and 40.9 respectively. The total of input coefficient was equal 1.08 and the return to scale was increasing. Conclusion: according to the positive marginal of production for all variables explanatory, for improving of productivity and efficient use of hospital resources is suggested that the managers of hospitals in exposure to regular and irregular demand can be used elasticity of production.

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Background: Educating patients and improving their self-care skills are main factors to achieve maintaining and improving health as health care organizations prime priorities all over the world. This study is aimed to assess nurses and doctors viewpoints on obstacles and facilitators of educating patients. Materials and Methods :This quasi experimental research were undertaken in Kermanshah Razi hospital.85 nurses and doctors were selected by Simple Random Sampling method. The data were collected by a questionnaire based on Likert scale consisted 32 questions in 3 parts. Validity and reliability of the questionnaire were confirmed by Content validity and Test-Retest methods respectively. Results : Shortage of nurses and lack of sufficient financial resources among inhibiting factors and holding seminars on teaching and learning strategies and also considering educating patients as a annual evaluation determinant among enhancing factors were the most important ones . Conclusion: Providing efficient resources and facilities and running personnel`s training courses seems necessary to overcome current obstacles.

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Background: nutrition department is one of the most important sectors of hospital to improve the patients' health and satisfaction. Lack of standards obsevance causes nosocomial infections and develops health risks. Establishing HACCP standards, many existing shortcomings will be omitted in the hospital nutrition department. This study aimed at assessing the mentioned nutritional standards system in the hospital nutrition department.

Materials and Methods:  This cross - departmental study was conducted at Kermanshah University of Medical Sciences' teaching hospitals in 2013. HACCP questionnaire was used. Data collection performed using observation, interviews and questionnaire filling in from hospitals' nutrition department.5-point likert scale used which rating scale was from 1(lowest) to 5(highest).in order to data entry and analysis SPSS software version 18 utilized using tables, graphs and Kruskal-Wallis test.

Results:  The mean score and percentage of five areas of HACCP standards were 3.58 and 70.23% respectively which were desirable in seven studied hospitals. There was no significant statistical relation between the mean scores of hospitals in the standards.

Conclusion: Although, the situation was assessed desirable, because of the importance of nutrition department, observance of optimum standards and quality improvement can prevent potential infections in food preparation and distribution and result in patients and staff satisfaction.

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• Background: Improper distribution of medical care creates access inequality to the services in developing countries. This study aimed at investigating inequalities in access to medical facilities in Kermanshah's Metropolitan Area.

  Materials and Methods: The study was an applied and descriptive – analytical one. Due to the spatiotemporal nature of current research, Geographic Information Systems (GIS) were used. Research data was included hospital addresses and demographic data from statistical blocks of Kermanshah based on Iran’s 2011 census report.

  Results: The study results represented that spatial distribution of hospitals was concerned on a random pattern in metropolitan of Kermanshah and there was not a special mechanism in hospitals' spatial distribution. In total, Kermanshah city has 13 hospitals with 2342 hospital bed till 2014 which the most of them were related to general hospitals. In existing situation, the statistics revealed that only 48.51% of population has covered by hospitals and 51.49% of households have no standard access. The number of existing hospitals cannot response to the citizen's needs.In this study; current location of the most hospitals was not compatible with scientific criteria; standards and usage requirement.

  Conclusion: It is concluded that all residents had not equal access to hospitals; and also their distribution was not proportionate with population distribution and households. There is inequality in access to medical facilities focused on hospitals of Kermanshah's Metropolitan Area.

  Keywords: Inequalities, Management, Health, Accessibility, Hospital, Geographical Information System

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Introduction: Socio-economic inequalities in the use of dental services are a major challenge to health policies in many countries. This cross-sectional study was conducted to investigate socio-economic inequalities in utilization of dental services in households of Lorestan province and comparing it with neighboring provinces.
Methods: Data required for the study were collected from the household expenditure and income survey (HIES). The study population included 5547 households in the western provinces of the country. Logistic regression method was used to determine the most important factors affecting the use of dental services, and the focus index was used to measure inequality between income groups. Data analysis was performed using Stata software version 14.
Results: The highest and lowest percentages of dental services among households were related to Hamedan (7.02%) and Lorestan (3.19%) provinces, respectively. The results of the focus index showed that the benefits and costs of dental services were concentrated among households with higher socio-economic status. In other words, inequality benefits the rich. Being a female head of household and increased size of the household leads to a decrease in the use of these services. The higher education level of the head of the household and the increase in the number of employed and literate household members showed a positive relationship with the utilization of dental services.
Conclusion: Benefiting from dental services was significantly higher among higher socio-economic groups. These inequalities can be avoided by introducing and implementing targeted policies. Low-income households, lower education levels, and the unemployed should be the focus of health policies to address unmet dental care needs.

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Background: The aim of this study was to evaluate the effect of health sector evolution plan (HSEP) on the prevalence of cesarean section and vaginal delivery in public hospitals in Kermanshah province.

Methods: In the present study, cesarean section (C-section) and vaginal delivery data were collected and evaluated in 17 public hospitals from 2009 to 2019. The main variables of this study included the prevalence of C-section and the prevalence of vaginal delivery for 121 months, both were obtained by dividing the number of deliveries by C-section and vaginal delivery by the total number. Interrupted time series analysis was used to examine the effect of HSEP on the prevalence of cesarean and vaginal delivery rates.

Results: The prevalence of C-section before and after the HSEP was 42.5% and 43.2%, respectively. Months before the intervention, the rate of C-section was increasing by 0.13%, which was statistically significant. In the first month after the intervention, the prevalence of     C-section decreased by 3.6% that was statistically significant. The share of C-section in the months after the implementation of the HSEP showed a monthly increase of 0.12% compared to before the intervention, which was statistically significant.

Conclusions: The results of the study showed that the HSEP has led to a significant reduction in C-section in short term, but in the months after the implementation of the plan, the prevalence of C-section has increased again.