Journal of School of Public Health and

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Background and Aim: Amblyopia is an important cause of weak vision and blindness. A preliminary study on validity of the current screening program in Shahrood City's kindergartens showed that this method may not be efficient enough, especially because of low sensitivity and referral problems. We tried to compare efficiencies and costs of screening by trained staff and optometrists in detecting patients.

Materials and Methods: We conducted a cost-effectiveness analysis using the decision-tree method. We replaced nurses with optometrists to compare costs per detected case by the two screening methods. The number of detected cases and costs per each detected case are compared. Also, the cost-effectiveness of four criteria screening examinations (with different validities) used by optometrists was estimated.

Results: Costs per case detected by optometrists and by current screening methods were 270000 and 556000 Rails (Rs), respectively (with baseline examination criteria and 6.4% prevalence). With a lower prevalence of amblyopic patients, CER (cost-effectiveness ratio) will increase in both methods, but the increase in the current screening method is less than the optometric method. In the optometrist method, avoidable costs and savings per detected case vary from 250000 Rs at a prevalence of 7.4% to 1185000 Rs at a prevalence of 1.4%. Sensitivity analysis showed that costs of "monitoring of screening" in the optometrists method and costs of "follow up in the current screening method" have strong effects on CER CER will decrease by 9.6% and 15%, respectively, if this costs decrease to 25%.

Conclusion: The cost, per detected case, of screening amblyopia by optometrists in kindergartens is half that by the current method. In areas with a low prevalence, the efficiency of screening by using optometrists increases remarkably.

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Background and Aim: This study was undertaken to determine the effectiveness of a safe community program, as an international community-based program, for injury prevention and safety promotion, in Kashmar

Materials and Methods: In this retrospective study, the data on injured patients consulting hospital emergency wards in Kashmar and 44 other districts (as control) for a period of 3 years (March 20 2005 to March 19, 2008) were analyzed and compared.

Results: The number of injuries/100,000 population in Kashmar was 4654.6, 4570.9, and 4949.2 in March 2005-2006, 2006-2007, and 2007-2008, respectively. The corresponding figures (means) for the control districts were 822.7, 1130.0 and 1245.5. The injury- related fatality rate in the emergency ward for the 3 periods was 57.6, 52.9, and 44.2 per 100,000 in Kashmar and 12.2, 13, and 11.9 per 100,000 in the control districts. The injury rate showed an increase and the injury- related fatality rate showed a decrease in both Kashmar and the control districts over the 3 year period, but there was a statistically significant difference between the decreased injury-related fatality rate in Kashmar (p<0.0001).

Conclusion: The Kashmar International Safe Community Program resulted in no significant decrease in the rate of injuries in Kashmar. However, as compared to the control distrcts, it caused a decrease in the injury-related fatality rate over the 3-year period. Long-term studies are necessary to confirm these results.

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Background and Aim: The first step in establishing a safety system is hazard identification.  If this is not done properly, the subsequent steps steps will not be done effectively either. Since any given identification technique often targets the hazards of one or two of the main elements of a safety system, it is not possible to identify all hazards by a single technique

Materials and Methods: This cross-sectional study was conducted to explore the available scientific literature aiming at finding practicable hazard identification techniques that can potentially determine the highest number (%) of hazards in a safety system. First five techniques were implemented and the number of identified hazards by each was determined, followed by calculation of the coefficient of hazard identification effectiveness for each technique. Using this approach two techniques in two different safety systems were tested

Results: The number of hazards identified using the hazard and operability analysis (HAZOP) technique, and, as a result, its coefficient of hazard identification effectiveness was the highest as compared to other techniques. Individually, the HAZOP and AEA techniques, used as primary hazard identification techniques, identified only 20-80% of all the hazards which could otherwise be identified if all identification techniques had been used.

Conclusion: The results show that the HAZOP technique can identify a higher number of hazards than any other technique. However, if used alone, this technique will probably identify only 40% of all the hazards. The important point is that selection of an appropriate technique plays an important role in identifying a higher number of hazards.

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 Background and Aim: Global growth in the elderly population for both health care providers and families and also the community is an important challenge . Elders are the largest and fast factor for increasing hospital admissions in Society . Increasing costs of aging is the most concern to elders and their families. This study aimed to investigate the health team s approach about cost–effective alternatives for aging health services.

  This study is a qualitative research which was done through content analysis.

  18 people consisting of five faculty members , 6doctors , 3 nurses and 4health public health expert were participated. Samples were selected based on purposive sampling . Data were collected through interviews .

  Results: Four core themes derived from this study which included: 1- Emphasis on training for aging care ( including training doctors, nurses , health professionals , public health experts, elder sand their family caregivers). 2- Emphasis on proper implementation of primary health care for the elderly. 3- Emphasis on home care for elderly.4-attntion to mental health of elderly.

  Conclusion: It seems effectiveness of tree alternatives emphasis to training, home care and mental health for elderly are obvious and evident, so implementing and applying these suggestions would be helpful.

  But the second alternative emphasis on proper implementation of primary health care for the elderly must be performed based on a comprehensive needs assessment in elders population. Finally it is stressed that calculating and comparing actual costs of each alternative in elders caring must be measured through quantitative researches.

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Background and Aim: Economic evaluation of health interventions by comparing the relevant costs and benefits will result in optimum allocation of resources and increasing the effectiveness of the health system and, through improving equity and increasing accessibility to health services, will lead to increased effectiveness of the health system. The purpose of this study was to critically evaluate the Cost Effectiveness Analysis (CEA) studies on health interventions worldwide.
Materials and Methods: A critical review of the published CEA studies on health interventions was conducted. Seven databases including PubMed, Cochrane Database of Systematic Reviews, Web of science, Science Direct, Scopus, Springer Link, and SID were searched between 1975 and 2018, using appropriate keywords. The retrieved articles were evaluated using the Drummond (2005) quality assessment checklist. Overall, 173 articles met the entry criteria and were included in this study.
Results: CEA of health-related interventions were classified into six categories, namely, studies on immunization, education, nutrition, sexually transmitted diseases prevention, gynecological diseases prevention and vector-borne diseases and, eventually, cost-effective interventions were identified. Further analysis of the data showed that the methods used in health intervention CEA studies are very heterogeneous and lack sufficient scientific quality especially in developing countries. Researchers working in this area should pay more attention when designing studies and follow valid guidelines for CEA, particularly as regards research methods, sample size, CEA model, cost and benefit calculations, determining effectiveness, timeframe and, finally,  analysis of  the sensitivity and validity the research data.
Conclusion: The number of cost effectiveness analysis and cost utility studies has increased greatly during the last two decades. In order to improve the quality of these studies it is essential to revise the guidelines and procedures for economic evaluation of health interventions and train and update researchers in this area.