ORCID Profile
0000-0002-4591-8531
Current Organisation
Dalhousie University
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Publisher: Emerald
Date: 09-09-2019
DOI: 10.1108/JPMH-03-2019-0036
Abstract: Mental health is an inevitable and vital dimension when it comes to providing a global definition for the appropriate health status. This highlights the importance of investigating factors influencing utilization and out-of-pocket payments (OOP) for mental health services. Thus, the purpose of this paper is to assess the determinants of the utilization and OOP for psychiatric healthcare in Iran. A total of 39,864 households were included in this cross-sectional study. Data on the utilization and OOP for psychiatric healthcare as well as all their determinants (e.g. wealth index of households, geographical area, household size, etc.) were extracted from the Household Income and Expenditure Survey (HIES). The HIES was conducted by the Statistical Center of Iran in 2016. A zero-inflated Tobit model was used to identify the main factors affecting utilization and OOP for psychiatric healthcare utilization. The average of utilization and OOP for psychiatric services was found to be 14.67 times per 1,000 households and $7.783 per month for service users, respectively. There were significant positive relationships between income and utilization ( p =0.0002) and OOP ( p .0001) for psychiatric services. Significant negative associations were found between the number of illiterate people in the household and OOP (coefficient=−1.56) and utilization (coefficient=−0.2002) for psychiatric services. Utilization and OOP for psychiatric services were statistically significantly higher among households with higher wealth status. Despite the higher rate of mental disorders, the utilization of psychiatric services in Iran is very low. Due to financial barriers and insufficient insurance coverage, high socioeconomic status (SES) households utilize more psychiatric services than low-SES households. Thus, the integration of mental health services in public health programs is required to improve the utilization of psychiatric services in Iran.
Publisher: Springer Science and Business Media LLC
Date: 21-10-2019
DOI: 10.1186/S12889-019-7715-Z
Abstract: The level of socioeconomic-related inequality in physical activity in Iran is largely unknown. This study investigates socioeconomic-related inequality in poor-physical activity (PPA) among Iranian adults. A total of 129,257 adult participants enrolled in the PERSIAN (Prospective Epidemiological Research Studies in IrAN) Cohort were included in this study. Physical activity of adults was measured using metabolic equivalent rates (METs). Physical activity less than 41 METs/hour/day was considered PPA. The Concentration index (C) was used to quantify socioeconomic-related inequality in PPA. Moreover, the C was decomposed to identify the relative contribution of explanatory variables to inequality in PPA. There were significant regional variations in physical activity level among Iranian adults (29.8–76.5%). The positive value of C (0.098, 95% CI = 0.092 to 0.104) suggested that the higher concentration of PPA among higher socioeconomic status (SES) adults in Iran which was consistently observed in all cohort sites. The higher prevalence of PPA among Iranian adults, especially, women and older adults, warrant further public health attention. Since PPA is concentrated more among the high-SES population in Iran, strategies for the promotion of physical activity should focus more on economically well-off population.
Publisher: Emerald
Date: 08-05-2017
DOI: 10.1108/IJHRH-12-2016-0024
Abstract: Education is a human right and access to high quality education is key to sustainable socioeconomic development. Improving the quality of higher education institutes is essential for generating the productive human resources. Assessing the quality of higher education from the students’ perspective can be considered a crucial factor in the monitoring of service quality in universities. The purpose of this paper is to evaluate the quality of educational services in a higher education institute, the Kermanshah University of Medical Sciences (KUMS), in the west of Iran. A multistage s ling method was used to select 346 students from the KUMS, who were enrolled in the second semester of the academic year 2015-2016. The SERVQUAL questionnaire was used to gather data on students’ perceptions and their expectations about the quality of educational services. The authors used a statistical significance level of 0.05 to examine the gap between the students’ expectations and their perceptions of service quality in five dimensions, namely tangibles, responsiveness, reliability, empathy and assurance. The results showed that there was a negative service quality gap in all five dimensions. The overall mean score of students’ expectations and their perceptions was 3.19±0.44 and 2.4±0.45, respectively. The score gap between the overall mean score of perceptions and expectations of students was −0.79, which was statistically significant ( p .0001). The highest and lowest quality gaps were related to the assurance (−0.84) and tangible (−0.70) dimensions, respectively. The study indicated that the quality of educational services provided in the KUMS did not meet students’ expectations in five dimensions of service quality. Thus, it warrants further investigations to determine how to improve the quality of educational services in higher education institutes such as the KUMS.
Publisher: Springer Science and Business Media LLC
Date: 22-10-2019
DOI: 10.1186/S12939-019-1072-5
Abstract: Socioeconomic inequalities in dental care utilization in Iran are rarely documented. This study aimed to provide insight into socioeconomic inequalities in dental care utilization and its main contributing factors among Iranian households. A total of 37,860 households from the 2017 Household Income and Expenditure Survey (HIES) were included in the study. Data on dental care utilization, age, gender and education attainment of the head of household, socioeconomic status of households, health insurance coverage, living areas and provinces were obtained for the survey. The concentration curve and the normalized concentration index ( C n ) was used to illustrate and quantify socioeconomic inequalities in dental care utilization among Iranian households. The C n was decomposed to identify the main determinants of the observed socioeconomic inequality in dental care utilization in Iran. The study indicated that the prevalence of dental care utilization among Iranian’s households was 4.67% (95% confidence interval [CI]: 4.46 to 4.88%). The results suggested a higher concentration of dental care utilization among socioeconomically advantaged households ( C n = 0.2522 95% CI: 0.2258 to 0.2791) in Iran. Pro-rich inequality in dental care utilization also found in rural ( C n = 0.2659 95%CI: 0.2221 to 0.3098) and urban ( C n = 0.0.2504 95% CI: 0.0.2159 to 0.2841) areas. The results revealed socioeconomic status of households, age and education status of head of households and residing provinces as the main contributing factors to the concentration of dental care utilization among the wealthy households. This study revealed pro-rich inequalities in dental care utilization among households in Iran and its provinces. Thus, health policymakers should focus on designing effective evidence-based interventions to improve healthcare utilization among household with the older head of households, lower education status, and living in relatively poor provinces to reduce socioeconomic inequality in dental care utilization in Iran.
Publisher: Springer Science and Business Media LLC
Date: 07-04-2017
DOI: 10.1007/S10198-017-0889-3
Abstract: Reasonable access to health services without financial or other barriers is a primary objective of the Canadian health system. Notwithstanding such concern about accessibility of services, long waiting times for health services have been a prominent health policy issue in recent years. Using pooled data from four nationally representative Canadian Community Health Surveys (CCHSs, 2000/01, 2003, 2005 and 2010 n = 266,962) we examine socioeconomic inequality in lengthy wait time (LWT) to health care among adults (aged 18-65) in Canada. The relative and absolute concentration indices (RC and AC, respectively) are used to quantify income-related inequality in LWT in Canada and for its provinces. Additionally, we decompose the RC and AC indices to identify factors affecting income-related inequality in LWT. Our descriptive results show that, on average, 5% of Canadian adults experienced LWT to access health services in the past 12 months. While 3% of the residents of British Columbia and Saskatchewan reported LWT to access health care services, this figure was 7% in Quebec. Our findings also demonstrated that LWT was mainly concentrated among the poor in Canada [RC = -0.039 95% confidence interval (CI) -0.049 to -0.028 and AC = -0.067 CI -0.086 to -0.049]. The RC and AC suggested statistically significant pro-rich inequality of LWT in Nova Scotia, New Brunswick, Quebec, Manitoba, Saskatchewan and British Columbia. Decomposition analyses indicate that, besides income itself, health status (measured by a set of 15 chronic condition indicators), immigration status and geographical factors were the most important factors contributing to the concentration of LWT among the poor in Canada. These results provide some evidence that low-income in iduals tend to have lengthier wait times for publicly-funded health care in Canada in comparison to their high-income counterparts. The observed negative gradient between income and long waiting time may be interpreted as evidence of socioeconomic inequity within Canadian health care system. Thus, further work is required to understand the mechanisms explaining the concentration of long wait time among the poor in Canada.
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.CJCA.2022.02.006
Abstract: The association between travel time from tertiary care centre and outcomes after ascending thoracic aortic surgery is unknown. We determined the effect of travel time from the tertiary care centre on outcomes in ascending aortic repair in Nova Scotia. A retrospective analysis of patients undergoing elective and emergent ascending thoracic aortic operations from 2005 to 2015 was carried out. Patient's residential geographic coordinates were used to calculate travel time to the tertiary care centre, and patients who resided < 1 hour vs ≥ 1 hour were compared. Multivariable logistic regression was performed to determine the effect of travel time on in-hospital outcomes. Cox-proportional hazard modelling and Kaplan-Meier survival estimates were created to determine the effect on long-term survival. A total of 476 patients underwent ascending thoracic aortic surgery from 2005 to 2015. Patients who resided < 1 hour from the tertiary care centre vs patients who resided ≥ 1 hour had similar rates of in-hospital mortality (4.4% vs 6.1%, P = 0.42), in-hospital composite complications (66.7% vs 67.7%, P = 0.80), hospital length of stay (median 9 days interquartile range [7-16] vs 10 [7-17], P = 0.41), and discharge disposition other than home (9.7% vs 11.7%, P = 0.55). Compared with patients who resided < 1 hour from the tertiary centre, patients who resided ≥ 1 hour were at higher risk for long-term mortality (hazard ratio, 2.19 95% confidence interval, 1.13-4.28 P = 0.02). Patients who reside remotely from the tertiary centre experience equivalent in-hospital outcomes but decreased long-term survival following ascending aortic operations. These findings may guide resource expansion for postoperative follow-up.
Publisher: Informa UK Limited
Date: 12-2010
Publisher: Informa UK Limited
Date: 18-11-2020
Publisher: Emerald
Date: 04-05-2012
DOI: 10.1108/03068291211224919
Abstract: This paper uses a unique nationwide survey data derived from the 2003 Utilisation of Health Services Survey (UHSS) in Iran ( n =16,935) to analyse inequities of health care utilisation. Concentration indices are used to measure socioeconomic inequality in actual use of the five types of health services, and in unmet need for two of those types of service (any ambulatory care and hospital admissions). Horizontal inequity indices are employed to examine inequity in ambulatory and hospital care. Generalised linear model (GLM) was employed to investigate factors contributing to the phenomena of “unmet need” and “met unneed”. Moreover, a decomposition analysis of inequality is performed to determine the contributions of each factor to the inequality of “unmet need”. Results suggest that self‐reported need for ambulatory and inpatient care is concentrated among the poor, whereas the utilisation of ambulatory and inpatient care were generally distributed proportionally. Results of horizontal inequity indices show that the distributions of any ambulatory care and hospital admissions are pro‐rich. The probability of “unmet need” for ambulatory care was higher among wealthier in iduals. The decomposition analysis demonstrates that the wealth index, health insurance, and region of residence are the most important factors contributing to the concentration of “unmet need” for ambulatory health care among the poor. Results also illustrate that higher wealth quintiles used more unneeded ambulatory care than their poorer counterparts. A special characteristic of the UHSS is that it contains questions about the need for medical services use and about actual services use. This characteristic provides an opportunity to measure the inequality of health care consumption against self‐assessed treatment needs, as well as an analysis of which observables are associated with “unmet need”. Moreover, the incidence of health care use when it is reported as not needed can be analysed with this dataset. The analysis of this phenomenon – which we refer to as “met unneed” – is another novel aspect of this work.
Publisher: Public Library of Science (PLoS)
Date: 08-04-2015
Publisher: MDPI AG
Date: 08-02-2020
Abstract: Socioeconomic inequality in child malnutrition is well-evident in Bangladesh. However, little is known about whether this inequality differs by regional contexts. We used pooled data from the 2011 and 2014 Bangladesh Demographic and Health Survey to examine regional differences in socioeconomic inequalities in stunting and underweight among children under five. The analysis included 14,602 children aged 0–59 months. We used logistic regression models and the Concentration index to assess and quantify wealth- and education-related inequalities in child malnutrition. We found stunting and underweight to be more concentrated among children from poorer households and born to less-educated mothers. Although the poverty level was low in the eastern regions, socioeconomic inequalities were greater in these regions compared to the western regions. The extent of socioeconomic inequality was the highest in Sylhet and Chittagong for stunting and underweight, respectively, while it was the lowest in Khulna. Regression results demonstrated the protective effects of socioeconomic status (SES) on child malnutrition. The regional differences in the effects of SES tend to erge at the lower levels of SES, while they converge or attenuate at the highest levels. Our findings have policy implications for developing programs and interventions targeted to reduce socioeconomic inequalities in child malnutrition in subnational regions of Bangladesh.
Publisher: Informa UK Limited
Date: 12-2012
Publisher: Springer Science and Business Media LLC
Date: 14-09-2011
DOI: 10.1007/S10754-011-9099-1
Abstract: Since the beginning of 1980s, the Iranian health care system has undergone several reforms designed to increase accessibility of health services. Notwithstanding these reforms, out-of-pocket payments which create a barrier to access health services contribute almost half of total health are financing in Iran. This study aimed to provide a greater understanding about the inequality and determinants of the out-of-pocket expenditure (OOPE) and the related catastrophic expenditure (CE) for hospital services in Iran using a nationwide survey data, the 2003 Utilisation of Health Services Survey (UHSS). The concentration index and the Heckman selection model were used to assess inequality and factors associated with these expenditures. Inequality analysis suggests that the CE is concentrated among households in lower socioeconomic levels. The results of the Heckman selection model indicate that factors such as length of stay, admission to a hospital owned by private sector or Ministry of Health and Medical Education, and living in remote areas are positively associated with higher OOPE. Results of the ordered-probit selection model demonstrate that length of stay, lower household wealth index, and admission to a private hospital are major factors contributing to the increase in the probability of CE. Also, we find that households living in East Azarbaijan, Kordestan and Sistan and Balochestan face a higher level of CE. Based on our findings, the current employer-sponsored health insurance system does not offer equal protection against hospital expenditure in Iran. It seems that a single universal health insurance scheme that covers health services for all Iranian-regardless of their employment status-can better protect households from catastrophic health spending.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.VACCINE.2019.09.054
Abstract: Extant work suggested pro-rich distribution of vaccination coverage in low- and middle-income countries (LMICs). However, the current literature also suggested pro-poor distribution of vaccination in some countries, including the Gambia, the Kyrgyz Republic and Namibia. This study aimed to explain socioeconomic inequalities in the completion rate of the four-core vaccines (i.e., Bacille Calmette-Guérin [BCG], diphtheria-tetanus-pertussis [DTP, 3 doses], Polio [3 doses] and Measles vaccines) in the three aforementioned countries. We used the most recent available Demographic Health Surveys (DHS) to measure vaccination completion rates among children (aged 0-59 months, n = 16,752) in the three countries. The normalized concentration index (C
Publisher: Elsevier BV
Date: 02-2021
Publisher: Oxford University Press (OUP)
Date: 13-08-2020
Abstract: There is evidence of socioeconomic inequalities in cancer incidence in Canada and other countries globally, yet there is no study investigating socioeconomic inequalities in national cervical cancer incidence in Canada. Thus, the current study investigated income and education inequalities in the incidence of cervical cancer in Canada from 1992 to 2010. Data were derived from a linked dataset that combined cervical cancer incidence from the Canadian Cancer Registry and demographic and socioeconomic information from the Canadian Census of Population and the National Household Survey. The Concentration index approach was used to measure income and education inequalities in the incidence of cervical cancer over time. National incidence of cervical cancer decreased significantly from 1992 to 2010. The age-standardized C was negative for the majority of years for both income and education inequalities, but the preponderance were not significant. Trend analyses of socioeconomic inequalities suggested an increasing concentration of cervical cancer incidence among less-educated females over the study period. Over almost two decades, there were no pervasive socioeconomic inequalities in the incidence of cervical cancer in Canada. As such, policies aimed at reducing the incidence of cervical cancer should focus on the general population, irrespective of socioeconomic status.
Publisher: Springer Science and Business Media LLC
Date: 19-05-2022
DOI: 10.1038/S41598-022-12621-7
Abstract: Despite a substantial decline in child mortality globally, the high rate of under-five mortality in Nigeria is still one of the main public health concerns. This study investigates inequalities in geographic and socioeconomic factors influencing survival time of children under-five in Nigeria. This is a retrospective cross-sectional quantitative study design that used the latest Nigeria Demographic Health Survey (2018). Kaplan–Meier survival estimates, Log-rank test statistics, and the Cox proportional hazards were used to assess the geographic and socioeconomic differences in the survival of children under-five in Nigeria. The Kaplan–Meier survival estimates show most under-five mortality occur within 12 months after birth with the poorest families most at risk of under-five mortality while the richest families are the least affected across the geographic zones and household wealth index quintiles. The Cox proportional hazard regression model results indicate that children born to fathers with no formal education (HR: 1.360 95% CI 1.133–1.631), primary education (HR: 1.279 95% CI 1.056–1.550) and secondary education (HR: 1.204 95% CI 1.020–1.421) had higher risk of under-five mortality compared to children born to fathers with tertiary education. Moreover, under-five mortality was higher in children born to mothers’ age ≤ 19 at first birth (HR: 1.144 95% CI 1.041–1.258). Of the six geopolitical zones, children born to mothers living in the North-West region of Nigeria had 63.4% (HR 1.634 95% CI 1.238–2.156) higher risk of under-five mortality than children born to mothers in the South West region of Nigeria. There is a need to focus intervention on the critical survival time of 12 months after birth for the under-five mortality reduction. Increased formal education and target interventions in geopolitical zones especially the North West, North East and North Central are vital towards achieving reduction of under-five mortality in Nigeria.
Publisher: Maad Rayan Publishing Company
Date: 14-12-2016
Publisher: Springer Science and Business Media LLC
Date: 10-09-2020
DOI: 10.1186/S12913-020-05700-W
Abstract: Maternal mortality has remained a challenge in many low-income countries, especially in Africa and in Nigeria in particular. This study examines the geographical and socioeconomic inequalities in maternal healthcare utilization in Nigeria over the period between 2003 and 2017. The study used four rounds of Nigeria Demographic Health Surveys (DHS, 2003, 2008, 2013, and 2018) for women aged 15–49 years old. The rate ratios and differences (RR and RD) were used to measure differences between urban and rural areas in terms of the utilization of the three maternal healthcare services including antenatal care (ANC), facility-based delivery (FBD), and skilled-birth attendance (SBA). The Theil index (T), between-group variance (BGV) were used to measure relative and absolute inequalities in the utilization of maternal healthcare across the six geopolitical zones in Nigeria. The relative and absolute concentration index (RC and AC) were used to measure education-and wealth-related inequalities in the utilization of maternal healthcare services. The RD shows that the gap in the utilization of FBD between urban and rural areas significantly increased by 0.3% per year over the study period. The Theil index suggests a decline in relative inequalities in ANC and FBD across the six geopolitical zones by 7, and 1.8% per year, respectively. The BGV results do not suggest any changes in absolute inequalities in ANC, FBD, and SBA utilization across the geopolitical zones over time. The results of the RC and the AC suggest a persistently higher concentration of maternal healthcare use among well-educated and wealthier mothers in Nigeria over the study period. We found that the utilization of maternal healthcare is lower among poorer and less-educated women, as well as those living in rural areas and North West and North East geopolitical zones. Thus, the focus should be on implementing strategies that increase the uptake of maternal healthcare services among these groups.
Publisher: Springer Science and Business Media LLC
Date: 24-02-2021
DOI: 10.17269/S41997-021-00478-8
Abstract: Inspired by Fiset-Laniel et al.’s (2020) article entitled “Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada”, we assessed public health investments since the establishment of the Nova Scotia provincial health authority in 2015. We analyzed Nova Scotia Department of Health and Wellness budgets from 2015−2016 to 2019–2020 and observed that less than 1% of funding was budgeted for public health annually, an amount well below the recommendation that 5–6% of healthcare funding be spent on public health. Healthcare spending has increased annually since 2015–2016, but proportions of funding to different programs and services have remained static. Specifically, we did not observe a change in investment in public health over time, suggesting that while the government does not necessarily spend too much or too little on healthcare, it spends far too little on public health. This chronic under-funding is problematic given the high rates of non-communicable diseases in Nova Scotia and health inequities experienced within the population. The 2020 COVID-19 pandemic has highlighted the importance of public health work, and the need for a pandemic recovery plan that prioritizes investment in all areas of public health in Nova Scotia.
Publisher: Emerald
Date: 11-03-2019
DOI: 10.1108/IJHCQA-03-2018-0067
Abstract: The purpose of this paper (systematic review and meta-analysis) is to synthesize and analyze studies that assessed Iranian hospital efficiency. A systematic literature search was conducted using both international (the Institute for Scientific Information, Scopus and PubMed) and Iranian scientific (Magiran, IranMedex and Scientific Information Database) databases. The review included original studies that used the Pabon Lasso Model to examine Iranian hospital performance, published in Persian or English. A self-administered checklist was used to collect data. In total, 12 questions were used for quality assessment. In total, 34 studies met our inclusion criteria. The fixed-effects meta-analysis indicated that 19.2 percent (95% confidence interval (CI): 15.6–23.2 percent) of hospitals were in Zone 1 (poor performance: low bed turnover rate (BTR) and bed occupancy rate (BOR) and high average hospital stay (ALoS)), 23.7 percent (95% CI: 20.1–27.8 percent) were in Zone 2, 31.7 percent (95% CI: 27.7–36 percent) in Zone 3 (good performance: high BTR and BOR and low ALoS) and 25.4 percent (95% CI: 21.7–29.5 percent) in Zone 4. Results help Iranian health policymakers to understand hospital performance, which, in turn, may lead to promoting greater awareness and policy attention to improve Iranian hospital efficiency. This study indicated that most Iranian hospitals had sub-optimal performance. Further studies are required to understand factors that explain the country’s hospital inefficiency.
Publisher: Springer Science and Business Media LLC
Date: 19-02-2022
DOI: 10.1007/S10198-022-01441-1
Abstract: Equity in healthcare utilization is a globally accepted measurement of health system performance. In Canada, equity is included as a policy goal in the Federal health legislation that governs healthcare systems. This study used ten cycles of the Statistics Canada Canadian Community Health Survey (CCHS, n = 664,548) to examine the trends in income-related inequities in healthcare utilization in Canada from 2000 to 2014. The horizontal inequity (HI) index was used to quantify inequity in healthcare utilization for general practitioner (GP) visits, specialist physician (SP) visits and hospital admissions (HA) nationally, in urban and rural areas, and for all provinces. Nationally, GP and SP visits show pro-rich inequity, while HA demonstrates pro-poor inequity. This pattern is consistent in the provincial and urban and rural areas results. Trend analysis suggested that inequity in GP visits became more pro-poor in New Brunswick, but more pro-rich in Prince Edward Island and Quebec. Despite the inclusion of equity as a main policy goal, this study demonstrated that inequity in healthcare utilization remains a persistent issue in the Canadian healthcare system.
Publisher: Hindawi Limited
Date: 22-01-2018
DOI: 10.1111/JONM.12579
Abstract: To estimate the 1-year period prevalence of medication errors and the reporting rate to nurse managers among nurses working in hospitals in Iran. Medication errors are one of the main factors affecting the quality of hospital services and reducing patient safety in health care systems. A literature search from Iranian and international scientific databases was developed to find relevant studies. Meta-regression was used to identify which characteristics may have a confounding effect on the pooled prevalence estimates. Based on the final 22 studies with 3556 s les, the overall estimated 1-year period prevalence of medication errors and its reporting rate to nurse managers among nurses were 53% (95% confidence interval, 41%-60%) and 36% (95% confidence interval, 23%-50%), respectively. The meta-regression analyses indicated that the sex (female/male) ratio was a statistically significant predictor of the prevalence of medication errors (p < .05), but not of the prevalence of reporting medication errors to nurse managers. The period prevalence of medication errors among nurses working in hospitals was high in Iran, whereas its reporting rate to nurse managers was low. Continuous training programmes are required to reduce and prevent medication errors among nursing staff and to improve the reporting rate to nurse managers in in Iran.
Publisher: Knowledge E
Date: 27-10-2020
Abstract: Background & Aim: Adherence of nurses to hand hygiene is important for the prevention of healthcare-associated infections. This study aims to systematically review the existing studies that assess Iranian nurses' adherence to hand hygiene and estimate their amount with meta-analysis. Methods & Materials: We performed a systematic search for peer-reviewed journals published from 2005 to 2018. The systematic search was conducted using both international (Google Scholar, PubMed, SCOPUS, and Web of Sciences) and Iranian databases (Scientific Information Database, IranMedex, Magiran, and MedLib). The search was carried out using a combination of the following terms: “adherence”, “compliance”, “hand hygiene”, “nurse”, “Iran”, “nursing practice”, “nursing”, and “guidelines”. The combinations of these words with Boolean operators like ‘AND’, ‘OR’ and ‘NOT’ were used. Results: A total of 22 articles were used in the final analyses. The pooled proportion of hand hygiene adherence was 40.5 percent [95% confidence interval [CI]: 31.1–49.8]. Sensitivity analysis confirmed that the overall estimated pooled proportion of hand hygiene adherence did not vary significantly with the elimination of any of the 22 studies, observer or self-reported hand hygiene, instrument of measurement, unit of measurements, s le size, and time. Conclusion: The level of adherence of Iranian nurses to hand hygiene can potentially increase the chance of healthcare-associated infections and put patients and nurses at risk. Hospital and nursing managers should take practical steps to investigate factors contributing to the failure of hand hygiene adherence among nursing staff. They should ensure the continuous implementation of hand hygiene improvement strategy.
Publisher: BMJ
Date: 16-06-2016
DOI: 10.1136/TOBACCOCONTROL-2015-052828
Abstract: To provide the first analysis of socioeconomic inequalities in children's daily exposure to indoor smoking in households in 26 low-income and middle-income countries (LMICs). We used nationally representative household s les (n=369 654) collected through the Demographic Health Surveys between 2010 and 2014 to calculate daily exposure to secondhand smoke (ESHS) among children aged 0-5 years. The relative and absolute concentration (RC and AC) indices were used to quantify wealth-based inequalities in daily ESHS in each country and in urban and rural areas in each country. We decomposed total socioeconomic inequalities in ESHS into within-group and between-group (rural-urban) inequalities to identify the sources of wealth-based inequality in ESHS in LMICs. We observed substantial variation across countries in the prevalence of daily ESHS among children. Children's ESHS was higher in rural areas compared to urban areas in the majority of the countries. The RC and AC demonstrated that daily ESHS was concentrated among poorer children in almost all countries (RC, median=-0.179, IQR=0.186 and AC, median=-0.040, IQR=0.055). The concentration of ESHS among poorer children was greater in urban relative to rural areas. The decomposition of the overall socioeconomic inequality in daily ESHS revealed that wealth-based differences in ESHS within urban and rural areas were the main contributor to socioeconomic inequalities in most countries (median=46%, IQR=32%). Special attention should be given to reduce ESHS among children from rural and socioeconomically disadvantaged households as social inequalities in ESHS might contribute to social inequalities in health over the life course.
Publisher: SAGE Publications
Date: 04-2023
DOI: 10.1177/10732748231197580
Abstract: Breast cancer is the most common cancer among females in Canada. This study examines trends in socioeconomic inequalities in the incidence of breast cancer in Canada over time from 1992 to 2010. A census ision level dataset was constructed using the Canadian Cancer Registry, Canadian Census of the Population and National Household Survey. A summary measure of the Concentration index (C), which captures inequality across socioeconomic groups, was used to measure income and education inequalities in breast cancer incidence over the 19-year period. The crude breast cancer incidence increased in Canada between 1992 and 2010. Age-standardized C values indicated no income or education inequalities in breast cancer incidence in the years from 1992 to 2004. However, the incidence was significantly concentrated among females in high income and highly educated neighbourhoods almost half the time in the 6 most recent years (2005–2010). The trend analysis indicated an increase in breast cancer incidence among females living in high income and highly educated neighbourhoods. Breast cancer incidence in Canada was associated with increased socioeconomic status in some more recent years. Our study findings provide previously unavailable empirical evidence to inform discussions on socioeconomic inequalities in breast incidence.
Publisher: Emerald
Date: 12-08-2019
DOI: 10.1108/IJSE-01-2019-0034
Abstract: Financial protection of households against catastrophic healthcare expenditure (CHE) is defined as one of the main goals in health systems. The purpose of this paper is to measure and decompose socioeconomic inequality in CHE among households in Kermanshah province, Western of Iran. This cross-sectional study was carried out among 1,188 households in 2017. Data were extracted from the Household Income and Expenditure Survey which is conducted by the Statistical Center of Iran. The CHE is defined as household healthcare expenditure greater than or equal to the 40 percent of household’s “capacity to pay.” The concentration curve and the Wagstaff ( W ) and Erreygers ( E ) indexes were used to illustrate and measure the extent of socioeconomic inequality in CHE. In addition, the authors decomposed the W and E indexes to identify the main determinants of socioeconomic inequality in CHE. The results indicated that the prevalence of CHE among households was 4.12 percent (95% confidence interval (CI): 3.13 to 5.42 percent). The estimated value of the W and E indexes were −0.2849 (95% CI: −0.4493 to −0.1205) and −0.0451 (95% CI: −0.0712 to −0.0190), respectively suggesting the concentration of CHE prevalence among the poor households. Decomposition analyses indicated socioeconomic status as the most important factor contributing to the concentration of CHE among the poor. In contrast, health insurance coverage was found to increase the concentration of CHE among the rich in Iran. The current study demonstrated a higher concentration of CHE among the poor households in Kermanshah province. These results call for the government’s efforts to reduce healthcare expenditure among socioeconomically disadvantaged populations. Further studies are required to understand the mechanisms through which health insurance coverage increased the probability of CHE among rich in Kermanshah province.
Publisher: Research Square Platform LLC
Date: 09-03-2020
Abstract: The authors have withdrawn this preprint from Research Square.
Publisher: Springer Science and Business Media LLC
Date: 03-07-2021
DOI: 10.1186/S12936-021-03834-8
Abstract: Although malaria in pregnancy is preventable with the use of intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp-SP), it still causes maternal morbidity and mortality, in sub-Saharan Africa and Nigeria in particular. Socioeconomic inequality leads to limited uptake of IPTp-SP by pregnant women and is, therefore, a public health challenge in Nigeria. This study aimed to measure and identify factors explaining socioeconomic inequality in the uptake of IPTp-SP in Nigeria. The study re-analysed dataset of 12,294 women aged 15–49 years from 2018 Nigeria Demographic Health Survey (DHS). The normalized concentration index (C n ) and concentration curve were used to quantify and graphically present socioeconomic inequalities in the uptake of IPTp-SP among pregnant women in Nigeria. The C n was decomposed to identify key factors contributing to the observed socioeconomic inequality in the uptake of adequate (≥ 3) IPTp-SP. The study showed a higher concentration of the adequate uptake of IPTp-SP among socioeconomically advantaged women (C n = 0.062 95% confidence interval [CI] 0.048 to 0.076) in Nigeria. There is a pro-rich inequality in the uptake of IPTp-SP in urban areas (C n = 0.283 95%CI 0.279 to 0.288). In contrast, a pro-poor inequality in the uptake of IPTp-SP was observed in rural areas (C n = − 0.238 95%CI − 0.242 to − 0.235). The result of the decomposition analysis indicated that geographic zone of residence and antenatal visits were the two main drivers for the concentration of the uptake of IPTp-SP among wealthier pregnant women in Nigeria. The pro-rich inequalities in the uptake of IPTp-SP among pregnant women in Nigeria, particularly in urban areas, warrant further attention. Strategies to improve the uptake of IPTp-SP among women residing in socioeconomically disadvantaged geographic zones (North-East and North-West) and improving antenatal visits among the poor women may reduce pro-rich inequality in the uptake of IPTp-SP among pregnant women in Nigeria.
Publisher: Korean Society of Epidemiology
Date: 17-05-2017
Publisher: Public Library of Science (PLoS)
Date: 29-03-2016
Publisher: Springer Science and Business Media LLC
Date: 28-02-2020
DOI: 10.1186/S12903-020-1036-6
Abstract: Socioeconomic-related inequality in oral hygiene behaviors in Iran is poorly understood. This study aims to measure and decompose socioeconomic-related inequalities in oral hygiene behaviors among middle-aged and elderly adults in Iran. A cross-sectional analysis was performed using data from the Prospective Epidemiological Research Studies in IrAN (PERSIAN), a large national cohort study. A total of 130,016 in iduals aged 35 years and above from 17 cohort centers in Iran were included in the study. The normalized concentration index ( C n ) was used to measure the magnitude of inequality in oral hygiene behaviors, i.e. brushing at least twice and flossing once daily, among middle-aged and elderly Iranian adults included in the cohort centers. Decomposition analysis was performed to quantify the contribution of each determinant to the observed inequality in oral hygiene behaviors. Totally, 65.5% of middle-aged and elderly adults brushed their teeth twice a day or more, 7.6% flossed at least once a day and 3.48% had both habits. The estimated C n of the two habits combined, i.e. tooth brushing and dental flossing, for all provinces taken part in the PERSIAN cohort study was 0.399 (95% confidence interval [CI]: 0.383 to 0.417), indicating that the prevalence of the two habits combined is more concentrated among in iduals with higher socioeconomic status. Inequality in oral hygiene behaviors was pro-rich in all cohort centers. The decomposition results suggested socioeconomic status as the main factor contributing to the overall inequality, followed by the level of education, and the province of residence. A low prevalence of oral hygiene behaviors among middle-aged and elderly Iranian adults was observed. There was also a pro-rich inequality in oral hygiene behaviors among middle-aged and elderly adults in all cohort centers. These results suggest an urgent need for targeted policy interventions to increase the prevalence of preventive oral hygiene behaviors among the poor and less-educated middle-aged and elderly adults in Iran.
Publisher: Korean Society for Preventive Medicine
Date: 31-07-2019
DOI: 10.3961/JPMPH.19.046
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.SOCSCIMED.2022.115186
Abstract: This study presents longitudinal evidence on the trends and determinants of income-related inequities in general practitioner (GP), specialist, and any physician visits among older adults (aged 65+) in Canada. Using the Canadian National Population Health Survey between 1998/99 and 2010/11, random effect probit and negative binomial models were employed to model the probability of visit and the total number of visits, respectively. The concentration index-based horizontal inequity (HI) approach was used to measure income-related inequities in physician services. The decomposition technique was applied to explain the factors contributing to the observed inequities. The mobility index (MI) was also calculated to compare short-run and long-run estimates of inequities. The HI indices reveal significant pro-rich inequities in both the probability and the number of specialist visits. Inequities in the likelihood of GP visits and any physician visits were pro-rich but trivial in magnitude. The MI shows that upwardly income mobile in iduals contribute to inequity in specialist visits in the long run. After income, education was the most important contributor to inequity in specialist visits, while unobserved heterogeneity explained most of the pro-rich inequity in the total number of GP and any physician visits. Although physician services are free at the point of the provision in Canada, this study demonstrates that poorer older adults utilized fewer specialist services than richer older adults for the same level of need. Specific policies are needed to ensure equity in specialist care use among the older adults in Canada.
Publisher: Emerald
Date: 11-2019
DOI: 10.1108/IJSE-04-2019-0271
Abstract: Behavioral economic analysis of health-related behavior is a potentially useful approach to study and control non-communicable diseases. The purpose of this paper is to explore the time preferences of in iduals and its impact on obesity in an adult population of Iran. A structured questionnaire was completed by 792 in iduals who were randomly selected from the participants of an ongoing national Prospective Epidemiological Research Studies in IrAN cohort study in West of Iran. The quasi-hyperbolic discounting model was used to estimate the parameters of time preferences and a probit regression model was used to explore the correlation between obesity and time preferences. There was a statistically significant correlation between obesity and both the long-run patience and present-biased preferences of participants. In iduals with a low level of long-run patience were 10.2 percentage points more likely to be obese compared to in iduals with a high level of long-run patience. The probability of being obese increased by 11 percentage points in present-biased in iduals compared to future biased in iduals. The long-run patience and time inconsistent preferences were significant determinants of obesity. Considering the time-inconsistent preferences in the development of policies to change obesity-related behavior among adults might increase the success rate of the interventions.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.HEALTHPOL.2016.07.019
Abstract: Notwithstanding a general improvement in health status, the socioeconomic gradient in health remains a public health challenge worldwide. Using longitudinal data from the National Population Health Survey (NPHS, n=17,276), we examined trends in socioeconomic gradients in two health indicators, viz. the Health Utility Index (HUI) and the Frailty Index (FI), among Canadian adults (25 years and older) between 1998/9-2010/11. The relative and slope indices of inequality (RII and SII, respectively) were employed to summarize income- and education-based inequality in the FI and the HUI in Canada as whole, and in five regions: the Atlantic provinces, Quebec, Ontario, the Prairies and British Columbia. We found that education- and income-related inequalities in health were present in all five regions of Canada. The estimated RIIs and SIIs suggested that education-related inequalities in the FI and the HUI increased among women. The results also revealed that relative and absolute income-related inequalities in the HUI increased in Canada, especially among women. Both absolute and relative inequalities indicated that income-related inequalities in the HUI increased in Quebec and in the Prairies over time. Persistent and growing socioeconomic inequalities in health in Canada over the past one and half decades should warrant more attention. The mechanisms underlying socioeconomic-related inequalities in Canada are less clear. Therefore, further studies are required to identify effective polices to reduce the socioeconomic gradient in health in Canada.
Publisher: Springer Science and Business Media LLC
Date: 24-02-2022
DOI: 10.1186/S12913-022-07629-8
Abstract: Removal of user fee for vulnerable people reduces the financial barriers associated with healthcare payments, which, in turn, improves health outcomes and promotes health equity. This study sought to provide policy strategies to reduce user fee at the point of service delivery for the poor in Iran. This is a qualitative study carried out in 2018. The purposive s ling method was applied, and 33 experts with relevant and valuable experiences and maximum variation to obtain representativeness and rich data were interviewed. Trustworthiness criteria were used to assure the quality of the results. The data were analyzed based on thematic analysis using the MAXQDA10 software. The most important issue regarding financial protection against user fee for the poor in Iran is policy integration and cohesion. Differences in access to financial support for user fee coverage among different groups of the poor have led to inequalities in access and financial protection among the poor. The suggested protection policies against the user fee at the point of service delivery in Iran can be categorized into three main categories: 1) basic health social insurance instruments, 2) free health services to the poor outside of the health insurance system, and 3) complementary insurance mechanisms. Implementing a cohesive social assistance policy for all disadvantaged groups is needed to address inequalities in financial protection against user fee payment among the poor in Iran. Reducing user fee through mechanisms such as deductible cap, stop-loss, variable user fee and sliding fee scale can improve financial protection and enhance healthcare utilization among the poor. A user fee exemption is not enough to remove barriers to access to service for the poor, as other costs such as transportation expenditures and informal payments also put financial pressure on them. Therefore, financial support for the poor should be designed in a comprehensive protection package to reduce out-of-pocket payments for healthcare services, and indirect costs associated with healthcare utilization.
Publisher: Maad Rayan Publishing Company
Date: 2014
Publisher: Korean Society of Epidemiology
Date: 15-08-2017
Publisher: Informa UK Limited
Date: 08-2013
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.HEALTHPOL.2018.06.011
Abstract: Using three nationally representative Aboriginal Peoples Surveys (2001, 2006 and 2012, n = 68,040), we examined income-related inequalities in self-perceived poor/fair general health status among Indigenous adults (18+) living off-reserve in Canada. We used the relative and absolute concentration indices (RC and AC, respectively) to quantify income-related inequalities in health for men and women, within the three Indigenous populations (First Nations, Métis, and Inuit), and in different geographic regions. Moreover, we performed decomposition analysis to determine factors that explain income-related inequality in health within the Indigenous peoples living off-reserve in Canada. The prevalence of poor/fair health status among the Indigenous population living off-reserve increased from 18% in 2001 to 22% in 2012. The extent of pro-rich relative (absolute) income-related inequalities in health increased by 23% (42%) from 2001 to 2012. Income-related inequalities in health increased statistically significantly within First Nations and Métis populations as well as in Atlantic provinces, Ontario, Alberta, British Columbia and Territories. Decomposition analyses indicated that, besides income itself, occupational status and educational attainment were the most important factors contributing to the pro-rich distribution of health among Indigenous peoples living off-reserve. Growing socioeconomic inequalities in health among Indigenous peoples should warrant more attention. Policies designed to address the broader array of social determinants of health may mitigate the continuing inequalities in health among Indigenous peoples living off-reserve in Canada.
Publisher: Elsevier BV
Date: 03-2023
Publisher: Briefland
Date: 05-05-2017
DOI: 10.5812/IJPBS.4778
Publisher: Informa UK Limited
Date: 13-05-2020
Publisher: Springer Science and Business Media LLC
Date: 19-07-2023
DOI: 10.1038/S41467-023-39936-X
Abstract: RNA-binding proteins (RBPs) are key players regulating RNA processing and are associated with disorders ranging from cancer to neurodegeneration. Here, we present a proteomics workflow for large-scale identification of RBPs and their RNA-binding regions in the mammalian brain identifying 526 RBPs. Analysing brain tissue from males of the Huntington’s disease (HD) R6/2 mouse model uncovered differential RNA-binding of the alternative splicing regulator RBM5. Combining several omics workflows, we show that RBM5 binds differentially to transcripts enriched in pathways of neurodegeneration in R6/2 brain tissue. We further find these transcripts to undergo changes in splicing and demonstrate that RBM5 directly regulates these changes in human neurons derived from embryonic stem cells. Finally, we reveal that RBM5 interacts differently with several known huntingtin interactors and components of huntingtin aggregates. Collectively, we demonstrate the applicability of our method for capturing RNA interactor dynamics in the contexts of tissue and disease.
Publisher: Springer Science and Business Media LLC
Date: 2014
Publisher: Springer Science and Business Media LLC
Date: 10-08-2023
Publisher: Springer Science and Business Media LLC
Date: 05-06-2020
DOI: 10.1186/S13011-020-00279-1
Abstract: Drug use can lead to several psychological, medical and social complications. The current study aimed to measure and decomposes socioeconomic - related inequalities in drug use among adults in Iran. This was a cross-sectional study The PERSIAN Cohort is the largest and most important cohort among 18 distinct areas of Iran. This study was conducted on 130,570 adults 35 years and older. A structured questionnaire was applied to collect data. The concentration index (C) was used to quantify and decompose socioeconomic inequalities in drug use. The prevalence experience of drug use was 11.9%. The estimated C for drug use was − 0.021. The corresponding value of the C for women and men were − 0.171 and − 0.134, respectively. The negative values of the C suggest that drug use is more concentrated among the population with low socioeconomic status in Iran ( p 0.001). For women, socioeconomic status (SES) (26.37%), province residence (− 22.38%) and age (9.76%) had the most significant contribution to socioeconomic inequality in drug use, respectively. For men, SES (80.04%), smoking (32.04%) and alcohol consumption (− 12.37%) were the main contributors to socioeconomic inequality in drug use. Our study indicated that drug use prevention programs in Iran should focus on socioeconomically disadvantaged population. Our finding could be useful for health policy maker to design and implement effective preventative programs to protect Iranian population against the drug use.
Publisher: Maad Rayan Publishing Company
Date: 25-05-2016
Publisher: Springer Science and Business Media LLC
Date: 13-05-2020
DOI: 10.1186/S12888-020-02596-Y
Abstract: Socioeconomic inequality in mental health in Iran is poorly understood. This study aimed to assess socioeconomic inequality in poor mental health among Iranian adults. The study used the baseline data of PERSIAN cohort study including 131,813 participants from 17 geographically distinct areas of Iran. The Erreygers Concentration index (E) was used to quantify the socioeconomic inequalities in poor mental health. Moreover, we decomposed the E to identify factors contributing to the observed socioeconomic inequality in poor mental health in Iran. The estimated E for poor mental health was − 0.012 (95% CI: − 0.0144, − 0.0089), indicating slightly higher concentration of mental health problem among socioeconomically disadvantaged adults in Iran. Socioeconomic inequality in poor mental health was mainly explained by gender (19.93%) and age (12.70%). Region, SES itself, and physical activity were other important factors that contributed to the concentration of poor mental health among adults with low socioeconomic status. There exists nearly equitable distribution in poor mental health among Iranian adults, but with important variations by gender, SES, and geography. These results suggested that interventional programs in Iran should focus on should focus more on socioeconomically disadvantaged people as a whole, with particular attention to the needs of women and those living in more socially disadvantaged regions.
Publisher: Korean Society for Preventive Medicine
Date: 30-09-2018
DOI: 10.3961/JPMPH.18.012
Publisher: Elsevier BV
Date: 08-2020
Publisher: Springer Science and Business Media LLC
Date: 04-07-2019
DOI: 10.1007/S10508-019-01507-X
Abstract: Using the Survey on Sexual Misconduct in the Canadian Armed Forces (n = 43,440) we examined risk factors associated with the experience of sexual misconduct in the Canadian Armed Forces (CAF). We used logistic regression models to identify predictors of being a target of sexual misconduct among CAF members. We also examined whether risk factors associated with sexual misconduct vary by sex and environmental command (Army, Navy, Air Force, or Military Personnel). The proportions of CAF members who experienced sexual assault, inappropriate sexualized behavior, or discriminatory behavior on the basis of sex and sexual orientation or gender identity in the past year were 2%, 18.4%, and 5.9%, respectively. The odds ratio of being the target for sexual assault or inappropriate sexual behavior and discriminatory behavior in the past year among females compared to males was 4.75 (95% confidence interval [CI] = 4.14 to 5.44), 2.55 (95% CI = 2.41 to 2.71), and 4.67 (95% CI = 4.3 to 5.08), respectively. Being a victim of one or more of the three types of sexual misconduct in the past year was associated with one or more of the following factors: younger, single, Indigenous, disabled, lesbian, gay, bisexual or transgender, highly educated, or junior non-commissioned members of the CAF. Results were generally consistent when we stratified our analysis by sex and environmental command. These results suggest that sexual misconduct is a problem within the CAF. There is a need for change within the CAF to prevent sexual misconduct among at-risk members.
Publisher: Springer Science and Business Media LLC
Date: 31-03-2013
DOI: 10.1007/S10198-013-0469-0
Abstract: This study examines trends in socioeconomic-related inequalities in obesity risk among Canadian adults (aged 18-65 years) from 2000 to 2010 using five nationally representative Canadian Community Health Surveys (CCHSs). We employed the concentration index (C) to quantify the socioeconomic inequalities in obesity risk across different demographic groups and geographic regions in each survey period. A decomposition analysis of inequality is performed to determine factors that lie behind income-related inequality in obesity risk. Although declining over time, the results show that there exists income-related inequality in obesity risk in Canada. The estimated Cs for men indicate that obesity is concentrated among the rich and its trend is increasing over time. The findings, however, suggest that obesity is more prevalent among economically disadvantaged women. While we found that obesity is mainly concentrated among the poor in the Atlantic Provinces, the degree of socioeconomic related inequality in obesity risk is increasing in these provinces. The results for Alberta showed that obesity is concentrated among the better-off in iduals. The decomposition analysis suggests that factors such as demographics, income, immigration, education, drinking habits, and physical activity are the key factors explaining income-related inequality in obesity risk in Canada. Our empirical findings suggest that, in order to combat the obesity epidemic, health policies should focus on poorer females and economically well-off males.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
Publisher: Springer Science and Business Media LLC
Date: 09-04-2020
Publisher: BMJ
Date: 11-2019
DOI: 10.1136/BMJOPEN-2019-033806
Abstract: Transition from paediatric to adult care is challenging for adolescents and emerging adults (ages 18 to 30 years) with type 1 diabetes (T1D). This transition is characterised by a deterioration in glycaemic control (haemoglobin A1c (HbA1c)), decreased clinical attendance, poor self-management and increased acute T1D-related complications. However, evidence to guide delivery of transition care is lacking. Given the effectiveness of group education in adult diabetes glycaemic control and improvements in qualitative measures in paediatric diabetes, group education is a potentially feasible and cost-effective alternative for the delivery of transition care. In emerging adults with T1D, we aim to assess the effectiveness of group education visits compared with usual care on HbA1c, T1D-related complications, psychosocial measures and cost-effectiveness after the transfer to adult care. In a multisite, assessor-blinded, randomised, two-arm, parallel-group, superiority trial, 212 adolescents with T1D (ages 17 years) are randomised to 12 months group education versus usual T1D care before transfer to adult care. Visits in the active arm consist of group education sessions followed by usual T1D care visits every 3 months. Primary outcome is change in HbA1c measured at 24 months. Secondary outcomes are delays in establishing adult diabetes care, T1D-related hospitalisations and emergency department visits, severe hypoglycaemia, stigma, self-efficacy, diabetes knowledge, transition readiness, diabetes distress, quality of life and cost-effectiveness at 12 and 24 months follow-up. Analysis will be by intention-to-treat. Change in HbA1c will be calculated and compared between arms using differences (95% CI), along with cost-effectiveness analysis. A similar approach will be conducted to examine between-arm differences in secondary outcomes. The study was approved by McGill University Health Centre Research Ethics Board (GET-IT/MP-37-2019-4434, version ‘Final 1.0 from November 2018). Study results will be disseminated through peer-reviewed publications. NCT03703440 .
Publisher: Emerald
Date: 19-12-2016
DOI: 10.1108/IJHRH-06-2016-0008
Abstract: Oral health is a major public health problem, both in developed and developing countries. The purpose of this paper is to examine the utilization of dental care and identify the main socioeconomic factors affecting the use of these services in the city of Sanandaj, west of Iran, in 2015. A cross-sectional survey using multistage s ling was conducted to obtain information on the dental care visits of 520 head of households in Sanandaj. A self-administered questionnaire was used to collect data on the utilization of dental visits. Multivariable logistic regression was used to identify the main socioeconomic factors affecting the utilization of dental care in Sanandaj. Results showed that 61.3 percent of the respondents visited a dentist at least once in the last year, of which 45 percent visited dentist for restoration, 27.9 percent had extraction and 10.3 percent had a dental checkup. The average number of dentist visits by respondents was 1.9. Regression results indicated a significant association between socioeconomic factors (e.g. income, educational level and employment status) and utilization of dental care. This study suggested that dental care visit was influenced by socioeconomic status of households. Therefore, strategies aimed at improving dental care utilization for socioeconomically disadvantaged households (e.g. dental health insurance) are required to promote oral health among socioeconomically disadvantaged groups.
Publisher: Emerald
Date: 12-04-2018
DOI: 10.1108/IJHG-09-2017-0046
Abstract: The Health Sector Evolution Plan (HSEP) is the most recent reform in Iran’s health care system that was launched in May 2014 in all university-affiliated hospitals to reduce health care expenditure for patients, while improving the efficiency and quality of hospital services. The purpose of this paper is to evaluate the impact of the HSEP on the performance of 15 hospitals affiliated with Kermanshah University of Medical Sciences (KUMS), located in the western region of Iran. The Pabon Lasso model was used to measure the performance of hospitals before and after the implementation of the HSEP in 2013-2014 and 2015-2016, respectively. Three indicators of average length of stay (ALoS), bed occupancy rate (BOR) and bed turnover rate (BTR) were analyzed by the Pabon Lasso model. The results showed that the average ALoS, BTR and BOR before the introduction of the HSEP were 2.59 days, 92 times and 57 percent, respectively, and the corresponding figures for these indicators after the implementation of the HSEP were 2.61 days, 98.9 times and 59.9 percent. The results indicated that before the introduction of the HESP, 40 percent of hospitals were in zone 1 (poor performance: low BTR and BOR and high ALoS), 27 percent in zone 2, 20 percent in zone 3 (good performance: high BTR and BOR and low ALoS) and 13 percent in zone 4. After the HSEP, the proportion of hospitals in zones 1-4 was 33, 27, 20 and 20 percent, respectively. This study is the first to use the Pabon Lasso model technique to evaluate the impact of the HSEP on hospitals affiliated with KUMS.
Publisher: Maad Rayan Publishing Company
Date: 18-07-2020
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.SOCSCIMED.2015.07.008
Abstract: The availability of maternity leave might remove barriers to improved vaccination coverage by increasing the likelihood that parents are available to bring a child to the clinic for immunizations. Using information from 20 low-and-middle-income countries (LMICs) we estimated the effect of paid maternity leave policies on childhood vaccination uptake. We used birth history data collected via Demographic and Health Surveys (DHS) to assemble a multilevel panel of 258,769 live births in 20 countries from 2001 to 2008 these data were merged with longitudinal information on the number of full-time equivalent (FTE) weeks of paid maternity leave guaranteed by each country. We used Logistic regression models that included country and year fixed effects to estimate the impact of increases in FTE paid maternity leave policies in the prior year on the receipt of the following vaccines: Bacillus Calmette-Guérin (BCG) commonly given at birth, diphtheria, tetanus, and pertussis (DTP, 3 doses) commonly given in clinic visits and Polio (3 doses) given in clinic visits or as part of c aigns. We found that extending the duration of paid maternity leave had a positive effect on immunization rates for all three doses of the DTP vaccine each additional FTE week of paid maternity leave increased DTP1, 2 and 3 coverage by 1.38 (95% CI = 1.18, 1.57), 1.62 (CI = 1.34, 1.91) and 2.17 (CI = 1.76, 2.58) percentage points, respectively. Estimates were robust to adjustment for birth characteristics, household-level covariates, attendance of skilled health personnel at birth and time-varying country-level covariates. We found no evidence for an effect of maternity leave on the probability of receiving vaccinations for BCG or Polio after adjustment for the above-mentioned covariates. Our findings were consistent with the hypothesis that more generous paid leave policies have the potential to improve DTP immunization coverage. Further work is needed to understand the health effects of paid leave policies in LMICs.
Publisher: Springer Science and Business Media LLC
Date: 16-05-2020
Publisher: Wiley
Date: 30-05-2017
DOI: 10.1002/NUR.21801
Abstract: The purpose of this systematic review and meta-analysis was to provide a precise estimate of the period prevalence of needlestick injuries (NSI) among nurses working in hospitals in Iran and the reporting rate of NSI to nurse managers. We searched both international (PubMed, Scopus and the Institute for Scientific Information) and Iranian (Scientific Information Database, Iranmedex and Magiran) scientific databases to find studies published from 2000 to 2016 of NSI among Iranian nurses. The following keywords in Persian and English were used: "needle-stick" or "needle stick" or "needlestick," with and without "injury" or "injuries," "prevalence" or "frequency," "nurses" or "nursing staff," and "Iran." In a s le of 21 articles with 6,480 participants, we estimated that the overall 1-year period prevalence of NSI was 44% (95% confidence interval [CI], 35-53%) among Iranian nurses. The overall 1-year period prevalence of reporting NSI to nurse managers was 42% (95% CI, 33-52%). In meta-regression analysis, s le size, mean age, years of experience, and gender ratio were not associated with prevalence of NSI or reporting rate. The year of data collection was positively associated with period prevalence of NSI (p < .05), but not with the period prevalence of reporting NSI to nurse managers. Results indicated a high NSI period prevalence and low NSI reporting rate among nurses in Iran. Thus, effective interventions are required in hospitals in Iran to reduce the prevalence and increase the reporting rate of NSI. © 2017 Wiley Periodicals, Inc.
Publisher: Elsevier BV
Date: 05-2020
Publisher: Emerald
Date: 22-02-2019
DOI: 10.1108/IJHG-06-2018-0026
Abstract: Appropriate access to formally-trained health workers for people living in rural and underdeveloped areas is a continuing challenge worldwide. The purpose of this paper is to investigate the willingness of formally-trained health workers to practice in underdeveloped areas and its main determinants among medical students in the western provinces of Iran. A total of 753 medical students from four provinces in western Iran (Kermanshah, Ilam, Lorestan and Kurdistan) were surveyed cross-sectionally in 2017. A self-administrated questionnaire was used to collect data on sociodemographic characteristics, willingness to practice in underdeveloped areas, intrinsic (e.g. desire to help others and self-interest in medicine) and extrinsic (e.g. the high income of physicians and social prestige) motivations of the study population. Multivariable logistic regression was used to identify the main determinants of willingness to practice in underdeveloped areas among medical students after their graduation. The results indicated that 58.3 percent of students were willing to practice in underdeveloped areas. While 59 percent of the study population had a strong extrinsic motivation to study medicine, the remaining 41 percent of the study population had a strong intrinsic motivation to study medicine. The logistic regression results indicated that low parental professional and educational status, an experience of living in rural areas and having strong intrinsic motivation were associated with greater willingness to practice in underdeveloped areas. This is the first study to investigate the willingness to practice in underdeveloped areas and its main determinants among medical students in the west of Iran.
Publisher: Springer Science and Business Media LLC
Date: 17-06-2019
Publisher: Elsevier BV
Date: 2023
Publisher: Informa UK Limited
Date: 04-04-2021
DOI: 10.1080/03630242.2021.1909202
Abstract: Ovarian cancer is the seventh most common cancer among women worldwide. We assessed the effect of socioeconomic status on ovarian cancer incidence in Canada between 1992 and 2010. We linked data from the Canadian Cancer Registry (CCR), Canadian Census of Population (CCP), and National Household Survey (NHS) to measure socioeconomic inequalities in the incidence of ovarian cancer among Canadian women over the study period. The age-standardized relative and absolute concentration index (RC and AC, respectively) were calculated to quantify income- and education-related inequalities in the incidence of ovarian cancer in Canadian women during this period. Despite a slight increase in the crude incidence of ovarian cancer in Ontario, Quebec, New Brunswick, Newfoundland and Labrador & Prince Edward Island, and Canada as a whole, the incidence of ovarian cancer in Canada has mostly remained stable, between 13 and 15 new cases per 100,000 per year between 1992 and 2010. The estimated age-standardized RC and AC values for the study period did not indicate any statistically significant relationship between income or education status, and the incidence of ovarian cancer in Canada. Future work should be directed at seeking related risk factors other than socioeconomic status that may contribute to the incidence of this disease.
Publisher: Oxford University Press (OUP)
Date: 19-12-2017
Abstract: To investigate the effect of the health sector evolution plan (HSEP) on hospitalization and cesarean section (C-section) rates in Kermanshah province in the western region of Iran. Interrupted time series analysis. Hospital care system in Kermanshah province. Fifteen hospitals affiliated to Ministry of Health and Medical Education (MoHME) in Kermanshah province. Health sector evolution plan. Hospitalization rate and C-section rate. We observed a statistically significant increase in the hospitalization rate (12.9 hospitalizations per 10 000 population, P < 0.001) in the first month after the implementation of the HSEP. Compared with the monthly trend in hospitalization rate before the intervention, we found a significant increase of 0.70 hospitalizations per 10 000 population (P < 0.001) in monthly trend in hospitalization rate after the HSEP. Although the proportion of C-section from total deliveries decreased by 11% (P = 0.044) in the first month after the implementation of the HSEP, the proportion of C-section from total deliveries increased at the rate of 0.0017% (P = 0.001) per month during post-intervention period. We found an increase in the hospitalization rate after the intervention of HSEP. Although the C-section rate in the first month after the HSEP decreased, we observed an increasing trend in C-section rate over the study period this implies that the HSEP did not promote vaginal delivery in Iran, which is outlined as one of the objectives of the intervention.
Publisher: BMJ
Date: 02-2020
DOI: 10.1136/BMJOPEN-2019-035656
Abstract: Polypharmacy and potentially inappropriate medication use is common in older adults and is associated with adverse outcomes such as falls and hospitalisations. This study is a pharmacist-led medication optimisation initiative using an electronic tool (the Drug Burden Index (DBI) Calculator) in four hospital sites in the Canadian province of Nova Scotia. The study aims to enrol 160 participants between the preintervention and intervention groups. The Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT 2013 checklist) was used to develop the protocol for this prospective interventional implementation study. A preintervention retrospective control cohort and a multiple case study analysis will also be used to assess the effect of intervention implementation. Statistical analysis will involve change in DBI scores and assessment of clinical outcomes, such as rehospitalisation and mortality using appropriate statistical tests including t-test, χ 2 , analysis of variance and unadjusted and adjusted regression methods. Ethics approval has been granted by the Nova Scotia Health Authority Research Ethics Board. The findings of this study will be published in peer-reviewed journals and presented at local, national and international conferences. NCT03698487 .
Publisher: Springer Science and Business Media LLC
Date: 15-11-2021
DOI: 10.1007/S10552-021-01518-X
Abstract: Colorectal cancer is the third most commonly diagnosed cancer in Canada. This study aimed to measure and examine trends in socioeconomic inequalities in the incidence of colorectal cancer in Canada. This study is a time trend ecological study based on Canadian Census Division level data constructed from the Canadian Cancer Registry, Canadian Census of Population, and National Household Survey. We assessed trends in income and education inequalities in colorectal cancer incidence in Canada from 1992 to 2010. The age-standardized Concentration index ([Formula: see text]), which measures inequality across all socioeconomic groups, was used to quantify socioeconomic inequalities in colorectal cancer incidence in Canada. The average crude colorectal cancer incidence was found to be 61.52 per 100,000 population over the study period, with males having a higher incidence rate than females (males: 66.98 females: 56.25 per 100,000 population). The crude incidence increased over time and varied by province. The age-standardized C indicated a higher concentration of colorectal cancer incidence among lower income and less-educated neighborhoods in Canada. Income and education inequalities increased over time among males. The concentration of colorectal cancer incidence in low socioeconomic neighborhoods in Canada has implications for primary prevention and screening.
Publisher: Korean Society of Cancer Prevention
Date: 30-06-2021
Publisher: Oxford University Press (OUP)
Date: 28-12-2022
DOI: 10.1093/NTR/NTAB270
Abstract: Understanding the elasticities of cigarette smoking demand among the youth could help improve the effectiveness of tobacco control interventions. The objective of this study is to measure the price and income elasticities of cigarette smoking demand among urban Bangladeshi male adolescents and young adults aged 10-24 years. Using data from a cross-sectional survey conducted in seven urban districts of Bangladesh, we applied probit and ordinary least square (OLS) models to examine the effect of price and income on smoking participation (decision to smoke) and intensity (number of cigarettes smoked). Our results showed that price was not significantly associated with the decision to smoke, while income was a significant determinant of smoking participation. Both price and income determined the smoking intensity. The positive income elasticity (0.39) indicated that participants with greater access to money were more likely to participate in cigarette smoking and smoked more cigarettes. Negative price elasticity (-0.62) implied that increasing prices could lead to a reduction in smoking intensity among adolescents and young adults in urban Bangladesh. The inelastic price demand for cigarette smoking suggests that there is scope for increasing tax on cigarettes without compromising the tax revenue. This is the first study to investigate price and income elasticities among urban adolescents and young adults in Bangladesh. The study found no evidence that increasing the price of cigarettes discourages smoking participation but did show that increasing the price reduces the intensity of smoking among existing smokers. The results also suggest that economic measures such as taxation that increase the price of cigarettes could be a useful policy tool to limit smoking intensity without compromising government tax revenue.
Publisher: Springer Science and Business Media LLC
Date: 03-11-2016
Publisher: Medknow
Date: 2019
Publisher: Maad Rayan Publishing Company
Date: 05-11-2022
Abstract: In line with the global trend, the Middle East and North Africa (MENA) region has been growing vulnerable to the direct and indirect health effects of climate change including death tolls due to climatological disasters and diseases sensitive to climate change since the industrial revolution. Regarding the limited capacity of MENA countries to adapt and respond to these effects, and also after relative failures of the previous negotiation in Glasgow, in the upcoming COP27 in Egypt, the heads of the region’s parties are determined to take advantage of the opportunity to host MENA to mitigate and prevent the worst effects of climate change. This would be achieved through mobilizing international partners to support climate resilience, a major economic transformation, and put health policy and management in a strategic position to contribute to thinking and action on these pressing matters, at least to avoid or minimize the future adverse consequences.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Springer Science and Business Media LLC
Date: 22-02-2020
Publisher: BMJ
Date: 26-03-2018
Abstract: Socioeconomic inequalities in child vaccination continue to be a global public health concern. This study aimed to measure and identify factors associated with socioeconomic inequalities in full immunisation coverage against the four core vaccine-preventable diseases (ie, bacille Calmette-Guérin, diphtheria-tetanus-pertussis (three doses), polio (three doses) and measles vaccines) in 46 low/middle-income countries. The most recent nationally representative s les of children (aged 10–59 months, n=372 499) collected through the Demographic Health Surveys were used to measure vaccination rates. The concentration index (C) was used to quantify socioeconomic inequalities in vaccination coverage. Furthermore, meta-regression analyses were used to determine factors affecting socioeconomic inequalities in vaccination coverage across countries. Results suggested that immunisation coverage was pro-rich in most countries (median C=0.161, IQR 0.131). Gambia (C=−0.146, 95% CI −0.223 to −0.069), Namibia (C=−0.093, 95% CI −0.145 to −0.041) and Kyrgyz Republic (C=−0.227, 95% CI −0.304 to −0.15) were the only countries where children who belong to higher socioeconomic status group were less likely to receive all the four core vaccines than their lower socioeconomic status counterparts. Meta-regression analyses suggested that, across countries, the concentration of antenatal care visits among wealthier mothers was positively associated with the concentration of vaccination coverage among wealthier children (coefficient=0.606, 95% CI 0.301 to 0.911). Pro-rich distribution of child vaccination in most low/middle-income countries remains an important public health policy concern. Policies aimed to improve antenatal care visits among mothers in lower socioeconomic groups may mitigate socioeconomic inequalities in vaccination coverage in low/middle-income countries.
Publisher: Academic World Research
Date: 30-10-2018
DOI: 10.14196/MJIRI.32.59
Publisher: Korean Society of Epidemiology
Date: 02-07-2018
Publisher: Springer Science and Business Media LLC
Date: 05-05-2022
Publisher: SAGE Publications
Date: 2021
DOI: 10.1177/10732748211055272
Abstract: Understanding the effects of socioeconomic status on cancer incidence and their trends over time will help inform public health interventions for cancer control. This study sought to investigate trends in socioeconomic inequalities in prostate cancer incidence among Canadian males. Using a census ision level dataset (n = 280) constructed from the Canadian Cancer Registry, Canadian Census of Population (1992, 1996, 2001, 2006) and 2011 National Household Survey, we examined the effect of socioeconomic status on prostate cancer incidence among Canadian males between 1992 and 2010. The age-adjusted concentration index was used to quantify education/income-related inequalities in prostate cancer incidence. The crude prostate cancer incidence increased from 115 to 137 per 100 000 males in Canada from 1992 to 2010 with a peak in 2007. The rate increased significantly in all but three of four western provinces. The age-adjusted concentration index showed a higher concentration of prostate cancer diagnoses among males living in high-income neighbourhoods in Canada in particular from 1996 to 2005. In contrast, the index was higher among males living in less-educated neighbourhoods in the most recent study years (2006–2010). The concentration of new prostate cancer cases among high-income populations in Canada may be explained by the rise of opportunistic screening of asymptomatic males however, this should be studied in further detail. Since we found a higher incidence rate of prostate cancer among less-educated males in Canada in recent years, risk-benefit investigation of primary prevention and opportunistic screening for less-educated males is advised.
Publisher: Wiley
Date: 30-01-2018
DOI: 10.1111/INR.12426
Abstract: This study aimed to summarize the available information in the literature to make an accurate estimate of the prevalence of burnout among Iranian nurses. Burnout is a work-related stress syndrome that has negative impact on healthcare providers, patients and healthcare delivery systems. A comprehensive search of literature using international [PubMed, Scopus and the Institute for Scientific Information (ISI)] and Iranian scientific data bases [Scientific Information Database (SID), IranMedex and Magiran] was conducted to identify English and Persian language studies, published between 2000 and 2016, that examined the prevalence of burnout among nurses in Iran. The I-squared test and Chi-squared-based Q-test suggested heterogeneity of reported prevalence among the qualified studies thus, a random-effects model was applied to estimate the overall prevalence of burnout among nurses in Iran. Based on 21 selected articles with 4180 participants, the overall prevalence of burnout among Iranian nurses was estimated to be 36% [95% confidence interval (CI), 20-53%] in Iran. Meta-regression indicated that s le size and year of data collection, mean age of s les, female to male ratio and geographic regions were not statistically significantly associated with the prevalence of burnout. Also, based on Egger's test and funnel plot, there is no publication bias among studies included in the analysis. Professional burnout affects more than one-third of nursing staff in Iran thus, effective interventions and strategies are required to reduce and prevent burnout among nurses. Due to the negative consequences of burnout on patients, nurses and organizations, nursing and healthcare managers should intervene to prevent and reduce burnout among nurses in Iran. Policy attention should focus on developing effective interventions to prevent and minimize the burden of burnout among nurses in Iran. Nurses' involvement in the policy-making process is crucial in the implementation of effective programs and initiatives tailored to address the higher prevalence of burnout among Iranian nurses.
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: Springer Science and Business Media LLC
Date: 21-09-2019
DOI: 10.1007/S10198-019-01118-2
Abstract: Equity in healthcare is an overarching goal of many healthcare systems around the world. Empirical studies of equity in healthcare utilisation primarily rely on the horizontal inequity (HI) approach which measures unequal utilisation of healthcare services by socioeconomic status (SES) for equal medical need. The HI method examines, quantifies, and explains inequity which is based on regression analysis, the concentration index, and the decomposition technique. However, this method is not beyond limitations and criticisms, and it has been subject to several methodological challenges in the past decade. This review presents a summary of the recent developments and debates on various methodological issues and their implications on the assessment of HI in healthcare utilisation. We discuss the key disputes centred on measurement scale of healthcare variables as well as the evolution of the decomposition technique. We also highlight the issues about the choice of variables as the indicator of SES in measuring inequity. This follows a discussion on the application of the longitudinal method and use of administrative data to quantify inequity. Future research could exploit the potential for health administrative data linked to social data to generate more comprehensive estimates of inequity across the healthcare continuum. This review would be helpful to guide future applied research to examine inequity in healthcare utilisation.
Publisher: Springer Science and Business Media LLC
Date: 03-04-2015
Publisher: Springer Science and Business Media LLC
Date: 08-06-2022
DOI: 10.1186/S12939-022-01683-8
Abstract: Healthcare system and intersectoral public health policies play a crucial role in improving population health and reducing health inequalities. This study aimed to quantify their impact, operationalized as avoidable deaths, on the gap in life expectancy (LE) and lifespan inequality (LI) between Iran and three neighbour countries viz., Turkey, Qatar, and Kuwait in 2015–2016. Annual data on population and causes of deaths by age and sex for Iran and three neighbour countries were obtained from the World Health Organization mortality database for the period 2015–2016. A recently developed list by the OECD/Eurostat was used to identify avoidable causes of death (with an upper age limit of 75). The cross-country gaps in LE and LI (measured by standard deviation) were decomposed by age and cause of death using a continuous-change model. Iranian males and females had the second lowest and lowest LE, respectively, compared with their counterparts in the neighbour countries. On the other hand, the highest LIs in both sexes (by 2.3 to 4.5 years in males and 1.1 to 3.3 years in females) were observed in Iran. Avoidable causes contributed substantially to the LE and LI gap in both sexes with injuries and maternal/infant mortality represented the greatest contributions to the disadvantages in Iranian males and females, respectively. Higher mortality rates in young Iranians led to a double burden of inequality –shorter LE and greater uncertainty at timing of death. Strengthening intersectoral public health policies and healthcare quality targeted at averting premature deaths, especially from injuries among younger people, can mitigate this double burden.
Publisher: CMA Joule Inc.
Date: 2021
Publisher: Elsevier BV
Date: 09-2023
Publisher: Springer Science and Business Media LLC
Date: 14-07-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-08-2021
Publisher: CMA Impact Inc.
Date: 24-03-2019
DOI: 10.1503/CMAJ.181374
Publisher: Informa UK Limited
Date: 07-2020
DOI: 10.2147/CEOR.S252244
Publisher: Springer Science and Business Media LLC
Date: 18-08-2020
DOI: 10.1186/S13690-020-00457-4
Abstract: The current study aimed to measure and decompose socioeconomic-related inequalities in DMFT (decayed, missing, and filled teeth) index among adults in Iran. The study data were extracted from the adult component of Prospective Epidemiological Research Studies in IrAN (PERSIAN) from 17 centers in 14 different provinces of Iran. DMFT score was used as a measure of dental caries among adults in Iran. The concentration curve and relative concentration index (RC) was used to quantify and decompose socioeconomic-related inequalities in DMFT. A total of 128,813 adults aged 35 and older were included in the study. The mean (Standard Deviation [SD]) score of D, M, F and DMFT of the adults was 3.3 (4.6), 12.6 (10.5), 2.1 (3.4) and 18.0 (9.5), respectively. The findings suggested that DMFT was mainly concentrated among the socioeconomically disadvantaged adults (RC = − 0.064 95% confidence interval [CI), − 0.066 to − 0.063). Socioeconomic status, being male, older age and being a widow or orced were identified as the main factors contributing to the concentration of DMFT among the worse-off adults. It is recommended to focus on the dental caries status of socioeconomically disadvantaged groups in order to reduce socioeconomic-related inequality in oral health among Iranian adults. Reducing socioeconomic-related inequalities in dental caries should be accompanied by appropriate health promotion policies that focus actions on the fundamental socioeconomic causes of dental disease.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.CANEP.2019.04.013
Abstract: Leukemia is the most common cancer among Canadian children, representing about a third of pediatric cancers in Canada and is responsible for about one-third of pediatric cancer deaths. Understanding the effect of socioeconomic status (SES) on pediatric leukemia incidence provides valuable information for cancer control and interventions in Canada. Using a linked data from the Canadian Cancer Registry (CCR), Canadian Census of Population (CCP) and National Household Survey (NHS) we aimed to quantify socioeconomic inequalities in the incidence of pediatric leukemia from 1992 to 2010. We used the concentration index (C) approach to quantify income- and education-related inequalities in the incidence of pediatric leukemia over time. Though there were fluctuations in incidence over the study period, our results showed that the total incidence of pediatric leukemia in Canada was generally consistent from 1992 to 2010. Incidence rate of 47 per 1,000,000 as at 1992 rose to 57 per 1,000,000 in 2010. The estimated values of the C over the study period failed to show any significant association between pediatric leukemia incidence and household income or education status. Although pediatric leukemia incidence is not rising significantly, it is not reducing significantly either. The incidence of pediatric leukemia showed no significant association with socioeconomic status. Future cancer control interventions should focus more on mitigating risk factors that are independent of socioeconomic status.
Publisher: BMJ
Date: 04-2022
DOI: 10.1136/BMJOPEN-2022-061660
Abstract: Poor diet is a leading preventable risk for the global burden of non-communicable disease. Robust measurement is needed to determine the effect of COVID-19 on dietary intakes and consumer purchasing, given the widespread changes to consumer food environments and economic precarity. The research objectives are as follows: (1) describe dietary intakes of foods, beverages and nutrients of concern during the COVID-19 pandemic (2) quantify change in diet during COVID-19 as compared with prepandemic, previously captured in the provincial s les of the population-representative 2015 Canadian Community Health Survey-Nutrition and (3) examine how household purchasing practices predict dietary intakes during COVID-19. Observational study of diet, using a population-based stratified probability s ling strategy allocated via dual-frame (landline and cellphone) calls to random-digit dialled numbers, followed by age-sex group quotas. The base population comprises the four provinces of the Atlantic region of Canada, jurisdictions with an excess burden of pre-existing dietary risk, compared with the rest of Canada. Our aim is n=1000 to obtain reliable estimates at a regional level to describe intakes and compare with prepandemic baseline. Data collection entails 12 weeks participation: (1) enrolment with sociodemographics (key dietary risk predictors such as age, sex, gender, pre-COVID-19 income, employment, household composition, receipt of economic relief, rural residence) (2) two 24hour diet recalls using the online ASA-24 Canada 2018 tool and (3) online uploads of household food purchase receipts over the 12 weeks enrolled. Participation incentives will be offered. This research protocol received funding from the Canadian Institutes of Health Research (FRN VR5 172691) and ethics review approval from the Dalhousie University Research Ethics Board. Study protocol and instruments and a de-identified dataset will be made publicly available. We will submit the findings to peer-reviewed journals, as well as conferences geared towards scientific and decision-maker audiences.
Publisher: Springer Science and Business Media LLC
Date: 11-02-2020
DOI: 10.1186/S12889-020-8322-8
Abstract: Overweight and obesity are major health concerns worldwide, with adverse health consequences during the life span. This study measured socioeconomic inequality in overweight and obesity among Iranian adults. Data were extracted from 129,257 Iranian adults (aged 35 years and older) participated in the Prospective Epidemiologic Research Studies in IrAN (PERSIAN) in 14 provinces of Iran in 2014. Socioeconomic-related inequality in overweight and obesity was estimated using the Concentration Index (C n ). The C n further decomposed to find factors explaining the variability within the Socioeconomic related inequality in overweight and obesity. Of the total number of participants, 1.98, 26.82, 40.76 and 30.43% had underweight, normal weight, overweight and obesity respectively. The age-and sex standardized prevalence of obesity was higher in females than males (39.85% vs 18.79%). People with high socioeconomic status (SES) had a 39 and 15% higher chance of being overweight and obese than low SES people, respectively. The positive value of C n suggested a higher concentration of overweight (0.081, 95% confidence interval [CI] 0.074–0.087) and obesity (0.027, 95% CI 0.021–0.034) among groups with high SES. There was a wide variation in socioeconomic-related inequality in overweight and obesity rate across 14 provinces. The decomposition results suggested that SES factor itself explained 66.77 and 89.07% of the observed socioeconomic inequalities in overweight and obesity among Iranian adults respectively. Following SES, province of residence, physical activity, using hookah and smoking were the major contributors to the concentration of overweight and obesity among the rich. Overall, we found that overweight and obesity is concentrated among high SES people in the study population. . Accordingly, it seems that intersectional actions should be taken to control and prevent overweight and obesity among higher socioeconomic groups.
Publisher: Springer Science and Business Media LLC
Date: 30-08-2013
Publisher: World Health Organization Regional Office for the Eastern Mediterranean (WHO/EMRO)
Date: 07-2020
DOI: 10.26719/EMHJ.20.001
Abstract: Socioeconomic-related inequalities in health are a major public health challenge in both developed and developing countries. Little evidence is available on socioeconomic-related inequalities in health in different regions of the Islamic Republic of Iran. This study aimed to determine socioeconomic-related inequality in poor self-rated health in adults in Kermanshah city, western Islamic Republic of Iran. This cross-sectional study with stratified s ling obtained data on socioeconomic status, demographic characteristics, behavioural risk factors and self-rated health of 2040 adults (≥ 18 years) in Kermanshah city. A self-administrated questionnaire was used to collect data from the participants. The concentration (C) index and C curve were used to determine the socioeconomic-related inequality in poor self-rated health. A decomposition analysis of the C index was done to identify the factors explaining socioeconomic-related inequality in poor self-rated health. The crude and age-adjusted prevalence of poor self-rated health was 13.8% and 18.1%, respectively. The estimated C for the whole s le was -0.295, indicating that poor SRH was concentrated in the poor. The decomposition results suggested that socioeconomic status (45.5%), having a chronic health condition (11.9%) and smoking (7.3%) were the main factors contributing to the concentration of poor self-rated health among those of lower socioeconomic status. The concentration of poor self-rated health among the poor in Kermanshah city warrants policy attention. Policies aimed at reducing inequality in wealth distribution and risky health behaviour and preventing chronic health conditions among the poor may mitigate socioeconomic-related inequalities in poor self-rated health in Kermanshah.
Publisher: Wiley
Date: 14-01-2014
DOI: 10.1111/ROIW.12103
Publisher: Springer Science and Business Media LLC
Date: 27-07-2021
Publisher: Emerald
Date: 07-05-2019
DOI: 10.1108/IJHRH-02-2018-0017
Abstract: Protecting households against financial risks of healthcare services is one of the main functions of health systems. The purpose of this paper is to provide a pooled estimate of the prevalence of catastrophic healthcare expenditures (CHE) among households in Iran. Both international (PubMed, Scopus and Clarivate Analytics (previously known as the Institute for Scientific Information)) and Iranian (Scientific Information Database, Iranmedex and Magiran) scientific databases were searched for published studies on CHE among Iranian households. The following keywords in Persian and English language were used as keywords for the search: “catastrophic healthcare costs,” “catastrophic health costs,” “impoverishment due to health costs,” “fair financial contribution,” “prevalence,” “frequency” and “Iran” with and without “health system”. The I 2 -test and χ 2 -based Q -test suggested heterogeneity in the reported prevalence among the qualified studies thus, a random-effects model was used to estimate the overall prevalence of CHE among households in Iran. A total of 24 studies with a cumulative s le of 301,097 households were included in the study. The estimated pooled prevalence of CHE among households was 7 percent (95 percent confidence interval: 6–8 percent). Meta-regression analysis indicated that the prevalence of CHE was inversely related to the s le size ( p .05). The results did not suggest a significant association between the prevalence of CHE and the year of data collection. The findings revealed that the prevalence of CHE among Iranian households is significantly higher than 1 percent, which is the goal set out in Iran’s fourth five-year development plan. This warrants further policy interventions to protect households from incurring CHE in Iran.
Publisher: Maad Rayan Publishing Company
Date: 28-10-2019
Abstract: Despite progressive universal drug coverage and pharmaceutical policies found in other countries, Canada remains the only developed nation with a publicly funded healthcare system that does not include universal coverage for prescription drugs. In the absence of a national pharmacare plan, a province may choose to cover a specific sub-population for certain drugs. Although different provinces have in idually attempted to extend coverage to certain subpopulations within their jurisdictions, out-of-pocket expenses on drugs and pharmaceutical products (OPEDP) accounts for a large proportion of out-of-pocket health expenses (OPHE) that are catastrophic in nature. Pharmaceutical drug coverage is a major source of public scrutiny among politicians and policy-makers in Canada. In this editorial, we focus on social inequalities in the burden of OPEDP in Canada. Prescription drugs are inconsistently covered under patchworks of public insurance coverage, and this inconsistency represents a major source of inequity of healthcare financing. Residents of certain provinces, rural households and Canadians from poorer households are more likely to be affected by this inequity and suffer disproportionately higher proportions of catastrophic out-of-pocket expenses on drugs and pharmaceutical products (COPEDP). Universal pharmacare would reduce COPEDP and promote a more equitable healthcare system in Canada.
Publisher: Korea Disease Control and Prevention Agency
Date: 30-06-2023
DOI: 10.24171/J.PHRP.2023.0041
Abstract: Objectives: This study aimed to examine the effect of the coronavirus disease 2019 (COVID-19) outbreak on the hospitalization rate, emergency department (ED) visits, and outpatient clinic visits in western Iran.Methods: We collected data on the monthly hospitalization rate, rate of patients referred to the ED, and rate of patients referred to outpatient clinics for a period of 40 months (23 months before and 17 months after the COVID-19 outbreak in Iran) from all 7 public hospitals in the city of Kermanshah. An interrupted time series analysis was conducted to examine the impact of COVID-19 on the outcome variables in this study.Results: A statistically significant decrease of 38.11 hospitalizations per 10,000 population (95% confidence interval [CI], 24.93–51.29) was observed in the first month of the COVID-19 outbreak. The corresponding reductions in ED visits and outpatient visits per 10,000 population were 191.65 (95% CI, 166.63–216.66) and 168.57 (95% CI, 126.41–210.73), respectively. After the initial reduction, significant monthly increases in the hospitalization rate (an increase of 1.81 per 10,000 population), ED visits (an increase of 2.16 per 10,000 population), and outpatient clinic visits (an increase of 5.77 per 10,000 population) were observed during the COVID-19 pandemic.Conclusion: Our study showed that the utilization of outpatient and inpatient services in hospitals and clinics significantly declined after the COVID-19 outbreak, and use of these services did not return to pre-outbreak levels as of June 2021.
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.SOCSCIMED.2013.11.019
Abstract: Growing work demonstrates social gradients in infant mortality within countries. However, few studies have compared the magnitude of these inequalities cross-nationally. Even fewer have assessed the determinants of social inequalities in infant mortality across countries. This study provides a comprehensive and comparative analysis of social inequalities in infant mortality in 53 low-and-middle-income countries (LMICs). We used the most recent nationally representative household s les (n = 874,207) collected through the Demographic Health Surveys (DHS) to calculate rates of infant mortality. The relative and absolute concentration indices were used to quantify social inequalities in infant mortality. Additionally, we used meta-regression analyses to examine whether levels of inequality in proximate determinants of infant mortality were associated with social inequalities in infant mortality across countries. Estimates of both the relative and the absolute concentration indices showed a substantial variation in social inequalities in infant mortality among LMICs. Meta-regression analyses showed that, across countries, the relative concentration of teenage pregnancy among poorer households was positively associated with the relative concentration of infant mortality among these groups (beta = 0.333, 95% CI = 0.115 0.551). Our results demonstrate that the concentration of infant deaths among socioeconomically disadvantaged households in the majority of LMICs remains an important health and social policy concern. The findings suggest that policies designed to reduce the concentration of teenage pregnancy among mothers in lower socioeconomic groups may mitigate social inequalities in infant mortality.
Publisher: World Health Organization Regional Office for the Eastern Mediterranean (WHO/EMRO)
Date: 10-2020
DOI: 10.26719/EMHJ.20.007
Abstract: The associations between socioeconomic status (SES) and tobacco use, alcohol consumption and drug use are poorly understood in the Islamic Republic of Iran. To measure education- and wealth-related inequalities in cigarette smoking, hookah smoking, illicit drug use and alcohol consumption in Kermanshah Province, Islamic Republic of Iran. We used baseline data from the Ravansar Noncommunicable Disease (RaNCD) study. The study collected information on socioeconomic and demographic characteristics, cigarette and hookah smoking, alcohol consumption and illicit drug use of 10 015 adults aged ≥ 35 years between 2014 and 2016. The relative concentration index and absolute concentration index were used to measure education- and wealth-related inequalities in cigarette smoking, hookah smoking, illicit drug use and alcohol consumption. Cigarette smoking was concentrated among less-educated and less-wealthy men and women. Similarly, illicit drug use was concentrated among lower-SES men. In contrast, hookah smoking and alcohol consumption were more prevalent among higher-SES men. There were education- and wealth-related inequalities in tobacco, alcohol and illicit drug use in the west of the Republic of Iran. Future studies should aim to identify the main socioeconomic determinants of these inequalities in Kermanshah Province and generally in the Islamic Republic of Iran.
Publisher: Springer Science and Business Media LLC
Date: 28-05-2019
DOI: 10.1007/S10198-019-01074-X
Abstract: Equity in healthcare is an important policy objective of the Canadian healthcare system. Out-of-pocket payments for healthcare (OPPH) by Canadian households account for a substantial share of total healthcare expenditures. Using data from Statistics Canada's Survey of Household Spending (SHS, n = 33,367), this study examined the progressivity and catastrophic effect of OPPH in Canada over the period 2010 to 2015 inclusive. The Kakwani Progressivity Index (KPI) was used to measure the progressivity of OPPH for each year of the study period. The catastrophic effect of OPPH was calculated using a threshold of 10% of total household consumption. The computed KPI indicated that OPPH are a regressive source of healthcare funding in Canada and the regressivity of OPPH has increased over the study period. This indicates that the distribution of OPPH in Canada is not equitable and the percentage contribution of households from their total consumption to healthcare as OPPH decreases as their consumption increase. The results also suggested that 7% of Canadian households face catastrophic out-of-pocket payments for healthcare (COPPH) over the study period. The proportion of households with COPPH was higher in rural areas compared with urban areas over the study period. Policies to enhance financial risk protection among low-income and rural households are required to improve equity in healthcare financing in Canada.
Publisher: Springer Science and Business Media LLC
Date: 25-10-2021
DOI: 10.1186/S12913-021-07183-9
Abstract: Understanding patient preferences in emergency departments (EDs) can provide useful information to enhance patient-centred care and improve patient’s experience in hospitals. This study sought to find evidence about patients’ preference for physicians when receiving services in EDs in Iran. In this discrete choice experiment survey, 811 respondents completed the scenarios with 5 attributes, including type of physicians, price of services, time to receive services, physician work experience, and physician responsibility. Analyses were conducted for different social and economic groups as well as for the total population. This study showed that the willingness to pay (WTP) for being visited by a physician with a high sense of responsibility was 67.104US$. WTP for being visited by an emergency medicine specialist (EMS) was 22.148US$. WTP for receiving ED services 1 min earlier was 0.417US$ and for being visited by 1 year higher experienced physician was 0.866US$. WTP varied across different age groups, sex, health status, education, and income groups. As the expertise and experience of providers are important factors in selecting physicians in EDs by the patients, providing this information to patients when they want to select their providers can promote patient-centred care. This information can decrease patients’ uncertainty in the selection of their services and improve their experience in hospitals.
No related grants have been discovered for Mohammad Hajizadeh.