Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study.

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.

Targeted subsidy plan and Kakwani index in Iran health system.

INTRODUCTION: Health care is considered as a human right, and fair financial contribution to health care plays an important role in providing effective services for all members of society. This study aimed at investigating the effects of targeted subsidy plan (since 2010) on equality in health-care financing in Iran from 2004 to 2014. MATERIALS AND METHODS: This was a descriptive-analysis, cross-sectional study that was conducted using data obtained from households' expenditure-income survey that is performed every year by the Statistical Center of Iran. The Lorenz curve, Gini coefficient, and Theil index were applied to measure inequality in healthcare expenditures (HEs). Furthermore, the Kakwani index was used to examine inequality in health-care finance during the study period. The analysis was performed using Stata version 13. RESULTS: Kakwani index was negative for all the studied years, except 2007. The value of this index was equal to -0.032, -0.045, and -0.046 in 2004, 2008, and 2014 for rural areas and was equal to -0.041, -0.029, and -0.0001 for urban areas, respectively. Despite the Kakwani index has been negative for most of the years, which reflects regressive financing in health care, there is no significant change in the trend of this indicator after the implementation of the subsidies. In addition, this indicator is moving toward being positive (progressive) in urban areas in 2014, which represents increased share of the poor in health payments. CONCLUSIONS: According to the results, the targeted subsidy plan could not reach to its purpose in health-care system for supporting the poor from HEs. It is recommended for policy-makers to design a specific plan for health-care financing and to allocate some defined resources such as taxes or subsidies to health-care sector.

The prevalence of phantom vibration/ringing syndromes and their related factors in Iranian' students of medical sciences.

BACKGROUND AND AIM: Mobile phone abuse can cause pathologic stress that may lead to addictive behavior such as Phantom Vibration Syndrome (PVS) and Phantom Ringing Syndrome (PRS). The current study aimed to determine the PVS and PRS due to mobile phone use in students of Qom University of medical Sciences in Iran. DESIGN: Cross-sectional study. PARTICIPANTS: The participants were 380 students selected by proportional stratified random sampling method in each stratum. MEASUREMENTS: Data were collected by a self-administered questionnaire and analyzed by descriptive and analytic statistical methods including t-test, chi square and analysis of variance. FINDINGS: The prevalence of PVS and PRS due to mobile phones in students of medical sciences was estimated to be 54.3% and 49.3%, respectively. PVS was higher in female students than in males while the PRS was higher in male students. There was a significant relationship between PVS and using social networks such as Viber, WhatsApp, and Line. In addition, a significant association was observed between PVS and friend-finding, chatting and entertainment. CONCLUSION: Studies should be done in the future to assess the long-term complication of overusing mobile phones. In the current study, the prevalence of PVS and PRS in half of students is considerable.

Psychometric Properties of the Persian Language Version of Yang Internet Addiction Questionnaire: An Explanatory Factor Analysis.

BACKGROUND: Reliability and validity are the key concepts in measurement processes. Young internet addiction test (YIAT) is regarded as a valid and reliable questionnaire in English speaking countries for diagnosis of Internet-related behavior disorders. OBJECTIVES: This study aimed at validating the Persian version of YIAT in the Iranian society. PATIENTS AND METHODS: A pilot and a cross-sectional study were conducted on 28 and 254 students of Qom University of Medical Sciences, respectively, in order to validate the Persian version of YIAT. Forward and backward translations were conducted to develop a Persian version of the scale. Reliability was measured by test-retest, Cronbach's alpha and interclass correlation coefficient (ICC). Face, content and construct validity were approved by the importance score index, content validity ratio (CVR), content validity index (CVI), correlation matrix and factor analysis. The SPSS software was used for data analysis. RESULTS: The Cronbach's alpha was 0.917 (CI 95%; 0.901 - 0.931). The average of scale-level CVI was calculated to be 0.74; the CVI index for each item was higher than 0.83 and the average of CVI index was equal to 0.89. Factor analysis extracted three factors including personal activities disorder (PAD), emotional and mood disorder (EMD) and social activities disorder (SAD), with more than 55.8% of total variances. The ICC for different factors of Persian version of Young Questionnaire including PAD, EMD and for SAD was r = 0.884; CI 95%; 0.861 - 0.904, r = 0.766; CI 95%; 0.718 - 0.808 and r = 0.745; CI 95%; 0.686 - 0.795, respectively. CONCLUSIONS: Our study showed that the Persian version of YIAT is good and usable on Iranian people. The reliability of the instrument was very good. Moreover, the validity of the Persian translated version of the scale was sufficient. In addition, the reliability and validity of the three extracted factors of YIAT were evaluated and were acceptable.

Satisfying patients' rights in Iran: Providing effective strategies.

BACKGROUND: Assessment of patients' views about the observance of their rights and obtaining feedback from them is an integral component of service quality and ensures healthcare ethics. The aim of this study was to assess patients' awareness of their rights and their satisfaction with observance of their rights, and provide effective strategies to improve the management of patients' rights in hospitals of Markazi Province, Iran in 2012. MATERIALS AND METHODS: This analytical study was conducted on 384 patients at 10 hospitals. Patients' awareness of the relevant hospital legislation was assessed by a structured interview, and then patients' satisfaction with observance of their rights was measured by a standardized questionnaire consisting of 10 principles approved by the Iran Ministry of Health of Iran in 2012. In this study, through Delphi technique, effective strategies have been provided to improve the management of patients' rights in the hospitals of Iran. Analysis of variance (ANOVA), t-test, and Z test were applied for data analysis. RESULTS: Overall, 89% of the patients were unaware of the relevant hospital legislation and 28% of them were not satisfied with the observance of their rights (1.4 ± 0.6). A significant difference was observed between observance of patients' rights according to hospitals, language, and place of residence of the patients (P < 0.05), but there was no significant difference with respect to patients' rights according to sex, education, job, and duration of hospital stay (P > 0.05). CONCLUSIONS: The Patient Bill of Rights of Iran needs further revision and modification. Moreover, extensive education of patients and healthcare processionals as the most structural strategies to promote professional ethics, reduce ethical conflict, and increase implementation of the law to respect patients' rights should be taken into deeper consideration.

Barriers and challenges in researches by Iranian students of medical universities.

BACKGROUND: Health sciences research (HSR) is an essential part of improving health care which plays a critical role in the field of medicine and clinical practice. The aim of the current study was to assess barriers to the research by students of medical sciences as well as to find out effective strategies for management of student researches in Iranian universities. MATERIALS AND METHODS: This study utilized a hybrid design with quantitative and qualitative analytical approaches conducted on 627 students in six schools of medical sciences in two universities in Central Province in Iran from April to December, 2012. Questionnaires were distributed among researcher and non-researcher students to find barriers to the research. These barriers were approved and validated by similar studies and strategies using the Delphi technique on 36 students. RESULTS: The most important barriers among researcher students were institutional barriers (3.3 ± 1.3), but in non-researcher students they were individual barriers (3.6 ± 1.7). The majority of barriers to involvement in the research among researcher students appeared to be time, lack of access to electronic resources and prolongation of the process of buying equipment. In addition, the greatest barriers among non-researcher students included the lack of time, scientific writing skills, and access to trained assistants. CONCLUSION: The results showed the issue of attitudes towards compulsory research as a component of critical scholarship in the curriculum of medical courses. Moreover, employment of the research experts can be helpful for research training in schools of medical sciences.

Education-related Inequity in Access and Utilization of Oral Health Care in Iran.

BACKGROUND: Oral health affects peoples' lives physically and psychologically and is related to general health, quality of life, and feelings of social well-being. As the educational level is an important predictor of healthy life and can affect healthcare utilization, this study aims to estimate the inequity related to the educational level of parents on the access and utilization of oral health care (OHC) in Qom, Iran. STUDY DESIGN: An analytical, cross-sectional study. MATERIALS AND METHODS: Overall 281 children, six to seven years of age, were given a self-administrated questionnaire to fill. The sex, access to utilization of OHC, and educational level of the children's parents were questioned. The concentration (C) index was used as the inequity measure and statistical inference was conducted by chi square and the confidence interval of C. STATISTICS: The mean age of the children was 6.48 ± 0.5 years. There was not statistically significant difference in the access and utilization rate of OHC between the two sexes (P > 0.05). There was an increasing trend in the utilization rate of OHC, because of the increased educational level of the parents. The C for access and utilization rate, for different levels of fathers' education was 0.055(-0.095 to 0.205) and 0.097(-0.068 to 0.261) and for mothers' educational level was 0.086(-0.068 to 0.241) and 0.091(-0.81 to 0.263), respectively. CONCLUSION: Our results did not show evidence of sex disparity in the access and utilization of OHC in Iranian children. Also the inequity related to the educational level in access and utilization of OHC was low and not considerable.

Health Expenditure and Catastrophic Costs for Inpatient- and Out-patient Care in Iran.

BACKGROUND: Protecting households from risk of impoverishment due to out-of-pocket costs in health care is a major challenge for health systems. Therefore, this study aimed at evaluating some health expenditure of inpatient and outpatient care as well as assessing the predictors of catastrophic costs for inpatient care in one of central provinces of Iran. METHODS: In this cross-sectional study, 760 household were selected by multistage sampling method in Markazi province of Iran and interviewed in order to complete a standard questionnaire. Catastrophic costs were evaluated in a scale that varied from 0 (no money for care) to 100 (spending all income and wealth). Patients who were paid over 20% of household financial sources or 40% of month income were regarded as being exposed to catastrophic costs. Negative binomial model with robust estimator logit function was used for prediction of catastrophic costs. RESULTS: Based on data analysis, 42.6% of hospitalized subjects encountered catastrophic costs. Moreover, 11.2% households faced catastrophic cost among all participated households and 39.3% were reported to need inpatient need care. Multivariate regression model showed that age range 40-59 years and being in the lower levels of wealth index were significant predictors of facing catastrophic costs (P < 0.05). CONCLUSIONS: Lack of money is the most important cause of un-seeking care. Hospitalizations due to inpatient care needs, household members aged 40-59 years old, especially with chronic diseases and nonrich status of the household were the highest predictors of facing catastrophic costs. Reducing out-of-pocket costs can increase health care utilization.

"Parents a dead end life": The main experiences of parents of children with leukemia.

BACKGROUND: The quantitative studies show that due to the widespread prevalence, high death rate, high treatment expenses, and long hospital stay, leukemia influences the families and their children to a great extent. In this regard, no qualitative study has been conducted in Iran. So, this study was conducted in Arak in 2011 with the aim of expressing the experiences of the parents whose children suffered from leukemia. MATERIALS AND METHODS: Using qualitative research approach, by applying content analysis method, 22 participants were interviewed in two educational hospitals during 2 months. The study was started by purposive sampling and continued by theoretical one. The data were analyzed based on the content analysis method. RESLUTS: Data analysis showed that insolvency, knapsack problems, cancer secrecy, trust on God, self-sacrifice, adaptation, medical malpractice, and hospital facilities were the level 3 codes of parents' experiences and "parents a dead end life" was the main theme of this study. CONCLUSION: In this study, the experiences of the parents whose children suffered from cancer were studied deeply by the use of qualitative method, especially by the use of resources syncretism rather than studying quantitatively. Parents a dead end life emerged as the main theme of this study, emphasizing the necessity of paying further attention to the parents. On the other hand, making more use of parents' experiences and encouraging them helps make the treatment more effective. It is suggested that these experiences be shared with parents in the form of pamphlets distributed right at the beginning of the treatment process.