Cost of illness studies in COVID-19: a scoping review.

BACKGROUND: Human communities suffered a vast socioeconomic burden in dealing with the pandemic of coronavirus disease 2019 (COVID-19) globally. Real-word data about these burdens can inform governments about evidence-based resource allocation and prioritization. The aim of this scoping review was to map the cost-of-illness (CoI) studies associated with COVID-19. METHODS: This scoping review was conducted from January 2019 to December 2021. We searched cost-of-illness papers published in English within Web of Sciences, PubMed, Google Scholar, Scopus, Science Direct and ProQuest. For each eligible study, extracted data included country, publication year, study period, study design, epidemiological approach, costing method, cost type, cost identification, sensitivity analysis, estimated unit cost and national burden. All of the analyses were applied in Excel software. RESULTS: 2352 records were found after the search strategy application, finally 28 articles met the inclusion criteria and were included in the review. Most of the studies were done in the United States, Turkey, and China. The prevalence-based approach was the most common in the studies, and most of studies also used Hospital Information System data (HIS). There were noticeable differences in the costing methods and the cost identification. The average cost of hospitalization per patient per day ranged from 101$ in Turkey to 2,364$ in the United States. Among the studies, 82.1% estimated particularly direct medical costs, 3.6% only indirect costs, and 14.3% both direct and indirect costs. CONCLUSION: The economic burden of COVID-19 varies from country to country. The majority of CoI studies estimated direct medical costs associated with COVID-19 and there is a paucity of evidence for direct non-medical, indirect, and intangible costs, which we recommend for future studies. To create homogeneity in CoI studies, we suggest researchers follow a conceptual framework and critical appraisal checklist of cost-of-illness (CoI) studies.

Mental workload profile and its relationship with presenteeism, absenteeism and job performance among surgeons: The mediating role of occupational fatigue.

Introduction: Surgeons are one of the most significant jobs in the health care system that plays an important role in the patients' health promotion and their treatment. In the current study, the effect of mental workload on the work performance of surgeons was tested by considering the mediating effect of fatigue on this relationship. Method: This study was done analytically on 165 surgeons working in the operating rooms of hospitals in Iran. To determine of mental workload, the SURG-TLX method was used. The job performance was measured using the short version of the job performance questionnaire provided by the World Health Organization (WHO-HPQ), and accordingly relative presenteeism, relative absenteeism and job performance variables were calculated. The Swedish Occupational Fatigue Inventory (SOFI) questionnaire was used to determine occupational fatigue. A conceptual model was built to determine the direct and indirect relationship between mental workload and job performance, and the mediating effect of occupational fatigue on the relationship between mental workload and job performance was tested using structural equation modeling (SEM). Results: Out of 165 distributed questionnaires, 140 questionnaires were completed and delivered to the researchers (85% response rate). The mean ± standard deviations of mental workload, fatigue, and work performance were 16.57 ± 5.83, 6.32 ± 2.86, and 0.65 ± 0.28, respectively. The results of model fit indexes revealed that all indexes are within the acceptable range. Regarding this model, the direct effect of mental workload on job performance was not significant (ß = -0.21; p = 0.072). A significant positive relationship was observed between mental workload and fatigue (ß = 0.36; p < 0.001). The direct effect of fatigue on job performance was also the opposite and statistically significant (ß = -0.39; p < 0.001). Finally, results indicated that the effect of mental workload on work performance mediated by occupational fatigue. Conclusion: Surgeons suffer a high level of mental workload during their work, and this factor can have a negative effect on surgeons' job performance. The effect of mental workload on job performance in surgeons can be detected, directly and indirectly, through the mediating effect of occupational fatigue. Improving the mental and physical conditions of the work environment can reduce occupational fatigue and improve surgeons' job performance.

Comparison of the Distribution of Household Financial Contributions to the Health System before and during COVID-19 Outbreak: Evidence from Nationwide Survey in Iran.

Background: Health and economy has substantially been influenced by the coronavirus disease 2019 (COVID-19) pandemic. Because of these impacts, household financial contribution to health system is likely to be changed. This study aimed to compare the distribution of household financial contributions before and during the COVID-19 epidemic. Methods: This is a cross-sectional study. The data were obtained from Iran's Households Income and Expenditure Survey as a national representative survey and included 38,328 households in 2019 (before COVID-19) and 37,577 households in 2020 (during COVID-19 pandemic). The household expenditures deflated according to the Consumer Price Index. The indices of households' out-of-pocket Payments (OPP), catastrophic health expenditures (CHE), and impoverishment were calculated based on a standard methodology. Data analysis was done using an Excel-based software. Results: The households' total expenditures declined for both urban and rural areas during the COVID-19 outbreak. Meanwhile, health expenditure experienced a negative growth rate for urban and rural households at -25.75% and -15.47%, respectively. The average per capita of OOP annually was 1,220,416 ($41.086 PPP) Rials for urban households and 1,017,760 Rials ($34.263 PPP) for rural households in 2020 (the era of COVID-19), which had dropped -30% and -16%, respectively, relative to 2019 (before COVID-19). The proportional share of health service types from the total health expenditure did not change importantly after the onset of COVID-19. The incidence of CHE and impoverishment due to health payments reduced after the onset of COVID-19. Conclusion: The households' health expenditures changed considerably during the COVID-19 pandemic and these changes were the same for the urban and rural areas. Despite COVID-19 multi-faceted shocks, the findings of this study showed a slight decline in the incidence of CHE and impoverishment caused by health expenditures. It might be due to forgone health services during the COVID-19 pandemic. Data from these household surveys have some limits to depicting the real effects of this crisis.

Association of ergonomics risk factors among Iranian calico crafts-men and musculoskeletal discomforts: a cross-sectional study.

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) have always been complaints reported by handicraft workers due to the repetitive and static nature of work. Therefore, the current study aimed to investigate the ergonomic conditions of craftsmen engaged with the calico industry. METHOD: This cross-sectional study was done in small calico industrial workshops in Isfahan, Iran, in 2022. The sample selection method in this study was census. Using QEC (Quick Exposure Checklist) and Cornell-Musculoskeletal Discomfort Questionnaire (CMDQ), the ergonomic status of workers was evaluated. The data were analyzed using Chi-square (χ2) and Pearson's product-moment correlation test. RESULTS: The risk level of working postures in wrist/hand, shoulder /arm, and neck were high or very high among the craftsmen. The relationships between discomfort complaints reported by the participants and the risk level of working postures were significant for neck χ2 (1, N = 100) = 13.603, Pvalue = 0.034, left knee χ2 (1, N = 100) = 12.310, Pvalue = 0.030 and lower left leg χ2 (1, N = 100) = 11.906, Pvalue = 0.042. The posture risk level scores for %57.7 of the participants who self-reported the right shoulder discomfort were found to be high or very high. CONCLUSIONS: The high risk found in most calico craftsmen may induce more serious musculoskeletal problems that require applicable interventions. The most important risk factors realized among calico craftsmen were prolonged sitting postures and repetitive tasks.

A multicomponent quasi-experimental ergonomic interventional study: long-term parallel four-groups interventions.

BACKGROUND: Musculoskeletal disorders (MSDs) are known as one of the main problems affecting the health of industrial workers and can lead to lost working days, functional disability of workers and wasting the financial resources of an organization. Therefore, the present study aimed to evaluating the effect of ergonomic interventions on reducing MSDs and improving working posture in the in a foundry industry workers. METHODS: A field multicomponent cross-interventional study was conducted on workers working in a foundry industry. In this study, 117 male workers were divided into 4 groups, including a control group, a group with specialized ergonomics training, a group with workstation intervention, and a group simultaneously undergoing training and workstation intervention. All 4 groups were evaluated during a period of baseline, 6 and 12-months follow- up. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) and direct observations of working postures by using the Quick Exposure Check (QEC) method were used. RESULTS: The results showed that the implemented interventions in the shoulder/arm, back and stress level were effective and the difference in the final score was significant among different groups (P-value > 0.05). In addition, the interventions led to a significant decrease in the QEC scores and musculoskeletal symptom scores in the neck, shoulder, lower back, knee, and lower leg regions among different groups (P-value > 0.05). CONCLUSION: The results showed that workstation modification and training and workstation intervention simultaneously had a greater effect on MSDs and improving working posture compared to training alone.

Comparison of the chemical health risk assessment of exposure to metal fumes for the furnace operator of a foundry industry using quantitative and semi-quantitative methods.

Heavy metals have several adverse effects on the workers' bodies due to their accumulation in the vital organs. Besides that, the current study aimed to assess the health risk of exposure to metal fumes for furnace operators working in a foundry industry based on the three different methods. The current sectional descriptive-analytical research conducted on a foundry industry in Isfahan (Iran) in 2022. Three common methods currently available, including the Semi-Quantitative Risk Assessment Method (SQRCA) and two methods provided based on the US-EPA provided technique, were used in this study. At first, the extent of people's exposure to metal fumes of Fe, Ni, Cr, and Mn was measured. Then, the chemical risk assessment of exposure to these metals' fumes was done using the three methods, and their results were compared. The SPSS Ver.25 has been used for data analysis and comparison in the current study. Results indicated that the furnace operator's exposure to all four metals was above the allowed limit of occupational exposure. The chemical risk assessment results also showed that in the first method (US-EPA-based), the risk of exposure for all workers was acceptable, while in the second method (SQCRA), the risk level of a majority of workers was medium, and in the third method (US-EPA-based), the risk level of a majority of workers was not acceptable. Comparing the methods showed that average risk scores in the first and second methods were significant compared to the exposure to fumes with equivalent concentration (Pvalue<0.05). The average score of carcinogenicity risk in method 3 was significant compared to the concentration of chromium and nickel (P-value < 0.05), but it was not significant for iron and manganese and the non-carcinogenic risk of chromium and nickel. Chemical exposure risk level for the furnace operator was approximately moderate in all three methods. In terms of complexity and information required to implement the method, all three methods were almost the same, with the difference that the results of the first method cannot be generalized to other people who have the same job conditions because individual information such as a person's weight is used to calculate its score.

The noise absorption prediction of a combined and independent absorber under different conditions and at different frequencies, using the new Engineering Noise Control Software (ENC).

Noise is one of the most harmful factors in the work environment, which is very important to control. There are various techniques to achieve this goal. One of the most important of them is the use of noise absorbers. Absorbent materials are often used to counteract the effects of reflected noise from hard surfaces and reduce their level. This is an experimental-applied study conducted in the physical factor laboratory of the Faculty of Health. The purpose was to predict the Noise absorption rate of combined and independent absorbers under different conditions and frequencies using the new ENC (engineering noise control) software. The sound absorption determination was carried out in 5 stages, including sound frequency analysis for the source, measurement of the dominant frequency, measurement of the absorption coefficient of absorbent materials in different conditions, measurement of the limit frequency (peak frequency of noise absorption) and comparison of the software results with the findings of the impedance tube in Real conditions. The best absorption mode for combined and independent absorbents is using a 5 cm rock wool absorbent with a 2 cm thick air layer behind it without a polyurethane absorbent layer and a 10 cm wide rock wool absorbent with a 1 cm air layer behind it without polyurethane layer. A polyurethane layer on the stone wool absorber decreased the amount of noise absorption for high frequencies. The results obtained from the best absorption conditions in the ENC software were consistent with the findings from the impedance tube device in real situations. The results of this study showed that suitable and optimal conditions of sound absorption could be achieved by using the ENC software, correct design, use of suitable absorbers, changes in the physical parameters of the absorber, and the use of a combined absorber.

Direct Inpatient Cost and Payments of COVID-19 in Iran: Quantile Regression Analysis.

Background: COVID-19 pandemic imposes a substantial medical and socioeconomic burden on health systems. The study aimed to estimate the direct inpatient costs of COVID-19 in Iran. Methods: This is a Cost of Illness (COI) study with the bottom-up method. Provider perspective and prevalence approach were applied for cost identification. Data included inpatient charges and clinical characteristics of all COVID-19 cases (2015 patients) admitted to a teaching hospital during a financial year (March 2020 to February 2021). We extracted data from Hospital Information System (HIS) and applied the quantile regression to estimate determinant factors of COVID-19 inpatient cost using STATA software. Results: 1026 (50.92%) of admitted COVID-19 patients were female, and 42.3% were older than 65 years. More than 82% of discharged COVID-19 patients in this study recovered. 189 (9.38%) patients admitted to ICUs. Length of Stay (LOS) for about 70% of admitted COVID-19 cases was 7 days or less. The Total Inpatient Charges (TIC) was 155,372,056,826 Rials (5,041,836 PPP USD). The median charge was 42,410,477 Rials, and Average Inpatient Charges (AIC) was 77,107,720±110,051,702 (2,461 PPP USD) per person. Drugs and supplies accounted for 37% of total inpatient charges. Basic insurance companies would pay more than 79% of total claims and the share of Out-of-Pocket Payments (OOP) was 7%. ICUs admission and LOS of more than 3 days are associated with higher costs across all percentiles of the cost distribution (p<0.001). Conclusion: This study call attention to the substantial economic burden based on real-world data. According to the broad socio-economic impacts of COVID-19 and also multiple components of COI study designs, conducting meta-analysis approaches is needed to combine results from independent studies.

The Story of Female Sex Workers in The Shadow of Sex Work Coercion: A Qualitative Study.

Background: What has been less considered in the literature of the sex work research, especially in Iran, is to look at the causes of sex work from the perspective of women. The present study sought to understand the causes of the problem and the experience of female sex workers. Methods: The present study was conducted by using qualitative method. Twenty-eight sex workers participated in the study voluntarily and with informed consent. The researcher conducted deep semistructured interviews. Purposive sampling continued until data saturation was reached. Conventional content analysis of the transcribed interviews and field notes were performed to identify key themes, first by each of researchers separately and then in joint discussions. Results: The main theme of the study, according to the participants, was the sense of "what pushed me into sex worker" which included the five main categories of "despair, psychic restlessness, getting drunk by alcohol and drug, incomplete families, not to be left behind by the sudden social changes." Conclusions: Social and health consequences, especially reproductive health of female sex, workers are affected by several factors. However, to deal with this social and health problems, specific attention should be paid to social factors affecting health. Accordingly, each of the influential variables known in this study could be a target for the country's intervention programs, especially in public health centers and even charities related to the healthcare counseling of sex workers.

Predicting and classifying hearing loss in sailors working on speed vessels using neural networks: a field study.

BACKGROUND:  Noise-induced hearing loss (NIHL) is one of the main risk factors affecting people's health and wellbeing in the workplace. Analysing NIHL and consequently controlling the causing factors can significantly affect the improvement of working environments. Methods: One hundred and twelve male sailors participated in this study. They were classified into three groups depending on occupational noise exposure: (A) none, i.e., sound pressure level (SPL) lower than 70dBA, (B) exposed to SPL in the range of 70-85dBA, and (C) exposed to SPL exceeding 80dBA. In a first phase, hearing loss shaping risk factors were identified and analysed, including hearing loss in different frequencies, age, work experience, sound pressure level (SPL), marital status, and systolic and diastolic blood pressure. Then, neural networks were trained to predict the hearing loss changes of personnel and used to determine the weight of hearing loss factors. Finally, the accuracy of predicting models was calculated relying on Bayesian statistics. Results and conclusion: In the present study using neural networks, five models were developed. Their accuracy ranged from 92% to 100%. The frequencies of 4000Hz and 2000Hz showed the strongest association with the hearing loss of the sailors. Also, including systolic and diastolic blood pressure did not have any impact on predicted hearing loss, indicating that SPL was poorly correlated with extra-auditory effects.

Effect of the level of manual performance disability caused by exposure to vibration among sailors working on sailing speed vessels.

BACKGROUND: hand-arm vibration is one of the typical annoying physical factors. Hand-arm vibration syndrome (HAVS) is a disorder caused by vibrating working tools which vibrate hands beyond the threshold. Long-term HAVS may result in damage to blood vessels, chronic numbness in the fingers, bone injury, and muscular weakness. People are exposed to high-rate noise vibration in a variety of situations, including vessel employment and operating in tiny boats. Moreover, the extant study was conducted to examine manual function disability levels caused by Sailing Speed Vessels (SSV) vibration. METHODS: The extant study was quasi-experimental research in which, 52 male sailors in SSVs were chosen as the experimental group, and 27 office personnel were selected as the control group. The demographic factors questionnaire, DASH questionnaire, grip and pinch strength tests, the neurosensory exam, and the skill-dexterity test were all employed in this study. SPSS23 software was used to analyze the data. RESULTS: The findings suggested that the experimental group experienced greater vibration disorder symptoms than the control group. Because the experimental group had a higher score, the individuals experienced poorer circumstances in terms of arm, shoulder, and hand impairment as compared to the control group. The mean grip strength of hands and fingers in two hands of the experimental group was lower than the control group (P < 0.05). There was a statistically significant relationship among grip strengths of both experimental and control groups (P < 0.05). There was a reduction in skill and dexterity of both dominant and non-dominant hands of members in the experimental group. According to the statistical tests, there was no significant association between dominant (P = 0.001) skills and non-dominant (P = 0.010) hands in experimental and control groups. There was not also any significant relationship between skill and dexterity of both hands (P = 0.001) and the dominant hand tweezer test (P = 0.001) in two experimental and control groups. There was a statistically significant association between experimental and control groups in terms of assembly skill and dexterity (P = 0.482). CONCLUSION: Individuals who are at risk of vibration experience less physical and sensory function. DASH score, grip strength, skill, and dexterity could predict the reduction in physical function disability.

Evaluating the effect of heat stress on cognitive performance of petrochemical workers: A field study.

INTRODUCTION: Heat stress disrupts blood hormones and reduces workers' cognitive performance. To further shed light on the dysfunction of heat stress, the present study aimed to evaluate its effect on cognitive performance of petrochemical workers. MATERIALS AND METHODS: This descriptive-analytical cross-sectional study was conducted in 2020 in one of the Iranian petrochemical companies. Participants were divided into 2 case groups and 1 control group. They worked 12 h and their shift entialed one week working day and one week working night. According to the ISO 7243 standard, the heat stress index of employees was measured at the beginning, in the middle and at the end of the shift separately. Continuous Performance Test (CPT) and N-back cognitive performance tests were performed at the beginning, in the middle and at the end of the shift to determine the level of cognitive performance. The data were analyzed using SPSS software version 20 and the significance level was set at 0.05. RESULTS: Comparison of the results in the continuous performance test showed significant differences between the three groups with regard to the omission error and response time at the end of the shift. Moreover, according to the working memory test, participants reaction time during the shift significantly increased. Besides, average correct responses significantly reduced during the shift. Finally, the heat stress throughout the shift had a significant effect on the commission error and the response time of individuals. CONCLUSION: Heat stress affects people's cognitive performance in such a way that it can decrease their cognitive performance by increasing the commission error and response time and reducing the average correct response of site operators, generally reducing the cognitive performance of people at the end of the shift.

Risk assessment of fire, explosion and release of toxic gas of Siri-Assalouyeh sour gas pipeline using fuzzy analytical hierarchy process.

BACKGROUND: Risk assessment of gas pipelines is very important because of various hazards and economic losses. Using fuzzy logic increases the reliability and accuracy of the results. The purpose of this study is to evaluate the fuzzy risk of fire, explosion and release of toxic gas in the pipeline using fuzzy analytical hierarchy process. METHODOLOGY: Extraction of all hazards from HAZOP and HAZID was carried out. Fuzzy risk assessment was performed using MATLAB software. Using fuzzy hierarchy process analysis, the weight of each basic risk item (BRI) was summed up in a framework, and the fuzzy risk level was determined with a five-state criterion including highly desirable, favorable, moderate, undesirable and highly undesirable. RESULTS: The final risk score was equal to 0.1492, which according to the five-state criterion the risk level is in the favorable area. The highest risk score was related to hot work with open flame item with a risk score of 0.2485. CONCLUSIONS: The final risk score of fire, explosion and release of toxic gas in Siri-Assaluyeh gas pipeline is in the optimal area. Fuzzy risk assessment, compare to conventional risk matrices, provides more data to safety managers about the hazards and their rankings. Accordingly, the results are expected to be applicable to the safety managers while making decisions related to the risk management of gas pipelines.

The impacts of family physician plan and health transformation plan on hospitalization rates in Iran: an interrupted time series.

BACKGROUND: Low and middle income countries has recently implemented various reforms toward Universal Health Coverage (UHC). This study aims to assess the impact of Family Physician Plan (FPP) and Health Transformation Plan (HTP) on hospitalization rate in Iran. METHODS: We conducted an Interrupted Time Series (ITS) design. The data was monthly hospitalization of Mazandaran province over a period of 7 years. Segmented regression analysis was applied in R version 3.6.1. RESULTS: A decreasing trend by - 0.056 for every month was found after implementation of Family Physician Plan, but this was not significant. Significant level change was appeared at the beginning of Health Transformation Plan and average of hospitalization rate increased by 1.04 (P < 0.001). Also hospitalization trend increased significantly nearly 0.09 every month in period after Health Transformation Plan (P < 0.001). CONCLUSIONS: Family physician created a decreasing trend for hospitalization in urban area of Mazandaran province in Iran. HTP with lower user fee in governmental public hospitals and clinics as well as fee-for-service mechanisms, stimulated both level and trend changes in hospital admissions. Some integrated health policy is required to optimize the implementation of diverse simultaneous reforms in low and middle-income countries.

Change in health spending after implementation of a health transformation plan in Iran: an interrupted time series analysis.

BACKGROUND: Health transformation plan (HTP) implemented in Iran since 2014 to improve accessibility and financial protection of patients. This study aimed to assess the impact of HTP on health spending in Iran. METHODS: This was a quasi-experimental design using Interrupted Time Series. All registered impatient records in Iran health insurance organization (IHIO) for the population of Mazandaran province (1,628,919 population in 2011), north of Iran from March 2010 to February 2019 were included. Data for three depended variables: hospitalization rate, average inpatient cost and inpatient expenditure per capita was extracted in 96 monthly observations. Segmented regression analysis was done in R version 3.6.1. RESULTS: Hospitalization rate in 2010 was 6.6 in 1000 people and its level change was 0/799 immediately after HTP (P < 001). Post-reform level and trend changes for monthly average inpatient cost of registered admissions in IHIO were also significant (P < 001). IHIO inpatient expenditure per capita for 1,628,919 population in Mazandaran province was 24,436 Rials in 2011 and increased significantly immediately following HTP as 34,459 Rials (P < 001). CONCLUSIONS: Three important components of health spending including hospitalization rate, average inpatient cost and inpatient expenditure per capita were increased dramatically after HTP. Cost containment strategies and strengthening the preventive care initiatives is required to control the escalating trends of inpatient expenditure in Iran.

Occupational stress assessment of health care workers (HCWs) facing COVID-19 patients in Kerman province hospitals in Iran.

BACKGROUND: The health care workers (HCWs) at the frontline of fighting COVID-19 are at higher risk for mental health problems, including stress, anxiety, depression, and insomnia. This study aimed at assess the status of occupational stress in the three occupational groups of nurses, physicians and hospital cleaning crew facing COVID-19 patients in hospitals of Kerman province in Iran. METHODOLOGY: This cross-sectional descriptive analytical study was performed on 290 medical staffs including nurses, physicians and cleaning crew facing COVID-19 patients working in different hospitals in Iran in 2020. Demographic information form and occupational Stress Questionnaire (HSE tool indicator) were used to collect data. The health and safety executive (HSE) questionnaire has 35 questions and 7 areas, which was developed in the 1990s by the UK Health and Safety Institute to measure occupational stress. RESULTS: The mean score of total dimensions among HCWs was 2.93. Communications, Manager support, Changes and Demand factors with scores of 2.76, 2.77, 2.83 and 2.87 had the greatest impact on participants' stress levels, respectively. Also, Colleague support factor with a score of 3.38 had the least effect on stress levels. Also, according to the results, 87% of nurses, 79% of cleaning crew and 67% of physicians had a partial to high levels of stress that, on average, 77.5% of the HCWs participating in this study had at least a small amount of stress. CONCLUSIONS: The mean stress score among the participants of the present study was between high stress level and moderate stress level. Factors such as communications, manager support, change and demand had the greatest impact on employee stress levels. Therefore, by improving the communication between people working in hospitals, increasing managers' support for staff, and reducing workplace demands such as reducing workload and improving workplace environment, the stress level of staff in hospitals during the outbreak of COVID-19 can be reduced.

Perceived social support and compliance with stay-at-home orders during the COVID-19 outbreak: evidence from Iran.

BACKGROUND: Strong evidence demonstrates that social support plays a key role in facilitating preventive health behaviors. The aim of the current study was to assess the effects of perceived social support on compliance with stay-at-home orders in response to a COVID-19 outbreak during the Persian New Year (Nowruz) holydays, since Nowruz holidays of 2020 coincided with the peak of the coronavirus epidemic in Iran. METHODS: This cross-sectional survey was carried out based on phone interviews of 1073 adults aged over 18 years from 4 to 12 April 2020 in Mashhad, Khorasan-Razavi Province, as the second largest city of Iran. A systematic random sampling was carried out using fixed phone number lists provided by Telecommunication Company of Khorasan-Razavi Province. Phone interviews were carried out by trained interviewers from the Iranian Students Polling Agency (ISPA) at various times of the day. The survey included sociodemographic questions, perceived social support scale (MSPSS) and questions about self-isolation during the Nowruz holiday. Statistical analysis included Chi-square test, Mann-Whitney test and multivariate logistic regression. RESULTS: 20.5% of participants reported poor compliance with stay at home orders during the first 2 weeks of Nowruz. Clear social gradients were not found in stay-at-home compliance. When controlling socio-demographic factors, perceived social support, interestingly, both fostered and hindered people's compliance with stay at home orders, depending on the source of support from family members (OR = .874, 95% CI = .803, .950, p < .005), friends (OR = 1.147, 95% CI = 1.076, 1.222, p < .001) and a significant other person (OR = .926, 95% CI = .849, 1.010, p = .084). CONCLUSIONS: Public health messaging may need to emphasize the role that friends and families can play in helping to protect those in their friendship/family groups by promoting compliance with social distancing. Further in-depth studies are recommended to evaluate how this kind of messaging can most effectively encourage people to engage in social distancing practices.

Impacts of Health Reform Plan in Iran on Health Payments Distributions and Catastrophic Expenditure.

BACKGROUND: Health reform in Iran began in 2014, aimed at improving financing pattern of health services. We assessed the reform by changes in variables representing distribution of health payments and catastrophic expenditures. METHODS: Using data from households' income-expenditure survey, this study computed the financial variables, representing poverty line and households at poor state, household's catastrophic health expenditure, fairness in financial contribution (FFC) index, and household's impoverishment state, in the years 2010-2016, in urban and rural areas. The variables were computed by special software designed for this study, based on C-Sharp(C#) programming language, with yearly data on more than 38000 households, each with 1072 information sources. RESULTS: The food share-based poverty line after sharp rise in 2010-2013, in 2014-2016 raised slowly, and the average percent of households facing catastrophic health expenditure, after sharp rise in 2011-2013, left at 3.25 in 2014-2015 and raised to 3.45 in 2016. The average FFC index remained at 0.839 to 0.837 in 2013-2016. However, interestingly, the average percent of households impoverished after out-of-pocket payments improved from 1.36 to 0.912 in 2013-2016. CONCLUSION: In three years of health reform, the major impact of reform was considerable improvements in the rate of the impoverished after out-of-pocket payments. The reform had limited impacts on the rates of households facing catastrophic health expenditure, and on FFC indexes, for the rural and urban residents.

Development of age-sex adjusted capitation payment: The experience of Iranian public health complexes.

BACKGROUND: Flat capitations are not necessarily able to compensate health providers equitably due to the variability of resource consumption among different age and sex groups. The aim of this study is to develop a risk adjusted capitation formula as a base for primary health care payment in Health Complexes of Tabriz, in Iran. METHOD: This cross-sectional study was conducted in four stages: (1) determining health service package, (2) calculating unit cost of services, (3) estimating service utilization, and (4) calculating age/sex weighted capitation. We calculated unit cost of services with and without building and equipment expenses. Data collection was carried out through a data extraction checklist. Data management and analysis was carried out via Microsoft Excel 2007. RESULT: A list of 99 services and their processes were identified and then assigned each to one of 10 categories according to their resource consumption. The lowest and highest unit cost, respectively, belonged to prenatal care and group training by family physicians. The risk adjusted capitation was calculated with and without renting cost of building and equipment, respectively, 347 000 and 332 000 Rials (1 US$ worth 35 000 Iranian Rials). CONCLUSION: The development of health risk adjusted capitation could improve equity in payment system and the efficiency of delivering primary health care services. Estimated weights proposed with our study can be adapted then applied in contexts with similar characteristics.

The status and predictors of hypertension preventive nutritional behaviors in adolescents based on the constructs of the Theory of Planned Behavior.

BACKGROUND: Malnutrition is an important factor affecting hypertensive incidence. Since the unhealthiest nutritional behaviors are rooted in childhood attitudes and experiences, applying educational interventions to these age groups will be most useful in the formation of preventive nutritional behaviors. OBJECTIVE: To determine the predictive power of the TPB on hypertension in junior high-school students. METHODS: The present cross-sectional study was conducted on 160 junior high-school students in Kashmar, Iran in academic year commencing 2-13-2014, selected through random sampling. The participants completed a researcher-made questionnaire consisting of a demographic information form and a section to evaluate the constructs of the TPB. The data collected were analyzed in SPSS-16 using the correlation Wilcoxon statistics test, the one-way ANOVA and multiple linear regression analysis. RESULTS: The mean age of the students was 13.51. A total of 47% of the students had snacked on potato chips and cheese puffs, 45% had eaten high-fat foods and 51.2% had eaten cookies and chocolates within the past week. The variable of behavioral intention predicted 32% of the variations in preventive nutritional behaviors by itself. The Pearson product-moment correlation analysis found that hypertension preventive nutritional behaviors were significantly correlated with attitude (p<0.001, r=0.38), perceived behavioral control (p<0.001, r=0.38), and behavioral intention. Moreover, significant correlations were observed between subjective norms and attitude (p<0.028, r=0.173), perceived behavioral control and attitude (p<0.003, r=0.231), behavioral intention and attitude (p<0.001, r=0.370), behavioral intention and subjective norms (p<0.030, r=0.171) and between behavioral intention and perceived behavioral control (p<0.001, r=0.484). CONCLUSION: The examined students revealed an adequate adherence to preventive nutritional behaviors. Nutrition education interventions should be developed based on variables such as behavioral intention and its determinants, i.e. attitude, perceived behavioral control and subjective norms.