Assessing health determinants worldwide: Econometric analysis of the Global Burden of Diseases Study 2000-18 - Highlighting impactful factors on DALY, YLL, and YLD indicators.

Background: As the health status of a population is influenced by a variety of health determinants, we sought to assess their impact on health outcomes, both at the global and regional levels. Methods: This ecological study encompassed all 194 member countries of the World Health Organization (WHO) from 2000 to 2018. We first identified all health determinants and then retrieved the related data from various global databases. We additionally considered three indicators - disability-adjusted life years (DALYs), years of life lost (YLL), and years lived with disability (YLD) - in evaluating health outcomes; we extracted their data from the Global Burden of Disease (GBD) 2019 study. We then applied econometric analyses using a multilevel mixed-effects linear regression model. Results: The analysis using the DALY indicator showed that the variables of sexually transmitted infections, injuries prevalence, and urbanisation had the highest effect size or regression coefficients (ß) for health outcomes. The variables of sexually transmitted infection (ß = 0.75, P < 0.001) in the African region; drinking water (ß = -0.60, P < 0.001), alcohol use (ß = 0.20, P < 0.001), and drug use (ß = 0.05, P = 0.036) in the Americas region; urbanisation (ß = -0.34, P < 0.001) in the Eastern Mediterranean region; current health expenditure (ß = -0.21, P < 0.001) in the Europe region; injuries (ß = 0.65, P < 0.001), air pollution (ß = 0.29, P < 0.001), and obesity (ß = 0.92, P < 0.001) in the South-East Asia region; and gross domestic product (ß = -0.25, P < 0.001), education (ß = -0.90, P < 0.001), and smoking (ß = 0.28, P < 0.001) in the Western Pacific region had the most significant role in explaining global health outcomes. Except for the drug use variable in regional findings, the role of other variables in explaining the YLL indicator was greater than that of the YLD indicator. Conclusions: To address global health disparities and optimise resource allocation, global and interregional policymakers should focus on determinants that had the highest ß with health outcomes in each region compared to other regions. These determinants likely have a higher marginal health product, and investing in them is likely to be more cost-effective.

Challenges facing international students at Iranian universities: a cross-sectional survey.

BACKGROUND: This study examines the challenges faced by international students at Tehran University of Medical Sciences (TUMS) and provides insights into their experiences and needs. METHODOLOGY: A self-developed structured questionnaire was administered to international students who completed their first year at TUMS. Data were collected from 165 participants (76% response rate) and analyzed using SPSS 22.0. RESULTS: The study reveals that international students encounter various challenges, including difficulties accessing information, language barriers, ineffective communication, administrative inefficiencies, cultural issues, financial constraints, and limited scholarship opportunities. Analysis of students' characteristics indicates that the length of study at TUMS is significantly associated with the challenges experienced. The findings highlight the importance of enhancing support services and resources for international students, such as language classes, academic counseling, scholarships, and cultural exchange programs. CONCLUSION: Addressing these challenges can foster a more supportive environment, contributing to the academic success and well-being of international students at TUMS and similar universities.

Role of family factors in provision and perception of social support for older people in Iran: a cross-sectional survey.

BACKGROUND: Iran has experienced a very fast fertility transition. The process of demographic transition, coupled with modernization, has had considerable consequences for the structure and function of families. There is rising concern in Iran about a potential decline in family care and support for older people as a result of these changes. The main aim of this study was to provide a benchmark by examining current associations between family factors and older people's social support, both perceived and received. METHODS: A cross-sectional survey of a random sample of 644 people aged 60 + years resident in Tehran was conducted using stratified cluster random sampling method in 2015. Outcome variables were perceived social support, as measured by Social Provision Scale, and received instrumental social support. Multilevel mixed-effects models were used to examine the hypotheses. RESULTS: The analyses showed that most of the family factors measured, including family size (p = 0.01), living arrangements (p = 0.05), and amount of contact with family members (p = 0.001) were associated with older people's receipt of instrumental social support. Living arrangements and quality of relationships with family members were associated with older people's perceptions of social support (p < 0.001). Also, a significant gender interaction was found in associations between family size and SPS (p = 0.03). Having a large size family was positively associated with higher SPS for women (Coef. = 3.9, p = 0.009) but not for men (Coef. = -0.4, p = 0.7). CONCLUSION: findings of this study support the premise that most of family factors play an important role in provision and perception of social support for Iranian older people. Further policies should mostly be selective of those at higher risk of low support such as widowed, childless, those living alone, having poor relationship with their relatives and those with worse health status. The results of this study may be utilized to target older populations who are at higher risk of low support with innovative programs that focus on building social networks and enhancing social support.

Trend analysis of noncommunicable diseases and their risk factors in Afghanistan.

Background: Afghanistan is suffering from 40-year chronic conflicts, displacement, and demolition of its infrastructure. Afghanistan mortality survey 2010 shows nearly 46% of all deaths in the country were attributed to noncommunicable diseases (NCDs). In this study, we aimed to understand the differences in mortality and premature death due to NCDs by sex and the trend for the next 8 years. Methods: We applied trend analysis using the secondary data from the Institute for Health Metrics and Evaluation, Global Burden of Diseases 2019. The information on NCD mortality, NCD deaths attributed to its risk factors, NCD percent of total years lived with disability (YLDs) attribution to each risk factor extracted from this database from 2008 to 2019. We investigated the trend from 2008 to 2019 for the mentioned factors and then forecast their trends until 2030. Results: Our study shows that Afghanistan has had an increasing death number due to NCDs from 2008 to 2019 (50% for both sexes) and this will reach nearly 54% by 2030. Currently, half of NCDs deaths are premature in Afghanistan. The mortality rate and prevalence of risk factors are higher among women. More than 70% of YLDs will be due to NCDs in Afghanistan till 2030. Five risk factors including high systolic blood pressure (28.3%), high body mass index (23.4%), high blood glucose (20.6%), high low-density lipoprotein cholesterol (16.3%), and smoking (12.3%) will have the highest contribution to NCDs death in 2030, respectively. Conclusions: In general, our study indicates that without any specific intervention to address NCDs in Afghanistan, not only the Sustainable Development Goal target for NCDs will not be met, but an increase in almost all risk factors prevalence, as well as NCD mortality, will be seen in Afghanistan.

Developing a Conceptual Framework for an Age-Friendly Health System: A Scoping Review.

BACKGROUND: Population aging is usually associated with increased health care needs. Developing an age-friendly health system with special features, structure, and functions to meet the special needs of older people and improving their health status and quality of life is essential. This study aimed to develop a conceptual framework for an age-friendly health system, which would offer a conceptual basis for providing the best possible care for older people in health system to let them experience a successful, healthy, and active aging. METHODS: A scoping review was used to design the conceptual framework based on Arksey and O'Malley's model, including six stages, with the final stage of using expert's opinions to improve and validate the initial framework. The health system model of Van Olmen, was selected as the baseline model for this framework. Then, by reviewing the available evidence, the characteristics of an age-friendly health system were extracted and incorporated in the baseline mode. RESULTS: Using the electronic searching, initially 12 316 documents were identified, of which 140 studies were selected and included in this review study. The relevant data were extracted from the 140 studies by two reviewers independently. Most studies were conducted in 2016-2020, and mostly were from United States (33.6%). To have an age-friendly health system, interventions and changes should be performed in functions, components and objectives of health systems. This system aims to provide evidence-based care through trained workforces and involves older people and their families in health policy-makings. Its consequences include better health acre for older people, with fewer healthcare-related harms, greater care satisfaction and increased use of cost-effective health services. CONCLUSION: To meet the needs of older people, health systems should make interventions in their functions for better performance. In line with these changes, other parts of society should work in harmony and set the health of older people as a top priority to ensure they can have a successful aging.

A systematic review of individual and ecological determinants of maternal mortality in the world based on the income level of countries.

BACKGROUND: This systematic review was conducted to map the literature on all the existing evidence regarding individual and ecological determinants of maternal mortality in the world and to classify them based on the income level of countries. Such a systematic review had not been conducted before. METHODS: We conducted an electronic search for primary and review articles using "Maternal Mortality" and "Determinant" as keywords or MeSH terms in their Title or Abstract, indexed in Scopus, PubMed, and Google with no time or geographical limitation and also hand searching was performed for most relevant journals. STROBE and Glasgow university critical appraisal checklists were used for quality assessment of the included studies. Data of the determinants were extracted and classified into individual or ecological categories based on income level of the countries according to World Bank classification. RESULTS: In this review, 109 original studies and 12 review articles from 33 countries or at global level met the inclusion criteria. Most studies were published after 2013. Most literature studied determinants of low and lower-middle-income countries. The most important individual determinants in low and lower-middle-income countries were location of birth, maternal education, any delays in health services seeking, prenatal care and skilled birth attendance. Household-related determinants in low-income countries included improved water source and sanitation system, region of residence, house condition, wealth of household, and husband education. Additionally, ecological determinants including human resources, access to medical equipment and facilities, total fertility rate, health financing system, country income, poverty rate, governance, education, employment, social protection, gender inequality, and human development index were found to be important contributors in maternal mortality. A few factors were more important in higher-income countries than lower-income countries including parity, IVF births, older mothers, and type of delivery. CONCLUSION: A comprehensive list of factors associated with maternal death was gathered through this systematic review, most of which were related to lower-income countries. It seems that the income level of the countries makes a significant difference in determinants of maternal mortality in the world.

Prevalence and Determinants of Severe Mental Disorders in Iran: Evidence from the National Survey of STEPs- 2016.

BACKGROUND: The determinants and correlates of severe mental disorders are less understood compared to the common mental disorders, both in the world and in Iran. In this study, we aimed to identify a wide range of determinants of severe stress, severe anger, and severe sadness among Iranian population. METHODS: This study is part of a large nationwide cross-sectional survey entitled STEPs conducted using a comprehensive questionnaire to determine the prevalence of main preventable risk factors of non-communicable diseases (NCDs) in Iran by age and sex groups in 2016. In total, 30541 people aged 18+participated in this study. Univariate and multivariate logistic regression analyses were used to examine the associations between the dependent variable, which is severe mental disorders, and independent variables including socio-economic factors, lifestyle and selected NCDs. RESULTS: The prevalence of severe stress, severe anger and sever sadness in the Iranian society was 33%, 35%, and 25%, respectively. Of the investigated socio-economic factors, being men, older, never married and living in rural areas were associated with significantly lower experience of severe mental disorders compared to other groups. For education, income and wealth index, there was no linear and clear pattern. Among lifestyle factors, being nonsmoker, having low physical activities, and higher intake of fruits and vegetables were found to be preventive of severe mental disorders. Additionally, having NCDs including hypertension, high cholesterol, diabetes and heart attacks were also significantly correlated with severe mental disorders. CONCLUSION: determining factors associated with severe mental disorders in this study would help in raising people's awareness on avoiding harmful factors, and taking healthier lifestyle such as quitting smoke, and consuming enough vegetables and fruits. Screening high risk people in terms of mental health could contribute to the reduction of mental disorders in the Iranian community.

Vision-Related Quality of Life of Older People in Tehran and their Access and Utilization of Eye Care Services.

Background: Access to and utilization of eye care services may improve vision-related quality of life (VRQoL) of older people. This study aimed to evaluate the VRQoL of older adults and its associations with access to and utilization of eye care services. Methods: This is a community-based cross-sectional survey conducted in Tehran, Iran, on 566 older people in 2018. The NEI-25 VFQ was used to measure the VRQoL. Multilevel Linear Regression analysis used to test the study hypotheses. Results: The average score of the VRQoL was 80 out of 100. About 61% of the participants did not utilize the annual routine eye examination and the mean score of overall access to eye care was 85 out of 115. Having a higher physical, socio-cultural and overall access were significantly associated with higher VRQoL, but those with regular utilization had no better VRQoL status compared to non-users. Conclusion: Access to eye care services showed to be very important in improvement of the VRQoL, whereas higher utilization was not found to be associated with better VRQoL statue of older people, as there might have a reverse causality with using more eye services with higher Visual impairment.

Gender Interaction in Association of Perceived Social Support and Health-Related Quality of Life Among Iranian Older People: A Cross-sectional Survey.

Background: The purpose of this study was to examine the relationship between perceived social support (PSS) and dimensions of health-related quality of life (HRQoL) and to examine possible gender interaction in the mentioned associations. Methods: A community-based cross-sectional study conducted among 644 participants over the age of 60 years old in Tehran. The data were collected through face-to-face interviews conducted in their own homes, by using a structured multi-sectional questionnaire. The version 1 of the SF-12 scale was used to measure the HRQoL, consisting of two summary measures; PCS (Physical Component Score) and MCS (Mental Component Score). The Persian version of the Social Provisions Scale (SPS) was used to measure PSS. Four multilevel mixed-effects logistic regression models were used to examine the associations. Results: Older people with poor SPS score were 1.8 times more likely to be in the worst quartile of the MCS distribution (CI=1.11-2.93, P =0.021), and twice as likely to be in the worst quartile of the PCS distribution (CI=1.18-3.54, P =0.011). We found strong evidence to support the hypothesis of gender interaction in the association between economic status and PCS [Men: OR 0.28, CI (0.11-0.71); Women: OR 1.00, CI (0.53-1.88); P of Interaction 0.021], and a borderline evidence for gender interaction in the association between physical activity and PCS [Men: OR 5.32, CI (2.14-13.20); Women: OR 1.80, CI (0.82-3.93); P of Interaction 0.051]. Conclusions: Social support could be regarded as one of the main social determinants affecting HRQoL among older people. Men with poor economic status and poor physical activity, compared to women, are more likely to suffer from poor quality of life, thus men should be prioritized in financial support and life style and physical activity interventions.

Challenges to Achieving Universal Health Coverage Throughout the World: A Systematic Review.

OBJECTIVES: No systematic review has explored the challenges related to worldwide universal health coverage (UHC). This study reviewed challenges on the road to UHC. METHODS: A systematic electronic search of all studies that identified the challenges of worldwide UHC was conducted, without any restrictions related to the publication date or language. A hand search and a bibliographic search were also conducted to identify which texts to include in this study. These sources and citations yielded a total of 2500 articles, only 26 of which met the inclusion criteria. Relevant data from these papers were extracted, summarized, grouped, and reported in tables. RESULTS: Of the 26 included studies, 7 (27%) were reviews, 6 (23%) were reports, and 13 (50%) had another type of study design. The publication dates of the included studies ranged from 2011 to 2020. Nine studies (35%) were published in 2019. Using the World Health Organization conceptual model, data on all of the challenges related to UHC in terms of the 4 functions of health systems (stewardship, creating resource, financing, and delivering services) were extracted from the included studies and reported. CONCLUSIONS: This study provides a straightforward summary of previous studies that explored the challenges related to UHC and conducted an in-depth analysis of viable solutions.

Individual-Level Active Aging Index and Quality of Life of Older People: A Population-Based Survey in Tehran.

Background: Iran is one of the fastest ageing countries in the world. The model of Active Ageing (AA) could be a strategy contributing in addressing the problem of population ageing in Iran. This study measured the status of AA in Iran and examined its associations with the health-related quality of life of older people. Methods: A quantitative cross-sectional survey of a random sample of 623 people aged 55 + years resident in Tehran was conducted. In total, 590 people responded. The AA was measured using the Active Ageing Index (AAI) questionnaire and the health-related quality of life was measured using SF-36 questionnaire. Associations between the domains and the overall AAI scores with the quality of life were examined by MANCOVA analysis in four models using the STATA software. Results: The score of overall AAI was calculated at 26.8 (men 33.9 vs. women 20.6) out of 100. We found a stronger association of the AAI with the physical component than the mental component of the SF-36. Generally the 1st (employment) and the 2nd (participation in society) domains of the AAI showed little or no association with SF-36, but there was an association between the 3rd domain (enabling environment for active ageing) and the SF-36 and a particularly strong associations with the 4th domain (independent, healthy and secure living capacity). Conclusions: Iranian elderly, particularly women, are experiencing relatively inactive life, which negatively influence on their health-related quality of life. To improve the AAI status in Iran, some aspects including "enabling environment" and "independent, healthy and secure living capacity" need special attention.

Donors' Participation in Iran's Health System: Challenges and Solutions.

BACKGROUND: Philanthropic activities play an important role in health systems. Donors contribute to financing, generating resources, and providing healthcare services in Iranian health system. However, they face many challenges. This study aimed to identify barriers to donors' participation in the Iranian health system and to provide solutions. METHODS: This qualitative study was performed using semi-structured interviews with 38 donors and 26 policy-makers and managers in the social affairs department of health ministry and medical universities in 2018. In addition, document analysis was performed and the relevant data were extracted. Thematic analysis was used for data analysis. All ethical considerations were followed in this research. RESULTS: Insufficient structures, poor communications, low trust, ineffective working processes, bureaucracy, insufficient senior managers' support, weak legal support and poor monitoring were the most important challenges for donors' participation in the Iranian health system. Effective donor participation in the health system requires the creation of an appropriate system including the right structures, processes, culture, and management. The necessary changes must be planned, led and monitored to promote donors' participation in healthcare. A conceptual model was developed to strengthen donors' participation in the health system. CONCLUSION: Iranian donors face structural, procedural, cultural, and managerial challenges when financing the health system, generating resources, and providing health services. Policy-makers and managers should tackle these challenges and adopt strategies to reinforce donors' participation in the health system. Planning, organizing, leading, monitoring, evaluation, transparency, accountability, and a commitment to meet donors' needs are necessary for successful philanthropy initiatives in the health sector.

Evaluation of Elderly's Integrated Healthcare components in primary healthcare centers of Tehran, Iran.

BACKGROUND: Over the past few decades, significant demographic and epidemiological changes have been occurred and led to serious changes in the health-care needs of the elderly. Integrated care has been emerged as a strategy to provide better care for the elderly in the community. The aim of this study was conducted to evaluate components of integrated health-care program of the elderly. MATERIALS AND METHODS: This quantitative cross-sectional study was conducted in Tehran (Iran) in 2019. For the purpose of the study, a two-stage cluster sampling method was employed. In the firs stage, primary health-care centers were selected, then in the second stage, a systematic random sampling was conducted based on the number of the elderly covered by each center. level of frailty, medication use awareness, and self-care ability were evaluated by the elderly self-report questionnaire. The questionnaire was piloted with thirty respondents. The test-retest reliability score for the questionnaire was r = 0.795, P < 0.001. Data analysis of the questionnaire was conducted using generalized estimating equation model by SPSS software Version 22. Statistical significance for all analyses was set at P < 0.05. RESULTS: Findings of the components showed that the mean ± standard deviation of frailty (80 ± 17) and self-care ability (87 ± 17) were higher than the mean of medication use awareness (49 ± 19). Frailty and self-care ability (ß = frailty, self-care) of the elderly had a positive statistical significance with the ones with good financial status (ß = 5, 10) and without chronic disease (ß = 4, 5). Medication use awareness had a negative statistical significance with illiteracy (ß = -9.5). CONCLUSIONS: It is suggested that the medication use awareness of the elderly should be prioritized by improving integrated health-care program.

Determinants and causes of maternal mortality in Iran based on ICD-MM: a systematic review.

BACKGROUND: No systematic review has explored the causes of and factors associated with maternal mortality in the context of Iran. This study reviewed determinants and causes of maternal mortalities during pregnancy, delivery and the puerperium using the International Classification of Diseases-Maternal Mortality (ICD-MM), introduced by the World Health Organization. METHODS: A systematic electronic search of all the studies that identified causes and/or determinants of maternal deaths in any part of Iran or in the whole country were included, without any restriction of time or language of studies. To identify the studies to include in this study, a combination of hand searching and bibliographies was also conducted. These sources and citations yielded a total of 653 articles; nevertheless, only 29 articles met the inclusion criteria, hence, required data were extracted, summarized, and grouped together from these papers and are reported in the tables. RESULTS: Amongst the 29 studies published between 2003 and 2017 in Iran, 24 studies were cross-sectional. Overall, 4633 deaths were reviewed, and 2655 (58%) of the cases included the data on the causes of death generally. According to the ICD-MM, a total of 69.9, 20.6, and 5.2% of the mortalities were due to direct, indirect and unspecified causes respectively and 4.3% of the causes were not clear in several studies. The leading direct and indirect causes of death were identified as hemorrhage (30.7%) and hypertensive disorders (17.1%) and circulatory system diseases (8.1%) respectively. Several factors including gravidity, type of delivery, socio-economic status of mothers, locations of birth, death and maternity care venues were found in the original studies as the most important determinant of maternal mortalities in Iran. CONCLUSIONS: This study, provided an updated summary of evidences on the causes and determinants of maternal death in Iran, which is critically important for the development of interventions and reduction of the burden of maternal mortality and morbidities.

Knowledge of and attitudes toward HIV/AIDS among Iranian women.

OBJECTIVES: This study investigated the knowledge of Iranian women about HIV/AIDS and whether they had accepting attitudes towards people living with human immunodeficiency virus (HIV), and sought to identify factors correlated with their knowledge and attitudes. METHODS: The data analyzed in the present study were taken from Iran's Multiple Indicator Demographic and Health Survey, a national survey conducted in 2015. In total, 42,630 women aged 15-49 years were identified through multi-stage stratified cluster random sampling and interviewed. Associations of the socio-demographic characteristics of participants with their knowledge and attitudes were examined using multiple logistic regression analysis. RESULTS: The majority (79.0%) of Iranian women had heard about HIV/AIDS, but only 19.1% had a comprehensive knowledge. In addition, only 15.4% of women had accepting attitudes toward people with HIV. Being older, married, more highly educated, and wealthier were factors associated with having more comprehensive knowledge of HIV/AIDS, and living in urban areas was associated with having more positive attitudes toward people with HIV. CONCLUSIONS: The relatively poor knowledge of Iranian women and the low prevalence of accepting attitudes toward people living with HIV highlight the need to develop policies and interventions to overcome this issue, which would be a basis for further prevention of HIV/AIDS in Iran.

Social support and mental health status of older people: a population-based study in Iran-Tehran.

OBJECTIVES: To investigate direct and stress-buffering associations between social support from family and the mental health of older people in Iran, a country which has recently undergone an exceptionally fast fertility transition and is consequently experiencing rapid population ageing. METHOD: A cross-sectional stratified random survey of 800 people aged 60+ years resident in Tehran was conducted. In total, 644 people responded. The Social Provisions Scale and the General Health Questionnaire were used to measure perceived social support and mental health, respectively. Multilevel mixed-effects models were used to examine the hypotheses. RESULTS: The findings supported the hypothesis of a direct association between perceived and received social support and mental health. However, we did not find strong evidence to suggest that social support buffered the effects of stress arising from limitations of physical functioning. Lack of help doing paperwork was associated with worse mental health for women but not men. Source of support did not seem to be important. CONCLUSION: Our results indicated that in Tehran, as in Western settings, social support is important for the mental well-being of older people. Recommendations for policy and further research priorities based on the study findings were provided.

Developing a Persian inpatient satisfaction questionnaire.

PURPOSE: Valid and reliable measures are required for assessing patient satisfaction meaningfully. The purpose of this paper was to develop and validate a Persian-language in-patient satisfaction questionnaire for patients discharged from Iranian medical and surgical services. DESIGN/METHODOLOGY/APPROACH: The cross-sectional survey included 400 patients randomly selected from six Tehran hospitals. A total of 405 patients responded to the questionnaire (76.3 percent response). To assess inter-item reliability and construct validity, factor analysis was carried out. Items belonging to each factor and their Cronbach's alpha coefficient were calculated. FINDINGS: A total of seven dimensions were identified: doctor-patient communication; nursing care; convenience; visitors; cleanliness; costs; and general satisfaction. Together, these dimensions explained 60 percent of the variance. All items, except three, revealed loadings above 0.4, while Cronbach's alpha exceeded 0.8 for all dimensions, except visitors (0.66). Patient satisfaction levels were relatively high. PRACTICAL IMPLICATIONS: Results must be interpreted cautiously owing to high satisfaction, which should not be considered as comprehensive evidence of high performance without important additional service-performance information. Qualitative studies are recommended to complement the authors' quantitative satisfaction study. ORIGINALITY/VALUE: The patient satisfaction questionnaire strives to be a valid and reliable instrument for assessing in-patient satisfaction with hospital services in Iran.

Social support and health of older people in Middle Eastern countries: a systematic review.

The aim of this study is to systematically review quantitative studies exploring the association between social support (SS) and the health of older people in Middle Eastern countries. Sixteen electronic databases and other resources were searched to identify studies that met the inclusion criteria of the review. Abstracts of identified papers were screened for relevancy, following which the authors determined eligibility, applied quality criteria and extracted the data. Twenty-two studies met the inclusion criteria. Even allowing for the diversity of the studies included, this review offered strong and consistent evidence for a positive relation between SS and mental health, while there was inconsistent evidence of an association between SS and other health outcomes. The limited evidence for the Middle Eastern region confirms findings from other settings on the importance of SS for mental health in later life. Current evidence is inadequate to assess whether SS is associated with physical health.

Determinants of health-related quality of life in elderly in Tehran, Iran.

BACKGROUND: As Iran started to experience population ageing, it is important to consider and address the elderly people's needs and concerns, which might have direct impacts on their well-being and quality of life. There have been only a few researches into different aspects of life of the elderly population in Iran including their health-related quality of life. The purpose of this study was to measure health-related quality of life (HRQoL) of elderly Iranians and to identify its some determinant factors. METHODS: This was a cross-sectional survey of a random sample of community residents of Tehran aged 65 years old and over. HRQoL was measured using the Short From Health Survey (SF-36). The study participants were interviewed at their homes. Uni-variate analysis was performed for group comparison and logistic regression analysis conducted to predict quality of life determinants. RESULTS: In all, 400 elderly Iranian were interviewed. The majority of the participants were men (56.5%) and almost half of the participants were illiterate (n = 199, 49.8%). Eighty-five percent of the elderly were living with their family or relatives and about 70% were married. Only 12% of participants evaluated their economic status as being good and most of people had moderate or poor economic status. The mean scores for the SF-36 subscales ranged from 70.0 (SD = 25.9) for physical functioning to 53.5 (SD = 29.1) for bodily pain and in general, the respondents significantly showed better condition on mental component of the SF-36 than its physical component (mean scores 63.8 versus 55.0). Performing uni-variate analysis we found that women reported significantly poorer HRQoL. Multiple logistic regression analysis showed that for the physical component summary score of the SF-36, age, gender, education and economic status were significant determinants of poorer physical health-related quality of life; while for the mental component summary score only gender and economic status were significant determinants of poorer mental health-related quality of life. The analysis suggested that the elderly people's economic status was the most significant predictor of their HRQoL. CONCLUSION: The study findings, although with a small number of participants, indicate that elderly people living in Tehran, Iran suffer from relatively poor HRQoL; particularly elderly women and those with lower education. Indeed to improve quality of life among elderly Iranians much more attention should be paid to all aspects of their life including their health, and economic status.

Report: The assessment of hospital waste management:a case study in Tehran.

Hospital waste management is an important process that must be dealt with diligently. The management of hazardous waste material requires specific knowledge and regulations and it must be carried out by specialists in the field. In this cross-sectional study, we assessed the main stages of hospital waste management including separation, containment, removal and disposal of waste materials in public hospitals affiliated with Tehran University of Medical Sciences (TUMS). We selected 108 units of six hospitals (three general hospitals and three subspecialty hospitals) from those hospitals supervised by TUMS using the cluster sampling method. The measurement was conducted through a questionnaire and direct observation by researchers. Association analysis was done by statistical tests; Fisher exact test and chi-squared using SPSS software. According to the results obtained by the questionnaire, most of the studied wards scored moderately in terms of quality of their performance in all stages of waste management. About one-fifth of the wards were suffering from poor management of their medical waste and only a minority of wards obtained good scores for managing their waste materials. The findings also revealed significant associations between temporary waste storage and collection and the level of education of the managers (P = 0.040, P = 0.050, respectively). In summary, the study indicated a moderate management in all processes of separation, collection, containment, removal and disposal of waste materials in hospitals with several observed problems in the process.