Socioeconomic and environmental factors associated with waterpipe tobacco smoking among Iranian adults: a PERSIAN cohort-based cross-sectional study.

BACKGROUND: Waterpipe tobacco smoking (WTS) is associated with several deleterious health outcomes. We sought to estimate the prevalence of WTS and explore socioeconomic inequalities associated with this culturally-rooted tobacco smoking practice among Iranian adults. METHODS: A cross-sectional analysis was conducted among 20,460 adults (ages 18 and older) enrolled in the PERSIAN cohort study during 2020. Data were collected on socioeconomic status (SES), lifestyle, alcohol consumption, cigarette smoking, and several risk factors related to non-communicable diseases. The concentration curve and relative concentration index (RCI) were administered to assess and quantify the SES-based inequality in WTS. RESULTS: Overall age-adjusted prevalence of past-month WTS was 5.1% (95%CI:4.6-5.8), with about 1% for women and 10.6 for men. Age-adjusted prevalence of WTS was higher among younger adults, men, cigarette smokers, obese adults, and those with higher SES. The RCI estimation showed that WTS is more popular among adults with high income and education. WTS was higher among younger adults, cigarette smokers, obese adults, and those with higher SES. CONCLUSION: There is a clear socioeconomic inequality in WTS, with a higher prevalence among adults with higher income and education. The findings suggest the need for targeted interventions to address this inequality and reduce the prevalence of WTS among high-income communities.

Economic burden of cardiovascular diseases before and after Iran's health transformation plan: evidence from a referral hospital of Iran.

BACKGROUND: Different countries have set different policies to control and decrease the costs of cardiovascular diseases (CVDs). Iran was aiming to reduce the economic burden of different disease by a recent reform from named as health transformation plan (HTP). This study aimed to examine the economic burden of CVDs before and after of HTP. METHODS: This cross-sectional study was conducted on 600 patients with CVDs, who were randomly selected from a specialized cardiovascular hospital in the north-west of Iran. Direct and indirect costs of CVDs were calculated using the cost of illness and human capital approaches. Data were collected using a researcher-made checklist obtained from several sources including structured interviews, the Statistical Center of Iran, Iran's Ministry of Cooperatives, Labor, and Social Welfare, the central bank of Iran, and the data of global burden of disease obtained from the Institute for Health Metrics and Evaluation to estimate direct and mortality costs. All costs were calculated in Iranian Rials (IRR). RESULTS: Total costs of CVDs were about 5571 and 6700 billion IRR before and after the HTP, respectively. More than 62% of the total costs of CVDs accounted for premature death before (64.89%) and after (62.01%) the HTP. The total hospitalization costs of CVDs was significantly increased after the HTP (p = 0.038). In both times, surgical services and visiting had the highest and lowest share of hospitalization costs, respectively. The OOP expenditure decreased significantly and reached from 54.2 to 36.7%. All hospitalization costs, except patients' OOP expenditure, were significantly increased after the HTP about 1.3 times. Direct non-medical costs reached from 2.4 to 3.3 billion before and after the HTP, respectively. CONCLUSION: Economic burden of CVDs increased in the north-west of Iran after the HTP due to the increase of all direct and indirect costs, except the OOP expenditure. Non-allocation of defined resources, which coincided with the international and national political and economic challenges in Iran, led to unsustainable resources of the HTP. So, no results of this study can be attributed solely to the HTP. Therefore, more detailed studies should be carried out on the reasons for the significant increase in CVDs costs in the region.

Quality of work life and work-family conflict: a cross-sectional study among nurses in teaching hospitals.

BACKGROUND: The nursing profession is known to induce high levels of stress, and being simultaneously engaged in a stressful professional occupation and having a family life can lead to work-family conflict. Healthcare providers require recruitment and retention strategies that preserve nurses' quality of work-life and mitigate work-family conflict. AIM: To investigate the relationship between quality of work-life and work-family conflict among hospital nurses in Iran, as well as the relationships between work-family conflict and quality of work life, and between age, professional experience, type of employment, work shift and marital status. METHOD: This cross-sectional study was conducted among 378 nurses working in six Iranian teaching hospitals, who were selected using random quota sampling. Data on age, professional experience, type of employment, work shift and marital status was collected. The study questionnaire was based on the 53-item Quality of Work Life scale and the 18-item Work-Family Conflict scale. Correlations were established using Pearson's chi-squared and eta-squared tests. RESULTS: A total of 93% of participants experienced moderate or high levels of work-family conflict and 83% had a low or moderate quality of work life. On average, the levels of work-family conflict and quality of work life were moderate. Quality of work life decreased with increasing work-family conflict. CONCLUSION: Healthcare providers can use these results to inform their recruitment and retention strategies. Nurse managers can mitigate any adverse effects of work-family conflict on quality of work life by offering staff interventions such as short training courses on how to manage work-family conflict.

Pentacam Indices in Photorefractive Keratectomy Surgery.

Refractive eye surgeries are one of the most non-emergent ophthalmic surgeries due to the effect on the reduction of refractive errors, increasing visual acuity, enhancing the quality of vision, and indirectly increasing the quality of life of patients. The aim of this study was to determine Pentacam indices in the patients who underwent photorefractive keratectomy (PRK) during 2014-2018, as well as to show their correlation with the type of refractive error. This descriptive cross-sectional study was performed on 2215 eyes of 1125 patients undergoing PRK surgery. The patients' checklist, including demographic information, refractive index, keratometry, pachymetry, corneal surface zone indices, and progressive corneal thickness indices, was provided. All data were analyzed using the IBM SPSS software, version 25. The findings showed that there was a significant association between posterior corneal astigmatism (PCA) and anterior corneal astigmatism (ACA) (p=0.00). The mean Kmax front was recorded as 44.844 ± 1.58 D, which was significantly correlated with the type of refractive errors (p=0.00). According to the findings, there was a significant relationship between anterior chamber indices and refractive error types and their severity (p=0.00). There was also a significant correlation between the surface zone and keratoconus indices (i.e., index of surface variance - ISV, index of vertical asymmetry - IVA, index of height asymmetry - IHA, and minimum radius of curvature - Rmin) with refractive errors (p=0.00). The findings showed that some of the Pentacam indices could be related to the types of refractive errors in patients undergoing PRK surgery. Therefore, their evaluation is of great importance in this regard.

Measuring the Efficiency of a Hospital based on the Econometric Stochastic Frontier Analysis (SFA) Method.

INTRODUCTION: Hospitals are the most expensive health services provider in the world. Therefore, the evaluation of their performance can be used to reduce costs. The aim of this study was to determine the efficiency of the hospitals at the Kurdistan University of Medical Sciences using stochastic frontier analysis (SFA). METHODS: This was a cross-sectional and retrospective study that assessed the performance of Kurdistan teaching hospitals (n = 12) between 2007 and 2013. The Stochastic Frontier Analysis method was used to achieve this aim. The numbers of active beds, nurses, physicians, and other staff members were considered as input variables, while the inpatient admission was considered as the output. The data were analyzed using Frontier 4.1 software. RESULTS: The mean technical efficiency of the hospitals we studied was 0.67. The results of the Cobb-Douglas production function showed that the maximum elasticity was related to the active beds and the elasticity of nurses was negative. Also, the return to scale was increasing. CONCLUSION: The results of this study indicated that the performances of the hospitals were not appropriate in terms of technical efficiency. In addition, there was a capacity enhancement of the output of the hospitals, compared with the most efficient hospitals studied, of about33%. It is suggested that the effect of various factors, such as the quality of health care and the patients' satisfaction, be considered in the future studies to assess hospitals' performances.