Time series analysis of COVID-19's impact on physician and dentist visits in Iran

This study aimed to assess the impact of the COVID-19 pandemic on general practitioner (GP), specialist, and dentist visits among 40 million Iranians covered by the Social Security Organization (SSO). A monthly interrupted time series analysis was conducted over a period of 72 months, including—47 months before the pandemic and 25 months after its onset. The outcomes variables were monthly number of GP, specialist, and dentist visits per 1000 SSO-insured individuals. The analysis was performed by total visits, visits to the SSO direct sector, and visits to the indirect sectors. The study found that in the first month of the pandemic, the number of visits per 1000 insured individuals significantly decreased for visits to GPs (by 51.12, 95% CI −64.42 to −37.88), visits to specialists (by 39.11, 95% CI −51.61 to −26.62), and visits to dentists (by 6.67, 95% CI −8.55 to −4.78). However, during the subsequent months of the pandemic, there was a significant increase in the number of monthly visits for all three categories, with GPs experiencing the highest increase (1.78 visits per 1000 insured), followed by specialists (1.32 visits per 1000 insured), and dentists (0.05 visits per 1000 insured). Furthermore, prior to the pandemic, the number of monthly GP visits per 1000 insured individuals was statistically significantly lower in the indirect sector compared to the direct sector (45.79, 95% CI −52.69 to −38.89). Conversely, the direct sector exhibited lower rates of specialist visits (25.84 visits per 1000 insured individuals, 95% CI 22.87 to 28.82) and dentist visits (0.75 visits per 1000 insured individuals, 95% CI 0.12 to 1.36) compared to the indirect sector. Additionally, the study found that in the first month of the pandemic, the monthly number of GP visits in the indirect sector significantly increased by 34.44 times (95% CI 24.81 to 44.08) compared to the direct sector. For specialist visits and dentist visits, the increase was 3.41 (95% CI −5.87 to 12.69) and 5.01 (95% CI 3.48 to 6.53) per 1000 insured individuals, respectively. Overall, the findings of this study demonstrate statistically significant disruptions in GP, specialist, and dentist visits during the COVID-19 pandemic, although some recovery was observed. Both the direct and indirect sectors experienced decreased visits

Comparative analysis of morphometric parameters of intercondylar notch in patients with and without anterior cruciate ligament tears

BACKGROUND: Anterior cruciate ligament (ACL) injury is the most common type of ligament injury whose prevalence is higher in athletes. There are different external risk factors for this injury. However, it is important to find its physiological risk factors, as well. This study assessed the relationship between morphometric parameters of intercondylar notch and ACL tears in patients suffering from knee complications. METHODS: Patients with or without ACL tears who had undergone knee magnetic resonance imaging for any reason were recruited based on inclusion criteria. Intercondylar notch width, femoral bicondylar width, and intercondylar notch index were calculated in both groups. Then, significant variables from univariate analysis were entered in multiple regression analysis with intercondylar notch width, femoral bicondylar width, and intercondylar notch index being assumed as dependent variables. RESULTS: Overall, 199 participants, including 81 patients with ACL tear and 118 without ACL tear, were evaluated. Multiple regression analysis revealed intercondylar notch width and intercondylar notch index to be less common among women and subjects with ACL tears (P < 0.001). CONCLUSION: Based on the results of this study, there are relationships between ACL tears and being female and intercondylar notch width. Therefore, intercondylar notch index can be used for screening athletes and people at risk of ACL tears

Socioeconomic-related inequalities in oral hygiene behaviors: a cross-sectional analysis of the PERSIAN cohort study

Background Socioeconomic-related inequality in oral hygiene behaviors in Iran is poorly understood. This study aims to measure and decompose socioeconomic-related inequalities in oral hygiene behaviors among middle-aged and elderly adults in Iran. Methods A cross-sectional analysis was performed using data from the Prospective Epidemiological Research Studies in IrAN (PERSIAN), a large national cohort study. A total of 130,016 individuals aged 35 years and above from 17 cohort centers in Iran were included in the study. The normalized concentration index (C-n) was used to measure the magnitude of inequality in oral hygiene behaviors, i.e. brushing at least twice and flossing once daily, among middle-aged and elderly Iranian adults included in the cohort centers. Decomposition analysis was performed to quantify the contribution of each determinant to the observed inequality in oral hygiene behaviors. Results Totally, 65.5% of middle-aged and elderly adults brushed their teeth twice a day or more, 7.6% flossed at least once a day and 3.48% had both habits. The estimated C-n of the two habits combined, i.e. tooth brushing and dental flossing, for all provinces taken part in the PERSIAN cohort study was 0.399 (95% confidence interval [CI]: 0.383 to 0.417), indicating that the prevalence of the two habits combined is more concentrated among individuals with higher socioeconomic status. Inequality in oral hygiene behaviors was pro-rich in all cohort centers. The decomposition results suggested socioeconomic status as the main factor contributing to the overall inequality, followed by the level of education, and the province of residence. Conclusion A low prevalence of oral hygiene behaviors among middle-aged and elderly Iranian adults was observed. There was also a pro-rich inequality in oral hygiene behaviors among middle-aged and elderly adults in all cohort centers. These results suggest an urgent need for targeted policy interventions to increase the prevalence of preventive oral hygiene behaviors among the poor and less-educated middle-aged and elderly adults in Iran

Comparative analysis of morphometric parameters of intercondylar notch in patients with and without anterior cruciate ligament tears

BACKGROUND: Anterior cruciate ligament (ACL) injury is the most common type of ligament injury whose prevalence is higher in athletes. There are different external risk factors for this injury. However, it is important to find its physiological risk factors, as well. This study assessed the relationship between morphometric parameters of intercondylar notch and ACL tears in patients suffering from knee complications. METHODS: Patients with or without ACL tears who had undergone knee magnetic resonance imaging for any reason were recruited based on inclusion criteria. Intercondylar notch width, femoral bicondylar width, and intercondylar notch index were calculated in both groups. Then, significant variables from univariate analysis were entered in multiple regression analysis with intercondylar notch width, femoral bicondylar width, and intercondylar notch index being assumed as dependent variables. RESULTS: Overall, 199 participants, including 81 patients with ACL tear and 118 without ACL tear, were evaluated. Multiple regression analysis revealed intercondylar notch width and intercondylar notch index to be less common among women and subjects with ACL tears (P < 0.001). CONCLUSION: Based on the results of this study, there are relationships between ACL tears and being female and intercondylar notch width. Therefore, intercondylar notch index can be used for screening athletes and people at risk of ACL tears

Time series analysis of COVID-19's impact on physician and dentist visits in Iran

This study aimed to assess the impact of the COVID-19 pandemic on general practitioner (GP), specialist, and dentist visits among 40 million Iranians covered by the Social Security Organization (SSO). A monthly interrupted time series analysis (ITSA) was conducted over a period of 72 months, including - 47 months before the pandemic and 25 months after its onset. The outcomes variables were monthly number of GP, specialist, and dentist visits per 1,000 SSO-insured individuals. The analysis was performed by total visits, visits to the SSO direct sector, and visits to the indirect sectors. The study found that in the first month of the pandemic, the number of visits per 1,000 insured individuals significantly decreased for visits to GPs (by 51.12, 95% CI: -64.42 to -37.88), visits to specialists (by 39.11, 95% CI: -51.61 to -26.62), and visits to dentists (by 6.67, 95% CI: -8.55 to -4.78). However, during the subsequent months of the pandemic, there was a significant increase in the number of monthly visits for all three categories, with GPs experiencing the highest increase (1.78 visits per 1,000 insured), followed by specialists (1.32 visits per 1,000 insured), and dentists (0.05 visits per 1,000 insured). Furthermore, prior to the pandemic, the number of monthly GP visits per 1,000 insured individuals was statistically significantly lower in the indirect sector compared to the direct sector (45.79, 95% CI: -52.69 to -38.89). Conversely, the direct sector exhibited lower rates of specialist visits (25.84 visits per 1,000 insured individuals, 95% CI: 22.87 to 28.82) and dentist visits (0.75 visits per 1,000 insured individuals, 95% CI: 0.12 to 1.36) compared to the indirect sector. Additionally, the study found that in the first month of the pandemic, the monthly number of GP visits in the indirect sector significantly increased by 34.44 times (95% CI: 24.81 to 44.08) compared to the direct sector. For specialist visits and dentist visits, the increase was 3.41 (95% CI: -5.87 to 12.69) and 5.01 (95% CI: 3.48 to 6.53) per 1,000 insured individuals, respectively. Overall, the findings of this study demonstrate statistically significant disruptions in GP, specialist, and dentist visits during the COVID-19 pandemic, although some recovery was observed. Both the direct and indirect sectors experienced decreased visits

Self-Rated Health among General Population in the West of Iran: A Cross-Sectional Analysis of Socioeconomic Determinants

Background: Self-rated health (SRH), as a powerful independent predictor of mortality, has been used worldwide.However, there is currently lack of information about the SRH in Iran as a developing country. This study was conductedto investigate the relationship between SRH and socioeconomic factors in the general population in western Iran.Methods: A cross-sectional study was conducted in 2017 enrolling 1,444 subjects aged 18 years and over in fiveareas of Kermanshah City, Iran. A single question of SRH with five scales of excellent (coded as 1), very good, good,fair, or poor (coded as 5) was used. Univariate and multiple logistic regression models were performed to determinefactors associated with poor self-rated health.Results: The proportion of poor SRH was 14.7%. Multiple logistic regression showed that the most importantdeterminants of poor SRH were older age (adjusted odds ratio (AOR)31-50year=1.96, AOR≥51year=4.93, married status(AOR=2.53), divorced or widowed status (AOR=2.62), self-reported income level as middle (AOR=2.51) andlow (AOR=4.59), rural residency (AOR=1.5), low physical activity (AOR=11.97), and having chronic diseases(AOR=6.85). In addition, the educational level had a negative relationship with poor SRH (AOR academic=0.47).Conclusion: Our results revealed that both individual and social factors are directly associated with poor SRH.Therefore, these determinant factors should be considered in health policies and planning for promoting health andSRH in the west of Iran

Macro Determinants of Infant Mortality in ECO Countries:Evidence from Panel Data Analysis

Abstract Introductio

Do Hospitals Affiliated With the Kurdistan University of Medical Sciences Perform Efficiently? Non-parametric Data Envelopment Analysis

Background: One way to improve the performance of hospitals, the largest resource-consuming units in the healthcare sector, is to continuously evaluate their performance.Objective: The current study assessed the performance of hospitals affiliated with the Kurdistan University of Medical Sciences using data envelopment analysis (DEA).Methods: This retrospective descriptive-analytic study used DEA to assess efficiency types (technical, managerial, and scale) in hospitals of the Kurdistan University of Medical Sciences (n = 12) in the years 2007 to 2011. The number of active beds, nurses, physicians (general and specialist), and other staff were inputs; inpatient admission and occupied bed days were outputs. Stata version 12 was used for data analysis.Results: The mean technical, scale, and managerial efficiency values were 0.85, 0.89, and 0.95, respectively. The highest and lowest slack inputs were nurses and active beds, respectively.Conclusion: The findings indicate that Kurdistan hospitals were less than appropriately efficient during the studied period. They also suggest that there is a capacity of about 15% for enhancing output in hospitals (compared with the most efficient studied hospitals) without increasing costs or inputs

Burden of pediatric asthma in Kurdistan Province, West of Iran

BACKGROUND: Asthma is the most common chronic respiratory disease (CRD) and one of the most serious and important pediatric diseases in developing countries. The present study aims to estimate the burden of asthma among children in Kurdistan Province, Iran.METHODS: Disability-adjusted life year (DALY) was used in order to estimate the burden of asthma. In a cross-sectional study, with a sample size of 4000, and using the multi-stage sampling method and Asthma and Allergies in Childhood (ISAAC) questionnaire, the prevalence of asthma was estimated for two 6-7 and 13-14 age groups in Kurdistan Province in 2013. In addition, some necessary data were extracted from the death registration system in Kurdistan Provincial Health Center and Statistical Center of Iran (SCI).RESULTS: Burden of asthma for 6-7 age group was 71.6 DALYs in boys (2.77 DALYs per 1000 population) and 48 in girls (2.22 DALYs per 1000 population) with a total burden of 119.6 DALYs (2.52 DALYs per 1000 population). Moreover, its burden for 13-14 age group was 121.1 DALYs in boys (4.86 DALYs per 1000 population) and 82.3 in girls (3.98 DALYs per 1000 population) with a total burden of 203.4 DALYs (4.46 DALYs per 1000 population).CONCLUSION: Considering the significant prevalence of asthma and its burden among children in Kurdistan Province, it is suggested that prevention and management of this disease be considered as a priority by policy makers and in health programs, in addition to attempting to prevent and reduce its burden by setting out effective interventions

Gastric troubles in Iran: The role of social and economic factors in Helicobacter pylori infection

Background: Helicobacter pylori infection is a major risk factor for gastric cancer in Iran, but the impact of socioeconomic factors on its prevalence is poorly understood. This study aimed to assess the socioeconomic inequalities and risk factors associated with H. pylori infection in Iran. Methods: This cross-sectional study was conducted based on the PERSIAN cohort study. A total of 20460 individuals aged 35 to 70 years in Ardabil, Iran were included in the study. H. pylori infection was determined based on stool tests and clinical records. Multilevel logistic regression models with random intercepts at household and community levels were used to identify risk factors associated with H. pylori prevalence. The concentration index (CIn) and concentration curve (CC) were employed to assess socioeconomic-related inequality. Results: In this study, 70.4% (CI 69.6–71.0) of the participants were infected with H. pylori, with a higher prevalence in women (71.2%) than men (69.6%). Age (OR: 1.37, CI: 1.17-1.61), sex (OR: 1.20, CI: 1.12-1.28), level of education (OR: 1.33, CI: 1.17-1.49), cardiac disease (OR: 1.32, CI:1.18-1.46), and BMI groups (OR: 2.49, CI: 1.11-5.58) were significantly associated with H. pylori infection based on the multivariable logistic regression. The results of the CIn and CC indicated that H. pylori were more prevalent among economically disadvantaged groups (CIn: -0.1065; [-0.1374 to -0.0755]). Conclusion: The prevalence of H. pylori in Iran is higher than in other developing countries, and significant socioeconomic inequality exists between the poor and the rich. To reduce the rate of gastric cancer, socio-economic and demographic factors, especially the poor and people with low levels of education, should be considered