Is critical care service relevant to Iran’s hospital care?

The numbers of acutely ill patients (AIP) are admitted in general hospital wards increased. The failing to identify, manage and deliver timely and optimal care to AIPs may lead to catastrophic outcomes. A qualitative study aimed to define the current state of AIPs in Iranian hospitals showed the flaws and shortcomings in the current services for identifying and managing AIPs. An evaluation study was designed to explore the potential impact of Critical Care Service (CCS) in an Iranian University Hospital. The study design was a Stepped-Wedge Cluster Randomized Controlled Trial. The study included, for each ward, an unexposed to the intervention, training, and an exposed to the intervention phase. The data was analyzed using three methods: all patients, matched randomized and before-after. The null-hypothesis was tested using the mixed effect logistic regression, linear mixed and the mixed effects models. The results showed that there are no significant differences in mortality, CPR, ICU admission and length of stay. A second qualitative to find the views of staffs toward the CCS indicated that the CCS had several favorable effects, however; overcoming contextual problems in the hospital, prior to implementation of CCS, may facilitate its implementation

A burden assessment of occupational exposures in Iran, 1990–2010: Findings from the global burden of disease study 2010

Background: The present study describes the burden of occupational diseases in Iran based on the results of the Global Burden of Disease study conducted in 2010 (GBD 2010). This study aimed to determine the burden of occupational diseases in Iran based on the results of GBD 2010. It is a cross-sectional study. Methods: Disability-adjusted life years (DALYs) of occupational diseases were calculated based on the prevalence rates obtained through model estimation, as well as GBD 2010 disability weights and mortality rates obtained from different data registry systems of Iran. Causal association criteria application to select risk outcome pairs, estimation of exposure to each risk factor in the population, estimation of etiological effect size, selection of a counterfactual exposure distribution, risk assessment, and identification of burden attributable to each risk factor were the main conducted statistical steps. Results: There was an increasing trend of DALYs (710.08/100,000 people in 1990 and 833.00/100,000 people in 2005) followed by a slight decrease (833.00/100,000 in 2005–784.55/100,000 people in 2010). A total of 50.4% and 36% of total DALYs per 100,000 people were due to the adverse effects of musculoskeletal disorders and work-related injuries, respectively. Conclusions: Musculoskeletal disorders and work-related injuries are the most important adverse consequences of work-related risks that require urgent interventions to be controlled. Male workers (15–25 years and over 60) with the highest DALYs and mortality rates need more training programs, safety regulations, and higher level of protection support. In spite the decreasing trend of occupational disease related DALYs and death rates in Iran in recent years, a long-term effort is required to maintain the currently decreasing trend

Impact of rural family physician program on child mortality rates in Iran: a time-series study

Abstract Background The rural family physician program and social protection scheme were started in Iran about 10 years ago, and no comprehensive study has been carried out to investigate the effects of this program on mortality-related health indicators yet. The present study aims to examine the impacts of implementation of the family physician program and rural insurance program, which was launched in June 2005, on neonatal (NMR), infant (IMR), and under-5-year (U5MR) mortality rates in rural areas of Iran between 1995 and 2011, using a time-series analysis. Methods Three segmented regression models were built to evaluate the effects of the program on NMR, IMR, and U5MR, and several independent variables were entered into the models, including annual incremental effect of the program (variable of interest), time effect, behvarz density, effect of the family physician and rural insurance programs, as well as socioeconomic variables including years of schooling, wealth index, sex ratio, and logarithmic scales of rural population size in each area. Data were gathered from secondary sources and other studies. Data pertaining to the year 2007 were excluded from the final analysis due to their inaccuracy. Results Our results show that the incremental effect of implementing the rural family physician program is associated with significant reductions in NMR (β = − 0.341. p − value = 0.003) and IMR (β = − 0.016. p − value = 0.009). Although the association between this effect and reductions in U5MR were evident, they were not statistically significant (β = − 0.003. p − value = 0.542). Moreover, wealth status of inhabitants was associated with reductions in NMR (β = − 0.889. p − value = 0.001), IMR (β = − 0.052. p − value < 0.001), and U5MR (β = − 0.055. p − value < 0.001) in the time period of the study. Conclusions In this nationally representative study, we showed that implementation of the second health system reform in Iran, known as the family physician program and social protection scheme for rural inhabitants, is associated with significant reductions in NMR and IMR. However, reported reductions in U5MR were not found to be statistically associated with the launch of the program. The advantage of this study was the ability to depict a more precise picture of the outcomes of a national-level intervention

Additional file 2: of Impact of rural family physician program on child mortality rates in Iran: a time-series study

Table S1. Mean values of mortality rates and covariates for 25 provinces of Iran, 1995–2004 and 2005–2011. Values are shown in number of deaths per 1,000 live births and are presented as number (standard error). Years of schooling takes values between 0 and 30. Sex ratio is the number of males in the population divided by the number of females. Data from 2007 were excluded from the study due to inaccuracy. Data are extracted from the vital horoscopes study. (DOCX 20 kb