Determinants of Healthcare Expenditure in Economic Cooperation Organization (ECO) Countries: Evidence from Panel Cointegration Tests

Background : Over the last decade there has been an increase in healthcare expenditures while at the same time the inequity in distribution of resources has grown. These two issues have urged the researchers to review the determinants of healthcare expenditures. In this study, we surveyed the determinants of health expenditures in Economic Cooperation Organization (ECO) countries. Methods : We used Panel data econometrics methods for the purpose of this research. For long term analysis, we used Pesaran cross sectional dependency test followed by panel unit root tests to show first whether the variables were stationary or not. Upon confirmation of no stationary variables, we used Westerlund panel cointegration test in order to show whether long term relationships exist between the variables. At the end, we estimated the model with Continuous- Updated Fully Modified (CUP-FM) estimator. For short term analysis also, we used Fixed Effects (FE) estimator to estimate the model. Results : A long term relationship was found between the health expenditures per capita and GDP per capita, the proportion of population below 15 and above 65 years old, number of physicians, and urbanisation. Besides, all the variables had short term relationships with health expenditures, except for the proportion of population above 65 years old. Conclusion : The coefficient of GDP was below 1 in the model. Therefore, health is counted as a necessary good in ECO countries and governments must pay due attention to the equal distribution of health services in all regions of the country

Road Fatalities and Their Determinants in Iran: Evidence From Panel Provincial Data

Background Studies have shown that the number of road fatalities has been decreasing in developed regions and increasing in less and middle developed regions. Iran has one of the highest road fatalities in the world. Controlling road fatalities is vital for less and middle developed countries like Iran. Objectives The aim of this study was to find factors affecting road fatalities in Iran using macro provincial data. Materials and Methods Panel data of provinces of Iran between 2008 and 2012 were used for this study. Panel data Poisson estimator was used for estimating the model. Hausman test and Breusch-pagan test were used for finding between pooled or panel and fixed or random effects. Results No significant relationships were found regarding the percentage of emergency sites and percentage of cars with road fatalities. Increase in the percentage of motorcycles, rain, highways and freeways increased the risk of road fatalities. The effect of highways in road fatalities was higher than freeways. Increase in the percentage of traffic police sites and people living in urban regions decreased the risk of accident fatalities. Conclusions The government, ministry of health and policy makers must develop strategies for controling high levels of road fatalities in Iran

Epidemiology of organophosphate poisoning in the North of Iran

The use of pesticides as one of the main agricultural poles has been increased in Iran in recent years. Organophosphate poisoning has harmful the consequences for human health. This study present clinical and laboratory evidences on the patients exposed to agricultural insecticides poisoning and the cause of these poisons. We collected clinical data from the patients referred to Razi Hospital, Rasht, Iran who were poisoned with organophosphorus toxins. For this purpose, a checklist was prepared, and data were collected for 414 patients between 2011 and 2016. The results showed that the most cases of poisoning were men (73%) and about 27.2% of the patients was in the age group of 45-60 years (highest frequency in age groups). The most frequent symptoms were vomiting (65%), nausea (61%), abdominal pain (39%), and perspiration (27%). There was also a decrease in consciousness (16%) and sialorrhea (16%). Totally, 186 (46.2%) patients were exposed to organophosphorus toxins by respiratory and 215 (53.4%) orally. Out of the 414 samples, 102 (33%) had abnormal creatine phosphokinase (CPK) enzymes and 114 (34.5%) abnormal lactate dehydrogenase (LDH). Mean hospital length of stay (LOS) was 3.3 days. We found significant relationship of LOS with heart failure, hypertension, and addiction. To better manage the process of treatment of agricultural poisoned patients and to reduce the waste of limited resources available, careful consideration should be given to the type of pesticide used by the patient to prevent overdose and unintentional use of antidote

Willingness to Pay in Choosing Pre-hospital Emergency Services in Iran: A Population-Based Discrete Choice Experiment

Providing pre-hospital emergency services is accessible in Iran but costly for the country’s health system. This study calculated the willingness to pay (WTP) for pre-hospital emergency services in Iran. Discrete choice experiment (DCE) was used to measure the population’s WTP for ambulance services focusing on time, price, and quality of services. Four hundred and sixty people in Rasht city, Iran, participated in this online survey. Participants preferred lower transfer fees (β = -0.7, P˂ 0.05), lower time of reaching to the scene (β = -0.061, P˂ 0.05), lower time to arrive to the hospitals (β = -0.038, P ˂ 0.05), Private ambulance (β = -0.151, P ˂ 0.05), and emergency medical services (EMS) technicians (β = 0.209, P ˂ 0.05). Patients’ WTP in selecting EMS services can help policymakers to provide the best services

Return to work after traumatic spinal fractures and spinal cord injuries:a retrospective cohort study

This study aimed to determine the factors associated with return to work (RTW) after traumatic spinal fracture and spinal cord injury. It provided a predictive model for RTW among patients with spinal fractures and spinal cord injury and determined important factors influencing the time to RTW after injury. A retrospective cohort study was conducted in Poursina Tertiary Hospital, Guilan, Iran between May 2017 and May 2020. Patients aged 18 to 65 who were hospitalized with traumatic spinal fractures and spinal cord injuries were included. Demographic and clinical data were collected from the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR). A researcher-administered questionnaire was used through a telephone interview to obtain complementary data on social and occupational variables. Kaplan–Meier survival analysis was used to estimate the average time to RTW and the predictors of RTW were determined by multivariate Cox regression model. Of the 300 patients included, 78.6% returned to work and the average time to RTW was about 7 months. The mean age of the participants was 45.63 ± 14.76 years old. Among the study variables, having a Bachelor’s degree (HR 2.59; 95% CI 1.16–5.77; P = 0.019), complications after injury (HR 0.47; 95% CI 0.35–0.62; P = 0.0001), full coverage health insurance (HR 1.73; 95% CI 1.10–2.72; P = 0.016), opium use (HR 0.48; 95% CI 0.26–0.90; P = 0.023), number of vertebral fractures (HR 0.82; 95% CI 0.67–0.99; P = 0.046), and length of hospital stay (HR 0.95; 95% CI 0.93–0.98; P = 0.001) were found to be significant in predicting RTW in Cox regression analysis. Our analysis showed that wealthier people and those with high job mobility returned to work later.</p

Comparison of the Effects of Public and Private Health Expenditures on the Health Status: A Panel Data Analysis in Eastern Mediterranean Countries

Background: Health expenditures are divided in two parts of public and private health expenditures. Public health expenditures contain social security spending, taxing to private and public sectors, and foreign resources like loans and subventions. On the other hand, private health expenditures contain out of pocket expenditures and private insurances. Each of these has different effects on the health status. The present study aims to compare the effects of these expenditures on health in Eastern Mediterranean Region (EMR). Methods: In this study, infant mortality rate was considered as an indicator of health status. We estimated the model using the panel data of EMR countries between 1995 and 2010. First, we used Pesaran CD test followed by Pesaran’s CADF unit root test. After the confirmation of having unit root, we used Westerlund panel cointegration test and found that the model was cointegrated and then after using Hausman and Breusch-Pagan tests, we estimated the model using the random effects. Results: The results showed that the public health expenditures had a strong negative relationship with infant mortality rate. However, a positive relationship was found between the private health expenditures and infant mortality rate (IMR). The relationship for public health expenditures was significant, but for private health expenditures was not. Conclusion: The study findings showed that the public health expenditures in the EMR countries improved health outcome, while the private health expenditures did not have any significant relationship with health status, so often increasing the public health expenditures leads to reduce IMR. But this relationship was not significant because of contradictory effects for poor and wealthy peoples

Migraine headache in Multiple Sclerosis. Is more frequent among MS patients?

Objectives. Multiple sclerosis (MS) is a chronic disease of the central nervous system that is associated with inflammation, demyelination of neurons and gliosis. There are different reports about the association between migraine and MS. Taking note of headaches experienced by people with MS and providing appropriate treatment can help enhance their quality of life. We aimed to determine the frequency of migraine headache in MS patients. Materials and methods. This was a descriptive cross-sectional study, conducted in 2020 among 125 MS patients referred to neurology clinic of Poursina Hospital or registered in Guilan MS Registry System and 125 controls with minor head trauma in Rasht. After obtaining written consent, all the subjects were asked to fulfil a checklist about their demographics, MS and headache characteristics by phone call. Outcomes. In this study 96 RRMS, 19 PPMS and 10 SPMS patients participated among which frequency of mild, moderate and severe disability was 74.4%, 22.4% and 3.2%, respectively. The frequency of migraine in MS patients was significantly higher than the control group [28.8% (n=36) vs. 12.8% (n=16) p=0.002]. After adjusting the confounding factors a significant relationship was found between MS and migraine (OR: 2.76, p = 0.004). Conclusions. MS patients experience migraine headaches approximately twice the general population

Burden of injury along the development spectrum : associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017

Background The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. Methods Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. Results For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. Conclusions The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.Peer reviewe

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. FINDINGS: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30-30·30 million) new cases of TBI and 0·93 million (0·78-1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40-57·62 million) and of SCI was 27·04 million (24·98-30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (-0·2% [-2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (-3·6% [-7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0-10·4 million) YLDs and SCI caused 9·5 million (6·7-12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. INTERPRETATION: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations