Medical Journal of the Islamic Republic of Iran最新文献

{"title":"Migration of the Gamma Nail Neck Screw into the Pelvis with Bladder Damage.","authors":"Ergali Nabiyev, Ramazan Askerov, Khadisha Kashikova, Arnat Baizakov, Zhassulan Argynbayev, Zhenisbek Baubekov, Kuanysh Baikubesov","doi":"10.47176/mjiri.38.58","DOIUrl":"https://doi.org/10.47176/mjiri.38.58","url":null,"abstract":"<p><strong>Background: </strong>Medial migration of the cervical screw is a frequent complication of Gamma nails and is observed in 4.3% - 6% of cases. The reasons are a violation of the surgical technique of osteosynthesis of a trochanter fracture, including an unrepaired fracture, a breach of the insertion point of the fixator, and a suboptimal position of the cervical screw. However, the migration of the Gamma nail neck screw into the pelvic cavity is sporadic, and only a few cases have been published in the literature.</p><p><strong>Case description: </strong>This is the case of a patient born in 1952 who was admitted to the hospital with pain syndrome in the pelvis and dysuric phenomena. As a result of clinical X-ray examination, CT, and MRT examination of the pelvis, medial migration of the Gamma nail cervical screw with damage to the bladder was revealed. The patient was urgently operated on the day of admission. The cervical screw from the bladder was removed, the bladder was sutured, and an epicystostomy was installed. The Gamma nail from the right femur was also released. There were no intraoperative complications. In the postoperative period, the patient was prescribed antibiotics and analgesics. The duration of hospitalization was six days. Being examined for five weeks after the operation, the patient does not make any particular complaints, walks without means of support, and the intertrochanteric fracture of the right femur fused incorrectly. The patient was offered an endoprosthesis of the right hip joint, but he and his relatives refused.</p><p><strong>Conclusion: </strong>The traumatologist should be aware of the possibility of such complications after osteosynthesis and its associated risks. They should be able to recognize the etiological factors causing the medial migration of the cervical screw of the intramedullary retainer. If medial screw migration is detected, the traumatologist should assess the function of internal organs and the condition of the main vessels and take measures to safely remove the migrated fixator from the anatomical cavity of the body in one team with a surgeon, urologist and vascular surgeon.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Proximal Femural Fractures among the Elderly People of Almaty City.","authors":"Khadisha Kashikova, Ergali Nabiyev, Ramazan Askerov, Zhassulan Argynbayev, Ussama AbuJazar, Arnat Baizakov, Nurlan Turbekov","doi":"10.47176/mjiri.38.57","DOIUrl":"https://doi.org/10.47176/mjiri.38.57","url":null,"abstract":"<p><strong>Background: </strong>Proximal femoral fractures are a global epidemiological concern due to their association with mortality and morbidity in the geriatric population.</p><p><strong>Methods: </strong>We conducted an epidemiological study using hospital registry data to assess the incidence and associated factors of proximal femur fractures among individuals aged 60 years or older living in Almaty City. Student's t-test was used to assess for between-group differences.</p><p><strong>Results: </strong>The data showed that the overall frequency of fractures among the population of Almaty City aged 60 years and older between 2014 and 2019 averaged 169.6 per 100,000, with a higher rate among women (190.3) compared to men (135.8). However, in age groups up to 70 years and over 85 years, the frequency of proximal femur fractures was higher among men. From 2014 to 2019, the incidence of proximal femur fractures increased by 1.6 times. An analysis of the distribution of fracture frequency by season revealed that winter was the most dangerous period.</p><p><strong>Conclusion: </strong>Our research suggests a need for further epidemiological studies on the incidence of proximal femur fractures in various regions, identifying risk factors, and developing targeted regional prevention programs.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the Impact of TBL Versus Lecture Method on Pharmacy Students' Academic Self-efficacy in a Pharmaceutical Biotechnology Course: A Quasi-Experimental Study.","authors":"Mahsa Rasekhian, Sadra Haji, Maryam Shahabi, Azizeh Barry, Akram Hashemi, Mahdiyeh Ghasemi, Ghobad Ramezani","doi":"10.47176/mjiri.38.56","DOIUrl":"https://doi.org/10.47176/mjiri.38.56","url":null,"abstract":"<p><strong>Background: </strong>Students with higher academic self-efficacy usually show higher levels of academic adaptation and are agile in using variant learning strategies. In this regard, training-based learning (TBL), a relatively new educational method, can be considered a complementary method in the education of pharmacy students. This research aims to compare the effect of TBL with the lecture method on the academic self-efficacy of pharmacy students in pharmaceutical biotechnology courses.</p><p><strong>Methods: </strong>This was a quasi-experimental study of pretest and posttest types with random assignment to 2 control and experimental groups, in which the effects of team-based training and lecture methods were studied in the pharmaceutical biotechnology course. In the experimental group, the students were divided into 8 groups of 6 people, and they spent 5 sessions of the pharmaceutical biotechnology course with the TBL method, and the control group also received the same content by the lecture method. Both groups answered the self-efficacy tool before the intervention, and at the end of the intervention, both groups answered the tool again. After the approval of the university ethics committee and obtaining informed consent, the self-efficacy questionnaire was distributed in person and online among the participants. The quantitative data were collected and analyzed using SPSS software Version 19 (mean and standard deviation, homogeneity of the 2 groups, tests, and Kolmogorov-Smirnov).</p><p><strong>Results: </strong>The data analysis showed that most of the participants were 22 years old. The independent samples t test results showed that the 2 groups did not have a statistically significant difference in the mean age (<i>P</i> = 0.058). Also, there was no statistically significant difference between the 2 groups in the pretest (<i>P</i> = 0.391), and the 2 groups had almost the same mean. Still, there was a statistically significant difference between the 2 groups in the academic self-efficacy variable in the posttest (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Team-based teaching methods can increase students' participation and enthusiasm in learning and applying self-efficacy and self-management skills, introducing more diverse career and educational opportunities for pharmacy students.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial Gastrocnemius Strain: Clinical Aspects and Algorithmic Approach.","authors":"Farzin Halabchi, Mohammad Mahdi Tavana, Vahid Seifi, Marzieh Mahmoudi Zarandi","doi":"10.47176/mjiri.38.55","DOIUrl":"https://doi.org/10.47176/mjiri.38.55","url":null,"abstract":"<p><p>Medial gastrocnemius strain (MGS), is the most common cause of mid-calf pain in athletes due to the stretch of the gastrocnemius muscle when the knee is in extension and the ankle is in dorsiflexion. Chronological age and previous calf injury are the most substantial risk factors for MGS, including high body mass index, previous lower limb injuries, L5 radiculopathy, and inadequate warm-up. The dominant presentation of MGS is a pain that can be diverse from acute to latent, which is felt in the posteromedial aspect of the calf and is often preceded by a feeling of a pop. The signs of MGS include antalgic gait, ecchymosis, swelling, local tenderness, and sometimes a palpable gap felt along the muscle. Passive dorsiflexion of the ankle or resistive ankle plantarflexion with knee extension can indicate a more severe injury, while functional tests can illicit milder injuries of calf muscles-including gastrocnemius. The diagnosis of MGS is usually made by clinical evaluation. However, imaging modalities-including magnetic resonance imaging and ultrasound-can be helpful in case of suspicion. In most cases of MGS, the cornerstone of treatment is nonoperative rehabilitation, which can be performed as a 4-phase program and should be tailored individually. Some instances of MGS are referred for early or later surgical treatment if indicated. In this article, we review the literature about various aspects of MGS, from diagnosis to treatment and rehabilitation, and propose a structured approach to this injury.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subjective Valuation of Screening for Spinal Muscular Atrophy and Analysis of its Influencing Factors: Evidence from Iran.","authors":"Majid Khosravi, Aziz Rezapour, Najmeh Moradi, Setare Nassiri Zeidi, Namamali Azadi","doi":"10.47176/mjiri.38.54","DOIUrl":"https://doi.org/10.47176/mjiri.38.54","url":null,"abstract":"<p><strong>Background: </strong>Spinal muscular atrophy is an inherited neurodegenerative disorder that typically leads to severe physical disability. The present study aimed to determine the subjective evaluation of this disorder screening and analyze its influencing factors in Iran.</p><p><strong>Methods: </strong>A cross-sectional study was performed using data from the second survey of women either pregnant or planning to become pregnant in Tehran, the capital of Iran, in 2022. The dependent variable was the willingness to pay for this disease screening test. The independent variables included sociodemographic, economic, and health characteristics, the history of this disease or other diseases of the person and family, and knowledge about this disease in the included population. Logistic regression was utilized to identify independent variables associated with the dependent variable, and the results were reported as unadjusted and adjusted odds ratios and P values with 95% CIs. A questionnaire was used as a research tool, and STATA 17 software was used for data analysis. The monetary value of spinal muscular atrophy (SMA) screening was calculated by estimating willingness to pay using the congenital valuation method.</p><p><strong>Results: </strong>In total, 578 women were included. About 64.85% of respondents had a willingness to pay for SMA screening as the dependent variable, with a mean of $526. University education (<i>P</i> = 0.009) and pregnancy experience (<i>P</i> = 0.021) were associated with the dependent variable.</p><p><strong>Conclusion: </strong>Iranian women expressed their willingness to undergo screening tests, but due to financial constraints, they expected the government and nongovernmental organizations to bear most of the cost.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Sleep Quality and Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Patients with Bipolar Disorder.","authors":"Roya Vaziri Harami, Amirreza Keyvanfar, Yousef Semnani, Hanieh Najafiarab","doi":"10.47176/mjiri.38.53","DOIUrl":"https://doi.org/10.47176/mjiri.38.53","url":null,"abstract":"<p><strong>Background: </strong>Many patients with bipolar disorder (BD) experience sleep problems. Sleep abnormalities are associated with immune dysfunction, which may be reflected by hematological indices. Purpose: This study aimed to investigate the association between sleep quality and the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in patients with BD.</p><p><strong>Methods: </strong>This cross-sectional study was performed at Imam Hossein Hospital, Tehran, Iran, from March to September 2023. Hospitalized patients newly diagnosed with BD were interviewed to complete questionnaires. Sleep quality and manic and depressive symptoms of the participants were assessed using the Pittsburg Sleep Quality Index (PSQI), the Young Mania Rating Scale (YMRS), and the Hamilton Depression Rating Scale (HDRS), respectively. Furthermore, blood samples were taken from each patient to investigate hematological indices. Continuous and categorical variables were compared between groups using an independent-sample t test and chi-square/Fisher's exact tests, respectively. The Poisson regression model was also used to investigate predictors of the PSQI score.</p><p><strong>Results: </strong>Of 305 patients included in the study, 78.7% and 21.3% were experiencing manic and depressive episodes, and 90.20% had poor sleep quality. The prevalence of poor sleep quality was significantly higher in depressed patients than in manic patients (100% vs. 87.5%; <i>P</i> = 0.003). Depressed patients had significantly higher platelet counts (mean difference [MD], 34.09 [95% CI, 9.35-58.83]; <i>P</i> = 0.007) and PLR (MD, 38.14 [95%CI, 10.25-66.02]; <i>P</i> = 0.008) and lower lymphocyte counts (MD, 266.04 [95% CI, [14.41-517.67]; <i>P</i> = 0.038) compared with manic patients. The Poisson regression model with adjustment revealed that men (risk ratio [RR], 1.113; <i>P</i> = 0.025), those with lower educational levels (RR, 1.164; <i>P</i> = 0.001), and those with higher HDRS scores (RR, 1.370; <i>P</i> < 0.001) had significantly deteriorated sleep quality.</p><p><strong>Conclusion: </strong>Most bipolar patients have poor sleep quality, particularly those with depressive episodes. Depressed patients had significantly higher platelet counts and PLR. Also, depressed patients with male sex, lower educational levels, and more severe depressive symptoms had poorer sleep quality.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Selenium Level in Thyroid Cancer: A Case-Control Study.","authors":"Saeed Dahmardeh, Zahra Heidari","doi":"10.47176/mjiri.38.52","DOIUrl":"https://doi.org/10.47176/mjiri.38.52","url":null,"abstract":"<p><strong>Background: </strong>Despite the implementation of national iodine supplementation programs, structural thyroid diseases are still highly prevalent in most countries. Thus, the link between trace elements other than iodine, such as selenium, and thyroid diseases should be investigated.</p><p><strong>Methods: </strong>In this case-control study, adult patients with newly diagnosed papillary thyroid carcinoma, benign thyroid nodules, and healthy euthyroid controls without nodules were recruited. Thyroid function tests and serum selenium levels were assessed and compared between groups. The One-way ANOVA test was used to assess the mean difference of numerical variables among the three studied groups (PTC, Benign nodule, and healthy control group). In addition, a post-hoc comparison was conducted based on Bonferroni correction for a pairwise comparison of these three groups.</p><p><strong>Results: </strong>Data from 182 patients with papillary thyroid carcinoma (PTC), 185 patients with benign thyroid nodules, and 180 healthy individuals as a control group were analyzed. The mean serum selenium levels in the PTC, benign thyroid nodules, and control group were 94.9, 121.6, and 134.3 µg/l, respectively (<i>P</i> < 0.001). There was a significant relationship between the cancer stage and selenium level in the PTC group. Patients in higher stages of cancer had a lower mean of selenium (<i>P</i> < 0.001). In univariate logistic regression, TSH and selenium were significant variables for PTC compared with patients with benign thyroid nodules. Each unit increase in selenium reduces the chance of PTC by about 6%.</p><p><strong>Conclusion: </strong>The low levels of selenium were associated with PTC. Also, serum selenium levels were inversely correlated with the stage of thyroid cancer.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pleiotropic Bias and Study Design Considerations in Genetic Association Studies.","authors":"Sana Eybpoosh, Seyyed Amir Yasin Ahmadi","doi":"10.47176/mjiri.38.51","DOIUrl":"https://doi.org/10.47176/mjiri.38.51","url":null,"abstract":"<p><strong>Background: </strong>Case-control studies are efficient designs for investigating gene-disease associations. A discovery of genome-wide association studies (GWAS) is that many genetic variants are associated with multiple health outcomes and diseases, a phenomenon known as pleiotropy. We aimed to discuss about pleiotropic bias in genetic association studies.</p><p><strong>Methods: </strong>The opinions of the researchers on the basis of the literature were presented as a critical review.</p><p><strong>Results: </strong>Pleiotropic effect can bias the results of gene-disease association studies if they use individuals with pre-existing diseases as the control group, while the disease in cases and controls have shared genetic markers. The idea supports the conclusion that when the exposure of interest in a case-control study is a genetic marker, the use of controls from diseased cases that share similar genetic markers may increase the risk of pleiotropic effect. However, not manifesting the disease symptoms among controls at the time of recruitment does not guarantee that the individual will not develop the disease of interest in the future. Age-matched disease-free controls may be a better solution in similar situations. Different analytical techniques are also available that can be used to identify pleiotropic effects. Known pleiotropic effects can be searched from various online databases.</p><p><strong>Conclusion: </strong>Pleiotropic effects may result in bias in genetic association studies. Suggestions consist of selecting healthy yet age-matched controls and considering diseases with independent genetic architecture. Checking the related databases is recommended before designing a study.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccine Refusal and Hesitancy among Iranians Participated in the National COVID-19 Vaccine Hesitancy Survey: A Qualitative Study.","authors":"Hajar Nazari Kangavari, Ahmad Hajebi, Hamid Peyrovi, Masoud Salehi, Mohammad Hossein Taghdisi, Abbas Motevalian","doi":"10.47176/mjiri.38.50","DOIUrl":"https://doi.org/10.47176/mjiri.38.50","url":null,"abstract":"<p><strong>Background: </strong>Success in COVID-19 vaccination depends on understanding why people refuse or hesitate to take the vaccine. This study aims to explore vaccine refusal and hesitancy among Iranians who participated in the national COVID-19 vaccine hesitancy survey.</p><p><strong>Methods: </strong>A qualitative content analysis approach was used. Twenty-six participants were selected by purposive sampling. In-depth, semi-structured telephone interviews were conducted during the year 2022. A directed content analysis approach was used for analyzing the data by extracting the codes, subcategories, and categories.</p><p><strong>Results: </strong>Four major categories and their respective subcategories related to refusal and/ or hesitancy against COVID-19 vaccination emerged: \"lack of confidence\" (distrust in policymakers and pharmaceutical companies, distrust in national media, belief in conspiracy theory, and lack of confidence in the vaccine's safety and effectiveness), \"complacency\" (Fatalism and philosophical beliefs, low perceived risk, and belief in the adequacy of the precautionary principles), \"constrains\" (personal and psychological barriers), and \"coercion\" (coercion by relatives and unsteady imposed mandatory vaccination by the government).</p><p><strong>Conclusion: </strong>Distrust, fatalism, low perceived risk, and overconfidence in traditional Persian medicine were important barriers to COVID-19 vaccine acceptability needing a variety of measures for improving COVID-19 vaccine uptake, including enhancing public trust in government and policymakers, clarifying vaccine safety and effectiveness, dealing with religious fatalism, and regulating anti-science messages on social media.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catastrophic Health Expenditure among Iranian Households: Evidence from the COVID-19 Era.","authors":"Mohammadreza Sheikhy-Chaman, Aziz Rezapour, Aidin Aryankhesal, Ali Aboutorabi","doi":"10.47176/mjiri.38.49","DOIUrl":"https://doi.org/10.47176/mjiri.38.49","url":null,"abstract":"<p><strong>Background: </strong>Monitoring households' exposure to catastrophic health expenditure (CHE) based on out-of-pocket (OOP) health payments is a critical tool for evaluating the equitable financial protection status within the health system. The COVID-19 pandemic has brought unprecedented global change and potentially affected the mentioned protection indicators. This study aimed to assess the prevalence of CHE among households in Iran during the COVID-19 period.</p><p><strong>Methods: </strong>The present study employed a retrospective-descriptive design utilizing data derived from two consecutive cross-sectional Annual Household Income and Expenditure Surveys (HIES) undertaken by the Statistical Centre of Iran (SCI) in 2020 and 2021. The average annual OOP health payments and the prevalence of households facing CHE were estimated separately for rural and urban areas, as well as at the national level. Based on the standard method recommended by the World Health Organization (WHO), CHE was identified as situations in which OOP health payments surpass 40% of a household's capacity to pay (CTP). The intensity of CHE was also calculated using the overshoot measure. All statistical analyses were carried out using Excel-2016 and Stata-14 software.</p><p><strong>Results: </strong>The average OOP health payments increased in 2021, compared to 2020, across rural and urban areas as well as at the national level. Urban residents consistently experienced higher OOP health payments than rural residents and the national level in both years. At the national level, the prevalence of CHE was 2.92% in 2020 and increased to 3.18% in 2021. In addition, rural residents faced a higher prevalence of CHE based on total health services OOP, outpatient services OOP, and inpatient services OOP compared to urban residents and the national level. Regarding the intensity of CHE using overshoot, the results for 2020 and 2021 revealed that the overshoot ranged between 0.60% and 0.65% in rural areas, between 0.30% and 0.33% in urban areas, and between 0.38% and 0.41% at the national level.</p><p><strong>Conclusion: </strong>A considerable percentage of households in Iran still incur CHE. This trend has increased in the second year of COVID-19 compared to the first year, as households received more healthcare services. The situation is even more severe for rural residents. There is an urgent need for targeted interventions in the health system, such as strengthening prepayment mechanisms, to reduce OOP and ensure equitable protection for healthcare recipients.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}